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Vaccines in Egypt
For the past 20 years, the Centers for Disease Control and Prevention (CDC) of the United States has assisted the Egyptian government by providing aid to fight vaccine-preventable diseases. Efforts such as strengthening immunization services, responding to public health emergencies and conducting surveillance studies and surveys have contributed to the reduction of these fatal diseases. The CDC has provided financial support for diseases that can be prevented by vaccines in Egypt through the World Health Organization (WHO), which focuses on polio, measles and rubella elimination.

Impeding Access to Vaccines

In 2006, vaccinations in Egypt eradicated wild poliovirus transmissions. The government continues to monitor the environment for wild polioviruses in a program involving the CDC and other organizations. However, despite the efforts of these organizations, many of those living in poverty in Egypt still do not have access to the vaccination. This presents a problem in the eradication of vaccine-preventable diseases since disease such as the wild poliovirus could return.

According to WHO, full immunization coverage for the poorest to the wealthiest populations showed national levels in Egypt to be under 20 percent. Studies show that the high rates of unemployment and low literacy rates contribute to the increase in the population living in poverty. This results in many individuals being unaware of the healthcare and medical aid they are entitled to and leads to the low proportions of immunization within the population.

Many children are also part of the child labor industry. Working interferes with their school attendance and education, resulting in low literacy rates, which perpetuate the ongoing poverty cycle. Without awareness of health and safety maintenance, those who live under the poverty line may not have the necessary knowledge to access vaccinations in Egypt.

Improvements Made in Vaccinations

The Expanded Program of Immunization (EPI) in Egypt focuses on saving lives by controlling vaccine-preventable diseases such as measles, diphtheria, tetanus, polio and whooping cough through constant surveillance and an increase in vaccine coverage. Despite the extreme decline of cases of vaccine-preventable diseases in the past decades, outbreaks of measles in 2013 and 2014 suggests that full immunization coverage is not yet supported for all populations of Egypt.

However, despite 60 percent of the population living under the poverty line and a large number of people not receiving immunizations, resources and efforts towards improving access to vaccinations in Egypt have increased. WHO claims that only 24 cases of measles, 5.9 cases of mumps and 34 cases of rubella were reported in 2017. A drastic decrease compared to decades of consistent outbreaks in the thousands. Part of the progress could be a result of the fact that 94 percent of children aged 12-23 had received measles vaccinations in 2017. Furthermore, in 2008-2009, there was a significant increase in vaccines in Egypt for measles, mumps and rubella, with 95 percent of children having been vaccinated, an increase of 53 percent from 2007.

The Future of Disease Control

The Ministry of Health and Population (MoHP) works to promote the funding of the Haemophilus influenza vaccine as a part of the PENTA vaccine, a type of vaccine designed to protect the receiver from multiple diseases. The PENTA vaccine will help fight bacterial pneumonia, a communicable disease that contributes to high mortality rates. With WHO supporting the MoHP, the push for programs that fight viral hepatitis is stronger as more resources are being devoted to procuring equipment, allocating funding and the constant surveillance of vaccine-preventable disease outbreaks.

Efforts to control vaccine-preventable diseases are allocating funding to provide coverage for those who may not be able to afford it. Now, increased focus on spreading awareness to the population about the importance and availability of vaccines in Egypt is needed in order to increase coverage and finally eradicate some of the vaccine-preventable diseases in the country.

– Aria Ma
Photo: Flickr

global health security agendaThe Global Health Security Agenda (GHSA) is a partnership of nations, international organizations and NGOs that are seeking to keep the world safe from infectious diseases and maintain health security as a main global priority. The program launched in 2014 as a five-year initiative to increase country-level health security to stop disease outbreaks at their source.

In October 2017, GHSA was extended until 2024. This extension will allow the global health community to enhance data sharing, preparedness planning, epidemiological and laboratory surveillance, risk assessment and response to infectious diseases and other health issues and threats.

The Global Health Security Agenda has created a set of eleven targets and an assessment tool, which is currently being carried out in five countries: Georgia, Peru, Portugal, Uganda and the United Kingdom. In the organization’s assessment of Georgia, it noted that zoonotic diseases are a problem, as 60 percent of human pathogens are zoonotic. Much of the diseases seen in humans within the country are of animal origin, spreading, for example, through contact with veterinarians. These assessment reports contain information about immunization, biosafety and biosecurity and real-time surveillance among other things.

The Centers for Disease Control and Prevention (CDC) believes that global health security strengthens United States security. The CDC works in association with GHSA to combat disease worldwide. The organization currently has partnerships with 31 countries, including the Caribbean, that are working to meet the goals of GHSA. The CDC has established Global Disease Detection Centers around the world, providing assistance to over 2,000 requests for disease outbreaks and creating more than 380 diagnostic tests in laboratories of 59 countries.

GHSA has had success stories in many countries, including Tanzania. The nation’s government is determined to play a role in ensuring GHSA’s success, both nationally and internationally. Tanzania joined the program back in August 2015, and in February 2016, it became the first country to use the Joint External Evaluation to assess its 19 capacities to prevent, detect and respond to public health issues.

In a formal event, Tanzania also launched the National Action Plan for Health Security. Held on September 8, 2017, the event was well attended, including guests such as USAID, the World Bank and the World Health Organization.

The fight to keep the world safe from disease may still be a long road, but with programs like the Global Health Security Agenda, the future seems promising.

– Blake Chambers

Photo: Flickr

Diseases in SurinameSuriname is a small country on the north coast of South America with a population of nearly 600,000. The country has improved much of its health standards in recent years when it comes to treatable diseases in Suriname.

As the country has grown economically and life expectancy has increased, the threat of diseases such as cardiovascular disease typhoid fever and malaria has been reduced. While the country has made progress, certain diseases in Suriname remain a threat in the form of outbreaks.

Suriname’s most recent disease outbreak was a yellow fever outbreak, the country’s first since 1972. This came as a surprise due to Suriname’s comprehensive vaccination programs, which have required yellow fever vaccines for all children starting at one year old since 2014. In response to the outbreak, the Suriname government enhanced vaccination activity to increase coverage and upgraded entomologic and epidemiologic surveillance by strengthening laboratory capacity.

Vaccination improvements have been one of the main factors reducing the threat of treatable diseases in Suriname in recent years. Today, national immunization coverage up is to 86 percent. Certain high-risk diseases such as Hepatitis B and C have been controlled thanks to the widespread childhood immunization programs.

Suriname also dealt with the outbreak of the Zika virus at the end of 2015, after four initial cases appeared, making them one of the earliest countries hit by the outbreak. Suriname implemented a health emergency risk communication plan to help spread awareness about the disease and contained it successfully. Today, government detection programs and strategies are utilized to reduce the threat of mosquitos, including the widespread use of treated netting.

Malaria treatment is another area which Suriname has seen significant improvement in the last decade. Confirmed malaria cases per 1,000 individuals have decreased drastically since 2005, dropping from 120 cases per 1000 to as few as 20 by 2014. Malaria deaths have also decreased as medical treatment and health infrastructure have improved.

Other diseases in Suriname that have been flagged by the government as recent threats are dengue fever and chikungunya fever. Over 2000 cases of dengue fever have been reported in the last 12 years, though none of them have been fatal. Chikungunya fever, another mosquito-borne illness, broke out in Suriname in 2014 with 17 cases, prompting the CDC to launch preventative efforts to raise awareness against the disease.

While several diseases in Suriname such as yellow fever present a threat to the country’s population, improved healthcare and immunization in the last decades have improved life expectancy in the country. Suriname‘s quality vaccination programs have reduced childhood deaths and will help the country when the next outbreak strikes.

Nicholas Dugan

Common Diseases in HondurasHonduras is a country with fairly poor healthcare available to its citizens. This means that patients who cannot afford care suffer unnecessarily from curable diseases. However, the CDC is helping the country strengthen their healthcare systems by increasing the technical skills of doctors in the region. A few common diseases in Honduras can turn rather serious without the appropriate care to get better.

According to the World Bank, Honduras currently has just over 9 million people. The per capita income is $3,710, and the life expectancy is 76 years for the women and 71 years for the men.

One of the major problems in Honduras is the childbirth complications, and many mothers have issues with their pregnancies and some could lead to infant deaths. In fact, 16 percent of deaths in Honduras come from perinatal conditions. This may not be a disease, but it is a problem that needs to be addressed. The CDC can clean up some conditions and help the doctors address the issues that are causing so many deaths in the birthing process.

Diabetes is a major problem in Honduras, as well. In 2010, it was the second leading cause of death in Honduras, sitting at just under seven percent. Some of the major risk factors leading to the presence of diabetes includes physical inactivity and obesity. The problem exists in Honduras because the only capability they have are blood glucose measurement.

Many other medicines, such as insulin and metformin, and procedures available elsewhere around the world are not available in Honduras. They also don’t possess many of the procedures and policies such as a registry, national guidelines, etc. These are vital to helping the people that need insulin and other procedures to help relieve them of the problems that they face with diabetes.

Some of the other common diseases in Honduras include heart disease, lower respiratory disease, diarrhea and other lower respiratory and common infectious diseases, and HIV/AIDS and other sexually transmitted diseases.

HIV/AIDS has an estimated prevalence in Honduras between one and just over three percent within adults ages 15-49. The estimated number of people living with either HIV or AIDS in Honduras is between 35,000 and 110,000 people.

There needs to be more awareness and testing available to the people in Honduras. In addition, only about a third of HIV/AIDS patients were receiving the therapy they needed in 2005. That proportion has no doubt increased in the past decade, but new technology will be able to assist people in need. The CDC’s involvement in the country is definitely a good thing for those with HIV and AIDS to make sure they are treated for.

Honduras needs better healthcare in place to help their citizens. There is help from the CDC, who has been there in recent years, to attempt to help them improve their care for the common diseases in Honduras. The look toward the future is brighter with the CDC’s involvement than the past.

Brendin Axtman

Photo: Flickr

Zika Vaccine

Since May 2015, the Zika virus epidemic has plagued many nations and continues to spread to more. However, the mosquito-transmitted disease may soon be eradicated with the development of a new Zika vaccine.

On Monday, June 20, 2016, reports went viral when the U.S. Centers for Disease Control and Prevention (CDC) approved the following drug developers to initiate human clinical trials for the Zika Vaccine: Inovio Pharmaceuticals Inc, based in Plymouth Meeting, Pennsylvania, and GeneOne Life Sciences Inc, based in Seoul, South Korea.

Both Inovio and GeneOne have co-created vaccines for Ebola and MERS, which are also undergoing efficacy testing.

The vaccine, labeled GLS-5700, will be enrolled in a phase I study. This study will include 40 healthy volunteer human test subjects who will be given the vaccine to measure the safety, tolerability and effectiveness of the drug.

The initial trials are scheduled to begin July 2016, and should they yield successful results, they will be promoted to phase II clinical trials. These trials will test GLS-5700’s efficacy on people who have already contracted the Zika virus.

If these phase II trials are successful, then the Zika vaccine will be tested on a large experimental group before it is finally approved for the field.

So far, the Zika virus has affected 58 countries and territories and continues to expand. Initially believed to be harmless, the virus is transmitted by the mosquito species Aedes aegypti. If it is contracted by a pregnant woman, it can cause a neurological birth defect known as microcephaly.

Optimally, the Zika vaccine will be ready for public use by early 2018. Currently, more plans are being made to begin phase II trials in early 2017, which will be conducted by the U.S. National Institute of Allergy and Infectious Diseases (NSAID) based in Bethesda, Maryland.

Jenna Salisbury

Photo: Health Impact News

Miniature Figures on White Background

According to the World Health Organization, 35 percent of women worldwide have experienced intimate partner violence or non-partner sexual violence, and 38 percent of murders of women are committed by intimate partners. Violence against women increases during times of stress or conflict, which can occur in many developing countries, but domestic violence is also prevalent in the developed world.

Gender-based violence can inflict serious physical and mental harm. Examples include injury, sexually-transmitted diseases and depression. Furthermore, there is an economic cost to intimate partner violence. A United Nations report indicates that the costs of intimate partner violence in the U.S. in 2003 added to $5.8 billion. Costs can include medical expenses, lost time at work and deaths. In the developing world, costs will come in the form of slower GDP growth in addition to deaths and unemployment. These types of harm prevent families and communities from developing and contributing to the social and economic health of their communities.

Programs like the REAL (Responsible, Engaged and Loving) Fathers Initiative work toward minimizing these costs by creating more gender equitable communities. Research has determined that one of the most effective ways to accomplish this is by positively engaging men to work with their partners and children to end patterns of violence.

The U.S. Centers for Disease Control and Prevention cites different strategies to address violence in high and low income settings. In higher income settings, school programs that address dating violence have proven to be effective. In lower income settings, programs that require the entire community to address gender equality are likely to be effective.

The REAL Fathers Initiative implemented by the Institute for Reproductive Health is a current program in post-conflict Northern Uganda. The project works to engage young fathers in efforts to reduce intimate partner violence and harsh punishment of children. Having programs that involve men can be beneficial in reducing domestic violence.

Mentors, who are fathers in the community, are trained in relationship skills and positive parenting practices. They are selected from the community and trained by the research team in order to work with other young fathers.

Initial testing of the program indicates that young fathers are making positive changes. For example, fathers are more involved in childcare and more dedicated to helping their wives with chores.

The Fatherhood Institute, a nonprofit in the U.K., recognizes the value in engaging fathers to break the cycle of violence. When fathers are more involved in the lives of children and supportive of their partners, communities can thrive with healthy family dynamics.

 

– Iliana Lang

Sources: CDC, Fatherhood Institute, Institute for Reproductive Health, UN Women, WHO
Photo: Dr. Phil

Superbugs
Researchers have been tracking the increase of the global spread of antimicrobial resistant infections, also known as superbugs. But the reason for this increase surprised the researchers—drug co-pays seem to have increased superbugs.

Superbugs are defined as “strains of bacteria that have changed (or mutated) after coming into contact with an antibiotic. Once this happens, these bacteria are ‘resistant’ to the antibiotic to which they have been exposed, which means the antibiotic can’t kill the bacteria or stop them from multiplying.”

Many individuals may suggest going back to a doctor and receiving a new prescription for a different antibiotic. But in the developing world, many individuals cannot afford the co-pays for multiple doctor visits, let alone the cost of multiple antibiotic prescriptions.

With the rising costs of prescriptions, many individuals are turning to informal or black markets for their prescriptions. The pills that they buy from black markets may be lower quality, prescribed inappropriately or dosed incorrectly. All of these factors can lead to the spread of superbugs.

According to an analysis of data from 47 countries published in the Lancet Infectious Disease Journal, the amount people spend out-of-pocket on healthcare has turned out to be a better predictor of antibiotic resistance than poverty, sanitation or livestock production.

In the first major report last year, the World Health Organization (WHO) has called antibiotic resistance “a growing public health threat.” This report, which tallied the level of antibiotic resistance in each country, warned that “many of the available treatment options for common infections in some settings are becoming ineffective.”

According to the Centers for Disease Control, each year superbugs cause 2 million people in the United States to become sick, killing 23,000. With the advanced healthcare available in the United States, what effects do superbugs have on the developing world?

With the WHO report in mind, researchers from Stanford University in California and Gandhi Medical College & Hospital in India set out to determine whether the levels of resistance in low and middle income countries were linked to the direct healthcare costs that patients pay.

The researchers found that in countries where patients paid a higher share of healthcare costs, there was a higher level of antibiotic resistance. But this was also only evident in countries that charge co-payments for prescriptions.

While this data does not prove that higher prescriptions costs cause greater antibiotic resistance, it does show that the two are linked.

Co-payments are usually used to discourage people from seeking unnecessary healthcare, but are currently having the opposite effect. With higher co-payments, patients that cannot afford the cost must look elsewhere for their prescriptions: the black market.

Not only are patients endangering themselves with unknown prescriptions and doses, but they are also enabling antibiotic resistance. There needs to be a change so that patients are able to receive needed antibiotics at a reasonable price. If not, antibiotic resistance will become a major problem in the future.

– Kerri Szulak

Sources: ABC Health & Wellbeing, Bloomberg Business
Photo: Live Science

New Vaccine to Protect Children in Côte d’Ivoire-TBP
Under the recommendation from the Polio Eradication and Endgame Strategic Plan 2013-2018, the Ivorian government has introduced the Inactivated Polio Vaccine (IPV), a new vaccine to protect children, into routine immunization programs.

The plan was drawn up due to the spread of polio to over 20 virus-free countries in the past 10 years from regions still considered endemic areas.

Côte d’Ivoire has been implementing strategies from the Global Polio Eradication Initiative (GPEI), which has members who support the plan, since 1997, the last time a polio type 2 case was reported. There has been no detection of wild polio cases in the country since July 2011.

By introducing IPV into routine immunization programs, Côte d’Ivoire will ensure the protection of 650,000 children every year from the virus. The first vaccines were administered at a ceremony on June 26.

The Polio Eradication and Endgame Strategic Plan 2013-2018 focuses on four objectives. The plan aims to identify and disrupt the transmission of the virus, create a stronger immunization system and withdraw the oral polio vaccine (OPV), contain the virus and use the knowledge, and help address other global health goals.

By removing OPV from immunization programs, Côte d’Ivoire is eliminating the chance of vaccine-derived polio, a small risk associated with the vaccine.

IPV, however, will increase the protection of children in the West African nation.

The plan was originally endorsed by the World Assembly in 2013 and organizations such as the World Health Organization, Centers for Disease Control and Prevention, and United Nations Children’s Fund are helping to spearhead the plan.

Matt Wotus

Sources: Gavi 1, Gavi 2, Global Polio Eradication Initiative
Photo: All Africa

medications
Health professionals attempting to treat patients with malaria are currently facing another complex obstacle in the developing world: the distribution of substandard, falsified and degraded antimalarial medications.

Drugs classified as substandard are medicines that have insufficient amounts of the necessary active ingredient. In order to effectively kill the bacteria and other harmful organisms thriving inside a malaria patient, the full, prescribed dose of the drug needs to be ingested.

When anything less than the full dose is ingested, these organisms not only continue to survive, but also develop a resistance to the drug entirely. This renders current anti-malaria drugs completely ineffective.

“Poor quality antimalarial drugs are very likely to jeopardize the unprecedented progress and investments in control and elimination of malaria made in the past decade,” according to Fogarty scientist, Gaurvika M.L. Nayyar.

Since the early 2000s, the World Health Organization has recommended artemisinin as the first line of treatment for malaria patients, since “artemisinin and its derivatives are powerful medicines known for their ability to swiftly reduce the number of Plasmodium parasites in the blood of patients with malaria.”

Artemisinin is combined with other supplementary drugs in Artemisinin Combination Therapy treatments in order to effectively assist those diagnosed with malaria. However, these substandard drugs are causing an increase in bacterial resistance to artemisinin treatments, rendering the first line of malaria defense utterly useless.

According to a study done by National Public Radio in 2012, “a third of all anti-malarial drugs taken off the shelf in nonrandom surveys in Africa and Asia were absolutely fake. In about 4,000 samples, there was not a drop of active ingredient there.”

The distribution of these partially active medications has recently been classified as a “global pandemic” affecting the poorest parts of the world, specifically West Africa and Southeast Asia, where drug regulatory systems are weak.

The Centers for Disease Control and Prevention said, “Counterfeiting occurs throughout the world, but it is most common in countries where there are few or no rules about making drugs. An estimated 10 percent to 30 percent of medicines sold in developing countries are counterfeit. In the industrialized world (countries such as the United States, Australia, Japan, Canada, New Zealand, and those in the European Union), estimates suggest that less than one percent of medicines sold are counterfeit.”

On April 20, The American Journal of Tropical Medicine and Hygiene released a special issue, titled “The Global Pandemic of Falsified Medicines: Laboratory and Field Innovations and Policy Perspectives,” which contained a series of 17 papers. Each is written by a different author from a different university or institution, yet all cover the implications surrounding the distribution of substandard medicines throughout the developing world.

According to one of the studies, over 122,350 child deaths were caused by insufficient or partially-active anti-malaria drugs in 2013 alone. This figure represents one-fifth of all deaths caused by malaria.

“These findings are a wake-up call demanding a series of interventions to better define and eliminate both criminal production and poor manufacturing of antimalarial drugs,” Nayyar said.

– Hanna Darroll

Sources: NPR, FIC, ASTMH, WHO
Photo: TheraBreath

antibiotics_resistance
The threat of antibiotic resistance is once again in the spotlight. Professor Jeremy Farrar, the new head of Britain’s biggest medical research charity warns again of the dangers of antibiotic abuse.

Reports from Chicago are showing the effects of Farrar’s warnings. The largest outbreak of a very specific and very dangerous bacterium in the U.S. has been linked to a procedure performed at a north suburban hospital last year. 44 cases of a strain of bacteria called “carbapenem-resistant enterobacteriaceae” or CRE were identified by the Center for Disease Control (CDC) and Prevention.

The main problem with resistant bugs is their high transmission. Alex Kallen, an infectious diseases doctor who served as the supervisor of the CDC investigation, has stated that most of the patients screened had the bacteria in their digestive track, but not the disease.

The most common infection the bacteria causes is a urinatry tract infection, but if that infection gets to the bloodstream, the patient has a 40 to 50 percent chance of dying, making the bug extraordinarily dangerous.

Simple bugs that reside in the stomach like E. coli and Klebsiella, now require carbapenems, a powerful antibiotic, often used as a last resort, to be treated. In South Africa, an extraordinarily powerful strain of tuberculosis that is virtually untreatable has been popping up around the world. Called XDR-TB, it requires eight different medicines a day, including a shot, and tens of thousands of dollars to treat.

Many individuals who are exposed to these diseases do not have the means to be treated, and as a result, usually are resigned to a bleak fate. However, Professor Greg Hussey of the Institute of Infectious Diseases and Molecular Medicine at UCT believes that the key is in immunization.

“The only solution to defeating TB is to prevent the disease from occurring,” He said. “As with any infectious disease, effective vaccines are of critical importance.”

Professor Farrar has called for the industry to be given incentives to work on antibiotics and research on infectious diseases and greater restrictions placed on access to these medicines.

Professor Dame Sally Davies who, described antibiotic resistance as a “ticking time bomb,” has argued that in up to 20 years, routine operations could become deadly if people lose the ability to fight infection. This will pose exceptionally large problems for cancer treatments or organ transplants where patients are exceptionally susceptible to infections.

“If we don’t take action, then we may all be back in an almost 19th century environment.” Dame Sally said.

Pharmaceutical companies, she said, are discouraged to develop new drugs because the manufacture of antibiotics is not viewed as profitable. Antibiotics usually are only used for a week or two when they’re needed, and even then, they have a limited life span because of the development of resistance. However, drugs for high blood pressure or diabetes, for example, which patients use every day, have much larger markets and therefore receive more funding.

Dr. Ibrahim Hassan, a consultant microbiologist at Wythenshawe Hospital in Manchester, said there are more cases of patients with bacterial infections resistant to antibiotics. Meaning fewer treatment options and higher risk factors.

Dame Sally urges politicians to treat the threat as seriously as the superbug MRSA, an antibiotic resistant form of the common staph infection. She also blames the overuse in animal husbandry, agriculture and fish farming for the current antibiotic epidemic.

The problem arises because while no new classes of antibiotics have been introduced since 1987, new pathogens have been emerging every year. The Chief Medical Officer said antimicrobial resistance was to be put on the government’s national risk register of civil emergencies, which provides guidance for things such as terrorist attacks, pandemic flu and major flooding.

Chloe Nevitt
Feature Writer

Sources: BBC News Health, BBC News, BBC, CBS Chicago, The Wall Street Journal
Photo: The Guardian