by Charlotte Kilpatrick | Apr 30, 2024 | Infection |
In April 2024 Ministers of Health and partners in Africa met in Kinshasa, Democratic Republic of Congo, for a high-level emergency regional meeting about mpox in Africa. An outbreak in Democratic Republic of Congo (DRC) has been causing growing global concern, with a recent report identifying a novel Clade I MPXV lineage “associated with sustained human-to-human transmission”. The authors call for immediate action to contain any pandemic potential. However, while the smallpox vaccine was found to prevent about 85% of mpox cases, it was deployed almost exclusively in high-income countries, and DRC still has no access to vaccines or treatments.
A divergent strain
In October 2023 a “large” mpox outbreak emerged in the Kamituga region of DRC; this outbreak is the subject of a 2024 preprint. The authors state that 241 suspected cases were reported within 5 months of the first reported case; these “rapidly” increasing numbers were tested to reveal a “distinct MPXV Clade Ib lineage”, which is “divergent” from previously sequenced Clade I strains in the country. Of 108 confirmed cases, 29% were in sex workers, “highlighting sexual contact as a key mode of infection”.
Significant concerns
The authors of the preprint highlight “significant concerns” raised by the “sustained spread” of Clade I in a “densely populating, poor mining region”.
“Local healthcare infrastructure is ill-equipped to handle a large-scale epidemic, compounded by limited access to external aid.”
Not only are reported cases a concern, but they are “likely an underestimate of the true prevalence”. Conversations with local HCWs revealed that “many people” have mpox “signs and symptoms” but do not seek care. The “frequent travel” between Kamituga and neighbouring Bukavu is a worrying factor for the researchers, who anticipate “subsequent movement” to countries such as Rwanda and Burundi. Additionally, foreign sex workers returning to their home countries and the “highly mobile nature” of the mining population privude a “substantial risk of outbreak escalation”.
“Urgent measures must be implemented, including intensifying local surveillance, enhancing referral systems and case management, and implementing targeted mpox vaccination for individuals at high risk”.
African health ministers unite
At the high-level emergency meeting in DRC this month, the health ministers of Angola, Benin, Burundi, Cameroon, Central African Republic, Congo, Democratic Republic of Congo, Gabor, Ghana, Liberia, Nigeria, Uganda, and “partners” shared a communiqué:
Noting with concern – the prolonged and ongoing epidemic of mpox in several Central and West African countries and the potential risk of transmission to neighbouring countries and beyond
Seriously concerned – about the changing transmission dynamics, high mortality rate and transmissibility of the monkeypox virus, as well as the morbidity, mortality, and social and economic impacts
Aware – of the limitations on access to and acquisition of medical countermeasures, including diagnostics, treatments, vaccines, and other tools for early detection, verification, care, treatment, and prevention
Recognising – the common threat posed by the mpox outbreak to the health and economic security of the populations to the Central and West African regions and the urgent need to address this common threat by all member states of the African Union
Acknowledging – the existing frameworks, protocols, strategies, and agreements for cross-border solidarity, collaboration, and coordination on infectious disease issues
The communiqué outlines various commitments by African health ministers, including:
- Promoting a “One Health” approach
- Facilitating cooperation and collaboration between all Member States
- Facilitating technical support through Africa CDC and WHO mechanisms at various levels
- Exchanging information rapidly
- Establishing the Africa Taskforce for Mpox Coordination, to be facilitated by the African Union Commission, Africa CDC, and WHO
- Demanding partners harmonise support by interacting with the Taskforce
Despite the evident commitment of African health ministers, they are concerned by the “scale and severity” of the epidemic. Goats and Soda reports that DRC’s Health Minister, Dr Samuel-Roger Kamba, addressed the meeting in French to express urgency:
“This situation constitutes a public health emergency.”
However, Dr Nicaise Ndembi, virologist and senior advisor to Africa CDC’s Director-General, is quoted in the same article noting that “meetings are meetings” unless we “really take action”. Dr Ndembi is cautious about an official declaration, recalling the difficult experience of COVID-19 restrictions on local economies.
“It’s very sensitive.”
Despite this delicacy, Dr Ndembi encourages health officials: “Declare!”
“By declaring, you have access to the drugs, you have access to the vaccines…and that will open the door for international support to mobilise resources.”
Will vaccine approval be accelerated in time to protect at-risk communities? To stay up to date on the latest infectious disease and outbreak news, why not subscribe to our newsletters here?
by Charlotte Kilpatrick | Apr 29, 2024 | Infection |
A joint risk assessment from FAO/WHO/WOAH in April 2024 considers the public health risk and risk of virus spread among animals for the A(H5N1) viruses of highly pathogenic avian influenza (HPAI). The assessment coincides with FDA reports that “initial results from a nationally representative commercial milk sampling study” revealed that “about 1 in 5 of the retail samples tested” were qPCR-positive for HPAI viral fragments. This update caused global concern, despite the agency’s caution that “additional testing is required” to understand the risk to consumers.
The risk assessment
The joint risk assessment puts the current outbreak in a (recent) historical context; in 2020, highly pathogenic avian influenza (HPAI) A(H5N1) clade 2.3.4.4b viruses arose from “previously circulating” influenza A(H5Nx) viruses. These have spread “predominantly” through migratory birds to parts of Africa, Asia, and Europe, causing “unprecedented” deaths in wild birds and outbreaks in domestic poultry.
By the end of 2022, the viruses were detected in North and South America. To add to growing concerns, there were “increased detections” of A(H5N1) viruses in non-avian species. Furthermore, 28 detections of A(H5N1) in humans have been reported to WHO.
“Avian influenza A(H5N1) viruses, especially those of clade 2.3.4.4b, continue to diversify genetically and spread geographically.”
The infection of a “broader range” of wild bird species has provoked “deleterious ecological consequences” and “mass die-offs in some species”. Some wild mammal species have suffered “significant mortality events”. The assessment highlights that there have been “limited reports” of transmission between mammals, despite an increase in mammalian infections. However, since March 2024, A(H5N1) detections in 33 dairy cattle herds in 8 states in the USA suggest that “lateral transmission among cattle” was “likely”.
The assessment refers to 28 detections of A(H5N1) in humans since the beginning of 2021, 13 of which have been associated with the clade 2.3.4.4b viruses. The geographical distribution of these is:
- China (2)
- Chile (1)
- Ecuador (1)
- Spain (2)
- The UK (5)
- The USA (2)
The cases in Europe and North America were “asymptomatic or mild”, but the cases in China were severe, with one resulting in death. In Chile and Ecuador both cases had severe symptoms and recovered. All human cases, excluding the case in Chile, had exposure to infected animals through participation in outbreak response activities or direct exposure in farm, backyard holdings, or live bird market environments. It is believed that the case in Chile was caused by “environmental exposure”.
The assessment suggests that WHO assesses the overall public health risk posed by A(H5N1) to be “low”, for those with exposure to infected birds or animals or contaminated environments to be “low-to-moderate”. However, this requires “close monitoring”.
US agencies: commercial milk supply is safe
Amid the US outbreak of HPAI across dairy farms in “multiple” states, the FDA and USDA have drawn on “currently available information” to conclude that the commercial milk supply is safe because of two reasons:
- The pasteurisation process
- The diversion or destruction of milk from sick cows
The emphasis on pasteurisation is clear:
“The pasteurisation process has served public health well for more than 100 years. Pasteurisation is a process that kills harmful bacteria and viruses by heating milk to a specific temperature for a set period of time to make milk safer…pasteurisation is generally expected to eliminate pathogens to a level that does not pose a risk to consumer health.”
The FDA states that “nearly all (99%)” of the commercial milk supply from dairy farms in the US is provided by farms on the Grade ‘A’ milk programme that follow the Pasteurised Milk Ordinance. This emphasis on pasteurisation addresses reports that the presence of the virus has been detected in raw milk. While pasteurisation is “likely to inactivate the virus”, it is not expected to “remove the presence of viral particles”.
Experts’ opinions
STAT News’ Helen Branswell spoke to several pathogen experts about the “danger associated with raw milk”. One such expert is Professor Thijs Kuiken from Erasmus Medical Centre in the Netherlands, who has been engaged in H5N1 research for “about two decades”.
“If I were in charge, for the moment I would forbid the selling of raw milk.”
Equally averse to raw milk consumption is US-based St Jude Children’s Research Hospital’s Dr Richard Webby:
“I absolutely wouldn’t go anywhere near raw milk in terms of consuming it.”
Dr Jürgen Richt, Director of the Centre of Excellence for Emerging and Zoonotic Animal Diseases at Kansas State University’s College of Veterinary Medicine, echoes this concern.
“I wouldn’t want to drink raw milk. And I wouldn’t feed it to my cats, nor my dogs, nor my calves, if I’m on a farm.”
Professor Florian Krammer of the Icahn School of Medicine at Mount Sinai, New York, considered the possibility of starting infections from the mid gut less likely than other options, as stomach acids could inactivate the virus. However, he too is cautious about the risks.
“Maybe it does something very unexpected. There’s just not enough data to say anything conclusive. So, I think people should just be watchful.”
As the H5N1 situation continues to evolve and infectious disease management remains a primary global concern, we will share insights and updates in our newsletters, so do make sure that you have subscribed here.
by Charlotte Kilpatrick | Apr 25, 2024 | Infection |
For World Malaria Day 2024, WHO shared a message from the Director of the WHO Global Malaria Programme and emphasised the need to return to malaria progress in line with this year’s theme:
“Accelerating the fight against malaria for a more equitable world.”
WHO suggests that, in recent years, progress in reducing malaria has “ground to a standstill”, affecting health and costing lives. Furthermore, it “perpetuates a vicious cycle of inequity”. In this article we cover the message from WHO Global Malaria Programme Director, explore the key concerns shared for this year’s World Malaria Day, and share UKHSA’s update on malaria cases observed in the UK.
World Malaria Day: in pursuit of an equitable world
The theme, “accelerating the fight against malaria for a more equitable world”, highlights the fact that malaria “disproportionately” affects people who live in the “most vulnerable situations”. WHO states that the African Region “shoulders the heaviest burden” of the disease; in 2022 it accounted for 94% of malaria cases and 95% of malaria deaths. WHO reflects that the “current trajectory” indicates that we will miss critical 2025 milestones for reductions in cases and deaths.
The most likely to be affected are those who live in “situations of poverty and with less access to education”. This year, WHO is joining the RBM Partnership to End Malaria and other partners to highlight barriers to health equity, gender equality, and human rights in malaria responses worldwide, with “concrete measures to overcome them”.
Dr Ngamije’s message
Dr Daniel Ngamije, Director of the WHO Global Malaria Programme, shared a message in April 2024, highlighting the collaboration with the RBM Partnership and others. The statement begins by “acknowledging the tremendous contributions of national malaria programmes and their partners”.
“Our collective work will contribute to a more equitable future.”
However, malaria is still a “serious global health challenge” that takes the “heaviest toll on the most vulnerable”. Dr Ngamije is concerned that “too many people” are missing the services and information needed to prevent, detect, and treat malaria. This is particularly true for those “experiencing disadvantage, discrimination, and exclusion”.
“We need to strengthen and step up our support for these populations – not only is it our moral duty, it is the best way to get back on track to achieve our global malaria targets.”
Since 2017, WHO has been reporting “stalling of progress”, notably in countries that carry a high burden of disease. In 2022, malaria killed around 608,000 people and caused 249 million new cases.
“Without a change in the current trajectory, many people, especially those living in situations of greatest poverty and vulnerability, will continue to die from malaria – a disease that is preventable and treatable.”
High burden countries
Dr Ngamije identifies “health inequities” as “hampering efforts” to reduce malaria in the countries hardest hit by disease. With the “High burden to high impact” (HBHI) approach from 2018, countries have been identifying those who suffer most and responding with a “concerted effort” to provide customised packages of interventions and services.
Low burden countries
“Health inequities are also undermining efforts to complete the last mile in the pathway to eliminate malaria.”
In “many” lower burden countries, cases of malaria are “concentrated among vulnerable, hard-to-reach populations”. These populations include mobile and migrant workers, refugees, and indigenous communities.
“Reaching, engaging, and empowering these populations with targeted, gender-responsive, and culturally sensitive interventions and services is an important strategy for achieving our collective vision of a malaria-free world.”
Yaoundé Declaration
In March 2024, Ministers of Health from HBHI countries demonstrated “further political commitment” as they signed the Yaoundé Declaration in Cameroon. This declaration signified Ministers’ commitment to providing “stronger leadership and increased domestic funding for malaria control programmes”, ensuring investment in data technology, applying the latest technical guidance, and enhancing control efforts at all levels.
The declaration demands that countries “sustainably and equitably” address the challenge of malaria, with Ministers recognising the importance of “tackling the root causes of stagnating progress in malaria control”. Further commitments relate to ensuring all populations at risk of malaria “consistently receive the appropriate tools”.
What are WHO and partners doing?
The global malaria response can be strengthened by increased investment into the research and development of new tools to benefit anyone who is at risk, especially the “poorest and most marginalised populations”. WHO hopes that recommended tools will be scaled up in an “equitable and sustainable way”. For example, recent recommendations, such as dual active ingredient nets and malaria vaccines, could increase health equity for populations at risk of malaria.
WHO also suggests that the fight against malaria can be accelerated through a commitment to UHC (universal health coverage).
“Everyone should have access to the health services they need – when and where they need them, and without facing financial hardship.”
WHO recommends reorienting health systems towards primary care, which is understood to be the “most inclusive, equitable, and cost-effective way to achieve UHC”. A recent operational strategy from the Global Malaria Programme has the “potential to shape the malaria ecosystem and achieve impact at country level”. The strategy emphasises that efforts to fight malaria should be “rooted in the principles of health equity, gender equality, and human rights”.
UKHSA data
In advance of World Malaria Day, UKHSA shared data that reveal an increase in malaria cases across England, Wales, and Northern Ireland. Reported cases exceeded 2,000 for the first time since 2001, with cases confirmed in individuals who had “recently been abroad”. The number of cases is described as a sign of the importance of “taking precautions” while travelling abroad.
In 2023 there were 2,004 cases of malaria confirmed after international travel, which compares with 1,369 in 2022. UKHSA links this rise to a “resurgence of malaria in many countries” and an increase in overseas travel as pandemic restrictions were lifted.
ABCD and commentary
UKHSA shares the ABCD of malaria prevention: “Awareness of risk, Bite prevention, Chemoprophylaxis, and Diagnose promptly and treat without delay”. This method can ensure that travellers are protected as they follow travel advice for their destination. There are currently no licensed malaria vaccines for travellers.
Professor Peter Chiodini is Director of the UKHSA Malaria Reference Laboratory (MRL) and remarked that “all malaria cases are preventable”, with “simple steps” reducing infection risks.
“While malaria can affect anyone, the majority of Plasmodium falciparum malaria cases in the UK occur in those of African background. Even if you have visited or lived in a country before, you will not have the same protection against infections as local people and are still at risk.”
Professor Chiodini is working “in partnership with communities at greater risk” to improve access to and use of “effective” malaria prevention measures. Dr Dipti Patel, Director of the National Travel Health Network and Centre, encouraged travellers to “prioritise” their health and “plan ahead”.
“Check the relevant country information pages on our website, TravelHealthPro, and ideally speak to your GP or travel health clinic 4 to 6 weeks ahead of travelling to ensure you have had all the necessary vaccinations and advice you need to ensure your trip is a happy and healthy one.”
At The World Vaccine Congress malaria continues to be a topic of priority and we look forward to continuing these conversations with the community. Do make sure you have subscribed to our weekly newsletters here for more information and insights.
by Charlotte Kilpatrick | Apr 23, 2024 | Infection |
During European Immunisation Week 2024 (21st-27th April), the European Centre for Disease Prevention and Control (ECDC) released data that show an “increase in cases of vaccine-preventable diseases”. Diseases such as measles and pertussis are demonstrating a marked increase across the region. The greatest risk is to young children, with ECDC emphasising the importance of “community immunity”.
A “disheartening” trend
Dr Andrea Ammon is the Director of ECDC and is concerned by the data.
“It is disheartening to see that despite decades of a well-documented safety and effectiveness track record of vaccines, countries in the EU/EEA and globally still face outbreaks of several vaccine-preventable diseases.”
Dr Ammon suggested that the “key actions” against diseases will be “achieving and maintaining high vaccination uptake, disease surveillance, and prompt response actions”.
“Vaccines have protected many generations, and we should ensure that this continues to be the case.”
Measles
ECDC reports that the increase in measles cases began in 2023, and the trend has continued in “several” EU Member States. Between March 2023 and the end of February 2024, “at least” 5770 measles cases were reported. This includes “at least” 5 deaths. In February 2024, 29 countries shared measles data with the ECDC. A total of 623 cases were reported by 21 countries. While case numbers decreased in comparison with the previous month, ECDC implies that this could be attributed to “reporting delays”.
Countries that reported the highest case counts were Austria (190), Romania (152), Italy (92), Germany (59), and France (38). The highest risk is faced by infants below one year of age, who are too young to be vaccinated. They should “therefore be protected by community immunity”.
“Measles spreads very easily, therefore, high vaccination coverage, of at least 95% of the population vaccinated with two doses of measles-containing vaccine, is essential to interrupt transmission.”
Pertussis
Pertussis cases have also been observed in greater numbers since mid-2023, and ECDC suggests that a “more than 10-fold increase in cases” is emerging in preliminary data from 2023 and 2024 compared to 2022 and 2021. Again, newborn babies and infants, who are too young to be “fully vaccinated”, are at an increased risk of severe disease or death.
“To best protect them, it is essential to ensure that all recommended pertussis-containing vaccines are given on time.”
Furthermore, vaccination during pregnancy can protect infants.
Identifying immunity gaps
ECDC encourages countries to apply “continuous efforts” to the identification of immunity gaps in the population. Individuals should check with healthcare providers to ensure that they are up to date with recommended vaccines and timelines, which vary by country.
“Additional work is needed to ensure no one is left behind, especially amongst vulnerable and underserved populations such as refugees, migrants, asylum seekers, and other groups.”
European Immunisation Week
European Immunisation Week is recognised as a “key occasion” to “underscore the importance of vaccination” for health and wellness at all stages of life. It is also a change to celebrate “one of the most remarkable achievements in public health of the 20th century”: vaccines.
“ECDC remains committed to supporting and enhancing national vaccination programmes, prioritising the principles of vaccine quality, safety, and efficacy, and ensuring timely and fair access for all.”
If European vaccine coverage and disease control are of interest, why not join us in Barcelona for the Congress this October, or subscribe to our newsletters for more updates?
by Charlotte Kilpatrick | Apr 12, 2024 | Infection |
In April 2024 WHO shared that the 2024 Global Hepatitis Report, released at the World Hepatitis Summit, reveals an increase in the number of lives lost to viral hepatitis. The disease is reportedly the “second leading infectious cause of death globally”, claiming 1.3 million lives a year. This is the same as tuberculosis, described as a “top infectious killer”. The report highlights that, although we are equipped with diagnostic and treatment tools, coverage rates for testing and treatment have “stalled”. However, WHO suggests that the elimination goal for 2030 should “still be achievable” if “swift actions” are taken.
Data highlights
Data from 187 countries reveal that the estimated number of deaths from viral hepatitis increased from 1.1 million in 2019 to 1.3 million in 2022. Hepatitis B was the cause of 83% of these deaths, and hepatitis C caused 17%. The increase in estimated mortality over the past few years indicates that the number of hepatitis-related cancer cases and deaths are increasing.
“Access to effective interventions must be urgently expanded to save lives and prevent a future generation of new infections, cancer cases, and deaths.”
The estimated number of new infections declined from 2.5 million in 2019 to 2.2 million in 2022. Of these new infections, 1.2 million were hepatitis B and nearly 1 million hepatitis C. Improved data imply that hepatitis B and C prevention, including immunisation and safe injections, as well as the initial effect of expanded hepatitis C cure, have influenced the incidence reduction.
The report states that “half the burden” of chronic hepatitis B and C infection is among people between the ages of 30 and 54 years, and men account for 58% of all cases. Roughly 12% of the burden is borne by children, particularly for hepatitis B. Populations at greatest risk are those with a history of or risk of exposure through unsafe blood supplies, medical injections, and other health procedures. Newborns and children at risk through vertical transmission of hepatitis B are also at higher risk. The report also identifies “key populations”, including people who inject drugs and people in “closed settings”.
There is “regional variation in the viral hepatitis burden and response. For example, the WHO African Region accounts for 63% of new hepatitis B infections, but only 18% of newborns in the Regions receive the hepatitis B birth-dose vaccination. Another example is the Western Pacific Region, which accounts for 47% of hepatitis B deaths but has “low” treatment coverage.
“Innovative approaches are needed to expand prevention and treatment for hepatitis B and C in varying regional and country context.”
2030 targets
The report emphasises that the global response is “off-track” for 2030 goals.
“If action is taken now, universal access to viral hepatitis interventions will have a major public health impact.”
This could drive a reduction in incidence by 90%, mortality by 65%, and the costs of achieving global targets by 15%. The report also states that the benefits of achieving global targets will be apparent by 2030, saving 2.85 million lives and averting 9.5 million new infections and 2.1 million cases of cancer.
Access to vaccines
The report highlights the lack of equitable access to vaccines. For example, the coverage of the hepatitis B birth dose “remains low”, particularly in the African Region, which has the “highest prevalence of hepatitis B”. Coverage varies between 18 in the African Region and 80% in the Western Pacific Region. A total of 115 countries worldwide have introduced a universal hepatitis B birth dose. However, access to the birth dose vaccination is “often hampered” by a “lack of policy within the national immunisation programme” or a “lack of access to newborn infants within the first 24 hours of life”.
An additional barrier is identified in “out-of-pocket expenditure” for hepatitis B vaccines. Finally, efforts to develop an effective vaccine against for HCV should be an “important component of the viral hepatitis research agenda”.
10 Key Actions
The report proposes 10 key actions to “advance a public health approach”:
- Testing: expand access to high-quality, affordable viral hepatitis testing and diagnostics services.
- Treatment: shift from policies to implementation for equitable access to viral hepatitis treatment and care.
- Prevention: strengthen investment in primary prevention of viral hepatitis to bridge the coverage gap in pregnancy, especially in Africa.
- Service delivery: simplify and decentralise the delivery of viral hepatitis services through a public health approach.
- Product regulation, procurement, and supply: optimise product registration, procurement, and supply, improve market transparency and support local production.
- Investment cases: develop investment cases in priority countries for a rapid shift to a public health approach.
- Financing: increase financing from all sources.
- Data for action: use improved country data and strengthen country data systems and accountability for viral hepatitis.
- Community engagement: engage the affect populations and civil society in the viral hepatitis response for advocacy and service delivery.
- Innovation: advance the research agenda for viral hepatitis to improve diagnostics and work towards a hepatitis B cure.
WHO’s commitment
Dr Tedros Adhanom Gebreyesus, WHO Director-General, commented on the report in a statement from WHO, suggesting that it “paints a troubling picture”.
“Despite progress globally in preventing hepatitis infections, deaths are rising because far too few people with hepatitis are being diagnosed and treated. WHO is committed to supporting countries to use all the tools at their disposal – at access prices – to save lives and turn this trend around.”
For more on disease prevention and control and public health updates, don’t forget to subscribe to our weekly newsletters here!
by Guest Editor | Apr 12, 2024 | Infection |
This article is a guest post, kindly contributed by Giuliana Furiato.
Measles is a viral illness caused by infection with the measles virus. The first symptoms are fever, then cough, runny nose, and red eyes. It culminates as a rash of tiny, red spots which starting from the head spreads to the rest of the body. Measles virus is highly contagious, and it is transmitted from person to person by respiratory droplets, small particle aerosols, and close contact. In fact, it can stay in the air for up to 2 hours after an infected person has released it.
Despite the ease of contagion, the epidemiology of measles is variable across the globe. But why?
This infection occurs only in humans; animals are not a potential reservoir of infected particles. However, among the human population three different classes of people can be identified: vaccinated, non-vaccinated but infected, non-vaccinated non-infected. The former are protected due to vaccination, the second due to primary infection, but the latter are a potential target for viral particles. In this last group there are people who have not been vaccinated yet (i.e. young infants), and those who can’t receive a vaccine, such as pregnant women and immunocompromised patients.
What is the difference between these three groups? While the first two groups may be healthy carriers and, therefore, contract the virus but not manifest symptoms, the last group manifests typical symptoms that in a minority of cases can be fatal. While healthy people can survive measles infection complications, those who are immunosuppressed and, therefore, have a compromised immune system, are less likely to make a quick recovery. The most common complications are pneumonia or middle-ear infection due to the measles virus itself or a secondary bacterial infection. For pregnant women with measles there is an increased risk of maternal death, spontaneous abortion, and intrauterine foetal death.
Yet, as we said earlier, this virus is only transmitted to humans, so it could be eradicated. How? Through vaccination. In fact, it is estimated that if between 93% and 95% of the population were vaccinated, we could eradicate the disease. WHO’s definition of eradication is:
“The permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts.”
The vaccine
The vaccine is a live attenuated measles strain, thus is a harmless, less virulent version of the infectious agents. It is usually administered in combination with mumps, and rubella vaccines (i.e. MMR vaccine: measles, mumps, and rubella) and it requires more than one dose to achieve a higher level of protection. According to WHO, in developed countries the first dose should be given at 12 to 15 months and the second at 4 to 5 years.
This vaccine is very effective. In fact, according to data, two doses are about 97% effective at preventing measles if exposed to the virus. One dose is about 93% effective. What does this mean? Those who received two doses of vaccine are at a 97% lower risk of developing disease than the group who don’t receive them.
When can you say you’re protected? To work a vaccine must induce the production of protective antibodies in response to it. Detectable antibodies against the measles vaccine generally appear within just a few days after vaccination. People are usually fully protected after about 2 or 3 weeks. Therefore, the immune systems of vaccinated people exposed to someone with measles remember how to fight off the wild-type virus.
The adverse effects of the measles vaccination are rare and minor and resolve without any specific treatment; indeed, 5% of immunised children experience malaise and fever 1 to 3 weeks following vaccination. No link between receiving vaccines and developing autism spectrum disorder (ASD) has been detected by solid scientific research performed all around the globe including Centres for Disease Control (CDC) and National Academy of Medicine. In contrast, without vaccination, there is a high risk of transmitting the infection to others and inducing life-threatening diseases to those who can’t get vaccinated.
Nevertheless, it is important to make a clarification. Fully vaccinated people are not exempt from measles infection, they can still get measles; however, they are more likely to have a milder illness. Moreover, they are also less likely to spread the disease to other people, including people who can’t get vaccinated because of young age or due to a weakened immune system. To protect such people, we need to reach herd immunity. Herd immunity can be reached when enough people in the population have developed protective antibodies against the virus. Being highly contagious, herd immunity against measles can be achieved mainly through active immunisation. Giving measles vaccine early in life should enable us to decrease the rate of virus circulation and raise the age at which children are infected and, therefore, should be vaccinated. Thus, through a tight immunisation schedule it should be possible to protect the majority of the measles-susceptible population.
The availability of a safe, inexpensive, and effective vaccine might let measles elimination become reality. However, although every region in the world has a measles elimination goal, no region has achieved and sustained elimination. Why? We cannot forget that eradication of a disease is not only dependent on the scientific context. Smallpox and rinderpest eradication required political, economic, and social education efforts to succeed.
Tracking and containment of disease outbreaks require cooperation on an international level. Without cooperation, global health campaigns cannot hope to succeed. Without economic support, crucial resources cannot be mobilised effectively. To all this in recent years has been added an increased mistrust in science, as highlighted by the rise of anti-vaccination sentiment. Eradication campaigns require public trust in science and in global health initiatives, thus it will be crucial to gain and maintain it to guarantee their success.
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by Charlotte Kilpatrick | Apr 11, 2024 | Infection |
Ahead of World Chagas Disease Day, observed on 14th April for the fifth year, WHO has issued a statement emphasising the importance of “early diagnosis and lifelong care” within the theme for 2024. Alongside these goals, the day is intended to increase public awareness of the disease and secure “greater support and funding” for both early diagnosis and “comprehensive follow-up care initiatives”. There is currently no effective vaccine for Chagas disease.
Chagas disease
Chagas disease is also known as American trypanosomiasis and is caused by the protozoan parasite Trypanosoma cruzi. It is mainly transmitted to humans by contact with the faeces or urine of infected blood-sucking triatomine bugs, which live in the wall or roof cracks of homes and peridomiciliary structures. The triatomine bugs become active at night to feed on animal and human blood, often biting an exposed area of skin; the name “kissing bug” is associated with bites on the face. The bugs then defecate or urinate close to the bite, which is smeared into the bite or skin breaks by the host.
WHO states that, “for centuries”, the disease was mostly confined to rural populations in Latin America. However, as population movement has increased, other transmission routes have become more relevant, including oral transmission, blood transfusion, and congenital transmission. Additionally, climate change has expanded the geographical distribution of triatomine bugs.
Early detection is “key” because the disease can be curable. However, if diagnosis is delayed, the infection can become life-threatening. As there is no effective vaccine against Chagas disease, vectorial control, food safety, transfusion and transplantation screening and detection of infections in women of childbearing age are the “most effective disease public health control tools”.
The burden of disease
WHO estimates that between 6 and 7 million people worldwide are infected with the parasite Trypanosoma cruzi, causing around 12,000 deaths every year. At least 75 million people are at risk of infection, but in many countries the detection rates are low. Furthermore, people who suffer from the disease can “encounter significant barriers to diagnosis and adequate healthcare”. Although cases have been documented in 44 countries, only 6 countries have information systems in place to monitor cases and active transmission routes.
Chagas disease is known as a “silent disease” because patients often have no symptoms during the acute or chronic phases of infection, until damage is “too advanced to be reversed”. WHO identifies the burden on health systems as “the highest” in Latin America.
World Chagas Disease Day 2024
World Chagas Disease Day 2024 identifies the importance of “early diagnosis and lifelong care”, with WHO advocating “comprehensive approaches spanning diagnosis and treatment for any confirmed case”.
“Decentralising diagnostic and care services within national health systems can significantly enhance case detection, notification, and management.”
Dr Jérôme Salomon, Assistant Director-General, Universal Health Coverage/Communicable and Noncommunicable Diseases, WHO, emphasised the importance of taking the “essential step” of “strengthening global surveillance” for the disease. This will enable “appropriate measures to tackle its neglect”.
Dr Ibrahima Socé Fall, Director of WHO’s Global Neglected Tropical Diseases Programme, invites everyone to join WHO in observing the annual day.
“This is an occasion to reflect on how climate change and migration have changed the epidemiological landscape of Chagas disease and turned it into a global condition in just a few years, underscoring the urgent need for heightened awareness and support for initiatives focused on early diagnosis and comprehensive care.”
Neglected tropical diseases and the development of vaccines for diseases with unmet medical needs are key concerns at our events each year, so make sure you subscribe to hear more from our experts.
by Charlotte Kilpatrick | Apr 9, 2024 | Infection |
In April 2024 the United States reported a case of human infection with an influenza A(H5N1) virus; on 9th April 2024 the WHO shared a “disease outbreak news” update on the situation, assessing the public health risk to the general population as “low”. This follows a CDC press release, which emphasises that the agency is working “closely” with state and federal agencies to “further investigate and closely monitor this situation”.
WHO is notified of a case
On 1st April 2024, the IHR NFP of the US notified WHO of a laboratory-confirmed human case of avian influenza A(H5N1), which was detected in the state of Texas. The case is an adult who had a history of exposure to cows through work at a commercial dairy cattle farm and presented with conjunctivitis on 27th March. On 28th March, respiratory and conjunctival specimens were collected from the case and tested by the Texas Tech University Bioterrorism Response Laboratory.
RT-PCR analysis revealed that both specimens were “presumptive positive” for influenza A(H5) virus; the specimens were passed on to the US CDC for further testing, which confirmed them as high pathogenicity avian influenza (HPAI) A(H5N1) virus clade 2.3.4.4b. The patient was advised to isolate and has been treated with antiviral treatment in accordance with US CDC guidance; WHO states that the individual “was recovering” at time of reporting.
Cases in cattle
WHO reflects that influenza A virus infection is “exceptionally rare” in bovine species. However, the human case had exposure to dairy cattle, presumed to be infected with HPAI A(H5N1). This follows a report from the USDA on 25th March that HPAI A(H5N1) virus had been detected in dairy cattle and unpasteurised milk samples from cattle in Texas and Kansas in four herds.
Additional detections have since been reported in six states: Idaho, Kansas, Michigan, New Mexico, Ohio, and Texas. WHO understands that USDA continues to monitor and test samples from other farms where cattle are “displaying decreased lactation, low appetite, and other signs”.
Public health response and risk assessment
The following public health measures have been implemented:
- Surveillance activities are being conducted in Texas.
- US CDC is working with state health departments to monitor workers who may have been in contact with infected or potentially infected birds/animals.
- US CDC has issued public recommendations.
“The United States has a robust surveillance system that is designed to mitigate the spread of animal diseases, thereby protecting public health, and maintaining a safe food supply for domestic and international markets.”
As the virus has not acquired mutations that facilitate transmission among humans, WHO considers “available information” to conclude that the public health risk to the general population is “low”. For occupationally exposed persons the risk of infection is considered “low-to-moderate”.
Dr Cohen at the Congress
We were privileged to hear from US CDC Director Dr Mandy Cohen during the Congress in Washington this April, during which she emphasised to MedPageToday that her agency is “all over” the threat of avian influenza. In her keynote speech she highlighted the importance of intelligent investment to tackle this and other growing issues.
“We need to continue to invest in data, in lab capacity, in our ability to respond to health threats, and we need a talented workforce.”
Dr Cohen reflected that “we cannot solve problems we don’t see”, addressing the strengths and potential for growth of the US disease surveillance capabilities.
It was fantastic to hear an almost immediate reaction from Dr Cohen to the threat of avian influenza at the Congress last week, and we will continue to track the developments of this and other infectious diseases here; do subscribe for more updates.
by Guest Editor | Apr 4, 2024 | Infection |
This is a guest post, kindly authored by Dr Juan Carlos Jaramillo, Chief Medical Officer, Valneva, and Vice President, Vaccines Europe.
Climate change is one of the biggest global challenges of current times. From rising sea levels to increasing temperatures and heatwaves, the effects of climate change on our physical environment are increasing in scale, frequency and intensity.1 However, according to the World Health Organization1, climate change also presents a fundamental threat to human health, notably by augmenting the risk of infectious diseases.
The Rise of Infectious Diseases
Climate change impacts our health both indirectly (e.g. respiratory diseases linked to pollution) and directly (e.g. flooding and hurricanes can cause injury or death).2 Infectious diseases are also influenced by climate changes. Warmer temperatures can affect the geographical distribution of infectious diseases and, for some, extend the transmission periods.3
In particular, the spread of mosquito-borne diseases presents a growing challenge. Currently, mosquito-borne diseases infect up to 700 million people worldwide each year,4 and mosquitoes have now become the deadliest creatures in the world because of the many diseases they can transmit.5 Common types of mosquito-borne diseases include malaria, dengue, chikungunya, West Nile virus, yellow fever and Zika.6 Historically, the mosquitoes which carry these diseases have predominantly inhabited tropical and subtropical regions,7 such as Central and South America, sub-Saharan Africa, and Southeast Asia.
However, these disease-carrying mosquitoes have expanded their reach due to extreme climate and weather patterns.7 In recent years, previously unaffected areas, such as Southern Europe and the United Kingdom, are also facing an increased risk of these diseases8 and a spike of incidence was also recorded in the United States in 2023.9
If current climate change trends persist, projections suggest that as many as 8.4 billion people could be at risk of contracting these diseases by the end of the century.10
This presents a stark reality which underscores the urgent need for proactive measures to mitigate climate change and its impact on public health. Current approaches to disease prevention must also evolve to address the complex relationship between climate change and infectious diseases – this includes continued advancements in vaccine development.
Valneva’s Ongoing Commitments
At Valneva, we remain driven by scientific innovation. Our vision is to live in a world where no one dies or suffers from a vaccine-preventable illness. This vision empowers us to develop vaccines aimed at protecting people from infectious diseases for which no other vaccines or effective treatments currently exist. While we can’t reverse the impact of environmental changes that have already taken place, our commitment to advancing unique new vaccines means we can be part of the solution, by helping reduce the impact of infectious diseases fuelled by climate change.
We also want to continue raising awareness amongst key stakeholders about the threat of infectious diseases as this public health challenge increases in prominence. We’re looking forward to being part of conversations on this topic at this year’s World Vaccine Congress US, where Valneva will take part in a panel discussion on the efforts towards eradicating chikungunya alongside representatives of the Coalition for Epidemic Preparedness Innovations (CEPI), the Pan American Health Organization (PAHO) and the International Vaccine Institute (IVI). Valneva will also moderate an interactive roundtable focusing on the emerging threats of Zika and chikungunya.
As a global company, we also take every opportunity to continuously improve our sustainability model. From the production line to our support functions, we are all actively working to reduce our carbon footprint, lower the consumption of energy and natural resources, and limit the creation of waste.
Creating a Safer Future for All
The battle against infectious diseases is one which is intensifying alongside climate change. While we continue to make both scientific and environmental efforts, we also call for greater action and collective responsibility from governments and communities worldwide to help slow down the effects of climate change. Without decisive action, we risk facing unprecedented global health challenges that could have far-reaching consequences.
It’s becoming ever-more crucial that we work together to make change, ultimately creating a healthy and safer world for future generations.
We’re thrilled that Dr Juan Carlos Jaramillo and the Valneva team were able to share insights with us before the Congress next week, and look forward to hearing more then! Don’t forget to subscribe to our newsletters here for guest posts and insights to come!
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by Charlotte Kilpatrick | Mar 27, 2024 | Infection |
Amid an “unprecedented multi-year upsurge” in global cholera cases, the International Coordinating Group (ICG) on Vaccine Provision is appealing for “immediate action” from the global community. This could include investments in access to safe water, sanitation, and hygiene, testing and detecting outbreaks quickly, improving quality of and access to healthcare, and fast-tracking additional production of the affordable oral cholera vaccine (OCV). The ICG is responsible for managing the global cholera vaccine stockpile, comprising the International Federation of Red Cross and Red Crescent Societies, Mèdecins Sans Frontières, UNICEF and WHO. The stockpile and delivery of vaccines is financed by Gavi.
A global increase
The current increase in cholera cases has been observed since 2021; 473,000 cases were reported to WHO in 2022, which is “more than double those reported in 2021”. Preliminary data for 2023 “reveal further increases”, with over 700,000 cases reported. Some of the outbreaks have high case fatality rates that exceed the 1% threshold used as an indicator for “early and adequate treatment” of patients with cholera.
“These trends are tragic given that cholera is a preventable and treatable disease and that cases had been declining in previous years.”
Countries that are currently the most affected include the Democratic Republic of the Congo, Ethiopia, Haiti, Somalia, Sudan, Syria, Zambia, and Zimbabwe.
Factors behind the increase
Cholera is an acute intestinal infection spread through food and water contaminated with faeces that contains the Vibrio cholerae bacterium. WHO states that the rise in cholera cases is “being driven by persistent gaps in access to safe water and sanitation”.
“Although efforts are being made to close these gaps in places, in many others the gaps are growing, driven by climate-related factors, economic insecurity, conflict, and population displacement.”
What can be done?
“Now more than ever, countries must adopt a multisectoral response to fight cholera.”
The ICG Members call on “currently and potentially affected countries” to take “urgent steps” to ensure that all populations have access to clean water, hygiene, and sanitation services, as well as the information required to prevent any cholera spread. This “requires political will and investment” at country level.
“This includes creating capacity for early detection and response, enhanced disease detection, rapid access to treatment and care, and working closely with communities, including on risk communication and community engagement.”
Pressure on the stockpile
Alongside water and sanitation requirements there is a “severe gap in the number of available vaccine doses” in comparison with the current need. Between 2021 and 2023 more doses were requested for outbreak response than had been needed for the “entire previous decade”. Indeed, in October 2022, the shortage necessitated the ICG to recommend a single vaccine dose rather than the “previous, long-standing two-dose regimen”.
Around 36 million doses were produced last year, but 14 affected countries registered a need for 72 million doses within a one-dose reactive strategy.
“These requests understate the true need.”
Preventative vaccination campaigns have been delayed to save doses for emergency outbreak control efforts. This creates a “vicious cycle”.
Global production capacity in 2024 is forecast to be 37-50 million doses but will “likely continue to be inadequate”. There is only one manufacturer that currently produces the vaccine: EuBioligics. Although the company is “doing its utmost to maximise output”, the ICG requires more doses. No new manufacturers are expected to join the market before 2025.
“The same urgency and innovation that we saw for COVID-19 must be applied to cholera.”
The ICG appeals to the vaccine and health community to “prioritise an urgent scale-up of vaccine production” and to “invest in all the efforts needed to prevent and control cholera”.
To participate in important discussions about how vaccines can be used to control outbreaks and prevent emergencies do join us at the Congress in Washington this April. Don’t forget to subscribe to our newsletters here!
by Charlotte Kilpatrick | Mar 21, 2024 | Infection |
In March 2024 the University of Oxford announced a partnership with the University of Edinburgh to examine the immune system’s response to “repeated” malaria infections. The BIO-004 study is a collaboration between the Department of Biochemistry and Oxford Vaccine Group from Oxford and the University of Edinburgh’s Institute of Immunology and Infection Research and will offer a “unique insight” into how the immune system “adapts” after a few malaria infections to tolerate the parasites and develop natural immunity to severe illness.
BIO-004
The trial, hosted by the Oxford Vaccine Group, will infect adult volunteers who have never had malaria three times in “carefully monitored conditions”. Serial “malaria challenges” will be conducted over a 20-month period, allowing researchers to compare the immune response to all three infections. Although over 600 people have previously participated in malaria challenge studies in Oxford, this is the “word first” use of repeated malaria challenges to study the human immune system in “such close detail”.
Dr Angela Minassian is Chief Investigator for the trial and commented that malaria is a disease “caused by a parasite infection that is spread by mosquitoes”. While it causes “hundreds of thousands of deaths every year”, Dr Minassian reflected that 75% of these occur in children under the age of 5 years.
“Current efforts to control the disease are focused on stopping mosquitoes from biting, either by spraying insecticides or sleeping under bed nets, and by reducing the number of parasites in the blood, using drugs or the recently licensed malaria vaccines, RTS,S and R21. However, these measures are only partially effective.”
Dr Minassian suggests that the first malaria infection in life is “the most dangerous” with the immune system learning to adapt to the parasite over repeat infections. However, the mechanism by which this occurs is “unknown”.
“BIO-004 is an experimental medicine study funded by the UKRI-MRI which aims to answer this question and help inform strategies to protect young children in endemic countries from severe disease and death due to malaria.”
Principal Scientific Investigator, Edinburgh’s Dr Phil Spence, commented that “children who survive their first malaria infection quickly develop immunity” against the most severe forms of disease, which often prevents severe infection in the future.
“We now understand that, during the first malaria infection, the immune system launches a full-scale attack which causes collateral damage to healthy tissues. Then, with subsequent infections, the immune system learns to rein in this damaging response and tolerate the presence of parasites in the bloodstream.”
Dr Spence hopes that the trial will “change” the fact that doctors “do not currently know the mechanisms that allow the immune system to do this”.
“Understanding how ‘tolerance’ to disease is induced and maintained in malaria will, for the first time, allow us to harness the power of this defence strategy to design new policies, medicines, or vaccines that combat severe malaria in children and ultimately save lives.”
We’re looking forward to hearing more from our experts on malaria elimination at the Congress in Washington this April, so do join us if this is of interest and don’t forget to subscribe to our newsletters here.
by Charlotte Kilpatrick | Mar 21, 2024 | Infection |
In March 2024 the WHO African Region shared a “disease outbreak news” update on yellow fever (YF) in the region from the beginning of 2023. 13 countries have documented “probable and confirmed cases”, and although the overall risk at regional level has been reassessed as “moderate” and the global risk “remains low”, WHO calls for “active surveillance” due to the potential for onward transmission. The “urban proliferation of Aedes spp. mosquitoes can “significantly amplify transmission risks”, which would lead to “swift outbreaks”. However, thanks to the WHO-led global Eliminate Yellow Fever Epidemics (EYE) secretariat’s coordinated preventative and reactive efforts, vaccination coverage has been “substantially enhanced”. Around 62 million people have been vaccinated in Africa through mass vaccination campaigns.
Yellow fever
WHO describes yellow fever as an “epidemic-prone, vaccine-preventable disease”, which is caused by an arbovirus transmitted mainly through the bites of infected mosquitoes. The incubation period ranges from 3 to 6 days, but many people do not experience symptoms. For those who do, fever, muscle pain, and nausea are common.
A small percentage of cases progress to a “toxic phase” with systemic infection affecting the liver and kidneys. In these cases, patients can have more severe symptoms, such as high-grade fever, abdominal pain and vomiting, and jaundice and dark urine caused by acute liver and kidney failure. Bleeding can occur from the mouth, nose, eyes, or stomach. In half of cases with severe symptoms death can occur within 7 to 10 days.
Yellow fever can be prevented with an effective vaccine, which is described by WHO as “safe and affordable”; a single dose offers sustained immunity and life-long protection, without requiring a booster dose.
Cases in 13 countries
WHO reports that, from the beginning of 2023 until 25th February 2024, a total of 13 countries in the region have documented “probably and confirmed cases” of YF: Burkina Faso, Cameroon, the Central African Republic, Chad, Republic of the Congo, Côte d’Ivoire, the Democratic Republic of the Congo, Guinea, Niger, Nigeria, South Sudan, Togo, and Uganda. Preliminary data for 2023 indicate a case fatality rate (CFR) of 11% and a sex ratio of 1:7 (M: F). The median case age is 25.
“Suboptimal surveillance capacity exists in many affected countries, with data fragmentation, limited integration with routine surveillance and clinical systems, and a lack of standardised case definitions that contribute to underreporting and increased mortality rates.”
WHO’s risk assessment
Within efforts to monitor and respond to infectious disease outbreaks WHO conducted a Rapid Risk Assessment for yellow fever on 12th February 2024. This was intended to reassess the current regional risk of multiple ongoing YF outbreaks and provide recommendations for a more effective and coordinated response.
The regional level risk is described as “moderate” and the global risk “remains low”. However, WHO emphasises the need for “active surveillance” in the context of the potential for onward transmission through viraemic travellers and the presence of the competent vector in neighbouring regions.
For more discussions on infectious disease management, particularly encouraging greater uptake of vaccines for vaccine-preventable diseases, why not join us at the Congress in Washington this April, or subscribe to our newsletters here?
by Charlotte Kilpatrick | Mar 13, 2024 | Infection |
A statement from the World Organisation for Animal Health in March 2024 describes the “unprecedented milestone” reached by highly pathogenic avian influenza (HPAI), which is confirmed to have “traversed continents” to Antarctica’s mainland.
“The gravity of the situation intensifies as it infiltrates the northern tip of Antarctica’s mainland.”
This incidence was earlier reported by Argentinean scientists at the Primavera base and has been recorded on the World Animal Health Information System (WAHIS). A South Polar skua, a large seabird that breeds in sub-Antarctic and Antarctic zones, was found dead and tested positive. This is concerning as skuas are a potential vector as they migrate further north when not breeding.
A “new normal”
WOAH comments that while HPAI was previously considered “primarily a threat to poultry” it has “ushered in a ‘new normal’” as it now moves from wild birds to wild mammals with consequences “beyond anything previously seen”. WOAH’s most recent estimates suggest that 485 species from over 25 avian orders have been affected and 37 new mammal species infected since 2021. The Pacific Islands, Australia, and New Zealand are the only regions that WOAH considers “free of the disease”, recognising that the “situation is changing rapidly”.
Protection and prevention
Although HPAI outbreaks have resulted in “marked declines” in wildlife populations, WOAH identifies strategies for both long- and short-term protection of wildlife. For example, improved biosecurity, improved surveillance systems, and coordinated, interagency-multisecotral approaches can prevent spillover events and contain them when they do occur. WOAH recommends its own guidelines on the emergency vaccination of wild birds of high conservation importance against HPAI and the management of HPAI in marine mammals.
“The loss of wildlife at the current scale presents an unprecedented risk of wildlife population collapse, creating an ecological crisis.”
WOAH “encourages” Members to “quickly and thoroughly respond to outbreaks” and emphasises the importance of incorporating wildlife health into animal health surveillance, reporting, preparedness, and response systems.
“These efforts require not merely viewing wildlife as a potential risk to production animal and human health, but as beings warranting protection in their own right.”
Within the veterinary vaccines and One Health track at the Congress in Washington we look forward to hearing from Dr Daniel Peréz on the challenges and opportunities associated with mass vaccination against avian influenza. Get your tickets here to participate in these discussions, and don’t forget to subscribe to our newsletters for more insights.
by Charlotte Kilpatrick | Mar 13, 2024 | Infection |
In March 2024 the UK Health Security Agency (UKHSA) announced that a new collaboration with The Pirbright Institute has been launched to support the development of vaccines against henipavirus, the genus that includes Nipah virus, with funding from the Medical Research Council. UKHSA scientists will use a model of Nipah virus disease to evaluate vaccines developed by the Pirbright Institute to determine protective effects.
Nipah virus
With a high case fatality rate and no licensed vaccines or treatment, Nipah virus is a “current and future threat” to global health. It is currently on WHO’s priority pathogen list and has caused recent outbreaks in Bangladesh and India. While there have not been recorded cases in the UK, the UKHSA recognises that effective vaccines could provide protection to people in countries where the virus is endemic, with the secondary effect of preventing imported cases.
Nipah virus is part of the henipavirus genus, and UKHSA states that there is a possibility for the emergence of a novel virus with outbreak potential. Thus, instead of focusing on a specific virus target for vaccination, the aim is to develop a vaccine that provides “cross protection against the whole genus” (pan-henipavirus vaccine).
Professor Isabel Oliver, Chief Scientific Officer at UKHSA, hopes that the study will “deepen our understanding of henipaviruses” and encourage “significant progress in our efforts to protect health from this current and future global health threat”.
“The work will also make a vital contribution to the 100 Days Mission – an important initiative to make sure the world is better prepared for the next pandemic by accelerating the development of diagnostics, therapeutics, and vaccines.”
Dr Dalan Bailey, Viral Glycoproteins group leader and project lead for Pirbright, emphasised that the project represents a “really important first step in the development of broadly acting vaccines”.
“This is especially important as we try to build more robust pandemic preparedness plans in the wake of the COVID-19 pandemic, and we are delighted to be working with UKHSA on this project.”
Professor Oliver will join us at the Congress in April to discuss approaches to some of the most challenging and threatening pathogens so do get your tickets to hear more from her or subscribe to our newsletters here.
by Charlotte Kilpatrick | Mar 11, 2024 | Infection |
In March 2024 the WHO Eastern Mediterranean Region announced that Sudan’s Federal Ministry of Health (FMOH) is to launch a polio vaccination campaign in April 2024 in response to a “new emergence of variant poliovirus type 2” that was reported in January 2024. The emergence was detected in six wastewater samples collected between September 2023 and January 2024 in the Port Sudan locality, Red Sea State.
The FMOH has been supported by WHO to complete field investigations and a risk assessment to understand the extent of virus circulation. The campaign preparations have begun in Red Sea, Kassala, Gedaref, River Nile, Northern, White Nile, Blue Nile, and Sennar States. WHO reports that the other states will have a “differentiated approach” as appropriate.
Learning from previous outbreaks
This detection has been reported 14 months after Sudan declared an “unrelated” outbreak of variant poliovirus type 2, detected in a 4-year-old child in West Darfur in October 2022. In response to that outbreak the FMOH worked with UNICEF and WHO to deliver and distribute 10.3 million doses of oral polio vaccine in a March 2023 campaign. Around 8.7 million children under the age of 5 were reached.
Since then, no vaccination campaign has taken place “due to the ongoing conflict”. However, surveillance for poliovirus in children has been “strengthened”. This is conducted by searching for acute flaccid paralysis (AFP), the “most common indicator” of polio infection, and wastewater surveillance.
Dr Dalya Eltayeb, Director-General of Primary Health Care in the FMOH, commented that “since the escalation of the conflict”, the FMOH has worked “closely” with WHO and UNICEF to “develop and implement the Polio National Emergency Action Plan”.
“The new detection has only redoubled our commitment to safeguarding our children’s future. In collaboration with partners, we are mobilising an outbreak response campaign to ensure that every child under 5 years in accessible areas receives the polio vaccine, and special plans will follow for hard-to-reach areas.”
Although no child has been paralysed in the new emergence, this detection “puts children across the country at high risk”. Furthermore, the “breakdown in health services” such as routine vaccination “significantly increases” the risk of outbreaks and spread of communicable diseases. Dr Mohammad Taufiq Mashal, Polio and Immunisation Team Lead for WHO Sudan, recognised the remarkable efforts of public health officers.
“Despite extremely challenging conditions, our health workers have managed to sustain surveillance for poliovirus, which has allowed us to detect and respond to this new poliovirus strain in a timely manner.”
Dr Tedla Damte, Chief of Health and Nutrition at UNICEF Sudan, suggested that “the ongoing war is undoing the enormous gains” that have been made on childhood vaccinations.
“Millions of displaced children on the move cannot be protected against life-threatening diseases, like polio, yet these can be prevented through vaccination. Health systems are overstretched, subsequently impacting the delivery of health services including vaccinations.”
Dr Damte emphasised that “UNICEF remains committed to supporting vaccination campaigns to protect children, no matter what”.
The importance of rigorous, sustained surveillance in health systems is an issue that will be explored by some of our experts at the Congress in Washington this April so do join us to participate in the discussion or subscribe here for more updates.
by Charlotte Kilpatrick | Mar 8, 2024 | Infection |
In March 2024 the UKHSA revealed that new data show a “continued increase” in cases of pertussis (whooping cough) at the start of the year. The statement from the agency indicates that this increase comes after a “prolonged period of low case numbers” due to COVID-19 restrictions. Although cases of whooping cough “rise cyclically every few years”, UKHSA is concerned that there has been a “steady decline in uptake” of the vaccine in pregnant women and children. Whooping cough is a bacterial infection that affects the lungs.
January data
The data show a dramatic increase compared to the whole of the previous year (2023). In January, there were 553 confirmed cases in England, whereas the country reported a total of 858 in 2023. In 2016 there was a peak in cases with 5,949. The data also reveal that 22 infants under the age of 3 months were diagnosed with whooping cough. These children, too young to be fully vaccinated, are at “greater risk of severe disease” and death.
With the increase taking off so quickly already, the UKHSA has moved to a monthly reporting cycle for whooping cough infections to offer “timely information” on disease rates. This will allow public health teams to respond to outbreaks and support health professionals as they deliver the routine vaccination programme.
Get protected
In response to the increase in cases, UKHSA is encouraging pregnant women to get protected so that their newborns are protected. It states that vaccination of pregnant women is 97% effective at preventing death in infants from whooping cough. Furthermore, parents and carers are urged to check that their children are vaccinated. The current schedule offers vaccines to infants at 8, 12, and 16 weeks old (within the 6-in-1 combination vaccine), with a further dose in the pre-school booster vaccine.
Unfortunately, a recent decline in uptake of vaccinations has become noticeable; the number of 2-year-olds who had completed their 6-in-1 vaccinations by September 2023 was at 92.9%, which was lower than 96.3% in March 2014. Furthermore, uptake of the maternal pertussis vaccine, which is offered to every woman in pregnancy, dropped from over 70% in September 2017 to around 58% in September 2023.
The new campaign
The latest reminders feature in the UKHSA’s recent Childhood Immunisation Campaign, which calls upon parents and carers to check that their children are protected against measles and other serious diseases. Dr Gayatri Amirthalingam, Consultant Epidemiologist at UKHSA, commented that, while whooping cough “can affect people of all ages”, it can be “particularly serious” for very young infants.
“However, vaccinating pregnant women is highly effective in protecting babies from birth until they can receive their own vaccines. Parents can also help protect their children by ensuring they receive their vaccines at the right time or catching up as soon as possible if they have missed any.”
Steve Russell, National Director for Vaccinations and Screening at NHS England, emphasised the importance of families taking the protection offered by the vaccine.
“If you are pregnant and have not been vaccinated yet, or your child is not up-to-date with whooping cough or other routine vaccinations, please contact your GP as soon as possible, and if you or your child have symptoms ask for an urgent GP appointment or get help from NHS 111.
For more on encouraging vaccine uptake and protecting vulnerable populations, join us in Washington for the Congress this April, or subscribe for insights here.
by Charlotte Kilpatrick | Mar 7, 2024 | Infection |
In March 2024 the Gates Foundation announced a collection of “major new policy, programmatic, and financial commitments” to contribute to efforts to eliminate cervical cancer. These commitments include almost $600 million in funding and were made at the first Global Cervical Cancer Elimination Forum: Advancing the Call to Action in Cartagena de Indias, Colombia. The Foundation states that a woman dies from cervical cancer every two minutes, despite the knowledge and tools to “prevent and even eliminate” the disease. Vaccination against human papillomavirus (HPV), which is the leading cause of cervical cancer, can prevent most cases.
The Gates Foundation statement acknowledges “many challenges on the path to elimination”. A combination of “supply constraints, delivery challenges, and the COVID-19 pandemic” meant that only 1 in 5 eligible adolescent girls were vaccinated in 2022. Furthermore, while cost-effective and evidence-based tools for screening and treatment exist, under 5% of women in many LMICs are screened for cervical cancer. These barriers cause “deep inequity”; over 90% of cervical cancer deaths in 2022 happened in LMICs.
The first global forum
In 2022, WHO’s global recommendation for one-dose HPV vaccine schedules “significantly reduced barriers” to scaling up vaccination programmes, a move that was reinforced by the America’s Region in 2023 and the Regional Office for Africa in 2024. However, the latest commitments “mark a watershed moment” to accelerate progress to eliminate cervical cancer.
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, commented that “vaccination, screening, and treatment programmes are still not reaching the scale required”, even though we “have the knowledge and tools to make cervical cancer history”.
“This first global forum is an important opportunity for governments and partners to invest in the global elimination strategy and address the inequities that deny women and girls access to the life-saving tools they need.”
Country level commitments
Indonesia made a “re-commitment” to its National Action Plan 2023. Further commitments include:
- Democratic Republic of Congo commits to start introducing the HPV vaccine as early as possible with the WHO-recommended single-dose schedule and to do everything to get to the cervical cancer elimination strategy immunisation coverage target for girls aged 9 to 14 years as soon as possible.
- Ethiopia commits to implement a robust vaccine delivery strategy across the country, targeting at least 95% coverage in 2024 for all 14-year-old girls, regardless of their socioeconomic and education status, and to screen 1 million eligible women every year and to treat 90% of those who present with positive precancerous lesions. HPV single dose has been approved for introduction this year and scale up within the country’s Expanded Programme on Immunisation plans.
- Nigeria launched its HPV vaccine national programme this year, adopting the single-dose schedule for girls aged 9 to 14 and now commits to achieving at least 80% vaccine coverage of girls and continuing to increase coverage through a robust delivery strategy that will meet girls where they are, whether in school or not.
Experts weigh in
Quoted are several public health and development leaders, including Dr Chris Elias, President, Global Development at the Gates Foundation, who described HPV vaccines as a “miracle of modern medicine”. However, “too many” in LMICs do not have access to them.
“There is no reason why women should die from cervical cancer when a vaccine to prevent it exists…cervical cancer elimination is within reach. Now is the time for governments and partners around the world to increase HPV vaccine access and protect future generations from cervical cancer.”
Aurélia Nguyen, Gavi’s Chief Programme Officer, believes the HPV vaccine is “one of the most impactful vaccines on the planet” and has “already helped save thousands of lives”. Gavi is committed to supporting efforts to vaccinate 86 million adolescent girls by 2025.
“With bold commitment and decisive action, we can look forward to a future where cervical cancer has been eliminated for good.”
Juan Pablo Uribe, Director of the Global Financing Facility for Women, Children, and Adolescents (GFF) and Global Director for Health Nutrition and Population at the World Bank, emphasises the World Bank and the GFF are “doubling down efforts for cervical cancer elimination”.
“Every woman and every girl should have access to cervical cancer prevention, screening, and treatment as part of regular health care services. Much more work is ahead of all of us with a shared goal: eliminate cervical cancer. We need to build on today’s momentum and support countries’ leadership to accelerate progress.”
Director of PAHO, Dr Jarbas Barbosa, identifies an “urgent need” to scale up access and coverage for vaccination, screening, and treatment”
“I express PAHO’s profound commitment to elevate the political will and prioritise cervical cancer elimination in the public health agenda of countries in the Americas.”
Helga Fogstad, UNICEF Director of Health, sees the “end of an entire category of cancer” in sight for the first time.
“With the necessary tools at our disposal, commitment and political will are the next critical steps to a future free of cervical cancer for generations to come.”
UNITAID’s Executive Board Chair, Marisol Touraine, “cannot accept that women die from cervical cancer, when we know how to prevent and treat this disease”.
“At this pivotal moment, we must ensure the efficient tools we have are both affordable and available to every woman and girl in need…Together with our partners, we will continue to lay the groundwork for a future where all women have equitable access to the care they deserve, regardless of their socio-economic status or geographic location.”
Dr Atul Gawande, Assistant Administrator for Global Health at the US Agency for International Development, reflected that the “powerful shield” of the vaccine, regular screening, and early treatment will enable us to “safeguard a generation from the devastating effects of cervical cancer”.
“Every shot is a bold stride towards a future where cervical cancer is eliminated…Together we’re forging a path towards a future where cervical cancer is no longer a threat to the health and wellbeing of women worldwide.”
We’re looking forward to exploring some of the key challenges and opportunities in the WHO Cervical Cancer Elimination Goal during the HPV workshop at the Congress in Washington, so do get tickets to join us there at this link, and don’t forget to subscribe for more insights here.
by Charlotte Kilpatrick | Mar 1, 2024 | Infection |
A study in Cell in February 2024 explores mpox transmission and population-level changes associated with controlling the spread after the public health emergency of international concern (PHEIC) that was declared in July 2022. The authors find “community transmission prior to detection”, changes to case reporting during the epidemic, and a “large degree of transmission”. They also find that “viral introductions played a limited role in prolonging spread after initial dissemination”, and that mpox transmission in North America started to decline “before more than 10% of high-risk individuals in the USA had vaccine-induced immunity”.
“Our findings highlight the importance of broader routine specimen screening surveillance for emerging infectious diseases and of joint integration of genomic and epidemiological information for early outbreak control.”
Mpox
Mpox, previously known as monkeypox, is a viral zoonotic disease that is caused by the mpox virus (MPXV). It is endemic to West and Central Africa; the paper states that most cases of mpox outside these regions were identified in individuals with a recent travel history to Nigeria or an exposure to live animals from endemic areas.
On 7th May 2022 an individual with a travel history to Nigeria was diagnosed with mpox in the UK. After this case, the number of cases without a travel history to endemic countries “began to increase rapidly in various reasons” in a way that was “consistent with epidemic human-to-human spread”. By July 2023 the CDC had recorded 88,549 global cases since January 2022. The epidemic was characterised by human-to-human transmission “outside of endemic areas”, mostly in men who have sex with men (MSM).
The cases were defined by a “less severe illness presentation” in comparison with historical short human-to-human transmission chains and the long incubation period of 5-21 days suggests that “mpox may have spread undetected prior to initial case discovery”. Furthermore, presymptomatic transmission of mpox has been document, which implies that the epidemic was “at least partially fuelled by transmission occurring prior to symptom onset”.
Interventions and investigations
When WHO declared mpox a PHEIC countries began investigating disease spread, the use of vaccines, and potential guidelines on international travel. However, there were criticisms of the delay in starting “effective vaccination campaigns in high-risk areas”. The authors believe that genomic epidemiology is “uniquely poised” to explore “global and regional transmission dynamics” through a “joint integration of viral genomic information and epidemiological metadata”. This “augments traditional public health surveillance”.
Therefore, the study uses advances in phylogeographic and phylodynamic methods to estimate changes in case detection rate, the effect of “underdetection” on transmission, and the role of “introductions in promoting local community spread in various global regions”. Furthermore, they examine the consequences of vaccination campaigns on epidemic “growth and decay” in North America and estimate the degree of transmission heterogeneity in the declining phase of the epidemic.
The study’s findings
The study presents a “global and regional view” of mpox detection, expansion, and containment. Among their findings, the authors highlight “limited impact of vaccination campaigns during the early phases of the North American epidemic”. They compared changes in local transmission to the cumulative percentage of high-risk individuals in the US with vaccine-derived immunity. Despite the effectiveness of even half a vaccination dose in providing “robust immunity” against mpox, there was “concern over the delayed start of vaccination campaigns in the US”.
The conclusions that they draw are “concordant” with CDC conclusion, finding that Rt fell below one in August 2022 when “only about 1.3% of the high-risk population” in the US had any vaccine-induced immunity. Mpox modelling in Washington DC indicates that “behavioural modifications” within the MSM community were the “main contributing factor to slowing initial mpox spread”. However, vaccination campaigns were “ultimately needed to definitively curb the local epidemic and prevent future outbreaks”.
In the UK, a study that focused on MSM found that “vaccination could not explain the drop in mpox incidence in the region”. Instead, it attributes the declining incidence to “changes in behaviour”.
“These findings highlight the significant effect of behavioural change among MSM in curbing the epidemic as well as emphasise the need for prompt public health response in order to maximise the population-level effectiveness of vaccination campaigns.”
What implications does this study have for future public health efforts, and how might it influence public health messaging as well as public health interventions? For more on disease management with vaccination and to participate in discussions about lessons from and for mpox, get your tickets to the Congress in Washington in April. Don’t forget to subscribe to our newsletters for more insights!
by Charlotte Kilpatrick | Feb 29, 2024 | Infection |
In February 2024 Mass Eye and Ear announced the publication of a paper in Proceedings of the National Academy of Sciences (PNAS) that describes the discovery of 18 “never-before seen species of bacteria of the Enterococcus type” in research to understand antibiotic resistance. Antibiotic resistance (AMR) is a growing global health threat, with antibiotic-resistant infection “projected to catch up to cancer” as the leading cause of death by 2050.
Introducing Enterococci
The paper describes enterococci as “unusually rugged and environmentally persistent microbes”. Their “unusual hardiness” is understood to contribute to the spread of antibiotic-resistant enterococci in hospitals. They are “among the most widely distributed members of gut microbiomes in land animals”. However, their occurrence varies “widely”, which offers a “unique opportunity to explore how diverse host backgrounds” drive microbiome membership.
The study
The authors intended to “sample the Earth broadly” for “enterococci from diverse hosts, geographies, and environments”. This would offer a “first approximation of the diversity of species on the planet” and allow comparison of the “content and degree of divergence of their genomes toward the broader goal of understanding the mechanisms that drive association with particular hosts”.
To do this, they collected and taxonomically identified at DNA sequence level 430 enterococci from unprocessed animal samples and 456 enterococci isolated by contributors from diverse sources; the result was a collection of 886 isolates. Then they sequenced the entire genomes of strains that exhibited sequence diversity “suggestive of distant relationship to any known species”, which identified 18 “previously undescribed species” of Enterococcus and 1 new species of the ancestrally related genus Vagococcus.
Relevance for AMR infections
The paper emphasises that developing an understanding of “host association principles” is “imperative”. By isolating 18 “previously undescribed species” they determine that “much species-level diversity” within the genus “remains to be discovered”. Dr Michael S. Gilmore, director of the Infectious Disease Institute at Harvard Medical School and Chief Scientific Officer at Mass Eye and Ear, recognised that “over the past 75 years” antibiotics have “saved hundreds of millions of lives” and “contributed greatly to the success of all types of surgery”.
“Over the past 30 years, however, many of the most problematic bacteria have become increasingly resistant to antibiotics and this is now reaching crisis proportions. Our findings may improve understanding of how resistance genes spread to hospital bacteria and threaten human health.”
Dr Gilmore suggests that insects have been eating rotting plant material, where antibiotics are naturally produced by microbes in the soil. They have therefore been dosing themselves with antibiotics, exposing the bacteria in their gut to these antibiotics and encouraging resistance.
“The COVID-19 pandemic revealed that nature contains many infectious risks for humans. This study shows that insects and their relatives in nature are a large and uncharacterised reservoir of undiscovered genes in microbes closely related to those that cause some of the most antibiotic resistant infections.”
Dr Ahslee Earl, director of the Bacterial Genomics Group at Broad, commented that, “until recently, most of what we’ve understood about the genetics of enterococcus come from those that make us sick”. However, this is a “problem” that is “like trying to understand darkness without ever seeing the light”.
“Expanding our view to include those from outside of hospitals, with the help of citizen scientists, gave us the contrast we needed to identify how they make people sick in the hospital, and also gives the public the chance to co-own solutions.”
AMR is a key workshop theme at the Congress in Washington this April, so do join us to participate in the discussions about how vaccines can contribute to managing the problem. For more research insights, why not subscribe to our newsletters here?
by Charlotte Kilpatrick | Feb 28, 2024 | Infection |
In February 2024 WHO reported that two laboratory-confirmed cases of Nipah virus (NiV) infection have been identified from the Dhaka division of Bangladesh since the start of the year. Outbreaks of NiV are seasonal in Bangladesh; cases usually occur between December and April as date palm sap is harvested and consumed. Since the first case was reported in 2001, human infections have been recorded “almost every year” with a case fatality rate of between 25% (2009) and 92% (2005).
The overall risk at national levels is described as “moderate”, which considers the disease severity, limitation of treatment, shared natural habitat of bats and zoonotic transmission partners, and the lack of licensed vaccines against NiV infection.
Two cases
On 30th January and 7th February 2024, the Bangladesh National Focal Point (NFP) for the International Health Regulations (IHR) notified WHO of two “epidemiologically unlinked cases” of NiV. The first was a 38-year-old male from Manikganj district, who developed a fever followed by respiratory distress, restlessness, and insomnia on 11th January. He was admitted to a local hospital on 16th January before being transferred to the intensive care unit of a hospital in Dhaka City on 18th January.
On 21st January, blood and throat samples were collected and the patient tested positive (RT-PCR and ELISA) for NiV. After being transferred to another hospital in Dhaka city on 27th January, the patient died on 28th January. WHO states that he had a “history of consuming raw date palm sap”. After extensive contact tracing, 91 contacts were identified but none tested positive by PCR or ELISA.
The second case was a three-year-old female from Shariatpur district. She was taken to a healthcare facility on 30th January after two days of fever, altered consciousnesses, and seizures. She was diagnosed with encephalitis and shock and was transferred to the isolation ward of a hospital in Dhaka city. Blood and throat samples were collected on 30th January and tested positive the following day, when the patient died. WHO notes that this case also had a “history of regularly consuming fresh raw date palm sap”. On 7th February contact tracing found no other positive cases.
NiV transmission and presentation
NiV is a bat-borne zoonotic disease that is transmitted through infected animals or contaminated food. It can also be transmitted from person to person, but this is “less common”. The incubation period usually ranges from 4 to 14 days, although a previous incubation period of up to 45 days has been reported.
Infection can cause a “range of clinical presentation” such as acute respiratory infection and fatal encephalitis. The case fatality rates depend on local capabilities for early detection and clinical management, particularly because there are no licensed vaccines or therapeutics.
To learn more about diseases without vaccines that present a significant public health threat, join us in Washington this April for the Congress or subscribe to our newsletters here.
