5 Infectious Disease Outbreaks Were not Contained in 2019, What Can You Learn from it?

It is well known that pharmaceutical distribution is all about solving the right medical needs, at the right time and place. To do this, information is the key, and even if all resources show a steady growth of non-communicable diseases (NCDs), such as cardiovascular conditions, diabetes, and cancer, one must still understand patterns of infectious communicable diseases on the other side of the equation. While its overall percentage number is decreasing in relation to the NCDs, containment and control are still of high importance.

By looking at last year’s disease outbreak patterns in emerging markets, pharma distributors can look beyond OTC medication and antibiotics, when thinking about their client's future needs. While some of the developing world is truly fighting the pandemic increase of ‘western’ type of diseases due to the changes in lifestyle and growing megacities, unpredicted outbreaks of highly viral infections still occur. Not so rarely, those outbreaks are the leading cause of many fatalities and economic loss. This is particularly true for emerging countries where the businesses are already struggling, mainly because containment is not managed properly. Consequently, massive transmissions occur rapidly. Many governments and industry sectors have been acknowledging the necessity of better healthcare availability, however, changes are happening slower than we would hope, and hindrances are still expected to halt the control of some emerging and re-emerging diseases in the years to come.

By looking at last year’s disease outbreak patterns in emerging markets, pharma distributors can look beyond OTC medication and antibiotics, when thinking about their client's future needs

Even more, from the beginning of 2019, the world is seeing the spread of communicable emerging diseases at an unprecedented rate. The World Health Organization’s archive shows that out of 37 various global outbreaks in 2019, 33 of them occurred in emerging countries. Moreover, some happened over a short period of only a few months. As a result, diseases like Ebola and Yellow Fever continue to affect the most vulnerable of the population.

Renowned healthcare professionals have already expressed their forecast and concerns for various emerging and re-emerging infectious diseases. On top of all this, even the WHO has in the past stated that various health challenges will be inevitable in the upcoming decade. For proof, one has to only look at the pattern of outbreaks in 2019. Climate change along with much increasing antimicrobial resistance are just some of the biggest barriers in repressing these outbreaks. Others include external factors, such as hyper-connected world economies where travel is frequent and common, political conflicts with refugee movements and security problems, as well as ever-increasing popular anti-vaccination movements with popular personalities endorsing them.

To be better prepared for tackling worldwide health epidemic concerns in the new year, here is an overview of 5 top outbreaks of the last year, with tips on how you can help contain them as a distributor.

Ebola virus disease (EVD) is a viral hemorrhagic fever caused by ebolaviruses. It is a high-risk disease with a mortality rate of up to 50%. The disease was first identified in 1976 in South Sudan and the Democratic Republic of Congo (DRC). However, the largest outbreaks to date happened between 2013 and 2016. Additionally, Ebola continues to cause outbreaks in the years following. By March 2019, the second-largest Ebola outbreak ever was recorded in the DRC. Consequently, in June 2019, two people also died of Ebola in neighboring Uganda. Soon after, the WHO declared the outbreak a world health emergency. Due to its high contagiousness, communities with infected people as well as health care workers are highly exposed to this virus.

On the opposite side of prevention, diagnosis, and treatment, significant progress in fighting the Ebola outbreak was seen in November 2019. Ebola vaccines passed pre-qualification tests as two experimental treatments were found to be 90% effective.

Ebola outbreaks occur mostly in regions fighting political conflict where displacement is recurrent. While medical professionals are now able to contain Ebola virus contamination and provide recovery, poor water and sanitation caused especially by environmental hostility post great challenges. Not to mention, the areas most inflicted by Ebola have a history of weak health systems, leaving people to only be able to rely on non-profit organizations for care.

Yellow fever is a viral disease spread through mosquito bites. While it is typically of short duration, 15% of cases enter a second, toxic phase accompanied by jaundice. With this development, the fatality rate rises to 20-50%. Moreover, severe cases have a mortality rate even greater than 50%. Problems occur not only because the diagnosis is slow since the virus can be only confirmed after six to ten days after the infection, but also because there is no specific treatment for the disease. Fortunately, vaccinations exist, can prevent the disease and provide immunity for life. However, due to the high demand in prone areas such as Angola, DRC, Uganda, Nigeria and Brazil, global vaccine supply is currently strained.

Besides, new regions in Nigeria have been seeing numerous cases of yellow fever infection in 2019, with nearly a three-fold increase in the number of confirmed cases since 2018. Brazil is confirming new cases since 2015, and Venezuela has also seen the first confirmed autochthonous case of yellow fever after 2005.

Vector-borne diseases such as Yellow Fever are very much affected by climate. With climate change causing differences in temperature and rainfall patterns, the disease has emerged in regions where it has never been recorded before and in seasons for which it has been previously uncommon. Additionally, climate change causes the disease to spread wider as the increase in temperature causes previously more temperate areas to experience climate similar to tropical areas.

While there is no specific treatment for the already infected, the disease is preventable with vaccines that provide lifetime immunity. The pharmaceutical companies together with NGOs and health authorities of countries previously not prone to the disease, should make vaccines widely available as climate changes will bring more cases to new regions. Prevention can also include vector control.

On the side of Yellow Fever patients, treatment of symptoms is crucial to reduce the severity of the disease as there is no cure for it. This can include but is not limited to use of pain-relieving medication such as Dipyrone (tablets, injections), AVOIDING anti-inflammatory drugs and using IV in hospital supportive care when moderate to severe cases occur.

Basic support of distributors to the Yellow Fever communities can, however, also include campaigning with authorities to make vaccines more available, as well as promoting the use of mosquito repellent nets, clothing and sprays for protection against infection.

Polio, short for poliomyelities, is an infectious disease caused by the poliovirus. The disease is preventable with the polio vaccine, however, cases of vaccine-derived polio happen more predominantly since 2018 compared to the wild disease. The progress against polio is so significant that total eradication is expected in the near future. Currently, only 3 polio-endemic countries remain (Afghanistan, Nigeria, and Pakistan) with Nigeria not showing any wild cases in 2018. However, circulating vaccine-derived cases have been happening in multiple countries due to virus mutation. In 2019, ten countries reported this kind of cases.

Polio eradication is a goal that health world organizations worldwide would like to see in the near future

Polio eradication is a goal that health world organizations worldwide would like to see in the near future. Circulating vaccine-derived cases are the leading cause of outbreaks in polio. These cases are preventable, but are unfortunately occurring due to fragile and vulnerable settings generally circulating among poorly vaccinated children. Famine, conflict and population displacement can lead to the unavailability of not-live vaccines nor qualified vaccinators, who are giving injections.

For polio eradication in its totality, vaccines outreach, availability and quality is a priority. Firstly, the switch of live oral vaccines to not-live ones must be made worldwide. Secondly, the availability of trained vaccinators to give injections has to be assured, which will for sure be a challenge for some governments and healthcare agencies.

On the side of Polio patients, as no cure is available, the focus should be on increasing patient’s comfort, ensuring speedy recovery and preventing possible complications. This can be done by, but not limited to providing:

• MEDICATION FOR PAIN RELIEF
• BREATHING ASSISTANCE WITH PORTABLE VENTILATORS
• PHYSICAL THERAPY TO PREVENT DEFORMITY AND LOSS OF MUSCLE FUNCTION

Dengue fever is a mosquito-borne disease caused by a dengue virus. Similarly to malaria, it is transmitted by the bite of an infected mosquito, that got infected by biting a person with dengue virus in their blood. Though it can’t be spread directly from one person to another, it can be spread via infected blood products, organ donation or from mother to child. There are four closely related dengue viruses, meaning a person can potentially be infected four times. Besides Dengue Fever, the same viruses can also cause West Nile infection or Yellow Fever. Nonetheless, dengue can cause a variety of diseases, and many people may not even know they are infected. Some of those develop severe dengue, first recognized in the 1950s during dengue epidemics in the Philippines and Thailand.

Every year around 390 million cases occur worldwide, out of which around 96 million proceed to illness due to infection. Regions with the greatest risk because of the tropical environments are the Indian subcontinent, South-East Asia, Southern China, Taiwan, the Pacific Islands, the Carribean, Mexico, and Africa. However, the WHO reports a significant rise in global incidence of Dengue Fever and estimates that around half of the world population is now at risk. Between 2010 and 2016 the reported cases increased from less than half a million to 3.34 million, but then a significant reduction was detected in 2017-2018. Unfortunately, in 2019, there has been a worldwide increase again. Since last January many infections have emerged in the Western Pacific, Latin America and Caribbean region, with a lot of cases also observed in Australia, Cambodia, Malaysia, Singapore, Vietnam, Congo, Ivory Coast, Tanzania, and African region. Additionally, in countries like Honduras, Philippines, and Bangladesh the escalating number of patients lead to nationally declared outbreaks of this mosquito-borne disease.

Fragile and vulnerable settings, such as living in areas of crises caused by drought, famine, conflict or population displacement, can lead to Dengue Fever outbreaks. Global warming causing rainy seasons to be longer in some regions even increases the risks of the disease. Countries like this are for example Bangladesh and India. In addition, Dengue infections are also spreading towards countries with temperate climates, like Nepal, that has not had to fight the disease in the past. After outbreaks in 2019, due to international travel, the WHO even estimated a possible outbreak in Europe.

Since Dengue Fever can show mild symptoms, commonly mistaken for the flu or other viral infection, proper diagnosis is significant. To reduce mortality rates from severe cases, distributors can help by supplying their hospitals and clinics with quality and accurate dengue test kits. This is especially important for people with weakened immune systems or those that have been infected by dengue virus in the past, as they can be at greater risk of developing severe cases. Additionally, prevention efforts by promoting the use of mosquito repellent nets, clothing and sprays for protection against infection are also always valuable when talking about mosquito-borne diseases.

On the other side, while there is still no specific treatment, there are ways to minimize the mortality risks from 20% to 1% for those infected. Methods include but are not limited to:

• MAINTAINING PATIENT’S BODY FLUID VOLUME
• TAKING MEDICATION SUCH AS PARACETAMOL TO TREAT SYMPTOMS AS MUSCLE ACHES, PAINS AND FEVER
• AVOID ANTI-INFLAMMATORY DRUGS OR NON-STEROIDAL DRUGS, SUCH AS IBUPROFEN

In the end, there has been a vaccination developed and approved in 2015, with the first use beginning in 2017. However, analysis of trial participants showed that some of them had a higher risk of more severe Dengue and hospitalizations from Dengue compared to unvaccinated participants. Because of this, the use of the vaccine is limited to people living in endemic areas, who are 9 to 45 years old and have already lived through one or more documented infections.