World TB Day 2007 commemorated
Despite friendly warnings that World TB Day should be "commemorated" and not "celebrated," the Philippines marked the day on March 23 with nothing short of festive atmosphere-with balloons, banderitas, ati-atihan dancers, fire breathers, and child performers to spice it up and draw attention to the theme, TB
kahit sino, kahit saan … tutok gamutan, DOTS lang yan!
And there is reason to celebrate. In 2005, the Philippines met and even surpassed the WHO Western Pacific Region target of a 70-percent TB-detection rate and 85-percent treatment success. "I believe that the Philippines is entitled not only to commemorate World TB day but to celebrate [it] for its achievements," said Dr. Jean-Marc Olivé, WHO representative to the Philippines. "However, there is no time for complacency. Much hard work is expected from all of us."
This is especially true if the Philippines hopes to achieve the new target set by the WHO to cut TB cases and deaths in half by 2010. But Health secretary Francisco Duque III is up to the challenge. Part of his strategy is directing the focus on previously neglected but high-risk populations such as children with TB.
"Left neglected, children with TB become a reservoir for future adult disease and even explosive epidemics," said Duque. "The National Policy and Technical Guidelines on Childhood TB adhere to the DOTS strategy and is now an essential tool for all our field workers to finally conquer TB and to protect our youngest generations and all the future ones from this most fearsome threat."
Other challenges that the country is facing are TB coinfection with HIV/AIDS, multidrug-resistant TB and the emerging threat of extensively drug-resistant TB. The first nationwide drug-resistant survey in 2003 and 2004 revealed a four-percent prevalence of multidrug-resistant forms of TB, but this could be an underestimation of the real figure, warned Duque.
"This is not the time to back down. Our path toward a nation and a world free of TB cannot be derailed by fear, discouragement, and inaction because where we fail to prevent and treat basic TB, the enemy becomes even more hardy, resilient, and truly hard to defeat. And when we fall short of hunting down drug-resistant TB with more powerful tools and weapons, the health of our poorest people and our youngest generations are seriously put at risk."
M Carisa Paraz, MD
More needs to be done in TB fight
KUCHING, Malaysia
Countries in the Western Pacific Region have made good progress in the fight against tuberculosis, but the battle is far from over.
"As a region, we have achieved the global targets set for 2005. We now face the challenge of making an even greater impact on the TB burden by meeting the regional targets for 2010," said Dr. Pieter van Maaren, regional adviser for the WHO Stop TB program in the Western Pacific.
For 2005, WHO and its member states had targeted to detect at least 70 percent of TB cases, cure at least 85 percent of those detected, and achieve full coverage with directly observed treatment, short course (DOTS), the world health body's recommended strategy for TB control.
These interim targets were set as a means to eventually meet the 2010 goal of reducing the prevalence and deaths due to TB by half, compared with 2000 levels. The Western Pacific Region is the first and only WHO region to have achieved the 2005 targets.
TB control efforts in the region were intensified subsequent to the declaration of a TB crisis in 1999. The WHO considerably scaled up its technical assistance to countries, with increased funding to countries mainly coming from the Australian Agency for International Development; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the Government of Japan; the United States Agency for International Development; and the World Bank.
"Despite the good progress made in recent years, over 3.5 million TB cases and nearly 300,000 deaths still occur in the region every year. We clearly still have a lot of work to do before we can meet the goal we have set for ourselves," cautioned van Maaren, urging countries to step up efforts even further. Most countries face significant constraints to further progress in TB control to achieve the 2010 goal.
Among other factors, these include limited access to and quality of DOTS services, multidrug-resistant TB (MDRTB), HIV-associated TB epidemics, inadequate engagement of all care providers, lack of adequate human resources, and other health-systems weaknesses.
About a quarter of the global burden of MDRTB is in the Western Pacific Region, with 140,000 cases in China alone. Reports of extensively drug-resistant TB emerged in 2006 and have been documented in the Republic of Korea and the Philippines. TB-HIV coinfection is a major challenge in Cambodia and Papua New Guinea, the two countries in the region with a generalized HIV epidemic. In many countries, TB patients continue to be managed outside DOTS program, often with inadequate or unnecessary treatment. Affected countries are now addressing these issues through programmed management of MDRTB, and by implementing collaborative TB-HIV activities and public-private-mix DOTS approaches.
"In settings such as in Singapore and Malaysia where TB and HIV share common risk factors, TB-HIV coinfection is of increasing concern," said Dr. Han Tieru, WHO representative to Malaysia, Brunei Darussalam, and Singapore. "We cannot control one without controlling the other. So, we must rapidly scale up TB-HIV collaborative activities through formally established mechanisms and plans."
Representatives of health ministries from eight countries, TB experts, and partners held a meeting March 12 to 14 in Kuching to review the progress made by individual countries and the region as a whole, and to identify areas that need further strengthening or prioritization to achieve the 2010 TB goal.
M
UICC launches World Cancer Campaign
GENEVA
The statistic is amazing: 43 percent of cancer cases can be prevented through healthy lifestyles established in childhood. The World Cancer Campaign-Today's Children, Tomorrow's World-underscores prevention by sharing knowledge about lifestyle behaviors.
The International Union Against Cancer (UICC), a Geneva-based nongovernment organization, and its member organizations in 86 countries launched the campaign on February 4, World Cancer Day.
Targeting parents, health-care professionals and policy-makers, the campaign presents a common theme: fostering healthy habits during childhood can help prevent cancer later in life.
The World Cancer Campaign focuses on four key messages: provide a smoke-free environment for children; be physically active, eat a balanced, healthy diet, and avoid obesity; learn about vaccines for virus-related liver and cervical cancers; and avoid overexposure to the sun.
More than seven million people die from cancer and close to 11 million new cases are diagnosed every year. In 2006, cancer killed more people than AIDS, malaria, and tuberculosis combined.
"Cancer strikes all segments of society in every country. The good news is cancer is largely preventable," says Isabel Mortara, UICC executive director. "The first steps toward prevention are education and action. That needs to start with children. That's why this campaign is so important."
In addition to targeting individuals, the World Cancer Campaign encourages policy decision-makers to put cancer on the public agenda.
"Cancer control can only be effective if given priority at the highest decision-making levels. Complacency and inaction on the part of the world community will effectively contribute to more than 10 million deaths every year by 2020," says Dr. Franco Cavalli, UICC president.
Former United States First Lady Barbara Bush, Her Royal Highness Lalla Salma of Morocco, Nigerian President Olusegun Obasanjo, and tennis star Steffi Graf are among those lending their voices to the World Cancer Campaign with encouragement for those touched by cancer.
The UICC is a global resource for action with more than 270 member organizations in Africa, Asia-Pacific, Europe, Latin America, the Caribbean, the Middle East, and North America. For more information, visit uicc.org.
M
Antioxidants may not be that healthy
WASHINGTON
Taking vitamins A, E, and other antioxidant supplements may increase the risk of death and carries no clear health benefits as claimed by vitamin makers, a comprehensive new study shows.
In a blow to the healthy image often associated with dietary supplements, the study led by Danish researchers concluded that vitamins A, E, and beta carotene are linked to a rise of five percent in the risk of mortality, according to an analysis of 47 clinical trials involving 180,938 patients. The findings, based on electronic databases and bibliographies, were published in the Journal of the American Medical Association.
"Beta carotene, vitamin A, and vitamin E given singly or combined with other antioxidant supplements significantly increase mortality," the authors wrote. "Our findings contradict the findings of observational studies, claiming that antioxidants improve health," wrote the authors, led by Goran Bjelakovic of the Center for Clinical Intervention Research at Copenhagen University Hospital.
The study also found that there was no evidence vitamin C may increase longevity and added: "We lack evidence to refute a potential negative effect of vitamin C on survival."
With an estimated 10 to 20 percent of the adult population in North America and Europe-80 to 160 million people-taking antioxidant supplements, "the public-health consequences may be substantial," the authors wrote.
The US market for antioxidant supplements was estimated at more than US$5 billion in 2006.
The authors deplored the intense marketing that touts the alleged health benefits of antioxidant supplements and offered several possible explanations as to why the products can have a negative effect.
"By eliminating free radicals from our organism, we interfere with some essential defensive mechanisms," it said.
The antioxidant supplements are synthetic and not subject to the same toxicity studies as other pharmaceutical agents.
"Better understanding of mechanisms and actions of antioxidants in relation to a potential disease is needed," the researchers conclude.
The makers of vitamins and other dietary supplements are not required to register their products with the US government's Food and Drug Administration that regulates medicine and food products. But the FDA can order the withdrawal of products on the market that are found to pose a risk to public health.
M AFP
Drive for ethanol poses health risks
SAN FRANCISCO
Ethanol-fueled vehicles could contribute to more illnesses and deaths from respiratory disease than gasoline-powered cars and trucks, research in the United States has found. If all cars and trucks were replaced by vehicles fueled by ethanol, deaths related to air pollution would rise by about four percent in the US, according to the study in the journal Environmental Science & Technology.
"Our results show that a high blend of ethanol poses an equal or greater risk to public health than gasoline, which already causes significant health damage," said Mark Jacobson, an atmospheric scientist at Stanford University and lead author of the study.
The study raises questions about ethanol, a fuel produced from corn or other crops, which many hope will reduce oil dependency and air pollution.
Jacobson ran computer tests simulating atmospheric conditions in the US in 2020, when ethanol-fueled cars are expected to be widely available. His simulation focused on Los Angeles because of its poor air quality and dense population.
He programmed the computer to run air-quality simulations comparing two scenarios-one where all cars, trucks, motorcycles, and other vehicles are powered by gasoline and another where the same fleet is powered by E85, a blend of 85-percent ethanol and 15-percent gasoline. "In some parts of the country, E85 significantly increased ozone, a prime ingredient of smog," Jacobson said.
Asthma, weakened immune systems, and other health conditions have been linked to even small increases in ozone in the atmosphere. The World Health Organization estimates that 800,000 people die each year from ozone and other chemicals in smog.
E85 could boost US asthma-related emergency room visits by 770 a year and the number of respiratory-related hospitalizations by 990. In Los Angeles, there would be 650 more hospitalizations and 1,200 more asthma-related emergency visits in 2020 under the E85 model, the study found.
M AFP
Ampalaya in return bout v. diabetes
Ampalaya or bitter melon returns with a vengeance in the fight against diabetes mellitus.
Pulled out in 2003 from the list of 10 local medicinal plants recognized and promoted by the Department of Health, ampalaya is back in grace. The DOH reinstated ampalaya (Momordica charantia) in its medicinal-plants list following recent findings of the vegetable's efficacy against diabetes.
Health secretary Francisco Duque III issued a circular on January 29 reinstating ampalaya as a scientifically validated herbal medicinal plant. He said that ampalaya's reinstatement is based on scientific reports conducted on the tropic vegetable for over four decades. A DOH review of these studies concluded that "[ampalaya] fruits, leaves, seeds, and other parts when used as dry powders, extracts, decoctions, fresh or cooled, have clearly demonstrated hypoglycemic activity."
Key compounds in ampalaya include polypeptide-P, a plant insulin found only in bitter melon that lowers elevated blood sugar levels. Eaten as vegetable, ampalaya is also rich in vitamins and minerals, especially A, B1, B2, C, and iron.
An earlier 1995 circular included the bitter-tasting vegetable in the DOH-approved list of local medicinal plants of proven clinical efficacy. The list included lagundi or five-leaf chaste tree as anti-cough, antiasthma, and antipyretic; garlic as anticholesterol; guava as oral and skin antiseptic; niyug-niyogan as antihel-minthic; sambong for fever, headache, abscess, and as diuretic; akapulko or wild senna as antifungal wash and for itching; tsaang gubat as antimotility; and hierba buena or mint for cough, toothache, headache, dizziness, fainting, gaseous distention, arthritis, and as mouthwash.
To this day products from only four of the 10 DOH-approved plants have been developed and registered by the Bureau of Food and Drugs as medicine after successful clinical trials.
Ampalaya-processed products flooded the country in 2003 while DOH cast doubts on findings based on animal studies and a few small studies on diabetics. A local open-label crossover study with 27 subjects (on ampalaya) showed a significant decrease in HbA1c but not of fasting blood glucose. Findings in that study prompted DOH to reclassify the ampalaya as a food supplement with no approved therapeutic value.
In a statement, the Chamber of Herbal Industries of the Philippines commended the validation of ampalaya in light of a global trend toward natural and herbal therapies. It said that the country has one of the world's richest herbal medicine resources and ampalaya can be the "star" herb for the Philippines, much like ginseng is to Korea.
M Dong delos Reyes
WHO recommends IPD vaccination
Every year, more than 30,000 Filipinos-a third of them children-die of pneumonia, making it the fifth-largest killer in the country. The death toll includes 2,800 children under five years old. Pneumonia is the second killer of Filipino infants, accounting for 10 percent of total infant deaths. Add to the toll the 1,000 or so more who die of meningitis and septicemia which, like pneumonia, are caused by the same bacteria.
The culprit: Streptococcus pneumoniae or simply pneumococci bacteria that spawn pneumonia, meningitis, and febrile bacteremia. Less serious but more common manifestations of pneumococcal infection include otitis media, sinusitis, bronchitis, and bronchiolitis.
But these deaths can be prevented-with vaccination.
In its latest Weekly Epidemiological Record issued on March 23, the World Health Organization reiterates its recommendation for countries to include vaccination against pneumococcal disease in their national immunization programs-particularly those with mortality among children below five of more than 50 per 1,000 live births.
The World Health Organization estimates that 1.6 million people die of pneumococcal disease each year, including 700,000 to one million children less than five years old most of whom are in developing countries. The risk of serious pneumococcal disease remains high throughout childhood.
The WHO cites that pneumococci spread by direct contact with respiratory secretions from healthy carriers-sneeze does it. Disease is caused either by "contiguous spread to the sinuses or the middle ear, aspiration into the lower respiratory tract causing pneumonia, or by invasion of the bloodstream with or without seeding of secondary sites," explains the WHO.
Worries over pneumonia can worsen as the WHO also notes the disease's resistance to antibiotics such as "penicillins, cephalos-porins, trimethoprim-sulfamethoxazole, macrolides and fluoroquinolones (that has become) a serious and rapidly growing problem worldwide."
Stresses the WHO: "This emphasizes the importance of preventing [the] disease though immunization."
A pneumococcal vaccine introduced in 2000 in the United States is now licensed in more than 70 countries-the PCV-7 (or 7-valent polysaccharide-protein conjugate vaccine). While highly immunogenic in all age groups, PCV-7 is currently licensed for use only in children aged less than five years, including infants less than 12 months.
"The primary series of PCV-7 consists of three intramuscular doses administered to infants at intervals of at least four weeks, starting at the age of six weeks or later. It should not be mixed in the same syringe with other vaccines. A booster dose after 12 months may improve the immune response."
However, the WHO points out that "relatively little information on the outcome of PCV-7 immunization among children in developing countries."
Data from developed countries show "the duration of protection against invasive pneumococcal disease cause by vaccine serotypes is at least two to three years following primary PCV-7 immunization in infancy.
The WHO cites that in a large-scale field study in the US, protective immunity against invasive pneumococcal disease caused by vaccine serotypes was 97.4 percent among children who received at least three doses and 93.9 percent among children who received at least one dose of the vaccine.
"An analysis performed in February 2007 suggested that the use of pneumococcal vaccination at a coverage rate equivalent to that of DTP (diptheria-tetanus-poliomyolitis) could prevent 262,000 deaths per year in children aged three to 29 months in 72 developing countries," the WHO reports.
Other pneumococcal vaccines are being developed among them a 10-valent vaccine expected to be licensed in 2008. A 13-valent vaccine with tshe same carrier protein as PCV-7 is expected to become available before 2010. More than 20 other conjugate vaccine formulations are in the early stages of development.
M Dong delos Reyes
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