Vaccination

Community Engagement, Global Health Conferences, Healthcare Workforce, Infectious Diseases, Vaccination

World Hepatitis Day 2015 - Focusing on Prevention

~Written by Theresa Majesty (Contact: theresa.majeski@gmail.com; Twitter: @theresamajeski)

The World Health Organization (WHO) states that approximately 1.5 million people die each year from the various types of hepatitis caused by hepatitis viruses A, B, C, D, and E. It is estimated that half a billion people worldwide are infected with hepatitis B or C virus, the strains responsible for the majority of cases of liver cirrhosis and liver cancer.

In order to bring attention to the large global burden of disease caused by viral hepatitis, 2015’s World Hepatitis Day is July 28th. This date was chosen to honor the birthday of Nobel Laureate Professor Baruch Samuel Blumberg who discovered the hepatitis B virus and developed the first hepatitis B vaccine. This year the emphasis is on prevention, with the slogan “Prevent hepatitis. Act now.”

We can prevent hepatitis by providing safe food and water (hepatitis A and E), vaccines (hepatitis A, B, and E), screening blood donations and providing proper equipment to maintain infection control (hepatitis B and C). While hepatitis B and C can be treated, many people in low- and middle- income countries lack access to treatment due to a lack of screening and the high cost of treatment. Until screening and treatment options become more accessible and affordable, prevention messages are incredibly important.

To help people learn how to prevent hepatitis, the WHO World Hepatitis Day 2015 campaign focuses on four key prevention messages:

  1. Prevent hepatitis - know the risks
  2. Prevent hepatitis – demand safe injections
  3. Prevent hepatitis – vaccinate children
  4. Prevent hepatitis – get tested, seek treatment

Figure 1: A poster from World Hepatitis Alliance. 

If you’d like to get involved in raising awareness about hepatitis, please visit worldhepatitisday.org. There you’ll find some ideas on how to get involved, information on what social media campaigns have been formed, and materials to share to help spread the word that hepatitis is preventable.

The future of the fight against hepatitis looks promising. WHO has been increasing its efforts to fight hepatitis by establishing the Global Hepatitis Programme in 2011, and in 2014 moved that program to the cluster of HIV/AIDS, Tuberculosis, Malaria, and Neglected Tropical Diseases to help facilitate work between HIV/AIDS and hepatitis programs (due to the high number of people around the world living with both HIV and viral hepatitis). Furthermore, WHO, in conjunction with the Scottish Government and the World Hepatitis Alliance, is organizing the first ever World Hepatitis Summit in Glasgow, Scotland over 2-4 September 2015. This invite-only summit will bring together policy makers, patients, and other key stakeholders to determine how best to make lasting progress to reduce the global burden of hepatitis.

There is still progress to be made by the global community in order to win the fight against hepatitis. Key efforts, such as establishing events to publicize the global burden of viral hepatitis and holding summits to bring together the stakeholders that can make a difference, are contributing to saving lives in the fight against viral hepatitis.

Government Policy, Community Engagement, Political Instability, Vaccination, Infectious Diseases

Civil Unrest and the Global Polio Eradication Efforts

~Written by  Kate Lee - MPH Epidemiology, Vanderbilt University Medical Center (Contact: kathleen.g.lee@vanderbilt.edu)

Vaccine-preventable illnesses are an ongoing global health issue. Just in the United States alone there have been outbreaks of measles and pertussis (whooping cough) from parents refusing to vaccinate their children. In 2013, California had over 9,000 people infected with pertussis. As of September 2014, the United States had almost 600 measles cases. For every 1,000 children getting infected with measles, 1 to 2 will die. There will be continuous outbreaks of diseases once thought to have been controlled or eradicated if parents do not adhere to the immunization schedule for their children. This is, however, an argument for another day.

Despite all of this, the United States no longer has ongoing transmission of one of the more debilitating illnesses that affected a lot of children in its peak during the 1950s: polio. This is, of course, due to vaccination campaigns. Since the launch of global polio eradication efforts in 1988, polio incidence has dropped to more than 99%. What can be said of these efforts in parts of the world that are not as stable economically, politically, or socially? In early 2014 India celebrated its third year without wild-type polio. In 2013, the African continent had 274 cases of polio but only 22 in 2014. Overall in 2014, there were 350 cases of polio, down from 416 in 2013 in the African continent. Ongoing poliovirus transmission occurs in three endemic countries: Nigeria, Afghanistan, and Pakistan. Although poor sanitation is a risk factor for polio, prevention of vaccination is the biggest risk one that these countries face.

Mistrust, misconceptions, and religious reasons all feed into public notions of vaccination. Political unrest may be one of the most important obstacles in the global campaign to end polio. Boko Haram insurgency has led to civil unrest in areas of northern Nigeria where ongoing polio transmission occurs. There has been a decline in polio cases in Afghanistan since the Taliban has allowed vaccination in recent years, but that has not been the case for Pakistan. The Pakistani Taliban and other Islamist groups have led killings of health care workers in an anti-immunization campaign. These militant groups threaten not only health care workers that administer the vaccines to the communities, but also the parents who offer vaccination for their children. Since the Pakistani Taliban ban on immunizations in 2012, more than 60 polio workers have been killed. The result of this has been Pakistan counting its 260th case of polio as of November 2014.

Sadly, the political unrest feeds into public mistrust, resulting in a cycle that perpetuates civil instability and polio transmission, leaving the $10 million global eradication effort hanging in the balance. Some health authorities are questioning if the polio campaign is worth it. Lives are lost, health resources are wasted, and new strategies must be reached to continue the immunization effort in Pakistan. Many individuals wonder why polio should be a priority when the country is undergoing so many more problems. There are a variety of other infectious diseases that place the population at risk due to poor sanitation and malnutrition. Outside of health, the threat of the Taliban hangs over the heads of the population. But, why would the Taliban target immunization campaigns? Part of the answer lies in negotiating leverage to stop drone strikes from the United States. The other part of the answer is rooted in a CIA campaign in 2012 to hide Osama bin Laden intelligence operations through the guise of immunization campaigns. Polio in Pakistan is not the first disease to be heavily affected by political unrest and exploited by militant groups, and it sadly may not be the last. What is extremely crucial to understand is that health and politics are not mutually exclusive.

This theme of political cooperation is constant throughout every public health issue. The global effort to erase polio is not an exception. Militant groups, however, now present an added obstacle in achieving social and political stability so that health care workers can conduct their tasks peacefully. Families and vaccinators should not have to fear that their lives are at risk for undertaking public health activities. Rethinking the immunization strategy in Pakistan is necessary. Improvement of basic health services and sanitation are starting points not just for polio, but a multitude of other infectious diseases. These campaigns are important, but take time and money to come to fruition, two resources that are becoming scarcer in a very unstable country.

References:

http://www.cdc.gov/polio/updates/

https://news.vice.com/article/afghanistan-confirms-new-polio-cases-as-pakistans-outbreak-reaches-grim-milestone

http://www.theguardian.com/society/2014/sep/07/us-nearly-600-measles-cases-this-year-cdc

http://time.com/27308/4-diseases-making-a-comeback-thanks-to-anti-vaxxers/

http://www.polioeradication.org/

http://www.washingtonpost.com/blogs/worldviews/wp/2012/10/17/taliban-polio-vaccines/

http://www.bbc.com/news/world-asia-26121732

http://www.npr.org/blogs/goatsandsoda/2014/07/28/330767266/taliban-in-pakistan-derails-world-polio-eradication

Disease Outbreak, Vaccination, Antibiotics, Infectious Diseases

Big Stories in Infectious Diseases for 2014

~Written by Theresa Majeski (Contact: theresa.majeski@gmail.com)

Not many people probably paid much attention to public health, much less global public health, before Ebola arrived in the US and Spain. Despite the focus on Ebola, there have been other global infectious disease developments in 2014.

Antibiotic Resistance

A major threat to humans worldwide is the emergence of antibiotic resistance. According to the Infectious Diseases Society of America, the CDC, WHO, the European Union, and President Obama, the problem of antibiotic resistance has reached crisis level. This is due to the overuse of antibiotics worldwide and major pharmaceutical suppliers who have basically abandoned antibiotic development because they don’t make enough money to justify the expense. This is a major problem because we could end up going back to death rates akin to the pre-antibiotic era, where something as simple as a minor cut could be deadly. Another fact to mention is the huge use of antibiotics in agricultural animals. Agricultural use accounts for 80% of antibiotic use in the US and that continued usage gives bacteria more exposure to the antibiotics and more opportunity to develop resistance.

Hepatitis C and HIV/AIDS

In case you didn’t hear, in only a 25 year span from the discovery of hepatitis C virus (HCV), we now have a treatment that cures 95% of the people who take the pill once a day for 8-12 weeks. I want you to let that soak in a minute…….because this is huge. HCV affects something like 250 million people around the world and now we can not just suppress the virus, but can actually clear it from someone’s body. Unfortunately, right now the cost of this treatment is $74,000 or more per person, basically putting this cure out of reach of anyone in middle or low income countries. Also in 2014, the world reached the tipping point for HIV/AIDS. That means that for the first time in the 30+ year epidemic, the number of people newly infected was less than the number of HIV positive people who got access to HIV medicines. While not every individual country has reached this milestone, and we still have a ways to go to get everyone access to life-saving medication, this tipping point shows that with continued effort the end of HIV/AIDS may be nearer than we thought.

Vaccine development

Vaccines have been around for a while and humanity has tried to create vaccines for all sorts of diseases. Work is being done to create vaccine platforms that don’t involve a needle such as embedding the “stuff” of the vaccine into a microneedle array (a small disk with several microscopic points that dissolve when embedded in the skin).  There is also an effort to create a universal influenza vaccine. A universal vaccine would target viral proteins that are conserved between the different strains of influenza and don’t mutate very often, so the vaccine could be effective no matter what strains are circulating each influenza season.

Epidemics

I just want to touch on a few of the epidemics you may not have heard much about this year. There was an epidemic of enterovirus D68 this year that caused more severe disease than we had expected as enterovirus infections generally only cause mild respiratory symptoms in kids. A mosquito-borne disease, Chikungunya, has been sweeping the Caribbean and causing fever and severe joint pain. Guinea worm, affecting people living in Africa and Asia, grows inside the body and then erupts from anywhere in the body causing severe and debilitating pain. Guinea worm is on target to be the second disease eradicated in human history (after smallpox) and is being eradicated not with the use of expensive medicines but through inexpensive but challenging to implement behavioral change. 

Vaccination, Infectious Diseases, International Aid

Vaccines and Gavi to the Rescue for Millions of Children

~Written by Theresa Majeski (Contact: theresa.majeski@gmail.com)

As talk continues to increase about an Ebola vaccine possibly becoming a reality in a couple months, I thought I’d offer a larger look at vaccines in general and how Gavi, the Vaccine Alliance, is helping ensure children in the poorest parts of the world can take advantage of lifesaving immunizations.

Many people have probably heard of Edward Jenner and his smallpox variolation which served to immunize people against smallpox. But this sort of variolation, taking fresh matter from a sore of someone suffering from an infectious disease and inserting that under the skin of a healthy person to cause an immune response resulting in the variolated person being immune to the disease, had been taking place in Africa, India and China long before Edward Jenner was even born.

The work done by Jenner and his predecessors were humanity’s first attempts at controlling an infectious disease through vaccination.

In the current era we have vaccinations for many of the infectious diseases that previously plagued many of the world’s richer nations, and still plague many of the poorer nations. Some may argue that we have too many vaccinations here in the West and that we are causing more harm than good through our childhood vaccinations. I’m not here to argue that particular topic with readers but if you’re interested in reading some science-based information about vaccines you can find that here, here, and here.

What I want to focus on is how vaccines have taken us from a world where millions upon millions of children died every year from infectious diseases and how the only hope for stopping an outbreak was quarantine, to a world where many of these infectious diseases are rarely seen in richer countries and are on the difficult path to being controlled in many lower income countries around the world. Now this is not to say that outbreaks of these vaccine preventable diseases such as polio, measles, and whooping cough, to name a few, are not occurring in the US, Europe, or Asia. They are, as evidenced by this interactive map from the Council on Foreign Relations.  We still have work to do that is for sure. But organizations like Gavi are focusing on eradicating these infectious diseases in middle and low income countries around the world, where these diseases exact a high toll.

So to put the effect of vaccines into perspective:

  • 3 million lives are saved worldwide every year due to vaccines
  • 1 child dies every 20 seconds from vaccine preventable diseases worldwide
  • The United States has seen a 99-100% decrease in cases of diphtheria, measles, H. influenza, mumps, rubella, congenital rubella, polio and smallpox due to vaccinations
  • Vaccines save the US $42 billion a year in medical costs and lost productivity

The incidence of many of these vaccine preventable diseases is still high in many of the poorer countries of the world; enter Gavi, the Vaccine Alliance. Gavi helps save children’s lives and protect people’s health by increasing access to immunizations in poor countries. Gavi is a public-private partnership with The Bill & Melinda Gates Foundation, WHO, UNICEF, and the World Bank. Gavi works with health ministries in 77 countries to use existing frameworks to deliver vaccines to those in need. Since 2000, Gavi has contributed to the immunization of 440 million children with another 243 million immunized between 2011 and 2015. These efforts amount to averting an estimated 3.9 million deaths from 2011 to 2015 due to vaccine preventable diseases.

Vaccines save lives; it’s as simple as that. Those vaccines we take for granted here in the US are the difference between life and death for many children in lower income countries. Gavi, the Vaccine Alliance is working to make those vaccines accessible to those who need them most. 

Disease Outbreak, Economic Development, Government Policy, Health Systems, Infectious Diseases, Vaccination, Research, International Aid

Politics and Medicine

~Written by Mike Emmerich, Specialist Emergency Med & ERT Africa Consultant (Contact: mike@nexusmedical.co.za

https://twitter.com/MikeEmmerich

"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow

Politics is defined as "organised human behaviour", thus we can postulate that Medicine is micro managed organised human behaviour, at times right down to the molecular level. If we examine the Ebola outbreak/s (globally) and how it is being managed on a macro (politics) and micro scale (medicine) we can begin to see the cracks in the system, and hopefully then move to addressing these cracks, before they begin yawning chasms that are not repairable.

The region (Liberia, Sierra Leone and Guinea) has had success (we could add Nigeria and Senegal to the successes) and failures in both areas. Neither is Spain and the USA exempt from this analysis as can be noted from the various press releases (government and medical) over the past few months.

Since the first outbreaks in 1976 (Sudan and The DRC) till the current one in West Africa; care has generally been palliative and symptomatic, questions have often been asked during this period; What of a vaccine and/or other means of treating the infected patients? There was a report in the British Sunday Times (12/10/14), cited a Cambridge University zoologist as saying that “it is quite possible to design a vaccine against this disease” but reported that applications to conduct further research on Ebola were rebuffed because “nobody has been willing to spend the twenty million pounds or so needed to get vaccines through trial and production”. Globally this has been one of the failures of the pharmaceutical companies, and most probably even the WHO, for not pushing harder over the years to get this in motion.

In her 1994 book /The Coming Plague: Newly Emerging Diseases in a World Out of Balance http://lauriegarrett.com/#item=the-coming-plague, //Laurie Garrett warned that there are more than 21 million people on earth “living under conditions ideal for microbial emergence.” http://www.independent.co.uk/arts-entertainment/science-mutating-microbes-1601604.html Garrett when on to win the Pulitzer Prize in 1996 for reporting on Ebola. In 1995 Joshua Lederberg, the American molecular biologist said: "The world is just one village. Our tolerance of disease in any place is at our own peril. Are we better off today than we were a century ago? In most respects, we're worse off. We have been neglectful of the microbes, and that is a recurring theme that is coming back to haunt us."

Jump forward to the 23^rd of September 2014, US President Obama issued an unprecedented ‘Presidential Memorandum on civil society http://www.whitehouse.gov/the-press-office/2014/09/23/presidential-memorandum-civil-society’ recognising that: Through civil society, citizens come together to hold their leaders accountable and address challenges that governments cannot tackle alone. Civil society organisations…often drive innovations and develop new ideas and approaches to solve social, economic, and political problems that governments can apply on a larger scale./

If we look at the current crises in West Africa civic leaders are what is missing, hence the inability to track and trace potential infected persons, motivate communities to change risky behaviours (handing of the deceased), agitate with government to create better health care systems, this all adds fuel to the fire of the current epidemic.

Have we listened and learnt as governments, NGO's and Multinational Pharmacare companies since then?

Despite Medical Advances, Millions Are Dying, this is a banner from 1996, not 2014! from the WHO, which was "declaring a global crisis and warning that no country is safe from infectious diseases, the World Health Organization says in a new report that diseases such as AIDS, Ebola, Hanta, Mad Cow, tuberculosis, etc., killed more than 17 MILLION people worldwide last year”.

As Laurie Garrett wrote in her the closing section of her book, The Coming Plague, /“In the end, it seems that American journalist I.F. Stone was right when he said, ‘Either we learn to live together or we die together.’ While the human race battles itself, fighting over ever more crowded turf and scarcer resources, the advantage moves to the microbes’ court. They are our predators, and they will be victorious if we, Homo sapiens, do not learn how to live in a rational global village that affords the microbes few opportunities. It’s either that or we brace ourselves for the coming plague.” Time is short.

The Ebola outbreak in West Africa is “unquestionably the most severe acute public health emergency in modern times,” Dr. Margaret Chan, the director general of the World Health Organization, said Monday 20/10/2014). We do seem to be going in circles... circa 1995.. have we learnt nothing from history.

Sooner or later we learn to throw the past away History will teach us nothing ~Sting – Musician, singer-songwriter
Where have all the people gone, long time passing? Where have all the people gone, long time ago? Where have all the people gone? Gone to graveyards, everyone. Oh, when will they ever learn? Oh, when will they ever learn? ~Pete Seeger - American folk singer and activist