Vaccine shortage threatens yellow fever response

 Limited supplies of the yellow fever vaccine is stalling full response efforts to the yellow fever outbreak in parts of Africa It takes six months to develop the vaccine. Confronted by acute shortage of vaccines to protect millions potentially at risk of yellow fever, public health officials are struggling to manage the disease outbreak in Angola and the Democratic Republic of Congo, even as worries that the virus could spread are making the rounds.
 The prevailing yellow fever transmission has been explosive and has rapidly exhausted global emergency stockpile of at least six million vaccine doses.
It is feared that a second outbreak in a densely populated country could deplete the dangerously low vaccine supply. Currently, experts are anxiously watching the progress of the outbreak and are concerned it could spread to countries that have never faced large scale outbreaks of the virus before and therefore have little natural immunity.
 As a stop-gap measure aimed at providing at least some protection, the World Health Organization (WHO), is vaccinating14 million people against the disease in 8,000 locations by diluting the vaccine to one-fifth the dose.
 Millions have already been vaccinated with a full dose of the protective yellow fever vaccine that provides lifelong protection, but as supplies have dwindled, health officials are implementing the emergency measure that involves diluting the vaccine further so that it will provide protection for one year.
 Health experts say the current vaccination plan may be inadequate to protect enough people, hence they have warned that the virus could spread and possibly reach densely populated regions in Africa and Asia, where the disease could rapidly become endemic.
 "Protecting as many people as possible is at the heart of this strategy. With a limited supply we need to use these vaccines very carefully," said William Perea, Coordinator for the Control of Epidemic Diseases Unit at WHO said in a statement.
 Yellow fever "transmission in 2016 has been explosive and rapidly exhausted the usual global emergency stockpile of at least six million vaccine doses. But a second outbreak in a densely populated country could deplete the dangerously low vaccine supply.
 Since December 2015, the yellow fever outbreak has infected over 5,000 persons with over 400 deaths in Angola and the Democratic Republic of Congo. The disease is spread by mosquitoes, especially the Aedes aegypti mosquito that also spreads Zika virus.
 Symptoms of yellow fever include fever, chills, severe headache, back pain and nausea; the virus has been fatal in approximately 20 percent of cases. Health officials are fighting the virus on two fronts, by treating people and reducing mosquito populations so it doesn't spread across the continent or globe.
Researchers from the Centers for Diseases Control and Prevention said: "This epidemic in the three countries and its introduction to seven other countries illustrates how all countries are connected and that a threat in one country is a threat everywhere."
 It is believed that Yellow fever is "tenacious" and the number of cases in Africa is probably far higher than what had been reported.
 About 99 per cent of people develop immunity within one month of vaccination with the Yellow fever vaccine, which is a live-virus vaccine that has been used for several decades. A single dose provides lifelong protection for most people.

New layers of immunity found in TB/HIV co-infections

Researchers at the Tulane University have discovered that some monkeys whose immune systems are depleted by the Simian strain of HIV have a second line of defense against tuberculosis. 

The research led by Deepak Kaushal, a Professor of Microbiology and Immunology at the Tulane National Primate Research Center,  said it could have significant impacts on future vaccines for TB. 

People co-infected with Mycobacterium tuberculosis (Mtb) and HIV are up to 20 times more likely than people without HIV to develop active, clinical tuberculosis over their lifetimes. 

HIV targets CD4 T cells and researchers believe depletion of those cells, the first layer of immune response, drives up the progression of TB. Currently, most vaccines being developed for TB only target the CD4 arm of immunity.

Kaushal's research team exposed macaques to Mtb and simian immunodeficiency virus (SIV) to replicate human co-infection. They discovered one-third of the animals maintained latent TB despite complete loss of lung CD4 T cells. 

A study of the lung tissue revealed CD8 cells and B cells both worked to provide immunity against active TB.

Kaushal says future vaccines for tuberculosis should try to elicit immune responses from not only CD4 cells but also CD8 and B cells.

"This monkey model is the closest we can get to the human environment of these two diseases," Kaushal says. "This discovery is important because it lays out the whole gambit of the different immune functions that are required for an optimum response."

The research revealed a sub-population of macaques better able to fight TB and HIV co-infection, and Kaushal says it can be presumed this sub-population of humans also exists. He believes the difference is genetic.

Kaushal hopes to continue the research and move on to the next step of developing a vaccine. "Our job now is to find out the mechanism of why these differences occurred," Kaushal says.

The findings are published in the Proceedings of the National Academy of Sciences,

My mandate is my interest, new NCDC boss declares

Dr Chikwe Ihekweazu

The newly appointed National Coordinator, Nigerian Centre for Disease Control, NCDC, Dr. Chikwe Andreas Ihekweazu has charged staff of the Centre to be more alive to their responsibilities and brace up to the challenges of the times so as to tackle emerging infectious diseases in the country.

Ihekeazu who made the call Monday in Abuja while taking over the mantle of leadership from his forebearer, Professor Abdusallami Nasidi, said he would operate an open door policy, bereft of impartiality irrespective of religion, tribal and political leanings.

"Today is the beginning of the journey; I invite you to join us on this journey with open minds so that we can deliver our mandate. I am not interested in anything else rather than the mandate Mr. President gave me."

Ihekeazu assured that he would consolidate on the achievements left by his predecessor adding that he would not leave any stone unturned to making sure that the gains achieved so far are sustained.

Commending the pioneer National Coordinator of the Centre for his leadership qualities and active role in establishing the NCDC, the Ihekweazu assured that the Centre would continue to tap from his wealth of experience of the founding father.

Earlier, Nasidi, who is now the acting Executive Director, Eco­nomic Community of West African States, ECOWAS, Re­gional Surveillance and Dis­ease Control Centre, RCDC, thanked President Muhammadu Buhari for appointing capable hand to take over the leadership of the NCDC.

He, however, urged staff of the Centre to extend the same cooperation and support to his successor.

To end malaria, Africa must commit more resources

— Joy Phumpahi, Executive Secretary, African Leaders Malaria Alliance (ALMA)

Joy Phumpahi is the Executive Secretary of the African Leaders Malaria Alliance (ALMA), an alliance of 49 African Heads of State and Government working to eliminate malaria by 2030. She was formerly Health Minister of Botswana, which has achieved a huge reduction in malaria transmission and deaths in recent years. 
During a recent teleconference Phumpahi talks about  the new road map to eliminate malaria known as the Catalytic Framework to End AIDS, TB and Eliminate Malaria in Africa By 2030 and its implications. She also highlights specific issues of malaria eradication in Nigeria and other African countries. Excerpts:

Role of ALMA
We’re at a pivotal moment in the fight against malaria. For the first time in the history of this fight against malaria, a malaria free Africa is actually in sight.
ALMA has played a critical role, not only in bringing African leaders together, and getting them to support efforts in their own countries… it has also developed an accountability and action tracking mechanism. This enables Heads of State to monitor performance of their own countries and the neighbours”.
 Despite the progress in the fight against malaria, 395,000 Africans were killed by malaria last year – most of them were children under the age of 5. “It is a real attack, not just of the livelihoods, but also the economies of our countries”.

 Catalytic Framework
 The Catalytic Framework builds upon the progress made during the MDG period. It clearly delineates the roles and responsibilities of every stakeholders, the key areas of focus, the targets and outcomes.
 It clearly also stipulates the role of research and new technologies, and how we can make them available. It also outlines for us the role of all of us in financing the Catalytic Framework.
While resources have been invested in the fight against malaria in the MDG era, we will have to more than double the resources as we work towards elimination. We are expecting a lot of resources to come out of the domestic arena – from the public sector and the private sector. There will be need for a new focus on those mobilizations.

Issues surrounding malaria vaccine
 We could definitely move faster – that goes without saying. But we must appreciate that we’ve moved extremely fast. We achieved considerable progress in the last 10 years of the MDGs – especially in the final 5 years.
 Now we are putting all of the interventions into play, and scaling-up. The real challenge is sustaining universal coverage - “If you’re spraying, you have to spray every year”.
 “What slows us down is when we’re not able to sustain the gains we’ve made”.
In a lot of cases, it’s not just about funding – it’s about the efficiency of our health systems. How fast we are able to procure, diagnose etc.
How much is needed? There are many different estimates. At least twice what was invested in the MDGs – we have to double our investment.

Impact of  Framework on malaria eradication efforts in Nigeria 
We have 15 countries that carry the bulk of the infections, and Nigeria is among the top three. The biggest challenge in Nigeria is achieving universal coverage and sustaining it. Nigeria is in dire need of additional resources for next year – 2017 – in order to fund the replacement of medicines, and sustain treatment.
The previous government explored the possibility of setting up a malaria bond – this is one thing the current government is looking at as an option to meet the funding gap they will have next year.
Nigeria also faces the challenge of weak systems – logistics and procurement. Nets manufactured do not meet WHO standards – companies need help to meet the WHO’s pre-qualification standards.

Accountability of governments
We have developed a tool at the national level – the ALMA scorecards. They contain smart actionable indicators, which help people identify where the key bottlenecks are. We do this on a monthly and quarterly basis.
This has been extremely helpful, and many African leaders have asked this to be done for maternal and child health.
We have also adapted this tool for use with malaria at a sub-national level.

Malaria and funding under SDGs
“We have to focus on efficiency gains. Efficiency gains in health can enhance outcomes by as much of 40 percent” This is the result of a study undertaken by the World Bank and DFID.
Funding is also a huge challenge. With over 160 targets in the SDGs, maintaining malaria as a priority is a challenge.
A study has been done by a group of 100 economists and about 17 Nobel Laureates, brought together by the Copenhagen Consensus, and they have taken all of the SDG targets, and rated them on a scorecard according to which one gives you the best return on investment. The malaria target has one of the highest returns on investment – especially investment on prevention and treatment of malaria. For every $1 you invest, you get $34 in return.
We are not saying that the fight against malaria is more important than the other targets. But, given the rate of return, if you are able to control malaria as quickly as possible, you will actually free up resources to effectively target the other SDGs. That is the strongest argument.

Investments in health in line with Abuja Declaration  
One of the tools that the Africa Union has decided to introduce into the Catalytic Framework is a scorecard on domestic financing. It shows, not only the amount of public expenditure allocation, but as a percentage and per capita spending on health in the country. All three of these recommended indicators are necessary.
 Very few countries already met the criteria of the Abuja Declaration. One of the countries that stands out is Swaziland, which has met all the three criteria. Using multiple measures to assess performance is going to be important.

ALMA’s expectations
At ALMA, we are going to embrace this AU tool, and report on what each countries is actually doing on a quarterly basis. In the end, this is an African challenge. Africa itself has to be the key funder and the key partner in resolving this challenge.

ALMA would like to partner more actively with the media going forward, now we’re in the SDG era. It is good to have the conversation with members of the media on how we can more actively engage with you, country-by-country, to make you active participants in this war. The elimination of the disease requires total engagement by all stakeholders.

Specialists call for more research on liver disorders

General Yakubu Gowon (Rtd) 

The fight against Hepatitis and other liver disorders in Nigeria received a major boost at the Annual General Meeting of the Society for Gastroenterology and Hepatology in Nigeria, SOGHIN, held in Lagos recently. 
The forum brought together specialists in the management of diseases of the gastrointestinal tract and ancillary organs including the liver.
Former Nigerian head of State and Ambassador General for viral Hepatitis, Rtd General Yakubu Gowon, called for incisive national effort towards tackling the menace of hepatitis and related liver disorders.  
“I was shocked when I realized that close to 20 million Nigerians are infected with this disease and I still couldn’t imagine how we got this point ."
Gowon who was Special Guest, said Nigerians should rise up to the challenge as it did against Guinea worm and polio.
Speaking at the scientific conference during the AGM, President of SOGHIN , Professor Musa Borodo, stressed the need for comprehensive research  because diseases that are associated with the liver are wide and require knowledge and skills. 
“Sub-Saharan Africa has 75 percent liver disease and Nigeria has the largest population with over 23 million”, he said. 
Borodo added that “the neglect of the chronic Hepatitis B and C get into complication, showing symptoms like swollen up, vomiting blood ,yellow eye and tiredness. 
“These symptoms develop due to neglect and patience are advised to go to the Hospital for checkup and if positive, they should seek urgent medical attention”. Negligence he said can lead to liver cancer and the need, which is the need for the  public to be aware of the features and risk factors of the disease.
At the conference, the various presentations advised that the most important thing is for everyone to know their status, go for screening at least once in a while, if infected get treated, if not get vaccinated against been infected. Pregnant women are to go for regular screening for hepatitis so that infected mothers do not pass the virus to their unborn children. 
As a way to boost the campaign against viral hepatitis, SOGHIN in conjunction with the Federal Government joined other World Health Organisation countries to launch the guideline for hepatitis treatment in Abuja to mark World Hepatitis Day, aimed at achieving the global goal of eliminating the disease to ensure a hepatitis free world.

Nigeria making slow progress in exclusive breastfeeding

Nigeria is making progress in exclusive breastfeeding very slowly. Over 10 years, Nigeria has increased its exclusive breastfeeding rate from 12 per cent to only 25 per cent. By comparison, in 1994, both Ghana and Nigeria had both exclusive breastfeeding rates of 7.4, but by 2013 Ghana had moved up to 63 per cent. 

More than 5 million newborns in Nigeria are deprived of essential nutrients and antibodies that protect them from disease and death as they are not being exclusively breastfed. said UNICEF today, as it marks World Breastfeeding Week. 

Approximately 7 million children are born in Nigeria every year and, according to the 2014 National Nutrition and Health Survey, only 25 per cent are exclusively breastfed from 0-6 months of age.
Research notes that an exclusively breastfed child is 14 times less likely to die in the first six months than a non-breastfed child and that breastfeeding drastically reduces deaths from acute respiratory infection and diarrhoea; two major child killer diseases.
“We know that the pressure to give water to newborns in addition to breast milk is high. But the stomach of a baby is so small it can barely hold 60 millilitres of liquid and when it is filled with water, it leaves no room for breast milk and its life sustaining nutrients,” said Arjan de Wagt, UNICEF Nigeria Chief of Nutrition, on World Breastfeeding Week 2016.
“Babies who are fed nothing but breastmilk from the moment they are born until they are six months old grow and develop better. Breast milk gives a child a head start in life and a chance to fight child malnutrition later in life.”The National Food and Nutrition policy 2014- 2019 has a strong exclusive breastfeeding component and while UNICEF has welcomed the policy it urges the Government of Nigeria to include a budget line for nutrition in the health sector budget and a timely release of budget for immediate programming.
“Lack of exclusive breastfeeding is implicated in the current high rate of child malnutrition in Nigeria,’ noted Jean Gough, UNICEF Representative in Nigeria. “Exclusive breastfeeding is free and breast milk is readily available, so exclusive breastfeeding should be our first strategy in fighting child malnutrition,’ she noted.

‘We are seeing more men with bad, weak or abnormal sperms'

--Dr. Abayomi Ajayi, Medical Director, Nordica Fertility Centre, Lagos, Nigeria

Medical Director, Nordica Fertility Centre, Lagos, Dr. Abayomi Ajayi, speaks to Sola Ogundipe on the challenges of male factor infertility as a result of declining sperm quality. He proffers available solutions and and treatment options. Excerpts:

Dr Ajayi with winners of the maiden Nordica Media Merit Award

Sperm counts have dropped over the years. What is regarded as normal sperm count is going down, even the World Health Organisation, WHO is aware of this. 

We are seeing more men who are having bad sperms, weak sperms and abnormal sperms, and there is a real need to explore a suitable intervention to meet the growing proportion of men that need help in this direction. 

Initially normal sperm count was 40 million per ml. Then it reduced to 20 million per ml, now it is 10 million per ml and still going down. Over the last 10 years, we have seen a 30 percent decline in the sperm parameters of men who presented at Nordica Fertility Clinic, Lagos. That’s an average of 3.3 percent every year and it is as severe all over the world. 

A man can father a child up till age of 70 and for those who are fertile they remain fertile but everybody’s sperm count reduces eventually and there are other reasons especially environmental factors. 

The cells of men divide more than cells of women. That is why we reproduce into older age and people are saying that may actually be where the problem is from because with the division can come mistakes and probably that is why sperm count is getting worse by the day. 

But as bad as things appear, there is hope. The first step of any successful treatment is the proper diagnosis of the male infertility cause. 

Although IVF is taking care  of the problem of low sperm count and poor motility, it can only work when there are some sperm to be got from the man, but even if there is none,we can go to the testes to get it. But there are some cases that even then you are    not going to get anything, so donor sperm may have to be used. 

While there are efforts to develop artificial sperm in the laboratory from stem cells, it is still experimental, but there are so many technologies to manage sperm problems. We know sperms contribute to the quality of the embryo, so if there are poor sperms, the    quality of the embryo will be bad and there may be no pregnancy at all, or the pregnancy will be lost through miscarriage. 

The poorer the quality of the sperm, the higher the number of abnormal embryos from the IVF procedure. Now there is technology to check the DNA of the sperm so we can check the sperms with damaged DNA. 

The only thing the man contributes to fertilization is his DNA and if that code is already damaged, he will not be giving anything viable.”