Day: May 11, 2019

Officials in Pakistan and the United Nations are investigating causes of a new outbreak of HIV infections in a southern district where nearly 400 people have been diagnosed in less than two weeks. Officials confirmed Saturday that nearly 80% of those infected are children, with nearly half of them under age 5.

Local media began reporting about the epidemic two weeks ago from Larkana, a district of Sindh province, which has already experienced three outbreaks in recent years. A local doctor who treated several patients with a single needle and syringe was blamed for spreading the virus, which causes AIDS. 

The provincial government rushed teams of public health workers to the district, with an estimated population of 1.5 million, to quickly assess the situation and mobilize resources to curtail further spread of HIV. More than 9,000 people have since been subjected to screening in the affected district, and the process is continuing, Sikandar Memon, the provincial head of the AIDS Control Program, told reporters.

A UNAIDS spokeswoman told VOA that international partners had joined local teams to help quickly carry out an outbreak investigation and address the acute needs of the people infected with HIV, including immediately linking them to treatment, care and support services. 

The spokeswoman, Fahmida Khan, said efforts were being made to ensure that unsafe injection and blood transfusion practices were being stopped. She also noted that there were unconfirmed reports of similar HIV outbreaks in surrounding districts. 

​Focus of problem

Sindh, with a population of nearly 48 million, accounts for 43% of an estimated 150,000 people living with HIV in Pakistan. 

U.N. officials say since 2010, there has been a 57% increase in new HIV/AIDS infections in Pakistan. They noted that among all identified HIV cases in Pakistan, 43,000 are females. 

Last year, an estimated 20,000 people were newly identified with HIV in Pakistan and 6,200 people died of AIDS, according to local and U.N. officials. 

Khan would not comment on the reasons for the high number of HIV infections among children and the potential causes of the latest outbreak in Larkana, saying “further investigations and epidemiological review is yet required and suggested.” 

Provincial authorities also have launched a high-level investigation to ascertain the veracity of the allegations against the local doctor, who already has been taken into police custody. 

Some also blame unsafe injection practices by quack doctors for contributing to the spread of HIV. Government officials estimate about 600,000 unqualified doctors are unlawfully operating in Pakistan and 270,000 of them are practicing in Sindh. 

Critics also blame lapses in Pakistan’s national health system, the low priority given to the problem, corruption, the recent abolition of the federal health ministry and the delegation of its functions to the provinces for the worsening health sector situation and the increase in HIV infections. 

Pakistani and U.N. officials say the HIV epidemic in Pakistan remains largely concentrated among key populations, including people who inject drugs, the transgender community, sex workers and their clients, and men who have sex with men.
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Nearly every country in the world has agreed upon a legally binding framework to reduce the pollution from plastic waste except for the United States, U.N. environmental officials say.

An agreement on tracking thousands of types of plastic waste emerged Friday at the end of a two-week meeting of U.N.-backed conventions on plastic waste and toxic, hazardous chemicals.

Discarded plastic clutters pristine land, floats in huge masses in oceans and rivers and entangles wildlife, sometimes with deadly results.

Rolph Payet of the United Nations Environment Program said the “historic” agreement linked to the 186-country, U.N.-supported Basel Convention means that countries will have to monitor and track the movements of plastic waste outside their borders.

The deal affects products used in a broad array of industries, such as health care, technology, aerospace, fashion, food and beverages.

“It’s sending a very strong political signal to the rest of the world — to the private sector, to the consumer market — that we need to do something,” Payet said. “Countries have decided to do something which will translate into real action on the ground.”

Countries will have to figure out their own ways of adhering to the accord, Payet said. Even the few countries that did not sign it, like the United States, could be affected by the accord when they ship plastic waste to countries that are on board with the deal.

Payet credited Norway for leading the initiative, which first was presented in September. The time from that proposal to the approval of a deal set a blistering pace by traditional U.N. standards for such an accord.

The framework “is historic in the sense that it is legally binding,” Payet said. “They (the countries) have managed to use an existing international instrument to put in place those measures.”

The agreement is likely to lead to customs agents being on the lookout for electronic waste or other types of potentially hazardous waste more than before.

“There is going to be a transparent and traceable system for the export and import of plastic waste,” Payet said.

 
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Dementia is a rapidly growing public health problem around the world. Fifty million people suffer from dementia, and in the next 30 years, that number is expected to triple.

Researchers are looking for ways to treat or prevent dementia, and a promising clinical trial is underway in the U.S.

Dementia is not a normal part of aging, but age is a huge risk factor. Regular exercise, a healthy diet, maintaining healthy blood pressure, cholesterol, and blood sugar levels help stave off dementia as we grow older

As people around the world live longer, health agencies and researchers are looking for ways to prevent, stop or treat dementia, including Alzheimer’s disease, one of the most common types of dementia.

Promising clinical trial

David Shorr was diagnosed with Alzheimer’s at 56.He is about to undergo a new procedure that could treat early stage Alzheimer’s. He is with his doctor, Vibhor Krishna, a neurosurgeon at Ohio State Wexner Medical Center.

The procedure Shorr is about to have involves sound waves. Ultrasound waves target and open the blood-brain barrier — a protective layer that shields the brain from infections. But Krishna says the barrier also makes it hard to treat neurodegerative diseases like Alzheimer’s.

“Opening the blood-brain barrier allows us to access more of the brain tissue and be able to increase the effectiveness or bioavailability of the therapeutics,” Krishna said.

Shorr and his wife, Kim, were willing to try any new treatment that might help with his dementia. Kim describes the couple’s reaction when they received a phone call inviting Shorr to participate in a clinical trial.

“There’s this trial. Would you be interested?” she said, describing the call. “And without really knowing what it was, we said, Sure.’”

Ultrasound targets protein buildup

Shorr became one of 10 patients enrolled in the study. The trial tests MRI-guided imaging to target the part of the brain responsible for memory and cognition. Krishna explains that’s where Alzheimer’s patients have a buildup of toxic proteins called amyloid.

“Higher deposition of amyloid goes hand in hand with loss of function in Alzheimer’s disease,” he said.

Krishna says this procedure might allow a patient’s own immune system to clear some of the amyloid.

In this procedure, ultrasound wave pulses cause microscopic bubbles to expand and contract in the brain.

“The increase and decrease in size of these microbubbles mechanically opens the blood-brain barrier,” Krishna said.

The patient is awake during the procedure.

Study could help others

Opening the barrier may one day allow doctors to deliver medication straight to the site of the disease.

Kim Shorr realizes her husband might not benefit from this treatment.

“We’re hopeful it can help him, but we also know maybe it will help somebody else,” she said.

Shorr is glad to be part of a study that could help others who are in the early stages of Alzheimer’s, even if it doesn’t help him.
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Dementia is a rapidly growing public health problem throughout the world. Fifty million people suffer from dementia, and in the next 30 years, that number is expected to triple. Researchers are looking for ways to treat or prevent dementia, and VOA’s Carol Pearson reports some of the work being done is promising.
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It’s 9 o’clock in the morning, time for 3-year-old Lucas’ weekly music therapy session.

“Lucas is autistic,” his mother Katey Hernandez explained. “He has a lot of sensory processing sensitivities, which means he’s really sensitive to loud noises, bright lights and a lot of [activity] around his body, and he really likes to jump and swing and climb and anything active.”

Music therapist Dixie Mazur brings to Lucas’ home session a bag full of instruments. During the session she plays music and sings.

“I like to bring in a wide variety of instruments because, especially with younger kids, the attention spans naturally are very short and I like to be able to give them the freedom and ownership to kind of move our session in the direction they want to go,” Mazur said.

She brings in a piano, a couple of drums, rain stick and egg shakers, “things that provide a lot of sensory feedback as well.”

Hernandez is happy with the results so far.

“It’s been very helpful,” she said. “Ms. Dixie has come up with a few songs to help him with social dialogue. So, it helps him communicate with us a lot more, when we can’t figure out what he needs.”

Healing soul and body

Music has long helped people express their emotions and connect with one another. Over the years, medical studies have shown that music has many health benefits, too. Those range from facilitating regular breathing and lifting mood to improving emotional function and motor control in patients.

So, music has become a part of the therapists’ toolbox, used either in one-on-one sessions or group settings. It can be passive, where patients listen to music, or active, where they participate in playing instruments and singing.

Zoe Gleason Volz brings music therapy to a group of people with a range of cognitive disabilities.

“As a group, they don’t really engage with each other,” she said. “So, a lot of my work is trying to slowly get them to positively engage with their fellow group members and actively engage with me.”

The instruments stimulate patients’ senses and muscles. She says the impact is obvious on brain scans of people listening to music. 

“When you’re listening to music the entire brain is lit up because it’s having the music and the intellectual sides both kind of firing all at once. Whereas when you’re talking with somebody, you’re probably more into one hemisphere of the brain rather than both.”

Becoming a music therapist

There are more than 6,000 board-certified music therapists in the United States. They’ve gone through 1,000 hours of training, including getting an undergraduate degree and completing a six-month internship, and passing a certification exam.

But music therapist Kelsi Yingling, who founded NeuroSound Music Therapy, where Gleason Volz and Mazur work, looks for more than a certificate. 

“The type of skills we wanted to see in a music therapist are strong musical skills, interpersonal skills and the ability to relate to our clients,” she said.

Music therapists should be patient and able to adapt to various situations, she says, adding that the work is easier when therapists have passion for music and for helping people. 

“The fact that I get to use music to help other individuals achieve their goals and their highest potential is really one of the most rewarding things I can be doing in my life,” she added.
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Music has long helped people express their emotions and connect with one another. Over the years, medical studies have proved that music has many health benefits, too. They range from facilitating regular breathing and lifting mood to improving emotional function and motor control in patients. Faiza Elmasry tells us more about music therapy. Faith Lapidus narrates.
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Contributors include Erikas Mwisi reporting from Beni, North Kivu; Margaret Basheer from the United Nations; and Eddy Isango, James Butty and Carol Guensburg from Washington.

Armed attacks, misinformation and a growing funding gap continue to impede the response to the Ebola outbreak in northeastern Democratic Republic of Congo, with the World Health Organization warning that the situation could spiral out of control.

Insecurity leaves response teams “unable to perform robust surveillance nor deliver much needed treatment and immunizations,” the WHO reported Friday in its latest update on the outbreak confirmed last August. The health organization warned that “without commitment from all groups to cease these attacks, it is unlikely that this EVD [Ebola virus disease] outbreak can remain successfully contained in North Kivu and Ituri provinces.”

The disease could spill into other parts of the country and across the borders of neighboring Uganda, Rwanda and South Sudan, the health organization suggested.

This month alone has brought setbacks such as a violent assault on a burial team in the town of Katwa and a gunfight between at least 50 armed militia and security forces in the city of Butembo, WHO reported. Mourners also buried Richard Valery Mouzoko Kiboung, a 41-year-old Cameroonian doctor killed April 19 while working for WHO and meeting with other front-line workers at Butembo University Hospital.

The threats continue.

On Thursday, a VOA correspondent in Butembo saw a series of letters scattered on a street, each weighted down with pebbles. Written in Swahili and attributed to Mai-Mai fighters, the letters warned police, soldiers and the general public against showing any support for Ebola responders or treatment centers. 

Anderson Djumah, whose 10-year-old son is being treated for Ebola at the general hospital in the North Kivu town of Beni, complained that “the lack of security has just added more suffering.”

“Even Ebola treatment centers are targeted by the assailants. We’re afraid. Ebola is killing so many people. We’re still expecting that the government would be able to protect us,” he said. “… [But] some people who are sick with Ebola are fleeing to other places for their lives and are meanwhile spreading the sickness.”

Complications for care

Violence sends people into hiding and disrupts response operations such as contact tracing, vaccination and safe burials, giving “time and space to the virus to spread within the community and make more victims,” Jessica Ilunga, spokeswoman for the DRC’s health ministry, told VOA.

“Every time we have a security incident, the number of cases and deaths obviously increases,” Ilunga said.

The health ministry, leading the response with WHO’s help, reported 1,600 total cases as of Wednesday, with 1,534 confirmed and 66 likely. This second-worst Ebola outbreak already has claimed 1,069 lives. The 2014-15 West African outbreak killed more than 11,000.

Many of the victims have died at home, potentially exposing others to the disease and leaving gaps in how — and to whom — the virus may have been transmitted.

“You don’t know who those contacts are,” said epidemiologist Jennifer Nuzzo, an epidemiologist and principal investigator for the Outbreak Observatory, a project of the Johns Hopkins Center for Health Security. “… Chances are you can’t offer them vaccines or treatment.”

Funding for the Ebola response has fallen far short of need, WHO spokesman Tarik Jasarevic said in an email to VOA Wednesday. As of May 2, WHO had received $32.5 million of the $87 million it estimated needing for six months ending in July.

“If the funds are not received,” Jasarevic wrote, “WHO will be unable to sustain the response at the current scale.” 

​New challenges in 10th DRC outbreak

This is the DRC’s 10th reported outbreak since the virus’ discovery near the Ebola River in 1976. The country has proved adept at snuffing out past outbreaks of Ebola, which has been found in bats, monkeys and other animals sometimes consumed as “bush meat.” The virus spreads through contact with an infected person’s body fluids.

Ebola was unfamiliar in the northeast, a region already destabilized by at least two decades of conflict. More than 100 armed groups roam the area, displacing hundreds of thousands of people.

High mobility and population density also raise the potential that the virus could cross into Uganda, Rwanda and South Sudan. (The U.S. Centers for Disease Control and Prevention has been providing technical guidance to the DRC and its neighbors, for instance, helping them ramp up surveillance and vaccination tracking.)

Wary public

Skepticism also factors into the Ebola equation. The northeast is an opposition stronghold, and its residents were angered to be kept from voting in December’s general elections, as former U.S. diplomat John Campbell pointed out in a Council on Foreign Relations blog post.

A study published in The Lancet medical journal in March found low public trust in local authorities and broad acceptance of misinformation about Ebola. Just a third of the 961 respondents — adults surveyed in North Kivu’s Beni and Butembo last fall — said they had confidence that local authorities acted in the public interest. A fourth indicated they didn’t believe Ebola exists.

Mistrust and misinformation make it less likely that individuals will heed public safety directives, such as accepting Ebola vaccines, seeking formal medical care or supporting safe burial practices, the researchers noted.

That mistrust can be weaponized, as Medecins Sans Frontieres/Doctors Without Borders experienced. Two of the international aid group’s Ebola treatment centers, in Katwa and Butembo, were attacked in February. MSF suspended services there, saying its ability to respond in the outbreak’s epicenter had been “crippled.” 

Anne-Marie Pegg, MSF’s clinical lead for epidemic response, said some Congolese look critically at the disparity between local clinics, which, if they exist, might lack basics such as running water and electricity, and the better-equipped Ebola treatment centers set up by international aid groups.

“Very little investment has gone into the existing health structures and the existing health system, and people notice this,” Pegg said. She said MSF, in “numerous interactions,” has heard complaints that international groups are involved “‘only because we [locals] are contagious and we’re a threat to you.’

“It’s not surprising that something like Ebola can be manipulated for any variety of reasons,” Pegg added. “… Absolutely, there are interest groups from all sides that are trying to use this.”

MSF continues to work in the region while pressing for “better integration of Ebola treatment into the health care system,” Pegg said. The virus’ early symptoms, such as headaches and muscle pain, are indistinguishable from those of malaria or other more common ailments, so “it’s difficult for someone who’s sick to think, ‘I have Ebola.’ So the capacity to isolate someone who may have an Ebola infection and test for that … needs to happen at a local level” rather than sending patients to a treatment center. “It would be nice if those people could be treated closer to home” and started on treatment while awaiting test results. If the virus is confirmed, then transfer the patient to an Ebola treatment center, “which is the best place.”

But, she said, MSF’s goal is to treat whatever ailment a patient might have.

​Vaccine plans revised

As Ebola infections rise, a WHO advisory group this week recommended that an approved vaccine be distributed more widely in smaller doses and that an experimental vaccine, developed by Johnson & Johnson, also be offered. More than 100,000 doses of the approved Merck vaccine have been distributed since August, but supplies are running low. The dosage would be halved from the current 1 milliliter for the primary and secondary “ring vaccination,” which prescribes inoculation for anyone in contact with an infected person. Eligibility would be expanded through “pop-up and targeted geographic approaches” in high-risk areas.

“We know that vaccination is saving lives in this outbreak,” WHO Director-General Tedros Adhanom Ghebreyesus said in a statement.

The advisory group also recommended more training for local health workers.
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