WHO: Over 1.6B People Infected with Neglected Tropical Diseases

Ahead of World Neglected Tropical Diseases Day Monday, the World Health Organization is calling for action to tackle these debilitating illnesses, which affect an estimated 1.65 billion people globally.

A diverse group of 20 parasitic and bacterial tropical diseases is categorized as neglected. This is because they disproportionally affect people who live in poor, remote communities and are not on the list of global health priorities.

Ibrahima Soce Fall is director of WHO’s Department of Neglected Tropical Diseases. He says these vector-borne diseases are transmitted by insects in areas that lack safe water, sanitation, and access to health care. He says they also are spread via contaminated food and water.

Fall says they cause immense suffering because of their disfiguring and disabling impact.

“If you take diseases like onchocerciasis, you know, so-called river blindness because it can lead to blindness. The same for trachoma. So, these are so many diseases that are fatal and very debilitating,” he said.

Trachoma is an eye disease that can cause permanent blindness.

Fall says these diseases do not attract the amount of investment needed to access health services or develop new tools for diagnostics, treatments, and vaccines.

He notes some of these ailments have been around for a very long time. For instance, the biblical disease, leprosy, still exists in 139 countries and dengue, which has been around for 800 years, remains prevalent in 129 nations.

Despite the many challenges, progress is being made in the elimination of the NTDs. WHO reports the number of people requiring NTD interventions fell by 80 million between 2020 and 2021. It finds 47 countries have eliminated at least one NTD and more countries are in the process of achieving this target.

 

According to the Carter Center, there were only 13 human cases of Guinea worm disease last year, pushing the illness closer to eradication. The Atlanta-based center was co-founded by former U.S. President Jimmy Carter and his wife, Rosalynn Carter. When it began leading the international campaign to eradicate Guinea worm in 1986, there were an estimated 3.5 million cases in at least 21 countries in Africa and Asia.

WHO officials say the goal it has set to eliminate at least one neglected tropical disease in 100 countries by 2030 can be achieved. It says the scientific community has the tools and the know-how to save lives and prevent suffering. But WHO says nations need to act together and invest in helping get rid of this dreaded group of diseases.

 

 

 

Source: Voice of America

Health Care Facilities in Poor Countries Lack Reliable Electricity

A new report finds nearly a billion people in the world’s poorer countries are treated for often life-threatening conditions in health care facilities that lack a reliable electricity supply. A joint report by the World Health Organization, the World Bank, and the International Renewable Energy Agency, “Energizing Health: Accelerating Electricity Access in Health-Care Facilities,” has just been issued.

 

Health officials say electricity access in health care facilities can make the difference between life and death.

 

Heather Adair-Rohani is Acting Unit Head, Air Quality, Energy and Health at the World Health Organization. She says it is critical that health care facilities have a reliable, always functioning electricity supply available.

 

“Imagine going to a health care facility with no lights, with no opportunity to have a baby warmer functioning,” said Adair-Rohani. “To have medical devices functioning and powered all the time. It’s absolutely fundamental that we have this electricity. This is an often-overlooked infrastructure aspect of health care facilities that are desperately needed to continue to provide care to those most vulnerable populations in low- and middle-income countries.”

 

The report finds more than one in 10 health facilities in South Asia and sub-Saharan African countries lack any electricity access. It adds power is unreliable for half of all facilities in sub-Saharan Africa.

 

It notes electricity is needed to power the most basic devices such as lights and refrigeration as well as devices that measure vital signs like heartbeat and blood pressure. It says increasing the electrification of health-care facilities is essential to save lives.

 

Adair-Rohani adds it is important to maintain these systems once they are installed to ensure their reliability and functionality.

 

“Reliable decentralized renewable electricity in health care facilities can really ensure the resilience of climate change for health care facilities so that they can provide care in the most dire circumstances and provides emergency preparedness so that yes, indeed, when there is a hurricane or floods or what have you, they still are able to have some form of power to provide emergency care as needed,” said Adair-Rohani.

 

Authors of the report say healthcare systems and facilities increasingly are affected by the accelerating impacts of climate change. They say decentralized sustainable renewable energy solutions are available. For example, they note solar photovoltaic systems are cost-effective and clean and can be rapidly deployed on site.

 

The authors say building climate-resilient health care systems can meet the challenges of a changing climate while ensuring the delivery of quality health care services.

 

 

Source: Voice of America

Energizing health: Accelerating electricity access in health-care facilities

Close to one billion people globally are served by health-care facilities with no electricity access or with unreliable electricity

 

New joint report launched

 

Close to 1 billion people in low- and lower-middle income countries are served by health-care facilities with unreliable electricity supply or with no electricity access at all, according to a new report from the World Health Organization (WHO), the World Bank, the International Renewable Energy Agency (IRENA), and Sustainable Energy for All (SEforAll). Access to electricity is critical for quality health-care provision, from delivering babies to managing emergencies like heart attacks, or offering lifesaving immunization. Without reliable electricity in all health-care facilities, Universal Health Coverage cannot be reached, the report notes.

 

Increasing electrification of health-care facilities is essential to save lives

 

The joint report, Energizing Health: Accelerating Electricity Access in Health-Care Facilities, presents the latest data on electrification of health-care facilities in low- and middle-income countries. It also projects investments required to achieve adequate and reliable electrification in health-care and identify key priority actions for governments and development partners.

 

“Electricity access in health-care facilities can make the difference between life and death,” said Dr Maria Neira, Assistant Director-General a.i, for Healthier Populations at WHO. “Investing in reliable, clean and sustainable energy for health-care facilities is not only crucial to pandemic preparedness, it’s also much needed to achieve universal health coverage, as well as increasing climate resilience and adaptation.”

 

Electricity is needed to power the most basic devices – from lights and communications equipment to refrigeration, or devices that measure vital signs like heartbeat and blood pressure – and is critical for both routine and emergency procedures. When health-care facilities have access to reliable sources of energy, critical medical equipment can be powered and sterilized, clinics can preserve lifesaving vaccines, and health workers can carry out essential surgeries or deliver babies as planned.

 

And yet, in South Asia and sub-Saharan African countries, more than 1 in 10 health facilities lack any electricity access whatsoever, the report finds, while power is unreliable for a full half of facilities in sub-Saharan Africa. Although there has been some progress in recent years on electrification of health-care facilities, approximately 1 billion people worldwide are served by health-care facilities without a reliable electricity supply or no electricity at all. To put this in perspective, this is close to the entire populations of the United States, Indonesia, Pakistan and Germany combined.

 

Disparities in electricity access within countries are also stark. Primary health-care centres and rural health facilities are considerably less likely to have electricity access than hospitals and facilities in urban areas. Understanding such disparities is key to identifying where actions are most urgently needed, and to prioritize the allocation of resources where they will save lives.

 

Health is a human right and a public good

 

Electricity access is a major enabler of Universal Health Coverage, the report states, and so electrification of health-care facilities must be considered an utmost development priority requiring greater support and investments from governments, development partners and financing and development organizations.

 

According to a World Bank needs analysis included in the report, almost two-thirds (64%) of health-care facilities in low and middle-income countries require some form of urgent intervention – for instance, either a new electricity connection or a backup power system – and some US$ 4.9 billion is urgently needed to bring them to a minimal standard of electrification.

 

No need – and not time – to ‘wait for the grid’

 

Decentralized sustainable energy solutions, for example based on solar photovoltaics systems, are not only cost-effective and clean, but also rapidly deployable on site, without the need to wait for the arrival of the central grid. Solutions are readily available, and the impact for public health would be huge.

 

Additionally, healthcare systems and facilities are increasingly affected by the accelerating impacts of climate change. Building climate-resilient health care systems means building facilities and services that can meet the challenges of a changing climate, such as extreme weather events, while improving environmental sustainability.

 

 

Source: World Health Organization

Disease Outbreak News: Yellow fever – African Region (AFRO) (3 January 2023)

Outbreak at a glance

 

This is an update on the yellow fever situation in the WHO African Region since the last disease outbreak news was published on 2 September 2022.

 

From 1 January 2021 to 7 December 2022, a total of 203 confirmed and 252 probable cases with 40 deaths (Case Fatality Ratio 9%) were reported to WHO from 13 countries in the WHO African Region.

 

Risk factors for further yellow fever spread and amplification include low population immunity, population movements, viral transmission dynamics, and climate and environmental factors that have contributed to the spread of Aedes mosquitoes. Recent Reactive Vaccination Campaigns increase population immunity and may have contributed to reducing the risk of yellow fever spread in targeted countries, resulting in a gradual downward trend in reported confirmed cases in 2022. However, the countries remain at high risk.

 

Description of the outbreak

 

In 2022, 12 countries in the WHO African Region have reported confirmed cases of yellow fever (Cameroon, the Central African Republic, Chad, Côte d’Ivoire, the Democratic Republic of the Congo, Ghana, Kenya, Niger, Nigeria, the Republic of the Congo, Sierra Leone and Uganda). Eight of these countries are experiencing a continuation of transmission from 2021 (Cameroon, the Central African Republic, Chad, Côte d’Ivoire, the Democratic Republic of the Congo, Ghana, Nigeria, and the Republic of the Congo) and four countries are newly reporting confirmed cases (Kenya, Niger, Sierra Leone and Uganda). One country, Gabon, reported an isolated confirmed case in 2021, but no further cases were registered in 2022.

 

Since 2021, a total of 203 confirmed and 252 probable cases with 40 deaths and a CFR of 9% have been reported. Of these, 23 deaths have been reported among confirmed cases (CFR among confirmed cases 11%) (Table 1). The high overall CFR among confirmed cases in 2021 (17 deaths, 11%) continued in 2022 (six deaths, 12%).

 

The male-to-female ratio among confirmed cases is not significantly different in 2021 and 2022 (1.3 and 1.6 respectively). The most affected age group amongst confirmed cases in 2021 was 10 years and below; meanwhile, the most affected group in 2022 is 20 to 30 years old. Overall, about 71% of confirmed cases are aged 30 years and below, and children aged 10 years and below are disproportionately affected.

 

According to the WHO/UNICEF Estimates of National Immunization Coverage (WUENIC), in 2021 routine immunization coverage against yellow fever in the African Region for childhood vaccinations was 48%, much lower than the 80% threshold required to confer population immunity against yellow fever, indicating the presence of an underlying susceptible population at risk of yellow fever and the risk of continued transmission. Country-specific estimates of vaccination coverage for 2021 are 54% in Cameroon, 41% in the Central African Republic, 45% in Chad, 67% in the Republic of the Congo, 65% in Côte d’Ivoire, 56% in the Democratic Republic of the Congo, 64% in Gabon, 94% in Ghana, 7% in Kenya, 80% in Niger (subnational introduction limited to four counties in 2021), 63% in Nigeria and 85% in Sierra Leone. Uganda has recently rolled-out yellow fever into the Routine Immunization programme.

 

Increasing population immunity through past and ongoing Preventive Mass Vaccination Campaigns (PMVC) supported through the EYE Strategy, and Reactive Vaccination Campaigns (RVC) have increased population immunity rapidly in implementing countries which has contributed to reducing the risk of spread of yellow fever in targeted countries. This may contribute to the gradual downward trend in reported confirmed cases in 2022, but should be noted that there is also variation in virus transmission dynamics that are difficult to predict.

 

Epidemiology of Yellow fever

 

Yellow fever is an epidemic-prone, vaccine-preventable disease caused by an arbovirus transmitted to humans by the bites of infected Aedes and Haemagogus mosquitoes. The incubation period ranges from 3 to 6 days. Many people do not experience symptoms, but when they occur, the most common are fever, muscle pain with prominent back pain, headache, loss of appetite, and nausea or vomiting. In most cases, symptoms disappear after 3 to 4 days. A small percentage of cases progress to a toxic phase with systemic infection affecting the liver and kidneys. These individuals can have more severe symptoms of high-grade fever, abdominal pain with vomiting, jaundice and dark urine caused by acute liver and kidney failure. Bleeding can occur from the mouth, nose, eyes, or stomach. Death can occur within 7 – 10 days in about half of cases with severe symptoms.

 

Yellow fever is prevented by an effective vaccine, which is safe and affordable. A single dose of yellow fever vaccine is sufficient to grant sustained immunity and life-long protection against yellow fever disease. A booster dose of the vaccine is not needed. The vaccine provides effective immunity within 10 days for 80-100% of people vaccinated, and within 30 days for more than 99% of people vaccinated.

 

Public health response

 

Surveillance and Laboratory.

 

WHO provides support to national health authorities in conducting field investigations and determining the epidemiological classification of yellow fever cases. A total of 51 personnel from at least 10 countries have been trained to investigate confirmed or probable cases of yellow fever. Furthermore, case investigation reports were reviewed, and feedback was provided to field teams to assess disease exposure and risk of disease spread.

An innovative programme to facilitate the international shipment of yellow fever samples to regional reference laboratories, as well as laboratory testing and capacity building, has been initiated with support from the EYE Strategy. WHO is engaged in ongoing activities to support countries in the laboratory diagnosis of yellow fever, including periodic accreditation visits and capacity development.

Reactive vaccination

 

Since the beginning of the current outbreak (2021 to 7 December 2022), a total of 4 385 320 persons have been vaccinated in five countries: Cameroon, the Central African Republic, Chad, Ghana and Kenya, as part of the ICG-supported response. Nine ICG requests for vaccination campaigns were approved for Cameroon (one request), the Central African Republic (two requests), Chad (two requests), Ghana (two requests), Kenya (one request), and Niger (one request).

Reactive campaign conducted in Kembe Satema in the Central African Republic from 2 to 19 November 2022 had 101.7% coverage. Based on preliminary results, the campaign in Bambari, the Central African Republic, which ended on 23 November 2022, had 87.7% coverage.

Final results are pending from an ICG-supported RVC in Niger, which is anticipated to protect approximately 1.1 million people.

Preventive mass campaign vaccination

 

Most priority countries have conducted a PMVC against yellow fever or are in process. Gabon, Kenya, and Niger have not planned PMVCs, however, they are included in the EYE Strategy as priority countries. Approximately 50 million people are expected to be protected by PMVCs conducted in 2022.

Chad: The country has prepared an application for a PMVC to be submited in January 2023. Weekly risk analysis sessions supported by the EYE Strategy have been conducted since 18 October 2022 to inform the planning of priority areas for the PMVC.

The Republic of the Congo: PMVC for yellow fever and measles integrated vaccination was organized from 5 to 14 August 2022 in 11 out of 12 departments with a coverage of 93% for yellow fever (preliminary report). The final report of the campaign and the mandatory Post Campaign Coverage Survey (PCCS) are pending.

The Democratic Republic of the Congo: Eight provinces have organized preventive campaigns in 2021 including Bas-Uele, Equateur, Haut-Uele, Mongala, Nord-Ubangi, Sud-Ubangi, Tshopo and Tshuapa. Three provinces have been scheduled to conduct preventive campaigns from the end of November 2022 through January 2023, and include Maniema, Sankuru and Sud Kivu.

Nigeria: The country has entered its final phases of PMVCs. In 2022 alone, campaigns have been conducted in Adamawa, Borno (special approach), Enugu, Gombe, Kano and Ogun States. Bayelsa State is planned for early 2023. The country is anticipated to complete nation-wide PMVCs by 2024.

Uganda: The country introduced yellow fever vaccination into routine immunization in late October 2022. In addition, 10 of 13 million vaccine doses have been received for PMVC, the rest were expected at the end of November 2022 but have not yet been received. PMVC has been planned for late January 2023.

Prevention of International Spread and Points of Entry (PoE)

 

All 13 countries that reported confirmed cases have implemented requirements for proof of vaccination against yellow fever as a condition for entry. Ten countries require proof of vaccination against yellow fever for any traveller, regardless of the origin of their voyage; whereas three countries (Chad, Kenya, and Nigeria) require proof of vaccination against yellow fever for travellers arriving from countries with areas at risk for yellow fever transmission as determined by the WHO Secretariat.

WHO risk assessment

 

Between 26 August 2022 and 29 November 2022, there have been 22 additional confirmed cases of yellow fever reported from ten countries. However, based on retrospective classification of the cases, there were only seven new confirmed cases and one death. Countries including Burkina Faso, Senegal and Togo have reported probable cases that were subsequently discarded, indicating that there is enhanced surveillance put in place. However, there is still persistent yellow fever virus circulation, as several of the recent confirmations have been from locations with little or no underlying immunity (e.g., near urban areas in Cameroon and Uganda; areas with no history of yellow fever vaccination such as Isiolo county, Kenya) hard-to-reach and under-served populations, including children that have been disproportionately impacted.

 

Based on the current situation of yellow fever in the WHO African region, the risk at the regional level was re-assessed as moderate on 12 December 2022 (high in November 2021 and June 2022) due to:

 

  1. The decrease in the number of reported cases and the increasing population immunity, since there are ongoing and recent preventive vaccination campaigns, as well as reactive campaigns that have been organized in the affected countries, with more than four million people vaccinated in five countries (Ghana, Cameroon, Chad, the Central African Republic and Kenya), and an estimated 50 million people immunized during the PMVCs in 2021-2022 (Nigeria, the Democratic Republic of the Congo, the Republic of the Congo) supported by the EYE Strategy.

 

  1. There is ongoing yellow fever virus circulation in some high-risk areas, the most recent cases, and outbreaks are reported in areas impacted by underlying risk factors, including gaps in routine immunization, missed special populations (e.g., nomadic or pastoralists and other mobile populations), security and access challenges.

 

  1. Most confirmed cases were reported in the last quarter of 2021, however several of the recent confirmations have been from urban areas and/or locations with little or no underlying immunity (e.g., near urban areas in Cameroon and Uganda; areas with no history of yellow fever vaccination);

 

  1. Case classifications, and response operations remain a challenge;

 

  1. Delays in detection and investigation; delays in the implementation of previously planned PMVC, competing outbreaks and pandemics of COVID-19 and Mpox that are attracting more attention in yellow fever-affected countries, and security constraints in affected areas (the Central African Republic, far North of Cameroon, Eastern – the Democratic Republic of the Congo, and Northern Nigeria), population movement, all present risks that could lead to new yellow fever transmission.

 

The overall global risk remains low, as no cases related to this current outbreak have been reported at this stage outside of the African region. However, there are favorable ecosystems for yellow fever outside the African region, especially in the neigbouring countries in the WHO Eastern Mediterranean Region. There might be challenges in surveillance and immunization capacities due to the potential onward transmission through viremic travellers and due to the presence of the competent vector, if not detected in a timely way.

 

The impact on public health will persist until the ongoing outbreaks are controlled, vaccination coverage is high and immunity gaps in the population are closed. The importation of cases to countries with suboptimal coverage and persisting population immunity gaps poses a high risk and may jeopardize the tremendous efforts invested to achieve elimination.

 

WHO advice

 

Transmission can be amplified in circumstances where the Aedes mosquitos (day feeder) are present in urban settings and densely populated areas causing rapid spread of the disease.

 

Surveillance: WHO recommends close monitoring of the situation with active cross-border coordination and information sharing, due to the possibility of cases in neighboring countries. Enhanced surveillance with investigation and laboratory testing of suspect cases is recommended.

 

Vaccination: Vaccination is the primary means for the prevention and control of yellow fever. Yellow fever vaccines approved by WHO are safe, highly effective, and provide life-long protection against infection.

 

The countries reporting yellow fever cases and outbreaks are all high-priority countries for the EYE Strategy. The EYE Strategy recommends that all high-risk countries introduce yellow fever vaccination into their routine immunization (RI) schedule for those aged 9 months (Ethiopia, South Sudan have yet to introduce it into RI). Review of the risk analysis and scope of immunization activities to protect the population could help avert the risk of future outbreaks (e.g. Kenya).

 

To protect populations in high-risk areas in the longer term, it is important to continue the roll-out of Preventive Mass Vaccination Campaigns (PMVCs) and bolster Routine Immunization (RI), as well as take steps to strengthen the application of International Health Regulations (IHR 2005) and bolster surveillance for rapid detection aligned to EYE objectives.

 

WHO recommends vaccination for all international travellers, aged 9 months and older, going to areas determined by the WHO Secretariat as at risk for yellow fever transmission and for additional areas the recommendation for vaccination of international travellers is subject to the assessment of the likelihood of exposure of each individual traveller.

 

Yellow fever vaccination is safe, highly effective and a single dose provides life-long protection. Yellow fever vaccination is not recommended for infants younger than 9 months, except during epidemics when the risk of yellow fever virus transmission may be very high. The risks and benefits of vaccination in this age group should be carefully considered before vaccination. The vaccine should be used with caution during pregnancy or breastfeeding. However, pregnant or breastfeeding women may be vaccinated during epidemics or if travel to a country or area with a risk of transmission is unavoidable.

 

According to the provisions of the International Health Regulations (IHR), any country may decide to implement the requirement for proof of vaccination against yellow fever for arriving travellers. For international travel purposes, the proof of vaccination against yellow fever is only valid if recorded in the International Certificate of Vaccination or Prophylaxis. The International Certificate of Vaccination or Prophylaxis becomes valid 10 days after vaccination against yellow fever and extends for the life of the person vaccinated with a WHO-approved vaccine. A booster dose of the yellow fever vaccine cannot be required of international travellers as a condition of entry.

 

Vector control: In urban centres, targeted vector control measures are also helpful to interrupt transmission. As a general precaution, WHO recommends avoidance of mosquito bites, including the use of repellents and insecticide-treated mosquito nets. The highest risk for transmission of yellow fever virus is during the day and early evening.

 

Risk communication: WHO encourages its Member States to take all actions necessary to keep travellers well informed of risks and preventive measures including vaccination. Travellers should be made aware of yellow fever symptoms and signs and instructed to rapidly seek medical advice if presenting signs and symptoms suggestive of yellow fever infection. Infected returning travellers may pose a risk for the establishment of local cycles of yellow fever transmission in areas where a competent vector is present.

 

International travel and trade: WHO advises against the application of any travel or trade restrictions to the Region.

 

The updated areas at-risk for yellow fever transmission and the related recommendations for vaccination of international travellers were updated by WHO on 1 July 2020; the map of revised areas at risk and yellow fever vaccination recommendations is available on the WHO International Travel and Health website.

 

 

Source: World Health Organization

Long COVID: Could Mono Virus or Fat Cells Be Playing Roles?

A British historian, an Italian archaeologist and an American preschool teacher have never met in person, but they share a prominent pandemic bond.

Plagued by eerily similar symptoms, the three women are credited with describing, naming and helping bring long COVID into the public’s consciousness in early 2020.

Rachel Pope, of Liverpool, took to Twitter in late March 2020 to describe her bedeviling symptoms, then unnamed, after a coronavirus infection. Elisa Perego in Italy first used the term “long COVID,” in a May tweet that year. Amy Watson in Portland, Oregon, got inspiration in naming her Facebook support group from the trucker cap she’d been wearing, and “long hauler” soon became part of the pandemic lexicon.

Nearly three years into the pandemic, scientists are still trying to figure out why some people get long COVID and why a small portion — including the three women — have lasting symptoms.

Millions of people worldwide have had long COVID, reporting various symptoms including fatigue, lung problems, and brain fog and other neurological symptoms. Evidence suggests most recover substantially within a year, but recent data show that it has contributed to more than 3,500 U.S. deaths.

Here’s some of the latest evidence:

Women more at risk?

Many studies and anecdotal evidence suggest that women are more likely than men to develop long COVID.

There could be biological reasons.

Women’s immune systems generally mount stronger reactions to viruses, bacteria, parasites and other germs, noted Sabra Klein, a Johns Hopkins professor who studies immunity.

Women are also much more likely than men to have autoimmune diseases, where the body mistakenly attacks its own healthy cells. Some scientists believe long COVID could result from an autoimmune response triggered by the virus.

Women’s bodies also tend to have more fat tissue and emerging research suggests the coronavirus may hide in fat after infection. Scientists also are studying whether women’s fluctuating hormone levels may increase the risks.

Another possible factor: Women are more likely than men to seek health care and often more attuned to changes in their bodies, Klein noted.

“I don’t think we should ignore that,” she said. Biology and behavior are probably both at play, Klein said.

It may thus be no coincidence that it was three women who helped shine the first light on long COVID.

Pope, 46, started chronicling what she was experiencing in March 2020: flu-like symptoms, then her lungs, heart and joints were affected. After a month she started having some “OK” days, but symptoms persisted.

She and some similarly ill colleagues connected with Perego on Twitter. “We started sort of coming together because it was literally the only place where we could do that,” Pope said. “In 2020, we would joke that we’d get together for Christmas and have a party,” Pope said. “Then obviously it went on, and I think we stopped joking.”

Watson started her virtual long haulers group that April. The others soon learned of that nickname and embraced it.

Mono virus

Several studies suggest the ubiquitous Epstein-Barr virus could play a role in some cases of long COVID.

Inflammation caused by coronavirus infection can activate herpes viruses, which remain in the body after causing an acute infection, said Dr. Timothy Henrich, a virus expert at the University of California, San Francisco.

Epstein-Barr virus is among the most common of these herpes viruses: An estimated 90% of the U.S. population has been infected with it. The virus can cause mononucleosis or symptoms that may be dismissed as a cold.

Henrich is among researchers who have found immune markers signaling Epstein-Barr reactivation in the blood of long COVID patients, particularly those with fatigue.

Not all long COVID patients have these markers. But it’s possible that Epstein-Barr is causing symptoms in those who do, although scientists say more study is needed.

Some scientists also believe that Epstein-Barr triggers chronic fatigue syndrome, a condition that bears many similarities to long COVID, but that also is unproven.

Obesity

Obesity is a risk factor for severe COVID-19 infections and scientists are trying to understand why.

Stanford University researchers are among those who have found evidence that the coronavirus can infect fat cells. In a recent study, they found the virus and signs of inflammation in fat tissue taken from people who had died from COVID.

Lab tests showed that the virus can reproduce in fat tissue. That raises the possibility that fat tissue could serve as a “reservoir,” potentially fueling long COVID.

Could removing fat tissue treat or prevent some cases of long COVID? It’s a tantalizing question, but the research is preliminary, said Dr. Catherine Blish, a Stanford infectious diseases professor and a senior author of the study.

Scientists at the University of Texas Southwestern Medical Center are studying leptin, a hormone produced by fat cells that can influence the body’s immune response and promote inflammation.

They plan to study whether injections of a manufactured antibody could reduce leptin levels — and in turn inflammation from coronavirus infections or long COVID.

“We have a good scientific basis together with some preliminary data to argue that we might be on the right track,” said Dr. Philipp Scherer.

Duration

It has been estimated that about 30% of people infected with the coronavirus will develop long COVID, based on data from earlier in the pandemic.

Most people who have lingering, recurrent or new symptoms after infection will recover after about three months. Among those with symptoms at three months, about 15% will continue to have symptoms for at least nine more months, according to a recent study in the Journal of the American Medical Association.

Figuring out who’s at risk for years-long symptoms “is such a complicated question,” said Dr. Lawrence Purpura, an infectious disease expert at Columbia University.

Those with severe infections seem to be more at risk for long COVID, although it can also affect people with mild infections. Those whose infections cause severe lung damage including scarring may experience breathlessness, coughing or fatigue for more than a year. And a smaller group of patients with mild initial COVID-19 infections may develop neurologic symptoms for more than a year, including chronic fatigue and brain fog, Purpura said.

“The majority of patients will eventually recover,” he said. “It’s important for people to know that.”

It’s small consolation for the three women who helped the world recognize long COVID.

Perego, 44, developed heart, lung and neurologic problems and remains seriously ill.

She knows that scientists have learned a lot in a short time, but she says “there is a gap” between long COVID research and medical care.

“We need to translate scientific knowledge into better treatment and policy,” she said.

Watson, approaching 50, says she has “never had any kind of recovery.” She has had severe migraines, plus digestive, nerve and foot problems. Recently she developed severe anemia.

She wishes the medical community had a more organized approach to treating long COVID. Doctors say not knowing the underlying cause or causes makes that difficult.

“I just want my life back,” Watson said, “and it’s not looking like that’s all that possible.”

 

 

 

Source: Voice of America

Disease Outbreak News: Yellow fever – East, West, and Central Africa (22 December 2022)

Event summary

 

This is an update on the yellow fever (YF) situation in the WHO African region published in the Event Information Site (EIS) announcement on 8 December 2021 and 26 August 2022 .

 

In 2022, 12 countries in the WHO African region have reported outbreaks of yellow fever (Cameroon, Central African Republic (CAR), Chad, Côte d’Ivoire, Democratic Republic of Congo (DRC), Ghana, Kenya, Niger, Nigeria, Republic of the Congo, Sierra Leone and Uganda). Eight of these countries are experiencing a continuation of transmission from 2021 (Cameroon, CAR, Chad, Côte d’Ivoire, DRC, Ghana, Nigeria, and Republic of the Congo) and four countries are newly reporting confirmed cases (Kenya, Niger, Sierra Leone and Uganda). One country, Gabon, reported cases in 2021, but no further cases were registered in 2022 indicating the end of the outbreak in Gabon.

 

From 1 January 2021 to 19 December 2022, a total of 203 confirmed and 252 probable cases with 40 deaths (CFR 9%) have been reported to WHO from 13 countries in the WHO African Region, with 49 additional plaque reduction neutralization test (PRNT) positive samples currently pending classification.

 

Since 5 August 2022 (data included in the previous EIS), a total of 22 additional confirmed cases have been reported from ten countries: Cameroon (1), CAR (3), Chad (6), Côte d’Ivoire (1), DRC (2), Ghana (1), Niger (4), Nigeria (2), Sierra Leone (1) and Uganda (1)). However, only seven confirmed cases had symptoms onset after 5 August 2022 and those were reported from four countries (CAR (2), Cameroon (1) Nigeria (2) and Niger (2) including one death from Niger. The rest of the cases were retrospectively classified as confirmed (with symptom onset prior to 5 August 2022), based on confirmatory tests performed and details obtained from investigations.

 

Since 2021, 40 deaths (CFR 9%) have been reported in the total 455 confirmed and probable cases. Of those, 23 deaths have been reported among confirmed cases (CFR 11%) (Table 1). The high global CFR among confirmed cases in 2021 (17 deaths, 11%) continued into 2022 (6 deaths, 12%) with multiple countries reporting CFRs above 1%.

 

The M:F ratio amongst confirmed cases was similar in 2021 and 2022 (1.3 and 1.6 respectively). The most affected age group amongst confirmed cases in 2021 was 10 years and below; meanwhile, the most affected group in 2022 is 20 to 30 years. Overall, about 71% of confirmed cases are aged 30 years and below and children aged 10 years and below seem particularly affected.

 

The majority of confirmed cases in the two year period were reported in the last quarter of 2021, with most from Ghana (62 cases, 12 deaths), Cameroon (35 cases, 0 deaths), Chad (30 cases, 5 deaths), Nigeria (24 cases, 0 deaths), and CAR (23 cases, 3 deaths). The other countries that have reported confirmed cases in the two year period are Côte d’Ivoire (8 cases, 0 deaths), DRC (6 cases, 1 death), Congo (4 cases, 0 deaths), Niger (4 cases, 1 death), Kenya (3 cases, 0 deaths), Uganda (2 cases, 0 deaths), Gabon (1 case, 0 death), and more recently Sierra Leone (1 case, 0 death). Countries including Burkina Faso, Senegal and Togo have reported probable cases that were subsequently discarded. One probable case from Benin is currently pending classification.

 

The M:F ratio amongst confirmed cases was similar in 2021 and 2022 (1.3 and 1.6 respectively). The most affected age group amongst confirmed cases in 2021 was 10 years and below; meanwhile, the most affected group in 2022 is 20 to 30 years. Overall, about 71% of confirmed cases are aged 30 years and below and children aged 10 years and below seem particularly affected. Approximately 48% of confirmed cases were in children and young adults <20 years which is greater than expected burden given that they were born after implementation of YF into routine immunization in many of the affected countries.

 

Several of the recent confirmations have been from urban areas and/or locations with little or no underlying immunity (e.g. near urban areas in Cameroon and Uganda; areas with no history of YF vaccination as in Isiolo, Kenya). Hard-to-reach and underserved populations have been disproportionately impacted.

 

 

Source: World Health Organization