Mark your calendar for WORLD AIDS DAY – December 1st!

The first global health day ever recognized, World AIDS Day, is observed on December 1st every year. This day is an opportunity for people all over the globe to support those living with HIV, support the fight and research against HIV, and remember those who have died because of AIDS-related illnesses.

Since the beginning of the AIDS epidemic in the 1980’s, over 70 million people have acquired the infection and an estimated half have died from AIDS related complications. Today, there are over 37 million across the globe that live with the disease. Twenty-two million of the 37 million are currently on treatment.

Today, an HIV diagnosis is not a death sentence. There are many different treatment and prevention options (such as PrEP) and services for those in vulnerable populations. Still, access to care and treatment remains a significant problem, especially in developing nations, and more needs to be done to address this issue and increase access. There is also still a general gap in awareness. This year’s theme is “Know Your Status” because one in four people with HIV are unaware that they have the disease. Unfortunately, this may be due to barriers to getting tested.

The WHO recommends the use of self-tests for HIV in areas where there is a lack in availability of HIV tests. This is where a person can collect their own specimen, typically oral fluid or blood, and perform the test in a private setting such as their home. Currently, 59 countries have started using HIV-self tests.  The largest HIV self testing programs have been implemented in six countries in south Africa by the WHO with help from international organizations such as Unitaid.

The UN has a target of diagnosing 90% of all people with HIV by year 2020 and the world has committed to ending AIDS by 2030. Self tests are a huge step in getting vulnerable populations and communities access to testing and knowing their status. Knowing your status and getting on antiviral treatment as soon as possible are the consequential steps to ending AIDS. However, it all begins with awareness and access to testing.

What are some ways YOU can spread awareness and recognition for World AIDS Day and contribute to the goals for 2020 and 2030?

  1. Rock the RED Ribbon to show everyone you support the movement – this symbol became part of the AIDS awareness movement in 1991 when New York artists created it. Fun Fact:  It was the first disease-awareness ribbon made and was later adopted by other health awareness causes, such as breast cancer awareness and mental health awareness.
  2. Print out #ROCKTHERIBBON posters or share them on social media to spread the message. Find these images here!
  3. DONATE to organizations that support AIDS research. Be sure to do your own research to make sure the organization’s mission aligns with your motivations.
  4. Volunteer at a World AIDS Day event near you!
  5. GET TESTED & KNOW YOUR STATUS!
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World Rabies Day: Rabies Prevention Around the World

September 28th is World Rabies Day! This day of observance was created by the Global Alliance for Rabies Control (GARC) to spread awareness about the disease and educate others on how to prevent it. This year’s theme is Rabies “Share the message. Save a life.” 

Rabies is a preventable viral disease that affects only mammals and is transmitted through the saliva, cerebral spinal fluid or brain tissue of an infected host. If untreated, rabies is fatal. Most commonly, the disease is transmitted through a bite, but can also be transmitted if the infectious material gets directly into the eyes, nose, mouth or an open wound.  Rabies infects the central nervous system and causes a “disease of the brain.” Early symptoms of rabies can include fever, headache and fatigue – symptoms that are similar to many other illnesses such as the flu or common cold. However, as the disease develops, symptoms specific to rabies begin to appear: insomnia, paralysis, hallucinations, agitation, hypersalivation, difficulty swallowing and hydrophobia. The disease typically results in death within a few days after the onset of these rabies-specific symptoms.  

In the United States, reported rabies cases have shifted from mainly domestic animals to predominantly wildlife animal reports. Specifically, more than 90% of all rabies cases today are from wild animals. In addition, the number of rabies-related deaths in humans has decreased dramatically from 100 cases per year in the 1900’s to 1-2 per year. Our efforts to encourage prophylaxis after an exposure and the effectiveness of the vaccine have proven successful in decreasing rates of rabies in the United States.

However, rabies is found on every continent other than Antarctica and some continents struggle with the burden of rabies more than others. The overall death rate for rabies around the world is estimated at a staggering 59,000 people a year. Countries in Africa and Asia are affected by rabies disproportionately than the other continents and almost half of the victims of rabies in these countries are children younger than 15 years.

A main reason that such a young population affected is due to uncontrolled canine rabies in these countries. Canine rabies – which spreads from dog to dog – is actually the cause of 98% of human deaths globally. In the United States it has been eliminated because many people keep their animals vaccinated to prevent this type of rabies from re-entering our environment.  However, in many other countries, stray dogs roam around neighborhoods freely and when they contract rabies, they likely spread it to many people (primarily children) they come in contact with. Scientists predict that if 70% of dogs are vaccinated for rabies in an area, rabies can be controlled and human deaths will decrease.

Haiti has the highest number of human deaths by rabies – around 2 deaths per week. CDC and the Government of Haiti have started an animal rabies surveillance program (2013) to detect and have situational awareness of which regions of the country are greatly affected by rabies. In 2015, CDC also evaluated how many dogs were vaccinated in the country and found that only 45% of dogs received their shots. In addition, the total amount of dogs in the country was actually double the number they initially predicted. After these studies were done, the CDC helped train animal health workers to conduct large dog vaccination campaigns and continue rabies prevention efforts.  Many children started bringing their puppies to the events and were proud of their certificates ensuring their dogs had been vaccinated. It is CDC’s (along with the Government of Haiti) hope to reach a 70% vaccination rate among their dog population and sustain it for five years – long enough to create a ripple of effect among human deaths due to rabies.

CDC has helped establish similar campaigns in other countries. For example, they have trained animal control officers in Ethiopia to capture, vaccinate and release stray dogs as well as monitor human exposure cases and keep track of post-exposure prophylaxis (PEP) treatments.  In Vietnam, while there is not a high human death rate for rabies – 91 per year, the government spends an extraordinary amount of money on expensive PEP. It is much more feasible to vaccinate dogs than provide the costly post exposure treatment – $1.32 dollars vs one course of PEP at $153 dollars.  The CDC has helped support Vietnam in improving their rabies surveillance and coming up with new approaches to vaccinate their dogs and achieve the 70% canine vaccination goal.

The World Health Organization has been having meetings to discuss ways to eliminate rabies in Africa too. This past month, representatives from 24 countries in Africa met in Johannesburg to share information from a study they conducted regarding rabies.  The representatives pitched ideas for implementing the new recommendations for human rabies vaccines and how to improve surveillance dog vaccination campaigns. These meetings are exciting as they provide new insight for the global plan to achieve zero deaths from rabies.

Single countries like the Philippines, have proved to be great examples for national campaigns organized against rabies. The Philippines holds a nationwide World Rabies Day celebration as part of its educational outreach campaigns each year. The celebration has continued to grow yearly as more and more events are added to the agenda. It’s success emphasizes the importance of a program that is led and supported by their own national government and how the topic of rabies elimination is valued by the country’s leaders.

Overall, targeting the countries where rabies poses a significant risk and coming up with goals, campaigns and new tactics to eliminate rabies are substantial goals for the globe and many lives will be impacted by the CDC, the WHO and its many public health partners. But what can YOU do on a personal level that can also impact many lives? Here’s a quick checklist to follow:

  1. To start, you should always take your pet to the vet to get vaccinated for rabies regularly.
  2. Spaying or neutering your pet can also help with decreasing the amount of stray and potentially dangerous animals into your pet’s environment.  
  3. Always supervise your pet when they are outdoors. Wild high risk animals for rabies such as raccoons, coyotes or opossums can be in your backyard.
  4. Lastly, avoid contact with wild or unfamiliar animals (including dead animals). As tempting as it is to pet a stray cute kitten or dog, it is in your best interest to not feed or handle them.
  5. Continue sharing the message and saving lives!  Happy World Rabies Day!

What’s Being Done to Promote Vaccinations Across the Globe?

August is National Immunization Awareness Month (NIAM)! Every year, the public health community focuses on spreading awareness of the importance of vaccinations for people of all ages. There are four main messages that are promoted through this campaign:

1) Vaccines protect against serious diseases

2) These diseases still exist and outbreaks do occur

3) Vaccines are recommended throughout our lives

4) Vaccines are very safe.

The United States backs up the importance of these messages with strict school attendance policies regarding vaccinations. Each state has their own laws, but they each require vaccines for children not only attending public schools, but also private schools, universities and daycares. All states allow for medical exemptions, but only some states offer religious or philosophical exemptions. In addition to these policies, the country pushes out amazing social media campaigns that focus on this observance in August. These messages are promoted in many diverse social media outlets in the United States. To name a few, the National Public Health Information Coalition has a toolkit with multiple social media strategies promoting on-time vaccination, and the American Academy of Pediatricians has created and shared a video with many doctors across the country sharing their perspective on why they vaccinate. There are dozens of news articles published everyday with questions and answers regarding the importance of vaccines and reminding parents to get their kids vaccinated before school starts. There are even great articles stressing the importance of adult vaccination – which we don’t see very often! So much good material is pushed out towards the public during this month to promote the truth in how they protect ourselves and our communities.

From an international health perspective, diseases impact everyone, all over the globe.

What are some things being done in other countries around the world? Do they encourage and push out vaccine efforts and policies as much as the United States? Is it just as important?

It turns out, yes! Vaccines are important in many different countries across the world. Here’s a quick spotlight from CNN and other current articles on a few countries that have recently improved their efforts through policy to increase vaccination rates in their countries.

France just passed a new law that requires all children born after January 1st to receive 11 mandatory vaccines. The Ministry of Health is trying to increase their vaccination coverage to meet the World Health Organization’s recommendation of 95% with this new law. The ministry did not want to use forceful methods to motivate the public into getting vaccinated, however this new law will strongly incentivize parents to get their children their shots – otherwise they will not be allowed to attend schools or daycares.

To address the recent measles outbreaks going on in Europe, Italy has followed the United States’ lead and required vaccinations for school entrance. However, they are different from the United States because they are NOT allowing conscientious objections and their citizens will be issued a fine if they do not choose to vaccinate.

Germany recently introduced legislation that makes it required for Kindergarten schools to report to their health departments any parents who have not submitted proof of vaccination for their children. The vaccinations have been required in the past, however reporting parents to the health department is a new stronger twist in ensuring vaccination coverage in schools across the country.

Canada has worked on increasing their vaccination rates by combining vaccine appointments with their routine check ups, providing home visits, creating more vaccine clinics and sending out reminders. This makes it easier for those living further out from clinics and larger cities to get their kids’ vaccination needs taken care of.

In 2016, Australia’s government passed a law that allows families with lower incomes to get “tax rebates” if they keep their child up to date on vaccines. More than 210,000 families have participated since the program was implemented in January 2016 – that’s a lot of kids vaccinated!

On August 6th, 2018, Brazil launched a nationwide vaccination campaign for measles and polio after a large outbreak of measles that resulted in five children deaths. In states where measles is more concentrated, the Ministry of Health has given out free shots in clinics and citizen homes. Their ambitious goal is to vaccinate 95% of children ages 1 to 5 by the end of August.

In an article by Nicholas Dugan, we see that progress has been made in the South Asian countries of Nepal and Bhutan regarding 90% diptheria-tetanus-pertussis (DTP3) coverage since the adoption of the Global Vaccine Action Plan (GVAP) in 2012. Bangladesh has also increased their DTP3 rates by over 20% after the 1980’s when they invested in health infrastructure and training regarding immunizations. These rates are encouraging to hear, as the region of South Asia has typically lagged behind other regions in their vaccination requirement efforts.

Lastly, about 20 million infants worldwide have not been reached through immunizations services and about 60% of those 20 million can be pinpointed to live in 10 countries: Afghanistan, Angola, the Democratic Republic of Congo, Ethiopia, India, Indonesia, Iraq, Nigeria, Pakistan and South Africa. The WHO is working with these countries through initiatives like the Global Vaccine Action Plan mentioned above. In 2017, the GVAP was revamped to further encourage government to improve monitoring and surveillance systems regarding immunization rates so that the data from these systems is up to date and able to guide policy and decision-making for the future. It also requests the WHO Secretariat support these countries continuously to achieve these goals.

Overall, each of these country policies are a little different, but they all encourage and strive to increase vaccination coverage in their respective countries – some with help from other organizations like the WHO.  Over the last few years, the proportion of children across the world with recommended vaccines has stayed stable according to the World Health Organization. With all of these different methods for bringing awareness to the importance of vaccinations through social media this month and different health policies around the world, I am encouraged and optimistic about efforts to increase the proportion of children across the world covered by these essential vaccinations.

Getting involved with health policies that encourage vaccinations is worthwhile and leads to great changes in many different countries as seen above, but if you want to be involved in a smaller (but still impactful) way, I’ve included a few different resources you can use via social media, regardless of where you live, and do your part in increasing awareness and importance of vaccines during the month of August:

  • Health.gov’s toolkit (includes information to add to a newsletter, tweets, community events)
  • American Academy of Pediatricians toolkit (blogs and articles to share)
  • CDC’s recommended immunization schedule

Retweet, post and share away the importance of this observance!

Chagas: A Bug That Gives More Than Kisses

It is definitely feeling like summertime here in America, specifically Texas, where I live. This week, the high temperature reaches 100 degrees Fahrenheit multiple times. During these kinds of summer days, I find myself spending a lot of time outdoors recreationally exploring water holes and hiking. With all the outdoor time, I’ve also come across so many different types of bugs and contemplated how many of these bugs can cause vector-borne infectious diseases. There is one disease in particular that has been at the front of my mind after attending an insightful conference over diseases in nature last month – Chagas disease.

Chagas disease is caused by a parasite called Trypanosoma cruzi and transmitted to people and animals by insects called Triatomines, or more commonly known as “kissing bugs.” Uniquely, these vectors are only found in the Americas (mainly Latin America). The vector, or insect, can infect a person or animal when it takes a blood meal bite near a wound, mouth, eye or other mucus membrane and then deposits feces near the bite. If the human or animal rubs the infected feces into their eye or mucus membrane then the parasite will begin its life cycle, multiply and cause disease.

Chagas disease is tricky to diagnose because it causes mild to no symptoms at all and can go from an acute stage to a relatively quiet chronic stage. Fever and swelling near the bite is common in those that experience symptoms in the acute stage. In some very rare cases, people can experience inflammation of the heart or brain. After the acute stage, most will enter the chronic stage of Chagas disease. Most people will never have any other problems associated with the disease at this point. However, 20-30% can develop life-threatening medical problems associated with the chronic disease including heart rhythm abnormalities, a heart that does not pump correctly, or a dilated esophagus or colon that can cause issues with eating or passing stool. Antiparasitic treatment is recommended for all cases under the age of 50 that have not developed medical problems from the chronic stage. This treatment is typically through the drug nifurtimox or benznidazole.

Chagas diseases does not only affect humans. Dogs have been found to be significantly impacted as well if they ingest bugs or are passed the disease congenitally from their mother. Symptoms in dogs include: fever, loss of appetite, lethargy, swollen lymph nodes, liver or spleen. Many owners don’t notice these symptoms because they are similar to other diseases and resolve over time. If a dog develops a chronic infection, they can develop deadly heart disease which can result in heart failure or sudden death. Unfortunately, there is no medication that has been found to be effective for treating Chagas in dogs and no vaccine against the disease in dogs or humans.

The disease has gotten much attention in the news and public health realm as of recently. CDC deemed it a “neglected tropical disease” and has devoted time to learning more about the disease and its impact. The public health burden of the disease in the United States is uncertain because many states are not required by law to keep track of the number of confirmed cases. As immigration increases in America, specifically from Latin America to the U.S., we are seeing increasing numbers of Chagas reports. In Texas, a research group from A&M that studies kissing bugs extensively has even created a collaborative project where citizens can send in bugs to have identified and be counted for. This study emphasizes the importance of “citizen science” – where the community can contribute to the advancement of scientific research through their participation in the study by sending in insects. They even have provided an interactive map on their website that shows where kissing bugs have been submitted from in the state of Texas.

If you’re interested in seeing a picture of a kissing bug, check out this link from the Texas A&M research site. The photos are taken by Dr. Gabriel Hamer and show the kissing bugs that can be found in Texas as well as the ones found across the United States.

If you live in the Americas, keep your eyes peeled for these bugs this summer and know when to seek care. This article by USA today, hits on some places that the bug can be found including: under porches, cement, in between rock, wood or brush and in outdoor dog houses or chicken coops. If you do come across these bugs and are interested in submitting them to the Texas A&M research team, check out this link. They have a few FAQ’s and reminders on how to handle the bug. Happy summer and bug swatting season!

MS: An Unpredictable Disease That Needs More Attention

What would you do if you had symptoms of extreme fatigue, blurred vision, loss of balance, slurred speech, tremors, problems with memory and concentration, or paralysis that occurred sporadically throughout your life and potentially worsened over time? It is a crazy and debilitating thing to think of, but this is what people with multiple sclerosis deal with every day. Multiple sclerosis (MS) is a chronic neurological disease of the central disease system (brain, spinal cord and optic nerves) and is thought to be a disease in which the immune system incorrectly attacks its own healthy tissue. Over 2.3 million people are affected by MS across the globe, but because symptoms can be invisible or difficult to diagnose, the National Multiple Sclerosis Society predicts there are many more cases than accounted for.

This past month I volunteered at the MS150 – a two day, 150 mile bike ride from Houston to Austin that fundraises for the National MS Society. Anyone that races has a four hundred dollar minimum to raise towards MS. This year, they were able to raise over $10 million dollars total towards helping the National MS Society bring hope to those affected. I had heard of this race and organization in the past, but had never really pursued looking further into it. This year I decided to cheer on a fellow friend racing in it and learn a little more about MS while I was there. I was so glad I did. It was such an uplifting experience with everyone gathered and racing for a common cause. It really made me consider if there’s anything similar being done – information sharing, raising money, learning about the disease – in other countries. The U.S. is lucky to have resources to coordinate these kinds of events, but they are not the only people affected by the disease.

MS does not know country borders or only affect populations in certain nations. It is a disease that affects those across the globe. Global prevalence of MS showed greater numbers in higher income countries (>60 people per 100,000) than lower income countries (ranging from 0-20 people per 100,000) from a study done by the Global Atlas in 2013. However, these numbers could be skewed from showing the whole picture due to less lower income countries adequately diagnosing and reporting the disease. Another study, the global burden of disease study, or GBD, conducted in 1990 estimated the incidence, prevalence, duration and mortality for more than 500 different diseases and injuries. Neurological diseases, like MS, were measured in disability-adjusted life years, or DALYs. These measure the impact of a disease such as MS, on a person’s healthy lifespan. If the impact is one DALY, then it can be thought of as losing one year of healthy life free from disease and disability. This study revealed that noncommunicable diseases, including neuropsychiatric diseases like MS, had a notable impact on the health burden in all parts of the world. MS was predicted to have an increasing number of total DALYs from 2005 (1,510,000 DALYs) to 2030 (1,648,000 DALYs). This was measured out of a total of 92 million DALYs contributed by neurological disorders in 2005 and a predicted 103 million DALYs in 2030. Although the burden of MS seems small in the group of neurological disorders, it is predicted to increase and continue to make an impact.

Luckily, scientists today are researching and testing different theories to try and pinpoint the unknown cause of multiple sclerosis. A recent study published this past week points to gene expression of what’s called TOX. TOX contributes to the development of lymphocytes that attack foreign threats in the body. However, when this TOX is activated in CD8+ T lymphocytes, the lymphocytes can not hear signals from the brain telling them that the neurons they want to attack are actually healthy and not a threat. They instead attack the brain cells and eventually lead to the development of MS. This discovery is an exciting first step in understanding MS better and how to prevent it from impacting so many.

However, we are not all scientists. So what can we do to help those with MS or other noncommunicable diseases across the globe? We can start with learning, understanding and speaking out about the burden that noncommunicable diseases like MS have on our communities. In the 2013 Atlas of MS survey, it was found that there were 4.7 neurologists per 100,000 people in high income countries compared to 0.04 per 100,000 people in low income countries. The range of MS nurses was also similar and many low income countries reported having zero nurses with these specific skills and expertise. The number of MRI machines also closely matched this trend, with lower income countries having less machines available to them. Low and middle income countries unfortunately have the double burden of communicable and noncommunicable diseases. It is easy to spend so much time on infectious and communicable diseases because we see “easier fixes” to the problem such as providing vaccines, adequate hand hygiene education, and access to clean water initiatives. However, diseases like MS, while trickier to tackle, should be kept in the forefront of our minds.

The World Health Organization has an awesome chapter from a book called, “Neurological Disorders: Public Health Challenges” that hits home this point about resources (both financially and the public health workforce) being needed to help those with neurological disorders alongside communicable disease resources. It aims to provide a basis for decision making at global, regional and national levels so that resources are available for both realms of public health challenges. I believe if we’re acknowledging and advocating that noncommunicable diseases are also of public health importance – we can slowly chip away at the multitude of different global health challenges we are faced with everyday. I’ll end with a quick link to the World Health Organization’s page titled 10 facts on noncommunicable diseases. Check it out and see if there’s something new you can learn today!