Giving name to new disease without causing harm or stigma to anyone

When there is emergence of a new disease, it is generally given a common name by the reporting scientists or the media which attracts quick attention of the masses and gets communicated across the globe very fast through rapid electronic means. Many times, such common names may give wrong perception of the disease, may incite undue fear or may cause far reaching negative economic or social consequences. WHO, OIE and FAO have developed best practices for the naming of new human diseases in such a manner that their names do not cause unnecessary negative impact on trade, travel, tourism or animal welfare, and avoid causing offence to any cultural, social, national, regional, professional or ethnic groups. WHO strongly encourage scientists, national authorities, the national and international media and other stakeholders to follow the best practices so that inappropriate names do not become established. These practices include:

1. Use generic descriptive terms such as respiratory disease, hepatitis, neurologic syndrome, watery diarrhoea, enteritis.
2. Specific descriptive terms may be used with preference to plain terms rather than highly technical terms, e.g. progressive, juvenile, pediatric, senile, maternal, severe, winter, subterranean, coastal, river, swamp etc.
3. If the causative pathogen is known, it should be used as part of the disease name with additional descriptors e.g. novel coronavirus respiratory syndrome, influenza virus, parasitic.
4. Names should be short and easy to pronounce e.g. H7N9.
5. Long names are likely to be shortened into an acronym, hence, potential acronyms should be evaluated to ensure they also comply with these best practices.
6. Names should be as consistent as possible with guidance from the International Classification of Diseases (ICD) Content Model Reference Guide.
7. Avoid following terms:

• Avoid geographic locations: Cities, countries, regions, continents e.g. Middle East Respiratory Syndrome, Spanish Flu, Rift Valley fever, Lyme disease, Crimean Congo hemorrhagic fever, Japanese encephalitis
• Avoid people’s names: e.g. Creutzfeldt-Jakob disease, Chagas disease
  Species/class of animal or food: e.g. swine flu, bird flu, monkey pox, equine encephalitis, paralytic shellfish poisoning
• Avoid cultural, population, industry or occupational references: Occupational, legionnaires, miners, butchers, cooks, nurses 
• Avoid terms which incite undue fear: e.g. unknown, death, fatal, epidemic

Source: WHO (2015) and Science (2015) DOI: 10.1126/science. 348.6235.643

Antibiotics Use and Misuse: A Monograph

The Indian College of Physicians, the academic wing of the Association of Physicians of India has brought out a monograph on ‘Antibiotics Use and Misuse’ edited by Dr. Dhruva Chaudhry (dhruvachaudhry@yahoo.co.in) and Dr. Subhash Todi (drsubhashtodi@gmail.com). It has been divided into 3 sections. In the first section, discussion is about the rationale and appropriate use of antibiotics including suggested antibiotics for various infections with dosing followed by their use in outpatient departments, indoors, intensive care, immunecompromised states and peri-operative area. The second section discusses their misuse particularly over the counter use and use in veterinary, differences in urban and non urban consumption and how the antibiotics are being used in developing countries including India. The last section gives perspective of microbiologists towards antibiotic resistance, issues related to regulations and how audits can improve the prescription behaviour, compliance to regulations and lastly the Chennai Declaration – an initiative of professional medical bodies, which provides a road map to reduce the incidence of resistance and introducing the culture of discipline in antibiotic use and prescription in the country. The monograph is authored by a mix of physicians, intensivists, microbiologists, administrators, clinical pharmacologist and veterinary public health professionals, well known in their respective areas to have a 360 degree view on the issue. The contents of the monograph are as under:

Section 1 – Rational Antibiotic Use

• Chapter 1: Guidelines for Antibiotic Use in India by George M. Varghese (georgemvarghese@hotmail.com) and Paul Trowbridge (ptrowb@hotmail.com)
• Chapter 2: Use and Abuse of Antibiotics in Outdoor (OPD) Patients by Dhruva Chaudhry (dhruvachaudhry@yahoo.co.in) and Mukesh Sharma (drmks80@gmail.com)
• Chapter 3: Antibiotic Use and Abuse in Inpatients (Medical and Surgical) by Dhruva Chaudhry (dhruvachaudhry@yahoo.com) and Sunny Virdi (drsunnyvirdi@gmail.com)
• Chapter 4: Use and Misuse of Antibiotics in the Intensive Care Unit by Subhash Todi (drsubhashtodi@gmail.com)
• Chapter 5: Antibiotics in Peri-operative Care by J. V. Divatia (jdivatia@yahoo.com) and Amol Kothekar 
• Chapter 6: Antibiotics in an Immunocompromised Setting by Gaurav Prakash and Subhash Varma (suvarma@hotmail.com)

Section 2 – Misuse of Antibiotics

• Chapter 7: Over the Counter Use of Antibiotics by Subhash Todi (drsubhashtodi@gmail.com) 
• Chapter 8: Use of Antimicrobials in Veterinary and Animal Husbandry Practices by Sudhi Ranjan Garg (srgarg415@gmail.com)
• Chapter 9: Urban and Non-urban Consumption of Antibiotics by M. C. Gupta (dr.mcgupta57@gmail.com) and Niti Mittal (drniti.mittal@gmail.com)
• Chapter 10: Antibiotic Use in Developing Countries by Dhruva Chaudhry (dhruvachaudhry@yahoo.co.in) and Rahul Roshan (rahul.roshan81@gmail.com) 

Section 3 – Way Forward

• Chapter 11: Regulatory Issues in Antibiotics by B. L. Sherwal (drblsa703@yahoo.co.in) and Sonal Saxena
• Chapter 12: Microbiologist Perspectives on Antimicrobial Resistance by Raman Sardana (ramansardana@apollohospitals.com)
• Chapter 13: Prescription Behaviour and Audit of Antibiotics by M. C. Gupta (dr.mcgupta57@gmail.com) and Savita Verma
• Chapter 14: Antibiotic Stewardship by Neetu Jain (neetusms@yahoo.com) and Gopi C. Khilnani (gckhil@gmail.com)
• Chapter 15: Chennai Declaration by Abdul Ghafur (drghafur@hotmail.com) 

World Health Assembly addresses antimicrobial resistance

The World Health Assembly recently made resolutions to tackle antimicrobial resistance. Delegates endorsed a global action plan to tackle antimicrobial resistance - including antibiotic resistance, the most urgent drug resistance trend. Antimicrobial resistance is occurring everywhere in the world, compromising our ability to treat infectious diseases, as well as undermining many other advances in health and medicine.

The plan sets out 5 objectives:

1. Improve awareness and understanding of antimicrobial resistance.
2. Strengthen surveillance and research.
3. Reduce the incidence of infection.
4. Optimize the use of antimicrobial medicines.
5. Ensure sustainable investment in countering antimicrobial resistance.

The resolution urges Member States to put the plan into action, adapting it to their national priorities and specific contexts and mobilizing additional resources for its implementation. Through adoption of the global plan, governments all committed to have in place, by May 2017, a national action plan on antimicrobial resistance that is aligned with the global action plan. It needs to cover the use of antimicrobial medicines in animal health and agriculture, as well as for human health. WHO will work with countries to support the development and implementation of their national plans, and will report progress to the Health Assembly in 2017.

Source: WHO

10 facts about zoonotic neglected tropical diseases (zNTD)

Zoonoses are diseases that are naturally transmitted from vertebrate animals to humans and vice-versa. Neglected zoonotic diseases are a subset of the neglected tropical diseases. The term “neglected” highlights that the diseases affect mainly poor and marginalized populations in low-resource settings. There is now recognition that several zoonotic diseases within the Neglected Tropical Diseases (NTD) merit attention and these include rabies, echinococcosis, taeniasis/ cysticercosis and foodborne trematodiases.

1. Pathogens circulating in animals can create a risk for human health.
2. Zoonotic diseases (zoonoses) are naturally transmitted from animals to humans and vice-versa.
3. zNTDs are major causes of poor-health among rural populations.
4. There is a pressing need to tackle zNTDs.
5. Community participation is key to successful control programmes.
6. Dog rabies can be eliminated.
7. Undercooked pork is a major cause of porcine tapeworm infection.
8. Synergy between medical and veterinary practices is crucial for a ‘One Health’ approach.
9. WHO is addressing priority zoonotic diseases.
10. More resources are needed to control and eliminate zNTD.

Source: WHO

Ebola Virus Disease Outbreak

In March 2014, the Ministry of Health of Guinea notified WHO of a rapidly evolving outbreak of Ebola virus disease in forested areas of south-eastern Guinea. As of 22 March 2014, 49 cases including 29 deaths (case fatality ratio: 59%) had been reported. The disease later spread to the neighbouring countries of Liberia and Sierra Leone. It recently spread to Nigeria through a traveller from Liberia. Between 12 and 13 August 2014, a total of 152 new cases of Ebola virus disease (laboratory-confirmed, probable, and suspect cases) as well as 76 deaths were reported from Guinea, Liberia, Nigeria and Sierra Leone. As of 13 August 2014, total 2127 cases, including 1310 confirmed, 594 probable, and 223 suspect cases of Ebola virus disease have been recorded in Guinea, Liberia, Nigeria, and Sierra Leone resulting in 1145 human deaths.

The disease (previously known as Ebola haemorrhagic fever) is a severe zoonotic and often fatal disease that affects humans and nonhuman primates. It got its name because it was first recognized in a village situated near Ebola River in the Democratic Republic of the Congo (formerly Zaire) in Africa. Since its initial recognition in 1976, the disease outbreaks have been recorded in Africa. These are usually associated with very high case fatality rates up to 90%. The disease is caused by Ebolavirus. Current evidence suggests that fruit bats of the Pteropodidae family are the natural host for ebolaviruses. The virus is transmitted to people from wild animals (primates) and once the virus has entered the population, it can spread from person to person. Ebola virus disease outbreaks can devastate families and communities, but the infection can be controlled through the use of recommended protective measures in clinics and hospitals, at community gatherings, or at home. WHO recommends standard precautions in the care and treatment of all patients regardless of their perceived or confirmed infectious status. They include the basic level of infection control - hand hygiene, use of personal protective equipment to avoid direct contact with blood and body fluids, prevention of needle stick and injuries from other sharp instruments, and a set of environmental controls.

Source: WHO, CDC, Garg S.R. 2014. Ebola Haemorrhagic Fever. In: Garg S.R. (Ed.) Zoonoses: Viral, Rickettsial and Prion Diseases. Daya Publishing House, New Delhi. pp. 244-254.