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Weekly Digest: National AMR planning data from WHO; Hepatitis C advocates in India file patent complaint; Outbreak of XDR typhoid expands in Pakistan.

Weekly Digest: National AMR planning data from WHO; Hepatitis C advocates in India file patent complaint; Outbreak of XDR typhoid expands in Pakistan.

WHO publishes data and case studies on national antimicrobial resistance planning. An open access database of 154 country self-assessments on national antimicrobial resistance (AMR) planning has been published by the World Health Organization (WHO), together with a summary report. The report shows that more progress is made across a range of human and non-human indicators when the membership of a country’s multisectoral AMR working group is broadly representative. In addition, three case studies on AMR planning in low- and middle-income countries have been completed. The reports from Nigeria, Ghana, and Nepal focus on mobilization of resources, insertion of AMR into the plans and budgets of government and development partners, and strategies to integrate the prevention of AMR into existing programs and budgets. [WHO Report: Monitoring Global Progress on AMRWHO: Case Studies on AMR Budgeting]

Better than private sector subsidies: incentivize treatment after patient is diagnosed. Artemisinin-based combination therapies (ACT) are available in retail pharmacies without a prescription or diagnostic proof of infection. Over 50% of ACTs are consumed by people who are not infected with malaria, while up to 70% of individuals with malaria do not receive ACT, due to cost or a lack of diagnosis. A recent study in Kenya evaluated an incentive intervention in which 32,404 participants were tested by community health workers using malaria rapid diagnostic tests from July 2015 to May 2017. Discount vouchers for ACT were provided to 10,870 who were found to be infected. Rational use of ACTs in the intervention cohort increased from 41.7% to 59.6% over 18 months. [PLoSHealio]

Genetic evolution occurs as Staphylococcus aureus moves from people to animals.  Researchers from the University of Edinburgh’s Roslin Institute have published the results of their study comparing the genomes of over 800 strains of S. aureus isolated from animals and humans. The team concluded that each time the bacteria moves from one human or animal host to another, it acquires new genes, some of which confer antibiotic resistance. Differences in the strains found in humans versus animals were shown to reflect differences in antibiotic use. This study could help in the development of new treatments, reduction of transmission, and curtailing the evolution of resistance. [Nature Ecology and EvolutionEurekaAlert]

Hepatitis C advocates in India file “evergreening” complaint against pharmaceutical company Gilead. Representing people with Hepatitis C (HCV) infection, Delhi Network of Positive People (DNP+) has filed opposition to Gilead’s application to extend its patent fortwo medications used to inhibit HCV. The advocacy group claims that Gilead’s patent filing is designed to prevent competitors from developing affordable alternatives to its HCV drugs.The Indian Patents Act of 1970 restricts “evergreening,” a strategy whereby slightly different versions of existing drugs receive new patents. [Intellectual Property Watch]

Human T-cells recognize Ebola nucleoprotein in 96% of survivors. Researchers found that killer (CD8+) T cells recognized a viral nucleoprotein expressed on the surface of infected cells that 96% of the blood samples from 30 survivors of Ebola. Compared to the 38% response of the T-cells to an Ebola glycoprotein, the results may lead to the development of a new vaccine that targets the nucleoprotein. [PNASEurekaAlert]

Vaccine scandal rocks China. As reports surfaced of substandard manufacturing in private vaccine facilities, outraged parents called for intervention from Chinese officials, including President Xi Jinping. Up to 250,000 potentially faulty doses of diphtheria, tetanus, and pertussis (DTP) vaccine may have been administered to children. [NYT]

Study raises importance of diagnostics for fever in Madagascar. A study of 682 patients with fever reporting to sentinel clinics in Madagascar found that 40.5% of patients were found to be infected with at least one pathogen.  The leading causes of fever were malaria (17.0%) and viruses (26.5%). Forty-two individuals (6.2%) were coinfected. Laboratory tests also detected one instance of Rift Valley Fever virus and one case of leptospirosis among the 642 individuals. The results support the argument that point-of-care diagnostics could assist with treatment and care of febrile patients. [PLoS Neglected Tropical Disease]

Old drug with new tricks: Tafenoquine for recurring malaria. Tafenoquine, an older drug with newfound therapeutic properties, has been approved by the US Food and Drug Administration to combat Plasmodium vivax. Tafenoquine rousts the parasite and eliminates it from the liver with a single dose, giving it an advantage over14-dose primaquine, which can also clear dormant parasites from the liver. Scientists believe the drug could contribute to global elimination of recurring malaria, but there is one major drawback: before taking the drug, patients must first be tested to rule out the possibility of a side effect that causes potentially dangerous anemia. The test requires costly equipment and is not readily available areas where malaria is endemic. [BBCNPR Goats and Soda]

Improving malaria treatment efficacy through changes in dosage. Researchers aiming to improve first-line treatment of Plasmodium vivax found that an increase of 5 mg/kg of chloroquine brought about a reduction of 18% in the overall rate of malaria recurrence and a reduction of 41% in malaria recurrence among children under five. Adding a target dose of primaquine in the first three days of treatment further reduced recurrence, as reported in Lancet Infectious Diseases. Understanding that incompleteparasite clearance promotes drug resistance, researchers worked to adjust treatments to bring about total parasite elimination. One researcher recommends an increase in WHO recommended dosage of chloroquine. [Lancet Infectious DiseasesComment]

The microbiome and diabetes: How antibiotics affect insulin sensitivity. Previous studies have shown that mice with certain deficiencies are more likely to develop diabetes, while the presence of certain microbes may be protective against diabetes.  Salk Institute researchers have found in a new study that mice whose microbiome was depleted were able to clear glucose from their blood faster because of changes in liver function. [Salk InstituteNature Communications]

UN political declaration on the fight against tuberculosis completed in advance of high level meeting. According to intellectual property rights watchdogs, the final draft political declaration on the fight against tuberculosis ends months of negotiations in which the United States delegation pushed for weaker language on affordable medicines and the removal of a provision detailing flexibilities in Trade-Related Aspects of Intellectual Property Rights. [The WireUnited NationsIntellectual Policy Watch]

Pakistan outbreak of drug-resistant typhoid expands. An extensively drug-resistant (XDR) bacterium has infected over 2,000 people in what researchers warn is the world’s first outbreak of XDR Salmonella typhi. The outbreak strain is only susceptible to costly intravenous medication and one oral antibiotic, azithromycin, at present. As intravenous medications are impractical for widespread use, the outbreak poses a serious threat to the people of Pakistan. An expert warns that during the monsoon season, there is increased mixing of drinking water and sewage, which could trigger a broader epidemic. [Science]


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