#Polio eradication in @CDCMMWR: Are we finally on the cusp of that elusive dream?

Note: This was cross-posted to my own blog.


I came across a very encouraging article in last week’s MMWR (the CDC’s Morbidity and Mortality Weekly Report) this morning about polio eradication. After several reappearances in 2013, cases are down again this year and, if things continue to go well, the end may be in sight:

Four of six WHO regions have been certified as free of indigenous WPV, and endemic transmission of WPV continued in only three countries in 2014. In 2013, the global polio eradication effort suffered setbacks with outbreaks in the Horn of Africa, Central Africa, and the Middle East; however, significant progress was made in 2014 in response to all three outbreaks. Nonetheless, the affected regions remain vulnerable to WPV re-importation from endemic areas and to low-level, undetected WPV circulation. Continued response activities are needed in these regions to further strengthen AFP surveillance and eliminate immunity gaps through high-quality SIAs and strong routine immunization programs.

Progress in Nigeria since 2012 has brought the goal of interrupting the last known chains of indigenous WPV transmission in Africa within reach. Elimination of all poliovirus transmission in Nigeria in the near term is feasible, through intensified efforts to 1) interrupt cVDPV2 transmission, 2) strengthen routine immunization services, and 3) increase access to children in insecure areas. Similar efforts should be implemented in all countries in Africa, where 9 months have passed without a reported WPV case, and 6 months have passed since the last reported cVDPV2 case.

"Number
Number of cases of wild poliovirus type 1 in countries with recent polio outbreaks, by territory* — January 1, 2013–March 30, 2015

*Central Africa (Cameroon and Equatorial Guinea), Horn of Africa (Ethiopia and Somalia), and Middle East (Iraq and Syria).

The eradication push has suffered major blows in the last two years. In 2013, after six years of being polio-free, a major outbreak in Somalia contributed more polio cases to the year’s tally than the rest of the world combined; meanwhile, the virus made its way back into Syria that same fall after a 14-year hiatus. Luckily, extraordinary efforts in the midst of conflict zones on the part of health workers were able to beat the virus back to the heart of the fight – the final three countries in which it remains endemic.

Number of cases of wild poliovirus type 1 among countries with endemic poliovirus transmission, by country — January 1, 2013–March 30, 2015
Number of cases of wild poliovirus type 1 among countries with endemic poliovirus transmission, by country — January 1, 2013–March 30, 2015

Most (86%) WPV cases in Afghanistan in 2014 resulted from importation from Pakistan; however, the detection of orphan viruses highlights the need to strengthen the quality of both polio vaccination and AFP surveillance (10). Efforts are also needed to increase population immunity by intensifying routine polio immunization activities to ensure high coverage among infants with at least 3 OPV doses.

Recent challenges to the secure operation and public acceptance of the polio eradication program in Pakistan are unprecedented (10). Although poliovirus transmission has been concentrated primarily in the FATA region of northwest Pakistan, transmission has continued in the greater Karachi area, and WPV cases have been reported from all major Pakistan provinces. Successful efforts to enhance security to protect health workers and increase public demand for vaccination are urgently needed.

The recent gains in control and elimination of poliovirus transmission globally must be maintained and built upon through innovative strategies to access populations during SIAs in areas with complex security and political challenges, improve AFP surveillance, and strengthen routine immunization. With the progress achieved in 2014 to interrupt endemic WPV transmission in Nigeria and polio outbreaks in Africa and the Middle East, permanent interruption of global poliovirus transmission appears possible in the near future, provided that similar progress can be made in Afghanistan and Pakistan; progress there would also reduce the risk for future importation-related outbreaks in polio-free countries.

While there have been several cases of circulating vaccine-derived poliovirus in northern Nigeria, the fact that no wild poliovirus has been seen in the country since last July is extremely encouraging – eradication in Africa may be in sight. The final stronghold will be Pakistan and Afghanistan (primarily its regions that border Pakistan) – where, as the global health community has discussed ad nauseum, militants take advantage of the lack of public trust in eradication owing to bad intelligence schemes, among other things.

Obviously, it is still too early to tell. Gaps in surveillance mean incomplete data; there are most likely more cases that have not been reported. Furthermore, ongoing conflict (not to mention the recent Ebola outbreak) has left the health systems of many countries devastated, so vulnerabilities are everywhere. Nevertheless, with continued dedication (and a little luck), we may very well get there. Here’s hoping.

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Global Health News Last Week

Note: There will be no news round-up next week, as the IH section will be conducting its usual array of activities during APHA’s Annual Meeting.  Please tune in for updates on section sessions and activites at the conference.  Meanwhile, you can get your global health news fix from the DAWNS digest, Humanosphere, or the Healthy Dose.

October 16 was World Food Day.
October 17 was International Day for the Eradication of Poverty.

POLITICS AND POLICY

  • Scientists are warning officials negotiating a global treaty on mercury that banning the deadly chemical completely would be dangerous for public health because of the chemical’s use in vaccines. 
  • The Washington Post runs an editorial critical of the GOP presidential candidates’ hostility toward foreign aid.
  • An influential panel of MPs warned that changes in UK aid policies may make overseas aid more prone to corruption and misuse.
  • Attendees at the Asia Pacific Conference on Sexual and Reproductive Health and Rights have called on countries in the region to introduce comprehensive sexuality education in schools.
  • The Kaiser Family Foundation has released a report which finds that global HIV/AIDS funding dropped by 10% in 2010.

PROGRAMS

  • HP Signed a Memorandum of Understanding with USAID to collaborate in the fight against global poverty through initiatives directed at issues such as public health.
  • GAVI CEO Seth Berkley pens an op-ed in Huffington Post on the economic value of childhood vaccines.
  • The Pan African Parliament has passed a resolution that urges African nations to prioritize maternal, newborn and child health programs.
  • USAID is initiating research to find out whether developing world families will adopt a new cooking technology and adapt their cooking methods to save their health.
  • At an event in Washington, the Aspen Institute’s Global Leaders Council called for increased accessed to contraception worldwide. 
  • Microfinance initiatives to fund development could benefit from reinvigorating their aims and taking on new, integrated approaches, according to experts at the 2011 International Forum on the Social and Solidarity Economy in Montreal.

RESEARCH

  • A new study, by researchers from the National Institutes of Health, Gilead Sciences Inc. and universities in Belgium and Italy, suggests that a microbicide gel, which was originally developed to fight AIDS in Africa, could lower the incidence of herpes in many women.
  • RTS,S a malaria vaccine developed by GlaxoSmithKline, is showing great of promise in the early stages of its huge clinical trial.  The American Society for Tropical Medicine and Hygiene Council Member and Science Director at the PATH Malaria Control Program, Rick Steketee, explores the impact of the new RTS,S clinical trial results and what this breakthrough means for science and neglected tropical disease research. On the other hand, Sarah Boseley wonders where the money will come from once the vaccine has passed its trials, and Karen Grepin is not as excited about the new GSK malaria trial results as many others.
  • Adults who have fallen behind on mortgage payments exhibited higher rates of depression and are skipping meals and medications because they cannot pay the bills, a study published in the American Journal of Public Health found.
  • Teenage drivers have fewer crashes after they’ve been driving for a while, but new research in the American Journal of Public Health suggests that a few months behind the wheel do not improve their driving skills much.
  • A recent study finds that the best way to fight TB in patients with HIV is to treat as early as possible.

DISEASES AND DISASTERS

  • The famine in Somalia isn’t getting much public attention, but not because things are improving. Aid workers predict things will get worse before they get better. Much-needed rain is coming, but the rainfall could deepen the crisis for the four million people there who need help.
  • Numerous UN agencies are ready to be deployed if Southeast Asian nations ravaged by flooding request for assistance.
  • A report by Roll Back Malaria Partnership released at the start of the Gates Foundation’s Global Malaria Forum says that the world is making positive steps towards eradicating malaria. Specifically, 29 countries are on track to stop malaria within a decade.
  • Environmental hazards sicken or kill millions of people — soot or smog in the air, for example, or pollutants in drinking water. But the most dangerous stuff happens where the food is made — in peoples’ kitchens.
  • World Health Organization officials say the rapid and extensive globalization of food production has increased the incidence of food contamination worldwide.
  • Speculators in the agricultural commodities markets are forcing grocery prices to rise too quickly and erratically, according to some top economists marking World Food Day Sunday.
  • Climate change poses an immediate and serious threat to global health and stability, as floods and droughts destroy people’s homes and food supplies and increase mass migration, experts warn.
  • A survey of 87 countries showed more than half the countries reported more or much more awareness of mental illnesses in the past three years. Unfortunately, there is not a whole lot of new money behind that awareness.

Global Health News Last Week

September 5 was Labor Day.

POLITICS AND POLICY

  • The State Department has announced the official US Delegation to the UN High Level Meeting on NCDs, which will take place September 19-20.
  • Access to affordable lifesaving medicines will be threatened where they are needed most—in parts of the developing world—if the U.S.insists on implementing restrictive intellectual property policies in the Trans-Pacific Partnership (TPP) trade agreement, says Médecins sans Frontières (Doctors without Borders).
  • Sarah Boseley shares the great news that Kenya has officially made female genital mutilation illegal.
  • A federal appeals court in Virginia has dismissed two lawsuits challenging the constitutionality of President Barack Obama’s health care overhaul.
  • United Nations chief Ban Ki-moon singled out sustainable development as the top issue facing the planet with the world’s seven billionth person expected to be born next month. Key to this was climate change, and he said time was running out with the population set to explode this century.
  • Thousands of proposed cuts in the US Congress could lead to significant cuts to USAID.
  • The Philippines reproductive health bill is still making its way through the senate.  Meanwhile, 7 villages in Bataan, the Philippines have banned “artificial contraception” amid national debate over the bill.
  • A report co-authored by an Australian academic highlights the need for healthy ecosystems as the basis for sustainable water resources and stable food security for people around the world.

PROGRAMS

  • Sometime this fall, the world’s population will reach 7 billion people. Experts now forecast that by 2050, the population could be 10 billion. Some say those numbers should force policy makers to focus more intently on making family planning much more widely available in the developing world.
  • The Institution of Mechanical Engineers has put together a one day conference bringing together innovators and health workers to share ideas about ways to more easily deliver interventions.
  • It has been commonly held that insecticide treated bed nets reduce the rate of malaria for people who use them. Now there is hard evidence to back up that assumption.

RESEARCH AND INNOVATIONS

  • A new study shows that less than three doses of the vaccine against cervical cancer can effectively protect women in the developing world where 80% of global deaths due to cervical cancer take place.
  • Only three African countries are on track to achieve MGD 5, according to an African Institute for Development Policy study.
  • Most efforts in the Western world seeking to find solutions for developing world problems tend to think of inventing new technologies or, at least, using the tools we typically use to fix things — modern drugs for diseases, improved seeds for crops, a better mousetrap. Sometimes, all you need is a newly geared donkey
  • Scientists may have developed a new TB vaccine after tests showed the elimination of TB from infected tissue in mice.
  • A socially active lifestyle can dramatically speed up weight loss through the burning of fat in mice, a study shows. Researchers at Ohio State University in the US identified a link between the amount of social interaction in a mouse’s environment and its weight.
  • An easy-to-use diagnostic chip for HIV could “give results in minutes” and be a game changer in the field of cheap diagnostics for remote regions, claim the researchers who developed it.

DISEASES AND DISASTERS

  • Having to contend with U.S.army drones and the crossfire between the Taliban and the Pakistani army, the residents of Pakistan’s tribal areas find access to treatment for HIV/AIDS harder than in most other parts of the world.
  • Three-quarters of a million people are facing death by starvation in Somalia according the United Nations, who declared Monday that famine had spread to a sixth southern region of the beleaguered Horn of Africa state.  Meanwhile, an investigation has revealed that masses of food meant for famine victims in Somalia are being stolen. There have also been reports of rioting and killings during food distribution at camps for famine victims.
  • A magnitude 6.6 earthquake struck 100km southwest of the city of Medan, Sumatra and 110km beneath the earth’s crust.
  • A New York Times editorial castigates the international community’s response to the cholera outbreak in Haiti.
  • The CEO of insulin manufacturer Novo Nordisk says the WHO should buy low cost diabetes drugs in bulk for the developing world.
  • Messages of good health and positive self-esteem for girls aren’t hard to come by in kid lit, so what’s the deal with all the attention for a not-yet-published rhyming picture book about an obese, unhappy 14-year-old named Maggie?

INFOGRAPHICS AND OTHER MEDIA

Global Health News Last Week

SECTION NEWS
Attention IH section members! We are still in need of moderators for the scientific sessions at this year’s annual meeting. According to our program committee, the following sessions are still available:

Monday, October 31
10:30 a.m. to 12:00 p.m.: International Health Programs & Policy 1

2:30 p.m. to 4:00 p.m.: Act Global, Think Local: Domestic applications of international health lessons; Child Survival & Child Health 1

Tuesday, November 1
8:30 a.m. to 10:00 a.m.: Builidng Partnerships and Coalitions for better International Programs; Emerging, Re-emerging & Neglected Tropical Diseases

10:30 a.m. to 12:00 p.m.: International Health Communication/ Behavior Change Communication

12:30 p.m. 2:00 p.m.: HIV/AIDS 2

Wednesday, November 2
8:30 a.m. to 10:00 a.m.: HIV/AIDS 3; Innovations in International Health 2

Please contact Omar Khan (ih.apha@gmail.com) for more information, or to volunteer!


USAID celebrated its 50-year anniversary this week.

The benefits of breastfeeding are being showcased around the world
for Breast Feeding Week.

POLITICS AND POLICY

  • US organizations will find it easier to deliver aid to parts of Somalia controlled by a pro-Al Qaeda group – the threat of prosecution if it ends up in the wrong hands has been reduced  after an announcement by the State Department.
  • Dr. Ariel Pablos-Méndez was sworn in as the new Assistant Administrator for the Global Health Bureau at the U.S. Agency for International Development (USAID).
  • Although Congress resolved the debt ceiling debate, the way the budget package is being shaped — particularly by combining International Affairs with defense in a single “security” category, global poverty spending is getting severely handicapped.
  • Blood tests for tuberculosis (TB) diagnosis may be putting patients’ lives at risk through providing misleading results, and should not be used, according to a WHO policy statement.

PROGRAMS

  • The inaugural charter of the Alliance for Oral Health Across Borders was signed at Temple University yesterday.
  • Tom Paulson of Humanosphere breaks down the 2010 Gates Foundation annual report, with some interesting commentary.
  • Jaclyn Schiff of UN Dispatch says we can look for more global health leadership coming from the city of Houston (my hometown!), as Dr. Peter Hotez, whom Schiff calls “an international health force of nature,” and an arm of the Sabin Vaccine Institute move there.
  • The Measles Initiative today announced it has helped vaccinate one billion children in more than 60 developing countries since 2001, making significant gains in the global effort to stop measles.
  • India’s health minister announced Tuesday a new initiative underway to boost the country’s rate of immunizing newborns by collecting mobile phone numbers of all pregnant mothers to monitor their babies’ vaccinations.

RESEARCH

  • A multi-resistant strain of Salmonella Kentucky could be spreading globally, suggests a study by Institut Pasteur. Case numbers have risen in Europe and the US, and infections have also been acquired in various parts of Africa and the Middle East. The strain has also been found in food animals in Africa.
  • Pharmaceutical manufacturer iBio, Inc announced the successful animal testing of a malaria vaccine candidate in trials sponsored by the Bill & Melinda Gates Foundation.
  • A new study in the American Journal of Tropical Medicine and Hygiene shows a relationship between a kind of river flow and cholera outbreaks.
  • A new study in the Lancet shows that text messaging can be an effective tool in malaria treatment and prevention.
  • PLoS Medicine published a new study on HIV/AIDS in the Middle East and North Africa. Among its key findings was the startling fact that sex between men (MSM) accounts for nearly one quarter of all new HIV infections across the region.
  • According to a new study, children of depressed mothers in developing countries are 40 percent more likely to be underweight or stunted than those with mothers in good mental health.
  • A cheap and portable blood test could provide a breakthrough for diagnosing infections in remote areas of the world, a scientific study says.
  • Using WHO data, researchers found that children who experience abuse and develop mental health disorders are at increased risk for chronic physical problems later in life.
  • A new study in the journal Nature Medicine finds that a credit card shaped device used for testing HIV, known as “Lab-on-a-Chip,” has had a successful trial run in Rwanda.

DISEASES AND DISASTERS

  • Mass treatment of river blindness and lymphatic filariasis with ivermectin has been hampered by severe reactions if the patient also has Loa loa. A new map developed by WHO’s African Programme for Onchocerciasis Control will help communities identify low risk areas for Loa loa and distribute ivermectin for lymphatic filariasis control safely.
  • The CDC reports that the annual number of HIV infections in the USA is holding steady at about 50,000, and that African American MSM are at particular risk.
  • AIDS remains a metaphor for inequality, argues Michel Sidibe in the LA Times. In the world’s wealthier nations, where access to medicine is widespread, AIDS is becoming a chronic disease rather than a death sentence. But in the eveloping world, 1.8 million people die of AIDS each year.
  • Global cholera incidence has increased since 2000, with Haiti’s large outbreak tipping the largest burden away from Africa for the first time since 1995, the World Health Organization (WHO) said Sunday.
  • Tens of thousands of Somalis have died and more than half-a-million children are on the brink of starvation. Western aid isn’t flowing to where the worst of the famine is — partly due to the “war on terror.”
  • The head of World Food Program in Ethiopia says the country’s emergency food stocks are almost gone, the latest trouble caused by the drought in the Horn of Africa.

TOTALLY UNRELATED TO ANYTHING – Apparently Hollywood has discovered its next Greg Mortenson: Sam Childers, the “Machine Gun Preacher,” is the subject of much hubbub and an upcoming movie starring Gerard Butler.  This man claims to have been a gangbanger and drug dealer who found Jesus and then took up arms to rescue child soldiers from the LRA.  Global health blogger Brett Keller offers some commentary into Childers’ outlandish (and, frankly, dubious) story, while anonymous aid blogger “J” at Tales from the Hood has a few choice words.

Global Health News Last Week

POLITICS AND POLICY

Human Rights Watch has urged the Bahraini authorities to halt what it said was a “systematic campaign” to intimidate doctors and other medical staff suspected of sympathising with recent anti-government protests.

PROGRAMS

  • The GlobalPost has been doing an excellent series of stories examining President Barack Obama’s Global Health Initiative (GHI) is focusing on in Guatemala. Slow in its implementation and hampered by little new money, GHI was supposed to be an example of Obama’s new, innovative commitment to global health.
  • The King of Swaziland has called for all of the men in the South African nation to get circumcised in order to prevent the spread of HIV/AIDS.
  • Results from a pilot program in Philippines have shown that deaths from rabies can be dramatically reduced when taking a community driven bottom up approach.
  • A child in Khartoum, Sudan is the first to receive a rotavirus vaccine, kicking off a campaign to vaccinate children in 40 low and middle-income countries.

RESEARCH

  • A recent report from UNAIDS cites data from a recently released South African study that shows the effectiveness of male circumcision reducing HIV prevalence in men.
  • A campaign to encourage African men to get circumcised to prevent infection by HIV gained a powerful boost on Wednesday by three new studies unveiled at an international AIDS forum in Rome.
  • A new study has found that women in conflict areas want to utilize
    contraceptives, but only 4 to 16 percent are able to gain access.
  • At the International AIDS Society, one of the big stories is a CDC study showing the drug Truvada prevented HIV transmissions in more than 60 percent of heterosexuals. The study’s author Dr. Michael Thigpen discusses how much Truvada costs, why HIV is so pervasive among women in Botswana, and how much people must take the drug for it to be effective.
  • Researchers have discovered that chloroquine, often used to treat malaria, may be effective in treating other autoimmune diseases.
  • An antiviral drug to combat HIV/AIDS synthesised by genetically modified plants is being tested on a small number of women in the UK to establish its safety, reports the Guardian.
  • A recent study has shown that stress experienced by a pregnant mother can have a negative impact on the development of the child in the womb.
  • Researchers presenting at the 6th International AIDS Society Conference on HIV Pathogens, Treatment, and Prevention in Rome, say that they have inched closer to a vaccine by leveraging a genetically altered version of SIV.

DISEASES AND DISASTERS

  • The World Health Organization is sounding the alarm on hospital safety and infections acquired while patients are in a health care facility, saying that a hospital  stay is riskier than air travel.
  • Researchers have determined that Hepatitis C can be transmitted sexually, after performing a 5 year study on HIV positive MSM.
  • Famine in parts of southern Somalia has killed tens of thousands of people, mostly children, the UN said Wednesday in an official declaration of what aid officials describe as the worst humanitarian crisis in the troubled country in two decades.
  • A new study warns that Pakistan “risks becoming the last global outpost of [polio], this vicious disease.” The disease has also resurfaced in four other countries.
  • Even in developing countries where child mortality is falling, the poorest under-fives are at high risk of dying from entirely preventable diseases because they do not receive basic immunization and have no treatment for diarrhea.
  • Peter Hotez, president of the Sabin Vaccine Institute, says new studies indicate a parasitic infection, schistosomiasis, may be one of the most important — and least recognized — co-infections increasing the risk of HIV transmission.
  • An All Africa editorial examines how the price of drugs leads to deaths that could be otherwise averted.