17 November 2013
LANCET: INFECTIOUS DISEASES COMMISSION on ANTIBIOTIC RESISTANCE
http://www.reactgroup.org/uploads/news/Comments-on-The-Lancet-Infectious-Diseases-Commission-on-Antibiotic-Resistance-Nov2013.pdf
16 November 2013
ProMED: FREE ebook by GIDEON on Infectious Diseasesof the Philippines.
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Sat 16 Nov 2013
From: Uri Blackman [edited]
A massive effort is underway to supply medical assistance to the
Philippines. ProMED has arranged to supply a free copy of Infectious
Diseases of the Philippines, 2013, to all subscribers. This e-book
(411 pages, 88 graphs, 1869 references) is the only comprehensive
source for background information on the status of every individual
infectious disease in the Philippines.
To obtain Infectious Diseases of the Philippines, 2013:
1. click on the following link:
[We expect that the conditions in the typhoon-affected areas of the
Philippines may well result in emerging disease outbreaks and
increases in endemic diseases. ProMED appreciates this offer from our
friends at GIDEON. - Mod.LM]
15 November 2013
ARTEMISININ RESISTANT MALARIA
MALARIA, ARTEMISININ RESISTANCE - SOUTHEAST ASIA
************************************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Tue 12 Nov 2013
Source: Firstpost [edited]
Rise of drug-resistant malaria in Southeast Asia
------------------------------------------------
US experts are raising the alarm over the spread of drug-resistant
malaria in several Southeast Asian countries, endangering major global
gains in fighting the mosquito-borne disease that kills more than 600
000 people annually.
While the communicable disease wreaks its heaviest toll in Africa,
it's in nations along the Mekong River where the most serious threat
to treating it has emerged.
The availability of therapies using the drug artemisinin has helped
cut global malaria deaths by a quarter in the past decade. But
resistance to it emerged on the Thai-Cambodia border in 2003, and has
since been confirmed in Viet Nam and Myanmar too. It has also been
detected in southwest China and suspected as far away as Guyana and
Suriname, according to a new report by the Center for Strategic and
International Studies think tank.
The report warns that could be a health catastrophe in the making, as
no alternative anti-malarial drug is on the horizon. The UN World
Health Organization, or WHO, is warning that what seems to be a
localized threat could easily get out of control and have serious
implications for global health. "Absent elimination of the malaria
parasite in the Mekong, it is only a matter of time before artemisinin
resistance becomes the global norm, reversing the recent gains,"
writes Dr Christopher Daniel, former commander of the US Naval Medical
Research Center, in the report for a conference at the Washington
think tank Tuesday [12 Nov 2013].
Mosquitoes have developed resistance [it is the malaria parasite which
develops resistance, not the mosquito. - Mod.EP] to antimalarial drugs
before. The same happened with the drug chloroquine, which helped
eliminate malaria from Europe, North America, the Caribbean, and parts
of Asia and South-Central America during the 1950s. Resistance first
began appearing on the Thai-Cambodia border, and by the early 1990s it
was virtually useless as an antimalarial in much of the world.
Nowhere are the challenges in countering the threat to drug-resistance
greater than in Myanmar, also known as Burma. Some 70 percent of its
55 million people live in malaria-endemic areas, and as a nation, it
accounts for about three-quarters of malaria infections and deaths in
the Mekong region, the report says. Myanmar's public health system is
ill-equipped to cope, as government spending on health dwindled to the
equivalent of just 60 US cents per person under military rule,
although it has been increased significantly under the quasi-civilian
administration that took power in 2011.
In a third of townships, there been virtually no public health
presence for years. It's an issue of regional concern as Myanmar has
large transient populations in its border regions, including ethnic
minorities displaced by fighting and migrant workers who cross
borders. "It is clear that this country with its chronically
under-resourced health system needs urgent additional attention,"
Daniel said. Resistance to artemisinin can be driven by various
factors: delays in giving treatment, use of counterfeit or substandard
drugs, and prescribing artemisinin on its own rather than in
combination with another longer-acting drug to ensure that all
malaria-carrying parasites in a patient's bloodstream are killed off.
Cambodia and Laos have banned the use of such monotherapies, and
Myanmar's military, which manufactures pharmaceuticals, announced in
June [2013] it would cease production of them by early 2014. That
comports with the global push by the UN for proper testing, treating,
and tracking of malaria cases to prevent the disease spreading.
The Center for Strategic and International Studies is advocating
greater US involvement and aid for health and fighting malaria in the
Mekong region, particularly in Myanmar, where Washington has been in
the vanguard of ramping up international aid, as sanctions have been
eased to reward it for democratic reforms. The centrist think tank
argues that it can increase America's profile in Southeast Asia in a
way that will benefit needy people and not be viewed as threatening to
strategic rival, China. But securing more funds won't be easy at a
time when Washington is cutting back on programs for its own poor. The
US is already a major contributor to international anti-malaria
efforts, and in Myanmar, is promising USD 20 million per year in
health assistance under its recently resumed bilateral aid program.
--
Communicated by:
ProMED-mail from HealthMap Alerts
[The emergence of artemisinin resistance in Myanmar (Burma) and
Cambodia and indeed in the rest of Southeast Asia is a matter of grave
concern. This is also where resistance to chloroquine (as pointed out
in the message), sulfadoxine/pyrimethamine [Fansidar(R)], and
mefloquine [Lariam(R)] first developed. The main driver is probably
substandard dosing where purchase of single tablets is possible and
counterfeit drugs containing substandard doses are common.
We have previously argued that the development of resistance is best
contained by providing the population with free malaria drugs ensuring
a full course of treatment with drugs which contain the active
compounds in the required doses (Schlagenhauf P, Petersen E:
Antimalaria drug resistance: the mono-combi-counterfeit triangle.
Expert Rev Anti Infect Ther. 2009; 7(9): 1039-42). Free drugs are
provided to patients with HIV and tuberculosis and should be provided
to malaria patients as well to remove the market for counterfeit and
substandard drugs. - Mod.EP
13 November 2013
Hep. C transmission by tears.
Hepatitis C and ocular surface disease.
AU
Jacobi C, Wenkel H, Jacobi A, Korn K, Cursiefen C, Kruse FE
SO
Am J Ophthalmol. 2007;144(5):705.
PURPOSE: To assess the frequency of changes in the ocular surface and the presence of hepatitis C virus (HCV) in tear samples of patients with chronic HCV infection.
DESIGN: Prospective, nonrandomized, clinical, interdisciplinary, single-center study.
METHODS: Seventy-one patients with previously untreated chronic HCV infection and a control group consisting of 66 patients without systemic HCV infection were enrolled in the trial. The patients with HCV infection were screened for ocular symptoms, visual acuity, and ocular changes. Tear production was measured by the Jones test. Conjunctival impression cytologic analysis was performed. The presence of HCV ribonucleic acid (RNA) in tear and blood samples was determined by quantitative polymerase chain reaction.
RESULTS: On examination, systemic HCV infection was present for a median of 30 months. Fifty percent of all HCV patients showed a decrease in tear production measured by the Jones test. Apart from epithelial changes related to dry eye syndrome in 12 patients,two patients presented mild peripheral corneal thinning. Polymerase chain reaction analysis detected HCV RNA in five (10%) of 52 tear samples. HCV RNA levels in tear samples (mean, 1.0 x 10(4) copies/ml) were considerably lower than in blood samples (mean, 5.3 x 10(5) copies/ml).
CONCLUSIONS: Dry eye syndrome is the most frequently observed ocular feature in HCV infection. Patients with HCV infection (age range, 21 to 60 years) compared with the controls had a significant lower tear production (P = .05). The presence of HCV RNA in 10% of tear samples emphasizes the potential risk of viral transmission through tears.
AD
Department of Ophthalmology, University of Erlangen, Erlangen, Germany. christina.jacobi@augen.imed.uni-erlangen.de
PMID
17870047
UTRECHT Univ. Hospital: Prof HENK LOKHORST on DARATUMUMAB for Multiple Myeloma
http://myeloma.org/ArticlePage.action?tabId=0&menuId=0&articleId=4118&aTab=-4
VIDEO of Prof LOKHORST on DARATUMUMAB trials.
ProMED:OBITUARY Dr. J.H.STEELE DVM(Mich.) MPH(Harvard)
OBITUARY: JAMES HARLAN STEELE
*****************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: 11 Nov 2013
From: Peter Cowan, ProMED-mail Animal Disease Assistant Moderator
Yesterday [10 Nov 2013], we all witnessed the exit of a lion.
Over his 100-year-plus lifespan, James Harlan Steele was a true
pioneer in Public Health and the rebirth of One Health. He was
tenacious in his quest to enlarge the role of veterinary medicine in
public health, emboldened by the conviction that any avenue that can
benefit the health and well-being of people leads to a more
progressive, rational and fair state of affairs for his community,
country, and the world.
Steele set the direction, found the resources, selected and cultivated
enough talented people to achieve his dream of One Health, which was
manifested as the establishment of vital veterinary public health
infrastructure at the state, national, and international levels. He
literally built the 1st of many veterinary public health programs in
the United States and the world beginning at CDC in 1946.
Dr. Steele was a systems thinker, a strategic analyst, and a magnet
for bright, young talented veterinarians, physicians, and other health
professionals. He took the idea of One Health and implemented it,
building a framework for programs such as rabies control, which could
showcase what One Health, 1st named by Steele as Veterinary Public
Health, could do.
Dr. Steele received a doctorate of veterinary medicine from Michigan
State University in 1941 and an MPH from Harvard University in 1942.
Until yesterday [10 Nov 2013], he was the oldest living graduate of
the Harvard School of Public Health. He founded and named the 1st
Veterinary Public Health program at CDC and within the United States
Public Health Service where he served for many years.
Early on, Jim worked closely with Alex Langmuir and was so critical to
the implementation and growth of CDC's EIS training program through
the 1950s and 1960s that he was inducted as an honorary EIS member in
1976. He served as Assistant Surgeon General for Veterinary Affairs
and the 1st Chief Veterinary Officer of the USPHS. He played a
critical part at the 1st meeting of the Veterinary Public Health
Expert Committee on Zoonosis at WHO. He played an inspirational role
in the development of several European Veterinary Public Health
Services, particularly in West Germany.
Professor Steele was the Editor in Chief of the CRC Handbook of
Zoonoses series and a consultant to the Control of Communicable
Disease Manual for decades. These accomplishments are only a brief
mention of his activities and barely scratch the surface of his impact
both nationally and internationally. Jim's honors and awards are
almost too numerous to count.
In 1971, he joined the University of Texas School of Public Health's
Infectious Disease Center, where he served as Professor until his 80th
birthday. He then went into "retirement," which consisted of a
whirlwind of writing, editing, consulting, and mentoring that would
dwarf the output of many younger people. He was incredibly sharp and
active right up to the end, engaging at over 100 years of age in an
update of his work on tuberculosis, a short history of One Health, and
planning for a special symposium entitled the James H. Steele
Challenge: A better world through One Health. His video speech last
July [2013] to the American Veterinary Medical Association's 150th
anniversary was an inspiration, not solely because he had lived
through 2/3rds of the existence of that professional organization
dating back to the U.S. Civil War, but because of the forwardness of
the thoughts in his speech. To have a vision to hand over to others at
age 100 is truly remarkable.
Jim loved to tell stories related to the history and purpose of
Veterinary Public Health. He recalled this experience many times to
many of us: "In 1945, at the end of WW II, Joseph Mountin, a physician
and chief of the USPHS's Bureau of State Services, met with him to
discuss the global origin and importance of zoonotic diseases. He
challenged Steele by saying: "What are you veterinarians going to do
for public health now that the war is over?" Jim Steele's response was
vital to the future of veterinary public health and the rest of his
career. Eventually, he suggested the creation of a program within
USPHS that would work on zoonotic diseases. He looked down the hall
and saw Dental Public Health and Public Health Nursing and decided
Veterinary Public Health would do just fine. He further recommended
the establishment of a corps of veterinary officers within the USPHS
so that veterinarians who became Commissioned Corps members would have
a place in the structure. Craig Carter, at the University of Kentucky,
has written a very nice biography entitled One Man, One Medicine, One
Health: The James H. Steele story.
Over his career, Jim had big megaphones at CDC, WHO, USDA, PAHO, APHA
and AVMA, which he used to advocate for acceptance of the idea of One
Health. He developed programs which served as models the world over
and that proved that good animal health meant good human health,
which, in turn, translates to good economic health. Steele played a
seminal role in the rebirth of the idea of One Health. His efforts
finally flowered in full bloom in the 1st decade of the 21st century,
embodied by the wide acceptance of One Health and activities worldwide
in response to HPAI H5N1 and other emerging disease threats.
Notwithstanding his gargantuan accomplishments and his photographic
memory, Jim's singular quality was mentoring. He loved people,
especially young people, and for the last 2 decades of his life,
everyone was young to Jim. He loved to work with people, and so very
many of them became friends. He was an optimist with a sense of humor,
and the jokes he made on the occasion of his 100th birthday were too
rich to repeat here. He had charisma to the maximum extent, but he was
also a hard driving realist who knew how to fund and build programs
the world over. He was never too busy, and he truly knew how to
listen. Whether the problem was epidemiological or personal, Jim would
provide sound advice, oftentimes guiding his mentees towards their own
solutions.
Jim loved to think and do; he loved to listen and comfort. The list of
Jim's "students" included not only those for whom he had acted as a
professor at the University of Texas School of Public Health but also
so many individuals at CDC and the United States Public Health Service
as well as veterinary colleges and the United States Department of
Agriculture. The width of the swath cut by Jim's mentees was truly
impressive. Bill Foege, the former director of CDC, said at Jim's 90th
annual birthday lecture that Jim's seminal contribution was that the
health of humans and the health of animals are inseparable. This
premise was Jim's greatest gift and allowed us to develop a more
rational public health future, because you cannot consider the health
of people without considering the health of animals.
Dr. Foege finished Jim's 90th birthday address with the following
paragraph, which bears repeating now:
"And so our tribute to a long life well lived as a generalist,
specialist, globalist, futurist, moralist, optimist, and gift giver is
mixed with gratitude, gratefulness, and the anticipation of the next
decade being the best ever. On behalf of countless generations, yet
unborn, we say: Thank you Jim, for this greatest gift."
Yes, a lion has roared, and we are all the better for it.
--
Peter Cowen
ProMED-mail Animal Disease Assistant Moderator
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