International Control Efforts Research Articles

Epidemiological trends of rabies and control strategy in China: A narrative review

Rabies is widely prevalent worldwide, and China is among the countries most affected. To achieve the goal of zero human deaths from dog-mediated rabies by 2030, dog management and immunization must be improved and comprehensive prevention and control measures must be adopted. We analyze the epidemiological profile of rabies in China in the past 30 years to clarify the origins of China's high prevalence, and propose a comprehensive rabies prevention and control concept based on “One Health” by drawing on successful international control efforts.

International Control Efforts to Curb the Global Production and Trafficking of Fentanyl and Other Synthetic Opioids.

The purpose of this Policy Watch column is to provide a brief overview of the global problems associated with the illicit production and trafficking of synthetic opioids as well as international efforts and policy approaches designed to curb them. An in-depth evaluation of drug control efforts of many different nations is important for a comprehensive analysis. However, because of the vast amount of information available, this column is limited to cooperative global control efforts, not efforts specific to any one nation. A great deal of information about production methods, clandestine laboratories, international trafficking methods, and online sales over the dark Web has been omitted. It is important to understand key issues regarding the illicit cultivation and distribution of plant-based opioids derived from natural compounds found in opium poppies (heroin, opium, morphine, codeine) or other drugs (cocaine, methamphetamines, etc.), but the scope of this column is limited to discussion about synthetic opioids including fentanyl, fentanyl analogues, and fentanyl precursor chemicals. Issues about human rights and ethical considerations for nurses and other addictions professionals are also discussed.

The race to extinguish insect pests by enlisting their own kind

The unheralded success of a massive operation to control the insidious screwworm offers lessons learned and cautionary tales for mosquitoes and other insect scourges. On a Friday in the fall of 2016, John Welch got an email he’d been dreading—a picture of a mystery insect sent from the Florida Keys. “I knew immediately what it was—and that it was bad,” the United States Department of Agriculture (USDA) entomologist says. He immediately hopped on a plane to Florida. There he found dozens and dozens of endangered Key deer dead or staggering around blind with the tops of their heads or eyes eaten away or terrible wounds on their bodies. “It was horrific,” Welch recalls. Screwworm larvae use sharp mandibles to eat away at the living tissue of their animal hosts. The results can be devastating for livestock and wildlife. But decades-long international control efforts by the USDA and other agencies have helped keep the damaging bugs in check. Image courtesy of ScienceSource/Philippe Psaila. And the clues suggested a threat to far more than just deer. The culprit was screwworm, a fly that lays its eggs in open wounds or in moist areas like eyes and noses of warm-blooded mammals, from dogs to people. When the eggs hatch, the larvae start dining. Without aggressive immediate treatment, “it’s pretty much a death sentence, being eaten alive by the maggots,” says Welch. The stakes were high. In the past, screwworm had devastated the livestock industry all across the US South before the pest was eradicated. Now it was back. Could science win the battle again? The fight had further implications for battles against a host of destructive and disease-carrying insect pests—mosquitoes in particular. Such fights are likely to intensify. In May 2018, the Centers for Disease Control and Prevention reported that between 2004 and …

Public health implications of changing patterns of recruitment into the South African mining industry, 1973\u20132012: a database analysis

BackgroundThe triple epidemic of silicosis, tuberculosis and HIV infection among migrant miners from South Africa and neighbouring countries who have worked in the South African mining industry is currently the target of regional and international control efforts. These initiatives are hampered by a lack of information on this population.MethodsThis study analysed the major South African mining recruitment database for the period 1973 to 2012 by calendar intervals and demographic and occupational characteristics. Changes in area of recruitment were mapped using a geographic information system.ResultsThe database contained over 10 million contracts, reducible to 1.64 million individuals. Major trends relevant to health projection were a decline in gold mining employment, the major source of silicosis; increasing recruitment of female miners; and shifts in recruitment from foreign to South African miners, from the Eastern to the Northwestern parts of South Africa, and from company employees to contractors.ConclusionsThese changes portend further externalisation of the burden of mining lung disease to home communities, as miners, particularly from the gold sector, leave the industry. The implications for health, surveillance and health services of the growing number of miners hired as contractors need further research, as does the health experience of female miners. Overall, the information in this report can be used for projection of disease burden and direction of compensation, screening and treatment services for the ex-miner population throughout Southern Africa.

Epidemiology of visceral leishmaniasis.

Leishmania species are the causative agents of leishmaniasis, a neglected tropical disease. These parasitic protozoans are usually transmitted between vertebrate hosts by the bite of blood sucking female phlebotomine sand flies. This review focuses on the two parasites causing most human visceral leishmaniasis (VL), which leads to substantial health problems or death for up to 400,000 people per year. Except for travel cases, Leishmania donovani infections are restricted to the (sub-)tropics of Asia and Africa, where transmission is mostly anthroponotic, while Leishmania infantum occurs in the drier parts of Latin America as well as in the Mediterranean climate regions of the Old World, with the domestic dog serving as the main reservoir host. The prevalence of VL caused by L. infantum has been declining where living standards have improved. In contrast, infections of L. donovani continue to cause VL epidemics in rural areas on the Indian subcontinent and in East Africa. The current review compares and contrasts these continental differences and suggests priorities for basic and applied research that might improve VL control. Transmission cycles, pathogenesis, diagnosis, treatment and prognosis, prevention (including vector control), surveillance, transmission modeling, and international control efforts are all reviewed. Most case detection is passive, and so routine surveillance does not usually permit accurate assessments of any changes in the incidence of VL. Also, it is not usually possible to estimate the human inoculation rate of parasites by the sand fly vectors because of the limitations of survey methods. Consequently, transmission modeling rarely passes beyond the proof of principle stage, and yet it is required to help develop risk factor analysis for control programs. Anthroponotic VL should be susceptible to elimination by rapid case detection and treatment combined with local vector control, and one of the most important interventions may well be socioeconomic development.

Synthetic Cannabinoids: A New Frontier of Designer Drugs

Synthetic cannabinoid use has increased in the United States. The consequences are dangerous, and public health concern about these products has led to international control efforts. This commentar...

Ccr7 is critical for resistance against experimental Trypanosoma cruzi infection (56.4)

Abstract The protozoan parasite Trypanosoma cruzi is the etiological agent of Chagas’ Disease, which affects ~12 million people in Latin America despite coordinated international control efforts. Cardiomyopathy due to chronic inflammation and fibrosis is the most common and serious presentation of Chagas’ Disease, but its pathogenesis is poorly understood. Several inflammatory chemokines and chemokine receptors have been implicated in mouse models of T. cruzi infection; however, roles for homeostatic chemokines have not previously been reported. Here, we found that mRNA for the homeostatic chemokine Ccl19 and its receptor Ccr7 were both increased in the heart during the acute phase after infection of WT C57BL/6 mice. Consistent with an important functional role, infection was uniformly fatal during the acute phase in infected Ccr7-/- mice, whereas mortality was only 10% in WT control mice. Death in infected KO mice was associated with uncontrolled parasitemia and increased parasite burden in both heart and liver, whereas infected WT mice controlled parasite burden in all 3 compartments. Leukocyte infiltration was also greater in the hearts of infected KO mice compared to infected WT controls, and was characterized by a lower frequency of CD8+ T cells and a greater frequency of Gr-1hiCD11b+IA- cells. Thus Ccr7 is a critical factor for survival and control of T. cruzi infection in C57BL/6 mice. The mechanisms of resistance conferred by Ccr7 are currently under investigation.

Tuberculosis in New York City--turning the tide.

From 1978 through 1992, the number of patients with tuberculosis in New York City nearly tripled, and the proportion of such patients who had drug-resistant isolates of Mycobacterium tuberculosis more than doubled. We reviewed, confirmed, and analyzed data obtained during the surveillance of patients with tuberculosis. From 1992 through 1994, there was a 21 percent decrease in reported cases of tuberculosis in New York City. An evaluation of the surveillance system revealed very few unreported cases. The number of cases decreased by more than 20 percent among blacks and Hispanics, persons with documented human immunodeficiency virus infection, homeless persons, and patients with multidrug-resistant tuberculosis; in all these groups, tuberculosis is likely to result from recent transmission. In contrast, the number of cases of tuberculosis increased among elderly and foreign-born persons, in whom the disease is likely to result from the reactivation of an infection acquired many years earlier. Enrollment in a program of directly observed therapy, in which health workers watch patients take their medications, increased from fewer than 100 patients to nearly 1300, with more than 32,000 patient-months of observation from 1992 through 1994. Epidemiologic patterns strongly suggest that the decrease in cases resulted from an interruption in the ongoing spread of M. tuberculosis infection, primarily because of better rates of completion of treatment and expanded use of directly observed therapy. Another contributing factor may have been efforts to reduce the spread of tuberculosis in institutional settings, such as hospitals, shelters, and jails. Expansion of measures to prevent and control tuberculosis and support of international control efforts are needed to ensure continued progress.

Drug Abuse Control and International Treaties

The author discusses major problems relating to international efforts to control non-medical use of narcotics and psychotropic substances and the international treaties that have been concluded to help control such use. He makes recommendations designed to improve international control efforts and strongly supports the 1971 Convention on Psychotropic Substances. He especially urges the United States and other Western nations which are manufacturers of such substances to ratify the treaty. He advises the United States that it cannot realistically expect other countries to agree to measures for reducing the illicit production of opium, if it is unwilling to support the Psychotropic Convention and the international controls on psychotropic substances called for by the Convention.

Public Health and the Law

ON June 3, 1971, three news reports appeared in the New York Times. One began on the first page and was continued to an inside page. The other two appeared on that same inside page. Together they afford the most compelling evidence of the growing problems of drug abuse I have ever read in any one place. Perhaps these stories will help to galvanize interest in another news release which also appeared on the front page of the Times on this same June day. It announced President Nixon's plan to set up new federal agency to deal with domestic drug problems and with addiction among returning Vietnam veterans. The first story, appearing on page one, told of two young people, girl of 16 and man of 22, who died of heroin overdose on the steps of New York hospital at 4:30 A.M. on June 2. The girl was lying with her head in the young man's lap. Several weeks before, the girl's older brother, who was 20, had also died of an overdose of narcotics. These two deaths were the 423rd and 424th deaths from acute reaction to dangerous drugs in New York City in 1971. This girl, Miss Margaret Golup, was the 52nd teenager to so die. The newspaper reporters questioned relatives, friends, and police in the neighborhood where the youths lived. It was reported that both friends and detectives were aware that Margaret took pills, but were surprised that she was on hard drugs. Policemen described both as neighborhood kids, not heavy with junk. One policeman was said to have commented without rancor in his voice that these types of kids were a bunch of idiots. They don't know what they're doing and now they are dead. The second story, back-to-back with the above on page 46, reported on federal court conviction of 65-year-old general medical practitioner in Manhattan for running what the story called supermarket in amphetamines in his Central Park South office. Patients came from as far away as Texas to receive the doctor's speed shots. The government had obviously prepared well for the case, and had brought in many former patients of the doctor. It was the first conviction in new drive against doctors in large cities who are alleged to be making fortunes on drugs. The judge denied plea for clemency and sentenced the physician to five years in prison and $10,000 fine. The third story, sandwiched in between the other two in just one short column, was report on testimony before Congressional committee by the director of the Federal Bureau of Narcotics and Dangerous Drugs indicating that 80 per cent of the heroin coming into the U.S.A. is grown in Turkey. Most of the rest comes from Burma, Thailand, and Laos. The governments of these countries were said to be directly involved in the growing, manufacture, and distribution. International control efforts are currently ineffective, it was indicated. Here are very, very serious public health problems: one, local neighborhood tragedy which shrieks of neglect,