Public health news: October 2005

New money for malaria research

31 October 2005

The Bill & Melinda Gates Foundation has pledged £145m for worldwide research into malaria.  £28m of this will go to the Liverpool School of Hygiene and Tropical Medicine.

New prospects in the fight against malaria (Bill & Melinda Gates Foundation, October 2005)
Gates give £28m to malaria team  (BBC News, October 2005)

Avian flu vaccine to start trials 'within weeks'

28 October 2005

Drug company GlaxoSmithKline (GSK) announced it would start clinical trials on a vaccine to combat the current H5N1 strain within the next few weeks.  In order for the current virus to spread more easily between humans it is thought a process of genetic reassortment or mutation is necessary.  Just how much protection against any eventual pandemic strain the new vaccine will confer is therefore not known.

Bird flu vaccine to start trials in weeks (Telegraph.co.uk, October 2005)
Flu pandemic planning (Internal link)

Backtrack on smoking ban

27 October 2005

After internal disputes within the Cabinet a revised Health Improvement Bill will propose a non-universal ban on smoking in public places, to the dismay of the public health community.  Pubs and private clubs not serving food will be allowed to decide whether to implement a ban, although theoretically bar areas should be smoke-free.  Apart from possible difficulties implementing the legislation, the much wider issue that this will increase health inequalities (people who are more likely to work in poorly paid jobs, such as bartendering, are more likely to come from deprived sections of the community) is a major concern.

Smoking ban put before Parliament (BBC News, October 2005)

UK adverse drug reaction reporting now online

26 October 2005

A pilot service to allow doctors - and patients - to register suspected adverse drug reactions online has been extended to the whole of the UK.  Previously reporting had been mainly done in writing by health professionals, thanks to the yellow forms at the back of the BNF.

MHRA press release [pdf, 52kb] (MHRA, October 2005)
Yellowcard.gov.uk (MHRA, October 2005)

Bird flu continues its march through Europe

26 October 2005

The H5N1 strain of avian influenza has now been confirmed in birds in Croatia, and suspected cases have been reported in Germany.  It is probably just a matter of time before the strain becomes endemic in European birds, as it has in many SE Asian countries.

Lethal bird flu strain in Croatia (BBC News, October 2005)
Ministers consider bird import ban after avian flu hits Germany (Times Online, October 2005)
Flu pandemic planning (Internal link)

Circumcision may protect against HIV

25 October 2005

Results of an African study published today suggest that circumcision may reduce the risk of HIV infection from sexual intercourse.  After controlling for behavioural factors the rate of new HIV infection was reduced by 61% (CI 34-77%) in the circumcised group at 18 months.

Auvert et al, PLoS Medicine (PLoS, October 2005)

H5N1 in dead bird in UK quarantine

24 October 2005

Last week a bird imported to the UK from Suriname, South America, tested positive for the H5N1 strain of avian influenza whilst in quarantine.  Whilst Suriname has not reported any cases of bird flu, it was apparently quarantined in the vicinity of birds from Taiwan.  Although Taiwan itself has not reported any indiginous cases it is near countries which have the disease and infected birds have apparently been smuggled there from China.  Taiwan however has strongly protested against its birds being implicated in the Suriname case.  UK quarantine rules are being reviewed and an EU-wide ban on bird imports considered.

Quarantine review over bird flu (BBC News, October 2005)
Taiwanese birds didn't pass flu (Taipei Times, October 2005)
Avian flu reaches Taiwan (International Herald Tribune, October 2005)

UK pandemic flu plan updated

24 October 2005

The UK Department of Health has updated its pandemic flu plan, taking into account the new WHO phases of a pandemic.

DH pandemic flu plan (DH, October 2005)
Flu pandemic planning (internal link)

H5N1 influenza strain in Turkish birds

13 October 2005

Tests have confirmed the H5N1 influenza subtype in birds in north-west Turkey, the same strain that has been causing limited human illness in SE Asia.  There are also reports of an H5 strain in Romanian birds. The H5N1 subtype is thought to have the potential to become a pandemic influenza in humans.

Turkey bird flu 'deadly strain'  (BBC News, October 2005)
Indonesia confirms further human bird flu case (internal link)
Flu pandemic planning (internal link)

Too much focus on HIV/Aids, TB & malaria in Africa

12 October 2005

Molyneux et al argue in this month's PLoS Medicine that healthcare funding in the developing world overemphasises the 'big three' diseases, with the result that 'neglected' diseases which are cheap and simple to treat are being ignored.  Interventions costing as little as US$0.40 per head per year could dramatically reduce the health burden of six major 'neglected' diseases.  This cost is a fraction of treatment costs associated with HIV/Aids, TB or malaria.

Molyneux et al, PLoS (2005) Volume 2 (PLoS, Advanced online pub, 2005)
See also How best to improve healthcare in sub-saharan Africa, below

A million in acute need

12 October 2005

The World Health Organisation (WHO) has estimated that one million of the four million inhabitants in the areas affected by the recent earthquake in Pakistan are in acute need of assistance following injury or homelessness.  Measles is endemic in the area and drinking water is in short supply.  Healthcare facilities and staff have also been badly affected.

WHO appeal for US$21.7m aid  (WHO, October 2005)
Aid floods into earthquake region (BBC News, October 2005)
UK Disasters Emergency Committee appeal  (DEC, October 2005)

PbR comes under scrutiny

11 October 2005

The Audit Commission in the UK has released an interim report on the new system for commissioning and charging within the NHS called Payment by Results (PbR).  It concludes that whilst there are many potential gains from PbR it will require greater financial management within NHS Trusts, and must not detract from partnership working between organisations which will potentially be competing for custom.

Early lessons from Payment by Results (Audit Commission, October 2005)

Partial smoking ban proposal dropped

10 October 2005

Government plans to outlaw smoking in public places in the UK with the exception of pubs not serving food have apparently been dropped as 'unworkable', possibly in favour of an outright ban.  The original idea was widely regarded as inconsistent and concerns were raised over the legality of continuing to allow exposure of barworkers to cigarette smoke.

Ministers plan total smoking ban in pubs (Guardian.co.uk, October 2005)
Smoking ban plans to be dropped (BBC News, October 2005)

Council penalises smokers for taking cigarette breaks

7 October 2005

Nottingham City Council has told smokers they either have to clock in and out for cigarette breaks, or work an extra 2 hours each week to compensate for time spent outside while their non-smoking colleagues are at the desk.

Council butts in on smoker breaks (BBC News, October 2005)

The end of cervical cancer?

7 October 2005

There is already strong evidence that cervical cancer is caused by infection with the human papillomavirus (see Walboomers et al, below).  Merck has today announced preliminary results of a phase III clinical trial involving 12,167 women vaccinated with either Gardasilâ„¢ (a recombinant HPV 6/11/16/18 quadrivalent vaccine) or placebo.   Encouragingly, primary analysis revealed no cases of early-stage cervical cancer in the vaccine group (n=5301) compared with 21 cases in the placebo group (n=5258).  Although the full data have yet to be published it would appear routine vaccination to prevent HPV infection - and therefore cervical cancer - may now be on the horizon.
Merck Press Release (Merck.com, October 2005)
Cervical cancer jab 'in a year' (BBC News, October 2005)
Walboomers et al. J Pathol (1999) 189:12-19 (PubMed.org, October 2005

Health Secretary signals go-ahead for trastuzumab

5 October 2005

The Health Secretary, Patricia Hewitt, has announced that Herceptinâ„¢ (trastuzumab) will be available to treat early-stage HER2-positive breast cancer in the UK from next year.  However whilst the Secretary of State is responding to both public calls and apparently good evidence of its efficacy in early disease, the latter has not yet been reviewed by NICE, which could still give a different recommendation in the new year.  It was also announced that routine testing for HER2 positivity would begin with immediate effect.  Trastuzumab is currently used mainly in patients with metastatic HER2-positive disease.

Breast cancer drug test for all (BBC News, October 2005)
Roche UK press release (Roche, May 2005)
Tan-Chiu et al. Oncology (2002) 63(S1):57-63 (Oncology, 2002)

Prostate Cancer ad weathers storm

5 October 2005

A radio advert raising awareness of prostate cancer and trying to reduce the embarrassment surrounding digital rectal examination (DRE) to assess prostate size was briefly banished to late night radio for fear of causing offence.  The ban on the advertisement, which features comedian Ricky Gervais, has now been lifted.

The Prostate Cancer Charity - link to advert (PCC, October 2005)
U-turn on Gervais prostate ad (BBC News, October 2005)

How best to improve healthcare in sub-saharan Africa

1 October 2005

In this week's Africa-themed BMJ, Dare and Reeler suggest that rather than concentrating on funding single-disease initiatives in poor developing countries, the focus should be on improving the standard of basic comprehensive healthcare.

Dare & Reeler. BMJ (2005) 331:759-762  (BMJ online, October 2005)