YCLOAK

Tuberculosis is a vicious epidemic that is drastically underfunded. That was the takeaway message from the first high-level meeting focused on the infectious disease at the U.N. General Assembly in New York.

Amina Mohammad, U.N. deputy secretary-general, said the disease is fueled by poverty, inequality, migration and conflict, and that an additional $13 billion per year is needed to get the disease under control.  

Last year, tuberculosis killed more people than any other communicable disease — more than 1.3 million men, women and children.

The World Health Organization estimates that the 10 million people who become newly infected each year live mostly in poor countries with limited access to health care.

Dr. Tedros Adhanom Ghebreyesus, head of the WHO, told the assembly that partnership is vital to end the disease. He said the WHO is committed to working with every country, partner and community to get the job done.

The WHO plans to lead U.N. efforts to support governments and other partners in order to drive a faster response to TB.

Most people can be cured with a six-month treatment program. But as world leaders told the assembly, medication is expensive, and the stigma associated with TB interferes with getting people screened and treated.

Nandita Venkatesan, a young woman from India, told the assembly about the toll the disease has taken on her life. She got TB more than once, including a drug-resistant variety. She said it robbed her of eight years of her life while she was being treated. One of the medications she took to help cure TB robbed her of her hearing.

Venkatesan said getting cured involved hospital stays, six surgeries and negative reactions to at least one drug used to cure her.

Just days before the high-level meeting, the WHO released its annual TB report. It found cases in all countries and among all age groups. It also found that two-thirds of the cases were in eight countries — India, Pakistan, Bangladesh, China, Indonesia, the Philippines, South Africa and Nigeria.

The meeting ended with the adoption of a declaration intended to strengthen action and investments for ending TB and saving millions of lives.
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A new report warns that wetlands are disappearing three times faster than the world’s forests, with serious consequences for all life on earth. 

The Ramsar Convention on Wetlands is a global treaty ratified in 1971 by 170 countries to protect wetlands, which are ecosystems inundated by water, such as swamps, bogs and floodplains. 

Unfortunately, the goal of this treaty is under threat. Ramsar Convention officials report about 35 percent of the world’s wetlands have been lost between 1970 and 2015.

State of crisis

Unless this situation is urgently reversed, Ramsar Convention Secretary-General Martha Roja Urrego warns the world will be in a state of crisis because wetlands are critical for all aspects of life.

“All the water that we use for consumption, irrigation and for hydro-electricity comes directly or indirectly from wetlands,” Urrego said. “Secondly, wetlands also have a main function in filtering waste and pollutants, so they act as the kidneys of the world. They filter the waste.”

Urrego says wetlands also are essential in regulating the global climate as peatlands store twice as much carbon as the world’s forests. 

Several factors

The report finds wetland loss is driven mainly by such factors as climate change, population increase, changing consumption patterns and urbanization, particularly in coastal zones and river deltas.

Authors of the report say biodiversity also is in a state of crisis. They say more than 25 percent of all wetlands plants and animals are at risk of extinction.

Scientists say without biodiversity, there is no future for humanity, because the air people breathe, the water they drink and the food they eat ultimately rely on biodiversity in its many forms.
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An observatory in Barrow, Alaska, the most northerly astronomical outpost in the U.S., has become a key scientific instrument in studying climate change. Established in 1973, the Barrow Observatory is staffed year-round by two researchers who measure and track changes in air quality and weather, while also acclimating with local traditions. Natasha Mozgovaya traveled to Barrow, now officially called Utqiagvik, its Inupiaq name, to see what life is like in one of the coldest places in the world.
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An estimated 80,000 Americans died of flu and its complications last winter, the disease’s highest death toll in at least four decades.

The director of the U.S. Centers for Disease Control and Prevention, Dr. Robert Redfield, revealed the total in an interview Tuesday with The Associated Press.

Flu experts knew it was a very bad season, but at least one found the size of the estimate surprising.

“That’s huge,” said Dr. William Schaffner, a Vanderbilt University vaccine expert. The tally was nearly twice the figure previously seen by health officials as representing a bad year, he said.

In recent years, flu-related deaths have ranged from about 12,000 to 56,000, according to the CDC. 

Last fall and winter, the U.S. went through one of the most severe flu seasons in recent memory. It was driven by a kind of flu that tends to put more people in the hospital and cause more deaths, particularly among young children and the elderly.

The season peaked in early February and it was mostly over by the end of March.

Making a bad year worse, the flu vaccine didn’t work very well. Experts nevertheless say vaccination is still worth it because it makes illnesses less severe and saves lives.

CDC officials do not have exact counts of how many people die from flu each year. Flu is so common that not all flu cases are reported, and flu is not always listed on death certificates. So the CDC uses statistical models, which are periodically revised, to make estimates.

Fatal complications from the flu can include pneumonia, stroke and heart attack.

CDC officials called the 80,000 figure preliminary, and it may be revised. But they said it was not expected to go down.

The 80,000 figure eclipsed estimates for every flu season going back to the winter of 1976-77. Estimates for many earlier seasons were not readily available.

Last winter was not the worst flu season on record, however. The 1918 flu pandemic, which lasted nearly two years, killed more than 500,000 Americans, historians estimate.

It’s not easy to compare flu seasons through history, partly because the nation’s population is changing. There are more Americans — and more elderly Americans — today than in decades past, noted Dr. Daniel Jernigan, a CDC flu expert.

How bad will the coming flu season be? So far, the flu that’s been detected is a milder strain, and early signs are that the vaccine is shaping up to be a good match, Jernigan said.

The makeup of the vaccine has been changed this year to try to better protect against expected strains.

“We don’t know what’s going to happen, but we’re seeing more encouraging signs than we were early last year,” Jernigan said. 
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After decades of disappointment in efforts to develop a malaria vaccine, researchers are starting to see promise in a new approach.

While most vaccines trigger the body’s defenses to produce antibodies against a disease-causing germ, the new approach recruits an entirely different branch of the immune system.

If it works, it could open up a new route to attack other diseases, including hepatitis and possibly HIV, the virus that causes AIDS.

Nearly 450,000 people die of malaria each year, according to the World Health Organization. The parasites that cause the disease are increasingly becoming drug-resistant. 

One successful vaccine has been developed so far, but it prevented only about a third of cases in a clinical study.

Experts have decided that’s better than nothing. The vaccine is being piloted in Ghana, Kenya and Malawi.

New angle

Other scientists are trying a different angle of attack.

There are basically two ways to prevent germs from causing infections. “You either prevent them from getting into cells with antibodies, or you kill them inside the cells with T-cells,” said Stephen Hoffman, chief executive officer of Sanaria, a company working on one vaccine.

Most vaccines target the infection by building up antibodies. “If you need to kill them inside the cells with T-cells, we haven’t been overwhelmingly successful,” Hoffman said.

But Sanaria is one group seeing success by targeting malaria parasites inside infected liver cells, the first stop in the complex life cycle of the disease.

One key difference is how the vaccine is delivered. Hoffman’s group tried a typical route: injecting radiation-weakened parasites into patients’ skin or muscle. That didn’t work.

But it did work when injected directly into veins.

The weakened parasites traveled to the liver, where they set off an immune reaction. Defensive cells killed liver cells that were infected with malaria parasites.

And the liver’s defenses were ready when faced with the real thing months later.

Most of that early work has been done in mice and macaques. When Hoffman and colleagues did something similar with a handful of human patients, most were protected against infection.

No waiting

Recruiting immune cells in the liver is especially effective because “we don’t need to wait until the immune system figures out that the parasite is in the liver and starts mounting an immune response, which can take days and sometimes weeks,” said Adrian Hill, director of the Jenner Institute at Oxford University. 

“By then, the malaria’s gone. It only spends a week in the liver, and then it’s out in your blood causing disease.”

Hill’s group just published a study in the journal Science Translational Medicine in which immune cells in the liver were triggered by using a protein from the parasite, rather than the entire organism.

Scientists hope to get a better grasp on the system these vaccines employ, known as cellular immunity. Harnessing this system could help tackle hepatitis and HIV infection.

Drugs can control HIV infection but can’t eliminate it from the body.

“If somebody could get cellular immunity to work really well for vaccination, that would be transformative for a whole range of diseases,” Hill said. “Not just for infectious diseases that we want to prevent, but ones that we want to treat and we can’t treat today.”
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Sometimes, all the hand sanitizer in the world cannot prevent the inevitable.

College freshmen across the country are being introduced to a whole new world of pathogens and other infections at this time of year.

It starts with just one or two people in a dorm hall, said Dr. David Reitman, medical director of the Student Health Center at American University in Washington. They cough without covering the spray of germs that can reach 30 feet, as measured by Massachusetts Institute of Technology researcher Lydia Bourouiba.

Then comes a sore throat and a general feeling of ickiness that lasts a week or so. It spreads slowly but surely, and soon the whole floor of the dorm is a sick ward. Once again, new students have been struck by the freshman plague.

Brendon Gardner, a freshman at Fordham University in New York, had been warned by older siblings and friends about the cesspool of pathogens he was about to enter, but he still wasn’t prepared. 

“I figured, eh, wouldn’t happen to me. But then it did,” said Gardner from his dorm after a week of coughing and a runny nose. “And it was so annoying.”

Not a specific pathogen

The freshman plague, Reitman said, is not one particular disease or pathogen, but “refers to viruses that are easily transmissible by people who are living in close quarters in which they easily pass from one person to another.”

The plague emerges in freshman dorms because of a perfect storm of factors: a large group of people crammed into a relatively small space, often sharing facilities such as showers, kitchens and bathrooms. This makes it easy for viruses to hop from one victim to the next.

The reason these illnesses appear more commonly in freshman dorms than in upperclassman housing is freshman are exactly that — fresh. They are still learning the ropes of dorm living and have not yet mastered the practices and routines that could keep them healthy.

The best way to avoid catching the plague, Reitman said, is to maintain basic hygiene and healthy habits. Wash your hands often, including your wrists. Use a hand sanitizer, especially before eating. This, as well as avoiding behaviors like sharing drinks or food, can improve one’s odds against contracting viruses. And don’t smoke. It inflames the respiratory system, he said.

Less obvious ways of dodging the plague are to drink lots of fluids and maintain regular sleep and eating schedules. That’s easier said than done for college students.

And there’s always the flu vaccine. Although 70 percent of college students in the U.S. say they believe it is important to get a yearly flu shot, only 46 percent say they get vaccinated, according to a National Foundation for Infectious Diseases report in 2017. So, the plague persists.

“I just wanted to stay in bed all day but couldn’t because I have 8:30 classes every morning. And in class, I didn’t want to talk at all because I sounded like a croaking toad,” said Arnav Bhutada, another freshman plague sufferer at Fordham.

Tips for coping

Though freshman plague is not a serious or threatening disease, it can really put a damper on those first months of college. To make it more bearable,  take ibuprofen to help ease sore throats and general achiness, Reitman said. Get lots of fluids and sleep, and maybe swap out that pizza and fries for soup at the dining hall.

If more serious symptoms appear — fever above 102 degrees or diarrhea — or the illness persists beyond a week, students should consider seeking medical attention.

Students who are bedridden should curl up with a nice mug of tea, catch up on Netflix and wait for the body to cleanse itself of the virus so they can go back to making the most of their college experience. 
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The Trojan Horse allowed the ancient Greek army to enter the city of Troy and defeat it. A similar strategy could help doctors destroy superbugs that are resistant to current antibiotics.

The decreasing effectiveness of antibiotics is among the most critical challenges facing medicine today, as drug-resistant bacteria resist almost every therapy thrown at them. But researchers at the University of Washington School of Medicine wondered if superbugs could be tricked into taking in a molecule that looks like food but wreaks havoc once inside.

Microbiology professor Pradeep Singh said they focused on iron, which is a critical nutrient for bacteria to multiply and spread. He told VOA that natural binders in the body take up iron, which is also important for our health, and try to keep it from bacteria. But the invaders have mechanisms to get to the bound iron.

“So, we were thinking about an alternative way that didn’t involve iron binding,” he explained. “How could we exploit the really high requirement for iron for infecting bacteria? And that’s how we came up with the idea of using a chemical mimic to exploit the bacteria’s own uptake system to get an antimicrobial drug inside.”

An iron Trojan Horse

The mimic they chose was gallium, a metal similar to iron. And like many successful antibiotics, Singh notes that gallium targets a number of vital functions in the bacteria.

“We know that one of the things it does is it inhibits an enzyme that is involved in producing copies of bacterial cell DNA — that’s really important for making daughter cells. If you can’t replicate your DNA, you can’t multiply. We’ve also shown that gallium can inhibit an enzyme that protects (bacteria) from oxidative stress like hydrogen peroxide. It probably does a bunch of other things, too, so it kind of just causes this kind of haywire in the cell for a bunch of those biological functions of iron.”

In lab studies, bacteria developed resistance to gallium at low rates, and its potency was increased when it was administered with some existing antibiotics. These factors led Singh and his colleague Chris Goss, a professor of medicine and pediatrics, to do preliminary tests of gallium in mice and humans, with exciting results detailed in the current issue of Science Translational Medicine.

A promising strategy against bad bacteria

 

In mice, they found that a single dose of gallum cured lethal lung infections.

The human trial — involving 20 patients with the lung disease cystic fibrosis — provided some tantalizing findings. Goss told VOA the gallium was given by infusion over five days. And while it rapidly cleared from the blood, it moved to the lungs, positively impacting patients’ breathing for up to a month.

“The key measure in cystic fibrosis and many lung diseases is forced expiratory volume, which is, you blow in a tube, and we see how much you can blow. And what we found is actually (forced expiratory volume) increased significantly from baseline in the realm of what we would normally see in an antibiotic-treated population. So, a similar effect as giving inhaled antibiotics or some oral antibiotics. And that was what I think made this an unusual finding, that the proof seemed to be there that you can give this drug intravenously, and it would actually impact lung function.”

More research is needed to confirm gallium’s safety and effectiveness as a treatment, but preliminary results suggest that the strategy that ended the Trojan War might be a winning approach to today’s battle against superbugs.
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An experimental GlaxoSmithKline vaccine could prevent tuberculosis developing in half of those who receive it, making it potentially the first new shot against the global killer in a century, researchers said on Tuesday.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Heavy rains

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

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

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

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

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

Activists on social media said the number of people infected by the disease was much higher than the government’s figure and that there had been deaths not documented by the government.
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