Tropical diseases updates

waltky · Sep 27, 2017

UN steps up aid for cholera outbreak in north-east Nigeria...

Amid cholera outbreak in north-east Nigeria, UN steps up aid, warns pregnant women most vulnerable
26 September 2017 -- Large-scale displacement and a health system in tatters as a result of persistent violence by the Boko Haram terrorist group have left many " most worryingly, pregnant women and their unborn babies " vulnerable to cholera in the wake of an outbreak in August, the United Nations Population Fund (UNFPA) has warned.

"Studies show that cholera infections during pregnancy can lead to sudden loss of the foetus, premature delivery, stillbirth and an increased mortality and morbidity, both for the baby and the mother," said Homsuk Swomen, a UNFPA reproductive health specialist in Maiduguri, north-eastern Nigeria, one of the worst affected areas by the Boko Haram violence. Due to the ongoing conflict, many pregnant women are malnourished, aggravating their vulnerability to cholera and the consequences if they fall ill. Furthermore, the "traditional role" played by women and girls in the region is making them all the more susceptible to the disease.

According to Sylvia Opinia, a UNFPA expert in gender issues, it is usually women and girls who care for sick family members, clean latrines, fetch and handle untreated water, and prepare food for the family. "We need to understand that cholera is not gender neutralcholera is not gender neutral," she underscored. On its part, the UN agency is working with local health staff, community and social workers in the camps to impress upon them the need to include women and girls in education messages on the disease, and especially targeting pregnant women with those messages. It is also engaging health workers to identify vulnerable women and girls, including pregnant women, for referral to appropriate care.

But funds are needed.

Last Sunday, the UN and partners launched a $9.9 million appeal to respond to the current outbreak in Borno state (north-east Nigeria) and to prevent further outbreaks in high-risk areas. A Cholera Response and Prevention Plan has been developed to address the immediate needs of 3.7 million people that could be affected by the outbreak. In related news, the World Health Organization (WHO), the UN health agency, concluded an oral cholera vaccination campaign around Maiduguri this weekend, inoculating some 844,000 people in affected areas.

According to WHO, it takes those immunized about a week to develop the immune response that should protect against the disease, and most individuals vaccinated should be protected for up to six months. As of 25 September, 3,934 suspected cases of cholera including 54 deaths have been reported in and around Maiduguri. About 14 million people are affected by the crisis in north-eastern Nigeria (Adamawa, Borno and Yobe states), of whom 6.9 million need health assistance.

http://www.bignewsnetwork.com/news/...s-up-aid-warns-pregnant-women-most-vulnerable
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waltky · Oct 24, 2017

New typhoid vaccine...

Typhoid vaccine set to have 'huge impact'
Tue, 24 Oct 2017 - Around 22 million people get typhoid fever each year and 220,000 die.

A new vaccine that could prevent up to nine-in-10 cases of typhoid fever has been recommended by the World Health Organization. Experts say it could have a "huge impact" on the 22 million cases, and 220,000 deaths, from typhoid each year. Crucially it works in children, who are at high-risk of the infection, unlike other typhoid vaccines. It is hoped the vaccine could eventually help countries eliminate typhoid.

Typhoid fever is caused by Salmonella Typhi bacteria and patients have:

* prolonged fever
* headache
* nausea
* loss of appetite
* constipation
* in one-in-100 cases it causes fatal complications

Typhoid is spread through dirty water and contaminated food.

The bacteria are highly contagious and spread through contaminated food or water. The infection is most common in countries with poor sanitation and a lack of clean water, particularly in south Asia and sub-Saharan Africa. Two typhoid vaccines already approved to help reduce the number of cases, but none are licensed for children under the age of two. The decision to recommend the new conjugate typhoid vaccine was made by the WHO's Strategic Advisory Group of Experts on Immunization (Sage).

Prof Alejandro Cravioto, the chairman of Sage, said: "For the first time I think we do have a very effective vaccine." Sage recommended the vaccine should be given to children aged six-months old and said catch-up campaigns focusing on children up to 15 years old should also take place. Prof Cravioto said the vaccine was vital as the world was "reaching the limit" of current treatments due to the "crazy amount" of antibiotic resistance the typhoid bacterium had acquired.

'A valuable weapon'
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Every childhood vaccine may go into a single jab
15 September 2017 - A technology that could eventually see every childhood vaccine delivered in a single injection has been developed by US researchers.

Their one-shot solution stores the vaccine in microscopic capsules that release the initial dose and then boosters at specific times. The approach has been shown to work in mouse studies, described in the journal Science. The researchers say the technology could help patients around the world.

Childhood immunisations come with tears and screams. And there are a lot of them.

* Diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B at eight, 12 and 16 weeks.
* Pneumococcal jab at eight weeks, 16 weeks and one year
* Men B vaccine at eight weeks, 16 weeks and one year
* Hib/Men C vaccine at one year
* Measles, mumps and rubella at one year and three years and four months

Source: NHS Choices

A team at Massachusetts Institute of Technology has designed a new type of micro-particle that could combine everything into a single jab. The particles look like miniature coffee cups that are filled with vaccine and then sealed with a lid. Crucially, the design of the cups can be altered so they break down and spill their contents at just the right time. One set of tests showed the contents could be released at exactly nine, 20 and 41 days after they were injected into mice. Other particles that last for hundreds of days have also been developed, the researchers say. The approach has not yet been tested on patients.

'Significant impact'

Prof Robert Langer, from MIT, said: "We are very excited about this work. "For the first time, we can create a library of tiny, encased vaccine particles, each programmed to release at a precise, predictable time, so that people could potentially receive a single injection that, in effect, would have multiple boosters already built into it. "This could have a significant impact on patients everywhere, especially in the developing world." The work differs from previous attempts, which slowly released medicines over a long period of time. The idea is the short, sharp bursts of vaccine more closely mimic routine immunisation programmes. Fellow researcher Dr Kevin McHugh said: "In the developing world, that might be the difference between not getting vaccinated and receiving all of your vaccines in one shot."

http://www.bbc.com/news/health-41269196
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waltky · Nov 30, 2017

New Dengue Vaccine Could Worsen Disease in Some People...

New Dengue Vaccine Could Worsen Disease in Some People
November 30, 2017 — Drugmaker Sanofi says that its dengue vaccine, the world's first, should only be given to people who have previously been sickened by the virus, according to new long-term data.

In a statement, Sanofi said it had recently examined six years of patient data. Scientists concluded that while the vaccine protects people against further infection if they've already been infected with dengue, that's not the case for people who haven't previously been sickened by the disease. “For those not previously infected by dengue virus...the analysis found that in the longer term, more cases of severe disease could occur following vaccination,” Sanofi said. “These findings highlight the complex nature of dengue infection.”

A patient, enclosed in a mosquito net, recovers from a bout of dengue fever at a hospital in Luque, Paraguay

People who catch dengue more than once can be at risk of a hemorrhagic version of the disease. The mosquito-spread disease is found in tropical and sub-tropical climates worldwide. It causes a flu-like disease that can cause joint pain, nausea, vomiting and a rash. In severe cases, dengue can cause breathing problems, hemorrhaging and organ failure. The World Health Organization says that about half the world's population is at risk of dengue and estimates that about 96 million people are sickened by the viral infection every year.

Sanofi is proposing that national authorities update their prescribing information. It also said doctors should assess the likelihood of prior dengue infection in people before choosing whether they should get the vaccine. “For individuals who have not been previously infected by dengue virus, vaccination should not be recommended,” Sanofi said. The vaccine is currently recommended in most dengue-endemic countries for people over age nine. The company expects to take a 100 million euro ($118 million) loss based on the news. There is no specific treatment for dengue and there are no other licensed vaccines on the market.

https://www.voanews.com/a/dengue-vaccine/4143540.html
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waltky · Dec 4, 2017

Dengue vaccine could pose health risks...

Philippines launches probe into dengue vaccine scare
4 Dec.`17 - The Philippines has launched an investigation into the immunisation of 730,000 children with a dengue vaccine that could pose health risks.

Last week French drug company Sanofi announced its vaccine could worsen the potentially deadly disease in people not previously infected. The public immunisation programme was suspended on Friday. Dengue fever affects more than 400 million people each year around the world. The mosquito-borne disease is a leading cause of serious illness and death among children in some Asian and Latin American countries, according to the World Health Organization (WHO). Sanofi's Dengvaxia is the first-ever approved dengue vaccine. In addition to the Philippines, the company said the vaccine was registered in Argentina, Australia, Bangladesh, Bolivia, Brazil, Cambodia, Costa Rica, El Salvador, Guatemala, Honduras, Indonesia, Malaysia, Mexico, Paraguay, Peru, Singapore, Thailand and Venezuela. The vaccine has also been used in a public immunisation programme in Brazil which, combined with the Philippines scheme, has to date provided around one million people at least one dose of drug.

Dengue is a potentially deadly mosquito-borne disease

Sanofi said in a press conference on Monday that there had been no reported deaths related to its dengue vaccine in the Philippines. "As far as we know, as far as we are made aware, there are no reported deaths that are related to dengue vaccination," the company's medical director, Ruby Dizon, told reporters on Monday. "Of course, rest assured, monitoring is continuing, we are working with the department of health (DOH), in collaboration, to make sure this is maintained. "Philippine presidential spokesperson Harry Roque said on Monday that "people should not panic over the dengue vaccine" as the government was looking into the matter. Dengue is a viral infection which causes a severe, flu-like illness that can be fatal if it develops into its most serious form. The global incidence of dengue has risen dramatically in recent decades, according to the WHO, putting about half the world's population at risk of the disease.

WHO recommendation

Sanofi said last week that a new long-term study had shown that while the Dengvaxia vaccine worked with people who had prior infection, it posed a risk for those who hadn't. "For those not previously infected by dengue virus, the analysis found that in the longer term, more cases of severe disease could occur following vaccination upon a subsequent dengue infection," the company said in a statement. The French drug maker said it would ask health authorities to update the information given to doctors and patients working with the vaccine. In its latest advice on the vaccine, the WHO recommended that Dengvaxia should only be administered to "subjects that are known to have been infected with dengue prior to vaccination," pending a full review of the study.

http://www.bbc.com/news/world-asia-42218612
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waltky · Dec 11, 2017

Pharmaceutical highway robbery...

Why A Pill That's 4 Cents In Tanzania Costs Up To $400 In The U.S.
December 11, 2017 - Two pills to wipe out hookworm could cost you 4 cents. Or $400. It just depends where you live.

The 4 cents is in Tanzania. That'll cover the two pills it takes to knock out the intestinal parasite. But in the United States, where hookworm has re-emerged, the price for two 200 mg tablets of albendazole can cost as much as $400. The pill will put an end to the problems hookworm can cause, such as anemia and protein deficiency as well as stunting growth in children. It's not just a problem with the anti-hookworm pill. Drugs for diseases of the developing world, in particular the so-called "neglected tropical diseases" like hookworm and leishmaniasis, are enormously more expensive in the United States than in the developing world. "There really is no good reason for this price," Dr. Jonathan Alpern says of the albendazole price tag. Alpern works for the HealthPartners Institute, the research division of a health care organization in Minnesota. Impax Laboratories is the only pharmaceutical company that offers the drug in the U.S. Impax did not wish to comment on product pricing for this story but stated in an email to NPR: "Given the very different regulatory regimes in the U.S. versus outside the U.S., pricing is a very awkward comparison."

Because the drug's patent expired decades ago, other companies can sell the generic version. But for medications that fight neglected tropical diseases, pharmaceutical companies have been slow to jump in and manufacture the medicine. As for those that do: "[Impax] fits into a category of companies that have taken drugs that have been around for many years, acquired the rights and jacked up the price [for the Western market]," says Alpern. Indeed, prices for generic drugs that treat neglected tropical diseases are skyrocketing in the U.S. When a disease affects only a small number of patients in the U.S., "there's less incentive for generic companies to enter the market," Alpern explains. That's because there's less potential for profit. Hookworm, which was recently discovered in a small community in the U.S., is just one example of this trend. Neurocysticercosis, a parasitic disease that causes seizures and epilepsy, is another example. The disease is rare in the U.S. with an estimated 1,000 to 5,000 new cases every year. Either albendazole or praziquantel are used to treat the disease. Praziquantel is also pricey: about $525 for six 600 mg tablets.

An employee of GlaxoSmithKline Pharmaceuticals holds bottles of albendazole, an anti-hookworm medication.

Leishmaniasis, which affects 700,000 to a million people annually throughout the world, is more expensive to treat in the U.S., too. Though rare in the U.S. — only 13 cases were uncovered between 2000 and 2007 — the disease can cause disfiguring skin sores or swelling of the spleen or liver depending on the form of the disease that's contracted. Two 50 mg tablets of miltefosine for 28 days can treat the infection; the price of each pill wholesale is $685, according to Alpern's research. "When there's limited competition in the market, the company that holds the monopoly is able to price [the drug] however they want," Alpern says. "In these cases, we often see companies taking advantage of their market position." And some of these disease aren't all that rare. Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine, says certain neglected tropical diseases in the U.S. are surprisingly widespread, especially among those who may not be able to afford treatment. For example, he estimates that 1.1 million Americans are annually diagnosed with a parasitic infection called toxoplasmosis. The treatment is Daraprim; four 25 mg tablets currently cost between $3,000 and $3,400 on the U.S. market. "We have now identified nearly half-a-dozen neglected tropical diseases that are widespread in the U.S. among the poor, especially in the American South," says Hotez, who last year published Blue Marble Health, a book evaluating neglected diseases in America. "In all, I estimate that 12 million Americans now live in extreme poverty with a neglected tropical disease."

Some of them are in Lowndes County, Ala., where a community of individuals was recently discovered to have hookworm. The average income in the county is just $18,036. If patients don't have health insurance, they must pay the full price for prescriptions or skip treatment altogether. "Some of the people in Lowndes County are living off $600 or $700 a month," says Catherine Flowers, founder of Alabama Center for Rural Enterprise, a nonprofit that addresses poverty. "People have told me they sometimes have to choose between buying medication and eating." In cases where patients have Medicaid, taxpayers bear the burden. In the years following albendazole's price hike in 2011, Medicaid spending on the drug went from under $100,000 in 2008 to more than $7.5 million in 2013. Medicaid spending on Daraprim, another tropical disease drug that just experienced a price hike, went from $2.2 million in 2014 to $15.7 million in 2015. Other times, U.S. patients bypass the system, Alpern says, by asking relatives in other countries to bring them the drug they need. In the United Kingdom, for example, 400 mg of albendazole costs just $2.

Why are prices so different in the U.S.?
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waltky · Dec 14, 2017

Tremendous progress in five years...

1 Billion Treated in Battle Against Painful Tropical Diseases
ecember 14, 2017 — A pledge by health and development experts to tackle neglected diseases that blind, disable and disfigure millions of the world's poorest people has spurred tremendous progress in five years, a report said on Thursday.

More than one billion people were treated in 2016 for painful infections, such as sleeping sickness and elephantiasis, as increased funding, drug donations and political will helped health workers reach patients in remote areas, it said. "There are hundreds of millions more people getting treated now than five years ago," Ellen Agler, head of the END Fund, a philanthropic initiative to combat Neglected Tropical Diseases (NTD), told the Thomson Reuters Foundation in emailed comments. "Effective partnerships and efficient systems to get medicines to those most in need have been built."

The 2012 London Declaration on Neglected Tropical Diseases, set a goal of controlling, eliminating or eradicating 10 diseases, including leprosy and river blindness, by 2020. NTDs affect one in five people globally, mainly in areas of extreme poverty, often trapping individuals in a cycle of social exclusion. The number of people affected by NTDs has fallen to 1.5 billion from almost 2 billion in 2011, the report by Uniting to Combat NTDs, a partnership backing the 2020 goal, said.

A giant 25m worm representing the parasitic worm of schistosomiasis is pictured on the Lake Leman on the occasion of the Neglected Tropical Diseases Summit, in Geneva

Since 2012, five countries have eliminated trachoma as a public health problem — meaning it no longer poses a major threat to community health — and four countries in the Americas have eliminated river blindness, it said. A push to train local health workers is an important element behind the campaign's success, the report said, as they are trusted by rural communities never reached before. "We have an obligation to ensure that [communities] are part of the solution," said Julie Jacobson, a program officer with The Bill & Melinda Gates Foundation, adding that South Sudan has only had one case of Guinea worm disease so far this year.

Only 26 cases of Guinea worm disease have been reported so far in 2017, down from more than 1,060 cases in 2011, it said. British physicist Stephen Hawking said this week that eliminating neglected tropical diseases is "within our grasp."

https://www.voanews.com/a/treatmen-painful-tropical-diseases/4163987.html
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Half of World's People Can't get Basic Health Services: WHO
December 13, 2017 - At least half the world's population is unable to access essential health services and many others are forced into extreme poverty by having to pay for healthcare they cannot afford, the World Health Organization said on Wednesday.

Some 800 million people worldwide spend at least 10 percent of their household income on healthcare for themselves or a sick child, and as many as 100 million of those are left with less than $1.90 a day to live on as a result, the WHO said. In a joint report with the World Bank, the United Nations health agency said it was unacceptable that more than half the world's people still don't get the most basic healthcare. "If we are serious - not just about better health outcomes but also about ending poverty - we must urgently scale up our efforts on universal health coverage," World Bank President Jim Yong Kim said in a statement with the report.

A Yemeni health worker marks a finger of a girl after giving her a polio vaccination.

Anna Marriott, health policy advisor for the international aid agency Oxfam, said the report was a "damning indictment" of governments' efforts on health. "Healthcare, a basic human right, has become a luxury only the wealthy can afford," she said in a statement. "Behind each of these appalling statistics are people facing unimaginable suffering - parents reduced to watching their children die; children pulled out of school so they can help pay off their families' health care debts; and women working themselves into the ground caring for sick family members."

The WHO and World Bank report did have some positive news: This century has seen a rise in the number of people getting services such as vaccinations, HIV/AIDS drugs, and mosquito-repelling bednets and contraception, it said. But there are wide gaps in the availability of services in sub-Saharan Africa and southern Asia, the report found. In other regions, basic services such as family planning and child immunization are more available, but families are suffering financially to pay for them. Yong Kim said this was a sign that "the system is broken". "We need a fundamental shift in the way we mobilize resources for health and human capital, especially at the country level," he said.

https://www.voanews.com/a/half-of-w...t-basic-health-services-who-says/4162316.html
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waltky · Feb 4, 2018

Deaths of 3 Children Linked to Dengue Vaccine In Philippines...

In Philippines, Deaths of 3 Children Linked to Dengue Vaccine
February 03, 2018 — The Philippines said Friday the anti-dengue vaccine Dengvaxia may be connected to three deaths in the country, according to a government-ordered inquiry, and that the drug is not ready for mass immunization.

Sanofi revealed in November that Dengvaxia, the world’s first dengue vaccine, might increase the risk of severe disease in people who had never been exposed to the virus. The news prompted an uproar in the Philippines, where more than 800,000 school-age children were vaccinated in 2016. “We sympathize with all the families who have suffered the loss of a child. Sanofi Pasteur’s mission is to reduce or eliminate suffering for millions around the world through vaccination, including in the Philippines,” a spokesman for the French drugmaker said in an emailed statement.

Protesters display slogans during a rally against the controversial immunization of more than 700,000 Filipino children with the anti-dengue vaccine Dengvaxia in Manila, Philippines, Dec. 18, 2017. The controversial vaccine, manufactured by Sanofi Pasteur was recently put on hold by the Philippines after new study findings showed it posed risks of severe cases in people without previous infection. The controversy has prompted the Philippine Senate to conduct an investigation.

The Philippine Health Ministry halted Dengvaxia immunizations in November. It formed a 10-member panel of experts to determine if the drug was directly connected to the deaths of 14 children after they were given the vaccine. It found it may have been connected to the deaths of three. “Three cases were found to have causal association. They died of dengue even (though) they were given Dengvaxia. Two of them may have died because of vaccine failure,” Health Undersecretary Enrique Domingo told a news conference. “These findings strengthen the decision of the Department of Health to stop the vaccine. It has failed in some children. Dengvaxia is not ready for mass vaccinations, and we would need three to five more years to watch and monitor if there would be other adverse reactions from the vaccine.”

Mosquito-borne dengue is the world’s fastest-growing infectious disease, afflicting up to 100 million people worldwide, causing half a million life-threatening infections and killing about 20,000 people, mostly children, each year. Domingo said the panel’s findings would be shared with the justice department, which is considering cases against those responsible for the mass immunization program. Pediatrician and panel member Juliet Sio-Aguilar, from the University of the Philippines-Philippine General Hospital (UP-PGH), said the team was recommending further studies because it was difficult to directly connect the three deaths to Dengvaxia. No vaccine has a 100 percent success rate, she said. The dengue death rate in the Philippines was 60 times higher than global rate, Sio-Aguilar said.

Department of Health Undersecretary Dr. Rolando Enrique Domingo, right, and Philippine General Hospital Director Dr. Gerardo Legaspi, attend a press conference at the Department of Health office in Manila, Philippines

Sanofi said Saturday the UP-PGH’s findings confirmed there is currently no evidence directly linking the Dengvaxia vaccine to any of the 14 deaths. “In Dengvaxia clinical trials conducted over more than a decade and the over 1 million doses of the vaccine administered, no deaths related to the vaccine have been reported to us,” the company said in a statement. The Philippines spent 3.5 billion pesos ($68 million) on the Dengvaxia program to reduce the 200,000 dengue cases reported every year. Sanofi said clinical evidence confirms dengue vaccination in the Philippines will provide a net reduction in dengue disease, including severe dengue. The Philippines has fined Sanofi a symbolic $2,000, citing violations in product registration and marketing.

https://www.voanews.com/a/philippines-dengue-vaccine/4237456.html
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