Time for a jumpstart: accelerating access to new and promising DR-TB drugs

On World TB day, Grania Brigden (@TBbrigden) of Médecins Sans Frontières (@MSF) calls for improved global access to MDR-TB drugs.

Image credit: Matthias Steinbach

Image credit: Matthias Steinbach

World TB Day is an opportunity to reflect on the progress that has been made in beating this ancient disease. At first glance, the news looks good: two new drugs – the first in decades – have been registered for hard-to-treat multidrug-resistant tuberculosis (MDR-TB) and the global rate of new cases of MDR-TB has remained stable at 3.5%.

However, appearances can be deceptive. While the global rate of MDR-TB is stable, on closer examination the data are not complete; many parts of the world are dealing with a serious and growing MDR-TB crisis. In some countries, including Belarus, Kyrgyzstan and Kazakhstan, up to 35% of people diagnosed with TB for the first time already have MDR-TB, and more than 70% of patients previously treated for TB now have MDR-TB.

These countries are facing a potential future where MDR-TB is the ‘normal’ TB diagnosis. Both MDR and the even-more-severe extensively drug-resistant TB (XDR-TB), carry huge human and financial costs. And the cure rates are abysmally low: around 50% for MDR and 20% for XDR-TB.

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Category: General, Global Health, Tuberculosis | 1 Comment

The Oral Microbiota Affects More Than Just the Mouth

For World Oral Health Day, Lily Berrin, daughter of a periodontist and dental hygienist, highlights recent PLOS Pathogens content to remind us that oral pathogens do more than just cause cavities.

There is more going on behind that smile than you know; brushing, flossing, and seeing the dentists regularly are only the beginning to a healthy mouth and a healthy body. Bacteria, fungi, and even protozoa can inhabit the mouth, leading to more than just bad breath and cavities. If not treated, these pathogens can cause more severe ailments, from inflammatory diseases, such as cardiovascular disease and rheumatoid arthritis, to cancer. In addition to being partly responsible for causing and exacerbating these diseases, and the critters in your mouth can also help inform scientists about the health in other parts of the body.

Coronation Dental Specialty Group, Wikimedia Commons

Image credit: Coronation Dental Specialty Group, Wikimedia Commons

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Category: General | Tagged , , , | 7 Comments

Engaging the Public on Global Health

In the wake of Ebola, Sara Gorman (@saragorm) discusses the need to keep the general public engaged and informed on global health issues.

Image credit: Михаил Чуркин, Flickr.

Image credit: Михаил Чуркин, Flickr.

A simple Google AdWords search of Ebola keyword searches in the past twelve months in the U.S. shows a general disinterest in Ebola all through the summer when cases were raging in West Africa and a sudden spike to 24 million searches in October 2014 just when cases were coming to the U.S. Similarly, average search volumes of “Ebola in Africa” are around 8,100 per month, while “Ebola in the U.S.” gets about 74,000 searches per month. Clearly, something is not right.

Yet the problem may not be exactly what we think it is. It is certainly not the case that people simply don’t care about global health and only become concerned when a disease encroaches on their own borders. In a Kaiser Family Foundation survey from 2012, 52% of people said that the media pays too little attention to health issues in developing countries. 50% of people said they paid at least some attention to global health issues in the news, 18% said they paid a lot of attention, and only 6% said they paid no attention at all. Lest we think people are merely self-interested, when asked why the U.S. should spend money on global health, 51% of people said it was because “it is the right thing to do”. Charitable giving statistics lend a bit more meat to this argument. In 2013, individual donation to health organizations in the U.S. amounted to a total of $31.86 billion, up 6% from 2012. Naturally, many of these health organizations have domestic missions. However, it does show concern about health in particular.

From these surveys and statistics, it would be difficult to argue that the American public has absolutely no interest in global health and international development. But there does seem to be a barrier to getting more involved in these issues: the way the information is presented. But the American public seems interested in knowing more about global health outside of these crises.

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Category: Ebola, Global Health, Policy, Public | 4 Comments

Reflecting on the Maternal Health Collections

In celebration of the MHTF-PLOS Maternal Health collaboration we take a look back through the collections and highlight some of the most influential and interesting articles included in the collections.

In November 2011, the Maternal Health Task Force (MHTF) and PLOS Medicine embarked on a 3 year partnership culminating in the launches of 3 collections focussed on improving maternal and infant health globally. Today we take a look back through the achievements of these collections and using article level metrics gather a picture of the diverse issues and solutions for women and their offspring.

Jack Zalium at flickr.com

Jack Zalium at flickr.com

Year 1: Quality of Maternal Health 

Announced in PLOS Medicine, the theme was chosen to highlight the continued need for attention and action to improve the overall quality of maternal health.

Following the call for papers and rigorous editorial and peer review, 18 articles were published from a wide range of authors and settings, including 14 original research articles and 4 policy and health in action papers.

One of those Health in Action articles, The Midwives Service Scheme in Nigeria, focussed on a project to balance the level of care through Nigeria – so both urban and rural-based mothers received a similar level of care at births. The outcome of this project indicated an uneven improvement in the quality of care received, with the availability and retention of trained midwives noted as a particularly major challenge faced.

Year 2: Maternal Health is Women’s Health

In November 2012, we called for papers for the second year of the collection. The theme recognized the importance of considering maternal health in the context of women’s health throughout their lifespans.

A celebratory event was held in December 2013, featuring authors of the collection sharing their insights and lessons learned.

A prominent topic of this discussion was addressed by Dr. Agampodi through his PLOS ONE paper, Antenatal Depression in Anuradhapura, Sri Lanka and the Factor Structure of the Sinhalese Version of Edinburgh Post Partum Depression Scale among Pregnant Women’. The conversation focused on working towards a coordinated consensus in order to treat ‘minor aliments’, such as nausea, vomiting and lower back ache, during pregnancy, primarily concentrating on best-practice treatment for Sri Lankan women.

Year 3: Integrating Health Care to Meet the Needs of the Mother–Infant Pair

Moving into the final year, we chose the theme of integration with the aim of strengthening the evidence for approaches to providing combined care for both mothers and infants.

The culmination of this collection highlighted the pressing need to consider treatment and prevention simultaneously to form a clearer understanding of the importance for the integration of care.

The MHTF followed up with one of the collection authors, Yaliso Yaya, whose paper, Maternal and Neonatal Mortality in South-West Ethiopia: Estimates and Socio-Economic Inequality, highlighted the importance of strengthening obstetric inventions in rural Ethiopia. Dr. Yaya concluded with advice to include the results of all pregnancies and not just the pregnancy outcomes to ensure proper antenatal controls and referrals to institutions when required.

Three Very Global Collections

From Argentina to Zimbabwe, the articles in the collections were submitted from over 400 institutions around the world.

Representing work from low- and middle-income countries including Burundi, China, DRC, Ghana, India, Indonesia, Kenya, Lesotho, Nepal, Nigeria, New Guinea, the Philippines, Sri Lanka, Vietnam, and Zambia, as well as high income countries, the collections were distinctly diverse, setting them apart from other collections in the field.

Map of MHTF authors

Image Credit: PLOS

The 100+ articles in the collections have represented hugely varied and topical issues that have now been brought to the attention of the global community through the collections in a concise and contained format.

We wish to thank all authors, editors & reviewers who assisted in the creation and development of the collection articles and hope that the work published will continue to nurture opportunities to improve maternal, newborn and children’s health worldwide.

To view the collections, please visit: www.ploscollections.org/maternalhealth

To view the Article Level Metrics Reporting data for the collections, please click here.

Category: Maternal Newborn and Child Health | 2 Comments

Boko Haram and Africa’s Neglected Tropical Diseases

Peter Hotez (@PeterHotez), Co-Editor in Chief of PLOS NTDs, was named U.S. Science Envoy by the White House and State Department with a focus on vaccine science diplomacy and joint vaccine development with countries in the Middle East and North Africa.

This week The New York Times and other news sources reported on new ties between the Nigerian-based Boko Haram and the Islamic State in Iraq and Syria (ISIS).   A new Jihadi alliance in Africa is concerning on a number of fronts, but through my lens of neglected tropical diseases (NTDs) it has special consequences.

Today, Boko Haram controls an important area of northeastern Nigeria, but it is also threatening neighboring areas of Cameroon, Chad, and Niger. Last year I identified this region as one of ten global “hotspots” for NTDs, and indeed some new numbers on NTDs released by the World Health Organization (WHO) confirm this observation. Currently the four nations under threat by Boko Haram account for approximately one third each of the 169 million people at risk for onchocerciasis (river blindness, and the estimated 472 million people who require mass treatment for lymphatic filariasis (LF), elephantiasis, in Africa. Moreover, transmission of Gambian human African trypanosomiasis (HAT) still occurs in Cameroon, Chad, and possibly Niger.


Figure 1. New Cases of Sleeping Sickness Reported for All Africa between 1927 and 1997 doi:10.1371/journal.pmed.0050055.g001

I am concerned that the expansion of Boko Haram into West and Central Africa could have important consequences for the spread of the vector-borne NTDs highlighted above. For instance, we saw during the last half of the twentieth century how war and conflict produced breakdowns in public health infrastructure that led to dramatic increases in Gambian HAT and hundreds of thousands of deaths (Fig. 1).

My worry is that Boko Haram has the capacity to interrupt onchocerciasis and LF control and elimination activities, while simultaneously thwarting and reversing recent gains in HAT elimination, as they have for polio in recent times. As I have pointed out previously, there are similar concerns for ISIS-occupied regions of the Middle East and North Africa.

The NTD community of scientists and public health experts has much to fear about Boko Haram’s aggressive expansion, and its potential for threatening previous gains in control and elimination efforts in Africa. The global health community must plan accordingly.

Category: General | 4 Comments

Sweetening their own deal

Michael F. Jacobson, executive director of the Center for Science in the Public Interest (@CSPI), comments on a research article appearing in PLOS Medicine this week that describes the sugar industry’s continuing efforts to subvert public health policies.

Image Credit: David Pacey, Flickr

Image Credit: David Pacey, Flickr

Forty or 50 years ago, at least in the United States, tooth decay was seen as the major health problem associated with consumption of refined sugars.  Back then, many dentists (probably unsuccessfully) warned patients away from sugar, and public health researchers sought ways to reduce the toll of caries, the most prevalent chronic disease in children and adolescents.  Few, if any, were looking into the relationship between refined sugars and obesity or diabetes or heart disease.  Now, in a remarkable piece of dental-political forensics, researchers at the University of California San Francisco have brought to light the forces that shaped oral-health policy in that era.

In a research article appearing in PLOS Medicine this week, Cristin E. Kearns, Stanton A. Glantz, and Laura A. Schmidt mined an archive of industry papers long buried in the library of the University of Illinois, Urbana, as well as ancient documents at the National Institute of Dental Research (NIDR).  They skillfully wove a public health whodunit that we didn’t even know had been done to us, showing how sugar-industry executives and the International Sugar Research Foundation (ISRF, which later became the Sugar Association) sought, successfully, to influence NIDR policy.

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Category: Big Food, Global Health, Policy, Public | 1 Comment

Open access to anti-Trypanosomatid compounds selected from whole-cell high throughput screenings

Ana Rodriguez, Deputy Editor of PLOS NTDs, and Julio Alonso Padilla, former visiting fellow at GlaxoSmithKline, announce the disclosure of a large collection of antiparasitic compounds to facilitate research and drug development for Chagas Disease, Human African Trypanosomiasis (HAT) and Leishmaniasis.


Trypanosoma cruzi trypomastigote Image Credit: Carlos Bautista Ojeda http://www.carlosbautista.es

High throughput screening (HTS) against a particular microbe or target protein is a powerful tool for drug development against infectious diseases that Pharma companies frequently use. Three of the main Tropical Neglected Diseases –Chagas, HAT and Leishmaniasis– are in great need of new drugs with improved efficacy and lower toxicity, but the parasites causing these diseases are not frequently targeted outside academic labs. Recently, a Pharma company with the required facilities and experience in HTS, GlaxoSmithKline (GSK) merged forces with academic labs (New York University, University of Dundee and Instituto Lopez-Neyra of Granada) that were doing research in the parasites causing these diseases and screened a 1.8 million compound library against whole-cell Trypanosoma cruzi, Trypanosoma brucei and Leishmania donovani. As expected, these three large HTS have identified numerous compounds with activity against each of the parasites.

This valuable information has been processed at GSK to release 200 structures of compounds with activity against each parasite and is reported here. These compounds were selected with bioinformatics methodologies to include structures from different chemical families that are likely to be active against a wide variety of targets. The analysis suggests that most of the compounds are new chemical entities with potential novel mechanisms of actions that have not been previously clinically exploited against these parasites. Importantly, all the data have been made publicly available and the compound sets –called chemical boxes– will be provided on request as an open resource for researchers (contact julio.j.martin@gsk.com or albane.2.kessler@gsk.com).

Researchers in the field of drug development for trypanosomatid diseases have also an additional resource for testing more advanced candidate compounds. A service center which offers in vitro and mouse screening services for Trypanosoma cruzi, Trypanosoma brucei, Leishmania and Plasmodium is available to academic and pharma scientists. These resources should facilitate the early stages of development of new, improved medicines for trypanosomatid diseases.

Category: General | 1 Comment

Chagas Disease: The New Numbers

Peter Hotez (@PeterHotez), Co-Editor in Chief of PLOS NTDs, comments on new WHO estimates of the burden of Chagas disease in Latin America.

Image Credit: Nicolas Raymond

Image Credit: Nicolas Raymond

The World Health Organization (WHO) has just released new estimates on the number of people living with Chagas disease (American trypanosomiasis caused by Trypanosoma cruzi) in Latin America by country (for the year 2010), together with estimates on new cases due to vectorial, maternal-to-child, and blood transfusion transmission (pdf available here). Shown in Tables 1 and 2 is my summary and ranking of some of these data.

Today the largest numbers of people living with Chagas disease live in Argentina, Brazil, and Mexico, followed by Bolivia and Colombia (Table1).  Similarly, Argentina and Brazil lead in the number of cases of Chagasic cardiomyopathy, although more cases are found in Colombia and Bolivia than in Mexico.

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Category: General | 2 Comments

“Vaccine Hesitancy”: The PLOS Currents Collection

Peter Hotez (@peterhotez), President of the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, announces the launch of PLOS Currents Outbreaks collection on Vaccine Hesitancy.

needle-vials_squared(Dawn Huczek, Flickr)

Image Credit: Dawn Huczek, Flickr

Measles was eliminated from the United States in 2000 – with elimination defined as “the absence of continuous disease transmission for 12 months or more in a specific geographic area”.  But in 2014 things began to unravel when the US experienced its largest number of measles cases since elimination was declared, and later at the beginning of 2015 when a measles outbreak began in Disneyland and subsequently spread to multiple states.  The primary cause of the California measles outbreak was parents who chose not to vaccinate their children because of unwarranted fears that vaccines were linked to autism, despite the fact that such connections have been disproven in the scientific literature.  As both a parent of a child who is severely disabled by autism and other mental disabilities and a vaccine researcher and head of a non-profit vaccine product development partnership, I like to also point out the absence of any scientific plausibility for connecting autism to vaccines  (Thoughts on World Autism Awareness Day).

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Category: General | 2 Comments

Chlamydia trachomatis –Urgent need for an effective T cell vaccine to combat the silent epidemic of a stealth bacterial pathogen

Toni Darville from the University of North Carolina considers the potential for a successful T cell vaccine to combat the silent epidemic of Chlamydia trachomatis.

Human pap smear showing clamydia in the vacuoles at 500x and stained with H&E.

Human pap smear showing chlamydia in the vacuoles at 500x and stained with H&E. Image credit: Wikimedia Commons

Chlamydia trachomatis accounts for ~100 million genital tract infections in industrialized nations annually, and continues to be the most frequently reported bacterial sexually transmitted infection in the United States. The majority of genital infections in men and women are asymptomatic, and thus go undetected and untreated, likely contributing to its high prevalence.
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Category: General | 1 Comment