Archive for Infectious Diseases

Starting Out Early

December 13, 2018 Child Health, Communication, Global Health, Health and Wellness Promotion, Infectious Diseases No comments

It is a hot, humid day in mid-June, 2011 in this remote village in Niger state, Nigeria. The state is in a low development region with poor health indicators. I am a newly qualified doctor and have just concluded a Lot Quality Assurance Sampling (LQAs) assignment for the state office of the World Health Organization (WHO). The LQAs is a method of assessing the vaccination coverage after the supplementary polio immunization campaigns. I am at the home of Mallam Adamu, a middle aged, poor peasant farmer. Adamu is married with 6 children, 3 of which are under the age of five and therefore eligible for the polio immunization.

He is visibly angry and in a loud voice yells “tefi” in Hausa, the local language to myself and my translator. “Tefi” means “go away”. My translator tells me that for the past 6 months, he has barred his 3 eligible children from receiving polio immunization. He has been reported to the Mai angwa (the local community chief) but he is adamant.

When he learnt I was a doctor, he visibly relaxed and we sat down on a mat in front of his mud house to chat. He has 6 kids and they have all received routine immunization. However, he wonders why the need for the yearly polio immunizations and wonders when they will cease. He has heard the rumours; these polio vaccines were created by the West to cause sterility among his people and he would never compromise the safety of his children. “Lekita, do you have kids?” he asked and I replied “no”. He shook his head slowly.

I proceeded to explain that the rumours are untrue. The vaccines are safe and nobody would deliberately administer a vaccine that can harm kids including myself. Perhaps I answered his questions satisfactorily or he believed me as a medical person but I learnt that on the next round of polio immunization he had allowed his kids to be vaccinated. The encounter however made me realise that I did not have enough answers myself!

As a healthcare provider, just how well did I know these vaccines that I confidently recommended for babies? How is their safety and effectiveness assessed? Yes, while undergoing paediatrics and family medicine training in medical school, I had received lectures on vaccination but there was a knowledge gap that could impact my ability to perform in this field. Three years after this encounter another incident would motivate me to gain more expertise in vaccinology.

This time, I was working at the paediatrics department of a large district hospital in another state in northern Nigeria. One morning a neonate who had been delivered at the hospital, given his first dose of birth vaccines which included the Bacillus Calmette Guerin (BCG) vaccine against tuberculosis and discharged home the previous day was rushed to the paediatric emergency room where I was stationed. His parents were visibly distraught- their son had a fever and a large swelling on his left upper arm, the BCG vaccine injection site. My team had admitted the baby for observation and he was discharged home 3 days later. Before being discharged, his father, a teacher in one of the state owned secondary schools confided in me that he may be unwilling to let the child receive further childhood vaccination and I had to spend considerable time reassuring him. Vaccines are administered to healthy people, usually kids, so there is a low tolerance for any risk and moreover, despite being generally very safe, an Adverse Event Following Immunization (AEFI) can occur, although not usually caused by the vaccine.

Vaccination has been a useful tool in the control of infectious diseases. It led to the eradication of small pox, the first disease to be eradicated through vaccination. Equally, progress is being made towards the elimination of another disease, polio. However, these feats recorded by vaccination paradoxically are beginning to lead to a tendency from the public to question the need for further vaccination and in some cases have led to outright refusal of parents to have their children vaccinated. Tragically this could lead to the resurgence of previously controlled diseases, for example, measles is resurfacing in some high income countries.

All of this must be a wake up call for Global Health. Across Africa, there are instances where rumours have derailed vaccination campaigns requiring intense advocacy to regain public trust and restart the campaigns.  Derailment is not only a political problem, derailment is a matter of life and death.

There is a need for a pool of well-trained local scientists in all spheres-research and development, academia, national regulatory agencies to engage with their communities and advocate for vaccination. Everyone has a right to know and to hear in their own language.  The public will need to be constantly reassured by their own sons and daughters. We cannot afford to wait until it is too late.

 

Dr Edem Bassey is an online scholar of the MSc in Global Health and Infectious Diseases at the University of Edinburgh. He works at the Medical Research Council, Unit the Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM) as a research clinician where he is involved in the clinical trial of life saving vaccines for the developing world. 

 

Uganda July 2016 – the Global Health Academy Summer School

August 25, 2016 Conservation, Distance Learning, Global Health, Global Health Academy Summer School Uganda, Infectious Diseases, One Health, Summer Schoool, Sustainable Development Goals (SDGs), Uganda July 2016 No comments

Earlier this month, I was extremely fortunate to take part in the Global Health Academy summer school held this year in Makerere University, Uganda. For the first time, this year, invitations were extended to our program, fulltime Infectious Diseases by research masters students –in addition to the part-time online global health, eHealth, wildlife conservation, public health and infectious diseases master’s students. Tempted by the idea to get out of the lab and meet fellow students studying from distance, I immediately seized the opportunity, and, despite being close to the hand-in deadline for my thesis, it was totally worth it! Since it all happened really quickly and last minute, I didn’t really have time to create any expectative but had I had any, the experience definitely went beyond: what an experience!

The event and subsequent discussions that came up during the study sessions were a perfect illustration of the concept of One Health: sharing everybody’s opinions and point of view on different topics approached differently by students from different fields and disciplines, seeing how interconnected we all are and how interdisciplinary approaches are the best way to solve global issues. This highlighted the need for more communication and collaboration between disciplines: environment, health, technology, conservation, everything needs to be linked and if we can bring all those fields together towards a common objective, we can reach a much wider audience and raise awareness much more easily, hence solving problems a lot more efficiently.

Additionally, it was extremely inspiring to hear about other students’ projects and listen to the stories of alumni students; realise how their master’s program empowered them to set up their own projects and use the skills and knowledge they learnt to practically benefit their communities and make a difference. As the quote says: a picture is worth a thousand words, in this case, having the chance to see first-hand some of the great things some students are achieving was worth a thousand lectures. I was very encouraging to see how, despite being students, we can already start making a change and, through this kind of opportunities, network and get our classmates involved, support each other sharing our skills or spreading awareness and share ideas.

The trip to Budongo was the best example: seeing how Caroline is leading a dedicated team to fight for the protection of endangered species such as chimpanzees and build a strong hub of research on the species to better understand and design conservation strategies. The long walks patrolling in the search for snares also showed us how challenging and complex it can be to open the dialogue with traditional communities and find for them alternative ways of subsistence that do not harm the wildlife and surrounding ecosystem.

There is still a lot to be done, but this is the proof that with hard work and dedication, alumni of the University of Edinburgh are directly contributing to making a positive change across the world.

Elena Perez Fernandez, MSc Global Health: Infectious Diseases, University of Edinburgh

My Ugandan Global Health Academy, Summer School Experience!

August 11, 2016 Conservation, Distance Learning, Environment and Health, Global Health, Global Health Academy Summer School Uganda, Infectious Diseases, One Health, Summer Schoool, Sustainable Development Goals (SDGs), Uganda July 2016, Uncategorized No comments

When I received the invitation for the Global Health Academy summer school in Uganda, I have to admit I was hesitant.

After just finishing my first year on the MPH course, I wondered if I could muster the motivation to do one more minute of work until the next term. However, after re-reading the course itinerary numerous times, I finally persuaded myself it was the right decision to go.  The itinerary was just too tempting; 4 days of summer school and 2 bonus days of chimp tracking in the forests of Budongo?

With flights booked, I ran over the checklist for Kampala and Budongo again and packed my things. Budongo was going to be quite different from Kampala and we needed to be prepared for that environment. We were given the link to the Budongo Wildlife website beforehand which gave full information on where we would be staying and everything we needed, including how to behave whilst visiting the forest.

The university discussion page went over accommodation and transport in both Kampala and Budongo and all my questions were answered quickly and informatively.

To be honest, I didn’t know what to expect from the school. I felt quite out of my depth at first, with my limited global health experience, and having only just completed my first year? However, my fears were soon put to rest as this scary bunch actually turned out to be some of the friendliest and motivational, individuals I have had the pleasure to share a room with, staff and lecturers included.

Makerere University pic 1 Makerere University pic 2

 

 

 

 

 

 

 

 

My co-students were a group of professionals, from all over the world, studying a number of different disciplines at various stages in their studies, however, it soon became evident that no matter what background we came from, we all shared a passion for making the world a better place.   I felt immediately at ease.

Dr Ricky Okwir, University of Edinburgh Alumni

Dr Ricky Okwir, University of Edinburgh Alumni

 

 

 

 

 

 

 

 

To briefly summarize: The lectures were inspiring; the activities were thought provoking and the teamwork brilliant! Everyone got stuck in and shared all they had to share.  There were many brave people who stood up to give presentations on their topics, (myself not included, but I will certainly be on the list for next year) and we received lectures from faculty ranging from epidemiology to simply how to reference properly.  There were many questions and many discussions, but we always had time for a laugh, cup of tea and deep fried cup cake!!

The summer school not only taught me a great deal academically, but also gave me the opportunity to learn from other cultures and nationalities, the value they put on their environments, from a social, medical and environmental perspective. There were so many ideas and all added something to the wealth of knowledge the summer school brought about.

Of course, our experience in the Makerere University was just the start of our adventures. We still had the trip to Budongo to look forward to.

Accommodation at Nyabyeya Forestry College

Accommodation at Nyabyeya Forestry College

Accomm Budongo 2

After a few hours bus trip (stopping off to investigate the local culture on the way) we arrived at what I would describe as a little haven, right out of a holiday magazine. Our very basic but comfortable accommodation set amidst the luscious forest at the Nyabyeya Forestry College. It was certainly a sharp contrast to the hustle and bustle of Kampala.

We travelled a little way to the Budongo Wildlife Reserve after settling in, where we were welcomed with dinner, tea and coffee, a very informative introduction to the reserve and a briefing on what we could expect from the next couple of days.

What a couple of days we had! We participated in monkey and chimp tracking with highly skilled staff who also gave us an introduction to the whole ecosystem of the forest.  We met other visiting teams who were studying the forest and the surrounding areas and enjoyed discussing their experiences, having been based there for the last 4 weeks.

We were not just treated as passive visitors, but expected to report back on the day’s findings. Our feedback was very much valued and gave us a chance to really get thinking in groups, about things that would contribute to the continued success of the research centre and surrounding areas.  We discussed improving awareness and promotion of the project, and ways that would promote the engagement of the community.  I suddenly found myself utilizing a number of concepts we had learnt throughout the MPH course and the lectures we had received earlier in the week.
Budongo 1Budongo 2

 

 

 


 

 

 

Following this we followed our guides into the forest for a spot of snare patrol, where we were taught how to find and identify snares often set by hunters. These ranged from small wires to huge mantraps, all an extreme hazard to creatures living in the forest, and also forest rangers.

Budongo 5

 

We later visited local villages where we were given a talk about the on-going battle bco-existence of humans and wildlife. We learnt about sustainable crop development and the setting of buffer zones in order to control the disruption of local communities by the chimpanzees and other animals living in the forest, which frequently visit to crop raid when food levels are low in the forest.

Only too soon, it was time to return to Kampala and make our way home to our respective countries, to take back all that we had learned and apply it not only to our studies but to our everyday lives and those around us.   I couldn’t wait to get started!

To say I have learned a great deal would be an understatement and it is with great pleasure that I write to inspire others to join in the next one.

 

Seonaid Biagioni, Masters of Public Health, University of Edinburgh

Why it is critical to genotype the causative agents of tuberculosis

March 24, 2015 Cycles of Disease and Illness, Health and Wellness Promotion, Infectious Diseases, Intervention Agents and Opportunities, Measuring and prioritising health interventions and impact., Uncategorized No comments

Sun Tzu, a Chinese military philosopher in the 6th century BC, said “ if you know your enemy and yourself, you will not be imperiled in hundred battles”.

If not taken in literal terms, it would suggest that learning more about the humanity and livestock’s arch enemy Tuberculosis (TB), with whom we have been battling for millennia, can only arm us all the better for the fight.  As part of this battle, The University of Edinburgh has long been contributing to the research and development arm of the World Health Organisation’s “Stop TB Global Strategy”. 

The WHO has achieved the 2015 Millennium Goal of halting and reversing the incidence of the disease.  Despite this great acheivement, in 2013 alone the WHO registered 9 million cases of TB, half a million of which succumbed to the disease.  Horrifyingly this latter number loosely translates to four super jumbo jets crashing every day for the entire year.  Going forward to 2035, the WHO has set yet more ambitious goals to end the global TB epidemic with corresponding targets of 95% and 90% reduction in TB deaths and incidence respectively.

Knowing your enemy

In order to achieve this mighty aim, now more than ever, it is critical for the definitive diagnostics to not only reveal the mycobacterial species but also the genotype.  The majority of cases of human TB are caused by Mycobacterium tuberculosis, however a small, but significant geographically-limited, proportion is due to Mycobacterium bovis the causative agent of bovine tuberculosis. The latter is what is commonly referred to as zoonotic tuberculosis. The current statistics shows that when considered as a proportion of the global TB burden, zoonotic tuberculosis accounts for a small proportion however, if reported in absolute terms it translates to between 95,000 and 150,000 cases of which 15% succumb to this disease form globally. It is noteworthy that 9 out of the 22 high-burden TB countries are responsible for ~70% of the global zoonotic TB cases.

Vaccination as a defence against infection

In general, vaccination is an effective method of controlling infectious diseases.  The BCG vaccine, developed agianstM. bovis, is the most widely administered TB vaccine in the world.  However its varied efficacy globally has always been a challenge to the TB control strategy.  If the endemic population of infective bacteria is different from that contained in the vaccine, this can lead to vaccine failure.  Vaccines that target a narrow range of phenotypes may not offer sufficient prevention against infections in settings where multiple different strains of the infective agent may be present.

This is particularly relevant to areas where several different strains of M. bovis are prevalent, and where the TB burden is correspondingly high. It is also reasonable to argue that some of the TB treatment failures in these areas are likely due to species and genotypes un-accounted for in the treatment protocols.  Thus it is critical to document the diversity of M. bovis, and use this data to increase the phenotypic range in novel vaccines, thereby improving patient immunity.

Sequencing the genomes of the bacteria that cause TB

The currently documented genotypes of M. bovis in high-burden settings lack “granularity” because they are based on PCR methods that target less than 0.005% of the genome.  It is therefore likely that niche and host-specific polymorphisms that are critical for population-based vaccine implementation, are left unused in determining these genotypes.

This disparity in genotype diversity and breadth of target phenotype is likely part of the reasons why the efficacy of BCG vaccination is lowest in Africa.  A solution to this comes in the form of whole genome SNPs based genotyping, which offers high definition genotyping power capable of revealing subtle niche and host specific diversity.

Large international collaboration fighting the disease

Researchers from the University of Edinburgh are now part of a large international collaboration that will sequence and genotype 254 isolates of Mycobacterium bovis from eight African high burden countries.

They will be working alongside colleagues from eight African research institutions, and from the United States Department of Agriculture, Colorado State University, the University of Georgia, the University of Tromsø, theNorwegian Veterinary Institute, and the Norwegian University of Life Sciences.

The new data the team generates will be made freely available for researchers and industry involved in TB vaccine, diagnostics and therapeutics development.  By piecing together more and more information about the strains of Mycobacteria causing TB in different areas, researchers will generate the ammunition needed to finally defeat TB.

adrian m a

            

                    Adrian Muwonge (DVM, MSc, PhD), Research Fellow, Roslin Institute, 

                   Edinburgh Infectious Diseases, University of Edinburgh, UK

 

 

 

Links

 

 

 

Reflections from the HIV, Human Rights and Development (HHRD) Network on World AIDS Day, December 1, 2014

December 1, 2014 AIDS, Cycles of Disease and Illness, HIV, Human Rights, Infectious Diseases, Measuring and prioritising health interventions and impact., Millennium Development Goals No comments

The Joint United Nations Programme on HIV/AIDS (UNAIDS) (2014) Report “Fast-Track: Ending the AIDS epidemic by 2030” provides more than a beacon of hope on World AIDS Day 2014.

It states boldly that “The world is embarking on a Fast-Track strategy to end the AIDS epidemic by 2030”.

It envisages that if the world scales up its HIV prevention and treatment programmes and reaches certain fast-track targets or goals, it will manage to prevent almost 28 million new infections and more crucially “end the AIDS epidemic as a global health threat by 2030”.

The report points to a number of “fast-track targets” that need to be achieved in the next five years by 2020. These optimistic targets include: attaining a 90-90-90 target, i.e. 90 percent of people with HIV knowing their status, 90 percent of those who know their status being on treatment, and then 90 percent of those on treatment suppressing the virus. For the year 2030, this goal goes up to 95-95-95. New infections will be reduced by 75 percent to 500,000 by the year 2020, and then to 200,000 by 2030. And, it points to the overarching goal of zero discrimination and zero tolerance for both years—2020 and 2030.

However, to achieve this monumental, yet attainable goal, the report cautions that “countries will need to use the powerful tools available, hold one another accountable for results and make sure that no one is left behind”.

We at the HHRD Network believe that the commitment to human rights will provide the bedrock of the AIDS response, and that human rights will need to remain in the fore front of all efforts. Moreover, that there is a need for a sustained and continued investment to build and promote the capacity of health systems all over the world, but particularly in the context of developing countries and forced migration. We need to consider on how best we can attain the theme of World AIDS Day 2014 to “Focus, Partner, Achieve: An AIDS-free generation – to highlight the need to for governments and health officials, NGOs and individuals to address AIDS prevention and treatment”. And, finally, the “fast-track targets” need to be held closely by all players across the globe if we are to “not just bend the epidemic trajectory, but to break it irreversibly”.

 

Dr George Palattiyil and Dr Dina Sidhva

Joint Convenors, HIV, Human Rights and Development Network

What are the long-term consequences of deworming programmes?

November 3, 2014 Child Health, Cycles of Disease and Illness, Health and Wellness Promotion, Infectious Diseases, Intervention Agents and Opportunities, Measuring and prioritising health interventions and impact., Millennium Development Goals, Neglected Tropical Diseases No comments

Dr Francisca Mutapi, University of Edinburgh

What happens afterwards? This apocalyptic question is one that is integral to all forms of intervention in human and animal diseases. This is particularly important in cases where the intervention occurs at a national scale. My research group has been asking this question in relation to the current global efforts to control worm (helminth) infections which significantly impact on the health and development of children. Specifically, we work on bilharzia (urinary schistosomiasis) an important, but neglected infectious disease caused by the blood fluke Schistosoma haematobium. Although we hear occasional reports of tourists infected during visits to resorts in endemic areas, bilharzia is typically a disease of poverty due its association with poor sanitation and unsafe water. People become infected when they come into contact with the infective stage in freshwater after it has been released by freshwater snail- hence the other name of the disease- snail fever. The disease affects over 100 million people, mainly in Africa.  Children carry the heaviest burden of infection; as a result, they experience bladder and kidney disorders, stunted growth and poor development.

Current global initiatives from Partners of Parasite Control including the World Health Organization (WHO), Bill and Melinda Gates Foundation, UNICEF, Schistosome Control Initiative and the World Bank are advocating regular school-based de-worming interventions to reduce the development of morbidity, promote school-child health and improve cognitive potential of the children. Children are treated with the antihelminthic drug praziquantel. Over the past decade, there has been a concerted global effort to control bilharzia, galvanised initially by the Millennium Development Goal (MDG) 6 to combat HIV/AIDS, malaria and other diseases by 2015 and the World Health Assembly resolution 54.19 to treat at least 75% of all school-age children at risk of schistosomiasis by 2010. The most recent schistosomiasis resolution, World Health Assembly resolution WHA65.21 passed in 2012 is advocating for the elimination of schistosome transmission and the WHO Schistosomiasis Strategic Plan 2012-–2020 sets out its vision of for a world free from schistosomiasis. This represents a real drive at the global scale not previously seen, to control this important disease of childhood.

Millions of school children in Africa are currently being treated with this drug resulting in significant health improvements. In several countries where the control programmes are currently being implemented, they are typically running for 5 years. The questions we are asking is what will happen to 1) the children who have been treated, 2) the rest of the population that has not been treated and 3) the parasites? The overall, long-term outcome of these treatment programmes for human health is believed to be good- but what evidence do we have for this? In my research group, we are interested in the long-term consequences of praziquantel treatment. Our studies and those of others have shown that the effects of praziquantel treatment go beyond the transient reduction of infection intensity and morbidity. Treatment with the antihelminthic also reduces future pathology and induces immune responses protective against re-infection by the parasites. What will be the effect of the 5-year treatment programmes on the host immune system and overall health?  Experimental studies of the regulation of the immune system suggest that treatment of helminth infection results in susceptibility/worsening of immune disorders (explained through the hygiene hypothesis). What is the relevance of these studies to human helminth infection? What are the long-term health implications in children treated through these national treatment programmes? Similar to malaria, people exposed to schistosome parasites develop natural acquired immunity to the parasites following repeated infection with the parasites. What is the consequence of praziquantel treatment on schistosome immunity and disease, decades after cessation of the control programmes? Providing answers to these questions is critical for informing strategic planning for ministries of health and prioritisation of resources as well as formulating /directing global health policy.

These really interesting scientific questions and the potential impact of the findings for human health are the drivers of research for Dr Francisca Mutapi and her group, the Parasite Immuno-epidemiology Group, at the University of Edinburgh.