Health Issues in Africa

Health Issues in Africa

Non Communicable Diseases

Breast implants linked to cancer risk?

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Breast cancer is a major threat to women’s health across the globe.

The US Food and Drug Administration (FDA) on Thursday warned women who have breast implants or are considering getting them that certain cancers may develop in scar tissue forming around the implants. www.nytimes.com/2022/09/08/health/breast-implants-cancer.html?

The malignancies seem to be rare, but they have been linked to implants of all types, including those with textured and smooth surfaces, and those filled with saline or silicone.

Scientists had already linked an unusual cancer called anaplastic large cell lymphoma primarily to textured implants, whose rough exteriors presumably cause more inflammation than those of smooth implants. Lymphoma is a cancer of the immune system.

The FDA confirmed that link over a decade ago, but textured implants, made by Allergan, were on the market until 2019. The agency’s new warning called attention to another cancer, called squamous cell carcinoma, and also to other types of lymphoma that may be related to the implants.

In a typical year, some 400,000 women get breast implants in the United States, 300,000 for cosmetic reasons and 100,000 for reconstruction after mastectomies performed to treat or prevent breast cancer.

Numbers dropped substantially during the first year of the pandemic, according to the American Society of Plastic Surgeons.

Last year, the FDA placed so-called black-box labels on breast implants, warning that they had been linked to a host of chronic medical conditions, including autoimmune disease, joint pain, mental confusion, muscle aches and chronic fatigue, as well as to lymphoma.

Among those at highest risk for developing later illnesses are breast cancer patients who have had or plan to undergo chemotherapy or radiation treatments — and who represent a large percentage of the women who are encouraged to have breast reconstruction with implants.

World Mosquito Day 2022: Climate change could threaten to expand malaria transmissions in Africa

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African child toddler sick with malaria medicine in the background, laying down on a blanket in the yard.

Africa faces new challenges in its fight against malaria: the climate is becoming more mosquito friendly just as the insects are evolving to evade the insecticides and the malaria parasites are becoming resistant to medicines that have brought down deaths. In 2020, the World Health Organization estimated approximately 90% of malaria cases and 92% of deaths occurred in Africa. Over 600,000 African children died of malaria in that year alone. 

This article uses Rwanda, a small and landlocked central African nation, to illustrate the struggle between governments and insects. 

Progress in fighting malaria

There has been huge progress in malaria control since 2000. In the last 20 years, more than 600 million malaria cases and more than 6 million deaths have been averted. This progress has been made through unprecedented political commitment and partnerships. However, progress has slowed since 2016. In 2022, the fight against malaria faces new and growing challenges. Better data confirms the global malaria burden is higher than previously estimated and COVID-19 and other challenges such as increasing drug and insecticide resistance and humanitarian emergencies led to an increase in malaria deaths for the first time in over a decade. 

Take Rwanda as an example. According to data from the Rwanda Biomedical Centre (RBC), the country saw a decrease in the prevalence of malaria, where cases declined from 5 million to 1 million over a five-year period, from 2016 to 2021. Severe malaria cases also dropped from 18,000 to fewer than 2,000, and the number of deaths related to malaria shrunk from 700 to 69.

The accomplishments were made possible by a variety of factors, including RBC’s interventions to ensure that services for diagnosing and treating malaria are made more accessible to the public. Currently, up to 60% of all malaria cases are diagnosed and treated at home by community health workers.

Boy in a mosquito bed net

In the past, the government rolled out indoor residual spraying campaigns, where trained staff sprayed insecticides inside residential homes to get rid of mosquitoes, as well as the use of drones for spraying outdoor mosquito breeding grounds. Dr Aimable Mbituyumuremyi, the Division Manager for malaria and other parasitic diseases at RBC in 2021, said that drones helped in the precision mapping of mosquito breeding sites and in spraying the larvicide. 

Rwanda joined the Zero Malaria Starts with Me movement in 2020 as part of efforts to eradicate the disease. The campaign was launched in 2018 by Rwanda’s President Paul Kagame, in his role then as Chair of the African Union, to build community ownership of malaria efforts and increase political commitment for malaria elimination. So far, 25 countries have launched the movement. Progress was not unique to Rwanda alone, as, throughout Sub-Saharan Africa, there have been symbiotic efforts to tackle malaria head-on by investing in communities and health systems and rolling out innovative and integrated programmes to defeat this millennia-old disease. Such cases show that malaria can be eliminated. However, the fight against malaria remains a tough battle, especially in Sub-Saharan Africa. 

Lockdowns and climate change have helped mosquitoes  

According to the results of the World Health Organization’s survey, many countries in Sub-Saharan Africa experienced disruptions in malaria prevention, diagnosis and treatment services during the first quarter of 2021. Lockdowns and restrictions on the movement of people and goods led to delays in the delivery of insecticide-treated mosquito nets or indoor insecticide spraying campaigns. Although, malaria programmes did a great job in continuing services as much as possible and avoided the direst of predictions in terms of the impact of COVID. 

Deforestation

However, some of the factors responsible for malaria deaths are long-term and include population and demographic dynamics; and;  human activities such as deforestation, irrigation and swamp drainage. These add to the existing factors on the continent, such as weak and under-resourced health systems, human resources limitations, remaining critical gaps in access to malaria control services and poor surveillance systems. 

The situation could get worse, as recent data from the United Nations shows that there is a complex relationship between malaria and climate change, which could soon put millions more at risk of the disease.

Climate change is often characterized by increasing temperatures, a surge in natural disasters, locust invasions, floods, drought, and so on. With warmer temperatures and variations in rainfall, researchers from the University of Florida expect that malaria vulnerable areas will change and the total transmission zone will expand. At higher altitudes, the malaria-carrying female anopheles mosquito multiplies, which could result in an increase in malaria transmissions in areas where it was not even reported before. As malaria arrives in new areas or in tropical and temperate countries that have, either eliminated or controlled transmission, this presents a significant risk to populations never exposed to the malaria parasite as they lack protective immunity. For example, districts in Rwanda’s Northern Province and Kigali are not generally known for epidemics but are most likely prone based on altitude and climate conditions.

Although researchers are not yet sure of how dramatic the impact of climate change will be on malaria, it’s clear that its influence, as well as other environmental factors on vector-borne disease, is a significant threat that could be prevented with the right strategies and consistent approach. 

Therefore, there is an ardent need for adequate and equitable investments in research and monitoring exercises, to identify how climate may impact upon malaria control and elimination programmes and to identify regions where climate conditions may become suitable for resurgence or spread. This could help provide current and improved treatment to those who are most vulnerable and to monitor how the distribution of the disease is changing.

Resistance to insecticides and medicines

Hundreds of thousands of people died from malaria after resistance developed to the treatments in the second half of the 20th century. At that time, there was no meaningful research and development (R&D) pipeline for new antimalarials to replace them until artemisinin-containing combinations were introduced at the turn of the century. Innovations in treatment, along with the widespread use of tools such as long-lasting insecticide-treated nets and rapid diagnostic tests, have helped save more than seven million lives and prevent more than one billion new malaria infections since the early 2000s. Currently, the WHO recommended first-line treatment, artemisinin-based combination therapies (ACTs), are largely effective and well tolerated and have been used for almost 20 years. However, the emerging threat of resistance demands urgent action to develop new medicines with novel and distinct mechanisms of action.

Rapid tests for Malaria

Emerging resistance to artemisinin has been observed in the Greater Mekong region and spontaneous resistance is now increasingly seen in Africa in Eritrea, Ethiopia, Rwanda, Somalia, Sudan, Uganda, and with increasing frequency in the Horn of Africa. Currently artemisinin resistance means that each patient must take more tablets, but if parasites also become resistant to the partner drug, then the treatment will become ineffective, leading to many deaths. 

As well as resistance to treatment, a different kind of resistance is emerging rapidly to a vital line of defence in malaria: insecticides. Failure to monitor, mitigate and manage insecticide resistance will likely result in an increase of malaria cases and deaths. This is particularly worrisome in the case of pyrethroids, the insecticide used on insecticide-treated bed nets (ITNs). The growing inability of insecticides to kill malaria vectors is concerning because insecticide-based interventions are vital to preventing death and disease from malaria in African children. ITNs are estimated to be responsible for 78% of the 663 million clinical malaria cases averted in sub-Saharan Africa since 2001, and more than 50% of people in malaria-endemic areas in sub-Saharan Africa slept under ITNs in 20161.

Vaccines

In 2021, the WHO recommended withe despread use of the world’s first malaria vaccine for children. Although this is a major breakthrough in child health, the vaccine is yet to reach the most affected regions in Sub-Saharan Africa. Despite the recent announcement by UNICEF to supply 18 million doses of RTS,S/AS01 (RTS,S) through a contract with GSK, even with this announcement, supply will continue to be limited at first and will only increase over time as manufacturing capacity ramps up to the level required. 

A syringe with an antimalarial vaccine to be injected as part of a malaria control program

Rwanda is in a unique position to become a leader, as the country is home to the first of three planned mRNA vaccine manufacturing facilities across Sub-Saharan Africa. This development has the potential to make Rwanda a leader in vaccine R&D and manufacturing for the continent, especially as these new technologies are applied to the malaria fight. 

“What got us here …will not get us where we need to be”

At the recent Commonwealth Head of Government meeting in Kigali, the leaders called out the opportunity to accelerate the fight against infectious diseases, including malaria. Kenya’s President, who also doubles as the Chair of the African Leaders Malaria Alliance, President Uhuru Kenyatta, in his opinion piece after the meeting, highlighted the need for vaccines and investment to tip the scales against malaria. “…. what got us here in the fight against malaria will not get us where we need to be in 2030. We need fresh tools, such as the new malaria vaccine, RTS, S. We must ensure that everyone, everywhere, can have access to tools, which prevent the disease, such as mosquito nets, indoor residual spraying and seasonal chemoprevention. We must also ensure that when people get sick, they can get treatment as soon as they need it.”

By Immy Mulekatete
Communications, Media and Marketing Enthusiast 

US declares monkeypox a public health emergency; The latest health stories from around the world

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Map of Monkeypox Outbreak 2022 as of 6th August
Map of Monkeypox Outbreak 2022 as of 6th August. Source: Wikieditor019, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

The Biden administration in the United States (US) has declared monkeypox a public health emergency. 

There have been more than 7,000 cases detected in the US, but that is likely an undercount. The majority of cases are concentrated in the gay and queer community, primarily among men who have sex with men. But the Centers for Disease Control (CDC) and Prevention has also reported infections in a small number of cisgender women and at least two children.

Declaring a public health emergency in the US can trigger grant funding and open up more resources for various aspects of a federal response. It also allows the Department of Health and Human Services to enter into contracts for treatments and other necessary medical supplies and equipment, as well as support emergency hospital services, among other things. Public health emergencies last for 90 days, but can be extended.

CDC Director Rochelle Walensky said the declaration will provide resources and increase access to care. She also said it will expand the CDC’s ability to share data.

Epidemiologists and public health experts have warned that the US is running out of time to contain the outbreak.

Meanwhile, health officials in Britain said there were early signs that the spread of monkeypox was slowing. The country has some 2,900 confirmed cases of the virus.

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US administration has decided to stretch out its limited supply of monkeypox vaccine by allowing a different method of injection that uses one-fifth as much per shot, according to people familiar with the discussions. www.nytimes.com/2022/08/08/us/politics/monkeypox-vaccine.html?

In order for the Food and Drug Administration (FDA) to authorize so-called intradermal injection, which would involve injecting one-fifth of the current dose into the skin instead of a full dose into underlying fat, the Department of Health and Human Services will need to issue a new emergency declaration allowing regulators to invoke the FDA’s emergency use powers. That declaration is expected as early as Tuesday afternoon.

The move would help alleviate a shortage of vaccine that has turned into a growing political and public health problem for the administration.

Even though it invested more than $1 billion in developing the two-dose vaccine known as Jynneos that works against both monkeypox and smallpox, the government has only 1.1 million shots on hand. It needs about three times as many doses to cover the 1.6 million to 1.7 million Americans who, according to the CDC, are at high risk of contracting monkeypox.

The vaccine is currently delivered in two 0.5-milliliter doses 28 days apart, with immune protection reaching its “maximum” 14 days after the second dose, according to the CDC.

The shot is recommended by the C.D.C. for people who have been exposed to monkeypox and those who might be likely to get it. Those in the latter category include people identified as a contact of someone with monkeypox, those who know a sexual partner from the last 14 days was diagnosed with the disease and those who have had “multiple” sexual partners in that time frame in an area with “known monkeypox.”

Federal health officials said last week that so far, they have distributed about 600,000 doses of the vaccine to state and local jurisdictions.

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Japan’s health ministry on Tuesday approved KM Biologics freeze-dried smallpox vaccine LC16 KMB for use against monkeypox, after an experts’ panel recommended the move last week. www.medscape.com/viewarticle/978502?

KM Biologics, a unit of candy maker Meiji Holdings Co, has had “several inquiries from overseas” a company official told Reuters on Wednesday, declining to comment on any export plan for the shot.

Japan has had only two confirmed cases of monkeypox during the current global outbreak.

Based in the southern prefecture of Kumamoto, KM Biologics mainly produces vaccines for humans and veterinary use. It has an inactivated COVID-19 shot currently in development.

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The European Medicines Agency (EMA) is recommending Novavax’s COVID-19 vaccine carry a warning of the possibility of two types of heart inflammation, an added burden for a shot that has so far failed to win wide uptake.( www.medscape.com/viewarticle/978527?)

The heart conditions – myocarditis and pericarditis – should be listed as new side-effects in the product information for the vaccine, Nuvaxovid, based on a small number of reported cases, the EMA said last Wednesday.

Novavax said no concerns about heart inflammations were raised during the clinical trials of Nuvaxovid and that more data would be gathered, adding that the most common cause of myocarditis is viral infections.

In June, the US FDA flagged a risk of heart inflammation from the Novavax vaccine.

Myocarditis and pericarditis were previously identified as rare side- effects, mostly seen in young men, from ground breaking messenger RNA (mRNA) vaccines made by Moderna and the Pfizer and BioNTech alliance, with the vast majority of those affected recovering fully.

The EMA said on Wednesday it had asked Novavax to provide additional data on the risk of these side-effects.

Last month, the EU agency identified severe allergic reactions as potential side-effects of the vaccine.

Novavax was hoping that people who have opted not to take Pfizer and Moderna’s vaccines would favour its shot because it relies on technology that has been used for decades to combat diseases including hepatitis B and influenza.

However, only around 250,000 doses of Nuvaxovid have been administered in Europe since its launch in December, according to the European Centers for Disease Prevention and Control.

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North Korea says everyone who fell sick since the country confirmed its first Covid-19 infections has recovered. On Friday state media reported zero fever cases for a seventh straight day. North Korea refers to “fever” rather than “Covid” patients due to a lack of testing equipment. The country announced its first Covid outbreak in May and has reported fever infections and deaths since. But there is widespread doubt over the data, especially the number of deaths. “No new fever cases were reported during the past week and all those receiving treatment have recovered across the country,” the Korean Central News Agency (KCNA) reported on Friday.

https://www.bbc.co.uk/news/world-asia-62435809

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New York state health officials have urged unvaccinated residents to get their polio shot “right away.”

One case of polio was confirmed last month in a county north of New York City, which the state’s health commissioner described as possibly “the tip of the iceberg.”

Wastewater samples taken in several locations north of New York City potentially signal community spread of the highly contagious disease.

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The world’s response to the HIV/AIDS pandemic is faltering badly in the face of declines in spending and the COVID-19 pandemic, according to an annual update from the Joint United Nations Programme on HIV/AIDS (UNAIDS) released last week. In a campaign announced in 2015 to “end AIDS as a public health threat” by 2030, UNAIDS set targets for 2025 that the new report finds are far from being met. Last year, 1.5 million people became infected with HIV, 1 million more than the 2025 target. Of the 38.4 million people living with the virus in 2021, 10 million are still not receiving lifesaving antiretroviral drugs, and last year saw the lowest number of new people starting treatment in a decade. Alarmingly, UNAIDS notes, 52% of infected children aren’t being treated.

www.science.org/content/article/news-glance-ai-protein-structures-racism-memory-rising-tiger-numbers

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The British Heart Foundation will award £30 million ($36 million) over 5 years to an international team to develop genetic cures for some inherited heart diseases called cardiomyopathies. The group, dubbed CureHeart, won over three others shortlisted by the Big Beat Challenge, a competition launched in 2019 to fund transformative heart disease research. The team aims to use one-time injections of gene-editing tools to precisely correct or silence mutations that cause heart muscle cells to produce too little or a harmful form of a needed protein. These cardiomyopathies affect one in every 250 people, putting them at risk for heart attacks and heart failure; some will need a heart transplant. Within 5 years, CureHeart members in the United States, United Kingdom, and Singapore hope to develop one or more treatments to the point that companies will pick them up for clinical testing.

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Lalita Panicker is Consulting Editor, Views and Editor, Insight, Hindustan Times, New Delhi

New COVID-19 strain poses serious reinfection risk; The latest health stories from around the world

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Stock Photo - Inscription COVID-19 on blue background. World Health Organization WHO introduced new official name for Coronavirus disease named COVID-19. COVID-19 outbreak concept. Image credit: nunataki / 123rf
Image credit: nunataki / 123rf

Health experts across the globe are signalling alarm as they begin reporting that Omicron BA.5, the coronavirus strain that is currently outpacing other variants in infection and has become the dominant strain in the United States (US) and abroad, has the ability to reinfect people within weeks of contracting the virus. Andrew Robertson, the chief health officer in Western Australia, told News.com.au that though previously the wisdom held that most people would retain a certain level of protection against reinfection if they were vaccinated or had retained some level of natural immunity due to a recent contraction of the virus, this hasn’t been the case with the most recent strain. The ability of strains BA.4 and BA.5 to reinfect individuals who would in previous waves of COVID-19 had stronger immunity has led some experts to start calling this latest strain the most transmissible yet.

https://www.independent.co.uk/news/world/americas/ba5-covid-symptoms-omicron-reinfection-b2119725.html

With BA 5 occupying a dominant position, the share of tests that come back positive is shooting upward and is now higher than during most other waves of the pandemic. According to the US Centers for Disease Control & Prevention (CDC), the risk from COVID-19 is increasing in much of the country. (www.nytimes.com/interactive/2022/07/07/us/ba5-covid-omicron-subvariant.html?)

BA.5 and BA.4, both subvariants of the Omicron variant that swept the world during the winter, are the most capable versions of the virus yet at evading immunity from previous infections and vaccines. Both variants have mutations in their spike proteins that are different enough from earlier versions of the virus that they are able to dodge some antibodies.

In Portugal, where vaccination rates are higher than in the US, cases rose sharply after BA.5 became dominant in May, and hospitalisations neared their previous Omicron peak.

Before BA.4 and BA.5 became dominant in South Africa in April, research suggested that 98 percent of the population had some antibodies from vaccination or previous infection or both.

Even with those protective antibodies, many people in the country still became infected with BA.4 and BA.5, and the subvariants caused a small increase in cases, hospitalisations and deaths.

Places just emerging from significant spring waves of the virus may not be spared, either. Several countries in Europe had big outbreaks of a different Omicron subvariant, BA.2, that led to new waves of hospitalisations and deaths that peaked as recently as April. Yet in those countries, cases are going up again as BA.5 becomes dominant.

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The city of Shanghai has discovered a COVID-19 case involving a new subvariant Omicron BA.5.2.1, an official told a briefing on Sunday. https://www.reuters.com/world/china/chinas-shanghai-says-new-omicron-subvariant-found-2022-07-10/

Earlier, millions in Shanghai queued for a third day of mass COVID-19 testing on Thursday as authorities in several Chinese cities scrambled to stamp out new outbreaks. 

Unless local officials succeed in preventing the virus from spreading, they could be compelled to invoke prolonged, major restrictions on residents’ movement, under China’s “dynamic zero-COVID” strategy.

The country’s most populous city, Shanghai, has just emerged from a painful two-month lockdown and is again on high alert – racing to isolate infections. 

Shanghai reported 54 new locally transmitted COVID cases for Wednesday, versus 24 the previous day. 

Overall, mainland China reported 338 new local COVID cases for Wednesday, down from 353, with no new deaths, numbers that most countries would now consider insignificant.

www.medscape.com/viewarticle/976836?src=wnl_edit_tpal&uac=398271FG&impID=4411040&faf=1 

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Redesigned COVID-19 booster shots are expected in the US this autumn, after advisers to the Food and Drug Administration (FDA) voted 19-2 last week in favour of incorporating an Omicron strain into existing vaccines. (www.science.org/content/article/news-glance-debate-classifying-research-giant-water-lily-species-hummingbird-feather)

The FDA’s asking manufacturers to retool their shots for a spike protein component shared by Omicron BA.4 and BA.5, which are currently gaining ground worldwide. The new vaccines, which Pfizer and Moderna say they can make available by about October, will have the same messenger RNA dose as previous boosters but will target both Omicron and the original coronavirus strain first detected in 2019. 

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As monkeypox cases continue to rise globally, the World Health Organization  (WHO) is considering again whether to declare the outbreak a public health emergency of international concern. In late June, WHO’s Emergency Committee determined that the outbreak did not meet the criteria for such a declaration. Across the world, there have been more than 6,000 cases recorded in 58 countries,  WHO Chief Adhanom Ghebreyesus Tedros said. Monkeypox is a viral disease similar to smallpox that most commonly spreads from person to person through direct contact with infectious body fluids.

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Yet another much-anticipated Alzheimer’s medication, crenezumab, has proved ineffective in clinical trials — the latest of many disappointments. Public health experts and researchers argue that it is past time to turn our attention to a different approach — focusing on eliminating a dozen or so already known risk factors, like untreated high blood pressure, hearing loss and smoking, rather than on an exorbitantly priced, whiz-bang new drug. (www.nytimes.com/2022/07/03/health/dementia-treatment-behavior-eye-care.html?)

“It would be great if we had drugs that worked,” said Dr. Gill Livingston, a psychiatrist at University College London and chair of the Lancet Commission on Dementia Prevention, Intervention and Care. “But they’re not the only way forward.”

The latest modifiable risk factor was identified in a study of vision impairment in the United States that was published recently in JAMA Neurology. Using data from the Health and Retirement Study, the researchers estimated that about 62 per cent of current dementia cases could have been prevented across risk factors and that 1.8 per cent — about 100,000 cases — could have been prevented through healthy vision.

That’s because eye exams, eyeglass prescriptions and cataract surgery are relatively inexpensive and accessible interventions. “Globally, 80 to 90 per cent of vision impairment and blindness is avoidable through early detection and treatment, or has yet to be addressed,” Dr Joshua Ehrlich, ophthalmologist at the University of Michigan said.

The influential Lancet Commission began leading the modifiable risk factor movement in 2017. A panel of doctors, epidemiologists and public health experts reviewed and analysed hundreds of high-quality studies to identify nine risk factors accounting for much of the world’s dementia: High blood pressure, lower education levels, impaired hearing, smoking, obesity, depression, physical inactivity, diabetes and low levels of social contact.

In 2020, the commission added three more: excessive alcohol consumption, traumatic brain injuries and air pollution. The commission calculated that 40 per cent of dementia cases worldwide could theoretically be prevented or delayed if those factors were eliminated.

“A massive change could be made in the number of people with dementia,” said Dr. Livingston. “Even small percentages — because so many people have dementia and it’s so expensive — can make a huge difference to individuals and families, and to the economy.”

In fact, in wealthier countries, “it’s already happening as people get more education and smoke less,” she pointed out. Because the odds of dementia increase with age, as more people reach older ages, the number of dementia cases keeps rising. But the proportions are dropping in Europe and North America, where the incidence of dementia has fallen by 13 per cent per decade over the past 25 years.

Dr Ehrlich hopes the Lancet Commission will add vision impairment to its list of modifiable risks when it updates its report, and Dr Livingston said it would indeed be on the commission’s agenda.

Why would hearing and vision loss contribute to cognitive decline? “A neural system maintains its function through stimulation from sensory organs,” explained Dr. Julio Rojas, a neurologist at the University of California, San Francisco and a co-author of an accompanying editorial in JAMA Neurology. Without that stimulation, “there will be a dying out of neurons, a rearrangement of the brain,” he said.

Hearing and vision loss could also affect cognition by limiting older adults’ participation in physical and social activity. “You can’t see the cards, so you stop playing with friends,” Dr. Ehrlich said, “or you stop reading.”

The link between dementia and hearing loss, the single most important factor the Lancet Commission cited as a modifiable risk, has been well established. There is less clinical data on the connection to impaired vision, but Dr Ehrlich is a co-investigator of a study in southern India to see whether providing older adults with eyeglasses affects cognitive decline.

Even fairly routine medical practices, like measuring and monitoring high blood pressure and taking drugs to control it, can be difficult for low-income patients.

Still, despite the caveats and cautions, reducing modifiable risk factors for dementia could have enormous payoff, and the US CDC has incorporated that approach into its National Plan to Address Alzheimer’s Disease.

Even delaying its onset can have a great effect. “If, instead of getting it at 80, you get it at 90, that’s a huge thing,” Dr Livingston said.

Eye and hearing exams, exercise, weight control, stopping smoking, blood pressure medications, diabetes care — “we’re not talking about expensive interventions or fancy surgery or seeing specialists who are hours away,” Dr. Ehrlich added. “These are things people can do in the communities where they live.”

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Monday 11 July was World Population Day with the global population expected to reach 8 billion this year. 

In 2011 it was 7 billion.

Moving away from the Malthusian postulate that the human population grows more rapidly than the food supply until famines, war or disease reduces the population, UN Secretary-General António Guterres said: “Reaching a global population of eight billion is a numerical landmark, but our focus must always be on people. In the world we strive to build, 8 billion people means 8 billion opportunities to live dignified and fulfilled lives.”

Some population points:

  • It took hundreds of thousands of years for the world population to grow to 1 billion – then in just another 200 years or so, it grew sevenfold. 
  • In 2011, the global population reached the 7 billion mark, it stands at almost 7.9 billion in 2021.  
  • It’s expected to grow to around 8.5 billion in 2030, 9.7 billion in 2050, and 10.9 billion in 2100.
  • The world’s population more than tripled in size between 1950 and 2020.
  • The growth rate of the world’s population reached a peak between 1965 and 1970, when human numbers were increasing by an average of 2.1% per year.
  • From 2000 to 2020, even though the global population grew at an average annual rate of 1.2 per cent, 48 countries or areas grew at least twice as fast: these included 33 countries or areas in Africa and 12 in Asia. www.un.org/en/observances/world-population-day

Lalita Panicker is Consulting Editor, Views and Editor, Insight, Hindustan Times, New Delhi

Monkeypox declared public health emergency of international concern; The latest health stories from around the world

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One of the symptoms of monkeypox are lesions that can develop across the body. http://phil.cdc.gov (CDC’s Public Health Image Library) Media ID #2329

The World Health Organization (WHO) opted against calling the recent monkeypox outbreak a public health emergency of international concern. The outbreak is “clearly an evolving threat,” the WHO said in a statement Saturday, though it doesn’t constitute an international public health emergency “at this moment.” An emergency committee convened on Thursday to discuss the outbreak. “What makes the current outbreak especially concerning is the rapid, continuing spread into new countries and regions and the risk of further, sustained transmission into vulnerable populations including people that are immune-compromised, pregnant women and children,” according to the statement. “It requires our collective attention and coordinated action now to stop the further spread of the monkeypox virus.”

https://www.bloomberg.com/news/articles/2022-06-25/monkeypox-isn-t-international-public-health-emergency-who-finds

The first instances of “community transmission”, cases that could not be traced back to parts of Africa where the virus is endemic, were discovered in Europe last month. On May 29, the WHO changed its risk assessment for the outbreak from “low” to “moderate”. Now the disease has spread to other continents, too. A total of 3,337 cases in at least 53 countries have been reported. About 45% of cases are outside Europe. Cases in Britain have doubled since June 9 and had reached 793 by June 22, more than in any country outside Africa. Spain has reported 552 infections and Germany 469. South Korea and Singapore reported their first cases on June 22. 

Some countries are “ring” vaccinating the personal contacts of those infected, using the smallpox jab, which is estimated to be 85% effective against monkeypox.

Bavarian Nordic, the Danish maker of the jab, has already raised its revenue projections for the rest of the year, as rich countries have started to stockpile.

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Tests that screen seemingly healthy people for many kinds of cancer by analysing a blood sample are starting to enter the clinic—worrying some physicians and scientists that they could do more harm than good. Now, as part of President Joe Biden’s reignited Cancer Moonshot, the National Cancer Institute (NCI) is framing plans to evaluate the promise of such tests. www.science.org/content/article/complexities-are-staggering-u-s-plans-huge-trial-blood-tests-multiple-cancers?

Last week, NCI advisers endorsed a $75 million, 4-year pilot study enrolling at least 24,000 people to assess the tests, which mostly pick up trace amounts of DNA and proteins that tumours shed into the blood. What it shows about the feasibility of these tests, sometimes called liquid biopsies, will help NCI decide whether to launch a longer term clinical trial, in as many as 300,000 volunteers ages 45 to 70, to learn whether they save lives.

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Health authorities in Britain have declared a national incident after finding evidence suggesting local spread of the poliovirus in London.

Although health authorities indicated that the use of the term “national incident” was used to outline the scope of the issue, no cases of polio have been identified so far, and the risk to the public is low. But health authorities urged anyone who is not fully immunized against the poliovirus, particularly young children, to immediately seek vaccines. https://www.nytimes.com/2022/06/22/health/uk-polio-london-poliovirus.html

The last case of polio in Britain was in 1984, and the country was declared polio-free in 2003. Before the introduction of the polio vaccine, epidemics were common in Britain, with up to 8,000 cases of paralysis reported every year.

Routine surveillance of sewage in the country picks up the poliovirus once or twice a year, but between February and May, officials identified the virus in several samples collected in London, according to Dr. Shahin Huseynov, technical officer for the WHO’s vaccine-preventable diseases and immunization program in Europe.

Genetic analysis suggests that the samples have a common origin, most likely an individual who travelled to the country around the New Year, Dr. Huseynov said. The last four samples collected appear to have evolved from this initial introduction, likely in unvaccinated children.

British officials are now collecting additional samples and trying to identify the source of the virus. But the wastewater treatment plant that identified the samples covers about 4 million people, almost half of the city, making it challenging to pinpoint the source.

The virus in the collected samples came from a type of oral polio vaccine that is used to contain outbreaks, according to Dr. Huseynov.

In recent months, that type of vaccine has been used only in Afghanistan, Pakistan and some countries in the Middle East and Africa, he said.

Wild poliovirus has been eliminated from every country in the world, except Afghanistan and Pakistan. But vaccine-derived polio continues to cause small outbreaks, particularly in communities with low vaccination coverage.

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In a significant curtailment of women’s rights, the U.S. Supreme Court overturned  Roe v. Wade, a 1973 landmark decision giving women in America the right to have an abortion before the foetus is viable outside the womb — before the 24-28 week mark. The ruling, 6-3, was expected for some weeks now, after a draft opinion leaked in early May, sending shock waves through the country and sparking protests. Abortion rights — which have been available to women for over two generations — will now be determined by individual states.

Addressing the nation in the early afternoon on Friday, US President Joe Biden called the decision a “tragic error” and a “sad day” for the court and the country. “The court has done what it has never done before, expressly take away a constitutional right that is so fundamental to so many Americans,” he said.

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Leaders of the global scheme aiming to get COVID-19 vaccines to the world’s poorest are pushing manufacturers including Pfizer and Moderna to cut or slow deliveries of about half a billion shots to avoid waste. (https://www.medscape.com/viewarticle/976025?)

COVAX, the WHO-led scheme, wants between 400 and 600 million fewer vaccines doses than initially contracted from six pharmaceutical companies, according to internal documents seen by Reuters.

While at first the initiative struggled for shots as wealthy nations snapped up limited supply, donations from those same countries later in 2021, as well as improved output from manufacturers – alongside delivery challenges and vaccine hesitancy in a number of countries – has led to a glut of vaccines in 2022.

In total, COVAX has delivered more than 1.5 billion doses in the last 18 months.

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Deep in the human gut, myriad “good” bacteria and other microbes help us digest our food, as well as keep us healthy by affecting our immune, metabolic, and nervous systems. Some of these humble microbial assistants have been in our guts since before humans became human—certain gut microbes are found in almost all primates, suggesting they first colonized a common ancestor. But humans have also lost many of these helpers found in other primates and may be losing even more as people around the world continue to flock to cities, a researcher reported last week at a microbiology meeting in Washington, D.C.

The microbiome comprises all the bacteria, fungi, viruses, and other microscopic life that inhabit an individual, be it a person, a plant, or a planaria. For humans and many other species, the best characterized microbiome centres on the bacteria in the gut. The more microbiologists study these gut microbes, the more they link the bacteria to functions of their hosts. In humans, for example, gut bacteria influence how the immune system responds to pathogens and allergens, or interact with the brain, affecting mood.

Andrew Moeller, an evolutionary biologist at Cornell University, was one of the first to show that gut bacteria and humans have built these relationships over a very long time. Six years ago, he and colleagues reported the work showing human gut microbes are very similar to those in other primates, suggesting their intestinal presence predates the evolution of humans.

But his follow-up studies, and work by others, also indicate the human gut microbiome has, in a general sense, become less diverse than the gut microbes in our current primate cousins. One study found 85 microbial genera, such as Bacteroides and Bifidobacterium, in the guts of wild apes, but just 55 in people in U.S. cities. Splitting the difference, people in less developed parts of the world have between 60 and 65 of those bacterial groups, an observation that ties the decrease in microbial diversity to urbanization.

Changes in diet as humans moved on from their hunter-gatherer past and then into cities, antibiotic use, more life stresses, and better hygiene are all possible contributors to the loss of human gut microbes, says Reshmi Upreti, a microbiologist at the University of Washington, Bothell. Several prominent researchers have argued that this lower diversity could contribute to increases in asthma and other inflammatory diseases.

Moeller and his colleagues collected dung from several groups of African chimps and bonobos, isolating and sequencing microbial DNA in the faeces that derives from the gut’s microbes. They also gathered gut microbe DNA data previously collected for gorillas and other primates by other researchers—accumulating details on 22 non-human primates. With computers, they were able to compile the fragments of DNA sequenced into whole genomes of the gut microbes present.

They showed some specific gut microbes diversified as they evolved with their primate host, whereas others went missing. Quite a few microbes have abandoned the human gut, as humans have lost 57 of the 100 or so branches, or clades, of microbes currently found in chimps or bonobos and at least one other non-human primate, Moeller reported on June 11 at Microbe 2022, the annual meeting of the American Society for Microbiology. Moeller was also able to estimate when some of the human gut microbes disappeared.

Moeller and others also suggest identifying the missing microbes may be the first step toward bringing them back. “If we determine that these groups were providing important functions to keep humans healthy,”  says Jessica Maccaro, an evolutionary biology graduate student at the University of California (UC), Riverside “perhaps we can restore them with probiotics.”

www.science.org/content/article/modern-city-dwellers-have-lost-about-half-their-gut-microbes?

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Lalita Panicker is Consulting Editor, Views and Editor, Insight, Hindustan Times, New Delhi