Weekly Digest: Meningitis A vaccine success; Sierra Leone declared free of Ebola

Key findings and recommendations from the volume on Cancer of Disease Control Priorities, 3rd Edition appeared on-line in The Lancet (11 November). The review, co-authored by CDDEP Associate Director Hellen Gelband, recommends that low- and middle-income countries (LMICs) adapt a package of interventions to address their burden of cancer with the resources available. Five and a half million of the global annual total of 8 million cancer deaths occur in LMICs and that proportion is set to rise. The interventions that the analysis finds effective, cost-effective, feasible and nationally affordable in most LMICs go beyond the often-mentioned prevention measures such as tobacco control and Hepatitis B and HPV vaccination, to diagnosis and treatment of early breast cancer, cervical cancer and some childhood cancers; and palliative care, including widespread availability of oral morphine for severe pain. Gelband was featured on a podcast for The Lancet discussing the paper and recommended package of interventions, where she explained, “The package has to be tailored by each country to its own conditions, and what we suggest is a way of getting there and a starting point.” [The Lancet, The Lancet Audio]

India’s Safe Motherhood Scheme (JSY), one of the largest conditional cash transfer programs for pregnant women in the world, may have resulted in a 2.5–3.5 percentage point rise in the probability of childbirth or pregnancy in some states. CDDEP researchers Arindam Nandi and Ramanan Laxminarayan assessed possible unintended effects of JSY in a study in the Journal of Population Economics. JSY began in India in 2005 and offers cash incentives for socioeconomically disadvantaged women to give birth to children in healthcare facilities. Nandi and Laxminarayan found that the program may have increased the probability of childbirth or pregnancy by 2.7 percentage points (equivalent to a 7% rise from baseline) among women who are either poor or belong to socioeconomically disadvantaged caste groups. [CDDEP, Journal of Population Economics]

Red meat may cause cancer and also poses other significant indirect health risks, such as from climate change and increased antibiotic resistance due to antibiotic overuse of livestock, according to an op-ed by CDDEP Director Ramanan Laxminarayan in The Hindu newspaper.  Writes Laxminarayan, “[L]et us make no mistake: the meat we produce shapes our health more by how it shapes our environment and the world we live in than in its direct impact on health.” [The Hindu]

IndiaSpend interviewed CDDEP Director Laxminarayan about CDDEP’s report, State of the World’s Antibiotics: 2015 and ResistanceMap. Laxminarayan highlighted key messages from the report, including the need to change societal norms about antibiotic use, a decrease in livestock antibiotic use for growth promotion and increased vaccination coverage to prevent bacterial infections. [IndiaSpend]

Sierra Leone has been declared free of Ebola, and Guinea—the last remaining country in West Africa where cases have been reported in the last six weeks—has now gone one week with no new cases. Sierra Leone and Liberia are currently in a 90-day enhanced surveillance period to search for undetected cases. According to the WHO, Guinea has now gone 16 consecutive weeks with fewer than five recorded cases. [The New York Times, WHO]

When doctors and patients discuss antibiotic treatment together, physicians tend to prescribe fewer antibiotics for acute respiratory tract infections, according to a new Cochrane systematic review that assessed 10 randomized trials including more than 1000 physicians and nearly 500,000 patients. In most of the studies, the intervention involved training doctors in communicating with patients about the patients’ understanding of the need for antibiotics and their benefits and harms, and in others, information was presented directly to patients. Following the training or other intervention, 29 percent of patients who saw doctors in intervention groups were prescribed antibiotics, compared with 47 percent of patients who saw doctors in control groups. [Cochrane]

Rollout of the affordable meningitis A vaccine known as MenAfriVac in the last five years has contributed to a dramatic decline in cases of the disease in Africa’s “meningitis belt.” A collection of 29 articles in Clinical Infectious Diseases describes the development, licensure, introduction and impact of the vaccine on the region, which stretches across 26 African countries from Senegal to Ethiopia and is home to 450 million people. The incidence rate of meningitis A in the10 study countries fell more than 10-fold, from 0.27 per 100 000 in 2004–2010 to 0.02 per 100 000 in 2011–2013. The researchers warned, however, that the disease could rebound in as little as 15 years if the vaccine is not continued in routine infant immunization schedules. [Clinical Infectious Diseases]

Treatment of methicillin-resistant Staphylococcus aureus (MRSA) with beta-lactam antibiotics may cause bacterial cell walls to become inflamed. In a study in mice, researchers at Cedars-Sinai Medical Center found that treating MRSA with certain beta lactams caused a change in the function of the enzyme PBP2A, which forms bacterial cell walls. PBP2A is rendered inactive by antibiotics in susceptible bacteria, halting their spread, but when the bacteria are methicillin resistant, the enzyme instead creates a stronger, more inflamed cell wall. The authors commented that their findings raise the possibility that prescribing some beta lactams for MRSA may not be just ineffective, but could worsen infections. [Cedars-Sinai Medical Center, Cell Host & Microbe]

Next week, November 16-22, is World Antibiotic Awareness Week, and November 18 is Global Antibiotic Awareness Day. To coincide with the events, CDDEP is pleased to announce the publication of  a paper, co-authored by Ramanan Laxminarayan focusing on the worldwide challenge of access to effective antimicrobials  in The Lancet series “Antimicrobials: sustainable access and effectiveness,”  The World Health Organization is hosting a global twitter chat on antibiotic resistance throughout the day on November 18^th; twitter users can participate using the hashtag #AntibioticResistance. Countries around the world are hosting events, including CDC’s annual Get Smart Week in the United States, as well as events through CDDEP’s GARP working groups in Kenya and Nepal, and in South Africa through the South African Antibiotic Stewardship Programme. [WHO, CDC]

CDDEP is hiring Research Analysts in New Delhi, India and a Research Admin Assistant in Washington, D.C. For more information and to apply, visit cddep.org/jobs.