Tickborne illness
Last year, nearly 60,000 cases of tickborne disease were reported to the CDC by state health departments and the District of Columbia. Though it can’t be predicted how bad any particular season will be, it is known that reducing exposure to ticks is the best defense against Lyme disease, Rocky Mountain spotted fever, and other tickborne infections.
The CDC has more information available here: https://www.cdc.gov/media/dpk/diseases-and-conditions/lyme-disease/index.html.
Infectious disease
Decline in measles vaccination is causing a preventable global resurgence of the disease. In 2000, measles was declared to be eliminated in the United States. Today, however, the U.S. and many other countries are experiencing concerning outbreaks of measles because of declines in measles vaccine coverage. Without renewed focus on measles vaccination efforts, the disease may rebound in full force, according to the New England Journal of Medicine by infectious diseases experts at NIAID, part of the NIH, and the Penn State University College of Medicine’s Milton S. Hershey Medical Center.
Measles is an extremely contagious illness transmitted through respiratory droplets and aerosolized particles that can remain in the air for up to two hours. Most often seen in young children, the disease is characterized by fever, malaise, nasal congestion, conjunctivitis, cough, and a red, splotchy rash. Most people with measles recover without complications within a week. However, for infants, people with immune deficiencies, and other vulnerable populations, the consequences of a measles infection can be severe. Rare complications can occur, including pneumonia, encephalitis, other secondary infections, blindness, and even death. Before the measles vaccine was developed, the disease killed between 2 and 3 million people annually worldwide. Today, measles still causes more than 100,000 deaths globally each year.
Measles can be prevented with a vaccine that is both highly effective and safe. Each complication and death related to measles is a “preventable tragedy that could have been avoided through vaccination,” the authors write. Some people are reluctant to vaccinate their children based on widespread misinformation about the vaccine. For example, they may fear that the vaccine raises their child’s risk of autism, a falsehood based on a debunked and fraudulent claim. A very small number of people have valid medical contraindications to the measles vaccine, such as certain immunodeficiencies, but almost everyone can be safely vaccinated.
When levels of vaccine coverage fall, the weakened umbrella of protection provided by herd immunity—indirect protection that results when a sufficiently high percentage of the community is immune to the disease—places unvaccinated young children and immunocompromised people at greater risk. This can have disastrous consequences with measles. The authors describe a case in which a single child with measles infected 23 other children in a pediatric oncology clinic, with a fatality rate of 21 percent.
If vaccination rates continue to decline, measles outbreaks may become even more frequent, a prospect the authors describe as “alarming.” This is particularly confounding, they note, since measles is one of the most easily prevented contagious illnesses. In fact, it is possible to eliminate and even eradicate the disease. However, they say, achieving this goal will require collective action on the part of parents and healthcare practitioners alike.
Leadership
Strong laboratory leaders—a key asset for global disease control. Laboratories play an essential role in the detection, diagnosis, prevention, and control of diseases. To strengthen this role, ECDC (European Centre for Disease Prevention and Control) and five partner organizations have developed the Global Laboratory Leadership Program (GLLP) to support and sustain national laboratory systems under a One Health approach.
Reliable laboratory services continue to be limited in many low- and middle-income countries. Although there have been examples of effective laboratory responses to outbreaks, a well-documented number of such events have shown how a lack of robust laboratory systems can impede disease control and prevention efforts.
To strengthen laboratory systems and address gaps in laboratory leadership competency across sectors, the GLLP was established. ECDC collaborated with five partners to develop the GLLP: Association of Public Health Laboratories (APHL); Centers for Disease Control and Prevention (CDC); Food and Agriculture Organization of the United Nations (FAO); World Organization for Animal Health (OIE); and World Health Organization (WHO).
The GLLP targets professionals working in human and animal health laboratories, as well as laboratories with public health functions such as environmental, agricultural, food, chemical, and aquatic laboratories.
The development of the GLLP represents the first global effort involving input and support from multiple organizations and institutions to create a core set of competencies for laboratory leaders working in support of health systems and a related flexible and adaptable learning package.
HIV
Novel antibody may suppress HIV for up to four months. Regular infusions of an antibody that blocks the human immunodeficiency virus (HIV) binding site on human immune cells may have suppressed levels of HIV for up to four months in people undergoing a short-term pause in their antiretroviral therapy (ART) regimens, according to a report published online in The New England Journal of Medicine. Results of the Phase 2, open-label study indicate the antibody, known as UB-421, was safe and did not induce the production of antibody-resistant HIV. The study was supported in part by NIAID, a component of the NIH, and United Biopharma. The study was conducted in Taiwan and led by Chang Yi Wang, PhD, Chief Scientific Officer and Chairperson of United BioPharma. Twenty-nine volunteers with well-controlled HIV discontinued their normal regimens of daily oral ART at the time of their first infusion or one week later, depending on their ART regimen. Fourteen study participants received eight regular weekly infusions of UB-421, while 15 received eight higher-dose infusions every other week. At the end of the eight- or 16-week treatment period, all volunteers restarted their previous ART regimen and were evaluated in follow-up visits up to eight weeks later. Apart from a single participant who discontinued the study because of a mild skin rash, volunteers in both groups maintained HIV suppression throughout the treatment period in the absence of ART.
Previous experimental infusions of broadly neutralizing antibodies (bNAbs) have suppressed HIV for about two weeks by targeting proteins on the virus itself, but the rapid mutation rate of HIV induces antibody-resistant strains that render the treatment ineffective. UB-421 theoretically avoids this possibility by blocking a stable human protein that HIV uses to infect T cells.
Indeed, resistance to UB-421 was not seen in this study. Because the small study did not include a comparator group receiving a placebo infusion, further studies have been planned in Taiwan and Thailand to evaluate the safety and efficacy of UB-421 as a treatment for HIV.
HPV
HPV rates for women under 40 increasing, putting them at higher risk of related cancers. Human papillomavirus (HPV) infection rates are increasing in women born after 1980 who did not receive the HPV vaccine—putting them at higher risk for HPV-related cancers, according to a University of Michigan study.
While more than 90 percent of HPV-related cancers are preventable, HPV causes more than 40,000 cases of cancer in the U.S. each year, including cervical, oropharyngeal, anal, and other genital cancers. The CDC estimates that at least half of all sexually active men and women will acquire HPV in their lifetime.
Because testing for genital HPV started in 2003 for women and in 2013 for men, there are no direct measurements of how HPV incidence and prevalence have changed over the past decades—before the vaccine became available for women in 2006 and for men in 2009.
Researchers said previous analyses focused only on measures of current HPV infection (viral DNA) or past HPV infection (antibodies), producing sometimes competing results, making it difficult for experts to predict current and future trends.
For their analysis, researchers developed a model that uses both HPV infection and past infection data, as well as mathematical representations of the underlying mechanisms of infection, recovery, and the generation of antibodies, to paint a better picture of HPV prevalence in the present and past.
Their model indicates that while there may be a substantial increase in HPV prevalence in more recent birth cohorts, HPV vaccination may ultimately control adverse HPV-related outcomes, including genital warts and cancer. Questions still remain, such as why there is a peak in HPV infection among 45-to-55-year-olds.
