Rotavirus Vaccine Is Safe, Study Finds

for full story go to http://www.voanews.com/english/news/health/Rotavirus-Vaccine-Is-Safe-Study-Finds-141259913.html

 

Web cast interview with Epidemiologist Irene Shui,

Excerpts from the story:

“A study in the Journal of the American Medical Association examines the safety and effectiveness of another rotavirus vaccine now being used.”

“Other vaccines have since taken its place. But a manufacturer’s study of one of them, the RotaTeq vaccine, suggested it, too, might cause intestinal blockage after the first dose. Epidemiologist Irene Shui, at the Harvard School Of Public Health, decided to investigate. “

““Because the rotavirus vaccine is given to almost every child in the United States, it’s crucial to monitor the vaccine’s safety,” said Shui.”

“Shui and other researchers examined the records of almost 800,000 babies who received this vaccine, including 300,000 first doses. They were looking for incidents of intussusception, the medical term for this kind of blockage. “

“We did not find an elevated risk of intussusception following any dose of the vaccine, and especially following the first dose,” she said.”

Related articles

• Kids’ Diarrhea Vaccine Appears Safe After All (nlm.nih.gov)
• U-M study shows updated rotavirus vaccine not linked to increase in bowel obstruction (eurekalert.org)

Impact of sanitation on survival

worthy of reprinting:  Here is the beginning of a great article by Francisca Oluyole in the Daily Triumph

Impact of sanitation on survival
By Francisca Oluyole

Water

UNICEF reports recently indicated that diarrhea prevalence rate in Nigeria is 18.8 per cent.
The rate, according to the report, is “one of the worst in sub-Saharan Africa”.
For many experts, the situation is “just not good enough” for a leading producer of crude oil, especially as children remain the worst victims of such a preventable disease.
Associated mostly with vomiting, purging and dehydration, diarrhea has been identified by the Nigerian health authorities as the second largest direct cause of child morbidity and mortality in Nigeria.
According to statistics from UNICEF, diarrhea accounts for more than 16 per cent of child deaths. That is a total of 150,000 deaths amongst children under five, annually.
Experts trace the disease to a lack of access to basic sanitation facilities and poor hygiene practices.
They say it is closely connected with malnourishment, as undernourished children usually have a compromised immune system and are also at a higher risk of developing pneumonia.
Recent reports from the World Health Organisation (WHO) have confirmed that Nigerian children will continue to be victims of diarrhea as the country is said to be one of the seven high-population countries with
total sanitation coverage of less than 50 per cent.
In effect, less than half of the population has access to improved sanitation and the access is as low as 10 per cent in some states with the situation worse in the rural areas.
The situation, according to the reports, has worsened in the last two decades, with environmental sanitation problems resulting in an escalating negative impact on public and environmental health.
Experts say poor environmental sanitation in Nigeria is characterised by the presence of heaps of refuse in cities, indiscriminate disposal of solid and other wastes, blocked drains, overgrown weeds, among others.
The state of food sanitation in homes, markets and abattoirs is equally appalling and unwholesome as food meant for human consumption is exposed to dust, flies, bacteria and other micro-organisms, they say.
The experts say that such probably accounts for the increasing cases of food-borne diseases such as cholera, food poisoning and typhoid fever.
According to Mr Jones Abari, an Abuja-based community health expert, the lack of safe and private toilets and hand-washing facilities in schools has ensured a quicker development of sanitation-related diseases on children. ….

to read full article  by Francisca Oluyole in Daily Triumph go to http://www.triumphnewspapers.com/impact1522010.html R/AUWAL 1 1431 A.H. published MONDAY  FEBRUARY 15 2010.

the latest revised version of the WHO Technical Notes for Emergencies

posting per request

Please find the latest revised version of the WHO Technical Notes for Emergencies freely available at:

http://wedc.lboro.ac.uk/knowledge/notes_emergencies.html

Other free downloadable resources for emergencies are available from the WEDC Bookshop, including:

Emergency Water Supply
Emergency Sanitation
Controlling and Preventing Disease
Excreta Disposal in Emergencies
Emergency Vector Control

Visit: http://wedc.lboro.ac.uk/knowledge/bookshop.html

PLEASE FORWARD THIS MESSAGE TO COLLEAGUES WHO MAY FIND THESE RESOURCES HELPFUL.

Thank you

WEDC Publications

Toilets -essential?

washlink notes: via a link I saw the title below  and assume it was a humorous story from the US or Europe…Reading the first line  “Do landlords know that it is an offense not to provide toilet facilities…”  I’m thinking what’s the catch… some badly placed joke  but  I  read on….  I caught on rather quickly that sadly there was no clever catch to it, like to sell  toilet paper etc.  This is  just another part of the world …stupid me.  But  then the outrage:  something so improbable for for me in Massachusetts :”Do landlords know that it is an offense not to provide toilet facilities…” that I anticipate a humorous story!!
Yes so probable for a good portion of  the human race, when  I realize mistake I am saddened ….at what trick perspective  has played…..

Toilet – A very essential part of every home

Do landlords know that it is an offense not to provide toilet facilities in their houses before renting them out?

Well, a lot of them do not know and that is why they continue to put up houses without toilet facilities and expect their tenants to use the public toilets.

essential ?

So the reminder of the Director of Environmental Health and Sanitation, Mr Demedeme Naa Lenason, to landlords that it is an offence not to provide toilet facilities in their houses or to convert their toilets and bathrooms into living rooms is timely.

Quoting from the 2000 Population and Housing Census, he said more than 20 per cent of Ghanaians did not have any form of latrines and therefore resorted to open defecation.

Mr Lenason said the 2000 census revealed that 31.45 per cent households

see map

in Ghana used public latrines as compared to 8.5 per cent using water closet; 22 per cent used pit latrine, 6.9 per cent used KVIP, four per cent used bucket or pan latrine and 6.9 per cent attend to nature’s call in other people’s houses.

He said the Ministry’s Environmental Sanitation Policy of 1999 was unequivocal on households and public toilets and the policy states that at least 90 per cent of the population should have access to acceptable domestic toilet, while the remaining 10 per cent should have access to hygienic public toilets.

As we observe World Toilet Day on November 19, a day to celebrate the humble, yet vitally important toilet and to raise awareness of the global sanitation crisis, we need to learn from other countries, such as the United Kingdom, how toilets became a vital part of any building.

As far back as in 1891, there were legislations for the construction of water closets in houses by the British under the London Householder’s chart.

There were nuisances, which could be dealt with summarily under the Public Health (London) Act 189.

There were strict regulations regarding erected or re-built houses, with the provision of proper water closets. Penalty was 20 pounds then.

Additionally, the British found it necessary to support this Law having had very bad experiences in waste management and becoming sufferers of epidemics such as typhoid and cholera in the 1840s.

There is no way a building can be erected in the UK now without the provision of at least a toilet.

But in Ghana people still build houses without making provision for toilet facilities.

Dr John Snow’s work in tracing the source of a cholera outbreak in Soho, England, in 1954, is described now as “a major event in the history of public health and can be regarded as the founding event of the science of Epidemiology”.

The discovery of what causes cholera was followed by the crisis, which was termed, “The Great Stink or the Big Stink.” In the summer of 1858, the smell of untreated sewage almost overwhelmed people in Central London.

Within 18 days a bill was passed and the task of building the city’s sewers began and those sewers still serve London.

Sadly, there are still outbreaks of cholera in Ghana almost every year, but no serious focus has been given to building hygienic toilets across the country to check this outbreak.

Click here to  read this wonderful great story in its entirety …
from Peace FM

More information

• Water supply and sanitation in Ghana From Wikipedia, the free encyclopedia
• WaterAid Ghana
• Girl-friendly latrines for Ghanaian schoolgirls
• Google scholar search: Ghana sanitation water 2008+

WHO’s new report: “Diarrhoea: why children are still dying and what can be done”

While this is being covered everywhere , I thought it is worth  mentioning.  It seems important that in this report  WHO is stressing Zink tablets in conjunction   the oral rehydration solution (ORS)  The tables and charts provide excellent statistic for fundraisers and agencies wanting to bring help and awareness. For those in the field there are important points to note but ones  in the field may ask  “tell us something we don’t know”

Recognition  of the reality that “WASH/WATSAN”  address seems to be following the same slow path of   Global Warming (and other critical realities) ,  taking its time  to come to be mainstream and get the energy it deserves. Hopefully the material presented within  shall be an effective red flag to wave to get recognition and resources.

the publication Diarrhoea: why children are still dying and what can be done is available in pdf format for viewing

from the press release:

Past success and present needs

Campaigns targeting childhood diarrhoea in the 1970s and 1980s achieved success by scaling up the use of oral rehydration solution (ORS) to prevent dehydration and by educating caregivers. In spite of the promising results of these campaigns, in recent years the international community has shifted its focus to other global emergencies. There is now an urgent need to focus once more on preventing and treating diarrhoea.

Treatment with ORS and zinc tablets

WHO and UNICEF recommend treating diarrhoea with low-osmolarity ORS and zinc tablets, which decrease the severity and duration of the attack. These treatments are simple, inexpensive and life-saving.

Access to clean water and good hygiene practices are extremely effective in preventing childhood diarrhoea. Hand washing with soap has been shown to reduce the incidence of diarrhoeal disease by over 40 per cent, making it one of the most cost-effective interventions for reducing child deaths from this neglected killer.

from the publication:

printable version Diarrhoea: why children are still dying and what can be done

For a number of years, there was one zinc product that met quality standards for international procurement by UNICEF. Zinc is now procured by UNICEF, governments and
other agencies and is manufactured locally in a handful of countries. However, meeting policy and regulatory requirements for importing a new product continues to present challenges for zinc introduction in many countries. Moreover, changing child health treatment recommendations nationally can also be difficult.

Compounding the problem is the fact that initial start-up funds for these new treatments can be significant, and beyond the scope of regular health budgets. In addition, many countries are hesitant to buy zinc because they have little experience with it as part of diarrhoea management programmes: They are unsure of the demand and are reluctant to devote funds to one-time start-up activities, such as developing training materials. ….

The challenges of scaling up zinc and increasing usage rates of ORS are steep, but not prohibitive. A renewed call to action is needed to ensure that increasing coverage
of diarrhoea treatment interventions becomes an international
priority.
pulications Sources: Global Zinc Task Force, 2009; UNICEF Supply Division, 2009.

Commercial Launch of HYLENEX for use in Pediatric Rehydration anounced by Baxter

a new drug for use in Pediatric Rehydration

the question is  with all drug  how long must the clock tick before it becomes available in the most neediest of places, at a price point that makes it  affordable to be subsidized by agencies. Perhaps we should have a site that is a  virtual wall of  timers each labeled with a drug count the years before the neediest op people are able to benefit.

excerpt  from from the press release found in  press room room of BAXTER

HYLENEX

BOSTON – October 5, 2009— Baxter International Inc. (NYSE: BAX) today announced the commercial launch of HYLENEX recombinant (hyaluronidase human injection) for use in pediatric rehydration at the 2009 American College of Emergency Physicians (ACEP) scientific assembly (Boston). HYLENEX, an enzyme, allows fluids to be administered under the skin (subcutaneously) rather than through a vein. This allows for rapid treatment initiation and delivery of intravenous (IV)-like fluid rates, which can help lead to successful rehydration of children in a less invasive manner. Additionally, data from Baxter’s Increased Flow Utilizing Subcutaneously-Enabled (INFUSE) PEDS 1 study are debuting today in the preeminent pediatric journal, Pediatrics. The study was designed to assess the efficacy, safety and clinical utility of HYLENEX recombinant-facilitated subcutaneous rehydration in mild to moderately dehydrated children ages two months to 10 years. This approach was found to be effective, easy to use and well-tolerated. 1 Baxter licensed HYLENEX, the first and only recombinant human hyaluronidase, from Halozyme Therapeutics, Inc. (Nasdaq: HALO)…..

washlink notes

google scholar/journal  search results

NAPO pushes Crofelemer for Pediatric Populations

Excerpt From Napo press release:

SOUTH SAN FRANCISCO, Calif.–(BUSINESS WIRE)–Napo Pharmaceuticals, Inc. (Napo) recently hosted an educational panel to address the impact of the lack of access to clean water and enteric disease on global health, the environment, and human rights. Robert F. Kennedy, Jr., Napo’s Environmental Advisor, discussed the negative consequences of non-sustainable development on indigenous peoples and the environment.

Other speakers included E. Benjamin Skinner, who has written about the connection between the war on diarrhea and modern-day slavery in his book, A Crime So Monstrous; and James Workman, whose book, Heart of Dryness, details the current and future struggles surrounding the scarcity of clean water, as told through the experiences and traditional wisdom of bushmen in southern Africa’s Kalahari region. Dr. Pradip Bardhan of the International Centre for Diarrhoeal Disease Research in Bangladesh (ICDDR,B), a state-of-the-art cholera hospital, shared his experiences with enteric disease, not only at the ICDDR,B, but also with respect to cholera crises around the world, such as the recent outbreak in Zimbabwe.

“This event was an important gathering of world experts to address the various factors affecting the health of global populations,” said Napo CEO Lisa Conte. “The development of crofelemer, Napo’s investigational drug for secretory pediatric infectious diarrhea, is part of an effort by many partners to address the devastating dehydration in pediatric populations, regardless of their geography of social or economic status.”

Napo invites you to view highlights of the discussion at http://vimeo.com/6819224. You may view the entire hour-long event at http://vimeo.com/6819500.

The panel event followed a recent discussion among international experts on Napo’s global advisory board about the development of crofelemer for use in pediatric population. In addition, on Oct. 2, Ms. Conte addressed the MIT Legatum Center’s second annual Progress Through Innovation conference, which highlights the development and empowerment of people in developing regions of the world. Ms. Conte’s remarks focused on Napo’s global business plan to bring its first-in-class anti-diarrheal agent, crofelemer, to all populations in all countries through a sustainable business model by working with local partners. She also commented on the human-rights impacts and environmental repercussions of unmet global health needs, and the common traits shared by innovators and entrepreneurs around the globe.

Crofelemer for Pediatric Populations (CRO-PED)

Napo is organizing a program to accelerate the development of crofelemer for pediatric infectious diarrheal diseases, targeting regulatory approval in 2011-2012 (pending additional funding). The company has established a global advisory board to ensure that the development of a pediatric product incorporates World Health Organization (WHO) Essential Medicines guidelines for oral rehydration solution (ORS), zinc, etc., and to generate a formulation that is practical and safe for resource-constrained regions with limited health personnel. Napo has formed alliances with Direct Relief International and others to make crofelemer accessible to every childhood population in need. Napo is also in the planning stages for clinical development of crofelemer for severe cholera in pediatric populations at the ICDDR,B.

About Crofelemer

Napo’s proprietary patented gastrointestinal compound, crofelemer, is a first-in-class anti-secretory agent extracted from Croton lechleri, a medicinal plant sustainably harvested in several South American countries. Crofelemer is in various stages of clinical development for four distinct programs, including a late-stage Phase 3 program. The FDA has granted fast-track status to crofelemer development for IBS and HIV-related indications (CRO-IBS and CRO-HIV):

• CRO-HIV for HIV-related diarrhea, Phase 3 (under Special Protocol Assessment)
• CRO-IBS for diarrhea irritable bowel syndrome (D-IBS), Phase 2
• CRO-ID for acute infectious diarrhea (including cholera), Phase 2
• CRO-PED for pediatric diarrhea, Phase 1

Napo’s licensee, Salix Pharmaceuticals, Inc. has exclusive rights to crofelemer for all indications in North America, Europe (excluding Iceland, Liechtenstein, Norway, and Switzerland), and Japan, and, for certain other indications including irritable bowel syndrome, worldwide. Salix estimates that the HIV-associated diarrhea market opportunity alone may be $300 million. The ADVENT trial of crofelemer as a treatment for chronic diarrhea in patients on antiretroviral therapies for HIV or AIDS is being conducted under fast-track status and Special Protocol Assessment agreement with the FDA.

Crofelemer has also been licensed to Glenmark Pharmaceuticals, Ltd. in India and 140 emerging countries for indications related to HIV (CRO-HIV), use in acute adult infectious diarrhea (CRO-ID), and use in pediatric diarrhea (CRO-PED). Glenmark and Salix have entered into a commercial supply agreement for crofelemer active pharmaceutical ingredient (API). AsiaPharm Group, Ltd. has rights to crofelemer in China (including Hong Kong and Macau).

washlink notes

see Journal of Pediatric Gastroenterology and Nutrition: for more information on Infectious Diarrhea in Children

see google journal search  results for studies with Crofelemer

Yale School of Medicine gets $1.8 million from Bill & Melinda Gates Foundation for oral rehydration solution ( ORS) study

New Haven, Conn. —  http://media-newswire.com/release_1100879.html

To improve treatment of acute diarrhea, the Bill & Melinda Gates Foundation recently gave a two-year, $1.8 million grant to the Yale School of Medicine to design clinical trials to test the effectiveness of a major modification of oral rehydration solution ( ORS ) in the treatment of acute diarrhea in children in developing countries.

After working together on various aspects of this project for more than 15 years, a team of scientists — Dr. Henry J. Binder, professor of medicine and of cellular and molecular physiology at Yale, and his two collaborators Dr. B.S. Ramakrishna, professor of gastroenterology at Christian Medical College, Vellore, India, and Professor Graeme P. Young, head of the Flinders Centre for Cancer Prevention and Control, Flinders University, Adelaide, Australia — have proposed a modified ORS, based on the addition of a starch that reduces fluid loss.

“The development of ORS to treat diarrhea more than three decades ago has been considered one of the most important milestones in therapeutics during the last century,” says Binder. But although oral rehydration therapy has been responsible for a substantial reduction in infant mortality in the developing world, Binder says, “It is not used as much as it should be for many reasons, including the failure of mothers and caregivers to appreciate its effectiveness. Although ORS corrects dehydration, it does not reduce diarrhea.”

Since diarrhea can be caused by bacterial, viral and parasitic infections, an improvement in current therapies will have far-reaching impact, say the scientists. The primary objectives of this two-year planning grant are to establish a network of sites to collaborate in a series of clinical trials in developing countries, and to identify the most effective starch to be used in these trials.

background

Resistant starch – 0verview

Amylase – overview

related articles

• Amylase-Resistant Starch plus Oral Rehydration Solution for Cholera NEJM
• A Randomized Controlled Trial of Glucose versus Amylase Resistant Starch Hypo-Osmolar Oral Rehydration Solution for Adult Acute Dehydrating Diarrhea PLOS

Time Magazine reports: Zink tames diarrhea

there is  a good new story in Time this past August (’09) Here is an excerpt

Can One Pill Tame the Illness No One Wants to Talk About?

By Vivienne Walt / Sogola Monday, Aug. 17, 2009

African communities fight diarrhea

It is hard to grasp the impact diarrhea has on people’s lives across Africa and Asia. The disease kills more children than either malaria or AIDS, stunts growth, and forces millions — adults and children alike — to spend weeks at a time off work or school, which hits both a country’s economy and its citizens’ chances of a better future. In countless villages like Sogola, where people have long drawn water from unreliable wells, diarrhea kills so many that there is a general sense of resignation, as if watching children die is simply one of life’s inevitable tragedies. One morning I ask Djene-Sira Diakité how many children she has. “God gave me 10 children, and took five of them back,” she says with a shrug.

But now a quiet revolution is under way. Over the past few years, a handful of aid organizations and governments — including the Bill and Melinda Gates Foundation and the U.S. Agency for International Development — have begun distributing zinc supplements to villagers in Bangladesh, India, Mali and Pakistan. Several other groups are working with governments in Africa to introduce zinc, which comes both in tablet form and as a syrup. In Mali, Save the Children U.S. used $680,000 from a 2007 charity concert of American Idol to distribute zinc tablets to a handful of villages in the south of the country. (Read TIME’s Persons of the Year cover story on Bill and Melinda Gates.)

So far, the small programs have drawn little attention. But their impact has been dramatic. Zinc pills appear to halt diarrhea in its tracks. “Before, we were terrified when children’s stomachs began running, because we knew some of them would die,” says Sata Djialla in the Malian village of Morola. “Now our children are not dying of diarrhea.”

…A second medical breakthrough should also help. At least one-third of all diarrhea deaths among young children are caused by the rotavirus, which infects the cells lining the small intestine and causes gastroenteritis. In June, the WHO approved the first rotavirus vaccine for global use. The vaccine, which in trials in Latin America, Europe and the U.S. cut rotavirus infections by 85%, could someday be part of routine vaccination programs for children, along with those for polio, measles and other diseases whose death rates have plummeted in recent years.

for full story : http://www.time.com/time/magazine/article/0,9171,1914655-1,00.html

JAMA addresses effectiveness of Azithromycin in treating Trachoma

source JAMA Vol. 302 No. 9, September 2, 2009  Abstract

http://jama.ama-assn.org/cgi/content/abstract/302/9/962

From article titled:

“Effect of Mass Distribution of Azithromycin for Trachoma Control on Overall Mortality in Ethiopian Children”

Context Mass oral azithromycin distribution to affected communities is a cornerstone of the World Health Organization’s trachoma elimination program. Antibiotics are provided to target the ocular strains of chlamydia that cause trachoma, but may also be efficacious against respiratory disease, diarrhea, and malaria—frequent causes of childhood mortality in trachoma-endemic areas.

Interventions A single dose of oral azithromycin (adults, 1 g; children, 20 mg/kg) was administered for treatment of ocular Chlamydia trachomatis infection. Antibiotic coverage levels for children aged 1 to 9 years exceeded 80% at all visits.

Results The odds ratio for childhood mortality in the intervention communities was 0.51 (95% confidence interval, 0.29-0.90; P = .02; clustered logistic regression) compared with the control group.

In the treated communities, for children aged 1 to 9 years

• the estimated overall mortality rate during this period for in the untreated group was 8.3 per 1000 person-years (95% confidence interval, 5.3-13.1),
  
• while among the treated communities, the estimated overall mortality rate was 4.1 per 1000 person-years (95% confidence interval, 3.0-5.7)
  

Travis C. Porco, PhD, MPH; Teshome Gebre, MBA; Berhan Ayele, MSc; Jenafir House, MPH; Jeremy Keenan, MD; Zhaoxia Zhou, BS; Kevin Cyrus Hong, BS; Nicole Stoller, MPH; Kathryn J. Ray, MA; Paul Emerson, PhD; Bruce D. Gaynor, MD; Thomas M. Lietman, MD

source: abstract Vol. 302 No. 9, September 2, 2009  Journal of the American Medical Association JAMA. 2009;302(9):962-968. : http://jama.ama-assn.org/cgi/content/abstract/302/9/962

A Brief Background on Trachoma:

“Trachoma, a disease caused by bacteria called Chlamydia trachomatis, affects more than 80 million individuals worldwide, and 8 million persons are blind because of this infection. Inflammation of the conjunctiva (lining of the eye surface) causes irritation and scarring, leading to blindness if trachoma is not treated. Trachoma is a serious public health problem in developing countries. Better sanitation and improved clean water supplies are ways to decrease the prevalence of trachoma and reduce trachoma-related blindness. Trachoma occurs in children as well as adults in all parts of the world. Women are much more likely than men to develop trachoma or become blind from trachoma. In the United States, blindness due to trachoma has been eliminated because of widespread prevention and treatment efforts. Since trachoma is a contagious disease, it can occur in family groups or in persons who live in close quarters. The bacteria are spread by secretions from the eye or the nose and pass from person to person. Flies can also pass on the bacteria, especially in areas that have poor sanitation. The September 2, 2009, issue of JAMA includes an article about the effects of mass distribution of an antibiotic for treatment and prevention of trachoma.”

source  and   for more details ( SIGNS AND SYMPTOMS, TREATMENT AND PREVENTION, and addition links) see the following  JAMA Patient Page http://jama.ama-assn.org/cgi/content/full/302/9/1022?home