Infected EBOLA carriers escape quarantine hospital in the Democratic Republic of Congo

Image: Infected EBOLA carriers escape quarantine hospital in the Democratic Republic of Congo

A new and growing Ebola outbreak is hitting the Democratic Republic of Congo, and additional concerns have been raised as three infected people escaped their quarantine hospital, potentially infecting countless others.

The three patients had been quarantined in the northwestern city of Mbandaka, a port city with a population of nearly 1.2 million. Two of the patients have passed away, while a third has been found alive and brought back to the hospital for observation. Medecins Sans Frontieres said that two of the escapees had been brought by their families to a church to pray.

World Health Organization Spokesman Tarik Jasarevic told ABC News that while the incident was very concerning, it isn’t unusual for people to wish to spend their final moments in their homes with loved ones. WHO staff is now redoubling its efforts to track down everyone who might have come into contact with these patients.

The problem is compounded by the fact that Ebola is so easily spread. Exposure to the body, fluids, or even personal items of someone who has died from the disease can spread it easily, something that not everyone there is aware of. The WHO is working with community and religious leaders to get the word out in hopes of keeping infections to a minimum.

Another challenge is the fact that traditional practices in the area don’t match up with health recommendations, particularly when it comes to funeral practices. In addition, some of the rural population does not believe in Ebola in the first place and has no faith in the ability of Western medicine to help.

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Workers from the WHO and Oxfam are going door to door to let everyone know what hygienic precautions they can take to lower their chances of contracting the deadly disease. They’re also letting them know about symptoms to look out for, which include headache, muscle pain, fatigue, fever, diarrhea, vomiting, rash, and bleeding or bruising.

How far will the current outbreak spread?

Until recently, the current Ebola outbreak had been confined to the country’s rural areas, but it has now made its way to bigger cities like Mbandaka, where it has the potential to spread to many more people. The city’s location along the Congo River and its use as a transit hub is raising fears about just how far the outbreak could spread. The city of Kinshasa, which has a population of 10 million, is just downstream, and across the river is the Republic of the Congo’s capital, Brazzaville.

So far, 58 people have reported hemorrhagic fever symptoms in the country, although it’s likely that there are many more cases going unreported given the general mistrust of doctors in the country. Thirty cases have tested positive for Ebola, 14 are suspected, and 14 are considered probable. Some of the infected include health care workers. Twenty-two people have died so far in what is the country’s ninth outbreak since the deadly virus was first identified in 1976, and the outbreak only started earlier this month.

Experts have said that the outbreak has now reached a critical point, with the next few weeks indicating whether they’ll be able to keep the outbreak under control or if it will hit urban areas in full force. Health workers have a list of more than 600 people who are known to have come into contact with confirmed cases, and they are working hard to keep it from becoming a repeat of past outbreaks. One of the biggest Ebola outbreaks struck Guinea, Sierra Leone, and Liberia between 2013 and 2016, killing more than 11,300 people.

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GMOs Become Obsolete, Bazilian Scientists Make Breakthrough.

Agriculture scientists in Brazil have spent the past decade developing so-called “superfoods” that will soon become a natural alternative to genetically modified frankenfoods grown in many countries including the United States and will alleviate malnutrition for nearly one-third of the world’s population.
These eight biofortified foods are expected to be widely available to consumers throughout Brazil in less than a decade; already there is a pilot program underway in 15 municipalities around the country, Britain’s Guardian newspaper reported.

Continuing, the paper said:

Biofortification uses conventional plant-breeding methods to enhance the concentration of micronutrients in food crops through a combination of laboratory and agricultural techniques.

The goal is to combat micronutrient deficiencies, which can cause severe health problems such as anemia, blindness, impaired immune response and development delays. According to the UN Food and Agriculture Organization, micronutrient malnutrition affects 2 billion people globally.

Taking on ‘hidden hunger’

Efforts to develop biofortified superfoods began a decade ago, when Embrapa, the government’s agricultural research agency, began the project as part of a group of nations seeking to develop varieties of crops that have higher concentrations of necessary micronutrients. The department chose eight foods that are staples in the Brazilian diet: beans, cowpeas (black-eyed peas), rice, sweet potatoes, corn, wheat, cassava and squash.

“We are working on increasing the iron, zinc and provitamin A content. These are the nutrients most lacking not only in Brazil, but in the rest of Latin America and the world as well, the cause of what we call hidden hunger,” food engineer and a biofort co-ordinator, Marilia Nutti, told Tierramerica.

Nutti said iron was especially important, because half of Brazil’s children suffer from some level of iron deficiency.

In addition to the current biofortification project, Brazilian scientists are also working to breed plants of the same species, choosing seeds that appear to exhibit the best traits regarding micronutrient content.

“This is not transgenics. We want a varied diet. Biofortification attacks the root of the problem and is aimed at the poorest sectors of the population. It is scientifically viable and economically viable as well,” Nutti said.

And it’s not genetic modification, either – and that’s key.

The development project is being supported by HarvestPlus and AgroSalud, a pair of research programs that operate in Latin America, Africa and Asia with funding from the Bill and Melinda Gates Foundation, the World Bank and other developmental agencies.

Booming nutritional content

So far, it looks as though the project is, um, fruitful. The iron content of the beans, for instance, has been elevated from 50 to 90 milligrams of iron per kilogram; cassava, which normally has almost no beta-carotene, now has nine milligrams of the essential vitamin A source per gram.

Meanwhile, the beta-carotene level in sweet potatoes has grown from 10 micrograms per gram to an astounding 115 per gram. Zinc content of rice has grown from 12 to 18 milligrams per kilogram.

Not bad – and without turning the foods into “Frankenfoods.”

Already pre-school children are benefiting from the bio-nutritionally enhanced foods. “In Itaguai, an industrial municipality 44 miles south of Rio de Janeiro, about 8,000 pre-school children are benefiting from these extra-nutritious foods,” the Guardian reported.

Eventually all of the municipality’s family farmers will be included in the project – at least, that’s the goal. Further, within a couple years, the plan is to offer biofortified foods in all schools within the municipality, as well as in stores and public markets.

Curiosity of children is one factor that is “selling” the new biofortified superfoods. “When we tell them that these foods have more vitamins, and they see the deeper colors [of the biofortified crops], they are eager to try them out,” municipal secretary of environment, agriculture and fisheries, Ivana Neves Couto told Tierramerica.

“Brazil is the only country working with eight biofortified crops. Bangladesh, Colombia, India, Mozambique, Nicaragua, Pakistan, Peru, the Democratic Republic of the Congo and Uganda are conducting research on one crop each,” Guardian reported.

Source: Raw For Beauty

Global Burden of Sickle Cell Anaemia in Children under Five, 2010–2050: Modelling Based on Demographics, Excess Mortality, and Interventions.



The global burden of sickle cell anaemia (SCA) is set to rise as a consequence of improved survival in high-prevalence low- and middle-income countries and population migration to higher-income countries. The host of quantitative evidence documenting these changes has not been assembled at the global level. The purpose of this study is to estimate trends in the future number of newborns with SCA and the number of lives that could be saved in under-five children with SCA by the implementation of different levels of health interventions.

Methods and Findings

First, we calculated projected numbers of newborns with SCA for each 5-y interval between 2010 and 2050 by combining estimates of national SCA frequencies with projected demographic data. We then accounted for under-five mortality (U5m) projections and tested different levels of excess mortality for children with SCA, reflecting the benefits of implementing specific health interventions for under-five patients in 2015, to assess the number of lives that could be saved with appropriate health care services. The estimated number of newborns with SCA globally will increase from 305,800 (confidence interval [CI]: 238,400–398,800) in 2010 to 404,200 (CI: 242,500–657,600) in 2050. It is likely that Nigeria (2010: 91,000 newborns with SCA [CI: 77,900–106,100]; 2050: 140,800 [CI: 95,500–200,600]) and the Democratic Republic of the Congo (2010: 39,700 [CI: 32,600–48,800]; 2050: 44,700 [CI: 27,100–70,500]) will remain the countries most in need of policies for the prevention and management of SCA. We predict a decrease in the annual number of newborns with SCA in India (2010: 44,400 [CI: 33,700–59,100]; 2050: 33,900 [CI: 15,900–64,700]). The implementation of basic health interventions (e.g., prenatal diagnosis, penicillin prophylaxis, and vaccination) for SCA in 2015, leading to significant reductions in excess mortality among under-five children with SCA, could, by 2050, prolong the lives of 5,302,900 [CI: 3,174,800–6,699,100] newborns with SCA. Similarly, large-scale universal screening could save the lives of up to 9,806,000 (CI: 6,745,800–14,232,700) newborns with SCA globally, 85% (CI: 81%–88%) of whom will be born in sub-Saharan Africa. The study findings are limited by the uncertainty in the estimates and the assumptions around mortality reductions associated with interventions.


Our quantitative approach confirms that the global burden of SCA is increasing, and highlights the need to develop specific national policies for appropriate public health planning, particularly in low- and middle-income countries. Further empirical collaborative epidemiological studies are vital to assess current and future health care needs, especially in Nigeria, the Democratic Republic of the Congo, and India.

Multiple warnings regarding the effect of epidemiological and demographic transitions in low-income countries and their consequences for SCA burden have been published . By quantifying this increase from 2010 to 2050 using evidence-based data and identifying potential changes in the distribution of areas the most affected, we hope (i) to highlight further the need for greater awareness of SCA, appropriate public health policies, and funding; (ii) to guide the implementation of appropriate policies; and (iii) to provide a framework that could be applied to other birth defects. In most countries, the burden of SCA has so far not been recognised. Its long-term toll is nevertheless significant. These results highlight once more the need for further epidemiological collaborative studies, particularly in Nigeria, the DRC, and India, to define more accurately the current and future health burden of SCA.

Source: PLOS

Sickle Cell Anaemia in a Changing World.

Populations and their health are dynamic. Societal, environmental, and economic changes lead to changes in rates of birth, death, and disease, often described as transitions in mortality, demography, and epidemiology. The notion of epidemiologic transition provides an insight into the relationship between levels of overall mortality and the distribution of its causes [1][3], in which the greatest changes arise from the survival of children and young women. Recent falls in global child mortality are good news [4], but will lead to increases in the relative burdens of morbidity and disability in children who would previously have died, and of congenital malformations and inherited disorders. The work of Frédéric Piel and colleagues on sickle cell anaemia (SCA), published in this week’s PLOS Medicine [5], speaks strongly to this point: SCA is an inherited disease whose global importance will increase in terms of absolute numbers and relative population burden. SCA occurs when individuals are homozygous for sickle haemoglobin (HbS) in place of normal adult haemoglobin, and is the most common form of sickle cell disorder (SCD) [6]. Piel and colleagues have collated HbS allele frequency surveys and used them in models to generate a global distribution map and estimate the numbers of infants born heterozygotic and homozygotic for HbS. Using population and mortality projections, they predict an increase in the numbers of newborns with SCA to over 400,000 in 2050. They also estimate the potential mortality effects of four care-provision scenarios, with a best-case scenario that between 7.5 and 15.5 million newborn lives could be saved, most of them in Africa.

Modelled estimates are a growth area in global health. Whilst useful at supra-national and national levels, their emergence highlights the lack of reliable data on populations, disease, and mortality across most of the world: precisely the sort of information that policy makers and health planners need. The utility of estimates for planning screening programmes, infrastructural and human resource requirements, and clinical care protocols at sub-national levels is likely to be limited where the generalisability of assumptions is challenged by diversity at the local level. Even at a global level, estimates can cause confusion. Research teams using different models may, for example, come to different conclusions [7]. Piel et al. have combined available data, statistical methods, and assumptions to predict current burdens and future trends. Their uncertainties are described clearly, and a preoccupation with methodological critiques can easily distract us from the public health concerns that estimates raise.

The epidemiologic transition has been reframed as a health transition that involves sociocultural, behavioural, and health service factors [8], and policy and health services must respond to changing disease burdens. Unfortunately, the notion of transitions is general. Parallel transitions are happening in different groups within one nation, the best example being differences between socioeconomic groups. Rates of transition vary with local environment, and counter-transition is even possible [9]. Policy makers must set priorities in an environment of multiple burdens, unfinished agendas, competing discourses, and the voices of interest groups[10], a process that has been described as a chaos of purposes and accidents [11]. In an environment of Realpolitik, the generation of estimates of burden is important for advocacy. Characteristically, investigators working in an important public health field that has not received global attention lay down the strategic epidemiology [7],[12], as Piel and colleagues are doing, demonstrating that lack of progress will hinder efforts to attain targets such as those of the Millennium Development Goals.

Quantifying the problem is important, but not sufficient. In a consideration of issue attention for newborn health, Jeremy Shiffman considered four elements: the power of the actors involved, new ideas that can be brought to the table, the characteristics of the issue in terms of attractiveness and tractability, and political context [13]. The kind of strategic epidemiology that the SCA figures exemplify needs to be linked with granular understanding of local epidemiology and service provision [7]. SCA poses a particular challenge in terms of tractability. Haematopoietic stem cell transplantation, an emerging cure, is currently too costly a technology for the countries on which the burden predominantly falls, as is hydroxyurea therapy for children at high risk of illness. Survival, health, and well-being can all be improved substantially, but rely on health care systems with a certain level of functionality. Piel and colleagues suggest that the priority is to identify births of infants with SCA, but that such births could be avoided through genetic counselling and prenatal diagnosis. Termination of pregnancy is one of several options, which include preconception genetic screening and strategic reproductive choices, education for carrier parents, and holistic management from infancy. Quite apart from the logistic and financial challenges, these approaches raise substantial ethical questions summarised in recent work from Ghana [14].

Several interventions would be enormously helpful. Routine newborn screening remains costly—but is likely to become less so—and may miss infants born at home. Penicillin prophylaxis and pneumococcal immunisation are possible in most health care systems. The most beneficial approach involves comprehensive care [15]: family education, routine immunisation, malaria prevention, nutrition and hydration, prophylactic antibiotics, folic acid supplements, transfusion when required, support groups for children and their families, protocols for the management of acute events by health workers and—most importantly—regular follow-up. Human resources for health need to be well trained, and the medicines required need to be affordable and available, including the pain relief required by many people with SCD [16].

Steps towards a systematic approach are being taken [17]. A 2006 World Health Assembly resolution on SCA recommends increased awareness in the international community and emphasises collaboration between countries, including technical support, development of practice models, and coordination [18]. The World Health Organization has published a strategy for the African Region, with targets that include development and implementation of national control programmes in member states with high SCD prevalence, adoption of comprehensive health care management, and establishment of surveillance systems [19]. The estimates from Piel and colleagues underscore the need for both collaborative responses and better data for planning and monitoring.

Source: PLOS


Loa loa: neglected neurology and nematodes.

In the early 1990s, efforts to eradicate river blindness came up against an unexpected problem: a rare parasitic worm that seemed to cause serious neurological adverse events in patients treated with the anti-filarial drug ivermectin. David Holmes reports on how the battle against the worm might finally be turning.


There are neglected tropical diseases, and then there is loiasis: a rare filariasis that is caused by the nematode worm Loa loa. Loiasis has come increasingly to light as a result of the serious adverse neurological events that very rarely arise in patients infected with L loa when they undergo treatment for another neglected tropical disease, onchoceriasis, a filarial disease more commonly known as river blindness. Confused? You wouldn’t be alone, but a small group of researchers have been slowly unravelling the L loa enigma.

As early as 1991, reports were starting to emerge of severe adverse neurological events in a handful of patients treated with ivermectin in areas of Cameroon and the Democratic Republic of Congo (DRC) where loiasis and onchoceriasis are co-endemic. Although the incidence of serious adverse events (SAEs) is low (22 out of 17 877 people in Cameroon treated with ivermectin in a study published in The Lancet), about 9% of these events are neurological. According to Farrah Mateen, a neurologist by training who now specialises in international health at Johns Hopkins University in Baltimore, MD, USA, “the range of symptoms that have been reported is pretty impressive”. They include cases of coma, some of which result in encephalopathy, parkinsonism, or death. The first signs, which appear after about 12 h, usually include fatigue and generalised athralgia, but can also include mutism and incontinence. After a day or so, more severe disorders of consciousness start to manifest.

According to a 1955 review by the eminent Belgian neurologist Ludo van Bogaert, the first case report of a L loa worm, extracted from a woman’s eye, was published in 1770 by a French surgeon at San Domingo in the Caribbean. van Bogaert argued, rather presciently as it turns out, that the neurological manifestations of L loa were a subject “of some importance in view of the increasing availability of highly potent anti-filarial drugs”, but the filariasis was nevertheless considered largely benign until, in the late 1980s and early 1990s, the first cases of SAEs began to be described in regions that were co-endemic for L loa and Onchocerca volvulus, and where ivermectin treatment for O volvulus was ongoing.

In 1995, a coalition led by the World Bank and WHO set out to eradicate onchoceriasis by rolling out the African Programme for Onchoceriasis Control. The programme works by creating a community-based distribution network for the broad-spectrum antiparasitic drug ivermectin, which when delivered as a one-time dose (150 μg/kg) kills and protects against theO volvulus parasite that causes onchoceriasis. About 90 million people were treated last year through the programme in the 12 countries of subsaharan Africa where onchoceriasis persists; ivermectin will be donated indefinitely through the Mectizan Donation Program until the disease is eradicated. Now, as the programme moves from control towards an end game of elimination, and therefore into increasingly remote areas where populations have until now remained untreated, it has become increasingly important to look at the problems caused by L loa, explains Adrian Hopkins, Director of the MDP. “In the past there was the justification for ivermectin treatment because onchoceriasis definitely shortens life, so taking the risk was justified in areas with very high levels of onchoceriasis. But if we talk about eradication then we’re talking about treating in areas where there is a very low prevalence of onchoceriasis, so we have to make sure we’ve got as much information as we can”, he says.

Michel Boussinesq, Director of Research at the Institut de Recherche pour le Developpement in Montpellier, France, has worked for over 20 years on the epidemiology of onchocerciasis and ivermectin-based control strategies, and was one of the first to look into the relationship between L loa and ivermectin SAEs. “The first studies were done in the early 1990s, and our first task was to demonstrate that there was a relationship between the SAEs and L loa”, he says. Boussinesq was part of the team that published the Lancet study that established that the risk of developing marked or serious reactions to ivermectin was significantly higher when the filarial load exceeded 8000 microfilariae per mL of blood, and was very high for loads of more than 50 000 microfilariae per mL.

“The threshold of risk is assumed to be about 30 000 microfilariae per mL of blood, and the proportion of people with such high loads in the most endemic villages is probably 5% max”, says Boussinesq. “So the proportion of people with high loads who are at risk is fairly high, but only a small proportion of these people develop an SAE: it’s not that everyone with a level of above 30 000 will develop a SAE, so there must be some other cofactors”.

Two of the biggest challenges facing investigators have been the rarity of cases, and the fact that almost all cases occur in extremely remote areas of the bush, so gathering information is difficult. But there are enough data to establish the general pattern of how most symptoms manifest, explains Hopkins. “It goes through a process: patients become disorientated and confused, and this can take place over a number of hours or half a day, progressing to a coma”, he explains.

Unpicking the pathogenesis, however, has been a tortuous process. “There have been two approaches”, says Charles Mackenzie, a Professor of Pathology at Michigan State University, MI, USA. “One is to try to see what went wrong by doing autopsies on patients. And then because the parasite is also found in mandrils and in baboons, which was understood many years ago by Brian Duke in Cameroon, the MDP assisted in setting up a programme to look at what happened in those infected animals after treatment in parasitologically similar situations of very high parasitic loads”, he explains.

The leading hypothesis that has emerged from these studies is that the sudden die off of L loa in patients treated with ivermectin can, in patients with a high parasitic load, trigger an immunological response. But the paucity of data means the jury is still out on the pathology. Indeed, Joseph Kamgno, Director of the Center for Research on Filariasis and Other Tropical Diseases (CRFilMT) at Yaounde in Cameroon, described a case in DRC in which a patient infected with L loadeveloped encephalopathy without any ivermectin treatment. “The mechanism is quite unclear”, says Kamgno.

Together with maintaining a very active surveillance programme to try to detect and report as many cases as possible, Kamgno’s group have also devised local guidelines for the supportive care that should be given to patients who become comatose. “One of the problems we have is that, sometimes, with patients that go comatose, a lot of people look for traditional remedies first, and particularly in the DRC the hospital has always been the last place to go if you have a coma, which means you get patients 3 or 4 days later, often with bed sores already well established. And patients often die from septicaemia through bed sores”, says Hopkins. “So part of the strategy is ensuring that the population understands what has to be done, and that if a patient gets confused or starts going comatose that they’re transferred to a centre set up specially for the management of these patients”.

The management itself is not complicated, consisting of supportive care, and provided patients have been well cared for, they should wake up over a period of 3 or 4 days. But what happens to the patients after they wake up is slightly more mysterious. “Initially we thought that when patients woke up, we didn’t think there were any real sequelae to that episode, but we need to do more research on that because it does seem to be that there might be a problem”, says Hopkins. “There are one or two teachers who say they can’t concentrate to go back to teaching, but we don’t have an awful lot of information on that”. Bringing some neurological evaluation to bear on the situation is something that Mateen is hoping to get started on soon, to try to see whether she can follow up some of those people who have reported SAEs. “Some of the basic questions are still unanswered”, she notes. “Did they survive? What’s their neurological situation? Are they cognitively intact? And there are a lot of other research issues: normative cognitive data are still being established in many of these regions”.

Meanwhile, researchers are trying to tackle L loa from other directions. The Gates Foundation has funded a project to test the feasibility of using automatic counting techniques to test people in the field, to identify patients who have high levels of the L loa parasite and exclude them from ivermectin treatment. Others are looking for alternatives to ivermectin that could be used to treat onchoceriasis in areas where L loa is endemic. A group led by Mark Taylor at the Liverpool School of Tropical Medicine, UK, are looking at targeting Wolbachia spp, bacterial symbionts of some filarial parasites that are present in onchoceriasis and lymphatic filariasis but not in loiasis. Killing the symbionts eventually kills off the O volvulusfilaria while leaving the L loa unharmed, although the treatment must be taken daily for 6 weeks, so isn’t yet amenable to large-scale treatment. But with the “host of research going on at the moment looking at the disease from every different angle”, Hopkins says, Loa loa looks like it might not be quite so neglected after all.

Source: Lancet


Changing how food aid is allocated ‘may save more lives’.

Malawi_Food_Aid_Flickr_Peter_Casier_140x140International development agencies may be able to save the lives of a greater number ofundernourished children by changing how they allocate food aid in developing countries, suggests a study published today (4 March) inProceedings of the National Academy of Sciences.

Instead of allocating food based solely on weight-for-height measurements, as is currently recommended, making use of additional ‘height-for-age’ data reduced the effects of malnutrition by nine per cent in the study.

Also, the same end results in alleviating malnutrition were achieved with the new method as with the current one but with a 61 per cent cut in the cost of providing ready-to-use therapeutic and supplementary food, the study found.

The findings are based on mathematical modelling using data from more than 5,600 children from Bwamanda in the Democratic Republic of Congo.

The study also proposes that when making crucial food allocation decisions, aid agencies should prioritise those children most in need — even if it means that others go without.

Lawrence M. Wein, professor of management science at Stanford University, United States, and the corresponding author of the study, says one of the main results is that “relative to the currently used policies, incorporating height-for-age information into the allocation decision improves performance — that is, it saves lives”.

The other key finding is that “the optimal policy is an ‘all-or-nothing’ policy where the most at-risk children receive 500 kilocalories per day and the other children receive nothing,” he says.

But because of the limited scope of the study, the authors do not make specific policy recommendations.

They call for more data that can be used to inform such pressing allocation decisions, and also highlight the scarcity of useful data on the effect of food-based treatment.

“Without better data, policymakers will continue to make these important allocation decisions in the face of very limited information,” says Wein.

However, paediatrician Patricia Wolff, executive director of US-based food aid organisation Meds & Food for Kids, argues that height-for-age is a measure of chronic rather than acute malnutrition.

“Being stunted is not related to acute risk of death, although over a lifetime a stunted person will be less healthy than a non-stunted person,” she says.

“I don’t agree that, in resource-poor environments, this stunted group has an equivalent risk-benefit ratio to those children who are low on the weight-for-height graph,” she adds.

Although wary of the benefits of including height-for-age data in food allocation decisions, Wolff admits that the proposed ‘all-or-nothing’ approach could save more lives.

“If you mean by an ‘all-or-nothing’ policy that you give the appropriate treatment resources to the sickest children first and then look around to see if you can find more resources, then I agree. First, you save lives. Second, you optimise health,” she says.

Source: SciVx