Untreatable Antibiotic-Resistant Strains of Gonorrhoea Are Going Global


The World Health Organisation (WHO) has issued a warning over the rise of resistant strains of the infectious bacteria responsible for gonorrhoea.

Superbugs are bad news at the best of times, but with little on the horizon by way of potential treatments for this common sexually transmitted infection (STI), we could very well be rewinding the clock on venereal disease.

 

The warning follows the discovery of several patients in France, Japan, and Spain who harboured strains of Neisseria gonorrhoeae that wouldn’t respond to any antibiotics.

WHO medical officer Teodora Wi predicts there are plenty more to come.

“These cases may just be the tip of the iceberg, since systems to diagnose and report untreatable infections are lacking in lower-income countries where gonorrhoea is actually more common,” says Wi.

Gonorrhoea is one of the most common pathogens passed around through sexual contact, largely thanks to the fact it’s often asymptomatic, meaning people often don’t even know they have the bacteria.

Decreased use of condoms and a rise in travel also contribute greatly to its spread, with an estimated 78 million people infected annually.

The bacteria not only infect the genitals of men and women, but can be found in the tissues of the throat and rectum as well, and lead to complications including infertility and increased susceptibility to catching HIV.

Since the 1930s, bacterial STIs such as gonorrhoea, chlamydia, and syphilis have been treated with a simple course of antibiotics.

“The best time to have had gonorrhoea was the eighties, since there were many drugs to treat it with,” US director of the Centre for Disease Dynamics, Economics and Policy Ramanan Laxminarayan told Nature.

While non-symptomatic cases go untreated, in the absence of an on-the-spot diagnosis kit, doctors also have a tendency to assume STI based on reported symptoms alone, prescribing antibiotics regardless of the presence of infection.

The decades since have seen an increasing number of so-called superbugs – bacteria that have acquired a resistance to numerous antibiotics.

New research has found widespread resistance to several types of antibiotics commonly prescribed for gonorrhoea.

All but 3 percent of countries surveyed between 2009 and 2014 reported Neisseria gonorrhoeae with a resistance to a common and inexpensive antibiotic called ciprofloxacin. About 66 percent of countries reported resistance to a last-resort group of antibiotics called extended-spectrum cephalosporins (ESCs).

 That’s seriously bad news, since in many countries ESCs are the only option left for treating gonorrhoea.

If we’re hoping for a miracle cure to pop up soon, we’ll be disappointed. There’s nothing much in the pipeline, with only 3 candidates being tested – one at the end of a phase 3 trial, and two that have just completed phase 2 trials.

The WHO has been vocal in the past about the reluctance of commercial companies to invest in pharmaceuticals where there is little hope of profit.

Following the 2014 outbreak of Ebola, an epidemic which claimed around 5000 lives, WHO director general Margaret Chan cited profit as the reason vaccines were slow in being developed.

“A profit-driven industry does not invest in products that cannot pay,” said Chan.

Similarly, antibiotics aren’t always appealing candidates for commercial pharmaceutical companies, since – somewhat ironically – bacteria can develop a resistance to them.

The WHO has joined forces with the Drugs for Neglected Diseases initiative to launch the Global Antibiotic Research and Development Partnership in order to address this dire issue.

“In the short term, we aim to accelerate the development and introduction of at least one of these pipeline drugs, and will evaluate the possible development of combination treatments for public health use,” says the partnership director Dr Manica Balasegaram.

Even if we develop more accurate and rapid diagnostic techniques and new antibiotics, prevention is far better than any cure.

Addressing the availability gap of quality generic cardiology drugs in developing countries.


In September 2016, the World Health Organisation (WHO) launched the ‘Global Hearts’ initiative in order to tackle the global threat of cardiovascular disease, especially in developing countries. This is no mean feat. According to the WHO, in 2012 an estimated 17.5 million people died from CVD – that is around 31% of all deaths worldwide. [1]

One of the big issues facing patients and healthcare providers in developing countries is access to quality medicines. The United Nations Millennium Development Gap Task Force Report 2012 [2] states that just over half (51.8%) of public health facilities in developing countries are able to provide ‘essential medicines’.

There are initiatives in place to improve access to medicines, with particular regard to the production of generic drugs. However, the quality of these medicines is of great concern.

The SEVEN Study assessed the quality of seven cardiovascular drugs in 10 Sub-Saharan countries: 3468 samples were collected, 1530 were tested at random. Of these, 249 (16.3%) were of ‘poor quality’ (defined as a ratio of 85% – <95% to >105%-115% of the expected dose of the active ingredient.). [3]

An editorial published in JAMA Cardiology – ‘Evaluating and Improving the Cardiovascular Drug Supply for Better Global Health’ – [4] highlighted the results of this study. Author Mark D. Huffman, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, US, asserts that the availability gap of quality drugs must be addressed, saying that: “Improving and maintaining the safety of the global medicine supply is a shared priority for many stakeholders including patients, physicians, governments, and payers as well as legitimate pharmaceutical manufacturers, who all benefit from a safe and effective medicine chain.” [4]

Cardio Debate recently published a series of interviews discussing the challenges of using generic drugs in cardiology. Here, Professor David Holt, Professor of Bio-Analytics at St George’s University of London says: “I am often asked if generic formulations are all the same in terms of efficacy and safety with respect to the originator formulation. The thing you have to understand for the generic regulations, the procedure you go through when you produce a generic medication, they do not look at safety and efficacy. We have a process whereby they show bioequivalence for solid dose formulations – liquid formations don’t have to show that, only that they are the same drug in the same drug.”[5, 6] This is in the context of producing generic drugs in Europe, one can only imagine the challenges in areas of the world with less stringent manufacturing regulations in place.

References

  1. http://www.who.int/cardiovascular_diseases/global-hearts/en/
  2. MDG Gap Task Force Report 2012. ‘The global partnership for development: Making rhetoric a reality.’
  3. Quality assessment of seven cardiovascular drugs in 10 Sub-Saharan countries. The SEVEN Study. JAMA Cardiol 2017; 2(2): 223-5.
  4. http://jamanetwork.com/journals/jamacardiology/fullarticle/2569799
  5. http://www.cardio-debate.com/2017/03/06/critical-challenges-when-using-generic-agents/
  6. http://www.cardio-debate.com/2017/02/27/challenges-of-using-generic-drugs/

Source:http://www.cardio-debate.com

A jab in time


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Some Western countries have lower vaccination rates than poor parts of Africa. Anti-vaxxers are not the main culprits

ERADICATING a disease is the sort of aim that rich countries come up with, and poor ones struggle to reach. But for some diseases, the pattern is reversed. These are the ailments for which vaccinations exist. Many poor countries run highly effective vaccination programmes. But as memories of the toll from infectious diseases fades across the rich world, in some places they are making a comeback.

The World Health Organisation (WHO) reckons that vaccines save 2.5m lives a year. Smallpox was eradicated in 1980 with the help of a vaccine; polio should soon follow. In both cases, rich countries led the way. The new pattern looks very different.

contagious. At least 95% of people must be vaccinated to stop its spread (a threshold known as “herd immunity”). Although usually mild, it can lead to pneumonia and cause brain damage or blindness. The countries with the lowest vaccination rates are all very poor, but many developing countries run excellent programmes (see chart). Eritrea, Rwanda and Sri Lanka manage to vaccinate nearly everyone. By contrast several rich countries, including America, Britain, France and Italy, are below herd immunity.

Last year Europe missed the deadline it had set itself in 2010 to eradicate measles, and had almost 4,000 cases. America was declared measles-free in 2000; in 2014 it had hundreds of cases across 27 states and last year saw its first death from the disease in more than a decade. The trends for other vaccine-preventable diseases, such as rubella, which can cause congenital disabilities if a pregnant woman catches it, are alarming, too.

This sorry state of affairs is often blamed on hardline “anti-vaxxers”, parents who refuse all vaccines for their children. They are a motley lot. The Amish in America spurn modern medicine, along with almost everything else invented since the 17th century. Some vegans object to the use of animal-derived products in vaccines’ manufacture. The Protestant Dutch Reformed Church thinks vaccines thwart divine will. Anthroposophy, founded in the 19th century by Rudolf Steiner, an Austrian mystic-cum-philosopher, preaches that diseases strengthen children’s physical and mental development.

In most countries such refuseniks are only 2-3% of parents. But because they tend to live in clusters, they can be the source of outbreaks. A bigger problem, though, is the growing number of parents who delay vaccination, or pick and choose jabs. Studies from America, Australia and Europe suggest that about a quarter of parents fall into this group, generally because they think that the standard vaccination schedule, which protects against around a dozen diseases, “overloads” children’s immune systems, or that particular vaccines are unsafe. Some believe vaccines interfere with “natural immunity”. Many were shaken by a claim, later debunked, that there was a link between autism and the MMR vaccine, which protects against measles, mumps and rubella.

In America, some poor children miss out on vaccines despite a federal programme to provide the jabs free, since they have no regular relationship with a family doctor. Some outbreaks in eastern Europe have started in communities of Roma (gypsies). Members of this poor and ostracised minority are shunned by health workers and often go unvaccinated.

Several governments are trying to raise vaccination rates by making life harder for parents who do not vaccinate their children. A measles outbreak last year that started with an unvaccinated child visiting Disneyland and spread from there to seven states prompted California to make a full vaccination record a condition of entry to state schools. The previous year, in a quarter of schools too few children had been vaccinated against measles to confer herd immunity. A dozen other states are considering similar bills. After a toddler died from measles last year, Germany recently started to oblige parents who do not wish their children to be vaccinated to discuss the decision with a doctor before they can enroll a child in nursery. Australia’s new “no jabs, no pay” law withdraws child benefits from parents who do not vaccinate, unless they have sound medical reasons.

Persuasion, a fine art

There is, however, surprisingly little evidence that tough laws make a big difference to vaccination rates. European countries that are similar in most respects (such as the Nordics) may have similar rates for jabs that are mandatory in one country but not in another—or very different rates despite having the same rules. Rates in some American states where parents can easily opt out are as high as in West Virginia and Mississippi, which have long allowed only medical exemptions.

And strict rules may even harden anti-vaccination attitudes. Australia had previously made exemption conditional on speaking to a doctor or nurse about the benefits of vaccines. The new rules mean fewer chances to change parents’ minds. Research suggests that making it harder to avoid the most important vaccines may make it more likely that people who strongly oppose vaccination in general shun optional ones, says Cornelia Betsch of the University of Erfurt.

More important, say public-health experts, is to boost confidence in the safety of vaccines and trust in the authorities that recommend them—both badly damaged in many European countries by pastpublic-health mis-steps, such as a scandal with contaminated blood supply in France from the late 1990s. The best way to handle a vaccine scare is to express empathy and promptly share the results from investigations of alleged adverse reactions, says Heidi Larson of the London School of Hygiene and Tropical Medicine. British authorities’ dismissive response to the MMR scare failed to reassure worried parents.

One promising new approach is to keep track of the vaccine myths circulating in cyberspace and rebut each one as it appears. This requires tracking information from search engines and following anti-vaccination websites and parents’ forums. On one such forum, worriers say they have scoured government and vaccine-manufacturer websites but feel overwhelmed by information that they regard as inconclusive or contradictory. One mother seeks advice on how to get around California’s “fascist” new rule. Another casts doubt on a study on severe allergic reactions to vaccines: 33 cases from 25m jabs, she says, seems “fishily low”.

Some countries are starting information campaigns that treat such concerns with respect. A parents’ organisation in Bulgaria launched one recently, under the auspices of the ministry of health and the national association of paediatricians. Its website is jargon-free and easier to navigate than unwieldy official hubs. France is launching a national dialogue on vaccines this spring, with a website where citizens can swap gripes, worries and advice.

Although vaccine-hesitant parents often search for answers on the internet, their most trusted sources are doctors and nurses. The WHO recently developed guidelines to help health workers figure out, through a questionnaire, which type of worrier a parent is—and how to alleviate specific concerns. But recent research from several European countries shows that many doctors and nurses are also hesitant about vaccines, for much the same reasons as their patients. In a survey conducted in 2014, 16-43% of French family doctors said they never or only sometimes recommended some of the standard vaccines.

An additional problem is that many adults were not immunised as children and have not caught up since. In the 1970s and 1980s, when the measles vaccine was new, many children did not receive it, or got just one shot, which is now known not to be reliable in conferring immunity. Some countries offer free catch-up jabs to some adults when outbreaks flare up—usually parents with small children and health workers in affected areas.

But such efforts have, on the whole, been too little, too late. The return of easily preventable diseases that had all but disappeared is a shame. A bigger shame would be for governments to continue blaming it all on ignorant parents.

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Caesarean sections should only be done out of medical necessity, WHO says


World Health Organisation says procedure carries health risks, but does not improve mortality rates in countries where high numbers are performed

A caesarean section is performed at Queen Charlotte’s hospital in London.
A caesarean section is performed at Queen Charlotte’s hospital in London. Photograph:

Caesarean sections should only be carried out when medically necessary, according to the World Health Organisation, which says the surgical procedure can put the health of women and their babies at risk.

The WHO reiterates the view of its health experts, who have said since 1985 that the “ideal rate” for caesarean sections is between 10% and 15% of births. Caesareans save lives for example when women are in obstructed labour or their babies are in distress. But two new studies show that in countries where they account for more than 10% of births, “there is no evidence that mortality rates improve”, the WHO said.

About 25% of UK births are through caesarean section, up from 12% in 1990. The rise is worldwide and thought to be a combination of doctors believing surgery is safer in potentially difficult births and women choosing not to undergo labour. More than half of women giving birth have caesarean sections in Brazil and the figure rises to over 80% in private hospitals.

There are risks in any surgical procedure. According to the National Institute of Healthcare and Clinical Excellence (Nice), a caesarean increases the risk that a baby will end up in intensive care and that women will stay longer in hospital, have a hysterectomy or a cardiac arrest. Its 2011 guidelines, however, state that women who want a caesarean should get one, even if it is not for medical reasons.

The WHO says the full effects of a caesarean on mother and child are not yet clear. “Across a population, the effects of caesarean section rates on maternal and newborn outcomes such as stillbirths or morbidities like birth asphyxia are still unknown. More research on the impact of caesarean sections on women’s psychological and social wellbeing is still needed,” it said.

There are many countries in the developing world, however, where women and their babies are dying for want of a caesarean section. The WHO says that decisions about whether to operate should be made on a case by case basis, and not according to target figures.

Ebola cases in W Africa reach 20,000


The World Health Organisation on Wednesday said that the number of people infected by the Ebola outbreak in the three west African countries has passed 20,000, even as the death toll from the deadly-disease reached 7,842.

Cumulative Ebola cases in the three west African countries — Sierra Leone,Liberia and Guinea — stood at 20,081, the WHO said in a statement.

Despite various missions launched by the UN, after it declared the outbreak a “public health emergency of international concern” in August, the disease has continued to spread and experts warn the epidemic will last a full second year.

Meanwhile, the UN Population Fund (UNFPA) today announced that the so—called “CommCare” technology has been chosen to support the Guinean Government Response Plan against Ebola in order to obtain timely and reliable information on patients as well as facilitate contact tracing.

UNFPA said the innovative and time—saving application will be used to locate the contacts and to transfer, in real time, the data collected by the community workers.

Nearly, 158 community workers have already been using these phones to retrieve the data collected in the field.

The UNFPA office in Guinea has been organising training sessions for community workers and supervisors throughout the territory.

 

 

Gutka ban helped many kick the habit: WHO study


A study conducted by the World Health Organisation country office for India in collaboration with the Johns Hopkins Bloomberg School of Public Health across seven States in India shows that banning gutka, a form of chewing tobacco, helps users kick the habit.

A study conducted by the World Health Organisation country office for India in collaboration with the Johns Hopkins Bloomberg School of Public Health across seven States in India shows that banning gutka, a form of chewing tobacco, helps users kick the habit.

India is estimated to be the world’s largest consumer of smokeless tobacco; WHO estimates indicate that 26 per cent of adults use smokeless tobacco, a major cause of death and disease. Nearly one million people die in India every year because of tobacco use.

The new study conducted across Assam, Bihar, Gujarat, Karnataka, Madhya Pradesh, Maharashtra, Odisha and the National Capital Region, shows that there are “strong indications” that State-level laws banning gutka have a positive impact owing to reduced product availability and a decrease in its consumption.

It also shows as many as 92 per cent of the respondents support a gutka ban while 99 per cent agreed that a ban is good for the health of India’s youth. A substantial proportion of respondents in each State (from 41-88 per cent) reported that they quit using gutka because of the ban.

“These findings have a strong message that regulatory mechanisms are effective and can have a positive impact on the consumption pattern,” said Dr. Nata Menabde, WHO Representative to India.

According to her, the study revealed that product ban did impact use. “Of the respondents who continue to use pre-packaged gutka, half (49 per cent) reported they consume less since the ban. I am also happy to learn that there was high degree of unanimity (90 per cent of the respondents) that the government should ban the manufacturing, sale and distribution of other forms of smokeless tobacco,” she said.

 

 

New, one-dollar injectable contraceptive to reach world’s 69 poorest countries by 2020.


A new cheap, easy-to-use injectable contraceptive has been made available to women in West Africa, with the plan to distribute it throughout 69 of the world’s poorest countries by 2020.

Sayana Press is a new injectable contraceptive that costs just one dollar, and lasts for three months. Developed by US drug company Pfizer, it’s been distributed throughout Burkina Faso – a landlocked, drought-stricken country said to be poor, even by West African standards – thanks to the involvement of the Bill and Melinda Gates Foundation, US drug company Pfizer and the Children’s Investment Fund Foundation.

If all goes well in Burkina Faso, Pfizer has guaranteed that women in Niger, Senegal and Uganda will gain access to Sayana Press, followed by the rest of the world’s poorest countries over the next five years.

The injectable is not just any old syringe – it’s much safer and easier to use than that. The technology is called Uniiject, and it’s a pre-packaged device that provides the exact dosage required with a simple squeeze of bubble at the top. Very little training is required by health professionals to use it, it cannot be spilled, and it cannot be used again for illegal drug injection. Each one costs just one dollar.

The technology has been used before to inject hepatitis B medications in Indonesia, but this is the first time it’s been used to deliver contraceptives.

“Normally for injections you have to put them in someone’s bottom, or the top of their leg, but with this – you use the arm,” Kadidia Diallo, a nurse working in Burkina Faso told Jane Dreaper at BBC News. “That’s an advantage for women living in the bush. Many women don’t come forward for injections if they have to pull their dresses up – but this is more discreet.”

According to Dreaper, the World Health Organisation (WHO) has estimated that a staggering 222 million women in developing countries around the world have said they’d like to stop or delay pregnancy, but for various reasons are not using any form of contraception.

The results have so far been very positive in Burkina Faso, with Gates Foundation-funded site, Take Part, reporting that nearly 6,000 women have used the contraceptive, and for almost a quarter of them, it’s the first contraceptive they’ve ever taken.

“When women are able to plan their families, they are more likely to survive pregnancy and childbirth, to have healthier newborns and children, and to invest more in their families’ health and well-being,” said Chris Elias, president of Global Development Programs at the Gates Foundation, in a statement.

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Superbugs ‘more deadly than AIDS’ as antibiotics become increasingly useless, according to The World Health Organisation .


Reuters / Getty
Risk: Dame Sally Davies

An infected scratch could become an everyday killer as antibiotics become increasingly useless, the world’s top doctors have warned.

The World Health Organisation said superbugs are now more deadly than the 80s Aids epidemic in a major report which declared, “the era of safe medicine is coming to an end”.

WHO Europe antimicrobial resistance adviser Dr Lo Fo Wong warned: “Everyone is potentially in danger.”

The WHO warned cash must urgently be pumped into developing new drugs after examining data from 114 countries.

The report warned of growing antibiotic resistance in seven bacteria linked to diseases such as sepsis, diarrhoea, pneumonia, urinary tract infections and gonorrhoea.

Dr Keiji Fukuda, assistant director general for health security, said: “Without urgent action, the world is headed for a post-antibiotic era in which common infections which have been treatable for decades can once again kill.”

England’s chief medical officer Dame Sally Davies has called for restrictions on prescribing antibiotics for mild infections and incentives for drugs firms to produce new medicines.

She said resistance was being fuelled because drugs were being unnecessarily used for mild infections.

Patients can help by only using prescribed antibiotics, making sure they complete the treatment and never sharing left-over prescriptions, the WHO said.

Microbiologist Prof Laura Piddock, of the University of Birmingham, said: “The world needs to respond as it did to the Aids crisis.

“We need a better understanding of resistance and development of new antibiotics.”