Why Latin America is nearer elimination of rabies than Africa

"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.

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Workshop on “Food Security: Infectious Diseases in Farm Animals”- Invited Lectures, Day 2

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.

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Venue: St. Catherine's College, Manor Road, Oxford

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Can We Strike Back Against Dengue?

Dengue is a mosquito-borne viral infection causing a severe flu-like illness and, sometimes causing a potentially lethal complication called severe dengue. The incidence of dengue has increased 30-fold over the last 50 years. The latest estimates suggest that up to 400 million infections occur annually in over 100 endemic countries, putting half of the world’s population at risk. Dengue flourishes in urban poor areas, suburbs and the countryside but also affects more affluent neighbourhoods in tropical and subtropical countries. But can dengue be brought under control?


Image courtesy of ProjectManhattan

“Mosquito control, the only option available for dengue control, has failed,” says Duane Gubler, Professor and Founding Director of the Signature Research Program in Emerging Infectious Diseases at the Duke-NUS Graduate Medical School, Singapore. in a CAB Reviews Mini Review. However, he says new and innovative tools in the pipeline may provide the opportunity to rollback this disease.

The release of sterile male mosquitos, or mosquitoes infected with a common bacteria, Wolbachia, have the potential to limit the spread of infection, and field trials of both have been encouraging. There are new insecticides and antiviral drugs in the pipeline, and six vaccines are in clinical trials, three of which may be licensed by 2018-2019.The full text of the mini review “Is it time to rollback dengue?CAB Reviews 2014 9, 029, can be accessed free of charge by clicking on the title.


Duane Gubler is one of the editors of “Dengue and Dengue Hemorrhagic Fever”, newly published by CABI. This 29-chapter book brings together leading research and clinical scientists to review dengue virus biology, epidemiology, entomology, therapeutics, vaccinology and clinical management. For more details about the book, go to: http://www.cabi.org/bookshop/book/9781845939649

Hepatitis: a case of see no evil hear no evil speak no evil.

Pamela Anderson 3

What do Pamela Anderson the actor, and Billy Graham the
wrestler have in common?

A quick search on Wikipedia will show you they both
are reported to have had hepatitis C. Pamela got it apparently by sharing a needle
for a tattoo, Billy by exposure of blood during competitions. Evel Knievel the
dare devil stuntman got hepatitis C after a blood transfusion. WHO celebrates World Hepatitis
on July 28th to raise awareness about this insidious disease
with the theme of 3 monkeys and the ancient proverb “see no evil hear no evil
speak no evil” to highlight how people are not communicating about this

Hepatitis C and B are chronic diseases, passed by blood or
other body fluids. Often symptomless for years they result in extensive liver
damage and cancer. Their silent nature makes them particularly difficult to
combat – people don’t make the link between the occasion they got infected and
the disease, and don’t find it easy to stick to treatments that feel worse than
their symptoms.  On top of that, although
in many countries hepatitis B is a disease of childhood there is stigma associated with the infection in some
countries because it can be sexually transmitted. Both illnesses are associated
with injecting drug use.

The list of
celebs with hepatitis C
on Wikipedia is one way of breaking the taboo to
get people talking about hepatitis C. 
Airing the issue is important because less than half hepatitis C
infected people know that they have the illness, according to recent research.
While they don’t know they are ill they can be suffering liver damage  and spreading the disease. Ignorance isn’t

There has been no better time to break the silence around
hepatitis because it is treatable and preventable. There is a vaccine for
hepatitis B that can be used from birth. For hepatitis C, new antivirals are on
the way that could herald a totally oral treatment with fewer side effects:
several new protease inhibitors as well as a viral polymerase inhibitor. There
are simple public health measures to stop disease spread too- safe sex with
condoms, use of clean needles for injections of any kind, screening blood
donations, mass vaccination.

In 2012 WHO established a Global Hepatitis
to prevent and treat viral hepatitis and world leaders recommitted themselves at the 66th World Health Assembly to taking action. The
Hepatitis coalition think WHO could
do more to make treatment more available in lower income countries- by making
some of the drugs part of the Essential Medicines list and funding better
vaccination programmes

 See 'Latest research'  page on Global Health Knowledge Base for selected records about hepatitis C from Global Health database.

April 25th World Malaria Day: affordable medicines & artemisinin-based control


April 25th is World Malaria
Day and we’ve had some mixed news this month concerning the GlaxoSmithKline
RTS,S vaccine, reported in New England Journal
of Medicine
. 65% of children were protected in the 1st year,
but protection then declined to zero over the next 3 years: which means booster
shots will be essential.  Vaccine efficacy also declined faster in children who were more exposed
to malaria than in those who had below-average exposure. Not the grail we hope
for, but we inch our way there.

Effectiveness is at the heart of the problem of malaria
control. Last year Oxfam’s report “Salt,
Sugar And Malaria Pills
  highlighted their concerns on the effectiveness of the “Affordable
medicines facility for malaria” (AFMm)
hosted and managed by the Global Fund, with financial support from UNITAID, the
UK Department for International Development (DFID), and others.

A fuller discussion of these issues can be found in the April issue of Global Health Knowledge Basealong with the latest research on drug-related aspects of malaria control

Related articles

Wellcome Image of the Month: Malaria
News in Brief: Malaria drug made by baker's yeast
Amyris (AMRS) Scientists to Publish Data on Breakthrough in Key Malaria Vaccine Ingredient
Prevalence rate of malaria declining in Ghana
Malaria: the Institute of Tropical Medicine focuses on elimination using knowledge

Universal influenza vaccine is now a possibility..

Across my desk today at CABI, came the New England Journal of Medicine (NEJM) and tucked away at the back in a section called “Clinical Implications of Basic Research” was “Stalking influenza diversity with a universal antibody” by Charles R. Russell (St Jude Children’s Hospital, Memphis).

Here I learnt that an antibody has been isolated which recognizes all 16 hemagglutinin (HA) subtypes of influenza (H1 to H16),  and will protect mice and ferrets from dying from the infection.  Simplistically called F16 (!), it was isolated from human blood plasma cells (104,000 cells from 8 donors) by selecting for those cells that produced an antibody binding to 3 very diverse influenza strains:  H1N1 (swine-origin) , H5N1 and H7N7 (both are highly pathogenic avian-influenzas).  (Light dawns, yes, that’s what the H numbers mean…)

I am sure you remember the pandemic fears caused by bird-flu and swine-flu, and are familiar with the annual flu-jabs for seasonal influenza.  So the significance of an antibody that can bind all 3 will not be lost on you.

The HA protein of influenza has a head and stalk structure, with the head exposed and the stalk tethering it to the virus surface . It’s the  regular changes in the head of HA protein that keeps the virus ahead of our immune system and means that we have to update seasonal influenza vaccine most years.  F16 binds to the  more "constant" stalk, in parts highly conserved across subtypes,  and so it stands a really good chance of protecting us against seasonal influenza. If it can’t,  then it has at least identified portions of the HA stalk that could be used to create a universal vaccine or be targeted by anti-viral drugs.

If you are a subscriber to NEJM, you can read Russell’s article for a simple explanation of the significance of this discovery. If you are a really keen bunny, then I hope you read the original article by Corti et al in Science.

You may not have heard it here first, but 3rd hand is better than never when it comes to good news.

Further reading:

Stalking influenza diversity with a universal antibody C. R. Russell

A Neutralizing Antibody Selected from Plasma Cells That Binds to Group 1 and Group 2 Influenza A Hemagglutinins Corti et al

Related blogs:

H1N1 influenza research- free papers

Flu – can we say goodbye to yearly vaccines soon?