Dengue on the increase in the Americas

The number of dengue cases in the Americas increased five-fold between 2003 and 2013, according to data presented at a recent highlevel regional meeting on dengue hosted by the Pan American Health Organization/ World Health Organization (PAHO/WHO).

Between 2009 and 2012, over 1 million cases were reported annually, on average, with more than 33,900 severe cases and 835 deaths. Last year (2013) was one of the worst years for dengue in the hemisphere’s history, with 2.3 million cases, including 37,705 severe cases and 1,289 deaths. By comparison, the number of cases reported regionwide in 2003 was 517,617.

Despite countries’ efforts to control the disease, dengue continues to spread due to uncontrolled, unplanned urbanization, lack of basic services in communities, poor environmental management, and climate change, among other reasons. In the Americas, nearly 500 million people are at risk of contracting the disease.

“Controlling the Aedes aegypti mosquito, which transmits the disease, is a great regional and global challenge,” said Marcos Espinal, Director of the Department of Communicable Diseases and Health Analysis at PAHO/WHO. “All government sectors, communities, and families have to work together to fight the vector and control this disease, which knows no borders, discriminates against no one , and is everyone’s problem, not just the health sector’s.”

Canada, continental Chile, and Uruguay are the only countries in the Region that have reported no dengue cases to date (despite the presence of A. aegypti in Uruguay). The United States detected dengue for the first time in 2007 and by 2013 had registered 1,292 cases, although none were severe or resulted in death.

French funding award for Argus II Retinal Prosthesis System

Second Sight Medical Products has become the first recipient of the French Government national healthcare reimbursement program entitled ‘Forfait Innovation’ for their Argus II Retinal Prosthesis System, the world’s first approved device intended to restore some functional vision for people suffering from blindness due to outer retinal degenerations.

The ‘Forfait Innovation’ Award is a new funding mechanism launched by the French Ministry of Social Affairs and Health to fast track the provision of innovative healthcare technologies.

With funding for this innovative technology now in place, a long-awaited official program to treat advanced retinitis pigmentosa (RP) is commencing in France. Up to 30 RP patients per year in France now stand to benefit from this lifechanging technology.

Professor Jose-Alain Sahel, professor of Ophtalmology, University Pierre et Marie Curie, head of department, Quinze-Vingts Hospital, director of the Vision Institute (UPMC/INSERM/CNRS), said of this decision: “We have been involved in the development of this product for more than five years. This announcement is hugely significant for us and for French patients blinded by retinal diseases. These patients face a great unmet medical need, as there are no current solutions to improve their vision. Additionally, the announcement provides encouragement for other solutions currently under development at Vision Institute in Paris, to further ameliorate conditions resulting in blindness.”

Gregoire Cosendai, Second Sight’s vice president, Europe, said: “It is tremendous news for several patients in France who have been blind for some time and are awaiting a treatment to improve their vision and quality of life. It’s also a great tribute to the excellence of the Quinze- Vingts Hospital who participated in the multicenter clinical trial that lead to the first market approval of the Argus II retinal prosthesis in Europe and the USA.”

The Argus II System works by converting video images captured by a miniature camera housed in the patient’s glasses into a series of small electrical pulses that are transmitted wirelessly to an array of electrodes on the surface of the retina. These pulses are intended to stimulate the retina’s remaining cells resulting in the corresponding perception of patterns of light in the brain. The patient then learns to interpret these visual patterns, thereby regaining some visual function.

doi:10.1136/bjophthalmol- 2012-301525

WHO issues guidelines for treatment of hepatitis C

The World Health Organization (WHO) has issued its first guidance for the treatment of hepatitis C, a chronic infection that affects an estimated 130 million to 150 million people and results in 350,000 to 500,000 deaths a year. The publication of the WHO Guidelines for the screening, care and treatment of persons with hepatitis C infection coincides with the availability of more effective and safer oral hepatitis medicines, along with the promise of even more new medicines in the next few years.

“The WHO recommendations are based on a thorough review of the best and latest scientific evidence,” says Dr Stefan Wiktor, who leads WHO’s Global Hepatitis Programme. “The new guidance aims to help countries to improve treatment and care for hepatitis and thereby reduce deaths from liver cancer and cirrhosis.”

WHO will be working with countries to introduce the guidelines as part of their national treatment programmes. WHO support will include assistance to make the new treatments available and consideration of all possible avenues to make them affordable for all. WHO will also assess the quality of hepatitis laboratory tests and generic forms of hepatitis medicines.

“Hepatitis C treatment is currently unaffordable to most patients in need. The challenge now is to ensure that everyone who needs these drugs can access them,” says Dr Peter Beyer, Senior Advisor for the Essential Medicines and Health Products Department at WHO. “Experience has shown that a multi-pronged strategy is required to improve access to treatment, including creating demand for treatment. The development of WHO guidelines is a key step in this process.”

The new guidelines make nine key recommendations. These include approaches to increase the number of people screened for hepatitis C infection, advice as to how to mitigate liver damage for those who are infected and how to select and provide appropriate treatments for chronic hepatitis C infection.

Screening: WHO recommends a screening test for those considered at high risk of infection, followed by another test for those who screen positive, to establish whether they have chronic hepatitis C infection.

Mitigating liver damage: Since alcohol use can accelerate liver damage caused by hepatitis C, WHO now advises that people with chronic hepatitis C infection receive an alcohol assessment. The Organization also recommends providing counselling to reduce alcohol intake for people with moderate or high alcohol use. In addition, the guidelines provide advice on the selection of the most appropriate test to assess the degree of liver damage in those with chronic hepatitis C infection.

Treatment: The guidelines provide recommendations on existing treatments based on interferon injections as well as the new regimens that use only oral medicines. WHO will update recommendations on drug treatments periodically as additional antiviral medicines are registered on the market and new evidence emerges.

Prevention: The 2014 recommendations also summarize for policy makers and health care workers interventions that should be put in place to prevent transmission of hepatitis C, including measures to assure the safety of medical procedures and injections in health care settings and among persons who inject drugs. Rates of new hepatitis C infections remain unacceptably high in many countries because of the reuse of injection equipment and lack of screening of blood transfusions.

WHO Guidelines for the screening, care and treatment of persons with hepatitis C infection

Hill-Rom to acquire medical division of Trumpf

The Medical Technology division of the Ditzingen-based machine tool and laser manufacturer Trumpf, with its two German factories in Saalfeld (Thuringia) and Puchheim (Bavaria) and its foreign subsidiaries, is to be acquired by the American medical technology manufacturer Hill- Rom Holdings, Inc. TRUMPF and Hill- Rom have signed the relevant contracts.

Completion of the sale is still subject to approval from the anti-trust authorities and is expected to be concluded by the end of quarter 3, 2014.

Hill-Rom, founded in 1929, is an internationally recognized manufacturer of medical products (including hospital beds, patient lifts, and patient positioning systems in operating rooms). Trumpf Medical Systems focuses on innovative system solutions for operating rooms and intensive care units; the portfolio includes operating tables, operating lights, ceiling-mounted supply units, video solutions and assistance-systems.

Commenting on the deal, Harald Völker, Head of Medical Technology in the Trumpf Group Management said: “The product portfolios of both companies enhance each other perfectly, and in international sales, too, we both cover more international markets than either of us would on their own.” This will have positive effects on the development of the division: “Joining forces with Hill-Rom offers excellent prospects for rapid and sustainable further development of the German and foreign sites,” he added

Imperial College London to create new biomedical engineering centre

Imperial College London is to build a new and pioneering biomedical engineering centre thanks to an unprecedented £40 million (US$69m) gift from Michael Uren OBE and the Michael Uren Foundation.

The donation will support the construction of the Michael Uren Biomedical Engineering Hub, a building at Imperial West, the College’s new research and innovation campus in White City, west London.

The centre will house life-changing research into new and affordable medical technology, helping people affected by a diverse range of medical conditions. Imperial’s worldclass engineers, scientists and clinicians will work together in the new space and facilities alongside spin-out companies, helping to create a vibrant innovation district at Imperial West. The Hub will also incorporate clinical areas, providing patients with direct access to innovations in healthcare.

The building and its location will cement Imperial and the UK’s position as world-leaders in biomedical engineering research and application. Sir Keith O’Nions, President of Imperial College London, said: “Imperial is profoundly grateful to Michael Uren and his Foundation for this remarkable gift, the most generous it has ever received. It will create a wholly new building and set of facilities for engineers and medics to come together and make new discoveries and innovations on an unparalleled scale. It provides enormous impetus to the development of Imperial West as an innovation district.”

Michael Uren OBE said: “It is an honour for me to be able to help this great university. Medical teaching and research didn’t exist at Imperial in my day, but it has evolved into an institution where the work between engineering and medicine is today one of its outstanding strengths. Imperial has always applied academic excellence for the greater good, and I am thrilled by the prospect of this Biomedical Engineering Hub doing exactly that.

“What I find so exciting about this project is that here is Imperial building one of the biggest research centres in the world within a few miles of the City of London, which itself has become the biggest financial centre in the world today. By putting the two together, what is quite clear is that the investment world will be watching for, and waiting for, the research and inventions which will create tomorrow’s great companies.

Imperial is already world-renowned for excellence in biomedical engineering research. Its Institute for Biomedical Engineering, founded in 2004, draws together expertise from across the College’s Faculties of Engineering and Medicine, incorporating a wide range of collaborative networks and research centres.

Johns Hopkins receives funds for worldwide influenza virus research

The US National Institutes of Health (NIH) has awarded a contract to researchers at The Johns Hopkins University to launch a new centre devoted to developing innovative ways to identify and track influenza viruses worldwide.

One top goal is to rapidly identify new influenza virus strains that may emerge as the next seasonal influenza or global pandemic that could threaten public health. Under terms of the contract from NIH’s National Institute of Allergy and Infectious Diseases, Johns Hopkins will be one of only five institutions in the United States to be a part of the Centers of Excellence for Influenza Research and Surveillance (CEIRS). The institutions in the CEIRS network will pursue independent research projects and collaborate on others.

A high priority for the Johns Hopkins centre is to develop better ways to rapidly identify which circulating influenza virus strains are robust enough to infect large numbers of people and cause serious, widespread illness, said Andrew Pekosz, Ph.D., Johns Hopkins University Bloomberg School of Public Health, who will codirect the new centre.

To that end, the Johns Hopkins CEIRS team plans to track human influenza virus strains in the United States and Taiwan as part of an effort build a database of influenza cases in real time from hospitals and other healthcare facilities.

The data will be stored in a central, cloud-based computer network so that researchers across the CEIRS network can access the information for their own projects and share insights and findings from across the country and around the world.

The centre’s staff will also analyze genetic characteristics of influenza viruses and use genome sequencing technologies on viruses collected for the database.

The Johns Hopkins CEIRS team hopes to improve the response to influenza epidemics and pandemics by isolating and characterizing new influenza virus strains faster and earlier in the influenza season, thereby giving more time to generate vaccines and formulate public health intervention policies.

Other projects the Johns Hopkins centre will focus on include:

- Using human cell cultures to determine the likelihood of influenza viruses infecting humans;

- Using advanced computer modelling to assess how well different public health intervention strategies work to slow or mitigate an emerging pandemic;

- Using global modelling to assess a country or region’s risk for an epidemic or pandemic; and

- Developing tactical response training programs for medical support and virus surveillance for a pandemic. Air quality deteriorating in many of the world’s cities

Air quality in most cities worldwide that monitor outdoor (ambient) air pollution fails to meet World Health Organization (WHO) guidelines for safe levels, putting people at additional risk of respiratory disease and other health problems. WHO’s Urban Air Quality database covers 1600 cities across 91 countries – 500 more cities than the previous database (2011), revealing that more cities worldwide are monitoring outdoor air quality, reflecting growing recognition of air pollution’s health risks.

Only 12% of the people living in cities reporting on air quality reside in cities where this complies with WHO Air Quality Guideline levels. About half of the urban population being monitored is exposed to air pollution that is at least 2.5 times higher than the levels WHO recommends – putting those people at additional risk of serious, long-term health problems.

In most cities where there is enough data to compare the situation today with previous years, air pollution is getting worse. Many factors contribute to this increase, including reliance on fossil fuels such as coal fired power plants, dependence on private transport motor vehicles, inefficient use of energy in buildings, and the use of biomass for cooking and heating.

But some cities are making notable improvements – demonstrating that air quality can be improved by implementing policy measures such as banning the use of coal for “space heating” in buildings, using renewable or “clean” fuels for electricity production, and improving efficiency of motor vehicle engines.

The latest available data have prompted WHO to call for greater awareness of health risks caused by air pollution, implementation of effective air pollution mitigation policies; and close monitoring of the situation in cities worldwide.

“Too many urban centres today are so enveloped in dirty air that their skylines are invisible,” said Dr Flavia Bustreo, WHO Assistant Director-General for Family, Children and Women’s Health. “Not surprisingly, this air is dangerous to breathe. So a growing number of cities and communities worldwide are striving to better meet the needs of their residents – in particular children and the elderly.”

In April 2014, WHO issued new information estimating that outdoor air pollution was responsible for the deaths of some 3.7 million people under the age of 60 in 2012. The Organization also emphasised that indoor and outdoor air pollution combined are among the largest risks to health worldwide.

There are many components of air pollution, both gaseous and solid. But high concentrations of small and fine particulate pollution is particularly associated with high numbers of deaths from heart disease and stroke, as well as respiratory illnesses and cancers. Measurement of fine particulate matter of 2.5 micrometers or less in diameter (PM2.5) is considered to be the best indicator of the level of health risks from air pollution.

In high-income countries, 816 cities reported on PM2.5 levels with another 544 cities reporting on PM10, from which estimates of PM2.5 can be derived.

In low-and middle income countries, however, annual mean PM2.5 measurements could be accessed in only 70 cities; another 512 cities reported on PM10 measurements.

Ambient (outdoor) air pollution in cities database 2014 

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