As Lee Riley read article after article about the deadly 2014 Ebola outbreak, his frustration mounted. “I was seeing all of these newspaper reports and even scientific reports talking about this unprecedented epidemic in West Africa,” says Riley, a specialist in urban public health at the University of California, Berkeley, “and there wasn’t a single mention of the words ‘slums’ or ‘informal settlements’.”
Ebola is feared because of its high mortality and limited treatment options, but generally it has been limited to remote rural regions. The 2014 outbreak was different: flare-ups in cities such as Conakry in Guinea and Monrovia in Liberia revealed the havoc that this lethal virus could wreak in urban environments. The dense and highly mobile populations provided greater opportunities for the infection to spread. And according to Mosoka Fallah, an epidemiologist who was working with Liberia’s Ministry of Health at the front line of the Monrovia outbreak, urban slums bore the brunt. “Wherever there were big outbreaks, most people being infected were among the poor,” he says. “Those that didn’t have basic sanitation, who had the most distrust of institutions — they also had the most disease.”
Developing nations have experienced an astonishing boom in urbanization in the past few decades. The urban population of Kenya, for example, has grown at an average rate of 4.3% per year since 2010, as rural citizens have moved to cities in pursuit of new opportunities. “The range is between 3% and 6% in most of Africa,” says Robert Breiman, an infectious-disease epidemiologist at Emory Global Health Institute in Atlanta, Georgia. Riley says that there has been a similar trend in Brazil, where 85% of the population now lives in cities. Many migrants initially make their home in informal settlements at the city periphery. The United Nations Human Settlement Programme UN-Habitat estimates that 863 million people — one-third of the developing world’s urbanites — live in slums.
Although better access to medical care means that the health of city dwellers across the socio-economic spectrum is generally superior to that of their rural counterparts, cities can also provide greater opportunities for infectious diseases to flourish. Crowding and poor or non-existent infrastructure exacerbate the risk of infectious disease to slum inhabitants in particular. However, as demonstrated by the rapid spread of the Zika virus over the past year, outbreaks can be a threat to entire cities, nations and — thanks to globalization — the rest of the world. http://www.nature.com/nature/journal/v531/n7594_supp/full/531S61a.html
In a study using mice, the Johns Hopkins University School of Medicine infectious disease experts have added to evidence that statin drugs—known primarily for their cholesterol-lowering effects—can significantly reduce the time it takes to clear tuberculosis infection.
“If our results hold up in humans, the use of statins as adjuncts to standard drug treatment could confer substantial benefits to public health and the nearly nine million new TB patients diagnosed worldwide each year,” says study author Petros Karakousis, M.D., associate professor of medicine in the Division of Infectious Diseases at the Johns Hopkins University School of Medicine. “Because statins like the one we tested are already approved by the U.S. Food and Drug Administration and have a long history of safety in patients, the new data might substantially accelerate their repurposing for tuberculosis patients.”
First-line treatment for tuberculosis, which consists of a combination of four antibiotics, should in theory cure all drug-susceptible infections if strict compliance can be assured. However, says Karakousis, a curative course of treatment usually requires six to nine months, with a minimum of 18 months for drug-resistant forms of the lung disease. To assure compliance, most patients in developed countries undergo directly observed therapy, in which a trained health care worker provides the prescribed drugs and watches patients swallow every dose—a strategy that mitigates spread of the disease but diverts resources from other needed medical care. In many developing countries, patients stop taking their antibiotics early when their symptoms abate, contributing to continued spread of tuberculosis in the community and the emerging problem of drug resistance.
Because new drugs that might shorten treatment duration are few in number and years from clinical use, Karakousis says his team’s focus has been on repurposing already approved medicines that bolster the first-line regimen.
Toward that goal, the researchers focused on simvastatin, used by millions in the U.S. alone to reduce heart disease risk. In recent years, evidence has emerged that statins work, in part, by reducing inflammation by modulating the immune system, says Karakousis’ colleague and study author Noton Dutta, Ph.D., research associate in the Division of Infectious Diseases at the Johns Hopkins University School of Medicine.http://medicalxpress.com/news/2016-03-statins-tuberculosis-treatment-mice.html
During a recent outbreak of the Zika virus in French Polynesia, roughly one in 100 women infected in the first trimester of pregnancy developed a fetus with an abnormally small head and brain damage, researchers reported on Tuesday.
The research, published in The Lancet, provides some reassurance that the complication is rare, experts said.
“It means you have a 99 percent chance of having a normal baby,” said Dr. Laura C. Rodrigues, a professor of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine, who wrote an editorial accompanying the report.
By comparison, the risk of congenital rubella syndrome — which may include heart disease, hearing loss and developmental delays in infants — ranges from 38 percent to 100 percent when mothers are infected in the first trimester.http://www.nytimes.com/2016/03/16/health/zika-virus-microcephaly-rate.html?_r=0
The World Health Organization on Tuesday released its 2012 report on unhealthy environment-related deaths.
The big takeaway? The number of deaths attributed to unhealthy environments still make up 23% of all deaths each year, which is unchanged from a decade earlier.
But there was one particular area in which healthcare efforts seem to be making progress: the spread of infectious diseases like malaria.
This is something to cheer, because while a lot of these diseases don’t kill people in developed countries, they do plague poorer nations.
The WHO considered instances of disease in 2002 and compared that to 2012. Among the findings:
- Instances of malaria caused by environmental factors fell from 500,000 to 259,000.
- Similarly, deaths by diarrhea diseases fell by half from 1.7 million deaths to 846,000.
- The decline offset an increase in environmental deaths tied to noncommunicable disease, such as cancer, diabetes and cardiovascular diseases.http://www.businessinsider.com/drop-in-infectious-disease-who-report-2016-3
The World Health Organization on Tuesday cautioned pregnant women against traveling to areas where there is ongoing transmission of Zika virus — something the U.S. Centers for Disease Control and Prevention advised more than a month ago.
Director General Margaret Chan said reports and investigations from affected countries in the Americas “strongly suggest” that sexual transmission is more common than previously assumed.
During a media telebriefing, WHO officials were pressed on why the organization had not issued a travel warning earlier. In addition to the CDC’s guidance, health agencies in numerous countries have urged pregnant women and their sexual partners to avoid travel to regions where the virus is spreading and to practice safe sex or abstain from sex for the duration of a pregnancy.https://www.washingtonpost.com/news/to-your-health/wp/2016/03/08/stronger-zika-links-to-sexual-transmission-birth-defects-who-says/
The drug called BCX 44 from BioCryst Pharmaceuticals (NASDAQ: BCRX) showed improvement in survival rates among mice infected with the Zika virus in a preclinical study. It was tested against a placebo and an oral antiviral called ribavirin.http://www.pulseheadlines.com/drug-zika-shows-promise/19911/
U.S. health experts cautioned Friday that the apparent discovery of the Zika virus in saliva and urine from people in Brazil does not necessarily mean the virus can be spread by more casual contact with infected people, such as through kissing.
“I think we need to be careful that don’t we jump to any conclusions about transmissibility,” Anthony Fauci, who leads the National Institute of Allergy and Infectious Diseases, said during an interview on NPR’s Morning Edition.
“When you find a virus or fingerprints of a virus in a body secretion, it absolutely does not mean that it is transmitted that way,” Fauci said.
The virus may be present in a form that is incapable of spreading, or in such low levels that transmission is impossible or unlikely, several scientists said. There also could be substances present in saliva that prevent the virus from spreading.
More research will be needed to determine what role, if any, the presence of the virus in saliva plays in the spread of the Zika virus, the scientists said.
“The important thing is now to determine whether the virus in saliva and urine can transmit the virus to others. We’ll just have to wait and see,” said William Schaffner, an infectious disease researcher at Vanderbilt University.
While other viruses can be found in saliva, such as the human immunodeficiency virus (HIV), it is not spread that way, Fauci noted.
Mosquitoes clearly remain the main way the Zika virus is transmitted, says Thomas Frieden, who heads the Centers for Disease Control and Prevention.
“I think it’s important to step back and emphasize that Zika is a mosquito-borne virus and the overwhelming majority of cases are spread by mosquitoes,” Frieden told reporters during a briefing Friday morning.
The CDC did, however, issue new guidelines for how pregnant women should protect themselves from getting infected, following a report out of Dallas this week that Zika had been spread through sexual contact in one case.
The CDC recommends that pregnant women whose sexual partners live in or have traveled to places where the virus is spreading should either abstain from sexual activity or “consistently and correctly” use condoms during vaginal, oral or anal sex.
Women who are not pregnant should consider doing the same if they are “concerned about sexual transmission,” according to the guidelines.
The Zika virus is spreading rapidly through many parts of Latin America and the Caribbean. Concern has spiked because the virus is apparently causing some babies in Brazil to be born with microcephaly, a condition marked by small heads and brains. It has also been linked to Guillain-Barre syndrome, which can cause paralysis.
Mosquitoes that can transmit the Zika virus are found in the U.S., but so far aside from the Dallas sexual transmission case all the infections reported in the continental United States have been among travelers who got infected elsewhere. The CDC said there have been 50 such cases so far.
While officials say mosquitoes could spread the virus in the U.S., they are optimistic there will not be widespread transmission because of several factors, most notably good mosquito-control efforts.
But Frieden stressed that there is a lot that remains unknown about Zika.
“The situation is evolving rapidly, and as we learn more we’ll share more so Americans can best decide how to protect their health,” Frieden says.