The Observatory

Nov. 21, 2017

Fast Facts:

Women and HIV

17.8 million
Is the number of women (15 and older) worldwide living with HIV, 2015 estimate.

2.3 million
Is the number of girls and young women (15-24 years) living with HIV.

Is the number of new HIV infections among women (15 and older) in 2015.

58 percent
Is the proportion of new HIV infections among persons aged 15-24 in 2015 that occurred in women and girls.

56 percent
Is the proportion of new HIV infections among adults in sub-Saharan Africa that occurred in women.

46 percent
Is the proportion of new HIV infections among adults in the Caribbean that occurred in women.

31 percent
Is the proportion of new HIV infections among adults in Eastern Europe and Central Asia that occurred in women.

38 percent
Is the proportion of new HIV infections among adults in the Middle East and North Africa that occurred in women.

29 percent
Is the proportion of the newly infected adults in Latin America who were women.

32 percent
Is the proportion of the newly infected adults in the Asia-Pacific region who were women.

22 percent
Is the proportion of the newly infected adults in Western and Central Europe and North America who were women.

77 percent
Is the proportion of pregnant women who have been accessing antiretroviral medicines to prevent mother-to-child transmission of HIV.

Source:UN Women web page.


Experts recommend fewer lab tests for hospitalized patients. In a review article publishing recently in JAMA Internal Medicine, physicians at the Johns Hopkins University, along with experts from several other institutions across North America, compiled published evidence and crafted an experience-based quality improvement blueprint to reduce repetitive lab testing for hospitalized patients.

Repeated blood draws for such tests can lead to hospital-acquired anemia and other complications. This is the second paper co-authored by residents and faculty from the High Value Practice Academic Alliance, a consortium of nearly 90 academic medical centers collaborating to improve healthcare quality and safety by reducing unnecessary components of practice that do not add value to patient care.

Experts have estimated that nearly 20 percent of hospitalized patients can develop moderate to severe hospital-acquired anemia as a result of repeated blood draws. This spiral can generate additional unnecessary tests, interventions, and costs for the patient. Moreover, published studies show that decreasing repetitive daily laboratory testing did not result in missed diagnoses or increase the number of readmissions to the hospital.

Citing individual studies where front-line healthcare workers reduced the number of orders for lab tests by anywhere between eight percent and 19 percent, the authors reported that cost savings have ranged from $600,000 to more than $2 million per year. While many professional societies have recommended reducing repetitive lab tests, recommendations alone typically do not change behavior. The most successful efforts to reduce daily lab testing in this review included a combination of educating healthcare providers about charges, obtaining feedback by showing providers’ ordering habits, and changing clinical workflow to restrict automated repeat ordering of tests.

The recommendations are as follows: Design hospital-wide educational initiatives backed by data to collectively outline and standardize best practice; establish target numbers by which to reduce lab test ordering and provide instant feedback to those ordering tests to show their personal ordering patterns, so they are aware of their own behavior with respect to agreed-upon standards; and reprogram the electronic systems used to order tests to restrict the number of “pre-ordered” tests.

Drugs of Abuse

New Medicaid policy to combat the opioid crisis. The Centers for Medicare & Medicaid Services (CMS) has announced a new policy to allow states to design demonstration projects that increase access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD). CMS’s new demonstration policy responds to a presidential directive and provides states with greater flexibility to design programs that improve access to high quality, clinically appropriate treatment.

Through this updated policy, states will be able to pay for a fuller continuum of care to treat SUD, including critical treatment in residential treatment facilities that Medicaid is unable to pay for without a waiver. Previously, states had been required to build out their entire delivery system for SUD treatment while also meeting rigid CMS standards before Medicaid demonstration approvals could be granted. The new policy will allow states to provide greater treatment options while improving their continuum of care over time.

The new policy also enhances the ability for CMS to evaluate how effectively the demonstration programs are working through the collection of information and data that can be used to inform CMS on best practices and methods to specifically combat the opioid epidemic. It is hoped that this will increase the agency’s capacity to learn what treatment delivery methods are the most effective in addressing the nation’s public health emergency.

Fentanyl involved in more than half of opioid overdose deaths in 10 states. More than half of people in 10 states who died of opioid overdoses during the second half of 2016 tested positive for fentanyl, according to new data recently published in CDC’s Morbidity and Mortality Weekly Report (MMWR) Early Release.

The report found that out of a total of 5,152 opioid overdose deaths, almost 3,000 tested positive for fentanyl, and more than 700 tested positive for drugs that have similar chemical structures to fentanyl (fentanyl analogs)—including the extremely potent fentanyl analog carfentanil, which is used to sedate large animals.

This is the first report on data from the State Unintentional Drug Overdose Reporting System (SUDORS), which tracks fatal opioid overdoses and is a component of CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) program. SUDORS makes it possible to use toxicology and death scene investigation data previously unavailable across states to provide insights into specific substances and circumstances driving overdoses. This information can help uncover changes in the opioid epidemic and inform interventions.

CDC researchers examined opioid overdose deaths from July 1 to December 31, 2016, in 10 states: Maine, Massachusetts, Missouri, New Hampshire, New Mexico, Ohio, Oklahoma, Rhode Island, West Virginia, and Wisconsin.
Because of the large proportion of opioid overdose deaths testing positive for fentanyl and fentanyl analogs, opioid overdose surveillance must expand to track the rapidly changing illicit opioid market. Funding for enhanced and timely surveillance is one of CDC’s key investments to inform opioid overdose prevention efforts.


Newly discovered viral marker could help predict flu severity in infected patients. Flu viruses contain defective genetic material that may activate the immune system in infected patients, and new research published in PLOS Pathogens suggests that lower levels of these molecules could increase flu severity.

Influenza is particularly dangerous for infants, the elderly, and people with underlying medical issues, but otherwise-healthy people sometimes experience severe infection, too. This suggests that, among the multiple strains that circulate yearly, some are more virulent than others. Markers of severity have been found for specific strains, but a general marker that applies to multiple strains would be more useful to inform treatment and policy.

To identify such a marker, Ana Falcón of the Spanish National Center for Biotechnology, Madrid, and colleagues focused on defective viral genomes (DVGs). These molecules, which consist of pieces of viral RNA with missing genetic information, are found in multiple strains of flu virus. Previous research suggests that DVGs activate the immune system in infected animals, and thus might restrict severity.

To test whether DVGs could serve as a general marker of flu severity, the researchers infected both mice and human tissue cell cultures with different strains of influenza A H1N1 virus—the subtype responsible for flu pandemics. They found that strains resulting in lower levels of DVG accumulation in the cell cultures also produced more severe infection in the mice.

The research team also analyzed the genomes of viruses isolated from respiratory samples taken from people who experienced severe infection or death during the 2009 “swine flu” pandemic or later “swine flu-like” seasons. They found that the H1N1 strain that caused severe symptoms had significantly less DVG accumulation than influenza A strains sampled from people who experienced only mild symptoms.

Together, these results suggest that low levels of DVGs may indicate greater risk of severe disease in patients infected with influenza A virus.

Flu shot manufacturing forces influenza virus to mutate. According to a new study from scientists at The Scripps Research Institute (TSRI), the common practice of growing influenza vaccine components in chicken eggs disrupts the major antibody target site on the virus surface, rendering the flu vaccine less effective in humans.

“Now we can explain—at an atomic level—why egg-based vaccine production is causing problems,” says TSRI Research Associate Nicholas Wu, PhD, first author of the study, published recently in the journal PLOS Pathogens.

For more than 70 years, manufacturers have made the flu vaccine by injecting influenza into chicken eggs, allowing the virus to replicate inside the eggs, and then purifying the fluid from the eggs to get enough of the virus to use in vaccines.

The subtype of influenza in this study, called H3N2, is one of several subtypes shown to mutate when grown in chicken eggs, and the researchers say the new findings further support the case for alternative approaches to growing the virus. “Any influenza viruses produced in eggs have to adapt to growing in that environment and hence generate mutations to grow better,” explains study senior author Ian Wilson, PhD.

The new study shows exactly why egg-based manufacturing is a problem for the H3N2 subtype. As H3N2 influenza has become more prevalent, scientists formulating the seasonal flu vaccine have sought to include this virus and teach the human immune system to fight it. Despite this effort, recent flu vaccines have proven only 33 percent effective against H3N2 viruses.

Wu used a high-resolution imaging technique called X-ray crystallography to show that, when grown in eggs, the H3N2 subtype mutates a key protein to better attach to receptors in bird cells. Specifically, there was a mutation called L194P on the virus’s hemagglutinin glycoprotein (HA). This mutation disrupts the region on the protein that is commonly recognized by our
immune system.

This means a vaccine containing the mutated version of the protein will not be able to trigger an effective immune response. This leaves the body without protection against circulating strains of H3N2. In fact, Wu’s analysis shows that the current strain of H3N2 used in vaccines already contains this specific mutation L194P on HA.


Scientists link pancreatic cancer survival to four genes. Alterations in four main genes are responsible for how long patients survive with pancreatic cancer, according to a new study in JAMA Oncology.

Before now, the presence and patterns between the genes and disease progression were not clearly established. One key difference in this study is the relatively large size: it involved 356 patients who all had pancreatic adenocarcinoma that could be surgically removed. Adenocarcinoma is by far the most common type of pancreas tumor.

Ninety of the patients were treated at the University of Rochester Medical Center’s Wilmot Cancer Institute, the others at Dana Farber/Brigham and Women’s Cancer Center in Boston and Stanford Cancer Institute. In all cases, after the tumors were removed, scientists extracted DNA from the cancerous tissue and nearby normal tissue, and conducted next-generation DNA sequencing on the specimens.

The analysis centered on the activity of the KRAS, CDKN2A, SMAD4, and TP53 genes. Results showed that patients who had three or four of the altered genes had worse disease-free survival (the time between surgery and when the cancer returns), and overall survival (from surgery to death), compared to patients with a single or two altered genes. A more detailed breakdown of survival and specific gene activity is available in the full study.

Pancreatic cancer generally has poor survival odds. Patients who can undergo surgery as part of treatment often survive longer, and some patients fare best when they can receive chemotherapy prior to surgery. Having customized molecular information will provide an even greater understanding of how the disease is likely to progress in each patient.