Thermostable TB vaccine on the horizon

Dr. Aswin Doekhie with a vial of ensilicated protein

A promising TB vaccine can be protected from heat damage with Ensilication - a technique developed at the University of Bath. The method prevents crucial vaccine components from going bad outside of refrigeration, giving hope for the development of a thermally stable vaccine that can be reliably delivered to remote areas around the world.

A new TB vaccine is urgently needed to withstand ‘cold chain’ challenges, especially as up to 50 percent of vaccine doses are discarded before use due to exposure to suboptimal temperatures. Thermostable vaccines are priority research to the World Health Organisation’s Global Vaccine Action Plan 2011-2020.

Ensilication

Ensilication “shrink-wraps” vaccine proteins in position using layers of silica that build up into a cage around the molecules – so they don’t unravel when exposed to temperatures that would usually break them down. The proteins are held in place until ready to be removed from the silica cage and delivered.

The research team from the Departments of Biology & Biochemistry and Chemistry first demonstrated that the TB antigen ag85b and a vaccine fused with the adjuvant protein Sbi are sensitive to breaking down outside of refrigerated temperatures. They then showed that these vaccine components were protected from heat damage when ensilicated and kept on a shelf at room temperature for long periods of time without loss of structure and function.

This is the first time that ensilication has been used to improve the thermal stability of proteins in a vaccine setting, after proof-of-principle work using model proteins.

The results are a big step forward not only in developing thermally-stable TB vaccines, but in showing that ensilication could be used for many different kinds of vaccines.

“A new TB vaccine is really urgently needed to supplement or replace the existing BCG vaccine and reduce the number of TB cases and deaths – particularly as drug-resistant TB infections remain high,” said Lead author Prof Jean van Den Elsen.

First author Ayla Wahid, added: “To make the vaccine as effective as possible it needs to be thermally-stable, or in other words not spoil outside of a fridge, which is why we’re really encouraged by these results. Cold-chain storage leads to a lot of wastage and expense which could be avoided by ensilication.”

Dr. Asel Sarbaeva, who invented ensilication, added: “Our results reveal the potential of ensilication in storing and transporting life-saving vaccines at ambient temperatures globally – in particular to remote areas of developing countries where disease rates are often highest.

“With up to 50 percent of vaccines being thrown away, and refrigeration raising vaccine costs by up to 80 percent, this is a major global health challenge that we need to overcome. By demonstrating for the first time that ensilication works to protect vaccine-relevant proteins from breaking down outside a fridge, we’re a big step closer to achieving this goal.”

OPEN DEFECATION: Nigeria leads Africa, trails India

With 47 million persons defecating in the open, Nigeria  the worst open defecation country in Africa and second in the world after India.

The 2018 WASH National Outcome Routine Mapping, (WASH NORM) Survey, says 75 million Nigerians use unimproved toilets while only 1 in 4 Nigerians have access to basic toilets.

The survey conducted by the National Bureau of Statistics, NBS, Federal Ministry of Water Resources and the United Nations Children's Fund, UNICEF, also reveals that Nigeria loses N455 billion ($ 1.3 billion) annually due to poor sanitation.

Five other African countries rank among the worst 10 where open defecation is prevalent. They include Ethiopia (3rd), Niger (7th), Sudan (8th), Chad (9th) and Mozambique (10th). Other countries in the worst 10 are Indonesia (4th), Pakistan (5th), and China (6th).

Further,  the survey revealed that 90 percent of the 122, 000 Nigerians, including 87,000 children ged under 5, who die each year from diarrhoea, is directly attributable to lack of Water and Sanitation and Hygiene.

Remarking on the report, UNICEF’s Chief of Water Sanitation and Hygiene, WASH, Zaid Jurji, said Nigeria's losses constitute 1 percent of her GDP.

"Open defecation costs Nigeria over US$ 1 billion a year (the GDP of Gambia)", Jurji noted.

Nigeria has remained on the list of top five open defecation countries in the world for 15 years, moving from 5th in 2003 to 2nd in 2015.

The UNICEF chief said Nigeria could achieve economic gains up to N359.1 billion (US$ 1.026 billion) annually from the N455 billion it loses due to lack of sanitation.

In 2012, the World Health Organisation, WHO and UNICEF  reported that Nigeria was among 10 countries that accounted for almost three-quarters of the people who practice open defecation. From the report, India ranks 1st with 626 million, Indonesia 63 million, Pakistan 40 million, Ethiopia 38 million, Nigeria 34 million, Sudan 19 million, Nepal 15 million, China 14 million, Niger -12 million, Burkina Faso -9.7 million, Mozambique  9.5 million and Cambodia 8.6 million.

There is the need for the country to prioritize sanitation on the federal and state government agenda and declare a state of emergency in the sector.

However, the former Minister of Water Resources, Suleiman Adamu, had warned that if India was able to exit from its number one position in the list of countries with poor sanitation and open defecation by the middle of 2019, it would be a "national shame" for Nigeria not to.

"Three years ago, only 40 percent of Indians were using toilets but now, 95 percent of Indians are practicing full sanitation practices.

52 ILLEGAL pharmacies sealed up in Lagos

A TOTAL of 52 pharmacies, patent medicine shops, and unlicensed premises have been sealed up by the Lagos State Taskforce on Counterfeit, Fake Drugs and Unwholesome Processed Foods.

The outlets located at Isolo, Egbeda, Ikotun, Bariga, and Somolu in Oshodi-Isolo, Alimosho and Somolu Local Government areas of Lagos were shut for offenses bordering on the illegal operation, amongst others.

 HealthNewsExtra gathered that the enforcement and compliance raid was carried out by the State Task force on Counterfeit, Fake Drugs and Unwholesome Processed Foods in collaboration with the National Agency for Food Drug Administration and Control (NAFDAC), Pharmacists’ Council of Nigeria (PCN), Pharmaceutical Society of Nigeria (PSN), Federal Taskforce on fake drugs and Police Officers from Environmental and Special Offences Unit (Task Force) of Lagos Police Command.

Permanent Secretary of the Lagos State Ministry of Health, Dr. Titilayo Goncalves, said the affected pharmacies and patent medicine shops were shut for operating without a license and engaging unqualified persons to operate the outlets and dispense drugs to unsuspecting citizens.

Other offenses include operating beyond scope through the sale of ethical products and displaying and storing drugs in an unconducive environment that compromises the potency and integrity of the drugs, rendering them ineffective.

 Goncalves said although registered, it was disheartening to note that quite a number of the pharmacies had no qualified pharmacists on duty and displayed expired drugs for sale to the public.

She added that some of the premises visited also engaged in illegal clinical practices such as patient admission and setting of intravenous infusions. 

Such practice is unacceptable, she noted even as she vowed that the State Government would do all necessary to enforce the law and sanction erring operators. 

 “The sealing of the affected pharmacies and patent medicine stores was in accordance with the provisions of Section C34 of the Counterfeit, Fake Drugs and Unwholesome Processed Foods Miscellaneous Provision Act of 1999, No. 25”, Goncalves said. 

 She said licensed patent medicine vendors are authorized to sell only drug products in their original packs in approved pack size as produced by the manufacturing companies. “The law prohibits dispensing and wholesaling of drugs by patent medicine vendors,” she said. 

Operation of the task force came on the heels of the war against fake drugs and illegal drug shops. Goncalves warned that activities of the State Task Force on Fake Drugs would be sustained, and intensified until operators in the sector adhere strictly to the provisions of the law on the operation of pharmacies and patent medicine shops, in order to safeguard the health of the citizenry. 

Director of Pharmaceutical Services in the Ministry, Dr. Moyosore Adejumo said  the State Government will not relent in its efforts to stop the inherent dangers associated with the operations from unlicensed pharmaceutical outlets and drug shops.

 Task Force through the Pharmaceutical Inspectorate Unit (PIU) of the Pharmaceutical Services Directorate has been re-energized to intensify the on-going war against fake, expired and substandard drugs being peddled by unlicensed and illegal premises.

 “This closure is thus part of the government’s renewed efforts to sanitize the drug distribution system and curb proliferation of fake drugs in the State,” Adejumo said.  

 An investigative meeting would be held with owners of the sealed premises to make further inquiries on the status of the sealed premises and to notify them of the procedures and appropriate conditions to be met for reopening in line with government regulations and payment of an administrative fee. 

 The enforcement and compliance raid by the State Taskforce on Counterfeit, Fake Drugs and Unwholesome Processed Foods was carried out in collaboration with the National Agency for Food Drug Administration and Control (NAFDAC), Pharmacists’ Council of Nigeria (PCN), Pharmaceutical Society of Nigeria (PSN), Federal Taskforce on fake drugs and the Police Officers from Environmental and Special Offences Unit (Task Force) of Lagos Police Command.

Diabetes threatens Nigeria's population, DICOMAG warns

CONCERNED about the growing population of people living with diabetes in Nigeria, the Diabetes Control Media Advocacy Group, DICOMAG, has called for urgent measures to stem the tide.

Speaking on the 2019 World Population Day, the Trustee Chairperson of DICOMAG, Dr. Afoke Isiavwe, said diabetes could become a serious threat to the nation’s population in the next few years if urgent steps are not taken to address the growing spread. 

Isiavwe noted that the steady increase of the global population, which stands at approximately 7.7 billion people, has made diabetes, also increasing at an alarming rate,  a major health issue that should be in focus.

"Currently, no fewer than 425 million persons live with diabetes worldwide. In Nigeria, it is estimated that nearly 4 per cent – 11 per cent of the population, about 4 million people, live with the condition.

“The prevalence is however higher than figures often quoted because it is known that nearly a half of all people with diabetes don’t know they have it, thus missing the opportunity for early detection and necessary treatment needed to reduce the dangerous complications often associated with diabetes.

“It is also known that 80 per cent of type 2 diabetes mostly suffered by adults could be prevented while 70 per centy of deaths among adults are largely due to behavior initiated during adolescence.

"The major aim of the World Population Day is to focus attention on the consequence of population issues and how it affects overall development plans and programs. In particular, this year's edition calls for global attention to the unfinished business of the 1994 International Conference on Population and Development thus stressing the need for leaders, policymakers, grassroots organizers, institutions and individuals to help make reproductive health and rights a reality for all.

 "DICOMAG however believes that with its alarming increase in all parts of Nigeria, like elsewhere in the world, diabetes may soon become a population issue if urgent steps are not taking to address the current an unacceptable high burden of the disease.

 “We therefore call on governments at all levels on this occasion of World Population Day to step up measures towards the control of diabetes in the country.

 "Such measures will include preventive measures such as public screening for early signs ofdiabetes, public enlightenment,  effective control measures such as scientific guidelines fordiabetes treatment and prevention, access to medications and test kits for people living with the condition, among others.”

Kalenga resigns over Ebola response in DR Congo

Oly Ilunga Kalenga visiting an Ebola clinic in Butembo, DR Congo, in March.

 

JOHN WESSELS/AFP/GETTY IMAGES

Oly Ilunga Kalenga, erstwhile minister of health of DR Congo  resigned Monday in  protest of takeover of the country’s Ebola response by President Félix Tshisekedi. In a letter, Kalenga, 59, alleged there were hidden plans to deploy an experimental Ebola vaccine  to battle the year-long EBV outbreak.

Since August 2018, the DRC has recorded more than 2500 cases of Ebola and, among them, more than 1700 deaths.

He had been Minister since January 2017. He wrote that Tshisekedi’s decision to remove him from heading the country’s Ebola response was made without his knowledge while he was supervising the response in the city of Goma, DRC, where a first Ebola case was diagnosed 14 July.

“As a result of your decision to oversee the response to the Ebola epidemic, and because I anticipate that this decision will inevitably lead to a predictable outcry, I submit to you my resignation as Health Minister,” Kalenga stated in the letter.

He said his ministry had communicated daily on the situation in the ongoing outbreak “to reassure and show the world that the country is managing this epidemic, thus preserving its reputation and preventing negative socioeconomic effects on the impacted regions.”

In his letter, Kalenga attacked efforts to launch trials of an experimental vaccine made by Johnson & Johnson in the country. A Merck & Co. vaccine is already in use in DRC.

 Tshisekedi’s administration had announced that direct supervision of the Ebola response was being placed with a team of experts under the direction of Jean Jacques Muyembe Tamfum, Director-General of the DRC’s National Institute for Biomedical Research (NIBR) and a microbiologist at the University of Kinshasa’s medical school. Tamfum has studied Ebola and responded to outbreaks for more than 40 years.

The change in leadership came days after the World Health Organization declared the DRC outbreak a Public Health Emergency of International Concern.

Peter Piot, director of the London School of Hygiene & Tropical Medicine, welcomed the move as a bold decision to change strategy and bring the Ebola response under direct supervision.

. “The [Merck] vaccine currently used in the context of this epidemic is the only one that has shown efficacy,” Kalenga wrote, and it does so within 10 days. “It is fantastical to think that the new vaccine being recommended (with two doses administered 56 days apart) … could have a determinative effect on the epidemic that’s now underway,” Kalenga wrote. He charged that those proposing the use of the J&J vaccine “have shown a clear lack of ethics by intentionally hiding important information from the health authorities.”

​WHO assists Nigeria to contain Lassa fever outbreak

The  World Health Organization is scaling up its response to outbreak of Lassa fever in Nigeria, which has spread to 17 states infected up to 450 people between 1 January and 4 February 2018. 

 No less than 132 cases  are laboratory confirmed Lassa fever with 43 deaths reported, 37 of which were lab confirmed. 

A statement from WHO said among those infected are 11 health workers, four of whom have died.

"The acute viral haemorrhagic fever is endemic in Nigeria but for the current outbreak the hot spots are the southern states of Edo, Ondo and Ebonyi. 

  “The high number of Lassa fever cases is concerning. We are observing an unusually high number of cases for this time of year, ” said Dr. Wondimagegnehu Alemu, WHO Representative to Nigeria.

 The Agency  is advising national authorities on strengthening infection, prevention and control practices in healthcare settings. 

With the increase in the number of cases, WHO initially donated personal protective equipment to the Nigeria Center for Disease Control and to the affected states and procured laboratory reagents to support the prompt diagnosis of Lassa fever. 

The WHO is deploying international experts to coordinate the response, strengthen surveillance, provide treatment guidelines, and engage with communities to raise awareness on prevention and treatment.

 Since the onset of the outbreak, WHO Nigeria deployed staff from the national and state levels to support the Government of Nigeria’s national Lassa fever Emergency Operations Centre and state surveillance activities.  

The WHO is helping to coordinate health actors and is joining rapid risk assessment teams travelling to hot spots to investigate the outbreak.

 The agency observed that healthcare workers caring for Lassa fever patients require extra infection and control measures, including the use of personal protective equipment to prevent contact with patients’ bodily fluids.

NCDC launches 5-yr plan for disease control, prevention

Towards ensuring the prevention and control of diseases of public health importance in Nigeria, the Nigeria Centre for Disease Control (NCDC) has launched her strategy and implementation plan for 2017-2021. 
The document detailing the strategy was launched in Abuja at an event tagged “Idea To Reality”, as a platform to closely monitor and support the work of the NCDC.

National Coordinator/CEO of the NCDC, Dr. Chikwe Ihekweazu, said the new strategic plan seeks to create a strong vision for the NCDC underpinned by clearly defined principles and supported by well-articulated implementation and delivery plans.

“Under the mandate of the current leadership of the NCDC, activities started in late 2016 to collaboratively develop a 2017–2021 strategic plan, incorporating a new vision and mission to guide activities.

Ihekweazu said the Agency now has a new vision entitled: ‘A healthier and safer Nigeria through the prevention and control of diseases of public health importance’.

“This cascades into a mission Statement, which is further broken down into five key strategic goals with defined outcomes, 22 objectives and 89 corresponding activities for the 2017–2021 horizon.

“In addition, a performance management structure has been instituted to oversee and coordinate the execution of the multiple initiatives, as well as evaluate the progress made towards achieving the strategic goals.

“Our vision is to build the confidence of Nigerians and the global community in the NCDC in our preparedness to protect the health of citizens through information, inclusion and timely response to health concerns.

“We are ready to take on the task ahead, working in partnership with the Nigerian people. We assure you that we will give all it takes to strengthen our contribution to improving public health in Nigeria. Thank you for supporting taking our Idea to reality,” he noted.

The NCDC is Nigeria’s national public health institute with the mandate to provide a healthier and safer Nigeria through the prevention and control of diseases of public health importance.

It is focused on protecting the health of Nigerians through evidence based prevention, integrated disease surveillance and response activities, using a one-health approach, guided by research and led by a skilled workforce.