On April 25, 2007, the city of San Francisco (CA, USA) launched Hep B Free San Francisco, the largest health-care campaign to target Asians and Pacific islanders in the USA. Under the slogan “B sure, B tested, B free”, the collaborative effort brings together city government, private health-care and non-profit community organisations in a 2-year campaign to screen, vaccinate, and treat all Asian Pacific islander residents in the city for hepatitis B. San Francisco has the highest liver cancer rate in the USA, and Asian Pacific islanders are up to 100 times more likely to have chronic hepatitis B virus infection and four times more likely to die from liver cancer compared with the general population, according to the campaign. The following websites also target hepatitis B awareness. Clinical implications of HIV and hepatitis B co-infection in Asia and AfricaHepatitis B virus (HBV) is the leading cause of chronic liver disease and liver-related death worldwide, with the majority of these cases occurring in areas of Africa and Asia where HBV prevalence is high. Many of the countries that are affected by hepatitis B are also affected by a high HIV burden, leading to frequent HIV/HBV co-infection. The consequences of co-infection, including increased liver-related morbidity and mortality, increased hepatitis B viral replication, immune reconstitution to HBV in the setting of antiretroviral therapy, and hepatotoxicity from antiretroviral drugs, are especially important in regions with expanding antiretroviral programmes. Full-Text PDF Should hepatitis B vaccination be introduced into childhood immunisation programmes in northern Europe?Infection with hepatitis B causes between 500 000 and 1·2 million deaths per year worldwide, and is the leading cause of liver cancer. Over 12 years ago, WHO recommended that universal childhood hepatitis B vaccination be implemented globally. Despite this, Denmark, Finland, Iceland, Ireland, the Netherlands, Norway, Sweden, and the UK have yet to implement such a policy and instead currently adopt an “at-risk” strategy. Although all eight countries are classed as having low endemicity, factors such as increased travel and integration of immigrant communities are increasing the number of at-risk individuals in these countries. Full-Text PDF

US researchers shed light on the factors and mechanism responsible for virulent toxoplasma infections in three studies published in December, 2006. The findings “might allow more informed management of cases where infection might be more severe” and could ultimately pave the way to more effective treatments, said David Sibley (Washington University, St Louis, MO, USA), a coauthor of two of the studies.

As TLID goes to press, US health officials continue to debate the requirement that young girls be inoculated against human papillomavirus (HPV). The vaccine, Gardasil, has been shown to be 100% effective against HPV strains 16 and 18, which together cause 70% of cervical cancers and 90% of genital warts. “The vaccine is a marvel and seems to be extremely safe”, said Gilbert Ross, American Council on Science and Health, a public-health advocacy organisation based in New York City. “If it is given to enough young girls, some degree of community (or herd) immunity might develop to protect even those who are not vaccinated.”

Chagas disease has spread from Latin America to the USA and Europe as a result of inadequate blood screening, according to a statement from WHO. “This disease still poses a threat to so many people in Latin America and now that threat has spread to other countries via blood banks lacking adequate screening of infected donors,” Mirta Roses Periago, WHO regional director for the Americas warned in a statement.

Invasive disease caused by serotypes not covered in the routine pneumococcal vaccination is emerging among Alaska's native children, report US researchers. “Serotype replacement—that is, a changing prevalence of pathogenic bacterial serotypes—is a phenomenon we've been concerned about. But it has not emerged to a significant extent until now in most populations”, lead author Rosalyn Singleton of the US Centers for Disease Control and Prevention (Anchorage, AK, USA) told TLID.

The US Food and Drug Administration (FDA) has reaffirmed its 1983 policy to refuse blood donations from men who have sex with men. Any man who has had sex with another man since 1977, the beginning of the AIDS epidemic in the USA, will remain disqualified from donating blood. According to the FDA, this policy will remain in place to protect all people who receive blood transfusions from an increased risk of exposure to potentially infected blood and blood products. “These men have an HIV prevalence 60 times higher than the general population, 800 times higher than first time blood donors, and 8000 times higher than repeat blood donors”, claims the agency.

The $40 billion gift from billionaire philanthropist Warren Buffett to the Bill & Melinda Gates Foundation will “deepen and accelerate” the charity's commitment to global health and education, Melinda Gates said in a press conference announcing the gift on June 26, 2006, in New York City. “It's a big challenge for us to make sure that this money gets used the right way, but one that we're thrilled about”, added Bill Gates. “We're going to do our best to have as much impact as possible.”

The following reviews highlight projects that are using technology to rapidly detect and counter bioterrorism threats and prevent the spread of infectious diseases.

A coming-of-age film whose main character is a drug company sales rep? I was intrigued. Karly Hert (Katherine Heigl) is conflicted. She loves the perks of the job, but feels guilty that she is forced to hide concerns about certain drugs when she makes her sales pitches. Despite her conscience, she is seduced by the huge cheques and becomes the company's new darling. On the eve of the launch of the company's blockbuster drug, however, some potentially deadly side-effects surface. The data are squelched, but not before Karly finds out. Will she blow the whistle during a meeting, where she will be honoured as rep of the year?Producer/director Kathleen Slattery-Moschkau worked as a sales rep for a large drug company for 10 years. She wrote the script for Side Effects, then left the industry. Rather than succumbing to Hollywood pressures to “dumb down” the script, she produced it herself, releasing it in theatres that play independent films in various cities in the USA (plans for a UK release are underway). At the same time, she produced a chilling documentary, Money Talks: Profits Before Patient Safety, in which physicians, a medical journalist, and others familiar with the drug industry talk candidly about selling drugs, rewarding prescribers, courting physicians with gifts, the impact of direct-to-consumer advertising, and ghostwriting of journal articles. Both film and documentary push the message that “most-of-what-they-do-is-profit-driven”, but in a quirky and engaging way. A coming-of-age film whose main character is a drug company sales rep? I was intrigued. Karly Hert (Katherine Heigl) is conflicted. She loves the perks of the job, but feels guilty that she is forced to hide concerns about certain drugs when she makes her sales pitches. Despite her conscience, she is seduced by the huge cheques and becomes the company's new darling. On the eve of the launch of the company's blockbuster drug, however, some potentially deadly side-effects surface. The data are squelched, but not before Karly finds out. Will she blow the whistle during a meeting, where she will be honoured as rep of the year? Producer/director Kathleen Slattery-Moschkau worked as a sales rep for a large drug company for 10 years. She wrote the script for Side Effects, then left the industry. Rather than succumbing to Hollywood pressures to “dumb down” the script, she produced it herself, releasing it in theatres that play independent films in various cities in the USA (plans for a UK release are underway). At the same time, she produced a chilling documentary, Money Talks: Profits Before Patient Safety, in which physicians, a medical journalist, and others familiar with the drug industry talk candidly about selling drugs, rewarding prescribers, courting physicians with gifts, the impact of direct-to-consumer advertising, and ghostwriting of journal articles. Both film and documentary push the message that “most-of-what-they-do-is-profit-driven”, but in a quirky and engaging way.

"Few people would picture the face of the HIV pandemic as a wrinkled one", note the authors of an excellent, up-to-date overview of HIV/AIDS and older people, posted on the AVERT website. They warn that "ignorance, stereotyping and false assumptions are failing older people within the response to the pandemic and failing the wider community with an unwillingness to engage older people in the fight against AIDS". They proceed to look at the data and public health and policy implications of the issues surrounding HIV/AIDS in adults aged 50 years plus, which include risk, testing, treatment, prevention, stigma, older people as carers, and the role of poverty.

The US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) warned contact lens wearers to “immediately discontinue” use of ReNu with MoistureLoc solution by Bausch & Lomb (Rochester, NY, USA) after an investigation revealed a statistically significant increased risk for fusarium keratitis, a fungal infection of the cornea, compared with use of other contact lens solutions. The warning came on the heels of a preliminary report from the US Food and Drug Administration (FDA) citing deviations from the FDA quality system at two Bausch & Lomb manufacturing facilities, and the company's withdrawal of the solution from the world market on May 15, 2006. The CDC report ended weeks of speculation about the cause of the fungal infection and confusion among contact lens wearers (including this reporter) about the safety of their contact lens cleaning products.

A search in Google's news section reveals that scabies is ubiquitous. Recent examples include an outbreak in San Antonio, TX, USA, an outbreak in an office in Leeds, UK, and infestation of a prison on the island of Jamaica. Yet, despite the fact that infestations affect some 300 million people worldwide of all races, sex, and socioeconomic status, as the review on page 769 suggests, treatment is time consuming and requires diligence and follow through. Reading through the scabies information on the following sites emphasises the need for new approaches. Scabies: a ubiquitous neglected skin diseaseScabies has been a scourge among human beings for thousands of years. Its worldwide occurrence with epidemics during war, famine, and overcrowding is responsible for an estimated 300 million people currently infested. Scabies refers to the various skin lesions produced by female mites, and their eggs and scybala that are deposited in the epidermis, leading to delayed-type hypersensitivity reaction. Recent immunological findings such as cross-reactivity with house dust mite allergens and an altered T-helper-1/T-helper-2 pattern contribute to a better understanding of the pathomechanism. Full-Text PDF

The Bill & Melinda Gates Foundation has awarded grants totaling US$287 million to create an international network of “highly collaborative research consortia” aimed at accelerating the pace of HIV vaccine development. The grants fund 11 consortia that bring together more than 165 investigators from 19 countries, known collectively as the Collaboration for AIDS Vaccine Discovery, said Nicholas Hellmann, Gates Foundation interim director of HIV, tuberculosis, and reproductive health programmes, in a July 19, 2006 press briefing.

The rate of infectious disease hospitalisations increased by 13% in the last decade among US adults aged 65 years or older, whereas the rates for those under the age of 65 decreased, report researchers at the US Centers for Disease Control and Prevention. Since the number of older adults is expected to double by 2030, efforts to reduce infectious disease hospitalisations should be “a high priority”, says lead author Aaron Curns.

Counterfeit anti-infective drugsThe production of counterfeit or substandard anti-infective drugs is a widespread and under-recognised problem that contributes to morbidity, mortality, and drug resistance, and leads to spurious reporting of resistance and toxicity and loss of confidence in health-care systems. Counterfeit drugs particularly affect the most disadvantaged people in poor countries. Although advances in forensic chemical analysis and simple field tests will enhance drug quality monitoring, improved access to inexpensive genuine medicines, support of drug regulatory authorities, more open reporting, vigorous law enforcement, and more international cooperation with determined political leadership will be essential to counter this threat. Full-Text PDF Combating counterfeit drugs onlineThe internet has become “the primary tool for criminal organizations to advertise, communicate and conduct sales of counterfeit pharmaceuticals”, according to a July 11, 2006 report from the US Immigrations and Customs Enforcement (ICE). But the internet is also being used to combat the counterfeit drug problem, and SafeMedicines.org , which links to the US ICE report, is among the leaders in this effort. SafeMedicines.org was created by the Partnership for Safe Medicines, a group of organisations and individuals that have policies in place to protect consumers from fake drugs. Full-Text PDF

The explosion of information about avian flu and the potential pandemic has spawned Flu Wiki, an online collaboration that allows anyone to contribute to the site's pages. As evidenced in the free online encyclopaedia Wikipedia, the wiki format allows “diverse, decentralized participation” by experts and novices alike, from any part of the world. “No one, in any health department or government agency, knows all the things needed to cope with an influenza pandemic”, note the Flu Wiki editors. “The world is filled with competent others who are likely to have credible and useful information … By pooling and sharing our knowledge, we hope to advance both preparation for and the ability to cope with events as they unfold.”

Last month, a day after the US Food and Drug Administration (FDA) approved sitagliptin phosphate (Januvia) to treat type 2 diabetes, the US Federal Trade Commission (FTC) announced a collaborative effort by US regulators and government agencies in Canada and Mexico to stop deceptive internet advertisements and sales of products misrepresented as cures or treatments for diabetes. Warnings and advisories were sent to online outlets in all three countries. The FTC also launched a consumer education campaign on how to avoid phony diabetes cures using a bogus website that promotes a purported cure, Glucobate. When the visitor clicks to order the product, the site reveals information about avoiding ads for phony cure-alls in the future. To help physicians better treat the burgeoning number of patients with diabetes, and to help patients help themselves, many websites offer useful information. From the USA, the FDA's Diabetes Information site offers user-friendly information on glucose meters and other aspects of diabetes management. The robust National Diabetes Information Clearinghouse, a service of the US National Institute of Diabetes and Digestive and Kidney Diseases, includes links to clinical trials, and reports, guidelines, access to relevant databases, and education materials for patients. The American Diabetes Association Website offers extensive educational materials for the public and health professionals. Useful UK sites include Diabetes UK, a charity that funds research and provides education for people with diabetes and health professionals. Highlights here are a diabetes awareness tool to help meet the needs of diverse communities and various reports and statistics. The National Library for Health's Diabetes Specialist Library is filled with relevant reviews, studies, and information. This website can be used in conjunction with the National Diabetes Support Team, which offers news, guidance, advice, information, and online forums for health-care professionals implementing the Diabetes National Service Framework. For a global view of diabetes, visit WHO's non-communicable disease prevention and health promotion page and the diabetes section of the global strategy on diet, physical activity, and health. FTC on diabetes productshttp://www.cfsan.fda.gov/∼dms/dialist.htmlFTC site Glucobatehttp://wemarket4u.net/glucobate/index.htmlFDA Diabetes Informationhttp://www.fda.gov/diabetesNational Diabetes Information Clearinghousehttp://diabetes.niddk.nih.govAmerican Diabetes Associationhttp://www.diabetes.org/home.jspDiabetes UKhttp://www.diabetes.org.ukDiabetes Specialist Libraryhttp://www.library.nhs.uk/diabetesNational Diabetes Support Teamhttp://www.diabetes.nhs.ukWHO Fact Sheet Diabeteshttp://www.who.int/hpr/gs.fs.diabetes.shtml FTC on diabetes products http://www.cfsan.fda.gov/∼dms/dialist.html FTC site Glucobate http://wemarket4u.net/glucobate/index.html FDA Diabetes Information http://www.fda.gov/diabetes National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov American Diabetes Association http://www.diabetes.org/home.jsp Diabetes UK http://www.diabetes.org.uk Diabetes Specialist Library http://www.library.nhs.uk/diabetes National Diabetes Support Team http://www.diabetes.nhs.uk WHO Fact Sheet Diabetes http://www.who.int/hpr/gs.fs.diabetes.shtml

The Global Initiative for Asthma (GINA) is an excellent starting point for generalist clinicians and researchers who want to learn more about worldwide efforts to reduce asthma prevalence, morbidity, and mortality. GINA is a founding member of WHO's recently launched Global Alliance Against Chronic Respiratory Diseases, which aims to help, among others, the 300 million people around the world with asthma. The GINA site offers downloadable reports, such as the Global Burden of Asthma; instructions for inhaler and spacer use; pocket guides for asthma management and prevention in adults and children; teaching slide sets; and information on regional initiatives. There are several other sites that help clinicians stay aware of the latest asthma research and treatments. The American Academy of Allergy, Asthma, & Immunology: Professionals includes summaries of recent studies published in the Journal of Allergy and Clinical Immunology, clinician referral guidelines, a comprehensive allergy and medication guide, an “ask the expert” function, and downloadable patient education handouts. Asthma UK: Health Professionals provides information and funds research aimed at improving the health and wellbeing of people with asthma in the UK. For clinicians, the site offers reports on asthma prevalence; application for funding of local projects; education materials for patients; and a forum. Researchers can access a database of ongoing projects, profiles of grant recipients, and information on funding opportunities. Another robust site that offers a wide range of materials for health professionals is CDC: Asthma. The site's many reports, maps, tables, charts, and slides cover asthma prevalence and surveillance, the course of the disease, and interventions, as well as legislative and policy issues. The US Environmental Protection Agency's Asthma Health Care Professionals site provides materials and supports research on links between asthma and environmental factors. Highlights include a checklist for in-home assessments on indoor environmental asthma triggers; downloadable videos, brochures, and other tools for parents and carers; and access to an online continuing education course on environmental triggers of asthma. For a general overview on asthma go to WHO: Asthma, which offers in-depth information on asthma burden, causes, and management, alongside reports on relevant WHO initiatives and activities.