Tag Archives: WHO

It is not possible to pinpoint how humans in China were first infected with SARS-CoV-2

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Until the source of this virus is identified and controlled, there is a risk of reintroduction of the virus into the human population and the risk of new outbreaks like the ones we are currently experiencing.

Geneva / Washington DC: The WHO report on Origin of SARS-CoV-2 says at this stage, it is not possible to determine precisely how humans in China were initially infected with SARS-CoV-2. However, all available evidence suggests that SARS-CoV-2 has a natural animal origin and is not a manipulated or constructed virus. SARSCoV-2 virus most probably has its ecological reservoir in bats.

A number of investigations in the area believed to be the source of the outbreak in China are currently underway or planned. These include investigations of human cases with symptom onset in and around Wuhan in late 2019, environmental sampling from markets and farms in areas where the first human cases were identified, and detailed records on the source and type of wildlife species and farmed animals sold in these markets.

On Tuesday, March 30, when the report of the international team on their Wuhan field visit, from 14 January -10 February 2021, was published, WHO Director-General Dr Tedros Adhanom Ghebreyesus called for further studies, including data on origin of SARS-CoV-2 virus. Who has reiterated that all hypotheses remain open.

WHO chief said the report advances our understanding in important ways, while raising questions that will need to be addressed by further studies.

We have not yet found the source of the virus, and we must continue to follow the science and leave no stone unturned as we do,” said Dr Tedros

Throughout 2020, WHO continued to discuss with China and other Member States the need to study and share information around the virus origins.

In July 2020 WHO sent a small team to China to plan a joint study comprising Chinese and independent international scientists.

It was agreed that WHO would select the international scientists. The Terms of Reference for the Virus Origins Study were completed by fall 2020.

The World Health Assembly resolution of May 2020, which was adopted by all Member States, cited a need “to identify the zoonotic source”:

The team of scientists came from around the world: Australia, China, Denmark, Germany, Japan, Kenya, Netherlands, Qatar, the Russian Federation, the United Kingdom, the United States of America and Viet Nam.

The joint international team comprised 17 Chinese and 17 international experts from 10 other countries as well as the World Organization for Animal Health (OIE); and WHO.

Members of the international team:

Prof. Dr. Thea Fisher, MD, DMSc(PhD) (Nordsjællands Hospital, Denmark)
Prof. John Watson (Public Health England, United Kingdom)
Prof. Dr. Marion Koopmans, DVM PhD (Erasmus MC, Netherlands)
Prof. Dr. Dominic Dwyer, MD (Westmead Hospital, Australia)
Vladimir Dedkov, Ph.D (Institute Pasteur, Russia)
Dr. Hung Nguyen-Viet, PhD (International Livestock Research Institute (ILRI), Vietnam)
PD. Dr. med vet. Fabian Leendertz (Robert Koch-Institute, Germany)
Dr. Peter Daszak, Ph.D (EcoHealth Alliance, USA)
Dr. Farag El Moubasher, Ph.D (Ministry of Public Health, Qatar)
Prof. Dr. Ken Maeda, PhD, DVM (National Institute of Infectious Diseases, Japan)

The Governments of the United States of America, Australia, Canada, Czechia, Denmark, Estonia, Israel, Japan, Latvia, Lithuania, Norway, the Republic of Korea, Slovenia, and the United Kingdom on Tuesday issued a joint statement sharing concerns that concerns that the international expert study on the source of the SARS-CoV-2 virus was significantly delayed and lacked access to complete, original data and samples. Scientific missions like these should be able to do their work under conditions that produce independent and objective recommendations and findings.

Together, we support a transparent and independent analysis and evaluation, free from interference and undue influence, of the origins of the COVID-19 pandemic. In this regard, we join in expressing shared concerns regarding the recent WHO-convened study in China, while at the same time reinforcing the importance of working together toward the development and use of a swift, effective, transparent, science-based, and independent process for international evaluations of such outbreaks of unknown origin in the future, the joint statement says.

Taking note of the findings and recommendations, including the need for further studies of animals to find the means of introduction into humans, these countries have laid stress on momentum for expert-driven phase 2 studies. Going forward, there must now be a renewed commitment by WHO and all Member States to access, transparency, and timeliness.

In a serious outbreak of an unknown pathogen with pandemic potential, it has been underscored that a rapid, independent, expert-led, and unimpeded evaluation of the origins is critical to better prepare our people, our public health institutions, our industries, and our governments to respond successfully to such an outbreak and prevent future pandemics.

Study flags problems in availability and prices of anti-cancer drugs

Study flags problems in availability and prices of anti-cancer drugs

Sunderarajan Padmanabhan

New Delhi: A new study has shown that availability of essential drugs for treatment of childhood cancers was well below the World Health Organisation (WHO)-prescribed standards in both public and private sector pharmacies even in the national capital, Delhi.

The survey looked into availability of 33 essential anti-cancer medicines in four public and three private hospitals as well as 32 private retail pharmacies. It was found that their mean availability was a mere 70 per cent as against the WHO’s norm of at least 80 per cent.

The situation was, however, somewhat better in private hospitals over public hospitals and private retail pharmacies. Private hospitals recorded availability of 71 per cent, while public hospitals reported 43 per cent and retail pharmacies 38 per cent. 

The study has also found problem with prices of drugs. Medicine prices were relatively low in Delhi compared with international reference prices. However, even at a lower price the medicines were unaffordable for a vast section of society.  The lowest cost of chemotherapy for treating a 30 kg child with standard risk leukaemia was Rs. 27,850 and for a child with early stage Hodgkin’s lymphoma wasRs.17,500.

“Low availability and poor affordability of anti-cancer essential medicines highlight the need to streamline public sector and private sector medicine procurement and supply systems,’ said Neha Faruqui of the George Institute for Global Health, and a member of the research team.

The study has been published in journal BMJ GlobalHealth. The study team included researchers from The George Institute for Global Health, University of Sydney, Cankids India, Max Super Speciality Hospital and Boston University School of Public Health.(India Science Wire)

Twitter handle: @ndpsr

War against Rotavirus to get a boost

Dr TV Venkateswaran & Jyoti Singh

New Delhi: The war against diarrheal diseases is all set to get a boost as the government has decided to introduce the indigenously developed Rotavac vaccine against diarrheal diseases in four more states including Uttar Pradesh. With this, the vaccine will be available to more than half population of the country. Till now, it was introduced in only four states.

Rotavirus is a leading cause of severe diarrhoea in children below five, with India accounting for 22 percent of deaths caused due to rotavirus diarrhoea worldwide, as per estimates of the World Health Organisation.

“It is estimated that every child in world will become infected with Rotavirus if we do not vaccinate them. Among the children who become infected, one in eight will need a outpatient visit to hospital, one in 30 to 50 would be hospitalized due to gastrointestinal infection and one in 1,000 would die because of Rotavirus”, says Dr. Gagandeep Kang, Executive Director of Translational Health Science and Technology Institute at Faridabad, on the outskirts of Delhi.

Dr Kang was involved in the phase I to III trials of the vaccine. There is an interesting history behind the discovery of Rotavirus and the fight against it.

In 1973, Ruth Bishop, Geoffrey Davidson, Ian Holmes, and Brian Ruck working in the Royal Children’;s Hospital, Melbourne, Australia were examining the cause of dehydrating gastrointestinal infection in children. When they examined the faeces and the gut of children having protracted diarrhea through electron microscopy they saw a new virus that was shaped
like wheel. The virus was named rota, from Latin for wheel.

Once the virus was discovered as the cause of the life threatening diarrhea, scientists world over started to work on developing a vaccine against it. After years of research, the first vaccine was licensed in the US in 1998. It, however, had to be withdrawn as it had very severe side effects. It took another eight years before another vaccine was developed.

In India too, efforts to develop a vaccine started in 1980s. Dr M.K. Bhan, who was then an Assistant Professor of Paediatrics and later became Secretary of the Department of Biotechnology (DBT) in the Government of India, began to work on a vaccine after a rotavirus epidemic broke out in Delhi in 1985. Some of the new born children showed evidence of the presence of rotavirus but did not develop the disease. He followed up these children for two years and found that they had acquired immunity to rotavirus.

Meanwhile, Professor C. Durga Rao of the Indian Institute of Science (IISc) Bangalore had also isolated attenuated rotaviruses
in new-born children.

India then did not have the wherewithal to characterize viruses properly. The Department of Biotechnology’s Indo-US vaccine action plan came handy and the virus strain was taken to US and made into a candidate vaccine. The vaccine was tested in US children and adults.

“The foreign manufactured vaccine was costing around 200 US dollars per child which was clearly not affordable in India. We decided to develop an indigenous vaccine that should cost less than one dollar per child. Bharat Biotech in Hyderabad, DBT and a host of other partners got together and took up the challenge.” says Dr Kang. After mandatory trials and study, the vaccine was licensed in 2014.

Speaking to India Science Wire, Dr. Kang also expressed concern over the persisting problem of worm infestation in children. “Hookworm infestation may not kill. But, children get weakened by frequent diarrhoea episodes and they become vulnerable to malnutrition, stunting, and opportunistic infections such as pneumonia. We have to make toilets affordable and acceptable to the people”.

Having done field studies on the issue, she notes that people are not antagonistic to toilets and that the problem was with regard to how they were selected. “One size cannot fit all. The design of toilets for Rajasthan will not work for say a coastal area with high water table. Likewise, if faecal excrement floats around open sewerage, people are not going to accept toilets. Functional sewerage system is a must” she says.

Dr. Kang completed her MBBS in 1987 and her MD in Microbiology in 1991 from Christian Medical College, Vellore and later on obtained 1998. She carried out her post- doctoral research With Dr Mary Estes at Baylor college of Medicine, Houston, before returning to Vellore.

She has helped establishment of networks of sentinel hospitals and laboratories that carry out surveillance for rotavirus disease in children and ancillary studies in association with the Indian Council for Medical Research and the World Health Organization.

Dr Kang has published over 250 papers in national and international journals and has been awarded with the prestigious Infosys Prize in life science for her pioneering contributions to understanding the natural history of rotavirus and other infectious diseases that are important both globally and in India. (India Science Wire)

Home care for stroke patients ineffective, reveals new study

Dinesh C Sharma

New Delhi: For years, doctors in Indian hospitals have been recommending home-based care for rehabilitation of stroke patients. But a new study – largest of its kind – has revealed that this does not work.

Stroke patients require continuous care including physiotherapy to recover and minimize life-long disability. In the absence of adequate professional and affordable rehabilitation facilities, doctors often recommend care at home by family members supplemented physiotherapist visits. Hospital-based care is also offered in various centres but is costly.

In order to study if home-based care results in desired outcomes, a study was done at 14 public, private and district hospitals across the country. A total of 1250 stroke patients were followed up over six months. The study participants were divided in two groups – one received standard package of care given by respective hospital while the other group was given home-based care which included training to family members and weekly visits by physiotherapists for two months. The results revealed that there was no reduction in disability for patients who got care at home, compared to those who received the standard package.

The findings, published in medical journal The Lancet on Tuesday, have surprised medical community because earlier studies carried out in developed countries had indicated that community-based rehabilitation played significant role in recovery of stroke patients. The World Health Organisation (WHO) too recommends such an approach.
“We found that despite extensive training in hospital and during follow up visits in the home, there was no difference in the degree of recovery or quality of life of people who received this extra treatment,” explained Professor Richard Lindley of the George Institute for Global Health and the University of Sydney, who led the study.

The study, supported by the National Health and Medical Research Council (NMHRC) of Australia, was coordinated by Christian Medical College, Ludhiana. Patients in the intervention group had access to physiotherapists who taught the family techniques such as mobility training and communication practice.

“Professional help like training and visits by physiotherapists was provided for first two months only because the intervention needed to be cost effective and sustainable. If family members required more training, then the aspiration of routinely providing rehabilitation through family caregivers might not be feasible,” pointed out Jeyaraj Pandian, neurologist from Christian Medical College, Ludhiana who led the trial. “Our training programme might not have been sufficient (in time and content) to deliver effective family rehabilitation, as we observed only about 30 minutes of daily activities in the intervention group. Conventional western rehabilitation is usually associated with greater daily therapy time.” Accredited Social Health Activist (ASHA) might have been a more effective strategy, but probably more expensive.

Dr Vijaya Nath Mishra, a neurologist at the Sir Sunderlal Hospital at BHU, Varanasi, said the results of the study are surprising. “We will have to carefully examine the evidence because we have so far believed and also observed that caregivers and family members have a major role in outcome of stroke.” Dr Mishra was not associated with the study.

It is estimated that around 1.6 million people have a stroke in India each year, yet the vast majority receive no formal rehabilitation. The whole country has just 35 stroke units, and most are in the cities, despite stroke being the third commonest cause of death in the adult population.

Professor G V S Murthy of the Indian Institute of Public Health, the Co-Chair of the study, commented, “task shifting is increasingly seen as a solution to targeting chronic diseases in many countries in the world. But our results show it may be ineffective for some conditions and waste already limited resources. We need more rigorous examinations of such family and community led programs before they become commonplace.”

The participating hospitals included Christian Medical College, Ludhiana; Apollo Gleneagles Hospitals, Kolkata; All India Institute of Medical Sciences, New Delhi; Baptist Christian Hospital, Tezpur; Christian Medical College and Hospital, Vellore; GNRC Hospitals, Dispur; Lalitha Super Specialty Hospital, Guntur; Nizam Institute for Medical Sciences, Hyderabad; Postgraduate Institute for Medical Sciences and Research, Chandigarh; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Global Hospitals, Chennai; BGS Global Hospitals, Bangalore; Amrita Institute of Medical Sciences, Kochi and St Stephen’s Hospital, New Delhi. (India Science Wire)

Twitter handle: @dineshcsharma