Taylor Capizola

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The only existing tuberculosis (TB) vaccine—the bacille Calmette-Guerin (BCG) vaccine—has proven to be more effective than previously thought, delivering protection against the disease for around 20 years. The London School of Hygiene and Tropical Medicine led a study that found half of those individuals who were given the vaccine at ages 12 or 13 were protected against TB for at least 20 years. The vaccine was thought to deliver protection for only 10 to 15 years. These findings strenthen the case for administering BCG to children in low- and middle-income countries with high TB rates. The Tanzanian government has announced that in 2018 the country will begin using Zipline drones to deliver essential medical technologies to citizens in the capital city of Dodoma. The drone service can deliver everyday goods like food, but can also deliver live-saving medicines and vaccines, and contraceptives like condoms. Technology in low-resource and rural parts of the world has been used in the past to help diagnose and track diseases, but these technologies have proven challenging to deliver due to rugged terrain or geographic isolation. The Zipline drones are the first of their kind and can deliver products within a 50-mile radius. The Tanzanian Ministry of Health is working to add three more drone locations within the nation. The University of North Carolina Chapel Hill is studying the efficacy of a rapid diagnostic tool for malaria in very rural areas of Uganda. Researchers testing the low-cost tool in these areas and found that it could perform diagnoses with high specificity and sensitivity for both uncomplicated and severe malaria. This level of accuracy in diagnosis may allow health professionals to prioritize treatment for cases that may be more life threatening than others. Accurately diagnosing children who contract a severe form of malaria makes it possible to prioritize cases and potentially save lives.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Scientists at the UK’s John Innes Centre believe that a plant closely related to tobacco may hold promise in accelerating polio eradication by transforming vaccine manufacturing. Scientists have hijacked the plant’s growing mechanisms with genetic code for making the outer surface of poliovirus and taught them to grow virus-like particles, which are then extracted into a vaccine. This resulting vaccine mimics the poliovirus, and thus elicits an immune response, but contains none of the properties that cause a poliovirus infection. Scientists are hopeful this may be an effective way to create safe vaccines in the future that aren't made with live viruses, and hope to mimic the process with other viruses as well. Following the 2014 Ebola outbreak in several African countries, an African Centers for Disease Control and Prevention (Africa CDC) was formalized and launched to focus on capacity building in Africa to protect against infectious disease threats. Ending malaria is an important target of the Africa CDC, but there is much to be done to achieve this goal. First, efforts to collect real-time data must be strengthened to ensure the Africa CDC makes informed decisions. Second, international aid institutions and African nations must provide adequate resources to support the Africa CDC. Third, the international community must continue to work toward malaria eradication. Scientists believe individuals in the Americas have developed herd immunity that has resulted in a significant drop-off in Zika incidence. Once a person is infected with Zika, it is not possible for them to be infected again, so they can no longer pass on the virus to mosquitoes who pass it on to other individuals. Scientists think because Zika is usually asymptomatic in non-pregnant individuals, many have been infected and are now immune. This suggests that as the number of people resistant to the virus increases, incidence of others contracting the virus will decrease. With that said, however, scientists still urge pregnant women to take caution when traveling to Zika endemic areas of the world.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. A new tool developed by the University of Greenwich uses hot water and human scent to lure and trap mosquitoes. The tool is a simple black bucket attached to a wind tunnel that blows warm air with a human scent. The mosquitoes, initially attracted to the scent, are lured to the bucket, and then use the thermal indicators of the warm water to land. The bucket itself is covered in a sticky plastic that traps the mosquitoes. This tool is inexpensive, easy to build, and has proven to be effective in trapping large amounts of the insect. The developers are testing the prototype in three African nations and believe the tool could be a breakthrough in reducing mosquito-borne diseases. Pew Charitable Trusts has announced it will create a new cloud-based digital platform to allow researchers to share data and collaborate to discover new antibiotics to tackle antimicrobial resistance (AMR). As AMR levels continue to rise across the globe, scientists are moving quickly to discover new antibiotics that can treat resistant strains of viruses and bacteria. The platform will host a “virtual laboratory” for scientists to collaborate and crowdsource information to break through common obstacles and limitations associated with discovering new antibiotics. The system is expected to launch within a year. Antibiotic use in Chinese factory farms is expected to double by 2030, causing concern in the science community. Because more than half of the antibiotics used globally are used in China, scientists are worried that increased use in the poultry industry could accelerate the growth of antimicrobial resistance. Researchers are also concerned the industry practices have made avian flu an increasing global threat. The global livestock industry has been under scrutiny for years following a major dirty meat scandal involving major fast food chains, highlighting continued issues with the worldwide impact of food supply chains. Scientists urge changes to make livestock healthier, reduce greenhouse gases, and track the global movement of meat.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Scientists at the National Institutes of Health’s National Institute of Allergy and Infectious Diseases have developed a Zika transmission model using mice in order to model the virus’ transmission from human-to-human. While humans are naturally more susceptible to contracting Zika than mice are, scientists were able to use genetically modified mice to validly mimic the transmission. Scientists found that while vertical transmission is possible from mother to fetus, some of the fetuses were not infected with the disease, suggesting the placenta is capable of being an effective barrier to the disease. They also found that Zika can be found in the lymph nodes, suggesting the virus can infect more areas of the body than previously thought. The World Health Organization has provisionally recommended the use of a new insecticide bed net, the Interceptor G2, which is capable of killing up to 75 percent of mosquitos that have become resistant to a common insecticide. The Interceptor G2 bed net combines two different insecticides: pyrethroid, which is currently used in insecticide-treated nets, and chlorfenapyr, an insecticide previously only used in agricultural settings. Studies in sub-Saharan Africa have yielded promising outcomes, with the nets remaining effective even after having been washing up to 20 times. Three studies recently published in Emerging Infectious Diseases found new treatments against multidrug resistant (MDR) and extensively drug resistant (XDR) tuberculosis (TB) are delivering positive results. The largest study focused on a year-long delamanid treatment for 53 MDR-TB patients. Following treatment, 73.6 percent had a favorable response, with 67.6 percent of participants having multiple negative TB cultures. The second study analyzed bedaquiline therapy on 27 children with both MDR- and XDR-TB, and found that of the 23 children that remained a part of the study over the year, all had negative cultures. The third study was retroactive, with researchers observing combined bedaquiline and delamanid therapies in XDR-TB patients. In a total of five participants, researchers found one was culture negative, three were continuing treatment, and one had died. While these studies all have small sample sizes, preliminary data suggests these drugs have a high efficacy in treating resistant strains of TB.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week.  The dapivirine ring—a monthly vaginal ring that releases the antiretroviral dapivirine (ARV)—was shown to be effective in girls younger than 18 in a phase 2a clinical trials. Developers of the product are currently seeking approval for the ring’s use in women ages 18–45, but health professionals want to expand the targeted age group to teenagers ages 15–17. Researchers conducted this initial trial on female teenagers in the United States and found positive results. Not only was the tool safe and effective in delivering ARVs into the females’ bloodstreams, it was also deemed easy to use and enjoyable to use by over 90 percent of participants. Next steps include conducting a study on teenage girls in Africa. The National Institute of Allergy and Infectious Diseases (NIAID) and Janssen Pharmaceutical Companies, a subsidiary of Johnson & Johnson, partnered to create an HIV vaccine candidate to protect against multiple strains of HIV at once. Scientists used a mosaic technique—patching together several strains of HIV and looping them together into one vaccine—and initial studies suggest this vaccine is promising. Participants in an early study handled the vaccine well, and blood results suggested the participants had an adequate immune response to the vaccine. While these results are promising, NIAID stressed that these are preliminary results and more testing is necessary. This marks the fifth time an HIV vaccine has reached clinical trials in humans. Three of these approaches were abandoned because of low efficacy in later trials, while the other trial remains ongoing. As the fight against HIV and AIDS continues, there is still much to be done. Health professionals fear a second HIV and AIDS pandemic as HIV drug resistance rises, manufacturing capability is maxed out, and funding from major donors falls. It is expected that 54 million individuals globally will be living with HIV by 2030, requiring a massive supply of front-line medicines and second-line therapies for the estimated 10 percent of cases where HIV is resistant to front-line treatment. Sites responsible for manufacturing and producing front-line HIV medications have limited ability to expand further, and expanding production sites to endemic areas of Africa is limited due to inadequate infrastructure. Finally, funding sources are becoming increasingly more scarce. As the White House focuses capital on domestic issues and donor funding decreases, researchers fear the lack of funding necessary to conduct important HIV and AIDS research in the future.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The World Health Organization (WHO) and UNICEF have reported nearly 1 in 10 children did not receive any immunizations in 2016. This includes immunizations for diphtheria-tetanus-pertussis (DTP). WHO and UNICEF reported that the global immunization rate for the full round of the DTP vaccine is only 86 percent, falling short of the 90 percent goal of global immunization. Furthermore, in 2016, eight countries had DTP immunization rates of less than 50 percent. Estimates by WHO and UNICEF suggest that 10 million more children in 64 countries need to be vaccinated every year in order to achieve the 90 percent goal. This highlights the need to bring vaccines to low-resource settings that have been chronically affected by low immunization rates. A new study published in Proceedings of the National Academy of Sciences highlights a new diagnostic tool that performed well in distinguishing Zika from other flaviviruses, including dengue. UC Berkeley and Humabs BioMed partnered to create a low-cost, easy-to-use diagnostic tool to specifically test for the Zika virus. Researchers found this tool was capable of distinguishing between Zika and other flaviviruses, as well as distinguishing current and past Zika infections in patients. The tool had 91.8 percent sensitivity—the ability to correctly identify those with the disease—and 95.9 percent specificity—the ability to correctly identify those without the disease. This tool could be used in Zika- and dengue-endemic areas, assisting in diagnostic processes and subsequent treatment, especially among populations adversely affected by Zika, like pregnant women. For the first time in history, more than half of all HIV-infected individuals are receiving treatment. In 2016, it was estimated that 19.5 million individuals were receiving HIV treatment, with a total of 36.7 million people infected with HIV. These estimates are both increases from the estimated 17.1 million treated and 36.1 infected in 2015. Further, AIDS-related deaths have decreased by more than half since 2005. Though these rates are promising in the fight against the global epidemic, the United Nations (UN) acknowledges that there is much left to do in the fight against HIV and AIDS, particularly in the context of less stable health systems in resource poor settings.