"World Rabies Day" is September 28th. Copyright: CC, Global Alliance for Rabies Control
Rabies: a contagious and fatal viral disease of dogs and other mammals, transmissible through the saliva to humans and causing madness and convulsions. Rabies is fatal once symptoms appear.
Latin America is doing far better at managing, controlling and ultimately eliminating rabies from the region. Africa is failing to make the same gains and a rethink is required: can the lessons learned in Latin America be applied or adapted to Africa?
At the biennial RSTMH meeting “Challenges in Disease Elimination” held in Cambridge [September 12-16th, 2016], Katie Hampson [University of Glasgow] described the Pan American Health Organisation (PAHO)'s surveillance & management framework operating in Mexico and Brazil, and devised to support the elimination of rabies in 25 PAHO countries. She also described the work of Tanzanian colleagues who have developed a “pragmatic approach to surveillance” for the African setting where resources are constrained.
Current situation of rabies control in Latin America vs Africa
The short answer is that in Latin America, PAHO, which exists to “strengthen national and local health systems and improve the health of the peoples of the Americas”, has concentrated on vaccinating the dog population against rabies and interrupting transmission. African countries have no similar regional support structure for their health ministries and rely on post-exposure prophylaxis (PEP) of humans bitten by dogs, to achieve a form of control of rabies. PEP vaccination only saves lives if the bitten person has timely access to a well-stocked clinic, and the money to pay for the shots. In remote and rural areas, this can lead to grim choices: which child do you treat if you only have money for one? We heard at the RSTMH of an African mother with several children bitten by the “family dog”, who having travelled a great distance to reach the vaccine, was then faced with that very choice.
St. Catherine’s College, Manor Road, Oxford, UK, 4-7th April 2016
Attended by M Djuric, CAB International, Wallingford, UK, on 5th April 2016 (Day 2)
This workshop meeting was jointly organised by the Pirbright Institute, Woking, UK and Cairo University, Egypt and was sponsored by the British Council Research Links Programme.
The aims of the workshop were to build long-term and sustainable links between scientists in the UK and Egypt working in the field of infectious diseases of poultry and livestock.
The second day of the workshop consisted of two sessions and included four invited expert and engaging presentations by Professor Mohamed Shakal, Professor Fiona Tomly, Professor Javier Guitian and Dr Roberto La Regione.
Venue: St. Catherine's College, Manor Road, Oxford
Air pollution in Delhi
In January 2016, Delhi, India, improved air quality on its streets when it conducted a 2-week air pollution reduction experiment, with private cars allowed on the streets only on alternate days, depending on license plate numbers. The idea is not new and has been tried elsewhere (Paris and Rome) but I guess its novelty (“who’d have thought” brigade) to the USA explained why it made The New York Times!
Last year, it was all headlines about Bejing [China] and the air quality citizens had to deal with. However it would seem that actually Beijing’s levels of PM10 (particulate matter up to 10 micrometres in size), a measure of air quality, decreased by 40% from 2000 to 2013, whereas Delhi's PM10 levels have increased 47% from 2000 to 2011.
Delhi's PM10 levels are nearly twice as much as in Beijing, and it has the worst PM 2.5 levels of 1600 cities in the world. Thus the need for the license plate experiment. In a BBC article, you can read more about the reasons “Why Delhi is losing its clean air war” and discover the varied & innovative measures China has taken to ameliorate motor car use.
No doubt spurred on by Delhi’s experiment, a health journalist in Bangladesh alerted the HIFA forum to the equally bad situation in India’s neighbour, Bangladesh.
Antibiotic resistance is growing steadily round the world and threatening our ability to treat many infectious diseases. The World Health Assembly approved a new action plan to counter antibiotic resistance recently, sparking off activities in countries round the world. Several reports on antibiotic use and resistance caught my eye this week, while I was scanning the news for Global Health Knowledge Base, some with startling findings, highlighting some of the difficulties and suggesting some approaches to solving the problem.
A great deal of time and effort these days goes into making TV medical dramas both authentic and technically accurate. But it would appear that an unlooked for bonus of such detail is that these dramas – whilst being mainly entertainment vehicles- unintentionally improve health awareness in the watching public. They do so by providing accurate health information and can cause individuals to take action in regard to their own health or that of their family. In other words, take action to achieve “wellness”. These dramas can thus aid the current shift of focus of governments and public health practitioners to deliver Health & Wellness, aka Health & Wellbeing, (a National Wellness service rather than a National Health service?)
This shift to Wellness i.e. staying healthy, is in response to the rise of chronic diseases and inequity. The aim is to empower the individual to make healthy choices and to address the social, environmental and economic factors which limit that choice. Health awareness is therefore a prerequisite for wellness.
Call the Midwife, the hit medical TV drama, works hard to depict accuracy and authenticity
An essay in April's Journal of the Royal Society of Medicine describes the steps taken by the writers, production team and actors of the hit BBC TV series, Call the Midwife, to ensure the series has sufficient medical accuracy and authenticity [the series is set in the poor Poplar district of East London during the early years of the National Health Service (1950s)]. The series is viewed by more than 10 million people each week, and sold to almost 200 territories worldwide.
The author of the essay is the actor Stephen McGann who plays the local community docter [GP], Dr Patrick Turner.
As one would expect, a clinical advisor [a practising midwife and lecturer] oversees childbirth and nursing procedures but this series has gone further. Open-access journals and the Wellcome Trust archive are used as resources by the writer, and relevant health charities are called upon to provide an insight into the health impact of social conditions of the time. McGann himself deliberately chose to make his character a smoker “after reading a BMJ study* [by Richard Doll: Mortality in relation to smoking’: 50 years' observation on male British doctors BMJ 328 (7455): 1519] which observed the effects of smoking on men over a 50-year period, starting in 1951. A total of 34,439 smokers took part in the research – all of them doctors.” [*The first publication based on this cohort was in 1954 and is in the Global Health Archive database: ‘The mortality of doctors in relation to their smoking habits ’. BMJ 328 (7455): 1529.]
But McGann then goes on to explain that the medical accuracy and authenticity pioneered by ‘Call the Midwife’ has communicated valuable insights to ordinary people into important public health issues …giving them the information to improve their own health.
Band Aid is a tried and tested method of public engagement, bringing Ebola to public attention and giving us all something we can do to help rather than just scaring us. What is also needed here and in West Africa, is education.
For a novel method of education, I bring you Giant Microbes, which are sold as teaching tools. They are soft plush “cuddly” toys, anthropomorphised versions of microscopic images of microbes, and provide information on the microbe and the disease it causes in the attached label. Apparently they are currently sold out!
I own their version of Ebola virus (shown opposite is the actual toy sitting on my desk): its based on the shape of the virus seen in an electron microsopic image. My colleague owns a tuberculosis (TB) virus toy. Bought at a public health conference, the label for my Ebola toy is dated 2004 and describes the symptoms, the 50-90% mortality but also tells me that outbreaks are limited to a few hundred cases. The toy produced now, in 2014, will have a very different set of statistics to present.
The West African outbreak today stands at 14383 cases, with 5165 deaths in 6 countries.
Of those 6 African countries, Nigeria and Senegal have had their Ebola Virus Disease (EVD) outbreaks declared as officially over. [A national EVD outbreak is considered to be over when 42 days (double the 21-day incubation period of the Ebola virus) has elapsed since the last patient in isolation became laboratory negative for EVD].
Last week, my colleague had house-guests. On seeing the TB “cuddly toy” at home, they asked where was the Ebola one (?) and she was gratified to say “its at work”! Clearly information on Ebola has successfully entered UK public consciousness.
Sierra Leone National Ebola Emergency Operations Center
Credit: Jennifer Brooks, CDC.
Following the launch of Band Aid 30, "the Ebola song”, on X-factor [Sunday 16 November 2014], Bob Geldorf did the media rounds on the Monday morning including BBC 5live, to further drive home the message. People are dying from Ebola in West Africa because they are poor, living in countries without the health service infrastructure to stop it in its tracks, and “we are all just a plane ride away from it”.AS of that Monday, you can buy and download the song here via Amazon, Itunes and Google Play, or purchase the CD.
WE at CABI, devoted last month’s focus of the Global Health Knowledge Base e-newsletter to Ebola research.
With the charitable effort of Band Aid 30 ringing in our ears, I thought it timely to highlight another such effort, from researchers, specifically from the Wellcome Trust.
Wellcome Trust: Emergency Ebola initiative
The Wellcome Trust (WT), the world's second largest private funder of medical research after Bill & Melinda Gates Foundation, are funding a multi-million pound emergency research package [Emergency Ebola Initiative] to investigate new approaches to treat, prevent and contain Ebola viral disease, during the current epidemic in West Africa. WT will also support research into the ethical challenges of testing experimental medicines during epidemics, and has a £40 million long-term investment in African science.
One of their anti-Ebola vaccines is being fast-tracked.
A new rapid sequencing method created for Lassa, was applied to Ebola virus, sequencing nearly 100 Ebola patient blood samples In Sierra Leone, within 10 days. The method is also cost-effective, and may help West African nations rapidly and effectively track outbreaks with limited resources. This article is one of the records on CABI's Global Health database.
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