World TB Day

Did you know? March 24th was World TB Day. The date commemorates the day in 1882 when Dr. Robert Koch announced he’d discovered the cause of Tuberculosis.

Did you know? Every day there are 24,000 new cases of TB diagnosed. This means more than 2 billion people are infected with TB and 1.5 million people die each year (according to the Stop TB Partnership).

Did you know? The number of people diagnosed with multi-drug resistant TB (MDR-TB) has tripled since 2009 (according to the WHO TB fact sheet).

The burden of TB is highest in resource limited countries and in places where the incidence of HIV is highest. TB is the most common opportunistic infection for individuals with HIV/AIDS and is the most common cause of death in HIV/AIDS patients. In resource limited countries diagnosis and consistent treatment is a challenge. Lack of laboratory resources to use for diagnosis means TB diagnosis are often made based on empirical signs and symptoms.

Once a patient is diagnosed (either clinically or based upon a confirmed laboratory test) given the strenuous treatment, it can be difficult to keep people on a consistent treatment plan. Most treatment lasts six to nine months. In rural settings where access to drugs is limited this can be a prohibitive amount of time. Not only does the cost of the drug add up but the opportunity cost involved in missing work to travel to get the drug, the cost of the travel, and the physical strain of the travel all hamper a patient’s ability and commitment to sticking with the full course.   This can and has led to increased prevalence of MDR-TB.

Unfortunately, the ways to prevent the spread of MDR-TB (quick, accurate diagnosis; taking medication exactly as prescribed; avoiding exposure) aren’t easy in resource limited areas. Basic cell phone technology may be one tool helping to make a difference, however. Some researchers and health care providers are experimenting with sending text message reminders to other health care providers and/or patients to take their medication. Multiple studies are currently underway to determine whether this method of communication has been useful in increasing drug regimen adherence and improving the TB cure rate. If this can solve one of the challenges related to TB, it will be a big step in the right direction.

 

Levy

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

 

Significant, but Fragile, Gains In the Fight Against Malaria

Marie Levy

January 2015 Lablogatory post

In recent months it seems that the only news stories about sub-Saharan Africa presented by western media are about Ebola. There are some bright spots in that news, but in general it is scary and saddening. Lost in the Ebola shuffle, however, is some good news about the fight against malaria. A recently released report from the WHO Global Malaria Programme states that worldwide the malarial mortality rate fell by 47% between 2000 and 2013 and currently 55 countries are on track to reduce their malarial burden by 75% by 2015. Those are exciting numbers. The report attributes these improvements to increased use of insecticide treated bed nets, accurate diagnostic testing, and increasingly effective drug therapies.

Accurate diagnostic testing means that the lab is playing a crucial role in the fight against malaria. Data from 2013 shows an increase in the use of diagnostic tests in sub-Saharan Africa. This supports additional data that shows there has been a shift from presumptive treatment to diagnostic treatment.

As a public health community, however, we cannot become complacent. The WHO report states that, in Africa, over 43,000 children die from malaria each year, 15 million pregnant women do not have access to preventative treatment, and over 200 million people live in households without access to insecticide treated bed nets.   Drug and insecticide resistance is a serious concern (thus underscoring the importance of accurate diagnostic testing to prevent presumptive treatment that can contribute to drug resistance). In the West African countries hit by the Ebola outbreak, health care resources have all been directed towards the fight against Ebola leaving them vulnerable to increases in other disease occurrence. If nothing else, however, the Ebola outbreak has provided a reason and impetus for discussions surrounding the importance of health systems strengthening. Strengthening that will not only fight future outbreaks of diseases such as Ebola, but will improve health care networks for every day care and treatment.

Thus, in the spirit of the holidays, let’s celebrate this good news. But while doing so, let’s also continue the fight and keep up the good work.

Links for further reading:

http://apps.who.int/iris/bitstream/10665/144852/2/9789241564830_eng.pdf

http://www.nytimes.com/2014/12/14/opinion/sunday/fragile-gains-against-malaria.html?_r=0

http://kff.org/news-summary/significant-global-gains-made-against-malaria-but-ebola-threatens-progress-in-west-africa-who-report-says/

Levy

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

Season of Greetings

It’s amazing the year is nearly over, the halls are decked, candles lit, celebrations scheduled. Friends and families gather, eat too much, hug and kiss, pass around gifts and graciousness…and microbes.

Laboratory professionals know all too well that “Seasons Greetings” are just the thing for passing along your favorite virus or enteric pathogen. This year, we are especially conscious of the contagious nature in the world of unseen assailants. Global health has faced the disastrous affects of improper hand washing and challenging sanitation conditions; and not just with the Ebola crisis, but in refugee camps and among those facing the strife of war.

Laboratories don’t close for holiday celebrations…and laboratory professionals don’t always get the days and times off that would make them happy around the holidays. But this year I challenge us with two things:

  • Remember to offer “Seasons Greetings” with best practices and don’t take any of your laboratory favorites along to the parties and gatherings!
  • If you’re working that extra shift, or one that is encroaching on your family and personal time—remind yourself that there are so many in the world who would rejoice in the opportunity to be working, to be healthy enough to be working and free of disease, strife and conflict, and could watch their children and families smile, eat too much, hug and kiss and pass along “Seasons Greetings”.

My best to you for this holiday season, whatever ways you celebrate, and ‘tis the season to remember our colleagues globally and do something to make the world a little better place locally! Happy Holidays!

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Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Pandora’s Box

Archived in the ever-rich and exotic mythologies of the Greeks is the story of Pandora’s Box. It was actually a “jar”—which is strangely close to a “test tube” in my opinion. Pandora was given a wedding gift, a beautiful jar, with instructions not to open it under any circumstances. Curiosity killed the cat, so to speak, and she finally couldn’t resist. When she opened it, all the evil contained in the jar escaped and spread over the earth. She tried to close it but too late—the contents had already escaped. Only one thing remained in the jar at the very bottom—the Spirit of Hope.

I’m not sure the World Health Organization would agree with me, but “Pandemic” is very close to “Pandora.” In a world where international travel is commonplace the spread of contagious disease is a major concern. Rats on ships carrying plague may be a thing of the past, but viral-loaded passengers on an international flight happen every hour of every day. Think of all the headlines in the past decade that have highlighted international health risk issues. It seems that Pandora has unleashed a few additional mutated “evils,” and I doubt we’re through with all her mischief.

As laboratory professionals, we are essential to solving the public health issues confronting our world today. Rapid diagnosis, evidence-based research, viral load monitoring, susceptibility and pharmacological validation, managing toxicity—familiar territory for us, and just think of how much relies on our expertise? We are called on daily to be the platform and framework for “pandemic control” measures. Sitting in our clean, efficient, well-lit, safe and busy laboratories throughout our country it’s easy to forget there are bacterial and viral war zones not far from our shores…all it takes is a small rat on a creaky ship (or a young child on a red-eye international flight) to initiate a modern day plague world-wide.

Next time you hear “pandemic”, remember Pandora. Wash your hands, put on a mask, and peer inside that jar of hers and shake out some Spirit of Hope. Sprinkle it liberally around our laboratories and colleagues, and let’s roll up our lab coat sleeves—we have a lot of work to do!

 

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Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

 

Laboratory Response to the Ebola Outbreak

You may have heard in the news over the past few months that there has been an outbreak of Ebola in West Africa. The first registered case was in Guinea in February of 2014. Reports have since noted the spread of the virus to other areas in Guinea, as well as Liberia and Sierra Leone. As of June 24, the CDC noted on their website that ministries of health in the three countries have reported 390 cases in Guinea (this includes 270 fatalities and 260 laboratory confirmed cases); Sierra Leone had 147 laboratory confirmed cases with 34 fatalities; and Liberia reported 34 laboratory confirmed cases and 34 fatal cases.

Genetic analyses of the confirmed cases show that this strain of the virus is closely related (97 percent) to variants of the virus that have been previously identified in Gabon and the Democratic Republic of the Congo.

Response to the outbreak is difficult for many reasons, including the lack of medical and laboratory resources in the regions where it has been discovered. The WHO and other partners have deployed laboratory experts to staff mobile field laboratories in order to provide accurate testing to confirm cases. Other specialized medical personnel have been deployed to treat affected patients and provide education to local communities. There are reports, however, of local medical personnel in Liberia not showing up at work due to fear of contracting the virus because they say they lack the appropriate personal protective equipment (PPE) in order to adequately protect themselves.

Spread of the virus has been attributed to the ease of contagion in densely populated cities (such as Conakry, Guinea), local traditions and beliefs that have resulted in lack of quarantine and/or removing patients from medical care, and the porous borders and ease of border crossings in the West African region. However, some countries have taken various measures to close borders or restrict movement across borders. The CDC, WHO and MSF (known as Doctors Without Borders in the US) are working with partners on the ground to lead the response to the outbreak.

 

Levy

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

 

 

 

 

The African Century

“In demographic terms, it seems, the Asian century could be followed by the African century…Whether Africa is able to prepare for its coming population boom may well be one of the most important long-term challenges the world faces right now.” So says Max Fisher in the Washington Post article “The amazing, surprising, Africa-driven demographic future of the Earth, in 9 charts.” I found these charts and Fisher’s commentary incredibly interesting and well-worth exploring (especially with the future of health care resources in mind).  As he points out, the next century being the ‘African century’ will have good, bad, and unforeseen consequences. Even if it is does not turn out to be the ‘African century,’ continued population growth seems to becertain and will put increasing burdens on resources in African countries. With more people, there is need for more water, more food, more jobs, more sources for transport, etc. More people also mean the need for more health care and thus, increased capacity for laboratory services.  Yet another argument for the importance of expanded and improved laboratory (and all health care) services in the next decade.

Another interesting statistic from Max Fisher’s charts is that life expectancy in Africa in the next 80 years is expected to increase by 50%. However, in 2090, it will still not be equivalent to that in the U.S., Europe, South America or Asia. From a health care perspective this is interesting both in the reasons why it will still be the lowest life expectancy in the world, and, in how health care is affected by a growing aging population (much like challenges we are beginning to see and expecting to see expand in the coming years in the U.S.). However, with this in mind, take a close look at his chart number 9 on dependency ratios (the ratio of the population under age 15 and over age 64 and thus ‘dependent’ on others and the government to provide for them). Africa’s dependency ratio is projected to decrease from 80% today to 60% by 2055, while the dependency ratios in the rest of the world are projected to increase. This could mean a more productive work force, and more people to take care of a population that is living longer. As Mr. Fisher points out, however, a large younger population can result in increased political instability.

While these charts are all projections and any number of factors could completely alter the course of these projections, it is fascinating to think about and study, and certainly worthwhile preparing for.

I originally stumbled across Mr. Fisher’s charts through a different article of his in the Washington Post called “40 more maps that explain the world.”  This one is equally fascinating and I could have spent hours absorbed in the various maps.

On an unrelated note, a quick update to my post from last month: President Obama nominated Dr. Deborah Birx to become the next Global AIDS Coordinator. Dr. Birx has spent her career focusing on immunology, vaccine research, and global health. From the laboratory-strengthening perspective she is an exciting choice for this role. Her nomination still needs to be approved by the Senate. Her bio on the CDC website.

 

Levy

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.