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)

WHO report: Antibiotic resistance happening right now all over the world (The Independent-April 30, 2014)

Cancer on the rise in the world

Since the release of the  World Cancer Report 2014 by the WHO, we have been seeing headlines like 'Cancer 'tidal wave' on horizon, warns WHO' (BBC World) and for good reason.

The stats in the report have gotten everyone's attention. It suggests that the number of cancer cases might reach 24 million by 2035. It also points out that world health issues such as smoking, drinking, and obesity must be effectively dealt with to reduce that number. 

The International Agency for Research on Cancer (WHO) press release states:

Global battle against cancer won’t be won with treatment alone.

Effective prevention measures urgently needed to prevent cancer crisis.

Based on the latest statistics on trends in cancer incidence and mortality worldwide, this new book reveals how the cancer burden is growing at an alarming pace and emphasizes the need for urgent implementation of efficient prevention strategies to curb the disease.
Despite exciting advances, this Report shows that we cannot treat our way out of the cancer  problem,” states Dr Christopher Wild, Director of IARC and co-editor of the book. “More commitment to prevention and early detection is desperately needed in order to complement improved treatments and address the alarming rise in cancer burden globally.”

In 2012, the worldwide burden of cancer rose to an estimated 14 million newcases per year, a figure

expected to rise to 22 million annually within the next two decades. Over the same period, cancer deaths are predicted to rise from an estimated 8.2 million annually to 13 million per year.

According to the report globally the highest number of diagnosed cancers were lung cancer, breast cancer and cancer of the large bowel. The highest number of cancer deaths were caused by cancer of the lungs, followed by cancers of the liver and stomach.

This World Cancer Report 2014 highlights the presence of a cancer divide.

As a consequence of growing and ageing populations, developing countries are disproportionately affected by the increasing numbers of cancers. More than 60% of the world’s total cases occur in Africa, Asia, and Central and South America, and these regions account for about 70% of the world’s cancer deaths, a situation that is made worse by the lack of early detection and access to treatment.

 Many of the cancers seen in developing countries are high infection related cancers (cancer of liver, cervix and stomach) or are cancer known to be associated with the industrialized lifestyles (cancer of lungs, breast and large bowel). Therefore high mortality from cancer in these countries could be significantly reduced if they have access to effective and affordable cancer treatments but also by implementation of vaccination programs (Hep B and HPV) and preventive efforts towards the spread of tobacco.
The rising number of cancer cases is proving to be detrimental to the economy of even the richest countries. According to the report 'In 2010, the total annual economic cost of cancer was estimated to reach approximately US$ 1.16 trillion. Yet about half of all cancers could be avoided if current knowledge was adequately implemented.'

Last but not least the report stresses on the need for widespread efforts towards early detection and treatment and the promotion of adequate legislation to reduce exposure and risk behaviours.



P.S:

Cancer 'tidal wave' on horizon, warns WHO (BBC World February 4th 2014)
International Agency for Research Cancer  
World Cancer Research Fund International 

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)

High Incidence of Diseases Endemic to the Amazon Region of Brazil, 2001–2006 (CDC)

 

Welcome to MINDbank a new resource for mental health information.

On December 10th 2013, the WHO released its gigantic online database by the name of MINDbank. This database contains information on mental health, substance abuse, disability, human rights and the different policies, strategies, laws and service standards being implemented in different countries. One can also find key international documents and treaties in the MINDbank.

Because mental health is still a topic shunned and avoided in many countries all over the world, it can often be difficult to find out information on resources pertaining to mental health. The MINDbank is the only single point globally to access all comprehensive information related to to mental health, substance abuse, disability, general health, human rights and development.

WHO announcement for the media says;

Launched on Human Rights Day, the platform is part of WHO’s QualityRights initiative, aiming to end human rights violations against people with mental health conditions.

“People with mental disabilities still face discrimination, violence and abuse in all countries,” says Dr Michelle Funk, from WHO’s Department of Mental Health and Substance Abuse. “The easy-to-use platform was established as a tool to facilitate debate, dialogue, advocacy and research on mental health, to improve care and to promote human rights across the globe.”

The care available in mental health facilities may often not only be of poor quality but can also hinder recovery. It can still be common in some countries for people to be locked away in small, prison-like cells with no human contact or to be chained to their beds, unable to move. The MiNDbank will help decision makers to address these issues, support reform efforts and ultimately improve the lives of people with mental health conditions in line with the Comprehensive Mental Health Action Plan 2013-2020, adopted by the World Health Assembly in May 2013.

“If a government, for example, wishes to develop a new mental health policy in line with international human rights standards it can - on the new platform - quickly get an overview about the policies of other countries and benefit from their experiences and an array of international guidance tools and resources,“ explains Nathalie Drew, WHO Technical Officer working on mental health and human rights. So far, already more than 160 countries are sharing key mental health information through the MiNDbank and updates will be provided on a regular basis.

The MINDbank is meant to be the go-to site for everyone, from clinicians, health policy makers, legislators, academics research professionals to educationists and anyone anywhere in the world interested in finding reliable information on mental health and related topics. 

PS:  MINDbank Website
WHO launches MINDbank News