2013年5月27日月曜日

マラリア偽薬

マラリアの偽薬が拡大している。
 全世界で年間2億人以上の患者が発生しているマラリアについて、粗悪
な治療・予防薬の流通が急増していることが、国連の調査で分かった。
アフリカと東南アジアで販売された薬のうち、約5割に薬効が不十分な
成分などが混ぜられていたという。こうした“偽薬”は中国や印が主要
製造元と推定されている。

UNODC
Transnational Organized Crime in East Asia and the Pacific
・1999-2005年
 東南アジアでの(マラリア薬成分?)検査で33-90%の薬が問題
・2000-2010年
 アフリカ諸国の(マラリア薬成分?)検査では、12-82%が不合格。
・(偽マラリア薬は、)粗悪な薬の中には血中のマラリア原虫を殺す成分が
 少ない安価な化学成分や石灰粉末などが混ぜられたものがある。

2010年の集計
・偽薬の製造国は、中国、印、パラグアイ、パキスタン、英国。
・東南アジアの偽薬の売上げは40億ドル。
・アフリカの偽薬の売上げは50億ドル。

マラリア原虫に耐性をつけさせ、さらにマラリア薬を買わせ、儲けよう
としている製薬会社があるようだ。

マラリア薬は儲からないから、先進国は製造しないと批判されたことが
あったが、この批判は高価だけでなく、信用も欲しかったのかもしれない。

NDM1の感染が拡大した頃、印では抗生物質が必要に以上に使用されている
との報道もあったが、偽マラリア薬から推察すると濃度の薄い抗生物質を
混ぜた偽薬も売買されているのかもしれない。
偽ヘパリンや工業用薬品を混ぜた医薬品が報道された中国に関しては、
想像がついた。英国も偽薬が売買されていた。

UNODCを知らなかったが、東アジア・太平洋地域の組織的な越境犯罪報告
書を見ると、偽商品や違法薬物、幼児売買春、人身売買等は多い。

バクスターCEO 偽ヘパリンは中国で混入
中国 メラミンで世界制覇
NDM1
コリスチン 希少疾病用医薬品認定へ
耐性菌感染
多剤耐性菌 国内定着か
抗生物質のない世界の終末シナリオ
Japan Rapid Weight Loss Diet Pills
Superbug感染予測


Fake Malaria Drugs Kill


World Malaria Day: Fake Drugs in the Global Fight


---世界のマラリア薬、半分偽物 主要製造元は中国とインド、国連が報告書---
2013.5.20 10:00
http://sankei.jp.msn.com/world/news/130520/erp13052010050000-n1.htm

 全世界で年間2億人以上の患者が発生しているマラリアについて、粗悪な治療・予防薬の流通が急増していることが、国連の調査で分かった。アフリカと東南アジアで販売された薬のうち、約5割に薬効が不十分な成分などが混ぜられていたという。こうした“偽薬”は中国やインドが主要製造元と推定されている。
 国連薬物犯罪事務所(UNODC)がまとめた東アジア・太平洋地域の組織的な越境犯罪に関する初の報告書で判明した。効果の薄い薬の投与が続けば、抗生物質が効かない薬剤耐性マラリアなどが拡散する恐れがあると警鐘を鳴らす。
 報告書によると、1999~2005年の東南アジアでの検査で33~90%の薬が問題とされ、00~10年にアフリカ諸国の検査では、12~82%が不合格だった。粗悪な薬の中には血中のマラリア原虫を殺す成分が少ない安価な化学成分や石灰粉末などが混ぜられたものがあり、報告書は、こうした薬の製造ビジネスが中国とインドで拡大していると指摘している。(共同)


---New malaria test kit gives a boost to elimination efforts worldwide---
20130519
http://www.healthcanal.com/infections/38783-new-malaria-test-kit-gives-a-boost-to-elimination-efforts-worldwide.html

LAMP test will also improve diagnosis for imported UK cases.

A new, highly sensitive blood test that quickly detects even the lowest levels of malaria parasites in the body could make a dramatic difference in efforts to tackle the disease in the UK and across the world, according to new research published in the Journal of Infectious Diseases.

In two studies led by researchers in the UK and Switzerland, the new LAMP (loop-mediated isothermal amplification) test was compared to existing methods in London laboratories that deal with imported cases of malaria to the UK, and to diagnostic methods used in the field in Uganda, where malaria is a leading cause of illness and death.

The simple test, which can be performed by a non-specialist health worker and does not need refrigerating like other tests, requires a sample of blood to be processed and placed in a test tube with a reactive powder then heated. If the malaria-causing Plasmodium parasites are present, the tube glows green. The whole process takes less than an hour.

The first study, led in London by the Hospital for Tropical Diseases (HTD), the Foundation for Innovative New Diagnostics and the London School of Hygiene & Tropical Medicine, compared LAMP to existing laboratory diagnostic methods on 705 blood samples of suspected imported malaria cases in the UK.

Dr Colin Sutherland, Clinical Scientist at HTD and Reader in Parasitology at the Malaria Reference Laboratory at the London School of Hygiene & Tropical Medicine, said: “According to data collected for Public Health England by the London School of Hygiene & Tropical Medicine, the UK treats at least 1,500 cases of imported malaria every year. Despite the very best efforts of the NHS, a handful of malaria related deaths still occur annually in UK hospitals. The new LAMP test for malaria performed very well when tested in the parasite reference laboratory at HTD, and correctly identified every malaria patient out of 705 malaria tests performed.

“An important advantage of LAMP is that non-specialist staff in any hospital in the UK will be able to accurately and rapidly detect the presence of malaria parasites, and immediately begin treatment without waiting for confirmation from local experts or specialist laboratories. This speed of diagnosis can make the difference between an uncomplicated episode of malaria that rapidly responds to treatment, and progression to severe disease, organ failure and heightened risk of death. It could also save the NHS a significant amount of money from having to treat the complications of malaria.”

LAMP was faster than PCR (polymerase chain reaction) tests, which require specialised laboratory equipment, costly reagents and advanced training. It was also more accurate than microscopic examination of blood slides, which require a trained specialist to identify the malaria parasites.

In the second study, researchers from HTD, the Foundation for Innovative New Diagnostics, Switzerland, the London School of Hygiene & Tropical Medicine and the Uganda Ministry of Health, Kampala, looked at the accuracy of the test at a rural clinic in Uganda.

Blood samples from 272 patients with suspected malaria were tested using LA MP using a simple generator to provide electrical current. These results were compared with expert microscopy and PCR performed at central reference laboratories. LAMP detected cases of low-level malaria parasite infection that were missed by expert microscopy, and achieved accuracy similar to that of PCR down to very low levels. The researchers say these findings have important implications for eliminating malaria, which causes an estimated 660,000 deaths worldwide every year.

Dr Sutherland, who worked on both of the studies, said: “Patterns of malaria disease in Africa and elsewhere across the tropics are becoming much less predictable, and control of malaria needs an appropriate test to identify infected individuals in the populations at risk. These people may not display any malaria symptoms. We have begun using LAMP as a new tool for identifying "hot spots" of malaria infections which can be mopped up quickly through a combination of drug treatment, house spraying and distribution of bed-nets.

“LAMP will potentially contribute to saving many families and communities from the blight of a disease that keeps children from succeeding at school, prevents adults from growing food or working, holds back regional economies and exacts an annual death toll in the hundreds of thousands.”

The LAMP malaria test will now be used in the Malaria Reference Laboratory at the London School of Hygiene & Tropical Medicine to help identify imported cases of malaria in the UK as well as being used by health workers in the field in malaria endemic countries.

The LAMP malaria test is commercially available and was developed by the Foundation for Innovative New Diagnostics, the Hospital for Tropical Diseases, London and Eiken Chemical Company Ltd, Japan. The studies were funded by the Bill and Melinda Gates Foundation, the Ministry of Foreign Affairs of the Government of The Netherlands, and the UK Department for International Development.
Publications:

    First study: Polley, Gonzalez, Mohamed, Daly, Bowers, Watson, Armstrong, Gray, Perkins, Bell, Kanda, Tomita, Kubota, Mori, Chiodini, Sutherland. Clinical Evaluation of a LAMP test kit for Diagnosis of Imported Malaria. Journal of Infectious Diseases. DOI: 10.1093/infdis/jit183
    Second study: Hopkins, Gonzalez, Polley, Angutoko,Ategeka, Asiimwe, Agaba, Kyabayinze, Sutherland, Perkins, Bell. Highly sensitive detection of malaria parasitemia in an endemic setting: Performance of a new LAMP kit in a remote clinic in Uganda. Journal of Infectious Diseases. DOI: 10.1093/infdis/jit184

London School of Hygiene & Tropical Medicine


---Malaria: finding a preventive strategy that African countries can afford---
Mike Davies and Julian Eaton
Guardian Professional, Wednesday 15 May 2013 12.27 BST
http://www.guardian.co.uk/global-development-professionals-network/2013/may/15/malaria-resource-gap

In countries where health services are fragmented, there are still ways to bridge the gap between the needs of malaria survivors with neurological impairment and the resources available

Every year in sub-Saharan Africa, more than 500,000 children contract cerebral malaria - 110,000 of these will die and many other are left with neurological impairments that can affect their physical and intellectual functioning. Evidence is scarce on exact numbers, but field teams encounter children with impairments for which there is no known cause or where "fever" is cited by the family in most sub-Saharan countries.

The cost to communities and the impact on their development is substantial, estimated to account for billions of dollars in lost productivity, reducing potential economic growth that would lift people out of poverty.

A severe episode of cerebral malaria can result in epilepsy, cerebral palsy, or intellectual or physical disabilities. Even in well resourced countries, it can be challenging for families to manage the needs of disabled children. These malaria victims are in the poorest, and sometimes most remote parts of the world, increasing the difficulty in finding support to cope with their disabilities.

Cerebral malaria is a complication of infection by the Plasmodium falciparum sub-type of the malaria parasite. The World Health Organisation (WHO) reports that the parasite has developed resistance to chloroquine, the cheapest and most commonly used anti-malarial drug in Africa. The more recent artemisinin drugs are now recommended by the WHO, but chloroquine continues to be used in many parts of sub-Saharan Africa.

Until recently, doctors have focused on the survival of patients with cerebral malaria and not on long-term outcomes. As a result, the number of patients who have developed chronic neuro-cognitive dysfunction following malaria has been underestimated and under-reported.

Challenges
A lack of healthcare professionals in remote communities is a major challenge; they are vital to manage complications of malaria effectively. The disease can be fatal or leave residual neurological deficits. Inadequate care or inappropriate administration of anti-malarial agents can likely lead to disabling conditions such as post-injection paralysis and gluteal fibrosis.

For example, many children in low-income countries develop sciatic nerve paralysis and muscle fibrosis from inappropriate or poorly administered injections. Quinine which is used as anti-malarial should be reserved for treatment of complicated malaria, and should only be administered in health centres where the dosage can be monitored to avoid the risk of long-term hearing or physical impairments.

Poverty has been shown to increase the chances of disability, and disability, in turn, increases the chances of poverty. Healthcare, education and livelihood services may be scarce, costly and not easy for persons with disabilities to access. Our community-based rehabilitation strategy focuses on promoting preventive measures, but also on early detection and intervention of all forms of childhood impairment, including those impairments caused by cerebral malaria. In reality, the causes of many impairments are not known because of lack of access to health services. While some countries are starting to address malaria prevention, less attention is given to dealing with the consequences. Much more effort is needed to campaign for increased government support for services that help to minimise the disabling consequences of disease, including cerebral malaria.

What's next?
Services in Africa are still very fragmented. It is estimated that only around 15% of people with severe mental and neurological illness in sub-Saharan Africa can access the care they need. In the field of neurological impairment, the gap between needs and resources can be partly addressed using a twin-track approach of advocacy for greater government support, combined with grassroots work - often by local NGOs - to prevent malaria and to provide early detection and intervention services. Community-level intervention typically includes cognitive stimulation exercises, physical therapy, medication to prevent epileptic seizures and promoting access to education and livelihood services.

In recent years, a substantial amount of money has been invested by international bodies in malaria prevention, typically in the promotion or distribution of treated mosquito nets, anti-malarial drugs and in environmental improvements. According to the WHO, the elimination of malaria would cost 20% of a country's public health budget, a target that is clearly unrealistic for poor countries, given their other pressing priorities.

Research in the field of blindness has shown the economic impact of visual impairment on families, and this impact is the same for those with other forms of impairment, including neurological problems. Mitigating the disabling consequences of neurological impairment through community-based early detection and intervention activities remains the best hope for an improved quality of life of many thousands of children in Africa and elsewhere.


---Organised crime worth $90b a year in East Asia---
Created on April 16, 2013 at 20:54
Tribune Online Report Australia
http://dhakatribune.com/australia/2013/apr/16/organised-crime-worth-90b-year-east-asia

The top money-makers for criminal groups are the trade in counterfeit goods ($24.4b), illegal wood products ($17b), heroin ($16.3b) and methamphetamines ($15b)

 AFP, Sydney

Organised crime gangs dealing in fake goods, drugs, human trafficking, and the illicit wildlife trade earn nearly $90b annually in East Asia and the Pacific, a UN report showed Tuesday.

"Transnational Organised Crime in East Asia and the Pacific: A Threat Assessment" is the most comprehensive study ever undertaken of the subject, the UN Office on Drugs and Crime said.

It estimates that the top money-makers for criminal groups are the trade in counterfeit goods ($24.4b), illegal wood products ($17b), heroin ($16.3b) and methamphetamines ($15b).

Fake medicines ($5b), the black market trade in used electronics components to avoid legitimate recycling ($3.75b) and the illegal wildlife trade ($2.5b) also rank highly.

Migrant smuggling and the trafficking of women and girls for prostitution or general labour also earn crime bosses hundreds of ms of dollars each year.

UNODC deputy executive director Sandeep Chawla said the report opened the window on "the mechanics of illicit trade: the how, where, when, who and why of selected contraband markets affecting this region".

"It looks at how criminal enterprises have developed alongside legitimate commerce and taken advantage of distribution and logistics chains," he said at the launch in Sydney.

Chawla highlighted the growing problem of heroin. Consumption is rising across the region - estimated at 65 m tons in 2011 - with Chinese the main users and Myanmar the key producer.

"Myanmar is the principal source of opiates in Southeast Asia. Doing something about tackling opiates in Myanmar is a very important thing for the region," said Chawla.

"Clearly that is something that more attention can be given to with the change in government that's happening in the country at the moment.

Jeremy Douglas, the UNODC regional representative for Southeast Asia and the Pacific, said many of the organised criminal activities could have serious global health implications.

"Between one-third to 90% of anti-malarial drugs tested in Southeast Asia are fraudulent," he said, with China and India the main culprits in production.

"They do not contain what they say they do. Sub-standard drugs have two serious public health consequences: One: people get sicker or die; Two: drug-resistant strains can develop and cause a global health threat."

With rapid economic growth leading to a proliferation of criminal networks, he said the threat was now so great that it has the ability to "destabilise societies around the globe".

"Illicit profits from crimes in East Asia and the Pacific can buy property and companies and corrupt anywhere," he said.

"We need to talk about this, and organise a coordinated response now. It takes a network to defeat a network."

The trade in counterfeit goods is the most lucrative activity, despite being considered a "soft" form of crime, with China the worst culprit.

According to the World Customs Organisation, 75% of all fake products seized worldwide from 2008 to 2010 were from East Asia, primarily China, with the industry accounting for some two percent of world trade.

"The key players in counterfeit markets are brokers and logisticians who connect supply and demand," the report said.

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