Sunday, November 22, 2020

TB Vaccine (BCG) helpful for COVID-19?

 The Bacillus Calmette-Guerin vaccine is a vaccine used for tuberculosis (TB) disease, and is not widely used in the US and is typically only meant for infants/small children and healthcare workers where TB is most common. Researchers from Cedars-Sinai conducted blood tests on 6,000+ healthcare workers from the Cedars-Sinai health system, and found that among those who received the TB vaccination, there was a "significantly less likely [chance] to test positive for SARS-CoV-2 antibodies". The research states though, that a "large randomized prospective clinical trial" of BCG vaccination is need to understand the confirm if "BCG vaccination can induce a protective effect against SARS-CoV-2 infection. 

Analysis and research is still widely needed in order to see if the BCG vaccination is needed, though, it must be noted that the BCG is not generally recommended, because of the low chance of infection with Mycobacterium tuberculosis. 

-Justin

https://losangeles.cbslocal.com/2020/11/20/tuberculosis-vaccine-could-mitigate-risk-of-contracting-covid-19-study-shows/

https://www.jci.org/articles/view/145157

https://www.cdc.gov/tb/topic/basics/vaccines.htm#:~:text=Bacille%20Calmette%2DGu%C3%A9rin%20(BCG),protect%20people%20from%20getting%20TB.

TB - A Modern Tragedy affected by COVID-19

Unfortunately, for millions around the world, TB (tuberculosis) is still a predominant and persevering threat that is severely underfunded (leading to treatments and diagnosis that wrongfully take the lives of millions). The Stop TB Partnership has stated that many countries that still face the problems of TB, are using methods that are outdated, and that treatment of patients were only going to be further slowed, due to the COVID-19 pandemic.  


Despite TB being a very preventable and curable disease, though, remains "the top infectious disease killer". Many would like to see the responsiveness and urgency given to TB, as is given to COVID - as COVID-19 vaccines have seen roughly 50 human trial phases (all within less than a year), but for TB, only one vaccine has been seen in human trials, over the past several years. 
- Justin

https://www.telegraph.co.uk/global-health/science-and-disease/modern-tragedy-millions-miss-latest-treatments-tb/?utm_source=Global+Health+NOW+Main+List&utm_campaign=f33d9a6b21-EMAIL_CAMPAIGN_2020_11_16_04_09&utm_medium=email&utm_term=0_8d0d062dbd-f33d9a6b21-2870277

Chapare virus: Updates from the old Novel virus?

 Back in 2004, Chapare virus (CHAPV) was identified and was classified as a novel New World arenavirus, being able to cause a fatal case of what is known as Chapare hemorrhagic fever (CHHF).No cases have since been found, snice 2004, though back in 2019 in Caranavi, Bolivia, cases of  hemorrhagic fever cases of unknown etymology were found. It wasn't until recently though, that this circulating virus in Caranavi was found be be a strain of CHAPV.

Researchers, in collaboration with the Pan American Health Organization, deployed assays and processed/analyzed specimen at the Bolivian Center for Tropical Diseases. Through these tests, CHAPV RNA was found in a variety of human blood, serum, tracheal aspirates, urine, semen, and within rodent specimen. Potentially rodents could be a reservoir for this virus, though more research is needed to understand where the CHAP virus originated, it's routes for transmission (and how it infects humans), and if there is a likelihood for a larger outbreak of CHAPV. Thanks to the work of international collaboration for urgent public health responses, this work was possible. 

- Justin

https://www.abstractsonline.com/pp8/?utm_source=Global+Health+NOW+Main+List&utm_campaign=f33d9a6b21-EMAIL_CAMPAIGN_2020_11_16_04_09&utm_medium=email&utm_term=0_8d0d062dbd-f33d9a6b21-2870277#!/9181/presentation/3040

Indigenous Populations & response to COVID-19

Overall, within the US, amongst Native American and Alaskan Native populations, the case rate of COVID-19 has far exceeded that of whites - being about 3.5 times higher, and damaging. Within the Cherokee Nation (my other tribal affiliation), public health officers and support from the Cherokee government, has led to lower death rates and curtailed COVID-19 cases, compared to those in the surrounding areas in Oklahoma. As of now, there have been no reported cases of workplace transmission, and even the local high school was reopened - with appropriate safety precautions. The Cherokee Nation has accredited their local control on COVID-19, in part due to their early and aggressive response (which in comparison to surround areas, waited much longer to take action). 

The Chief of the Cherokee Nation - Chuck Hoskin Jr. - highlighted early importance and adoption of face mask usage, and strongly supported the recommendations made by the tribe's health program. Thanks to implementations such as wearing masks indoors/outdoors/around others, reverence and respect to elders (and the Cherokee Nation's desire to protect them from the virus), and a strong adherence to leading experts like Dr. Fauci, the coordinated and rapid response made by the Cherokee Nation was made possible. 

https://www.npr.org/sections/coronavirus-live-updates/2020/11/16/935445425/navajo-nation-enters-new-lockdown-as-coronavirus-cases-rise?utm_source=Global%20Health%20NOW%20Main%20List&utm_campaign=f33d9a6b21-EMAIL_CAMPAIGN_2020_11_16_04_09&utm_medium=email&utm_term=0_8d0d062dbd-f33d9a6b21-2870277

https://www.statnews.com/2020/11/17/how-covid19-has-been-curtailed-in-cherokee-nation/?utm_source=Global+Health+NOW+Main+List&utm_campaign=f33d9a6b21-EMAIL_CAMPAIGN_2020_11_16_04_09&utm_medium=email&utm_term=0_8d0d062dbd-f33d9a6b21-2870277

UK - Breaking data by Race for COVID-19

In the UK, it was recently noted that scientists are pushing for more data by race/ethnicity, as in most European countries, data by race/ethnicity is a taboo. Because of this taboo, even through collection data, policy makers are struggling on how to rest respond to COVID-19's immense impact on Black and Asian people. 

A number of factors - not yet reported - have be arising and questioned, as to why certain communities are affected more than others: ranging from whether or not minority communities trust hospital staff or if hospital staff treat minorities fairly, how much access to healthcare do certain minority groups have, and more. In the UK, it was even noted by a survey (by ClearView), that 60% of Black people did not feel that their health was protected as equally as white people's were - under the National Health Service. 

In the US, ethnicity data helped scientists/authorities identify that African Americans/Blacks were some of the highest rates of HIV/AIDS, in the general population - allowing authorities to create targeted programs to help these (and other) ethnic communities. A color-blind model, is what a number of European countries are sticking too, though, leaving a number of gaps and absence of comprehensive data. My question is, would tracking ethnicity/race in data moving forward impact the future of research in European countries, and how has tracking ethnicity/race in the US helped reduce/aid COVID-19 infected patients? 

-Justin

https://news.trust.org/item/20201119050454-foy2l/?utm_source=Global+Health+NOW+Main+List&utm_campaign=fcbf81eeac-EMAIL_CAMPAIGN_2020_11_18_03_53&utm_medium=email&utm_term=0_8d0d062dbd-fcbf81eeac-2870277

Shifting COVID-19 prevention behaviors: Airborne filtration or Scrubbing surfaces

 Recently, NYTimes reported that scientists are now saying that scrubbing down surfaces is not nearly as effective as focusing on improving ventilation and filtration of indoor air. In fact, there are also those saying that "there is little to no evidence that contaminated surface can spread the virus", but instead, being inside a closed/crowded space poses a much greater threat for transmission - like airports. Scientists also note that hand washing/sanitizers are still strongly encouraged, but that energy/time is wasted on surface disinfection; additionally, surface disinfection could possibly give people a false sense of security about the spread of coronavirus//the safety of being in crowded places. 

Instead, there is growing evidence that suggests that the virus could "stay aloft for hours" as tiny droplets, and infecting people as soon as they are inhaled. Even the CDC has switched its stance on transmission, noting that "surfaces are 'not the primary way the virus spreads", but instead respiratory droplets. 

-Justin

https://www.nytimes.com/2020/11/18/world/asia/covid-cleaning.html?utm_source=Global+Health+NOW+Main+List&utm_campaign=fcbf81eeac-EMAIL_CAMPAIGN_2020_11_18_03_53&utm_medium=email&utm_term=0_8d0d062dbd-fcbf81eeac-2870277

Ethical Concerns: Catching disabilities & teratogenic virus effects in utero

 The Atlantic recently published an article that talked about how Down Syndrome is one of the least severe and first conditions screened for, in utero. Within Denmark, there exists a universal Down syndrome screening available for nearly all families. Amongst those families, nearly all (95%) who get a positive test for Down Syndrome for their unborn child, choose to abort. Within Western Europe (and some parts of the US), a similar pattern can be see. In Denmark, (2019), only 18 children with Down Syndrome were born in the entire country - a stark contrast to the 6,000 children born with down syndrome in the US, each year. This article raised questions for me, about viruses that could cause teratogenic effects to children in utero. A number of viruses (ranging from Zika Virus, Mumps, Hepatitis, Varicella-Zoster Virus), and could leave some mentally or physically disabled. Cases of viruses causing teratogenic effects are somewhat rare, though, a limited amount of treatments can be done, if caught too late.

Ethical questions are endless, about whether aborting a child with disability is morally right and what it says about people and how they think of disabled people. Is the power to "decide what kind of life is worth bringing into the world" too much for people to handle? Some argue that we could be missing a part of our "humanity", if we didn't have people with special needs/vulnerabilities. In the case of those with virus infections in utero, is there something to be learned about these individuals? 

- Justin

https://www.theatlantic.com/magazine/archive/2020/12/the-last-children-of-down-syndrome/616928/?utm_source=Global+Health+NOW+Main+List&utm_campaign=0f07ed1d9f-EMAIL_CAMPAIGN_2020_11_19_03_00&utm_medium=email&utm_term=0_8d0d062dbd-0f07ed1d9f-2870277

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC413802/pdf/bactrev00040-0027.pdf

HIV/AIDS deaths in US decrease: Efforts from 2010-2018

A recent CDC report was released on Friday (Nov 20), noting that HIV-related deaths have decreased have decreased by 48%, and that persisting efforts to diagnose/treat/aid HIV victims must continue (especially for certain populations). Specifically, in 2017, the article notes that those who identify as multiple races, or as Black/African American, have high rates of deaths per 1,000 persons with diagnosed HIV (7.0 and 5.6), with those who identify as white or Hispanic/Latino having a rate of 3.9. The article notes that this could be due to structural barriers that limit health outcomes, especially among Black persons with HIV in the South. Regardless, these rates have still decreased from 2010-2018, as efforts towards maintaining access to high-quality care and treatment (over a lifetime), continue to raise/improve life expectancy for those with HIV. 

The CDC article goes on to note that efforts must be made to ensure that young people are aware of their infections, as the proportion of HIV-related deaths among younger persons with diagnosed HIV (13-44) were higher than among older persons with HIV.

A number of activities are available out there, like the CDC's "Let's Stop HIV together" national campaign, "Ending the HIV Epidemic: A Plan for American" initiative, and others that try to initiate treatment as quickly as possible for those infected with HIV.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6946a1.htm?utm_source=STAT+Newsletters&utm_campaign=7b63a54aa0-MR_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-7b63a54aa0-134140705&utm_source=Global+Health+NOW+Main+List&utm_campaign=0f07ed1d9f-EMAIL_CAMPAIGN_2020_11_19_03_00&utm_medium=email&utm_term=0_8d0d062dbd-0f07ed1d9f-2870277

COVID-19 surge on the Navajo Nation

 The Navajo Nation - which spans over 27,000 sq miles, and includes a population of roughly 170,000 - 200,000 - had a recent spike of new COVID-19 cases, after a previous decline. 168 new COVID-19 cases were declared as of November 21, 2020 (an all time record high for a single day), and in response to these new cases, the Navajo Nation Department of Health re-issued a public health order to stay at home for an additional 3 weeks - Nov 16 - December 6. The total cases are now upwards of 14,000 and 147,354 COVID-19 tests had been administered. 

Ultimately, the Navajo Nation and its border town, are being heavily affected, as cases continue to surge. The Navajo Nation president strongly urged tourists/visitors from visiting the area, as national parks like the Grand Canyon, Canyon De Chelly, and Window Rock are located close to Navajo communities

-Justin

https://nativenewsonline.net/currents/covid-19-surge-continues-on-navajo-nation-168-new-cases-and-3-more-deaths

https://www.azcentral.com/story/news/local/arizona/2020/11/20/navajo-nation-hits-record-number-covid-cases-single-day/6367272002/

FDA & monoclonal antibody treatment for COVID-19

 Recently, the FDA issued an emergency use authorization for casirivimab and imedimab (to be used together) in order to treat cases of mild-moderate COVID-19, for adults and children 12+. Trials were hopeful, and with administration of both drugs, there were a reduction of COVID-19 hospitalizations/emergency room visits (related to COVID), in comparison to the placebo. The trial and the data based on this trial note that under double-blind, placebo-control in 799 non-hospitalized adults with mild-moderate COVID-19 symptoms, two groups of 266 and 267 received one infusion of monoclonal antibody treatment (1,200mg and 8,000 mg, respectively) and 266 received the placebo, within 3 days of getting a positive SARS-CoV-2 test.

The FDA notes that these drugs are not advised to those who are hospitalized, or anyone on oxygen therapy - as no positive benefits have been seen with these issues. 

The FDA also explains that casirivimab and imdevimab are monoclonial antibodies that are directed against the SARS-CoV-2 spike proteins - blocking attachnment/entry into human cells.

- Justin 

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-monoclonal-antibodies-treatment-covid-19

Friday, November 20, 2020

COVID-19 Response in Refugee Camps

Disease surveillance in refugee camps was already a major part of outbreak response. Contact tracing in refugee camps has become especially important to minimize COVID-19 transmission. In places like Cox’s Bazar, the largest refugee camp in the world, the World Health Organization now tests over 500 samples for COVID-19 a day.

But unlike the rest of the world, measures like physical distancing are difficult in refugee camps. Most refugee camps are more densely populated than the Diamond Princess, a cruise ship where an outbreak of COVID-19 led to transmission four times faster than in Wuhan. Additionally, low literacy levels make distribution of health and safety information difficult. In Cox’s Bazar, the UNHCR is addressing these challenges using Community Outreach Members and recorded voice messages sent to mobile phones. Both of these platforms allow the communication of information about mask usage, contact tracing, and quarantine and isolation. Internet services were recently restored to Cox’s Bazar and have allowed the UNHCR to send 211,336 broadcast calls to refugees. These calls provide COVID-19 info to decrease transmission. All of these efforts have led to positive cases in these camps now decreasing while the rest of the world spikes. 

Ultimately, COVID-19 is affecting minorities and low income communities disproportionately. This is especially true for refugees. Evidence shows that an inclusive approach to COVID-19 response is required. Important factors for COVID-19 planning for refugees include creating sanitary and less crowded living conditions, as well as ensuring that refugees are not trapped by states of emergency and lockdowns.

-Olivia

https://www.dhakatribune.com/bangladesh/rohingya-crisis/2020/11/18/who-336-rohingyas-infected-with-covid-19-in-refugee-camps-till-october

https://www.rescue.org/covid-19-threatens-refugee-camps#:~:text=People%20in%20refugee%20camps%20in,times%20faster%20than%20in%20Wuhan.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30791-1/fulltext


Medium Article: Polio public health campaign, vaccination efforts and a united country

    In the early half of this century, Americans were frightened by a contagious, paralyzing disease. There were 1.3 cases per 100,000 in 1938, then 9.3 per 100,000 in 1943, and rates as high as 20 per 100,00 in the early 1950s. (Wilson, 2005). That disease was polio. My grandfather and great grandfather on my mother’s side contracted polio, and my grandparents on both sides vividly remember both the fear of those days as well as the way the country came together to respond to the threat to the nation and the relief that came following the availability of vaccines. 

    For polio, both the public health and public education campaigns were successful. Polio was an incurable disease at the time, infecting both children and adults, paralyzing and sometimes proving fatal, peaking at nearly 60,000 cases in 1952 according to the Center for Disease Control and Protection (CDC). It was a very emotional time for the country. As my grandmother shared, “My mother wouldn't even, as religious as she was, would not allow me to go to vacation bible school because I might catch polio. I couldn't go to the community indoor pool because I might catch polio especially in the summer. You tried to avoid crowded places because people were really frightened." There was no known protection from this illness and no cure. People saw children in braces, in wheelchairs, and in iron lungs, afflicted with this horrific disease, and these images were made widely available to the public to escalate resentment toward a disease which caused such suffering for thousands every year. My grandmother said that she “did see a relative in an iron lung and that was just awful…I can still see that in my head.” Polio was crippling the nation. People became united for the fight against polio and even initial campaigning had wide public support. 


President Franklin D. Roosevelt, who had contracted the disease in 1921 at the age of 39, started the National Foundation for Infantile Paralysis (Waxman, 2018), and, through an inspiring and united fundraiser through the March of Dimes in only one month in 1938, collected 2,680,000 dimes that went directly into vaccine research.  In 1954 alone the March of Dimes collected $67 million dollars (more than $500 million in today’s dollars; Barrett, 2008). People gathered around their radio heard the words: “The only way to fight infantile paralysis is with money, and so I'm asking you tonight to send a dime to President Roosevelt at the White House.”  No disease received more funding during the 1950’s than polio research (British Broadcasting Corporation (BBC), The Polio Story). It was small donations from the millions. Anyone would donate a dime to help a child walk again. The cause was advertised through marches and careful advertising campaigns using celebrities like comedian, Eddie Cantor, (Waxman, 2018; Barrett, 2008) and other entertainers such as Marilyn Monroe, Elvis Presley, Judy Garland, and Mickey Rooney. Television campaigns showed images of Judy Garland saying, “Can I put a dime in your envelope?” and Mickey Rooney responding, “Oh, you know that you can. And that's what every good American should do. Join the March of Dimes. Send yours to Franklin Roosevelt in the White House.” (https://www.youtube.com/watch?v=74xJ__BoI9M). News anchors helped as well with spreading the news. Robert Trout, CBS News, appeared with a young polio survivor making a donation to the March of Dimes. 


    There had been some reluctance towards ongoing vaccine research due early vaccine failures in the mid-1930s that delayed research and haunted many. When Jonas Salk, a brilliant medical researcher and virologist, began his work toward finding a vaccine, he took a novel approach but faced serious criticism. When he had finally come up with a vaccine, he began first by testing it on children who had already had polio, and, after that proved successful, began testing the vaccine on healthy children throughout the United States. He was faced with criticism especially by the news reporter Walter Winchell who began his broadcasts saying, “Mothers and Fathers of America, they are preparing coffins for your children” (BBC). Even with Winchell’s public fame growing, as well as that of other critics of Salk’s new vaccine, it was clear that at least many Americans, behind a united educational campaign from the President and public health experts, despite some apprehension, were willing to take the risk. More than one million, eight-hundred thousand children volunteered to participate in the experiment because it offered hope for their child’s protection from this disease. As my grandfather put it, “Walter Winchell… was known not to be particularly reliable.” My grandmother said, “I got the vaccine as soon as it was available… it was a wonderful relief to have this vaccine… I would never have hesitated.” Salk went on air to confront these critics and to alleviate public concerns about his vaccine. In 1955, after a year of behind-closed-door analysis of the results of the trial, the results were presented at a major press conference at the Rackham Auditorium in Ann Arbor, Michigan. At the news of the successful results, people in Ann Arbor cheered “It worked, it worked!” It was the front headline of newspapers across the country, “Kids ran out onto the streets, school was called, church bells tolled, factory bells whistled, people were crying… It was in a way as if a war had ended and, in a way, a war had ended” (BBC). 


    The polio vaccine has been marked as one of the greatest successes in American medical history. The 1955 MovieTone News ("Nation-wide tests prove Dr. Salks Vaccine Success: Commentary by Peter Roberts on "News of the Day") reported, "A historic victory over a dreaded disease has dramatically unfolded over the University of Michigan. Here Scientists usher in a new medical age with the monumental reports that prove the Salk vaccine against crippling polio to be a sensational success. It's a day of triumph for 40-year-old Dr. Jonas E. Salk, developer of the vaccine.” Salk became a national hero, receiving several awards. President Eisenhower invited him to the White House, and thanked him on behalf of all of America saying, “When I think of the countless thousands of American parents and grandparents who are hereafter to be spared the agonizing fears of the annual epidemic of poliomyelitis, when I think of all the agony that these people will be spared seeing their loved ones suffering in bed, I must say to you I have no words in which adequately to express the thanks of myself and all the people I know – all 164 million Americans, to say nothing of all the people in the world that will profit from your discovery” (Eisenhower Presidential Library). Immediately after the release of Salk’s vaccine, the federal government set up a plan authorizing to have the polio vaccine distributed to children throughout the nation and within a year, “deaths attributed to polio declined by 50 percent” in the United States (Eisenhower Presidential Library, CDC) and is now close to full eradication. 


In 1958, President Eisenhower campaigned for the “Salk Vaccine” stating that he was “happy to join with millions of other Americans in supporting the drive for polio vaccinations this spring” and that “not to [take the vaccine] is to take unnecessary risks of lifetime disability and even death. I especially appeal to parents to take advantage of this great research discovery to protect themselves and their children against this dreaded disease. The national campaign being conducted by the Advertising Council […] has my hearty endorsement.” 


There had been and continues to be opposition to vaccines. But, as my grandmother explained, “There have been certain people who have spread concerns about how vaccines can lead to major problems… we had had small pox vaccines forever, and DPT [diphtheria, pertussis, tetanus] … there was never any question about it… I don’t recall people being afraid of [the Polio vaccine]”. Not only had other vaccines been successful in the past, but my grandparents, without prompting, said that these “certain people” often provided false and unreliable information with many studies proving them wrong. And, for many, the anti-vaccination arguments did not dissuade them. Ultimately, my grandparents “had no hesitation about vaccinations” for themselves or for their children. People were willing to take the risk and had high hopes as indicated by the high rates at which people immediately began volunteering to take the polio vaccine. While there have been continued shifts in attitudes toward vaccines as individuals like Andrew Wakefield, the “father of the anti-vaccination movement” (like Walter Winchell who opposed Salk vaccines early on), shared false accusations about vaccines, overall vaccination rates have remained high in this country with, even in 2020,  almost 93% of people having three or more doses of the polio vaccine (https://www.cdc.gov/nchs/fastats/immunize.htm) again, as of 1996, including mandatory doses of the Salk Vaccine (NY Times, 1996).


During the primary era of polio, people were united and inspired by President’s Roosevelt and Eisenhower who pulled the country together, cared about its citizens that were dealing with a frightening, paralyzing disease, and supported and appreciated and raised money for scientific research.  The people received their information through reputable sources and reliable news anchors such as Robert Trout, Edward R. Murrow, Lawrence Spivak, John Cameron Swayze, Dave Garroway, Douglas Edwards, and later Chet Huntley, David Brinkley, and Walter Kronkite (https://fiftieswebcome/tv/news; Waxman, 2018). Yes, there were naysayers, but people were still moved by scenes of fellow Americans in wheelchairs and iron lungs and were willing to join with others to care for one another through supporting scientific research and volunteering in massive numbers for vaccination. Unfortunately, today, the situation is much different and our nation is far more divided.  In a November, 2020, Scientific American article, Sean Carroll writes, “Polls indicate that despite the devastating health and economic impacts of the pandemic, with respect to a potential vaccine we are nowhere near as united as Americans were in 1955.”  We can only work to do our part in helping the nation come together again.


- Claire Hillier


References


Baicus, A. “History of polio vaccination.” World journal of virology vol. 1,4 (2012): 108-14. doi:10.5501/wjv.v1.i4.108. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782271/


Barrett WP. March of Dimes’ Second Act. 19 Nov 2008. Forbes.  (https://www.forbes.com/2008/11/19/march-dimes-revinvention-pf-charities08-cx_wb_1119dimes.html?sh=27bb210a4074)


British Broadcasting Corporation (BBC), The Polio Story (https://www.bbc.co.uk/programmes/b05n27mt)


Carroll SB. The denialist playbook: On vaccines, evolution and more, rejection has followed a familiar pattern. Scientific American, 8 Nov 2020. 

https://www.scientificamerican.com/article/the-denialist-playbook/


CDC Immunization from the National Center for Health Statistics. (https://www.cdc.gov/nchs/fastats/immunize.htm)


Eisenhower Presidential Library (https://www.eisenhowerlibrary.gov)


Example advertising campaign for the March of Dimes (https://www.youtube.com/watch?v=74xJ__BoI9M)


TV News Shows (https://fiftieswebcome/tv/news)


U.S. Changes Policy on Polio Inoculation, Recommending Salk Vaccine for First Doses.” The New York Times. 20 Sept. 1996. https://www.nytimes.com/1996/09/20/us/us-changes-policy-on-polio-inoculation-recommending-salk-vaccine-for-first-doses.html


Waxman, O. The Inspiring Depression-Era story of how the ‘March of Dimes’ got its name. Time. 3 Jan 2018 (

https://time.com/5062520/march-of-dimes-history/)



Wilson DJ. Living with Polio: The Epidemic and Its Survivors. University of Chicago Press. 2005. Chicago.




WHO advises against the use of Remdesivir

 

Just one month after the makers of remdesivir announced US Food and Drug Administration approval of remdesivir for treatment of coronavirus infection the World Health Organization updated its guidance on COVID-19 medications to recommend against using the antiviral drug remdesivir for treating hospitalized patients, regardless of the severity of the illness. This was decision was made based on current evidence that does not suggest that Remdesivir alters the risk of mortality from COVID-19, the risk of ventilation, or other important outcomes. 


Remdesivir is an "intravenous nucleotide prodrug of an adenosine analog which  binds to the viral RNA-dependent RNA polymerase, inhibiting viral replication through premature termination of RNA transcription." It has demonstrated in vitro activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but did not appear to be as successful in clinical trials. 


While Remdesivir received FDA approval, it did not receive WHO’s recommendation due to emerging research which at first demonstrated some benefit against COVID-19, but “as more data accumulate, that appears to be changing” according to Dr. Adalja, senior scholar at Johns Hopkins Center for Health Security. Dr. Adalja shared that the benefit of “remdesivir is marginal at best” and the “only benefit we had been touting was maybe it gets people better quicker but the evidence base for this is weak.” 


Based on data from four randomized trials including 7,333 people hospitalized with Covid-19, it was ultimately decided by the WHO to recommend against remdesivir as the “panel concluded that most patients would not prefer intravenous treatment with remdesivir given the low certainty evidence.”


- Claire Hillier, Nov. 20


References:

Jacqueline Howard. “WHO recommends against use of remdesivir for treatment of Covid-19” CNN. https://www.cnn.com/world/live-news/coronavirus-pandemic-11-19-20-intl/h_5890bce2fe969482f9aee583fbbd6ac3

“Remdesivir.” National Institutes of Health, U.S. Department of Health and Human Services, www.covid19treatmentguidelines.nih.gov/antiviral-therapy/remdesivir/.

A Cure to Herpes? In my Lifetime? It's More Likely Than You Think.

 According to the World Health Organization, 3.7 billion people worldwide under the age of 50 have HSV-1. That's a whopping 66.6% of the population we're talking about here. 

Herpes is a life-long infection, and there has yet to be a vaccine or cure for the viral infection. The only things we have available in treating herpes is antiviral medications such as acyclovir, famciclovir, and valacyclovir. 

However, new research is starting to suggest the end to this chapter of HSV-1. Scientists were successfully able to eliminate herpes simplex virus in vivo through gene editing in mice. Specifically, they removed the viral DNA that inserts itself into nerve cells. This action by herpes virus is what made it so difficult to eliminate in the first place. 

All of this would not have been successful had it not been for the advances in genome editing over the last five years.

And with the recent correlation of HSV and Alzheimers, this breakthrough couldn't have come at a better time. 

-Jenny Portillo 


https://www.fredhutch.org/en/news/center-news/2020/08/herpes-simplex-gene-therapy.html

https://www.who.int/news/item/01-05-2020-massive-proportion-world-population-living-with-herpes-infection

https://www.nature.com/articles/s41467-020-17936-5

Numerous cases of reinfection with COVID-19, suggesting that immunity diminishes quickly in some cases

 Sanna De Jong, a nursing assistant, tested positive for COVID-19 on April 17 and suffered mild symptoms for 2 weeks. On May 2, she tested negative, but her symptoms re-emerged a few weeks later and she received a positive test for COVID-19 on July 3. De Jong is not the only case of a COVID-19 re-infection. The first suspected reinfection occurred in April, and since then at least 24 cases of reinfections have been officially confirmed in Korea, though this is “definitely an underestimate,” according to scientists. 


To count as reinfection, a patient must have a positive PCR test twice with at least one symptom-free month in between. However, the second test may also be positive because the patient could still have “residues of nonreplicating viral RNA from their original infection in the respiratory tract because of an infection with two viruses at the same time or because they had suppressed but never fully cleared the virus.” As such, reinfection must be confirmed by identifying two full virus sequences from the first and second illnesses that are sufficiently different. However, in many cases “the genetic material just isn’t there” according to Paul Moss at the University of Birmingham. Further, many labs don’t have the time or money to do so. As such, the “number of genetically proven reinfections is orders of magnitude lower than that of suspected reinfections.” 


Although antibodies can wane within months, particularly in patients with less severe disease, they sometimes persist. Neutralizing antibodies as well as memory B cells and T cells also seem to be stable over at least 6 months which should “prevent most people from getting hospitalized disease or severe disease for many years.” People who have serious COVID-19 mount the strongest responses, just as is the case for the two other serious human diseases caused by coronavirus: SARS and MERS. Both SARS and MERS trigger high antibody levels that last up to 2 years, and T cell responses to SARS can be detected even longer. 


- Claire Hillier, Nov. 20


Reference:

Jop de Vrieze et al. “More People Are Getting COVID-19 Twice, Suggesting Immunity Wanes Quickly in Some.” Science, 18 Nov. 2020, www.sciencemag.org/news/2020/11/more-people-are-getting-covid-19-twice-suggesting-immunity-wanes-quickly-some. 



Thursday, November 19, 2020

We're All Spam

 Well, biologically speaking, we are all spam. From the tips of our fingers down to the nucleotides of our genome, and recent theories even involving our consciousness: we have viruses' abilities to be a genetic parasite to blame––or thank? 

Over millions of years, retroviruses have snuck into our DNA and established themselves as part of our genome. These viral DNA sequences mutate, change, and lose their ability to break out of our cells. Some jump from here and there within our genome, and others remain stuck forever where they invaded. 

And some of these viruses became incorporated in our sperm and egg cells. Being passed down from generation to generation, they are now a permanent part of our genome. 

Around half of the human genome can be traced back to long dead viruses or similar "jumping genes", known as transposons. There are even some researchers claiming that this number is up to 80% due to viral sequences being degraded over millions of years to the point of no recognition. 

To further emphasize this, we've all got ancient viruses in our brain. The viral gene Arc "comes to life" and produces RNA. The nerve cell then builds a capsid around the RNA that allows it to travel safely between cells. Eventually, this capsid enters another neuron cell and passes its genetic material onwards. 

The functionality of Arc is still not fully understood, but those who posses atypical neural conditions have a defect in this gene. 

Basically, we are viruses that work 9-5s.  

-Jenny Portillo  


https://www.sciencefocus.com/the-human-body/virus-human-evolution/amp/

https://www.livescience.com/61627-ancient-virus-brain.html


U.S. Surpassed 2000 CoVID Deaths for the First Time Since May

Thursday, November 19, 2020–– Coronavirus cases have spiked out of control all across the United States. As of today, there are a total reported 12,070,712 cases and 258,333 deaths––and counting. With Thanksgiving right around the corner and arising public refusal to practice social distancing during the holidays, we are quickly racing towards 300,000 deaths with no end in sight. 

This can largely be attributed to fatigue with the disease and compassion fatigue. With the pandemic dragging along for the better part of 2020, the public is beginning to behave irresponsibly as if the pandemic is over. Birthday parties, indoor dining, and straight-up dismissal of the disease as a whole is largely to blame for these new cases. And now people are beginning to grow more and more desensitized to rising deaths. 

Not only that, but the United States government is also showing complete disinterest in the national disaster unravelling. Congress was dismissed a day early for Thanksgiving Break, once again providing no aid to those affected by the virus.

Some states, such as Ohio, are unable to count the sheer number of cases that are being reported. At the moment, they have 12,000+ uncounted positive tests that need review before official reporting. At the rate we are going at right now, we are blindly waking up to a new World Trade Center attack every morning.  

The quote, "One death is a tragedy; one million is a statistic,” by Joseph Stalin is resonating in the United States today more than ever.

-Jenny Portillo 


https://www.worldometers.info/coronavirus/country/us/

https://abcnews.go.com/Politics/congress-heads-home-thanksgiving-pandemic-relief-deal/story?id=74296744

https://www.cleveland.com/datacentral/2020/11/ohios-dramatic-covid-19-spike-active-cases-up-fivefold-since-start-of-october-to-near-90000.html

https://nypost.com/2020/11/19/port-authority-faces-in-house-covid-19-surge-ahead-of-holidays/

Medium Blog: On HIV Exceptionalism

 HIV is often treated differently from other diseases, even sexually transmitted and infectious diseases. This notion gave rise to the term HIV exceptionalism. HIV is treated as beyond “normal” health interventions, and often granted additional privacy and confidentiality measures (Smith et al, 2010). Recently, with changes in the way HIV is perceived by the public and advances in HIV research, HIV exceptionalism has been widely criticized. Additionally, several people have criticized that HIV receives a large and disproportionate amount of attention in global health. In this article, I aim to examine the history of HIV exceptionalism, how HIV exceptionalism is manifested, and criticisms against HIV exceptionalism. 


In 1983, HIV was first isolated from a patient (Merson et al, 2006). Today, over 76 million have been infected with HIV. 38 million people are still living with HIV today (“The Global HIV/AIDS Epidemic,” 2020, page 1). HIV is a disease that disproportionately affects marginalized populations, including men who have sex with men, and people who inject drugs. In some countries, epidemics are found with 30% of individuals being infected (“The Global HIV/AIDS Epidemic,” 2020, page 5). 


In the United States, public health response to the rise in HIV cases was unprecedented. Within the stigmatized groups, certain public health measurements could make HIV even more underground. Because of this stigma, patients will continue to face discrimination in all facets of life. Thus, HIV was reframed as not just a health issue, but also a social issue in which patients are connected with counselling and safeguards for privacy and anonymity. For instance, in many places it is against the law to share HIV test results over the phone/internet. However, as HIV became less of a mass hysteria and antiretroviral treatments were found, HIV was reframed as less as a life sentence, but a disease that could be managed. Yet, many HIV positive people in the US and around the world still continue to be discriminated against and even assaulted and murdered. 


Outside of the United States, HIV/AIDS still remains a critical issue in many parts of the world, especially in sub-Saharan Africa.  UNAIDS was formed in 1996 to collect data about HIV and AIDS around the world, prevent transmission, and provide medical services and care. In 2003, there was over $61.1 billion invested in global development for HIV/AIDS. Controlling HIV/AIDS was seen was being able to control a host of other issues, such as poverty and debt relief and other diseases (Smith et al, 2010). 


Many people believe that HIV/AIDS programs have been disproportionately represented in public health efforts relative to global disease burden and public health official/scientists’ jobs. Some experts, like Roger England, criticized UNAIDS for “creating the biggest vertical programme in history” and believe that a better public health measure would be to put money into bed nets, immunization, and childhood diseases. He noted that HIV represented 3.7% of mortality but 25% of international healthcare aid (Smith et al, 2010). 


Additionally, many criticisms against HIV exceptionalism think that it creates bureaucratic burden. For instance, special safeguards have to be put in place for sharing HIV data, but we currently have better treatments and understanding as a society of HIV stigma. Advocates against HIV exceptionalism believe that keeping results under a veil of secrecy further stigmatizes the disease rather than accepting it as a chronic illness just like any other illness. 


In my opinion, it is important to address the pressing issue of HIV in the United States and beyond, but also to analyze the systems that are responsible for HIV care critically. Where is the money really going towards? How can we lessen bureaucratic burdens? 


Additionally, are patients ready for more transparency on data reporting or does the risk of being “found out” and the stigma of the disease still necessitate special safeguards? It would be helpful to first examine qualitative studies of current beliefs and perceptions towards HIV before rushing into any new policies. This varies among different cultures and practices. For instance, some cultures believe that someone diagnosed with HIV is responsible for their illness, devaluing patient suffering. This prejudice and victim blame was especially seen in the early years of the epidemic, so it would be interesting to see if and how this has evolved over time or if perceptions have largely remained unchanged.


Thus, HIV/AIDS is a complex issue and incredibly challenging to face. Perhaps we should focus on normalizing HIV public health practices first, such as the growing U=U movement, as opposed to radically changing existing infrastructure overnight. As we approach a new decade, we will need innovative solutions to address the delivery and messaging around HIV/AIDS initiatives. '


- Fan


Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004826/

https://www.kff.org/global-health-policy/fact-sheet/the-global-hivaids-epidemic/#:~:text=Approximately%2076%20million%20people%20have,the%20beginning%20of%20the%20epidemic.

https://www.nejm.org/doi/full/10.1056/nejmp068074#:~:text=On%20June%205%2C%201981%2C%20when,from%20a%20patient%20with%20AIDS.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004826/


What does Ebola and COVID-19 have in common?

Anthropologist and physician Paul Farmer wrote a book called Fevers, Feuds and Diamonds: Ebola and the Ravages of History describes the 2014 Ebola outbreaks in West Africa. The book provides an eye opening combination of facts about Ebola as well as the history of inequality in Africa that left many nations vulnerable to the spread of Ebola. 

The destruction of colonialism leading to civil wars left many people in refugee camps. When Ebola broke out, Farmer described the international crisis responders' habit to focus on containment of infection instead of care for infected patients. But as Farmer points out, the mortality outcome for Americans and Europeans was very different from West Africans infected with the same strand of Ebola, all depending on what care was available. An ingrained focus on containment and a rhetoric of blame on communities who attempted caregiving for those who were sick distracted from the possibility of treatment. Hope in the book comes from West African survivors of Ebola who work to help their communities rebuild.

Farmer finishes by highlighting the disparities in cases of COVID in the United States, which has hit Black Americans, Latinx, and Indigenous Americans especially hard. Farmer describes the need for addressing and rejecting global racial inequalities, as well as compassion for all people.


-Olivia


https://www.npr.org/2020/11/17/935337735/in-fevers-feuds-and-diamonds-paul-farmer-breaks-down-assumptions-about-ebola

Yellow Fever Outbreak in Nigeria

Twenty deaths have occurred in Benue state, believed to be caused by yellow fever. If confirmed, this will be the 4th Nigerian state with active yellow fever virus transmission. The state epidemiologist has called it a hemorrhagic viral infection with an unusual presentation, but they are waiting for results to call it yellow fever. 

Nigeria is currently planning a yellow fever campaign in response to the outbreak in several other states. Twenty six people in Benue state are currently sick, so the focus for now will remain on treating those infected. 

What will be informative to track will be the effectiveness of the yellow fever campaign planned. The state epidemiologist noted that the state has been challenged by local beliefs. The community believes this sickness is occurring because they offended the gods of the land. What approach will Benue take in order to effectively implement this yellow fever campaign for local communities? Cultural acceptance of any health initiatives will be vital.


-Olivia


https://punchng.com/yellow-fever-death-toll-hits-20-in-benue/


Some Good News

Yesterday, November 18th, a six month Ebola outbreak in the Democratic Republic of the Congo ended. The outbreak occurred in rural communities in the rain forest as well as urban communities, each with their own challenges. Resources were strained with the COVID-19 response. Some communities were only accessible by boat or helicopter. And some communities were resistant to vaccination and treatment efforts. In order to control the outbreak, the WHO vaccinated 40,000 people at high risk. Interestingly, to keep the vaccinations at -80 degrees Celsius, the WHO used an innovative cold chain storage. This was accomplished through the use of ARKTEK freezers, which kept the vaccine in cold temperatures in the field, even in communities without electricity. 

While responding to COVID-19 in addition to Ebola has presented a challenge, innovations like this present opportunities to address both threats. This cold chain storage could also be used to distribute vaccines for COVID-19 in rural communities in Africa.

We can also learn from the emergency preparedness that the WHO has worked on in Africa to respond to Ebola. Four days after this outbreak of Ebola, vaccination efforts were mobilized. The response took advantage of local health workers with experience in previous outbreaks, as well as using vaccinators who were almost all from local communities. These local workers visited households and provided important health information.

The Ebola response in Africa has come out of repeated tests and evolved as many challenges were encountered. We can learn a lot about how we should implement a COVID-19 response from the lessons they have learned in responding to Ebola. Obviously technologies like the ARKTEK freezer have potential to make a difference in the COVID response. But additionally, the idea of providing health information to local responders could be just as pivotal. Currently, our only tool against COVID is behavioral interventions. These require acceptance in local communities, which could best be achieved by local responders who know their own community and culture best.


-Olivia


https://reliefweb.int/report/democratic-republic-congo/11th-ebola-outbreak-democratic-republic-congo-declared-over

https://www.sciencemag.org/news/2020/11/temperature-concerns-could-slow-rollout-new-coronavirus-vaccines


Wednesday, November 18, 2020

Colorado Makes Last Effort Before Shutting Down

In an effort to keep Colorado’s economy afloat before requiring a complete shut down, health officials have added another zone to the dial of COVID19 severity. Previously the “red” zone was the most severe, but a new “purple” zone has been added thereby reducing the restrictions required by the red zone. Some of the key differences are that under the adjusted red zone requirements restaurants may remain open with outdoor seating and reduced capacity. Bars are also able to remain open with last call at 8 pm versus a mandate for total closure under the purple zone. 






x

According to the Colorado Department of Public Health and Environment, there have been over 220 new COVID19 outbreaks reported in the state just since last week. The struggle between keeping the economy going and preventing the spread of SARS-CoV-2 is one the nation has struggled with since the beginning of this crisis. The idea of having a response that can be dialed up or down as needed is a good one. Restaurants and businesses don’t need to remain closed forever, and in areas where spread is well controlled restrictions can be loosened. But the last minute addition of a purple zone makes one wonder whether it was a good call. If these dials are well designed, then last minute adjustments should not be made if we’re to protect the lives of people who will die from large scale outbreaks of SARS-CoV-2. On the other hand, if the dial design was not calibrated to the appropriate cost-benefit analysis, then an adjustment may be warranted. It’s unclear why the purple zone was added, but hopefully the health department made the choice to do so with great caution. 


- Renata


https://covid19.colorado.gov/covid-19-dial

https://www.9news.com/article/news/health/coronavirus/colorado-covid-outbreaks-latest-restaurants-grocery-stores-schools/73-5b1335ca-5c4a-40a2-a890-b6c9b1c2ba51

 

Ebola Beaten, again

 The Democratic Republic of the Congo, the DRC, has defeated its 11th Ebola outbreak to date, as declared today by the WHO. The outbreak lasted 6 months, in a country where Ebola has ransacked its people, and consisted of 119 cases and 55 deaths, showing the dangerously high death rate of the virus. The location of the outbreak favors the virus as well as it occurred in the rainforests and crowded cities of the Equateur Province, making isolation and contact tracing more difficult in densely-populated areas. 

The WHO was able to aid vaccine delivery and 40,000 vaccines were administered, contributing to stopping the pandemic in the short-time frame that was shown. The vaccine, similar to Pfizer, needs to be kept at unthinkable cold temperatures around -80 degrees via innovative cold chain storages. These were ARKTEK freezers which allowed the vaccines a 1-week lifespan on the ground in the DRC. No electricity was needed; however, the great outcome is indebted to the vaccinators who at high-risk to themselves, used contact-tracing and engaged communities in treatment. 

This outbreak engaged with the COVID-19 pandemic, creating an even larger challenge for DRC health workers; however, the technology used in freezing the vaccines provides useful insight for potential COVID-19 vaccine delivery in the coming months as gives hope to easier distribution without electricity. In addition, around the time of this outbreak, another outbreak was occurring on the opposite side of the country, though the two were not related. But the Equateur Province remains a favorite of the Ebola virus as this area I also responsible for the 9th recorded Ebola outbreak. That outbreak was put out in a matter of 3 months, however it was not also battling resources with COVID-19, like the 11th outbreak. Though the current outbreak is over, there is no telling when another one might arise. Therefore, the lessons learned from this outbreak in WHO and local government partnership and fast vaccine distribution will be vital in the case of another outbreak.

- Liz

Article:

https://www.afro.who.int/news/11th-ebola-outbreak-democratic-republic-congo-declared-over?utm_source=Global+Health+NOW+Main+List&utm_campaign=11c7ab1fae-EMAIL_CAMPAIGN_2020_11_17_05_11&utm_medium=email&utm_term=0_8d0d062dbd-11c7ab1fae-2994893


History Does Repeat Itself: Looking at the 2009 H1N1 pandemic and its lessons to bring to the current pandemic

 In the 2009 H1N1 pandemic, it was made evident that continued investment in public health was necessary and governments must be transparent in all their communication. Now, looking at the current pandemic, we have seen the opposite of transparent and clear communication on all sides, the media, the government, and clearly we did not learn from the 2009 pandemic. In addition, we have seen manufacturers switch their focus primarily on a COVID-19 vaccine and treatment, and neglecting other vaccines and treatments that many individuals rely on for other diseases, showing the importance for continued investment in public health.

A COVID-19 vaccine is promising but now the public health focus is on building a community of network providers that can deliver fair access to minority groups and rural areas. Communication strategies involving delivery have been ignored and shows that we did not learn from the H1N1 pandemic. The immunization program that will come following approval for distribution of the vaccine by the FDA, must follow a clear blueprint for delivery. The potential complexity of this situation is not being seen by current health departments. With this complexity includes the supply and demand of the vaccine and the storage of the vaccine. Though Moderna is a suitable candidate as its required temperature is significantly higher than that of Pfizer, this still poses as an obstacle to rural communities and communities outside the US with less access to electricity, while also balancing the supply issue. 

Government and media communication remains increasingly dangerous as well and this was shown in the H1N1 pandemic. Production issues of a federal vaccine allowed only 25% of the promised supply to be available when officials said 100% would be available. When 100% of the supply was available, clinics had already closed, both due to the then small threat of H1N1 and loss of confidence in the government, and less people were immunized. All of the funding for H1N1 invariably went to waste as by the time the government was organized, the pandemic was already gone. Thus, the US shouldn't count its chickens before they hatch, as a vaccine may not be so amazing after all. 

- Liz

Article:

https://www.washingtonpost.com/health/covid-vaccine-lessons-h1n1-vaccine/2020/11/17/b5626596-1ac1-11eb-aeec-b93bcc29a01b_story.html?utm_source=Global+Health+NOW+Main+List&utm_campaign=11c7ab1fae-EMAIL_CAMPAIGN_2020_11_17_05_11&utm_medium=email 

Recent study reveals that patients fare worse with COVID-19 than with severe influenza

A retrospective study published on November 13, 2020 in the Annals of the American Thoracic Society compared how patients fare with severe COVID-19 with those hospitalized with severe seasonal influenza. A key finding in the study was that the COVID-19 patients had an in-hospital death rate of 40% vs only 19% for influenza patients. The higher mortality rate was independent of patient age, co-occurring health conditions, gender, and severity of illness while in the intensive care unit. 

Patients with either condition often require mechanical ventilation, but patients with COVID-19 need to remain on mechanical ventilation for longer and with worse lung functioning overall. Patients with COVID-19 are also more likely to develop acute respiratory distress syndrome (ARDS), a life-threatening complication where the lungs become very inflamed. This finding that ARDS is more prevalent in COVID-19 patients helps to explain the mortality difference between the two diseases. 


The researchers also found that COVID-19 patients have “slower improvements in blood-oxygen levels, longer durations of mechanical ventilation, and lower rates of extubation than influenza patients.” Patients with COVID-19 are also more likely to be “male, have higher body mass index, and higher rates of chronic kidney disease and diabetes.”


In terms of populations affected, the study found that close to four times as many COVID-19 patients identified as Hispanic compared to influenza patients which could be related to underlying health factors and/or to socioeconomic inequalities. 


With rising cases of COVID-19 and the flu season, Dr. Natalie Cobb, a UW medicine physician in pulmonary and critical care, recommends that everyone get the flu vaccine and continue social distancing measures and masking to limit the spread of COVID-19 as we see spikes in hospitalizations and ICU admissions that could overwhelm our healthcare system.


Reference:

“Patients Fare Better with Severe Flu than with COVID-19.” Newsroom, 17 Nov. 2020, newsroom.uw.edu/news/patients-severe-flu-do-better-covid-19-cases?utm_source=UW_News_Subscribers. 


- Claire Hillier, Nov. 18 

Double Trouble: burden of cervical cancer associated with HIV

 The risk of getting cervical cancer is six-fold for women living with HIV associated with an increased risk of human papillomavirus (HPV) infection, rapid progression of infection to cancer, lower regression chances of pre-cancer lesions and higher rates of recurrence. 5% of cervical cancer cases worldwide can be attributed to HIV with an uneven distribution. The proportion of cervical cancer attributable to HIV is greater than 40% in 8 high HIV prevalence countries whereas for 127 countries with low HIV prevalence it estimates lower than 5%. This stark disproportion places cervical cancer burden in the African continent where 85% of cervical cancer cases are reported. In the sub-Saharan region of Africa, in addition to high HIV prevalence, insufficient HPV vaccination, screening and treatment for cervical pre-cancer and cancer contribute to this burden. 


A lot of work has to be done to reach WHO’s targets of eliminating cervical cancer by 2030 that includes 90% HPV vaccination coverage, 70% screening coverage, 90% access to treatment for cervical pre-cancer and cancer and access to palliative care. If this goal is achieved WHO estimates a 40% reduction in cervical cancer incidence and prevention of 5 million deaths by 2050. 


Some countries like Rwanda have championed cervical cancer screenings and HPV vaccinations but the question remains, with added COVID-19 burden, will African countries reach this goal? 


-Bethel 


Reference 


High HCV prevalence in men who have sex with men

In a newly published paper in The Lancet Gastroenterology & Hepatology, WHO, in collaboration with the Kirby Institue of UNSW Sydney, Australia, provided a meta-analysis of the prevalence and incidence of hepatitis C virus (HCV) infection in men who have sex with men. This year’s Nobel Prize in Physiology or Medicine went to Michael Houghton, Harvey Alter and Charles Rice for their discovery of HCV which they called a global threat to human health. 71 million people have chronic HCV infection globally with 1.75 million new infections each year. 


In the meta-analysis, 194 eligible publications were assessed. Even though substantial variations across countries were recorded, the overall prevalence of HCV amongst men who have sex with men was 3.4% (95% CI: 2.8-4.0). There was also a finding that confirmed a higher risk of HCV infection in HIV positive men who have sex with other men with a 6.3% (95% CI: 5.3-7.5) prevalence of HCV infection in HIV positive men compared to 1.5% (95% CI: 1.0-2.1) prevalence in HIV negative men. 


The major contributor to HCV transmission is injecting drug use. Amongst the study population with HCV infection in the meta-analysis, 30.2% (95% CI: 22.0-39.0) had ever injected and 45.6% 95% (CI: 21.6 – 70.7) currently inject drugs compared to 2.7% (95% CI: 2.0-3.6) who had never injected drugs. Dr Niklas Luhmann from WHO emphasized how critical it is to reach and support men who have sex with men who also inject drugs with effective prevention, testing and treatment services. 


Lastly, another major finding of this paper was the higher incidence of HCV among men taking PrEP. This was attributed to multiple factors. Men who choose to use PrEP usually are at higher risk for HIV, have barriers to condom use and/or greater sexual interaction with HIV positive men. However, a high prevalence of HCV in HIV negative men who chose PrEP was observed before PrEP initiation. This is all a call for improved access to prevention, testing and treatment for high risk, populations including marginalized populations. 


-Bethel 



Reference 


https://www.nobelprize.org/prizes/medicine/2020/press-release/