Significant progress has been made in delivering life saving malaria nets and treatments over the past few years, but the coverage of malaria programmes needs to be stepped up drastically in order to meet the Millennium Development Goals (MDGs), according to a report released today by the World Health Organization (WHO).
The World Malaria Report 2009 found that the increase in international funding commitments (US$ 1.7 billion in 2009 compared to US$ 730 million in 2006) had allowed a dramatic scale up of malaria control interventions in several countries, along with measurable reductions in malaria burden. However, the amounts available still fall short of the US$ 5 billion required annually to ensure high coverage and maximal impact worldwide.
The WHO Director-General, Dr Margaret Chan, described the findings in the report as cause for cautious optimism and said "While much remains to be done, the data presented here clearly suggest that the tremendous increase in funding for malaria control is resulting in the rapid scale up of today's control tools. This, in turn, is having a profound effect on health - especially the health of children in sub-Saharan Africa. In a nutshell, development aid for health is working."
The report found that more life-saving malaria nets and treatments were delivered in 2007 and 2008 compared to 2006.
More African households (31%) own at least one insecticide-treated net (ITN), and more children under 5 years of age used an ITN in 2008 (24%) compared to previous years. These averages are affected by low ITN ownership in several large African countries for which resources for scale-up are only now being made available. Household ITN ownership reached more than 50% in 13 of the 35 highest burden African countries.
Use of artemisinin-based combination therapies (ACTs) is increasing but remains low in most African countries with fewer than 15% of children with fever receiving an ACT.
More than one-third of the 108 malarious countries (9 African countries and 29 outside of Africa) documented reductions in malaria cases of more than 50% in 2008 compared to 2000.
Where scale-up of proven interventions has occurred, and surveillance systems are functioning, remarkable impact has been documented:
In countries and areas that have achieved high coverage with bed nets and treatment programmes (e.g. Eritrea, Rwanda, Sao Tome and Principe, Zambia and Zanzibar, the United Republic of Tanzania) recorded cases and deaths due to malaria have fallen by 50% (target set by World Health Assembly for 2010) suggesting that MDG target for malaria can be achieved if there is adequate coverage of key interventions.
Large decreases in malaria cases and deaths have been mirrored by steep declines in all-cause deaths among children less than 5 years of age suggesting that intensive efforts at malaria control could help many African countries to reach, by 2015, a two-thirds reduction in child mortality as set forth in the MDGs.
High levels of external assistance were shown to be linked to decreases in malaria incidence. However, many external funds are concentrated on smaller countries with lower disease burdens. More attention needs to be given to ensuring success in large countries that account for most malaria cases and deaths.
Parasite resistance to anti-malarial medicines and mosquito resistance to insecticides are major threats to achieving global malaria control. Confirmation of artemisinin resistance was reported in 2009, and WHO is leading a major resistance containment effort in South East Asia. Key elements in the global strategy to prevent the spread of drug resistance include: 1) Rapidly reducing the spread of malaria using malaria preventive tools 2) ensuring that all malaria infections are correctly diagnosed, effectively treated and followed-up to ensure that they do not spread the disease to others 3) halting the marketing and use of oral artemisinin monotherapies and importantly, 4) carefully monitoring the efficacy of medicines to detect early evidence of resistance.
The report noted that there was urgent need for the global community to completely fund the Global Malaria Action Plan in order to sustain early success and achieve the 2015 MDGs. The African Region had the largest increase in funding of all regions, led by investments by the Global Fund, the U.S. President's Malaria Initiative, and other agencies.
The success of malaria control efforts will be in reducing the burden of malaria and improving child survival. Investing in malaria control is not only helping the world to reach the MDGs, but is also helping to build health systems that will ensure that these development gains are sustained.
Tuesday, December 15, 2009
Oncologist at Children's Hospital of Philadelphia to Chair International Childhood Cancer Organization
Will Lead Children's Oncology Group -- Collaborative Organization in Pediatric Cancer
Peter C. Adamson, M.D., a pediatric oncologist and leading scientist at The Children's Hospital of Philadelphia Research Institute, has been selected to lead the Children's Oncology Group (COG) in its efforts to find cures for children with cancer.
An internationally recognized leader in pediatric cancer drug development, Dr. Adamson will assume his new role with COG on Jan. 1, 2010. He was elected by principal investigators of more than 200 COG sites. COG unites more than 5,000 experts in childhood cancer at leading children's hospitals, universities, and cancer centers across North America, Australia, New Zealand, and Europe in the fight against childhood cancer.
Dr. Adamson, who came to The Children's Hospital of Philadelphia in 1999 from the National Cancer Institute, is the director of Clinical and Translational Research and chief of the Division of Clinical Pharmacology and Therapeutics at Children's Hospital. He also is a professor of Pediatrics and Pharmacology at the University of Pennsylvania School of Medicine. He will remain on the staff of Children's Hospital and on the Penn faculty while serving as COG chair.
Emerging research shows that even the more common childhood cancers are actually a mix of different diseases, each potentially requiring a different specific therapy. Creating such disease-targeted therapies for children with cancer requires a better pathway for moving from the bench to the bedside, which Dr. Adamson will lead through expanding COG's role at Children's Hospital and fostering new and enhanced collaborations with COG sites throughout the world.
The Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. www.chop.edu
The Cancer Center at The Children's Hospital of Philadelphia's large basic and clinical research programs are particularly strong in pediatric neuro-oncology, neuroblastoma, leukemia and lymphoma, and sarcomas.
Physicians at Children's Hospital have had pioneering roles in developing international standards for diagnosing and treating neuroblastoma, and in developing programs for survivors of childhood cancer.
Peter C. Adamson, M.D., a pediatric oncologist and leading scientist at The Children's Hospital of Philadelphia Research Institute, has been selected to lead the Children's Oncology Group (COG) in its efforts to find cures for children with cancer.
An internationally recognized leader in pediatric cancer drug development, Dr. Adamson will assume his new role with COG on Jan. 1, 2010. He was elected by principal investigators of more than 200 COG sites. COG unites more than 5,000 experts in childhood cancer at leading children's hospitals, universities, and cancer centers across North America, Australia, New Zealand, and Europe in the fight against childhood cancer.
Dr. Adamson, who came to The Children's Hospital of Philadelphia in 1999 from the National Cancer Institute, is the director of Clinical and Translational Research and chief of the Division of Clinical Pharmacology and Therapeutics at Children's Hospital. He also is a professor of Pediatrics and Pharmacology at the University of Pennsylvania School of Medicine. He will remain on the staff of Children's Hospital and on the Penn faculty while serving as COG chair.
Emerging research shows that even the more common childhood cancers are actually a mix of different diseases, each potentially requiring a different specific therapy. Creating such disease-targeted therapies for children with cancer requires a better pathway for moving from the bench to the bedside, which Dr. Adamson will lead through expanding COG's role at Children's Hospital and fostering new and enhanced collaborations with COG sites throughout the world.
The Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. www.chop.edu
The Cancer Center at The Children's Hospital of Philadelphia's large basic and clinical research programs are particularly strong in pediatric neuro-oncology, neuroblastoma, leukemia and lymphoma, and sarcomas.
Physicians at Children's Hospital have had pioneering roles in developing international standards for diagnosing and treating neuroblastoma, and in developing programs for survivors of childhood cancer.
Afghanistan first in world to use new vaccine against polio Critical step as global eradication effort faces entrenched challenges
A new vaccine against polio will be used for the first time today in polio immunization campaigns in Afghanistan. The bivalent oral polio vaccine (bOPV), recommended by the Advisory Committee on Poliomyelitis Eradication, the global technical advisory body of the Global Polio Eradication Initiative as a critical tool to eradicate polio, can provide the optimal concurrent protection needed by young children against both surviving serotypes (types 1 and 3) of the paralysing virus. This will vastly simplify the logistics of vaccination in the conflict-affected parts of this country. This sub-national immunization campaign, from 15-17 December, will deliver bOPV to 2.8 million children under five in the Southern, South-Eastern and Eastern Regions of Afghanistan. Of the three wild polioviruses (known as types 1, 2 and 3), type 2 has not been seen anywhere in the world since 1999. This achievement led to the development of monovalent vaccines, which provide protection against a single type with greater efficacy than the traditional trivalent vaccine. To determine whether a bivalent vaccine could effectively protect children living in areas where both types circulate, a clinical field trial completed in June 2009 compared bOPV with the existing vaccines. For both types 1 and 3 polio, bOPV was found to be at least 30% more effective than the trivalent vaccine and almost as good as the monovalent vaccines, yet in a package that could deliver both at once.
The bOPV allows countries to simplify vaccine logistics and to optimize protection using a mix of the available polio vaccines according to local needs. In southern Afghanistan, where access to children can be limited depending on the security situation, using bOPV helps maximise the impact of each contact with a child.
Most of Afghanistan is polio-free: 28 out of the 31 children paralysed by polio this year come from 13 highly insecure districts (of 329 districts in the country). In 2009, polio eradication efforts in Afghanistan have focused on improving operations and creating a safe environment for vaccination teams. Nongovernmental agencies have been contracted and local leaders involved to ensure that parties in conflict are approached, safe passage for vaccinators assured and children reached. Due to such preparations and strengthened supervision and staffing, the proportion of the nearly 1.2 million children under five years old in the Southern Region who could not be reached was reduced from more than 20% in early 2009, down to 5% during the July and September 2009 campaigns. The availability of bOPV multiplies the effect of such improvements. However, in the 13 highest-risk districts of Kandahar and Helmand provinces in the Southern Region, the proportion of children who are still unimmunized is well above 20% – and more than 60% in some areas.
Four countries in the world have never stopped polio transmission – Afghanistan, India, Nigeria and Pakistan. Types 1 and 3 polio circulate in limited parts of all these countries, and the others will follow Afghanistan's lead in using bOPV during the coming months, marking the adoption of a major new tool in the international effort to eradicate polio. While the Global Polio Eradication Initiative, a public-private partnership leading the effort, has reduced the incidence of polio by more than 99% (from an estimated 1000 children affected daily in 1988 to 1483 children in all of 2009 to date) polio still has a foothold in the four endemic countries. The consequences are severe beyond those areas: 16 previously polio-free countries are currently suffering outbreaks following importations of the virus; in four of these, polio transmission has lasted more than a year.
The availability of bOPV is part of a range of new and area-specific tactics in 2009 to reach eradication more quickly. The swift production of the vaccine was the result of extraordinary collaboration between the World Health Organization, UNICEF, vaccine manufacturers and regulatory agencies.
The vaccination campaign in Afghanistan is financed by the Government of Canada. Canada, which assumes presidency of the G8 in 2010, first placed polio on the group's agenda when it last held the presidency in 2002. The G8 is the single-largest donor bloc to polio eradication.
The Global Polio Eradication Initiative is spearheaded by the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention and UNICEF.
The bOPV allows countries to simplify vaccine logistics and to optimize protection using a mix of the available polio vaccines according to local needs. In southern Afghanistan, where access to children can be limited depending on the security situation, using bOPV helps maximise the impact of each contact with a child.
Most of Afghanistan is polio-free: 28 out of the 31 children paralysed by polio this year come from 13 highly insecure districts (of 329 districts in the country). In 2009, polio eradication efforts in Afghanistan have focused on improving operations and creating a safe environment for vaccination teams. Nongovernmental agencies have been contracted and local leaders involved to ensure that parties in conflict are approached, safe passage for vaccinators assured and children reached. Due to such preparations and strengthened supervision and staffing, the proportion of the nearly 1.2 million children under five years old in the Southern Region who could not be reached was reduced from more than 20% in early 2009, down to 5% during the July and September 2009 campaigns. The availability of bOPV multiplies the effect of such improvements. However, in the 13 highest-risk districts of Kandahar and Helmand provinces in the Southern Region, the proportion of children who are still unimmunized is well above 20% – and more than 60% in some areas.
Four countries in the world have never stopped polio transmission – Afghanistan, India, Nigeria and Pakistan. Types 1 and 3 polio circulate in limited parts of all these countries, and the others will follow Afghanistan's lead in using bOPV during the coming months, marking the adoption of a major new tool in the international effort to eradicate polio. While the Global Polio Eradication Initiative, a public-private partnership leading the effort, has reduced the incidence of polio by more than 99% (from an estimated 1000 children affected daily in 1988 to 1483 children in all of 2009 to date) polio still has a foothold in the four endemic countries. The consequences are severe beyond those areas: 16 previously polio-free countries are currently suffering outbreaks following importations of the virus; in four of these, polio transmission has lasted more than a year.
The availability of bOPV is part of a range of new and area-specific tactics in 2009 to reach eradication more quickly. The swift production of the vaccine was the result of extraordinary collaboration between the World Health Organization, UNICEF, vaccine manufacturers and regulatory agencies.
The vaccination campaign in Afghanistan is financed by the Government of Canada. Canada, which assumes presidency of the G8 in 2010, first placed polio on the group's agenda when it last held the presidency in 2002. The G8 is the single-largest donor bloc to polio eradication.
The Global Polio Eradication Initiative is spearheaded by the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention and UNICEF.
Saturday, November 21, 2009
International Diabetes Federation Drives Global Action Ahead of World Diabetes Day-November 14
November sees global celebrations to mark Diabetes Awareness Month
In many countries, November is diabetes awareness month, with November 14 - World Diabetes Day - the most significant date on the diabetes calendar.
The need to increase diabetes awareness grows ever year with the increasing impact of the disease worldwide. The latest data published by IDF in the 4th Edition of the Diabetes Atlas, show that 285 million people worldwide now live with diabetes. IDF predicts that, the total number will exceed 435 million in 2030(i) if the current rate of growth continues unchecked.
Ahead of World Diabetes Day, IDF President Professor Jean Claude Mbanya called for increased health promotion and political action in the face of the epidemic."Diabetes is claiming four million lives each year," he said. "It is ravaging communities and threatening economies. We must improve care and stop the many millions at risk from developing the disease. With a growing cost of over 376 billion dollars a year, either we make healthy life choices available and affordable now, or pay billions more tomorrow."
World Diabetes Day around the globe
Celebrated every year, World Diabetes Day is a campaign led by the International Diabetes Federation (IDF) and its more than 200 member associations in over 160 countries and territories. Created by IDF and the World Health Organization in 1991, World Diabetes Day became an official United Nations Day in 2007 thanks to a UN resolution that calls on all member states to organize events to mark the day.
This year sees the first of a five-year campaign that addresses the growing need for diabetes education and prevention programmes to tackle diabetes and its life-threatening complications. The World Diabetes Day campaign aims to establish access to diabetes education as a right for all people with diabetes, to promote greater awareness of the risk factors and warning signs of diabetes, and encourage best-practice sharing in diabetes prevention.
The International Diabetes Federation is calling on all countries to mark World Diabetes Day and increase diabetes awareness by lighting monuments around the world in blue - the colour of the blue circle, the global symbol for diabetes. More than 400 monuments and iconic buildings have already confirmed participation on November 14. They include: Table Mountain in South Africa, the London Eye in the United Kingdom, the Burj al Arab in the United Arab Emirates, Christ the Redeemer in Brazil, the Hofburg in Austria, the Alamo in the USA and Tokyo Tower in Japan. Across Japan close to 60 monuments will light in blue; 82 will light in Argentina, 34 in Kazakhstan and 21 in the USA.
In addition to the lightings, hundreds of events will take place worldwide to mark the day from individual acts of celebration and community-based activities, all the way up to regional events such as the Pan-African meeting in Mauritius that will see the launch of an African Declaration on diabetes.
The World Diabetes Day campaign can be followed online at www.worlddiabetesday.org; www.twitter.com/wdd; Facebook-http://tinyurl.com/o7o6kf and www.youtube.com/worlddiabetesday.
Note to Editors
About IDF
The International Diabetes Federation (IDF) is an umbrella organization of 212 member associations in than 163 countries and territories, representing over 285 million people with diabetes, their families, and their healthcare providers. The mission of IDF is to promote diabetes care, prevention and a cure worldwide. Its main activities include education for people with diabetes and healthcare professionals, public awareness campaigns and the promotion and exchange of information. IDF is a non-governmental organization in official relations with WHO and associated to the United Nations' Department of Public Information. For more information, please visit www.idf.org and follow us at twitter.com/IntDiabetesFed
About World Diabetes Day
World Diabetes Day is celebrated on 14 November, a date chosen to mark the birthday of Sir Frederick Banting, one of the pioneers in diabetes research. An official United Nation's Day, World Diabetes Day is represented by the blue circle logo that is the global symbol of diabetes. The World Diabetes Day campaign is supported by 14 official partners: Abbott Diabetes Care, AstraZeneca, Boston Scientific, Bristol-Myers Squibb, LifeScan, Eli Lilly, Medtronic, Merck Sharp & Dohme (MSD), Novartis, Novo Nordisk, Pfizer, Roche, Sanofi Aventis and Takeda.
(i)IDF Diabetes Atlas 4th Edition, International Diabetes Federation, 2009. www.diabetesatlas.org
In many countries, November is diabetes awareness month, with November 14 - World Diabetes Day - the most significant date on the diabetes calendar.
The need to increase diabetes awareness grows ever year with the increasing impact of the disease worldwide. The latest data published by IDF in the 4th Edition of the Diabetes Atlas, show that 285 million people worldwide now live with diabetes. IDF predicts that, the total number will exceed 435 million in 2030(i) if the current rate of growth continues unchecked.
Ahead of World Diabetes Day, IDF President Professor Jean Claude Mbanya called for increased health promotion and political action in the face of the epidemic."Diabetes is claiming four million lives each year," he said. "It is ravaging communities and threatening economies. We must improve care and stop the many millions at risk from developing the disease. With a growing cost of over 376 billion dollars a year, either we make healthy life choices available and affordable now, or pay billions more tomorrow."
World Diabetes Day around the globe
Celebrated every year, World Diabetes Day is a campaign led by the International Diabetes Federation (IDF) and its more than 200 member associations in over 160 countries and territories. Created by IDF and the World Health Organization in 1991, World Diabetes Day became an official United Nations Day in 2007 thanks to a UN resolution that calls on all member states to organize events to mark the day.
This year sees the first of a five-year campaign that addresses the growing need for diabetes education and prevention programmes to tackle diabetes and its life-threatening complications. The World Diabetes Day campaign aims to establish access to diabetes education as a right for all people with diabetes, to promote greater awareness of the risk factors and warning signs of diabetes, and encourage best-practice sharing in diabetes prevention.
The International Diabetes Federation is calling on all countries to mark World Diabetes Day and increase diabetes awareness by lighting monuments around the world in blue - the colour of the blue circle, the global symbol for diabetes. More than 400 monuments and iconic buildings have already confirmed participation on November 14. They include: Table Mountain in South Africa, the London Eye in the United Kingdom, the Burj al Arab in the United Arab Emirates, Christ the Redeemer in Brazil, the Hofburg in Austria, the Alamo in the USA and Tokyo Tower in Japan. Across Japan close to 60 monuments will light in blue; 82 will light in Argentina, 34 in Kazakhstan and 21 in the USA.
In addition to the lightings, hundreds of events will take place worldwide to mark the day from individual acts of celebration and community-based activities, all the way up to regional events such as the Pan-African meeting in Mauritius that will see the launch of an African Declaration on diabetes.
The World Diabetes Day campaign can be followed online at www.worlddiabetesday.org; www.twitter.com/wdd; Facebook-http://tinyurl.com/o7o6kf and www.youtube.com/worlddiabetesday.
Note to Editors
About IDF
The International Diabetes Federation (IDF) is an umbrella organization of 212 member associations in than 163 countries and territories, representing over 285 million people with diabetes, their families, and their healthcare providers. The mission of IDF is to promote diabetes care, prevention and a cure worldwide. Its main activities include education for people with diabetes and healthcare professionals, public awareness campaigns and the promotion and exchange of information. IDF is a non-governmental organization in official relations with WHO and associated to the United Nations' Department of Public Information. For more information, please visit www.idf.org and follow us at twitter.com/IntDiabetesFed
About World Diabetes Day
World Diabetes Day is celebrated on 14 November, a date chosen to mark the birthday of Sir Frederick Banting, one of the pioneers in diabetes research. An official United Nation's Day, World Diabetes Day is represented by the blue circle logo that is the global symbol of diabetes. The World Diabetes Day campaign is supported by 14 official partners: Abbott Diabetes Care, AstraZeneca, Boston Scientific, Bristol-Myers Squibb, LifeScan, Eli Lilly, Medtronic, Merck Sharp & Dohme (MSD), Novartis, Novo Nordisk, Pfizer, Roche, Sanofi Aventis and Takeda.
(i)IDF Diabetes Atlas 4th Edition, International Diabetes Federation, 2009. www.diabetesatlas.org
Protect Your Child Against Pneumonia – the Leading Cause of Death in Children
World Pneumonia Day – 2 November 2009
Up to 61 million children under the age of five in South East Asia are expected to develop pneumonia over the next year[1].
Pneumonia kills more children than any other illness – more than aids, malaria and measles combined[2]. Alarming statistics show that one child dies from pneumonia every 15 seconds. 5,500 children every day. Two million children every year[3].
World Pneumonia Day (November 2, 2009) recognizes the millions of deaths caused by pneumonia and encourages parents across the world to take action to overcome the impact of this preventable disease.
The leading cause of pneumonia deaths in children is pneumococcal disease[4]. Pneumococcal disease is also a major cause of meningitis and sepsis (blood poisoning)[4]. Vaccination is the most effective way to ensure children are protected from this serious disease.
The Confederation of Meningitis Organisations (CoMO) is a global voice for the organisations and patient groups which continue to be formed to raise awareness about meningitis and sepsis and provide support for those affected by the devastating diseases.
As pneumonia and meningitis are serious health concerns for children, CoMO members continue to work within communities to raise awareness of the signs and symptoms of disease and advocate early detection and prevention of disease via national immunisation programmes.
It has been estimated that more than one million lives could be saved each year if both prevention and treatment interventions for pneumonia were implemented worldwide[5].
The WHO has recommended the priority inclusion of pneumococcal disease vaccine, PCV7, in national childhood immunisations worldwide since 2007[6]."Since the introduction of PCV7 to infant immunisation schedules in the United States, there has been a 65 percent decline in hospital admissions for pneumococcal pneumonia for children younger than two[7]." said Professor Lulu Bravo, Philippine Foundation for Vaccination and CoMO member who is participating in the World Pneumonia Day Summit in New York.
"In addition to vaccination, parents can proactively manage flu like symptoms in their children to recognise and help prevent the onset of more serious illnesses such as pneumonia and meningitis. It's important that families remain as healthy as possible to fight off illness, particularly in light of recent developments in infections like the swine flu (H1N1)," said Professor Bravo.
"Enough restful sleep and drinking plenty of fluids to prevent dehydration is essential in preventing more serious illness," said Professor Bravo. According to Mr Bruce Langoulant, President of CoMO, "It is important that parent are doing everything they can to minimise the illness in their families".
Below is a checklist which parents can use to reduce illness and protect against serious infection[8].
* Ensure your children drink plenty of fluids to help thin mucus and prevent dehydration. Provide your baby with water between feeds.
* Cover nose blowing, coughing and sneezing with a tissue and dispose of used tissues carefully.
* Wash hands with soap regularly, especially before cooking or eating and after blowing nose.
* Wash children’s dummies and toys regularly.
* Avoid sharing utensils used for eating and drinking.
* Eat a healthy, balanced diet.
* Ensure children are kept away from cigarette smoke – it can make symptoms worse.
For more information, parents are encouraged to speak to their doctor.
Interviews are available with:
Mr Bruce Langoulant
President, Confederation of Meningitis Organisations (CoMO)
Dr Lulu Bravo
Philippine Foundation for Vaccination
For further information or to coordinate interviews, please contact:
Andrea Brady – andreabrady01@gmail.com or +64 212 545 324.
About CoMO:
The Confederation of Meningitis Organisations (CoMO) was established in 2004 to be a global voice for the organisations and patient groups which continue to be formed to raise awareness about meningitis and septicaemia (blood poisoning) and to ensure support is available for those affected. CoMO is now comprised of
26 meningitis and children's health organisations and 7 individual advocates from around the world and is working to strengthen its network of families and healthcare professionals within the Asia Pacific region.
For more information please visit: www.comoonline.org
References:
[1] Rudan l, Boschi-Pinto C, Biloglav Z, Mulholland K & Campbell H.
Epidemiology and etiology of childhood pneumonia. Bulletin of the World Health
Organization 2008; 86:408-416. Accessed 16 October 2209
http://www.who.int/bulletin/volumes/86/5/07-048769.pdf
[2] World Health Organization, Pneumonia: the forgotten killer of children,
2006. Accessed 13 August 2009
http://www.who.int/child_adolescent_health/documents/9280640489/en/
[3] PneumoADIP, Child Death and Disability: Pneumococcal disease and
pneumonia, Child Morbidity and Mortality, 2009. Accessed 16 October 2009
http://www.preventpneumo.org/diseases/child_morbidity_and_mortality/index.cfm
[4] PneumoADIP, Serious pneumococcal infections are a major global health
problem and are vaccine preventable, Fact Sheet: Pneumococcal Disease, 2009.
Accessed 16 October 2009
http://www.pneumoadip.org/resources/factsheets/pneumococcal.cfm
[5] Unicef, Pneumonia, Pneumonia kills more children worldwide than any
other single cause, 6 May 2008. Accessed 15 October 2009
http://www.unicef.org/health/index_43828.html
[6] World Health Organization. Pneumococcal conjugate vaccine for childhood
immunization, March 2007- WHO position paper. Wkly Epidemiol Record 2007;12:
93-104 Accessed 13 October 2009
http://www.who.int/immunization/wer8212pneumococcus_child_Mar07_position_paper.
pdf
[7] Grijalva, CG MD. Effectiveness of PCV7 in Pneumonia: The United States
xperience. Vanderbilt University School of Medicine, Nashville, Tennessee, USA,
2009.
[8] Pharmaceutical Society of Australia, Pharmacy Self Care Health
Information, Colds and Flu, 2009.
Up to 61 million children under the age of five in South East Asia are expected to develop pneumonia over the next year[1].
Pneumonia kills more children than any other illness – more than aids, malaria and measles combined[2]. Alarming statistics show that one child dies from pneumonia every 15 seconds. 5,500 children every day. Two million children every year[3].
World Pneumonia Day (November 2, 2009) recognizes the millions of deaths caused by pneumonia and encourages parents across the world to take action to overcome the impact of this preventable disease.
The leading cause of pneumonia deaths in children is pneumococcal disease[4]. Pneumococcal disease is also a major cause of meningitis and sepsis (blood poisoning)[4]. Vaccination is the most effective way to ensure children are protected from this serious disease.
The Confederation of Meningitis Organisations (CoMO) is a global voice for the organisations and patient groups which continue to be formed to raise awareness about meningitis and sepsis and provide support for those affected by the devastating diseases.
As pneumonia and meningitis are serious health concerns for children, CoMO members continue to work within communities to raise awareness of the signs and symptoms of disease and advocate early detection and prevention of disease via national immunisation programmes.
It has been estimated that more than one million lives could be saved each year if both prevention and treatment interventions for pneumonia were implemented worldwide[5].
The WHO has recommended the priority inclusion of pneumococcal disease vaccine, PCV7, in national childhood immunisations worldwide since 2007[6]."Since the introduction of PCV7 to infant immunisation schedules in the United States, there has been a 65 percent decline in hospital admissions for pneumococcal pneumonia for children younger than two[7]." said Professor Lulu Bravo, Philippine Foundation for Vaccination and CoMO member who is participating in the World Pneumonia Day Summit in New York.
"In addition to vaccination, parents can proactively manage flu like symptoms in their children to recognise and help prevent the onset of more serious illnesses such as pneumonia and meningitis. It's important that families remain as healthy as possible to fight off illness, particularly in light of recent developments in infections like the swine flu (H1N1)," said Professor Bravo.
"Enough restful sleep and drinking plenty of fluids to prevent dehydration is essential in preventing more serious illness," said Professor Bravo. According to Mr Bruce Langoulant, President of CoMO, "It is important that parent are doing everything they can to minimise the illness in their families".
Below is a checklist which parents can use to reduce illness and protect against serious infection[8].
* Ensure your children drink plenty of fluids to help thin mucus and prevent dehydration. Provide your baby with water between feeds.
* Cover nose blowing, coughing and sneezing with a tissue and dispose of used tissues carefully.
* Wash hands with soap regularly, especially before cooking or eating and after blowing nose.
* Wash children’s dummies and toys regularly.
* Avoid sharing utensils used for eating and drinking.
* Eat a healthy, balanced diet.
* Ensure children are kept away from cigarette smoke – it can make symptoms worse.
For more information, parents are encouraged to speak to their doctor.
Interviews are available with:
Mr Bruce Langoulant
President, Confederation of Meningitis Organisations (CoMO)
Dr Lulu Bravo
Philippine Foundation for Vaccination
For further information or to coordinate interviews, please contact:
Andrea Brady – andreabrady01@gmail.com or +64 212 545 324.
About CoMO:
The Confederation of Meningitis Organisations (CoMO) was established in 2004 to be a global voice for the organisations and patient groups which continue to be formed to raise awareness about meningitis and septicaemia (blood poisoning) and to ensure support is available for those affected. CoMO is now comprised of
26 meningitis and children's health organisations and 7 individual advocates from around the world and is working to strengthen its network of families and healthcare professionals within the Asia Pacific region.
For more information please visit: www.comoonline.org
References:
[1] Rudan l, Boschi-Pinto C, Biloglav Z, Mulholland K & Campbell H.
Epidemiology and etiology of childhood pneumonia. Bulletin of the World Health
Organization 2008; 86:408-416. Accessed 16 October 2209
http://www.who.int/bulletin/volumes/86/5/07-048769.pdf
[2] World Health Organization, Pneumonia: the forgotten killer of children,
2006. Accessed 13 August 2009
http://www.who.int/child_adolescent_health/documents/9280640489/en/
[3] PneumoADIP, Child Death and Disability: Pneumococcal disease and
pneumonia, Child Morbidity and Mortality, 2009. Accessed 16 October 2009
http://www.preventpneumo.org/diseases/child_morbidity_and_mortality/index.cfm
[4] PneumoADIP, Serious pneumococcal infections are a major global health
problem and are vaccine preventable, Fact Sheet: Pneumococcal Disease, 2009.
Accessed 16 October 2009
http://www.pneumoadip.org/resources/factsheets/pneumococcal.cfm
[5] Unicef, Pneumonia, Pneumonia kills more children worldwide than any
other single cause, 6 May 2008. Accessed 15 October 2009
http://www.unicef.org/health/index_43828.html
[6] World Health Organization. Pneumococcal conjugate vaccine for childhood
immunization, March 2007- WHO position paper. Wkly Epidemiol Record 2007;12:
93-104 Accessed 13 October 2009
http://www.who.int/immunization/wer8212pneumococcus_child_Mar07_position_paper.
[7] Grijalva, CG MD. Effectiveness of PCV7 in Pneumonia: The United States
xperience. Vanderbilt University School of Medicine, Nashville, Tennessee, USA,
2009.
[8] Pharmaceutical Society of Australia, Pharmacy Self Care Health
Information, Colds and Flu, 2009.
Thursday, November 12, 2009
How the rice pledging scheme is backfiring on Thai farmers
The government rice pledging scheme, in place for six years and paying higher than market prices,has encouraged farmers to plant rice varieties with big yields. There has been no emphasis on quality. The quality of Thai rice has thus deteriorated and foreign buyers have reduced their purchases, notes a Thai Rath writer.Thai rice exports have fallen 30% over the six years to a global market share of 22% while Vietnam has seen its exports rise 56% to capture a 20% global share,becoming the second biggest rice exporter in the world.
Another adverse effect of the rice pledging scheme is that some rice traders are importing cheaper rice from neighbouring countries such as Burma and Cambodia and selling it to the gov-INernment under the pledging scheme,reaping double benefits. The result of this corrupt practice is many farmers in Burma and Cambodia have expanded production for export to Thailand to be sold to the government.
The rice pledging scheme not only encourages the planting of lower quality rice by Thai farmers but also helps farmers in neighbouring countries sell their produce in Thailand at a cost to Thai taxpayers who have to foot the bill.
As a trained economist, the Thai Rath writer said he did not agree with any form of price intervention, whether as a rice pledging scheme or as a rice guarantee scheme. Any measure that distorts market mechanisms will have adverse consequences for the economy as a whole.
But the writer recognised that, in terms of politics or even humanitarian consideration, helping poor farmers whose economic status is below any other sector in society is necessary. For this reason, most economists would not object to all price intervention schemes.They understand the good intentions of successive governments in trying to help poor farmers. They just feel that the rice price intervention scheme must be handled with utmost care to benefit farmers directly - and only when it is absolutely necessary.
Even if the scheme means the whole country has to shoulder some losses to benefit poor farmers, the writer believes most Thai taxpayers would be supportive. However, they would not be pleased to learn the scheme is being misused by some rice traders to buy cheaper rice from neighbouring countries and sell it for a profit to the government.
The writer said it was time to revise the rice pledging scheme. It has several adverse consequences. the main one being the low quality of Thai rice which has enabled Vietnam to expand its rice exports at the expense of Thailand. Vietnam may leapfrog Thailand to become the world's leading rice exporter next year or soon after, concluded Thai Rath .
Asean rice free trade
Prime Minister Abhisit Vejjajiva told the Asean ministerial meeting in Phuket this week that Asean would become like the EU within six years with people,labour, capital and goods flowing freely within the 10 Asean member countries,noted another Thai Rath writer.Asean member countries will gradually reduce or abolish tariffs on several products in the years to 2115,when a completely free trade environment is implemented. Starting from Jan 1 next year,rice trading within Asean will be tariff free, which means neighbouring countries can sell their rice to Thailand and Thailand can sell its rice to other Asean countries tariff free.
This may seem to be good news as Thailand is the world's No1 rice exporter.But the facts suggest otherwise. Thai farmers cannot compete against Vietnamese rice farmers in terms of productivity and price, meaning Vietnam will gradually grab a bigger rice export market share at the expense of Thai rice exporters.
Most Thai farmers plant rice according to the seasons because the irrigation system does not cover most rice fields.Most Thai farmers have to sell at low prices because they are at a disadvantage in dealing with rice traders. For this reason, successive governments have operated a pledging scheme to buy rice from farmers at higher than prevailing market prices, putting a huge dent in the national budget as the government has to sell the rice stocks at reduced prices to exporters.
The Abhisit government has proposed a new rice price guarantee scheme, which means the government will pay farmers less as there is no need to manage rice stocks.
When the Asean Free Trade Area on rice takes effect next year, the Thai Rath writer believes rice from Vietnam, Burma,Cambodia and Laos will be exported to Thailand to compete with the local variety, and could win a significant share due to lower prices.
If more and more Thais resort to buying cheaper rice from neighbouring countries, the writer believes Thai rice farmers will suffer.
How will they earn a living?
VeteranDemocrat MP shows insensitivity
The Election Commission on July 16 ruled that 13 Democrat MPs should lose their seats in parliament for breaching the provision in the constitution barring MPs from holding shares in media companies or those holding government concessions, noted Nongnuch Singhadecha,aMatichon writer.Nongnuch cited the reactions of some of the veteran Democrat MPs, including constituent MPs Juti Krairirk and Samphan Thongsamak and party-list MP Trairong Suwannakhiri.
Mr Juti, representing Phitsanulok province, said he accepted the EC's ruling.He did not blame anyone but himself for failing to study the constitution provision. He said he would contest the byelection made necessary by his disqualification and spend the next three to four months stumping for votes. He asked people to forgive him for necessitating a by-election to be paid for by taxpayers.
Nongnuch judged Mr Juti's remark to be full of political spirit and very mature, upholding the Democrat Party's standards.
She also praised Mr Samphan, a Nakhon Si Thammarat MP, for saying he accepted the EC's ruling and he too would contest the by-election.
But she took issue with veteran MP Trairong, who said the ruling was suspect because some EC commissioners might not understand stock trading and had misinterpreted the law.
He also lashed out at the constitution drafters for writing the provision ambiguously and causing this problem of interpretation.
As if the Democrat Party's image was not damaged enough, the next day Mr Trairong said Deputy Prime Minister Suthep Thaugsuban, who was also judged guilty and resigned from his seat in parliament, had quit mainly to spite the EC.
The remarks of the former cabinet minister gave the impression some Democrat MPs were no better than the MPs from the opposition party which is financed by former prime minister Thaksin Shinawatra. These MPs criticise any independent body's ruling that does not favour them as biased and praise any decision that goes their way.
What irked Nongnuch the most was Mr Trairong's phrase,"One need not believe [the EC commissioners] because they might lack knowledge about stock trading", which could be interpreted as saying the independent body, which is tasked by the law to hold both local and national elections, cannot be relied upon to be neutral or knowledgeable.
If everyone accepts Mr Trairong's argument, then independent bodies would not be able to function - including the courts - as people could cite the same argument - that judges lack expertise in economics and business and so their decisions cannot be accepted.
Nongnuch blasted Mr Trairong for being insensitive as the matter was still not final. The EC ruling is awaiting a Constitution Court interpretation. He should waitand argue in the Constitution Court that his stock holding is so small he could not influence the direction of the company with a concession with the government.
It would have been better if Mr Trairong and his party had said the issue rested with the Constitution Court. Or better, he could have said nothing if he disagreed with the EC ruling.
If Mr Trairong wishes to continue to blast the EC as an institution that cannot be believed, Nongnuch reminded him that former executives of the Thai Rak Thai and People Power parties might also argue they should not have been barred from politics for five years.
It is often said that before one speaks,one is the master. Once words are spoken,one is a slave of those words. Some Democrat MPs should be aware of this,concluded Matichon
Miscellany
The Public Health Ministry is reporting 20 more deaths from the deadly type-A (H1N1) flu and estimates more than 500,000 Thais have been infected.
The new fatalities recorded over the past seven days raise the national death toll to 44 from the flu pandemic. Another 35 patients were in hospital, seven of them in critical condition, the ministry said in its weekly report, which replaces its daily report in an attempt to calm public panic about the disease.
Kamnuan Ungchusak, a senior expert in preventive medicine, said the estimated figure of 500,000 A (H1N1) cases was based on ministry calculations, which used the number of patients who had sought hospital treatment as a factor.More than 25,000 people have sought treatment for flu-like symptoms at hospitals each day, the ministry has found.
But he said a surge in A (H1N1) cases was not impossible.
"If we can't quarantine the patients with mild symptoms at home, the figure will absolutely skyrocket," Dr Kamnuan said."If 50% of them stay home, the rising infection rate will stabilise. And if more than 70% of them stay home, we can successfully control the outbreak."
Another adverse effect of the rice pledging scheme is that some rice traders are importing cheaper rice from neighbouring countries such as Burma and Cambodia and selling it to the gov-INernment under the pledging scheme,reaping double benefits. The result of this corrupt practice is many farmers in Burma and Cambodia have expanded production for export to Thailand to be sold to the government.
The rice pledging scheme not only encourages the planting of lower quality rice by Thai farmers but also helps farmers in neighbouring countries sell their produce in Thailand at a cost to Thai taxpayers who have to foot the bill.
As a trained economist, the Thai Rath writer said he did not agree with any form of price intervention, whether as a rice pledging scheme or as a rice guarantee scheme. Any measure that distorts market mechanisms will have adverse consequences for the economy as a whole.
But the writer recognised that, in terms of politics or even humanitarian consideration, helping poor farmers whose economic status is below any other sector in society is necessary. For this reason, most economists would not object to all price intervention schemes.They understand the good intentions of successive governments in trying to help poor farmers. They just feel that the rice price intervention scheme must be handled with utmost care to benefit farmers directly - and only when it is absolutely necessary.
Even if the scheme means the whole country has to shoulder some losses to benefit poor farmers, the writer believes most Thai taxpayers would be supportive. However, they would not be pleased to learn the scheme is being misused by some rice traders to buy cheaper rice from neighbouring countries and sell it for a profit to the government.
The writer said it was time to revise the rice pledging scheme. It has several adverse consequences. the main one being the low quality of Thai rice which has enabled Vietnam to expand its rice exports at the expense of Thailand. Vietnam may leapfrog Thailand to become the world's leading rice exporter next year or soon after, concluded Thai Rath .
Asean rice free trade
Prime Minister Abhisit Vejjajiva told the Asean ministerial meeting in Phuket this week that Asean would become like the EU within six years with people,labour, capital and goods flowing freely within the 10 Asean member countries,noted another Thai Rath writer.Asean member countries will gradually reduce or abolish tariffs on several products in the years to 2115,when a completely free trade environment is implemented. Starting from Jan 1 next year,rice trading within Asean will be tariff free, which means neighbouring countries can sell their rice to Thailand and Thailand can sell its rice to other Asean countries tariff free.
This may seem to be good news as Thailand is the world's No1 rice exporter.But the facts suggest otherwise. Thai farmers cannot compete against Vietnamese rice farmers in terms of productivity and price, meaning Vietnam will gradually grab a bigger rice export market share at the expense of Thai rice exporters.
Most Thai farmers plant rice according to the seasons because the irrigation system does not cover most rice fields.Most Thai farmers have to sell at low prices because they are at a disadvantage in dealing with rice traders. For this reason, successive governments have operated a pledging scheme to buy rice from farmers at higher than prevailing market prices, putting a huge dent in the national budget as the government has to sell the rice stocks at reduced prices to exporters.
The Abhisit government has proposed a new rice price guarantee scheme, which means the government will pay farmers less as there is no need to manage rice stocks.
When the Asean Free Trade Area on rice takes effect next year, the Thai Rath writer believes rice from Vietnam, Burma,Cambodia and Laos will be exported to Thailand to compete with the local variety, and could win a significant share due to lower prices.
If more and more Thais resort to buying cheaper rice from neighbouring countries, the writer believes Thai rice farmers will suffer.
How will they earn a living?
VeteranDemocrat MP shows insensitivity
The Election Commission on July 16 ruled that 13 Democrat MPs should lose their seats in parliament for breaching the provision in the constitution barring MPs from holding shares in media companies or those holding government concessions, noted Nongnuch Singhadecha,aMatichon writer.Nongnuch cited the reactions of some of the veteran Democrat MPs, including constituent MPs Juti Krairirk and Samphan Thongsamak and party-list MP Trairong Suwannakhiri.
Mr Juti, representing Phitsanulok province, said he accepted the EC's ruling.He did not blame anyone but himself for failing to study the constitution provision. He said he would contest the byelection made necessary by his disqualification and spend the next three to four months stumping for votes. He asked people to forgive him for necessitating a by-election to be paid for by taxpayers.
Nongnuch judged Mr Juti's remark to be full of political spirit and very mature, upholding the Democrat Party's standards.
She also praised Mr Samphan, a Nakhon Si Thammarat MP, for saying he accepted the EC's ruling and he too would contest the by-election.
But she took issue with veteran MP Trairong, who said the ruling was suspect because some EC commissioners might not understand stock trading and had misinterpreted the law.
He also lashed out at the constitution drafters for writing the provision ambiguously and causing this problem of interpretation.
As if the Democrat Party's image was not damaged enough, the next day Mr Trairong said Deputy Prime Minister Suthep Thaugsuban, who was also judged guilty and resigned from his seat in parliament, had quit mainly to spite the EC.
The remarks of the former cabinet minister gave the impression some Democrat MPs were no better than the MPs from the opposition party which is financed by former prime minister Thaksin Shinawatra. These MPs criticise any independent body's ruling that does not favour them as biased and praise any decision that goes their way.
What irked Nongnuch the most was Mr Trairong's phrase,"One need not believe [the EC commissioners] because they might lack knowledge about stock trading", which could be interpreted as saying the independent body, which is tasked by the law to hold both local and national elections, cannot be relied upon to be neutral or knowledgeable.
If everyone accepts Mr Trairong's argument, then independent bodies would not be able to function - including the courts - as people could cite the same argument - that judges lack expertise in economics and business and so their decisions cannot be accepted.
Nongnuch blasted Mr Trairong for being insensitive as the matter was still not final. The EC ruling is awaiting a Constitution Court interpretation. He should waitand argue in the Constitution Court that his stock holding is so small he could not influence the direction of the company with a concession with the government.
It would have been better if Mr Trairong and his party had said the issue rested with the Constitution Court. Or better, he could have said nothing if he disagreed with the EC ruling.
If Mr Trairong wishes to continue to blast the EC as an institution that cannot be believed, Nongnuch reminded him that former executives of the Thai Rak Thai and People Power parties might also argue they should not have been barred from politics for five years.
It is often said that before one speaks,one is the master. Once words are spoken,one is a slave of those words. Some Democrat MPs should be aware of this,concluded Matichon
Miscellany
The Public Health Ministry is reporting 20 more deaths from the deadly type-A (H1N1) flu and estimates more than 500,000 Thais have been infected.
The new fatalities recorded over the past seven days raise the national death toll to 44 from the flu pandemic. Another 35 patients were in hospital, seven of them in critical condition, the ministry said in its weekly report, which replaces its daily report in an attempt to calm public panic about the disease.
Kamnuan Ungchusak, a senior expert in preventive medicine, said the estimated figure of 500,000 A (H1N1) cases was based on ministry calculations, which used the number of patients who had sought hospital treatment as a factor.More than 25,000 people have sought treatment for flu-like symptoms at hospitals each day, the ministry has found.
But he said a surge in A (H1N1) cases was not impossible.
"If we can't quarantine the patients with mild symptoms at home, the figure will absolutely skyrocket," Dr Kamnuan said."If 50% of them stay home, the rising infection rate will stabilise. And if more than 70% of them stay home, we can successfully control the outbreak."
Magnificent seven
In the most important, most revered event since the invention of the brontosaurus trap,Microsoft shipped the most incredibly fabulous operating system ever made; the release of Windows 7 also spurred a new generation of personal computers of all sizes at prices well below last month's offers.The top reason Windows 7 does not suck: There is no registered website called Windows7Sucks.com
Kindle e-book reader maker Amazon.com and new Nook e-book reader vendor Barnes and Noble got it on; B&N got great reviews for the "Kindle killer"Nook, with dual screens and touch controls so you can "turn" pages, plays MP3s and allows many non-B&N book formats, although not the Kindle one;Amazon then killed the US version of its Kindle in favour of the international one, reduced its price to $260(8,700 baht), same as the Nook; it's not yet clear what you can get in Thailand with a Nook, but you sure can't (yet) get much, relatively speaking, with a Kindle;but here's the biggest difference so far,which Amazon.com has ignored: the Nook lets you lend e-books to any other Nook owner, just as if they were paper books; the borrowed books expire on the borrower's Nook in two weeks.
Phone maker Nokia of Finland announced it is suing iPhone maker Apple of America for being a copycat; lawyers said they figure Nokia can get at least one, probably two per cent (retail) for every iPhone sold by Steve "President for Life" Jobs and crew via the lawsuit,which sure beats working for it -$6 (200 baht) to $12(400 baht) on 30 million phones sold so far, works out to $400 million or 25 percent of the whole Apple empire profits during the last quarter;there were 10 patent thefts, the Finnish executives said, on everything from moving data to security and encryption.
Nokia of Finland announced that it is one month behind on shipping its new flagship N900 phone, the first to run on Linux software; delay of the $750(25,000 baht) phone had absolutely no part in making Nokia so short that it had to sue Apple, slap yourself for such a thought.
Tim Berners-Lee, who created the World Wide Web, said he had one regret:the double slash that follows the "http:"in standard web addresses; he estimated that 14.2 gazillion users have wasted 48.72 bazillion hours typing those two keystrokes, and he's sorry; of course there's no reason to ever type that, since your browser does it for you when you type "www.bangkokpost.com" but Tim needs to admit he made one error in his lifetime.
The International Telecommunication Union of the United Nations, which doesn't sell any phones or services, announced that there should be a mobile phone charger that will work with any phone; now who would ever have thought of that, without a UN body to wind up a major study on the subject?;the GSM Association estimates that 51,000 tonnes of chargers are made each year in order to keep companies able to have their own unique ones.
The Well, Doh Award of the Week was presented at arm's length to the United Nations Conference on Trade and Development; the group's deputy secretary-general Petko Draganov said that developing countries will miss some of the stuff available on the Internet if they don't install more broadband infrastructure; a report that used your tax baht to compile said that quite a few people use mobile phones but companies are more likely to invest in countries with excellent broadband connections; no one ever had thought of this before, right?
Sun Microsystems , as a result of the Oracle takeover, said it will allow 3,000 current workers never to bother coming to work again; Sun referred to the losses as "jobs," not people; now the fourth largest server maker in the world, Sun said it lost $2.2 billion in its last fiscal year; European regulators are holding up approval of the Oracle purchase in the hope of getting some money in exchange for not involving Oracle in court cases.
The multi-gazillionaire and very annoying investor Carl Icahn resigned from the board at Yahoo ; he spun it as a vote of confidence, saying current directors are taking the formerly threatened company seriously; Yahoo reported increased profits but smaller revenues in the third quarter.
The US House of Representatives voted to censure Vietnam for jailing bloggers; the non-binding resolution sponsored by southern California congresswoman Loretta Sanchez said the Internet is "a crucial tool for the citizens of Vietnam to be able to exercise their freedom of expression and association;"Hanoi has recently jailed at least nine activists for up to six years apiece for holding pro-democracy banners. Iran jailed blogger Hossein "Hoder" Derakshan for 10 months - in solitary confinement.
Kindle e-book reader maker Amazon.com and new Nook e-book reader vendor Barnes and Noble got it on; B&N got great reviews for the "Kindle killer"Nook, with dual screens and touch controls so you can "turn" pages, plays MP3s and allows many non-B&N book formats, although not the Kindle one;Amazon then killed the US version of its Kindle in favour of the international one, reduced its price to $260(8,700 baht), same as the Nook; it's not yet clear what you can get in Thailand with a Nook, but you sure can't (yet) get much, relatively speaking, with a Kindle;but here's the biggest difference so far,which Amazon.com has ignored: the Nook lets you lend e-books to any other Nook owner, just as if they were paper books; the borrowed books expire on the borrower's Nook in two weeks.
Phone maker Nokia of Finland announced it is suing iPhone maker Apple of America for being a copycat; lawyers said they figure Nokia can get at least one, probably two per cent (retail) for every iPhone sold by Steve "President for Life" Jobs and crew via the lawsuit,which sure beats working for it -$6 (200 baht) to $12(400 baht) on 30 million phones sold so far, works out to $400 million or 25 percent of the whole Apple empire profits during the last quarter;there were 10 patent thefts, the Finnish executives said, on everything from moving data to security and encryption.
Nokia of Finland announced that it is one month behind on shipping its new flagship N900 phone, the first to run on Linux software; delay of the $750(25,000 baht) phone had absolutely no part in making Nokia so short that it had to sue Apple, slap yourself for such a thought.
Tim Berners-Lee, who created the World Wide Web, said he had one regret:the double slash that follows the "http:"in standard web addresses; he estimated that 14.2 gazillion users have wasted 48.72 bazillion hours typing those two keystrokes, and he's sorry; of course there's no reason to ever type that, since your browser does it for you when you type "www.bangkokpost.com" but Tim needs to admit he made one error in his lifetime.
The International Telecommunication Union of the United Nations, which doesn't sell any phones or services, announced that there should be a mobile phone charger that will work with any phone; now who would ever have thought of that, without a UN body to wind up a major study on the subject?;the GSM Association estimates that 51,000 tonnes of chargers are made each year in order to keep companies able to have their own unique ones.
The Well, Doh Award of the Week was presented at arm's length to the United Nations Conference on Trade and Development; the group's deputy secretary-general Petko Draganov said that developing countries will miss some of the stuff available on the Internet if they don't install more broadband infrastructure; a report that used your tax baht to compile said that quite a few people use mobile phones but companies are more likely to invest in countries with excellent broadband connections; no one ever had thought of this before, right?
Sun Microsystems , as a result of the Oracle takeover, said it will allow 3,000 current workers never to bother coming to work again; Sun referred to the losses as "jobs," not people; now the fourth largest server maker in the world, Sun said it lost $2.2 billion in its last fiscal year; European regulators are holding up approval of the Oracle purchase in the hope of getting some money in exchange for not involving Oracle in court cases.
The multi-gazillionaire and very annoying investor Carl Icahn resigned from the board at Yahoo ; he spun it as a vote of confidence, saying current directors are taking the formerly threatened company seriously; Yahoo reported increased profits but smaller revenues in the third quarter.
The US House of Representatives voted to censure Vietnam for jailing bloggers; the non-binding resolution sponsored by southern California congresswoman Loretta Sanchez said the Internet is "a crucial tool for the citizens of Vietnam to be able to exercise their freedom of expression and association;"Hanoi has recently jailed at least nine activists for up to six years apiece for holding pro-democracy banners. Iran jailed blogger Hossein "Hoder" Derakshan for 10 months - in solitary confinement.
Saturday, October 17, 2009
In US, relief for now but winter looms
It was six months ago that scientists discovered an ominous new flu virus, touching off fears of a catastrophic global outbreak that could cause people to drop dead in the streets. Doomsday, of course, never came to pass.
Now that the initial scare over the swine flu has subsided, health officials warn we are not out of danger yet.
"We've got many, many months ahead of us where we don't know what will happen and we need to take the best steps we can to protect ourselves," Dr Tom Frieden, director of the Centers for Disease Control and Prevention, said last week."Our biggest concern is that the virus could change, mutate to become more deadly."
With winter approaching in the US,another fear is a one-two punch in which a resurgent swine flu batters young people before the vaccine is widely available,while the ordinary flu strikes the elderly.Also, emergency doctors are worried about the strain on ERs and hospitals.
To date, swine flu has hospitalised hundreds of thousands of people around the world and killed at least 4,500, including at least 600 in the United States.At least 81 US children have died, including many who had no underlying health problems.
The CDC was the first to identify the new flu. It was on April 15 and 17 that the agency determined the nasal samples from two children in southern California revealed a swine flu virus that had never been seen before. It was found to contain bits of bird and human flu.
At first the cases represented more of a scientific puzzle than a public health threat. The two children recovered, but investigators were perplexed by how they got it, since the two children had not been in contact with each other or with pigs.
But within a week, the situation became more dramatic, when testing linked the two children and a handful of subsequent US cases to hundreds of illnesses in Mexico City. Mexican authorities closed schools, museums, libraries and theatres to stop the spread of the disease as initial reports suggested it was killing as many as one in 15 of those infected - a horrifying death rate more than three times higher than the terrible flu pandemic of 1918-19.
A series of bad and good news followed. First, the bad: it quickly became clear that the virus was spreading not only in Mexico and border regions of the United States, but around the world.As health officials had long surmised,international air travel provided a rapid path to world contagion.
What's more, studies indicated the millions of seasonal flu shots administered the previous winter offered no protection against the unusual new virus.
But then came some good news:
While the flu vaccine was no help,the antiviral medication Tamiflu reduced the severity of illness if taken right after symptoms appeared.
People 55 and older, who suffer and die the most from seasonal flu each year, seemed mostly to be spared by the new virus. Scientists credited some immunity that they had perhaps picked up from exposure decades ago to a similar-enough virus or vaccine.
Additional investigation in Mexico suggested that many people had suffered only mild illness. Those cases were not counted in initial reports, meaning the death rate was much, much lower than originally estimated.
In the United States, some of the initial response plans for the new swine flu, an H1N1 strain, envisioned "people dropping dead in the streets", recalled Dr Beth Bell, a CDC epidemiologist who has been a leader in the agency's response.
The disease kept spreading, and eventually the World Health Organisation declared it the first global flu pandemic in 40 years. But even before then, US health officials had downgraded some of their prevention advice, such as the call for schools to shut down for two weeks if any students became infected.
"Overall, it's a fairly typical flu virus,"Richard Webby, a prominent researcher at St. Jude Children's Research Hospital in Memphis, says now.
But this story is not over yet. There are still important unanswered questions.
Most health experts believe swine flu hits children and pregnant women harder than seasonal flu, but it's not clear how much harder because officials don't know exactly how many have caught the swine flu and had only mild symptoms.
A mutation of the virus seen in two Dutch patients last month at first seemed to indicate the bug might be getting more dangerous, but the patients recovered and no further problems were reported. Researchers are watching for more such changes.
Over the summer, new infections spread, often hitting kids' summer camps.That's unusual because seasonal flu usually disappears in summer. But it wasn't a shock, either, because summer spread had been seen in flu pandemics of the past, like one in 1957, said Dr Arnold Monto, a University of Michigan flu expert.
Experts predicted, correctly, that infections would jump in August and September, when schools and universities opened for fall classes.
Now, manufacturers are cranking out vaccine as fast as they can around the world, and the early shipments are trickling out.
Some health officials have speculated the worst may already be over for some parts of the United States, particularly the northeast. If the fall vaccination campaigns are effective, swine flu's winter season may not be as bad as the spring.
However, some experts think things could get worse. Some believe swine flu will be the dominant virus, as it has been during the Southern Hemisphere's winter, just ending. Others worry about the double-flu scenario in which the novel H1N1 virus strikes the young and the ordinary flu socks the old.
In either case, hospitals could be swamped. That's been causing a lot of hand-wringing, with a poll of 1,000 emergency room doctors this week finding that 90% are worried about their hospitals' ability to handle extra patients.
Whatever happens, health officials say it's been a memorable experience.
"There is a certain sense of history unfolding," Dr Bell said.NYT
Amutation of the virus seen in two Dutch patients last
month at first seemed to indicate the bugmight be gettingmore dangerous, but the patients recovered
and no further problems were reported.
In this flashback to May 11,2009, a teacher measures the temperature of a boy as he arrives for his first day of kindergarten after the initial outbreak of swine flu in Mexico City.
Now that the initial scare over the swine flu has subsided, health officials warn we are not out of danger yet.
"We've got many, many months ahead of us where we don't know what will happen and we need to take the best steps we can to protect ourselves," Dr Tom Frieden, director of the Centers for Disease Control and Prevention, said last week."Our biggest concern is that the virus could change, mutate to become more deadly."
With winter approaching in the US,another fear is a one-two punch in which a resurgent swine flu batters young people before the vaccine is widely available,while the ordinary flu strikes the elderly.Also, emergency doctors are worried about the strain on ERs and hospitals.
To date, swine flu has hospitalised hundreds of thousands of people around the world and killed at least 4,500, including at least 600 in the United States.At least 81 US children have died, including many who had no underlying health problems.
The CDC was the first to identify the new flu. It was on April 15 and 17 that the agency determined the nasal samples from two children in southern California revealed a swine flu virus that had never been seen before. It was found to contain bits of bird and human flu.
At first the cases represented more of a scientific puzzle than a public health threat. The two children recovered, but investigators were perplexed by how they got it, since the two children had not been in contact with each other or with pigs.
But within a week, the situation became more dramatic, when testing linked the two children and a handful of subsequent US cases to hundreds of illnesses in Mexico City. Mexican authorities closed schools, museums, libraries and theatres to stop the spread of the disease as initial reports suggested it was killing as many as one in 15 of those infected - a horrifying death rate more than three times higher than the terrible flu pandemic of 1918-19.
A series of bad and good news followed. First, the bad: it quickly became clear that the virus was spreading not only in Mexico and border regions of the United States, but around the world.As health officials had long surmised,international air travel provided a rapid path to world contagion.
What's more, studies indicated the millions of seasonal flu shots administered the previous winter offered no protection against the unusual new virus.
But then came some good news:
While the flu vaccine was no help,the antiviral medication Tamiflu reduced the severity of illness if taken right after symptoms appeared.
People 55 and older, who suffer and die the most from seasonal flu each year, seemed mostly to be spared by the new virus. Scientists credited some immunity that they had perhaps picked up from exposure decades ago to a similar-enough virus or vaccine.
Additional investigation in Mexico suggested that many people had suffered only mild illness. Those cases were not counted in initial reports, meaning the death rate was much, much lower than originally estimated.
In the United States, some of the initial response plans for the new swine flu, an H1N1 strain, envisioned "people dropping dead in the streets", recalled Dr Beth Bell, a CDC epidemiologist who has been a leader in the agency's response.
The disease kept spreading, and eventually the World Health Organisation declared it the first global flu pandemic in 40 years. But even before then, US health officials had downgraded some of their prevention advice, such as the call for schools to shut down for two weeks if any students became infected.
"Overall, it's a fairly typical flu virus,"Richard Webby, a prominent researcher at St. Jude Children's Research Hospital in Memphis, says now.
But this story is not over yet. There are still important unanswered questions.
Most health experts believe swine flu hits children and pregnant women harder than seasonal flu, but it's not clear how much harder because officials don't know exactly how many have caught the swine flu and had only mild symptoms.
A mutation of the virus seen in two Dutch patients last month at first seemed to indicate the bug might be getting more dangerous, but the patients recovered and no further problems were reported. Researchers are watching for more such changes.
Over the summer, new infections spread, often hitting kids' summer camps.That's unusual because seasonal flu usually disappears in summer. But it wasn't a shock, either, because summer spread had been seen in flu pandemics of the past, like one in 1957, said Dr Arnold Monto, a University of Michigan flu expert.
Experts predicted, correctly, that infections would jump in August and September, when schools and universities opened for fall classes.
Now, manufacturers are cranking out vaccine as fast as they can around the world, and the early shipments are trickling out.
Some health officials have speculated the worst may already be over for some parts of the United States, particularly the northeast. If the fall vaccination campaigns are effective, swine flu's winter season may not be as bad as the spring.
However, some experts think things could get worse. Some believe swine flu will be the dominant virus, as it has been during the Southern Hemisphere's winter, just ending. Others worry about the double-flu scenario in which the novel H1N1 virus strikes the young and the ordinary flu socks the old.
In either case, hospitals could be swamped. That's been causing a lot of hand-wringing, with a poll of 1,000 emergency room doctors this week finding that 90% are worried about their hospitals' ability to handle extra patients.
Whatever happens, health officials say it's been a memorable experience.
"There is a certain sense of history unfolding," Dr Bell said.NYT
Amutation of the virus seen in two Dutch patients last
month at first seemed to indicate the bugmight be gettingmore dangerous, but the patients recovered
and no further problems were reported.
In this flashback to May 11,2009, a teacher measures the temperature of a boy as he arrives for his first day of kindergarten after the initial outbreak of swine flu in Mexico City.
Sunday, October 11, 2009
THE GREAT SWINE FLU MYSTERY
As the pharmaceutical companies step up sales of swine flu vaccine,taxpayers are still in the dark about the cost By Alistair Dawber
It's a bonanza! At least that is how some describe the drug industry's expected windfall from the swine flu pandemic as it prepares to cash in on what could be the most widespread winter flu season for a generation. The H1N1 outbreak will certainly be good news for the pharmaceutical groups, but just how good remains a mystery as the firms supplying the vaccines and treatments, and the governments buying them, refuse to give details on how much it is all costing.
GlaxoSmithKline last Tuesday said various governments had placed orders for another 149 million doses of Pandemrix, its newly approved vaccine, taking the total number of orders to 440 million doses. At the same time Japan confirmed orders of enough GSK and Novartis-made vaccine to treat 50 million people.
GSK charges countries on a sliding scale, from ฃ6.48(346 baht) a dose for the most developed, to less for emerging nations. While the company will not say how much it expects to earn from swine flu, analysts put the figure at between ฃ1 billion and ฃ3bn. GSK has also agreed to give the World Health Organization 50 million free doses.
However Savvas Neophytou, an analyst at Panmure Gordon, points out that longer-term revenues could be higher.
"The issue is more what companies like GSK, which generates revenues of $40bn, will make in the longer term. There will be the windfall from the H1N1 pandemic, but the outbreak is likely to put pressure on governments to stockpile treatments and vaccines.That is more likely to provide the drugs companies with recurring revenues, and it is that that has got the investors more excited."
However, the drug companies are reluctant to give details on how much they will make and, in the UK especially, the numbers are shrouded in mystery.GSK and another vaccine maker, Baxter, have sold enough vaccine to the UK government for two doses per person, the recommended supply, for almost the whole population.
The two companies will not say how much they have each sold, however, or how much the UK taxpayer is paying. GSK is known to have given the British government a discount, but will not reveal the amount.The UK's Department of Health (DoH) is equally silent."We cannot divulge the figure for the actual vaccine procurement as it would violate confidentiality clauses in our contracts. The manufacturers have quite reasonably insisted on these, as if it is possible to calculate the amount per unit we paid for vaccine it could prejudice their negotiations with other countries," a DoH spokesman said.
GSK also refuses to say how many different governments have ordered vaccine, adding that some of those announced last week were second requests from administrations that had already asked for doses.
But it is not only GSK and the DoH that are secretive about the economics of swine flu. The Swiss pharmaceutical company Novartis is equally unwilling to give out information. A spokesman said it would only give details where the governments buying its vaccine had agreed to the disclosure. The group confirmed that it would get US$979 million from the US, but would not say how many doses it had ordered. France has ordered 16 million doses, for an undisclosed amount, while Switzerland had placed orders, but for an undisclosed number of doses, and for an undisclosed amount. Sanofi-Aventis also refused to give details that had not been published by governments, adding:"We see H1N1 vaccine production as a public health challenge, not as a business opportunity, although it will boost our revenues this year and next."
Baxter, the US group that along with GSK is supplying the UK with vaccine, simply says it refuses to discuss pricing.
In the UK this has led to calls for an inquiry into how the contracts were negotiated. Norman Lamb,the Liberal Democrats' health spokesman, wrote to the National Audit Office in July asking if the contract with GSK represents value for money. The National Audit Office has replied, says Mr Lamb, and is broadly happy with the deal. The Taxpayers' Alliance has also said it intends to investigate the agreements.
GSK hit back at any allegations of profiteering. In July its chief executive, Andrew Witty, refused to apologise for the swine flu revenues, adding that sales of the group's flu treatment, Relenza, had rocketed from ฃ57m last year to more than ฃ600m since the outbreak of the virus.
"Swine flu is going to be positive for performance,but only because we have put ourselves in a position to do it. And we have done that by taking very significant risks over a long time, diverting a huge amount of resource to it and doing the research that nobody else has done, so I'm not going to apologise for the fact that the company is going to make a return," he said.
The UK ordered 10.5 million doses of Relenza,while Roche, the Swiss makers of Tamiflu, sold 23 million batches to the Department of Health. The DoH declined to comment on how much the taxpayer paid. Roche said it "would rather not comment" on the deal, although it does say it will make about ฃ1.2bn from global sales of Tamiflu this year. The Independent
It's a bonanza! At least that is how some describe the drug industry's expected windfall from the swine flu pandemic as it prepares to cash in on what could be the most widespread winter flu season for a generation. The H1N1 outbreak will certainly be good news for the pharmaceutical groups, but just how good remains a mystery as the firms supplying the vaccines and treatments, and the governments buying them, refuse to give details on how much it is all costing.
GlaxoSmithKline last Tuesday said various governments had placed orders for another 149 million doses of Pandemrix, its newly approved vaccine, taking the total number of orders to 440 million doses. At the same time Japan confirmed orders of enough GSK and Novartis-made vaccine to treat 50 million people.
GSK charges countries on a sliding scale, from ฃ6.48(346 baht) a dose for the most developed, to less for emerging nations. While the company will not say how much it expects to earn from swine flu, analysts put the figure at between ฃ1 billion and ฃ3bn. GSK has also agreed to give the World Health Organization 50 million free doses.
However Savvas Neophytou, an analyst at Panmure Gordon, points out that longer-term revenues could be higher.
"The issue is more what companies like GSK, which generates revenues of $40bn, will make in the longer term. There will be the windfall from the H1N1 pandemic, but the outbreak is likely to put pressure on governments to stockpile treatments and vaccines.That is more likely to provide the drugs companies with recurring revenues, and it is that that has got the investors more excited."
However, the drug companies are reluctant to give details on how much they will make and, in the UK especially, the numbers are shrouded in mystery.GSK and another vaccine maker, Baxter, have sold enough vaccine to the UK government for two doses per person, the recommended supply, for almost the whole population.
The two companies will not say how much they have each sold, however, or how much the UK taxpayer is paying. GSK is known to have given the British government a discount, but will not reveal the amount.The UK's Department of Health (DoH) is equally silent."We cannot divulge the figure for the actual vaccine procurement as it would violate confidentiality clauses in our contracts. The manufacturers have quite reasonably insisted on these, as if it is possible to calculate the amount per unit we paid for vaccine it could prejudice their negotiations with other countries," a DoH spokesman said.
GSK also refuses to say how many different governments have ordered vaccine, adding that some of those announced last week were second requests from administrations that had already asked for doses.
But it is not only GSK and the DoH that are secretive about the economics of swine flu. The Swiss pharmaceutical company Novartis is equally unwilling to give out information. A spokesman said it would only give details where the governments buying its vaccine had agreed to the disclosure. The group confirmed that it would get US$979 million from the US, but would not say how many doses it had ordered. France has ordered 16 million doses, for an undisclosed amount, while Switzerland had placed orders, but for an undisclosed number of doses, and for an undisclosed amount. Sanofi-Aventis also refused to give details that had not been published by governments, adding:"We see H1N1 vaccine production as a public health challenge, not as a business opportunity, although it will boost our revenues this year and next."
Baxter, the US group that along with GSK is supplying the UK with vaccine, simply says it refuses to discuss pricing.
In the UK this has led to calls for an inquiry into how the contracts were negotiated. Norman Lamb,the Liberal Democrats' health spokesman, wrote to the National Audit Office in July asking if the contract with GSK represents value for money. The National Audit Office has replied, says Mr Lamb, and is broadly happy with the deal. The Taxpayers' Alliance has also said it intends to investigate the agreements.
GSK hit back at any allegations of profiteering. In July its chief executive, Andrew Witty, refused to apologise for the swine flu revenues, adding that sales of the group's flu treatment, Relenza, had rocketed from ฃ57m last year to more than ฃ600m since the outbreak of the virus.
"Swine flu is going to be positive for performance,but only because we have put ourselves in a position to do it. And we have done that by taking very significant risks over a long time, diverting a huge amount of resource to it and doing the research that nobody else has done, so I'm not going to apologise for the fact that the company is going to make a return," he said.
The UK ordered 10.5 million doses of Relenza,while Roche, the Swiss makers of Tamiflu, sold 23 million batches to the Department of Health. The DoH declined to comment on how much the taxpayer paid. Roche said it "would rather not comment" on the deal, although it does say it will make about ฃ1.2bn from global sales of Tamiflu this year. The Independent
Wednesday, September 23, 2009
A cleaning that can stave off THE FLU
It sounds so simple as to be innocuous, a throwaway line in publichealth warnings about Type A (H1N1) flu. But one of the most powerful weapons against the new virus is summed up in a three-word phrase you first heard from your mother: Wash your hands.
A host of recent studies have highlighted the importance and the scientific underpinning of this most basic hygiene measure. One of the most graphic was done at the University of California,Berkeley, where researchers focused video cameras on 10 college students as they read and typed on their laptops.
The scientists counted the times the students touched their faces, documenting every lip scratch, eye rub and nose pick. On average, the students touched their eyes, noses and lips 47 times during a three-hour period, once every four minutes.
Hand-to-face contact has a surprising impact on health. Germs can enter the body through breaks in the skin or through the membranes of the eyes,mouth and nose.
The eyes appear to be a particularly vulnerable port of entry for viral infections, said Mark Nicas, a professor of environmental health sciences at Berkeley. Using mathematical models,Nicas and colleagues estimated that in homes, schools and dorms, hand-toface contact appears to account for about one-third of the risk of flu infection,according to a report this month in the journal Risk Analysis .
In one study of four residence halls at the University of Colorado, two of the dorms had hand sanitiser dispensers installed in every dorm room, bathroom and dining area, and students were given educational materials about the importance of hand hygiene. The remaining two dorms were used as controls, and researchers simply monitored illness rates.
During the eight-week study period,students in the dorms with ready access to hand sanitisers had a third fewer complaints of coughs, chest congestion and fever. Overall, the risk of getting sick was 20 percent lower in the dorms where hand hygiene was emphasized,and those students missed 43 percent fewer days of school.
Young children benefit, too. In a study of 6,000 elementary school students in California, Delaware, Ohio and Tennessee, students in classrooms with hand sanitisers had 20 percent fewer absences due to illness. Teacher absenteeism in those schools dropped 10 percent.
Better hand hygiene also appears to make a difference in the home, lowering the risk to other family members when one child is sick. Harvard researchers studied nearly 300 families who had children 5 or younger in day care. Half the families were given a supply of hand sanitiser and educational materials; the other half were left to practice their normal hand washing habits.
In homes with hand sanitisers, the risk of catching a gastrointestinal illness from a sick child dropped 60 percent compared with the control families. The two groups did not differ in rates of respiratory illness rates, but families with the highest rates of sanitiser use had a 20 percent lower risk of catching such an illness from a sick child.
Regular soap and water and alcoholbased hand sanitisers are both effective in eliminating the H1N1 virus from the hands. In February, researchers in Australia coated the hands of 20 volunteers with copious amounts of a seasonal H1N1 flu virus.
The concentration of virus was equivalent to the amount that would occur when an infected person used a hand to wipe a runny nose.
When the subjects did not wash their hands, large amounts of live virus remained even after an hour, said the lead author, Dr M. Lindsay Grayson, a professor of medicine at the University of Melbourne. But using soap and water or a sanitiser virtually eliminated the presence of the virus.
Frequent hand washing will not eliminate risk. When an infected person coughs or sneezes, a bystander might be splattered by large droplets or may inhale airborne particles. In a recent Harvard study of hand sanitiser use in schools, hand hygiene practices lowered risk for gastrointestinal illness but not upper respiratory infections.
Still, it is a good idea to wash your hands regularly even if you're not in contact people who are obviously ill. In a troubling finding, a recent study of 404 British commuters found that 28 percent had faecal bacteria on their hands. In one city, 57 percent of the men sampled had contaminated hands,according to the study, which was published this month in the journal Epidemiology and Infection ."We were surprised by the high level of contamination," said Gaby Judah, a researcher at the London School of Hygiene and Tropical Medicine. Judah added that many of the contaminated commuters reported that they had washed their hands that morning. They may have been embarrassed to admit they hadn't washed, or they may have picked up the bacteria on their hands during their commute.
For all those reasons, the Centres for Disease Control and Prevention, with other health organisations around the world, urge frequent hand washing with soap and water or alcohol-based hand sanitisers.(They also repeat some advice you may not have heard from your mother: Cough or sneeze into the crook of your elbow, not your hands.)
And as hospitals put stricter hand hygiene programmes in place, absentee rates during cold and flu season also drop.
"Statistically, you can't determine a causal relationship, but it's very suggestive," said Neil O. Fishman, infectious disease specialist at the University of Pennsylvania.
"Our vaccination rates remained relatively stable, so what else changed? The only thing different was that hand hygiene rates increased."
A host of recent studies have highlighted the importance and the scientific underpinning of this most basic hygiene measure. One of the most graphic was done at the University of California,Berkeley, where researchers focused video cameras on 10 college students as they read and typed on their laptops.
The scientists counted the times the students touched their faces, documenting every lip scratch, eye rub and nose pick. On average, the students touched their eyes, noses and lips 47 times during a three-hour period, once every four minutes.
Hand-to-face contact has a surprising impact on health. Germs can enter the body through breaks in the skin or through the membranes of the eyes,mouth and nose.
The eyes appear to be a particularly vulnerable port of entry for viral infections, said Mark Nicas, a professor of environmental health sciences at Berkeley. Using mathematical models,Nicas and colleagues estimated that in homes, schools and dorms, hand-toface contact appears to account for about one-third of the risk of flu infection,according to a report this month in the journal Risk Analysis .
In one study of four residence halls at the University of Colorado, two of the dorms had hand sanitiser dispensers installed in every dorm room, bathroom and dining area, and students were given educational materials about the importance of hand hygiene. The remaining two dorms were used as controls, and researchers simply monitored illness rates.
During the eight-week study period,students in the dorms with ready access to hand sanitisers had a third fewer complaints of coughs, chest congestion and fever. Overall, the risk of getting sick was 20 percent lower in the dorms where hand hygiene was emphasized,and those students missed 43 percent fewer days of school.
Young children benefit, too. In a study of 6,000 elementary school students in California, Delaware, Ohio and Tennessee, students in classrooms with hand sanitisers had 20 percent fewer absences due to illness. Teacher absenteeism in those schools dropped 10 percent.
Better hand hygiene also appears to make a difference in the home, lowering the risk to other family members when one child is sick. Harvard researchers studied nearly 300 families who had children 5 or younger in day care. Half the families were given a supply of hand sanitiser and educational materials; the other half were left to practice their normal hand washing habits.
In homes with hand sanitisers, the risk of catching a gastrointestinal illness from a sick child dropped 60 percent compared with the control families. The two groups did not differ in rates of respiratory illness rates, but families with the highest rates of sanitiser use had a 20 percent lower risk of catching such an illness from a sick child.
Regular soap and water and alcoholbased hand sanitisers are both effective in eliminating the H1N1 virus from the hands. In February, researchers in Australia coated the hands of 20 volunteers with copious amounts of a seasonal H1N1 flu virus.
The concentration of virus was equivalent to the amount that would occur when an infected person used a hand to wipe a runny nose.
When the subjects did not wash their hands, large amounts of live virus remained even after an hour, said the lead author, Dr M. Lindsay Grayson, a professor of medicine at the University of Melbourne. But using soap and water or a sanitiser virtually eliminated the presence of the virus.
Frequent hand washing will not eliminate risk. When an infected person coughs or sneezes, a bystander might be splattered by large droplets or may inhale airborne particles. In a recent Harvard study of hand sanitiser use in schools, hand hygiene practices lowered risk for gastrointestinal illness but not upper respiratory infections.
Still, it is a good idea to wash your hands regularly even if you're not in contact people who are obviously ill. In a troubling finding, a recent study of 404 British commuters found that 28 percent had faecal bacteria on their hands. In one city, 57 percent of the men sampled had contaminated hands,according to the study, which was published this month in the journal Epidemiology and Infection ."We were surprised by the high level of contamination," said Gaby Judah, a researcher at the London School of Hygiene and Tropical Medicine. Judah added that many of the contaminated commuters reported that they had washed their hands that morning. They may have been embarrassed to admit they hadn't washed, or they may have picked up the bacteria on their hands during their commute.
For all those reasons, the Centres for Disease Control and Prevention, with other health organisations around the world, urge frequent hand washing with soap and water or alcohol-based hand sanitisers.(They also repeat some advice you may not have heard from your mother: Cough or sneeze into the crook of your elbow, not your hands.)
And as hospitals put stricter hand hygiene programmes in place, absentee rates during cold and flu season also drop.
"Statistically, you can't determine a causal relationship, but it's very suggestive," said Neil O. Fishman, infectious disease specialist at the University of Pennsylvania.
"Our vaccination rates remained relatively stable, so what else changed? The only thing different was that hand hygiene rates increased."
Eid gatherings fuel fears of flu contagion
Muslims across the world celebrated Eid al-Fitr yesterday to mark the end of Ramadan, but authorities urged caution as large social gatherings and returning Mecca pilgrims fuelled fears of swine flu spreading.
In Cairo, where two people have died from the H1N1 flu virus and nearly 900 cases have been reported, preachers suggested that worshippers perform the traditional dawn prayer at home rather than at crowded mosques.
"We ought to cancel Eid prayers ...there should be a national campaign to keep crowded places clean and ensure they are safe for people," Suad Saleh, head of Islamic Jurisprudence at Al-Azhar University told the Englishlanguage Egyptian Gazette .Cairo airport authorities have reinforced swine flu testing measures as the end of Ramadan means the return of thousands of pilgrims from Saudi Arabia.
Fear of the virus spreading in the crowded conditions during the pilgrimage is shared by many other countries who are considering cancelling the annual Hajj pilgrimage this year.
Jordanians have been urged to refrain from kissing each other in a bid to combat the contagious disease.
"People should not kiss at social events and gatherings. Instead, they should just shake hands," the government's fatwa department said in a statement ahead of the Eid holiday.
In Jakarta, thousands of people queued for hours outside the presidential palace to pay their respects to President Susilo Bambang Yudhoyono.
Indonesian officials fearful of the spread of swine flu set up thermal scanners at the open house event, which is part of a tradition whereby people throughout the country ask forgiveness from others for slights and offences.
In the world's largest Muslimmajority country, nearly 30 million people were estimated to have emptied out of cities and towns in a yearly exodus to celebrate the holiday.
The Transport Ministry said 184 people have died in the traffic chaos already.
The start of Eid is traditionally determined by the sighting of the new moon, often dividing rival Islamic countries and sects over the exact date.
In Iraq, Shi'ites loyal to the Grand Ayatollah Ali Husseini al-Sistani, the nation's top Shi'ite cleric, continued fasting yesterday, observing nationally televised and locally delivered messages that the new moon had not yet risen.
However those who follow the Shi'ite cleric Moqtada al-Sadr ended the holy month of Ramadan early yesterday.
Iraq's minority Sunnis ended Ramadan on Saturday.
In neighbouring Iran, politics overshadowed prayer, with supreme leader Ayatollah Ali Khamenei taking aim at Israel, Western powers and the foreign media. In his sermon, Mr Khamenei said a "Zionist cancer" was gnawing into the lives of Islamic nations.
In Afghanistan, President Hamid Karzai extended an olive branch to Taliban militants trying to overthrow his Western-backed government.
"On this auspicious day once again I ask all those Afghan brothers who are unhappy or are in others' hands to stop fighting, destroying their own land and killing their own people," he said at the presidential palace in Kabul."They must come to their houses and live in peace in their own country."
Pakistani families uprooted by conflict with the Taliban face a miserable Eid, with no cash to splash on celebrations and desirous of returning to homes they fear no longer exist.
The UN said about two million Pakistanis were displaced as a result of fighting between the army and Taliban militants.
Meanwhile, residents of restive Indian Kashmir jammed markets in defiance of a rise in militant violence to stock up for Eid.
The festival to celebrate the close of the holy month will be held Monday or Tuesday, depending when the new crescent moon is sighted in the restive Himalayan region where Islamic militants have been fighting against New Delhi's rule for 20 years.
Shopkeepers set up extra kiosks to cater to the mad shopping rush.
Muslim separatists who are leading the movement to break away from India and join Pakistan, or declare an independent state, called on followers to show austerity.
In Cairo, where two people have died from the H1N1 flu virus and nearly 900 cases have been reported, preachers suggested that worshippers perform the traditional dawn prayer at home rather than at crowded mosques.
"We ought to cancel Eid prayers ...there should be a national campaign to keep crowded places clean and ensure they are safe for people," Suad Saleh, head of Islamic Jurisprudence at Al-Azhar University told the Englishlanguage Egyptian Gazette .Cairo airport authorities have reinforced swine flu testing measures as the end of Ramadan means the return of thousands of pilgrims from Saudi Arabia.
Fear of the virus spreading in the crowded conditions during the pilgrimage is shared by many other countries who are considering cancelling the annual Hajj pilgrimage this year.
Jordanians have been urged to refrain from kissing each other in a bid to combat the contagious disease.
"People should not kiss at social events and gatherings. Instead, they should just shake hands," the government's fatwa department said in a statement ahead of the Eid holiday.
In Jakarta, thousands of people queued for hours outside the presidential palace to pay their respects to President Susilo Bambang Yudhoyono.
Indonesian officials fearful of the spread of swine flu set up thermal scanners at the open house event, which is part of a tradition whereby people throughout the country ask forgiveness from others for slights and offences.
In the world's largest Muslimmajority country, nearly 30 million people were estimated to have emptied out of cities and towns in a yearly exodus to celebrate the holiday.
The Transport Ministry said 184 people have died in the traffic chaos already.
The start of Eid is traditionally determined by the sighting of the new moon, often dividing rival Islamic countries and sects over the exact date.
In Iraq, Shi'ites loyal to the Grand Ayatollah Ali Husseini al-Sistani, the nation's top Shi'ite cleric, continued fasting yesterday, observing nationally televised and locally delivered messages that the new moon had not yet risen.
However those who follow the Shi'ite cleric Moqtada al-Sadr ended the holy month of Ramadan early yesterday.
Iraq's minority Sunnis ended Ramadan on Saturday.
In neighbouring Iran, politics overshadowed prayer, with supreme leader Ayatollah Ali Khamenei taking aim at Israel, Western powers and the foreign media. In his sermon, Mr Khamenei said a "Zionist cancer" was gnawing into the lives of Islamic nations.
In Afghanistan, President Hamid Karzai extended an olive branch to Taliban militants trying to overthrow his Western-backed government.
"On this auspicious day once again I ask all those Afghan brothers who are unhappy or are in others' hands to stop fighting, destroying their own land and killing their own people," he said at the presidential palace in Kabul."They must come to their houses and live in peace in their own country."
Pakistani families uprooted by conflict with the Taliban face a miserable Eid, with no cash to splash on celebrations and desirous of returning to homes they fear no longer exist.
The UN said about two million Pakistanis were displaced as a result of fighting between the army and Taliban militants.
Meanwhile, residents of restive Indian Kashmir jammed markets in defiance of a rise in militant violence to stock up for Eid.
The festival to celebrate the close of the holy month will be held Monday or Tuesday, depending when the new crescent moon is sighted in the restive Himalayan region where Islamic militants have been fighting against New Delhi's rule for 20 years.
Shopkeepers set up extra kiosks to cater to the mad shopping rush.
Muslim separatists who are leading the movement to break away from India and join Pakistan, or declare an independent state, called on followers to show austerity.
Poor "have no access" to vaccine
Top of the agenda for the World Health Organisation's (WHO)Western Pacific meeting this week will be how to combat the H1N1 flu pandemic in developing nations.
There are growing fears that poorer countries will not get enough vaccines,despite a pledge last week by the US and eight other nations to make 10% of their flu vaccine supply available to others in need.
"The developing world will have no access to vaccines for the time being.There are some donations but it is not enough," said Lo Wing-lok, a member of Hong Kong's government scientific committee on emerging diseases.
"It is very much a matter of equity and the WHO must look at any way to address this."
Developing countries such as the Philippines are not only unable to produce the vaccine for the H1N1 flu virus but their people are more vulnerable to infection because of poverty, crowded living conditions and lack of healthcare.
While the Americas still have the highest death toll from the virus, cases are expected to increase.
In the Western Pacific there are about a million people living in poor conditions without access to healthcare, making them particularly vulnerable, WHO regional director Shin Young-soo said yesterday, on the eve of the WHO meetings in Hong Kong.
"Hopefully many countries including China and the United States are soon going to vaccinate their own people but that is not the case for many developing countries and it is something we are worried about," he said.
The WHO and the UN are working on raising a billion dollars to help buy vaccines for countries that need help,he added.
Mr Shin said some experts estimate that 20% to 30% of the Western Pacific region will eventually be affected by the virus. So far Australia has the highest H1N1 flu death toll in the region, with about 171 deaths, according to the WHO.
The organisation warned last week that production of vaccines will fall substantially short of the amount needed to protect the global population.
The WHO put the number of deaths worldwide from the virus at 3,486, up 281 from the previous week.
Despite new evidence that only one dose of the vaccines currently being tested will be enough for most people,a WHO spokesman said output next year will be "substantially less" than the annual 4.9 billion doses production forecast. The US, Australia, Brazil, UK, France,Italy, New Zealand, Norway and Switzerland have said they will make donations to nations without vaccines.
There are growing fears that poorer countries will not get enough vaccines,despite a pledge last week by the US and eight other nations to make 10% of their flu vaccine supply available to others in need.
"The developing world will have no access to vaccines for the time being.There are some donations but it is not enough," said Lo Wing-lok, a member of Hong Kong's government scientific committee on emerging diseases.
"It is very much a matter of equity and the WHO must look at any way to address this."
Developing countries such as the Philippines are not only unable to produce the vaccine for the H1N1 flu virus but their people are more vulnerable to infection because of poverty, crowded living conditions and lack of healthcare.
While the Americas still have the highest death toll from the virus, cases are expected to increase.
In the Western Pacific there are about a million people living in poor conditions without access to healthcare, making them particularly vulnerable, WHO regional director Shin Young-soo said yesterday, on the eve of the WHO meetings in Hong Kong.
"Hopefully many countries including China and the United States are soon going to vaccinate their own people but that is not the case for many developing countries and it is something we are worried about," he said.
The WHO and the UN are working on raising a billion dollars to help buy vaccines for countries that need help,he added.
Mr Shin said some experts estimate that 20% to 30% of the Western Pacific region will eventually be affected by the virus. So far Australia has the highest H1N1 flu death toll in the region, with about 171 deaths, according to the WHO.
The organisation warned last week that production of vaccines will fall substantially short of the amount needed to protect the global population.
The WHO put the number of deaths worldwide from the virus at 3,486, up 281 from the previous week.
Despite new evidence that only one dose of the vaccines currently being tested will be enough for most people,a WHO spokesman said output next year will be "substantially less" than the annual 4.9 billion doses production forecast. The US, Australia, Brazil, UK, France,Italy, New Zealand, Norway and Switzerland have said they will make donations to nations without vaccines.
Monday, September 21, 2009
Migrant health care a critical issue
In Tak province, caring for migrant workers and their families is straining the provincial hospital toits limits, while in some border provinces many apparently go without needed treatment By Erika Fry
When Mae Sot General Hospital first ran out of space a few years ago,hospital staff pitched tents and dragged out old beds. Since then, the problem hasn't improved - the crowded conditions have become more frequent and new beds have been permanently stationed in the hospital corridors. They are seldom empty.
But beds are hardly the extent of the hospital's resource problems. The hospital has a skeleton staff of five Burmese migrants serving as health workers and translators who assist Thai health personnel, but because of labour regulations they are technically employed as domestic workers. The Ministry of Labour limits migrant workers to low-skill work in the agricultural, manufacturing, fisheries or domestic sectors.
The waiting room is invariably crowded,and hospital personnel are overworked. Last year the hospital ran a 50 million baht deficit.
The reason for this debt is well known,and a subject on the minds of hospital administrators, public health officials, NGO staff and a number of Thai patients who ask their doctors why they must treat patients from Burma - the rising cost of providing health care to Mae Sot's migrant population.
Dr Patjuban Hemhongsa, chief medical officer for Tak province, home to Mae Sot and 30 formal points of entry on the ThaiBurma border, looked exasperated when asked about the issue. He called Tak "a perfect place for so many problems we can't solve refugees, stateless, displaced persons and a continuous flow of illegal migrants. There is no budget or system to care for them".
Dr Supakit Sirilak, director of the Bureau of Policy and Strategy for the Ministry of Public Health (Moph), agrees that migration has increased the burden on Thailand's health services and manpower, and added challenges to the disease surveillance and outbreak control system. He also acknowledges that the burden is one that can't be ignored.
Under his nine-year watch in Tak province,the public health system has initiated a number of programmes to target migrant populations and increase their access to medical services.
These included a migrant health worker and volunteer programme, as well as an ini-tiative targeting malaria."The security of the country is security in the health of the people living in it, no matter if they are Thai or not,"said Dr Supakit.
Indeed, these migrant populations, who tend to live in cramped and unsanitary conditions, are often those most vulnerable to disease outbreaks and severe medical problems. Yet because of their mobility, they are also the most difficult to treat.
Dr Supakit spoke of concerns over outbreaks of cholera and emerging diseases like meningococcal meningitis in the border areas.
Tuberculosis, a disease once thought to have been largely conquered in Thailand,now has a strong and increasingly threatening presence in the form of drug-resistant strains along the border. Handfuls of cases of multidrug resistant and extremely drug-resistant forms of the disease have been detected in recent years.
Tuberculosis is a special concern among migrant populations because of the intensive six-month regimen needed to treat the disease.
Health workers speak of challenges in getting migrant patients to complete treatment - often they will begin to feel better and stop coming while at other times, they simply disappear.
In one case a worker being treated was learned to have been arrested and placed in the Immigration Detention Centre. Because of bureaucratic obstacles, it took the NGO nearly two weeks to get him the drugs he needed.
Yet, while many public health workers and officers at Moph agree with Dr Supakit's sentiments, there remains a disconnect between ideology and financing.
"Moph allocates money according to provincial headcounts, which exclude migrant populations. Hospitals cannot request extra budgets, and the government cannot allocate it. You can't spend money you don't have,"Dr Patjuban said.
The reasons for the rising costs are not as clear-cut as they might seem. While there have long been migrants in the border province - in Mae Sot and surrounding districts the Burmese population is estimated at more than 400,000- there hasn't always been hospital debt.
In 2005 and 2006, Mae Sot General Hospital actually earned enough revenue through the Compulsory Migrant Health Insurance (CMHI)scheme to cover the medical costs of both registered and unregistered migrant patients,said Dr Ronnatrai Ruangweerayut, the hospital's deputy director.
He blames the shortfalls that have arisen since largely on the decreasing number of registered workers, a problem which is as much the making of policy makers as it is of Mae Sot's migrants.
According to statistics from the Ministry of Labour,85% of migrant workers living in Thailand in 2004 were registered and insured.Workers pay an annal fee of 1,900 baht for a health screening and insurance that entitles them to health care similar to that available to Thai citizens.
The registration rate has fallen precipitously ever since - only 30% of migrant workers were registered in 2007- because of the restrictive nature (it had been closed to new workers) of the registration programme. Dr Ronnatrai estimates that only 20% of Mae Sot's migrant population is now registered.This figure is bound to increase, as the government opened registration to new migrants earlier this year.
However, the Thai government's recent promise to permanently close the border suggests a likely continuation in the pattern of decline in terms of registration.
As the number of registered migrants has fallen, so too has revenue from CMHI. Hospitals now have a fraction of the income generated through the insurance programme to care for a growing, or at least equal, number of migrants. Revenue collected from CMHI fell from 800 million baht in 2005 to 500 million baht in 2006. At the same time, fewer migrants are entitled to care and more are likely to face out-of-pocket health expenses they cannot afford.
The amount of health services provided free of charge to Burmese rose from nearly 44 million baht in 2006 to 49 million baht in 2008.
Before the advent of universal healthcare coverage in Thailand in 2001, hospitals used the income generated from out-of-pocket payments to fund care for those who could not afford it. With that income no longer available, hospitals and provinces are on their own. Dr Ronnatrai said his hospital has already burned through its past savings and has appealed, along with the Moph, to the government to allocate an additional budget to provinces with large stateless and migrant populations. Their requests have been denied.PROVINCIAL DIFFERENCES While Tak struggles with swelling health care costs, many provinces - some also with large migrant populations - continue to generate significant income through CMHI. Samut Sakhon and Rayong provinces, hubs for migrants working in the Thai fishing and manufacturing sectors, both generated nearly 10 million baht in revenue in 2006 through the insurance scheme, even after covering the costs of services that uninsured and unregistered workers could not afford.
Dr Supakit says the discrepancies are due to the particularities of each province. Tak has far more unregistered workers than registered ones, while that gap is not as great in Samut Sakhon and Rayong. Uninsured workers in these provinces, where wages are higher,may also be more able to pay out-of-pocket medical costs than those in Tak.
Just as hospital exemption payments for unregistered migrants have increased over the years, so too have out-of-pocket health payments made by migrants. Nationally, hospital exemptions in 2006 cost 170 million baht, while out-of-pocket costs by unregistered migrants totaled 120 million baht. In addition,registered migrants contributed 493 million baht through the CMHI scheme. This data includes only 47 provinces.
Any surplus income earned through the system is used, at the discretion of individual hospitals or provinces, to subsidise the costs of providing care to unregistered migrants and stateless people. In most cases, this income exceeds the costs of exempted payments and theoretically is intended for outreach to migrants in the community.
Though this is the expectation, it's hard to know what becomes of this surplus funding. Reports of populations covered and revenue collected through the CMHI scheme have been incomplete and inadequate, despite the fact that the Moph requests all provinces to report their data to the central office.
In 2007, only nine provinces submitted data - four of these are sites of IOM-Moph migrant health projects - down from 65 in 2004 and 46 and 47 in 2005 and 2006, respectively.
"There is no real enforcement of the penalty for those that don't do it," said Dr Nigoon Jitthai, programme manager of International Organisation of Migration's (IOM) Thailand Health programme, which since 2003 has collaborated with the Moph on a Migrant Health Program.
Meanwhile, figures which have been reported vary widely and attract questions on their own.
"The governance and management of the funds is being questioned by everybody, as it seems that it lacks transparency. Many NGOs have tried to find out how the funds are managed and how exactly the funds are spent,without success. To be honest, no one knows how the surplus is used," said Dr Nigoon.
Dr Supakit agrees that reporting has been a problem, and has for several years been working to establish a Migrant Health Management Information System to better monitor migrant health financing and population data.
The surplus funds in many provinces suggest to Dr Nigoon that the public health services - even those in Mae Sot - to which registered workers are entitled through CMHI,are vastly underused. Data from the Moph show that from 2004-2006, registered migrant workers were half as likely to visit public health centres as other insured patients insured migrant workers averaged less than one visit per year, while Thais under the universal coverage plan seek services an average of 2.5 times per year.
Dr Nigoon says this under-utilisation is due to several factors, including fear of local authorities - even those that are registered tend to feel this way - a lack of awareness of their coverage, long working hours, long journeys to health care facilities, restrictive employers, and perhaps, as a consequence of all of these, the preference to self-medicate.
She says the self-medication is unfortunate as migrants may lose money for inappropriate treatment, health providers may miss health developments within migrant populations,and in cases of infectious diseases, the chronic misuse of antibiotics etc can cause drug resistance.
Available data continues to show that migrants under the CMHI scheme are most likely to seek treatment when health cases are quite severe and require in-patient care.
While Dr Supakit calls CMHI an effective system for those it covers, he acknowledges there are some locations where there may not be adequate translators or cultural help for migrant workers to feel comfortable in accessing it. Those who are not covered by CMHI - stateless persons and illegal migrants - present the complications.
Accordingly, he recommends that policy makers adopt a system that will facilitate migrant workers into insurance schemes."The more they are insured, the better health insurance can survive."
While this year's influx of one million migrants into the registration system should buoy, or further bloat, hospitals' CMHI accounts, the increase will not resolve the disparities and gaps within the funding system.
A handful of NGOs and international organisations like IOM continue to pitch in, in areas where service is most patchy. These efforts are often specifically targetted to provide TB services or HIV/Aids prevention, though others more broadly address the migrant community's health needs. IOM, for example,funds several community health posts and the training and service of migrant health workers.
A health worker in a post in Tak's Thasong Yang district - a young Karen woman whose family has lived in Thailand for more than 40 years, but lacks Thai citizenship - attends the health needs of her village's 884 members,sometimes around-the-clock as her home is next to the health post, providing basic care.
Much relief also comes from Mae Sot's Mae Tao Clinic, an internationally-funded operation that in 2006 had a caseload of 80,000 and expended 55 million baht in health services to Burmese patients. Half of these came from Burma for treatment.
While the Moph and provincial health offices have recently absorbed some programmes once supported by IOM, in a nod for sustainability, much of the external assistance comes with an expiration date, and provides neither a complete nor permanent fix.
Dr Patjuban grapples with how to keep the population of Tak healthy, and his public health services financially solvent."The shortages impact the whole system. We need more human resources, more equipment.It's an insufficient budget."
While Tak province receives assistance for funding migrant health care from a handful of NGOs, the inequalities of the migrant health care system and lack of assistance from the government get to him.
"For education, its not a problem. The resources are allocated," he says, referencing the Education for All programme that, at least theoretically, provides education to Thais and non-Thais."Why more funding for education, but none for health?" he asks.
He sees no light at the end of the tunnel,and having given up on on his own government turns to another."The strain on our system is great. We need Burma to improve."
When Mae Sot General Hospital first ran out of space a few years ago,hospital staff pitched tents and dragged out old beds. Since then, the problem hasn't improved - the crowded conditions have become more frequent and new beds have been permanently stationed in the hospital corridors. They are seldom empty.
But beds are hardly the extent of the hospital's resource problems. The hospital has a skeleton staff of five Burmese migrants serving as health workers and translators who assist Thai health personnel, but because of labour regulations they are technically employed as domestic workers. The Ministry of Labour limits migrant workers to low-skill work in the agricultural, manufacturing, fisheries or domestic sectors.
The waiting room is invariably crowded,and hospital personnel are overworked. Last year the hospital ran a 50 million baht deficit.
The reason for this debt is well known,and a subject on the minds of hospital administrators, public health officials, NGO staff and a number of Thai patients who ask their doctors why they must treat patients from Burma - the rising cost of providing health care to Mae Sot's migrant population.
Dr Patjuban Hemhongsa, chief medical officer for Tak province, home to Mae Sot and 30 formal points of entry on the ThaiBurma border, looked exasperated when asked about the issue. He called Tak "a perfect place for so many problems we can't solve refugees, stateless, displaced persons and a continuous flow of illegal migrants. There is no budget or system to care for them".
Dr Supakit Sirilak, director of the Bureau of Policy and Strategy for the Ministry of Public Health (Moph), agrees that migration has increased the burden on Thailand's health services and manpower, and added challenges to the disease surveillance and outbreak control system. He also acknowledges that the burden is one that can't be ignored.
Under his nine-year watch in Tak province,the public health system has initiated a number of programmes to target migrant populations and increase their access to medical services.
These included a migrant health worker and volunteer programme, as well as an ini-tiative targeting malaria."The security of the country is security in the health of the people living in it, no matter if they are Thai or not,"said Dr Supakit.
Indeed, these migrant populations, who tend to live in cramped and unsanitary conditions, are often those most vulnerable to disease outbreaks and severe medical problems. Yet because of their mobility, they are also the most difficult to treat.
Dr Supakit spoke of concerns over outbreaks of cholera and emerging diseases like meningococcal meningitis in the border areas.
Tuberculosis, a disease once thought to have been largely conquered in Thailand,now has a strong and increasingly threatening presence in the form of drug-resistant strains along the border. Handfuls of cases of multidrug resistant and extremely drug-resistant forms of the disease have been detected in recent years.
Tuberculosis is a special concern among migrant populations because of the intensive six-month regimen needed to treat the disease.
Health workers speak of challenges in getting migrant patients to complete treatment - often they will begin to feel better and stop coming while at other times, they simply disappear.
In one case a worker being treated was learned to have been arrested and placed in the Immigration Detention Centre. Because of bureaucratic obstacles, it took the NGO nearly two weeks to get him the drugs he needed.
Yet, while many public health workers and officers at Moph agree with Dr Supakit's sentiments, there remains a disconnect between ideology and financing.
"Moph allocates money according to provincial headcounts, which exclude migrant populations. Hospitals cannot request extra budgets, and the government cannot allocate it. You can't spend money you don't have,"Dr Patjuban said.
The reasons for the rising costs are not as clear-cut as they might seem. While there have long been migrants in the border province - in Mae Sot and surrounding districts the Burmese population is estimated at more than 400,000- there hasn't always been hospital debt.
In 2005 and 2006, Mae Sot General Hospital actually earned enough revenue through the Compulsory Migrant Health Insurance (CMHI)scheme to cover the medical costs of both registered and unregistered migrant patients,said Dr Ronnatrai Ruangweerayut, the hospital's deputy director.
He blames the shortfalls that have arisen since largely on the decreasing number of registered workers, a problem which is as much the making of policy makers as it is of Mae Sot's migrants.
According to statistics from the Ministry of Labour,85% of migrant workers living in Thailand in 2004 were registered and insured.Workers pay an annal fee of 1,900 baht for a health screening and insurance that entitles them to health care similar to that available to Thai citizens.
The registration rate has fallen precipitously ever since - only 30% of migrant workers were registered in 2007- because of the restrictive nature (it had been closed to new workers) of the registration programme. Dr Ronnatrai estimates that only 20% of Mae Sot's migrant population is now registered.This figure is bound to increase, as the government opened registration to new migrants earlier this year.
However, the Thai government's recent promise to permanently close the border suggests a likely continuation in the pattern of decline in terms of registration.
As the number of registered migrants has fallen, so too has revenue from CMHI. Hospitals now have a fraction of the income generated through the insurance programme to care for a growing, or at least equal, number of migrants. Revenue collected from CMHI fell from 800 million baht in 2005 to 500 million baht in 2006. At the same time, fewer migrants are entitled to care and more are likely to face out-of-pocket health expenses they cannot afford.
The amount of health services provided free of charge to Burmese rose from nearly 44 million baht in 2006 to 49 million baht in 2008.
Before the advent of universal healthcare coverage in Thailand in 2001, hospitals used the income generated from out-of-pocket payments to fund care for those who could not afford it. With that income no longer available, hospitals and provinces are on their own. Dr Ronnatrai said his hospital has already burned through its past savings and has appealed, along with the Moph, to the government to allocate an additional budget to provinces with large stateless and migrant populations. Their requests have been denied.PROVINCIAL DIFFERENCES While Tak struggles with swelling health care costs, many provinces - some also with large migrant populations - continue to generate significant income through CMHI. Samut Sakhon and Rayong provinces, hubs for migrants working in the Thai fishing and manufacturing sectors, both generated nearly 10 million baht in revenue in 2006 through the insurance scheme, even after covering the costs of services that uninsured and unregistered workers could not afford.
Dr Supakit says the discrepancies are due to the particularities of each province. Tak has far more unregistered workers than registered ones, while that gap is not as great in Samut Sakhon and Rayong. Uninsured workers in these provinces, where wages are higher,may also be more able to pay out-of-pocket medical costs than those in Tak.
Just as hospital exemption payments for unregistered migrants have increased over the years, so too have out-of-pocket health payments made by migrants. Nationally, hospital exemptions in 2006 cost 170 million baht, while out-of-pocket costs by unregistered migrants totaled 120 million baht. In addition,registered migrants contributed 493 million baht through the CMHI scheme. This data includes only 47 provinces.
Any surplus income earned through the system is used, at the discretion of individual hospitals or provinces, to subsidise the costs of providing care to unregistered migrants and stateless people. In most cases, this income exceeds the costs of exempted payments and theoretically is intended for outreach to migrants in the community.
Though this is the expectation, it's hard to know what becomes of this surplus funding. Reports of populations covered and revenue collected through the CMHI scheme have been incomplete and inadequate, despite the fact that the Moph requests all provinces to report their data to the central office.
In 2007, only nine provinces submitted data - four of these are sites of IOM-Moph migrant health projects - down from 65 in 2004 and 46 and 47 in 2005 and 2006, respectively.
"There is no real enforcement of the penalty for those that don't do it," said Dr Nigoon Jitthai, programme manager of International Organisation of Migration's (IOM) Thailand Health programme, which since 2003 has collaborated with the Moph on a Migrant Health Program.
Meanwhile, figures which have been reported vary widely and attract questions on their own.
"The governance and management of the funds is being questioned by everybody, as it seems that it lacks transparency. Many NGOs have tried to find out how the funds are managed and how exactly the funds are spent,without success. To be honest, no one knows how the surplus is used," said Dr Nigoon.
Dr Supakit agrees that reporting has been a problem, and has for several years been working to establish a Migrant Health Management Information System to better monitor migrant health financing and population data.
The surplus funds in many provinces suggest to Dr Nigoon that the public health services - even those in Mae Sot - to which registered workers are entitled through CMHI,are vastly underused. Data from the Moph show that from 2004-2006, registered migrant workers were half as likely to visit public health centres as other insured patients insured migrant workers averaged less than one visit per year, while Thais under the universal coverage plan seek services an average of 2.5 times per year.
Dr Nigoon says this under-utilisation is due to several factors, including fear of local authorities - even those that are registered tend to feel this way - a lack of awareness of their coverage, long working hours, long journeys to health care facilities, restrictive employers, and perhaps, as a consequence of all of these, the preference to self-medicate.
She says the self-medication is unfortunate as migrants may lose money for inappropriate treatment, health providers may miss health developments within migrant populations,and in cases of infectious diseases, the chronic misuse of antibiotics etc can cause drug resistance.
Available data continues to show that migrants under the CMHI scheme are most likely to seek treatment when health cases are quite severe and require in-patient care.
While Dr Supakit calls CMHI an effective system for those it covers, he acknowledges there are some locations where there may not be adequate translators or cultural help for migrant workers to feel comfortable in accessing it. Those who are not covered by CMHI - stateless persons and illegal migrants - present the complications.
Accordingly, he recommends that policy makers adopt a system that will facilitate migrant workers into insurance schemes."The more they are insured, the better health insurance can survive."
While this year's influx of one million migrants into the registration system should buoy, or further bloat, hospitals' CMHI accounts, the increase will not resolve the disparities and gaps within the funding system.
A handful of NGOs and international organisations like IOM continue to pitch in, in areas where service is most patchy. These efforts are often specifically targetted to provide TB services or HIV/Aids prevention, though others more broadly address the migrant community's health needs. IOM, for example,funds several community health posts and the training and service of migrant health workers.
A health worker in a post in Tak's Thasong Yang district - a young Karen woman whose family has lived in Thailand for more than 40 years, but lacks Thai citizenship - attends the health needs of her village's 884 members,sometimes around-the-clock as her home is next to the health post, providing basic care.
Much relief also comes from Mae Sot's Mae Tao Clinic, an internationally-funded operation that in 2006 had a caseload of 80,000 and expended 55 million baht in health services to Burmese patients. Half of these came from Burma for treatment.
While the Moph and provincial health offices have recently absorbed some programmes once supported by IOM, in a nod for sustainability, much of the external assistance comes with an expiration date, and provides neither a complete nor permanent fix.
Dr Patjuban grapples with how to keep the population of Tak healthy, and his public health services financially solvent."The shortages impact the whole system. We need more human resources, more equipment.It's an insufficient budget."
While Tak province receives assistance for funding migrant health care from a handful of NGOs, the inequalities of the migrant health care system and lack of assistance from the government get to him.
"For education, its not a problem. The resources are allocated," he says, referencing the Education for All programme that, at least theoretically, provides education to Thais and non-Thais."Why more funding for education, but none for health?" he asks.
He sees no light at the end of the tunnel,and having given up on on his own government turns to another."The strain on our system is great. We need Burma to improve."
MOSQUITO-BORNE AFRICAN VIRUS "A THREAT TO WEST"
The United States and Europe face a new health threat from a mosquito-borne disease far more unpleasant than the West Nile virus that swept into North America a decade ago,a US expert said on Friday.
Chikungunya virus has spread beyond Africa since 2005, causing outbreaks and scores of fatalities in India and the French island of Reunion. It also has been detected in Italy, where it has begun to spread locally, as well as France.
"We're very worried," Dr James Diaz of the Louisiana University Health Sciences Center told a meeting on airlines,airports and disease transmission.
"Unlike West Nile virus, where nine out of 10 people are going to be totally asymptomatic, or may have a mild headache or a stiff neck, if you get Chikungunya you're going to be sick," he said.
"The disease can be fatal. It's a serious disease," Dr Diaz added."There is no vaccine."
Chikungunya infection causes fever,headache, fatigue, nausea, vomiting,muscle pain, rash and joint pain. Symptoms can last a few weeks, though some suffers have reported incapacitating joint pain or arthritis lasting months.
The disease was first discovered in Tanzania in 1952. Its name means "that which bends up" in the Makonde language spoken in northern Mozambique and southeastern Tanzania.
The virus could spread globally now because it can be carried by the Asian tiger mosquito, which is found across the world.
Chikungunya virus has spread beyond Africa since 2005, causing outbreaks and scores of fatalities in India and the French island of Reunion. It also has been detected in Italy, where it has begun to spread locally, as well as France.
"We're very worried," Dr James Diaz of the Louisiana University Health Sciences Center told a meeting on airlines,airports and disease transmission.
"Unlike West Nile virus, where nine out of 10 people are going to be totally asymptomatic, or may have a mild headache or a stiff neck, if you get Chikungunya you're going to be sick," he said.
"The disease can be fatal. It's a serious disease," Dr Diaz added."There is no vaccine."
Chikungunya infection causes fever,headache, fatigue, nausea, vomiting,muscle pain, rash and joint pain. Symptoms can last a few weeks, though some suffers have reported incapacitating joint pain or arthritis lasting months.
The disease was first discovered in Tanzania in 1952. Its name means "that which bends up" in the Makonde language spoken in northern Mozambique and southeastern Tanzania.
The virus could spread globally now because it can be carried by the Asian tiger mosquito, which is found across the world.
FRESH WAVE OF SWINE FLU INFECTS THOUSANDS IN MEXICO
Mexico was hit with 1,341 new swine flu cases since Monday, bringing the total to 26,338 ahead of the usual autumn flu season, health officials said yesterday.
The Health Ministry said one more person died from the A(H1N1) virus between Monday and Thursday, bringing the death toll to 218 in the country where the virus first emerged in April before becoming a pandemic. In late August, Health Minister Jose Angel Cordova estimated nearly one million people could be infected by the virus during the winter, out of a total population of 100 million in Mexico.
The official global flu death toll has reached 3,486, up 281 from a week ago, according to the World Health Organisation (WHO), which has reported 296,471 known cases of infection. That number is seenas far below actual figures as some countries lack systematic analysis.
The UN agency said the Americas region still has the highest death toll, at 2,625. The Asia-Pacific region reported 620 official fatalities, while Europe recorded at least 140 deaths.
In the Middle East, 61 people succumbed to the virus while in Africa, 40 people have died from it.
The WHO on Friday warned that the production of swine flu vaccines will fall "substantially" short of the amount needed to protect the global population.
"Current supplies of pandemic vaccine are inadequate for a world population in which virtually everyone is susceptible to infection by a new and readily contagious virus," WHO director general Margaret Chan said.
Despite new evidence that only one dose of the vaccines currently being tested will be enough for most people, WHO spokesman Gregory Hartl said output next year will be "sub-stantially less" than the 4.9 billion doeses annual production forecast.
Some 25 pharmaceutical laboratories working on vaccines have indicated that weekly production is lower than 94 million doses, he said.
In May, the WHO had forecast a weekly output of 94.3 million doses if full scale vaccine production was launched.
But pharmaceutical companies have in recent weeks slashed their production expectations due to poorer than expected yields from the so-called "seed virus" strians developed by WHO-approved laboratories.
Amid growing fears that poorer nations will not get enough vaccines, the United States led nine countries which on Thursday pledged to make 10 per cent of their swine flu vaccine supply available to other nations in need.
The UN health agency's chief applauded the move the United States, Australia, Brazil, Britain, France, Italy, New Zealand, Norway and Switzerland.
Mexico Health Minister Jose Angel Cordova estimated nearly 1 million people could be infected.
The Health Ministry said one more person died from the A(H1N1) virus between Monday and Thursday, bringing the death toll to 218 in the country where the virus first emerged in April before becoming a pandemic. In late August, Health Minister Jose Angel Cordova estimated nearly one million people could be infected by the virus during the winter, out of a total population of 100 million in Mexico.
The official global flu death toll has reached 3,486, up 281 from a week ago, according to the World Health Organisation (WHO), which has reported 296,471 known cases of infection. That number is seenas far below actual figures as some countries lack systematic analysis.
The UN agency said the Americas region still has the highest death toll, at 2,625. The Asia-Pacific region reported 620 official fatalities, while Europe recorded at least 140 deaths.
In the Middle East, 61 people succumbed to the virus while in Africa, 40 people have died from it.
The WHO on Friday warned that the production of swine flu vaccines will fall "substantially" short of the amount needed to protect the global population.
"Current supplies of pandemic vaccine are inadequate for a world population in which virtually everyone is susceptible to infection by a new and readily contagious virus," WHO director general Margaret Chan said.
Despite new evidence that only one dose of the vaccines currently being tested will be enough for most people, WHO spokesman Gregory Hartl said output next year will be "sub-stantially less" than the 4.9 billion doeses annual production forecast.
Some 25 pharmaceutical laboratories working on vaccines have indicated that weekly production is lower than 94 million doses, he said.
In May, the WHO had forecast a weekly output of 94.3 million doses if full scale vaccine production was launched.
But pharmaceutical companies have in recent weeks slashed their production expectations due to poorer than expected yields from the so-called "seed virus" strians developed by WHO-approved laboratories.
Amid growing fears that poorer nations will not get enough vaccines, the United States led nine countries which on Thursday pledged to make 10 per cent of their swine flu vaccine supply available to other nations in need.
The UN health agency's chief applauded the move the United States, Australia, Brazil, Britain, France, Italy, New Zealand, Norway and Switzerland.
Mexico Health Minister Jose Angel Cordova estimated nearly 1 million people could be infected.
Human trials of flu jab delayed again
Human trials of the Thai-made type-A (H1N1) influenza vaccine have been delayed for the second time after the World Health Organisation recommended the Thai team conduct more studies on the trial jab's safety.
Vichai Chokewiwat, the Government Pharmaceutical Organisation (GPO)chairman, said the WHO viewed that Thai scientists were new to the production of live-attenuated vaccine, so the country should take careful steps in producing a vaccine.
The WHO's recommendation came after the Thai team detected an abscess in a rat injected with its trial H1N1 vaccine earlier this month.
Although the WHO experts concluded that the abscess had nothing to do with the trial vaccine, they recommended more studies be done before Thailand goes ahead with human trials.
"So we decided to postpone the vaccine testing on humans for 10 more days. The trials will begin on Oct 5," Dr Vichai said after the meeting of a committee on vaccine trials on humans which he chaired yesterday.
The human testing was originally scheduled for Sept 21, but was later postponed to Sept 24 and then Oct 5.
"Yes, we are worried that Thailand's H1N1 vaccine development project is not going as smoothly as expected, but we have come this far and we won't give up," said Dr Vichai.
In the meantime, the GPO would recruit volunteers for vaccine trials.
The GPO planned to conduct vaccine tests on 24 volunteers, but only seven were on the list as most of the applicants did not meet the testing requirements.
In another development, the subcommittee on immunisation practices,a body that counsels the government on vaccine matters, yesterday proposed a priority list of H1N1 vaccine recipients.
The advisory panel would next week submit the list to the Public Health Ministry for review and then help state and local health departments plan for a vaccination campaign as soon as the previously-ordered 2 million vaccines arrive around December and January.
Under the list, health care workers,pregnant women and those with obesity problems will be among people first in line to receive the vaccine, followed by those with chronic diseases and developmental disabilities, totalling 5 million,who are at the highest risk of complications from the new flu strain.
Somchai Chakrabhandu, Disease Control Department chief, said the recommendation is based on the number of fatalities reported by the Bureau of Epidemiology.
The type-A H1N1 flu has caused over 10,000 hospitalisations and 153 deaths in 56 provinces as of Sept 16. Most of them were among these risk groups,except for the healthcare workers.
Charung Muangchana, director of the national vaccine committee, said an estimated 400,000 healthcare workers are listed to receive the vaccine first because they are on the front lines in providing services at hospitals.
Vichai Chokewiwat, the Government Pharmaceutical Organisation (GPO)chairman, said the WHO viewed that Thai scientists were new to the production of live-attenuated vaccine, so the country should take careful steps in producing a vaccine.
The WHO's recommendation came after the Thai team detected an abscess in a rat injected with its trial H1N1 vaccine earlier this month.
Although the WHO experts concluded that the abscess had nothing to do with the trial vaccine, they recommended more studies be done before Thailand goes ahead with human trials.
"So we decided to postpone the vaccine testing on humans for 10 more days. The trials will begin on Oct 5," Dr Vichai said after the meeting of a committee on vaccine trials on humans which he chaired yesterday.
The human testing was originally scheduled for Sept 21, but was later postponed to Sept 24 and then Oct 5.
"Yes, we are worried that Thailand's H1N1 vaccine development project is not going as smoothly as expected, but we have come this far and we won't give up," said Dr Vichai.
In the meantime, the GPO would recruit volunteers for vaccine trials.
The GPO planned to conduct vaccine tests on 24 volunteers, but only seven were on the list as most of the applicants did not meet the testing requirements.
In another development, the subcommittee on immunisation practices,a body that counsels the government on vaccine matters, yesterday proposed a priority list of H1N1 vaccine recipients.
The advisory panel would next week submit the list to the Public Health Ministry for review and then help state and local health departments plan for a vaccination campaign as soon as the previously-ordered 2 million vaccines arrive around December and January.
Under the list, health care workers,pregnant women and those with obesity problems will be among people first in line to receive the vaccine, followed by those with chronic diseases and developmental disabilities, totalling 5 million,who are at the highest risk of complications from the new flu strain.
Somchai Chakrabhandu, Disease Control Department chief, said the recommendation is based on the number of fatalities reported by the Bureau of Epidemiology.
The type-A H1N1 flu has caused over 10,000 hospitalisations and 153 deaths in 56 provinces as of Sept 16. Most of them were among these risk groups,except for the healthcare workers.
Charung Muangchana, director of the national vaccine committee, said an estimated 400,000 healthcare workers are listed to receive the vaccine first because they are on the front lines in providing services at hospitals.
Friday, September 18, 2009
GPO seeks hygienic eggs to make flu jab
The Government Pharmaceutical Organisation is seeking the help of the Livestock Department to acquire hygienic local hen eggs to produce flu vaccines after limitations were found with imported eggs.
GPO deputy managing director Somchai Srichainak yesterday said the agency could produce up to 1,000 specific pathogen-free (SPF) eggs a day for vaccine development.
He said the GPO and the department were discussing the feasibility of in-creasing the production and supply of SPF eggs."We're seeking ways to find local hygienic egg suppliers to help in the manufacture of vaccines as the time it takes to ship supplies from overseas could affect the eggs and the vaccine production," Mr Somchai said.
SPF eggs are now being imported from Germany and the US.
Mr Somchai said the GPO at first planned to use hygienic eggs from local poultry producers such as CP and Saha Farm to cultivate the virus. But their technologies were not tailored for SPF egg production unlike those from the Livestock Department.
However, imported eggs were still needed for vaccine production as an average of 1,500 SPF eggs were used to manufacture each batch of vaccine.
GPO chairman Vichai Chokewiwat said a committee overseeing human vaccine trials would meet tomorrow to decide if the trials should be delayed.They were scheduled to start on Sept 24.
A report of a lung infection in one of 12 guinea pigs being used in pre-trial tests had raised concerns, although studies had shown the flu vaccine did not cause the problem.
Postponing the human trials would set back the availability of the vaccine which was scheduled for January.
The Public Health Ministry yesterday confirmed 11 new deaths from the typeA (H1N1) flu, bringing the country's death toll since the outbreak began to 153, deputy permanent secretary for health Paijit Varachit said.
H1N1 WATCH Deaths: As of Sept 12,compared to Sept 5 142 153 Sept 5Sept 12 Contact numbers: * Public Health Ministry hotline: 02-590-1994 (24 hours) or 1422 * Health Emergency Response Unit: 02-590-3333 * BMA disease control division: 02-245-8106
GPO deputy managing director Somchai Srichainak yesterday said the agency could produce up to 1,000 specific pathogen-free (SPF) eggs a day for vaccine development.
He said the GPO and the department were discussing the feasibility of in-creasing the production and supply of SPF eggs."We're seeking ways to find local hygienic egg suppliers to help in the manufacture of vaccines as the time it takes to ship supplies from overseas could affect the eggs and the vaccine production," Mr Somchai said.
SPF eggs are now being imported from Germany and the US.
Mr Somchai said the GPO at first planned to use hygienic eggs from local poultry producers such as CP and Saha Farm to cultivate the virus. But their technologies were not tailored for SPF egg production unlike those from the Livestock Department.
However, imported eggs were still needed for vaccine production as an average of 1,500 SPF eggs were used to manufacture each batch of vaccine.
GPO chairman Vichai Chokewiwat said a committee overseeing human vaccine trials would meet tomorrow to decide if the trials should be delayed.They were scheduled to start on Sept 24.
A report of a lung infection in one of 12 guinea pigs being used in pre-trial tests had raised concerns, although studies had shown the flu vaccine did not cause the problem.
Postponing the human trials would set back the availability of the vaccine which was scheduled for January.
The Public Health Ministry yesterday confirmed 11 new deaths from the typeA (H1N1) flu, bringing the country's death toll since the outbreak began to 153, deputy permanent secretary for health Paijit Varachit said.
H1N1 WATCH Deaths: As of Sept 12,compared to Sept 5 142 153 Sept 5Sept 12 Contact numbers: * Public Health Ministry hotline: 02-590-1994 (24 hours) or 1422 * Health Emergency Response Unit: 02-590-3333 * BMA disease control division: 02-245-8106
SICK GUINEA PIG MAY DELAY FLU VACCINE TEST
The Government Pharmaceutical Organisation (GPO) will decide next Wednesday whether to delay the first phase of clinical trials of a vaccine against a new strain of type-A (H1N1) influenza discovered after a test with guinea pigs found one had an infection in its lungs.
Meanwhile, the Public Health Ministry announced yesterday the type-A (H1N1) virus has killed 11 people during the past seven days, bringing total fatalities to 153. Most were suffering underlying diseases.
The GPO had planned to run its first clinical vaccine trial against the flu virus on September 21. However, after finding an infection during an animal trial, GPO decided to put off its human trials for another three days.
GPO board chairperson, Dr Wichai Chokwiwat said the board will meet on Friday to discuss results of the animal trial where one of ten guinea pigs was found to have developed pockmarks in its lung.
"We will have to study all information about the guinea pig tests carefully before we make a decision whether or not to begin testing the vaccine in 24 volunteers from September 24," he said.
"We will postpone the human trials if we find any problems in the first lot of vaccine against new flu virus," he said.
Wichai said he has consulted with experts about the marks in the guinea pig's lungs and been advised they might have been caused by an abnormality in the animal and not by the vaccine.
He said scientists had injected the vaccine into two guinea pigs with the same concentration planned for humans. One of the two guinea pigs developed an infection which might have been caused by a previous lesion.
GPO's deputy director, Somchai Srichainaka said they were negotiating with the Livestock Development Department to produce local specific pathogen free eggs for the production of vaccine.
GPO has faced problems importing these hen's eggs for vaccine development from Germany and the United States.The long distance transportation might be affecting specific eggs and causing the virus incubated in them to grow more slowly. However 3,000 eggs from the US will arrive today.
Somchai said Thailand would save expense in the long term if it could produce local specific free pathogen eggs, reducing costs from Bt180 to Bt120 an egg. GPO has asked the US Food and Drug Administration for help with production of the specific free pathogen.
World Health Organisation (WHO) representative to Thailand, Dr Maureen Birmingham, said WHO is negotiating with two leading vaccine makers,Sanofi Pasteur and GlaxoSmithKline, to contribute vaccine to the WHO for distribution to developing countries. Agreement is expected in the next two weeks.
Meanwhile, the Public Health Ministry announced yesterday the type-A (H1N1) virus has killed 11 people during the past seven days, bringing total fatalities to 153. Most were suffering underlying diseases.
The GPO had planned to run its first clinical vaccine trial against the flu virus on September 21. However, after finding an infection during an animal trial, GPO decided to put off its human trials for another three days.
GPO board chairperson, Dr Wichai Chokwiwat said the board will meet on Friday to discuss results of the animal trial where one of ten guinea pigs was found to have developed pockmarks in its lung.
"We will have to study all information about the guinea pig tests carefully before we make a decision whether or not to begin testing the vaccine in 24 volunteers from September 24," he said.
"We will postpone the human trials if we find any problems in the first lot of vaccine against new flu virus," he said.
Wichai said he has consulted with experts about the marks in the guinea pig's lungs and been advised they might have been caused by an abnormality in the animal and not by the vaccine.
He said scientists had injected the vaccine into two guinea pigs with the same concentration planned for humans. One of the two guinea pigs developed an infection which might have been caused by a previous lesion.
GPO's deputy director, Somchai Srichainaka said they were negotiating with the Livestock Development Department to produce local specific pathogen free eggs for the production of vaccine.
GPO has faced problems importing these hen's eggs for vaccine development from Germany and the United States.The long distance transportation might be affecting specific eggs and causing the virus incubated in them to grow more slowly. However 3,000 eggs from the US will arrive today.
Somchai said Thailand would save expense in the long term if it could produce local specific free pathogen eggs, reducing costs from Bt180 to Bt120 an egg. GPO has asked the US Food and Drug Administration for help with production of the specific free pathogen.
World Health Organisation (WHO) representative to Thailand, Dr Maureen Birmingham, said WHO is negotiating with two leading vaccine makers,Sanofi Pasteur and GlaxoSmithKline, to contribute vaccine to the WHO for distribution to developing countries. Agreement is expected in the next two weeks.
Monday, September 14, 2009
Most infectious malaria strain came from chimps?
The most malignant known form of malaria may have jumped from chimpanzees to humans, according to a new study of one of the most deadly diseases in the world.
Malaria, a mosquito-borne illness, can be caused in humans by one of four strains of the Plasmodium parasite. More than a million people die from malaria each year.P. falciparum is the most virulent of these strains and accounts for nearly 85 percent of all malaria infections.
Three of the four human strains are known to have originally come from Old World monkeys. The exact origins of P. falciparum have been a mystery.Researchers had thought that P. falciparum and P. reichenowi - the malaria strain found in chimpanzees - evolved independently from a common ancestor about 5 to 7 million years ago. But the new study has found that the human strain is actually a mutated form of the chimp strain.
"Current wisdom that P. falciparum has been in humans for millions and millions of years is wrong," said study co-author Nathan Wolfe, director of the Global Viral Forecasting Initiative based in San Francisco, California, and a National Geographic emerging explorer.
"We now know that there was a point in time when this was primarily a disease in chimpanzees that jumped and took hold in humans."
Wolfe and his colleagues analysed tissues samples from 94 live wild and wild-born captive chimpanzees in Cameroon and Cote d'Ivoire. Eight of the animals were found to have malaria.
The team discovered that the human and chimpanzee strains have certain genetic similarities, but that the chimp strain is more genetically diverse. Further analysis placed all 133 variants of P.falciparum found around the world under a single branch of the P. reichenowi family tree.
"This suggests that there has been only one transfer. P. falciparum is the result of a single cross-species transmission event," said Wolfe, whose work appears this week in the Proceedings of the National Academy of Sciences .The scientists aren't sure how the chimp strain mutated to become infectious to humans or when it might have made the jump, although the oldest known human cases of malaria date back thousands of years. The team believes it's possible that, as early humans settled into an agrarian lifestyle in Africa,their likely encroachment into chimpanzee territory provided the parasite with new opportunities.
Biologist Dan Hartl of Harvard University noted that, until now, only one sample of the chimpanzee parasite had ever been studied.
"Researchers had believed that P. falciparum probably originated from parasites in birds," said Hartl, who was not involved in the study."[Wolfe and colleagues'] paper proves that is not true, and that data from those early studies were misleading."
Late last year, a team led by Arnab Pain, a malaria researcher at the Welcome Trust Sanger Institute in Cambridge, UK,announced they had sequenced the genome of P. knowlesi , a monkey malaria parasite that can also infect humans.Pain agrees that Wolfe and his colleagues have conclusively proven that the chimpanzee malaria parasite was transferred only once to humans. But researchers would need to know the entire genetic make-up of the chimp parasite to find out what changes it underwent, he added.
"How much the parasite changed,we don't know the full story yet."
According to study co-author Wolfe,the new work hints that even today similar disease-causing parasites may be ready to make the leap from monkeys and apes to humans.
"Our study suggests that there is a [version of P. reichenowi] out there that is very similar to P. falciparum - it has a tremendous amount of genetic diversity, and is present in animals that are close to humans in a very geographically distributed area," Wolfe said.
That means there's a chance that a new malaria parasite might make its way into people, he said.
The work also highlights how long a disease can last once a parasite has made that leap, Wolfe added.
"What this finding demonstrates is that the kinds of jumps we're having right now - HIV, Sars, etc.- could very well be the beginning of something that lasts for thousands of years."
Malaria, a mosquito-borne illness, can be caused in humans by one of four strains of the Plasmodium parasite. More than a million people die from malaria each year.P. falciparum is the most virulent of these strains and accounts for nearly 85 percent of all malaria infections.
Three of the four human strains are known to have originally come from Old World monkeys. The exact origins of P. falciparum have been a mystery.Researchers had thought that P. falciparum and P. reichenowi - the malaria strain found in chimpanzees - evolved independently from a common ancestor about 5 to 7 million years ago. But the new study has found that the human strain is actually a mutated form of the chimp strain.
"Current wisdom that P. falciparum has been in humans for millions and millions of years is wrong," said study co-author Nathan Wolfe, director of the Global Viral Forecasting Initiative based in San Francisco, California, and a National Geographic emerging explorer.
"We now know that there was a point in time when this was primarily a disease in chimpanzees that jumped and took hold in humans."
Wolfe and his colleagues analysed tissues samples from 94 live wild and wild-born captive chimpanzees in Cameroon and Cote d'Ivoire. Eight of the animals were found to have malaria.
The team discovered that the human and chimpanzee strains have certain genetic similarities, but that the chimp strain is more genetically diverse. Further analysis placed all 133 variants of P.falciparum found around the world under a single branch of the P. reichenowi family tree.
"This suggests that there has been only one transfer. P. falciparum is the result of a single cross-species transmission event," said Wolfe, whose work appears this week in the Proceedings of the National Academy of Sciences .The scientists aren't sure how the chimp strain mutated to become infectious to humans or when it might have made the jump, although the oldest known human cases of malaria date back thousands of years. The team believes it's possible that, as early humans settled into an agrarian lifestyle in Africa,their likely encroachment into chimpanzee territory provided the parasite with new opportunities.
Biologist Dan Hartl of Harvard University noted that, until now, only one sample of the chimpanzee parasite had ever been studied.
"Researchers had believed that P. falciparum probably originated from parasites in birds," said Hartl, who was not involved in the study."[Wolfe and colleagues'] paper proves that is not true, and that data from those early studies were misleading."
Late last year, a team led by Arnab Pain, a malaria researcher at the Welcome Trust Sanger Institute in Cambridge, UK,announced they had sequenced the genome of P. knowlesi , a monkey malaria parasite that can also infect humans.Pain agrees that Wolfe and his colleagues have conclusively proven that the chimpanzee malaria parasite was transferred only once to humans. But researchers would need to know the entire genetic make-up of the chimp parasite to find out what changes it underwent, he added.
"How much the parasite changed,we don't know the full story yet."
According to study co-author Wolfe,the new work hints that even today similar disease-causing parasites may be ready to make the leap from monkeys and apes to humans.
"Our study suggests that there is a [version of P. reichenowi] out there that is very similar to P. falciparum - it has a tremendous amount of genetic diversity, and is present in animals that are close to humans in a very geographically distributed area," Wolfe said.
That means there's a chance that a new malaria parasite might make its way into people, he said.
The work also highlights how long a disease can last once a parasite has made that leap, Wolfe added.
"What this finding demonstrates is that the kinds of jumps we're having right now - HIV, Sars, etc.- could very well be the beginning of something that lasts for thousands of years."
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