The World Health Organization’s representative to Myanmar (Burma) has repeated warnings that resistance to artemisinin (now the mainstay of treatment to malaria) is spreading in the region.

Speaking to IRIN News, Leonard Ortega highlighted the role of increased movement of individuals and populations, and of the widespread use of fake or substandard drugs, in spreading resistant strains of malaria. He referred to studies, presented late last year at a WHO regional workshop of health officials, indicating that artemisinin resistance is present in areas along the Myanmar-Thailand, Myanmar-China and Cambodia-Vietnam borders.

“The current state of country health information systems are inadequate and fail to meet the needs of decision-makers globally, nationally and locally.” This was the conclusion of delegates to the Global Health Information Forum held in Bangkok in January.

The meeting ended with the publication of a call to action that stressed the need for: transparency, good governance, adequate investment, capacity building, harmonization and integration, and planning for the future.

The Bangkok call to action follows a recent statement on health information systems from WHO, the World Bank, the Global Fund, UNICEF, UNAIDS, UNFPA, GAVI and the Bill & Melinda Gates Foundation that called for “new ways of working and a more systematic approach by all partners … to better monitor and evaluate progress and performance” [1].

Reference
1. Chan M, Kazatchkine M, Lob-Levyt J, Obaid T, Schweizer J, et al. (2010). Meeting the Demand for Results and Accountability: A Call for Action on Health Data from Eight Global Health Agencies. PLoS Med 7(1): e1000223.

Research aimed at developing new treatments for the infectious diseases of poverty (IDPs) has generally been of very little interest to the pharmaceutical industry. The people with these diseases are, by definition, poor and would be unable to afford expensive new drugs. Hence there is no profit to be made.

However, the economies of some of some countries with high rates of IDP incidence are now growing rapidly. China is a case in point. Tuberculosis is the country’s number one infectious cause of death, claiming some 160,000 lives annually. China has the world’s second highest number of TB cases, after India.

But thanks to its economic success China can now pay for TB drugs. A study by the market research group ResearchAndMarkets says that China’s demand for TB drugs has grown at a fast pace in the past decade. It predicts that, in the next five years, both production and demand will continue to grow. The study examines China’s economic trends, investment environment, industry development, supply and demand, industry capacity, industry structure, marketing channels and major industry participants. (Unfortunately the full report is only available for a very high fee - around $6,000.)

What impact will economic growth in IDP-endemic countries have on the research priorities of the pharmaceutical industry? Certainly countries that have both IDPs and money become a more interesting prospect. Many countries with growing economies are, for example, afflicted by dengue fever and by malaria. Will industry come to regard these as more attractive areas for research than previously?

Some of the highest rates of infectious diseases, however, are in Africa where economies are still struggling. The profit motive for addressing their disease burden is still lacking.

Tuberculosis control efforts in China are claimed to have saved over three-quarters of a million deaths and prevented 20 million new cases of the disease over the last eight years.

According to the Xinhua.net news service, the figures were given at a joint meeting of China’s health ministry with the World Bank and the UK Department for International Development, which supported the TB control programme based on DOTS (directly observed treatment, short course).

China’s population of TB patients was estimated as 4.5 million in 2009, the world’s second largest after India.

2010 is the Year of the Lung. It is interesting to see such a broad view taken of health conditions that affect the lung, for they are many and various - both infectious and non-infectious.

In many cases different health threats conspire to attack the lungs. The use of tobacco can worsen infectious conditions, for example tuberculosis. Analyses have suggested that a considerable proportion of the global burden of TB may be attributable to smoking. It seems likely that the recovery of patients receiving TB treatment will be held back if they use tobacco.

Surprisingly little is known as to how many TB patients use tobacco. Researchers in Malaysia (1) asked over 800 people receiving TB treatment whether they were users of tobacco. They found that 40% were current users and 14% had used tobacco at some point in their lives. They estimate the prevalence of ever-smoking among patients with TB to be 54,220 per 100,000 population. From conversations with the TB patients the researchers conclude that most of them had “deficiencies in knowledge of tobacco use and its health dangers”.

Efforts to control tuberculosis must clearly include action to discourage smoking.

Reference
1. Awaisu A et al. (2010). Tobacco use prevalence, knowledge, and attitudes among newly diagnosed tuberculosis patients in Penang State and Wilayah Persekutuan Kuala Lumpur, Malaysia. Tobacco Induced Diseases; 8:3.
http://www.tobaccoinduceddiseases.com/content/8/1/3

Leptospirosis is a bacterial disease of animals that can also affect humans. Exposure through water contaminated by urine from infected animals (most commonly rats) is the most common route of infection. Outdoor and agricultural workers (rice-paddy and sugarcane workers for example) are particularly at risk.

In India it is recognized as being one of the most common causes of fever in many parts of the country but not in the north, where it is regarded as being “non-endemic”. New research (1), however, confirms that it has become much more common in this part of India in recent years.

During the period 2004 to 2008 the Post-Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh received 1391 blood samples from suspected patients with fever of unknown origin, from several parts of northern India, which they tested for leptospirosis. They found there was a sustained rise of leptospirosis cases from 11.7% to 20.5% across the period.

The researchers followed up 86 of the leptospirosis cases in more detail. Infestation of dwellings with rats (53.7%), working in farm lands (44.2%), and contact with animals (62.1%) emerged as the most common risk factors. Five of the 86 patients died and many more suffered severe complications: kidney failure (60.5%), respiratory failure (20.9%), blood clotting (11.6%), and damage to the nervous system (11.6%).

Leptospirosis, say the researchers, is often not suspected by physicians in patients with fever in supposedly non-endemic areas. They argue that doctors in northern India should be more aware of the possibility of the disease in their patients, as early diagnosis and treatment may reduce the number of complications and the death rate.

Reference
1. Sethi S, Sharma N, Kakkar N, Taneja J, Chatterjee SS, et al. (2010). Increasing Trends of Leptospirosis in Northern India: A Clinico-Epidemiological Study. PLoS Negl Trop Dis 4(1): e579

Recently published new guidelines for the diagnosis, treatment, prevention and control of dengue (see TropIKA.net report) have been hailed by the Wellcome Trust as an example of how research can shape policy - see Trust press release.

The Wellcome Trust funded some of the research on which the new guidelines are based, particularly research conducted in Viet Nam. The press release also describes how malaria policy in Kenya has been influenced by Trust-funded work.

A report in the Hindu newspaper says that the Indian Council of Medical Research (ICMR) will be setting up an expert group to examine the increasing number of cases of the infectious disease Chikungunya.

ICMR also intends to create a National Virology Network to monitor the outbreak of all viral diseases throughout India.

Chikungunya - viral disease, carried by Aedes aegypti mosquitoes - was first reported in the 1950s and in recent years has steadily become more common in Africa, Asia and the Pacific islands, with the first European cases seen in 2007. It has similar symptoms to dengue, making diagnosis difficult. The fever lasts only a few days but severe joint pains and fatigue can persist for many months. The disease has also recently been shown to cause severe blistering of the skin of infected children (1). No vaccine or specific treatment exists for Chikungunya. There are concerns that the increasing frequency of the infection will cause problems for blood transfusion services in many parts of the world (2), although improved blood tests are under development (3).

References

1. Robin S, Ramful D, Zettor J, Benhamou L, Jaffar-Bandjee MC, Rivière JP, Marichy J, Ezzedine K, Alessandri JL (2010). Severe bullous skin lesions associated with Chikungunya virus infection in small infants. Eur J Pediatr; 169(1):67-72.
2. Petersen LR, Stramer SL, Powers AM (2010). Chikungunya virus: possible impact on transfusion medicine. Transfus Med Rev. 2010 Jan;24(1):15-21.
3. Sharma S, Dash PK, Santhosh SR, Shukla J, Parida M, Lakshmana Rao PV (2010). Development of a Quantitative Competitive Reverse Transcription Polymerase Chain Reaction (QC-RT-PCR) for Detection and Quantitation of Chikungunya Virus.

WHO has certified seven more nations as being free of guinea-worm disease (dracunculiasis). The countries are: Benin, Cambodia, Guinea, Mauritania, the Marshall Islands, Palau and Uganda. This brings the number of countries and territories now certified free of the disease to 187, compared with 21 in 1997.

It is necessary for at least three years to pass without notification of a case before WHO will certify a country as being guinea worm free. As recently reported on TropIKA.net, over a year has gone by since a case was seen in Nigeria. Neighbouring Niger is in a similar position. WHO considers that both nations have interrupted transmission and it is hoped that they are well on the way towards elimination of the disease.

Ethiopia, Ghana, Mali and Sudan are the four remaining ountries where transmission has yet to be interrupted.

Further details are available in a WHO press note.

Chinese scientists are working on a new class of tuberculosis drugs based on clofazimine, according to a Reuters’ report. Clofazimine itself is an old drug, used at one time in the treatment of leprosy.

New ways to prevent and treat tuberculosis are a priority globally but China’s needs are particularly acute. After India, the country has the second largest number of people with TB. Every year 1.4 million people in China fall ill with the disease; in 2008 there were 160,000 TB deaths. Drug-resistant forms of TB are also becoming more common. In 2000, 28% of China’s TB cases were drug resistant, compared with typically around 5% in developed nations.

Lin Yan, director of the China office of the non-profit International Union Against TB and Lung Disease, told Reuters that: “If there are more drug-resistant cases, the cost of TB treatment will rise by a lot, that’s for sure. With drug resistance, we can’t use first-line drugs and other drugs cost a lot more”.

Zhong Qiu, who heads the Anti-TB Research Institute in Guangdong province and is a member of of China’s TB Expert Consultative Committee, explained that regular TB costs 1,000 yuan to treat in China but drug-resistant TB ranges from 100,000 to 300,000 yuan per person.