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Tag: Meningitis

  • Landmark study highlights power of vaccination

    Landmark study highlights power of vaccination

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    A major landmark study to be published by The Lancet reveals that global immunization efforts have saved an estimated 154 million lives – or the equivalent of 6 lives every minute of every year – over the past 50 years. The vast majority of lives saved – 101 million – were those of infants.

    The study, led by the World Health Organization (WHO), shows that immunization is the single greatest contribution of any health intervention to ensuring babies not only see their first birthdays but continue leading healthy lives into adulthood.

    Of the vaccines included in the study, the measles vaccination had the most significant impact on reducing infant mortality, accounting for 60% of the lives saved due to immunization. This vaccine will likely remain the top contributor to preventing deaths in the future.

    Over the past 50 years, vaccination against 14 diseases (diphtheria, Haemophilus influenzae type B, hepatitis B, Japanese encephalitis, measles, meningitis A, pertussis, invasive pneumococcal disease, polio, rotavirus, rubella, tetanus, tuberculosis, and yellow fever) has directly contributed to reducing infant deaths by 40% globally, and by more than 50% in the African Region.

    “Vaccines are among the most powerful inventions in history, making once-feared diseases preventable,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “Thanks to vaccines, smallpox has been eradicated, polio is on the brink, and with the more recent development of vaccines against diseases like malaria and cervical cancer, we are pushing back the frontiers of disease. With continued research, investment and collaboration, we can save millions more lives today and in the next 50 years.”

    The study found that for each life saved through immunization, an average of 66 years of full health were gained – with a total of 10.2 billion full health years gained over the five decades. As the result of vaccination against polio more than 20 million people are able to walk today who would otherwise have been paralysed, and the world is on the verge of eradicating polio, once and for all.

    These gains in childhood survival highlight the importance of protecting immunization progress in every country of the world and accelerating efforts to reach the 67 million children who missed out on one or more vaccines during the pandemic years.

    Monumental efforts to increase access to vaccination over five decades

    Released ahead of the 50th anniversary of the Expanded Programme on Immunization (EPI) to take place in May 2024, the study is the most comprehensive analysis of the programme’s global and regional health impact over the past five decades.

    Founded in 1974 by the World Health Assembly, EPI’s original goal was to vaccinate all children against diphtheria, measles, pertussis, polio, tetanus, tuberculosis, as well as smallpox, the only human disease ever eradicated. Today, the programme, now referred to as the Essential Programme on Immunization, includes universal recommendations to vaccinate against 13 diseases, and context-specific recommendations for another 17 diseases, extending the reach of immunization beyond children, to adolescent and adults.

    The study highlights that fewer than 5% of infants globally had access to routine immunization when EPI was launched. Today, 84% of infants are protected with 3 doses of the vaccine against diphtheria, tetanus and pertussis (DTP) – the global marker for immunization coverage.

    Nearly 94 million of the estimated 154 million lives saved since 1974, were a result of protection by measles vaccines. Yet, there were still 33 million children who missed a measles vaccine dose in 2022: nearly 22 million missed their first dose and an additional 11 million missed their second dose.

    Coverage of 95% or greater with 2 doses of measles-containing vaccine is needed to protect communities from outbreaks. Currently, the global coverage rate of the first dose of measles vaccine is 83% and the second dose is 74%, contributing to a very high number of outbreaks across the world.

    To increase immunization coverage, UNICEF, as one of the largest buyers of vaccines in the world, procures more than 2 billion doses every year on behalf of countries and partners for reaching almost half of the world’s children. It also works to distribute vaccines to the last mile, ensuring that even remote and underserved communities have access to immunization services.

    Thanks to vaccinations, more children now survive and thrive past their fifth birthday than at any other point in history. This massive achievement is a credit to the collective efforts of governments, partners, scientists, healthcare workers, civil society, volunteers and parents themselves, all pulling in the same direction of keeping children safe from deadly diseases. We must build on the momentum and ensure that every child, everywhere, has access to life-saving immunizations.”


    Catherine Russell, UNICEF Executive Director

    In 2000, Gavi, the Vaccine Alliance, which includes WHO, UNICEF and the Bill & Melinda Gates Foundation (BMGF) as core founding members, was created to expand the impact of EPI and help the poorest countries in the world increase coverage, benefit from new, life-saving vaccines and expand the breadth of protection against an increasing number of vaccine-preventable diseases. This intensified effort in the most vulnerable parts of the world has helped to save more lives and further promote vaccine equity. Today, Gavi has helped protect a whole generation of children and now provides vaccines against 20 infectious diseases, including the HPV vaccine and vaccines for outbreaks of measles, cholera, yellow fever, Ebola and meningitis.

    “Gavi was established to build on the partnership and progress made possible by EPI, intensifying focus on protecting the most vulnerable around the world,” said Dr Sania Nishtar, CEO of Gavi, the Vaccine Alliance. “In a little over two decades we have seen incredible progress – protecting more than a billion children, helping halve childhood mortality in these countries, and providing billions in economic benefits. Vaccines are truly the best investment we can make in ensuring everyone, no matter where they are born, has an equal right to a healthy future: we must ensure these efforts are fully funded to protect the progress made and help countries address current challenges of their immunization programmes.”

    Immunization programmes have become the bedrock of primary health services in communities and countries due to their far reach and wide coverage. They provide not only an opportunity for vaccination but also enable other life-saving care to be provided, including nutritional support, maternal tetanus prevention, illness screenings and bed net distribution to protect families from diseases like malaria.

    Since the study only covers the health impact of vaccination against 14 diseases, the number of lives saved due to vaccination is a conservative estimate and not a full account of the life-saving impact of vaccines. Societal, economic or educational impacts to health and well-being over the 50 years have also contributed to further reductions in mortality. Today, there are vaccines to protect against more than 30 life-threatening diseases.

    While the HPV vaccine, which protects against cervical cancer in adults, was not included in the study, it is expected to prevent a high number of future deaths as countries work towards increasing immunization targets aimed at eliminating cervical cancer by 2030. New vaccine introductions, such as those for malaria, COVID-19, respiratory syncytial virus (RSV) and meningitis, as well as cholera and Ebola vaccines used during outbreaks, will further save lives in the next 50 years.

    Saving millions more is “Humanly Possible”

    Global immunization programmes have shown what is humanly possible when many stakeholders, including heads of state, regional and global health agencies, scientists, charities, aid agencies, businesses, and communities work together.

    Today, WHO, UNICEF, Gavi, and BMGF are unveiling “Humanly Possible”, a joint campaign, marking the annual World Immunization Week, 24-30 April 2024. The worldwide communication campaign calls on world leaders to advocate, support and fund vaccines and the immunization programmes that deliver these lifesaving products – reaffirming their commitment to public health, while celebrating one of humanity’s greatest achievements. The next 50 years of EPI will require not only reaching the children missing out on vaccines, but protecting grandparents from influenza, mothers from tetanus, adolescents from HPV and everyone from TB, and many other infectious diseases.

    “It’s inspiring to see what vaccines have made possible over the last fifty years, thanks to the tireless efforts of governments, global partners and health workers to make them more accessible to more people,” said Dr Chris Elias, president of Global Development at the Bill & Melinda Gates Foundation. “We cannot let this incredible progress falter. By continuing to invest in immunization, we can ensure that every child – and every person – has the chance to live a healthy and productive life.”

    Source:

    The World Health Organization

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  • Nigeria first to rollout new Men5CV vaccine against meningitis

    Nigeria first to rollout new Men5CV vaccine against meningitis

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    In a historic move, Nigeria has become the first country in the world to roll out a new vaccine (called Men5CV) recommended by the World Health Organization (WHO), which protects people against five strains of the meningococcus bacteria. The vaccine and emergency vaccination activities are funded by Gavi, the Vaccine Alliance, which funds the global meningitis vaccine stockpile, and supports lower-income countries with routine vaccination against meningitis. 

    Nigeria is one of the 26 meningitis hyper-endemic countries of Africa, situated in the area known as the African Meningitis Belt. Last year, there was a 50% jump in annual meningitis cases reported across Africa.

    In Nigeria, an outbreak of Neisseria meningitidis (meningococcus) serogroup C outbreak led to 1742 suspected meningitis cases, including 101 confirmed cases and 153 deaths in seven of 36 Nigerian states (Adamawa, Bauchi, Gombe, Jigawa, Katsina, Yobe, Zamfara) between 1 October 2023 and 11 March 2024. To quell the deadly outbreak, a vaccination campaign has been undertaken on 25–28 March 2024 to initially reach more than one million people aged 1-29 years.

    Meningitis is a serious infection that leads to the inflammation of the membranes (meninges) that surround and protect the brain and spinal cord. There are multiple causes of meningitis, including viral, bacterial, fungal and parasitic pathogens. Symptoms often include headache, fever and stiff neck. Bacterial meningitis is the most serious, can also result in septicaemia (blood poisoning), and can seriously disable or kill within 24 hours those that contract it.

    Meningitis is an old and deadly foe, but this new vaccine holds the potential to change the trajectory of the disease, preventing future outbreaks and saving many lives. Nigeria’s rollout brings us one step closer to our goal to eliminate meningitis by 2030.”


     Dr Tedros Adhanom Ghebreyesus, WHO Director-General

    The revolutionary new vaccine offers a powerful shield against the five major strains of the meningococcal bacteria (A, C, W, Y and X) in a single shot. All five strains cause meningitis and blood poisoning. This provides broader protection than the current vaccine used in much of Africa, which is only effective against the A strain.

    The new vaccine has the potential to significantly reduce meningitis cases and advance progress in defeating meningitis. This is especially important for countries like Nigeria where multiple serogroups are prevalent. The new vaccine uses the same technology as the meningitis A conjugate vaccine (MenAfriVac®), which wiped out meningococcal A epidemics in Nigeria.

    “Northern Nigeria, particularly the states of Jigawa, Bauchi and Yobe were badly hit by the deadly outbreak of meningitis, and this vaccine provides health workers with a new tool to both stop this outbreak but also put the country on a path to elimination,” said Prof. Muhammad Ali Pate of the Nigerian Ministry of Health and Social Welfare. “We’ve done a lot of work preparing health workers and the health system for the rollout of this new vaccine. We got an invaluable support from our populations despite this fasting period and from our community leaders especially the Emir of Gumel in Jigawa state who personally launched the vaccination campaign in the state. We’ll be monitoring progress closely and hopefully expanding the immunization in the coming months and years to accelerate progress.”

    This new multivalent conjugate vaccine was 13 years in the making and was based on a partnership between PATH and the Serum Institute of India. Financing from the UK government’s Foreign, Commonwealth and Development Office was critical to its development.

    In July 2023, WHO prequalified the new Men5CV vaccine (which has brand name MenFive®) and in October 2023 issued an official recommendation to countries to introduce the new vaccine. Gavi allocated resources for the Men5CV rollout in December 2023, which is currently available for outbreak response through the emergency stockpile managed by the International Coordinating Group (ICG) on Vaccine Provision, while roll-out through mass preventive campaigns is expected to start in 2025 across countries of the Meningitis Belt.

    “The rollout of one million vaccines in northern Nigeria will help save lives, prevent long-term illness and boost our goal of defeating meningitis globally by 2030,” said Andrew Mitchell, UK Minister for Development and Africa. “This is exactly the kind of scientific innovation, supported by the UK, which I hope is replicated in years to come to help us drive further breakthroughs, including wiping out other diseases.”

    WHO has been supporting the Nigeria Centre for Disease Control and Prevention (NCDC) in responding to the meningitis outbreak in the country. This includes disease surveillance, active case finding, sample testing, and case management. WHO and partners have also played a vital role in supporting Nigeria to prepare for the rollout of the new vaccine and training health workers.

    “Year after year, meningococcal meningitis has tormented countries across Africa,” said Dr Nanthalile Mugala, PATH’s Chief of Africa Region. “The introduction of MenFive® in Nigeria heralds a transformative era in the fight against meningococcal meningitis in Africa. Building on the legacy of previous vaccination efforts, this milestone reflects over a decade of unwavering, innovative partnerships. The promise of MenFive® lies not just in its immediate impact but in the countless lives it stands to protect in the years to come, moving us closer to a future free from the threat of this disease.”

    In 2019, WHO and partners launched theglobal roadmap to defeating meningitis by 2030. The roadmap sets a comprehensive vision towards a world free of meningitis, and has three goals:

    – elimination of bacterial meningitis epidemics;
    – reduction of cases of vaccine-preventable bacterial meningitis by 50% and deaths by 70%; and

    – reduction of disability and improvement of quality of life after meningitis due to any cause.

    “With outbreaks of infectious diseases on the rise worldwide, new innovations such as MenFive® are critical in helping us fight back,” said Aurélia Nguyen, Chief Programme Officer at Gavi, the Vaccine Alliance, which funds the global stockpile as well as vaccine rollout in lower-income countries. “This first shipment signals the start of Gavi support for a multivalent meningococcal conjugate vaccine (MMCV) program, which, with the required donor funding for our next five years of work, will see pentavalent meningococcal conjugate vaccines rolled out in high-risk countries. Thanks to vaccines, we have eliminated large and disruptive outbreaks of meningitis A in Africa: now we have a tool to respond to other serogroups that still cause large outbreaks resulting in long-term disability and deaths.” 

    Following Nigeria’s meningitis vaccine campaign, a major milestone on the road to defeat meningitis is the international summit on meningitis taking place in Paris in April 2024 where leaders will come together to celebrate progress, identify challenges and assess next steps. It is also an opportunity for country leaders and key partners to commit politically and financially to accelerate progress towards eliminating meningitis as a public health problem by 2030. 

    Source:

    The World Health Organization

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  • Largest-ever global deployment of cholera rapid diagnostic tests for better disease control

    Largest-ever global deployment of cholera rapid diagnostic tests for better disease control

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    The arrival of rapid diagnostic test (RDT) kits for cholera in Malawi today signals the start of a global programme that will see more than 1.2 million tests distributed to 14 countries at high risk for cholera over the next several months. Countries that will receive kits in the coming weeks in this largest-ever global deployment include those currently severely impacted by cholera outbreaks, such as Ethiopia, Somalia, Syria, and Zambia. This programme will improve the timeliness and accuracy of outbreak detection and response by boosting routine surveillance and testing capacity and helping rapidly identify probable cholera cases. Critically, it will also help countries monitor trends and build an evidence base for future preventive programmes, supporting the achievement of national cholera control and elimination targets.

    The global cholera diagnostics programme is funded and coordinated by Gavi, the Vaccine Alliance (Gavi), with procurement and delivery to countries led by UNICEF, and undertaken in collaboration with the Global Task Force on Cholera Control (GTFCC), and WHO. It was developed in partnership with FIND, who led development of a target product profile describing the required characteristics of cholera RDTs, and other organizations. These initial shipments signal the start of the programme, which aims to see partners deploy RDTs to additional countries that have expressed interest in the future. Long-term sustainability of the programme depends on successful fundraising for Gavi’s next strategic period, from 2026 to 2030.

    Through this effort, rapid diagnostic tests from two manufacturers – that have to-date been supplied via WHO and UNICEF for use in outbreak response – will now be used routinely for cholera surveillance. Pilot studies across the Democratic Republic of the Congo (DRC), Niger and Nepal, funded by Gavi and led by the United States Centers for Disease Control and Prevention (CDC), Johns Hopkins University (JHU) and Epicentre/ Médecins Sans Frontières have helped increase understanding of effective rapid testing strategies. Preliminary insights from these studies, which are still ongoing, have helped inform programme design – making the rollout of these tests at scale more effective.

    Cholera has been surging globally since 2021, with high case fatality rates despite availability of simple, effective and affordable treatment. The large number of outbreaks has led to unprecedented demand for vaccines from impacted countries. While global oral cholera vaccine supply has increased eighteen-fold between 2013 and 2023, the large and sustained spike in demand compared to the current availability has put a strain on the global stockpile. Preventive vaccination campaigns have had to be delayed to preserve doses for emergency outbreak response efforts. Recurring outbreaks in countries where emergency vaccination campaigns have already been implemented further highlight the need for improved speed and accuracy in identifying areas with new or persistent transmission – enabling these areas to be targeted during initial outbreak response efforts.

    In 2021, the Gavi Board approved US$ 55 million in funding to support a diagnostics programme between 2022 and- 2025 across cholera, yellow fever, measles, rubella, meningococcal meningitis and typhoid – with the aim to improve disease surveillance, outbreak detection and response and the design of preventive programmes. Gavi then opened a cholera diagnostics application window in June 2023 – which is still open – and so far 14 countries have submitted applications and been approved by an Independent Review Committee of experts. In 2023, Gavi also launched a preventive cholera vaccination programme, to support countries with long-term cholera control – a strategy that has successfully led to a decrease in outbreaks of diseases such as yellow fever and meningitis.

    Cholera is an acute intestinal infection that spreads through food and water contaminated with faeces containing the bacterium Vibrio cholerae. The rise in cholera is driven by continued gaps in access to safe water and sanitation, and failure to quickly detect outbreaks and limit their spread. The communities impacted often do not have access to basic health services, a situation made worse by climate-related factors, conflict and population displacement. In the face of the ongoing surge, partners working on cholera control have urgently called on countries, manufacturers and other partners to invest in the timely outbreak response and case management, rapid access to treatment, increased production of affordable vaccines, and urgent improvements in access to basic water and sanitation services in impacted communities.

    To be effective, these multisectoral strategies for the control of cholera must be guided by timely and reliable cholera surveillance data. Surveillance not only supports the early detection of and quick response to an outbreak, but also plays a central role in providing stakeholders in other cholera prevention and control pillars with the data they need to target, design, implement, and evaluate interventions. In 2023, the GTFCC updated recommendations in favor of strategic, routine and systematic testing of suspected cholera cases and the expanded use of RDTs to strengthen cholera surveillance. The global cholera RDT procurement program provides the additional support required for eligible countries to implement these recommendations.

    We are experiencing an unprecedented multi-year upsurge in cholera cases worldwide, and today’s announcement provides a critical boost in the fight against the disease. The rise in infections is being driven by continued gaps in access to safe water and sanitation, and our inability to reach vulnerable communities that are being put further at risk by climate change, conflict and displacement. Routine use of diagnostics will bolster cholera surveillance in impacted countries, and must be leveraged to better target vaccination efforts, which play a critical role in multisectoral cholera prevention and control programmes.”


    Aurélia Nguyen, Chief Programme Officer at Gavi, the Vaccine Alliance

    “Despite cholera being preventable and easily treatable, children continue to suffer from this potentially fatal disease. This is why we are working with partners on all fronts and in novel ways to stem outbreaks,” said Leila Pakkala, Director of UNICEF Supply Division. “Surveillance diagnostics help pinpoint hotspots with great precision. This allows partners to target cholera vaccines to exactly the time and place where the limited supply will save the most lives.”

    “It’s a tragedy that cholera-;a preventable and treatable disease-;continues to afflict and kill today. We need urgent action on all fronts, including commitment by countries to clean water, sanitation and hygiene,” said Dr Michael Ryan, Executive Director of WHO’s Health Emergencies Programme. “WHO welcomes the deployment of these rapid cholera tests. They will equip health workers with the critical and timely data needed to stop outbreaks early and direct efforts to better prevent and treat cholera.”

    “Cholera is now spreading to areas that have been free from the disease for many years, demanding a swift, multifaceted strategy to direct limited resources to critical areas and save lives. Accurate and high-quality testing and surveillance measures are vital to spot the disease where it is emerging, confirm cholera cases amidst other diarrheal illnesses, and evaluate the success of preventative measures such as vaccines,” said Dr Sergio Carmona, Acting CEO and Chief Medical Officer at FIND.

    Source:

    The World Health Organization

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  • WHO calls for urgent action on rising neurological conditions worldwide

    WHO calls for urgent action on rising neurological conditions worldwide

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    A major new study released by The Lancet Neurology shows that, in 2021, more than 3 billion people worldwide were living with a neurological condition. The World Health Organization (WHO) contributed to the analysis of the Global Burden of Disease, Injuries, and Risk Factor Study (GBD) 2021 data.

    Neurological conditions are now the leading cause of ill health and disability worldwide. The overall amount of disability, illness and premature death (known as disability-adjusted life years, DALYs) caused by neurological conditions has increased by 18% since 1990.

    Over 80% of neurological deaths and health loss occur in low- and middle-income countries, and access to treatment varies widely: high-income countries have up to 70 times more neurological professionals per 100 000 people than low- and middle-income countries.

    Neurological conditions cause great suffering to the individuals and families they affect, and rob communities and economies of human capital. This study should serve as an urgent call to action to scale up targeted interventions to allow the growing number of people living with neurological conditions to access the quality care, treatment and rehabilitation they need. It is more important than ever to ensure brain health is better understood, valued and protected, from early childhood to later life.”


    Dr. Tedros Adhanom Ghebreyesus, WHO Director-General

    The top ten neurological conditions contributing to loss of health in 2021 were stroke, neonatal encephalopathy (brain injury), migraine, dementia, diabetic neuropathy (nerve damage), meningitis, epilepsy, neurological complications from preterm birth, autism spectrum disorder, and nervous system cancers.

    Overall, neurological conditions cause more disability and health loss in men compared to women, but there are some conditions like migraine or dementia where women are disproportionately affected.

    Since 1990, the absolute number of individuals living with, or dying from, neurological conditions has increased, while age-standardized DALY rates have dropped. This means that increases in absolute numbers are mainly driven by demographic change and people living longer.

    Diabetic neuropathy was the fastest growing neurological condition. The number of people with diabetic neuropathy has more than tripled globally since 1990, rising to 206 million cases in 2021. This increase is in line with the worldwide increase in diabetes. Other conditions such as neurological complications from COVID-19 (for example, cognitive impairment and Guillain-Barré syndrome) did previously not exist and now account for over 23 million cases.

    At the same time, neurological burden and health loss due to other conditions decreased by 25% or more since 1990 as a result of improved prevention (including vaccines), care and research: tetanus, rabies, meningitis, neural tube defects, stroke, neurocysticercosis (parasitic infection that affects the central nervous system), encephalitis (inflammation of the brain), and neonatal encephalopathy (brain injury).

    The study also examined 20 modifiable risk factors for potentially preventable neurological conditions such as stroke, dementia and idiopathic intellectual disability.

    Eliminating key risk factors – most importantly, high systolic blood pressure and ambient and household air pollution – could prevent up to 84% of stroke DALYs. Similarly, preventing exposure to lead could reduce the burden of idiopathic intellectual disability by 63.1%, and reducing high fasting plasma glucose levels could reduce the burden of dementia by 14.6%. Smoking significantly contributed to stroke, dementia and multiple sclerosis risk.

    More investments needed to improve treatment, care and quality of life

    At the World Health Assembly in 2022, Member States adopted the Intersectoral global action plan on epilepsy and other neurological disorders 2022–2031 (IGAP) with an ambitious scope to address the long standing neglect of neurological disorders.

    “The Intersectoral Global Action Plan 2022–2031 sets out a roadmap for countries to improve prevention, early identification, treatment and rehabilitation of neurological disorders. To achieve equity and access to quality care, we also need to invest in more research on risks to brain health, improved support for the healthcare workforce and adequate services,” said Dévora Kestel, Director, WHO Department of Mental Health and Substance Use.

    IGAP sets out strategic objectives and targets to improve access to treatment, care and support for people with neurological disorders; implement strategies for brain health promotion and disease prevention; strengthen research and data; and emphasize a public health approach to epilepsy and other neurological disorders.

    Source:

    The World Health Organization

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  • Rapid rise in syphilis hits Native Americans hardest

    Rapid rise in syphilis hits Native Americans hardest

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    From her base in Gallup, New Mexico, Melissa Wyaco supervises about two dozen public health nurses who crisscross the sprawling Navajo Nation searching for patients who have tested positive for or been exposed to a disease once nearly eradicated in the U.S.: syphilis.

    Infection rates in this region of the Southwest — the 27,000-square-mile reservation encompasses parts of Arizona, New Mexico, and Utah — are among the nation’s highest. And they’re far worse than anything Wyaco, who is from Zuni Pueblo (about 40 miles south of Gallup) and is the nurse consultant for the Navajo Area Indian Health Service, has seen in her 30-year nursing career.

    Syphilis infections nationwide have climbed rapidly in recent years, reaching a 70-year high in 2022, according to the most recent data from the Centers for Disease Control and Prevention. That rise comes amid a shortage of penicillin, the most effective treatment. Simultaneously, congenital syphilis — syphilis passed from a pregnant person to a baby — has similarly spun out of control. Untreated, congenital syphilis can cause bone deformities, severe anemia, jaundice, meningitis, and even death. In 2022, the CDC recorded 231 stillbirths and 51 infant deaths caused by syphilis, out of 3,761 congenital syphilis cases reported that year.

    And while infections have risen across the U.S., no demographic has been hit harder than Native Americans. The CDC data released in January shows that the rate of congenital syphilis among American Indians and Alaska Natives was triple the rate for African Americans and nearly 12 times the rate for white babies in 2022.

    “This is a disease we thought we were going to eradicate not that long ago, because we have a treatment that works really well,” said Meghan Curry O’Connell, a member of the Cherokee Nation and chief public health officer at the Great Plains Tribal Leaders’ Health Board, who is based in South Dakota.

    Instead, the rate of congenital syphilis infections among Native Americans (644.7 cases per 100,000 people in 2022) is now comparable to the rate for the entire U.S. population in 1941 (651.1) — before doctors began using penicillin to cure syphilis. (The rate fell to 6.6 nationally in 1983.)

    O’Connell said that’s why the Great Plains Tribal Leaders’ Health Board and tribal leaders from North Dakota, South Dakota, Nebraska, and Iowa have asked federal Health and Human Services Secretary Xavier Becerra to declare a public health emergency in their states. A declaration would expand staffing, funding, and access to contact tracing data across their region.

    “Syphilis is deadly to babies. It’s highly infectious, and it causes very severe outcomes,” O’Connell said. “We need to have people doing boots-on-the-ground work” right now.

    In 2022, New Mexico reported the highest rate of congenital syphilis among states. Primary and secondary syphilis infections, which are not passed to infants, were highest in South Dakota, which had the second-highest rate of congenital syphilis in 2022. In 2021, the most recent year for which demographic data is available, South Dakota had the second-worst rate nationwide (after the District of Columbia) — and numbers were highest among the state’s large Native population.

    In an October news release, the New Mexico Department of Health noted that the state had “reported a 660% increase in cases of congenital syphilis over the past five years.” A year earlier, in 2017, New Mexico reported only one case — but by 2020, that number had risen to 43, then to 76 in 2022.

    Starting in 2020, the covid-19 pandemic made things worse. “Public health across the country got almost 95% diverted to doing covid care,” said Jonathan Iralu, the Indian Health Service chief clinical consultant for infectious diseases, who is based at the Gallup Indian Medical Center. “This was a really hard-hit area.”

    At one point early in the pandemic, the Navajo Nation reported the highest covid rate in the U.S. Iralu suspects patients with syphilis symptoms may have avoided seeing a doctor for fear of catching covid. That said, he doesn’t think it’s fair to blame the pandemic for the high rates of syphilis, or the high rates of women passing infections to their babies during pregnancy, that continue four years later.

    Native Americans are more likely to live in rural areas, far from hospital obstetric units, than any other racial or ethnic group. As a result, many do not receive prenatal care until later in pregnancy, if at all. That often means providers cannot test and treat patients for syphilis before delivery.

    In New Mexico, 23% of patients did not receive prenatal care until the fifth month of pregnancy or later, or received fewer than half the appropriate number of visits for the infant’s gestational age in 2023 (the national average is less than 16%).

    Inadequate prenatal care is especially risky for Native Americans, who have a greater chance than other ethnic groups of passing on a syphilis infection if they become pregnant. That’s because, among Native communities, syphilis infections are just as common in women as in men. In every other ethnic group, men are at least twice as likely to contract syphilis, largely because men who have sex with men are more susceptible to infection. O’Connell said it’s not clear why women in Native communities are disproportionately affected by syphilis.

    “The Navajo Nation is a maternal health desert,” said Amanda Singer, a Diné (Navajo) doula and lactation counselor in Arizona who is also executive director of the Navajo Breastfeeding Coalition/Diné Doula Collective. On some parts of the reservation, patients have to drive more than 100 miles to reach obstetric services. “There’s a really high number of pregnant women who don’t get prenatal care throughout the whole pregnancy.”

    She said that’s due not only to a lack of services but also to a mistrust of health care providers who don’t understand Native culture. Some also worry that providers might report patients who use illicit substances during their pregnancies to the police or child welfare. But it’s also because of a shrinking network of facilities: Two of the Navajo area’s labor and delivery wards have closed in the past decade. According to a recent report, more than half of U.S. rural hospitals no longer offer labor and delivery services.

    Singer and the other doulas in her network believe New Mexico and Arizona could combat the syphilis epidemic by expanding access to prenatal care in rural Indigenous communities. Singer imagines a system in which midwives, doulas, and lactation counselors are able to travel to families and offer prenatal care “in their own home.”

    O’Connell added that data-sharing arrangements between tribes and state, federal, and IHS offices vary widely across the country, but have posed an additional challenge to tackling the epidemic in some Native communities, including her own. Her Tribal Epidemiology Center is fighting to access South Dakota’s state data.

    In the Navajo Nation and surrounding area, Iralu said, IHS infectious disease doctors meet with tribal officials every month, and he recommends that all IHS service areas have regular meetings of state, tribal, and IHS providers and public health nurses to ensure every pregnant person in those areas has been tested and treated.

    IHS now recommends all patients be tested for syphilis yearly, and tests pregnant patients three times. It also expanded rapid and express testing and started offering DoxyPEP, an antibiotic that transgender women and men who have sex with men can take up to 72 hours after sex and that has been shown to reduce syphilis transmission by 87%. But perhaps the most significant change IHS has made is offering testing and treatment in the field.

    Today, the public health nurses Wyaco supervises can test and treat patients for syphilis at home — something she couldn’t do when she was one of them just three years ago.

    “Why not bring the penicillin to the patient instead of trying to drag the patient in to the penicillin?” said Iralu.

    It’s not a tactic IHS uses for every patient, but it’s been effective in treating those who might pass an infection on to a partner or baby.

    Iralu expects to see an expansion in street medicine in urban areas and van outreach in rural areas, in coming years, bringing more testing to communities — as well as an effort to put tests in patients’ hands through vending machines and the mail.

    “This is a radical departure from our past,” he said. “But I think that’s the wave of the future.”




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • Study highlights growing burden of neurological disorders worldwide

    Study highlights growing burden of neurological disorders worldwide

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    Globally, the number of people living with, or dying from, neurological conditions such as stroke, Alzheimer’s disease and other dementias, and meningitis has risen substantially over the past 30 years due to the growth and aging of the global population as well as increased exposure to environmental, metabolic, and lifestyle risk factors. In 2021, 3.4 billion people experienced a nervous system condition, according to a major new analysis from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021, published in The Lancet Neurology journal.

    The analysis suggests that worldwide, the overall amount of disability, illness, and premature death-;a measurement known as disability-adjusted life years (DALYs)-;caused by neurological conditions increased by 18% over the past 31 years, rising from around 375 million years of healthy life lost in 1990 to 443 million years in 2021.

    The absolute number of DALYs is increasing in large part due to aging and growing populations worldwide. However, if the impact of demographics is removed through age-standardization, rates of DALYs and deaths caused by neurological conditions have declined by around a third (27% and 34% respectively) worldwide since 1990-;largely due to better awareness, vaccination, and global prevention efforts for some conditions such as tetanus (93% decrease in age-standardized rates of DALYs), meningitis (62% decrease), and stroke (39% decrease). 

    The top 10 contributors to neurological health loss in 2021 were stroke, neonatal encephalopathy (brain injury), migraine, Alzheimer’s disease and other dementias, diabetic neuropathy (nerve damage), meningitis, epilepsy, neurological complications from preterm birth, autism spectrum disorder, and nervous system cancers. Neurological consequences of COVID-19 (cognitive impairment and Guillain-Barré syndrome) ranked 20th, accounting for 2.48 million years of healthy life lost in 2021. 

    The most prevalent neurological disorders in 2021 were tension-type headaches (around 2 billion cases) and migraines (about 1.1 billion cases). Diabetic neuropathy is the fastest-growing of all neurological conditions.

    The number of people with diabetic neuropathy has more than tripled globally since 1990, rising to 206 million in 2021. This is in line with the increase in the global prevalence of diabetes.”


    Dr Liane Ong, co-senior author from the Institute for Health Metrics and Evaluation (IHME), University of Washington, USA

    The current study builds on previous GBD analyses [2] to provide the largest and most comprehensive analysis to compare the prevalence and burden (illness and death) of nervous system disorders between countries on a global scale between 1990 and 2021-;expanding the number of studied neurological conditions from 15 to 37 that span from birth to later life.

    To better reflect that neurological disorders can occur at any stage of life, for the first time the GBD 2021 Nervous System Disorders Collaborators studied neurodevelopmental disorders and neurological conditions in children, and found that they were responsible for almost a fifth (18%) of all DALYs in 2021, accounting for 80 million years of healthy life lost worldwide. 

    “Every country now has estimates of their neurological burden based on the best available evidence,” said lead author Dr Jaimie Steinmetz from IHME. “As the world’s leading cause of overall disease burden, and with case numbers rising 59% globally since 1990, nervous system conditions must be addressed through effective, culturally acceptable, and affordable prevention, treatment, rehabilitation, and long-term care strategies.”

    The study, conducted to inform ongoing advocacy and awareness efforts, will support the WHO’s Intersectoral Global Action Plan on epilepsy and other neurological disorders 2022–2031 (IGAP) that aims to reduce the impact and burden of neurological disorders and improve the quality of life of people with neurological disorders as well as their caregivers and families.

    Over 80% of neurological deaths and health loss occur in low- and middle-income countries (LMICs)

    Overall, estimates reveal striking differences in nervous system burden between world regions and national income levels. In high-income Asia Pacific and Australasia – regions with the best neurological health – the rate of DALYs and deaths were under 3,000 and 65 per 100,000 people, respectively in 2021. In these regions, stroke, migraine, dementia, diabetic neuropathy, and autism spectrum disorders accounted for most health loss. 

    In contrast, in the worst-off regions of western and central sub-Saharan Africa, the rate of DALYs and deaths were up to five times higher (over 7,000 and 198 per 100,000 people respectively) in 2021, with stroke, neonatal encephalopathy (brain injury), dementia, and meningitis the biggest contributors to years of healthy life lost.

    “Nervous system health loss disproportionately impacts many of the poorest countries partly due to the higher prevalence of conditions affecting neonates and children under 5, especially birth-related complications and infections,” said Dr. Tarun Dua, Unit Head of WHO’s Brain Health unit and one of the co-senior authors of the study. “Improved infant survival has led to an increase in long-term disability, while limited access to treatment and rehabilitation services is contributing to the much higher proportion of deaths in these countries.”

    The authors highlight that, as of 2017, only a quarter of countries globally had a separate budget for neurological conditions, and only around half had clinical guidelines. What’s more, the medical personnel who care for people with neurological conditions are unevenly distributed around the world, with high-income countries having 70 times more neurological professionals per 100,000 individuals than LMICs.

    Prevention needs to be a top priority

    “Because many neurological conditions lack cures, and access to medical care is often limited, understanding modifiable risk factors and the potentially avoidable neurological condition burden is essential to help curb this global health crisis,” said co-lead author Dr Katrin Seeher, Mental Health Specialist at WHO’s Brain Health Unit. 

    The study quantified the proportion of nervous system burden that was potentially preventable by eliminating known risk factors for stroke, dementia, multiple sclerosis, Parkinson’s disease, encephalitis, meningitis, and intellectual disability. 

    The analysis suggests that modifying 18 risk factors over a person’s lifetime-;most importantly high systolic blood pressure (57% of DALYs)-;could prevent 84% of global DALYs from stroke. 

    Additionally, estimates suggest that controlling lead exposure could reduce the burden of intellectual disability by 63%, while reducing high fasting plasma glucose to normal levels could reduce the burden of dementia by around 15%. 

    “The worldwide neurological burden is growing very fast and will put even more pressure on health systems in the coming decades,” said co-senior author Dr Valery Feigin, Director of Auckland University’s National Institute for Stroke and Applied Neuroscience in New Zealand. “Yet many current strategies for reducing neurological conditions have low effectiveness or are not sufficiently deployed, as is the case with some of the fastest-growing but largely preventable conditions like diabetic neuropathy and neonatal disorders. For many other conditions, there is no cure, underscoring the importance of greater investment and research into novel interventions and potentially modifiable risk factors.”

    “Nervous system conditions include infectious and vector-borne diseases and injuries as well as non-communicable diseases and injuries, demanding different strategies for prevention and treatment throughout life,” said Steinmetz “We hope that our findings can help policymakers more comprehensively understand the impact of neurological conditions on both adults and children to inform more targeted interventions in individual countries, as well as guide ongoing awareness and advocacy efforts around the world.” 

    Despite these important findings, the authors note several limitations, including that, while they have done their best to capture all nervous system health loss, some conditions were left out because they could not isolate the neurological component, including infections such as HIV, which has a large impact in many parts of the world. And while the study uses the best available evidence, estimates are constrained by the quantity and quality of data, especially in LMICs.

    Writing in a linked Comment, Professor Wolfgang Grisold, President of the World Federation of Neurology, London, UK (who was not involved in the study) says, “This important new GBD report highlights that the burden of neurological conditions is greater than previously thought. In the next iteration, more attention should be given to neuromuscular diseases, the effects of cancer in the nervous system, and neuropathic pain. Comparing the disability caused by conditions with episodic occurrence versus those that cause permanent and progressive disease will remain challenging, because the effects on the individuals vary substantially.”

    Source:

    Journal reference:

    GBD 2021 Nervous System Disorders Collaborators. (2024). Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet Neurology. doi.org/10.1016/s1474-4422(24)00038-3.

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  • Harnessing artificial intelligence for infectious disease prevention

    Harnessing artificial intelligence for infectious disease prevention

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    A new research review to be given at a pre-congress day for this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2024) will look at the many ways artificial intelligence can help prevent infectious disease outbreaks including ensuring staff wear personal protective equipment correctly and managing day-to-day hospital activities such as medication prescription and cleaning. The presentation will be given by Prof Richard Drew, Rotunda Hospital and CHI at Temple St, Irish Meningitis and Sepsis Reference Laboratory and the Royal College of Surgeons in Ireland, Dublin, Ireland.

    Artificial intelligence is a rapidly developing area with huge potential for cost savings, but also wasting money. The key is to identify problems in your own institution that AI can help analyze and then fix. For example, can we ensure staff are wearing face masks properly? How do we keep the air/environment clean? When should we switch from intravenous to oral antibiotic therapy for individual patients?”


    Prof Richard Drew, Rotunda Hospital and CHI at Temple St, Irish Meningitis and Sepsis Reference Laboratory and the Royal College of Surgeons in Ireland, Dublin, Ireland

    For the face masks example, Prof Drew will refer to a review paper by Alturki et al, Frontiers in Public Health, 2022, where researchers reviewed how AI was used to both identify firstly if a mask was being worn at all, and secondly if it had been fitted properly. This review paper analyzed over 30 papers on the use of facial recognition AI technology to assess if staff were wearing masks correctly, concluding AI performs very well in identifying correct mask wearing in general. “However, even though AI technology successfully identified correct mask wearing, we must be careful that staff do not find such monitoring too intrusive,” says Prof Drew.

    He will also look how AI has evolved cleaning in hospitals from traditional manual scrubbing of all corners of the hospital to intelligent robots that know where to focus their cleaning. Robots are, with the assistance of AI, able to monitor the environment and air quality in real time, and then target cleaning where needed. 

    Recent advances in big data analytics have allowed for research groups from the UK (Bolton et al. Nature Communications, 2024) to analyze data from thousands of admissions to help identify when it is optimal to switch from IV antibiotics to oral antibiotics. Prof Drew explains: “Although this technology will not replace medical experience, it is a tool that could streamline antimicrobial stewardship rounds to focus in on patients who are suitable for oral switch, thus saving staff time and improving patient care.”

    In summary, Professor Drew will say the key to successful AI use in infection control is to first identify what problems your institution has and then see if AI can provide a solution. He says: “We should look to offload repetitive tasks to AI systems such as environmental cleaning and mask compliance auditing. AI can also offer significant opportunities in terms of big data analytics of certain patient groups. However, we have to ensure that staff engage with AI developments, and do not feel overwhelmed with the data outputs or consider AI monitoring systems as too intrusive on their personal freedom. It is important too that health systems still appreciate that infection prevention and control (IPC) practitioners are always needed to spot new or emerging problems, identify cultural aspects of IPC, and ensure appropriate communication with other staff.”

    Source:

    European Society of Clinical Microbiology and Infectious Diseases

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  • New guideline aims to improve diagnosis and treatment of cryptococcosis

    New guideline aims to improve diagnosis and treatment of cryptococcosis

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    A group of international mycology experts led by Professor Dr Oliver A. Cornely at the University of Cologne has jointly drafted a guideline for the diagnosis and treatment of cryptococcosis, which aims at improving infection management and thus the survival rate of patients. Cryptococcosis is a fungal infection of mainly the lungs that might lead to meningitis. The article ‘Global guideline for the diagnosis and management of cryptococcosis’ was published in the journal The Lancet Infectious Diseases.

    Cryptococcosis, especially cryptococcal meningitis (CM) as the most fatal form, is responsible for a high fatality rate among patients. It is one of the most widespread invasive fungal infections in the world and is a major threat particularly to people suffering from immunodeficiencies. For example, around one million cases of cryptococcal meningoencephalitis are diagnosed worldwide every year in people with HIV alone, and more than 600,000 people die from the disease each year. Patients who have undergone a bone marrow transplant or organ transplant are also at high risk of infection. It is transmitted through the inhalation of spores from soil. Other organs are then also infected via the bloodstream. The lungs, brain, skin and bones are most frequently affected.

    Invasive fungal infections are often difficult to recognize in everyday work in clinics because they occur so rarely. However, it is particularly important for patients at risk to be treated quickly and appropriately. At the same time, we must not forget that the conditions for recognizing the infection at an early stage are not equally good everywhere in the world and that resources are sometimes very limited. There are many countries with a high number of cases that are poorly equipped in this respect. As part of our Global Guideline Programme, we would like to contribute to improving this situation.”


    Dr Oliver A. Cornely from Department I of Internal Medicine at University Hospital Cologne and Director of the Institute of Translational Research at the University of Cologne’s CECAD Cluster of Excellence for Aging Research

    The cryptococcosis guideline is designed to support medical staff in handling invasive fungal infections. It is intended to provide practical guidance and support in decision-making and thus improve clinical approaches, diagnosis, management, and aftercare for the benefit of patients.

    The project was carried out by the mycological societies ECMM (European Confederation of Medical Mycology) and ISHAM (International Society for Human and Animal Mycology) in collaboration with the ASM (American Society for Microbiology). “More than 70 other international specialist institutions were involved in developing this new guideline. This is a great help for our scientific work and shows how great the interest, but also the need for such recommendations is,” explained Cornely. Authors from 22 countries contributed to this guideline. Dr Christina Chang from Monash University in Melbourne, Australia, and Professor Dr John Robert Perfect from Duke University in Durham, USA, were in charge of the project.

    Invasive fungal infections are emergencies. However, as a single pathogen often only occurs very rarely, it is often only discovered late. But patients’ lives depend on rapid detection and well-practiced procedures. Since 2017, University Hospital Cologne has been home to one of the European Centres of Excellence recognized by the ECMM. At the center, patients have access to modern testing procedures and treatment options. In addition, the experts under the direction of Professor Cornely serve as advisory contacts for colleagues in Germany and abroad.

    Source:

    Journal reference:

    Chang, C. C., et al. (2024). Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM. The Lancet Infectious Diseases. doi.org/10.1016/s1473-3099(23)00731-4.

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