This week PLOS Medicine publishes the following new articles:
Image Credit: Christian Guthier, Flickr
In their research article, Ferrari and colleagues report the most recent and comprehensive estimates on how much death and disability is attributable to depression, both world-wide and in individual countries and regions. The rates among all causes of disability are highest in Afghanistan and lowest in Japan, and depression ranks first in Central America and Central and Southeast Asia. Disability from depression affects mostly people in their working years, and women more than men. When compared to other diseases and injuries, major depressive disorder (MDD) ranked as the second leading cause of global disability (or YLDs) and the eleventh leading cause of global burden (or DALYs) in 2010. However, MDD also contributes to mortality for a number of other conditions, namely suicide and ischemic heart disease.
Yukari Manabe and colleagues evaluate the cost-effectiveness and budget impact of antenatal syphilis screening for 43 countries in sub-Saharan Africa and estimate the impact of universal screening on averted stillbirths, neonatal deaths, congenital syphilis, and disability-adjusted life years (DALYs). In sub-Saharan Africa, where it is estimated that up to 17% of pregnant women are infected and risk passing the bacterium to their fetus, current screening only achieves 40% coverage. They found that at current syphilis prevalence rates, the intervention could prevent up to 25,000 newborn deaths of and 64,000 stillbirths in sub-Saharan Africa every year. Importantly, although estimated costs varied between countries, on average the cost of each DALY averted was only $11, much less than interventions to prevent mother-to-child transmission of HIV. The authors suggest that an integrated approach to the prevention of mother-to-child transmission of HIV and syphilis combined, as has been introduced in Asia and South America, might further improve cost-efficiency.
Category: PLoS Medicine Week by Week
Tagged budget, depression, Elimination, global burden of disease, human rights, maternal health, maternal mortality, measles, outbreak, pregnancy, screening, syphilis, women's rights
In the second of two linked posts, Lindsay McKenna and Colleen Daniels of Treatment Action Group (TAG) describe the importance of access to timely diagnosis and appropriate treatment for patients with drug-resistant tuberculosis and demand that urgency be returned to the global DR-TB response.
“Drs. Dalene and Arne von Delft” the second short film in the series Tuberculosis: Behind the Numbers commissioned by TAG and directed by Jonathan Smith, highlights a young, brave, South African doctor’s two-year battle with multidrug-resistant tuberculosis (MDR-TB), a form of tuberculosis (TB) resistant to two of the most powerful TB drugs, isoniazid and rifampicin. Cure is only achieved in 50-60 percent of MDR-TB cases globally. Dr. Dalene von Delft’s diagnosis with MDR-TB was completely unexpected – she had what she believed to be a persistent dry cough and harmless sinusitis. Following MDR-TB diagnosis, Dalene underwent months of difficult treatment where she stomached 35 pills a day and endured painful daily injections. One of the injectable drugs in Dalene’s regimen was damaging her hearing and threatening to silence her world, a side effect that Dalene and her husband were unwilling to accept. They needed a replacement drug, but chronic under-investment in TB drug development left them to choose among a limited suite of decades-old drugs carrying high toxicities.
Chagas disease is a silent killer. Throughout the Americas, an estimated 8-10 million people, most of whom are predominantly poor and marginalized, are infected by the deadly parasite causing Chagas disease, Trypanosoma cruzi. Children are particularly affected. With globalization, the disease is increasingly found in the US, Europe, Australia, and Japan. The US is now the seventh most affected nation worldwide. Tens of thousands of patients die each year from Chagas disease. About 30% of chronically infected individuals will develop heart complications with high probability of death. Less than 0.2% receive treatment today (DNDi, unpublished data). New problems are emerging notably with mother-to-child transmission, which could become the new face of Chagas disease.
Chagas disease is a hidden public health crisis needing increased and urgent attention.
The following new articles are publishing this week in PLOS NTDs:
Arnott A, Mueller I, Ramsland PA, Siba PM, Reeder JC, et al. (2013). PLoS Negl Trop Dis 7(10): e2506. doi:10.1371/journal.pntd.0002506
The poorest people living in the Mexico and the U.S. are silently suffering under a heavy burden of Chagas disease, with pregnant women disproportionately affected. Peter Hotez and colleagues discuss how many lives can be saved with greater access to the treatments available today, while knowing the fate of tomorrow’s patients rests on increasing investments in research to develop new technologies to treat and diagnose Chagas disease, as well as improving scientific cooperation between the U.S., Canada, Mexico, and other key countries.
Vaccines are an essential component of global malaria control and elimination campaigns, but the diversity of malaria antigens is thought to be a major cause of vaccine failure. In this study, Alicia Arnott and colleagues investigate the global diversity of the P. vivax vaccine candidate, Apical Membrane Antigen 1 (PvAMA1), to determine the feasibility of designing a globally effective PvAMA1 vaccine and to determine which region of PvAMA1 is targeted by host immune responses, in order to identify the most promising candidates.
In the first of two linked posts, Mike Frick of Treatment Action Group (TAG) and Audrey Zhang of Harvard College argue that patient-centered approaches in treatment for drug-resistant and drug-sensitive tuberculosis are needed.
In “A Walk to Work with Dr. Vivan Cox,” the first short film in the series Tuberculosis: Behind the Numbers commissioned by TAG, director Jonathan Smith introduces an innovative approach to address multidrug-resistant tuberculosis (MDR-TB). In Khayelitsha, South Africa, Médecins Sans Frontières (MSF) is treating patients in community healthcare centers instead of confining them to hospitals. Vivian Cox, Deputy Medical Field Coordinator of Médecins Sans Frontières’ TB program in Khayelitsha, describes MDR-TB as “a community disease… that very often affects or infects whole families.” Dr. Cox describes how the dominant approach of confining MDR-TB patients to hospitals for up to two years can “tear families apart.”
Sara Gorman explores the interconnectedness of infectious and chronic diseases.
The headlines are everywhere. “Non-communicable diseases outsmart infectious diseases.” “Non-communicable diseases leading cause of deaths worldwide.” “Non-communicable diseases take center stage.” Non-communicable diseases are certainly on the rise worldwide and represent a growing concern for global health systems. But are chronic diseases truly taking the place of infectious diseases? In a world of global health systems that tend to focus on one disease or one category of disease at a time, should we be shifting our focus from HIV, tuberculosis, and malaria to asthma, heart disease, and diabetes?
In a thought-provoking article, Alanna Shaikh, a global health professional and writer, convincingly argues “not so fast.” The old view of the epidemiological transition, whereby non-communicable diseases “replace” infectious diseases as the primary threats to health, is probably too simple. Instead, communicable and non-communicable diseases are combining in new ways to present new threats. Shaikh takes the intersection of diabetes and tuberculosis as one prominent example. People with diabetes have a risk for tuberculosis infection 2-3 times greater that among people without diabetes. Even worse, people with diabetes have a higher risk of dying during TB treatment or confronting treatment failure, largely due to the fact that people with diabetes have difficulty tolerating TB drugs. Of course, diseases such as TB and malaria are largely irrelevant in developed countries, but in developing countries, the rise of chronic disease could mean devastating setbacks in the control of infectious diseases.
The following new articles are publishing this week in PLOS NTDs:
Soares Magalhães RJ, Fançony C, Gamboa D, Langa AJ, Sousa-Figueiredo JC, et al. (2013). PLoS Negl Trop Dis 7(10): e2321. doi:10.1371/journal.pntd.0002321
In contrast to all other known virus species in the genus Lyssavirus of the family Rhabdoviridae, Mokola virus is unique in that it appears to be exclusive to Africa and its reservoir host has not yet been identified. As only limited sequence information is available Joe Kgaladi and colleagues set out with this study to significantly contribute to the understanding of the genetic diversity and relatedness of Mokola viruses.
Improved understanding of the differential diagnosis of endemic Treponematoses is needed to inform clinical practice and to ensure the best outcome for a new global initiative for the eradication of yaws, bejel and pinta. Here, Oriol Mitjà and colleagues review the dilemmas in the diagnosis of endemic Treponematoses, and advances in the discovery of new diagnostic tools.
Unni Karunakara and Jean-Christophe Dollé describe the challenges faced by Médecins Sans Frontières’ TB programme as the organisation withdrew from Somalia in response to increasing violence.
On August 14th 2013, Médecins Sans Frontières (MSF) took one of the most difficult decisions in our history and closed all of our medical humanitarian aid operations in Somalia after more than 22 years of assisting people who have suffered decades of war, epidemics, man-made and natural disasters.
What would force MSF, known as one of the last organisations to leave an active war zone, to withdraw? Put simply, we have found the level of violence against our staff and the lack of respect from authorities for humanitarian action unbearable. We have been confronted with extreme attacks on our staff in an environment where armed groups and civilian leaders increasingly support, tolerate, or condone the killing, assaulting, and abducting of humanitarian aid workers.
Sixteen MSF staff have been killed in Somalia since 1991 and we have endured dozens of attacks on our staff, ambulances and medical facilities. We can intervene only if our presence is accepted by warring parties and communities and only if those groups agree to respect the safety of patients and our staff. This acceptance, always fragile in conflict zones, no longer exists in Somalia today.
This week, PLOS Medicine publishes the following new articles:
Image credit: Dave Proffer, Flickr
Using nine increasingly sophisticated mathematical models, Jan Hontelez from Erasmus MC, University Medical Center Rotterdam, Netherlands, and colleagues tested the time frames in which expanded access to antiretroviral viral therapy could lead to HIV elimination in South Africa. The current antiretroviral treatment policy in South Africa could lead to elimination of HIV within the country over the next 24 to 34 years, but a universal test and treat (UTT) approach could achieve elimination 10 years earlier, according to the research. All of the researchers’ models replicated the prevalence of HIV in South Africa (the proportion of the population that was HIV-positive) between 1990 and 2010, and all predicted that UTT would result in HIV elimination (less than one new infection per 1,000 person-years). The simplest model predicted that UTT would eliminate HIV after seven years, but the more complex, realistic models predicted elimination at much later time points. The most comprehensive model predicted that although elimination would be reached after about 17 years of UTT, the current strategy of ART initiation for HIV-positive individuals at a CD4 cell count at or below 350 cells/μl would also lead to HIV elimination, albeit ten years later than UTT.