Tag Archives: antibiotics

Haiti: disease model predicts more cholera and potential impact of clean water

The number of Haitians infected with cholera may reach 779,000 by the end of November 2011, nearly twice as many as UN estimates, according to a new study [1].

The UN estimate is “essentially a guess, based on no data, and ignoring the dynamics of cholera epidemics” co-author Dr. Jason Andrews told SciDev.Net.

Using a mathematical model of the epidemic, the study projects 779 000 cases of cholera and 11,100 deaths between March 1 and November 30, 2011, if there are no new interventions to curb transmission and treat victims.

The researchers estimate that 170,000 cases of cholera and 3,400 deaths could be averted by a combination of clean water, vaccination and greater distribution of antibiotics.

A 1% per week reduction in consumption of contaminated water would the greatest effect by averting 105,000 cholera cases and 1,500 deaths. Vaccination of 10% of the population would avert 63,000 cases and 900 deaths. The extension of the use of antibiotics to all patients with severe dehydration and half of patients with moderate dehydration would avert 9,000 cases and 1,300 deaths.

Andrews told SciDev.Net that the interventions could be achieved if the international community was willing to invest in them.

But Marcos Espinal, head of health surveillance, disease prevention and control at the Pan American Health Organization (PAHO), defended the UN’s approach. He told SciDev.Net that “the model used up to now is consistent with reality. We have seen just over 250,000 people with cholera in six months”.

A cholera epidemic broke out in Haiti in late October 2010, in the wake of the earthquake in January of the same year. The latest UN figures for the epidemic, published on 31 March 2011, are 267,224 cases, 4,749 deaths and a mortality rate of 1,8%.

[1] Andrews, J.R. and Basu, S. (2011). Transmission dynamics and control of cholera in Haiti : an epidemic model. The Lancet, 16 March 2011 (Article in Press). DOI: (free registration is required to view this article)

Source: María Elena Hurtado, SciDev.Net, 28 March 2011

Preventing spread of infectious diseases is everyone’s responsibility – and everyone’s job

Good hygiene starts within the family, but families need better guidance and advice, says new report.

According to a report published today, we must all share responsibility for preventing the spread of diseases such as swine flu, SARS, avian influenza, diarrhoeal and skin diseases, and even the common cold.

The swine flu scare has prompted some to say that we are over-reacting but it is important  to look at the bigger picture – because the next new pathogens are always just around the corner. The regular emergence of new pathogenic strains, and their unpredictable behaviour, means that sustained investment in effective strategies of mitigation and containment make absolute sense.

But if infections are to be kept in check, there needs to be a fundamental change in our approach to hygiene, with more emphasis being placed on empowering families  to take on this responsibility.

Professor Sally Bloomfield of the London School of Hygiene & Tropical Medicine and one of the report’s authors,  comments: ‘Although antibiotics and vaccines have given us unprecedented ability to prevent and treat killer diseases, hygiene is still fundamental to winning the battle against infectious disease in both developed and developing countries – and that’s a job for all of us. This is not about shifting responsibility, it’s about facing reality’.

The report, published by an expert group for the International Scientific Forum of Home Hygiene, indicates that a significant proportion of global infectious disease could be prevented through improved hygiene practice coupled with the provision of adequate water and sanitation. One of its key conclusions is that, if the burden of these diseases is to be contained in a manner which is economically sustainable, it must be a responsibility which is shared by all of us.

Information around hygiene is still too fragmented and confusing, however. For example, advice on preventing spread of colds and flu is very different from that on preventing diarrhoeal diseases. What is needed, argue the authors, is a less agency-centred approach, and one that is more family-centred, empowering parents to better protect themselves and their families against infection.   Dr Elizabeth A Scott, also a co-author comments: ‘The key to getting people to change their behaviour is to find a way to make hygiene behaviour more appealing and relevant by realigning it with other aspects of healthy living such as diet and exercise. People also need to understand that they can be proactive in protecting themselves and reducing their risk of acquiring an infection in their everyday lives’.

If we can prevent infections through good hygiene, we can also reduce the amount of antibiotics we need to prescribe, according to co-author Professor Martin Exner. Overprescription of antibiotics is the main cause of antibiotic resistance, which is threatening our ability to treat infections effectively when they occur.

In developing countries, the huge burden of hygiene and sanitation-related infectious diseases continue to be the most critical public health threat. Says co-author Professor KJ Nath: ‘Much of the focus in developing countries is on investment in community water supply and sanitation in order to meet the Millennium Development Goals, but if the health benefits are to be realised, programmes of hygiene promotion must be implemented in conjunction with improvements in water and sanitation’.

Last week’s report on the state of the NHS called for greater emphasis on ‘disease prevention strategies’ as a means to reduce pressure on NHS budgets.  Infection prevention will be particularly important for the ever-increasing ageing population, for whom infectious diseases can have much more serious consequences which require hospitalisation.

All of these trends underline the need for greater collective effort in better standards of hygiene. Says Professor Bloomfield: ‘In the current climate where infectious disease agents and our immunity to these agents are constantly changing, we need to return to the “not-so-good old days” when our parents and grandparents knew that protecting themselves and their families against infectious diseases was part of their responsibility and an important part of daily life’.

The full reportThe global burden of hygiene-related diseases in relation to the home and community : an IFH expert review” can be downloaded here

Source: IFH Press Release, 17 June 2009

India: world’s highest drug levels entering stream in Andhra Pradesh

PATANCHERU: When researchers [led by Joakim Larsson of  the University of Gothenburg, Sweden] analyzed vials of treated wastewater from a plant where about 90 Indian drug factories dump their residues, they were shocked. Powerful antibiotic was being spewed into one stream each day to treat every person in a city of 90,000.

And it’s not just ciprofloxacin. The supposedly cleaned water was a floating soup of 21 different active
pharmaceutical ingredients, used in generics for treatment of hypertension, heart disease, chronic liver ailments, depression, gonorrhea, ulcers and other ailments. It is the highest levels of pharmaceuticals ever detected in the environment, researchers say.

These factories, located [in Patancheru] on NH-9, just 28km from Hyderabad [in the Indian state of Andhra Pradesh], produce drugs for much of the world. The result: Some of Andhra’s poor are unwittingly consuming an array of chemicals that may be harmful, and could lead to the proliferation of drug-resistant bacteria.

[...] Patancheru became a hub for largely unregulated chemical and drug factories in the 1980s, creating what is described locally as an “ecological sacrifice zone” with its pharmaceutical waste. Since then, India has become one of the world’s leading exporters of pharmaceuticals, and the US which spent $1.4 billion on Indian-made drugs in 2007, is its largest customer. [T]he wastewater downstream from the Indian plants contained 150 times the highest levels detected in the US.

[...] M Narayana Reddy, president of India’s Bulk Drug Manufacturers Association, disputes Larsson’s initial results: “I have challenged it,” he said. “It is the wrong information provided by some research person.”

Reddy acknowledged the region is polluted, but said that the contamination came from untreated human excrement and past industry abuses. He echoed pollution control officials, saying villagers are supposed to drink clean water piped in from the city or hauled in by tankers which a court ordered the industry to provide. But locals complain of insufficient supplies and some say they are forced to use wells.

“We are using these drugs (traces of which are found in water here), and the disease is not being cured. There is resistance going on there,” said Dr A Kishan Rao, a medical doctor and environmental activist who has treated people for more than 30 years near the drug factories. He says he worries most about the long-term effects on his patients potentially being exposed to constant low levels of drugs. [...] “It’s a global concern,” he said. “European countries and the US are protecting their environment and importing the drugs at the cost of the people in developing countries.”

For more information on this topic see the US EPA’s page on Pharmaceuticals and Personal Care Products as Pollutants (PPCPs)

Source:  Margie Mason, AP / Yahoo! News, 25 Jan 2009 and Times of India, 27 Jan 2009