Current Affairs - Health & Disease

On May 9th, 2023, a report titled "Born too Soon: Decade of Action on Pre-term Birth" was released by United Nations (UN) agencies and partners, shedding light on the issue of pre-term births in several countries, including India.

Key points of the report are:

• Pre-term Birth Rate in India: In 2020, India had a pre-term birth rate of around 13 percent, resulting in approximately 3.016 million pre-term births.
• Factors contributing to pre-term births in India include limited access to quality healthcare services, inadequate neonatal care infrastructure, lifestyle changes, chronic diseases, and pregnancies through In Vitro Fertilization (IVF).
• Prevalence of Pre-term Births in Five Countries: Almost half of all pre-term births in 2020 occurred in five countries: India, Pakistan, Nigeria, China, and Ethiopia.
• Pre-term Birth Rates Across Regions and Globally: The report indicates that pre-term birth rates have remained unchanged in regions worldwide over the past decades.
• In 2020, the global pre-term birth rate was 9.9 percent, compared to 9.8 percent in 2010.
• Southern Asia: The pre-term birth rate in Southern Asia was 13.3 percent in 2010 and slightly decreased to 13.2 percent in 2020.
• Sub-Saharan Africa: In both 2010 and 2020, the pre-term birth rate in Sub-Saharan Africa remained unchanged at 10.1 percent.
• Collectively, these two regions account for over 65 percent of pre-term births globally.
• Initiatives and Challenges in Neonatal Care: Initiatives like special newborn care units and improved labor rooms have helped save many pre-term babies in India.
• However, there is a need for further expansion and improvement of neonatal care facilities, particularly in rural areas.
• Government Programs: The Indian government has launched programs such as the India Newborn Action Plan and Rashtriya Bal Suraksha Karyakram to address pre-term birth issues.
• Special Newborn Care Units (SNCUs) have been set up across the country to provide specialized care for pre-term infants.
• Importance of Improving Access and Awareness: Emphasis should be placed on improving access to quality healthcare, raising awareness about the risks of pre-term births, and providing support to mothers and families.
• Promoting practices like kangaroo care (prolonged skin-to-skin contact) and frequent breastfeeding can help reduce the risks associated with pre-term births.
• Overall Goal and Importance of Quality Healthcare: Ensuring every woman has access to quality health services before and during pregnancy is crucial in identifying and managing risks, reducing the prevalence of pre-term births, and improving child survival and health outcomes.

Recently, Indian Council of Medical Research (ICMR) released ethical guidelines for the use of artificial intelligence (AI) in healthcare and biomedical research.

These principles can be broadly categorized into the following ten points:

1. Accountability and Liability: AI systems should be held accountable for their actions and outcomes, and those responsible for their development and deployment should be held liable for any harm caused.
2. Autonomy: Patients should have control over their personal health data and the use of AI should respect their autonomy, privacy, and dignity.
3. Data Privacy: The use of AI in healthcare should adhere to strict data privacy and security standards, and patients should be informed about the use of their data.
4. Collaboration: Collaboration between stakeholders, including researchers, clinicians, hospitals, public health systems, patients, ethics committees, government regulators, and the industry, is essential for the development and deployment of AI tools in healthcare.
5. Risk Minimization and Safety: AI systems should be designed and deployed in a way that minimizes risks and ensures patient safety.
6. Accessibility and Equity: The use of AI in healthcare should be accessible to all, regardless of their socio-economic status, and should not exacerbate existing health disparities.
7. Optimization of Data Quality: AI systems should use high-quality data and avoid biased or incomplete data sets.
8. Non-Discrimination and Fairness: AI systems should be designed and deployed in a way that avoids discrimination and promotes fairness in healthcare outcomes.
9. Validity: AI systems should be validated using appropriate methods, and the results should be transparent and reproducible.
10. Trustworthiness: AI systems should be transparent, reliable, and trustworthy, and patients should have confidence in their use in healthcare.

On 26th December 2022 South Korea reported its first case of infection from Naegleria fowleri or “brain-eating amoeba”.

So far, Naegleria fowleri has been found in all continents and declared as the cause of primary amebic meningoencephalitis (PAM) in over 16 countries, including India.

About Naegleria fowleri

• Naegleria is an amoeba, a single-celled organism, and only one of its species, called Naegleria fowleri, can infect humans.
• It was first discovered in Australia in 1965 and is commonly found in warm freshwater bodies, such as hot springs, rivers and lakes.

How does it infect humans?

• The amoeba enters the human body through the nose and then travels up to the brain. This can usually happen when someone goes for a swim, or dive or even when they dip their head in a freshwater body. In some cases, it was found that people got infected when they cleaned their nostrils with contaminated water.
• Scientists haven’t found any evidence of the spreading of Naegleria fowleri through water vapour or aerosol droplets.
• Once Naegleria fowleri goes to the brain, it destroys brain tissues and causes a dangerous infection known as primary amebic meningoencephalitis (PAM).

Symptoms of PAM

• The first signs of PAM start showing within one to 12 days after the infection.
• In the initial stages, they might be similar to symptoms of meningitis, which are headache, nausea and fever. In the later stages, one can suffer from a stiff neck, seizures, hallucinations, and even coma.

Fatality

• The infection spreads rapidly and on average causes death within about five days.
• The fatality of PAM is as such that only four people have survived out of 154 known infected individuals in the United States from 1962 to 2021.

Treatment

• As the Naegleria fowleri infection is rare and progresses quickly, scientists haven’t been able to identify any effective treatments yet.
• At present, doctors treat it with a combination of drugs.

Concern

• With the rising global temperatures, the chances of getting Naegleria fowleri infection will go up as the amoeba mainly thrives in warm freshwater bodies.
• The organism best grows in high temperatures up to 46°C and sometimes can survive at even higher temperatures.

The Drugs Controller General of India (DCGI) has granted market authorisation to Serum Institute of India (SII) to manufacture indigenously-developed India's first Quadrivalent Human Papillomavirus vaccine (qHPV) against cervical cancer.

• Cervical cancer is the second most frequent cancer among women between 15 and 44 years of age with a high death ratio in India.
• The government advisory panel NTAGI had recently also approved the qHPV after reviewing the clinical trial data of the vaccine.
• The qHPV vaccine CERVAVAC has demonstrated robust antibody response that is nearly 1,000 times higher than the baseline against all targeted HPV types and in all dose and age groups.

About Cervical Cancer

• Cervical cancer is a type of cancer that takes place in cervix — the lower part of the uterus that connects to the vagina.
• It's not exactly known what causes cervical cancer, but human papillomavirus (HPV) definitely plays a role.
• Most cervical cancer cases are caused by the sexually transmitted HPV.
• There are about 100 different strains of HPV. Only certain types cause cervical cancer. The two types that most commonly cause cancer are HPV-16 and HPV-18."
• This means that being infected with HPV does not necessarily mean you have cervical cancer.

Importance of qHPV

• Every year, 122,844 women are diagnosed with cervical cancer and 67,477 die from the disease.
• Presently our country is fully dependent on foreign manufacturers for the HPV vaccine.
• With the introduction of qHPV vaccine CERVAVAC, several lives could be saved with low cost treatment.

Cases of ‘tomato flu’ were recently reported from Kerala among children below 5 years of age.

About Tomato flu

• “Tomato flu is an unidentified fever. It is a viral disease that causes rashes or blisters, skin irritation and dehydration.
• The flu gets its name from the red coloured blisters it causes.

Causes

• The exact cause of the flu is being investigated. Further it is debated - whether the disease is a viral fever or an aftereffect of chikungunya or dengue fever.

Symptoms

• Some of the most common symptoms include rashes, skin irritation and dehydration.
• The flu has also caused nausea, stomach cramps, vomiting, diarrhoea, coughing, body ache, sneezing, runny nose, tiredness, and pain in joints.

Preventive Measures

• Don’t scratch the blisters caused by the flu as it can make it worse.
• Take proper rest and hygiene.
• Fluid intake must also be increased to counter dehydration.
• Like other types of flu, tomato fever is also contagious. So if someone is infected, they need to be kept in isolation.

On 24th March 2022 (World TB Day), the Union Govt. has launched Data-Driven Research to Eradicate TB - “Dare2eraD TB”.

It is a joint initiative between the Ministry of Science & Technology and the Ministry of Health & Family Welfare, led by the Department of Biotechnology (DBT).

Dare2eraD TB will be the umbrella TB program of DBT comprising of following key initiatives-

• InTGS - Indian Tuberculosis Genomic Surveillance Consortium;
• InTBK Hub- Indian TB Knowledge Hub- Webinar Series;
• Host Directed therapies against TB; and
• Developing an evidence-based regimen for treating extra-pulmonary Tuberculosis.

About InTGS

Indian Tuberculosis Genomic Surveillance Consortium (InTGS) is proposed on lines of the Indian SARS-CoV-2 Genomic Consortia (INSACOG).

Key Objectives

• Develop a central database of Mtb strains and mutations to guide TB care in India.
• Understand the transmission dynamics of different Mtb strains.
• Understand and identify the relationship between mutations in MTB genome and drug resistance & monitor the trend of drug resistant TB.
• Understand pre-COVID and post-COVID changes in MTB strain and transmission dynamics in India
• Suggest public health actions based on the analysis of genomic and epidemiological surveillance data, presence of co-morbid conditions.

About InTBK Hub

• The InTBK Hub- Indian TB Knowledge Hub will be a Webinar series starting from World TB Day that will create Academia- Industry connect to discuss challenges and exchange ideas and carry forward open innovations between all TB stakeholders.

Why the focus on Whole Genome Sequencing?

• Analysing the genomic data of the organism is essential as the Whole Genome Sequencing (WGS) is increasingly gaining traction as an important molecular tool for Tuberculosis surveillance.
• Effective use of WGS technology would allow rapid identification of the origin and drug resistance (DR) profile of TB strains in the patients, which would, in turn facilitate treatment strategies for better control of TB transmission to reduce disease burden.

A boy infected with the Nipah virus has died in Kerala, a state already hit badly by Covid-19

About Nipah Virus(NiV) (Scientific name-Nipah henipavirus)

• It is a type of RNA zoonotic virus (it is transmitted from animals to humans) and can also be transmitted through contaminated food or directly between people.
• It is a member of the family Paramyxoviridae.
• Given that NiV is genetically related to Hendra virus, another henipavirus known to be carried by bats.

Host

• The animal host reservoir for NiV is the fruit bat (genus Pteropus), also known as the flying fox.

Transmission

• Direct contact with infected animals, such as bats or pigs, or their body fluids (such as blood, urine or saliva)
• Consuming food products that have been contaminated by body fluids of infected animals (such as palm sap or fruit contaminated by an infected bat)
• Close contact with a person infected with NiV or their body fluids (including nasal or respiratory droplets, urine, or blood)

Symptoms

• In infected people, it causes a range of illnesses from asymptomatic (subclinical) infection to acute respiratory illness and fatal encephalitis.
• The virus can also cause severe disease in animals such as pigs, resulting in significant economic losses for farmers.

Diagnosis

• Nipah virus infection can be diagnosed with clinical history during the acute and convalescent phase of the disease.
• The main tests used are real time polymerase chain reaction (RT-PCR) from bodily fluids and antibody detection via enzyme-linked immunosorbent assay (ELISA).
• Other tests used include polymerase chain reaction (PCR) assay, and virus isolation by cell culture.

Treatment

• There are currently no drugs or vaccines specific for Nipah virus infection although WHO has identified Nipah as a priority disease for the WHO Research and Development Blueprint.
• Intensive supportive care is recommended to treat severe respiratory and neurologic complications.

Outbreak

• Nipah virus was first recognized in 1999 during an outbreak among pig farmers in, Malaysia. No new outbreaks have been reported in Malaysia since 1999.
• It was also recognized in Bangladesh in 2001, and nearly annual outbreaks have occurred in that country since.
• The disease has also been identified periodically in eastern India.

There is a Norovirus outbreak in the United Kingdom - a very contagious virus that causes vomiting and diarrhea also called "winter vomiting bug".

• Concern: There are many different types of noroviruses. Infection with one type of norovirus may not protect one against other types. Though there is a possibility to develop immunity against certain types of norovirus, experts are not yet able to determine how long that immunity lasts.
• Symptoms: Diarrhea, vomiting, nausea and stomach pain. It can cause inflammation of stomach or intestines - called acute gastroenteritis. Other symptoms include fever, headache and body aches.
• Transmission: A person can contract norovirus by coming in direct contact of an infected person, consuming contaminated food or water and touching contaminated surfaces and then putting unwashed hands in mouth.
• Treatment: There is no specific medicine for this virus. Only we can follow proper hand hygiene and drinking plenty of liquids to replace fluid lost from vomiting and diarrhea to help prevent dehydration.

China has reported its first death by viral infection called the Monkey B virus after a veterinarian infected, after he dissected two dead monkeys.

About the Virus

Monkey B virus, also called the B virus (BV), was first discovered in 1932.

It is the only identified old-world-monkey herpesvirus, commonly called herpes B, herpesvirus simiae, and herpesvirus B, monkey B virus.

• Transmission: It is transmitted by macaques, chimpanzees and capuchin monkeys. The Monkey B virus spreads when a person comes in contact with an infected monkey's tissues or fluid. Apart from that, it can also infect a person if he or she is bitten by an infected monkey. As of now, there has been only one case of person to person transmission. In the case of a Beijing-based male veterinarian, people who came in contact with him have had no symptoms and have tested negative for the virus.
• Symptoms: The male vet who succumbed to the virus experienced nausea and vomiting, which appeared within 3 to 7 days. Other symptoms include fever and chills, headache, fatigue, body and muscle pain and neurological symptoms like memory problems, brain fog, etc. A person may start demonstrating symptoms “within one month of being exposed to a monkey with B virus infection, but could appear in as little as three to seven days.”
• Treatment: Currently, there are no vaccines available against the Monkey B virus. Experts have suggested fluid therapy as the only treatment for the virus.

The World Health Organization has issued new recommendations on human genome editing.

Major Recommendations

• Regulation and Creation of a Database: Among other things, it stressed the need for regulation and the creation of a database to track all forms of gene manipulation, providing a full overview, including pre-clinical research.
• Whistleblower Mechanism: It also called for a “whistleblower mechanism”- this would enable people to alert the WHO if they have concerns about unethical and unsafe research into genome editing. The WHO could then demand that the country’s authorities take action.
• National and Regional Authorities: The expert committee also called on national and regional authorities to simplify the task of supervising and spotting worrying developments in genome editing by attributing consistent keywords to different types of research.

Gene Editing with Recent Technology

• Gene editing has been revolutionised by the development of tools like CRISPR-Cas-9, which won its co-creators the Nobel Chemistry Prize last year and which can change the DNA of animals, plants, and micro-organisms with extreme precision.
• Such developments carry huge potential benefits for diagnoses, treatment, and the prevention of genetic disorders, but have also have unsafe and unethical uses.

WHO Expert Group on Human Genome Editing

• The WHO commissioned an expert group to study the implications of human gene editing back in 2018 after a Chinese scientist He Jiankui controversially claimed to have created the world’s first genetically edited babies. He Jiankui’s announcement that he had altered the DNA of twin girls in southern China by using molecular scissors – ostensibly to prevent them from contracting HIV — caused a global backlash.
• Other violation was from Russia:Russian biologist, Denis Rebrikov in June 2019 announced he wanted to make similar use of Crispr — to help deaf parents have children without the disability — to which the UN health agency voiced alarm.

WHO’s Caution

• WHO chief Tedros Adhanom Ghebreyesus urged countries to bar any further work on so-called germline genome editing, which alters the genome of human embryos and can be passed on to subsequent generations, “until the technical and ethical implications have been properly considered”. Scientists cautioned that the untested procedure was unethical and potentially dangerous.