Showing posts with label CDC. Show all posts
Showing posts with label CDC. Show all posts

Thursday, May 8, 2014

The autism vs vaccines controversy

In 1998 an article published in the British Journal The Lancet claimed it found a causal connection between the MMR vaccine and autism. Although that article was widely disputed and later retracted, it has left behind a significant following, leading many parents to refuse MMR vaccination for their children. The anti-vaccine groups also stressed on the use of mercury-based preservative Thimerosal in vaccines as a suspected culprit. As a result the government has gradually removed it or reduced it to trace amounts in all vaccines in 2001, in spite of no scientific proof of its possible link to incidence of autism. As explained on the CDC website;

"Over the years, some people have had concerns that autism might be linked to the vaccines children receive. One vaccine ingredient that has been studied specifically is thimerosal, previously used as a preservative in many recommended childhood vaccines. However, in 2001 thimerosal was removed or reduced to trace amounts in all childhood vaccines except for one type of influenza vaccine, and thimerosal-free alternatives are available for influenza vaccine. Evidence from several studies examining trends in vaccine use and changes in autism frequency does not support such an association between thimerosal and autism. Furthermore, a scientific review by the Institute of Medicine (IOM) concluded that "the evidence favors rejection of a causal relationship between thimerosal–containing vaccines and autism." CDC supports the IOM conclusion that there is no relationship between vaccines containing thimerosal and autism rates in children.
The IOM also recently conducted a thorough review of the current medical and scientific evidence on vaccines and certain health events that may be observed after vaccination. It released a report in August 2011 on 8 vaccines given to children and adults that found the vaccines to be generally safe and serious adverse events following these vaccinations to be rare."

The 2012 National Immunization Survey  found that about 90% of children aged 19 to 35 months completed recommended vaccinations and less than 1% received no vaccines at all. But it also highlighted the fact that rates are varied by states and regions therefore leaving some areas vulnerable to outbreaks of measles and other vaccine preventable diseases. The resurgence of measles and whooping cough (Pertussis) in recent years after decades of almost complete extinction could possibly be the distressing consequence of an increasing number of parents refusing the MMR vaccine on grounds of its possible association to autism. 

As explained by Puneet Kollipara in The Washington Post article How the anti-vaccine movement is endangering lives (May 5, 2014).

A measles outbreak that struck a Texas megachurch community late last summer sickened 21 people. And just recently, at least 16 people got sick during a measles outbreak in Ohio. In fact, the Centers for Disease Control and Prevention recently reported 13 measles outbreaks so far in 2014 -- the most since 1996.

According to an article in JAMA News;

Overall, among 140 US residents who acquired measles, 117 (84%) were unvaccinated, and 11 (8%) had unknown vaccination status. Of those who were unvaccinated, 92 (79%) had philosophical objections to vaccination, and 15 cases (13%) occurred among infants younger than 12 months who were not eligible for vaccination.


Besides leading to prevention and saving lives, these vaccines are also economically beneficial, as pointed out by Kuneet Kollipara;

A new study from CDC researchers led by Anne Schuchat analyzed what happened to disease rates as childhood vaccination rates increased starting in the early 1990s. The researchers used these findings to model the resulting effect over the kids' lifetimes. In the analysis, the researchers factored in most routine vaccines recommended for children below age 6 (among them the MMR and whooping cough vaccines). Their findings: Routine childhood vaccinations given between 1994 and 2013 will save 732,000 lives and prevent 322 million cases of illness and 21 million hospitalizations over the course of the children's lifetimes. 

In 2009 alone, the researchers determined, each $1 spent on vaccines and their administration yielded $10 in benefits to society. And the vaccinations from 1994-2013, the researchers found, will save society a net $1.38 trillion, both directly (by reducing health expenses) and indirectly (via the economic activity that is saved from avoided illnesses). That's almost 10 percent of the U.S. economy's gross domestic product.

In the end vaccines may not be without fault but there is no clear cut evidence to their causal link to autism. And they are definitely effective and save lives if given to a significant percentage of the population.



References:
How the anti-vaccine movement is endangering lives (The Washington Post-May 5, 2014).





Wednesday, April 30, 2014

A surge in antimicrobial resistance reported by WHO

The constant increase in the incidence of antimicrobial resistant infections is now becoming a major concern for the WHO. According to their recent report on 'Antimicrobial Resistance' this is a very real threat to global public health.
In recent decades the world has been aware of the rise in antibiotic resistant bacteria and has been trying to promote responsible use of antibiotic treatment in an effort to counteract this rise. But it is the first time that the WHO has warned of a much more serious problem since antimicrobial resistance covers a much broader spectrum of microbes (eg. parasites, fungi, and viruses).

If such a resistance is seen the world over, effective treatment of even common infection may be difficult or impossible. According to the report;

Infections caused by resistant microorganisms often fail to respond to the standard treatment, resulting in prolonged illness, higher health care expenditures, and a greater risk of death.
As an example, the death rate for patients with serious infections caused by common bacteria treated in hospitals can be about twice that of patients with infections caused by the same non-resistant bacteria. For example, people with MRSA (methicillin-resistant Staphylococcus aureus, another common source of severe infections in the community and in hospitals) are estimated to be 64% more likely to die than people with a non-resistant form of the infection.


Although this kind of resistance to antimicrobial is being seen more around the world. Unfortunately not only do many of these cases go unreported, but often the infections last longer, leaving the patients infectious for a much longer time period , thus increasing the risk of further spreading the infection to others.

The report also highlights another consequence of AMR (Antimicrobial resistance), when infections fail to respond to first line of drugs, doctors have to resort to more aggressive therapies which are far more expensive, patients need medical supervision for a longer duration and hospital stays are also prolonged. All together these factors significantly increase the health care costs.

According to the report, the economic outcome can be damaging;

The growth of global trade and travel allows resistant microorganisms to be spread rapidly to distant countries and continents through humans and food. Estimates show that AMR may give rise to losses in Gross Domestic Product of more than 1% and that the indirect costs affecting society may be more than 3 times the direct health care expenditures. It affects developing economies proportionally more than developed ones. 

Some of the noteworthy resistances being seen globally are:

Resistance in Bacteria

WHO’s 2014 report on global surveillance of antimicrobial resistance reveals that antibiotic resistance is no longer a prediction for the future; it is happening right now, across the world, and is putting at risk the ability to treat common infections in the community and hospitals. Without urgent, coordinated action, the world is heading towards a post-antibiotic era, in which common infections and minor injuries, which have been treatable for decades, can once again kill.

Resistance in Tuberculosis

Globally, 6% of new TB cases and 20% of previously treated TB cases are estimated to have MDR-TB, with substantial differences in the frequency of MDR-TB among countries. Extensively drug-resistant TB (XDR-TB, defined as MDR-TB plus resistance to any fluoroquinolone and any second-line injectable drug) has been identified in 92 countries, in all regions of the world.

Resistance in Malaria

The emergence of P. falciparum resistance to artemisinin in the Greater Mekong subregion is an urgent public health concern that is threatening the ongoing global effort to reduce the burden of malaria. Routine monitoring of therapeutic efficacy is essential to guide and adjust treatment policies. It can also help to detect early changes in P. falciparum sensitivity to antimalarial drugs.

Resistance in HIV

At the end of 2011, more than 8 million people were receiving antiretroviral therapy in low- and middle-income countries to treat HIV. Although it can be minimized through good programme practices, some amount of resistance to the medications used to treat HIV is expected to emerge. 

There is no clear evidence of increasing levels of resistance to other classes of HIV drugs. Of 72 surveys of transmitted HIV drug resistance conducted between 2004 and 2010, 20 (28%) were classified as having moderate (between 5% and 15%) prevalence of resistance.


Resistance in Influenza

Several countries have developed national guidance on their use and have stockpiled the drugs for pandemic preparedness. The constantly evolving nature of influenza means that resistance to antiviral drugs is continuously emerging.
By 2012, virtually all influenza A viruses circulating in humans were resistant to drugs frequently used for the prevention of influenza (amantadine and rimantadine). However, the frequency of resistance to the neuraminidase inhibitor oseltamivir remains low (1-2%). Antiviral susceptibility is constantly monitored through the WHO Global Surveillance and Response System.


How can this surge be slowed down?

According to the WHO report, this rise in AMR is the result of a multiple factors. 
Here are some suggestions it provides in the report:

People
  • using antibiotics only when they are prescribed by a certified health professional;
  • completing the full treatment course, even if they feel better;
  • never sharing antibiotics with others or using leftover prescriptions.
Health Care Workers And Pharmacists
  • enhancing infection prevention and control;
  • prescribing and dispensing antibiotics only when they are truly needed;
  • prescribing and dispensing the right antibiotic(s) to treat the illness.
Policymakers 
  • strengthening resistance tracking and laboratory capacity;
  • strengthening infection control and prevention;
  • regulating and promoting appropriate use of medicines;
  • promoting cooperation and information sharing among all stakeholders.
Policymakers, Scientists and Industry
  • fostering innovation and research and development of new vaccines, diagnostics, infection treatment options and other tools. 

In the end what is the WHO doing to counteract AMR? 
 
In 2014, WHO published its first global report on surveillance of antimicrobial resistance, with data provided by 114 countries.
WHO is guiding the response to AMR by:
  • bringing all stakeholders together to agree on and work towards a coordinated response;
  • strengthening national stewardship and plans to tackle AMR;
  • generating policy guidance and providing technical support for Member States;
  • actively encouraging innovation, research and development.
 

















References:
WHO Report on Antimicrobial Resistance (Updated April 2014)
Detect and Protect Against Antibiotic Resistance Budget Initiative (CDC)

Friday, January 31, 2014

Millions living with leprosy in spite of being curable

On January 26th The World Day of Leprosy, I saw a video on The Guardian global development news page by Maria Zupello  titled Leprosy in Brazil: Uncovering a hidden disease. Realizing that leprosy is still around was rather disturbing, especially because this is a curable disease and therefore there should be no such thing as living with leprosy in these times, but after doing some research it became apparent that is not the case.

WHO: Leprosy Statistics:

According to the World Health Organization's latest stats on leprosy in the world, there are still around 200,000 reported new cases of leprosy every year in the world. Also known as Hansen's Disease, leprosy is endemic in 91 countries around the world. The highest concentration of reported new cases (at the start of 2012) being in South East Asia (117,147). The majority of which are in India. The second highest incidence is in the Americas (34,801),  of these reported new cases the majority are from Brazil. But because of its long incubation period and the lack of tools to allow early detection leading to late diagnosis, the exact prevalence of Hansen's disease is not clear.

India:
Although the Indian Government declared it has eliminated leprosy in 2005. It has since then become clear that the claim was premature. Of the total leprosy cases in the world 55% are in India, and about 127,000 new cases were reported between 2010-2011. Besides lack of access to basic healthcare services, leprosy patients also suffer socioeconomic isolation as a result of the stigma and discrimination that still exists in India.

Brazil: 
Leprosy is more prevalent in Brazil than in any other country except India. More than 30,000 new cases are diagnosed each year. Despite economic development, expansion of public healthcare, and efforts of the leprosy control program in the past 30 years, this disease has not been eliminated, and new cases are still being detected. The leprosy control program in Brazil distributes free drugs as part of the World Health Organization multidrug regimen for treatment of leprosy. Unfortunately health care services are not available in rural parts of the country. The amazon region of Brazil where leprosy has been endemic for more than a century is almost deprived of such health services.
Leprosy is particularly prevalent among the poorest and most marginalised communities due to their lack of access to healthcare, poor sanitation and congested living spaces. - See more at: http://www.tlmindia.org/index.php/about-leprosy/facts#sthash.zlOMnaBW.dpuf

Government statistics under estimate the extent of leprosy according to research organisations, NGOs and some medical personnel who argue that leprosy cases are on the rise - See more at: http://www.tlmindia.org/index.php/about-leprosy/facts#sthash.zlOMnaBW.dpuf
Government statistics under estimate the extent of leprosy according to research organisations, NGOs and some medical personnel who argue that leprosy cases are on the rise - See more at: http://www.tlmindia.org/index.php/about-leprosy/facts#sthash.zlOMnaBW.dpuf
Government statistics under estimate the extent of leprosy according to research organisations, NGOs and some medical personnel who argue that leprosy cases are on the rise - See more at: http://www.tlmindia.org/index.php/about-leprosy/facts#sthash.zlOMnaBW.dpuf
To understand why the stigmatization, socioeconomic isolation, discrimination leading to leprosy communities in countries like India and Brazil is so wrong, here are some basic facts about Leprosy( Hansen's Disease);

What is Leprosy?

Leprosy is a chronic bacterial disease caused by Mycobacterium leprae and Mycobacterium lepromatosis. This infection primarily affects the skin, peripheral nerves and upper airway. It is well known that leprosy is not spread through casual contact. 

About 95% of human beings are naturally immune making leprosy the 'least contagious communicable disease'. The World Health Organization suggests that it is transmitted through moisture from the nose and mouth during frequent and close contact with an untreated leprosy-affected person. It might also happen if you are exposed to other nasal fluids (also known as secretions). Droplets and other secretions can contain the bacteria that cause Hansen’s disease. If you breathe these in, you can become sick with the disease.

According to the CDC,  as incubation period of the bacteria is long , it may take up to 2-10 years for signs and symptoms to appear. The disease mainly affects the skin, nerves and the mucous membranes. Common signs and symptoms include; disfiguring skin sores, lumps, or bumps that do not go away after several weeks or months. The skin sores are pale-colored. Nerve damage can lead to loss of feeling in arms and legs and muscle weakness. Without treatment, leprosy can permanently damage your skin, nerves, arms, legs, feet, and eyes.

Treatment of Leprosy

Leprosy can be cured. In the last two decades, more than 14 million people with leprosy have been cured. The World Health Organization provides free treatment for all people with leprosy.
Treatment depends on the type of leprosy that you have. It is treated with a combination of antibiotics. The treatment may last anywhere from 6 months to 2 years. People with severe leprosy may need to take antibiotics longer. Antibiotics cannot treat the nerve damage.
Anti-inflammatory drugs are used to control swelling related to leprosy. This may include steroids, such as prednisone.
Patients with leprosy may also be given thalidomide, a potent medication that suppresses the body's immune system. It helps treat leprosy skin nodules. Thalidomide is known to cause severe, life-threatening birth defects and should never be taken by pregnant women.

According to the WHO 'Access to information, diagnosis and treatment with multidrug therapy (MDT) remain key elements in the strategy to eliminate the disease as a public health problem, defined as reaching a prevalence of less than 1 leprosy case per 10,000 population. Only a couple of endemic countries have still to achieve this goal at the national level; most are now applying the same elimination strategy at regional, district and sub-district levels. MDT treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all types of leprosy.
Most countries that were previously highly endemic for leprosy have achieved elimination at the national level and are intensifying their efforts at regional and district levels.'

Information campaigns about leprosy in high risk areas are crucial so that patients and their families, who were historically ostracized from their communities, are encouraged to come forward and receive treatment. The most effective way of preventing disabilities in leprosy, as well as preventing further transmission of the disease, lies in early diagnosis and treatment with MDT. (WHO)







P.S: 
The Leprosy Mission India 
The Leprosy Mission Canada  
Hansen's Disease (CDC) 
Leprosy (WebMD)
Leprosy Today (WHO) 
National Hansen's Disease Program (HRSA) 
Watch Video: Leprosy in Brazil: Uncovering a hidden disease (The Guardian)
Watch Video: Battling leprosy in Brazil(BBC World)
Watch Video: Leprosy: India's Hidden Disease (The Guardian)
Photo Gallery: Colonia Antonio Alexio - Leprosy community in Manaus, Brazil (Photojournalist: Sharon Steinmann)
 

Friday, January 10, 2014

The rise of the drug-resistant infections

For many decades after the discovery of the first antibiotic, we have been able to root out and beat bacterial infections after bacterial infections. But when the medical professionals celebrated this invincibility with the widespread use of antibiotics, most of them forgot the fact that bacteria like any other life form know how to evolve. And thus after being victorious against even the most aggressive and deadly infections for almost a century, we are now facing a new breed of bacteria that have learned to survive even the strongest drugs in our antibiotic arsenal.

According to the CDC Antibiotic Resistant Threats 2013 Report;
Each year in the United States, at least 2 million people acquire serious infections with bacteria that are resistant to one or more of the antibiotics designed to treat those infections. At least 23,000 people die each year as a direct result of these antibiotic-resistant infections. Many more die from other conditions that were complicated by an antibiotic-resistant infection.
In addition, almost 250,000 people each year require hospital care for Clostridium difficile (C. difficile) infections.In most of these infections, the use of antibiotics was a major contributing factor leading to the illness. At least 14,000 people die each year in the United States from C. difficile infections. Many of these infections could have been prevented.

The most aggressive and lethal drug resistant infections are caused by gram-negative bacteria, which are mostly seen in healthcare settings, but other forms of bacteria are also showing presence of drug-resistant strains. As to who is more likely to be at high risk, according to the report, it is often individuals with suppressed, weak or damaged immunity. But many innovative treatments require effective treatment of any infection, as a result it is becoming very difficult to offer such options to individuals with other pre-existing conditions, such as diabetes, rheumatoid arthritis, and asthma.
Some of the common medical situations in which doctors are faced with this dilemma are;
  1. Cancer Chemotherapy
  2. Complex Surgeries (eg. Joint replacement, Cardiac Bypass)
  3. Rheumatoid Arthritis
  4. Dialysis for End-Stage Renal Disease
  5. Organ and Bone Marrow Transplants

What makes these new infections worrisome it the fact these can happen anywhere. Data has shown that majority of these happen in the general population but the antibiotic resistance mostly develops in a healthcare setting such as a hospital or nursing home.


The CDC also classifies these drug-resistant superbugs by threat levels: 
Urgent:
These are high-consequence antibiotic-resistant threats because of significant risks identified across several criteria. These threats may not be currently widespread but have the potential to become so and require urgent public health attention to identify infections and to limit transmission.
Serious:
These are significant antibiotic-resistant threats. For varying reasons (eg.,low or declining domestic incidence or reasonable availability of therapeutic agents), they are not considered urgent, but these threats will worsen and may become urgent without ongoing public health monitoring and prevention activities.
Concerning: 
These are bacteria for which the threat of antibiotic resistance is low, and/ or there are multiple therapeutic options for resistant infections. These bacterial pathogens cause severe illness. Threats in this category require monitoring and in some cases rapid incident or outbreak response.

The report in the end points to the lack of certain measures that might help, as a result, these are some of the suggested steps, that might allow healthcare professionals everywhere, better understand and cope with this serious growing medical problem, include;
 An efficient capacity to detect and respond to urgent and emerging antibiotic resistance threats at national, state and federal levels.
-A collaborative systematic international surveillance of antibiotic resistance threats.
-Systematically collect data on antibiotic use in human healthcare and agriculture.
-More widely use programs to improve antibiotic prescribing practices in the United States.
-Promote the use of advanced technologies that can identify threats much faster then current practices.

P.S: 
CDC Antibiotic Resistant Threats 2013 Report
CDC sets threat levels for drug-resistant 'superbugs' (CNN News)