IH Section’s Mentoring Applications OPEN

The Global Health Mentoring Program applications for mentors and mentees is now open. Applications and information on the program can be found here: https://aphaih.org/global-health-mentoring-program/

Applications for this cohort (January 2019 – September 2019) will be accepted until November 29, 2018  at 11:59 PM US Eastern Time.

For questions please email: ih.gh.mentoring@gmail.com

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Dengvaxia’s FDA Priority Review: Is the global health community settling on a Dengue vaccine?

The Food and Drug Administration (FDA) announced on October 30th that Dengvaxia’s, Sanofi Pasteur’s dengue vaccine, file has been accepted for priority review within the regulatory agency. With this announcement, the FDA will ensure that a decision will be declared on approval in the United States within six months for the world’s first licensed vaccine protecting against this flavivirus. While this declaration by the FDA displays an improved pragmatic approach to addressing neglected tropical diseases (NTDs), this vaccine has created controversy throughout the global health community. This vaccine is licensed in twenty countries to date and implemented into country wide vaccination programs. However, the concerns accompanying this recombinant, live, attenuated, tetravalent dengue vaccination have led to a discontinuation of this technology with a loss of confidence in several nation states. The Philippines, the first country to complement their vaccination program with this vaccine, has even instructed Sanofi to reimburse the $70 million the country spent to vaccinate 830,000 children. This has caused many global health experts to doubt the impact this vaccine can have throughout the world – causing many to wonder if the global health community is settling on a dengue vaccine.

The dengue virus is estimated to cause 400 million infections each year spanning each of the World Health Organization’s (WHO) regions. This arbovirus belongs to Flaviviridae family and is spread to humans through the bite of an infected female Aedes aegypti mosquito and to a lesser extent from the Aedes albopictus species. The dengue virus has four unique serotypes, DEN-1, DEN-2, DEN-3, and DEN-4, which has caused an effective vaccine to be eluded for centuries. When a person is infected with one certain serotype, the person gains life-long immunity to that serotype. However, if that person contracts a different serotype, it increases the risk of the person developing severe dengue. This phenomenon is called antibody-dependent enhancement (ADE) which allows the different serotype to enter cells more efficiently due to the previously created antibodies from the initial serotype. The symptoms that dengue causes depend on primary or secondary infection. Primary infection results in an acute febrile illness that is typically cleared by the immune system within seven days, while secondary infection can lead to dengue hemorrhagic fever or dengue shock syndrome causing serious morbidity and mortality. The dengue virus currently has no approved treatments – highlighting the importance of an effective and safe vaccine for children and adults alike.  

The significant setbacks for Dengvaxia first arose when Sanofi Pasteur released interim studies concerning children aged 2 to 16 receiving the vaccine who were seronegative. This information was released on November 29, 2017 and revealed that among dengue-seronegative participants, recipients had increased rates of hospitalization for virologically confirmed dengue (VCD) and severe VCD in the vaccine group than in the group not administered the vaccine. These risks were significantly elevated in patients who were aged 2 to 8 years of age and became evident earlier than those aged 9 to 16 years of age. When this data became available, it led to the Strategic Advisory Group of Experts on Immunization (SAGE) of the WHO to reconvene and update their guidance on Dengvaxia. On April 18, 2018, SAGE recommended that for countries considering implementing Dengvaxia, every individual should be screened to determine their serological status with only seropositive persons receiving the vaccine.

The flavivirus genus includes other NTDs including the Zika virus, Japanese Encephalitis, West Nile Fever and Yellow Fever in addition to the Dengue Virus. The symptoms of each these ailments can present almost identically, especially in their milder forms, seeming almost flu-like in nature. When considering these identical disease presentations and the WHO’s recommendation to prescreen individuals for Dengvaxia, health care professionals must turn to dengue serological testing to ensure best practice – if the vaccine is accidentally given to a person with, for example, the Zika virus with no previous case of dengue due to a misdiagnosis from medical history, this would increase the risk of morbidity and mortality if dengue was contracted subsequently. The gold standard for serological testing is isolation and characterization of the virus, like PCR; however, this typically takes six or more days to receive the results and can be burdensome with it’s cost on a public health care system. A more common approach is enzyme immunoassay (ELISA) which is cost effective and less time consuming. However, in areas where two or more of the aforementioned flaviviruses exist, there is IgG cross reactivity between the viruses causing false positives for the dengue virus when ELISA is used. This often rules out the use of ELISA due to a common vector, Aedes aegypti, being able to spread two or more of these viruses within the same zone. Since the dengue virus is endemic throughout the developing world, dedicated health care professionals in these areas often don’t have funds, technology, or training in order to utilize the gold standard, PCR, in dengue testing — further highlighting the health disparities that exist on this earth. This leaves a major barrier to giving proper care to a large portion of humanity including administering this vaccine safely.

With the addition of rapid, accurate dengue test for the serological status of individuals that is in the pipelines (although no estimate of how soon it will be developed has been released yet), this vaccine will certainly find its niche in the global health society. However, this niche will exclude an enormous percentage of humans that would benefit from a safe and effective dengue vaccine. Those individuals that are currently seronegative and those who don’t have access to well-funded public health care system will continue to be at risk for developing the fatal consequences of the dengue virus. Global health leaders need to continue to promote and demand a vaccine that will ensure protection for a greater majority of people. Although this vaccine will serve some well, health care professionals must not settle until the dengue virus and each neglected tropical disease is properly addressed.

Attending APHA in San Diego this year? Visit us at one of our IH section events or meetings and attend our sessions!

We hope that you are as excited as we are for the 2018 APHA Annual Meeting in San Diego! The APHA Annual Meeting represents the largest delegation of public health professionals of its kind and provides opportunities to learn, network with your peers and participate in meaningful public health discussions.

We believe that the greatest opportunity to get engaged and make the most of your APHA membership is through participation in your APHA Sections or Special Interest Groups (SPIGs), so we strongly encourage you to attend our business meetings and socials.  It’s a great way to network with your colleagues in the field of International Health and learn how to become more involved in our Section.  Below are a few events you may find beneficial to add to your calendar. Check out our complete IH section program list at APHA here: APHA 2018 – IH program highlights

International Health Special Sessions 

Session 3338.0  Forty Years since Alma Ata:  Achieving Health for All – Past, Present, and Future

Monday, November 12, 3:00 pm -4:30 pm: Collaborative Session (APHA Global Health-IH-MCH)

Session 4166.0 Health, Health Equity, and War: What is Happening in Yemen, Mexico, Syria and Gaza?

Tuesday, November 13, 10:30 am – 12:00 pm

Session 4274.1  Defending Women’s Rights in the Context of the Global Gag Rule

Tuesday, November 13, 1:00 pm – 2:30 pm:  Collaborative Session (IH-RSH)

International Health Section Awards Reception and Open House

Session 444.0  Tuesday, November 13, 6:00 pm – 9:00 pm.  (all IH members are welcome)

International Health Luncheon

Session 511.0  Wednesday, November 14, 12:30 pm – 2:00 pm  (tickets required)

International Welcome Desk

Please visit the International Welcome Desk next to the APHA Meeting Registration Area to let us know you arrived and to ask any questions.

IH Section Booth at the Public Health Expo

You can also visit us at the International Health Section booth in “Everything APHA” located in the Public Health Expo.  We would enjoy telling you about our Section benefits and learning from you what would be meaningful to you as an IH Section member in the future.

If you are new or need a refresher on getting the most out of the Annual Meeting, please join us at the Navigate & Network event on Sunday morning (details below).

Navigate and Network: APHA 2018

Sunday, November 11, 9:30 – 11:00 AM, Ballroom 6CF – SDCC

Please do not hesitate to contact Jay Nepal, membership committee co-chair at jnepal360@gmail.com, if you have any questions or comments.

We look forward to see you in sunny San Diego!

Join us for the 20th Annual Community-Based Primary Health Care (CBPHC) Working Group Pre-Conference of the APHA International Health Section

Community Health Workers As Transformative Agents For Health Equity: Global Models, Tools and Lessons Learned from Across Borders

Join us for a lively discussion and workshop about health equity and the role of community health workers (CHWs)! A growing body of evidence demonstrates the impact of CHWs on improving and saving lives of mothers and children, reducing health inequities, and transforming health systems around the world. In this workshop we seek to gain a greater understanding of what types of conditions and health care systems allow CHWs to be transformative agents both locally in the US and globally. Additionally, we hope to build on this knowledge and explore how to create environments or support existing systems that allow CHW’s to optimize their ability to transform health care, both in the US and internationally. This workshop will bring together CHWs, community leaders, health professionals, students, program managers, social scientists, and national and international experts of community health work and community-based primary health care.

REGISTER: You can register for the Pre-Conference Workshop independent of APHA full conference registration. The link to register for the CBPHC Pre-Conference workshop here.

FOR MORE INFORMATION: Contact Dr. Laura Chanchien Parajon, Chair of CBPHC Working Group or Dr. Henry Perry, Co-Chair of the CBPHC Working Group at cbphcworkgroup@gmail.com

Be part of the CBPHC working group community! CBPHC is an empowering approach to improving healthcare that engages communities as full partners and extends preventive and curative health services beyond health facilities to communities and households. We are a group of dedicated and passionate health professionals, students and people all contributing to the dream of “health for all” as described in the inspirational 1978 Alma Ata Primary Health Care document. We seek to collaborate, connect, dialogue and reflect with others working in community based primary health care about best practices for achieving health equity.

Have you read the latest issue of our newsletter, Section Connection?

Make sure to check out our APHA Annual Meeting Edition of the Section Connection and see how you can contribute and network during the upcoming annual meeting! You can find the latest issue here: http://bit.ly/SectionConnection9 

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