Keeping Kids Healthy in Sierra Leone

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Even before the recent Ebola outbreak, the lack of quality healthcare was a major challenge in Sierra Leone, leading to the country suffering some of the highest maternal and child mortality rates in the world. When a major outbreak strikes, overburdened health systems struggle to take care of other critical health issues, like making sure children are immunized against vaccine campaigns -preventable diseases.

Sierra Leone suffers some of the world’s highest maternal and child mortality rates. 2,000 women per year die in childbirth and 1 in 8 children do not reach age 5, meaning there are 30,000 child deaths per year in a country of 7 million.

In Sierra Leone, less than 60% of children receive all recommended vaccines during their first year, and urban areas have even higher vaccine dropout rates. During the Ebolaoutbreak, we saw even these routine immunizations grind to a halt as the healthcare system was quickly overwhelmed by the rapidly spreading virus.

Immunizations are key to preventing the spread of infectious diseases like measles, which is why it is so important to have strong data and trained public health workers to launch vaccination campaigns. With the right information, public health workers can spring into action to prevent diseases from taking hold. This is why we are focusing on improving surveillance systems and training the public health workforce in Sierra Leone.

When Ebola struck in 2014, Sierra Leone lacked an effective infectious disease reporting system and enough trained epidemiologists – or disease detectives – to stop the outbreak, which then turned into an epidemic that claimed thousands of lives.

The situation in the country has since changed. Sierra Leone now has 58 disease detectives trained through the Frontline Field Epidemiology Training Program (FETP) with an additional 23 disease detectives currently undergoing training. Trainees and graduates have already investigated more than 50 outbreaks. Sierra Leone also has an Integrated Disease Surveillance and Response (IDSR) system. The IDSR system monitors for more than 45 diseases, conditions, and public health threats. A single case of an epidemic-prone disease, such as viral hemorrhagic fever, yellow fever, or cholera, is now reported within 24 hours by local and district public health facilities to the national office of the Ministry of Health and Sanitation (MoHS) so they can take quick action.

More than 2.8 million children in Sierra Leone were vaccinated against measles during campaigns in 2016.

The IDSR system can detect outbreaks of vaccine-preventable diseases that impact children, such as measles. In 2016, the IDSR system helped increase the reporting of measles cases, which prompted the launch of nationwide measles vaccination campaigns. We are proud to say that, thanks to this campaign, more than 2.8 million kids were vaccinated against measles in Sierra Leone.

An added benefit to stronger data is that we realized that some cases that were being reported as measles were actually rubella. Rubella is very dangerous for pregnant women and their developing babies. With this new information, pregnant mothers diagnosed with rubella can be monitored and we can advocate our partners for additional vaccine campaigns targeting rubella.

Because fast and accurate information can help us get ahead of the disease, CDC has been providing technical help to improve data quality, including rolling out the electronic IDSR (eIDSR) platform across Sierra Leone. These electronic systems can capture data on any device, including desktops, laptops, tablets, and smartphones. Most systems also have the capability to be used off-line, which is especially helpful in rural areas with poor internet connectivity. In a sign of the progress made since the Ebola outbreak, all districts are now electronically reporting their IDSR data to the national level.

Data tells us what is needed and where so that we can take quick and effective action. As Sierra Leone is demonstrating, it can help inform strategies to protect children and the communities they live in. Having better data – and people who are trained to use that data effectively – can stop outbreaks in their tracks, before they have a chance to becomeepidemics.

Tropical Medicine Conference 2019

What are Neglected Tropical Diseases?

Looking Ahead: Innovation for NTD Elimination and Control

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The World Health Organization (WHO) prioritizes 17 neglected tropical diseases (NTDs) (Figure 1) that affect over a billion of the world’s poorest people and pose a significant economic burden to developing economies (scabies was just added to the list in June of 2014, bringing the count to 18). NTDs are a heterogeneous group of infections caused by parasites, viruses, and bacteria. What makes NTDs different from non-neglected diseases is that these diseases are disablers rather than killers. Indeed, these infections are co-endemic: an individual may be infected with more than one NTD in addition to other well-known diseases such as HIV, tuberculosis, and malaria. For example, the parasite infection schistosomiasis can make women and girls more susceptible to HIV infection, saps micronutrients and iron from developing children to stunt their growth, and renders children less likely to attend school. A chronic helminth parasite infection known as lymphatic filariasis (LF) may reduce vaccine efficacy by broadly modulating the immune system. LF causes severe swelling (lymphedema) in 40 million people rendering them socially stigmatized and largely unable to work. In addition to schistosomiasis and LF, many more NTDs are characterized by chronic disabilities, increased susceptibility to infectious and non-infectious diseases, social stigma, and an economic burden on the individual, the family, and the country.

NTDs don’t just affect low- and middle-income countries, although their victims are often socioeconomically disadvantaged. Cysticercosis, echinococcus, toxocariasis, Dengue virus, West Nile virus, and Chagas disease all have appeared in the United States, disproportionately afflicting the poor. Peter Hotez of the Sabin Vaccine Institute and Baylor College of Medicine has estimated that half of the 20 million people living in poverty in the US are infected with at least one NTD.

Since the London Declaration, some successes indicate that control and eradication are possible. Colombia recently became the first country in the world to eradicate onchocerciasis. Niger, Nigeria, and the Ivory Coast have also recently eradicated Guinea worm. Twenty-three countries treated at least 75% of children at risk for soil-transmitted helminth infections, and a massive disease mapping program of blinding trachoma using mobile technology has cut the unmapped regions of the world for this disease in half.

However, we still have a long way to go. It has been estimated that of all the drugs approved for distribution, only 65-75% are reaching the people who need them. Implementation and operational research on how to carry out mass drug administrations effectively must be a priority. Even when control programs go well, they can be quickly derailed by political unrest, natural disasters like Superstorm Haiyan, or even epidemics like the ongoing Ebola outbreak that have overwhelmed the existing health systems in Liberia and Sierra Leone. Furthermore, disease boundaries for mosquito-transmitted diseases are especially sensitive to changing temperature and precipitation patterns due to climate change.

Last November in his keynote address to the American Society of Tropical Medicine and Hygiene, Bill Gates highlighted a need for global health innovations, citing the example of the new diagnostic test for human African trypanosomiasis. Gates urged the community to take the digital revolution and apply it to disease surveillance to determine where to concentrate disease-fighting efforts The Bill and Melinda Gates Foundation is a strong proponent that “big data” health care informatics solutions must be apart of efficient disease control programs, and this will represent a burgeoning area of global health research in the near future.

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Source:https://blogs.plos.org

Infectious Diseases Conference 2019

Zika virus and public policy

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Zika virus, a mosquito-borne infection, has captured international attention after news of devastating complications in pregnant women. While early attention focused on events in Brazil, Zika has spread northward and is anticipated to spread further into the United States. While local transmission has not yet occurred in the continental United States, the country has nevertheless seen over 1,000 cases of Zika, resulting from infections acquired either as a result of travel to an affected country or through sexual contact with a traveller. Here in Texas, 68 cases of Zika have already been confirmed, 20 of which are in Harris County.

Understandably, much attention has focused on the unique challenges affecting pregnant women infected with the disease. However, Zika presents broader policy implications that merit our attention. At Baylor College of Medicine Center for Medical Ethics and Health Policy, we are very interested in larger hospital and health agency policies that are critical in light of the unique characteristics of this infection.

These policies are especially important in Houston, a city with a world-class medical center comprised of multiple institutions. Surprisingly, there is no medical-centre-wide consensus on how to address the anticipated influx of Zika infections. This is particularly concerning given the anticipated increase in mosquito activity during the summer months. Some of the important policy issues surround tissue donation and a potential deferral policy for donors, and surveillance to track the long-term effects of infection on young children who are still undergoing significant development in areas of the body the disease is most likely to impact.

Given that there is much we don’t know about Zika, clinicians, researchers, and policymakers will have to work together to confront the virus. By working together, these important groups can contribute their expertise to policy decisions related to other mosquito-borne diseases that affect patients, including chikungunya and dengue.

In an increasingly globalized world, cities like Houston that have a tropical climate and conditions suitable for disease vectors are particularly vulnerable to outbreaks and will need an informed, unified plan to address them. This collaborative, multi-disciplinary and multi-institutional work is vital to protecting and promoting the health of area residents, now and in the future.

Source:https://blogs.bcm.edu/2016/07/19/zika-virus-and-public-policy/

HRSA’s Ryan White HIV/AIDS Program Observes Hepatitis Awareness Month, Advances Efforts to Eliminate HIV/HCV Coinfection

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Two Special Projects of National Significance (SPNS) projects are underway that are supporting jurisdictions to increase their capacity to provide comprehensive screening, care, and treatment of hepatitis C among clients with both HIV and hepatitis C and increase the number of HIV/HCV coinfected clients who are diagnosed, treated, and cured of hepatitis C infection. We look forward to sharing best practices, lessons, and tools resulting from these projects to support other jurisdictions and clinics.

HRSA also supported the development and release of a free, online curriculum about HIV/HCV coinfection for healthcare providers and healthcare staff educators. HIV/HCV Co-infection: An AETC National Curriculum is an important, evidence-based resource for health professionals and will help expand capacity for treating everyone living with HIV/hepatitis C coinfection.

May is Hepatitis Awareness Month, and May 19, 2019, is Hepatitis Testing Day. The Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program has a long-standing commitment to providing health care and support services for low-income people with HIV who are coinfected with hepatitis C. As the Ryan White HIV/AIDS Program observes Hepatitis Awareness Month and Hepatitis Testing Day, we highlight the importance of testing and treating people coinfected with HIV and viral hepatitis and recognize hepatitis C-related efforts underway throughout the program.

Partly fueled by the opioid epidemic, new hepatitis C virus (HCV) infections more than tripled between 2010 and 2016. Although advances in HIV care and treatment result in longer life expectancy for people with HIV, those who are coinfected with HIV and hepatitis C still have a high risk of liver-related illness and death. Viral hepatitis progresses faster and causes more liver-related health problems among people with HIV than among those who do not have HIV. Approximately 25 percent of people with HIV in the U.S. are coinfected with hepatitis C.

Recent advances in treatment make it possible to win the fight against hepatitis C. A simple blood test can detect hepatitis C infection years before symptoms develop, and the several recently FDA-approved treatment options for hepatitis C are a game-changer for hepatitis C care and treatment. For the first time, persons infected with hepatitis C can be cured with all-oral, once-daily treatment regimens that last eight to 24 weeks and have minimal side effects. Experts recommend that all people with HIV be tested for hepatitis C and, if positive, considered for hepatitis C treatment because being cured of hepatitis C can prevent liver disease and liver cancer and greatly improve health outcomes.

The Ryan White HIV/AIDS Program provides the infrastructure to screen and treat people with HIV for hepatitis C and is committed to eliminating hepatitis C co-infection among all RWHAP clients. Toward that end, HRSA HAB has been supporting innovative work to expand provider, clinic, and jurisdictional capacity to provide comprehensive hepatitis C screening, care, and treatment for people with HIV.

As we observe Hepatitis Awareness Month, we acknowledge and send our appreciation to stakeholders across the Ryan White HIV/AIDS Program whose efforts are helping us advance toward the goal of eliminating hepatitis C co-infection among our clients. And we also congratulate the clients who have successfully completed treatment.

Source:https://www.hiv.gov/blog/hrsa-s-ryan-white-hivaids-program-observes-hepatitis-awareness-month-advances-efforts-eliminate

HRSA’s Ryan White HIV/AIDS Program Observes Hepatitis Awareness Month, Advances Efforts to Eliminate HIV/HCV Coinfection

Tropical Medicine Congress | Tropical Medicine Conference | Infectious Diseases Conference | Tropical Medicine Meetings | Infectious Diseases Congress | Infectious Diseases Meetings

Two Special Projects of National Significance (SPNS) projects are underway that are supporting jurisdictions to increase their capacity to provide comprehensive screening, care, and treatment of hepatitis C among clients with both HIV and hepatitis C and increase the number of HIV/HCV coinfected clients who are diagnosed, treated, and cured of hepatitis C infection. We look forward to sharing best practices, lessons, and tools resulting from these projects to support other jurisdictions and clinics.

HRSA also supported the development and release of a free, online curriculum about HIV/HCV coinfection for healthcare providers and healthcare staff educators. HIV/HCV Co-infection: An AETC National Curriculum is an important, evidence-based resource for health professionals and will help expand capacity for treating everyone living with HIV/hepatitis C coinfection.

May is Hepatitis Awareness Month, and May 19, 2019, is Hepatitis Testing Day. The Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program has a long-standing commitment to providing health care and support services for low-income people with HIV who are coinfected with hepatitis C. As the Ryan White HIV/AIDS Program observes Hepatitis Awareness Month and Hepatitis Testing Day, we highlight the importance of testing and treating people coinfected with HIV and viral hepatitis and recognize hepatitis C-related efforts underway throughout the program.

Partly fueled by the opioid epidemic, new hepatitis C virus (HCV) infections more than tripled between 2010 and 2016. Although advances in HIV care and treatment result in longer life expectancy for people with HIV, those who are coinfected with HIV and hepatitis C still have a high risk of liver-related illness and death. Viral hepatitis progresses faster and causes more liver-related health problems among people with HIV than among those who do not have HIV. Approximately 25 percent of people with HIV in the U.S. are coinfected with hepatitis C.

Recent advances in treatment make it possible to win the fight against hepatitis C. A simple blood test can detect hepatitis C infection years before symptoms develop, and the several recently FDA-approved treatment options for hepatitis C are a game-changer for hepatitis C care and treatment. For the first time, persons infected with hepatitis C can be cured with all-oral, once-daily treatment regimens that last eight to 24 weeks and have minimal side effects. Experts recommend that all people with HIV be tested for hepatitis C and, if positive, considered for hepatitis C treatment because being cured of hepatitis C can prevent liver disease and liver cancer and greatly improve health outcomes.

The Ryan White HIV/AIDS Program provides the infrastructure to screen and treat people with HIV for hepatitis C and is committed to eliminating hepatitis C co-infection among all RWHAP clients. Toward that end, HRSA HAB has been supporting innovative work to expand provider, clinic, and jurisdictional capacity to provide comprehensive hepatitis C screening, care, and treatment for people with HIV.

As we observe Hepatitis Awareness Month, we acknowledge and send our appreciation to stakeholders across the Ryan White HIV/AIDS Program whose efforts are helping us advance toward the goal of eliminating hepatitis C co-infection among our clients. And we also congratulate the clients who have successfully completed treatment.

Source:https://www.hiv.gov/blog/hrsa-s-ryan-white-hivaids-program-observes-hepatitis-awareness-month-advances-efforts-eliminate