TIME infectious diseases

More Than 100 Countries Have a Higher Measles Immunization Rate Than the U.S.

Shooting up earth, globe dripping out syringe (drugs medicine concept)
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Babies in desperately impoverished Libya and Zimbabwe, and in many other nations, are vaccinated more effectively, the WHO says

Measles immunization coverage for 1-year-olds in the U.S. may be at a reasonable-sounding 91%, but there are still more than 100 countries that are more successful at vaccinating their kids against the virus. They include Bangladesh, Russia, Iran and Libya, according to the World Health Organization (WHO).

America’s figure of 91% puts it on a par with Angola. To be sure, that’s enormous coverage compared with the Central African Republic (25%) or Equatorial Guinea (42%), but any decline in immunization will leave the country vulnerable as the current measles outbreaks are showing.

The WHO recommends every child be vaccinated against measles with at least one dose before their first birthday.

Countries more successful at immunizing their 1-year-olds than the U.S. include Brazil, Uruguay, Canada, Algeria, Zimbabwe, Egypt, Tunisia, Saudi Arabia, Iran, Kazakhstan, Kenya and nearly all European countries.

From 2012 to 2013 immunization rates in the U.S. saw a slight decline of 1%, the Washington Post reports. The WHO says there are several reasons why the U.S. is being left behind, including complacency and the antivaccine debate.

Read more at the Washington Post.

TIME Infectious Disease

Don’t Go to Disneyland’s California Parks If You Haven’t Been Vaccinated for Measles

DISNEY PARKS DISNEY SIDE
Newsire — AP More than 1,000 fans gather for a photo at Disneyland in Anaheim, Calif.

State health officials say 42 of California's 59 cases are linked to exposure at Disneyland

California state epidemiologist Gil Chavez is calling on anyone who hasn’t had the measles-mumps-rubella (MMR) vaccine to avoid visiting Disneyland’s two California theme parks “for the time being.”

State authorities say at least 59 people across California have been diagnosed with the highly infectious, airborne disease since December.

“Of the confirmed cases, 42 have been linked to an initial exposure in December at Disneyland or Disney California Adventure Park in Anaheim, California,” read a statement released by the California Department of Public Health on Wednesday.

Health officials have also called on any California resident who has not been vaccinated for the disease to consider getting inoculated immediately.

Read next: Disneyland: The Latest Victim of the Anti-Vaxxers

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TIME ebola

Priests Assaulted in Guinea After Being Mistaken for Ebola Workers

They had gone to a local village to spray insecticides

Three priests from a church in Guinea were physically assaulted while visiting the village of Kabac on Tuesday, as locals suspected they were health workers who would expose inhabitants to the Ebola virus.

The villagers beat up the priests, who had planned to spray insecticide around the area, the BBC reported. They also vandalized the nearby town council building, setting fire to it after burning the priests’ car.

Guinea, one of the three West African countries worst affected by the Ebola outbreak, has lost nearly 2,000 people to the disease. The nation’s schools reopened earlier this week following a five-month break, soon after the U.N. said the number of cases nationwide had fallen to its lowest weekly total since August.

[BBC]

TIME Infectious Disease

Unlicensed Cambodian Medic Charged With Murder After Allegedly Spreading HIV

212 HIV cases were found in the community where he practiced

An unlicensed medic is being charged with murder after Cambodian medical authorities found 212 cases of HIV in the district where he had been treating patients, allegedly with contaminated equipment.

Yem Chrin treated poor patients and was believed to have healing powers, Reuters reports. However, he did not have a medical license and was allegedly delivering injections and blood transfusions using unclean equipment. Authorities tested 1,940 people in the northwestern province where Yem Chrin worked, and 212 tested positive for HIV. Some children as young as 6 years old tested positive for the virus, according to al-Jazeera.

Yem Chrin allegedly told police that he sometimes used the same syringe on two or three patients before disposing of it.

The World Health Organization and UNAIDS found that “the percentage of people that reported receiving an injection or intravenous infusion as part of their health treatment was significantly higher among the people who tested positive for HIV than the people who were HIV negative,” in the area in which Yem Chrin treated patients, Reuters reports.

The development is a setback in Cambodia’s largely successful efforts to eradicate the virus since it first spread through the country in the 1990s.

[Reuters]

TIME infectious diseases

Avian Flu Outbreak in British Columbia Spreads to Seven Farms

The virus has affected 155,000 birds in the past week

A sudden spike in avian influenza cases in British Columbia in the past week has now spread to seven farms and affected thousands of birds, according to the Canadian Food Inspection Agency.

Some 155,000 birds have either died or will be euthanized, the Associated Press reports.

The outbreak originated in the Fraser Valley near Vancouver last week, where turkeys and chickens from two farms tested positive for the H5N2 strain of the virus.

Although the bug does not pose a major threat to humans as long as the meat from these birds is cooked properly, its sudden resurgence a huge blow to the region’s poultry industry.

[AP]

TIME health

How to Save More Than 14 Million Newborns By 2030

YEMEN-HEALTH-CHILDREN
MOHAMMED HUWAIS—AFP/Getty Images A Yemeni mother holds her malnourished infant at a therapeutic feeding centre in the capital Sanaa on December 9, 2014. Over one million Yemeni girls and boys under 5 suffer from acute malnutrition, including 279,000 who suffer from severe acute malnutrition (SAM), in a situation exacerbated by political instability, multiple localized conflicts and chronic underdevelopment, according to UNICEF.

Bjorn Lomborg is president of the Copenhagen Consensus Center, a think tank ranking the smartest solutions to the world's biggest problems by cost-benefit.

We would be wise to target neonatal deaths and cervical cancer

In a world where there are so many worthwhile targets demanding our attention, we need to focus on those for which we have the best chance of doing the most good. How about saving more than 14 million newborns by 2030? That’s a pretty eye-catching figure, but one which the author of a new analysis for the Copenhagen Consensus believes is not only achievable, but also highly cost-effective.

Günther Fink, from the Harvard School of Public Health, is a one of more than 60 expert economists my think tank has asked to make the case for a wide range of key targets that the world’s governments and the UN are currently debating, the so-called Sustainable Development Goals. These will shape global progress over the next 15 years, so it’s important to get them right.

Is it really possible to make such a dramatic difference in the survival of newborn babies? Past experience would suggest that it is. UN figures show that nearly 18 million children round the world died before reaching the age of 5 in 1970, while in 2013 that figure had come down to just above 6 million. This is still way too high, of course, but it’s nevertheless a very impressive figure when we realize that the number of children born annually has increased during those 40 years. The headline is that the number of under-5s dying per 1,000 live births fell from 142 to 44, a 70% drop.

The problem is that the more progress you make, the harder the remaining targets are to reach. Much of the progress in controlling infant mortality since 1970 has been in areas such as controlling infectious diseases and improving nutrition. Progress in this should and will continue, but this won’t be as rapid as before. It’s a sobering thought that, with the current birth rate, under-5 mortality would still exceed 4 million each year even if all infectious diseases were eradicated. One of the biggest challenges going forward will be providing high quality care to newborns, particularly to those born too early and with low birth weight. Deaths in the first seven days after birth are virtually one-third of all under-5 deaths, and premature birth is the biggest single cause, accounting for half of these.

As well as the perils of prematurity, birth complications and sepsis are significant causes of deaths of young babies. Proper care can have a really big impact, but it costs money to build more clinics and train and pay more doctors and nurses: about $17.3 billion a year to hit the target of a 70% reduction in neonatal deaths, according to estimates. That sounds like a lot, but the benefits are much bigger at more than $120 billion annually. Using standard health economics methodology, every dollar invested yields $9 in benefits.

Reducing infant mortality is not the only good target, of course. One that gets a lot of attention is access to contraception, which enables women to have children when the time is right for them, gives them better employment prospects and enables them to invest more in their children’s future. A dollar spent on this could pay back perhaps 120-fold.

But while family planning is high profile, there are other good ways for the international community to invest in women’s health. This was analyzed in another paper from Dara Lee Luca and colleagues from Harvard University. The fourth most common cancer among women globally is cervical cancer, with half a million cases diagnosed annually and more than 200,000 deaths each year. Eighty-five percent of cases occur in the developing world, where it is the second deadliest cancer among women, after breast cancer. Its impact is particularly great because it also affects younger women who are raising and supporting families.

Fortunately, many of these cases are preventable, because nearly all are associated with a viral infection, and a vaccination is available. The vaccine is more expensive than most and three doses are needed, but in total, a course of treatment in developing countries would cost $25 per girl. Vaccinating 70% of girls in one cohort throughout most of the developing world would cost about $400 million and would save 274,000 women from dying, often in the prime of their lives, from cervical cancer. For each dollar spent, we would do more than $3 worth of good.

Health is obviously high on everyone’s agenda, but the escalating costs in rich countries shows there are no easy answers. Choosing the best targets for the international community to support between now and 2030 is going to be important if we are to do the most good with the resources available. Dealing with neonatal deaths and cervical cancer could be two of the smart targets we should choose.

Bjorn Lomborg is president of the Copenhagen Consensus Center, a think tank ranking the smartest solutions to the world’s biggest problems by cost-benefit.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME infectious diseases

Malaria Deaths Have Almost Halved Since 2000 Says WHO Report

But eliminating the disease altogether remains an uphill task

Global deaths from malaria, as well as the number of overall malaria cases, have reduced dramatically in the last thirteen years, the World Health Organization said in a statement on Tuesday.

According to the World Malaria Report 2014, the mortality rate for the disease decreased by 47% worldwide since 2000, and the number of people infected by it went from 173 million the same year to 128 million in 2013.

“We have the right tools and our defenses are working,” said WHO Director-General Dr. Margaret Chan. “But we still need to get those tools to a lot more people if we are to make these gains sustainable.”

The report attributed the progress combating malaria to increased access to insecticide-treated mosquito nets and enhanced diagnostics and treatment, but admitted that there is still a lot of work to be done.

The increased susceptibility to the disease in Ebola-affected countries like Guinea, Liberia and Sierra Leone is an added cause for concern.

TIME ebola

Heathrow Airport Starts Screening for Ebola

Ebola screening to begin at London's Heathrow Airport
Andy Rain—EPA Passengers walk at Heathrow Airport in London on Oct. 14, 2014.

A health official says he expects a "handful" of cases to enter the UK

England’s Heathrow airport began screening passengers for Ebola Tuesday.

Arrivals from at-risk countries in West Africa will be subject to filling out a questionnaire and having their temperature taken before the process gets rolled out to other terminals within Heathrow and then other airports including Gatwick and Eurostar. Health Secretary Jeremy Hunt said that although the UK’s Ebola risk is low, he expects a “handful” of cases to enter the region, the BBC reports.

Health officials said anyone suspected to have Ebola will be taken to a hospital, while those who are asymptomatic but high-risk, having reported prior contact with patients, will receive daily follow-ups.

Journalist Sorious Samura, who traveled back from Monrovia, Liberia, through Brussels and into Heathrow, told The Guardian that he underwent the screening — but noted that it was optional.

“I could have just come throughout without any screening. That is how scary it is,” he said. “They asked for various details, about the symptoms, whether you experienced any of the symptoms, did you experience headaches, vomiting and things like that, and then they did my temperature using the normal equipment that you put in someone’s ear.”

“[The screening] appears not to be a scientific decision but a political one,” Dr. Ron Behrens from the London School of Hygiene and Tropical Medicine told The Telegraph, noting that it will benefit few but disrupt “large numbers of people.”

Health Secretary Hunt said that approximately 89% of people entering the UK from impacted regions would get checked, since some might take an indirect route in the airport that avoids the screening area. He added, “This government’s first priority is the safety of the British people.”

Read next: Ebola Health Care Workers Face Hard Choices

TIME ebola

Liberia’s New Plan to Get Ebola Sufferers Into Isolation

Residents take home family and home disinfection kits distributed by Doctors Without Borders, on Oct. 4, 2014 in New Kru Town, Liberia.
John Moore—Getty Images Residents take home family and home disinfection kits distributed by Doctors Without Borders, on Oct. 4, 2014 in New Kru Town, Liberia.

The new Ebola Community Care Centers pioneered by Save the Children strike a compromise between home care and hospital-grade treatment. But will they work?

When U.S. President Barack Obama promised, on Sept. 16, to help Liberia set up 17 Ebola treatment centers to help stem the outbreak, the sense of relief was palpable in the west African country. That was the kind of robust international response it needed to stop Ebola in its tracks. Getting patients afflicted with the virus into isolation, where they could no longer infect friends and family, would go a long way towards cutting down Ebola’s exponential spread.

But nearly a month later those clinics aren’t up yet, and so far only one—a 25-bed unit designated solely for infected health workers—is even close to completion. Even though there are currently about 600 beds in Liberia, with another 300 expected to come on line in the next few weeks, it is nowhere near the 1,990 that the World Health Organization [WHO] estimates will be required for the current caseload.

The U.S.-built centers, which would make some 1700 treatment beds available, won’t be up and running for another two to three months, U.S. officials said this week. With 8011 infected and 3857 dead in west Africa as of Oct. 8, according to the WHO, and little hope of seeing the number of new cases each week go down any time soon, no one can afford to wait. Which is why both international and Liberian health officials are looking for alternatives. “One of the biggest challenges we are having is getting people out of their homes and into the treatment centers,” says Frank Mahoney, Liberia team leader for the Centers for Disease Control and Prevention’s Ebola response. “We have been working furiously trying to stand up treatment centers, but [new cases] have been outpacing our ability to stand them up.”

As a stopgap measure, USAID and some international NGOs are looking at ways to protect caregivers at home. But one organization, with support from both the Liberian government and U.S. officials, is proposing a radical compromise that gets suspected patients out of the home for care, without requiring beds in the yet-to-be-completed official Ebola Treatment Units [ETU]. They are called Ebola Community Care [ECC] centers, hyper-local clinics run by community volunteers and staffed not by trained health workers, but by the very people who would otherwise be taking care of patients in the home: family members.

To a certain extent, stopping Ebola is a question of simple math. If you can get the transmission rate to below one, meaning each infected person spreads the illness to less than one person, on average, the virus will die out. If the numbers are more than 2.5, that means the epidemic is “out of control,” according to Carolyn Miles, President of Save the Children, an international humanitarian aid agency working on Ebola in both Liberia and Sierra Leone. In Liberia, the transmission rate is somewhere between 1.75 and 2.5, dangerously close to becoming unstoppable. One of the greatest contributors to the high transmission rate is patients staying at home, where they can infect multiple family members. “From a transmission standpoint, it is essential to get people out of their homes,” says Miles. Ebola Community Care centers, she says, give people a place to go while waiting for the specialized treatment units to be set up.

One of the key factors delaying the ETUs is the necessity for a highly-trained staff of physicians, assistants, nurses, pharmacists and sanitation teams working 24/7. Finding, hiring and training that staff is at least as difficult, if not more so, as getting the physical beds in place. But Save the Children’s response cuts down the staff requirements by building temporary holding centers in every community affected by Ebola.

In these centers, patients suspected of having Ebola can wait for testing without fear of infecting others, while those with confirmed infections can wait in isolation wards until a bed in an official treatment center opens up. One caretaker, who will be trained by an on-site supervisor in basic care and self-protection measures, will accompany each patient. The caretakers will be provided with disposable gloves, aprons, gowns and masks, as well as disinfecting solutions for keeping themselves and their charges clean. “Only one family member per patient is allowed into the ECC,” says Miles. “That alone will get transmission to below one.”

The centers won’t have a medical staff on hand full time. Instead each center will be visited daily by rotating teams of doctors, nurses, sanitizers and personal protection gear suppliers, who will replenish stocks as necessary. The mobile teams will be able to visit up to four community care centers a day, reducing the need for staffing and training. One such center, with 20 beds for suspected cases and 10 in a separate isolation ward, will open later this week, in Magribi County, one of Liberia’s most afflicted areas. By the end of the month Save the Children expects to have 10 more up and running.

The risk for family caretakers is still high, given that well-trained health care practitioners working for some of the most rigorously protective treatment centers are still getting sick. But the alternative is more dangerous, says Miles. “ECCs are not as safe as an ETU, but they are safer than having an ill person at home, being cared for by multiple family members in an environment where real isolation may not be possible.”

As much as communities are warming to the idea, the new care centers still face the fear and stigma that plagues anything to do with Ebola. “A lot of people do want to care for their loved ones in a safe environment, and they know there are not enough ETUs,” says Miles. The problem, she notes, is that no one wants a center next door. But until U.S. officials can keep President Obama’s promise, these kinds of stopgap solutions might be the only chance to slow the spread of Ebola.

TIME ebola

Liberia Burns its Bodies as Ebola Fears Run Rampant

A burial team disinfects an Ebola victim while collecting him for cremation on Oct. 2, 2014 in Monrovia, Liberia.
John Moore—Getty Images A burial team disinfects an Ebola victim while collecting him for cremation on Oct. 2, 2014 in Monrovia, Liberia.

In an effort to stem Ebola’s spread, Liberia’s government has all but banned burials in favor of cremation.

In the dusty shopfront of one of downtown Monrovia’s more desolate side streets, Sam Agyra flips through a fly-specked photo album showing off his custom caskets.

Cake-like confections of pale satin, gold detailing and elaborate wooden scrollwork, his coffins have earned him a well-deserved reputation for beautiful work at a cheap price. In good times he was turning out five handcrafted pine coffins a week. Now? He doesn’t even want to talk about it. Instead he just laughs, the hysterical cackle of a man watching his business of 25 years grind to a halt. He hasn’t sold a coffin in two months, ever since the Liberian government declared, in an effort to tackle the Ebola crisis, that all of the country’s dead should be burned and not buried.

An Ebola victim is most contagious in the moments and days after death, when unprotected contact with infected bodily fluids carries an extremely high risk of transmission. Liberia’s traditional burial practices, in which mourners bathe, dress and even kiss the corpse, are widely credited with the early explosion of Ebola in the country, where over 2,000 have so far died of the disease. Overwhelmed by the increasing number of dead, and faced with community fears that the buried bodies may also transmit the disease—which, if interred properly, they won’t—Liberia’s government declared in August that all those who died of Ebola should be cremated.

With international help and advice, the government established a Dead Body Management program to pick up Ebola’s victims and dispose of them safely. But testing for Ebola is difficult and time consuming. What little testing resources do exist are reserved for the living, says assistant health minister, Tolbert Nyenswah. With hospitals closed and doctors overwhelmed, it is almost impossible to prove that the cause of death is anything but the deadly virus. “These days, if someone dies, it’s Ebola,” says Agyra. “There is no testing, no questions. Just Ebola, and they take the body away. No one has time for coffins.”

The government directive, while logical from an epidemiological aspect, has taken a toll on a society already traumatized by Ebola’s sweep. It denies communities a final farewell, and has led to standoffs with the Dead Body Management teams who must pick up the dead even as the living insist that the cause of death was measles, or stroke, or malaria — anything but Ebola. “We take every body, and burn it,” says Nelson Sayon, who works on one of the teams. Dealing with the living is one of the most difficult aspects of his job, he says, because he knows how important grieving can be. “No one gets their body back, not even the ashes, so there is nothing physical left to mourn.”

Monrovia’s mass cremations, which take place in a rural area far on the outskirts of town, happen at night, to minimize the impact on neighboring communities. For a while the bodies were simply burned in a pile; now they are placed in incinerators donated by an international NGO. There are so many that it can sometimes take all night, says Sayon.

In a country where distrust between the people and the government runs deep, the mass cremations have caused a deeper rift, says Kenneth Martu, a community organizer from the Westpoint area of Monrovia. “In west Africa we don’t cremate bodies at all. So when the government takes away our bodies, and can’t even tell us if they died of Ebola or not, it breeds resentment.” Liberians, he points out, are no strangers to mass casualties: two civil wars, from 1989 to 1996 and 1999 to 2003, saw nearly half a million die. “Even with mass graves, people can bring flowers. They know where to find the dead. But here we don’t even know where the ashes are.”

There are exceptions to the cremation directive. If a family can get a signed death certificate from the Ministry of Health stating that the cause of death was not Ebola, they can take the body to a funeral parlor for embalming and eventual burial. There are even dispensations for those who do die of Ebola; under certain circumstances the dead can be buried in a cemetery, if the Dead Body Management team conducts the preliminary steps of laying the body six feet deep and soaking the next four feet of earth with chlorine solution.

But those dispensations are impossible to get without connections. One recent Saturday, a funeral cortege down one of Monrovia’s main thoroughfares drew questioning comments and glares of resentment from bystanders. “Haven’t seen that in a while,” exclaimed one woman. “Must be related to a minister,” muttered a man.

Considering Liberia’s mounting death toll, it is an irony not lost on coffin-maker Agyra that an enterprise that ordinarily profits from death should be struggling. “You hear of 50, 80, 100 people dying a day here, and the coffin business has never been so bad,” he groans. “This Ebola business. It’s bad for people, and it’s bad for me.”

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