World Health Day 2019: Evaluating the Infectious Disease Landscape

Each year on April 7th, the World Health Organization (WHO) celebrates World Health Day.

The WHO’s campaign for 2019 is focusing on universal health coverage and ensuring that individuals across the world have access to the care that they need when they need it.

This year for World Health Day, Contagion® is reflecting on the scientific advancements in treatment and prevention that have been made in the areas of infectious disease, while also looking at the infectious disease landscape to identify areas that require further improvement to reduce preventable deaths globally.

Let’s take a look at the current status of some important infectious disease topics:

HIV

In President Donald J. Trump’s State of the Union address earlier this year, he announced a plan to end the HIV epidemic in the United States with the goal of achieving a 75% reduction in new HIV infections over the next 5 years and a 90% reduction over the next 10 years.

“We don’t have any excuses anymore since we have the tools...this is the right people in the right place at the right time,” Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, told the audience at the opening session of the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2019) on March 4, 2019, in Seattle, Washington.

Fauci’s words reflect the ground-breaking progress that has been made in the HIV field since the virus was first detected in 1984. Earlier this year, Fauci and National Institutes of Health (NIH) officials validated the evidence of Undetectable Equals Untransmittable, or U=U. This move­ment definitively states that people living with HIV who have undetectable HIV RNA are unable to transmit HIV to others. Clinicians are hopeful that endorsement by critical health agencies such as NIH will encourage people to get tested for HIV and, if necessary, start and stay on treatment.

In addition to U=U, important advancements in HIV also include the uptake of pre-exposure prophylaxis (PrEP) for HIV prevention, and the news from CROI that emtricitabine/tenofovir alfenamide (F/TAF) is noninferior to emtricitabine/tenofovir disoproxil fumarate (F/TDF) for PrEP.

Cholera

Cholera, a diarrheal illness that can be transmitted through unclean food and water, is relatively rare in the United States, but global cases have increased in areas including Africa and Southeast Asia since 2005.

The disease can be prevented through vaccination and treated successfully with a rehydration solution 80% of the time, but it is a deadly disease that can kill within a few hours of the presentation of symptoms if treatment is not initiated.

In the wake of Cyclone Idai, 1 of the largest cyclones to ever hit Africa, a large cholera outbreak has been reported in Mozambique with more than 1000 documented cases and 2 deaths reported as of April 2.

Global health partners are rapidly deploying teams to help control the outbreak and 900,000 cholera vaccines, funded by Gavi, arrived in the African nation on April 2, just in time for a vaccination campaign to begin on April 3.

Cholera has historically been a challenging disease that emerges in the aftermath of natural disasters. Haiti has been dealing with a 9-year-long cholera epidemic since the catastrophic 7.0 magnitude earthquake in 2010.

Only time will tell how Mozambique will fare in the fight against cholera.

Ebola

More than 1000 cases have now been confirmed in the Ebola outbreak in the Democratic Republic of the Congo (DRC). The outbreak has entered its ninth month, with no signs of slowing down.

The outbreak has been notable in that the experimental rVSV-ZEBOV vaccine has been administered to 94,388 individuals as of April 3, 2019. Additionally, experimental treatments ZMapp, mAb114, and REGN-EB3 have been deployed for use in this outbreak, and are under evaluation in a multidrug trial for Ebola treatment in the outbreak zone.

Although scientific advancements such as the vaccine and experimental therapies have played a large role in the outbreak, much of the progress has been derailed by the violence and unrest associated with rebel activity in the outbreak zone. Treatment centers and health workers have been a target of the violence, resulting in the frequent halt to outbreak response activities and disruptions in case surveillance.

As World Health Day promotes access to health for all, it is also critical that safe environments be available for health workers, especially in critical situations such as this.

Measles

As of March 28, 2019, more 387 cases have been confirmed in the United States. This figure indicates that case counts in the US have already surpassed the total number of cases confirmed in 2018. Outbreaks associated with travel-based cases that spread through pockets of unvaccinated individuals are currently ongoing in Rockland County, NY; New York City; Washington; California; Illinois; and Texas.

“I think it’s important to note that the transmission of measles was eliminated in the United States in the year 2000 in the wake of a major outbreak in 1989 to 1991 that included upward of 50,000 cases total. And since then, all the cases have been linked to imported cases, mainly among pockets of underimmunized populations.” Glenn Fennelly, MD, MPH, professor and chair of pediatrics at Rutgers New Jersey Medical School, said in a segment of a recent Contagion® Insights program on measles.

As international travel is now accompanied by the risk of bringing a vaccine-preventable disease into unvaccinated and vulnerable individuals, it is important to educate parents about the measles mumps rubella (MMR) vaccine and ensure that both doses of the vaccine are administered to children to reduce the risk of infection.

“Measles can kill 1 to 2 in 1000. And in populations that are immunosuppressed or are malnourished, those rates can be much, much higher: as high as 5% overall, or higher. It can cause an encephalitis, which in many cases causes severe sequela in about 1 in 1000 cases. This is why we have to be vigilant. This can happen to any child anywhere who gets measles,” Fennelly emphasized.

Malaria

The 2018 WHO Malaria Report indicated that after years of success in controlling malaria across the globe, progress has stalled. The report, based on data from 2015-2017, found that no significant progress was made during that time period, with an estimated 219 million cases and 435,000 related deaths worldwide in 2017.

In the US, an average of 1700 travelers return home with malaria with growing incidence rates. The US Centers for Disease Control and Prevention (CDC) estimates that approximately 300 Americans return from abroad with severe malaria.

A change in protocol for the treatment of severe malaria was announced by the CDC last week. As of April 1, 2019, artesunate became the first-line treatment for severe malaria in the United States.

The new guidance was based upon the decision by the manufacturer of the antimalarial drug quindine, the only US Food and Drug Administration (FDA) approved intravenous antimalarial, to discontinue production of the drug.

Although progress is being made towards developing a vaccine to prevent against disease manifestations, malaria remains an urgent public health threat that requires global response to get back on track.

For up-to-date case counts on the current outbreaks of Ebola in the DRC, measles in New York, and cholera in Mozambique, check out the Contagion® Outbreak Monitor.