Hepatitis BIn a difficult year, 2020 carried some bits of great news for global health and children around the world. The incidence of hepatitis B in children under 5 dropped below 1% in 2019, a huge milestone and a cause for celebration for the public health community around the world. WHO Director-General Tedros Adhanom Ghebreyesus spoke positively about reaching the milestone by looking to the future: “Today’s milestone means that we have dramatically reduced the number of cases of liver damage and liver cancer in future generations.” The milestone marks the attainment of one of the Sustainable Development Goals to reduce viral hepatitis to less than 1% prevalence for children under 5 by 2020.

Hepatitis B

Hepatitis B is a viral infection of the liver which can lead to many health problems, the most serious of which being liver cancer. More than 250 million people worldwide are carrying a chronic hepatitis B infection, with 900,000 deaths from the disease occurring annually.

Mother-to-child infection is the most common, making the disease especially damaging to children. Infants are the most vulnerable to the disease — an overwhelming 90% of infected infants under the age of 1 become chronic carriers of the disease. This makes controlling hepatitis B in children very important to global health.

Methods of Control

The best method of prevention is through the hepatitis B vaccine. The vaccine became available in 1982 and prevents millions of hepatitis B cases a year. The timing of the doses is extremely important and three are required to complete the recommended vaccination course. The first “birth dose” is most effective when administered in the delivery room or less than 24 hours after birth. The second dose should follow 28 days thereafter. The third and final dose follows at least four months after the first dose.

The WHO aims to achieve universal childhood vaccination as the vaccine offers lifetime protection for children who receive it at the recommended times. The vaccine is most effective for infants but the vaccine series is still recommended for children up to 18 years old. In 2017, the FDA approved a two-dose vaccine for adults.

Hepatitis B Vaccinations in Numbers

About 85% of children received the recommended three doses in 2019, a remarkable improvement compared to 30% who received it in 2000. The birth dose must be timely as it the most crucial part of the vaccination. This is why timely access to these vaccines is an urgent concern.

Unfortunately, despite rapid improvement, timely access to the birth dose remains unequal. Currently, 43% of children globally receive a timely birth dose. However, this falls to 34% in the eastern Mediterranean region and even further down to a lowly 6% in Africa. This serves as a reminder that, despite significant progress, efforts must continue to completely eradicate hepatitis B in children.

The Road Ahead

While the vaccine is the predominant form of prevention, recent efforts have focused on expanding ways to prevent mother-to-child transmission. The WHO called on countries to test pregnant women for hepatitis B and provide antiviral therapy before the birth of the child, if necessary. This significantly reduces the likelihood of mother-to-child transmission and is one of the key areas of improvement the WHO stresses, along with greater birth dose coverage. While hepatitis B prevention is not yet complete, reaching the 1% landmark is incredibly important and is the result of decades of hard work and effective policy.

Clay Hallee
Photo: Flickr

Access to Medicine in Developing Countries
In the late 1990s, large pharmaceutical companies priced their HIV/AIDS medications at an exorbitant $15,000 a year, barring people from access to medicine in developing countries who suffered the most from the epidemic and raising public outcry across the world. Pharmaceutical companies defended their right to maintain these prices in the name of protecting their patent of these medical, life-saving drugs.

The good news is, leading pharmaceutical companies in recent years have turned their focus to helping the poor, in what they call “equitable pricing strategies.” This strategy targets middle-to-lower income countries. Large companies have priced HIV/AIDS medication for only $100 a year, a drastic decrease since the 1990s, and have made treatments for malaria, tuberculosis, hepatitis C and some cancers accessible in developing countries.

Impact of These Changes

Nearly 20 million Africans are on HIV/AIDS medication now, a statistic that stands in stark contrast to the thousands of people that died of HIV/AIDS each day in Africa 20 years ago due to the lack of access to medicine in developing countries.

The Access to Medicine Index ranks pharmaceutical companies on how accessible and affordable their medicine is. It ranked 20 of the world’s largest (research-based) pharmaceutical companies, indicating a healthy trend towards affordable medicine that can go to those most affected by common illnesses and diseases.

The Access to Medicine Foundation performs a deep analysis of these companies. For example, the foundation observes whether companies pay attention to the socioeconomic statuses of their customers in order to tailor the prices of their medicine effectively. The foundation has also remarked that large pharmaceutical companies have departed from previous policies and have granted licenses to generic drug companies who can produce a greater quantity of medicine at a lower price.

Cause of These Changes

Statistics show disparities between the health of high-income and low-income populations. In 2011, the life expectancy between high and low-income countries was as extreme as a 36-year gap. Given such a difference, it makes sense that pharmaceutical companies have specifically researched and developed cures for five main illnesses, including lower respiratory infections, diabetes, hepatitis, HIV/AIDS and malaria, that lead to premature deaths. It did this by improving access to medicine in developing countries.

FDA Involvement

The U.S. Food and Drugs Association (FDA) has also taken part in global health and access to medicine crisis in developing countries. The FDA awarded $50,000 to four companies and $25,000 to two companies during its National Capital Consortium for Pediatric Device Innovation. These six companies received awards for their innovative solutions for childcare, ranging from devices that diagnose spinal deformities to technology that cleans central-line associated bloodstream infections. Developing and investing in these technologies could have huge impacts on access to medicine in developing countries where child mortality still poses a serious threat.

Growth for Big Pharma

There are also economic reasons for these changes in the pharmaceutical industry. Research has shown that improving public health boosts the economy. Even incremental improvements in life expectancy can increase yearly economic growth rates by nearly 0.5 percent. As populations become healthier, it increases the demand for medicine. Consequently, pharmaceutical companies have witnessed growing revenues from emerging markets in developing countries. In fact, two large pharmaceutical international companies, AstraZeneca and Sanofi, receive a third of their revenues from developing markets. In short, improving access to medicine in developing countries means future profits for pharmaceutical companies.

The Upshot of These Changes to Access of Medicine in Developing Countries

Despite all the progress that pharmaceutical companies have made, there is still a persistent problem they will only invest and research in drugs that they think will make a profit. Drug prices are often high because of rebates, the cost of taking on risks for development and research of life-saving drugs and fees for intermediary pricing companies. In order to change these persistent industry practices, public pressure seems to play the strongest role, especially in America.

The continued change will come from the convincing of top leadership in pharmaceutical companies to focus on helping the world’s poor and sick, especially in developing countries. For example, under the direction of former Chief Executive, Andrew Witty, for GSK, a British-based pharmaceutical company which has always ranked first on the Access to Medicine Index, has pledged to do as much as he could for the poor in Africa and Asia. It is up to large pharmaceutical companies to set the tone in this new era of providing access to medicine in still developing countries.

–  Luke Kwong
Photo: Pixabay

New Ebola Vaccine Gives Hope
In 2014, West Africa saw the largest Ebola outbreak in history; more than 11,000 people died, and the disease infected more than 27,000 people. Ebola has a very high mortality rate; it kills up to 70 percent of its victims. An immense amount of fear surrounds this disease. In 2014, four cases of Ebola were reported in the United States, including two who contracted the disease on U.S. soil. The rampant global spread of the disease caught the medical community off guard, but it was not the first time they had searched for a solution.

Unfortunately, the Ebola vaccine research from 1974-2014 did not yield promising results, and the treatments for the disease were difficult and labor-intensive. Medical teams would enter an infected area, would separate the sick from those that had not been infected and they would burn the bodies of those that perished from the disease. The protective gear to prevent the medical staff from infection is difficult to wield and can be risky. The need for a vaccine was critical.

As the disease ravaged West Africa in 2014, researchers began working on a vaccine. Clinical trials for two vaccines began in 2014, but there were ethical concerns. The trials had to be expedited because of the aggressive nature of the disease and how many people were infected. The funding for Ebola treatments remained flat from 2004, and the challenges were immense.

In July 2015, the World Health Organization (WHO) released a statement saying that a vaccine developed and tested by Merck, Sharp & Dohme “is highly effective against Ebola.” The rapid work created a turning point in the fight against Ebola.

The Ebola vaccine uses an interesting methodology to stop the spread of the virus because the virus is so virulent, and it spreads so quickly. The vaccine is designed with a “ring” method meaning that every person that has come into contact with an Ebola patient is vaccinated. This stops the virus from spreading further.

The promise of the vaccine was validated in December 2016, as The Lancet reported final results from a Guinea trial that showed that the new Ebola vaccine shows 100 percent effectiveness. While it was not able to stop the last outbreak, an emergency stockpile of 300,000 doses has been developed in hopes of stopping the next outbreak. Merck must now apply to the WHO for full approval, and the U.S. Food and Drug Administration (FDA) will likely be tapped for licensing.

The vaccine may not be effective against all strains of Ebola, but it shows great promise to prevent a catastrophic outbreak like the one in 2014, and it gives hope to the nations that have been devastated by the disease.

Jennifer Graham

Photo: Flickr

mrsa treatment
Methicillin-resistant Staphylococcus aureus, better known as MRSA, is a staph bacterial infection that is resistant to most antibiotics, making it difficult to cure. The Food and Drug Administration has just approved a new MRSA treatment known as oritavancin.

MRSA is best known as the infection spread through hospitals, but is also commonly spread through communities, schools, prisons or other crowded areas. Since it is spread through skin-to-skin contact, the infection is spread in areas with crowding and sanitation deficiencies.

While developing countries may lack the medical records and diagnostic technology to confirm MRSA cases, the usual envirnoment in hospitals and crowded areas point to them as areas where MRSA can commonly spread. Surprisingly, the infection is also very common among hospitals in developing countries as well, making it a disease dangerous around the globe. While scientists are developing a way to treat people once infected, the simplest way of preventing it is simple sanitary solutions such as hand washing.

Once MRSA is in the body, it can cause infections of the valves of the heart or large abscesses. While many diseases need a cut or break in the skin to transfer, it has been recently discovered that MRSA just needs skin on skin. Although it is transferred easily and begins as a simple skin infection, in some cases it can lead to death.

The beauty of oritavancin as a MRSA treatment is that it is able to remain in the body for long periods of time, which eliminates the need to take antibiotics on a daily basis for up to a few weeks. This way, patients can lessen their time getting treated in the hospital and take away the risk of skipping antibiotic treatments.

In a study done to test the drug, researchers held a trial with 475 patients given one dose of oritavancin and 479 patients with one of the classic antibiotic vancomycin twice a day for 7-10 days. The results showed that the single dose of oritavancin worked just as well as the multiple doses of vancomycin.

The FDA has flagged the investigational drug as a “priority review,” meaning the regulatory agency must consider its application within six months. According to the Medicines Company website, the FDA’s action date for the drug is Aug. 6, 2014.

-Courtney Prentice

Sources: CNN, CBS News, NPR, Regional Health Forum
Photo: Sure Wash

The FDA has just released a statement warning consumers of the dangers of acetaminophen. The drug, which is prescribed and taken with nearly the same frequency as candy by North American consumers, can pose serious health risks in dosages as small as 325 mg.

The statement, which was released January 14, points to ignorance on the part of the consumer as a main culprit in inadvertent acetaminophen overdose. Patients frequently find themselves taking too much acetaminophen via over- the-counter drugs or prescription drugs.

Post-operative pains, pains from acute injuries or pains following dental procedures are usually treated with high doses of Vicodin (hydrocodone) and Percocet (oxycodone.) Unaware these pain pills already contain up to 325 to 500 mgs of acetaminophen, consumers will frequently take supplemental Tylenol, whose active ingredient is acetaminophen-causing dangerous results.

These inadvertent acetaminophen overdoses are a leading cause of acute liver failure. Unfortunately, initial symptoms of liver toxicity from acetaminophen are vague and hard to catch. They include fatigue and sometimes nausea, which can be easily mistaken for other illnesses such as the flu.

This frequently happens because when acetaminophen breaks down, its byproduct, NAPQI, can build up and cause serious damage to the liver’s cells. While acetaminophen in low dosages is an effective pain-killer, overwhelming evidence points to the fact that there are no additional benefits to taking more than 325 mg of acetaminophen that would outweigh the added risks for liver injury.

According to the National Institute of Health, acetaminophen poisoning is one of the most common forms of drug toxicity in the world.

Severe injury to the liver has occurred in patients who took more than the prescribed 24-hour period dose of a product that contains acetaminophen, took more than one acetaminophen-containing product at the same time, or, even worse, drank alcohol while taking acetaminophen products.

Drinking is closely linked with liver problems, and trouble really starts when regular heavy drinkers take a lot of acetaminophen over long periods of time.

If one occasionally drinks a lot of alcohol and takes a normal dose of acetaminophen the next day, they most likely will not suffer liver damage. However, multiple high doses of acetaminophen tend to be dangerous for heavy drinkers because they usually have poor diets and low levels of glutathione. This shunts acetaminophen metabolic pathway and results in higher levels of NAPQI.

Acetaminophen, even in doses close to 4,000 milligrams per day, the current daily limit can still be quite toxic to the liver in a small number of people. Anything over 7,000 mg/day is enough to cause a serious overdose.

Acetaminophen gained popularity because COX-2 inhibitors, acetaminophen’s class of drug, are easy on the stomach. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, were hard on the gut, Aspirin has been linked to Reye’s syndrome in children; thus, Tylenol became a panacea.

In 2009, a group of experts called the Acetaminophen Hepatotoxicity Working Group pushed for reform to the FDA and tightening up the rules for acetaminophen.

The Food and Drug Administration advises people always to follow dosing directions, never to take more than the dose indicated and not to take acetaminophen for longer than directed or mix multiple acetaminophen-containing medicines at one time.

Chloe Nevitt

Sources: Harvard Family Health Guide, Forbes, NPR, FDA

Entomophagy, or the practice of eating insects, could fight world hunger and global warming. A 200-page report, released by the UN Food and Agriculture Organization (FAO), at the organization’s Rome headquarters, is calling for restaurants, chefs, and food writers to promote eating insects.

According to the FAO, insects provide high-quality protein and nutrients compared to meat and fish. They can also be an important food supplement for undernourished children,  reproduce quickly, and leave a low environment footprint. Insects are high in protein, and can also be rich in copper, iron, phosphorus, manganese, magnesium, selenium and zinc. Furthermore, insects are four times more efficient in turning feed mass into edible meat, which suggests that food could be produced more cheaply and with fewer emissions.

The long history of entomophagy starts with grasshoppers served “toasted in a little oil with garlic, lemon and salt” on the streets of Oaxaca, Mexico and fly eggs called “Mexican caviar” that Montezuma devoured. Currently, two billion people worldwide indulge in the delicacy. However, consumer digestion will remain an issue when integrating insects into the Western diet. While ingesting insects outright makes many Westerners squeamish, reports by the FDA suggest that insect fragments can already be found several food products such as wheat and tomato juice but is safe to eat on a small scale.

Though this new protein may not find it’s way onto dinner plates in the near future, eating insects could fight would hunger and is an firm step forward in maintaining food security world wide.

– Kira Maixner

Source: The Telegraph