Thursday, July 11, 2019

A new antimalarial drug is identified...

 Tropical Medicine and Infectious Diseases

With the emergence and growing number of drug-resistant Plasmodium falciparum, a new drug for malaria control must be urgently developed. The new antimalarial synthetic compound N-251 was recently discovered. As an endoperoxide structure in the body, the compound shows high antimalarial activity and curative effects. We performed a pharmacokinetic (PK) analysis of N-251 under various conditions using mice to understand the inhibitory effect of N-251 in parasite-infected mice.

PK study of N-251 after intravenous and oral administration in mice showed plasma concentration of N-251 was decreased drastically by intravenous route. Cmax was reached in 2 h after oral administration of N-251, and the level decreased to a level similar to that obtained after intravenous administration. 
The area under the curves (AUCs) of the plasma concentration of N-251 increased dose-proportionally in both administrations, and bioavailability (F) was approximately 23%, Additionally, TmaxCmax, AUC, and F increased in fasted mice compared to normal-fed mice after the administration of N-251, indicating the influence of diet on the absorption kinetics of N-251. Furthermore, in parasite-infected fasted mice, the plasma concentration-time profile of N-251 was similar to that in normal-fasted mice. Based on the PK parameters of the single oral administration of N-251, we investigated the effect of multiple oral doses of N-251 (68 mg/kg three times per day for 2 days) in normal-fed mice. The plasma concentration of N-251 was between 10 and 1000 ng/mL. The simulation curve calculated based on the PK parameters obtained from the single-dose study well described the plasma concentrations after multiple oral dosing, indicating that N-251 did not accumulate in the mice. 
Multiple oral administrations of N-251 in mice were required to completely eliminate parasites without the accumulation of N-251.




Monday, May 20, 2019

Eliminate missed vaccination opportunities


Despite well-documented evidence regarding effectiveness and safety, overall adult vaccination rates in the United States fall short of national public health goals. Efforts to increase vaccine uptake have largely focused on reducing the number of so-called missed opportunities (eg, patients who visit health care providers without being vaccinated). All health care professionals, whether in public or private practice, should take advantage of every patient visit to ask about immunization history and provide patients with the recommended vaccines they need or refer them to providers who can offer the vaccines. While this may occur in some practices, I see missed opportunities all the time, particularly in speciality practices.
Whether it is the cardiologist who fails to recommend pneumococcal vaccination for their patient with cardiac disease or a physician in a tuberculosis clinic that doesn’t offer influenza vaccine —opportunities to make sure adults are immunized against vaccine-preventable diseases are being missed.
Paul Etkind, MPH, senior analyst for immunizations at the National Association of County and City Health Officials (NACCHO), said, “[While] it is not unusual for STD clinics to be offering HPV, Hepatitis B and Hepatitis A immunizations to their patients, it is more unusual for TB clinics to routinely offer flu and/or pneumonia vaccinations to their patients.” However, NACCHO supports the concept that rather than having TB clinics administer vaccines themselves, another possibility would be for TB clinic staff to routinely ask patients about their flu and pneumonia immunization histories and prompt the under- or unvaccinated patient to see their primary care provider or local health department to receive the appropriate immunization(s).

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The ultimate goal is to have every patient fully immunized, and that includes the entire array of vaccines recommended for adults by the CDC’s Advisory Committee on Immunization Practices: influenza, pneumococcal, Tdap, shingles, hepatitis B, hepatitis A and HPV. Achieving this goal will require the involvement of all health care professionals in both private and public health venues. And I challenge you to help meet this public health goal by leaving no opportunity behind.
Source:https://www.healio.com

Tuesday, May 14, 2019

Infectious Diseases Conference 2019

MEASLES OUTBREAKS: REINFORCING THE IMPORTANCE OF NATIONAL INFANT IMMUNIZATION WEEK


The Centers for Disease Control and Prevention (CDC) has designated April 27-May 4, 2019 as National Infant Immunization Week (NIIW), an annual observance highlighting the importance of protecting infants against vaccine-preventable diseases. 2019 marks the 25th anniversary of NIIW and celebrates the impact of vaccines on improving public health. The more than 600 confirmed cases of measles in 22 states between January and April 2019 serve as a stark reminder of the need to collectively raise our voices in support of childhood vaccination.
Vaccinating young children on time is the best way to protect them against 14 serious and potentially deadly diseases before their second birthday. For children born between 1994 and 2018, vaccination will prevent an estimated 419 million illnesses, 26.8 million hospitalizations, and 936,000 deaths in their lifetimes. When parents choose not to vaccinate, or to follow a delayed vaccination schedule, children are left unprotected against diseases that can still circulate in the US, including measles and whooping cough. 


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9 in 10
Measles is one of the most contagious infectious diseases and may be associated with severe side effects including major neurologic damage, or even death. As the number of unvaccinated, susceptible children increase, the risk of an epidemic grows rapidly and is a real threat to all at-risk groups. The total number of confirmed cases of measles in the US in 2019 is estimated to be the largest since measles was eliminated in the US in 2000.
When the overwhelming majority of children are vaccinated as recommended, those few who are susceptible to serious medical diseases are much safer, a concept referred to as ‘herd immunity’ or ‘community immunity.’ As the pool of unvaccinated children increases, community immunity declines, which can pose a tragic and unnecessary threat to many children (and adults) who cannot be protected through vaccination.

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multi-ivax2protect
Measles is still commonly transmitted in many parts of the world. Globally, nearly 10 million individuals get measles and about 134,200, mostly children, die from the disease each year. Despite the national measles, mumps, and rubella (MMR) vaccination coverage level of about 92%, one in 12 children in the US does not receive the first dose of MMR vaccine on time, underscoring measles susceptibility across the country. Vaccination coverage continues to vary by state from 84% in some states to 97% in others. At the county or local levels, vaccine coverage rates may also vary considerably and pockets of unvaccinated individuals can exist even in states with high vaccination rates.
What can you do to prevent measles?
  • Healthcare professionals (HCPs) must strongly recommend MMR vaccination to their patients
  • Children should get two doses of MMR vaccine, starting with the first dose at age 12 to 15 months, and the second dose at age 4 through 6 years
  • Adults should review their own vaccination history and get an MMR booster vaccine if they are unsure about past vaccination or immunity
  • All individuals travelling outside the US should consult with an HCP about recommended vaccines, including MMR 
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  • Despite a national #MMR #vaccination coverage of nearly 92%, 1 in 12 children in the US does not receive the first dose of MMR #vaccine on time 
  • Before the #chickenpox #vaccine was available, ~50 children died and more than 7,000 were hospitalized each year in the US 
  • #Pneumococcal #vaccines have helped lower the estimated number of cases of invasive pneumococcal disease in young children by almost 90%#PreventPneumo
  • For children born between 1994-2018, #vaccination will prevent an estimated 419M illnesses, 26.8M hospitalizations, & 936,000 deaths in their lifetimes 
Source: https://nfid.wordpress.com

Monday, May 13, 2019

Infectious Diseases Conference 2019

Facts about flu

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What are the symptoms? 
Common clinical symptoms for both influenza A and B may present with sudden onset of fever, cough, sore throat, myalgia/myositis, fatigue, and gastrointestinal (GI) presentations such as vomiting and diarrhoea. Fever is more common in children than in adults. Although clinical presentations are indistinguishable between influenza A and B infections, some studies report differences by age groups. Influenza A tends to cause more severe illness, although influenza B can be severe in children. In adults, influenza B infections more frequently present with vomiting, diarrhoea, abdominal pain, headache, general weakness and rhinorrhoea compared to influenza A. It was found that cases with influenza B infection presented more with upper respiratory tract infections, myosotis and gastroenteritis compared to influenza A in children. Without a test, however, you cannot prove influenza infection, as there are over 90 other cold and cough viruses which circulate in winter.  However, when an epidemic of flu is occurring, flu-like illness is more likely to be flu.
How does it spread?  
Influenza infection can be transmitted through droplets, aerosol and direct contact with the infected person. Whilst droplet is the main mode of spread, numerous studies have documented airborne transmission. In one US study, viable influenza virus was detected in the air of the emergency department 3 hours after the infected patient had left.
Who is affected?  
Influenza infects all ages, with peaks at the extremes of age – the very old and the very young. In 2017 the peak has been in older adults >80 years and over and children 5-9 years.  Males and females are equally affected. Up to a quarter of people can get infected in a severe epidemic.
What are the complications? 
Influenza can result in primary viral pneumonia, which occurs early in the course of illness, or secondary bacterial pneumonia, with onset later (1-2 weeks after initial symptoms). Bacterial pneumonia is the most common influenza-associated complication, especially in children and the elderly. Bacterial infection can be complicated by antibiotic resistance and there is are vaccines available for the most common bacterial complication, pneumococcal infection. Unfortunately, despite being provided free to people over 65 years and other risk groups, rates of vaccination against pneumonia are low. Other complications can be worsening of asthma and respiratory diseases and exacerbation of underlying comorbidities in persons who are at risk of the infection. Heart failure, precipitation of heart attacks and sinusitis may also occur. Occasionally encephalitis and complications of other organ systems may occur.
Influenza vaccine: 
Primary prevention is with vaccination with influenza vaccine annually. The mutation of the virus year to year requires annual vaccination. The vaccine is safe and effective, but effectiveness can vary depending on how well the vaccine is matched to circulating strains. People aged 65 years and over, and those with medical or other risk factors are recommended and funded for a free vaccine in Australia. The quadrivalent vaccine, introduced in 2016, allows protection against four strains, which gives better effectiveness against flu.  Research is underway for a universal flu vaccine which will remove the need for an annual jab.
Other prevention & control measures: 
Neuraminidase inhibitors (NAIs) can be used as prophylaxis or treatment, and when used as prophylaxis can curtail outbreaks.  Cough etiquette, hand hygiene and infection control measures are also vital to prevent further spread of infection. Personal protective equipment such as masks is recommended for healthcare workers. Guidelines recommend “droplet precautions” for seasonal influenza, however, airborne transmissions well documented for influenza.

Sunday, May 12, 2019

Ebola and Zika Viral Infections

Debut of preventive use of Ebola Virus Disease (EVD) vaccine for health care and frontline workers in Uganda before an outbreak

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For the first time, an unlicensed Ebola vaccine tested in clinical trials during the West African outbreak was offered to health care workers (HCWs) and other front line workers (FLWs) working in facilities bordering the outbreak areas in the Democratic Republic of Congo (DRC) under “compassionate use.”   Nearly 90,000 community members, HCWs and FLWshave been vaccinated in DRC using a ring vaccination protocol (as of March 24, 2019).
Also for the first time, in countries bordering DRC, preparedness efforts include offering the Ebola vaccine to HCW and FLW working at health facilities and border crossings just across the border from Ebola hotspots in DRC. WHO and the ministries of health lead the vaccination program. CDC is providing technical expertise and our experience continues to be valued in each new country undertaking Ebola vaccination. By April 2019, more than 4,100 HCWs and FLWs in 13 districts in Uganda, and nearly 1,500 in 3 states in South Sudan have been vaccinated.
Successfully implementing an experimental vaccine in field conditions and convincing HCW and FLW to receive a vaccine before a case occurred in Uganda was a major achievement. Not everyone offered vaccine took it and we learned a lot along the way and honed communication messages. On the first day of vaccination at the first site in Ntoroko District, a health centre in a remote area near Lake Victoria, we had the usual “first-day” challenges with staff new to their roles, and logistical challenges in getting all the required supplies to the sites. Several hours after we opened the site we successfully vaccinated the first participant, a senior clinical officer at the Health Center.   During the 30-minute post-vaccination observation period, I sat down to chat with him and thank him for his patience. 
When I asked why he had decided to take the vaccine he responded: “I was a medical officer during the 2008 outbreak of Ebola Bundibugyo in the next District. We did not have a vaccine then and I watched people die. Now you bring me a vaccine. Of course, I want it. In addition, I am making sure all my staff at the health centre are getting it today. It will make us feel safe if this Ebola comes to our facility.”   
Throughout the day, he brought all of the nurses, clinical officers and laboratory staff to the vaccination site and stayed with them, providing emotional support for those who were scared and encouraged. It was an incredible display of leadership and caring—while also respecting individual-level decision-making and the right of each person to consent to the vaccine or not.   It was a stressful time for the team supervising the work, but the inspiration of this first vaccination carried me through many long days and nights to come as we continued to roll out to new sites and new Districts.

Because the vaccine is unlicensed, it must be used under a trial protocol with vaccination teams trained in good clinical practices, and individuals must provide informed consent. Because pregnant and breastfeeding women are excluded from vaccination, programs offered pregnancy testing onsite.

With a new, unlicensed vaccine, there is a small pool of staff with field experience. Many of the WHO staff who worked on the vaccine trial in Guinea were fully engaged with the vaccination work in DRC.   CDC’s experience with the Ebola vaccine as part of the STRIVE vaccine trial in Sierra Leone created a small cadre of epidemiologists who have provided valuable assistance in the field for the current outbreak on delivering vaccine in health care facilities.
Because the Ebola vaccine trials conducted during the 2014-2016 West Africa outbreak in Guinea, Liberia and Sierra Leone demonstrated the safety and efficacy of the rVSV-ZEBOV (Merck) vaccine, the vaccine is now a standard part of an Ebola outbreak response.
Source: https://blogs-origin.cdc.gov

Thursday, May 9, 2019

Tropical Medicine Conference 2019

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

Wednesday, May 8, 2019

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 multipleaedes-aegypti-mosquito-featured-image 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/