global health

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Today is World AIDS Day. 

The world has come a long way since 2000, achieving the global target of halting and reversing the spread of HIV.

New infections have fallen by 35% since 2000 and AIDS-related deaths by 24%. Some 16 million people are now receiving antiretroviral treatment – more than 11 million of them in Africa. Ten million men in East- and Southern Africa have volunteered for medical male circumcision – a procedure that reduces a man’s risk of contracting HIV by 60%.

But now it’s time to act even more boldly, to take innovative steps so the world can meet the Sustainable Development Goal target of ending the epidemic by 2030. This September, world leaders agreed ambitious interim targets to fast track efforts to end AIDS.

On World AIDS Day, new WHO recommendations will launch to help achieve these targets. These include the use of innovative HIV testing methods; customizing treatment approaches to meet the full diversity of people’s needs; and offering a wider spectrum of prevention options.

Some low- and middle-income countries are already fast-tracking national AIDS responses. Countries do best when they make substantial domestic investments, base their HIV health-sector programmes on good data and simplify prevention and treatment programmes. Twelve countries have ensured that 60% or more of all people living with HIV are aware of their HIV infection and receive antiretroviral treatment.

Pioneering countries like these show that the new targets set for ending AIDS are feasible – even in resource-limited settings.

(From World Health Organization, WHO)

The Zika virus has gone from an obscure disease to an international public health emergency.

Researchers have been able to trace the gradual spread of Zika — slowly for decades and then, in the words of World Health Organization head Dr. Margaret Chan, “explosively” since 2015, when it was first detected in Brazil. Now the virus has reached more than 20 countries and territories in the Americas.

1947: FIRST IDENTIFIED

The virus was first identified in a rhesus monkey in the tropical Zika Forest in Uganda. The monkey was part of a study to identify viruses carried by mosquitoes. Researchers found that the monkey contracted a “hitherto unrecorded virus.”

1951 - 1981: AFRICA

Evidence of human infection was found in a number of countries in Africa, including Central African Republic, Egypt, Gabon, Nigeria, Sierra Leone, Tanzania and Uganda. As a rule, the number of cases over the decades was relatively small, but that could reflect the fact that symptoms are mild, nonexistent or mistaken for those of other viruses. 

1951 - 1981: ASIA

Evidence of human infection was found in some Asian countries, including India, Indonesia, Malaysia, the Philippines, Thailand and Vietnam.

2007: YAP ISLAND

In April 2007, an outbreak began in Yap Island in the Pacific Ocean — the first detection of the virus outside the African and Asian continents and the first evidence that Zika could spread rapidly through a population.

2013-2014: PACIFIC ISLANDS

An outbreak occurred in the islands of French Polynesia, with an estimated 20,000 possible cases, and spread to other Pacific Islands: Cook Islands, Easter Island, New Caledonia, Solomon Islands and Vanuatu.

2015-2016: THE AMERICAS

The rough estimate of current cases in Brazil is 500,000 to 1.5 million, although it could be higher because many people who are infected show no symptoms.

Read the full story here.

These maps reflect data available from the CDC as of February 5. Due to space constraints, not all countries are labeled.

Source: Centers for Disease Control and Prevention, Pan American Health Organization

Credit: Alyson Hurt/NPR

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New York City and Spain have reported what are thought to be their first cases of babies born with Zika-linked microcephaly in the last week. Our reporter Katie Worth reported from Recife — the epicenter of the outbreak in Brazil — earlier this year: 

Neuroscientists believe the [Zika] virus has a taste for neural stem cells, the cells from which a fetus’s brain grows in utero. In one study, researchers put neural stem cells and Zika virus in a petri dish together. In three days, 90 percent of the stem cells were infected by the Zika virus.

“Not only that, once they got infected they turned into a so-called viral factory, meaning they actually produced more virus,” said Dr. Guo-li Ming, a neuroscientist at Johns Hopkins’ Institute for Cell Engineering.

Zika’s damage is likely worst when it hits a fetus in the first trimester of pregnancy, the crucial time in brain development. By the time the baby’s immune system begins to combat the virus, much of the damage has been done.

Read about how the Zika virus wreaks unique damage in babies

📷 :Katie Worth

Mysterious kidney disease goes global

The region in coastal Andhra Pradesh is at the heart of what local doctors and media are calling a CKDu epidemic. There is little rigorous prevalence data, but unpublished studies by Gangadhar Taduri, a nephrologist at the Nizam’s Institute of Medical Sciences in Hyderabad, in the neighboring state of Telangana, suggest the disease affects 15% to 18% of the population in this agricultural region, known for rice, cashews, and coconuts. Unlike the more common kind of CKD, seen mostly in the elderly in urban areas, CKDu appears to be a rural disease, affecting farm workers, the majority of them men between their 30s and 50s. “It is a problem of disadvantaged populations,” says Taduri, who is leading the team of researchers in the village.

A rash of similar outbreaks in other countries has underscored that it is a global problem. Some rice-growing regions of Sri Lanka have their own epidemic, and the disease is rampant in sugar-producing regions of Mexico and Central America (Science, 11 April 2014, p. 143). It has also been reported in Egypt. Just about everywhere, prevalence numbers are scarce and uncertain, but “there is a great deal of concern,” says Virginia Weaver, an epidemiologist at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. “This is an illness that has substantial mortality. People who would [otherwise] be working, raising families, are dying. It’s quite extraordinary.”

“Zika”

You’ve probably heard of the Zika virus, it’s big news right now. Unlike Ebola, it isn’t known to be fatal. It’s symptoms are mostly mild, in fact, most people are thought to remain asymptomatic when they catch it. It is thought to be carried by the tropical mosquito a design aegypti, the same species which can carry dengue fever. Most cases right now are in South America. This species is found widely, giving rise to feats that this illness could spread far. It is an el Nino year, making global weather warmer and more unpredictable than before, and there are fears they could spread further than usual.

The only people it is thought to affect seriously are pregnant women and the foetuses they carry. We aren’t sure how or why, however it is suspected that the virus causes severe birth defects in some cases where it has been caught by pregnant women.

There has been advice in affected countries for women to avoid getting pregnant during this outbreak. But what about those already pregnant?
Those who can’t avoid pregnancy? Those who really wished to start or complete their family?

Family planning services are not universally available in many places and many of these countries prohibit or severely restrict access to abortions, even on health grounds. This makes the outbreak more dangerous.

Poor women in areas where the mosquitoes are prevalent are going to carry a hugely disproportionate burden. If a causative link between Zika virus and microcephaly is proved, this could mean many poor families may have severely disabled children without the resources to support them. It may mean more women risk unsafe illegal abortions due to the fear of giving birth to children who are likely to die very early and who they will struggle to look after. It will have a huge impact on the family planning of millions of people and on the lives of the families it affects.

Make no mistake: although it seems few people infected will die from this, many lives may be seriously affected, particularly the most vulnerable in areas where these mosquitos are native.

There is still a lot we don’t know about this illness, but we can’t afford to wait to find out.

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Recife, Brazil’s mosquito index gives an indication of the relationship between water supply and mosquitoes: Of the city’s 10 most mosquito-ridden neighborhoods, seven must store water, whereas none of the least mosquito-ridden neighborhoods do.

Mosquitoes are, by nature, indiscriminate: They breed in standing water anywhere and would happily bite as many rich as poor, if given the chance. But they get more chances in places that store water: Dr. Jailson Correia, the city health secretary, says that an estimated 80 percent of Aedes breed in water tanks.

READ: How Brazil became a breeding ground for the Zika outbreak

Brexit: what might it mean for global health?

This week on PLOS Translational Global Health, Rhea Saksena talks all things Brexit – and what it might mean for local and global health.

This week, the United Kingdom (UK) has made the unprecedented move of leaving the European Union (EU), an economic and political union of 28 member countries. After a close result, the Leave campaign won the referendum with 52% of the votes compared to 48% for the Remain campaign, with a 72.2% voter turnout. As the country now grapples to come to terms with the consequences of this election, this rejection of EU membership threatens to have a great impact on the health of people both within the UK as well as internationally.

In 2015, life expectancy at birth ranges from 46 in Sierra Leone to 84 in Japan. While large swathes of Europe now enjoy a life expectancy at birth of over 80 years, many African countries languish in the 50s. Infectious diseases continue to account for more of the burden in developing countries than non-communicable diseases.
—  What are some of the big challenges facing the field of global health economics?
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This week in vaccines

21st August 2016

This week saw the launch of a massive emergency vaccine campaign in DRC, using 1/5 of the normal dose, stretching supply to protect 10 million people before the beginning of the rainy season. And as the infographic shows, it’s mobilising a huge volume of resources. A similar campaign also began in Angola, and questions were raised around whether this disease had the potential to become the next pandemic.  

Campaigns to defeat polio continued in Nigeria, while Bill Gates and the international community remained confident that eradication could and would be achieved soon. 

Zika reached Miami in the US, but vaccine prospects still seemed to be a way off. A Liberian contact tracer looked back on his experience of the Ebola epidemic, and researchers also asked: what next for the experimental Ebola vaccine?

theguardian.com
Women vow to fight on in Peru after Alberto Fujimori absolved over forced sterilisations
Peru’s public prosecutor says former president and his health ministers were not responsible for forced sterilisations in 1990s, leaving survivors angry
By Dan Collyns

More than 300,000 Peruvians were forcibly sterilized in the 1990s. 

They must be heard and given justice.

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Ivermectin distribution in central Ghana to combat river blindness.
Ivermectin isn’t perfect.  It doesn’t even get rid of the parasites inside infected people yet it’s had a dramatic impact in driving down the incidence and morbidity of onchocerciasis in many parts of the world.

http://n.pr/1KfcyIO

Photos:  Jason Beaubien, NPR