Archive for category: Disease

Information and news about disease category

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The Causes of Multi-Drug Resistant Tuberculosis

drug_resistant_tuberculosis
In 2013, five percent of global tuberculosis cases were known as multi-drug resistant tuberculosis. MDR TB is a form of tuberculosis that does not respond to the standard first-line drugs of Isoniazid and Rifampicin, which are used to treat TB.

Multi-drug resistant tuberculosis is on the rise around the world. There are 27 high MDR TB burden countries. A large majority of these are also high burden countries for regular TB as well. MDR TB rates are extremely high in Eastern Europe, where as many as 28 percent of new TB cases are MDR. Two countries, India and China, carry the most incidences of MDR TB.

Multi-drug resistant tuberculosis is a man-made problem created by inadequate or improper administration of TB drugs. Because of the length of treatment required for TB, improper drug use is common. As patients start to feel better, they stop taking their medication. The TB bacteria are still not eradicated from the body so the TB builds resistance to the first-line drugs that the patient has already taken. When the patients fall ill again, their TB strain will not only not respond to first line drugs, it will be highly contagious.

Weak TB control programs at the country-level contribute to drug resistance because they allow for improper TB treatment. Because of the risk that patients will not finish the TB treatment cycle, TB control programs are designed to create a system of observation by health professionals that insures proper treatment. However, countries with low health infrastructure and limited resources cannot follow the progress of every TB patient.

A growing concern is not the new instances of MDR TB cases but the infectiousness of the people who already have it. Because TB disproportionately affects the poor, who live in crowded, unsanitary conditions, the threat of contagion is much greater. This is especially true in high-burden countries like India and China, where the living conditions of the poor are extremely crowded.

The treatment for MDR TB is extremely expensive and much harder to access. The treatment cycle can last upward of two years and includes a daily injection for a period of six months, increasing the risk of patients not finishing the treatment even more than regular TB treatment. Patients who do not finish treatment create resistance to the second-line drugs.

A new phenomenon emerging is an extremely drug resistant, or XDR, strain of TB. XDR TB cases only make up five percent of MDR TB cases. XDR TB is resistant to any fluoroquinolon, at least one of three second-line drugs and both first-line drugs. Research and infrastructure dealing directly with XDR TB are very limited and resource consuming. For least-developed and developing countries with limited medical resources, XDR TB is almost impossible to treat.

– Caitlin Huber

Sources: E-Medicine Health TB Alliance, WHO
Photo: The Guardian

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Senegal Fights Ebola With Text Messages

ebola
In late August, Senegal’s first case of Ebola was confirmed in a man who had previous direct contact with a patient in Guinea and then traveled to Dakar, the capital city of Senegal. In collaboration with the World Health Organization, the Government of Senegal took immediate measures to stop the virus dead in its tracks.

Nearly 5,000 people have died from the Ebola virus and over 10,000 people have been infected. To prevent the spread of Ebola within Senegal, the Ministry of Health sent out over 4 million SMS messages to the general population warning of the new Ebola case and ways to individually prevent the contraction of the virus. The messages, based off a social campaign previously used for diabetes, were sent to citizens in Dakar and Saint-Louis, another heavily populated region in the country. The SMS campaign entailed multiple partnerships with local mobile phone companies and urged people to contact health authorities with news of anyone showing signs of fever and bleeding by calling the number provided. The messages received were then broadcast in large public events, such as sports games and rallies.

Dr. Mbayange Ndiaye Niang, a project leader at the Ministry of Health, says the “SMS campaign was part of a much larger national project in Senegal focused on awareness, prevention and care for people with Ebola.” Other awareness methods included flyers, radio announcements and messages posted on government websites. Washing hands regularly and avoiding contact with infected persons and animals was heavily reinforced.

The SMS campaign was extremely successful and, to date, there has only been one Ebola case in Senegal. The efficient and quick reaction by the Ministry of Health was possible due to the existing platform designed to help people manage their diabetes, called mDiabetes. The campaign began during the holy month of Ramadan, where fasting elevated risks associated with having diabetes. By registering with the program, persons with diabetes could receive free tips and advice via text messages on how to control problems associated with fasting. Thus, when Ebola reached Senegal, the government already had mechanisms in place to send text messages on a large scale.

The SMS campaign in Senegal proves that the technology platform can present an opportunity to target awareness on any disease, ranging from HIV/AIDS to the flu. In a world where phones and mobile devices have taken over all forms of paper, governments should invest in more technology-based initiatives.

– Leeda Jewayni

Sources: World Health Organization, UN Multimedia

Photo: Text Magic

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How to Help Fight Ebola

fight ebola
With the current Ebola outbreak, it is no wonder people are in a rush to help fight the treacherous disease. Although no known cure has been found, there are preventive measures one can take to halt its transmission.

Ebola is often transferred to humans from wild animals and can spread in the population through human-to-human contact with bodily fluids. Fruit bats are common vectors that transfer Ebola to humans through contact with blood, sweat and secretions.

Further, health workers are at great risk of contracting the disease when they treat patients with Ebola without proper protective gear. The average case fatality rate is at about 50 percent, but past outbreaks have had an average fatality rate of 90 percent. In 1976, the first outbreaks of the disease were recorded in the outskirts of Sudan and the Democratic Republic of Congo. Ebola has since moved on to urban and rural areas of West Africa, as we are witnessing currently.

But how can we help fight Ebola? The World Health Organization claims that community participation is key in controlling outbreaks. There needs to be clear interventions set in case of rapid progression throughout the country, such as case management and surveillance, an adequate laboratory and effective burial methods.

Health care providers that are in close contact with the virus should wear gloves, masks and goggles, in turn diminishing chances of infection. In addition, people should stay clear of highly infected areas or restrict travel to countries with high prevalence of Ebola.

Since symptoms can take up to three weeks to manifest, it is crucial that people are aware of the risk factors for infection. Interaction with wildlife increases one’s chance of infection, and so to help fight Ebola, limit contact and always wear gloves and masks if working with animals. Also, if living in high-risk areas in Africa, make sure meat is cooked properly and thoroughly before consumption. Furthermore, when coming in contact with patients with Ebola, wash hands regularly. This includes contact with the living and the deceased. Thus proper and safe burial is essential for affected persons.

As the recent cases of health care workers in Dallas demonstrate, strict infection control measures and following protocols from the Centers for Disease Control and Prevention must be followed to help fight Ebola. Community engagement and education is also key in successfully controlling the outbreak. While an approved vaccine does not yet exist, the virus can be contained through protective measures that can effectively reduce human transmission.

– Leeda Jewayni

Sources: WHO, NLM
Photo: Flickr

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Global Vaccination Programs

When it comes to diseases, it is always preferred to prevent rather than treat. Over the years, vaccinations and immunizations have saved millions of lives and eliminated one of the deadliest diseases in the world: smallpox.

All children are born with an immune system that produces antibodies when a foreign substance, or antigen, is detected. In other words, when the child gets sick, these proteins will not be able to halt the disease from occurring, but the immune system will remember the antigen and give the child immunity when it invades the body a second time.

Vaccines contain those antigens, but in a weaker form. The body will sense an “invader” and still produce antibodies to fight the harmless antigen. Thus, without ever exposing a child to a disease, a vaccination is a safer way to gain protection and produce immunity.

The Centers for Disease Control and Prevention understands the importance of global vaccination programs and has created the Global Immunization Division, which is dedicated to creating a “world without the diseases and deaths that could be prevented with vaccines.”

Worldwide, one in five children do not have access to the most basic vaccines. Consequently, around 1.5 million children die each year from diseases that could be prevented with proper immunizations. By working with a variety of global partners, the CDC has implemented a multitude of routine immunization services and campaigns, in addition to providing bed nets, de-worming medication and safe water systems.

The Bill and Melinda Gates Foundation also invests in global vaccination programs and contributes to the goals of the Decade of Vaccines, an action plan that aims to deliver universal access to immunization. In collaboration with the World Health Organization and other civil society organizations, the foundation is introducing vaccinations into the countries that need it most. They focus on strengthening immunizations systems by supporting the collection and analysis of vaccine-related data, as well as developing new technology to help medical staff “assess population immunity to disease.”

Universal access to vaccinations remains a priority goal for both groups in the next year. Effective vaccination programs saves lives, is inexpensive and easy to administer. Universal availability of vaccines also reduces health inequities, if everyone can have access to life-saving discoveries. Access to vaccines will give all our global citizens a fighting chance to survive.

– Leeda Jewayni

Sources: CDC, CDC 2, Bill and Melinda Gates Foundation
Photo: Council on Foreign Relations

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The Pentavalent Vaccine

Pentavalent is a vaccine that is being used to protect against five diseases: tetanus, hepatitis B, Pertussis, haemophilus influenza type b and diptheria. The Global Alliance for Vaccines and Immunizations (GAVI) introduced the vaccine in 2001 in Kenya, and in July of 2014 South Sudan became the 73rd country to be introduced to the vaccine through the GAVI Alliance.

In order for the vaccine to be effective, it needs to be administered over a three-dose schedule. Increasing the availability of the pentavalent vaccine is an attempt to reduce the mortality rate of children under the age of five by two-thirds for the coming year (2015), which is goal number four on the Millennium Development Goals list.

GAVI has also partnered with organizations such as World Bank, WHO and UNICEF, as well as other donor countries, in order to increase the availability of the pentavalent vaccine in poor countries where child mortality is an extremely pressing concern.

Most recently, the Minister of Health in India, Harsh Vardhan, stated that the pentavalent vaccine would be introduced in eight of India’s states: Tamil Nadu, Gujarat, Karnataka, Puducherry, Kerala, Goa, Jammu and Kashmir and Haryana. The plan is for the vaccine to be distributed among twelve additional states in the near future.

The success rate of disease prevention once the pentavalent vaccine has been administered is extremely high; the next part of the plan regarding the vaccine is to make sure that coverage is provided in remote areas and in regions facing deep levels of poverty. GAVI plans to begin an initiative, to be implemented from 2016 to 2020, to increase the amount of coverage for the pentavalent vaccine worldwide.

The CEO of the GAVI Alliance, Dr. Seth Berkley, stated on the GAVI website that his “next challenge is to support some of the world’s largest countries to expand and strengthen their programmes to ensure they are reaching every child.”

– Jordyn Horowitz

Sources: GAVI Alliance, UNICEF, Business Standard
Photo: GAVI Alliance

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What is the MMR Vaccine?

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Measles, mumps and rubella are all viral diseases that can interrupt the development of children and adolescents. Accessing reliable information about the MMR vaccine is the most cost-effective method to increasing its uptake.

The MMR vaccine is recommended in childhood. The three-in-one vaccine is necessary for most children to enter school and can be given as early as 11-15 months, and children should get two doses. In addition, adults born after 1956 or 18 years or older should also receive one dose of the vaccination unless they have already had all three diseases.

The MMR vaccine can be given at the same time as other vaccines. Young children (under 12 years) can get a combination of vaccines known as the MMRV (measles, mumps, rubella and chicken pox).

Upon receiving the vaccination, there are some risks involved, but most people who receive the vaccine do not develop any problems.

Mild issues can occur 6-14 days after receiving the vaccine and can include any of the following: fevers, mild rashes, and swelling of cheek/neck glands. Moderate issues can range from: seizures, stiffness/ pain in joints, temporary low platelet count that leads to a bleeding disorder (1 in every 30,000 doses). Some severe and very rare problems are: serious allergic reaction (1 in every million doses), deafness, permanent brain damage, and long-term seizures/comas. There is no evidence that the vaccine causes childhood autism.

All of these listed risks are small however, in comparison with the risks of contracting measles: severe illness, hospitalization and death. The vaccine itself has brought huge leaps in early childhood disease prevention, providing vaccination to over 500 million people worldwide in over 100 countries. Before the vaccine, mumps was the most common cause of viral meningitis in children and rubella caused terrible damage to unborn babies.

Now, both mumps and rubella are virtually non-existent in children.

The Measles Outbreak

With concern to the current measles outbreak of 2014, two doses are recommended because 2-5 percent of vaccinated people do not respond to their first dose. More than 99 percent of people develop immunity after
the second dose.

Out of the 593 confirmed cases of measles, very few were from people who had been vaccinated twice.

The virus itself can stay in the air for two hours after a person with measles symptoms have left the area and is spread by respiratory droplets. The people infected are contagious four days before and after receiving the rash.

International Outbreak

In the third world countries of the world, measles outbreaks have been spreading more freely, with thousands of cases. In the Philippines, there were 50,000 registered cases and 77 deaths. In Vietnam, there are at least
8,700 cases with 112 deaths in children. In Pakistan, over 30,000 people have caught measles and 290 people have died, with the number increasing daily for children alone. The effect of measles has been spreading due to a lack of proper vaccination, more vulnerable immune systems and misinformation (MMR vaccine may produce autism).

In Africa, the number of measles-related deaths have decreased by 91 percent due to a surge in immunization. However, cases have still been growing, a number well into the thousands.

The potential benefits of the vaccine outweigh the risks. Parents should understand that the MMR vaccine is the best way to protect their children from these diseases, especially if traveling to an affected area, or the family resides in an affected area.

– Ashley Riley

Sources: About, About 2, CDC, CDC 2
Photo: Medimoon

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Climate Change and Pathogen Ranges

The effects of climate change are numerous: ocean levels are rising, meteorological events are becoming stronger and increasingly unpredictable and the incidence of heat-related illness is increasing across the world. Yet experts are just beginning to understand one effect of a changing climate: the capacity for pathogens to migrate around the globe and infect populations that have previously never been in contact with these microorganisms.

Combined, these effects have the potential to cause extreme poverty. Loss of property and life resulting from rising sea levels and strong storms deprive people of both wealth and other resources.

However, the global health conundrum that is changing pathogen ranges is also a poverty issue in its own right. Poor human health places burdens on individuals and their family members that may cause them to lose employment opportunities and large sums of money. Being ill is no easy fortune, but the impoverishment that often accompanies illness can be worse yet.

As warming weather drives animals toward more hospitable environments, pathogens too are expanding their ranges and at the same time, are finding hosts they’ve never met. While it’s working out well for these pathogens, humans, other animals and plants aren’t faring too well.

A species of sea otters in the Pacific Ocean off the coast of Alaska has become ill from a virus that originated in the northern Atlantic Ocean; science writer Chris Solomon suggests that due to declining sea ice levels, “disease is finding new lanes of travel.”

It makes sense – pathogens are highly dependent on temperature for survival, and many bacteria and viruses thrive in the type of warm, wet environments that are becoming more and more prevalent as the climate changes. Not only do rising sea levels give pathogens access to a wider range of space (and accordingly, hosts) but also as animals move around seeking cooler climates, they take pathogens and parasites along with them, allowing them to infect entirely new populations.

What does this mean for humans? Well, the effects of expanding pathogen ranges are manifold. First, like Alaska’s sea otters, humans may soon fall prey to microorganisms not previously seen in their parts of the world. Prevention and treatment of illnesses caused by unfamiliar pathogens will be difficult and costly.

Inevitably, some humans – though it is impossible now to estimate just how many – will die.

Since human health is directly related to poverty outcomes, the expanding pathogen ranges means expanded poverty “ranges;” if more people fall ill due to pathogens, more people will experience poverty.

Secondly, and this is an effect that agricultural communities are already beginning to observe, new pathogens will infect crops and jeopardize the livelihood of the peoples who depend on the harvest for either food or for employment.

According to a study from the Universities of Exeter and Oxford, crop threats include pests and pathogens spreading toward the poles at a rate of 3.2 kilometers per year. A fungus that infects yeast harvests has already wreaked havoc in Brazil, threatening farmers there with impoverishment.

It’s difficult to fathom that such tiny organisms could have such large effects, but pathogens have the potential to cause a lot of harm, in terms of both illness and poverty. Despite that their migration is one of the least publicized effects of climate change; however,  it is one of which humans should be wary.

– Elise L. Riley

Sources: NPR, NASA
Photo: Phys.org

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Yellow Fever in the Developing World

Despite increased understanding of the mosquito-transmitted disease since it presented in the 15th century, yellow fever in the developing world continues to have a widespread effect. The World Health Organize  estimates that there are 200,000 cases of yellow fever every year, with 30,000 deaths, 90 percent of which occur in Africa. In Africa and Latin America, 900 million people are at risk of infection as the disease spreads without a cure.

When a mosquito bites a person and transmits yellow fever, there are two paths the disease can take. It will either present as flu like symptoms with fever, aching and nausea, before going away in three to four days. However, 15 percent of patients take the second path. Symptoms worsen rapidly, as the patient develops jaundice, bleeding and increased vomiting. Half of these patients die within 14 days, and those who survive suffer from severe organ damage.

The fight against yellow fever is challenging for a few reasons. For starters, in the early stages, it is difficult to diagnose the disease, as its symptoms are similar to diseases like malaria, viral hepatitis and poisoning. Once the disease can be identified, it is often too far along to effectively control.

Additionally, yellow fever has no treatment. Though it can be prevented, there is no vaccine to cure it. Patients are often treated for secondary conditions that result from yellow fever, which can be effective in helping the patient survive the disease.

Despite the lack of treatment, there are myriad methods to prevent yellow fever. The GAVI Alliance, which has brought together the efforts of the WHO, UNICEF, the World Bank, the Bill and Melinda Gates Foundation and various other governmental agencies, has been successful in administering preventative vaccines worldwide. Since GAVI got involved, an estimated 64 million children have had the vaccine, and 17 of the 33 countries at risk have received routine vaccinations.

In addition to vaccination, protection from mosquitoes can be effective in preventing yellow fever, whether it be insecticide treated nets, clothing that covers as much skin as possible or remaining indoors at night when the mosquitoes are in abundance.

The WHO has been involved beyond its participation in the GAVI Alliance, acting as Secretariat for the International Coordinating Group for Yellow Fever Vaccine Provision. The ICG is adamant about maintaining a stockpile of yellow fever vaccinations in case of a sudden outbreak. Additionally, the WHO along with UNICEF and national governments has led the Yellow Fever Initiative which focuses its vaccination efforts in Africa, targets infants younger than nine months and works to monitor outbreaks to minimize damage.

Preventing yellow fever is very much dependent on efficient healthcare and sanitation, things that are difficult to achieve in impoverished areas. The efforts of GAVI, as well as the individual organizations, are crucial to control the number of yellow fever cases every year.

– Maggie Wagner

Sources: Gavi Alliance, NCBI, WHO
Photo: Gavi Alliance

Ebola in Sierra Leone

The Ebola outbreak spreading across Africa has become increasingly fatal over the past couple of months. The incubation period for Ebola ranges from two days to 21 days, and when not treated early on, has about a 90 percent fatality rate.

According to WHO, 630 people total in the West African countries of Sierra Leone (442 people infected, 206 deaths), Guinea (410 people infected, 310 deaths) and Liberia (196 people infected, 116 deaths) lost their lives to Ebola. One of the most recent victims of the disease includes one of the leading doctors in Sierra Leone, Sheik Umar Khan, who contracted the virus while attempting to help treat others afflicted by Ebola.

Psychologist Ane Bjoru, who has begun work in Sierra Leone, however, explains the impact of Ebola beyond purely the physical effects of the virus. In her article in The Guardian, she explains that as a non-medical staff member, a large part of her job is helping hygienists, who have to deal with disposing of the dead bodies, deal with this “new and disturbing experience” and much of her work “involves helping them with counseling and support.”

Ane Bjoru explains that to treat Ebola in Sierra Leone the hygienists are responsible for cleaning the blood and stool produced by the patients, and are confronted with a confusing mix of emotions when dealing with the dead bodies. They are filled with sadness from the loss, fear from the contagious bodies, and especially in Sierra Leone where the dead are usually dealt with by the elders of the society, some of the hygienists feel they are too young to be involved with this part of the life cycle.

Ane Bjoru, through her work, seeks to build a wider community of people to help citizens of Sierra Leone deal with the emotional consequences of the Ebola outbreak.

— Jordyn Horowitz

Sources: World Health Organization, The Guardian 1, The Guardian 2, BBC News
Photo: The Guardian

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Causes of Malaria

Malaria, a disease largely eliminated in the developed world, remains a health issue for developing nations. According to World Health Organization estimates, 207 million cases of the deadly disease emerged in 2012 alone, with about 80 percent coming from countries in Sub-Saharan Africa.

To help communities in these nations fight malaria, NGOs and foreign aid providers must not only provide malaria treatment methods but also find ways to address and protect people from its causes.

So, what are the causes of malaria?

The Mayo Clinic identifies the main path to infection as the transmission of parasites through mosquitoes. Mosquitoes can carry small parasites that cause malaria, and when they bite humans the parasites can enter the bloodstream. Once in the body, the malarial parasites travel to the liver, where they grow and develop. The maturation process lasts from a week to nearly a year, but once the parasites reach adulthood, they enter the bloodstream and infect red blood cells.

At this stage, the common symptoms of malaria, including fever, chills and sweating, develop. At the same time, mosquitoes that suck infected blood will get the malarial parasites, allowing them to spread through bites to other people.

Though malaria primarily spreads through mosquito bites, people can contract it from other sources. Malaria is a blood-borne disease, and receiving blood transfusions from infected individuals can lead to transmission. Sharing dirty hypodermic needles will also cause malaria to spread, and mothers can pass the disease on to their unborn children.

If left untreated within 24 hours of the first symptoms, malaria can cause brain damage, fluid buildup in the lungs and liver failure, all of which can be fatal. The World Health Organization believes that in 2012 malaria killed 627,000 people, the majority of whom were African children under five.

Fortunately, the mortality rates of malaria have fallen 42 percent globally since 2000. Still, the disease is lethal enough that a child in Africa dies every minute from malaria-related symptoms.

With no existing vaccine for the disease, programs to reduce deaths must focus on preventing malaria and safely treating existing cases.

Knowing that mosquitoes are the primary transmitters of malarial parasites, what do governments and other organizations do to prevent bites?

According to the World Health Organization, the two primary methods to keep mosquitoes away from people and their homes are to use insecticide-treated nets and indoor residual spraying of insecticides.

Projects from NGOs and foreign aid agencies to provide these services to communities free of charge will help prevent mosquitoes from spreading malaria.

While using either insecticide-treated nets or indoor residual spraying to stop mosquito bites is effective, the Institute for Health Metrics and Evaluation found that, in areas of medium transmission, using both methods reduced the risk of infection an extra 36 percent compared to one method alone.

Public education programs to teach people and doctors not to reuse medical equipment, not to give transfusions of infected blood and how to recognize symptoms quickly can also supplement insecticide-treated nets and indoor residual spraying to stop malaria at its source.

Malaria is a dangerous disease that takes the lives of many young children daily, but since people know what causes malaria, it can be prevented. Thanks to technology to kill parasite-carrying mosquitoes, deaths from malaria are dropping and the world is becoming a safer place to live.

– Ted Rappleye

Sources: The Mayo Clinic, World Health Organization, Institute for Health Metrics and Evaluation
Photo: TreeHugger