Learning from the South: influenza immunization in pregnancy

Writing from Dhaka, Bangladesh, Jocalyn Clark celebrates the impact of a paper by Bangladeshi researchers on Western medical provision.

When two worlds collide in global health it can be a marvelous thing. Take for example the fact that although countries like the US and UK have recommended influenza immunization during pregnancy for many years, there was no evidence from a randomized controlled trial (RCT) to support the importance of that policy for birth outcomes until now. And the RCT to provide the needed evidence was not done in North America or Europe, but in Bangladesh by an international team, providing critical insights to help guide clinical practice, immunization policy, and women’s informed decision-making.

Image Credit: Steven Depolo, Flickr

Image Credit: Steven Depolo, Flickr

The Bangladesh evidence, drawn from secondary analyses of an RCT involving 340 pregnant women, shows that a flu shot given in the third trimester increased the mean birth weight of infants by 200 grams. These data are valuable for evidence-based health policy and care: women who get flu during pregnancy (especially late pregnancy) may risk complications for themselves or their babies, and yet there is low uptake of vaccination – in Canada, for example, less than one in five pregnant women has had a recent flu shot.

The low uptake may be because previous findings on influenza immunization in pregnancy and birth outcomes have been mixed: North American studies conducted during the 2009 pandemic suggested that vaccination reduced the risk of preterm birth, but most studies done during ordinary flu seasons have not found a link between vaccination and lower risk of prematurity.


Continue reading »

Category: General | 1 Comment

Promoting Scientific Publications from Authors Overseas

PLOS NTDs Deputy Editor Daniel Bausch reflects on a Manuscript Writing Workshop recently conducted in Lima, Peru.

On February 19, 2014, PLOS Neglected Tropical Diseases and the American Journal of Tropical Medicine and Hygiene held a manuscript writing workshop in Lima, Peru, as part of the annual Peru satellite meeting of the American Society of Tropical Medicine and Hygiene (ASTMH).  Amy Morrison and I, both PLOS NTDs Deputy Editors living and working in Peru, discussed our approach to writing, reviewing, and editing scientific manuscripts with a group of about 200 young Peruvian scientists.

Audience of the NTDs and ASTMH Writing Workshop. Image Credit Roxana Lescano

Audience of the NTDs and ASTMH Writing Workshop. Image Credit Roxana Lescano

Some of the obstacles to publication from authors overseas are obvious, such as the language barrier in a scientific world presently dominated by English. Others are more subtle, and perhaps more universal. How do you get started? What journal do you choose? What happens if you get rejected? The intimidation of young writers (naively thinking that peer-review is a perfect system!) was palpable. Amy and I did our best to go through the various steps of writing, submission and review. I think it helped for the young scientists to see that people who write and review and edit manuscripts are just “real people.” No intimidation necessary. Amy and I probably learned as much as the attendees; going through each step (how do you write the Abstract? the Intro? the Methods?), we often discovered that we had slightly different approaches and pointers to offer.


Continue reading »

Category: General | 2 Comments

The Elderly: A neglected population with neglected tropical diseases

Image Credit: Flickr, Vinoth Chandar

Image Credit: Flickr, Vinoth Chandar

According to the World Health Organization, many of the world’s developed countries consider 65 years as the chronological age when people are considered “elderly,” while the United Nations uses the ages of 60 and above.  However, in parts of sub-Saharan Africa and elsewhere the cutoff age is often lower such as 50 or 55 years.

This month, PLOS Neglected Tropical Diseases published a new study by Rowe et al. from Singapore on dengue fever in the elderly (> 60 years of age).  Among their interesting findings were that the elderly had longer hospital admissions, and had higher rates of pneumonia and urinary infections.  Overall, the elderly had more dengue hemorrhagic fever and severe dengue.
Continue reading »

Category: Dengue, Neglected Diseases | Tagged , , | Comments Off

Tackling Cholera in Haiti: A Multi-Faceted Approach

The PLOS medical journals reflect on Haiti’s cholera epidemic, and the value of moving forward with an emphasis on holistic practice and research.

Image Credit: FMSC, Flickr

Image Credit: FMSC, Flickr

Almost three years ago, in May of 2011, PLOS Neglected Tropical Diseases published a Viewpoints piece, Meeting Cholera’s Challenge to Haiti and the World: A Joint Statement on Cholera Prevention and Care, which urged the development of a “comprehensive, integrated strategy” in response to Haiti’s 2010 cholera epidemic. The Pan American Health Organization estimates that the outbreak now includes over 650,000 survivors and 8,100 fatal cases. Indeed, the epidemic has had enormous repercussions for a nation already facing the effects of the devastating 2010 earthquake.

At PLOS, research and opinion from across the medical journals, and this blog, have grappled with the issues raised by that first joint statement. The topics have ranged from an investigation of mass vaccination feasibility to an analysis of Haiti’s water-borne bacteria, and each article has helped to build an important new knowledge base. Though the task of ending cholera in Haiti remains daunting, this knowledge ensures that future efforts can be faster, more thorough, and ultimately, more successful.
Continue reading »

Category: Cholera, MSF | Tagged , , , , | Comments Off

Gaining Perspective from Performing HIV/M. tuberculosis co-Infection Research in South Africa

In the second of two linked posts for World TB Day, American post doc Collin Diedrich shares his experience researching M. tuberculosis/HIV co-infection in South Africa.

To read the first of these linked posts, please click here.

World TB Day

World TB Day is March 24. Image credit: CDC.

As a graduate student at the University of Pittsburgh my research focused on a nonhuman primate model of HIV/Mycobacterium tuberculosis co-infection. HIV-infected individuals are significantly more susceptible to tuberculosis, but the cause of this increase is incompletely understood. Like most scientists, this project fueled my passion for the pathogens I was working with. The diversity of these interconnected pathogens is fascinating. On one side of the spectrum you have M. tuberculosis, a pathogen that has co-evolved with humans for millennia. This has led to this bug essentially hiding-in-plain-sight: infected individuals develop immune responses to these bugs but no one really knows how this immunogenicity actually correlates protection. On the other side you have HIV, a retrovirus that has been around a fraction of time of M. tuberculosis. HIV kills T cells and sets up latent reservoirs that are difficult to treat. Essentially, our immune responses to M. tuberculosis are relatively effective, but HIV directly attacks those responses, and M. tuberculosis reactivates. In addition, primary infections with M. tuberculosis are harder to control when someone is infected with HIV.

These pathogens became entangled in one of the worst biological syndemics of our lifetime. These pathogens are disproportionately and devastatingly affecting sub-Saharan Africa in such a way that it’s difficult for me to think about one of these pathogens without the other.
Continue reading »

Category: Tuberculosis | Tagged , , , , , | Comments Off

Gaining Perspective from Performing HIV/M. tuberculosis co-Infection Research in South Africa

In the second of two linked posts for World TB Day, American post doc Collin Diedrich shares his experience researching M. tuberculosis/HIV co-infection in South Africa.

To read the first of these linked posts, please click here.

World TB Day

World TB Day is March 24. Image credit: CDC.

As a graduate student at the University of Pittsburgh my research focused on a nonhuman primate model of HIV/Mycobacterium tuberculosis co-infection. HIV-infected individuals are significantly more susceptible to tuberculosis, but the cause of this increase is incompletely understood. Like most scientists, this project fueled my passion for the pathogens I was working with. The diversity of these interconnected pathogens is fascinating. On one side of the spectrum you have M. tuberculosis, a pathogen that has co-evolved with humans for millennia. This has led to this bug essentially hiding-in-plain-sight: infected individuals develop immune responses to these bugs but no one really knows how this immunogenicity actually correlates protection. On the other side you have HIV, a retrovirus that has been around a fraction of time of M. tuberculosis. HIV kills T cells and sets up latent reservoirs that are difficult to treat. Essentially, our immune responses to M. tuberculosis are relatively effective, but HIV directly attacks those responses, and M. tuberculosis reactivates. In addition, primary infections with M. tuberculosis are harder to control when someone is infected with HIV.

These pathogens became entangled in one of the worst biological syndemics of our lifetime. These pathogens are disproportionately and devastatingly affecting sub-Saharan Africa in such a way that it’s difficult for me to think about one of these pathogens without the other.
Continue reading »

Category: Tuberculosis | Tagged , , , , , | Comments Off

Challenging the Enemy-Tuberculosis- with Full Force

In the first of two linked posts for World TB Day, Sheetal Gandotra from the CSIR-Institute of Genomics and Integrative Biology, New Delhi, India reflects on the enduring quest of research in the fight against Tuberculosis.

To read the second of these linked posts, please click here.

World TB Day

World TB Day is March 24. Image credit: CDC.

As a scientist working in the area of tuberculosis (TB) in India, a country with the largest global burden of this disease, I am challenged every now and then on the value of basic research to the “need of the country”. With big pharma pulling out of years of efforts at finding a new cure, with public-private partnerships on the rise, and renewed interest in improving treatment regimens, let’s not forget what we have learnt from the basic research endeavours that cheer us on in this battle against TB.

The journey from compound to drug to resistance

Little did Hans Meyer and Joseph Malley know in 1912 that their doctoral work on the synthesis of isoniazid (INH) would 40 years later become the reason for a patent struggle between three pharma companies that would discover its potency against the tubercle bacillus – Mycobacterium tuberculosis (Mtb).
Continue reading »

Category: General, Tuberculosis | Tagged , , , , , , , , , | 2 Comments

Drug-Resistant TB: Dying for Better Treatment

On World TB day patient advocate Goodman Makhanda and Dr Jennifer Hughes from Médecins Sans Frontières reflect on successes and challenges of tackling TB in Khayelitsha, South Africa.

testmetreatme_fb-newsletter

Click here to help us send a message to world health decision-makers by signing MSF’s “Test Me, Treat Me” DR-TB Manifesto.

Two weeks ago there was a small celebration in a primary care clinic in Khayelitsha, South Africa. Siyabulela Qwaka* was officially declared CURED after taking more than 2 years of treatment for pre-XDR (extensively drug-resistant) TB. This is hugely significant given that the chance of cure for someone with pre-XDR or XDR TB is less than 20%.

Siyabulela Qwaka was one of the first patients enrolled in a pilot project run by Médecins Sans Frontières (MSF), in collaboration with the local health departments, to improve treatment outcomes among people with pre-XDR and XDR-TB as well as those in whom MDR (multidrug-resistant) treatment is failing. MSF joined the local clinic staff to congratulate him on being the fourth patient in the project to be cured. Tears pricked the eyes of all who listened to him as he recounted the difficulties of dealing with the shock of the diagnosis (“But I’m not even HIV positive…”), the horrendous daily side-effects of the treatment, the stigma of being labeled a ‘bad TB patient’ who brought the disease upon himself (despite never having had TB before), and the willpower needed to drag himself to the clinic every day to wait for pills which, he was told, may or may not cure his disease. The clinic staff and community workers who supported him deserved to feel proud of this achievement, which is also their achievement – Siyabulela was not always the easiest person to convince that the treatment was his only option if he actually wanted to live to pursue his career in information technology.


Continue reading »

Category: General, MSF | Tagged | Comments Off

Celebrating World Water Day with a good WASH

Attribution:  Flickr, Diganta Talukdar

Attribution: Flickr, Diganta Talukdar

This coming Saturday marks the 22nd year that the United Nations General Assembly has recognized March 22nd as World Water Day. In observation of this special day, we would like to take a look back at a few of the articles PLOS Medicine, PLOS Neglected Tropical Diseases, and PLOS Pathogens have published on the importance of clean water to human health.
Continue reading »

Category: General, WASH | Tagged , | 1 Comment

Health in Jeopardy: the Corporate Influence on Climate Negotiations

Alicia Pawluk argues that United Nations climate policymakers should learn from the WHO Framework Convention on Tobacco Control and diminish the influence of fossil-fuel producers in climate talks.  

Image Credit: NOAA/NASA GOES Project

Image Credit: NOAA/NASA GOES Project

The health impacts of climate change will undoubtedly be the most pressing global health issue of the upcoming century. Rising sea levels, warmer global temperatures, and extreme weather events will all have a widespread global effect. International governmental measures must be taken to minimise the damage caused by these phenomena, and to mitigate future health disasters. The United Nations is striving towards global climate solutions but significant intrusions at international climate negotiations have hindered any progress.

Last year’s UN Climate Talks in Warsaw (Conference of Parties 19) set a new precedent for climate negotiations.  Unfortunately, instead of progressing towards global consensus on climate action, COP 19 stood out for more ominous reasons. Among the diplomats, climate scientists, and civil society participants was the overwhelming presence of fossil-fuel-intensive industries.  A majority of the sponsorship of the COP came from companies which benefit considerably from fossil-fuels, raising questions about the place of the fossil-fuel industry in climate negotiations.  The official corporate partners, including Alstom, the Polish fossil fuel companies PGE and LOTOS, ArcelorMittal, BMW, General Motors and Emirates Airlines, are hardly ‘leading the way’ on sustainability.
Continue reading »

Category: General | 1 Comment