This is a short, sobering article that all of us in Africa should read. Perhaps the pandemic will never develop, but the signs are still worrisome. Maybe there is still time to correct some of the deficiencies in policy and practice that are highlighted in this article.
An entire issue (supplement) of Journal of Infectious Diseases is devoted to a look at the "rollout" or scaling up of antiretroviral treatment in developing countries, mainly South Africa. See the full table of contents for articles including
This article is more related to policy than to medical practice as such, but it is still interesting and useful. I think the big bottom-line message for most of us is this: "A major problem is shown to be that drug efficacy as perceived by people at risk will remain high even after drugs have become almost completely ineffective, resulting in a lack of community pressure for drug policy change." In other words, people will keep believing in a given treatment long after it is no longer effective, a dangerous situation. We see this with our expatriates here who continue using chloroquine or other failing drugs for prophylaxis. (read more ...)
"Data Synthesis Twenty-nine RCTs were identified, of which 3 targeted 4 diseases simultaneously, 20 targeted 3 diseases, and 6 targeted 2 diseases. Trials were published between 1972 and 2005 and baseline prevalence of individual diseases varied among RCTs. Albendazole plus diethylcarbamazine significantly reduced prevalence of elephantiasis (16.7% to 5.3%), hookworm (10.3% to 1.9%), roundworm (34.5% to 2.3%), and whipworm (55.5% to 40.3%). Albendazole plus ivermectin significantly reduced prevalence of elephantiasis (12.6% to 4.6%), hookworm (7.8% to 0%), roundworm (33.5% to 6.1%), and whipworm (42.7% to 8.9%). Levamisole plus mebendazole significantly reduced prevalence of hookworm (94.0% to 71.8%), roundworm (62.0% to 1.4%), and whipworm (93.1% to 74.5%). Pyrantel-oxantel significantly reduced hookworm (93.4% to 85.2%), roundworm (22.8% to 1.4%), and whipworm (86.8% to 59.5%), while albendazole alone significantly reduced prevalence of hookworm (8.1% to 1.3%), roundworm (28.4% to 0.9%), and whipworm (51.9% to 31.9%). No RCT examined treatment of river blindness or trachoma as part of an intervention to target 2 or more neglected tropical diseases. Adverse events were generally inadequately reported.
"Conclusions At least 2 of the most prevalent neglected tropical diseases can be treated simultaneously with existing oral drug treatments, facilitating effective and efficient treatment. Increasing awareness about neglected tropical diseases, their global impact, and the availability of oral drug treatments is an essential step in controlling these diseases. "
This week's Lancet reported the success of a phase I/IIb trial of a malaria vaccine, when tested in 214 young infants in a highly endemic area. The vaccine was given at 10, 14, and 18 weeks of age. The control group received hepatitis B vaccine rather than the experimental malaria vaccine.
The vaccine was found to be safe (no difference in adverse effects) and immunogenic, with the immunized infants developing high anti-malaria (anti-circumsporozoite) antibodies. There were 22 cases of documented malaria in the immunized group and 46 in the control group, a statistically (and clinically!) significant result.
A phase III trial is planned to start in about a year, involving 16,000 subjects in 10 centers in 7 countries. A commercial vaccine might be available as early as 2011.
This is the best news I have heard in a long time! If the vaccine performs as well in the phase III trials as in the current one, and if it can be commercially produced at a reasonable cost, it could be a major boost for the health and survival of African children, with an impact on health care systems and economics as well.
According to WHO, says the New York Times, some cases of poliomyelitis in Nigeria are caused by a mutated vaccine virus. Though the Times says "Nigeria is fighting an unusual outbreak of polio caused by mutating polio vaccine," later it's stated that "as many as 70 of Nigeria’s last 1,300 polio cases stemmed from a mutant vaccine virus." That would mean that only about 5% of the cases were from the mutant virus, hardly an alarming figure.
In fact, the more successful the campaign to eliminate polio, the greater the proportion of cases will be from vaccine virus. In countries where polio has been eradicated completely but where live vaccine was still used, 100% of (non-imported) cases were due to vaccine, because there simply was no wild-type virus.
Journal Club 
This week's Lancet reported the success of a phase I/IIb trial of a malaria vaccine, when tested in 214 young infants in a highly endemic area. The vaccine was given at 10, 14, and 18 weeks of age. The control group received hepatitis B vaccine rather than the experimental malaria vaccine.