News Scan for Jun 23, 2015

Health and climate change
Saudi MERS update
MDR-TB spread in contacts

Experts underscore effect of climate change on public health

An international research group today warned that climate change could erode 50 years' of public health gains, but addressing the problem now presents a global health opportunity, according to a report today in The Lancet. The group, called the Lancet Commission on Health and Climate Change, was formed earlier this year to sketch out climate change impacts and policy changes needed to protect the world's populations.

Some of the infectious disease issues addressed in the report include malaria and other vectorborne diseases, such as cholera. The report notes that a one-health approach is needed to manage zoonotic outbreaks such as Ebola and influenza. The experts said some climate factors, such as exposure to emissions, may take years to have an effect, for example, on respiratory infections.

Peter Byass, PhD, of Umea University in Swden, a senior advisor to the group, said in a statement that the direct health effects are enormous, and events could destabilize societies if people are forced to move because of climate conditions. "Mitigation and adaptation around climate change can have positive health effects, for example both by reducing emissions and improving dietary habits," he added.

The group proposes a new global action plan to monitor the situation and report every 2 years to the United Nations, and its report today is expected to inform discussions at the UN climate change conference slated for late November in Paris.

In a statement today, Jeffrey Levi, PhD, executive director of Trust for America's Health (TFAH), said the Lancet report clearly defines the consequences of not acting but also shows how new actions might help.

"We know that, as climate and weather patterns shift, they contribute to the emergence of new diseases and the reemergence or spread of diseases that were nearly eradicated or thought to be under control," he said. "As changes in temperature and weather patterns allow pathogens to expand into different geographic regions, some vector- and zoonotic-borne diseases may increase along with foodborne and waterborne diseases."

He added that sustained federal planning funding is needed to mobilize all agencies to address the problems.

A White House Climate Change and Health Summit was held today, but Levi said for an effective ongoing impact, federal policymakers need more than a 1-day forum. The White House released a report yesterday on the health and economic benefits of global action on climate change.
Jun 23 Lancet abstract
Jun 22 Umea University press release
Jun 23 TFAH press release
Jun 22 White House report climate change health and economics


WHO notes more Saudi hospital MERS outbreak cases

The World Health Organization (WHO) today provided more details about five MERS-CoV cases reported by Saudi Arabia between Jun 13 and Jun 17, four of them with links to an ongoing hospital outbreak in Hofuf.

Patients with links to the hospital outbreak include a 28-year-old male administrative assistant in a hospital experiencing an outbreak, a 69-year-old woman who frequently visited a hospital that is experiencing an outbreak, a 54-year-old woman who was admitted to an outbreak hospital, and 55-year-old woman who had been both an inpatient and an outpatient at an outbreak hospital.

The fifth MERS-CoV (Middle East respiratory syndrome coronavirus) patient is a 46-year-old man from the city of Huraymila who has a history of contact with camels and consuming raw camel milk.

Illness onsets for the patients range from May 23 to Jun 23. All five of the patients have underlying health conditions. Four are in stable condition, and one is listed as critical. The WHO noted that investigations into the source of the infections are still under way for the four patients with hospital links and that contact tracing is ongoing for all of the cases.

Also, the WHO said Saudi Arabia has notified it of five MERS-CoV deaths in previously reported patients.
Jun 23 WHO update


Study: MDR-TB less transmissible than drug-susceptible TB

Multidrug-resistant tuberculosis (MDR-TB) might be less capable of spreading within a household than drug-susceptible TB, according to a study of Peruvian patients today in PLoS Medicine.

UK, US, Peruvian, and WHO researchers followed 1,055 household contacts of 213 MDR-TB patients, as well as 2,362 household contacts of 487 patients with drug-susceptible TB for up to 3 years.

Thirty-five (3.3%) of the MDR-TB contacts developed TB, compared with 114 (4.8%) of the drug-susceptible TB contacts. When the investigators adjusted for risk factors such as HIV infection, socio-economic status, and sputum smear grade of the index case, household contacts of MDR-TB patients were 44% less likely to contract TB compared with the other contacts (0.56 hazards ratio).

The researchers noted that they did not have genoptyping data for infections in household contacts, so some of the secondary TB cases might have been contracted from someone outside the household. They also said that transmission dynamics might be different in the community setting.

The authors concluded, "The low relative fitness of MDR-TB estimated by this study improves the chances of controlling drug-resistant tuberculosis. However, fitter multidrug-resistant strains that emerge over time may make this increasingly difficult."
Jun 23 PLoS Med study

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