California officials, having concluded coffee drinking is not a risky pastime, are proposing a regulation that will essentially tell consumers of America’s favorite beverage they can drink up without fear.

The unprecedented action Friday by the Office of Environmental Health Hazard Assessment to propose a regulation to clear coffee of the stigma that it could pose a toxic risk followed a review of more than 1,000 studies published this week by the World Health Organization that found inadequate evidence that coffee causes cancer.

The state agency implements a law passed by voters in 1986 that requires warnings of chemicals known to cause cancer and birth defects. One of those chemicals is acrylamide, which is found in many things and is a byproduct of coffee roasting and brewing present in every cup of joe.

Win for coffee industry 

If the regulation is adopted, it would be a huge win for the coffee industry, which faces potentially massive civil penalties after recently losing an 8-year-old lawsuit in Los Angeles Superior Court that could require scary warnings on all coffee packaging sold in California.

Judge Elihu Berle found that Starbucks and other coffee roasters and retailers had failed to show that benefits from drinking coffee outweighed any cancer risks. He had previously ruled the companies hadn’t shown the threat from the chemical was insignificant.

The state’s action rejects that ruling.

“The proposed regulation would state that drinking coffee does not pose a significant cancer risk, despite the presence of chemicals created during the roasting and brewing process that are listed under Proposition 65 as known carcinogens,” the agency said in a statement. “The proposed regulation is based on extensive scientific evidence that drinking coffee has not been shown to increase the risk of cancer and may reduce the risk of some types of cancer.”

​Unprecedented move

Attorney Raphael Metzger, who won the court case on behalf of The Council for Education and Research on Toxics, said he was shocked the agency would move to nullify the court decision and undermine its own report more than a decade ago that drinking even small amounts of coffee resulted in a significant cancer risk.

“The takeaway is that the state is proposing a rule contrary to its own scientific conclusion. That’s unprecedented and bad,” Metzger said. “The whole thing stinks to high hell.”

The National Coffee Association had no comment on the proposed change. In the past, the organization has said coffee has health benefits and that the lawsuit made a mockery of the state law intended to protect people from toxics.

Scientific evidence on coffee has gone back and forth over many years, but concerns have eased recently about possible dangers, with some studies finding health benefits.

Big Coffee didn’t deny that acrylamide was found in the coffee, but argued it was only found at low levels and was outweighed by other benefits such as antioxidants that reduce cancer risk.

Congress

The state agency’s action comes about a week after bipartisan bills were introduced in both houses of Congress to require science-based criteria for labels on food and other products. One of the sponsors, Rep. Kurt Schrader, D-Oregon, alluded to the California coffee lawsuit as an example of misleading warnings.

“When we have mandatory cancer warnings on a cup of coffee, something has gone seriously wrong with the process,” Schrader said in a news release. “We now have so many warnings unrelated to the actual health risk posed to consumers, that most people just ignore them.”

The lawsuit against Starbucks and 90 companies was brought by the tiny nonprofit under a law that allows private citizens, advocacy groups and attorneys to sue on behalf of the state and collect a portion of civil penalties for failure to provide warnings.

The Safe Drinking Water and Toxic Enforcement Act, better known as Proposition 65, requires warning labels for about 900 chemicals known to cause cancer or birth defects.

The law has been credited with reducing cancer-causing chemicals, but it has been criticized for leading to quick settlement shakedowns and vague warnings that are often ignored.
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Among the millions of fans watching the World Cup are amateur football players who have dreams of being as good as their heroes, Now, they have a new way to compare their performance to the best professionals in the game, so they can build their skills. The help comes from a new wearable device that uses GPS and other sensors to track their movements. Faiza Elmasry has the story. Faith Lapidus narrates.
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The Central American nation of Costa Rica is among the tropical countries in the world with a very high concentration of snakes. Twenty of the country’s more than 130 species are among the most poisonous. VOA reporter Iacopo Luzi traveled to Costa Rica to report on the work of a research institute that produces the snakebite antidotes that, in many cases, are the only things that make a difference between life and death.
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The U.S. government is shutting down a planned study testing whether moderate drinking has health benefits over concerns that its funding by the alcohol industry would compromise its credibility.

The National Institutes of Health said Friday that the results of the planned $100 million study could not be trusted because of the secretive way that employees negotiated with beer and liquor companies to underwrite the effort.

Government officials say it is legal to use industry money to pay for government research as long as all rules are followed. However, in this case, NIH officials say employees did not follow proper procedures, including keeping their interactions with industry officials secret.

NIH Deputy Director Lawrence Tabak said the interactions between the employees and industry representatives appeared to “intentionally bias” the study so that it would have a better chance to conclude that moderate drinking is beneficial.

An NIH review panel was also concerned that the study’s proposed span of 10 years was too short a time period to adequately test the potential problems of a daily drink, such as an increased risk of cancer or heart failure.

NIH Director Francis Collins temporarily suspended the study last month after reporting by The New York Times first raised questions about the funding policy violations. Collins said Friday that he was completely shutting down the research. 

“This is a matter of the greatest seriousness,’’ he said.

The study had planned to track two groups of people, one group drinking a glass of alcohol a day and another abstaining from alcohol. The study had planned to compare new cases of cardiovascular disease and the rate of new cases of diabetes among participants.

Some of the world’s largest alcoholic beverage makers, including Anheuser-Busch InBev and Heineken, had contributed to the study, although Anheuser-Busch InBev had recently withdrawn its contribution.

The NIH said of the $67.7 million raised from private donations, nearly all from the alcohol industry, $11.8 million, had been spent for the study.

The NIH’s National Institute of Alcohol Abuse and Alcoholism (NIAAA) had planned to spend $20 million of its own money for the study. It said $4 million had been spent.
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Researchers in Hungary who found that normal and overweight dogs behaved differently in tasks involving food say the dogs’ responses were similar to those that might be expected from normal and overweight humans.

The study suggested dogs could be used as models for future research into the causes and psychological impact of human obesity, the authors of the paper from Budapest’s ELTE University said.

Researchers put two bowls — one holding a good meal, the other empty or containing less attractive food — in front of a series of dogs.

The study found that canines of a normal weight continued obeying instructions to check the second bowl for food, but the obese ones refused after a few rounds.

“We expected the overweight dog to do anything to get food, but in this test, we saw the opposite. The overweight dogs took a negative view,” test leader Orsolya Torda said.

“If a situation is uncertain and they cannot find food, the obese dogs are unwilling to invest energy to search for food — for them, the main thing is to find the right food with least energy involved.”

The behavior had possible parallels with overweight people who see food as a reward, said the paper, which was published in the Royal Society Open Science journal.
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U.S. astronaut Peggy Whitson, who has spent more time in space than any other American, retired Friday.

During her career, Whitson logged 665 days in space over three missions, the equivalent of about one year and 10 months outside the Earth’s atmosphere.

Whitson was also the first woman to command the International Space Station, holding the position twice, and the oldest woman ever to fly in space.

“It’s been the greatest honor to live out my lifelong dream of being a @NASA Astronaut,” Whitson wrote on Twitter. She thanked “all who have supported me along the way” and said “my journey at NASA has been out of this world!”

Whitson, 58, is a biochemist who grew up in Iowa. She joined NASA as a researcher in 1986 and became an astronaut in 1996. Whitson completed her last spaceflight in September 2017, after spending close to 10 months in space. 

During that mission, Whitson and the other crew members aboard the space station pursued hundreds of experiments in biology, biotechnology, physical science and Earth science.

Only Russian male astronauts have spent more time in space than Whitson. The world record belongs to Russia’s Gennady Padalka, who spent 879 days in space.

While not in space, Whitson also broke barriers at NASA operations. She served as chief of the astronaut corps from 2009 to 2012, becoming

both the first woman to hold the position and the first nonmilitary head of the corps.

“Peggy Whitson is a testament to the American spirit,” NASA Administrator Jim Bridenstine said in a statement Friday. “Her determination, strength of mind, character, and dedication to science, exploration and discovery are an inspiration to NASA and America.”
…

By now, you have probably heard that suicide rates in the United States have increased sharply over the past two decades.

There was a lot of media coverage after fashion designer Kate Spade and celebrity chef Anthony Bourdain took their own lives. Their suicides happened around the same time that the Centers for Disease Control and Prevention issued a report showing a 25 percent increase in suicide in the U.S. since 1999. Suicide is now the 10th leading cause of death in the U.S.

Deborah Stone, a behavioral scientist at the CDC, said the increase wasn’t surprising, as researchers have been seeing these rates going up for a long time.

“The data really speak volumes that the problem is getting worse, and what is really needed is suicide prevention,” Stone told VOA.

Risk factors

She said the risk factors are similar to the risk factors for homicides or mass killings. A person has relationship problems, including conflicts with a spouse or partner, is a victim of bullying, breaks up with or loses a loved one.

Substance abuse can also be involved. In 2016, there were 64,000 overdose deaths in the U.S. Some of the deaths were not intentional, but some were.

Homelessness, loss of a job, and financial problems are also risk factors, as are health problems.

Stone said both physical and mental health problems make people more vulnerable to committing suicide. The report said almost half of those who committed suicide had a known mental health condition, but more than half — 54 percent — did not.

Jennifer Payne, a psychiatrist at Johns Hopkins Medicine, said just because the CDC reported a majority of those who committed suicide did not have a known mental illness, does not mean they didn’t have one.

“I think it’s likely that a majority of cases of suicide are related to a mental health diagnosis,” she said.

The illness could have been undiagnosed, or because of the stigma associated with mental illness, people may have not sought treatment.

Psychiatrist Bashkin Kadriu at the National Institute of Mental Health said, “When you do that psychological autopsy, or the examination of people who have committed suicide, over 90 percent of them have an undiagnosed mental illness.”

In the U.S., mental health treatment is often expensive. Not all psychiatrists accept insurance, which puts treatment out of reach for many. Payne attributes this to a shortage of psychiatrists. 

Payne treats depression, which often leads to suicide, and depression is not always a life-long affliction. It can intensify for a while, and it can also go away. It can also be treated with medication.

No surprise

Paul Gionfriddo, head of Mental Health America, an advocacy group, said it’s no surprise suicide rates have risen.

“The time frame of the CDC report is troubling in that by using 1999 as a reference point, it captures what has happened in post-9/11 America. During that time, we have been subjected to major traumatic events, and our young people have fought in two very long and seemingly endless wars,” he said.

Gionfriddo said trauma and exposure to violence cause mental health conditions which, in turn, can lead to suicide.

The CDC report found that most suicides were committed in rural areas where people lack access to immediate care and where they often live in isolation — yet another risk factor.

Most U.S. suicides are also committed with guns.

Dr. Georges Benjamin, head of the American Public Health Association, told VOA that people who buy guns, even for self- protection, are at more risk of being hurt by their own gun than to be shot by a stranger.

He said the gun lobby has prevented research on how to make guns safer.

“For political reasons, people are not doing the kinds of things you would normally do if we had airplanes crashing every day,” Benjamin said.

Stone said the main thing is that suicide is preventable.

“It’s a public health problem that requires a public health approach. It’s not just due to one thing. And so, our strategies need to be multifaceted to address all of the range of suicides,” she added.

Suicide is a global problem, as well. The World Health Organization reports that suicide is the second-leading cause of death among 15- to 29-year-olds, and that 75 percent of all suicides occur in low- and middle-income countries. 

Close to 800,000 people die by suicide every year. Nearly 45,000 people took their lives in the U.S. in 2016.
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Once again, hard facts support the claim that the planet is getting warmer. According to a new report, published in the scientific journal Nature, Antarctica is losing ice so fast that by the end of this century, the sea level could rise as much as 16 centimeters. This may not sound like much, but scientists say the trend is alarming. VOA’s George Putic has more.
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Lions and tigers and bears are increasingly becoming night owls because of us, a new study says.

Scientists have long known that human activity disrupts nature. Besides becoming more vigilant and reducing time spent looking for food, many mammals may travel to remote areas or move around less to avoid contact with people.

The latest research found even activities like hiking and camping can scare animals and drive them to become more active at night.

Presence has consequences

“It suggests that animals might be playing it safe around people,” said Kaitlyn Gaynor, an ecologist at the University of California, Berkeley, who led the study. “We may think that we leave no trace when we’re just hiking in the woods, but our mere presence can have lasting consequences.”

Gaynor and her colleagues analyzed 76 studies involving 62 species on six continents. Animals included lions in Tanzania, otters in Brazil, coyotes in California, wild boars in Poland and tigers in Nepal.

Researchers compared how much time those creatures spent active at night under different types of human disturbance such as hunting, hiking and farming. On average, the team found that human presence triggered an increase of about 20 percent in nighttime activity, even in animals that aren’t night owls.

Results were published Thursday in the journal Science.

Robust study

The findings are novel because “no one else has compiled all this information and analyzed it in such a … robust way,” said Ana Benitez Lopez of Radboud University in the Netherlands, who reviewed the study.

Marlee Tucker, an ecologist at Goethe University Frankfurt in Germany who was not part of the research, was surprised that any kind of human activity is enough for mammals to see people as a threat.

“It’s a little bit scary,” she said. “Even if people think that we’re not deliberately trying to impact animals, we probably are without knowing it.”

Gaynor said animals that don’t adapt well to the darkness will be affected. But she said that behavioral shift could also help other animals reduce direct encounters with people.

“Humans can do their thing during the day; wildlife can do their thing at night,” she said. That way, people would be sharing the planet “with many other species that are just taking the night shift while we’re sleeping.”
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The beautiful, all-you-can-eat sushi platter you shared with friends last week might have included a special ingredient: plastic.

Microplastics — the remnants of plastic bags, takeout containers and straws that almost-but-not-quite disintegrate in the oceans — are found in 3 out of 4 fish, such as squid, cuttlefish and swordfish in markets around the world, say the authors of a February study.

“These fish inhabit a remote area, so theoretically they should be pretty isolated from human influences, such as microplastics,” said Alina Wieczorek, lead author of the Frontiers study.

“However, as they regularly migrate to the surface, we thought that they may ingest microplastics there,” she said.

Food chain pollutants

Consumers are waking up to pollutants in their food chain, and scientists are joining them to raise awareness and combat other issues like overfishing. Last week, thousands marched in the United States and 25 other countries for World Oceans Day.

Under the hood of a shark costume was Brian Yurasits, director of development at the nonprofit TerraMar Project, which educates and promotes ocean issues. Yurasits circulated with about 3,000 others at the march in the shadow of the Washington Monument and a life-size, inflatable blue whale.

Holding a sign that read, “Sharks are friends, not food,” Yurasits emphasized that issues about ocean health “is more than just plastic.”

[See our video interview with Yurasits here.]

“It’s overfishing, climate change, invasive species and habitat loss,” he said.

The youth-led Sea Youth Rise Up advocates for ocean conservation, including reduced single-use plastics such as plastic straws, water bottles and shopping bags, which the ocean breaks down into microplastics. Much of the plastic that ends up in the oceans was blown into rivers first from uncontained trash on land.

Microplastics are microscopic and smaller than plankton, a popular food choice of larger marine life. They are made of hydrocarbons, a compound found in petroleum and natural gas, and attract other pollutants, according to the National Association of Geoscience Teachers.

Because microplastics can’t be digested, they build up in the fish that consume them.

“The biggest impacts aren’t the ones we can see very easily,” said Katie Farnsworth, a professor and marine geologist who studies coastal sediments at the Indiana University of Pennsylvania. “The biggest danger is those microplastics, because they are being eaten by things in the bottom of the food web, and then move their way up through the chain.”

The plastics can give off toxins, she said, because plastic is made from hydrocarbons. And hydrocarbons, she explained, attract and bind with other pollutants that are in the ocean.

Carbon dioxide

But microplastics aren’t the only threat to marine life. Ocean acidification and overfishing also imperil the health of oceans.

Ocean acidification occurs when seawater absorbs carbon dioxide from the atmosphere. Carbon dioxide is released into the air by burning fossil fuels, like oil and coal. That makes the ocean more acidic, which harms shellfish, other marine life and plants.

Ocean acidity has increased about 25 percent since the Industrial Revolution starting in 1760, the EPA reports, commonly depicted by billowing smokestacks at coal-burning factories.

Julia Dohner is a second-year Ph.D. student studying marine chemistry and geochemistry at the Scripps Institution of Oceanography in San Diego. She is also a surfer who spends lots of time in the Pacific Ocean.

“Everything I think about is through the context of carbon dioxide,” Dohner said. “For me, reducing one’s carbon footprint is really important. It’s kind of a straightforward task, if you want to do something about the environment.”

Dohner said she believes awareness of ocean acidification has increased in the past few years.

“There’s been a lot of effort going into understanding how quickly our oceans are acidifying and understanding how those conditions will affect various forms in the ocean,” Dohner said.

Overfishing

Overfishing also threatens ocean health. It occurs when more fish are caught than the population can replace through natural reproduction. According to the World Wildlife Federation, several important commercial fish populations, such as Atlantic bluefin tuna, have declined to the point where their survival as a species is threatened.

Regulating overfishing is nearly impossible because “fish could care less about political boundaries,” said Farnsworth, meaning fishing boats follow the fish, often disregarding lines drawn around territorial boundaries. 

“Regulations in one country don’t help very much because you have to get treaties to get everybody in agreement,” she said.

Dohner said she believes that the biggest threat the ocean faces is a lack of awareness of these issues.

“There’s all this research going on about how our planet is changing and what it’s going to look like in the future,” Dohner said. “But at the end of the day, if we can’t convince people such that there is tangible policy changes enacted, then what have we really accomplished?”

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Millions of high school students are done. So done.

In flowing gowns and square caps, more than 3 million will walk across a stage this month and be handed a diploma, what they’ve been working toward for 12 years.

Latavea Cole, a graduating senior at Paul Laurence Dunbar High School in Baltimore, Maryland, wore a black cap decorated with yellow feathers and words that glittered.

“Mine says ‘Black girl magic,’” Cole told VOA. “It’s an inspirational thing, and graduating is really just … magic.”

Personalized caps

Many students personalize their caps with inspirational quotes, feathers and glitter to stand out in a sea of other graduates for family and friends in the grandstands. Some just want to celebrate their hard-won achievement that culminates in filing into a gymnasium and walking across a stage to receive their diplomas.

At Dunbar, the high school attended by the late rap artist Tupac Shakur, nearly 200 graduates filed in one by one as the school band played “Pomp and Circumstance,” the traditional music of graduations throughout America.

Over half of the caps were vividly decorated, with rhinestones that reflected the gymnasium’s light, and fake flowers mirroring real ones gifted to the graduates by their families.

On to college

Cole said she will pursue a degree in special education at a nearby community college after leaving Dunbar, which specializes in preparing students for careers in health care.

“Dunbar high school is a high school for professional health careers, and it gets you ready for college and the next level,” Kelvin Williams, a fellow graduating senior, told VOA.

Williams will move to North Carolina in the fall to major in sports medicine with plans to become a doctor to “help athletes.”

“The entire group is just dynamic, boisterous. They’re looking at wonderful things in their future,” said Tameka Taylor, an English teacher at Dunbar.

“They’re going to colleges in Arizona, Kansas, all over the state of Maryland, with over $500,000 to $1 million in scholarships. So, we are just excited, and we can’t wait to usher them out into the world,” Taylor said.

Before and after the ceremony, many students pondered their four-year journey through high school.

“I had a great experience. It was fun. There were some serious times, but mostly fun. I wouldn’t pick a different school,” Cole said.

“It’s been hard, but it’s been great,” her classmate Carl Kuniken added.

“Mine says I’m a draguate’,” said Jahi Chatman, turning around to show the camera his decorated cap. He will be headed to military basic training in the fall.

“I dragged my way through high school, so I’m a draguate!”
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Health experts are dispatching an experimental vaccine in areas of The Democratic Republic of the Congo that are considered ground zero in the fight against Ebola. Their hope is to try to combat the outbreak from the onset. The crucial test is providing hope, in times of uncertainty. VOA’s Julie Taboh has more.
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The head of UNAIDS says testing for the HIV virus is critical in reaching the goal of eliminating the virus by 2030. But the U.N. official tells VOA the effort is hampered in many countries by social taboos and stigma attached to AIDS and other HIV-related diseases. VOA’s Zlatica Hoke has more.
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Two promising new ways to prevent cholera are on the horizon. One is an entirely new kind of vaccine. The other is as simple as a cup of yogurt.

Both may offer fast, cheap protection from explosive outbreaks of a disease that claims tens of thousands of lives each year.

The research has so far only been done in animals. Human studies are yet to come. 

Cholera declawed

Cholera causes such serious diarrhea that it can kill within hours. Current vaccines take at least 10 days to work, don’t provide complete protection and don’t work well for young children. 

One group of scientists working to create a better vaccine engineered cholera bacteria that are missing the genes that make the microbe toxic. 

The researchers fed the modified bacteria to rabbits. The microbes colonized the animals’ guts but did not make them sick. 

When the scientists then fed rabbits normal, disease-causing cholera 24 hours later, most of the animals survived. 

Those that did get sick took longer to do so than rabbits given unmodified bacteria, or modified bacteria that had been killed. Those animals died within hours. 

The engineered cholera bacteria provided protection much faster than a conventional vaccine. They acted as a probiotic: colonized the animals’ intestines in less than a day and prevented the disease-causing microbes from getting a foothold. 

The researchers expect that the modified bacteria will also act like a typical vaccine, stimulating the body’s immune system to fight a future cholera infection. 

“This is a new type of therapy,” Harvard University Medical School microbiologist Matthew Waldor said. “It’s both a probiotic and a vaccine. We don’t know the right name for it yet.”

The research is published in the Science Translational Medicine journal. 

Yogurt solution

In another study in the same journal, a group of researchers discovered that a microbe commonly found in yogurt, cheese and other fermented dairy products can prevent cholera infection. 

Bioengineer Jim Collins at the Massachusetts Institute of Technology and colleagues had been working on genetically modifying the bacteria, known as Lactococcus lactis, to treat cholera. 

It hadn’t been working. 

But they accidentally discovered that unmodified L. lactis keeps cholera germs in check by producing acid that the disease-causing microbes can’t tolerate. 

Feeding mice doses of L. lactis bacteria every 10 hours nearly doubled their survival rate from cholera infection. 

“It was remarkably surprising and satisfying,” Colllins said. “We were really getting frustrated.” 

They also designed a strain of L. lactis that turns a cholera-infected mouse’s stool red. It could be a useful diagnostic, for example, to identify those carrying the bacteria but not showing symptoms. 

Collins said pills of L. lactis bacteria — or simply ample supplies of fermented milk products — could be “a very inexpensive, safe and easy-to-administer way to keep some of these outbreaks in check.”

Waldor said his group’s modified-cholera vaccine also could be grown and packaged in pills quickly and easily in case of an outbreak. 

Both caution that these animal studies are a long way from new treatments for human patients. They need to be proven in clinical trials. 

Beyond cholera

The two studies could not only have an impact on cholera, but could also influence how doctors treat other intestinal diseases and manage gut health, according to Robert Hall, who oversees research funded by the National Institute of Allergy and Infectious Diseases. 

While fermented foods promising better health are widely available, “the studies with probiotics in the field have really seldom shown great effectiveness when they’re done scientifically,” Hall said. 

The work Collins’s group did not only shows effectiveness, but explains how it works: by “making the intestine inhospitable” to cholera, he added.

Hall wrote a commentary accompanying the two studies. 

Other gut diseases work the same way as cholera, he noted, so it’s possible that other microbes could be developed that block harmful germs from gaining a foothold while acting as vaccines at the same time.

“It’s a very exciting principle,” Hall said. 

 
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The head of UNAIDS says the global community is at a “defining moment” in the effort to end the HIV/AIDS epidemic by 2030.  

“This midpoint is important for us to reflect on what was not working,” Michel Sidibe told VOA, noting this year marks the halfway point to agreed global targets. “It’s about how to deal with vulnerable communities, fragile society.”

According to 2016 data, 36.7 million people globally are living with HIV. There were nearly 2 million new infections and 1 million AIDS-related deaths.

 

WATCH: UNAIDS Chief: Testing is Critical in Combating HIV/AIDS

But the good news is there has been success in expanding access to critical anti-retroviral drugs (ARVs), which reached nearly 21 million people in 2016, leading to a reduction by one-third in global AIDS-related deaths.

Eliminating mother-to-child HIV transmission through childbirth and breast-feeding also has become a real possibility by 2030. This was considered a dream just a few years ago, Sidibe said.

“Today, we are seeing after six years that we reduced by almost 61 percent the infection among children — the transmission from mother to child,” Sidibe said. “But we still have 39 percent of babies born with HIV. We want to stop that and we are working very closely with countries who are lagging behind to make sure we have a catch-up plan.”

Know your HIV status

The UNAIDS executive director says one of the most critical factors in ending the epidemic is making sure people are tested and know their HIV status. This requires lifting taboos and making testing more widely available.

“We need to reduce the price of self-testing; we need to go to community levels, family levels, to reach people where they are,” he said. “The family-centered approach and also community-based approach will become central to what we will do in the future, if we want to reach those millions of people who don’t know their status.”

A recent United Nations report on the AIDS response found that at the end of 2016, some 70 percent of people living with HIV knew their status, and 77 percent of them were accessing ARV therapy. Once on those treatments, 82 percent had suppressed the virus to undetectable levels in their systems. That is not a cure. HIV still remains in their body, but it greatly reduces the likelihood of transmission to a partner.

Uneven progress

While there have been significant successes, progress is uneven, especially for women and adolescent girls. This is the case in sub-Saharan Africa, where females aged 15-24 accounted for 23 percent of new infections in 2016, compared to 11 percent for their male counterparts.

Sidibe says women and young girls face unique challenges, including cultural norms, child marriage and early pregnancies.

“It’s something which we need to address at not just a peripheral level, we need to deal with poverty, to deal with violence against women, to change the laws, to make sure we give them services,” he said.

In order to stop new HIV infections, other vulnerable populations also need a scaled-up response, including intravenous drug users, sex workers and men who have sex with men.

Working with at-risk groups and spreading awareness of the importance of condoms and single-needle use for drug addicts are all crucial to the fight against HIV.

Next month, thousands of experts, activists and people living with HIV/AIDS will meet in Amsterdam for the International AIDS conference. Special attention will be focused on the need to reach key populations, including in Eastern Europe, Central Asia, North Africa and the Middle East, where epidemics have grown.
…

From fears that eating chicken wings makes it hard to find a husband to beliefs that pineapple jeopardizes fertility, a host of food taboos are fueling malnutrition among Indonesian girls, experts said as they launched an adolescent health drive.

Nutritionists said girls ate very little protein, vegetables or fruit, preferring to fill up with rice and processed snacks which were often sweet or fried.

“Indonesian girls are being left behind when it comes to nutrition,” said Kecia Bertermann of Girl Effect, a non-profit that uses mobile technology to empower girls.

“They don’t understand why their health is important, nor how nutrition is connected to doing well at school, at work or for their futures.”

The U.N. children’s agency UNICEF says Indonesia has some of the world’s most troubling nutrition statistics.

Two in five adolescent girls are thin due to undernutrition, which is a particular concern given many girls begin childbearing in their teens.

Experts said the food taboos were part of a wider system of cultural and social habits leading to poor adolescent nutrition, which could impact girls’ education and opportunities.

One myth is that cucumber stimulates excessive vaginal discharge, another that eating pineapple can prevent girls from conceiving later on or cause miscarriages in pregnant women.

Others believe spicy food can cause appendicitis and make breast milk spicy, oily foods can cause sore throats and peanuts can cause acne, while chicken feet – like chicken wings – can cause girls to struggle finding a husband.

Research by Girl Effect found urban girls ate little or no breakfast, snacked on “empty foods” throughout the day and thought feeling full was the same as being well nourished.

Snacks tended to be carbohydrate-heavy, leaving girls short of protein, vitamins and minerals.

Girl Effect is teaming up with global organization Nutrition International to improve girls’ eating habits via its Springster mobile app, a platform providing interactive content for girls on health and social issues.

If successful, the initiative could be expanded to the Philippines and Nigeria.

Experts said Indonesia was a country with “a double burden of malnutrition” with some people stunted and others overweight but also lacking micronutrients.

Marion Roche, a specialist in adolescent health at Nutrition International, said the poor nutritional knowledge among girls was particularly striking given infant nutrition had improved in Indonesia.

“Adolescent girls don’t know what healthy looks like, as health is understood as the absence of illness,” she said. “We need to give them the knowledge to make healthy choices.”
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The head of the World Health Organization (WHO) on Tuesday cautioned against declaring victory too early in Congo’s Ebola epidemic, despite encouraging signs that it may be brought under control.

“The outbreak is stabilizing, but still the outbreak is not over,” WHO chief Tedros Adhanom Ghebreyesus told journalists on a visit to Democratic Republic of Congo’s capital Kinshasa. “We are still at war, and we need to continue to strengthen our surveillance and … be very vigilant.”

WHO officials on Friday expressed cautious optimism that the epidemic of the deadly virus was stabilizing, partly owing to the swift deployment of vaccines.

But a day earlier, Congo’s health ministry reported its first confirmed case of Ebola in over a week, in the rural community of Iboko.

Ghebreyesus said 2,200 people had been vaccinated, and that case management and tracing contacts of victims had gone well.

But he said: “It’s not over until it is over. Even if one case crosses into Congo (Republic) and gets to an urban area, that could trigger another epidemic.”

The hemorrhagic fever has killed 27 people since the outbreak began in April, and there have been 62 cases, 38 of which were confirmed in a laboratory. A further 14 are probable Ebola cases, and 10 more people are suspected of having Ebola.

In contrast to past Ebola outbreaks health workers have moved quickly to halt Congo’s latest epidemic. Ebola killed at least 11,300 people in 2013-16 in West Africa and during that outbreak WHO was criticized for not taking it seriously enough in its early stages.
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With frustration mounting over lawmakers’ inaction on gun control, the American Medical Association on Tuesday pressed for a ban on assault weapons and came out against arming teachers as a way to fight what it calls a public health crisis.

At its annual policymaking meeting, the nation’s largest physicians group bowed to unprecedented demands from doctor-members to take a stronger stand on gun violence — a problem the organizations says is as menacing as a lethal infectious disease.

The action comes against a backdrop of recurrent school shootings, everyday street violence in the nation’s inner cities, and rising U.S. suicide rates.

“We as physicians are the witnesses to the human toll of this disease,” Dr. Megan Ranney, an emergency-medicine specialist at Brown University, said at the meeting.

AMA delegates voted to adopt several of nearly a dozen gun-related proposals presented from doctor groups that are part of the AMA’s membership. They agreed to:

 — Support laws that would require licensing and safety courses for gun owners and registration of all firearms.

 — Press for legislation that would allow relatives of suicidal people or those who have threatened imminent violence to seek court-ordered removal of guns from the home.

 — Encourage better training for physicians in how to recognize patients at risk for suicide.

 — Push for eliminating loopholes in laws preventing the purchase or possession of guns by people found guilty of domestic violence, including expanding such measures to cover convicted stalkers.

Many AMA members are gun owners or supporters, including a doctor from Montana who told delegates of learning to shoot at a firing range in the basement of her middle school as part of gym class. But support for banning assault weapons was overwhelming, with the measure adopted in a 446-99 vote.

“There’s a place to start and this should be it,” Dr. Jim Hinsdale, a San Jose, California, trauma surgeon, said before the vote. 

Gun violence is not a new issue for the AMA; it has supported past efforts to ban assault weapons; declared gun violence a public health crisis; backed background checks, waiting periods and better funding for mental health services; and pressed for more research on gun violence prevention.

But Dr. David Barbe, whose one-year term as AMA president ended Tuesday, called the number of related measures on this year’s agenda extraordinary and said recent violence, including the Parkland, Florida, school shooting and the Las Vegas massacre, “spurred a new sense of urgency … while Congress fails to act.”

“It has been frustrating that we have seen so little action from either state or federal legislators,” he said. “The most important audience for our message right now is our legislators, and second most important is the public, because sometimes it requires public pressure on the legislators.”

While it is no longer viewed as the unified voice of American medicine, the AMA has more clout with politicians and the public than other doctor groups. It counted more than 243,000 members in 2017, up slightly for the seventh straight year. But it represents less than one-quarter of the nation’s million-plus physicians.

AMA members cited U.S. government data showing almost 40,000 deaths by gun in 2016, including suicides, and nearly 111,000 gun injuries. Both have been rising in recent years. 

By comparison, U.S. deaths from diabetes in 2016 totaled almost 80,000; Alzheimer’s, 111,000; and lung disease, 155,000. The leaders are heart disease, with 634,000 deaths in 2016, and cancer, about 600,000.
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The most widely used antimalarial therapy may not fully treat some children and pregnant women, according to a new study.

These patients’ bloodstreams contained lower concentrations of one active ingredient compared to adults who aren’t pregnant.

The research may explain why standard doses of artemether-lumefantrine combination therapy (ACT) sometimes fail to cure these sensitive groups. It suggests a change in the treatment regimen may help raise cure rates and prevent resistance.

But experts say this study alone is not enough to warrant changing treatment recommendations.

Treatment failures

Malaria cases have fallen by 60 percent since 2000, thanks to an intensive, multibillion-dollar global campaign of prevention and treatment. But the disease still claims more than 400,000 lives per year, mostly young children in sub-Saharan Africa.

Pills combining artemether and lumefantrine are the most commonly used antimalarial treatment worldwide. The 3-day treatment is generally safe and effective.

However, most drug trials have not included children and pregnant women, who may absorb or metabolize drugs differently than others.

Some studies have found they are more likely than others to contract malaria again within weeks of ACT treatment. Results vary, but some research found failure rates as high as 20 percent.

Lower blood levels

Writing in the journal PLOS Medicine, researchers combined data from 31 studies including more than 4,000 patients. They looked at concentrations of lumefantrine in the blood seven days after treatment began.

Lumefantrine is the longer-lasting part of the drug combination. It is intended to prevent relapses.

The study found lumefantrine levels were 20 percent lower than average in pregnant women’s blood, and 15 to 25 percent less in children.

“This is pretty important,” said lead author Frank Kloprogge at University College London. Drug levels that far below average “can really make a difference.”

Treatment failure is not the only risk. Malaria parasites exposed to lower levels of the drug may survive treatment and produce resistant strains. “And this is, of course, a longer term, potentially, really big problem,” he said.

The scientists developed a model that suggests taking the pills for 5 days would be more effective than the current 3-day schedule.

More information needed

The study is “very well done and important,” said Andrea Bosman, Malaria Prevention, Diagnosis and Treatment Coordinator at the World Health Organization.

However, Bosman added, “it is still a modeling study, and we do not generally make recommendations based on modeling studies alone. We require clinical data.”

Changing therapies is complicated, he notes. The longer treatment lasts, the less people stick to it. That, too, raises the risk that treatment will fail and resistance will develop.

Also, he adds, the bigger issue is poor-quality drugs, which are widespread in much of the malaria-prone world.

Opinions are split over how big a problem the reports of treatment failure in children and pregnant women are.

Earlier this year, the U.S. Centers for Disease Control and Prevention analyzed 21 studies. “They thought we should keep the regime exactly where it is,” noted molecular biologist Brian Grimberg at Case Western Reserve University School of Medicine.

Sleepy parasites

Scientists are still debating why treatment fails. The parasites may have developed resistance, or they may be what Grimberg calls “sleepy parasites.”

“They’re not resistant to the drug. They just go to sleep,” he said. “If it’s true that they’re sleepy, then maybe a longer duration of the treatment regime would be helpful.”

Kloprogge and colleagues are applying for funding to conduct a clinical trial of the 5-day treatment schedule. It will be several years before results are available.
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The recent suicides of high-profile celebrities lead experts to worry that young people will copy the act of taking their own lives.

“They think, ‘Well, OK, that person hung themselves from a banister using 10-foot rope,’ then that might be something that they want to emulate,” said Blaise Aguirre, M.D., a psychiatrist specializing in mood and personality disorders in adolescents at McLean Hospital outside Boston. 

“The sensationalism can make this option seem attractive,” comedian Bridget Phetasy, who has struggled with suicidal thoughts, wrote in a New York Post op-ed. “In all these cases, I’ve heard more details about their deaths than I care to know, and I can’t help but feel like the way we’re covering these deaths isn’t helping.” 

Suicide is the second-leading cause of death among 15- to 29-year-olds around the world, according to the World Health Organization (WHO) in Geneva, and has more than doubled in the past decade. Only road traffic fatalities top suicide as the primary cause of adolescent deaths, with boys accounting for 77 percent of those deaths worldwide. 

Experts say they are frustrated by the attention given to celebrity suicides, such as travel TV host Anthony Bourdain and fashion designer Kate Spade last week, and the impact on youths at risk. High-profile suicide can trigger contagion, which acts like a virus and may push others to take their lives. After the 2014 suicide of Robin Williams, a popular comedian and actor, researchers saw a nearly 10 percent increase in suicides. People grieving a suicide were 65 percent more likely to attempt to take their own life, a study from the University of London showed. 

No one is sure why the contagion effect exists, Aguirre said. He said he thinks that hearing or reading about a suicide “activates neurons that are correlated with suicide” and makes suicide more acceptable to those at risk. Contagion does not influence people who are not at risk, he said.

Many experts say media about suicide amplifies contagion. The popular show 13 Reasons Why, based on a young-adult novel by Jay Asher, follows 17-year-old Clay Jensen as he listens to tapes left by his deceased classmate Hannah, explaining why she killed herself. Asher’s novel was published in 2007 and made the American Library Association’s list of most banned books in 2012 and again in 2017, the year the Netflix show first aired.

Critics say the show and its explicit portrayal of Hannah’s suicide is irresponsible. The suicide is more graphic in the TV series than the book. 

“In a person who is not at risk, it’s not a dangerous show,” Aguirre said. “But in a person who is at risk, it’s a very dangerous show.”

Nic Sheff, who wrote the episode that portrays Hannah’s suicide, defended himself in a Vanity Fair op-ed.

“Facing these issues head-on — talking about them, being open about them — will always be our best defense against losing another life,” he wrote. “It overwhelmingly seems to me that the most irresponsible thing we could’ve done would have been not to show the death at all.”

The controversy remains fresh. Katrina Sheffield, a Florida mom, said the show inspired her daughter’s suicide attempt in May. Her daughter sent a text during her attempt, saying that it was “taking longer” than on 13 Reasons Why, and her method was similar to Hannah’s.

“I have told our daughter that instead of finding 13 reasons why — let’s find 14 on why not!” Sheffield wrote. In a Facebook video, she urged parents to talk to their children about suicide. 

Females are more likely to have suicidal thoughts, called ideation, although the suicide rate is almost four times higher in males. In the U.S., rates are increasing overall, reports the CDC. 

Research suggests that age and race are closely correlated with self-harm statistics. Black children aged 5 to 12 are twice as likely to commit suicide as their white peers, but black teens aged 13 to 17 are 50 percent less likely to do so than white teens. 

Lesbian, gay, bisexual, transgender, queer and other (LGBTQ+) students are also at high-risk — they’re more than twice as likely to consider suicide and over three times more likely to attempt it than their heterosexual peers. Nearly 45 percent of transgender respondents to a Canadian survey reported that they had planned an attempt at least once. 

Facebook has released a program intended to spot users at risk of suicide or self-harm based on their posts, even if no one reports it. 

The World Health Organization offers a guide on reporting suicide, advising the media to be cautious “in reporting celebrity suicides.” 

“Don’t place stories about suicide prominently, and do not unduly repeat such stories,” WHO advised. It discourages describing suicide details, such as method or location.

“The more detail that you give legitimizes that way of doing it. Why not just say the person died by suicide and have that be its own talking point?” Aguirre said. Describing the suicide in detail “doesn’t tell you about the underlying mental health.”

American mental health advocacy groups called for increased attention to and funding for mental health issues following news last week of the death of Bourdain and Spade.

“Too many people in America do not have access to mental health services, and too often we neglect the impacts of traumatic events that sometimes fester for decades before taking people’s lives,” Paul Gionfriddo, president and CEO of Mental Health America, said in a statement.

“With all of us working together, and by collectively making a massive investment in suicide prevention research, resources and quality mental health care, we can, and we will, reverse the rising suicide rate,” the American Foundation for Suicide Prevention wrote.

“Suicide Prevention is a social justice Issue,” tweeted mental health advocate Jacob Griffin. 

South African law student, writer and activist Luke Waltham called for action.

“Actively make your spaces brave ones where people, including yourself, can speak about your feelings and experiences,” Waltham tweeted.

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
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Irene Mboyo Mola spent 11 days caring for her husband as he died of Ebola in a hospital where she said nurses were too scared to get close. She helped him to the bathroom, picked up his feverish body when he lost his balance, and reinserted an IV that fell out of his bleeding arm.

“He told me all he could see was death,” recalls Mola, a 30-year-old mother of six, as she sat slumped on the floor in her small hut.

That close contact put Mola at high risk of getting a disease that has no cure and kills about half of those infected. But now, as Congo battles the most serious Ebola outbreak since the devastating 2014 epidemic in West Africa, health workers have something new to offer: a vaccine.

​Promising vaccine

With thousands of doses dispatched to front-line health workers, the world is watching to see if a promising but still experimental vaccine might help stop this terrifying disease faster than traditional measures doctors have tried since Ebola was identified 40 years ago.

Even if the vaccine helps, there are serious hurdles. The shots must be transported deep into forests with few paved roads without it spoiling in the heat. Health workers have to identify and track down anyone who’s had contact with a sick person. Hardest of all, they must persuade a scared and wary population that shots pushed by foreigners could save their lives.

“Communities themselves must be at the center of the response if the activities are going to be effective,” said Jonathan Polonsky of the World Health Organization, a surveillance coordinator in Mbandaka, a city of more than 1 million in northwestern Congo.

Mola’s six children have all been vaccinated. But she refused, telling government social workers and WHO workers that she didn’t believe her husband died from Ebola. She said the hospital never showed her records confirming he’d tested positive for the virus.

​Fear and opportunity

There’s no guarantee the long-sought vaccine will help stop the outbreak. But Congo’s health ministry and the WHO rushed in 7,500 doses, created by the Public Health Agency of Canada and owned by Merck.

It was deemed the best option because the vaccine was found highly promising in testing a few years ago, when the epidemic in West Africa, which killed more than 11,000 people between 2014 and 2016, was starting to wane.

The plan is called “ring vaccination,” to find and vaccinate everyone who’s had direct contact with a sick person — the first “ring” — and then the contacts of those people, too, to break the chain of infection.

Last month, 11-year-old German Umba and her 6-year-old brother lost their father to Ebola. Both were vaccinated. But a shot alone doesn’t end the worry. U.N. workers monitor the children several times a day for fevers, an early symptom, until the incubation period passes.

Standing in the yard outside her classroom at school the young girl suddenly bursts into tears. Surrounded by aid workers, classmates and teachers who are unable to touch and console her, she buries her face in her shirt. 

“I just miss my father,” she said.

​Crucial window

Success with the vaccination strategy hinges on the speed at which health workers can identify people at risk.

“If you detect cases late, you’re missing the opportunity to protect people,” said Dr. Iza Ciglenecki, who is working on the vaccination campaign with Doctors Without Borders.

Congo’s current outbreak has killed 14 people so far, according to the country’s Ministry of Health. There have been 38 confirmed infections.

Friday, WHO emergency response chief Peter Salama said many people vaccinated in Mbandaka received the shots more than 10 days ago, meaning they’re now protected — the vaccine has had time to kick in.

Finding people who need vaccination is much harder in the remote area of Iboko, where a new case was just reported. Shoddy infrastructure adds to the challenge.

“The roads are so bad that even if a person gets vaccinated it can be too late and they can still die,” said Rosy Boyekwa Yamba, a regional representative for the Ministry of Health in Mbandaka.

It can take days to travel just 100 miles (160 kilometers) to reach remote areas where Ebola still is spreading. The vaccine must be kept at a temperature of minus 76 to minus 112 degrees Fahrenheit (minus 60 to minus 80 degrees Celsius), and can only be kept in mobile freezers for up to seven days.

Yamba also worries that potentially infected people aren’t being found. Five such people came forward last week in Mbandaka after he pleaded with community members to “be honest with him” about whether they’d been in contact with someone who had the disease.

So far more than 2,000 people, including front-line health workers, have been vaccinated in Mbandaka and the rural villages of Bikoro and Iboko where confirmed cases have been found, says the Congo’s Ministry of Health.

​Distrust in the community

Mola’s refusal to believe that Ebola killed her husband is a common reaction in the region. While many in Mbandaka have taken to washing hands and avoiding physical contact amid the outbreak, many also remain skeptical. They often don’t trust a government they say is corrupt. Of the dozens of people The Associated Press spoke to on a recent visit, nearly all said they don’t believe Ebola exists and referred to it as witchcraft.

This is Congo’s ninth outbreak, but illnesses are usually in remote areas, not cities.

“Ebola is not here,” said local resident Aziza Monzu. “It’s a disease created by organizations to get money.”

Dr. Pierre Rollin, an Ebola expert with the U.S. Centers for Disease Control and Prevention, understands. 

“People die every day and everywhere but nobody’s interested. Suddenly because of Ebola people are interested and that makes you suspicious,” he said. “Why would they trust us?”

Mola seems to have escaped infection. The incubation period for Ebola is up to 21 days and her husband died three weeks ago. 

“I’m still here,” she said.

Still, WHO officials say three-quarters of those who have been approached have agreed to a shot since the campaign started two weeks ago. 

Once you’ve got people on board “you’ve tackled 90 percent of the problem,” said Dr. Alhassane Touré, the WHO coordinator for ring vaccination in Congo and Guinea.

Does the vaccine work?

Health experts say the next two weeks will be critical in determining whether the outbreak will be brought under control. The WHO is now shifting efforts to more remote areas to contain the outbreak. The organization has predicted there could be up to 300 cases of Ebola in the coming months.

“We could see is another introduction of someone that comes from Itipo (a village in Iboko) or somewhere else to see family (in Mbandaka),” said CDC’s Rollin. In the last few days there’s been a big push in Itipo, the epicenter of the outbreak with 24 confirmed cases, to retrace people and vaccinate contacts as well as health workers, he said.

No matter how the outbreak unfolds, Rollin says it will be nearly impossible to say whether the vaccine worked to stop the disease’s spread.

“We can say the vaccine plus all the other measures work, but you can’t say the vaccine by itself works,” he said. In order to do that a controlled test would have to be run where in one place only the vaccine is being used and in another it’s not being used at all.

Next year, Merck plans to seek approval of the vaccine from the U.S. Food and Drug Administration, based on previous studies of the shots. While the vaccine isn’t being formally studied in the current Congo outbreak, regulatory authorities would want to know if unforeseen side effects crop up.

“If it’s fully approved, then in each outbreak it’ll be the first measure and could be used all over the region,” Dr. Jean-Jacques Muyembe, director general of the National Institute for Biomedical Research in Kinshasa told the AP.

In West Africa, a large study is underway that compares the Merck shot and a second vaccine candidate made by Janssen Pharmaceuticals to determine the best vaccination strategies and track how long protection lasts.

In the meantime, some recipients say the shot provided peace of mind.

Seated in a yard in the center of town, Mbandaka resident Marie Louise proudly slaps her vaccination papers on the table. She had cradled her grandson in her arms as he vomited blood on the hospital floor, and he later died. His case wasn’t officially confirmed as Ebola, but she knew she needed to get vaccinated. Tapping her arm where she was given the needle, the 68-year-old beams. 

“Give me the vaccine,” she said. “I get life with the vaccine.”
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Keeping healthy could become more costly as climate change and water scarcity cause a huge drop in the global production of vegetables and legumes, scientists said Monday.

The amount of vegetables produced could fall by more than a third, especially in hot regions like southern Europe and swaths of Africa and South Asia, said researchers from the London School of Hygiene and Tropical Medicine.

By analyzing studies across 40 countries, with some dating as far back as 1975, they found that hikes in greenhouses gases, water scarcity and global temperatures lowered the amount of vegetables and legumes produced.

Such drastic changes could drive up the prices of vegetables, which would affect poorer communities the most, according to the study, which was published in the Proceedings of the National Academy of Sciences.

“If we take a ‘business as usual’ approach, environmental changes will substantially reduce the global availability of these important foods,” said Alan Dangour, a co-author of the paper, in a statement.

Scientists have warned that world temperatures are likely to rise by 2 degrees to 4.9 degrees Celsius this century compared with pre-industrial times.

This could lead to dangerous weather patterns — including more frequent and powerful droughts, floods and storms — increasing the pressure on agriculture.

Food production itself is a major contributor to climate change.

Agriculture, forestry and changes in land use together produce nearly a quarter of global greenhouse gas emissions, making them the second-largest emitter after the energy sector, said the United Nations Food and Agriculture Organization.

The volume of food transported around the world also is exacerbating global warming.

The global demand for food is expected to soar as the world’s population is projected to grow to 9.8 billion people by 2050, up from 7.6 billion today, according to the U.N.

Crops now take up 11 percent of the world’s land surface, and livestock grazing covers 26 percent of ice-free land, according to the Organization for Economic Cooperation and Development (OECD).

Farming accounts for about 70 percent of all water used globally, said the OECD.

Water scarcity already affects more than 40 percent of the world’s population, according to the U.N.

That number is expected to rise due to global warming, with one in four people projected to face chronic or recurring shortages by 2050, the U.N. said.

“Urgent action needs to be taken, including working to support the agriculture sector to increase its resilience to environmental changes,” said Dangour. “And this must be a priority for governments across the world.”
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A vaccine against bacterial pneumonia and another against meningitis have saved 1.45 million children’s lives this century, according to a new study.

The diseases the vaccines prevent are now concentrated in a handful of countries where the medications are not yet widely available or were only recently introduced, the research says.

Pneumonia is the leading cause of death among children worldwide. The bacteria targeted by the shots, Haemophilus influenzae type b (known as Hib) and Streptococcus pneumoniae (pneumococcus), are major causes of pneumonia and also cause meningitis. Together, the two bacteria claimed nearly 1.1 million lives in 2000, before the vaccines were widely available, according to the World Health Organization.

Vaccines against the bacteria are not new, but funding to provide them in low-income countries only became available recently.

To estimate their impact, the researchers started with country-by-country data from the WHO on pneumonia and meningitis cases and deaths, as well as vaccine coverage estimates. They factored in data from dozens of clinical studies on infections caused by the two bacteria to create estimates of illness and death from the diseases in 2000 and 2015.

They found deaths from Hib fell by 90 percent in 2015, saving an estimated 1.2 million lives since 2000. Pneumococcus deaths fell by just over half, accounting for approximately 250,000 lives saved.

The research appears in the journal The Lancet Global Health. 

“What was interesting was to see the rate at which some of these deaths have been prevented in the last several years,” said lead author Brian Wahl at Johns Hopkins University, “largely due to the availability of funding for these vaccines in countries with some of the highest burdens [of disease].”

The study estimates that 95 percent of the reduction in pneumococcal deaths occurred after 2010, when 52 low- and middle-income countries began receiving funding from Gavi, The Vaccine Alliance, to introduce the vaccine into their national immunization programs.

“The good news is that the numbers are moving in the right direction,” wrote Cynthia Whitney at the U.S. Centers for Disease Control and Prevention in an accompanying editorial.

However, Whitney added, “far too many deaths — about 900 every day — are still being caused by these two infections.”

She notes that more than 40 percent of the world’s children live in countries where pneumococcal vaccine is not a routine childhood immunization.

Many of the countries with the largest number of deaths from these two bacteria have recently introduced the vaccines, but coverage is uneven.

India, Nigeria, China and South Sudan had the highest rates of death from Hib, the study says. All but China have introduced the vaccine in the past few years.

Half of the world’s pneumococcal deaths occurred in just four countries: India, Nigeria, the Democratic Republic of the Congo and Pakistan. All have recently introduced the vaccine, though in India it is a routine immunization in only three states.

Lowering the global burden of these diseases will depend on improving coverage in these countries, the study says.
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Paraguay is officially free of malaria, the World Health Organization (WHO) said on Monday, making it the first country in the Americas in 45 years to have wiped out the deadly disease which is back on the rise globally.

Nearly half a million people — most of them babies and children in Africa —  died in 2016 from mosquito-borne malaria, while at least 216 million were infected, an increase of five percent over 2015, WHO said.

With no recorded cases of malaria in five years, Paraguay became the first country in the region to have eliminated malaria since Cuba in 1973, the WHO said. It was the first country to be declared malaria free since Sri Lanka in 2016.

“It gives me great pleasure today to certify that Paraguay is officially free of malaria,” Tedros Adhanom Ghebreyesus, head of WHO, said in a statement.

“Success stories like Paraguay’s show what is possible. If malaria can be eliminated in one country, it can be eliminated in all countries.”

While significant progress has been made over the past 20 years in reducing malaria cases and deaths, in 2016, for the first time in a decade, the number of malaria cases rose and in some areas there was a resurgence, the WHO said.

Health experts say this was partly to blame on a growing resistance to the sprays and drugs used to attack the mosquito that transmits the disease and the parasite that causes it.

They also say it is partly due to stagnant global funding for malaria since 2010. Climate change and conflict can also exacerbate malaria outbreaks.

“This is a powerful reminder for the region of what can be achieved when countries are focused on an important goal,” said Carissa Etienne, director of the Pan American Health Organization (PAHO), the WHO’s regional office.

“We are hopeful that other countries will soon join Paraguay in eliminating malaria,” she said in a statement.

In 2016 the WHO identified Paraguay as one of 21 countries with the potential to eliminate malaria by 2020.

The WHO said Algeria, Argentina and Uzbekistan are on track to be declared free from malaria later this year.
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