In what would be an unprecedented move, the head of the Africa Centres for Disease Control and Prevention (Africa CDC) says the organization will “most likely” declare a Public Health Emergency of Continental Security (PHECS) this week because of the rapid spread of mpox across 16 African countries. “What is critical to know is that in the past 10 days we have six new countries affected,” said Africa CDC Director-General Jean Kaseya, who spoke at a media briefing last Thursday. www.science.org/content/article/africa-poised-declare-continentwide-emergency-alarm-mpox-outbreak?
Some of the most recent spread of the sometimes-fatal viral illness has come from an ongoing outbreak in the Democratic Republic of the Congo (DRC)—the hardest hit country—which for the first time has seen sexual transmission as a major driver of the disease. The virus responsible for mpox is also spreading rapidly to children, who make up 60% of the cases in the DRC. “This a major alarm for the world,” Kaseya said, adding that Africa CDC is also working to increase the region’s supply of mpox vaccine, which has yet to be used in any country on the continent.
A PHECS declaration is a new option the Africa CDC created last year and is meant to improve the continent’s response to growing health threats. Early last week, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus announced he was convening an emergency committee to help him decide whether to declare a similar global alarm, known as a Public Health Emergency of International Concern (PHEIC), which was done for an mpox outbreak that began in Europe in May 2022. That PHEIC ended in May 2023.
If Africa CDC’s member states agree to a PHECS, Kaseya says it would complement any worldwide declaration. “It will not contradict what WHO will do at a global level,” he said. A PHECS, he suggested, will encourage more African countries to contribute funding to their collective efforts and will also “obligate our member states to notify Africa CDC of any health measures implemented in response to the emergency.”
Kaseya said Africa was “abandoned” during the COVID-19 pandemic, alluding to the slow rollout of vaccines there, and the continent does not want to find itself once again dependent on outsiders making decisions. “We are taking appropriate action,” he said. “We are deciding when there is an emergency.”
Many wealthy countries contained their outbreaks in 2022–23 using mpox vaccines including one made by Bavarian Nordic (BN) and another produced by KM Biologics. Although WHO said in April that the U.S. government had pledged to donate 50,000 doses of the BN vaccine to the DRC and another 10,000 to Nigeria, none have arrived. One hold up was that regulators in both the African countries had to authorize use of mpox vaccines, which they had done as of late June.
Paul Chaplin, CEO of BN, told ScienceInsider that the African countries also need to have strategies to store and distribute vaccine before doses can ship. “We understand this should be put in place later this month by the DRC authorities and then doses should follow,” Chaplin said. The U.S. Agency for International Development, which oversees the donation, said in a statement there are also some “contractual requirements” pending to complete the donation. “The U.S. has provided the funding, and stands ready to move forward with the donation when the remaining steps are complete,” the statement said.
Chaplin noted that BN has donated an additional 15,000 mpox vaccine doses to Gavi, the Vaccine Alliance, which will in turn make them available to affected countries.
The DRC has had more than 14,000 of the 15,132 mpox cases in Africa since the beginning of the year, according to Africa CDC. The case fatality rate has been about 3%, but Kaseya emphasized that rate jumped to 10% in a recent outbreak in South Africa, where many of the newly infected people are also living with HIV. Kaseya urged countries to design their vaccination programs to target the most vulnerable people, including those with HIV, front-line health care workers, and contacts of mpox patients.
Africa CDC estimates the continent needs 10 million doses of mpox vaccine to combat the current outbreak. Ngashi Ngongo, chief of staff at Africa CDC, said the DRC alone could use 3 million of those. Africa CDC is now in negotiation with BN to provide the DRC with 200,000 doses.
In the long run, Kaseya said he hopes BioNTech, which now has a messenger RNA (mRNA) vaccine for mpox in clinical trials with up to $90 million from the Coalition for Epidemic Preparedness Innovations, will supply many of those doses, especially because it has committed to providing the vaccine at “an affordable price.” BioNTech recently built an mRNA vaccine manufacturing plant in Rwanda, one of the countries that recently had its first cases of mpox.
“We have a limited availability of vaccines and that is a major challenge,” Kaseya said as he called for increasing testing for the mpox virus both in affected countries and at all border crossings. “This is why every day we are calling for local manufacturing. … But we’ll start with the 200,000 doses that will be available very soon.”
The mpox has been detected in 10 African nations this year, the Africa Centres for Disease Control and Prevention said last week.
The WHO declared mpox, previously known as monkeypox, a global emergency in 2022 after it spread to more than 70 countries. The virus is mostly prevalent among youths, the data shows.
The cases of the deadly mpox virus are up 160 per cent this year, with deaths surging by 19 per cent. As per Al Jazeera, 70 per cent of the total cases and 85 percent of the total deaths are recorded in children aged below 15.
The primary symptoms of the virus are fever, chills, respiratory problems (nasal congestion, cough), swollen lymph nodes and muscle pain.
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In 2011, a Chinese research team began visiting nearly 1,000 villages in Shandong province to launch an unprecedented cancer prevention experiment. A simple breath test given to more than 180,000 people revealed that, like most populations around the world, more than half harboured the bacterium Helicobacter pylori in their guts. Famed for causing stomach inflammation and ulcers, the microbe has also been tied to most gastric cancer cases, which account for 7.7% of all cancer deaths.
The team gave about half of those infected a brief course of antibiotics to rid them of the gut microbe. Then they waited—and waited.
More than a decade later, the group now reports the simple intervention slashed the treated group’s gastric cancer risk by 13%. For those whose H. pylori infection was successfully eradicated, the risk cut was even larger: 19%. Extrapolating to the entire country, “We could reasonably expect to prevent over 85,000 incident gastric cancer cases annually in China by H. pylori treatment,” the team reported in Nature Medicine on 30 July. www.science.org/content/article/eliminating-gut-microbe-could-slash-gastric-cancers?
Small studies with control arms have already shown that ridding the body of H. pylori reduces the cancer risk, and an informal population study in Japan has also supported the idea. But the randomized, controlled trial in China offers the most compelling evidence to date that large-scale screening and eradication efforts would be worth it, other researchers say.
In the 1980s, two Australian physicians linked gastric infections of H. pylori to ulcers, revolutionizing their treatment and earning the pair a Nobel Prize in 2005. The cancer connection is more mysterious. Only a small percentage of the billions of people infected develop gastric cancer. And for little understood reasons, the disease burden is heaviest in East Asia, Latin America, and Eastern Europe. Still, the cancer link was strong enough for a group led by epidemiologist Kai-Feng Pan of Peking University Cancer Hospital and Institute to test the benefits of eradicating the bacterium in the biggest controlled study yet.
The roughly 100,000 villagers who tested positive for H. pylori were split into two study arms. An eradication group got a 10-day multidrug regimen—antibiotics plus medications to reduce stomach acid—that eliminated the bacterium in 73% of participants. A control group got no antibiotics. Roughly 12 years later, 354 gastric cancer cases had been recorded in the eradication group and 399 among controls. There were also 282 cases among the 80,000 villagers who were H. pylori negative.
The reduction in gastric cancer risk was significantly greater for individuals under 45 years old at the start of the study. Those who successfully rid themselves of the bacterium had a 35% reduction in gastric cancer incidence and a 43% cut in mortality. For those 45 and older, the antibiotic treatment did not significantly cut gastric cancer incidence and mortality. Pan and colleagues say intervention early in life may be needed to interrupt the precancerous progression of the disease.
The eradication treatment may have had a bigger effect than it seems. At the suggestion of the study’s ethical review boards, the control group did get some treatment that included an anti-inflammatory drug, bismuth citrate, for their gastritis symptoms. That drug has also been shown to kill H. pylori, although not as effectively as antibiotics, says gastroenterologist Alexander Ford of the University of Leeds, who conducts meta-analyses of gastric cancer studies. Indeed, Pan and her colleagues report that 15% of those in the symptom treatment group also cleared their H. pylori infection.
In Japan, which has the world’s third highest gastric cancer rate, many people get regular health checkups that include testing for H. pylori antibodies. Many of those infected are treated—8.5 million from 2013 to 2019, which may explain why Japan’s gastric cancer deaths dropped from 50,000 annually in the 2000s to 42,300 in 2020, according to national cancer statistics. Drawing on those data, a modelling study led by Akiko Kowada, a physician and health economics researcher at Kitasato University, calculated that over the expected lifetimes of those 8.5 million patients, eradication will prevent more than 284,000 gastric cancer cases and 65,000 related deaths, and save $3.75 billion in health care costs.
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Though their exact role in the disease is debated, hardened clumps or ‘plaques’ of a peptide called amyloid-β clog the brains of people with Alzheimer’s. Many approved and in-development therapies aim to prevent or remove these plaques, but safely doing so has proven challenging. Now, researchers think they may have uncovered another tactic to achieve this aim: increasing the brain’s own amyloid-attacking enzyme, neprilysin.
Studies had previously revealed that mutations that lead to the overproduction of neprilysin protect aging mice against plaque formation. So, researchers sought a way of ramping up production of the enzyme without tinkering with genes. And they found it: everybody’s favourite reward-reinforcing neurotransmitter, dopamine.
In fact, when they gave mice with Alzheimer’s-like disease a drug called levodopa—a precursor of dopamine often used to treat Parkinson’s disease—for three months, the animals exhibited increased neprilysin levels, fewer plaques, and better performance on memory tests. The results were so promising that “the approach might be explored for patients with Alzheimer’s disease,” Science Signalling senior editor Leslie Ferrarelli writes in her summary. However, the authors note that levodopa often causes severe side effects , so their next step is to gain a better understanding of how dopamine leads to increased neprilysin, in the hopes of finding a cleaner way to boost the enzyme.
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Lalita Panicker is Consulting Editor, Views and Editor, Insight, Hindustan Times, New Delhi
