The BCG tuberculosis vaccine boosts the production of immune cells and this may explain how it protects newborns from dying of sepsis
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About half a billion people worldwide are living with genital herpes, and several billion have an oral herpes infection, new estimates show.
Authored by staff at the University of Bristol, World Health Organization (WHO), and Weill Cornell Medical College-Qatar, and published in the Bulletin of the World Health Organization,
the new study estimates the global infection prevalence and incidence of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) in 2016.
“Herpes infection affects millions of people across the globe and can have far-reaching health effects. We need more investment and commitment to develop better treatment and prevention tools for this infection.” says Dr Sami Gottlieb, Medical
Officer at WHO and an author of the study.
An estimated 491.5 million people were living with HSV-2 infection in 2016, equivalent to 13.2% of the world’s population aged 15 to 49 years. HSV-2 is almost exclusively sexually transmitted, causing infection in the genital or anal area (genital
herpes).
An estimated 3.7 billion people had HSV-1 infection during the same year – around 66.6% of the world’s population aged 0 to 49. HSV-1 is mainly transmitted by oral to oral contact to cause infection in or around the mouth (oral herpes). However,
HSV-1 can also be transmitted to the genital area through oral-genital contact – during oral sex – to cause genital herpes. Most HSV-1 infections were oral; however, between 122 million to 192 million people were estimated to have genital
HSV-1 infection, depending on the assumptions used in the estimation model.
Because herpes is a lifelong infection, estimated prevalence increased with age; HSV-2 prevalence was also higher among women and in the WHO African Region.
Most people living with herpes, caused by either HSV-1 or 2, are unaware they have the infection.
When symptoms do occur however, oral herpes infection can lead to painful sores around the mouth (“cold sores”). Genital herpes infection can cause recurring, often painful, genital sores, often referred to as genital ulcer disease.
WHO and partners published a study in March 2020 estimating that around 5% of the world’s population (187 million people) suffered from at least one episode of herpes-related genital ulcer disease in 2016 (1). Most of these episodes were due to
HSV-2, which can recur frequently over many years.
Recurrent symptoms of genital herpes can lead to stigma and psychological distress, and can have an important impact on quality of life and sexual relationships. However, in time, most people with herpes adjust to living with the infection.
“Genital herpes is a substantial health concern worldwide – beyond the potential pain and discomfort suffered by people living with the infection, the associated social consequences can have a profound effect on sexual and reproductive health”
says Dr Ian Askew, Director of the Department of Sexual and Reproductive Health and Research at WHO.
A strong association exists between HSV-2 infection and HIV infection. In 2019, WHO commissioned a modeling study to estimate how much HSV-2 infection might contribute to HIV incidence. The study estimated that almost 30% of new sexually acquired HIV
infections in 2016 worldwide were likely attributable to HSV-2 infection (2).
Evidence shows that people with HSV-2 infection are at least three times more likely to become infected with HIV, if exposed. HSV-2 leads to inflammation and small breaks in the genital and anal skin that can make it easier for HIV to cause infection.
In addition, people with both HIV and HSV-2 infection are more likely to spread HIV to others.
Women have higher biologic susceptibility to both HSV-2 and HIV. Women living in the WHO Africa Region have the highest HSV-2 prevalence and exposure to HIV – putting them at greatest risk of HIV infection, with negative implications for their health
and well-being.
For people living with HIV (or who are living with other conditions that compromise their immune systems) as well as HSV-2, the symptoms of herpes can be more severe and more frequent.
Neonatal herpes can occur when an infant is exposed to HSV in the genital tract during delivery. This is a rare condition, occurring in an estimated 10 out of every 100,000 births globally, but can lead to lasting neurologic disability or death. The risk
for neonatal herpes is greatest when a mother acquires HSV infection for the first time in late pregnancy. Women who have genital herpes before they become pregnant are at very low risk of transmitting HSV to their infants.
There is no cure for herpes. At present, antiviral medications, such as acyclovir, famciclovir, and valacyclovir, can help to reduce the severity and frequency of symptoms but cannot cure the infection.
As well as increasing awareness about HSV infection and its symptoms, improved access to antiviral medications and heightened HIV prevention efforts for those with genital HSV symptoms are needed globally.
In addition, development of better treatment and prevention interventions is needed, particularly HSV vaccines. WHO and partners are working to accelerate research to develop new strategies for prevention and control of HSV infections. Such research includes
the development of HSV vaccines and topical microbicides. Several candidate vaccines and microbicides are currently being studied.
“A vaccine against HSV infection would not only help to promote and protect the health and well-being of millions of people, particularly women, worldwide – it could also potentially have an impact on slowing the spread of HIV, if developed
and provided alongside other HIV prevention strategies” says Dr Meg Doherty, Director of the WHO Department of Global HIV, Hepatitis, and STI Programmes.
WHO guidelines for the treatment of Genital Herpes Simplex Virus
WHO preferred product characteristics for herpes simplex virus vaccines
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Indonesia recently completed the last of its annual large-scale treatment for lymphatic filariasis (also known as elephantiasis or Penyakit Kaki Gajah) in Malaka District located in its southernmost province, East Nusa Tenggara. Unprecedented
progress by the National Lymphatic Filariasis Elimination Programme has strongly placed the country on the path to achieving the elimination of lymphatic filariasis as a public health problem.
“We reached an estimated number of 40.7 million people living in the 118 high-risk districts during this month-long treatment campaign in October 2019” said Dr Anung Sugihantono, who recently retired as Director General of Diseases
Prevention and Control, Ministry of Health Indonesia. “Single doses of diethylcarbamazine citrate and albendazole facilitated by WHO were delivered to all eligible populations.”
In 2010, an estimated 125 million Indonesians were still at risk of the disease and required treatment.
But things changed considerably in 2015 when Indonesia mounted an annual national campaign to resolutely address transmission of the disease and to tackle the morbidity and disability associated with it. The results were apparent as early as 2017, with
remarkable progress.
In Indonesia, LF is considered a significant public health concern. In 2009, risk mapping identified a population of 124.5 million people needing treatment for LF. The country initiated a national level LF elimination campaign in 2015, addressing both
disease prevention and management.
“In 2017 and in just two years we managed to achieve 100% geographical coverage of all people requiring treatment” said Dr Sugihantono. “It meant achieving more than 78% epidemiological coverage – much higher than the generally recommended 65% to stop transmission.”
Transmission of lymphatic filariasis can be stopped through large-scale treatment (or mass drug administration – MDA) of entire at- risk communities with recommended medicines once a year. These medicines kill the microfilariae in an infected patient’s
blood preventing mosquitoes to transmit1 the disease to others. Through mass treatment, the aim is to reduce the reservoir of microfilariae in the blood to a level insufficient to maintain transmission by the mosquito vector.
This strategy to interrupt transmission is the corner-stone of the World Health Organization’s (WHO) Global Program to Eliminate Lymphatic Filariasis (GPELF). Indonesia has been using the GPELF’s strategy since 2002 using a district or city
as its implementation unit.
In 2005, it listed the elimination of LF as a national priority for controlling infectious diseases and the medicines it has been using in large-scale treatment programmes are diethylcarbamazine citrate (DEC) and albendazole2 which are
largely distributed by volunteer community health workers3.
“Community health volunteers are themselves members of the community and know how to reach people effectively to improve compliance” said Dr. Stefanus Bria Seran, the Regent of Malaka District, one of LF endemic district in Indonesia. “Besides ensuring every single person ingests the medicine given to them, these community workers help in disseminating information well before a large-scale treatment campaign and also assist in reporting activities related to each treatment campaign”.
Indonesia’s efforts to eliminate lymphatic filariasis began in the 1970s but faced numerous challenges including programme coordination in the many inhabited islands, conducting information, education and awareness programmes, lack of capacity and
insufficient medicines.
Furthermore, the situation in Indonesia is unusual than in many other countries endemic for lymphatic filariasis as the country is endemic for all three species of thread-like filarial worms – Brugia malayi, Brugia timori, and Wuchereria bancrofti –
that cause the disease. Most of the infections in Indonesia, however, are caused by B. malayi.
In the past, some of the factors that prevented access to the medicines (DEC and albendazole) were social stigmatization linked to the disease, the vast geography of the territory and challenges in reaching remote populations.
With an estimated population of 242 million, Indonesia is the world’s largest island nation and consists of approximately 17,000 islands, of which 5,000–6,000 are inhabited. It is the fourth most populated nation behind China, India, and the United
States.
Indonesia is endemic for many other neglected tropical diseases and an estimated 110 million Indonesians are believed to suffer from at least one neglected tropical disease (NTD), including lymphatic filariasis and soil-transmitted helminth infections.
Leptospirosis (not classified as NTD) is also widespread.
Indonesia is the only country of WHO’s South East Asia Region with endemic schistosomiasis. Like many other countries of the Region, it also faces recurrent threats of dengue outbreaks.
The world has made significant progress towards the elimination of lymphatic filariasis as a public health problem.
Sixteen countries4 and one territory are now acknowledged by WHO to have achieved elimination of lymphatic filariasis as a public health problem.
Seven additional countries have successfully implemented recommended strategies, stopped large-scale treatment and are under surveillance to demonstrate that elimination has been achieved.
Lymphatic filariasis is caused by infection with parasitic worms living in the lymphatic system. The larval stages of the parasite (microfilaria) circulate in the blood and are transmitted from person to person by mosquitoes.
Infection involves asymptomatic, acute, and chronic conditions. Most infections are asymptomatic, showing no external signs while contributing to transmission of the parasite. Although asymptomatic, these infections still cause damage to the lymphatic
system and the kidneys and alter the body’s immune system.
When lymphatic filariasis develops into chronic conditions it leads to lymphoedema (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs and hydrocele (scrotal swelling). Involvement of breasts and genital organs are common.
Manifestation of the disease after infection takes time and can result in an altered lymphatic system, causing abnormal enlargement of body parts, and leading to severe disability and social stigmatization of those affected.
1Lymphatic filariasis is transmitted by different types of mosquitoes – e.g the Culex mosquito which widespread across urban and semi-urban areas; Anopheles, mainly found in rural areas; and, Aedes, mainly
in endemic islands in the Pacific.
2In 2017, WHO recommended an alternative three drug treatment to accelerate the global elimination of lymphatic filariasis. The treatment, known as IDA, involves a combination of ivermectin, diethylcarbamazine citrate and albendazole.
It is recommended annually in settings where its use is expected to have the greatest impact.
3Community health workers, also called ‘cadres’, are volunteers who form part of the communities they serve and work with local
communities to educate families. Their contribution in promoting health has been significant in the country.
4Cambodia, The Cook Islands, Egypt, Kiribati, Maldives, Marshall Islands, Niue, Palau, Sri Lanka, Thailand, Togo, Tonga, Vanuatu, Viet Nam, Wallis and Futuna, and Yemen
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Fever is a pain, quite literally, but new evidence hints at its purpose. Here’s what you need to know
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NEW YORK: One medical worker called it “insane”, another said it induces paranoia – the speed with which patients are dying from the novel coronavirus is shocking even veteran doctors and nurses as they scramble to determine how to stop such sudden deterioration.
Patients “look fine, feel fine, then you turn around and they’re unresponsive”, said Diana Torres, a nurse at Mount Sinai Hospital in New York, the epicentre of the pandemic in the US where the virus has infected nearly 430,000 people and caused more than 14,700 deaths.
“I’m paranoid, scared to walk out of their rooms.”
It isn’t just the elderly or patients with underlying health conditions, who can be fine one minute, and at death’s door the next.
It can happen for the young and healthy, too, health professionals told Reuters.
A young woman died unexpectedly while nurse Laurie Douglas was on duty at Our Lady of the Lake Hospital in Baton Rouge, Louisiana.
After 34 years on the job, Douglas said she normally has “an intuition of who is going to fade and who may improve”.
“But these people are throwing that out the window.
“Last week, she was planning her wedding.
“This week, her family is planning her funeral,“ she said, referring to the deceased patient.
Patients might enter the hospital with strong oxygen levels and be engaged in happy conversation, said a resident emergency doctor at New York-Presbyterian Hospital, only to be “gasping for breath” and intubated a few hours later.
“The scary thing is there are no rules to it,“ the resident said on condition of anonymity.
These scenes are playing out everywhere as Covid-19 has infected more than 1.4 million worldwide and killed more than 85,000 as of Wednesday.
The quick turns for the worse are likely products of an “overly exuberant” reaction by the immune system as it fights the virus, said Dr Otto Yang, an infectious disease specialist at the UCLA Medical Centre in Los Angeles.
Called a cytokine storm, it occurs when the body overproduces immune cells and their activating compounds – cytokines – causing dangerously high blood pressure, lung damage and organ failure.
Emily Muzyka, 25, a nurse in the New York suburbs, said she reached her breaking point last week, when a relatively healthy 44-year-old woman needed sudden intubation.
“I had a meltdown that night,“ she said.
“I cried to my boyfriend.”
Intubation refers to inserting a tube into the mouth and through the airway of a Covid-19 patient struggling to breathe, so they can be hooked to a mechanical ventilator.
Journalist Anick Jesdanun, who was in good health and had run 83 marathons, died last week from Covid-19, according to a post on Facebook by his cousin Prinda Mulpramook.
Jesdanun, who was 51, at first didn’t need hospitalisation, according to the post.
He had begun to recover and showed clear lungs and strong vital signs during a doctor’s visit in late March. But “a sudden setback” sent him to the emergency room on April 1, and “13 hours later we lost him”, Mulpramook wrote.
A nurse at Mount Sinai’s intensive care unit recalled watching patients’ kidneys quickly shut down, adding that many require intravenous drips of the blood thinner Heparin.
“It’s insane how sick they get, how quickly.
“We’re really trying hard to figure out how to treat them.”
Some of those hospitals are experimenting with unproven drugs in hopes of helping patients, including the anti-malaria medication hydroxychloroquine.
“We’re essentially throwing the kitchen sink at these patients,“ a doctor said.
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AGAMIC. Unmarried; unmarriageable, sometimes non-sexed.
AGENIC. Lacking in reproductive power; sterile.
AMPHIMIXIS. That form of reproduction which involves the mingling of substance from two individuals so as to effect a mixture of hereditary characteristics. It includes the phenomena of conjugation and fertilization among both unicellular and multicellular organisms.
ANABOLISM. See METABOLISM.
ANAMNESIC. Pertaining to or aiding recollection.
ANEMIC. Deficient in blood; bloodless.
ANTHROPOMORPHISM. The attributing of human characteristics to natural, supernatural, or divine beings.
ANTHROPOMETRY. Science of measurement of the human body.
ARTIFACT. Any artificial product.
APHASIA. Impairment or lose of the ability to understand or use speech.
ASSOCIATIONISM. The psychological theory which regards the laws of association as the fundamental laws of mental action and development.
ATAVISTIC. Pertaining to reversion through the influence of heredity to remote ancestral characteristics.
ATAXIC. Pertaining to inability to coördinate voluntary movements; irregular.
CALAMO-PAPYRUS. Reed papyrus or pen-paper.
CATABOLISM. See METABOLISM.
CATHARSIS. Purgation or cleansing. Aristotle’s esthetic theory that little renders immune for much.
CEREBRATION. Brain action, conscious or unconscious.
CHOREA. St. Vitus’s dance; a nervous disease marked by irregular and involuntary movements of the limbs and face.
CHRESTOMATHY. A collection of extracts and choice pieces.
CHRISTENTHUM. The Christian belief; the spirit of Christianity.
COMMANDO EXERCISES. Gymnastic exercises whose order is dependent upon the spoken command of the director.
CORTEX. The gray matter of the brain, mostly on its surface.
CORTICAL. Pertaining to the cortex.
CRANIOMETRY. The measurement of skulls.
CRYPTOGAMOUS. Having an obscure mode of fertilization; or, of plants that do not blossom.
CULTUS. A system of religious belief and worship.
DEUTSCHENTHUM. The spirit of the German people.
DIATHESIS. A constitutional predisposition.
EPHEBIC. Pertaining to the Greek system of instruction given to young men to fit them for citizenship; adolescent.
EPIGONI. Successors; followers who only follow.
EPISTEMOLOGY. The theory of knowledge; that branch of logic which undertakes to explain how knowledge is possible and to define its limitations, meaning, and worth.
EUPEPTIC. Having good digestion.
EUPHORIA. The sense of well-being; of fullness of life.
EVIRATION. Emasculation; loss of manly characteristics.
FERAL. Wild by nature; untamed; undomesticated.
FORMICARY. An artificial ants’ nest.
GEMÜTH. Disposition; the entire affective soul and its habitual state.
HEBETUDE. Dullness; stupidity.
HEDONISTIC. Relating to hedonism, that form of Greek philosophy which taught that pleasure is the chief end of existence.
HETAERA. A Greek courtesan. This class was often highly trained in music and social art, and represented the highest grade of culture among Greek women.
HETEROGENY. (1) The spontaneous generation of animals and vegetables, low in the scale of organization, from inorganic elements. (2) That kind of generation in which the parent, whether plant or animal, produces offspring differing in structure or habit from itself, but in which after one or more generations the original form reappears.
HETERONOMOUS. Having a different name.
HOROLOGY. The science of measuring time and of constructing instruments for that purpose.
HYGEIA. The Greek goddess of health; health.
HYPERMETHODIC. Methodic to excess; overmethodic.
HYPERTROPHY. Excessive growth.
INDISCERPTIBLE. Incapable of being destroyed by separation of parts.
INHIBITION. Interference with the normal result of a nervous excitement by an opposing force.
IRRADIATION. The diffusion of nervous stimuli out of the path of normal discharge which, as a result of the excitation of a peripheral end organ may excite other central organs than those directly connected with it.
KINESOLOGICAL. Pertaining to the science of tests and measurements of bodily strength.
KINESOMETER. An instrument for measuring muscular strength.
MEDULLATION. The investment of nerve fibers with a protective covering or medullary sheath, consisting of white, fat-like matter.
MERISTIC. Pertaining to the levels or spinal and cerebral segments of the body.
METABOLISM. The act or process by which, on the one hand, dead food is built up into living matter—anabolism, and by which, on the other, the living matter is broken down into simpler products within a cell or organism—catabolism.
METAMORPHOSIS. Change of form or structure; transformation.
METEMPSYCHOSIS. The doctrine of the transmigration of the soul from one body to another.
MONOPHRASTIC. Pertaining to or consisting of a single phrase.
MONOTECHNIC. Pertaining to a single art or craft.
MORPHOLOGY. The science of form and structure of plants and animals without regard to function.
MYOLOGY. The scientific knowledge of the muscular system.
MYTHOPOEIC. Producing or having a tendency to produce myths.
NOETIC. Of, pertaining to, or conceived by, mind.
NUANCE. Slight shade; difference; distinction; degree.
ORTHOGENIC. Pertaining to right beginning and development.
ORTHOPEDIC. Relating to the art of curing deformities.
OSSUARY. A depository of dry bones.
PALEOPSYCHIC. Pertaining to the antiquity of the soul.
PANTHEISTIC. Relating to that doctrine which holds that the entire phenomenal universe, including man and nature, is the ever-changing manifestation of God, who rises to self-consciousness and personality only in man.
PATRISTICS. That department of study occupied with the doctrines and writings of the fathers of the Christian Church.
PHOBIA. Excessive or morbid fear of anything.
PHYLETICALLY. In accordance with the phylum or race; racially.
PHYLETIC. Pertaining to a race or clan.
PHYLOGENY. The history of the evolution of a species or group; tribal history; ancestral development as opposed to ontogeny or the development of the individual.
PHYLUM. A term introduced by Haeckel to designate the great branches of the animal and vegetable kingdoms. Each phylum may include several classes.
PICKELHAUBE. The spiked helmet of the German army.
PLANKTON. Sea animals and plants collectively; distinguished from coast or bottom forms and floating in a great mass.
POLYGAMIC (LOVE). Pertaining to the habit of having more than one mate of the opposite sex.
POLYPHRASTIC. Having many phrases; pertaining to rambling, incoherent speech.
POST-SIMIAN. Pertaining to an age later than that in which simian or monkey-like forms prevailed.
PRENUBILE. Pertaining to the age before sexual maturity or marriageability is reached.
PRIE DIEU. A praying desk.
PROPEDEUTIC. Preliminary; introductory.
PROPHYLACTIC. Any medicine or measure efficacious in preventing disease.
PSEUDOPHOBIAC. Pertaining to a morbid condition in which the subject is continually in fear of having said something not strictly true.
PSYCHOGENESIS. The origin and development of soul.
PSYCHONOMIC. Pertaining to the laws of mind.
PSYCHOSIS. Mental constitution or condition; any change in consciousness, especially if abnormal.
PUBERTY. The age of sexual maturity.
PUBESCENT. Relating to the dawning of puberty.
PYGMOID. Of pygmy size and form.
RABULIST. A chronic wrangler; one who argues about everything.
SCHEMA. A synopsis; a summary. In the Kantian sense, a general type.
SCHEMATISM. An outline of any systematic arrangement; an outline.
SUPERFOETATION. A second conception some time after a prior one, by which two foetuses of different age exist together in the same female. Often used figuratively.
TEMIBILITY. (From Italian temibile, to be feared.) The principle of adjustment of penalty to crime in just that degree necessary to prevent a repetition of the criminal act.
TIC. A nervous affection of the muscles; a twitching.
TRANSCENDENTAL. In the Kantian system having an a priori character, transcending experience, presupposed in and necessary to experience.
TRAUMATA. Wounds.
TRAUMATISM. A wound; any morbid condition produced by wounds or other external violence.
VERBIGERATION. The continual utterance of certain words or phrases at short intervals, without reference to their meaning, as seen in insane Gedankenflucht or rapid flight of thought.
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