The Global Pulse Journal Blog

Home to over 400 million people, the Ganges river winds through India’s history, culture and countryside. Unfortunately, rapid industrialization and urbanization has left an unholy mark on the Ganges as dangerous amounts of untreated industrial pollution and human excrement enter the river every day.  These conditions are all too common in rivers worldwide  and create an environment ripe for diseases ranging from schistosomiasis to Cryptosporidium.

But long time advocacy is finally paying off as the WSJ reports that World Bank and the Indian government are set to spend $4 billion to “to ensure that by 2020 no untreated municipal sewage or industrial runoff enters the 1,560-mile river.”.  The methods proposed also have the benefit of being less carbon and electricity intensive than traditional wastewater treatment plants – key aspects for a country with chronic brownouts in a warming world.  In order to reach their goal, the government and partners will need to engage the most neglected slums which, if done right,  has the potential to create environmental justice at the same time as cleaning the river.

Of course, governments have a tendency of announcing lofty environmental goals which are then forgotten in the next election cycle. The Ganges also had a previous cleanup effort that failed to reach its goals, partly because of lacking public participation. Hopefully things will be different this time, but GP would love to hear from anyone with on the ground insight.

After over 20 years of research, scientists believe that they have discovered a breakthrough that will allow for more effective treatments for HIV/AIDS. In a recent article in Nature, scientists from Imperial College London and Harvard University report success at elucidating the structure of integrase, an enzyme which the HIV virus uses insert a copy of its genetic material into host DNA. Researchers hope that this new knowledge will lead to a better understanding of how integrase inhibitors work, how they can be improved and how we can prevent HIV from developing resistance to them.

For more see http://www.reuters.com/article/idUSTRE6101AQ20100201

For the past seven years, the United States has supported and expanded its program to fight HIV/AIDS in developing nations, underwriting almost half of the world’s AIDS relief. But some are concerned by recent setbacks in the global campaign to fight disease in the developing world. At a time when the numbers of people infected with HIV is beginning to increase after stabilizing in countries like Uganda and the number of people in need of treatment is rapidly expanding, the US funding has not kept pace. With updated World Health Organization guidelines, the number of HIV-infected people eligible for treatment has expanded to 14 million, a large increase from the only 4 million people current in treatment.

In the face of this expanding pool of people in need, US government funding seems to be staying stable. For example, at the same time that the Obama administration has announced plans to expand HIV treatment to at least 4 million by 2013, they have also signaled no increases in funding budgets through fiscal 2011. Defending the administrations commitment to fight the global pandemic, Eric Goosby, the President’s AIDS czar, stated that “our commitment to universal coverage hasn’t wavered.”

For more on the global fight on AIDS and particularly the fight in Uganda, check out the Wall Street Journal’s January 30th article and slideshow.

It has long been established that high adherence to antriretroviral therapy is associated with slowed progression of HIV infection and increased survival, but a recent study by researchers at the Johns Hopkins Bloomberg School of Public Health suggest that high antiretroviral therapy adherence is also associated with lower health care costs. Their study suggests that improved health outcomes associated with high adherence to HIV therapy results in an overall median monthly health care cost savings of $85 per patient in a cohort of 6,833 HIV-infected adults in South Africa. A large component of this cost savings resulted from a decreased need for hospitalization in patients with high adherence to antiretroviral therapy. These results suggest that effective, practical strategies are needed to encourage and actively monitor antiretroviral therapy adherance in order to improve patient outcomes and, in the process, save much need health care resources.

More details on the study can be found in the January 5, 2010 issue of Annals of Internal Medicine.

The following article was first published on the PLoS Medicine Blog, “Speaking of Medicine“, and is cross-posted here.

The role of medical students in limiting the spread of antimicrobial resistance

Adam Castaño‡, Sujal Parikh‡ and Eunice Yu, medical students at the University of Michigan Medical School, Ann Arbor, Michigan, USA (‡ These authors contributed equally to this post). Contact Adam Castano on acastano@umich.edu.

Nowhere in the world is free from the spread of drug-resistant bacteria, parasites and viruses.  The World Health Organization (WHO) Global Alliance for Patient Safety has recognized the dual problems posed by the increasing incidence of drug-resistant bacteria and the decline in antibiotic innovation.  For the past two years, a working group of policy makers, scientists, epidemiologists, and economists have assembled at several international meetings to outline an international strategy to address antimicrobial resistance (1). Policy recommendations, to be launched in 2010, will establish new roles for governments, public health departments, industry, and physicians as primary stakeholders in AMR prevention and alleviation.  Physicians prescribe antimicrobials, contribute to the spread of pathogens (particularly hospital-acquired infections), educate patients about appropriate use of antimicrobials, perform research, and set research agendas.  Medical students are being trained in an era where the toll of antimicrobial resistant infections is evident on a daily basis.  As future physicians, they have the potential to help to address this problem.  Here, we describe new leadership roles for medical students within their medical schools, hospitals, communities, states, and countries to alleviate the problem of AMR.

The role of medical students in medical schools Read the rest of this entry →

Centers for cholera treatment in northern Mozambique have been vandalized recently due to a belief that they are actually causing cholera, rather than treating it.  The misunderstanding is partly blamed on the similarity between the Portuguese words for Cholera and Chlorine, since Chlorine is used to treat water and prevent cholera.  (Mozambique was a Portuguese colony until the mid-1970’s).

See the full story here: http://allafrica.com/stories/200911120948.html

It is a laudable goal to advance innovation in medicine, and the recently released results from the experimental HIV vaccine seem promising yet, with the growing trend of conducting clinical trials abroad and the corresponding increase in research subjects being drawn from developing nations, scientists, physicians, regulators and ethicists must strive to balance beneficence and justice and uphold their professional obligations. Large pharmaceutical companies and investigators based in developed nations are increasingly outsourcing clinical research trials to developing nations. The most commonly cited reasons for this globalization of clinical trials include decreased costs, stream-lined subject recruitment, international harmonization of research guidelines, the development of contract research organizations specializing in global trials and a rapidly expanding global market. While there may be identifiable benefits for the pharmaceutical industry, this trend towards looking to third world nations for research populations raises notable ethical concerns and has public health, economic and regulatory implications for the frequently vulnerable populations living there. Commonly, there is minimal regulatory oversight of clinical trials conducted in developing nations, resulting in a lack of knowledge about research conduct, ethical standards and data quality for many of these studies. Furthermore, there has been much debate over the appropriate content and interpretation of international research guidelines such as the Declaration of Helsinki as applied to international trials. Read the rest of this entry →

A quick round-up of cool stuff in global health news:

The Global Health Magazine discusses use of technology for health in resource-poor settings.

The New England Journal of Medicine sets up an Online First page for H1N1 (a.k.a. Swine-Origin Influenza)

Doctors Without Borders / Médecins Sans Frontières release The Photographer, a graphic novel documenting their humanitarian missions in Afghanistan.

More coming soon!

Pathogens can invade our bodies, lyse cells, and cause cell death. They however, cannot lyse our human spirit! Below are manifestations of some creative and fun ways to express the self behind masks. Perhaps a new fashion statement? 

As we all come down from last week’s frenzy surrounding the (now renamed for lesser offensiveness to pork-marketing sensibilities) Swine-Origin Influenza Virus (S-OIV) H1N1 , is it possible that there is a hint of disappointment in the air?  Perhaps a whiff of anti-climactic letdown after the threat of feverish, lung-rending apocalypse?  Are we seeing a lucky escape from a close brush with global pandemic, at mercy of mutation and chance?  The product of a genuine, coordinated worldwide epidemic response?  Or merely the end of one news cycle and the beginning of the next?

While you ponder those questions, I bring you what could be one of the last updates before S-OIV H1N1 becomes terminally uncool.  As of Monday, April 4, the World Health Organization registered 1,085 laboratory-confirmed cases in 21 countries.¹ Mexico has begun to step down its safety measures, with restaurants and other venues for public activity set to re-open on Wednesday, and U.S. public health officials will be allowing schools to remain open in spite of the continuing spread of the virus, as most new cases appear to be mild.  In the business of assuaging fears, it has been confirmed by the WHO that eating pork is safe (so long as you cook it to 70°C/160°F first), and in the business of fanning fears of a different kind, U.S. conservatives are wasting no time in casting President Obama’s “overreaction” to the crisis as big-government encroachment.

For the fun flu facts reading selection this time,  I introduce another global health resource: the University of Pittsburgh’s Supercourse online series on epidemiology and global health.  Click on the Swine Influenza A link (or on the image below), pick your language of choice (including Spanish, Russian, Farsi, Vietnamese, and Hebrew), and click “Start” for a refresher on hemagglutinins, neuraminidases, and case definitions.

For a cool overview of influenza virus genetics, check out this article by Carl Zimmer in the New York Times:

Scientists first isolated flu viruses from pigs in 1930, and their genetic sequence suggests that they descend from the Spanish flu of 1918. Once pigs picked up the flu from humans, that so-called classic strain was the only one found in pigs for decades. But in the 1970s a swine flu strain emerged in Europe that had some genes from a bird flu strain. A different pig-bird mix arose in the United States.

In the late 1990s, American scientists discovered a triple reassortant that mixed genes from classic swine flu with genes from bird viruses and human viruses. All three viruses — the triple reassortant, and the American and European pig-bird blends — contributed genes to the latest strain.

And for possibly the best selection of flu-tracking maps you’re likely to find, this one is brought to you by Google and Rhiza Labs:

¹ For the epidemiologically-minded, with a lab-confirmed death toll of 26, this makes for a Case Fatality Ratio of 2.4% and falling with every new case of lab-confirmed disease in the absence of further deaths.  For comparison, your annual, garden-variety flu has a CFR of less than 0.1% in the general population, with a bimodal distribution of mortality (mostly limited to the very young and the very old).  Past flu pandemics have had CFRs in the 0.1%-2.5% range, while the dreaded H5N1 avian flu virus tracked in Asia in recent years showed a CFR of 14%-60% by various estimates (Li et al., J Epidemiol Community Health. 2008 Jun;62(6):555-9 ).  One previously reported CFR for zoonotically-acquired swine influenza was 14% (Myers et al., Clin Infect Dis. 2007 Apr 15;44(8):1084-8 ).  As you may suspect, flu CFRs are notoriously difficult to calculate, due to the wide incidence and under-reporting of mild cases.