LONDON, 16 October 2012 (PlusNews) - A research team at Oxford University in the UK is very close to determining the efficacy of their new tuberculosis (TB) vaccine. If current clinical trials are successful, it will be the first new TB vaccine in almost a century.

The urgent need for a new vaccine is emphasised by research showing that extensively drug-resistant (XDR) forms of the disease are rapidly spreading.

Today, most babies in the world are immunized with the old Bacille Calmette-Guerin (BCG) vaccine, first used in 1921. The leader of the Oxford research team, Helen McShane, says it saves children's lives, but beyond infancy its effects are limited.

"We know that when BCG is given at birth, it does work well to protect against tubercular meningitis and the disseminated disease that has spread outside the lungs... What we also know is that BCG is very variable in protecting against lung disease, which is where the burden of the disease is, particularly in adults and adolescents," she said.

Oxford's vaccine, known as MVA85A, is designed to boost the effects of BCG. "It's that efficacy against severe disease which is the rationale behind keeping BCG and making it better," McShane said.

Clinical trials are taking place in South Africa, following 3,000 babies, all of whom received BCG; half of them also received the new booster vaccine. Trials of the vaccine's effectiveness in adults are taking place in both South Africa and Senegal, with results expected in the first quarter of 2013.

Boosting immune response

The vaccine is designed to stimulate an immune response known as cell-mediated immunity. "This is different from all the vaccines we have licensed today - with the exception of BCG - which work by the production of antibodies," McShane said.

"Because TB is very good at hiding within cells, we need T-cells [a kind of white blood cell] to protect against TB. And indeed that's the reason why HIV-infected people are more susceptible to TB - because HIV damages your T-cells. So the vaccine that we have developed works by boosting the T-cells which are induced by BCG."

TB is a major cause of death among the HIV-positive. Asked whether this kind of vaccine could prevent TB in people living with HIV, McShane said that it might - but only for those with immune systems strengthened by antiretroviral medications. "I do think that's going to be crucial for these vaccines to work, [but] I think it would be very hard for it to work in HIV-positive individuals with very low CD4 counts [a measure of immune health]."

Market consideration

After decades of neglect, the world is seeing a flurry of activity around the development of new TB vaccines, reflecting increased interest and funding from donors such as the Bill and Melinda Gates Foundation and the British and Dutch governments. Added pressure comes from the emergence, first, of multi-drug resistant TB, and, more recently, of XDR-TB, which can be nearly impossible to treat.

MVA85A is the front-runner among the vaccines in development, but there are others on the way. Some use virus vectors, like the Oxford vaccine, which uses an adenovirus, from the family of organisms that cause the common cold. Others use peptides, and one, says McShane, is a recombinant form of BCG, modified to express more antigens and to make it safer for use in people living with HIV.

Some researchers are working on improved TB treatments to address the disease's growing drug resistance, but the process of bringing new drugs to market is slow, and few new treatments have even started clinical trials. Vaccines may be a better bet and, given the market, may be easier to put into production.

The problem is that TB is a disease of poverty: According to the World Health Organization, over 95 percent of cases and deaths are in developing countries, where sufferers often cannot afford treatments. This makes the expensive process of developing new TB medications unattractive to drug companies. Most of the current research is publicly funded.

"It's been hard to make a convincing market argument for TB drugs," Ann Ginsberg, vice president of scientific affairs at Aeras, a non-profit organization working on TB vaccines, told PlusNews. "The reality is that the vast majority of companies working on TB drugs do not expect to make any profit from it. They are in it because they think it is the right thing to do. They hope not to lose money in the process, but they don't expect to make any," she said.

"But because of global vaccination, you are talking about so many people who would ideally be vaccinated that there's probably a reasonable profit to be made there."

(sumber: plusnews.org)

A lack of knowledge about eye health is the main reason behind the high blindness rate in Indonesia, a health practitioner has said.

The director of the Cicendo Eye Hospital and National Eye Center, Hikmat Wangsaatmadja, said that Indonesia had the highest number of blindness cases in the world, after Ethiopia.

"In fact, 80 percent of blindness can be cured," Hikmat told the World Sight Day forum in Bandung, West Java, recently.

Hikmat, an ophthalmologist, said that most cases of blindness in Indonesia were caused by cataracts.

The high occurrence of blindness in the country, according to Hikmat, could be attributed to the fact that most people in Indonesia were reluctant to undergo eye operations, especially for cataracts, which are a clouding of the transparent lens of the eye.

Many people, according to Hikmat, did not know that cataracts could be treated through surgery. Because of such reluctance to undergo operations, he added, one person would go blind every minute in Indonesia from cataracts.

Hikmat said that the incidence of cataracts in Indonesia reached 240,000 annually, while the numberof cataract operations performed in the nation numbered only 100,000.

Deputy Health Minister Ali Gufron Mukti expressed hope that more people would have their eyes checked to prevent blindness.

World Sight Day 2012 in Bandung was marked with the launch of an audio book, Skenario Indah dari Tuhan (A Beautiful Scenario from God).

The book presents the works of 12 people with vision problems, ranging from poor vision to total blindness, and included students, teachers and therapists.

The one-hour audio book describes the feelings, hopes and experiences of people with low vision and the blind.

"We try to help and facilitate the sufferers to become independent and productive personalities," said the chairperson of the Syamsi Dhuha Foundation, Dian Syarief, who also has vision problems.

At Syamsi Dhuha, the responsibility for low vision and blind patients has been given to its low vision

division.

Apart from giving motivation to those with vision problems, the division also provides training and certification for those with vision problems on shiatsu massage, computer use and writing.

"The audio book is one of the division's works,' Dian said.

Dian also underlined the important role of the community in improving low vision and permanent blindness sufferers' productivity, arguing that blindness was not just a public health problem, but was also a social problem.

Hikmat concurred, saying that a blind person who did not receive help could cause two other persons to be unemployed.

"This is because a blind person sometimes needs the help of two people and this is not productive," he said.

Globally, 135 million people have vision problems, 90 percent of whom are from developing countries.

"The economic losses because of the cases is US$28 billion a year. This accounts for why this has to be a concern for all of us," he said.

(sumber : thejakartapost.com)

THE World Health Organization (WHO) yesterday warned low-income countries they are more vulnerable to blindness and visual impairment, thus making it more necessary to improve access to quality eye care services.

In a statement on the World Sight Day, the WHO lamented the lack of sufficient eye care in low-income countries as one of the main reasons for widespread blindness.

"Surveys indicate that globally, 90 percent of people with blindness or low vision live in low-income countries," said the WHO-Western Pacific Region.

Worldwide, the WHO said, there are 39 million people who are blind and another 246 million people with poor vision.

Of this number, 10 million blind people and 79 million with poor vision live in the Western Pacific Region.

The leading cause of blindness in the world and in the Western Pacific Region is cataract, which is a clouding of the lens, a natural process that usually comes with age.

Other main causes of blindness in the Western Pacific Region include glaucoma and diabetic retinopathy.

Because of this, the WHO urged member-states to implement programs that will provide ample eye care, especially in poor communities.

"The WHO program is supporting low- and middle-income countries in their efforts to improve quality access to eye care services, especially for poor people. Activities include the support of human resource development and of increased access to eye health services for rural and poor populations," said the WHO.

(sumber : malaya.com.ph)

Delegates at the Gastein Health Forum have been told that measles and rubella are "raging" throughout Europe, with a lack of funding making the situation worse.

The Gastein Health Forum (EHFG) is the leading health policy event in the EU, which takes place annually.

During a workshop at the policymakers' forum on 5 October, Austrian MEP Karin Kadenbach said that "measles and rubella are once again raging in Europe".

As a result, the World Health Organization (WHO) has had to put back its goal of conquering these diseases to 2015, five years later than previously hoped.

The struggle to curtail the spread of these diseases is due to vaccination rates falling short in the 53 countries of the WHO European region. According to Kadenbach's estimation, measles viruses could be prevented from circulating if 95% of the population were inoculated.

Instead, recent studies show that the number of measles cases in the EU has risen by a factor of four between 2010 and 2011.

Costs are also proving a factor in preventing many from getting vaccinated, as the example of flu vaccinations has shown. Countries which spent the least on subsidising seasonal flu vaccination also had the lowest coverage rates. Austria, the Czech Republic, and Poland had the lowest coverage in Europe.

The internet is also proving to be a hindrance to vaccinations, with misinformation regarding the safety of vaccinations spreading via social media.

World Bank health expert Armin Fidler told delegates that there is evidence which shows that immunisations are among the most cost-effective public health interventions, but falling healthcare budgets are challenging them.

Fidler recommended an approach to vaccinations seen in many developing countries. "Even in many low-to-middle-income countries, those responsible for public budgets are not only prepared to waive contributions to immunisation, they literally pay people to take part in order to boost the vaccination rate," he said.

In countries like Brazil, Mexico, and Turkey, some social services such as school-fees are linked to vaccinations. Fidler advises that if such programmes "pay off", they should be encouraged elsewhere.

Kadenbach has called for a joint European initiative that brings in health experts and decision-makers to give more political support for vaccination programmes

(sumber : egovmonitor.com)

Jakarta - Experts have pegged the annual cost of air pollution in Jakarta at 38 trillion rupiah (RM12.2 billion), a figure they blame largely on the proliferation of cars and the use of low-quality subsidised fuel.

Ahmad Syarifuddin, chairman of the Committee to Phase Out Leaded Gasoline (KPBB), claimed on Thursday that vehicle emissions accounted for almost all the air pollution in the capital.

He said data gathered by the KPBB showed that health costs and lost productivity as a result of air pollution amounted to 38 trillion rupiah in 2010, and was believed to have increased since then with more vehicles hitting the city's streets.

"The air pollution we're dealing with includes dust particle, hydrocarbons, sulfur and so on, which can cause a range of illnesses such as asthma, respiratory tract infections, bronchitis, pneumonia and heart disease," Ahmad said at a seminar here with the theme of "Fuel Economy Initiative in Indonesia."

He warned that the costs would only keep increasing as long as there were no fundamental changes in transportation policies, including phasing out the use of low-grade subsidised fuel and enforcing emissions restrictions.

Ahmad urged the government to introduce cleaner fuels in a bid to limit the types of pollutants being emitted from vehicles.

"Our target is ultimately to see vehicle emissions slashed to 10 per cent of what they are now," he said.

"So if a vehicle has a hydrocarbon emissions rating of 2,500 ppm (parts per million), then we want to see it come down to 250 ppm.

"Low-emissions vehicle technologies are already available, but they will only be effective as long as the quality of the fuel being used is good," he added.

The most widely consumed vehicle fuel in the country is premium petroleum from Pertamina, which has an octane rating of 88 and is sold at a subsidised price of 4,500 rupiah a litre.

Ahmad argued that if the subsidy could be scrapped, or even just eased back to allow a price increase, the government would be able to offer a fuel with a higher octane rating and by extension better emissions characteristics and fuel economy.

"The government sells subsidised fuel at 4,500 rupiah a litre (with) an octane rating of 88, whereas the subsidy was actually calculated based on a fuel with an octane rating of 96 and price of 5,700 rupiah a litre," he said.

(sumber : btimes.com.my)

The full implementation of the healthcare insurance plan, targeted to kick off in 2014, may be derailed by private company workers who oppose the proposed obligation to pay a portion of the premium.

Officials from the Health Ministry and the National Social Security Council (DJSN) said it would be impossible to fully realize the goal of universal health care by 2014 as mandated by the 2010 Law on the Medium Term National Development Plan.

"The 2010 law stipulates that by 2014, universal health coverage is targeted to have covered at least 80 percent of the population. However, that's unlikely to happen because the workers union of private companies [SPSI] opposes the idea to share the cost of the insurance premium with their companies," said Theresia Ronny Andayani, a researcher at the ministry.

She was speaking on behalf of Deputy Health Minister Ali Ghufron Mukti at the 29th ASEAN Social Security Association (ASSA) board meeting in Nusa Dua, Bali on Tuesday.

According to her, currently only 10 percent or around 6 million private workers are covered by state insurance company PT Jamsostek.

"By 2014, the employees are expected to pay 2 percent of the premium, while their companies will pay 3 percent."

Health insurance is the first priority to be implemented among the seven healthcare reform priorities, which include improving health services in remote areas, availability of pharmacy and health equipment in all health facilities, bureaucracy reform, health operational assistance and the establishment of world-class hospitals.

While emphasizing that no other country in the world had managed to achieve 100 percent universal healthcare coverage, DJSN chairman Ghazali Situmorang said, "It's impossible to fully implement universal healthcare by 2014. Instead, we are targeting to realize the target by 2019, or within five years after 2014."

At present, only about 139 million people out of the country's overall population of 236 million have access to healthcare. "But they receive widely varied services, because the standard of every provider is different. By 2014, we plan to be able to intensively synchronize the diverse standards in medical services," Ghazali said.

"No matter how visionary the policy, the ultimate matter lies in the implementation. Good government matters and the future of social security depends on the social security organizations and stakeholders," said International Social Security Association (ISSA) president Frank Errol Stoove.

The 29th ASSA board meeting was held on Sept. 25-26 and saw the participation of social security stakeholder representatives from Indonesia, Korea, Brunei Darussalam, Cambodia, Laos, Malaysia, the Philippines, Singapore, Thailand, Vietnam, the ISSA and the International Labor Organization.

PT Jamsostek president director Elvyn G Masassya, as the host of the ASSA meeting, highlighted that the meeting served as a forum for Indonesia's social security stakeholders to share and learn from experiences in the region in terms of how to increase contributions, how to widen coverage, how to develop sophisticated administrative systems and how to effectively convey to the public the urgency of social security.

Parikesit Suprapto of the State-Owned Enterprises Ministry assured that the government remained committed to realizing the goal of universal healthcare.

"The ministry provides guidance for state-owned insurers PT Askes and PT Jamsostek, which are appointed as social security providers, to prepare more accurate databases and IT enhancements to support the establishment of better universal health coverage services and infrastructure," said Parikesit.

(sumber: thejakartapost.com)

MORTALITY RATES: Improving quality of life of the newborn is crucial, says Razali Ritonga

THE performance of a nation in the health sector is usually reflected in indicators, such as mortality rates and life expectancy.

The lower the mortality rate and the higher the life expectancy, the better the health programme in that country.

Unfortunately, the health programme in Indonesia shows a low performance, as indicated by a high mortality rate and neonatal mortality rate.

For every 1,000 live births, 19 die within a month. In industrialised countries, neonatal mortality stands at four per 1,000 live births according to the World Health Organisation in 2008.

Therefore, the government should seek every opportunity to bring down the neonatal mortality rate. This is crucial since Indonesia faces a demographic dividend that started in 2010 and will last until 2050. The demographic dividend is expected to peak in 2025.

This will create a window of opportunity for Indonesia to reach a higher potential economic growth and welfare status, since the proportion of the population at a productive age exceeds that of a non-productive age.

A shrinking, young population could allow the government to save its budget and invest in economic activities and human wellbeing.

However, hopes of reaching those goals may not be realised if the government fails to improve the quality of the population who will enter the labour market in 2020-2050. One segment of that population is those aged below 1.

The importance of bringing down the neonatal mortality rate is also shown by the higher contribution of this to infant mortality (under 1) and child mortality (under 5). The contribution of neonatal mortality to infant mortality is about 60 per cent, and to child mortality it is about 40 per cent (WHO, The State of the World's Children, 2008).

Generally, the causes of neonatal deaths are pneumonia, infections and diarrhoea. The "Neonatal survival series 2005" in the medical journal, The Lancet, reported that at least three out of four million neonatal deaths in the world could be anticipated if 90 per cent of pregnant women had access to health services.

Although Indonesia on average reached that percentage, health services for pregnant women remained below standard. The results of a demographic and health survey in 2007 reported that only 73 per cent of pregnant women received anti-tetanus injections, only about 77 per cent of pregnant women consumed iron pills and only 46 per cent of pregnant women gave birth at health facilities.

There are reasons for the failure to provide pregnant women with access to health services. The World Bank (2006) outlined four reasons that brought about the low coverage of pregnant women with access to health services in developing countries.

The first is low education and knowledge. The majority of pregnant women in developing countries lack knowledge on how to manage their pregnancies.

Second is women's exclusion from decision-making. In fact, pregnant women might know that they have to visit health services, but their husbands sometimes do not give them permission.

Third is a lack of health facilities. This aspect becomes a major problem in some regions in Indonesia, especially remote areas where health facilities are rare.

Fourth are non-technical aspects, such as pregnant women who are not ready to undergo medical treatment provided by male doctors or medical workers.

The government needs to take these four factors into consideration in delivering health services. Although the government, for example, gives pregnant women free access to health services, it is not a guarantee that they are ready to come and visit health centres.

Based on those reasons, it comes as no surprise that the health budget is enjoyed by higher-income groups rather than those in lower-income brackets. Surveys conducted by the World Bank in 2004 in 21 countries discovered that 20 per cent of high-income groups received 25 per cent of the total health budget, compared with 15 per cent that went to 20 per cent of low-income groups.

It is, therefore, high time for the government to increase its health budget and distribute it fairly in order to reduce the mortality rate, especially in the neonatal group. The government cannot rely on women to treat their children themselves.

It needs to do more to increase the quality of life of the population, especially newborn babies. Years from now, they will not only become productive workers but will also be taking over leadership positions in the country.

Failure to improve their quality of life will mean that Indonesia will waste the population dividend and perhaps lead the nation to the brink of disaster.

(sumber : nst.com.my)

A new and potentially fatal virus from the same family as SARS which was discovered in a patient in London last week appears not to spread easily from person to person, the World Health Organization (WHO) said on Friday.

In an update on the virus, which has so far killed a Saudi man and made a patient from Qatar critically ill, the United Nations health agency said it was working with international partners to understand the public health risk better.

"From the information available thus far, it appears that the novel coronavirus cannot be easily transmitted from person to person," it said in a statement.

The WHO put out a global alert on Sunday saying a new virus had infected a 49-year-old Qatari who had recently travelled to Saudi Arabia, where another man with the same virus had died.

The Qatari was described as critically ill on Tuesday and is being treated in a London hospital. No new confirmed cases of infection with the virus have since been reported, the WHO said.

The new virus shares some of the symptoms of SARS, or Severe Acute Respiratory Syndrome, another coronavirus, which emerged in China in 2002 and killed around a tenth of the 8,000 people it infected worldwide.

Both patients who have so far been confirmed with the new virus suffered kidney failure.

SEVERITY

"Given the severity of the two laboratory confirmed cases, WHO is continuing to monitor the situation in order to provide the appropriate response, expertise and support to its member states," the WHO statement said.

Scientists at the European Centre for Disease Prevention and Control (ECDC), which monitors disease in the European Union, said initial virology results and the separation in time of the only two confirmed cases suggest the infection may have developed from animals. Such diseases are known as zoonoses.

"(It) is quite probably of zoonotic origin and different in behaviour from SARS," the scientists wrote in a "rapid communication" study in the online journal Eurosurveillance.

Asked about transmission and the possibility of animal to human spread, WHO spokesman Glenn Thomas said investigations were continuing.

"But from the evidence we have, and given that there are only two cases confirmed so far and there was a distance and time distance between the two cases, (the) assumption is that it isn't easily transferable person to person," he told reporters.

The WHO's clinical guidance to its 194 member states says health workers should be alert to anyone with acute respiratory syndrome and requiring hospitalization who had been in the Middle East where the virus was found or in contact with a suspected or confirmed case within the previous 10 days.

The U.N. agency has not recommended any travel restrictions in connection with the new virus, but said it was working closely with Saudi authorities on health measures for Muslims making the haj pilgrimage to Mecca.

Health experts said rapid progress has already been made in figuring out the nature and genetic makeup of the new coronavirus, and in coming up with tests.

"We are developing with our partners sensitive and specific diagnostic assays and these should be available in the next few days," Thomas told a briefing at WHO headquarters in Geneva.

"If any national authority is concerned about a patient who is under investigation, if they want to contact us, we can put them in touch with these laboratories and provide initial tests for any cases which are suspicious," he added.

(sumber: windsorstar.com)