Dengue Chikungunya Zika
Aedes aegypti mosquitoes are the main vectors of dengue virus.

Dengue virus cases have reached an all-time high since January in the US territory of Puerto Rico, with 1,729 people infected so far – a more than 300% increase compared to last year. 

The uptick in the mosquito-borne disease, which causes mild to severe illness, follows a trend across the Caribbean region. The total number of reported cases for the Caribbean has reached nearly 57,000 – a 469% increase as compared to the same period in 2023. 

Climate change, the El Nino effect, and unplanned urban growth have fueled this year’s surge. 

While dengue tends to hit Brazil, Argentina, Paraguay and Uruguay the worst, the Caribbean, the Central American isthmus, and Mexico continue to see above-average transmission.

Further complicating efforts to control the mosquito-borne disease is the premature start to the hurricane season.  Hurricane Beryl has already devastated several small island nations in the Caribbean, damaging water and health infrastructure, thus making residents even more vulnerable to dengue.

Halfway into 2024, the total burden of dengue cases in the Americas has exceeded 10.1 million, more than twice the 4.7 million cases in 2023.  

The Puerto Rican Department of Health recently extended its dengue epidemic alert until December, after this year’s season brought the highest proportion of severe dengue in the Americas. 

Of the nearly 2,000 cases reported to the territory’s health officials, 92 are severe, meaning patients may suffer from painful symptoms including fever, headaches and vomiting. Three of the dengue serotypes – DENV 1, 2, and 3 – are currently circulating. 

This alert comes just two weeks after the US Centers for Disease Control and Prevention (CDC) issued a health advisory warning of the increased risk of dengue virus infections in the US. While most cases in the continental US come from overseas travelers, Florida has reported a handful of locally-transmitted cases.

Hurricane Beryl sets back health response 

Debris after Hurricane Beryl on Barbados
Debris, abundant rainfall, and inadequate shelter are all hurricane by-products that increase the risk of dengue virus infection.

The first category 5 hurricane of the season, Beryl devastated much of Saint Vincent and the Grenadines, Grenada, Dominica, Barbados, and Jamaica. The destruction left in the hurricane’s wake highlights small island nations’ vulnerabilities to climate change and its health effects.

The Caribbean region is particularly susceptible to healthcare disruptions from natural disasters. Studies of cyclones in China and hurricanes in Puerto Rico found increases in dengue virus infections in the weeks following hurricanes. 

“Pre-existing environmental health risk magnified after the pass of Hurricanes Irma and María,” said researcher José Pérez-Ramos, Assistant Professor of Public Health Sciences at the University of Rochester. He notes that in the aftermath of 2017’s devastating hurricanes, participants in the study were worried about frequent dengue outbreaks. 

While the International Federation of the Red Cross (IFRC) and other relief organizations active in the Caribbean nations are in the early days of response and assessment, the confluence of the hurricane’s destruction and peak dengue season may spell out an increased case burden.

“Hygiene kits, cleaning kits, tool kits, kitchen sets, tarpaulins, blankets and mosquito nets have already been dispatched to the hardest hit islands to meet the immediate needs of the affected population,” said Rhea Pierre, IFRC Disaster Manager for the English and Dutch-speaking Caribbean. “Still, rapid damage assessments show that the devastation is massive.”

‘A notable increase’ in cases, but low fatality rate

PAHO dengue infographic
Removing standing water sources is a key tactic in controlling for dengue.

Despite this year’s record number of cases, the World Health Organisation’s (WHO) regional office in the Americas, the Pan-American Health Organization (PAHO), notes that the fatality rate for the Americas has not exceeded the regional benchmark of 0.05%. 

“While we are seeing a notable increase in the number of dengue cases in the region this year, it is important to highlight that the proportion of cases that progress to death remains low thanks to countries’ efforts and the support of PAHO,” said Jarbas Barbosa, PAHO Director, in a recent press release.

“This situation highlights the importance of sustaining surveillance, strengthening prevention and control measures, and ensuring timely medical care,” he added.

Standing water post hurricane
Standing water, seen here in the aftermath of Hurricane Otis, is needed for mosquitoes to breed.

Few studies have assessed what causes some patients to progress to severe dengue. The WHO notes that ensuring access to sufficient medical care should remain at the forefront of countries’ priorities to treat severe dengue. 

PAHO’s Caribbean Mosquito Awareness Week, which took place in May, aimed to raise public awareness about the connection between mosquitoes and the diseases they transmit, such as dengue, chikungunya, and Zika, and to involve the community to prevent mosquito breeding.

“The population and household members should be encouraged to eliminate sources of mosquito breeding, both household and peri-household. This is everyone’s task: the family, the community, the public and private sector,” said PAHO in a recent alert on increased cases in Central America, Mexico, and the Caribbean regions.

Aedes aegypti, the main mosquito vector, typically breeds in sites such as water containers as well as in urban waste, including plastic wrapping that can accumulate rainwater.

As the virus doesn’t have a cure and repeat infections can even be more severe, surveillance and control of mosquito breeding sites is critical to reduce dengue transmission and illness,  particularly the most severe form of the disease,  dengue hemorrhagic fever. 

Dengue cases expected to rise in Mexico, Central America and Caribbean

Dengue cases in Caribbean and Mexico
Cases have yet to peak fully in the Caribbean, Central America and Mexico.

Farther north of the equator, cases have yet to peak in the PAHO regions of the Caribbean, Central America Isthmus and Mexico. 

“Although there has been a decrease in dengue cases in the Southern Cone [Brazil, Argentina, Paraguay, and Uruguay] and Andean sub-regions in recent epidemiological weeks, the subregions of the Central American isthmus and Mexico, and the Caribbean subregion are entering the period of increased dengue circulation, which could significantly increase the number of cases reported in the Region during the second half of 2024,” said PAHO in their May epidemiological alert.

Cases decreasing at tail-end of season 

Dengue in Southern Cone subregion
Brazil, which accounts for more than 80% of the Americas’ dengue cases, is at the tail-end of its season.

The number of dengue cases is finally tapering off for the South American countries hardest hit – Brazil in particular saw an explosive growth in cases earlier this year. PAHO attributes the country’s epidemic conditions to prolonged heat, higher rainfall levels, as well as decreased population immunity following COVID-19-related restrictions.

In response, and to avoid losing vaccine stock to expiration, the Brazilian government recently expanded the population eligible for dengue vaccination. Now, children six to sixteen are eligible, rather than just ten to fourteen year-olds.

Image Credits: Direct Relief/Felipe Luna, James Gathany/ PHIL, CDC, Public Domain, IFRC, PAHO , PAHO , PAHO.

HPV vaccine
An online WHO platform gathers information about various medical devices: from simple syringes to complex hospital equipment.

To help countries and organisations navigate a complex pool of over 10,000 different medical devices, the World Health Organization (WHO) launched an online platform on Monday that will collect and standardise the information about medical equipment.

Medical Devices Information System, or MeDevIS, is inspired by the WHO Priority Medical Devices List (MDL) and the Essential Medicines List, the latter of which will soon have existed for 50 years, serving as an important support for health progress globally.

MeDevIS includes 2,301 types of medical devices of varying levels of complexity: from single-use syringes, medical masks, and pulse oximeters, to imaging radiology technologies, implantable prostheses, or defibrillators.

“The number of medical technologies used in health care is growing, as is their complexity, which can make it challenging for health care practitioners and patients to navigate,” said Dr Yukiko Nakatani, WHO Assistant Director-General for Access to Medicines and Health Products. 

The aim is for a “one-stop shop of international information” to help stakeholders to find appropriate equipment.

The new platform references both major naming systems for medical devices, renowned internationally: the European Medical Device Nomenclature (EMDN) and the Global Medical Device Nomenclature (GMDN), used in some countries outside of the European region. Both systems facilitate handling specific types of equipment on the regulatory and logistics levels.

MeDivIS also features information about the infrastructure required for the device, the healthcare facility level where it is typically used, and links to thematic WHO guidelines connected with the branch of care for which the equipment is made.

“The MeDevIS platform can be useful for national policy-makers to develop or update their own national lists for the procurement of health technologies and devices and can contribute to the progress towards universal health coverage,” said Dr Deus Mubangizi, WHO Director for Health Products Policy and Standards.

 

Image Credits: Unsplash.

Children with cancer outside Okhmatdyt Hospital after the attack.

Russia’s bombing of a children’s hospital and women’s health centre in Ukraine’s capital Kiev on Monday is “abominable”, said UN High Commissioner for Human Rights Volker Türk.

“Civilians must be protected, and the laws of war strictly adhered to,” added Türk. “There must be prompt, thorough and independent investigations into these latest grave attacks on civilians and civilian infrastructure, and those responsible must be held to account.”

“Shockingly, one of the strikes severely damaged the intensive care, surgical and oncology wards of Okhmatdyt, which is Ukraine’s largest children’s referral hospital, and destroyed its children’s toxicology department, where children receive dialysis,” said Türk.

Okhmatdyt Hospital serves more than 20,000 children annually. Monday’s missile attack struck a medical building at the hospital where children were receiving dialysis, while also damaging the intensive care, operating, and oncology departments, according to the Minister of Health of Ukraine.

The entire hospital is without electricity, preventing the use of ventilators and other urgent care.

Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organisation (WHO), said that “several floors of the largest children’s hospital in Kyiv were severely impacted today, disrupting the hospital’s operations and affecting its ability to provide critical care to the young patients.”


Meanwhile, Türk said that OHCHR staff visiting the scene shortly after the attack had “observed children receiving treatment for cancer in hospital beds set up in parks and on streets, where medical workers had quickly established triage areas, amongst chaos, dust and debris.”

Health officials said the entire hospital was now without electricity, preventing the use of ventilators and other urgent care. It was not immediately clear how many people were killed in the strike.

The ISIDA Medical Centre, one of the largest women’s health and family planning centres in Ukraine, was also affected by the attack, with several casualties.

The attack comes the day before a NATO summit in Washington DC.

Russia has attacked Ukraine’s health care workers, facilities, and other medical infrastructure at least 1,442 times since its invasion of Ukraine in February 2022 and 13 April 2024,according to data from a partnership made up of the Ukrainian Health Center, Physicians for Human Rights (PHR) and others.

Russian attacks on Ukraine health care since February 2022.

“Russia’s strategy in Ukraine includes attacking babies and children. Domestic and international actors should intensify efforts to hold perpetrators accountable for these war crimes,” said Uliana Poltavets, PHR’s Ukraine emergency response coordinator in a statement.

Researchers have documented 79 attacks that affected children’s health care, including 54 attacks that destroyed or damaged children’s hospitals.

“Today’s devastating attack on the largest children’s hospital is emblematic of Russia’s onslaught against Ukraine’s health care system. Again and again, we have witnessed Russian forces attack vulnerable patients, health workers, and hospitals across the country,” said Poltavets.

PHR called on “domestic and international prosecutors, including the International Criminal Court, to prioritise the investigation and prosecution of attacks on health care.”

Image Credits: Twitter.

Sierra Leone First Lady Fatima Bio

Sierra Leone’s President Julius Maada Bio signed into law the Prohibition of Child Marriage Act last week, introducing a penalty of at least 15 years and a fine of around $4,000 for any man who marries a girl under 18.

The law also prohibits cohabiting with a child, and fines for anyone arranging, aiding or attending such marriage ceremonies.

First Lady Fatima Bio’s “Hands Off Our Girls” campaign has been instrumental in advocating against child marriage in Sierra Leone.

Sierra Leone has one of the highest rates of child marriages in Africa, alongside Niger and Nigeria. According to the 2019 Sierra Leone Demographic and Health Surveys, 30% of girls in Sierra Leone are married before their 18th birthday.

In 2020, there were 800,000 child brides, half of whom were married before they turned 15, according to UNICEF. The country of slightly over eight million people also has a high rate of female genital mutilation.

“Child marriages fuel the high adolescent pregnancy rate in Sierra Leone where, tragically, pregnancy complications are the leading cause of death for girls aged 15-19,” according to Human Rights Watch (HRW).

In 2021, the country introduced a policy of “radical inclusion” in schools, targeting and marginalised groups including girls, particularly pregnant girls and parent learners. 

Last year, Sierra Leone passed an education law that guarantees children free education, including one year of pre-primary. 

“The legislation is a milestone in Sierra Leone’s journey towards gender equality and child protection. It also sets a pathway forward for other African nations, such as Tanzania and Zambia, to revoke laws that permit child marriage, and ensure girls can complete primary and secondary education,” said HRW.

 

Neurons with tau protein highlighted in red.

Eli Lilly’s Alzheimer’s therapy, donanemab, has received FDA approval, offering new hope for patients with early symptomatic Alzheimer’s disease. The newly approved treatment, branded Kisunla, is set to challenge existing therapies from Eisai and Biogen. 

Clinical trials have shown Kisunla to be effective for individuals in the mild cognitive impairment or mild dementia stages of the disease, potentially marking a significant advancement in Alzheimer’s care.

The drug is administered as an intravenous infusion every four weeks. 

Alzheimer’s disease is a degenerative condition of the brain that impacts over 6.5 million Americans and over 55 million people worldwide. It causes a gradual decline in memory, cognitive functions, and, eventually, the ability to perform daily activities. The disease is marked by structural changes in the brain, such as the buildup of amyloid beta plaques and neurofibrillary tangles made of tau protein, which is supposed to help stabilize the internal skeleton of neurons in the brain. 

The Alzheimer’s Association celebrated the FDA’s decision.

“This is real progress,” said Joanne Pike, Alzheimer’s Association president and CEO, in a statement. “Today’s approval allows people more options and greater opportunity to have more time. Having multiple treatment options is the kind of advancement we’ve all been waiting for — all of us who have been touched, even blindsided, by this difficult and devastating disease.”

Slows cognitive decline by at least 22%

The approval was based on an extensive double-blind, placebo-controlled, parallel-group study evaluating the efficacy of Kisunla in slowing cognitive decline in participants with varying levels of tau protein in the brain. Tau is a protein that helps to stabilise the neurons in the brain. 

The study, conducted over 72 weeks with 1,736 patients averaging 73 years old, revealed that those receiving Kisunla experienced a 35% reduction in cognitive decline compared to those on placebo among individuals with low to medium tau levels. 

Even among participants with higher tau levels, the treatment demonstrated a meaningful but slightly reduced effect. Overall, including all tau levels, Kisunla slowed cognitive decline by 22% and reduced the likelihood of progressing to the next stage of the disease by 39% compared to placebo.

Additionally, the study monitored amyloid plaque levels using positron emission tomography (PET) scans throughout the treatment period. Results showed substantial reductions in amyloid plaques over time among patients receiving Kisunla, with reductions of 61% at six months, 80% at 12 months, and 84% at 18 months compared to baseline levels. These findings suggest that Kisunla not only targets cognitive decline but also effectively reduces the hallmark amyloid pathology associated with Alzheimer’s disease progression.

Potential side effects

For some patients, there is a risk of amyloid-related imaging abnormalities (ARIA) developing, the FDA said. ARIA typically manifests as temporary brain swelling, sometimes accompanied by small areas of bleeding on or in the brain. While ARIA often resolves on its own and may not cause symptoms, rare instances of severe and potentially life-threatening events have been reported. ARIA is a recognized side effect of antibody therapies targeting amyloid.

Infusion-related reactions are also a concern, including flu-like symptoms, nausea, vomiting, changes in blood pressure, and hypersensitivity reactions such as anaphylaxis (a severe allergic reaction) and angioedema (swelling). 

Kisunla joins Leqembi, on market since 2023

Kisunla is the third drug to receive FDA approval, although only the second is now available for use. Leqembi, a collaboration between Biogen of the United States and Eisai of Japan, gained approval in July 2023. In an 18-month Phase III trial, Leqembi demonstrated a 27% reduction in cognitive decline among early-stage Alzheimer’s patients compared to those receiving a placebo.

Another drug, aducanumab, also developed by Biogen and Eisai, was granted accelerated approval by the FDA in June 2021. However, due to some side effects, the therapy was pulled from the market. 

The Alzheimer’s Association emphasized the importance of early detection and diagnosis now that multiple FDA-approved treatments for Alzheimer’s are available. The organization stressed that timely access to these treatments is crucial for maximizing their benefits, asserting that no stage or entity should hinder or delay such access.

“Too many roadblocks have prevented individuals from getting equitable access to these beneficial treatments for far too long,” said Pike. “It is equally important that clinicians and health care systems are informed and prepared to help the individuals who could benefit. The Alzheimer’s Association is working with health systems and providers to ensure they have the tools and resources to meet the needs of their patients.”

Image Credits: Gerry Shaw/ EnCor Biotechnology Inc.

Fishing vessels at the Bridgetown Fisheries Complex in Barbados damaged by Hurricane Beryl.

Hurricane Beryl, which has destroyed homes and infrastructure in large parts of the eastern Caribbean, is the first first-ever Category 4 hurricane recorded in the region in June – and a portend of devastating changes in weather patterns.

It also underscores the need for urgent international assistance to Small Island Developing States (SIDS) to strengthen early warning systems and the climate resilience of key infrastructure – notably water, sanitation and health services, according to experts.

The hurricane reached peak speed of 265 km per hour at times as it whipped though Barbados, Grenada, St Vincent and the Grenadines, Haiti, northern Venezuela, the Dominician Republic, Cayman Islands, and Jamaica.

“The storm first impacted Barbados, causing severe damage to the south coast and significantly affecting the fishing industry with over 200 fishing vessels damaged or destroyed,” according to the International Federation of Red Cross and Red Crescent Societies (IFRC).

On Union Island, part of Saint Vincent and the Grenadines, 90% of infrastructure has been damaged, including houses, roads and the airport. 

Some 95% of homes in Grenada’s Carriacou and Petite Martinique islands, are damaged, and around 3,000 people are shelters, the IFRC added.

Parts of Jamaica’s St Elizabeth region in the south east were also devastated, with around 1,000 people taking refuge in shelters. The Dominican Republic, Cayman Islands reported damage. 

Venezuela’s President Nicolas Maduro said that 8,000 houses had been destroyed, according to Reuters.

More to still come?

“Hurricane Beryl, the first hurricane of the 2024 Atlantic hurricane season, rapidly strengthened to a Category 5 storm unusually early in the year,” according to a report from the National Ocean and Atmospheric Administration (NOAA), which is part of the US Department of Commerce 

“This explosive strengthening was fuelled in part by exceptionally warm ocean temperatures. That heat was one of the factors behind NOAA’s prediction in May of an 85% chance that the 2024 Atlantic hurricane season would be above normal.”

Sea surface temperatures were close to those usually found in mid-September, the peak of hurricane season, added NOAA.

In late May, NOAA weather forecasters predicted an 85% chance of above-normal hurricane for the 2024 Atlantic hurricane season, which runs from 1 June 1 to 30 November.

It also forecast eight  to 13 hurricanes, with four to seven likely to be “major” hurricanes (winds of over 178km per hour) in coming months.

Early warning systems 

“The unprecedented hurricane demonstrates the importance of effective multi-hazard early warning systems to save lives,” according to United Nations Disaster Risk Reduction (UNDRR).

“Globally, the sustained investments in those systems are making progress in reducing the loss of life in disasters. But economic losses are escalating. Every year millions of households lose their livelihood and risk being pushed into poverty. Ensuring that infrastructure is resilient and that communities ‘build back better’ in the face of future hazards is essential,” added UNDRR.

Damage sustained to the airport and surrounding areas on Union Island in the Grenadines during Hurricane Beryl.

In late May, the Fourth International Conference on SIDS adopted the Antigua and Barbuda Agenda for SIDS, a 10-year development agenda that  appeals for international assistance to address climate change.

The Agenda notes that “SIDS are facing the unrelenting and compounding impacts of climate change, biodiversity loss, pollution, disasters and natural hazards, health and other social related challenges and economic vulnerabilities.”

Key climate change challenges include “erratic precipitation, increasingly frequent and extreme weather phenomena, more frequent and severe tropical cyclones, floods and drought, diminishing fresh water resources, desertification, coastal erosion, land degradation and sea-level rise.”

However, there has been a “progressive deterioration” in SIDS’ ability to “withstand external shocks and enhance their resilience” – largely as a result of the economic impact of COVID-19 and climate challenges.

Financial reform to build resilience 

Protestors call on wealth countries to pay for climate-related loss and damage at COP27.

“In the wake of Hurricane Beryl, it is clear that we must redouble our efforts to build resilience and preparedness in the face of growing disaster risk, especially for small island developing states, which have contributed the least to the climate crisis but suffer the greatest costs,” said UNDRR head Kamal Kishore.

Kishore appealed for international support for the Antigua and Barbuda Agenda, which “integrates disaster risk reduction as central to climate change adaptation and sustainable development in SIDS with clear calls to action on enhancing multi-hazard early warning systems and resilient infrastructure.”

There have also been numerous calls for reform of the international financial architecture to assist developing countries most affected by climate change who are being forced to borrow money to address climate crises largely caused by wealthy nations. 

The most significant of these is the 2022 Bridgetown Initiative, spearheaded by Prime Minister Mia Mottley of Barbados. This called for key actions including new loan mechanisms, reform of the world’s development banks, and a loss and damages fund to enable developing countries to access to resilient finance to address climate and development crises.

The UN climate change conference, COP27, agreed to establish a loss and damage fund during the UN Climate Change Conference (COP27) in 2022. However, there is resistance from a number of wealthier countries to this as the world continues to experience record-breaking extreme weather events.

Meanwhile, the International Cort of Justice (ICJ) is expected to hold public hearings and issue an advisory later this year on the international legal obligations countries have to safeguard people against climate change. 

This follows the adoption last year of a landmark UN resolution to seek such an advisory opinion from the ICJ. While not legally binding, the advisory opinion holds legal and moral weight and will spotlight the human rights impacts of climate policy.

Image Credits: UNDP, AfricaNews.

Over one-half of Americans are not sure if pasteurised milk is safer than raw milk. In the time of avian flu epidemics in US cattle, this could even prove dangerous.

As the fourth human case of H5N1 avian flu in a US farmworker in Colorado was confirmed Wednesday by the US Centers for Disease Control and Prevention (CDC), so far, only farm workers, and not consumers, have reported avian flu infections.

This is likely due, at least in part, to the successful inactivation of the virus during the milk pasteurization process, experts say. And yet one-half or more Americans seem to have little idea about the dangers of drinking raw milk, according to a recent poll conducted by the University of Pennsylvania researchers.

The survey, which included a demographically representative sample of the US adult population, found that less than half (47% percent) of the U.S. adults surveyed understood that drinking raw milk not as safe as drinking pasteurized milk. Conversely, 53% of respondents don’t actually believe that pasteurized milk is safer. And 9% of respondents actually believed raw  milk is safer, while 15% said it was just as safe and 30% were unsure.  

Nearly a quarter (24%) of Americans either do not believe that pasteurization is effective at killing bacteria and viruses in milk products (4%) or are not sure whether this is true (20%), according to the survey of over 1000 US adults, conducted by the Annenberg Public Policy Center (APPC). The survey has a 3-3.5% statistical error rate.

Around half of US adults failed to recognize that raw milk  can be more dangerous than pasteurized milk products.

That, despite the fact that studies report that pasteurized milk limits hospitalizations for related illnesses by an order of 45, according to the APPC report. 

The French Scientist Louis Pasteur invented the pasteurization process 160 years ago, after recognizing that it killed off otherwise dangerous bacteria present in unheated wine. The process, which soon became a milk industry standard in the United States, successfully inactivates the modern-day avian flu virus, significantly limiting the risk of infection for the general public. 

Politics and milk 

In fact, only about 2% of Americans report drinking raw milk at least once a month, according to a Food and Drug Administration (FDA) study based on 2019 data.

Paradoxically, however, raw milk sales in the US have increased in recent months, according to some US media reports, despite the recent risks posed by a widening circle of avian influenza among dairy cattle.

Debate has been spurred  by the increased anti-science bent of some US political leaders. Presidential candidate Robert F. Kennedy Jr., for instance, who also has been a staunch opponent of COVID vaccination, has been quoted saying that he drinks raw milk exclusively.

The APPC survey also found that Republicans are more likely than Democrats to believe that drinking raw milk is as safe as pasteurized milk (57% vs. 37%). People living in an urban environment also are more likely to believe that pastuerized milk is safer than raw milk as compared to people in a rural environment (49% vs. 32%).

“The difference in views of raw milk that we see between Democrats and Republicans is difficult to disentangle from the difference between rural and urban dwellers,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center. “Those in rural areas are both more likely to identify as Republicans and to consume raw milk.”

55 more dairy herds reported infected in last 30 days

Some 55 more cattle herds in seven states have been infected with the virus over the past 30 days, according to CDC tracking. Infections in the past 30 days represent 40% of the total of 138 cattle herds infected in 12 states since the outbreak in dairy cattle was first reported on 25 March, the CDC reported. 

States affected by avian flu spread in dairy cattle

The real number of infections of both humans and cattle is very likely underestimated, insofar as farmers have been reluctant to have their staff or herds tested, experts warn.

Even so, the CDC maintained that infection risks for the general public remain low. 

“Based on the information available at this time, this infection does not change CDC’s current H5N1 bird flu human health risk assessment for the U.S. general public, which the agency considers to be low,” the CDC said in a statement.

Image Credits: Cotonbro studio, APCC, CDC.

Scientists at the West African Centre for Cell Biology and Infectious Pathogens (WACCBIP), University of Ghana, setting up a genome sequencing experiment in the laboratory.

Almost 15 years ago, when the University of Ghana established its Office of Research, Innovation, and Development, it did so with the goal of bolstering the West African nation’s research capacity. 

In the African region, where less than 0.5% of GDP is devoted to research, and a significant number of Africa’s educated is siphoned off to other countries, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) has spearheaded the effort to make universities like the University of Ghana research-intensive and competitive. 

TDR support for research capacity-strengthening activities at the University of Ghana focuses on enabling researchers to tackle infectious diseases of poverty through quality implementation research, the study of bridging basic science research and practice. 

This could mean examining why many patients on antiretroviral therapy drop out of treatment, or identifying barriers to TB treatment adherence – both the subject of recent publications authored by researchers at the University of Ghana.

Capacity-building works

Professor Gordon A. Awandare at TDR’s Joint Coordinating Board meeting in Geneva, 12 June 2024

“Capacity-building actually works,” remarked Professor Gordon A Awandare,  Pro Vice-Cancellor of Academic Student Affairs at the University of Ghana, at a TDR 50th anniversary event in Geneva, where he gave a detailed review of the collaboration before TDR’s Joint Coordinating Board on June 12. 

He cited, as one example, his own career trajectory. Awandare began a career in research through a TDR grant that allowed him to complete his masters training, and then got an opportunity to study for a PhD at the University of Pittsburgh while attending a  conference on malaria with support from TDR.  He returned home to the University of Ghana in 2010, founding the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) in 2014. Since then, the Centre, supported by the Wellcome Trust and the World Bank, has endowed 400 fellowships and received $53 million in grants, thereby directly reducing the “brain drain” across the African region.

A decade-long partnership

The University of Ghana leads efforts to train students in implementation research. Newly enrolled master’s students during their lab induction at WACCBIP, University of Ghana.

In 2014 the University of Ghana’s School of Public Health  signed a partnership agreement with TDR to create a regional training center that leads activities in the African region for strengthening capacity in implementation research to tackle infectious diseases of poverty.

The initiative has so far trained more than 25,000 individuals across Africa, including health practitioners, decision-makers and researchers.                                    

“Looking at how far we’ve come as a training centre, it is our desire to become a centre of excellence where the annual programmes can be extended to say five years,” said Professor Phyllis Dako-Gyeke, who led the TDR-supported research training programmes at University of Ghana until her passing on 11 June. 

But the success of an almost decade-long relationship is not without its challenges. Sustainable donor support and aligned interests on research priorities remain key, she said.           

Real-time research 

Implementation researchers at UG have tackled issues from TB treatment adherence to antiretroviral therapy. Here, a community health worker conducts an interview in Obuasi, Ghana to identify barriers and facilitators for TB control.

Dr Emmanuel Asampong, coordinator of the regional training centre at the University of Ghana, notes that “the impact of implementation research on disease themes in Africa and beyond is impressive because the initiative uses  real-time research results in various contexts – such as the neglected tropical diseases programme, the national malaria programme, and the tuberculosis control programme – to provide solutions to challenges.” 

The global program, which has played a significant role in positioning University of Ghana as a research-intensive university, supports seven regional training centres across six WHO regions. With additional partners in Colombia, Indonesia, Kazakhstan, Malaysia, Senegal and Tunisia, the program develops and updates implementation research courses, provides faculty training and supports career development. 

Map of capacity building TDR regional training centers
The global program, which has played a significant role in positioning University of Ghana as a research institution, also supports NTD research in six WHO regions.

The University of Ghana also partners with TDR on a postgraduate training scheme, which provides a full academic scholarship  for master’s students. The training is specifically focused on implementation research to tackle infectious diseases of poverty. 

The list of TDR alumni across the world runs long, and the University of Ghana can claim many  public health leaders among them. 

“My postgraduate training at the University of Ghana, supported by TDR, was an invaluable catalyst in shaping my academic and professional journey,” said Dr Mbele Whiteson, Senior Resident Medical Officer at the Ministry of Health in Zambia. “I have learned to recognize the intricate interplay between health outcomes and social determinants.”‎

This is the third article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions.

Sophia Samantaroy contributed to the writing and research of this story.

Image Credits: WACCBIP, TDR, African Regional Training Centre (ARTC), University of Ghana/TDR.

modernaAs H5N1 avian flu spreads in US dairy cows, the US Department of Health and Human Services (HHS) has granted approximately $176 million to Moderna to develop an mRNA-based vaccine for influenza with pandemic-potential.

“We have successfully taken lessons learnt during the COVID-19 pandemic and used them to better prepare for future public health crises. As part of that, we continue to develop new vaccines and other tools to help address influenza and bolster our pandemic response capabilities,” said HHS Secretary Xavier Becerra this week.

This award will help Moderna to set up additional pandemic influenza vaccine response capability, using existing domestic large-scale commercial mRNA-based technology and manufacturing platforms developed during the COVID-19 pandemic and ongoing seasonal influenza vaccine development, according to HHS.

The US government has also secured a fair pricing agreement “which will continue ensuring enduring equitable access to vaccines,” it added. Moderna’s COVID-19 vaccine was one of the most expensive on the market during the pandemic.

“The award made today is part of our longstanding commitment to strengthen our preparedness for pandemic influenza,” noted Assistant Secretary for Preparedness and Response Dawn O’Connell.

“Adding this technology to our pandemic flu toolkit enhances our ability to be nimble and quick against the circulating strains and their potential variants.”

The rapid spread of H5N1 bird flu in US dairy cows has rattled the US, affecting 12 states, according to the American Veterinary Medical Association.

The award will enable the rapid development of an mRNA vaccine targeted to various influenza strains with pandemic potential, and enable development and manufacturing to pivot quickly, if needed, to address other threats.

Image Credits: Jernej Furman/Flickr.

 Some 750 million people globally want to quit smoking but most lack access to help to do so.

Digital cessation programmes, behavioural support, and medication for tobacco cessation in adults are some of the measures contained in first-ever guidelines to help people quit smoking published recently by the World Health Organization (WHO). 

One in five adults – 1.25 billion users worldwide – consume various tobacco products such as  cigarettes, heated tobacco products, water pipes, smokeless tobacco products, or cigars. 

Even though more than half of them – around 750 million – want to quit, only 30% have access to effective cessation services.

Among the treatments recommended to help them are counselling, teaching patients to change their smoking-related habits, dedicated apps or calls, nicotine replacement therapy and medication.

 What works best is a combined approach: behavioural support and pharmacotherapy, WHO states. Member states are encouraged to provide quitting help for no or low fee to make it as accessible as possible.

The guideline marks a “crucial milestone” in combatting tobacco addiction, WHO Director-General, Dr Tedros Adhanom Ghebreyesus said in a press release. “It empowers countries with the essential tools to effectively support individuals in quitting tobacco and alleviate the global burden of tobacco-related diseases.”

Tobacco smoking affects nearly every organ of the body, causing over 20 types of cancer, increasing the risk of heart disease, stroke, and many other conditions. According to the WHO, tobacco kills half of its users and affects non-smokers through second-hand exposure.

Health system change, medication and behavioural support

The guidelines feature advised changes in the health systems: tobacco use status and implemented cessation interventions should be included in the patient’s medical records; it is also recommended that health care workers are trained on the appropriate therapies and provide a short behavioural support talk to smokers who want to quit. 

Treatments included in the guidelines: counselling, digital support, pharmacotherapy, and embedding smoking cessation in the healthcare system are key recommendations.

Pharmacotherapy using nicotine replacement therapy and drugs such as varenicline, bupropion, and cytisine, especially when combined with behavioural support. This may include skills and strategies for changing behaviour as well as more general counselling. 

Traditional, complementary and alternative therapies are not recommended due to insufficient evidence for their effectiveness.

Varenicline, but not vapes

While the guidelines strongly recommend the use of varenicline, they do not mention a possible role for vapes in quitting traditional cigarettes, more harmful than their e-cigarette alternative. 

A recent study published by the JAMA Network suggests vaping can be as efficient as varenicline in helping smokers quit – although, as WHO argues, it has little effect at the population level. 

WHO states that “e-cigarettes are beyond the scope of this guideline because the potential benefits and harms of using these products are complex, and are addressed in a separate body of literature. These products may be addressed in the future as evidence accumulates.”

The tobacco industry is highly invested in marketing vapes, framing them as a safer alternative to traditional smoking even though they are also addictive and harmful. The WHO might be more cautious to promote e-cigarettes knowing its statements can be used by tobacco firms to promote their products.

“We need to deeply appreciate the strength it takes and the suffering endured by individuals and their loved ones to overcome this addiction,” said Dr Rüdiger Krech, Director of Health Promotion at WHO, in a press release. “These guidelines are designed to help communities and governments provide the best possible support and assistance for those on this challenging journey.”

Image Credits: Sarah Johnson, WHO.