News in Brief

37 million cases of dengue estimated in India

CIDRAP quotes experts commenting in the New York Times on 6 November as saying dengue virus infections are widespread in India, and extreme underreporting of cases makes the problem worse. The government counts only labconfirmed cases reported in public hospitals, which totalled 30,002 for 2012 through October, compared with 18,860 cases for all of 2011. Scott Halstead, MD, a tropical disease expert, estimated the true number of annual cases at 37 million, with 227,500 hospitalisations. Manish Kakkar, MD, MPH, a specialist at the Public Health Foundation of India, said India’s “massive underreporting of cases” has contributed to the disease’s spread. Other experts said that India’s failure to build an adequate dengue surveillance system has hindered awareness of the illness’s vast extent, discouraged efforts to clean up its sources, and slowed the quest for a vaccine.

New cell discovery could lead to treatment for blindness

Scientists at the University of Southampton have discovered specific cells in the eye which could lead to a new procedure to treat and cure blinding eye conditions. The study found that cells called corneal limbal stromal cells, taken from the front surface of the eye have stem cell properties and could be cultured to create retinal cells. This could lead to new treatments for eye conditions such as retinitis pigmentosa or wet age-related macular degeneration, a condition which is a common cause of loss of vision in older people.
doi: 10.1136/bjophthalmol-2012- 301546

870 million suffer chronic malnutrition

Almost 870 million people, or one in eight, are suffering from chronic malnutrition, according to a new United Nations report – State of Food Insecurity in the World 2012 – released in October, which shows a sharp decline in the number of undernourished people over the past two decades, but warns that immediate action is still needed to tackle hunger particularly in developing countries.

Philips to equip Air France, KLM with AEDs

Philips and Air France-KLM Group have reached an agreement to equip all KLM Royal Dutch Airlines and Air France passenger flights with Philips’ HeartStart automated external defibrillators (AEDs). The AEDs can be used to resuscitate people who have sudden cardiac arrest by resetting the heart’s rhythm with an electric current, delivered by the AED. Philips says the HeartStart FRx AED has been tested and certified for airline use and does not interfere with airplane electronics. Rugged and durable, it features clear audio instructions for both guided use and CPR coaching in addition to intuitive icon-driven operation for ease of use. Philips AEDs are used by more than 91 airlines and 195 airports around the world.

Bubonic plague in Madagascar

Since the beginning of October and the start of the rainy season in Madagascar, 6 people are reported to have died of bubonic plague, according to a report (14 November) in L'Express de Madagascar. The cause of the plague is rats – and their fleas – which take refuge from the rain and seasonal bushfires in villages. “The plague victims sometimes live in remote areas and they self-medicate before going to a health centre when the disease worsens. However, all health centres are equipped with rapid diagnostic test and medications to treat this disease immediately,” said Alain Marcel Rahetilahy, head of epidemic and neglected diseases within the Ministry of Health.

UN calls for greater social protection

A new global initiative ensuring the social protection of the world’s poorest people is a growing necessity, two United Nations independent experts said, noting that without such a programme, chronic unemployment, food insecurity, and natural disasters would pose continuous impediments to those seeking to emerge from poverty. Magdalena Sepúlveda and Olivier De Schutter, the UN Special Rapporteurs on extreme poverty and the right to food, respectively, urged the creation of a Global Fund for Social Protection, stating that 2% of the world’s GDP would be enough to provide all the world’s poor with basic social protection from the effects of unemployment, illness, disability, crop failure and soaring food costs.

Meningitis vaccine milestone

A revolutionary meningitis vaccine reached the 100 millionth person in December in a region of Africa that has been plagued by deadly epidemics for more than a century. The milestone took place in northern Nigeria, part of Africa’s ‘meningitis belt’. The historic achievement comes two years after the MenAfriVac vaccine was first launched in Burkina Faso. Since then, nine other countries have held vaccination campaigns to protect people from ages 1 to 29 against meningitis A.

Malaria prevention funding slows

The WHO reports that global funding for malaria prevention and control levelled off between 2010 and 2012, and progress in the delivery of some life-saving commodities has slowed. This comes in the wake of rapid expansion in malaria control between 2004 and 2009 during which a concerted effort by endemic countries, donors and global malaria partners saved 1.1 million lives during this period – 58% of these were in the ten highest burden countries. The World malaria report 2012 says the slowdown could threaten to reverse the recent gains..

Obesity risk predicted at birth

A simple formula can predict a newborn baby’s likelihood of becoming obese in childhood, according to a study published 28 November 2012 in the open access journal PLoS ONE. The formula, which is available as an online calculator, estimates the child’s obesity risk based on its birth weight, the body mass index of the parents, the number of people in the household, the mother’s professional status and whether she smoked during pregnancy.

The researchers developed the formula using data from the Northern Finland Birth Cohort Study, which was set up in 1986 to follow 4,000 children from early pregnancy onwards. They initially investigated whether obesity risk could be assessed using genetic profiles, but the test they developed based on common genetic variations failed to make accurate predictions. Instead, they discovered that nongenetic information readily available at the time of birth was enough to predict which children would become obese. The formula proved accurate not just in the Finnish cohort, but in further tests using data from studies in Italy and the US.

The study was led by Professor Philippe Froguel and Professor Marjo-Riitta Jarvelin from the School of Public Health at Imperial College London. “This test takes very little time, it doesn’t require any lab tests and it doesn’t cost anything,” said Professor Froguel.

“All the data we use are well-known risk factors for childhood obesity, but this is the first time they have been used together to predict from the time of birth the likelihood of a child becoming obese.”

The researchers suggest that services of dieticians and psychologists, for example, could be offered to families with high-risk infants to help them prevent excessive weight gain.

Although common genetic variants did not prove to be helpful for predicting childhood obesity, the researchers say about one in 10 cases of obesity are caused by rare mutations that seriously affect appetite regulation. Tests for these mutations could become available to doctors in the next few years as the cost of DNA sequencing technology falls.

The obesity risk calculator

Eradication of polio feasible, but political will necessary, says WHO

The United Nations health agency called for renewed efforts to boost the campaign against polio, stressing that its eradication is technically feasible but political will is necessary to realise this goal.

On World Polio Day – the first since India was removed from WHO’s list of countries with active transmission of wild poliovirus, a spokesperson for the World Health Organization (WHO) Global Polio Eradication Initiative, Oliver Rosenbauer, said: “We have all the necessary tools to eradicate this disease, so now there is the question of political and societal will to make sure that the emergency plans are fully implemented and that they are fully financed.” He continued, “We have seen time and time again that this is a virus which spreads to polio free areas and causes devastating outbreaks. If we don’t finish the job now we could see, within the next decade, 200,000 new cases every single year all over the world. Given that we are under two hundred cases now we consider this a true humanitarian catastrophe that has to be averted at all costs.”

According to WHO, more than 4,000 people have been deployed to assist the three endemic countries, supporting vaccination campaigns through the Global Polio Eradication Initiative. In Nigeria, traditional leaders are taking part in selection of vaccinators; in Afghanistan, permanent vaccination teams operate in insecure parts to ensure children are vaccinated regardless of who controls the area; and, in Pakistan, every district is being made accountable for reaching every child in the area with a vaccine.

New data shows progress with vaccination programmes

Four in five children (83%) worldwide received the recommended three doses of diphtheria–tetanus-pertussis (DTP) vaccine during infancy in 2011, according to new data released in the WHO Weekly Epidemiological Record (WER).

The new data show sustained progress from the previous two years, and a significant achievement from when WHO’s Expanded Programme on Immunisation (EPI) was originally started nearly 40 years ago. At that time, fewer than 5% of the world’s children were being vaccinated against these three deadly diseases.

Achieving DTP vaccination of children before the age of one is one of the most important indicators of how effective vaccination programmes are in reaching children with life-saving vaccines.

While substantial progress has been made since EPI was established, the new data show more than 22 million children, mostly living in less-developed countries, missed out on the three basic vaccinations during their first year of life in 2011.

About half of all incompletely vaccinated children live in one of three countries: India, Indonesia and Nigeria. These countries have large child populations and their immunisation programmes are hampered by occasional problems with vaccine supply and inaccessibility of vulnerable populations.

In May 2012, ministers of health from 194 countries at the World Health Assembly endorsed a landmark Global Vaccine Action Plan involving four mutually reinforcing goals: strengthening routine immunisation to meet vaccination coverage targets; accelerating control of vaccine-preventable diseases; introducing new and improved vaccines; and spurring research and development for the next generation of vaccines and technologies.

Depression a global health crisis

UN Secretary-General Ban Ki-moon has described depression, which afflicts 350 million people worldwide, as an “underappreciated global health crisis” and has called for an international effort to increase access to a wide variety of effective and affordable treatments and remove the social stigma attached to the illness.

“Among the barriers to care and services are social stigma and the lack of general healthcare providers and specialists trained to identify and treat depression,” he said in a message marking World Mental Health Day on 10 October, in which he noted that about 1 million people commit suicide every year, the majority due to unidentified, or untreated, depression.

He stressed that although a wide variety of effective and affordable treatments are available to treat depression, including psychosocial interventions and medicines, these are not accessible to all people, especially those living in less developed countries and the least advantaged citizens of more developed nations. “We can all act to relieve the stigma around depression and other mental disorders, perhaps by admitting that we may have experienced depression ourselves, or by reaching out to those experiencing it now. This is the first critical step to removing one of the barriers to treatment and helping to reduce the disability and distress caused by this global crisis.

Ban’s message was echoed by the WHO, which underscored how depression interferes with the ability to function at work, school or home. “We have some highly effective treatments for depression. Unfortunately, fewer than half of the people who have depression receive the care they need. In fact, in many countries this is less than 10%,” said Shekhar Saxena, director of the Department for Mental Health and Substance Abuse.

WHO sets up global monitoring framework to tackle world’s biggest causes of mortality

The first-ever global monitoring framework to combat several of the world’s biggest killers has been agreed on by WHO Member States in November. The framework comprises nine voluntary global targets and 25 indicators to prevent and control diseases such as heart disease, diabetes, cancer, chronic lung disease and other noncommunicable diseases. The draft framework aims to focus efforts to address the impact of noncommunicable diseases and assess the progress made in reducing associated illness and death, the reduction of exposures to the main risk factors for the diseases, including tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity, and the response of national health systems to noncommunicable diseases.

“The new global monitoring framework will enable us to assess progress across regional and country settings and to monitor trends,” said Dr Bjørn-Inge Larsen, the chairman of the formal WHO meeting. “The agreed voluntary targets are aspirational but achievable and they will drive progress in prevention and control at national, regional and global levels.”

One of the global voluntary targets – to achieve 25% reduction in premature mortality from noncommunicable diseases by 2025 – had already been adopted by the World Health Assembly in May 2012.

The nine voluntary global targets are aimed at combating premature mortality from NCDs, harmful use of alcohol, tobacco use, physical inactivity, salt/sodium intake, raised blood pressure, diabetes, obesity, promoting drug therapy and counselling, and medicines and technologies for NCDs.

The 25 indicators are aimed at measuring premature mortality, cancer incidence, harmful use or alcohol, low fruit and vegetable intake, overweight and obesity, physical inactivity, raised blood glucose, raised blood pressure, raised total cholesterol, salt/sodium intake, tobacco use, fat intake, cervical cancer screening, drug therapy and counselling to prevent heart attacks and strokes, essential NCD medicines and technologies, palliative care, policies to reduce the marketing of foods and non-alcoholic beverages to children, vaccination against hepatitis B, policies to eliminate partially hydrogenated vegetable oils from food supply, and vaccination against human papillomavirus.

Noncommunicable diseases are the leading cause of death in the world and represent over 63% of all annual deaths. Of the 36 million people who die annually from these diseases, 14 million are under 70 years of age, and regarded therefore as premature and largely preventable deaths. 80% of the deaths related to noncommunicable disease occur in the developing world.

Calls for greater effort to fight TB

Despite progress in the global fight against tuberculosis (TB), the gains so far remain fragile and more needs to be done to eliminate the disease, according to the WHO. “The momentum to break this disease is in real danger,” said Dr Mario Raviglione, the Director of the Stop TB Department of the WHO. “We are now at a crossroads between TB elimination within our lifetime, and millions more TB deaths.”

Referring to the WHO Tuberculosis Report 2012, Dr Raviglione said: “In the space of 17 years, 51 million people have been successfully treated and cared for according to WHO recommendations. Without that treatment, 20 million people would have died.”

The WHO Tuberculosis Report 2012 features data from 204 countries and territories, and covers all aspects of TB, including multi-drug-resistant tuberculosis (MDR-TB), TB’s links to HIV, research and development and financing.

Despite the progress, TB remains a major infectious killer, according to the report. Among its findings, the report notes there is continued decline in the number of people falling ill from TB, but still an enormous global burden, with 8.7 million new cases in 2011.

The report notes that there were an estimated 1.4 million deaths from TB in the past year, including half a million women, underlining the disease as one of the world’s top killers of women. It also points to persistently slow progress in the response to MDR-TB, with diagnosis of only one in five presumed cases worldwide.

The report also warns that there is a US$1.4 billion funding gap per year for research and development into new ways to combat TB – in addition to a $3 billion per year shortfall over 2013-2015, which could have severe consequences for TB control.

To address this, WHO is calling for targeted international donor funding and continued investments by countries themselves to safeguard recent gains and ensure continued progress. Currently, 90% of external donor financing for TB is provided by the UN-backed Global Fund to Fight AIDS, Tuberculosis and Malaria.

However, the report also offers reason for hope. It praises the worldwide roll-out of a new diagnostic device capable of testing patients for TB, including drug-resistant TB, in just 100 minutes. The fully automated nucleic acid amplification test (NAAT), which can diagnose TB and rifampicinresistant disease, is now available in 67 lowand middle-income countries.

WHO Tuberculosis Report 2012

New international treaty adopted to eliminate illegal tobacco trade

The delegates of more than 140 parties to the WHO Framework Convention on Tobacco Control (WHO FCTC) have adopted a new international treaty setting the rules for combating illegal trade through control of the supply chain and international cooperation. The Protocol to Eliminate Illicit Trade in Tobacco Products commits countries to establishing, as a central measure, a global tracking and tracing system to reduce the illicit trade of tobacco products.

“The elimination of all forms of illicit trade in tobacco products, including smuggling and illegal manufacturing, is an essential component of tobacco control,” said Ricardo Varela, president of the Conference of the Parties (COP) to the WHO FCTC. “In adopting this new protocol today by consensus, countries have reiterated their historic commitment towards protecting the health of their citizens, particularly the young and vulnerable.”

Dr Haik Nikogosian, head of the secretariat of the WHO FCTC, said: “Eradicating illicit trade in tobacco products constitutes a clear win-win situation for governments and their people. The new protocol establishes what actions constitute unlawful conduct and sets out related enforcement and international cooperation measures, such as licensing, information-sharing and mutual legal assistance that will help counteract and eventually eliminate illicit trade.”

Product security for pharmaceuticals

Avery Dennison has launched a new anticounterfeiting technology that enables existing serial numbers to be read directly through the label, providing an extra layer of product security for pharmaceutical brands.

The innovative thin and clear coextruded film, called SharpTear, was designed for tamper-evident applications, where an easy tear is required in the label. “The growth of internet sales, together with limited supplies of pharma products in some regions and significant price differentials, means that counterfeiting has become a very significant threat to all pharma brands,” said Hans Eichenwald, senior product manager Specialty Segments at Avery Dennison Materials Group. “Today, around 10% of drugs sold are already counterfeit according to the World Health Organization. Sharp Tear offers a rapid and reliable way to secure both product safety and brand reputation without impacting productivity or product margins.”

The product reveals tampering immediately by providing a seal that remains intact during normal handling, but which tears easily in one direction if attempts are made to open the package. It can either mask unwanted packaging information or allow important product details to be visible through the label.


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