Cholera and other tropical diseases

You can get/catch cholera anywhere just from drinking water with human sh!t in it. Not necessarily tropical or exotic.
 
'Cholera hotspots' Threaten More Than 1M People in Nigeria Refugee Camps...
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Cholera Outbreak Threatens More Than 1M People in Nigeria Refugee Camps
September 07, 2017 — At least 1.4 million people uprooted by Boko Haram's insurgency in northeast Nigeria are living in 'cholera hotspots,' prey to an outbreak of the deadly disease which is sweeping through camps for the displaced, the United Nations said on Thursday.
An estimated 28 people have died from cholera in the conflict-hit region, while about 837 are suspected to have been infected with the disease, including at least 145 children under the age of five, said the U.N. children's agency (UNICEF). The outbreak was first identified last week in the Muna Garage camp in Maiduguri, the capital of Borno state, which is the heart of jihadist group Boko Haram's brutal eight-year campaign to carve out an Islamic caliphate in northeast Nigeria. About 1.8 million people have abandoned their homes because of violence or food shortages, U.N. agencies say, and many live in camps for the displaced throughout northeast Nigeria.

Several aid agencies last month told the Thomson Reuters Foundation that Nigeria's rainy season could spread disease in already unsanitary displacement camps, and 350,000 uprooted children aged under five are at risk of cholera, UNICEF said. "Cholera is difficult for young children to withstand at any time, but becomes a crisis for survival when their resilience is already weakened by malnutrition, malaria and other waterborne diseases," UNICEF's Pernille Ironside said in a statement. "Cholera is one more threat amongst many that children in northeast Nigeria are battling today in order to survive," added Ironside, UNICEF's deputy representative in Nigeria.

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People displaced by Islamist extremists fetch water at the Muna camp in Maiduguri, Nigeria.​

UNICEF said aid agencies have set up a cholera treatment centre at the Muna Garage camp, chlorinated water in camps and host communities to curb the outbreak, and mobilised volunteers and local leaders to refer suspected cases to health facilities. The disease, which spreads through contaminated food and drinking water, causes diarrhea, nausea and vomiting. It can kill within hours if left untreated, but most patients recover if treated promptly with oral rehydration salts.

The latest figures represent a 3.3 percent fatality rate - well above the 1 percent rate that the World Health Organization rates as an emergency. The short incubation period of two hours to five days means the disease can spread with explosive speed. More than 20,000 people have been killed in the conflict with Boko Haram, at least 2.2 million have been displaced, and 5.2 million in the northeast are short of food, with tens of thousands living in famine-like conditions, U.N. figures show.

Cholera Outbreak Threatens More Than 1M People in Nigeria Refugee Camps
 
Cholera in deepest darkest Africa...
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WHO: Over 500 Dead as Congo Cholera Epidemic Spreads
Monday 11th September, 2017 - More than 500 people have died so far in a cholera epidemic that is sweeping the Democratic Republic of Congo, the World Health Organization (WHO) said. Outbreaks of the water-borne disease occur regularly in Congo, mainly due to poor sanitation and a lack of access to clean drinking water.
But this year's epidemic, which has already hit at least 10 urban areas including the capital Kinshasa, is particularly worrying as it comes as about 1.4 million people have been displaced by violence in the central Kasai region.

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The WHO said at least 528 people had died and the epidemic had spread to 20 of Congo's 26 provinces. 'The risk of spread remains very high towards the Grand Kasai region, where degraded sanitary and security conditions further increase vulnerability in the face of the epidemic,' the WHO said in a statement.

So far, health officials have recorded more than 24,000 suspected cases of the disease across the vast nation this year, averaging more than 1,500 new cases per week since the end of July. The WHO sent a team of experts including epidemiologists and public health specialists to Congo this month in an effort to contain the disease's spread.

WHO Over 500 Dead as Congo Cholera Epidemic Spreads
 
WHO: Urgent Action Under Way to Prevent Spread of Cholera in West Africa...
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Urgent Action Under Way to Prevent Spread of Cholera in West Africa
September 18, 2017 — An emergency vaccination campaign is getting under way in northeastern Nigeria to prevent a deadly cholera outbreak from spreading to other countries.
The World Health Organization reports the potentially devastating cholera situation is emerging in Borno State in northeastern Nigeria. During the past few months, it says 2,600 suspected cases of this fatal disease, including 48 deaths, have occurred in this former stronghold of Boko Haram. The militant group has been waging war to establish an Islamic state in northeast Nigeria. Dominique Legros is cholera coordinator for WHO’s department for pandemic and epidemic diseases. He says the outbreak, which is centered in camps for internally displaced people, is spreading to other areas of northeastern Nigeria, toward Chad and northern Cameroon.

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A cholera patient lies in a treatment centre run by Medecins Sans Frontieres on Macauley Street in Sierra Leone's capital Freetown​

He says 900,000 people in the state will receive the oral cholera vaccine to quickly contain the spread of the disease. “Once it is out of the box, once it has spread, it is very, very difficult to contain and we have a huge number of cases and deaths," he said. "So, this outbreak in Nigeria, hopefully, will not reach Chad, because in Chad already, we have an alert in the eastern part of the country towards the border with Sudan, 344 cases, 49 deaths.” Legros says this comes to a 14 percent case fatality. He notes this is very high for a cholera outbreak, which usually has a case fatality rate of less than one percent.

WHO estimates the global cholera disease burden at around 2.9 million suspected cases, including 95,000 deaths. It reports Yemen has the world's worst cholera epidemic, with nearly 690,000 suspected cases and more than 2,000 deaths. The agency expresses concern about the situation in Africa, where it reports tens of thousands of suspected cases and thousands of deaths in, among others; Somalia, South Sudan, Sudan, eastern Democratic Republic of Congo, Kenya and Tanzania.

Urgent Action Under Way to Prevent Spread of Cholera in West Africa
 
UN steps up aid for cholera outbreak in north-east Nigeria...
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Amid cholera outbreak in north-east Nigeria, UN steps up aid, warns pregnant women most vulnerable
26 September 2017 -- Large-scale displacement and a health system in tatters as a result of persistent violence by the Boko Haram terrorist group have left many " most worryingly, pregnant women and their unborn babies " vulnerable to cholera in the wake of an outbreak in August, the United Nations Population Fund (UNFPA) has warned.
"Studies show that cholera infections during pregnancy can lead to sudden loss of the foetus, premature delivery, stillbirth and an increased mortality and morbidity, both for the baby and the mother," said Homsuk Swomen, a UNFPA reproductive health specialist in Maiduguri, north-eastern Nigeria, one of the worst affected areas by the Boko Haram violence. Due to the ongoing conflict, many pregnant women are malnourished, aggravating their vulnerability to cholera and the consequences if they fall ill. Furthermore, the "traditional role" played by women and girls in the region is making them all the more susceptible to the disease.

According to Sylvia Opinia, a UNFPA expert in gender issues, it is usually women and girls who care for sick family members, clean latrines, fetch and handle untreated water, and prepare food for the family. "We need to understand that cholera is not gender neutralcholera is not gender neutral," she underscored. On its part, the UN agency is working with local health staff, community and social workers in the camps to impress upon them the need to include women and girls in education messages on the disease, and especially targeting pregnant women with those messages. It is also engaging health workers to identify vulnerable women and girls, including pregnant women, for referral to appropriate care.

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But funds are needed.

Last Sunday, the UN and partners launched a $9.9 million appeal to respond to the current outbreak in Borno state (north-east Nigeria) and to prevent further outbreaks in high-risk areas. A Cholera Response and Prevention Plan has been developed to address the immediate needs of 3.7 million people that could be affected by the outbreak. In related news, the World Health Organization (WHO), the UN health agency, concluded an oral cholera vaccination campaign around Maiduguri this weekend, inoculating some 844,000 people in affected areas.

According to WHO, it takes those immunized about a week to develop the immune response that should protect against the disease, and most individuals vaccinated should be protected for up to six months. As of 25 September, 3,934 suspected cases of cholera including 54 deaths have been reported in and around Maiduguri. About 14 million people are affected by the crisis in north-eastern Nigeria (Adamawa, Borno and Yobe states), of whom 6.9 million need health assistance.

Amid cholera outbreak in north-east Nigeria UN steps up aid warns pregnant women most vulnerable
 
18 killed in Tanzanian Cholera Outbreak...

Tanzanian Cholera Outbreak Kills 18, Health Ministry Says
November 11, 2017 — An outbreak of cholera in Tanzania has left 18 dead in two months, the Health Ministry said Saturday, warning that the situation could worsen as the rainy season continues.
The ministry said the outbreak had left "18 dead out of 570 cases recorded" between September 1 and October 30, and it urged local authorities to take measures to keep the disease from spreading.

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Burundian refugees wait to board a U.N. ship, at Kagunga on Lake Tanganyika, Tanzania, to be taken to Kigoma, May 23, 2015. An outbreak of cholera at the time infected 10,000 people in a Tanzanian border region where refugees fleeing political unrest had massed.​

In 2015, Tanzania was struck by a major outbreak of cholera that infected 10,000 people and left 150 dead.

Cholera is transmitted through contaminated drinking water and causes acute diarrhea.

Tanzanian Cholera Outbreak Kills 18, Health Ministry Says
 
Pharmaceutical highway robbery...
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Why A Pill That's 4 Cents In Tanzania Costs Up To $400 In The U.S.
December 11, 2017 - Two pills to wipe out hookworm could cost you 4 cents. Or $400. It just depends where you live.
The 4 cents is in Tanzania. That'll cover the two pills it takes to knock out the intestinal parasite. But in the United States, where hookworm has re-emerged, the price for two 200 mg tablets of albendazole can cost as much as $400. The pill will put an end to the problems hookworm can cause, such as anemia and protein deficiency as well as stunting growth in children. It's not just a problem with the anti-hookworm pill. Drugs for diseases of the developing world, in particular the so-called "neglected tropical diseases" like hookworm and leishmaniasis, are enormously more expensive in the United States than in the developing world. "There really is no good reason for this price," Dr. Jonathan Alpern says of the albendazole price tag. Alpern works for the HealthPartners Institute, the research division of a health care organization in Minnesota. Impax Laboratories is the only pharmaceutical company that offers the drug in the U.S. Impax did not wish to comment on product pricing for this story but stated in an email to NPR: "Given the very different regulatory regimes in the U.S. versus outside the U.S., pricing is a very awkward comparison."

Because the drug's patent expired decades ago, other companies can sell the generic version. But for medications that fight neglected tropical diseases, pharmaceutical companies have been slow to jump in and manufacture the medicine. As for those that do: "[Impax] fits into a category of companies that have taken drugs that have been around for many years, acquired the rights and jacked up the price [for the Western market]," says Alpern. Indeed, prices for generic drugs that treat neglected tropical diseases are skyrocketing in the U.S. When a disease affects only a small number of patients in the U.S., "there's less incentive for generic companies to enter the market," Alpern explains. That's because there's less potential for profit. Hookworm, which was recently discovered in a small community in the U.S., is just one example of this trend. Neurocysticercosis, a parasitic disease that causes seizures and epilepsy, is another example. The disease is rare in the U.S. with an estimated 1,000 to 5,000 new cases every year. Either albendazole or praziquantel are used to treat the disease. Praziquantel is also pricey: about $525 for six 600 mg tablets.

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An employee of GlaxoSmithKline Pharmaceuticals holds bottles of albendazole, an anti-hookworm medication.​

Leishmaniasis, which affects 700,000 to a million people annually throughout the world, is more expensive to treat in the U.S., too. Though rare in the U.S. — only 13 cases were uncovered between 2000 and 2007 — the disease can cause disfiguring skin sores or swelling of the spleen or liver depending on the form of the disease that's contracted. Two 50 mg tablets of miltefosine for 28 days can treat the infection; the price of each pill wholesale is $685, according to Alpern's research. "When there's limited competition in the market, the company that holds the monopoly is able to price [the drug] however they want," Alpern says. "In these cases, we often see companies taking advantage of their market position." And some of these disease aren't all that rare. Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine, says certain neglected tropical diseases in the U.S. are surprisingly widespread, especially among those who may not be able to afford treatment. For example, he estimates that 1.1 million Americans are annually diagnosed with a parasitic infection called toxoplasmosis. The treatment is Daraprim; four 25 mg tablets currently cost between $3,000 and $3,400 on the U.S. market. "We have now identified nearly half-a-dozen neglected tropical diseases that are widespread in the U.S. among the poor, especially in the American South," says Hotez, who last year published Blue Marble Health, a book evaluating neglected diseases in America. "In all, I estimate that 12 million Americans now live in extreme poverty with a neglected tropical disease."

Some of them are in Lowndes County, Ala., where a community of individuals was recently discovered to have hookworm. The average income in the county is just $18,036. If patients don't have health insurance, they must pay the full price for prescriptions or skip treatment altogether. "Some of the people in Lowndes County are living off $600 or $700 a month," says Catherine Flowers, founder of Alabama Center for Rural Enterprise, a nonprofit that addresses poverty. "People have told me they sometimes have to choose between buying medication and eating." In cases where patients have Medicaid, taxpayers bear the burden. In the years following albendazole's price hike in 2011, Medicaid spending on the drug went from under $100,000 in 2008 to more than $7.5 million in 2013. Medicaid spending on Daraprim, another tropical disease drug that just experienced a price hike, went from $2.2 million in 2014 to $15.7 million in 2015. Other times, U.S. patients bypass the system, Alpern says, by asking relatives in other countries to bring them the drug they need. In the United Kingdom, for example, 400 mg of albendazole costs just $2.

Why are prices so different in the U.S.?
 
Tremendous progress in five years...
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1 Billion Treated in Battle Against Painful Tropical Diseases
ecember 14, 2017 — A pledge by health and development experts to tackle neglected diseases that blind, disable and disfigure millions of the world's poorest people has spurred tremendous progress in five years, a report said on Thursday.
More than one billion people were treated in 2016 for painful infections, such as sleeping sickness and elephantiasis, as increased funding, drug donations and political will helped health workers reach patients in remote areas, it said. "There are hundreds of millions more people getting treated now than five years ago," Ellen Agler, head of the END Fund, a philanthropic initiative to combat Neglected Tropical Diseases (NTD), told the Thomson Reuters Foundation in emailed comments. "Effective partnerships and efficient systems to get medicines to those most in need have been built."

The 2012 London Declaration on Neglected Tropical Diseases, set a goal of controlling, eliminating or eradicating 10 diseases, including leprosy and river blindness, by 2020. NTDs affect one in five people globally, mainly in areas of extreme poverty, often trapping individuals in a cycle of social exclusion. The number of people affected by NTDs has fallen to 1.5 billion from almost 2 billion in 2011, the report by Uniting to Combat NTDs, a partnership backing the 2020 goal, said.

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A giant 25m worm representing the parasitic worm of schistosomiasis is pictured on the Lake Leman on the occasion of the Neglected Tropical Diseases Summit, in Geneva​

Since 2012, five countries have eliminated trachoma as a public health problem — meaning it no longer poses a major threat to community health — and four countries in the Americas have eliminated river blindness, it said. A push to train local health workers is an important element behind the campaign's success, the report said, as they are trusted by rural communities never reached before. "We have an obligation to ensure that [communities] are part of the solution," said Julie Jacobson, a program officer with The Bill & Melinda Gates Foundation, adding that South Sudan has only had one case of Guinea worm disease so far this year.

Only 26 cases of Guinea worm disease have been reported so far in 2017, down from more than 1,060 cases in 2011, it said. British physicist Stephen Hawking said this week that eliminating neglected tropical diseases is "within our grasp."

1 Billion Treated in Battle Against Painful Tropical Diseases

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Half of World's People Can't get Basic Health Services: WHO
December 13, 2017 - At least half the world's population is unable to access essential health services and many others are forced into extreme poverty by having to pay for healthcare they cannot afford, the World Health Organization said on Wednesday.
Some 800 million people worldwide spend at least 10 percent of their household income on healthcare for themselves or a sick child, and as many as 100 million of those are left with less than $1.90 a day to live on as a result, the WHO said. In a joint report with the World Bank, the United Nations health agency said it was unacceptable that more than half the world's people still don't get the most basic healthcare. "If we are serious - not just about better health outcomes but also about ending poverty - we must urgently scale up our efforts on universal health coverage," World Bank President Jim Yong Kim said in a statement with the report.

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A Yemeni health worker marks a finger of a girl after giving her a polio vaccination.​

Anna Marriott, health policy advisor for the international aid agency Oxfam, said the report was a "damning indictment" of governments' efforts on health. "Healthcare, a basic human right, has become a luxury only the wealthy can afford," she said in a statement. "Behind each of these appalling statistics are people facing unimaginable suffering - parents reduced to watching their children die; children pulled out of school so they can help pay off their families' health care debts; and women working themselves into the ground caring for sick family members."

The WHO and World Bank report did have some positive news: This century has seen a rise in the number of people getting services such as vaccinations, HIV/AIDS drugs, and mosquito-repelling bednets and contraception, it said. But there are wide gaps in the availability of services in sub-Saharan Africa and southern Asia, the report found. In other regions, basic services such as family planning and child immunization are more available, but families are suffering financially to pay for them. Yong Kim said this was a sign that "the system is broken". "We need a fundamental shift in the way we mobilize resources for health and human capital, especially at the country level," he said.

Half of World's People Can't get Basic Health Services: WHO
 
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Cholera shows up in Cameroon...
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Cholera Threatens Cameroon
July 21, 2018 — A cholera outbreak in Cameroon has claimed at least a dozen lives. Hundreds of people have been rushed to several hospitals in the central African state. It is feared some of the cases were imported from Nigeria and may contaminate refugees fleeing the Boko Haram insurgency.
Arabo Saidou, the highest government official in charge of health in Cameroon's north region says the first cases of cholera were reported along Cameroon's border with Nigeria two months ago. He says the disease has continued to spread since four cases of cholera were recorded in the northern Cameroon town of Mayo Oulo that borders Nigeria on May 18. He says many people, especially children, have been dying both in and out of hospital.

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Cholera in Cameroon​

In May, the Word Health Organization reported that Nigeria's Adamawa, Borno and Yobe states had been experiencing recurrent cholera outbreaks since February, with a total of 1,664 suspected cases and 31 deaths. Many people from the three Nigerian states travel to Cameroon for business. At least a hundred thousand are in Cameroon as refugees fleeing the Boko Haram insurgency, with over 90,000 at the Minawao refugee camp.

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A Cameroonian police officer stands next to people waiting for water at the Minawao refugee camp for Nigerians who fled Boko Haram attacks in Minawao, Cameroon, March 15, 2016.​

Issac Bayoro, a Cameroonian epidemiologist working in the Mokolo administrative area where the Minawao refugee camp is located says they are educating refugees to respect hygiene norms and are also screening Nigerians coming to the camp in a bid to protect not only the refugees but their host communities. He says many people continue to defecate in the open air or in streams and river beds where both humans and animals go to find water to drink thereby facilitating the spread of cholera. He says hygiene is not respected as many people do not wash their hands with soap as advised. He says people should stop trusting the belief that an African is naturally vaccinated and can not die of dirt.

Cameroon's ministry of health indicated that the disease quickly spread to Yaounde and Douala, major cities in the central African state. The case reported in Yaounde was of a teenager who travelled to Yaounde from northern Cameroon with his mother. He latter died in a hospital according to the government. Thomas Tawe, a university student and resident of Yaounde says he fears cholera may spread rapidly in the city because just 30 percent of the population has access to good drinking water. "In the city of Yaounde only those who can pay can have water. When you go into the quarters (neighbourhoods) you see that people are carrying water from inhygienic sources," said Tawe. "If the water is contaminated, automatically we will be contaminated."

Cholera Threatens Cameroon
 

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