Month: September 2018

An experimental GlaxoSmithKline vaccine could prevent tuberculosis developing in half of those who receive it, making it potentially the first new shot against the global killer in a century, researchers said on Tuesday.

Given the failure of other candidates in recent years, it marks a milestone in the fight against TB, although the 54 percent efficacy rate achieved in adults in a mid-stage clinical trial is low compared to immunizations for other diseases.

The current vaccine called Bacille Calmette-Guérin (BCG) was developed in 1921 and is given routinely to babies in countries with high rates of TB to prevent severe disease.

However, BCG protection wears off in just a few years and it does nothing to protect against the most common form of TB that invades the lungs of adults and adolescents, and can be transmitted through coughing and sneezing.

A more effective vaccine is viewed by experts as key to controlling TB and fighting the growing scourge of drug-resistant infection. With TB a major focus for global health, the United Nations is holding its first ever high-level meeting on the disease in New York on Wednesday.

GSK’s vaccine is designed to stop latent TB from becoming active and causing sickness. An estimated 1.7 billion people – one quarter of the global population – have latent TB infection, putting them at risk of a disease that killed 1.6 million people last year.

Results of an ongoing Phase IIb trial of the vaccine – known as M72/AS01 and developed by GSK in conjunction with Aeras, a nonprofit TB group backed by the Bill & Melinda Gates Foundation – were published online by the New England Journal of Medicine.

After a mean follow-up of 2.3 years, 10 of the 1,786 adults vaccinated twice developed active pulmonary TB compared with 22 of the 1,787 given two placebo injections. The study was conducted in Kenya, Zambia and South Africa.

The vaccine did produce more side effects than placebo, with two-thirds of participants reporting at least one adverse event, typically injection-site reactions or flu-like symptoms.

Most of the volunteers had received the BCG vaccine and all were HIV negative. People with HIV are more vulnerable to TB because their immune systems are weakened.

Areas Chief Executive Jacqui Shea said the results were “ground-breaking” and showed that more effective TB vaccines were achievable.

GSK is confident it can do better in future, with larger trials set to refine the vaccine’s dosing schedule and potentially target specific groups of patients who are most likely to benefit.

“It’s the first time we really tested the biological potential of our vaccine and we think that there is a lot of additional improvement now that we can bring,” the company’s head of vaccines research, Emmanuel Hanon, told Reuters.

TB is a particularly tricky disease to vaccinate against because the bacteria that cause it can hide from the body’s immune system and scientists lack protective markers in the blood to predict whether a vaccine will work.

As a result, TB vaccines must be tested in big clinical trials, a large and costly gamble.

Mike Turner, head of infection and immunobiology at the Wellcome Trust medial charity, said the encouraging results represented a “landmark moment” and M72/AS01 now needed to be tested in much larger numbers of people.
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The number of babies born infected with syphilis in the United States has more than doubled since 2013, according to the U.S. Centers for Disease Control and Prevention.

In a report released Tuesday, the CDC said the number of cases of congenital syphilis, in which the disease is passed from the mother to the baby, increased 153 percent — from 362 in 2013 to 918 in 2017.

“When a baby gets syphilis, it means the system has failed that mother repeatedly, both before and during her pregnancy,” said David Harvey, executive director of the National Coalition of STD Directors.

“If STD prevention programs had anywhere near the support they need, no new mom would ever have to cope with this devastating diagnosis,” he said.

Syphilis is easily treatable with antibiotics. But when untreated in the mother, it increases the risk of miscarriage and newborn death. Children born with the disease can suffer severe health consequences, including deformed bones, blindness or deafness.

About 70 percent of the cases of congenital syphilis in the U.S. over the span studied were found in California, Florida, Louisiana, New Mexico and Texas. 

Harvey said women should be tested before becoming pregnant, soon after becoming pregnant, and throughout the pregnancy. 

One-third of the mothers who gave birth to babies with congenital syphilis had been tested. But the tests were performed too late in their pregnancies to prevent the infection of the fetuses, or the women became infected after being tested. 

“That we have any cases of syphilis among newborns, let alone an increasing number, is a failure of the health care system,” Harvey said. 

Congenital syphilis is only a part of the nation’s growing STD crisis. According to the CDC, the three most easily treatable sexually transmitted diseases — chlamydia, gonorrhea and syphilis — rose nearly 10 percent in 2017 to an all-time high of nearly 2.3 million cases. That eclipsed the previous record total from 2016 by more than 200,000 cases.
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More than 11,000 people in Sudan’s eastern state of Kassala have been infected over the past month by Chikungunya, a debilitating mosquito-borne viral disease, but no deaths have been reported, a Sudanese official said Tuesday.

Chikungunya is spread by two mosquito species and can cause severe symptoms, which develop three to seven days after a person is bitten by an infected mosquito. They include high fever, headache, muscle pain, back pain and rash. In rare cases, it is fatal. There are no dedicated treatments or vaccines for Chikungunya.

“So far official statistics say that about 11,000 people were infected, and there haven’t been any documented cases of death because of the Chikungunya fever,” said Magzoub Abou Moussa, a spokesman for the Kassala state administration.

Heavy rains

The outbreak began in recent weeks when heavy rains pummeled the area, which led to the flooding of a major river in Kassala.

Abou Moussa said his state had received health and technical aid from Sudan’s health ministry, but expressed concern over the spread of the virus and called for further help.

Eyewitnesses said they had seen planes on Monday sweeping over the state, spraying mosquito pesticides.

Sudanese opposition parties have accused the government of failing to deal with the situation in Kassala and called for international organizations’ help.

“We hold the government fully responsible for the spread of the epidemic,” said a statement from the National Umma Party, the largest opposition party. “We call on civil society organizations and the World Health Organization to help the people of Kassala.”

Activists on social media said the number of people infected by the disease was much higher than the government’s figure and that there had been deaths not documented by the government.
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When emergency tests showed the telltale right-sided pain in Heather VanDusen’s abdomen was appendicitis, she figured she’d be quickly wheeled into surgery. But doctors offered her the option of antibiotics instead.

A new study from Finland shows her choice is a reasonable alternative for most patients with appendicitis. Five years after treatment with antibiotics, almost two-thirds of patients hadn’t had another attack.

It’s a substantial change in thinking about how to treat an inflamed appendix. For decades, appendicitis has been considered a medical emergency requiring immediate surgery to remove the appendix because of fears it could burst, which can be life-threatening.

But advances in imaging tests, mainly CT scans, have made it easier to determine if an appendix might burst, or if patients could be safely treated without surgery.

The results suggest that nearly two-thirds of appendicitis patients don’t face that risk and may be good candidates for antibiotics instead.

“It’s a feasible, viable and a safe option,” said Dr. Paulina Salminen, the study’s lead author and a surgeon at Turku University Hospital in Finland.

Her study in adults is the longest follow-up to date of patients treated with drugs instead of surgery for appendicitis, and the results confirm one-year findings reported three years ago.

‘A new era’

Research has also shown antibiotics may work for some children with appendicitis.

The Finnish results were published Tuesday in the Journal of the American Medical Association.

A journal editorial said “it’s a new era of appendicitis treatment.”

Appendix removal is the most common emergency surgery worldwide, with about 300,000 performed each year in the United States alone, said Salminen. She said the results from her study suggest many of those surgeries could be avoided.

U.S. doctors have started offering antibiotics instead of surgery and Salminen said she occasionally does, too. The journal editorial said appropriate patients should be given that option.

The study involved about 500 Finnish adults who had CT scans to rule out severe cases. Half were treated with antibiotics; the others had surgery.

Among the antibiotics patients, 100 ended up having surgery within five years of treatment — most for a suspected recurrence of appendicitis in the first year. Seven of them did not have appendicitis and likely could have avoided surgery. The results suggest the success rate for antibiotic treatment was almost 64 percent, the authors said.

About 1 in 4 surgery patients had complications, including infections around the incision, abdominal pain and hernias, compared with only 7 percent of antibiotics patients. Antibiotic patients had 11 fewer sick days on average than the surgery group. In the first year, their treatment costs were about 60 percent lower. A cost analysis for the full five years wasn’t included in the published results.

‘Keyhole’ surgery

Surgery patients in the Finnish study all had conventional incisions rather than the less invasive “keyhole” surgeries that are more common for appendix removal in the United States. The nonsurgery patients received three days of IV antibiotics in the hospital, followed by seven days of pills at home.

Dr. Giana Davidson, a University of Washington surgeon, is involved in a similarly designed multicenter U.S. study that may answer whether similar benefits would be seen for antibiotics versus “keyhole” surgery.

Davidson called the Finnish study “a critical piece to the puzzle, but I don’t think it answers all of the questions.”

VanDusen was treated at the University of Washington in 2016. She said she chose antibiotic treatment partly to avoid surgery scars, and now offers advice to patients for Davidson’s study.

“I knew the worst-case scenario was ending up back in the hospital, so why not try antibiotics first?” said VanDusen, who works in university communications.

She said she has done well since her treatment, but that the biggest drawback was “wondering, with every episode of stomach or bad gas, if it could happen again.”
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As the summer planting season approaches in eastern Zimbabwe, small-scale farmers struggle with familiar questions: When will the rains come, and when should I sow my crops?

This year something else is keeping them awake: In late August the government issued a warning about a potential El Niño weather pattern, associated with changes in weather patterns worldwide.

Should El Niño arrive, Zimbabwe might see normal or higher-than-average rains, said Washington Zhakata, director of the country’s Climate Change Department. More likely, though, there would not be enough rain.

“Looking at the past observations … once an El Niño sets in, depending on the strength and nature of the El Niño, the chances of bad rains or below-normal rainfall in Zimbabwe are between 50 and 65 percent,” he said.

In trying to figure out what to plant and when this year, farmers are also missing an old ally: Birds, whose movements traditionally have helped predict coming weather.

Delayed rainfall

In Zimbabwe’s Eastern Highlands the farming season typically starts in late October or early November. But in recent years the weather has become less predictable, and that is a growing problem for farmers.

“At times the rainy season is now starting well into December. The weather is now changing,” said Leonard Madanhire, a farmer in Zimunya, a village close to the Mozambique border.

Once, he said, farmers watched changes in the environment around them – particularly activity by birds – to work out whether or not they could expect a good season.

“We used to learn a lot from the birds about the seasons.

But these birds have long vanished,” he said.

When different species of birds arrived or left told villagers in his subsistence farming community what might be coming: a storm, a change of seasons, even flooding.

Some farmers held off planting until they saw certain species of migratory birds. The appearance of one particular type of stork – known as shuramurove – foretold a good rainy season, for instance.

But most of the birds once relied on – including the stork – have now vanished, he said.

“We last saw them here more than five years ago,” said Madanhire.

Absent friends

Togarasei Fakarayi, a programme manager at BirdLife Zimbabwe, a non-profit, said changing conditions in the country were having an impact on birds – and there was a clear link between climate change and the diversity and abundance of bird species.

“Birds are sensitive to environmental changes, in particular habitat changes. Climate change causes habitat changes over time – for instance, drying up of forests, grasslands and wetlands habitats as a result of global warming,” he said.

As those changes happen, species may shift or disappear from certain areas, Fakarayi said. More regular dry weather also has led to fires, which can destroy bird habitats.

“Climate change affects routes of migratory birds – in particular food abundance which is key, especially in stopover roosting areas,” he said.

Among the birds that have become far less common in Zimbabwe, Fakarayi said, were bateleur eagles and the southern ground hornbill.

Under the country’s Parks and Wildlife Act, storks and bateleur eagles are listed as specially protected animals, while the southern ground hornbill is considered as vulnerable, Fakarayi said.

The hornbill’s absence is something the farmers of Zimunya know well. In this region, characterized by mountains, forest and montane grasslands, the bird, known as the mariti or matendera, was once much easier to see – and to hear.

“If you hear the deep singing of the southern ground hornbill then you know it’s going to rain and you can plan your day. But these birds are now very rare,” said Madanhire.

That is also the case for the bateleur eagle, or chapungu, whose presence is synonymous with reliable rains, a bountiful harvest and good luck, said farmer Nicholas Kwadzanai Mukundidza.

“Chapungu is now rarely seen in the area, but this bird was sacred. And the honey bird (tsoro) which used to direct us to beehives in the forest has vanished too,” Mukundidza said.

The lack of these birds means that farmers – who until recently combined traditional knowledge with forecasts from the meteorological department in deciding when to sow their crops – find it is harder to plan for changing conditions.

These days, Madanhire said, they do listen to the weather forecasts when they can get them. But, he added with a chuckle, “they are not reliable.”

Climate link

Linia Mashawi Gopo, the principal meteorologist at Zimbabwe’s Meteorological Services Department, said the department’s research indicated some – but not all – farmers use indigenous knowledge to forecast the weather.

“The younger generation prefers scientific forecasts while the older generation use both the (indigenous knowledge) and scientific forecasts,” she said.

But older people have found their traditional forecasting methods becoming less predictable over time, she said – in some cases because the indicators they once relied on had disappeared, while in others the behavior of animals and birds had changed.

“This is mostly attributed to climate change,” she said.

She said more work was needed to correlate indigenous knowledge of forecasting with scientific methods, and to set up a way to use both sets of information.

 
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