October 14, 2016
A weekly roundup of news on drug resistance and other topics in global health.
The malaria death rate in sub-Saharan Africa dropped by 57 percent between 2000 and 2015, according to an analysis from the Malaria Atlas Project and Global Burden of Disease Study, published in The New England Journal of Medicine. The analysis used geolocated data for clinical incidence of malaria, coverage of antimalarial drug treatment, case fatality rate, and population distribution according to age. Continent-wide, the malaria mortality rate fell from 12.5 per 10,000 population in 2000 to 5.4 in 2015. Results across countries were mixed, with coverage of insecticide-treated nets and access to treatment less than 50 percent and mortality remaining above 10 per 10,000 in much of Nigeria, Angola, and Cameroon; and in parts of the Central African Republic, Congo, Guinea, and Equatorial Guinea. [New England Journal of Medicine]
Use of antibiotics by prior hospital bed occupants increases risk for C. difficile infection in later occupants, according to a retrospective cohort study of adult patients hospitalized in four facilities between 2010 and 2015, published in JAMA Internal Medicine. When a patient took antibiotics, the risk for the next bed occupant increased by about 20 percent after adjusting for factors known to influence risk for C. diff infection (CDI). Patients were excluded from the study if they had recent CDI, developed CDI within 48 hours of admission, had inadequate follow-up time, or if the prior bed occupant was in the bed for less than 24 hours. The study broadly indicates that antibiotics can directly increase risk for CDI in patients regardless of their own antibiotic use. [JAMA Internal Medicine]
The tuberculosis burden is much higher than previously estimated. World Health Organization’s) Global Tuberculosis Report 2016 estimates 10.4 million new TB cases worldwide in 2015. Six countries accounted for 60 percent of the TB burden: India, Indonesia, China, Nigeria, Pakistan, and South Africa, in descending order of case numbers. Through the World Health Assembly and UN General Assembly, governments have agreed on targets to end the TB epidemic, including a 90 percent reduction in TB deaths and 80 percent reduction in cases between 2015 and 2030. According to WHO Director-General Margaret Chan, “We face an uphill battle to reach the global targets for tuberculosis. There must be a massive scale-up of efforts, or countries will continue to run behind in this deadly epidemic and these ambitious goals will be missed.” [WHO release, Global Tuberculosis Report 2016]
US economic burden of vaccine-preventable disease in adults estimated to be $9 billion. According to a modelling study in Health Affairs, vaccine-preventable diseases related to ten vaccines recommended for adults were responsible for a $9 billion economic burden annually, when researchers calculated costs of health expenditures, as well as lost income and productivity. Unvaccinated adults are responsible for almost 80 percent—$7.1 billion—of the financial burden. The results indicate the potential economic benefit of improving adult immunization; the authors suggest that policies should focus on the negative economic spillover effects due to nonvaccination in adults. [Health Affairs]
WHO supports fiscal policies aimed at reducing the consumption of sugary drinks. The related WHO report, Fiscal Policies for Diet and the Prevention of Noncommunicable Diseases, found that fiscal policies leading to at least a 20 percent increase in the retail price of sugary drinks results in proportional reductions in consumption. The report also indicates that subsidies for fresh fruits and vegetables that reduce prices by 10-30 percent can increase fruit and vegetable consumption. According to Dr. Douglas Bettcher, Director of WHO’s Department for the Prevention of NCDs, “If governments tax products like sugary drinks, they can reduce suffering and save lives. They can also cut healthcare costs and increase revenues to invest in health services.” [WHO release, WHO Fiscal Policy Report]
Brazil will release genetically-modified mosquitoes in effort against Zika. Brazil will release genetically-modified mosquitoes, hoping to reduce populations of Aedes aegypti mosquitoes, responsible for transmission of the virus. This strain of mosquitoes, OX513A, is designed to reduce populations by passing a lethal gene to offspring. The method was tested in April in the small city of Piracicaba, where it appears to have dramatically reduced dengue and kept Zika at bay. A similar mosquito control tool is currently being implemented by the nonprofit organization Eliminate Dengue, in some of Brazil’s coastal cities. These mosquitoes are infected with the bacterium Wolbachia pipientis, which protects them from infection with dengue, Zika, and chikungunya. [Science]
Two of six candidates in the running for WHO Director-General list AMR as one of the biggest threats to global health. In a Lancet special report, editors Richard Horton and Udani Sarasekera question each candidate about their priorities and skills. The new Director-General of the WHO will be selected in May 2017. The candidates are Tedros Adhanom Ghebreyesus from Ethiopia, Flavia Bustreo from Italy, Philippe Douste-Blazy from France, David Nabarro from the United Kingdom, Sania Nishtar from Pakistan, and Miklόs Szόcska from Hungary. Ghebreyesus and Nishtar listed AMR among what they see as the three biggest health threats around the world. The election has not garnered much attention, but is consequential, as many of the WHO’s current concerns—particularly its continual funding shortfalls—will land on the desk of the next Director-General. [The Lancet, STAT]
Image via USAID
