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  • 16
    Jan
    2013
    2:33pm, EST

    WHO: Dengue is fastest-spreading tropical disease

    By Stephanie Nebehay, Reuters

    GENEVA - Dengue is the world's fastest-spreading tropical disease and represents a "pandemic threat", infecting an estimated 50 million people across all continents, the World Health Organization (WHO) said on Wednesday. 

    Transmitted by the bite of female mosquitoes, the disease is occurring more widely due to increased movement of people and goods - including carrier objects such as bamboo plants and used tires - as well as floods linked to climate change, the United Nations agency said.

    The viral disease, which affected only a handful of areas in the 1950s, is now present in more than 125 countries - significantly more than malaria, historically the most notorious mosquito-borne disease.

    The most advanced vaccine against dengue is only 30 percent effective, trials last year showed.

    "In 2012, dengue ranked as the fastest spreading vector-borne viral disease with an epidemic potential in the world, registering a 30-fold increase in disease incidence over the past 50 years," the WHO said in a statement.

    Late last year, Europe's suffered its first sustained outbreak since the 1920s, with 2,000 people infected on the Portuguese Atlantic island of Madeira.

    Worldwide, 2 million cases of dengue are reported each year by 100 countries, mainly in Asia, Africa and Latin America, causing 5,000 to 6,000 deaths, said Dr. Raman Velayudhan, a specialist at the WHO's control of neglected tropical diseases department.

    But the true number is far higher as the disease has spread exponentially and is now present on all continents, he said.

    "The WHO estimates that on average about 50 million cases occur every year. This is a very conservative estimate," Velayudhan told Reuters, adding that some independent studies put the figure at 100 million.

    "Dengue is the most threatening and fastest spreading mosquito-borne disease. It is pandemic-prone, but it is a threat only. Definitely a bigger threat now than ever," he said

    Malaria caused more deaths but was on the decline, affecting fewer than 100 countries.

    Speaking to a news briefing after the WHO released a report on 17 neglected tropical diseases affecting 1 billion people, Velayudhan said: "The mosquito has silently expanded its distribution.

    "So today you have (the) aedes mosquito in over 150 countries. The threat of dengue exists all across the globe."

    In Europe, the aedes mosquitoes that cause both dengue and chikungya disease have spread to 18 countries, often via the importation of ornamental bamboo or second-hand tires, he said.

    "But we are trying to address this in a more systematic way, by controlling entry of vectors at points of entry - seaports, airports, as well as the ground crossings," Velayudhan said, noting that it was hard to detect mosquitoes and their eggs.

    Dengue causes flu-like symptoms that subside in a few days in some sufferers. But the severe form of the disease requires hospitalization for complications, including severe bleeding, that may be lethal.

    There is no specific treatment but early detection and access to proper medical care lowers fatality rates below 1 percent, according to the Geneva-based WHO.

    "You have to bear in mind that it has no treatment and vaccines are still in the research stage," Velayudhan said.

    The most advanced, being developed by French drugmaker Sanofi SA, proved only 30 percent effective in a large clinical trial in Thailand, far less than hoped, according to results published in September.

    But researchers said it did show for the first time that a safe vaccine was possible.

    The WHO also said aims to eliminate globally two neglected tropical diseases, dracunculiasis, known as guinea worm disease, in 2015, and yaws, or treponematoses, in 2020.

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  • 6
    Dec
    2012
    2:54pm, EST

    Key West waits on dengue mosquito experiment

    By Jennifer Kay, The Associated Press

    Mosquito control officials in the Florida Keys are waiting for the federal government to sign off on an experiment that would release hundreds of thousands of genetically modified mosquitoes to reduce the risk of dengue fever in the tourist town of Key West.

    If approved by the Food and Drug Administration, it would be the first such experiment in the U.S. Some Key West residents worry, though, that not enough research has been done to determine the risks that releasing genetically modified mosquitoes might pose to the Keys' fragile ecosystem.

    Officials are targeting the Aedes aegypti mosquitoes because they can spread dengue fever, a disease health officials thought had been eradicated in the U.S. until 93 cases originated in the Keys in 2009 and 2010.

    The trial planned by mosquito control officials and the British company Oxitec would release non-biting male mosquitoes that have been genetically modified to pass along a birth defect that kill their progeny before reaching maturity. The idea is that they will mate with wild females and their offspring will die before reproducing. After a few generations, Key West's Aedes aegypti population would die off, reducing the dengue fever risk without using pesticides and at relatively a low cost, the proponents say. There is no vaccine for dengue fever.

    "The science of it, I think, looks fine. It's straight from setting up experiments and collecting data," said Michael Doyle, pointing to research Oxitec has had published in peer-reviewed scientific journals. He inherited the project when he took the lead at the Florida Keys Mosquito Control District in mid-2011.

    The district's website says the modified genes will disappear from the environment after the mosquitoes carrying it die, resulting in no permanent change to the wild mosquito population. The district also says that the mosquito species isn't native to the Keys, nor is it an integral food source for other animals.

    Dengue fever is a viral disease that inflicts severe flu-like symptoms — the joint pain is so severe its nickname is "breakbone fever." It isn't fatal but victims who are re-infected can develop dengue hemorrhagic fever, which can be.

    "It's very uncomfortable. You ache all over, you have a terrible fever," said Joel Biddle, a Key West resident whose dengue fever symptoms lasted more than a week in 2009.

    Biddle is among those concerned about the Key West trial. He worries the modified genetic material will somehow be passed to humans or the ecosystem, and he wants more research done. He and other Key West residents also chafe at the fact that the project was in the works long before it was made public late last year.

    Only female mosquitoes bite, so the modified genetic material wouldn't be passed on to humans, mosquito control and Oxitec officials said. They also say they're being transparent about their data and the trial.

    Real estate agent Mila de Mier has collected more than 117,700 signatures on a petition she posted on Change.org against the trial. Most come from outside the Keys, which de Mier says shows that tourists don't support the mosquito control district.

    "We are dependent here on our tourists, and people from all over the country have been sending the message," de Mier said.

    A University of Florida professor who studies mosquito control said Oxitec's technology works and evidence from the company's experiments elsewhere show it can control mosquito populations, but it's not clear whether its methods are as effective at controlling the risk of disease transmission. Phil Lounibos of the Florida Medical Entomology Laboratory also said it would take repeated releases of modified mosquitoes for the program to work, and the public outcry against genetically modified organisms, even when it's irrational, may be insurmountable.

    "The public resistance and the need to reach some agreement between mosquito control and the public, I see that as a very significant issue, outside of the (operating) costs, since this is not just a one-time thing," Lounibos said.

    Aedes aegypti has shown resistance to pesticides used to control other species, and is the most difficult mosquito for the district to manage. Common in the Southeast and the Caribbean, it breeds in standing water around homes and businesses and can lay eggs in containers as small as bottle caps.

    District inspectors go door-to-door to remove the standing water where they breed, a time-consuming task. The district spends roughly $1 million a year to suppress Aedes aegypti, 10 to 15 percent of the agency's budget, Doyle said.

    "Unfortunately, control of Aedes aegypti is a never-ending job," said Larry Hriber, the mosquito control district's research director.

    In the trial, thousands of male mosquitoes bred by Oxitec would be released in a handful of Key West blocks where the Aedes aegypti is known to breed; the number of mosquitoes in those neighborhoods would be measured against the numbers from similar blocks where no modified mosquitoes were released.

    The state's agriculture department oversees the mosquito control district, and Doyle said he would not expect any challenge from the state if the FDA signed off on the trial. The mosquito control district wouldn't need any local permit for the trial, either, but officials held a public meeting earlier this year and have posted information on the agency's website.

    Still, it could take years for the FDA to approve the trial.

    There hasn't been a case of dengue fever in Key West since November 2010, but two other cases were reported elsewhere in South Florida this fall.

    The mosquito trial proposed for Key West wouldn't be the first release of genetically modified insects in the U.S.

    In 2009, the U.S. Department of Agriculture's Animal and Plant Health Inspection Service said integrating genetically modified pink bollworms into the agency's plant pest control program was "the environmentally preferable alternative" to combat the cotton pest. The gene-engineered worms are made by Oxitec to be sterile but more competitive in mating than regular bollworms.

    The program was discontinued, however, after officials found that the genetically modified insects were not as hardy as pink bollworms sterilized through irradiation, and that their use would cause farmers to lose their organic certification.

    Oxitec said the USDA's environmental assessment is one of several examples of proof that the trial's risks and methods are being independently evaluated. The company has trials in Brazil, the Cayman Islands and Malaysia, and it says it's gotten positive reviews from the latter two governments. It also cites its published research in peer-reviewed journals.

    But Biddle, the onetime dengue patient, wants Oxitec to continue testing the modified mosquitoes outside the U.S.

    "Why the rush here?" Biddle asked. "We already have test cases in the world where we can watch what is happening and make the best studies, because wouldn't it be wonderful if we could find out how it can be fail-safe — which it is not right now. It's an open Pandora's box."

    related stories:

    Disease-fighting mosquitoes

    GM mosquitoes fight dengue

    Genetically engineering mosquitoes to fight disease

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  • 11
    Sep
    2012
    3:01pm, EDT

    Early test suggests dengue vaccine possible

    By Maria Cheng
    Associated Press

    Results from an early test of a dengue vaccine suggest it isn't ideal, but scientists say the study is still encouraging news in the global fight against the disease known as "break-bone fever."

    There is currently no treatment or vaccine for dengue, which causes symptoms including fever, severe joint pain, headache and bleeding. The mosquito-borne disease infects up to 100 million people worldwide every year, mostly in Asia, Africa and Latin America.

    The research "provides the first evidence we could actually develop an effective vaccine against dengue," said Orin Levine, a professor at Johns Hopkins Bloomberg School of Public Health. He was not connected to the study, published online Tuesday by the journal Lancet.

    "This is a milestone, but we're not there yet," he said.

    Larger studies in about 30,000 people are now under way and should provide more information about the effectiveness of the vaccine made by Sanofi Aventis SA. Other dengue vaccines are being developed but Sanofi's is the furthest along.

    The Sanofi vaccine was tested in more than 3,600 Thai children ages 4 to 11. More than 2,400 got three injections of the vaccine six months apart while about 1,200 got a rabies vaccine or a dummy shot. The study was paid for by Sanofi.

    During about two years of follow-up, there were 134 dengue cases, including five severe cases. In the vaccine group, about 3 percent got dengue, compared to about 4 percent in the group that didn't get the shot. The difference wasn't big enough to suggest any benefit from getting the vaccine.

    Scientists said the vaccine seemed partly effective against three of the four viruses that cause dengue and no unusual side effects were reported. The study took place during an outbreak of mostly type 2 dengue, which causes the most serious disease, but the vaccine didn't work against that kind.

    "It's not exactly a slam dunk," said Scott Halstead, a senior scientific adviser for the Dengue Vaccine Initiative, who wrote an accompanying commentary. He said Sanofi might need to consider reformulating the vaccine or creating separate shots for each type of dengue.

    Joachim Hombach, a dengue expert at the World Health Organization, said it was encouraging that the vaccine appeared safe. "But the public health value of this vaccine remains to be demonstrated," he said.

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  • 10
    Sep
    2012
    8:45pm, EDT

    Early test suggests dengue vaccine possible

    By Maria Cheng, AP

    Results from an early test of a dengue vaccine suggest it isn't ideal, but scientists say the study is still encouraging news in the global fight against the disease known as "break-bone fever."

    There is currently no treatment or vaccine for dengue, which causes symptoms including fever, severe joint pain, headache and bleeding. The mosquito-borne disease infects up to 100 million people worldwide every year, mostly in Asia, Africa and Latin America.

    The research "provides the first evidence we could actually develop an effective vaccine against dengue," said Orin Levine, a professor at Johns Hopkins Bloomberg School of Public Health. He was not connected to the study, published online Tuesday by the journal Lancet.

    "This is a milestone, but we're not there yet," he said.

    Larger studies in about 30,000 people are now under way and should provide more information about the effectiveness of the vaccine made by Sanofi Aventis SA. Other dengue vaccines are being developed but Sanofi's is the furthest along.

    The Sanofi vaccine was tested in more than 3,600 Thai children ages 4 to 11. More than 2,400 got three injections of the vaccine six months apart while about 1,200 got a rabies vaccine or a dummy shot. The study was paid for by Sanofi.

    During about two years of follow-up, there were 134 dengue cases, including five severe cases. In the vaccine group, about 3 percent got dengue, compared to about 4 percent in the group that didn't get the shot. The difference wasn't big enough to suggest any benefit from getting the vaccine.

    Scientists said the vaccine seemed partly effective against three of the four viruses that cause dengue and no unusual side effects were reported. The study took place during an outbreak of mostly type 2 dengue, which causes the most serious disease, but the vaccine didn't work against that kind.

    "It's not exactly a slam dunk," said Scott Halstead, a senior scientific adviser for the Dengue Vaccine Initiative, who wrote an accompanying commentary. He said Sanofi might need to consider reformulating the vaccine or creating separate shots for each type of dengue.

    Joachim Hombach, a dengue expert at the World Health Organization, said it was encouraging that the vaccine appeared safe. "But the public health value of this vaccine remains to be demonstrated," he said.

    Comment

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    Explore related topics: dengue

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