Breakthroughs Blog: Diagnostics

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. A single, high-dose cholera vaccine—Vaxchora—could be an effective tool in controlling outbreaks more rapidly, according to new research from the University of Maryland School of Medicine. The current cholera vaccine consists of two doses of the inactivated virus administered over two weeks, but researchers believe they have developed a stronger, single dose vaccine approach that will be more effective in combatting outbreaks because it can be deployed more rapidly and easily. Researchers plan to further study how this vaccine may help curb outbreaks early before they become widespread and its potential use in preemptive vaccination. They also plan to study the vaccine’s effectiveness in children under the age of five—one of the most burdened demographics of cholera. Researchers at the Indiana University School of Medicine discovered a way to prohibit malaria-causing parasites from shielding themselves against treatment in mice, which could open new avenues for drug development. While the most common malaria medicines are effective at reducing the level of parasites in the blood, some of these parasites enter a latent stage during treatment, allowing them to survive through the treatment and eventually reinfect the individual after he or she has ceased taking medication. This process makes treating malaria more challenging and dangerous, particularly among individuals who do not have consistent access to therapies. Researchers discovered the molecular mechanism that leads to these parasites entering the latent stage and how to inhibit it, which they hope will lead to medicines that prevent treatment failure and subsequent reinfection. Researchers may have developed a urine test to detect tuberculosis (TB) in patients, according to a paper published in Science Translational Medicine. Current TB diagnostics include skin and culture tests that require a high level of expertise to carry out correctly. A new method, like a rapid urine test, will allow lower skilled health workers in TB-endemic areas to carry out quick and effective TB diagnostic tests. A study of 42 individuals in Peru found the test had greater than 95 percent sensitivity—or the ability to correctly identify those with the disease. Furthermore, researchers reported this test can be used to diagnose TB at any stage and among HIV-negative populations—populations who usually have more mild concentrations of the bacteria in the body.  

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. A resurrected malaria prevention strategy—seasonal malaria chemoprevention—saved an estimated 40,000 lives in 2015 and 2016, according to new research. The strategy involves giving children a dose of antimalarial drugs monthly during the rainy season—the season with the highest incidence of malaria—to prevent the disease. Researchers and public health professionals were initially skeptical of this technique when applied in real-world settings since it requires thousands of local aid workers to deliver malaria drugs to rural and hard-to-reach areas, but recent results have shown reductions in malaria prevalence similar to those seen in clinical trials in areas deploying the strategy. While historical and recent studies suggest this technique is effective, there are signs this method will only work for a limited time before existing drugs fail because of resistance, meaning alternative solutions must continue to be explored. As the world gets closer to eradicating polio, a funding crisis looms for many countries. Funding for the Global Polio Eradication Initiative is scheduled to be halved in 2019 and expire the following year, except in the most high-risk countries. A reduction in polio funding will leave countries with depleted resources, straining their capacity to vaccinate against other life-threatening diseases and conduct surveillance activities. Today, polio funding supports health workers that also deliver routine immunizations as well as 70 percent of all global funding for surveillance. Also, as polio transmission rates move toward zero, global strategies must be implemented to maintain eradication, including using the safer injectable polio vaccine for up to ten years following eradication, which will be more difficult to achieve if polio resources are strained. At the close of the first Global Ministerial Conference on Ending Tuberculosis, 75 health ministers agreed to take committed action to end tuberculosis (TB)by 2030. Ministers met in Moscow, Russia over two days to discuss and strategize solutions for TB. They concluded with a pledge to take action on four fronts: (1) move to achieve universal health coverage, (2)mobilize domestic and international investments to close gaps in implementation and research, (3) advance research and development for new tools to tackle TB, and (4) build accountability by tracking and reviewing progress in ending TB. Ministers also vowed to take increased action to minimize the risk and spread of antimicrobial resistance.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past we. A quick and inexpensive test may make it easier to diagnose and distinguish betweenZika and dengue. Both viruses produce the same NS1 protein, making it is impossible for current NS1 protein-based diagnostic tests to discern between the two. To overcome this problem, scientists developed a set of antibodies produced from immune cells that can distinguish between an NS1 protein produced by the Zika virus and an NS1 protein produced by the dengue virus. In a study, the diagnostic test was able to discern between the two viruses, even when there was a lowNS1 protein count in the body. While further studies are required, this tool could become an essential diagnostic tool in areas of the world where both Zika and dengue are endemic. A series of papers exploring the impact of group B streptococcus (GBS) was published in Clinical Infectious Diseases. GBS is an infection a mother can pass to her fetus that can cause septicemia, meningitis, and even death. The papers argue that there are 410,000 cases of GBS every year with 147,000 associated stillbirths and infant deaths. There is also a major disparity of GBS cases between developed and developing countries: Many at-risk women in developed countries receive prophylactic antibiotics during labor, but those resources are often not available to women in developing countries. Scientists believe the solution to this problem is a GBS-specific vaccine, which could save over 100,000 infant lives.This vaccine may be critically important as scientists believe “immunizing expecting mothers is a potentially groundbreaking approach that could dramatically reduce the number of maternal and child deaths.”There is currently no GBS vaccine available, but there are candidates in development. The US Environmental Protection Agency approved the release of lab-reared “killer mosquitoes” to help reduce the population of disease-carrying mosquitoes in certain American states. A biotechnology start-up based in Kentucky—MosquitoMate—will rear these mosquitoes with a lethal bacterium that impedes reproduction and release the infected males into the wild. When the infected males mate with wild females, the offspring will not be viable due to malformed chromosomes. Over time, disease-carrying mosquito populations will dwindle. Other countries, including Brazil, have tried this method and found it successful, suggesting this could be a solution for countries severely affected by mosquito-borne illnesses. This method is also a “non-chemical way of dealing with mosquitoes,” so offers an alternative to pesticide-based vector control.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Researchers at the 48th Union World Conference on Lung Health highlighted three promising innovations that have the potential to modernize the tuberculosis (TB) diagnostic and treatment landscape. The first innovation builds upon the current therapy monitoring protocol, which involves directly observing patients to ensure they take their medicines, in a novel and contemporary way. The new system, Remote Observation Therapy (ROT), uses an edible sensor and a wearable patch to remotely track whether patients are taking their TB medicine and assist public health professionals with treatment monitoring to ensure that patients continue and complete TB therapies. The second is an oral swab alternative to sputum tests. Current sputum tests are difficult to collect and pose various problems for patients who need to produce the sample. Instead, a simple cheek swab has delivered promising results, though the swab will still require analysis from a GeneXpert or a similar machine. Lastly, a new, rapid prototype blood test, which can detect TB in as few as 15 minutes and requires no electricity and limited medical training, is showing promise. This diagnostic tool would address a major gap in blood-based TB diagnostics. A new, oral therapy has shown promising results in clinical trials for curing sleeping sickness, a debilitating disease that affects the neurological system.. The oral drug—fexindazole—cured 91 percent of patients with severe sleeping sickness and 99 percent of patients in the early stages of the disease. Fexindazole is a much-needed alternative to current combination therapies that involve a mix of pills and intravenous infusions, which can be challenging to administer in low-resource settings where infrastructure and highly trained health workers may be limited. Wellcome Trust, with assistance from the UK government and the Bill and Melinda Gates Foundation, has announced the Global Burden of Disease Antimicrobial Resistance (AMR) project , a new research initiative to track global data on drug-resistant infections and deaths. Over four years, the project will compile relevant data, produce detailed maps for intervention and clinical purposes, and provide publicly available visual representations on AMR’s global burden. This project will allow governments and researchers to strategically target global efforts to combat AMR.