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Dracunculiasis eradication: intensifying surveillance amid continued zero human cases in Ethiopia and Mali

A total of 54 human cases of dracunculiasis (guinea-worm disease) were reported to the World Health Organization (WHO) in 2019, with Chad reporting 48 out of the 54 cases.

In Chad, Ethiopia, Mali and South Sudan, trained volunteers are supporting surveillance and detection of infections in domestic dogs and cats. Surveillance has been heightened, as evidenced by the increase in reports of rumoured human cases which in 2019 peaked at 108 207 out of which 106 678 were investigated within 24 hours.

“We are working with the broader scientific community to understand the epidemiology of animal infections, mainly in dogs in Chad, where the highest number of human cases were reported in 2019,” said Dr Dieudonné Sankara, who leads WHO’s eradication and elimination team in the Department of Control of Neglected Tropical Diseases. “Interestingly, there have been no human cases in Ethiopia and Mali, and 4 human cases in South Sudan in 2019, compared with 10 in 2018.”

In Mali, the number of animals infected with Dracunculus medinensis (the guinea-worm) has decreased from 20 animals in 2018 to 8 dogs and 1 cat in 2019. However, insecurity remains a challenge to freely accessing some endemic areas in Mali.

Conversely, Chad reported 1935 infections in dogs and 46 in cats in 2019, an increase of 85% from 2018, and a 176% increase among humans.

Angola reported only 1 human case in 2019. Community-based surveillance is being reinforced mainly in Cunene Province where a case was reported in 2018.

In South Sudan, integrated surveillance activities have been carried out with the trachoma and onchocerciasis control programmes, in accordance with WHO’s recommendation that programmes collaborate, integrate and co-implement activities, whenever possible, to strengthen surveillance.

In order to strengthen cross-border surveillance, WHO led a mission to Cameroon in November 2019 to investigate circumstances around an “imported” case in the country’s Far North Region. Discussions were held with the health authorities to establish active surveillance in all villages in the area, including training for application of temephos.[1]

Also, in 2019, and with the support of trained field workers, vector control was intensified to larvicide ponds and water sources in more than 400 villages, compared with 72 villages in 2018.

In late 2019, WHO supported cross-border meetings with officials of national dracunculiasis eradication programmes from Mali, Burkina Faso and Côte d’Ivoire in West Africa; between Ethiopia and South Sudan in East Africa, and between Angola and Namibia in Southern Africa, to share experiences and plan joint surveillance activities across the borders to prevent transmission of the disease.

The disease

Dracunculiasis is a crippling parasitic disease caused by infection with D. medinensis, a long, thread-like worm. It is usually transmitted when people drink stagnant water contaminated with parasite-infected water fleas.

WHO works with Member States and in partnership with The Carter Center and the United Nations Children’s Fund to support efforts to eradicate the disease. WHO provides technical guidance, works with national programmes to coordinate surveillance in dracunculiasis-free areas, and monitors and reports on the progress achieved.

WHO is the only Organization mandated to certify countries as free of transmission of the disease following the recommendations of the International Commission for the Certification of Dracunculiasis Eradication.

Since 1995, WHO has certified a total of 199 countries, territories and areas, including 187 Member States, as free of dracunculiasis transmission.

[1] Temephos is a cyclopicide used to kill water fleas (cyclops) that carry the infective guinea-worm larvae.

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https://www.who.int/news-room/detail/19-03-2020-dracunculiasis-eradication-intensifying-surveillance-amid-continued-zero-human-cases-in-ethiopia-and-mali

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March 20, 2020
Remote work will stress-test the internet—and parts will need repair, expert says

With offices across the country shuttered and workers being asked to work remotely when they can, the nation is relying on the robustness of the internet and technology infrastructure as never before. To understand the issues in play, the Gazette spoke with Jim Waldo, chief technology officer for the Harvard John A. Paulson School of Engineering and Applied Sciences, professor of the practice of computer science there, and professor of technology policy at the Harvard Kennedy School. Waldo, who spent three decades in the tech industry, discussed the likelihood that parts of the all-important internet will fail, and the equal likelihood that engineers will make repairs on the fly to keep people working.

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https://techxplore.com/news/2020-03-remote-stress-test-internetand-expert.html

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March 19, 2020
WHO teams with partners to mitigate the potential impact of the COVID-19 pandemic in malaria-affected areas
The rapid spread of COVID-19 is testing the resilience of robust health systems around the world. WHO and its partners are taking measures to mitigate the potential impact of sustained transmission of the coronavirus in malaria-endemic settings –
particularly in sub-Saharan Africa, which shoulders more than 90% of the global malaria burden.

To date, a small proportion of the global COVID-19 cases have been identified in malaria-affected countries. However, as of 17 March, 25 countries in the African Region had reported cases of COVID-19, and local transmission of the disease had been detected
in 6 countries (Algeria, Cameroon, Kenya, Rwanda, Senegal, South Africa).

“At this point, we still don’t know what the COVID-19 pandemic will look like in sub-Saharan Africa,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. “But we do know that when public health emergencies have
hit parts of Africa with weak health systems and high malaria transmission, the impact on malaria disease and death has been very severe.”

The 2014-2016 Ebola outbreak in Guinea, Liberia and Sierra Leone, for example, undermined malaria control efforts and led to a massive increase in malaria-related illness and death in the 3 countries.

Joint action

To support malaria-affected countries, WHO has identified the need for a set of inter-related actions among global partners:
- generating, using and disseminating accurate information;
- mitigating against health system disruptions; and
- ensuring the continuity of routine malaria-specific interventions while also providing, where needed, additional emergency measures, such as mass drug administration, in health systems significantly impacted by COVID-19.
The Organization convened partners on 17 March to discuss areas of collaboration, coordination and next steps.

WHO has begun monitoring the evolving geographic location of COVID-19 cases to understand the extent to which the coronavirus and malaria affect the same target groups. This information will reveal who is likely to be at greatest risk, where and when,
and thus inform the need for malaria-specific interventions to save lives.

In parallel, WHO is working across the 3 levels of the organization to ensure that any advice intended to curb coronavirus transmission and to guide COVID-19 disease management is appropriate in malaria-affected settings.

In recent days, there have been reports of disruptions, as a result of COVID-19, in the production and global supply chains of essential malaria commodities, such as the long-lasting insecticidal nets, diagnostic testing and antimalarial medicines. Coordinated
efforts are required to ensure the availability of key malaria control tools – particularly in countries with a high burden of the disease – and that efforts to limit transmission of COVID-19 do not compromise access to malaria prevention,
diagnosis and treatment services.

Malaria-affected countries may also experience disruptions in health systems in the coming months. A marked increase in febrile patients seeking treatment for COVID-19 at health facilities, for example, would present a significant challenge for a health
workforce that may itself be depleted by the disease.

Policy guidance

WHO is developing guidance for national malaria control programmes and implementing partners to prepare them for the challenges they may face as result of COVID-19.  Among other areas, the guidance will address the mitigation of stockouts of
malaria medicines and commodities; the use of preventive malaria therapy for health workers; the deployment of emergency measures in some settings; and the generation of information relating to the geographic distribution and populations affected
by COVID-19 in malaria-endemic settings.

Restrictions around grouping people together – for training, social and behavior change communication activities, fixed-site distribution and clinical care – as well as the restrictions around movement of people in the country, will require
significant adaptations in order to deliver quality interventions and care.

All people living in malaria-affected areas are advised to follow same precautions as the general population, including: frequent hand-washing, respiratory hygiene, social distancing, seeking prompt medical care if symptoms arise (cough, fever,
difficulty breathing), and other WHO-recommended actions.

WHO stands ready to work with countries and other stakeholders to mitigate the negative impact of the coronavirus on malaria responses worldwide and, where possible, contribute towards a successful COVID-19 response.

About COVID-19

COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. Essential information on the COVID-19 pandemic can be found in
a dedicated WHO site.

About malaria

Malaria is a preventable and treatable disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. In 2018, there were an estimated 228 million cases of malaria worldwide and
405 000 malaria-related deaths. For more on malaria, visit: www.who.int/malaria

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https://www.who.int/news-room/detail/18-03-2020-who-teams-with-partners-to-mitigate-the-potential-impact-of-the-covid-19-pandemic-in-malaria-affected-areas

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March 19, 2020
King decrees all Malaysians to obey movement control order

KUALA LUMPUR: Yang di-Pertuan Agong Al-Sultan Abdullah Ri’ayatuddin Al-Mustafa Billah Shah (pix) today decreed all Malaysians to obey the movement control order announced by Prime Minister Tan Sri Muhyiddin Yassin yesterday and to give full cooperation in containing the spread of Covid-19 infections in the country.

The order will take effect from tomorrow until March 31.

Comptroller of the Royal Household of Istana Negara Datuk Ahmad Fadil Shamsuddin said His Majesty, nevertheless, said that the people should face the situation calmly to help the government and the relevant authorities tackle the situation effectively.

“His Majesty urges the people not to take the movement control lightly. The people were also asked to follow the guidelines and preventive measures issued by the Ministry of Health because this is our mutual responsibility to ensure safety and wellbeing of our families, our communities and our beloved country,” he said in a statement issued by Istana Negara today.

He said Al-Sultan Abdullah also viewed seriously the rising number of positive Covid-19 cases in Malaysia, which was recorded at 553 yesterday and had placed his full trust in the government and the authorities to discharge their duties in containing the spread of the disease.

Ahmad Fadil said His Majesty was well aware that the people might feel that the action taken by the Perikatan Nasional government had made it difficult for them to go about their daily activities.

“However, we must try to understand and be patient because the government cannot wait for the situation to become more critical to take drastic action.

“As the Head of State, His Majesty also called on all Malaysians, regardless of race and religion, to stay united and play their parts to help the government in containing the spread of Covid-19 in the country.

“His Majesty believes that with the strong spirit, concern and cooperation from the people, we will be able to contain the spread of the disease quickly and effectively,” he said.

Ahmad Fadil said Al-Sultan Abdullah also decreed all Malaysians to refer to the Online Health Advisory Service or the National Crisis Preparedness and Response Centre (CPRC) via the Ministry of Health’s website to find the answers to all their doubts and questions so as to prevent the spread of fake news and false information that may cause panic and confusion among themselves.

The Yang di-Pertuan Agong also expressed appreciation and thanks to the government under the leadership of Muhyiddin, government agencies and most of all to the unsung heroes, the medical staff and healthcare personnel, the civil servants and all the others who have sacrificed their time and energy in ensuring that all preventive measures and control of the infectious disease were being implemented efficiently.

“His Majesty also called on all Muslims to join him to pray to Allah SWT so that all our efforts be blessed and so that the COVID-19 situation can be tackled and put to end as soon as possible. InsyaAllah,” he said. – Bernama

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https://www.thesundaily.my/local/king-decrees-all-malaysians-to-obey-movement-control-order-YD2140919

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March 17, 2020
New Cabinet portfolio requires time to study: Muhyiddin

PUTRAJAYA: Prime Minister Tan Sri Muhyiddin Yassin said today any Cabinet member holding a new portfolio would require time to study the ministry and manage it well.

Commenting on women’s groups concerns with the Women and Family Ministry’s new appointments, Muhyiddin said he had briefed the newly-minted minister Datuk Seri Rina Mohd Harun about what to do to manage the ministry because she was new at the ministry.

“But it’s not that she is totally lack of experience. The new portfolio requires everyone to take more time to study,“ he said, adding that he had also told Rina to work closely with her deputy Datuk Siti Zailah Mohd Yusoff.

According to media reports, women’s rights groups had expressed their concerns over the appointment of Rina and Siti Zailah as the new minister and deputy minister mainly because their track records allegedly do not inspire confidence.

“What is important is not what her personal view is. What is important is what the government thinks about it and that she or whoever is in the ministry needs to understand,“ Muhyiddin said at a news conference after chairing the Economic Action Council (EAC) meeting here.

“Bear with us; we will manage it,“ he added. – Bernama

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https://www.thesundaily.my/local/new-cabinet-portfolio-requires-time-to-study-muhyiddin-XC2136505

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March 16, 2020
The Importance of Knowing Your Audience

As a marketing or sales professional, knowing your customer is vital for success. Taking extra care to understand what your customer values will help you to communicate in an effective manner with him or her. Customers want to receive assurance about certain things before they purchase a product or invest in a service. They may want to know that a product or service is reliable, will remedy a certain problem or has an extensive warranty in place.

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http://www.associationofmarketing.org/articles/view.php?article_id=14640

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March 16, 2020
AI and machine learning help scientists understand human face recognition

Scientists from Salk Institute (U.S.), Skoltech (Russia), and the Riken Center for Brain Science (Japan) investigated a theoretical model of how populations of neurons in the visual cortex of the brain may recognize and process faces and their expressions, and how they are organized. The research was recently published in Neural Computation and highlighted on its cover.

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March 2, 2020
E-cigarettes are harmful to health
Globally, there are 1.1 billion adult smokers, 60% of them want or intend to quit. Much has been written and said about the potential of electronic nicotine delivery systems (ENDS) such as e-cigarettes to help tobacco users quit. While the evidence is still inconclusive, e-cigarettes are often used along with one or more tobacco products. As this is the practice with many ENDS users, the health effects of two or more products are combined. Governments who want to weigh the potential benefits and risks of e-cigarettes for their population should consider the following:
1. Regarding the potential health effects for which the evidence is mounting, there is insufficient data to understand the full breadth of their impact on health as devices have not been on the market long enough. Especially the long-term effects of using e-cigarettes or being exposed to them are yet unknown.
2. Nevertheless, the evidence is clear that the aerosols of the majority of ENDS contain toxic chemicals, including nicotine and substances that can cause cancer.ENDS on their own are associated with increased risk of cardiovascular diseases and lung disorders and adverse effects on the development of the fetus during pregnancy. ENDS are undoubtedly harmful, should be strictly regulated, and, most importantly, must be kept away from children. Nicotine is highly addictive and found in most e-cigarettes. Both tobacco products and e-cigarettes pose risks to health and the safest approach is not to consume either.
3. It is of particular public health concern that increasingly children and adolescents take up the use of e-cigarettes in some countries. Most ENDS can be manipulated by the user. Some manufacturers also hold patents to remotely manipulate nicotine dosages and toxicant delivery. Furthermore, there is a growing body of evidence in some countries that never-smoker adolescents who use ENDS at least double their chance of starting to smoke cigarettes later in life. Exposing children and adolescents to nicotine can have long-lasting, damaging effects on brain development and lead to nicotine addiction.
WHO continues to monitor the evidence and technological developments and will adapt this statement accordingly.

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https://www.who.int/news-room/detail/05-02-2020-e-cigarettes-are-harmful-to-health

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February 27, 2020
Remarks by Dr Michael Ryan, Executive Director, WHO Health Emergencies Programme at media briefing on COVID-19 on 13 February 2020

Good afternoon everyone and apologies for being late, and apologies too from Dr Tedros, who is just about to land in the Democratic Republic of the Congo where he is following up on important Ebola matters and meeting with President Tshisekdi and many others to look at the future post-Ebola of the health system in Congo.

I’m sure you’ll understand how important a task and mission that is given the last year-and-a-half in Congo and the ongoing struggles in that country to deliver effective healthcare and reduce suffering and mortality from infectious diseases.

Let me start by updating you on the latest numbers.

In the last 24 hours China has reported 1,820 laboratory-confirmed cases, bringing the total to 46,550.

In addition, China reported 13,332 clinically confirmed cases in Hubei province, and crucially, we understand that most of these cases relate to a period going back over days and weeks and are retrospectively reported as cases, sometimes back to the beginning of the outbreak itself.

So this increase that you’ve all seen in the last 24 hours is largely down to a change in how cases are being diagnosed and reported.

So, in other words, in Hubei province only, a trained medical professional can now classify a suspected case of COVID-19 as a clinically-confirmed case on the basis of chest imaging, rather than having to have a laboratory confirmation.

This allows clinicians to move and report cases more quickly, not having to wait for lab confirmation, ensuring that people get to clinical care more quickly, and also allows public health responses in terms of contact tracing and other important public health measures to be initiated.

As you’ve noticed with suspect cases, there have been some backlogs in testing and this is also going to help ensure that people get adequate care and adequate public health measures can be taken.

So we are not dealing, from what we understand, with a spike in cases of 14,000 on one day.

To an extent this is an artefact of the reporting and we are working with our colleagues in China, and our team there are working very hard to see exactly how many days and weeks and how those numbers are spread across those days and weeks.

In the rest of China and the rest of the world, laboratory confirmation for reporting is still required.

WHO will continue to track both laboratory and clinically-confirmed cases in Hubei province.

We’ve seen this spike in the number of cases reported in China, but this does not represent a significant change in the trajectory of the outbreak.

Outside China, there are 447 cases from 24 other countries, and now two deaths. In addition to the death in the Philippines, there is now one more death in Japan.

We have said consistently that we need to be cautious when drawing conclusions from daily reported numbers. I think we were having that discussion yesterday and I think the numbers today speak to that.

We need to be very careful when interpreting any extremes. Be it in incubation period, be it in daily numbers, we must take all numbers into account, we must look at all numbers seriously but we also must try and interpret what those numbers mean and not react directly to the number itself.

The number of countries reporting cases has still not changed and outside the cases on the Diamond Princess cruise ship, we’re not seeing a dramatic increase in transmission outside China.

That is the current picture. We’re still saying to governments around the world that we still have an opportunity to prepare for the potential spread of the virus.

Regarding the Diamond Princess cruise ship, which is currently quarantined in Yokohama, 218 passengers have tested positive for the virus, which does represent the largest cluster of COVID-19 cases outside China.

This morning, I briefed health ministers from the European Union, convened by Croatia, the presidency, about COVID-19 and our teams are working with governments and partners of the European Union to ensure that the latest information is disseminated, that preparations are made and there’s good coordination between ourselves and the European Union and our WHO Regional Office for Europe.

And we very much welcome the strong support from the European Union in supporting countries with weaker health systems and ensuring that other countries have the investment and support needed to prepare for the arrival of the virus.

In terms of the international mission, the advanced team and their Chinese counterparts have now finalized the scope of work and design of the mission and we expect the rest of the international team to start arriving in China over the weekend.

Thank you.

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https://www.who.int/news-room/detail/13-02-2020-remarks-by-dr-michael-ryan-executive-director-who-health-emergencies-programme-at-media-briefing-on-covid-19-on-13-february-2020

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February 27, 2020
E-cigarette vapor does not cause oxidative stress in viable lung epithelial cells

E-cigarette vapour is much less harmful to lung cells than cigarette smoke. Lab tests show that, unlike tobacco smoke, which causes oxidative stress and cell death, e-cigarette vapour does not. Oxidative stress and cell death are driving factors in the development of many smoking-related diseases such as COPD and lung cancer.

Vapour from e-cigarettes has been found to contain significantly lower levels of the toxicants found in cigarette smoke (Chemical Research in Toxicology DOI: 10.1021/acs.chemrestox.6b00188), but suitable lab tests and clinical studies are necessary to understand whether this translates into reductions in biological responses and disease.

Researchers at British American Tobacco have developed a standardized way of measuring and comparing the potential of conventional cigarette smoke and e-cigarette vapour to cause oxidative stress in an in vitro model of lung epithelium.

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February 27, 2020