Malaria and Aids
Malaria, transmitted exclusively through the bites of Anopheles mosquitoes, in the previous century the world’s most deadly tropical parasitic disease which killed more people than any other communicable disease, except tuberculosis, still kills 500,000 a year and a drug-resistant strain in Asia awakened fresh concern. The request in Belgium for more life-saving bed nets or insecticide-treated nets (ITNs), helped significant progress in the fight against malaria – a more than 50 percent reduction in deaths from malaria in several districts in Rwanda and Ethiopia. Integrated vector management (IVM), targeting both larval and adult mosquitoes, may have been a great help as well. Microbial larvicides reduced malaria vector mosquito larvae and adult females by > 90% in a rural town in western Kenya. However, the effectiveness of this approach for reducing the incidence of malaria among vulnerable children remains unproven.
There has not yet be found a solution for the Malaria endemic countries to bring them out of poverty (they are still of the poorest in the world) to have people enough resources to pay for good treatment. For the individual, costs include the price of treatment and prevention, and lost income. In rural areas, the rainy season is often a time of intense agricultural activity when poor families earn most of their annual income. Malaria can make these families poorer. The disease can lead to chronic absenteeism and impairment of learning ability in affected children. Urban malaria is increasing due to unplanned development around large cities, particularly in Africa and South Asia.
According to WHO the “global warming” and other climatic events such as “El Nino” also play a role in increasing the risk of the disease.
Having HIV more under control this makes less a babies born to a woman with placental malaria, otherwise almost three times as likely to be infected with HIV as a baby born to a mother without malaria parasites in the placenta, not such easy victims any-more. In recent years, some human cases of malaria have also occurred with Plasmodium knowlesi – a species that causes malaria among monkeys and occurs in certain forested areas of South-East Asia.
Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 42% globally and 49% in Africa. Increased political commitment and expanded funding have helped to reduce malaria incidence by 25% globally, and 31% in Africa.
At particular risk is progress on malaria in countries affected by the Ebola virus. The outbreak in West Africa has had a devastating impact on malaria treatment and the roll-out of malaria interventions. In Guinea, Sierra Leone and Liberia, the 3 countries most severely affected by the epidemic, the majority of inpatient health facilities remain closed, while attendance at outpatient facilities is down to a small fraction of rates seen prior to the outbreak.
Given the intense malaria transmission in these 3 countries, which together saw an estimated 6.6 million malaria cases and 20 000 malaria deaths in 2013, WHO has issued new guidance on temporary measures to control the disease during the Ebola outbreak: to provide ACTs to all fever patients, even when they have not been tested for malaria, and to carry out mass anti-malaria drug administration with ACTs in areas that are heavily affected by the Ebola virus and where malaria transmission is high. In addition, international donor financing is being stepped up to meet the further recommendation that bednets be distributed to all affected areas.
Interactive training programmes for health workers could reduce overdiagnosis of malaria by half and help prevent valuable drugs from being wasted on patients who don’t have the disease, according to new research published on World Malaria Day in The Lancet Global Health. The study shows that the roll-out of malaria rapid diagnostic tests (RDTs) in endemic countries should run alongside these new training programmes.
The study in Cameroon, carried out by the Artemisinin-based Combination Therapy (ACT) Consortium based at the London School of Hygiene & Tropical Medicine, compared the use of RDTs when packaged with either a basic or a comprehensive training programme for clinicians. The study’s lead author, Dr Virginia Wiseman from the London School of Hygiene & Tropical Medicine, said:
“If we are serious about improving the targeting of malaria medicines by using RDTs, then there needs to be a far greater focus on behaviour change. This study, the first of its kind in Cameroon, highlights that health workers not only need training to diagnose and treat malaria, but most of all need the confidence to put what they learn into practice and to communicate more effectively with patients about why they are tested and that fever is not always caused by malaria. Our results suggest that a good training programme designed to translate knowledge into practice could dramatically reduce overdiagnosis of malaria in Cameroon and prevent the wastage of valuable medicines.”
The third biennial conference Challenges in Malaria Research brought together at her Core science and innovation conference on September 22- 24 in Oxford, leading malaria researchers to review current progress and to chart future challenges, this time with a greater emphasis on basic science.
Internationally renowned speakers presented their insights into core science and innovation in malaria research – including Plasmodium vivax epidemiology; trends and impacts; G6PD deficiency; vaccines; genome mapping and molecular epidemiology; new clues for drug development; mathematical modelling; cutting edge in cell biology; new issues in clinical malaria and pathology; and a special session on vectors in memory of Mario Coluzzi.
The year 2014 ends with real – and fragile – progress: the longest stretch in history without wild poliovirus in Africa, large outbreaks stopped in the Middle East and the Horn of Africa, a certified polio-free South East Asia and no wild poliovirus type 3 for over 2 years, though in at least 10 countries the World Health Organization identified the spread of poliomyelitis.
On May 5, 2014, the World Health Organization (WHO) declared the international spread of polio to be a public health emergency of international concern (PHEIC) under the authority of the International Health Regulations (2005) and issued temporary vaccination recommendations for travel to prevent further spread of the disease. WHO will be reassessing the situation periodically, so requirements may change.
Outbreaks in Asia, Africa and Middle East are an “extraordinary event” needing a co-ordinated “international response”, the agency said. It recommends citizens of affected countries travelling abroad carry a vaccination certificate. It said Pakistan, Cameroon, and Syria “pose the greatest risk of further wild poliovirus exportations in 2014.”
The WHO recorded 417 cases of polio worldwide for the whole of 2013. For 2014, it had already recorded 68 cases by 30 April – up from 24 in the same period last year.
Assisted death or Euthanasia
Despite last-minute pleas for a rethink from within Belgium and as far away as Canada, parliament on agreed with the doctors who argued that in rare cases of unbearable and irreversible suffering, children should have the same right as an adult to ask to die with dignity.
Belgian euthanasia cases rose to 1,807 in 2013, compared with 1,432 in 2012, 708 in 2008 and 235 in 2003. Just over half of cases last year were aged 70 or over, and 80% of the applications were made by Dutch-speakers.
The decision to proceed with each proposal of euthanasia will also have be agreed by a treating physician and an outsider brought in to give a second opinion.
Children will have to be interviewed by a paediatric psychiatrist or psychologist, who must determine that the child possesses “the capacity of discernment”, and then certify that in writing.
The child’s physician must meet the parents or legal representatives to inform them of the outcome of the consultation and ensure they are in agreement with the child’s decision. The request for euthanasia, as well as the agreement by parents or legal representatives, must be delivered in writing, and the child and family must be given psychological care if wanted.
In my article “2014 Social contacts” you shall come to see that those who chose at one stage to make an end to their life at a later stage perhaps can find enough revitalising energy to continue in life. In the article and looking at Facebook, you will see that the person Bor Verkroost is still alive, though he wanted to make an end at his miserable life in 2014.
Born with epidermolysis bullosa (EB), an incurable condition that causes external and internal skin blisters Bor Verkroost has undergone 61 surgeries, including one in 2009 to amputate three fingers. He has skin cancer that can only be cut away, and it’s spreading. One of his hands has scarred into what he calls a “permanent fist.” The other cancerous hand lives in a bandage.
Verkroost said to Al Jazeera that he had managed his struggles with generous doses of dark humour and medical marijuana, but having to face every day beginning with hours of skin care and personal care with the help of an aide.
“Socks and buttons are my weak points,”
he told Al Jazeera.
Since the amputation of his fingers — whose cremated remains fill a small porcelain container in his living room — he’s spiraled downward physically and emotionally. Although he has many friends, his world has grown smaller. He said in 2014 he was lonely, and he longed for someone to love.
“Love would be the only reason to keep on fighting,”
he said. Without love, his life has
“become hopeless and unbearable,”
and he simply did not want to live beyond 2014. For that reason friends founded the EBor foundation and created a program Bor zoekt vrouw (Bor looking for woman)
For Holland in 2012 the 4,188 deaths by euthanasia or physician-assisted suicide represented 3 percent of all deaths that year, which is OK with most Dutch. According to a 2013 Één Vandaag poll, 91 percent favour assisted suicide in cases of hopeless and unbearable physical suffering. Some 85 percent support euthanasia for patients with dementia who don’t want to live with the condition, and 56 percent said they favour legalizing a suicide pill.
Ebola haemorrhagic fever
The Ebola (EBOV) or Ebola haemorrhagic fever outbreak in West Africa got international medical organizations on high alert and people all around the world antsy — even those who live in the Americas and Australia, oceans away from the disease’s epicenter. Ebola was first recognized in 1976 when 2 epidemics occurred almost simultaneously in Zaire and Sudan. Since then, more than 20 outbreaks have occurred, mostly in Equatorial Africa and most due to EBOV . The current outbreak, which began in December 2013 and is the largest ever, was first detected in March 2014 when cases were recognized in southern Guinea. There have been more cases and deaths in this outbreak than all others combined. It has also spread between countries starting in Guinea then spreading across land borders to Sierra Leone and Liberia, by air (1 traveller only) to Nigeria, and by land (1 traveller) to Senegal. More than 7,500 people have died from the outbreak in West Africa so far, the World Health Organization (WHO) says, with Sierra Leone to be the worst hit country.
The disease is normally carried by animals like fruit bats, but occasionally makes the jump to humans, and when it does, it is deadly, killing more than half of those infected. However, because it is only spread by direct contact with bodily fluids, most of the world need not fear for their lives, but in 2014 some mad fear broke out even getting people ordering ebola safety wear.
In recent months, some media outlets, and even a scientist or two, have begun to wonder aloud whether the Ebola virus could “mutate” and become airborne — but of course, what is actually meant is whether the virus can evolve in ways that allow it to be passed along more easily, just as the flu can be spread by a sneeze. This outcome is unlikely.
In the journal PeerJ in September the journal published a new study which helped to rewrite Ebola’s family history. It adds to scientists’ developing knowledge about known filoviruses, which experts once believed came into being some 10,000 years ago, coinciding with the rise of agriculture. The new study pushes back the family’s age to the time when great apes arose.
Two imported cases, including one death, and two locally acquired cases in healthcare workers have been reported in the United States. Spain and the UK had one person affected by Ebola. CDC and partners are taking precautions to prevent the further spread of Ebola within the United States. CDC is working with other U.S. government agencies, the World Health Organization (WHO), and other domestic and international partners and has activated its Emergency Operations Center to help coordinate technical assistance and control activities with partners. CDC has also deployed teams of public health experts to West Africa and will continue to send experts to the affected countries.
I still do not comprehend why they do not burn the dead, but it seems to be too difficult to convince the victim’s families this would be the best way to exclude the virus to continue living on afterwards when the plastic bags would deteriorate.
Preceding reviews of 2014:
Next: 2014 Social contacts
- What is Malaria?
- Fact-sheet on Malaria
- Malaria: Real and present danger
- Integrated Malaria Vector Control with Microbial Larvicides and Insecticide-Treated Nets in Western Kenya: A Controlled Trial/ Lutte Integree Contre Les Vecteurs Du Paludisme Au Moyen De Larvicides Microbiens et De Moustiquaires Impregnees D’insecticide Au Kenya Occidental : Essai Controle/ Lucha Antivectorial Integrada Contra la Malaria Mediante Larvicidas
- World Malaria Day, 25 April 2014
- World Malaria Day 2014 – Roll Back Malaria (RBM)
- Fighting Malaria; Public/private Partnership Targets Disease
- Malaria Resurgence in Senegal: Measuring Malaria Mortality in Mlomp
- Malaria, in Second Place, Sees Fewer Victims, but Greater Difficulty of Control
- Malaria and HIV: Interplay of Risk
- Interactive training halves malaria overdiagnosis and prevents wastage of drugs
- Challenges in Malaria Research
- Scale-up in effective malaria control dramatically reduces deaths
- PoliomyelitisDisease outbreak news
- Polio in Syria
- World facing polio health emergency
- Mass medication health-care research and dementia
- Right to die: Netherlands, Belgium ignite global debate on euthanasia
- Belgium Extends Euthanasia Law to Kids
- Euthanasia and assisted suicide laws around the world
- Belgium passes law extending euthanasia to children of all ages
- Assisted dying
- Ebola virus disease
- Ebola and evolution
- Ebola Hemorrhagic Fever in 2014: The Tale of an Evolving Epidemic
- Ebola’s evolutionary roots more ancient than previously thought, study finds
- 2014 Ebola Outbreak in West Africa
- 2014 Ebola Outbreak in West Africa – Case Counts
- Top 10 things you really do need to know about Ebola
- The natural beauties of life
- Lonely in the crowd
- Human relations 2013
- Did the picture change for Working dads
- Sierra Leone Announces New and Extended Anti-Ebola Measures (voanews.com)
Sierra Leone Sunday introduced new Ebola screening measures at the Freetown International Airport after two workers apparently contracted the virus.Government spokesman Abdulai Bayraytay said the measures are intended to reassure the public.
“We just had a case few days ago wherein a worker at the airport, who is attached to the restaurant, got infected with confirmed Ebola. That was a red flag for us recognizing that, since the outbreak of the Ebola virus in Sierra Leone, we have not exported any patient out of our airports who had confirmed to be Ebola positive based on the symptoms,” he said.
- Diary of UK Nurse With Ebola Reveals Devasting Suffering in Sierra Leone (onenewspage.us)
The nurse being treated for Ebola in a London hospital described her experiences working in Sierra Leone in a diary published only days earlier in a Scottish newspaper. In the piece, published by The Scotsman on Dec. 28, Pauline Cafferkey stated that before going to work in Sierra Leone’s infectious “Red Zone, where there is a high rate of Ebola, she and her colleagues would wish each other good luck.
- Sierra Leone declares Ebola lockdown (jamaica-gleaner.com)
Officials say shops, markets and non-Ebola related travel services will be shut down.Sierra Leone had already banned many public Christmas celebrations.
- Ebola virus discoverer visits Sierra Leone (en.starafrica.com)
The co-discoverer of the Ebola virus, Peter Piot is in Sierra Leone where he said Friday that the lessons learned from the West African epidemic showed that public health systems were weak. He also said addressing it required strong leadership.Dr Piot, a Belgian scientist and head of the London School of Hygiene and Tropical Medicine, was speaking at a public lecture organized by the University of Sierra Leone.
The lecture was held on the theme: The Role of Research and Academics in the Fight Against Ebola.
- Video: Ebola epidemic ‘could have bumpy tail’ (bbc.co.uk)
West Africa’s Ebola crisis is ‘in decline’ but is likely to last until the end of 2015, says a leading researcher who helped to discover the virus.Peter Piot, Director of the London School of Hygiene and Tropical Medicine, and a member of the team of scientists that discovered Ebola in 1976, has just returned from Sierra Leone.
He told the BBC that he was encouraged by progress there and by the promise of new anti-viral therapies.
He also warned that vaccines would take time to develop and would require a ‘sustained effort for the rest of 2015’.
Professor Piot spoke to the BBC’s Nkem Ifejika.
- Peter Piot interview: ‘I never imagined the Ebola virus would get out of control’ (independent.co.uk)
- Blood-based therapy an answer to Ebola? (news.bioscholar.com)
With no drugs available to treat Ebola, all eyes are now on a therapy that had largely been relegated to the history books.The therapy is all about transfusing patients with blood plasma donated by survivors, which contains antibodies against the virus, scientific journal Nature reported.
Clinical trials of convalescent plasma therapy (CPT) have started in the past few weeks in Liberia and are due to begin soon in Guinea and Sierra Leone.
If the therapy saves lives, the approach could quickly be scaled up.
- Study: IMF Austerity Helped Ebola Kill Nearly 8,000 People (truthdig.com)
Professors at three leading British universities say International Monetary Fund policies favoring the repayment of international debts over social welfare spending contributed to the Ebola crisis by inhibiting an effective response by health care professionals in the three worst-hit African countries.
- Expert: Ebola Outbreak Will Probably Last All of Next Year (time.com)
But although the outbreak has peaked in Liberia and probably will do so in Sierra Leone too in the coming few weeks, the epidemic could have a “very long tail and a bumpy tail.”
- International Monetary Fund criticised over Ebola policies (itv.com)
Policies advocated by the International Monetary Fund (IMF) have contributed to under-funded, insufficiently staffed and poorly prepared health systems in the countries with Ebola outbreaks in west Africa, academics have said.
Researchers from Cambridge University’s department of sociology, joined by colleagues from Oxford University and the London School of Hygiene and Tropical Medicine, examined links between the IMF and the rapid spread of the disease.
They said IMF programmes over the years have imposed heavy constraints on the development of effective health systems in Guinea, Liberia and Sierra Leone – the cradle of the Ebola outbreak that has killed more than 6,800 since March this year.