Measles outbreak across Europe


Measles

Measles is spreading across Europe wherever immunisation coverage has dropped, the World Health Organization is warning.

The largest outbreaks are being seen in Italy and Romania.

In the first month of this year, Italy reported more than 200 cases. Romania has reported more than 3,400 cases and 17 deaths since January 2016.

Measles is highly contagious. Travel patterns mean no person or country is beyond its reach, says the WHO.

For good protection, it’s recommended that at least 95% of the population is vaccinated against the disease.

But many countries are struggling to achieve that.

Most of the measles cases have been found in countries where immunisation has dipped below this threshold and the infection is endemic – France, Germany, Italy, Poland, Romania, Switzerland and Ukraine.

Preliminary information for February suggests that the number of new infections is rising sharply, says the WHO.

WHO regional director for Europe Dr Zsuzsanna Jakab said: “I urge all endemic countries to take urgent measures to stop transmission of measles within their borders, and all countries that have already achieved this to keep up their guard and sustain high immunisation coverage.”

The European Centre for Disease Prevention and Control says that between 1 February 2016 and 31 January 2017 the UK reported 575 cases of measles.

The MMR (measles, mumps and rubella) vaccine is available on the NHS for babies and pre-school children.

Lagging immunisation

Robb Butler, of the WHO Regional Office for Europe, says there are a number of reasons why vaccination coverage has waned in some regions.

“In some countries, like the Ukraine, there have been supply and procurement issues.”

Then there’s vaccine hesitancy. Some people are fearful of vaccination, while others are complacent or find it an inconvenience, he says.

In France, for example, people need to make an appointment with their doctor to get a prescription, go to the pharmacy to collect the vaccine and then rebook with their doctor to have the jab administered.

“We need to get to the point where we appreciate that people have busy lives and competing priorities.”

Dr Mary Ramsay, Head of Immunisation at Public Health England, said: “England’s uptake of MMR vaccine by five years of age has reached the WHO’s target of 95%.

“In the last year, the measles cases confirmed in England have mainly been in older adolescents and young adults with many linked to music festivals and other large public events. Individuals of any age who have not received two doses of the MMR vaccine, or those who are unsure, should speak to their GP – it’s never too late to have the vaccine and measles can still be serious in adults. We are continuing to invest in programmes which encourage uptake of the vaccine to ultimately consign measles to the history books.”

Measles

  • Unvaccinated young children are at highest risk of measles and its complications, including death
  • Measles is spread by direct contact and through the air by coughs and sneezes
  • The virus remains active and contagious on infected surfaces for up to two hours
  • The first signs of infection are usually a high fever and cold-like symptoms, such as a runny nose
  • You may notice small white spots on the inside of the cheeks as well
  • After several days, a rash develops, usually on the face and neck first and then spreading to the body and limbs
  • An infected person can pass on the virus to others from four days prior to developing the skin rash to four days after the rash erupts
  • There is no treatment, but two doses of vaccine can prevent infection in the first place

Source:BBC

The City States of Europe


“The 21st century will not be dominated by America or China, Brazil or India, but by the city,” writes Parag Khanna (1). The author of several books on global strategy, Khanna argues that (some) cities, as islands of good governance in an increasingly unstable world, will become the cornerstone of a new world order.

European_cities

That new world order won’t be a “global village” of nation states, for globalisation is corroding national sovereignty. Rather, it will be a loose network of semi-independent city states, perhaps resembling the Hanseatic League and other medieval trading alliances.

One difference between the city states of the Middle Ages and those of the 21st century: the decreasing significance of Europe. Even though half the world already lives in cities, urbanisation is still speeding up — but mainly in Africa and Asia. Over the next 20 years, 275 million Indians are projected to move from country to city. By 2025, China will have 15 megacities with 25 million inhabitants each. Europe will have none.

Yet perhaps Europe too can already be understood as a network of city states, rather than a patchwork of nation states. It may lack urban megacities the size of Mexico or Mumbai, but its biggest cities transcend their anchor countries, and share more characteristics with similar metropolises than with their own hinterlands.

In all, Europe (2) counts 305 cities with more than 200,000 inhabitants, and 99 metropolitan areas with over 1 million people. The biggest of these metro areas have far outgrown their historical urban cores. Metro London has a population of around 13.6 million, of which only 24 percent live in Inner London. Of Metro Paris’ 11.9 million citoyens, no more than 19 percent live inside the historical boundaries of the ville de Paris. Numbers three and four are both in Spain: Madrid (6.4 million) and Barcelona (5.4 million). Five and six are German: the Ruhrgebiet and Berlin (both around 5 million).

This map (3) shows the largest of Europe’s conurbations. While maintaining the geographical shape of the continent, the map both erases national boundaries and shows with an immediate clarity which are Europe’s major urban centres: London, Paris, and Istanbul — all counting more than 10 million inhabitants. Then come the Spanish and German megacities. Athens and Italy’s three biggest cities are the only other larger conurbations. The rest of Europe is dominated by mid-sized metropolises such as Frankfurt, Birmingham, Budapest, or Lisbon, or smaller ones like Antwerp, Gdansk, or Bilbao.

For much of the 20th century, urban growth seemed a thing of the past, at least in Western Europe, where historical urban cores had been emptying out. Inner London lost 55 percent of its inhabitants between 1911 and 1991. The ville de Paris has shrunk by more than 25 percent compared to 1921. Copenhagen’s population diminished by 35 percent over a comparable stretch of time. Most of the population drained away into suburbs and exurbs, effectively extending urbanity to well beyond the core city (see also #534).

Since 2000, this “urban draining” has been reversed, largely as a result of migration from beyond national borders. However, not all urban areas are growing at the same speed — or are growing at all. All of Italy’s and Greece’s urban centres are losing inhabitants, as are the Ruhr and Katowice, Ostrava and Bucharest. Biggest winners? Istanbul and Ankara, plus two other Turkish cities, and Brussels and Amsterdam — all gaining more than 2 percent p.a. Growing more modestly, at 1 percent, are the English and Scandinavian cities, and a scattering of towns across Europe and Turkey.

Survival for oesophageal, stomach and small intestine cancers in Europe 1999–2007: Results from EUROCARE-5


Background

European regional variation in cancer survival was reported in the EUROCARE-4 study for patients diagnosed in 1995–1999. Relative survival (RS) estimates are here updated for patients diagnosed with cancer of the oesophagus, stomach and small intestine from 2000 to 2007. Trends in RS from 1999–2001 to 2005–2007 are presented to monitor and discuss improvements in patient survival in Europe.

Materials and methods

EUROCARE-5 data from 29 countries (87 cancer registries) were used to investigate 1- and 5-year RS. Using registry-specific life-tables stratified by age, gender and calendar year, age-standardised ‘complete analysis’ RS estimates by country and region were calculated for Northern, Southern, Eastern and Central Europe, and for Ireland and United Kingdom (UK). Survival trends of patients in periods 1999–2001, 2002–2004 and 2005–2007 were investigated using the ‘period’ RS approach. We computed the 5-year RS conditional on surviving the first year (5-year conditional survival), as the ratio of age-standardised 5-year RS to 1-year RS.

Results

Oesophageal cancer 1- and 5-year RS (40% and 12%, respectively) remained poor in Europe. Patient survival was worst in Eastern (8%), Northern (11%) and Southern Europe (10%). Europe-wide, there was a 3% improvement in oesophageal cancer 5-year survival by 2005–2007, with Ireland and the UK (3%), and Central Europe (4%) showing large improvements.

Europe-wide, stomach cancer 5-year RS was 25%. Ireland and UK (17%) and Eastern Europe (19%) had the poorest 5-year patient survival. Southern Europe had the best 5-year survival (30%), though only showing an improvement of 2% by 2005–2007.

Small intestine cancer 5-year RS for Europe was 48%, with Central Europe having the best (54%), and Ireland and UK the poorest (37%). Five-year patient survival improvement for Europe was 8% by 2005–2007, with Central, Southern and Eastern Europe showing the greatest increases (⩾9%).

Conclusions

Survival for these cancer sites, particularly oesophageal cancer, remains poor in Europe with wide variation. Further investigation into the wide variation, including analysis by histology and anatomical sub-site, will yield insights to better monitor and explain the improvements in survival observed over time.

Targeted therapies for NSCLC underused


Nearly a quarter of patients with advanced non-small-cell lung cancer (NSCLC) in Europe, Asia and North America are started on first-line therapy before their EGFR mutation testing results are available, which compromises their access to individualized treatment.

The data, presented at the  European Lung Cancer Conference (ELCC) 2015 held recently in Geneva, Switzerland, came from an international survey that looked at the treatment practices of 562 treating physicians from 10 countries (Canada, France, Germany, Italy, Japan, Korea, Spain, Taiwan, UK and USA). [ELCC 2015, abstract LBA2_PR]

Mutation testing rate was similar in all three regions (82 percent in Asia, 77 in Europe and 76 in NA). “That’s suboptimal, as international guidelines recommend that all advanced NSCLC patients with nonsquamous histology should be tested, so they can receive appropriate treatment according to their mutation status,” remarked Dr. James Spicer of Guy’s hospital, London, UK, who reported the results.

The main reasons for not testing all patients, aside from tumour histology, are insufficient tissue, poor performance status, smoking, and long turnaround time for test results.

“In Asia, more patients are being tested for EGFR mutations and getting the results in a timely manner. Only 10 percent of Asian patients do not have the results before treatment decisions are made, vs 21 percent in North America and 26 percent in Europe,” noted Spicer.

The most important factor in the choice of first-line treatment across all regions was a clinically relevant increase in overall survival, but the survey showed that prescribing practices for EGFR-positive patients vary among regions.

“Physicians in North America and Asia offer significantly more first-line EGFR tyrosine kinase inhibitors [TKIs] than those in Europe [83, 81 and 76 percent, respectively]. Even when available, the use of mutation status to inform treatment decisions is variable, and a significant minority of EGFR-positive patients worldwide receive chemotherapy first, contrary to established guidelines,” he pointed out.

According to Spicer, the reasons why many patients with EGFR mutations receive chemotherapy first need to be understood. “Not being tested or being tested but not given a treatment associated with significant benefits affects patient outcomes,” he concluded.

The discussant, Professor Tony Mok of the Chinese University of Hong Kong, pointed out the survey’s limitations, including the small sample size, selection bias, and differences between types of physicians between continents.

“We don’t know whether the respondents were academic oncologists or private physicians, which may affect their access to EGFR analysis facilities,” he said. “Moreover, we don’t know whether testing or treatment selection had any financial implications for the patient or the physician. For example, were the respondents paid? Are testing and TKI therapy reimbursed?”

Mok also pointed out that a 2011 survey on EGFR mutation testing in Asia showed that overall, only 32 percent of Asian patients were tested, ranging from 18 percent in China to 65 in Japan. “The good news is that the proportion of those tested has been increasing steadily in the past few years,” he said.

“As for the choice of first-line therapy, I don’t think Europe is that different from Asia and North America,” he added.

High IQ could be shield against schizophrenia, scientists say.


An Albert Einstein pumpkin is pictured at Madame Tussauds in New York (Reuters / Carlo Allegri)

An Albert Einstein pumpkin is pictured at Madame Tussauds in New York .

High intelligence might halt the development of schizophrenia, especially in genetically predisposed people, according to a large-scale study contradicting earlier, more conventional beliefs that braininess may increase risk of this disorder.

A team of US and Swedish scientists has recently established that intelligence quotient, or IQ, is an important “moderator” in the development of schizophrenia, but the link actually works the opposite way.

“If you’re really smart, your genes for schizophrenia don’t have much of a chance of acting,” said first author Kenneth S. Kendler, professor of psychiatry and human and molecular genetics at Virginia Commonwealth University.

More than 1.2 million Swedish males born between 1951 and 1975 and registered in the Military Conscription Register participated in the study that assessed their IQ at ages from 18 to 20, in late adolescence, and tracked the history of schizophrenia-related hospitalization until 2010.

High IQ lowers the risk of schizophrenia (Image from the study published in American Psychiatric Association)

High IQ lowers the risk of schizophrenia (Image from the study published in American Psychiatric Association)

It turns out, low IQ is among other factors – like fetal experience, childhood trauma or early drug use – contributing to the development of the mental illness, although there is a huge variation in the intelligence scores of people with schizophrenia.

“What really predicted risk for schizophrenia is how much you deviate from the predicted IQ that [you] get from your relatives,” Kendler said. “If you’re quite a bit lower, that carries a high risk for schizophrenia. Not achieving the IQ that you should have based on your genetic constitution and family background seems to most strongly predispose for schizophrenia.”

According to the study, a 1-point decrease in IQ increases the risk of schizophrenia by 3.8 percent, and the strongest effect was seen within families – it “nearly disappears at the highest IQ level.”

 

Probability of schizophrenia predicted by risk of illness in close relatives (Image from the study published in American Psychiatric Association)

Probability of schizophrenia predicted by risk of illness in close relatives (Image from the study published in American Psychiatric Association)

The study, dubbed “IQ and schizophrenia in a Swedish national sample: Their causal relationship and the interaction of IQ with genetic risk”, is said to be the largest study of the relationship between IQ and schizophrenia to date. It has been published recently in the American Journal of Psychiatry.

Schizophrenia is a mental disorder that often manifests itself with poor social interaction and loss of motivation and initiative. In extreme cases psychosis, a state of losing contact with reality, flooded with hallucinations, paranoia and delusions occur. Treatment may help some people recover from the illness, although others may be affected for years, demonstrating unusual or bizarre behavior.

In the US 2.4 million adults and almost a quarter of a million Australians suffer from this severe mental disorder, which occurs in about one in 100 people worldwide.

European genetic identity may stretch back 36,000 years


Europeans carry a motley mix of genes from at least three ancient sources: indigenous hunter-gatherers within Europe, people from the Middle East, and northwest Asians from near the Great Steppe of eastern Europe and central Asia. One high-profile recent studysuggested that each genetic component entered Europe by way of a separate migration and that they only came together in most Europeans in the past 5000 years. Now ancient DNA from the fossilized skeleton of a short, dark-skinned, dark-eyed man who lived at least 36,000 years ago along the Middle Don River in Russia presents a different view: This young man had DNA from all three of those migratory groups and so was already “pure European,” says evolutionary biologist Eske Willerslev of the Natural History Museum of Denmark at the University of Copenhagen, who led the analysis.

Eske Willerslev found that a man from Kostenki in modern-day Russia had a lot in common with living Europeans.

In challenging the multiple migration model, the new genome data, published online today inScience, suggest that Europeans today are the descendants of a very old, interconnected population of hunter-gatherers that had already spread throughout Europe and much of central and western Asia by 36,000 years ago. “What is surprising is this guy represents one of the earliest Europeans, but at the same time he basically contains all the genetic components that you find in contemporary Europeans—at 37,000 years ago,” Willerslev says.

The origins of Europeans used to seem straightforward: The first modern humans moved into Europe 42,000 to 45,000 years ago, perhaps occasionally meeting the Neandertals whose ancestors had inhabited Europe for at least 400,000 years. Then, starting 10,000 years ago, farmers came from the Middle East and spread rapidly throughout Europe. As researchers recently sequenced the genomes of more than a dozen ancient members of our species, Homo sapiens, in Europe and Asia in rapid succession, they added a third genetic component: a “ghost” lineage of nomads who blew into northeast Europe from the steppesof western Asia 4000 to 5000 years ago.

To explore European ancestry further, Willerslev’s team extracted DNA from the ulna, or lower arm bone, of a skeleton of a young man discovered in 1954 at Kostenki 14, one of more than 20 archaeological sites at Kostenki-Borshchevo. This area in southwest Russia was a crossroads at the boundary of eastern Europe and western Asia and was famous for its carved Venus figures of women. Using radiocarbon dating, the man, also known as the Markina Gora, was recently dated to 36,200 to 38,700 years old, making it the second oldest modern human whose whole genome has been sequenced.

Kostenki XIV (Markina Gora), reconstructed by M. M. Gerasimov

A reconstruction of Kostenki 14.

Willerslev extracted 13 samples of DNA from the arm bone, and his graduate student Andaine Seguin-Orlando and other lab members sequenced the ancient genome to a final coverage of 2.42x, which is relatively low and means that on average each nucleotide site was read 2.4 times. From the sequence data, they found gene variants indicating that the man had dark skin and eyes. He also had about 1% more Neandertal DNA than do Europeans and Asians today, confirming what another, even older human from Siberia had shown—that humans and Neandertals mixed early, before 45,000 years ago, perhaps in the Middle East.

The man from Kostenki shared close ancestry with hunter-gatherers in Europe—as well as with the early farmers, suggesting that his ancestors interbred with members of the same Middle Eastern population who later turned into farmers and came to Europe themselves. Finally, he also carried the signature of the shadowy western Asians, including a boy who lived 24,000 years ago at Mal’ta in central Siberia. If that finding holds up, the mysterious DNA from western Eurasia must be very ancient, and not solely from a wave of nomads that entered Europe 5000 years ago or so, as proposed by researchers in September.

Willerslev says the data suggest the following scenario: After modern humans spread out of Africa about 60,000 years ago, they encountered Neandertals and interbred with them, perhaps in the Middle East. Then while one branch headed east toward Melanesia and Australia, another branch of this founder population (sometimes called “basal Eurasians”) spread north and west into Europe and central Asia. “There was a really large met-population that probably stretched all the way from the Middle East into Europe and into Eurasia,” Willerslev says. These people interbred at the edges of their separate populations, keeping the entire complex network interconnected—and so giving the ancient Kostenki man genes from three different groups. “In principle, you just have sex with your neighbor and they have it with their next neighbor—you don’t need to have these armies of people moving around to spread the genes.”

Later, this large population was pushed back toward Europe as later waves of settlers, such as the ancestors of the Han Chinese, moved into eastern Asia. The Kostenki man does not share DNA with eastern Asians, who gave rise to Paleoindians in the Americas.

Other researchers say that this new genome is important because “it is the first paper to document some degree of continuity among the first people to get to Europe and the people living there today,” says population geneticist David Reich of Harvard University, one of the authors on the triple migration model. It also is “a striking finding that the Kostenki 14 genome already has the three major European components present that we detect in modern Europeans,” says Johannes Krause of the University of Tübingen in Germany.

But even if the man from Kostenki in Russia had all these elements 36,000 years ago, that doesn’t mean that other Europeans did, Reich says. His team’s DNA data and models suggest that Europeans in the west and north did not pick up DNA from the steppes until much later. He and Krause also think that Willerslev’s study needs to be confirmed with higher resolution sequencing to rule out contamination, and to have more population genetics modeling explain the distribution of these genetic types. The bottom line, researchers agree, is that European origins are “seem to be much more complex than most people thought,” Willerslev says.