Written by ELIZABETH MERAB
The war on malaria has been hit by a funds shortage, slowing down a campaign against a disease that kills more than 10,000 Kenyans every year.
The biggest problem facing the country in its fight against the disease is over-reliance on donor funding, said Health Cabinet Secretary James Macharia.
Kenya requires Sh57 billion over the next four years to eradicate malaria but only has Sh28.5 billion so far, the Ministry of Health has said.
Health principal secretary Khadija Kassachoon said the money would be used to buy nets, drugs and insecticide used to kill mosquitoes by spraying their breeding areas.
“It is time we relied more on domestic funding than donor funding,” said Mr Macharia at a press conference on Tuesday ahead of the World Malaria Day scheduled for Saturday.
But the money will need to be raised by both the government and the private sector to steer the fight against malaria, said head of National Malaria Control Unit Waqo Ejersa.
He said most of the money is often channelled towards spraying households.
The government had set aside Sh200 million for spraying households using indoor residual spraying.
However, Mr Macharia said, the project was plagued by resistance to insecticide, which now calls for research to develop other non-resistant insecticides using natural products.
“We have faced challenges in the implementation of Indoor Residual Spraying (IRS) due to insecticide resistance.
“Kemri (Kenya Medical Research Institute) has already begun research on new insecticide to combat this rising problem,” the CS said.
Although there are challenges, Mr Macharia noted that more pregnant women in malaria-risk regions, especially those at the Coast, are using preventive medicines to reduce the risk of infection.
“We are pleased that the use of preventive medicines among pregnant women in areas where malaria is endemic has gone up. The number now ranges between 22 per cent and 80 per cent,” he said.
Although there are still challenges in eradicating the disease, the ministry said Kenya had made significant strides in combating malaria.
Its prevalence rate has dropped from 30 to 12 per cent over the years, with number of deaths also reducing to 11,000 annually.
There is also a noteworthy reduction in the disease burden among pregnant women and children under the age of five years, who over the years have been at a higher risk of infection.
Roll Back Malaria Partnership
This is a comprehensive plan to implement communication about malaria. This plan could be replicated for other issues or scaled down to meet a group’s needs.
The document includes:
Rationale for and purpose of this framework
The Role of Communication in Achieving Malaria Control Impact and Principles of Effective Programs
Strategic Framework for Advancing the Contribution and Quality of Communication
This document charts a Strategic Framework for ensuring that communication is placed high on the agendas of malaria policy makers and national malaria control strategies in line with the Global Malaria Action Plan (GMAP). The framework provides for significant steps forward, and for a change in both ambition and innovation in tackling malaria.
Please click to download resource http://www.rollbackmalaria.org/files/files/globaladvocacy/docs/BCCstrategicFramework.pdf
Written by Hannah Nichols
New findings by HIV specialists and network security experts at the University College London, UK suggest that the method that HIV spreads through the body mimics that of how computer worms spread to infect multiple computers and that ultimately HIV should be treated earlier to stave off AIDS.
The way HIV spreads is similar to how computer worms spread through both the Internet and local networks to infect as many computers as possible.
The experts at University College London (UCL) have created a new model for HIV progression. From this model they noticed that HIV spreads through the body using two methods:
Via the bloodstream
Directly between cells.
This method is similar to how computer worms spread through both the Internet and local networks to infect as many computers as possible.
The new HIV progression model for this “hybrid spreading” accurately predicts patients’ progression from HIV to AIDS in a major clinical trial.
Detailed sample data from 17 London-based patients were used to verify the model, indicating that “hybrid spreading” provides the most suitable explanation for HIV progression and highlights the benefits of early treatment.
HIV infects CD4+ T cells – the cells that play a vital role in the immune system and protect us from diseases. As HIV advances, the number of active T cells in the body reduces until the immune system can no longer function properly – a state known as “acquired immune deficiency syndrome” or AIDS.
The World Health Organization (WHO) guidelines recommend that HIV treatment should only commence once the number of T cells in the bloodstream fall below a certain level. However, UCL’s model forecasts that treatment should begin as soon as possible after infection to prevent AIDS from developing in the long term.
“The number of HIV cells in the bloodstream is always relatively low, and our model shows that HIV spread through the bloodstream alone would not be enough to cause AIDS,” explains co-senior author Prof. Benny Chain, UCL Infection and Immunity. “It is likely that when HIV gains a foothold somewhere with a high T cell population, such as the gut, it uses a cell-to-cell transfer mechanism to efficiently spread directly between them.” He continues:
“As such, if HIV has already spread to an area rich in T cells by the time treatment begins, preventing its spread through the bloodstream will not stop AIDS. Our model suggests that completely blocking cell-to-cell transfer would prevent progression to AIDS, highlighting the need to develop new treatments.”
HIV model inspired by 2008 damaging Conficker computer worm
The inspiration for the HIV progression model came from similarities between HIV and computer worms such as the highly destructive ‘Conficker’ worm. The Conficker worm was first detected in 2008, which infected military and police computer networks across Europe and is still active today.
Lead author Changwang Zhang, UCL Computer Science, says:
“HIV and Conficker have a lot in common. They both use hybrid-spreading mechanisms, persist for a very long time and are incredibly difficult to eradicate. Our model enables us to explain these important properties and to predict the infection process.”
Changwang’s supervisor, co-author Dr. Shi Zhou, UCL Computer Science, comments, “Although the cybersecurity community organized an unprecedented collaboration to tackle Conficker, they still failed to eliminate Conficker from the Internet. HIV researchers face a similar problem. We hope that our new understanding of hybrid epidemics will help us to fight against Conficker and HIV.”
Previous laboratory research led by co-senior author Dr. Clare Jolly, UCL Infection and Immunity has shown that shown that some drugs are better than others at stopping HIV from spreading directly between cells. However, as the spread occurs inside internal organs, it is unfeasible to measure cell-to-cell spread in patients directly.
“With this new model, we should be able to assess the effectiveness of drugs against different modes of HIV spread in real patients,” explains Dr. Jolly. She concludes:
“This could prove invaluable when interpreting the results of drug trials to understand what works and why. Using computer models to understand processes that we cannot directly observe is common in the physical sciences and supports many fundamental theories. Our model provides strong evidence that cell-to-cell spread is an important part of HIV spread, and we hope to show this directly in future animal studies.”
Medical News Today recently reported on the results of a new trial that shows that a common herpes medication can reduce levels of HIV independent of herpes infection.
culled from – http://www.medicalnewstoday.com/articles/291896.php
(March 24th, Lagos Nigeria) Friends Africa today officially launched a report documenting inspirational stories of TB survivors around the world to commemorate World TB Day. These stories were collated to record first-hand the experiences of TB survivors and the impact of tuberculosis in the lives of patients as well as the ripple effect in communities and families of persons affected with the disease. It also highlights the growing importance as to why we must increase the call for commitments and global responses to promptly reduce the spread.
Friends Africa recognizes the work of global organizations like the Global Fund, Stop TB Partnerships, the United Nations, WHO amongst several others who are working relentlessly to curb the spread and reach the 3million still living with the disease; that is why we must raise our support and call for more financial commitments towards the fight against tuberculosis.
The report titled “Winning the Fight against Tuberculosis, further highlights key areas that must be addressed if the battle must be won. Pertinent areas from poverty to misdiagnosis, lack of care from health care workers to availability of drugs amongst several others were also discussed in the report.
The document also highlights the very successful DOT interventions implemented by the Red Cross and how this has positively impacted the lives of people living with Tuberculosis. It further re-emphasizes the need for early voluntary testing as Tuberculosis is also known to remain latent in the body and can only be cured faster when diagnosed early.
It’s our intention with this report that more emphasis will be laid on early detection as a preventive approach as well as increased sensitization and awareness amongst the public as many people still underrate the impact of Tuberculosis.
Click to download report http://www.viewdocsonline.com/document/b40yu3
For further details, please contact
Researcher: Richard S. Garfein, Fatima Munoz
Tuberculosis (TB) is an airborne infectious disease that remains a global health threat affecting over two billion people — one-third of the world’s population — and is one of the three leading causes of death worldwide due to infectious diseases. TB can be effectively treated with antibiotic therapy, but better tools are needed to improve compliance for TB treatment regimens which last for longer than six months, otherwise illness progresses, TB transmission continues and bacteria can become drug-resistant.
To obtain high adherence and prevent drug resistance, health agencies recommend Directly Observed Therapy (DOT) to monitor patients taking each dose of medication; however, DOT is labor and cost intensive, requires transportation, restricts patient mobility, and may not be used when patients live far from health centers.
A solution has been developed by researchers at UC San Diego’s Division of Global Public Health and programmers at Calit2: a monitoring system of Video Directly Observed Therapy (VDOT), which allows patients to use smartphones to make and send videos of each medication dose taken that health workers watch from their office using a secure website. Through this quick, simple process, care providers can focus their efforts on non-adherent patients. In 2010 – 2012, the VDOT System was pilot tested with 43 patients in San Diego and nine patients in Tijuana, which found that VDOT was feasible, acceptable and more than 93 percent of expected doses were observed using VDOT.
PDEL is currently funding work to customize the VDOT software so that it works reliably and securely in the Mexican environment. The team will also establish operational protocols in Spanish and develop data collection instruments needed for a larger pilot study comparing VDOT to traditional in-person DOT among TB patients at the two largest providers of health care for TB cases in Tijuana: the Mexican Institute of Social Security (MISS) and Institute of Health Services, or ISESALUD.
Expected Results and Policy Implications
The results of the current work and subsequent pilot study could change policies at IMSS and ISESALUD to allow implementation of VDOT in Baja California and possibly the rest of Mexico.
Increased adherence to TB treatment as a result of VDOT has a significant public health benefits to both Mexico and the United States populations. While TB incidence overall has declined in the U.S., the proportion of foreign-born cases has increased, and 47 percent of all foreign-born cases in San Diego were from Mexico. TB control efforts elsewhere can directly impact TB in the U.S. The U.S.-Mexico border is not a barrier to TB transmission and TB incidence in this region is many times higher than the national averages in Mexico and the U.S.
Finally, a new empirical literature is demonstrating the fascinating interplay between schooling, aspirations, empowerment and long-term welfare for questions as diverse as child sponsorship and the relationship between fatalism and credit demand.
Coinciding with the new law, Brazil is the first pilot country adapting the Latin American Model Protocol for the Investigation of Gender-related Violent Deaths, promoted by UN Women and OHCHR
Announced on national television on International Women’s Day and hailed as a commitment to UN Women’s new Step It Up campaign, on 9 March Brazilian President Dilma Rousseff signed a new law that criminalizes femicide, the gender-motivated killing of women, and sets tougher penalties for those responsible for such crimes. Noting that on average 15 women are murdered every day in Brazil simply for being women, she described the matter as “a gender issue”.
The new legislation amends Brazil’s Penal Code to redefine “femicide” as any crime that involves domestic violence, discrimination or contempt for women, which results in their death. Imposing harder sentences of between 12 to 30 years’ imprisonment, the bill also includes longer jail terms for crimes committed against pregnant women, girls under 14, women over 60 and women and girls with disabilities. Brazil is the 16th Latin American nation to include a Femicide Act in its national legal framework.
UN Women representative in Brazil Nadine Gasman said, “It should be noted that femicide is the killing of women for being women, in a vicious cycle of violence and torture that degrades the feminine identity. This law reinforces the policy commitment made by the President to the country, a commitment to zero tolerance of gender-based violence and to prioritizing the rights of female citizens with regard to empowerment and equality.”
The bill was an initiative of the Brazilian parliament based on the foundation created by the Joint Parliamentary Commission of Enquiry into the Omission of Public Authorities of Violence against Women and will seek to also ensure further implementation of the 2006 Maria da Penha Law on domestic violence. After being passed by the Senate in December 2014, the femicide law was approved by the House of Representatives on 3 March 2015.
More than 92,000 women were murdered in Brazil between 1980 and 2010. According to the Map of Violence 2012, the number of deaths rose from 1,353 to 4,465 in this period, representing an increase of 230 per cent. A report by the Brazilian Centre for Latin American Studies and the Latin American Faculty of Social Sciences ranked Brazil at 7th place internationally for the murder of women.
Since August 2014, UN Women, Brazil’s Secretariat of Policies for Women and the Austrian Embassy have been coordinating with law and justice officials to adopt the Latin-American Model Protocol for the Investigation of Gender-related Violent Deaths* in Brazil. The instrument provides guidelines and tools to support the work of those responsible for the investigation and prosecution of the gender-based violent death of women.
Brazil femicide roundtable
The 10-member Inter-institutional Working Group, that is working on adapting the regional femicide protocol to Brazil’s national context, met for the first time in December 2014. Photo credit: UN Women Brazil/Isabel Clavelin
It captures the experiences and lessons learned of more than 200 experts from 18 countries across Latin America and Europe who took part in an extensive consultation process over several years to achieve its wording. The process was coordinated by UN Women and the UN Office of the High Commissioner for Human Rights (OHCHR) as part of the Secretary-General’s campaign UNiTE to End Violence against Women.
Several Latin American countries have shown interest in adapting the Model Protocol. On account of its high rates of violence and the existing provision, Brazil was chosen as the first pilot country in the region for incorporating the Protocol within its national legislation and guidelines, to investigate and collect material and other evidence of murder for legal processes.
To adapt the regional Protocol at national level, an Inter-institutional Working Group was set up, composed of 10 professionals – police, criminal experts, public prosecutors and magistrates – and representatives of various regions of Brazil. The Working Group met for the first time in December 2014, discussing procedures, routines and processes in investigating the murders of women.
Participating in the debate on femicide was criminal expert Herbert Boson, who practises in João Pessoa, capital of the state of Paraíba. He believes the protocol will expose the weakness of current investigations and provide learning opportunities to improve them.
“We, as criminal experts, are going to make this a reality to guarantee more robust investigations and more just punishments,” concluded Mr. Boson.
Professionals are still working on adapting the protocol, a task which is now taking on even greater relevance and urgency with the passing of the new Femicide Act.
Culled from UNWomen.Org- See more at: http://www.unwomen.org/en/news/stories/2015/3/in-brazil-new-law-on-femicide-to-offer-greater-protection#sthash.zs9Cbf22.dpuf
Twenty years ago, when the world convened a landmark conference on women’s human rights, the devastating conflict in the former Yugoslavia prompted deserved attention to rape and other war crimes there against civilians. Two decades later, with girls as young as seven not only targeted but used as weapons by violent extremists, it would be easy to lose heart about the value of international gatherings. But while we have a long way to go to achieve full equality – with ending gender-based violence a central goal – progress over the past two decades has proven the enduring value of the 1995 Beijing Conference on Women.
Since the adoption of its Declaration and Platform for Action, more girls have attained more access to more education than ever before. The number of women dying in childbirth has been almost halved. More women are leading businesses, governments and global organizations. I welcome these advances. At the same time, on this International Women’s Day, we must acknowledge that the gains have been too slow and uneven, and that we must do far more to accelerate progress everywhere.
The world must come together in response to the targeting of women and girls by violent extremists. From Nigeria and Somalia to Syria and Iraq, the bodies of women have been transformed into battlegrounds for warriors carrying out specific and systematic strategies, often on the basis of ethnicity or religion. Women have been attacked for trying to exercise their right to education and basic services; they have been raped and turned into sex slaves; they have been given as prizes to fighters, or traded among extremist groups in trafficking networks. Doctors, nurses and others have been assassinated for trying to operate in their professional capacity. The women human rights defenders brave enough to challenge such atrocities risk – and sometimes lose – their lives for the cause.
We must take a clear global stance against this total assault on women’s human rights. The international community needs to translate its outrage into meaningful action, including humanitarian aid, psycho-social services, support for livelihoods, and efforts to bring perpetrators to justice. With women and girls often the first targets of attack, their rights must be at the centre of our strategy to address this staggering and growing challenge. Empowered women and girls are the best hope for sustainable development following conflict. They are the best drivers of growth, the best hope for reconciliation, and the best buffer against radicalization of youth and the repetition of cycles of violence.
Even in societies at peace, too many girls and women are still targets of domestic abuse, female genital mutilation and other forms of violence that traumatize individuals and damage whole societies. Discrimination remains a thick barrier that must be shattered. We need to expand opportunities in politics, business and beyond. We need to change mind-sets, especially among men, and engage men in becoming active change-agents themselves. And we must back up our resolve with resources based on the sure understanding that investments in gender equality generate economic progress, social and political inclusion and other benefits that, in turn, foster stability and human dignity.
This is a vital year for advancing the cause of women’s human rights. The international community is hard at work on establishing a new sustainable development agenda that will build on the Millennium Development Goals and shape policies and social investments for the next generation. To be truly transformative, the post-2015 development agenda must prioritize gender equality and women’s empowerment. The world will never realize 100 per cent of its goals if 50 per cent of its people cannot realize their full potential. When we unleash the power of women, we can secure the future for all.
In 1995, at the Fourth World Conference on Women in Beijing, world leaders committed to a future where women are equal. One hundred and eighty nine countries and 4,000 civil society organizations, attended the conference. Women left Beijing with high hopes, with a well-defined path towards equality, and firm commitments at the highest level. Their hope was that we would see this by 2005. Today, not one single country has achieved equality.
It is more urgent than ever that we define – and stick to – a time frame. There has been some progress in the last 20 years – although it has been slow and uneven. Countries have narrowed the gender gap in education and some have even reached gender parity in school enrollment. They have reduced the toll of maternal mortality and morbidity. Many more women survive pregnancy and childbirth than in 1995. Many countries have created institutions that address gender inequality. Many have passed laws against gender-based discrimination. Many have made domestic violence a crime. This is all good news. And yet we are still a long way from achieving equality between men and women, boys and girls.
Implementation of good policies has been patchy. Allocation of the resources needed for effective implementation has been insufficient to fund women’s ministries, gender commissions, gender focal points, and gender-responsive budgeting. For too many women, especially in the least-developed countries, not enough has changed. In Africa, 70 per cent of crop production depends on women yet women still own only 2 per cent of the land. Violence against women continues to blight lives in all countries of the world. And no country has achieved gender equality.
Women need change and humanity needs change. This we can do together; women and girls, men and boys, young and old, rich and poor. The evidence is overwhelming of the benefits that equality can bring. Economies grow, poverty is alleviated, health status climbs, and communities are more stable and resilient to environmental or humanitarian crises. Women want their leaders to renew the promises made to them. They want leaders to recommit to the Beijing Declaration, to the Platform for Action, and to accelerated and bolder implementation. They want more of their leaders to be women. And they want those women, together with men, to dare to change the economic and political paradigms.
Gender parity must be reached before 2030, so that we avert the sluggish trajectory of progress that condemns a child born today to wait 80 years before they see an equal world. Today, on International Women’s Day, we call on our countries to “step it up” for gender equality, with substantive progress by 2020. Our aim is to reach ‘Planet 50:50’ before 2030. The world needs full equality in order for humanity to prosper. Empower women, empower humanity. I am sure you can picture an equal world!
The current global influenza situation is characterized by a number of trends that must be closely monitored. These include: an increase in the variety of animal influenza viruses co-circulating and exchanging genetic material, giving rise to novel strains; continuing cases of human H7N9 infections in China; and a recent spurt of human H5N1 cases in Egypt. Changes in the H3N2 seasonal influenza viruses, which have affected the protection conferred by the current vaccine, are also of particular concern.
Viruses in wild and domestic birds
The diversity and geographical distribution of influenza viruses currently circulating in wild and domestic birds are unprecedented since the advent of modern tools for virus detection and characterization. The world needs to be concerned.
Viruses of the H5 and H7 subtypes are of greatest concern, as they can rapidly mutate from a form that causes mild symptoms in birds to one that causes severe illness and death in poultry populations, resulting in devastating outbreaks and enormous losses to the poultry industry and to the livelihoods of farmers.
Since the start of 2014, the Organisation for Animal Health, or OIE, has been notified of 41 H5 and H7 outbreaks in birds involving 7 different viruses in 20 countries in Africa, the Americas, Asia, Australia, Europe, and the Middle East. Several are novel viruses that have emerged and spread in wild birds or poultry only in the past few years.
Some of the outbreaks notified to OIE have involved wild birds only. Such notifications are indicative of the heightened surveillance and improved laboratory detection that have followed the massive outbreaks of highly pathogenic H5N1 avian influenza that began in Asia in late 2003.
Detection of highly pathogenic avian influenza viruses in wild birds signals the need for a close watch over poultry farms. Migratory waterfowl, immune to the disease, are known to spread avian viruses to new areas by quickly crossing continents along the routes of several flyways. These migratory waterfowl subsequently mix with local wild birds and poultry that then become infected.
H7N9: no change in the epidemiology of human infections
The world’s first three human cases of infection with the H7N9 avian influenza viruses were reported by China on 31 March 2013. Investigations by Chinese authorities determined that the earliest likely cases had symptom onset in mid-February. That event also marked the first time that this H7N9 subtype had been detected in humans, poultry or any other animals.
To date, 602 human H7N9 cases and 227 deaths have been reported, the vast majority in mainland China. This total includes 4 cases reported by the Taipei Centers for Disease Control and 13 cases reported by the Centre for Health Protection, Hong Kong SAR, China. Malaysia reported one case in a Chinese traveller in 2014, and Canada reported two mild cases in travellers returning from China in January 2015.
The epidemiological pattern seen during 2013 showed a sharp spike in cases in March and April followed by only two cases reported during the summer. The official closing of live poultry markets in several provinces in April may have contributed to this decline. A second wave of infections began more slowly in October.
A similar pattern of seasonality was seen during 2014, but with a higher and earlier spike in January and more cases reported during the spring compared with 2013. Again, cases virtually ceased over the summer, then gradually increased in November. Cases increased in January 2015, but not as sharply as seen during the same month in 2014.
Like H5N1, the H7N9 virus causes serious illness in humans. But unlike H5N1, H7N9 does not cause illness or deaths in birds. The absence of signs of disease in infected birds omits the warning signal calling for heightened surveillance for human cases. Consequently, the detection of human cases has triggered a search for the virus in birds.
As observed, a substantial proportion of human cases have reported direct exposure to live poultry or contaminated environments, including live poultry markets. In addition, careful studies have shown that exposure to live poultry and poultry markets are risk factors for H7N9 infection.
All evidence indicates that the H7N9 virus does not spread easily from one person to another, though it may transmit from poultry to humans more readily than H5N1.
In a few small clusters of human cases, the possibility of limited human-to-human transmission cannot be excluded. However, all possible transmission chains have been short, with no evidence of spread into the wider community.
Approximately 36% of reported human cases have been fatal. It is not yet known whether significant numbers of asymptomatic or mild cases also are occurring without being detected. The existence of asymptomatic and mild cases would lower the percentage of people who died from this infection.
H5 viruses: currently the most obvious threat to health
The highly pathogenic H5N1 avian influenza virus, which has been causing poultry outbreaks in Asia almost continuously since 2003 and is now endemic in several countries, remains the animal influenza virus of greatest concern for human health. From end-2003 through January 2015, 777 laboratory-confirmed human cases of H5N1 virus infection have been reported to WHO from 16 countries. Of these cases, 428 (55.1%) have been fatal.
Over the past two years, H5N1 has been joined by newly detected H5N2, H5N3, H5N6, and H5N8 strains, all of which are currently circulating in different parts of the world. In China, H5N1, H5N2, H5N6, and H5N8 are currently co-circulating in birds together with H7N9 and H9N2.
The H9N2 virus has been an important addition to this mix, as it served as the “donor” of internal genes for the H5N1 and H7N9 viruses. Over the past four months, two human infections with H9N2 occurred in China. Both infections were mild and the patients fully recovered.
Virologists interpret the recent proliferation of emerging viruses as a sign that co-circulating influenza viruses are rapidly exchanging genetic material to form novel strains. Viruses of the H5 subtype have shown a strong ability to contribute to these so-called “reassortment” events.
The genomes of influenza viruses are neatly segmented into eight separate genes that can be shuffled like playing cards when a bird or mammal is co-infected with different viruses. With 18 HA (haemagluttinin) and 11 NA (neuraminidase) subtypes known, influenza viruses can constantly reinvent themselves in a dazzling array of possible combinations. This appears to be happening now at an accelerated pace.
For example, H5N2 viruses recently detected in poultry in Canada and in wild birds in the US are genetically different from H5N1 viruses circulating in Asia. These viruses have a mix of genes from a Eurasian H5N8 virus, likely introduced into the Pacific Flyway in late 2014, along with genes from North American influenza viruses.
Little is known about the potential of these novel viruses to infect humans, but some isolated human infections have been detected. For example, the highly pathogenic H5N6 virus, a novel reassortant, was first detected at a poultry market in China in March 2014. The Lao People’s Democratic Republic reported its first outbreak in poultry, also in March, followed by Viet Nam in April. Genetic studies showed that the H5N6 virus resulted through exchange of genes from H5N1 viruses and H6N6 viruses that had been widely circulating in ducks.
China detected the world’s first human infection with H5N6, which was fatal, in April 2014, followed by a second severe human infection in December 2014. On 9 February 2015, a third human H5N6 infection, which was fatal, was reported.
The emergence of so many novel viruses has created a diverse virus gene pool made especially volatile by the propensity of H5 and H9N2 viruses to exchange genes with other viruses. The consequences for animal and human health are unpredictable yet potentially ominous.
H5N1 infections in Egypt
The sudden increase in the number of H5N1 human infections in Egypt that began in November 2014 and continued during January and February 2015 awakened concern. From the start of November to 23 February, Egypt reported 108 human cases and 35 deaths. The number of cases over this period is larger than yearly totals reported by any country since human H5N1 virus infections re-emerged in late 2003.
According to FAO, a total of 76 outbreaks of highly pathogenic H5N1 avian influenza were detected in 20 of Egypt’s 27 governorates between 18 January and 7 February 2015. Of these outbreaks, the majority – 66 – occurred in household poultry.
Although all influenza viruses evolve over time, preliminary laboratory investigation has not detected major genetic changes in the viruses isolated from patients or animals compared to previously circulating isolates that would help to explain the sudden increase in human cases.
Health and agricultural officials in Egypt have extensive experience with this disease. In their view, more widespread circulation of H5N1 in poultry during this time, combined with the large number of households that keep small flocks with poor understanding of the associated health risks, is the most likely explanation for this spurt in new cases.
This observation, in turn, signals an urgent need for agricultural investigations to identify, and reduce, the source of this heavy viral contamination. A second motivation is the very real risk that poultry trade, whether legal or illegal, will introduce the virus to new countries. The detection of cases with moderate illness suggests that surveillance on the human side is reasonably good.
On 10 February, Egyptian authorities notified WHO of a case of H9N2 infection in a three-year-old boy. The illness was mild and the boy was discharged from hospital fully recovered. However, the fact that H9N2 is co-circulating with H5N1 is cause for concern.
Reduced vaccine protection against seasonal influenza
Experts convened by WHO decide on the composition of seasonal influenza vaccines for the northern hemisphere in February of each year. Doing so gives manufacturers sufficient time to have doses of vaccines ready before the start of the flu season, usually in October or November.
Since February 2014, the genetic make-up and antigenic properties of the H3N2 virus, the predominant seasonal virus circulating in North America and Europe, changed significantly. This change allowed most of the viruses circulating in the flu season to elude protection provided by the vaccine which was designed for an older virus with distinctly different characteristics.
As a result, interim estimates of the effectiveness of the current seasonal vaccine in reducing the risk of medical visits associated with influenza infection – in all age groups – was only 23% in the US. This is lower protection than usual but is not unexpected for seasons when there is a significant rapid change in the properties of circulating viruses. Seasons where there is a significant reduction in seasonal vaccine protection due to the rapid and unpredictable evolution of influenza A viruses are relatively rare with only four seasons during the past 25 years.
Since the 2004–2005 influenza season, US researchers have produced annual estimates of vaccine effectiveness. Estimated vaccine effectiveness in the US has ranged from 10% to 60%, with effectiveness in most years being 40-60%. This calls for better vaccines.
The state of global preparedness for an influenza pandemic
On many levels, the world is better prepared for an influenza pandemic than ever before.
The level of alert is high, supported by elevated virological surveillance in both human and animal populations. For example, during 2014, the 142 laboratories in 112 countries in the WHO Global Influenza Surveillance and Response System tested more than 1.9 million clinical specimens. By keeping a close watch over the volatile world of influenza viruses, these laboratories operate as a sensitive early warning system for the detection of viruses with pandemic potential.
More national laboratories are now equipped, staffed, and trained to conduct early detection, isolation, and characterization of viruses. Drawing on support from laboratories in the WHO System, WHO offers all interested laboratories – anywhere in the world – free diagnostic reagents and test kits for seasonal viruses and for viruses of the H5 and H7 subtypes.
During the 2009 H1N1 pandemic, WHO and its collaborating laboratories were able to start shipping diagnostic reagent kits in 7 days after the declaration of a public health emergency of international concern. The mechanisms worked out for accomplishing this rapid response will be another asset when the next pandemic inevitably begins.
Countries that have experienced human cases of avian influenza know the disease well and have mechanisms in place to detect cases quickly, track the likely source of infection, and monitor close contacts for symptoms and any evidence of human-to-human transmission.
WHO, through its Global Influenza Surveillance and Response System network, is closely monitoring the emergence and evolution of influenza viruses with pandemic potential, assessing associated risks, and developing candidate vaccine viruses for pandemic preparedness purposes.
Ways are being found to shorten the time between the emergence of a pandemic virus and the availability of safe and effective vaccines. Advances in synthetic vaccine technology mean that candidate vaccine viruses can be produced in about two weeks following detection of a virus with pandemic potential.
Fast-track procedures for regulatory approval have been developed. In Europe, advance studies using “mock-up” vaccines can greatly expedite regulatory approval. These studies use an influenza strain that has not circulated recently in human populations to mimic the novelty of a pandemic virus.
Strengthened surveillance, advances in vaccine production technology, and regulatory preparedness can possibly shorten the time lapse between the detection of a pandemic virus and the availability of vaccines to 3–4 months. With WHO support, more low- and middle-income countries now have facilities for manufacturing vaccines. According to a recent estimate, the maximum annual global manufacturing capacity has risen to 1.5 billion doses of seasonal influenza vaccines and the potential of 6.2 billion doses in the event of a pandemic.
Safety and immunogenicity data on pandemic vaccines are now substantial. These data draw on more than 130 clinical trials of H5 vaccines and vaccines combining protection against H5 with protection against seasonal influenza.
More antiviral medicines, including peramivir and laninamivir as well as oseltamivir and zanamivir, are now available to treat influenza and reduce the duration and severity of infection.
The WHO Pandemic Influenza Preparedness framework, which came into effect in May 2011, provides mechanisms for ensuring that the information and benefits that accrue from sharing influenza viruses and biological materials are fairly distributed, as expressed through increased access of developing countries to vaccines and other medical products needed during a pandemic. The framework includes provisions for manufacturers to share a fixed proportion of their pandemic vaccines with WHO as these vaccines roll off the production line.
In the final analysis, as was shown during the 2009 H1N1 pandemic, the overall response of health systems, especially in the developing world, will have a major impact on how well available vaccines and other medical interventions can be provided to protect populations during the next pandemic.
Critical capacities needed include adequate storage and delivery channels, an ability to quickly extend services to large numbers of people in all age groups, a well-developed laboratory system, and sufficient numbers of staff and hospital beds. Experience in conducting mass public education campaigns, supported by public confidence in the health system, is another key asset. However, these capacities are lacking in a large number of developing countries.
Warning: be prepared for surprises
Though the world is better prepared for the next pandemic than ever before, it remains highly vulnerable, especially to a pandemic that causes severe disease. Nothing about influenza is predictable, including where the next pandemic might emerge and which virus might be responsible. The world was fortunate that the 2009 pandemic was relatively mild, but such good fortune is no precedent.
WHO and its collaborating laboratories continue to help countries strengthen their alert, surveillance, and response capacities. A quality assurance program has been conducted by WHO since 2007 to maintain global influenza virus laboratory detection capacity, with panels of testing materials being provided free-of-charge to countries once or twice a year. To further capacity building in countries, particularly developing countries, nearly $17 million was provided in 2014 through the Pandemic Influenza Preparedness framework.
Virological research, which has done so much to aid the detection and understanding of novel viruses, assess their pandemic risks, and track their international spread, needs to continue at an accelerated pace.
More R&D is needed to develop better vaccines and shorten the production time. During a severe pandemic, many lives will be lost in the 3 to 4 months needed to produce vaccines.
An influenza pandemic is the most global of infectious disease events currently known. It is in every country’s best interests to prepare for this threat with equally global solidarity.
The President of the Federal Republic of Nigeria, H.E Dr. Goodluck Ebele Jonathan GCFR, has signed the HIV and AIDS Anti-Discrimination ACT 2014, a reflection of Nigeria’s commitment to stopping all forms of stigmatization and discrimination targeted at people living with HIV/ AIDS.
This historical legislation makes provisions for the prevention of HIV-related discrimination and provides for access to healthcare and other services. It also provides for protection of the human rights and dignity of people living with HIV and those affected by AIDS in Nigeria.
The new law is a notable milestone in the fight to end discrimination as well as a source of renewed hope that all acts of discrimination against people living with HIV such as recruitment and termination of employment, denial of access to services including healthcare, education, association and other social services will be quickly reduced and ultimately ended.
Reacting to this news, the Network of People Living with HIV in Nigeria (NEPWHAN) also expressed its joy in the legislation. The National Secretary of the body Mr. Victor Omosehin said “This is a New Year gift from Mr. President to the 3.5 million Nigerians living with HIV. We appreciate this unprecedented development as it is the beginning of the end to stigma and discrimination in Nigeria”
The law is the latest addition to Nigeria’s commitment to end the AIDS epidemic by 2030. During the past four years alone, close to four million pregnant women were tested for HIV and now know their status, while 8.2 million adults in the general population were tested. By 2013, the number of HIV infections had declined by 35% and Nigeria is pursuing efforts to stop new infections altogether. The number of sites providing services to prevent mother-to-child transmission of HIV increased from 675 in 2010 to 5,622 in 2013.
The Government of Nigeria remains fully committed to improving the health of Nigerians and getting to zero new HIV infections, zero AIDS related deaths and zero discrimination. Ultimately, Nigeria will be able to end the AIDS epidemic by 2030.