Global News Round Up

Politics & Policies

An affordable hepatitis C treatment has been shown to be safe and effective, with very high cure rates for patients including hard-to-treat cases, in interim clinical trial results that offer hope to the 71 million people living with the disease worldwide.

The Trump administration is releasing the first of its kind interagency review of US overseas involvement that creates a framework for how the State Department, US Agency for International Development, and Department of Defense can coordinate efforts to streamline diplomacy, aid, and military operations around the world and maximize resources and results.

Programs, Grants & Awards

As part of its efforts to improve maternal healthcare in the country, Serene Health will kick off a campaign dubbed “Dollar4life”.

Four Duke doctoral students have been selected to join the Global Health Doctoral Scholars program at the Duke Health Institute (DGHI), bringing the current cohort total to 13 scholars.

Research

Evolve BioSystems, Inc. and the icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh) today announced their collaboration, funded by the Bill & Melinda Gates Foundation, to study the use of Evivo® in infants to aid in recovery from severe acute malnutrition (SAM).

A far-reaching study conducted by scientists at Cincinnati Children’s reports that the Epstein-Barr virus (EBV)—best known for causing mononucleosis—also increases the risks for some people of developing seven other major diseases.

A natural variation of the gene KLF14 causes some women to store fat on their bellies and hips and outs them at significantly increased risk of type 2 diabetes, new research reveals.

Falls are a leading cause of injury and death among older adults.  In 2014, about 1 in 3 adults aged 65 and older reported falling, and falls were linked to 33,000 deaths.

Diseases & Disasters

The first known epidemic of extensively drug-resistant typhoid is spreading through Pakistan, infecting at least 850 people in 14 districts since 2016, according to the National Institute of Health Islamabad.

There have been recent spikes in Buruli ulcer cases in Australia, a chronic infection that leads to erosion of flesh. This condition once considered rare, is caused by Mycobacterium ulcerans.

Technology

A group of scientists from VCU Massey Cancer Center and UCLA Jonsson Comprehensive Cancer Center have developed new, high-speed microscopy platform that can measure a cancer cell’s resistance to drugs up to 10 times faster than existing technology, potentially informing more effective treatment selection for cancer patients. The technology is being presented in abstract form today at the American Association for Cancer Research’s Annual Meeting in Chicago.

A new e-health system designed to be a whole-home sensor aims to allow the elderly to live in their own homes with a higher degree of independence.

Environmental Health

A University of Montana researcher and her collaborators have published a new study that reveals increased risks for Alzheimer’s and suicide among children and young adults living in polluted megacities.

According to the World Poverty Clock, more than 73,000 people have escaped poverty – today.  The flip side of that coin is that more than 15,000 people have, today, fallen into poverty.  The sum total of people living in extreme poverty as of March 23, 2018, is about 619,800 people. By the time you read this, many more people will make the escape.

Two of the most elite waste treatment systems available today on farms do not fully remove antibiotics from manure, research finds.

Equity & Disparities

In two suburbs of the American city of St. Louis, separated by fewer than 30 miles, the odds of living a long and healthy life could not be more different.  If you reside in the mostly white, wealthy suburb of Wildwood, your life expectancy is 91.4 years. But if you live in the mostly black, poorer suburb of Kinloch, your life expectancy is only 55.9 years.

One in five older adults is socially isolated from family or friends, increasing their risks for poor mental and physical health, as well as higher rates of mortality, a new study shows.

Nearly nine months after Myanmar’s military was accused of widespread sexual violence in a crackdown against Rohingya communities, aid groups in Bangladesh’s Rohingya refugee camps are scrambling to identify women and girls now pregnant by rape.

Women, Maternal, Neonatal & Children’s Health

Taking painkillers during pregnancy could affect the fertility of the unborn child in later life, research suggests.

Maternal anemia is an important global health problem that affects about 500 million women of reproductive age.  Much is known about the consequences of anemia during pregnancy, including the increased risks of low birth weight, preterm birth, perinatal mortality, and neonatal mortality.

Many moms-to-be know that their health even before they become pregnant- known as pre-conception health – can affect the health of their babies. Now, research is continuing to show that the pre-conception health of fathers also can influence a pregnancy and the baby.

Infants in some of the world’s poorest regions are vulnerable to a common worm parasite infection and their treatment should become a priority, according to a study.

Despite a global decline in childhood infectious diseases, the prevalence of mental illness among youth has remained the same. That makes mental disorders one of the main origins of illness in children aged 4-15 years around the world, according to a new study published in the journal Child and Adolescent Psychiatry and Mental Health.

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A Highlight from National Public Health Week: North Dakota State University’s “New Perspective on Refugees Roundtable”

Every April, the public health community celebrates National Public Health Week.  National Public Health Week is a time in which we recognize the amazing contributions of public health professionals and highlight the pressing public health issues important to improving our nation’s health. This year’s National Public Health Week theme was Changing our Future Together.

IH Section Councilor Mark Strand organized a roundtable entitled A New Perspective on Refugees in the Community: Changing our Future Together at North Dakota State University where he is a professor. 40 attendees from 12 countries participated in this National Public Health Week event which was held on April 3rd. Attendees learned many things they didn’t know before:

(1) At least one member of the family is working within 6 months of arriving in the U.S.

(2) Over an adult’s first 20 years here, a refugee pays approximately $21,000 more in taxes than they receive in social service benefits.

(3) There is no evidence for increased crime rates among refugees.

(4) There are many positive impacts resettled refugees make on their new communities.

Visit their Facebook post for a look at some of the photos from their event:  https://www.facebook.com/ndsu.chp/posts/10160362153045694

Share your National Public Health Week highlights with us for a chance to be featured on our blog!

Read the latest issue of the IH newsletter, Section Connection!

The latest issue of Section Connection, the IH Section quarterly e-newsletter, is now available!

You can find the latest issue of the newsletter here: http://bit.ly/SectionConnection7

If you can’t access the newsletter for any reason please email Theresa Majeski, Global Health Connections Chair, at theresa.majeski@gmail.com.

Is Zika still a thing? My experiences as a Zika Case Manager in the field (South Florida)

Zika was a hot topic, but now it seems like it is a thing of the past. People always ask me…”Is Zika still is a thing?” And my response is, “Of course! Just because it has declined, certainly does not mean that it isn’t still a public health threat.”

Interesting enough, comments like “Is Zika still a thing” come from physicians and various public health professionals as well as individuals living in regions with active Zika transmission. Those that express more of a concern include individuals that have planned future travel to the state of Florida and are planning to conceive, or a close family member of someone who is currently pregnant.

What is Zika?

Perhaps you never heard of Zika, or still quite aren’t sure what Zika is exactly. Zika can be described as a virus that spreads to people primarily through the bite of an infected Aedes species mosquito. It is closely related to other flaviviruses such as Zika can also be transmitted sexually from a person that has Zika to their partner as well as from a pregnant woman to her developing fetus, which can result in serious birth defects. Want to learn more about Zika? Check out some other IH section blog posts about Zika here.

My role, criteria for testing, testing/funding limitations

I was hired as one of two Zika Case Managers within my local county health department through funding allocated to the state of Florida by the CDC. One of my duties is to coordinate the testing of suspected local, or travel cases, pregnant women, and any infant born to a potentially exposed pregnant woman. The testing criteria for pregnant women include those who traveled to a Zika-active transmission area, had sexual exposure during pregnancy, or 8 weeks prior regardless of the mother’s testing status, as well as those with any abnormal ultrasound results. Testing is also recommended if the mother was not previously tested. Just like other reportable infectious diseases, it takes effective communication between health professionals at all levels to get quality information across regarding Zika. In order to get the job done, we collaborate with infection control practitioners of local hospitals, nurses, physicians, and other public health clinicians to get samples of babies collected at birth for Zika testing while also making sure that a head ultrasound and hearing test are performed on the baby. This is very important because once the baby leaves the hospital it is almost impossible to get samples collected. A majority of the pediatric clinics don’t have the means to ship the specimens to the state laboratories. Some of the general responses we have received from these clinics include not knowing how to properly prepare the specimens for shipping, having the money to do so, and lack of knowledge about billing the patient’s insurance for the procedure. Although the county health department has the access and ability to ship specimens, it would be a liability for us to ship the specimens if another facility collected the samples.

As of March 2017, the department of health has conducted Zika virus testing for more than 13,020 people statewide. At Governor Scott’s direction, all county health departments were mandated to offer a free Zika risk assessment and testing to pregnant women. Unfortunately, due to a decline in cases, and federal funding allocated to state programs winding down, free testing is no longer accessible to the community, and is only provided on a case by case basis. Zika tests can be pretty expensive ranging anywhere from $200 – $400 when conducted at a commercial laboratory and even more in some cases.

State laboratories have just about depleted federal funds received for testing initiatives. If a patient does not meet testing criteria at our department of health, we recommend testing through affiliated commercial laboratories. In addition to the many changes in testing criteria including requiring patients to show proof of insurance, there has been issues with the insurance companies and patients’ have been incorrectly billed over $1000 for their Zika tests when in fact the test was free. This has been a big issue with tests conducted as far back as November and December which we have recently been made aware of. Mosquito control services specifically for Zika efforts provided by our county health department’s Environmental Health program has ended.

Management of Infants with confirmed, or possible Zika Infection

Currently, we have reached the stage where the pregnant women that are case managed have already given birth. We are now tasked with conducting 24 month active follow-ups of all infants exposed to a positive mother via in utero. We conduct follow-up of the infants exposed regardless of whether the infant tested negative, or positive. These infant follow-ups occur at 2, 6, 12, 18, and 24 months. This is because abnormalities can still occur during child development. A majority of our babies being followed are currently between the 12 and 18 month mark.

Out of all the babies we have tested, and are currently following, only one is confirmed to be microcephalic. Looking into the future, at the 18 month follow-up mark, the infants being followed will have to be re-tested in order to confirm if the antibodies are indeed negative or positive. Another complication with testing these babies will be whether the baby has traveled since it has been born. There is a possibility that the baby could have been infected during travel and not in utero. As of July 31st 2018, Zika contracts for our county health department will end and it is unsure who will take on the responsibility for maintaining the case management of these families.

Community Outreach

Best practices we have utilized as a county has been community outreach which we collaborate across the division of communicable diseases. I have been able to work closely with a CDC field assigned Zika Community outreach nurse to assemble and distribute Zika prevention and testing kits with a specific focus on obstetrician-gynecologist and pediatricians. We have been able to identify the gaps in testing and communication among our health department and local hospitals, clinics, and private physician offices. Additional community outreach activities of focus include visiting women, infant, and children (WIC) clinics throughout the county in order to conduct health education on Zika as well as community health fairs primarily within the Haitian population due to Haiti being one of the top countries which we get the most amount of travel related cases. Unfortunately, these outreach efforts will also end at the end of this summer due to the depletion of funds, and our CDC field assigned nurse’s contract ending.

Where we are now

As of right now, Florida still does not have any identified areas with ongoing, active Zika transmission. Florida is a hotspot for vacationers, especially the counties of Miami-Dade and Broward. Since the local transmission of Zika in 2016 in both counties, it seems that very few individuals consider Zika as being a major concern. Very few physicians’ are screening for Zika. Some still aren’t sure what it is exactly, and how it can affect an unborn fetus. Congenital Zika infection is still a global health threat to pregnant women and their infants. Zika is still a fairly new infectious disease, and we are learning as we go, especially the risks after pregnancy. The reality is that Zika is here to stay. Funding for zika prevention and treatment should be a top priority in order to aid in the health and wellbeing of children and families across the United States.

Kenya Just Banned a Homosexuality Test

Suspicion of having gay sex or relationships is illegal in Kenya and punishable by 14 years in jail. As a result, a group of activists and human rights lawyers in Kenya have been challenging this criminal code and fighting laws that punish LGBT people for being in a relationship or having sex.

One of the most prominent organization leading the issue is the National Gay and Lesbian Human Rights Commission in Nairobi, an organization arguing that LGBT communities are being unfairly targeted. In 2016, the commission received 193 reports of violations, mostly cyber-bullying, blackmail, verbal assault, and physical assault. Other forms of violence and discrimination include eviction, employer termination, or “corrective” rape. Most recently, forced anal exams were still carried out in Kenya despite being considered a degrading form of torture and having no medical merit; while straight people who have anal sex are not considered criminals. Forced anal examinations are usually performed by a healthcare provider at the request of law enforcement officials. These examinations are intended to cause emotional and physical pain and offer no potential benefits to the individual. This could also result in serious mental health concerns such as depression or suicide. This forced homosexuality test is not only a violation of medical ethics but a violation of health equity.

It originated when two men were found and arrested by police because they were thought to be gay. During this time, the court ruled against them and had them get the tests. Little is known about the true prevalence of this practice but the fact that it was codified in legal systems is astonishing. This ruling was reversed in Kenya in March 2018. Many are trying to determine if the ruling on forced anal testing could be an indicator for a turning point for LGBT cases. Promoting equality through health is extremely valuable, especially in this instance, and addressing any barriers could improve the overall health around the LGBT community.

To this day at least nine countries, several of which are in Africa, force anal examinations to investigate or punish alleged same-sex behaviors between consenting men or transgender women. A study from 2016 found that Kenya and several other countries use anal examinations as a means of determining a man’s sexuality. Tunisia, Egypt, Turkmenistan, Cameroon, Lebanon, Uganda, and Zambia, and Tanzania and possibly some others that have reported some instances, such as Syria, are included.  Law enforcement officials should never order the examinations since they lack evidentiary value. Doctors should not conduct them and courts should not admit them into evidence.