News

��ֱ��Ƶ – Marburg outbreak in Rwanda declared over

lshpf1 — Fri, 20 Dec 2024 09:55:26 +0000

��ֱ��Ƶ – Marburg outbreak in Rwanda declared over by lshpf1 Fri, 12/20/2024 - 09:55

An outbreak of Marburg Virus Disease (MVD) in Rwanda has officially been declared over by the Government of Rwanda, with no new cases recorded since the last patient tested negative on 7 November 2024, according to the World Health Organization (WHO).

The Ministry of Health of Rwanda confirmed the country’s first outbreak of MVD on 27 September 2024. Cases of infection with the Marburg virus, a filovirus similar to Ebola, typically present with high fever and headaches, followed by vomiting, diarrhoea and haemorrhagic symptoms.

Marburg infections are often deadly, with case-fatality rates varying between 23% and 88%, depending on the outbreak and the level of medical care available in the region.

As a zoonotic disease, infections can occur following prolonged exposure to mines or caves inhabited by Rousettus bats, a type of fruit bat that carries the virus without showing significant symptoms. Once humans become infected, the virus spreads from person to person through direct contact with bodily fluids, such as blood, vomit, or saliva.

The countdown to declare the end of the MVD outbreak in Rwanda began after the last confirmed case received their second negative PCR results on 7 November 2024. The 42-day countdown period accounted for twice the maximum incubation period for Marburg virus infections.

In total, the outbreak comprised of 66 confirmed cases including 15 deaths, making this the third largest Marburg outbreak reported to date. Of these patients, 51 recovered and almost 80% of patients worked as healthcare workers in the region.

Response teams working to control the outbreak, supported by WHO, conducted over 7,408 Marburg virus tests, with approximately 100-350 samples being tested daily at the Rwanda Biomedical Center.

Daniela Manno, Clinical Assistant Professor at LSHTM, said: “This is a clear example of the benefits of outbreak preparedness. Health systems in Rwanda had robust outbreak response plans and enacted them swiftly, ultimately saving many lives.

“This Marburg outbreak has been particularly challenging due to its spread across multiple districts and a significant impact on healthcare workers. As with any highly virulent infection, healthcare workers are among those at the highest risk due to close contact with patients, particularly when the disease is not promptly identified and strict infection control measures are not adopted.

“This highlights the critical importance of early disease recognition and the implementation of appropriate infection control measures to protect frontline healthcare workers. Currently, no approved vaccine for Marburg virus exists, though several candidates are in various stages of development, offering hope as an additional tool to protect healthcare workers in the future.

“Countries at risk of Marburg outbreaks should remain vigilant, as factors like climate change, deforestation, and increased human-wildlife interaction may contribute to the risk of future outbreaks. Environmental changes are pushing people closer to habitats of bats, the natural carriers of the Marburg virus, increasing the chances of human exposure.

“To reduce future human infections and deaths, it is also essential to continue raising community awareness about the risk factors for Marburg virus infection, particularly human-to-human transmission, and the protective measures individuals can take to minimise their exposure to the virus.

“This includes encouraging anyone with symptoms to immediately contact the designated health authority or helpline to improve their chances of recovery and reduce the risk of community transmission.

“In this outbreak, 77% of patients survived, underscoring the importance of early medical care. Prompt treatment saves lives, and this message should be strongly emphasised within communities.”

During the outbreak, the UK-Public Health Rapid Support Team (UK-PHRST), a key international partner in epidemic disease response, responded to a Request for Assistance from the Global Outbreak and Response Network (GOARN) to support UNICEF in their role in strengthening the national response to Marburg virus in Rwanda.

Three UK-PHRST deployees, one from LSHTM and two from the UK Health Security Agency (UKHSA), were selected to provide expertise in social science, risk communication and community engagement and infection prevention and control. The deployment ran for nine weeks between October and December 2024.

Nadine Beckmann, Social Science Lead at UK-PHRST and Associate Professor in Social Science at LSHTM, said: “It was great to contribute social science expertise to Rwanda’s Marburg outbreak response efforts through a GOARN deployment with UNICEF.

“My deployment experience highlights the importance of collecting community-based qualitative data to target public health response measures effectively during disease outbreaks. Talking to those directly affected and most at-risk about their experience of the outbreak itself, and of the response interventions, helps create outbreak response measures that are based on what affected communities need in order to protect themselves from infection, and to seek care and treatment early.”

The UK-PHRST is an innovative partnership between UKHSA and LSHTM, funded with UK aid by the UK Department of Health and Social Care. It partners with low- and-middle income countries to respond to infectious disease outbreaks before they develop into global health emergencies.

Further LSHTM work

LSHTM continues to be involved in research projects that focus on improving outbreak preparedness for filovirus diseases, including Marburg. This includes studying the role of vaccines in controlling outbreaks and refining models that can provide insights during future epidemics. The ongoing work aims to improve rapid response capabilities and reduce the impact of future outbreaks, not only for Marburg but also for other high-risk viruses.

LSHTM Data Compass

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Introduction

LSHTM experts explain how a rapid response saved lives, and warn countries at risk of outbreaks to remain vigilant

Women more likely to need mobility aids but less likely to use them

lshpf1 — Fri, 13 Dec 2024 14:25:15 +0000

Women more likely to need mobility aids but less likely to use them by lshpf1 Fri, 12/13/2024 - 14:25

Women are more likely than men to experience mobility limitations that could benefit from mobility aids but are much less likely to use them when needed, according to new research.

The study, published in The Lancet Public Health, investigated which demographics might be more or less likely to use mobility aids – such as walking sticks or wheelchairs - when this type of equipment would help them to maintain independence and social engagement.

The authors say this highlights a gender inequality that needs to be addressed to improve an overlooked area of public health.

Researchers from the London School of Hygiene & Tropical Medicine (LSHTM) and UCL analysed survey responses from 12,080 participants aged 50-89 over 13 years (2006-2019), using data from the English Longitudinal Study of Ageing.

During that time, 8,432 participants reported having some mobility difficulty. Of these, 5,102 (61%) experienced unmet need at least once (not using a mobility aid despite experiencing difficulty), while 3,330 (39%) reported using a mobility aid at least once.

Women were 50% more likely than men to transition from not needing a mobility aid to unmet need status during the study period, but were 20% less likely to transition from unmet need to use.

Participants were considered to have a lower mobility limitation and need mobility aids if they reported difficulty with one or more of the following: walking 100 yards, climbing a flight of stairs without resting, kneeling or crouching, and/or getting up from a chair after sitting for long periods of time.

The study documented other demographic factors associated with a higher likelihood of needing a mobility aid, including lower educational attainment, unemployment or disability, and lower wealth. However, these demographics were also more likely to use mobility aids if they needed one, further underlining that gender is a key determinant of unmet need.

Shereen Hussein, senior author of the study and Professor of Health & Social Care Policy and lead of the Social Care Group at LSHTM, said: "This study underscores the critical need to address gender disparities in access to mobility aids, a vital yet often overlooked component of public health and disability inclusion.

“The research provides compelling evidence of gender disparities in accessing assistive technology, suggesting that cost, design bias, and social stigma are likely to disproportionally affect women. This underscores the need for inclusive, gender-sensitive approaches in the design, production and inclusivity of assistive technologies. These insights offer a valuable foundation for national and global policymakers to prioritise gender equity in ageing and disability policy developments."

Previous research from the UCL Global Disability Innovation Hub found cost is the biggest barrier to mobility aid use for both genders.

Jamie Danemayer, first author of the study from UCL Computer Science and UCL’s Global Disability Innovation Hub, said: “Though unmet need for mobility aids like walking sticks and wheelchairs is a prevalent global health issue, it’s unclear how non-clinical characteristics like age, gender, or socioeconomic position might make people more likely to experience unmet need.

“Our analysis suggests that there is a clear gender gap in access to mobility aids. Though our data didn’t ascertain the reason why participants weren’t using mobility aids, other research tells us that women are often more likely than men to face obstacles such as cost barriers as a result of well-documented income disparities between genders.

“Many mobility aids are designed for men rather than women, which we think may be a factor. Using mobility aids can also make a disability visible, which can impact the safety and stigma experienced by women in particular. There’s a critical need for further research to identify and break down the barriers preventing women from accessing mobility aids that would improve their quality of life.”

Professor Cathy Holloway, an author of the study from UCL Computer Science and UCL’s Global Disability Innovation Hub, said: “Not having access to mobility aids when a person needs one can have a big impact on their independence, well-being and quality of life. Our analysis suggests that women in particular, regardless of other factors such as education and employment status, are not getting the support that they need.

“I expect that the reasons why women are less likely than men to use mobility aids if they need one are numerous and the overall picture is probably complex. Further research in this area would help to identify where barriers can be removed.”

This study was funded by UK Aid as part of the Global Disability Innovation Hub’s AT2030 programme.

Publication

Jamie Danemayer et al. Demographic, socioeconomic, and social barriers to use of mobility assistive products: a multi-state analysis of the English Longitudinal Study of Ageing. The Lancet Public Health. https://doi.org/10.1016/S2468-2667(24)00243-3

This news story is based on an original press release from UCL.

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Introduction

Study highlights gender gap in access to equipment such as canes, walkers and wheelchairs

��ֱ��Ƶ – UK near to eliminating meningococcal C

lshkb29 — Wed, 11 Dec 2024 16:02:00 +0000

��ֱ��Ƶ – UK near to eliminating meningococcal C by lshkb29 Wed, 12/11/2024 - 16:02

Cases of meningococcal disease, known to cause meningitis and septicaemia, are continuing to decline in the UK, according to the UK Health Security Agency (UKHSA).

Meningococcal disease refers to invasive infection with the bacterium Neisseria meningitidis, also known as meningococcus, and cases usually spread through close or lengthy contact. There are 12 identified serogroups: groups B, C, W and Y were historically the most common in the UK.

The two main types of meningococcal infections are meningitis and bloodstream infections, known as sepsis. Both illnesses have a high mortality rate if left untreated, however these infections are preventable through protective vaccination.

Between July 2023 and June 2024, only three cases of meningococcal group C (MenC) disease were reported in the UK. This is a 99% decrease since the start of the UK’s National Health Service (NHS) routine vaccination programme in 1999.

Other groups of meningococcal disease, including A, W and Y, also remain very low in the UK but data shows that the decline in meningococcal Group B (MenB) cases has slowed. Experts believe this may be due to a drop in the uptake of childhood vaccinations, including the MenB vaccine, which is given to babies as part of the NHS’s Childhood Vaccination Programme.

Professor Liz Miller at the London School of Hygiene & Tropical Medicine (LSHTM) said: "The near elimination of meningitis C in England illustrates the power of vaccination and what can be achieved when research and public health communities work together for a common goal.

“The UK was the first country to introduce the meningitis C vaccine in 1999 and its success led the way for the development and successful introduction of a meningitis C vaccine in Africa.

“However there is no room for complacency as other bacterial strains continue to cause meningitis in the UK and globally, and renewed efforts are needed to achieve the WHO goal of defeating meningitis by 2030."

While the data from the UK demonstrates the positive impact of vaccination, meningitis still remains a major public-health challenge globally, with young children most at risk.

The highest burden of disease is seen in a region of sub-Saharan Africa known as the African Meningitis Belt, especially recognised to be at high risk of epidemics of meningococcal meningitis.

In April 2024, Nigeria became the first country to roll out Men5CV, a vaccine against five strains of the meningococcus bacteria: A, C, W, Y and X. Although research has shown that it is largely preventable with proper vaccination, there was a 50% jump in annual meningitis cases reported across Africa in 2023.

A key trial of the Men5CV vaccine was conducted in June 2021, led by a group of researchers at the Medical Research Council Unit The Gambia (MRCG) at LSHTM. The important data generated in this trial led to the WHO recommendation that all countries in the region should introduce the meningitis Men5CV vaccine into their routine immunisation programmes.

An earlier study convened by the World Health Organization (WHO) and led by researchers including from LSHTM, also found that WHO-recommended vaccines have provided the single greatest contribution to improved infant survival over the past 50 years. 

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Introduction

LSHTM expert explains why vaccinating children against meningococcal infections remains vital to protect against deadly disease

��ֱ��Ƶ - World Malaria Report 2024

lshkb29 — Wed, 11 Dec 2024 14:46:56 +0000

��ֱ��Ƶ - World Malaria Report 2024 by lshkb29 Wed, 12/11/2024 - 14:46

While there has been significant progress in malaria control across the globe, persistent challenges still remain including rising drug resistance, population displacement and emerging zoonotic threats, according to the World Malaria Report 2024 published by the World Health Organization (WHO).

The latest figures reveal that while 2.2 billion cases and 12.7 million deaths have been averted since 2000, malaria remains a significant threat, claiming nearly 600,000 lives in 2023.

Dr Bhargavi Rao, Clinical Associate Professor in Humanitarian Health and the incoming Co-Director of the Malaria Centre at the London School of Hygiene & Tropical Medicine (LSHTM), emphasised the urgent need to understand how malaria behaves in regions affected by conflict and climate instability.

She said: “The latest World Malaria Report highlights the threat of population displacement to controlling malaria - whether in areas of conflict or climate instability. We desperately need to better understand malaria dynamics in these contexts, to better target new and existing interventions for the communities most at need. Anticipatory action will be a critical tool in this battle, including using climate data to predict malaria peaks and outbreaks.”

Dr Roly Gosling, Professor of Global Health at LSHTM, commented on the growing concern of artemisinin resistance, which is spreading across borders particularly in Africa.

He said: “Our investments in malaria control and elimination have saved millions of lives globally, with Africa seeing the greatest benefits. However, as the World Malaria Report highlights, resistance to artemisinin is spreading across borders. This resistance jeopardises the effectiveness of Artemisinin Combination Therapies (ACTs), with parasites surviving longer in patients’ blood. While ACTs remain effective, urgent action is needed to prevent widespread treatment failure.

“The World Malaria Report emphasises the critical need for coordinated regional responses to artemisinin resistance. Countries where resistance is concentrated must be supported with mitigation plans, targeted interventions and progress monitoring. Urgent action in East, Southern, and the Horn of Africa is vital to halt cross-border resistance spread, and sustain malaria control and elimination progress globally.”

The report also underscores worrying trends in countries like Ethiopia, Madagascar, and Pakistan. In Ethiopia, diagnostic resistance, invasive mosquito species and human movement compound the challenges.

Dr Chris Drakeley, Professor of Infection and Immunity at LSHTM, said: “The rising incidence of malaria in Ethiopia, Madagascar, and Pakistan is deeply concerning. In Pakistan, extreme weather events are likely driving this increase, while in Ethiopia and Madagascar, multiple factors are at play. Ethiopia faces diagnostic resistance, drug resistance mutations, and the presence of elusive mosquito species, exacerbated by population movement. These challenges highlight the urgent need for sustained support and innovative control strategies.

“The growing burden of zoonotic malaria (P. knowlesi) in Southeast Asia further complicates elimination efforts. These cases, often tied to land-use changes, demand novel environmental control approaches. Maintaining diagnostic and clinical capacity in areas nearing elimination is crucial, and current definitions of malaria elimination may need revisiting to address this emerging threat.”

The latest World Malaria Report continues the mixed picture of previous years. While global malaria remains concentrated in high-transmission countries grappling with conflict and climate vulnerability, the report also highlights encouraging signs. For example, India, Liberia, and Rwanda have achieved significant case reductions, and Egypt, Africa’s third most populous country, is now malaria-free. The Greater Mekong Subregion is also nearing elimination, despite resistance challenges, and the rollout of new malaria vaccines such as RTS,S and R21 signal progress in vaccination programmes.

However, underserved groups including pregnant women, migrants and Indigenous peoples remain at risk. Rising threats such as drug resistance, invasive species (An. stephensi), and zoonotic malaria (P. knowlesi) jeopardise progress. The report also highlights climate-induced crises like Pakistan’s flooding and sharply increased cases in Ethiopia and Sudan, emphasising the urgency of addressing malaria in fragile contexts.

To address this slowdown in progress amid spiralling threats, the report highlights "The Big Push" framework to coordinate and prioritise access to interventions with a focus on equity, to strengthen political will and to catalyse funding to urgently change the narrative on malaria.

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Introduction

LSHTM experts share insights on the actions needed to slow the global spread of malaria

COP29: Implications for health and the path ahead

lshpf1 — Fri, 29 Nov 2024 13:56:10 +0000

COP29: Implications for health and the path ahead by lshpf1 Fri, 11/29/2024 - 13:56

Agreements made at COP29 fell short of the ambition and focus needed to fully address the impacts of climate change on health and maximise the benefits of action, according to experts from the London School of Hygiene & Tropical Medicine (LSHTM).

As the dust settles on the 29th UN Climate Change Conference in Baku, they acknowledged some progress towards integrating health into the climate agenda, but said significant shortfalls remained.

At COP29, LSHTM researchers called for proper financing for climate action to protect health, and highlighted the need for a just transition to net zero, taking into account current and historical inequalities in carbon emissions.

By the end of the two-week negotiations, richer countries agreed to provide $300 billion a year to poorer countries by 2035 to support their efforts to tackle climate change. While hailed by some leaders as a step in the right direction, the agreement falls well short of the $1.3 trillion that developing countries were calling for, and will have significant implications for the health and livelihoods of people living in climate-vulnerable countries that often have the least resources to adapt and transition to a low-carbon economy.

Commenting on the outcome, Shakoor Hajat, Professor of Global Environmental Health at LSHTM and COP29 delegate, said: “The amount committed in the new agreement is certainly disappointing, but also doesn't make clear whether this will be grants or loans. Many of the most climate vulnerable countries already pay more servicing existing loans from other countries than they do on their own health systems. The COP29 agreement must only be a starting point for further negotiations and the additional finance needed to save lives.”

Speaking at a pre-COP event hosted by LSHTM, Dr Vanessa Kerry, Founder of SEED Global Health, WHO Director-General Special Envoy for Climate Change & Health, and LSHTM alumna, also emphasised the importance of highlighting the economic costs of the health impacts of climate change.

Members of the health community have said the outcome of the finance agreement at COP will fail to protect millions of lives, especially those most vulnerable to the impacts of climate change, such as developing countries and small island nations.

In addition to finance, a key focus of COP discussions is around commitments to climate change mitigation, or actions to transition away from fossil fuels and reduce the amount of greenhouse gases entering the atmosphere. During side events at COP29, LSHTM researchers and partners of the Pathfinder Initiative called for the urgent need to cut greenhouse gas emissions across all sectors. They highlighted the overwhelming evidence of near-term health benefits through reduced air pollution from fossil fuel phase out, more sustainable diets, and increased physical activity from promoting active transport.

Despite ambitious statements from the COP29 Presidency on addressing mitigation, little progress was seen in the final agreements, with some unresolved discussions postponed to COP30.

Rachel Juel, who represented the Children, Cities and Climate Action Lab, LSHTM and YOUNGO at COP29, said: “Postponing discussions delays critical climate action and costs lives. Urgent action is needed to create the systemic change we need to tackle the climate crisis and protect health. Most critically, action must be led by developed countries, who are currently failing to take full responsibility in leading the transfer of climate finance to developing countries, increasing the already disproportionate burden of climate impacts on countries on the frontline.

“Despite this, there were some small steps signalling progress for health. Parties received quality criteria for integrating health into Nationally Determined Contributions, and the Global Goal on Adaptation included specific language on cross-cutting indicators related to the health of children and young people, and specific indicators that capture information about human rights (including health), and people that are typically at increased risk of ill-health due to climate change, such as those living with disabilities, migrants, children, young people, and Indigenous Peoples.”

Outside the official negotiations, momentum in the climate and health intersection continued to grow. The World Health Organization (WHO) launched the COP29 Special Report on Climate Change and Health, highlighting health as the argument for climate action, and outlining priorities from the global health community for governments, policymakers and other sectors to put health at the centre of climate solutions.

On Health Day (18 November), the Baku COP Presidencies Continuity Coalition for Climate and Health was established, co-led by the United Kingdom, Egypt, United Arab Emirates, Azerbaijan and Brazil, in partnership with the WHO. This initiative aims to bridge efforts across COP presidencies to drive global climate-health initiatives, and ensure that health remains central in climate discussions towards COP30 in Belém.

Speaking at an event hosted by the Wellcome Trust at the UK COP29 Pavilion on ‘The Road to Belém: Connecting Health, Science and Indigenous Knowledge’, Hugh Sharma Waddington, Assistant Professor at LSHTM shared findings from the Pathfinder Initiative on the health benefits and cost-effectiveness of nature-based solutions, as well as highlighting evidence on the health benefits of cross-sectoral actions.

Dr Sharma Waddington said: “Evidencing the growing health impacts of climate change and the major near-term health benefits of action, and communicating this to decision makers is key as we look ahead to COP30 and beyond. We need to keep pushing for health to be at the centre of climate action and highlighting solutions that work for both people and the planet.”

During a panel discussion on ‘Advancing climate action for health at COP29 and beyond’ at the pre-COP LSHTM conference, Sarah Whitmee, Assistant Professor at LSHTM, said: “What we need to push for beyond this COP is to branch out beyond the healthcare sector. We need to engage with ministers from across transport, energy and finance sectors. As a research community, we need to provide evidence on both the cost of inaction, and the health benefits of effective climate solutions.”

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Introduction

LSHTM researchers reflect on the outcomes of COP29, and what they mean for the future of climate and health

��ֱ��Ƶ - Why conversations around men’s health aren’t just for November

lshkb29 — Mon, 25 Nov 2024 09:14:17 +0000

��ֱ��Ƶ - Why conversations around men’s health aren’t just for November by lshkb29 Mon, 11/25/2024 - 09:14

Globally, the month of November is associated with campaigns to raise awareness and encourage conversation around men’s health, particularly on topics such as prostate cancer, testicular cancer, mental health and suicide prevention.

In the UK, around 1 in 4 adults will experience a diagnosable mental health condition in any given year and current 2024 figures suggest that 1 in 7 rate their mental health either as bad, or the worst it has ever been.

Although mental health conditions can affect anyone, suicide is the leading cause of death for men under the age of 50 in the UK, accounting for three quarters of all deaths by suicide.

Men are less likely than women to access psychological therapies, making up only just over a third of referrals to the UK’s National Health Service (NHS) talking therapies. Compared to women, men in the UK are also more likely to go missing and make up almost 90% of rough sleepers.

Abhijit Nadkarni, NIHR Professor of Global Health Research at the London School of Hygiene & Tropical Medicine (LSHTM), said: “Depression affects men in unique ways, which has significant implications for diagnosis and treatment.

“While women are more frequently diagnosed with depression, men are up to three times more likely to die by suicide in the UK alone. Disparities between depression diagnoses in men and women may be partly due to social stigma, which has been shown to reduce help-seeking behaviours among men.

“Men living in deprived areas are also substantially more likely to have depression compared to those in non-deprived areas, highlighting the impact of environmental factors.

“The most effective way we can address these issues is by making psychological services more accessible and adopting collaborative care models tailored to men's needs. Non-stigmatising platforms of care, such as community support groups, can facilitate access to treatment by providing safe spaces for men to address mental distress.”

Petra Gronholm, Assistant Professor at the Centre for Global Mental Health at LSHTM, said: “Men’s mental health struggles often go unrecognised or undiagnosed, as they are much less likely than women to open up to those around them about how they’re feeling or to seek help.

“We know that stereotypes around women’s looks and behaviour are extremely damaging and it’s important to recognise that stereotypes also affects men. Mental health stigma and societal expectations of masculinity both attribute to why men may be more likely to suffer in silence. Traditional gender roles, toxic masculinity, and skewed expectations around how men should display emotion often lead to a fear of being judged or appearing weak. It is completely incorrect to assume that men do not struggle with their mental health as much, simply because they are often portrayed, or expected, to be ‘strong’.

“As men are typically less likely to ask for help they may, in turn, be more likely to use harmful coping methods instead, such as drugs or alcohol, or use escapist behaviours, such as fixating on work or hobbies. This can then mean that early indicators are potentially suppressed for longer periods of time before help is sought. For example, men are more likely than women to be detained under the Mental Health Act in the UK; a requirement to stay in a hospital for treatment or assessment due to risk to self or others from an urgent mental health concern.

“While monthly campaigns continue to be extremely important in raising awareness and encouraging conversations around topics that are often seen as ‘taboo’, it’s vital that conversations around physical and mental health happen year-round. If you are facing challenges with your mental health, remember that you are not alone. It may feel as though talking about it is a sign of weakness but that could not be further from the truth.

“A good first step is to learn about mental health conditions through resources online, such as the World Health Organization’s toolkit to end stigma, or to explore local services. Reaching out to a trusted friend or family member to share how you are feeling can also be an important step forward.”

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Introduction

LSHTM experts explain how stigma continues to significantly impact conversations around men’s mental health

Patients with cancer favour evidence of success over quick drug approvals

lshkb29 — Wed, 20 Nov 2024 11:03:19 +0000

Patients with cancer favour evidence of success over quick drug approvals by lshkb29 Wed, 11/20/2024 - 11:03

Patients with cancer could be willing to wait for greater certainty of the benefit of new cancer drugs before they are formally approved by regulators, according to new survey results.

The study, led by researchers from the London School of Economics and Political Science (LSE) and the London School of Hygiene & Tropical Medicine (LSHTM), enrolled over 850 people in the United States (US) to take part in the survey, where participants were asked to make a series of hypothetical choices between potential cancer drugs.

In the US, new drugs or medicines are approved by the US Food and Drug Administration (FDA). As part of their evaluation, the FDA is faced with a trade-off between approving new drugs quickly or delaying approval until there is certainty about the clinical benefit they provide. In recent years, the FDA’s accelerated approval pathways have drawn criticism from some doctors and experts who have questioned whether the right balance is always struck between speed and certainty.

Previous research has also shown that most cancer drugs approved through the FDA’s accelerated approval pathway do not help patients with cancer to live longer.

Participants enrolled in the survey had either been diagnosed with cancer themselves or knew a close friend or family member previously or currently diagnosed with cancer. Researchers were able to model their choices to find out what was most important to individuals regarding new cancer drugs and how long they would be willing to wait to ensure a new drug provided meaningful clinical benefit.

The study, published in The Lancet Oncology, is the first to provide an estimate of the duration individuals would be willing to wait for greater certainty. Depending on their health status and other factors, individuals indicated they would prefer to wait up to 22 additional months to be sure a medicine worked before it was approved by the FDA.

Ajay Aggarwal, Consultant Clinical Oncologist and Professor of Cancer Services and Systems Research at LSHTM, and co-author of the study, said: “As an oncologist, providing new treatment options for patients with cancer that offer meaningful improvements in survival and quality of life is critical, however expediency should not come at the cost of robust evaluation especially when we know many drugs often fail to offer the benefits that patients themselves hope for.”

Robin Forrest, a researcher in LSE’s Department of Health Policy and lead author of the study, said: “People with experience of cancer value faster access to new cancer drugs, particularly when they have limited treatments available. But when faster access comes at the expense of certainty that a drug extends survival, then this might not always the case.”

Dr Huseyin Naci, Associate Professor of Health Policy at LSE and senior author of the study, said: “These results show that patients are not willing to access new cancer drugs at any cost. Some participants expressed their potential willingness to wait longer than necessary to run clinical trials and achieve greater certainty on the clinical benefit of new cancer drugs.”

Moving forward, the authors call for increased transparency and justification for the use of accelerated approval for cancer drugs, and a greater emphasis on outcomes that are most important to patients in the drug approval process.

Publication

Robin Forrest, et al. Preferences for speed of access versus certainty of the survival benefit of new cancer drugs: a discrete choice experiment. The Lancet Oncology. https://doi.org/10.1016/S1470-2045(24)00596-5

This news story is based on an original press release from the London School of Economics and Political Science (LSE).

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Introduction

New US survey suggests not all patients want faster cancer drug approvals without certainty they work

LSHTM expert tells Ukraine school meals programmes can help countries rebuild

lshpw5 — Tue, 19 Nov 2024 16:13:54 +0000

LSHTM expert tells Ukraine school meals programmes can help countries rebuild by lshpw5 Tue, 11/19/2024 - 16:13

First Lady Olena Zelenska welcomed European ministers and experts to Kyiv, Ukraine for the European School Meals Summit (12-13 November 2024) to discuss the collective goal of ensuring every child has access to a nutritious meal at school by 2030.

This ambitious goal is that of the School Meals Coalition (SMC) – a global government-led alliance of more than 100 countries committed to strengthening and scaling up their national school meals programmes as an investment in the future of their schoolchildren.

At the summit, hosted by Ukraine’s School Nutrition Reform team, Professor Donald Bundy, Director of the Research Consortium for School Health and Nutrition based at the London School of Hygiene & Tropical Medicine (LSHTM), chaired a panel discussion with European finance ministers on the impact of school meals on the economy.

Professor Bundy said: “There is a growing body of evidence that school meals are a powerful vehicle for economic development. Having once only been understood as a way of ensuring the most vulnerable children don’t go hungry, we now know school meals are much more than a plate of food – with the potential to promote child wellbeing, improve learning outcomes, boost local agricultural practices, and ultimately contribute to the creation of a nation’s human capital. This is important for all countries, but no more so than for countries preparing to rebuild from crisis.”

The Research Consortium for School Health and Nutrition is the research initiative of the SMC, established to support member states to optimise their national programmes through the provision of independent evidence on the design, implementation, and impact of school meals and complementary school health services.

Hosted for the first time in Ukraine, who joined the School Meals Coalition in 2023, the European Summit was an opportunity for key decision-makers from 20 European countries to share their experiences and learn from best practice – including hearing from Ukraine’s School Nutrition Reform team on its experience of strengthening Ukraine’s school meals programme during times of war. Discussions focused on understanding the unique benefits of school meals across several sectors, including health, education, social protection, and agriculture – with leaders committing to greater multi-sectoral collaboration at the local, national, and regional levels.

Ukraine’s School Nutrition Reform was initiated by First Lady Zelenska in 2020 as part of a broader government effort to rebuild the national education system, which had been in steady decline since the dissolution of the Soviet Union in 1991. In 2022, following the outbreak of the war with Russia, school meals took on a new dimension – as a long-term resilience-building intervention to support the future wellbeing and prosperity of the country.

Opening the Summit, First Lady Zelenska said: “I first became interested in school food through my wish to ensure that all children, including my own, are appropriately supported during the five days a week, for nine months of the year, that they spend in school. This concern became critical when considering the importance of food reliability in a time of war.

“Food is a significant factor in academic and life success. That’s why we first brought many different institutions together at one table: the Ministry of Health, the Ministry of Education and Science, the Ministry of Economy, representatives of civil society organizations, including nutrition experts, chefs, doctors, nutritionists, and dietitians – and we started taking action, step by step.”

First Lady Zelenska speaking at the summit in Ukraine.

Since 2022, Ukraine has embarked on several initiatives to continue to accelerate its School Nutrition Reform and scale up its school meals programme towards universal coverage, including formally joining the School Meals Coalition in October 2023.

In that time, the Research Consortium for School Health and Nutrition has supported Ukraine in its mission to reach every child in the country with a nutritious meal, through the development of an evidence-led policy brief with the WHO and the creation of a case study documenting the organisation of the current Ukrainian school meals programme.

Professor Bundy said: “The Research Consortium looks forward to continuing to support Ukraine and all countries of the School Meals Coalition to gain a deeper understanding into their national programmes. Through our Global Academy of more than 1,000 experts based in over 90 countries worldwide, we are committed to building a truly global evidence base on what makes a successful school meals programme in various economic, political, environmental, and cultural contexts – including those experiencing conflict, and those simply seeking to give their schoolchildren the best start in life, as an investment in the future of their country.”

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Introduction

School Meals Coalition supports Ukraine investing in school meals to support country’s future prosperity

��ֱ��Ƶ – Measles cases increase by 20% globally

lshkb29 — Mon, 18 Nov 2024 15:07:55 +0000

��ֱ��Ƶ – Measles cases increase by 20% globally by lshkb29 Mon, 11/18/2024 - 15:07

Measles infections are rising globally, according to new figures published by the World Health Organization (WHO). Since 2022, cases have increased by 20%, with an estimated 10.3 million infections recorded in 2023.

Measles infections are caused by one of the world’s most contagious viruses, Rubeola, and can be deadly. For those who survive measles, serious health effects can occur, some of which are lifelong. Infants and young children are at greatest risk of serious complications from the disease, which include blindness, pneumonia, and encephalitis, an infection which can causes brain swelling and subsequent damage.

Measles is preventable through two doses of measles vaccine, which has saved more lives than any other vaccine in the past 50 years. Yet, according to WHO, more than 22 million children missed their first dose of measles vaccine in 2023. Globally, an estimated 83% of children received their first dose of measles vaccine last year, while only 74% received the recommended second dose.

Coverage of 95% or greater of two doses of measles vaccine is needed in each country and community to prevent outbreaks. As a result of global gaps in vaccination coverage, 57 countries experienced large or disruptive measles outbreaks in 2023, affecting all regions except the Americas.

In January 2024, the UK Health Security Agency (UKHSA) declared the increase in UK cases of measles a national incident and initiated a public campaign to increase childhood vaccination against the disease.

Speaking about the reasons why cases may be increasing in the UK and more widely, Dr Ben Kasstan-Dabush, Assistant Professor in Medical Anthropology at the London School of Hygiene & Tropical Medicine (LSHTM), said: “Blaming parents for ‘vaccine hesitancy’ will not bring solutions to the declining levels of vaccine coverage we are seeing in the UK and internationally.  There are many other factors that need to be considered to ensure we develop a sustainable response to the challenges we are seeing.

“The links between declining childhood immunisation coverage and political decisions over the past decade need to be examined. Austerity has influenced the health and development of a generation of children across many countries. I would hazard to guess that it has reconfigured the ways that systems invest in public health and immunisation – whether that’s the funding available for the ‘where’ of vaccine delivery or the ‘how’ of communication about vaccines. These factors are crucial considerations when working in urban settings or with underserved communities, who may need additional support to participate in a routine immunisation programme.

“Declining rates of immunisation coverage have also been happening amidst an unforgiving cost of living crisis, characterised by a generational decline in living standards, and unequal pandemic recovery. There are clear links between deprivation and lower immunisation coverage because uncertainty affects so many aspects of a parent’s life.  

“The pre-austerity area often saw healthcare professionals discuss and deliver immunisations in Sure Start Children’s Centres, which were premised on improving child health and development at local levels. This saw immunisation packaged as part of a broader commitment to child, family and community wellbeing. High profile public health responses to the spread of polio and measles is a sign that the UK once again needs to develop an answer to the unacceptably high rates of child poverty and poorer child health outcomes that are plaguing our society.

“Our research at LSHTM is evaluating targeted outreach initiatives to try and boost vaccine uptake in London’s ultra-Orthodox Jewish community. We have seen vaccinations being offered as part of family fun days, alongside free toothbrushes for oral health, and diet and nutritional advice, because inequalities cause a domino effect. While it may not be possible to offer this as a standard service, the point is trying to offer vaccines as part of that bigger picture of a creating family-friendly service. To reverse the decline in vaccine uptake, immunisation services require sufficient resources to effectively engage communities and ensure capacity.

“The UK lost its World Health Organization (WHO) measles elimination status in 2019. Five years later, the prospect of re-gaining this status feels further away than ever.  The COVID-19 vaccination programme was a lesson for the UK Government in ‘putting money where your mouth is’ to bolster vaccine coverage and to address inequalities. Declining rates of immunisation coverage for diseases such as measles should be taken just as seriously as vaccine programmes during the COVID-19 pandemic and resourced appropriately.”

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Introduction

LSHTM expert explains why vaccines offered through family-friendly initiatives may be key to tackling resurgence in challenging global economy

First evidence of resistance to vital antimalarial in African children with severe malaria

lshkb29 — Thu, 14 Nov 2024 15:11:13 +0000

First evidence of resistance to vital antimalarial in African children with severe malaria by lshkb29 Thu, 11/14/2024 - 15:11

Mutations in malarial parasites linked to artemisinin-resistance in Southeast Asia have now been found in African children hospitalised for complicated malaria, according to a new study presented at the Annual Meeting of the American Society of Tropical Medicine & Hygiene (ASTMH).

It provides the first evidence that resistance to the lifesaving antimalarial drug may be emerging in the group of patients that account for most of the world’s deaths from malaria: young children in Africa with serious infections.

The study is published in the Journal of the American Medical Association (JAMA) and led by researchers from the Indiana University School of Medicine, Makerere University in Kampala, Uganda the University of Pennsylvania and the London School of Hygiene & Tropical Medicine (LSHTM).

The team found partial resistance to the malaria drug artemisinin in 11 of 100 children, aged 6 months to 12 years, treated in Uganda for a complicated case of infection by the malaria parasite Plasmodium falciparum. The term “complicated” malaria is used to define cases where the disease is at risk of causing potentially life-threatening complications, like severe anaemia or brain-related problems known as cerebral malaria.

The children in the study received what is considered to be the gold standard for treating complicated malaria infections: an intravenous infusion of artesunate, an artemisinin derivative, followed by an oral combination of artemether, another derivative of artemisinin, with a malaria drug called lumefantrine.

The introduction of artemisinin therapies 20 years ago was a major advance in malaria therapy due to their ability to treat cases quickly and came at a time when resistance was already being observed to other available treatments. The first evidence of partial resistance to artemisinin was reported in 2008 in Cambodia and by 2013, studies suggested the antimalarial was failing to treat some cases. Over the last few years, there has been increasing evidence that artemisinin-resistance may have spread into East Africa.

While all of the children in the study eventually recovered, 10 patients who were thought to have been cured also suffered a repeat malaria attack within 28 days from the same strain of malaria that caused the original infection, suggesting that the initial treatment did not fully kill the infecting parasites. Two children required longer than the standard maximum of three days of therapy because they failed to clear their parasites.

Colin Sutherland, Professor of Parasitology at LSHTM, and co-author of the study, said: “The WHO African region continues to shoulder the highest burden of malaria, with 95% of the total deaths recorded there in 2022.

“While studying the outcomes of children who experience episodes of severe malaria, we noticed that some children were slower to respond to treatment, which led us to look into resistance. Given that in Southeast Asia, evidence of partial resistance to artemisinin led to broadly resistant malaria parasites, our major concern is that this pattern will now be repeated in Africa.

“Children under the age of five make up the majority of fatal cases of malaria. We can’t afford to let resistance to vital antimalarials continue unchecked, without having effective replacements ready.”

Chandy John, Professor and Director of the Indiana University School of Medicine Ryan White Center for Infectious Diseases and Global Health, and one of the study's lead authors, said: “This is the first study from Africa showing that children with malaria and clear signs of severe disease are experiencing at least partial resistance to artemisinin.

“It’s also the first study showing a high rate of African children with severe malaria experiencing a subsequent malaria episode with the same strain within 28 days of standard treatment with artesunate, a derivative of artemisinin, and an artemisinin combination therapy (ACT).

“The fact that we started seeing evidence of drug resistance before we even started specifically looking for it is a troubling sign.”

In the study, the team classified patients as suffering from partial resistance based on the World Health Organization’s defined half-life cutoff for parasite clearance, whereby it takes more than five hours to reduce a patient’s parasite burden by 50%.

Publication

Ryan C. Henrici, et al. Artemisinin Partial Resistance in Ugandan Children With Complicated Malaria. JAMA. https://doi.org/10.1001/jama.2024.22343

This news story is based on an original press release from the American Society of Tropical Medicine & Hygiene.

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Introduction

Study suggests mutations linked to artemisinin-resistance are now being seen in most vulnerable malaria cases

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