News Scan for May 08, 2015

Cholera in Haiti
Sexual transmission of Ebola
WHO's 'essential medicines'
Antibiotic-responsible chicken
West Nile and weather
Disease-naming guidelines

Cholera cases in Haiti rise dramatically as rainy season nears

The ongoing outbreak of cholera in Haiti that began in late 2010 has led to a dramatic rise in cases over the past 6 months, with nearly 12,000 reported already this year. The rate is only expected to soar further when the rainy season starts next month and as international aid dries up, according to an Agence France-Presse (AFP) story yesterday.

Since the start of 2014, 11,721 new cases have occurred, 113 fatal, says the story. The rainy season starts in June, which will add fuel to the fire. The United Nations (UN) predicts that 50,000 cases may occur this year, compared with a low of 28,000 in 2014

Complicating the situation is a shortage of resources in Haiti as funding sources lag, international agencies leave, and treatment centers close. "For the donor community this is not an emergency, and because it is not considered an emergency, the money, the resources we need to deal with the humanitarian crisis are not coming," said Pedro Medrano, the UN coordinator for the outbreak.

Cholera has infected some 736,000 people in Haiti since 2010, and about 8,800 have died. The outbreak is blamed on UN peacekeepers from Nepal who, it is said, contaminated a river with sewage at their encampment upriver from population centers where people drink the river's water.

The UN, which has not officially admitted to a role in the outbreak, has plans to vaccinate 300,000 Haitians this year but needs $1.9 million to accomplish that goal. A total of $37 million is needed this year for the country's fight against the disease, says the story.
May 7 AFP story
Most recent (Apr 9) CIDRAP News item on the outbreak


WHO advises Ebola survivors about sexual hygiene

Interim advice regarding the risks of sexual transmission of Ebola was issued today by the World Health Organization (WHO), pending more evidence on the possibility of Ebola transmission through seminal and even vaginal fluid.

The recent finding of Ebola virus RNA in an Ebola survivor's semen 199 days after symptom onset, along with a finding of Ebola RNA in a woman's vaginal fluid 33 days after symptom onset, indicates the possibility of male-to-female sexual transmission and the more remote possibility of female-to-male transmission, says the WHO notice.

The agency's advice, based on present evidence, centers on the provision of counseling to Ebola survivors and their partners on safe sexual practices and good hand and personal hygiene after contact with semen; adherence by survivors and their partners to safe sex until semen-test results are negative two times; the offer of semen testing to male Ebola survivors 3 months after disease onset and then every month until two tests are negative; and, in survivors whose semen has not been tested, the practice of safe sex for at least 6 months after disease onset.

In addition, says the WHO, "All survivors, their partners and families should be shown respect, dignity and compassion."
May 8 WHO notice
Related May 1 CIDRAP News story
Related Apr 20 CIDRAP News story


WHO includes new hepatitis C, TB drugs on 'essential medicines' list

The new edition of the WHO's Model List of Essential Medicines includes what it calls ground-breaking new treatments for hepatitis C, multidrug-resistant tuberculosis (TB), and various cancers, the agency announced today.

"When new effective medicines emerge to safely treat serious and widespread diseases, it is vital to ensure that everyone who needs them can obtain them," said WHO Director-General Margaret Chan, MD, MPH. "Placing them on the WHO Essential Medicines List is a first step in that direction."

The list is updated every 2 years by a committee of experts, which this year emphasized the need to "promote equitable access and use of several new highly effective medicines, some of which are currently too costly even for high-income countries," the agency said.

Five new oral antivirals for hepatitis C have recently come on the market, transforming the disease from a barely manageable to a curable condition, the WHO noted. All five, including sofosbuvir and daclatasvir, were included in the list, but high prices currently make them unaffordable and inaccessible to most people who need them, the agency said.

"While some efforts have been made to reduce their price for low-income countries, without uniform strategies to make these medicines more affordable globally the potential for public health gains will be reduced considerably," Marie-Paule Kieny, PhD, WHO assistant director-general for health systems and innovation, said in the statement.

Also added to the WHO list were five new TB drugs, four of which, including bedaquiline and delamanid, target multidrug-resistant TB, the agency said. Their arrival follows about 45 years of little innovation for TB medicines.

The WHO committee also recommended supporting off-label uses of drugs in cases where there is clear evidence of major health benefits though no licensed indication, such as for many medicines for children.
May 8 WHO statement with link to lists for adults and children


Standards set for antibiotic-responsible chicken in school lunches

School Food FOCUS (SFF) and The Pew Charitable Trusts yesterday announced that schools will soon have an option to buy chicken for school lunch programs that meets a new standard for responsible use of antibiotics.

The groups said in a Pew press release that the US Department of Agriculture will verify compliance with the new Certified Responsible Antibiotic Use (CRAU) standard by suppliers who sell chicken to schools, hospitals, and other institutions. By reducing the amount of antibiotics given to poultry, CRAU could slow the emergence of drug-resistant bacteria in food animal, according to the release.

Also, Tyson Foods, the nation’s largest chicken producer, announced that it is the first company to adopt the standard. The company successfully completed an audit at its New Holland, Pa., facilities on Apr 7 and was verified by the USDA that its practices meet the CRAU standard.

SFF and Pew created CRAU with input from the National Procurement Initiative, a collaborative of 15 school districts that serve 2.3 million children nationwide.

"The new standard was created in response to a demand for more sustainably produced school food," said Kathy Lawrence, director of strategic development at SFF. "This is a market-driven, grassroots solution to a critical public health challenge, and demonstrates the leadership school districts can exert as institutional buyers."
May 7 Pew press release


Above-average temps linked to increased West Nile disease

Above-average temperatures were associated with increased levels of West Nile virus (WNV) disease in the United States, whereas dry conditions were tied to increased WNV disease in the eastern United States but not the West, according to a study in the current issue of the American Journal of Tropical Medicine and Hygiene.

Researchers from the National Center for Atmospheric Research (NCAR) and the Centers for Disease Control and Prevention (CDC) divided the country into 10 climate regions and correlated WNV data from 2004 through 2012 with meteorologic conditions.

They found that warmer temperatures were strongly correlated with higher rates of WNV disease throughout most of the country, but the effect was most pronounced in the Northeast and Southeast. In those regions, an annual temperature increase of 1°C (1.8°F) above the 2004-12 average meant a fivefold increased likelihood of above-average disease rates.

The same temperature increase approximately doubled the risk for much of the rest of the country, including the mid-Atlantic, Midwest, and Great Plains. But temperature increases seemed to have no impact in parts of the West.

When it came to precipitation, the relationship was more complex. Below-average annual precipitation was associated with higher disease incidence in the eastern United States, but the opposite was true in most western regions.

Drier-than-normal fall and spring seasons correlated with above-average WNV disease rates the following summer in eastern states. But in much of the West, wetter-than-average winters correlated with above-average rates. The authors surmised that the precipitation-related differences might be related to the types and habits of mosquitoes that inhabit each portion of the country.

"We've shown that it may be possible to build a system to forecast the risk of West Nile virus disease several weeks or months in advance, before the disease begins to peak in summer," said lead author Micah Hahn, PhD, MPH, a scientist with both NCAR and CDC, in an NCAR news release. "Having advance warning can help public health agencies plan and take additional steps to protect the public."
May Am J Trop Med Hyg abstract
May 7 NCAR news release


WHO sets guidelines for preventing stigma when naming new diseases

The WHO has issued a set of best practices for the naming of new diseases, with the aim of preventing the negative effects that can occur when diseases are associated with countries, regions, economic sectors, or groups of people.

"The use of names such as 'swine flu' and 'Middle East Respiratory Syndrome' has had unintended negative impacts by stigmatizing certain communities or economic sectors," said Keiji Fukuda, MD, the WHO's assistant director-general for health security, in a WHO statement.

"This may seem like a trivial issue to some, but disease names really do matter to the people who are directly affected," he said. "We've seen certain disease names provoke a backlash against members of particular religious or ethnic communities, create unjustified barriers to travel, commerce and trade, and trigger needless slaughtering of food animals."

The WHO said diseases are often given common names by nonscientists, and such names are hard to change once established. Therefore, it is important for whoever first reports on a new disease to use an appropriate name that is scientifically sound and socially acceptable.

The WHO advises that a disease name should consist of generic descriptive terms based on the symptoms (eg, respiratory disease, neurologic syndrome) and more specific descriptive terms when there is reliable information on how the disease manifests, whom it affects, and its severity or seasonality (eg, progressive, juvenile, severe, winter). If the pathogen that causes the disease is known, it should be part of the name.

Terms that should be avoided in disease names, the WHO says, include geographic locations (as in Middle East respiratory syndrome), people's names (eg, Creutzfeldt-Jakob disease), animal species or food (eg, swine flu, bird flu, monkeypox), cultural, population, industry, or occupational references (eg, legionnaires), and terms that incite undue fear (eg, unknown, fatal, epidemic).

The best practices apply only to new diseases that have potential public health impact and for which there is no commonly used name, the agency said. They do not apply to established disease names.

Also, the practices apply only to disease names for common usage and do not replace the existing International Classification of Diseases (ICD) system but rather provide an interim solution before the assignment of a final ICD name.
May 8 WHO statement on disease naming


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