Wednesday, February 29, 2012

Survey: Four in 10 Nigerian children have malaria

Photo/CDC-James Gathany

Malaria is a well-known scourge on many areas of the planet with over 200 million cases annually resulting in 655,000 deaths, primarily in African children.
The problem of malaria in children in the African nation of Nigeria is very serious according to the recently released Nigeria Malaria Indicator Survey 2010.
The  2010 Nigeria Malaria Indicator Survey (2010 NMIS) was  implemented by the National  Population Commission  (NPC),  National  Malaria  Control  Programme  (NMCP),  and  other  Roll  Back  Malaria partners from October 2010 through December 2010 on a nationally representative sample of  more than 6,000 households.
The primary  objectives  of  the  2010 NMIS  project are  to  provide  information  on  malaria  indicators  and malaria prevalence, both at the national level and in each of  the country's six geopolitical zones.
The data was the result of a combination of multiple questionnaires for the households and laboratory testing performed on children ages 6-59 months.
Malaria testing was performed by using the rapid, 15 minute test, Paracheck  Pf rapid  diagnostic  test (RDT), which tests for P. falciparum.
In  addition  to  the  Paracheck  Pf RDT,  a  thick  blood smear and  thin  blood  film  were prepared for  all  children tested.  These  blood smears  were dried,  packed  carefully  in the field,  and then transported to  the  Department of  Microbiology  and  Parasitology,  University  of  Lagos,  for  microscopic reading and determination of  malaria parasite presence and speciation. The purpose of  the blood slides is to provide a 'gold standard' for the presence of  parasites within the child's blood and to ascertain the type of  parasite.
Any children testing positive for malaria were treated appropriately.
Some of the key numbers coming from the survey include:
·         Using the RDT test, 52% of Nigerian children age 6-59 months tested positive for malaria.           Blood smears revealed 42% of the children as positive for malaria.
· Malaria prevalence increased with age regardless of methodology
·         Prevalence was higher in rural areas than urban areas
·         Malaria was highest in the Southwest of the country
·         44 percent of  households nationwide own at least one mosquito net of  any type, and 27  percent own more than one.
·         31  percent of  children  under  age  5 slept under  a  mosquito  net  the  night before the survey.

Monday, February 27, 2012

Guidelines written to prepare the Americas for the intro of Chikungunya


Although Chikungunya virus has yet to spread locally in the Americas, because of international travel, the mosquito borne virus has been seen increasingly in returning travelers to the United States in recent years.
As a result, The Pan American Health Organization/World Health Organization (PAHO/WHO), in collaboration with the U.S. Centers for Disease Control and Prevention (CDC) published Monday, Preparedness and Response for Chikungunya Virus Introduction in the Americas. The guidelines are designed to help countries in the Western Hemisphere improve their ability to detect the virus and be prepared to monitor, prevent, and control the disease, should it appear.
To get an idea how much the presence of chikungunya has increased in the US alone, a PAHO news release Monday said, from 2006 to 2010, 106 laboratory-confirmed or probable cases of chikungunya were detected among travelers returning to the United States. This compares with only three cases reported from 1995 to 2005.
According to the authors of the guidelines, “The broad distribution of mosquitoes capable of spreading chikungunya virus, coupled with the fact that people in the Americas have not been exposed to chikungunya virus, places this region at risk for the introduction and spread of the virus.”
 Roger S. Nasci, chief of the Arboviral Diseases Branch at CDC said the following about the guidelines: “These guidelines provide the information needed to develop a comprehensive regional plan for rapidly detecting and, hopefully, reducing the potential impact of chikungunya virus in the Western Hemisphere.”
Chikungunya fever is a viral disease transmitted to humans by the bite of infected mosquitoes, particularly Aedes aegypti and Aedes albopictus (the “Asian Tiger Mosquito”). Chikungunya virus is a member of the genus Alphavirus, in the family Togaviridae. Chikungunya fever is diagnosed based on symptoms, physical findings (e.g., joint swelling), laboratory testing, and the possibility of exposure to infected mosquitoes. There is no specific treatment or vaccine available for chikungunya fever; care is based on symptoms. Chikungunya infection is not usually fatal.

Sunday, February 26, 2012

Coalition of 50 call on Congress to pass legislation to fight ‘superbugs’

Antibiotic resistant bacteria are a growing problem and the number of new drugs in the pipeline is few to none. The problem is so dire that the following statement was in a letter sent to the US Congress late last week by a group of 50 organizations concerning the issue:
“If Congress does not enact strong solutions, we face a future that resembles the days before these miracle drugs were developed, one in which people died of common infections, and where many medical interventions that we take for granted—including care for premature infants, surgery, cancer chemotherapy, organ transplantation, and even dentistry for some patients—become impossible”.
The letter from the Infectious Diseases Society of America (IDSA), the American Society for Microbiology (ASM) and four dozen other diverse organizations call upon the Congress to follow through with action that will spur new antibiotic R&D.
They also call upon the Congress to incentivize the development of new related diagnostics.
They go on in the letter to elaborate saying, “Better diagnostics can reduce the costs of new antibiotic development by identifying patients who are eligible for clinical trials. Diagnostic tests also are important for conducting surveillance for the patterns of antimicrobial resistance and recognizing emerging drug resistance. In addition, rapid diagnostic tests improve physicians’ ability to prescribe antimicrobial drugs appropriately, which is critical to limit the development of resistant bacteria and preserve these important drugs’ effectiveness for as long as possible. Congress should strengthen federal efforts to promote the appropriate use of antibiotics in health care facilities.
Thomas G. Slama, MD, president of the IDSA said, “Many people may not realize how close we are to losing the ability to fight lethal infections. The antibiotics we currently have are becoming less effective because bacteria are constantly evolving and outsmarting the drugs used against them.”

Saturday, February 25, 2012

FDA: BreathTek UBT test approved for detection of H. pylori in children

Photo/CDC Janice Carr

The US Food and Drug Administration (FDA) has approved the first breath test for use in children aged 3 to 17 years to detect Helicobacter pylori, the bacterium responsible for gastritis and ulcers according to a Friday news release.
The BreathTek UBT test is not new. It was first approved for adult use in the US in 1996.
According to the FDA, they based its approval of  BreathTek UBT, manufactured by Otsuka America Pharmaceutical, on a multi-center study of 176 patients, comparing its performance to a composite reference method and demonstrating 95.8 percent sensitivity and 99.2 percent specificity.
An additional study was done at 1 to 6 months after therapy to support use for post-treatment monitoring of patients.  The sensitivity was 83.3 percent and the specificity was 100 percent. 
Alberto Gutierrez, Ph.D., director of the Office of In Vitro Diagnostic Device Evaluation and Safety in FDA’s Center for Devices and Radiological Health said of the test, “Results from this test, when considered with a physician’s assessment of the patient’s history, other risk factors, and professional guidelines, can quickly indicate infection, which allows a physician to initiate appropriate health measures in a timely manner.”
The US Centers for Disease Control and Prevention (CDC) estimates that approximately two-thirds of the world’s population is infected with H. pylori. In the United States, H. pylori is more prevalent among older adults, African Americans, Hispanics, and lower socioeconomic groups.
Although most infected people are asymptomatic, they have a two- to six-fold increased risk of developing gastric cancer and mucosal-associated-lymphoid-type lymphoma compared with uninfected people.
Helicobacter pylori (H. pylori) is a spiral-shaped bacterium that is found in the gastric mucous layer or adherent to the epithelial lining of the stomach. H. pylori causes more than 90% of duodenal ulcers and up to 80% of gastric ulcers.
Prior to the discovery of H. pylori 30 years ago, spicy food, acid, stress, and lifestyle were considered the major causes of ulcers. 
Today, appropriate antibiotic regimens can successfully eradicate the infection in most patients, with complete resolution of mucosal inflammation and a minimal chance for recurrence of ulcers.

Friday, February 24, 2012

"Chronic Lyme disease does exist” according to new book

There has been much debate over numerous issues regarding Lyme disease between sufferers and many in the medical community.
The controversy over Lyme disease ranges from transmission, diagnosis and testing, and treatment to geography and the issue on a chronic condition from the tickborne illness.
This has caused Lyme disease advocacy groups to crop up throughout the country to make their case on the issues that affect their health and lives.
According to a press release issued Friday, a new book authored by a very credible authority on Lyme has been published that says chronic Lyme is definitely a legitimate diagnosis.
The book, "Treatment of Chronic Lyme Disease: Fifty-One Case Reports and Essays in Their Regard" by renown infectious disease expert, Burton Waisbren, MD, FACP, FIDSA, not only establishes the foundation for chronic Lyme disease, but also discusses other hot topics like antibiotic treatments, the use of gamma globulin in chronic Lyme treatment, diagnostic testing methods and so much more.
Who is Dr. Burton Waisbren?
He is a practicing physician of over 57 years. He is one of the Founding Members of the Infectious Diseases Society of America (IDSA) and has published research on Lyme disease in prestigious journals such as The Lancet. He is board-certified by the American Board of Internal Medicine and is a fellow of the American College of Physicians, as well as the Infectious Diseases Society of America. He is also a founding member of the American Burn Association and the Critical Care Society of America.
With Dr. Waisbren’s authority and expertise on the topic, this book will certainly help the cause of chronic Lyme sufferers in the overall debate.

Thursday, February 23, 2012

Carter Center: River blindness interrupted in several areas of Uganda (VIDEO)

The Carter Center announced in a press release Thursday a historic achievement in the East African country of Uganda concerning the interruption of transmission of the parasitic scourge, river blindness, in three areas of the country.
The areas of Mt. Elgon, Itwara and Wadelai are the first to achieve disease interruption since Uganda began its river blindness elimination program in 2007.
Carter Center founder and former US President Jimmy Carter offered his congratulations saying, “The Carter Center congratulates and supports the people of Uganda in their ambitious fight to eliminate river blindness nationwide. Interrupting transmission in these first areas is an inspiration and a challenge to others to rethink what’s possible.”
Rethink what’s possible.
It has been a long held belief that such a pervasive public health issue in Africa like river blindness could only be controlled, not eliminated.
Dr. Dawson Mbulamberi, Uganda’s assistant commissioner of health service and national coordinator for the integrated control of neglected tropical diseases had this to say about the recent success:
“Scientifically, we knew Uganda could and should eliminate river blindness. Pursing elimination was more cost-effective than continuing control efforts indefinitely for 3.5 million citizens at risk. Interrupting transmission in these three areas alone means nearly a half a million people will no longer need treatment and will never again be threatened by the horrendous suffering caused by river blindness.”
In 2007, The Ugandan government launched its national onchocerciasis elimination strategy along with key partners like the Carter Center. The strategy included:
·         Intensive community-based distribution of the oral medicine ivermectin (donated by Merck as Mectizan®),
·         Health education, and
·         Blackfly control (genus Simulium)
After review of the epidemiological and laboratory evidence from the three areas, a multinational expert advisory committee recommended to the government of Uganda that interventions be stopped in the three areas where transmission of the parasite has been interrupted.
The Uganda Ministry of Health studied and concurred with that recommendation. In keeping with World Health Organization guidelines, the ministry will conduct three years of post-treatment surveillance before complete elimination of the disease in these areas can be declared.
Uganda has set 2020 as its goal for nationwide elimination of river blindness.
Onchocerciasis is an infection caused by the parasite Onchocerca volvulus (worm), spread by the bite of an infected blackfly.
Onchocerciasis, also known as river blindness, because the transmission is most intense in remote African rural agricultural villages, located near rapidly flowing streams.
110 million people are at risk of infection worldwide with 99% of all cases are found in Africa.
Persons with heavy infections will usually suffer from one or more symptoms- horrible itching, skin rashes and disfigurement and diminished vision or blindness.  Because of these conditions, people suffering from river blindness frequently lose their livelihoods and help perpetuate poverty for generations.
The Carter Center works in 11 countries in Africa and the Americas fighting river blindness providing training, technical and financial support and helped establish a state-of-the-art molecular laboratory.
In addition to the Carter Center, the following partners have provided financial and technical support: Merck and the Mectizan Donation Program, the Lions Clubs International Foundation, Sightsavers, Mr. John J. Moores, John C. and Karyl Kay Huges, WHO Uganda, the Kingdom of Saudi Arabia, the Alwaleed Bin Talal Foundation, University of South Florida, the River Blindness Foundation, African Programme for Onchocerciasis Control, Deutsche Gesellschaft für Internationale Zusammenarbeit, Bernhard Nocht Institute for Tropical Medicine, and many individual donors.
A not-for-profit, nongovernmental organization, The Carter Center has helped to improve life for people in more than 70 countries by resolving conflicts; advancing democracy, human rights, and economic opportunity; preventing diseases; improving mental health care; and teaching farmers in developing nations to increase crop production. The Carter Center was founded in 1982 by former U.S. President Jimmy Carter and his wife, Rosalynn, in partnership with Emory University, to advance peace and health worldwide.
Check out the trailer from the upcoming documentary from Cielo Productions called, “Dark Forest Black Fly”, which focuses on the Ugandan river blindness elimination 

Wednesday, February 22, 2012

Vietnam’s HFMD outbreak could be worse than last year

Photo/US Army Center of Military History

In a large scale outbreak in Vietnam in 2011, more than 100,000 people were sickened by hand, foot and mouth disease (HFMD) with nearly 200 children dying from the common childhood infection.
As bad as it was, 2012 is showing early signs that the epidemic could be worse this year. According to Tran Thanh Duong, deputy head of the health department Tuesday, believes that a more complex and serious epidemic situation may be developing in Vietnam.
The number of cases of hand, foot and mouth disease in the first 6 weeks of the year has reached 6,328. The number is 7.3 times higher than in the same period of a year earlier, and 9 cases have been fatal, the Health Ministry’s Preventive Health Department reported.
The outbreak has been recorded in approximately 10 Central Vietnam provinces.
One province hit hard was Can Tho where 600 kids have been admitted for the virus and three have died.
Although it has yet to be confirmed and reported, this outbreak, like last year is likely to be caused by the more virulent enterovirus-71 (EV-71).
EV-71 has been implicated in HFMD outbreaks in Southeast Asia over the several years. EV 71 is a non-polio enterovirus.
EV 71 is transmitted through direct contact with discharge from the nose and throat, saliva, fluid from blisters or the stools of an infected person. Cases are most infectious during the first week of acute illness but may continue to shed virus in stool for weeks.
HFMD is typically a benign and self-limiting disease. Most common in young children, it presents as fever, oral lesions and rash on the hands, feet and buttocks. The oral lesions consist of rapidly-ulcerating vesicles on the buccal mucosa, tongue, palate and gums. The rash consists of papulovesicular lesions on the palms, fingers and soles which generally persist for seven to 10 days and maculopapular lesions on the buttocks.
However, complications associated with HFMD caused by EV-71 include encephalitis, aseptic meningitis, acute flaccid paralysis, pulmonary edema or hemorrhage and myocarditis. Most deaths in HFMD occur as a result of pulmonary edema or hemorrhage.
The Health Ministry in Vietnam will be sending teams to the towns and localities to assist in controlling and prevention of the outbreak.
According to the report, Deputy Health Minister Nguyen Thanh Long said the ministry will report the epidemic situation to the Government and propose that it establish an interdisciplinary steering board to fight the epidemic nationwide.

Three quarters of US soldiers diagnosed with malaria got it in Afghanistan


The mosquito borne infection malaria has been a huge problem for US service people during war and deployments throughout the decades.  Although the use of prophylactic antimalarials, bed nets and other preventive measures are well established in today’s modern military, the risk is still there and cases still occur.
In a recent report published in the Medical Surveillance Monthly Report published by the Armed Forces Health Surveillance Center shows that in 2011, 124 US military members were diagnosed with the parasitic infection.
This represents the third highest total of malaria cases since 2003.
Of the 124 cases reported in 2011, 91 cases (73%) were acquired in Afghanistan, while nearly a fifth were picked up in Africa and just a handful in Korea.
Plasmodium  falciparum, the most serious and deadly strain of the parasite was identified in  23% of the cases. The most common species of malaria, Plasmodium vivax was identified in 29% of the cases. Nearly half of the cases were classified as “unspecified”.
Other statistics presented in the report include: the vast majority of cases occurred in men (98%), active duty (87%), members of the Army (80%), white (72%) and in their 20s (63%).

Monday, February 13, 2012

Oral Zithromax just as good as IM penicillin in treating yaws according to study

Photo/CDC Dr. Peter Perine

Yaws is a disfiguring non-venereal treponematoses that not too many years ago was close to eradication thanks to intramuscular penicillin. However, this bacterial infection is reemerging in children living in rural, humid and tropical areas of Africa, Indonesia and Papua New Guinea among other places.
Now in a study published recently in The Lancet, researchers from Papua New Guinea looked at the efficacy of using oral azithromycin (commercial name-Zithromax).
In the study, 250 children with serologically confirmed yaws in Papua New Guinea were randomly given either one 30 mg/kg oral dose of azithromycin or an intramuscular injection of 50 000 units per kg benzathine benzylpenicillin.
Specifically, the study’s primary endpoint was treatment efficacy, with cure rate defined serologically as a decrease in rapid plasma reagin titer of at least two dilutions by 6 months after treatment, and, in participants with primary ulcers, also by epithelialization of lesions within 2 weeks. 
Of the 250 infected children, evenly divided as far as antibiotic treatment, showed at 6 months follow-up that 106 (96%) of 110 patients in the azithromycin group were cured, compared with 105 (93%) of 113 in the benzathine benzylpenicillin group, thus meeting prespecified criteria for non-inferiority. The number of drug-related adverse events (all mild or moderate) was similar in both treatment groups (ten [8%] in the azithromycin group vs eight [7%] in the benzathine benzylpenicillin group).
The results of the study show that oral azithromycin is not inferior to intramuscular penicillin in the treatment of yaws. This is great news in the quest of eradicating this neglected tropical disease as the use of the oral drug would be much more conducive in mass drug administration programs for the elimination of this disfiguring scourge.
Yaws is transmitted from person to person by direct skin to skin contact with an infected lesion. The spirochetes themselves cannot penetrate intact skin.
The disease is characterized by highly contagious primary and secondary lesions and non-contagious late stage destructive lesions.
The initial lesion or the “mother yaw” appears as a papilloma on the face or extremities. It is painless and may last for months then heal without scarring.
From weeks to years after the appearance of the primary lesion, secondary lesions appear. They usually appear in multiples and form a yellow –brown scab. These can last up to 6 months and will scar if ulcerated.
Untreated yaws can cause destructive lesions of the skin and bone in up to 20 percent of people infected. It is rarely fatal but can be very disabling and disfiguring.
Yaws needs to be differentiated from other skin conditions include scabies, fungal infections, leprosy, leishmaniasis and psoriasis.

Sunday, February 12, 2012

Chronic fatigue seen in many previously infected with Q fever in the Netherlands


In 2007, the Netherlands began a large, drawn-out outbreak of Q fever, which resulted in thousands being infected and a dozen or so fatalities.
In a study just released in the European Journal of Public Health, Dutch researchers show that many of those infected with Coxiella burnetti previously, now face chronic fatigue syndrome and other physical symptoms.
1,168 Q-fever patients were notified in 2007 and 2008 in the Netherlands. The study targeted 898 acute Q-fever patients, notified in 2007 and 2008 residing in the Province Noord-Brabant. Patients from the 2008 cohort were mailed a questionnaire at 12 months and those of the 2007 cohort at 12-26 months after onset of illness. In the questionnaire, patients reported underlying illness, Q-fever-related symptoms and sick leave.
Some of the key results found in the study include:
  • Forty percent of the working patients reported long-term (greater than 1 month) sick leave. 
  • Daily activities were affected in 30% of cases.
  • 20% of respondents reported issues with fatigue.
  • 9% of those who did return to work reported they were (up to 2 years post-Q fever infection)  still unable to function at pre-infection levels due to fatigue or concentration problems.
Based on the results of the study, the authors conclude that Q-fever poses a serious persisting long-term burden on patients and society.
Q fever is caused by the obligate intracellular pathogen, Coxiella burnetii. The disease is usually transmitted to people through either infected milk or through aerosols.
This disease is found on most continents with the reported incidence probably much lower than the actual because so many cases are so mild.
Animal reservoirs of C. burnetii include sheep, cattle, goats, dogs and cats. In areas where these animals are present, Q fever affects veterinarians, meatpacking workers, and farmers.
Q fever is also considered a potential agent of bioterrorism.
The symptoms of Q fever according to the CDC are an unexplained febrile illness, sometimes accompanied by pneumonia and/or hepatitis is the most common clinical presentation. Illness onset typically occurs within 2–5 weeks after exposure.
The mortality rate for acute Q fever is low (1–2%), and the majority of persons with mild illness recover spontaneously within a few weeks although antibiotic treatment will shorten the duration of illness and lessen the risk of complications. Chronic Q fever is uncommon (<1% of acutely infected patients) but may cause life-threatening heart valve disease (endocarditis).