EU launches universal flu vaccine research project

A newly launched European project is set to take a major step towards the development of a universal flu vaccine. It aims to counter the emergence of new strains and seasonal epidemics.

The viral infection usually strikes in colder months with seasonal influenza being responsible for around 3 - 5 million cases of severe illness and 250,000 to 500,000 deaths worldwide.

Due to its rapid spread, particularly among high-risk population groups, influenza remains a serious public health problem. To date, the most effective way to prevent the disease or severe symptoms is annual vaccination, but current vaccines only offer limited protection against evolving strains of the infection.

To overcome these weaknesses, a publicprivate partnership comprising seven renowned organisations from Europe joined forces under the EDUFLUVAC project to develop a broad-spectrum, long-lasting vaccine. EDUFLUVAC aims to take a novel approach by ‘educating’ the immune system to cross-recognise common regions within multiple influenza virus strains.

“Developing a universal flu vaccine has become a global health priority for preventing the spread of the virus and the emergence of new strains, and we are convinced that EDUFLUVAC will be a major step towards achieving this goal,” says Othmar Engelhardt, principal investigator at the National Institute for Biological Standards and Control, United Kingdom. The research team expects to achieve better protection against epidemic influenza through the development of a vaccine that would not only offer the advantage of eliminating the need for a seasonal vaccine every year, but could also reduce the need for costly annual vaccination campaigns.

Odile Leroy, Executive Director of the European Vaccine Initiative and co-ordinator of EDUFLUVAC, says: “Low and middleincome countries currently have minimal influenza vaccination programmes. Thus, the development of a vaccine that elicits broad long-lasting defence would facilitate vaccination campaigns and confer protection against influenza in hitherto untargeted groups with limited health care.”

The four-year project is co-ordinated by the European Vaccine Initiative headquartered in Germany and was awarded a grant of EUR 4.6 million in EU funding.

Pneumonia – the single biggest cause of child mortality

Pneumonia remains the single biggest killer of children under five globally, claiming the lives of more than one million children every year. To celebrate World Pneumonia Day on 12 November, the GAVI Alliance, UNICEF and the World Health Organization (WHO) launched an “Innovate to End Child Pneumonia” campaign to highlight essential actions to help end child deaths from this entirely preventable disease. “Tackling pneumonia doesn’t necessarily need complicated solutions,” said Dr Mickey Chopra, Chief of Health, UNICEF, proposing five simple but effective interventions, which will help reduce the burden of the disease that is responsible for almost one-fifth of all child deaths around the world, if implemented properly. These are:

- Exclusive breastfeeding for six months and continued breastfeeding complemented by nutritious solid foods up to age 2;

- Vaccination against whooping cough (pertussis), measles, Haemophilus influenzae type b (Hib) and pneumococcus;

- Safe drinking water, sanitation and handwashing facilities; Improved cooking stoves to reduce indoor air pollution;

- Treatment, including amoxicillin dispersible tablets and oxygen;

Recognizing that child mortality cannot be addressed in a vacuum, but only through integrated efforts, in April 2013, WHO and UNICEF released an Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD).

The GAPPD presents an innovative framework bringing together prevention, protection and control of both pneumonia and diarrhoea – two of the world’s leading killers of children under 5 – to make more efficient and effective use of scarce health resources.

To mark 5th World Pneumonia Day, Mauritania and Papua New Guinea introduced the pneumococcal vaccine, which protects against one of the leading causes of pneumonia. With support from the GAVI Alliance, more than 50 countries will introduce this vaccine by 2015.

“The GAVI Alliance is helping to accelerate the fight against pneumonia by increasing access to pneumococcal vaccines, thanks to GAVI’s innovative Advance Market Commitment (AMC), but also to the five-in-one pentavalent vaccine which protects against Haemophilus influenzae type b, another major cause of pneumonia,” says Dr Seth Berkley, CEO of the GAVI Alliance.

Since the launch of the GAPPD seven months ago, several countries have taken this forward. For example, Bangladesh and Zambia are translating the GAPPD into local implementation plans in some districts. Program managers responsible for immunisation, child health, nutrition and water and sanitation have joined forces to accelerate progress and eliminate preventable deaths from pneumonia and diarrhoea.

In addition, in October 2013, the WHOupdated guidelines on the treatment of pneumonia, recommending simpler antibiotic regimens, and published a handbook on how to introduce the pneumococcal vaccine for staff, in line with the GAPPD.

“To achieve the vision and goals of the integrated plan – to end preventable deaths from pneumonia and diarrhoea in the next generation – the children of the world need to see political will, co-ordinated efforts, and increased resources at the global and national levels to fight these stubborn killers,” says Dr Elizabeth Mason, Director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health.

Cancer tumour analysis to be digitized

Philips has announced that it is collaborating with Institut Curie, in order to digitize tumour analysis research, with the aim of speeding up and improving cancer diagnosis and treatment.

While pathologists today view tissue sample images manually using a microscope, by using Philips Digital Pathology Solution, Institut Curie hopes to increase workflow efficiency and consolidate its pathology activities at multiple sites into one single virtual laboratory.

In addition to the diagnosis of tissue from patients with cancer indications, the pathology department at Institut Curie evaluates thousands of test samples from experimental cancer research programmes worldwide to gain a better understanding of the causes and mechanisms of diseases at both cellular and molecular level.

These new insights may give rise to new diagnostic approaches and therapeutic treatments. Currently, Institut Curie produces and diagnoses more than 200,000 glass pathology slides every year using a microscope.

Digitization of the pathology workflow could ease this logistical burden and enable new ways of working, such as real-time collaboration with peers and creation of a virtual network across the globe. Moreover, in cancer research, digital histopathology information can now, for example, be added to biology data and this opens up new ways to mine information from tumour tissue for further data analysis.

“Digitization of pathology will enable us to keep momentum going to accelerate cancer research and, in the end, improve patient care,” says Xavier Sastre-Garau, director of the Biopathology Department of Institut Curie. “Philips’ digital pathology solution is empowering Institut Curie to realize a single virtual laboratory that offers new opportunities for intensive collaboration,” says Guido du Pree, vice-president of Marketing & Sales for Philips Digital Pathology Solutions.

To support its cancer research, Insitut Curie has completed installation of the fully integrated Philips Digital Pathology Solution with ultra-fast scanners at its locations in Paris and St. Cloud, which are connected on-line through an image management system that provides an interface to communicate with commercially available Laboratory Information Systems (LIS).

Developing world faces breast cancer surge

Rising breast cancer incidence and mortality represent a significant and growing threat for the developing world, according to a new global study commissioned by GE Healthcare.

Report co-author Bengt J?nsson, Professor in Health Economics at the Stockholm School of Economics, explained: “Breast cancer is on the rise across developing nations, mainly due to the increase in life expectancy and lifestyle changes such as women having fewer children, as well as hormonal intervention such as post-menopausal hormonal therapy. In these regions, mortality rates are compounded by the later stage at which the disease is diagnosed, as well as limited access to treatment, presenting a ‘ticking time bomb’ which health systems and policymakers in these countries need to work hard to defuse.”

The report on “the prevention, early detection and economic burden of breast cancer” suggests that consumer understanding about breast cancer and screening methods is putting lives at risk in the developing world. For example, a recent survey in Mexico City indicated many women feel uncomfortable or worried about having a mammogram. “It is of great concern that women in newly industrialized countries are reluctant to get checked out until it is too late.

This is why GE is working with a number of governments and health ministries in these regions to expand access to screening and improve consumer awareness. Some of these initiatives are making excellent progress,” said Claire Goodliffe, Global Oncology Director for GE Healthcare. The study draws some interesting conclusions about the impact of breast cancer on sufferers’ lives.

According to the most recent published data, 15 million years of ‘healthy life’ were lost worldwide in 2008 due to women dying early or being ill with the disease. ‘Healthy life lost’ is defined by years lost due to premature death and incapacitation due to the effects of breast cancer. Women in Africa, China and the USA lost the most years of healthy life. Furthermore, of the 15 million years lost globally, more than three times as many years were lost due to dying than being ill with the disease. For women in Africa, Russia, Mexico, Turkey and Saudi Arabia, the number of healthy years lost due to death were up to seven times greater than elsewhere in the world.

Jonsson said: “The report findings suggest that a worryingly high proportion of women are still dying from breast cancer across the world and this seems to correlate strongly with access to breast screening programmes and expenditure on healthcare.”

He highlighted the distinct lack of accurate and current data in areas like breast cancer incidence and mortality, the economic burden of the disease, and detailed patient-linked data on outcomes in relation to treatment patterns and stage of diagnosis.

“This limits analyses of how changes in clinical practice affect patient outcomes and needs to be addressed,” he said. As breast cancer incidence rates have steadily increased in developed countries over the last 50 years, it is no surprise that the main focus of treatment has been survival.

However, as more women are now living with the disease, the report suggests that quality of life is becoming a growing issue as survival rates improve. As a result, doctors are urged to focus on measuring the impact of diagnosis and treatment on survivors’ quality of life to identify what problems patients may have and how these can be mitigated.

Goodliffe said: “This report finds a direct link between survival rates in countries and the stage at which breast cancer is diagnosed. It provides further evidence of the need for early detection and treatment which we welcome, given current controversies about the relative harms, benefits and cost-effectiveness of breast cancer screening.”

EU funds new research for strategies to prevent neurodegenerative diseases

The EU Joint Programme - Neurodegenerative Disease Research (JPND) - is launching two calls for proposals aimed at encouraging research teams across Europe to investigate the cross-disease pathways in neurodegenerative diseases such as Alzheimer’s and Parkinson’s, and to identify new, innovative preventative strategies for these debilitating conditions.

“Neurodegenerative Diseases such as Alzheimer’s and Parkinson’s are a global health, economic and social emergency with numbers affected expected to double by 2030 and more than triple by 2050,” according to Professor Philippe Amouyel, Chair of the JPND Management Board. “With this in mind, JPND-participating countries have identified two further areas of greatest need for targeted investment in order to improve understanding of the underlying links between different diseases, and to encourage new ideas on preventative strategies.”

Professor Amouyel added: “This investment is part of a series of JPND funding initiatives, aimed at addressing priority areas identified in our European Research Strategy. This year’s calls will see over 23 million euro made available to applicants from 18 different countries.” According to Professor Thomas Gasser, University of Tübingen and Chair of the JPND Scientific Advisory Board, “Neurodegenerative diseases currently cannot be cured, prevented, or even substantially slowed.

In order to tackle these diseases together, we need greater thinking across traditional clinical boundaries and new, innovative ideas aimed at preventing disease development and progression in healthy, at-risk and early-stage populations. These calls aim to harness the necessary expertise across Europe and globally to address these needs in the fight against these diseases.”

The following neurodegenerative diseases are included for both calls: l Alzheimer’s disease and other dementias l Parkinson’s disease and PD?related disorders l Prion disease l Motor neurone diseases l Huntington’s disease l Spinocerebellar ataxia (SCA) l Spinal muscular atrophy (SMA)

New HIV strain leads to faster AIDS development

A recently discovered HIV strain leads to significantly faster development of AIDS than currently prevalent forms, according to new research from Lund University in Sweden. The period from infection to the development of AIDS was the shortest reported among HIV-1 types, at around five years.

There are over 60 different epidemic strains of HIV-1 in the world, and geographic regions are often dominated by one or two of these. If a person becomes infected with two different strains, they can fuse and a recombined form can occur. “Recombinants seem to be more vigorous and more aggressive than the strains from which they developed”, explained Angelica Palm, a doctoral student at Lund University.

The recombinant studied is called A3/02 and is a cross between the two most common strains in Guinea-Bissau, West Africa - 02AG and A3. It has previously been described by Joakim Esbjörnsson, a post-doctoral fellow at the University of Oxford, who is a co-author of the study. So far, the new strain has only been identified in West Africa, but other studies have shown that the global spread of different recombinants is increasing.

In countries and regions with high levels of immigration, such as the US and Europe, the trend is towards an increasingly mixed and complex HIV flora, unlike in the beginning of the epidemic when a small number of non-recombinant variants of the virus dominated.

There is, therefore, reason to be wary of HIV recombinants in general. “HIV is an extremely dynamic and variable virus. New subtypes and recombinant forms of HIV-1 have been introduced to our part of the world, and it is highly likely that there are a large number of circulating recombinants of which we know little or nothing. We therefore need to be aware of how the HIV-1 epidemic changes over time”, said Patrik Medstrand, Professor of Clinical Virology at Lund University.

The research is based on a unique longterm follow-up of HIV-infected individuals in Guinea-Bissau, a project run by Lund University. In future research, Angelica Palm and her colleagues hope to be able to continue researching the characteristics of recombinant viruses and the presence of these among HIV carriers in Europe.

For health services, the new research results mean a need to be aware that certain HIV-1 types can be more aggressive than others, according to the research team.

Frost & Sullivan issues predictions for global healthcare market

Frost & Sullivan has released its three big predictions for the global healthcare market for 2014 and beyond: mHealth, Cloud in Healthcare and Regulatory Environments.

“Insights from a ‘2013 Search for Growth’ survey which involved 1835 executives in more than 40 countries worldwide has also been essential in unveiling the business outlook for Pharmaceuticals, Biotechnology, Clinical Diagnostics and Medical Devices, as well as to provide a global perspective on the industry’s geographical hot spots,” explains Frost & Sullivan Partner, Dorman Followwill. mHealth expansion has been fuelled by an unprecedented spread of mobile technologies, as well as advancements in their innovative application to address health priorities.

It is largely supported by mobile phones, patient monitoring devices, personal digital assistants (PDAs) and other wireless devices. The penetration prospects of mHealth technologies are significant in the following areas: wireless vital signs monitoring, location- aware telemonitoring systems and Bluetooth wireless technology-enabled health trackers.

It is an exciting area of opportunity for healthcare growth and will provide innovative solutions for healthcare providers and patients alike, across the board. In addition, as more healthcare IT and patient monitoring tools are integrated, every hospital facility will eventually have to acquire a full-enterprise wireless solution.

The most innovative mobile healthcare solutions that best meet pressing healthcare needs will be adopted as the gold standard. Enterprise-wide healthcare informatics will also improve the quality of medical services and efficiency of operations while reducing expenditure. Implementing cloud computing technologies appropriately will help healthcare providers improve the quality of medical services and the efficiency of operations, share information worldwide and manage budgets.

The concept can be applied in a variety of ways, including data storage and data loss prevention, maintaining patient information records and authorized sharing of information. As for Regulatory Environment, recent healthcare reforms and policy initiatives in many countries have emphasised the importance of quality of care over quantity. In the absence of sufficient proof of clinical benefit, reimbursements may pose a major hurdle.

Overall, three big predictions may be formulated based on the survey’s results: – As healthcare is geared towards a personalized medicine model, companion diagnostics will alter drug development and the commercialization process of drug candidates. Combining biomarkers and drugs will make for safer, more efficient therapy. – The healthcare and life sciences industry will consolidate further in this decade, with many big pharma companies seeking alternatives to the blockbuster model. – The rise of new technologies capable of integrating medical devices into a connected platform will improve function of devices, reduce the manpower burden and minimize errors.

World lung organisations call for better lung health policies

Experts from the world’s leading lung organizations have come together for the first time to call for a worldwide effort to improve healthcare policies and systems to make a positive difference for the lung health of the world.

Produced by the Forum of International Respiratory Societies (FIRS), the report was launched on 20 November, COPD (Chronic Obstructive Lung Disease) Day. Entitled Respiratory Diseases in the World: Realities of Today – Opportunities for Tomorrow, the report features five major disease areas that are of immediate and greatest concern, including COPD, which is the fourth-leading cause of death worldwide.

“This report aims to heighten awareness of lung disease throughout the world. We hope that this collaboration will help to shed light on the pervasiveness of these conditions and diseases and will be a call to action for health-care professionals, policy makers, patients, and advocates,” said Michael H. Baumann, MD, MS, FCCP, President, American College of Chest Physicians.

Some of the key issues highlighted in this publication include the following: l COPD affects more than 200 million people and is the fourth-leading cause of death in the world. l Asthma affects about 235 million people worldwide, is one of the most frequent reasons for hospital admissions among children, and leads to approximately 180 000 deaths each year. l Respiratory infections account for over 4 million deaths annually, disproportionately in children, and are the leading cause of death in low-income or middleincome countries.

l TB kills around 1.4 million people with about 8.7 million new cases of TB annually. l Lung cancer is the most commonly diagnosed cancer in the world, accounting for 13% of the total reported cancers and affecting over 1.6 million people annually.

Tapping into spinal cord injury

As many as 500,000 people suffer a spinal cord injury each year, and are two to five times more likely to die prematurely, with worse survival rates in low- and middleincome countries, according to the WHO.

A new WHO report, International Perspectives on Spinal Cord Injuries, summarizes the best available evidence on the causes, prevention, care and lived experience of people with spinal cord injury.

Males are most at risk of spinal cord injury between the ages of 20-29 years and 70 years and older, while females are most at risk between the ages of 15-19 years and 60 years and older. Studies report male to female ratios of at least 2:1 among adults. Up to 90% of spinal cord injury cases are due to traumatic causes like road traffic crashes, falls and violence. Variations exist across regions. For example, road traffic crashes are the main contributor to spinal cord injury in the African Region (nearly 70% of cases) and the Western Pacific Region (55% of cases) and falls the leading cause in the South-East Asia and Eastern Mediterranean Regions (40% of cases).

Non-traumatic spinal cord injury results from conditions such as tumours, spina bifida, and tuberculosis. A third of nontraumatic spinal cord injury is linked to tuberculosis in sub-Saharan Africa. Most people with spinal cord injury experience chronic pain, and an estimated 20-30% show clinically significant signs of depression.

People with spinal cord injury also risk developing secondary conditions that can be debilitating and even lifethreatening, such as deep vein thrombosis, urinary tract infections, pressure ulcers and respiratory complications. Spinal cord injury is associated with lower rates of school enrolment and economic participation.

Children with spinal cord injury are less likely than their peers to start school, and once enrolled, less likely to advance. Adults with spinal cord injury face similar barriers to socio-economic participation, with a global unemployment rate of more than 60%. Spinal cord injury carries substantial individual and societal costs.

Many of the consequences associated with spinal cord injury do not result from the condition itself, but from inadequate medical care and rehabilitation services, and from barriers in the physical, social and policy environments that exclude people with spinal cord injury from participation. Full Implementation of the Convention on the Rights of Persons with Disabilities is urgently required to address these barriers.

“Spinal cord injury is a medically complex and life-disrupting condition,” notes Dr Etienne Krug, Director of the Department of Violence and Injury Prevention and Disability, WHO. “However, spinal cord injury is preventable, survivable, and need not preclude good health and social inclusion.” Essential measures for improving the survival, health and participation of people with spinal cord injury include:

l Timely, appropriate pre-hospital management: quick recognition of suspected spinal cord injury, rapid evaluation and initiation of injury management, including immobilization of the spine. l Acute care appropriate to the level and severity of injury, degree of instability and presence of neural compression. l Access to ongoing health care, health education and products such as catheters to reduce risk of secondary conditions and improve quality of life. l Access to skilled rehabilitation and mental health services to maximize functioning, independence, overall well-being and community integration. l Access to appropriate assistive devices that can enable people to perform everyday activities, reducing functional limitations and dependency.

l Specialized knowledge and skills among providers of medical care and rehabilitation services. Essential measures to secure the right to education and economic participation include legislation, policy and programmes that promote: l Physically accessible homes, schools, workplaces, hospitals and transportation. l Inclusive education. l Elimination of discrimination in employment and educational settings. l Vocational rehabilitation to optimize the chance of employment. l Micro-finance and other forms of self-employment benefits to support alternative forms of economic self-sufficiency. l Access to social support payments that do not act as disincentives to return to work. l Correct understanding of spinal cord injury and positive attitudes towards people living with it. International Perspectives on Spinal Cord Injuries spinal_cord_injury

New resource expands access to family planning

A new resource for health program managers and policy makers released recently aims to improve access to family planning for women after childbirth and during the first 12 months of motherhood.

Closely spaced and unintended pregnancies are a health risk to both mother and child: spacing pregnancies at least two years apart can avert 10% of infant deaths and about one out of five deaths in children aged 1 to 4. Launched in Addis Ababa, the ‘International Conference on Family Planning for Postpartum Family Planning Full Access, Full Choice’ provides interventions at all levels of health care to expand access to scientifically-sound family planning methods for new mothers. The plan identifies three critical areas of work for countries to ensure successful implementation of the strategies:

l Close tracking of post-partum contraceptive use to ensure a steady supply and distribution of contraceptives; l High quality, easy-to-understand informational materials about family planning options to help women and families make informed choices; and l Health worker training of recommended practices so services are consistent with global standards of care. Programming Strategies is being launched by the World Health Organization (WHO), the US Agency for International Development (USAID) and its implementing partner, the Maternal and Child Health Integrated Program (MCHIP).

“Virtually all women who have just had a baby are not ready to have another one right away; but too often they don’t have access to family planning,” says Dr Marleen Temmerman, director of the Department of Reproductive Health and Research at WHO.

“Many women are not even aware that they can become pregnant within 12 months of giving birth.” Demographic and Health Survey (DHS) data from 27 developing countries show that 95% of post-partum women want to avoid a pregnancy for at least two years, yet 65% do not use contraception.

In Ethiopia, a similar analysis shows 81% of post-partum women are not using any contraception. “There are many obvious, although often missed, opportunities to inform postpartum women on their options for healthy birth spacing and offer them an effective method of contraception,” said Patricia MacDonald, Senior Technical Advisor, Office of Population and Reproductive Health, USAID.

“Antenatal care givers, birth attendants, child health providers and vaccinators should all take the time to ask a woman whether she is interested in family planning to protect herself from having another pregnancy too soon.

This critical window may be the only chance to offer post-partum women the information they need for safe and healthy motherhood.” “This document demonstrates the global health community’s response to the growing demand for post-partum family planning,” according to Koki Agarwal, MCHIP Director and moderator of the launch event.

“Today we call on stakeholders across the spectrum – from health extension workers to midwives, nurses, medical doctors and policy makers – to ensure that every mother, every couple, is better able to safely plan their families.” Programming Strategies for Postpartum Family Planning


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