Number 3, Trachoma Treatment Saves Sight & Saves Lives

Maybe an unexpected highlight, but I’m impressed at these findings… A recent study proved that application of azithromycin (Zithromax) to treat trachoma saved sight in Ethiopia and saved lives too. Chlamydia trachomatis is the leading cause of preventable blindness. Left untreated, chronic and repeated trachoma infections in children can lead to irreversible adult blindness; there are an estimated 8 million irreversible visual impairments attributed to trachoma.  Surgery, Antibiotics, Facial cleanliness and Environmental improvement (SAFE)  can all play a role in reducing the risk of disease, as well as treating and resolving infections.

The study published in September was conducted in Ethiopia, where 119 of every 1000 children die before 5 years of age. After azithromycin treatment for trachoma, the overall mortality rate among children who had taken the drug was half that of those who had not. One of the study leaders, Dr Tom Lietman, from the University of California at San Fransico, commented that “For years, people in trachoma-affected communities have reported that the antibiotic helped address other health problems”.

This study validates those reports, particularly so in the wider context that azithromycin is used to effectively treat many other infections. Diarrhoeal diseases and malaria are common causes of death for children under 5 in sub-Saharan Africa, causing an estimated combined 2.5 million childhood deaths annually. In the study setting, it’s likely that broad use of azithromycin may have treated a host of the neglected diarrhoeal and respiratory diseases as well as malaria, resulting in a significant reduction in childhood mortality.

These important findings are impressive, offering great potential to scale up the antibiotic treatment element of the SAFE programme and save many young lives. But wide-scale application of non-specific drug treatment should be taken with real prudence; such approaches must be integrated with other interventions and considerate of scientific understanding about the development of drug resistance. The rise of drug resistant organisms is no fiction; malaria, tuberculosis, HIV and staphylococcal infections, amongst others, certainly prove the need to proceed with caution!

 

Number 2, An Effective Malaria Vaccine Coming Soon?

In 2009, phase 3 human clinical trials began with the most promising malaria vaccine to date. The vaccine known as RTS,S/AS02 (aka RTS,S or Mosquirix) can be used safely, generating specific immunity to malaria and most importantly seeming to provide significant reductions in severe malaria (49%) and clinical disease (35%) in African children. The RTS,S vaccine was developed by Glaxo SmithKline (GSK) in the mid 1980s with support from the Walter Reed Medical Centre; since 1991 the vaccine effort has been a public-private partnership between GSK and the PATH Malaria Vaccine Initiative.  Designed primarily for use in Africa and first tested on humans in the early 1990s, this is the most promising malaria vaccine to date.

The start of the largest ever malaria vaccine trials was announced this year; seven African countries, including 11 medical research institutes, will participate. The vaccine will be administered to up to 16,000 infants and children younger than 17 months in Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique and Tanzania. Results of this trial are expected in 2012. With the already encouraging results shown so far, the first malaria vaccine may be available for wide-scale use by 2015.

 

Number 1, Swine Flu Fever Takes Over The World & Everything!

Swine flu happened to the whole world in a big way in 2009, overshadowing all other public health/infectious disease news. By mid 2009, WHO had declared H1N1 (swine flu) a global pandemic, and some measure of panic, or perhaps I should say elevated concern, set in for a good while. There were masks in public places, and (hopefully!) much practice of good hand-washing hygiene. The H1N1 virus spreads rapidly (just like seasonal influenza), and is a new virus which causes a highly infectious disease. While thousands of deaths have occured, H1N1 is not highly pathogenic, and has not caused the feared high rates of illness and death.

Vaccines have proven highly controversial and aroused much suspicion regarding safety and efficacy. There is no reliable evidence to show that current vaccines are either unsafe or ineffective; rather there is increasing peer reviewed evidence to the contrary ^{1 2}. However, in the US, nasal and pediatric syringe-filled H1N1 vaccines have recently been recalled due to dosage concerns. 

Most countries have stopped recording the numbers of new infections, and millions are thought to have been infected with the H1N1 virus without serious symptoms. The number of deaths continues to rise; to date at least 12,220 deaths have been attributed to H1N1 globally.

Swine flu will undoubtedly continue to inspire research, debate and discussion in this new decade, as will other pressing infectious diseases and public health happenings. So stay tuned for more global pandemics news in 2010.

To Good Health and a Happy New Year!

 

1. Greenberg ME, Lai MH, Hartel GF, Wichems CH, Gittleson C, Bennet J, Dawson G, Hu W, Leggio C, Washington D, Basser RL. Response to a monovalent 2009 influenza A (H1N1) vaccine. N Engl J Med 2009; 361 (25) 2405-13 http://nejm.highwire.org/cgi/reprint/NEJMoa0907413.pdf

2. Nolan T, McVernon J, Skeljo M, Richmond P, Wadia U, Lambert S, Nissen M, Marshall H, Booy R, Heron L, Hartel G, Lai M, Basser R, Gittleson C, Greenberg M. Immunogenicity of a Monovalent 2009 Influenza A(H1N1) Vaccine in Infants and Children: A Randomized Trial. Jama 2009;   http://jama.ama-assn.org/cgi/reprint/2009.1911v1