Clinical trials for cholera vaccines produced in rice plants

Japan’s Astellas, a pharmaceutical company, is carrying out clinical trials for MucoRice-CTB vaccine, which protects against cholera and enterotoxigenic E. coli. Here’s the interesting point: it’s produced in transgenic rice plants.

Antisense genes specific rice storage proteins is introduced to switch the normal carbohydrate for the vaccine antigens. The matured rice is polished and powdered to release the drug substance.

Some good points: it is stable at room temperature, easy to produce in bulk, does not need to be refrigerated, typically cheaper, and will be orally-administered, which provides mucosal immunity in addition to systemic immunity.

Currently, the more commonly used cholera vaccines are in oral form, often marketed as Dukoral and Shanchol. There is an injectable form but is rarely in use.

This MucoRice-CTB vaccine is developed by researchers at the International Research Development Centre for Mucosal Vaccines (IMSUT) in Japan. Though transgenic plants has been a way to produce cheaper recombinant protein products for years, there are many difficulties like growing conditions. Astellas’ decision to license MucoRice-CTB vaccine signifies that there’s commercial prospect of transgenic plant production of vaccines.

Here’s hoping the trials succeed and the vaccine become more widely available to those who need them, especially in countries where cholera is endemic.

References

Talylor, P., 2016. BioPharma. [Online]
Available at: http://www.biopharma-reporter.com/Bio-Developments/Astellas-to-develop-rice-based-oral-cholera-vaccine
[Accessed 7 August 2016].

Outbreak affecting students of Nyang’ori High School in Kenya

There has been an outbreak of cholera at the Nyang’ori High School in Hamisi constituency in Kenya. On 12 July 2016, the Hamisi sub-county health department was informed of students vomiting and having diarrhoea. A team of doctors, clinical officer, and nurses was rushed to the school, with a treatment centre being set up there to deal with the cases.

92 students are quarantined at school, 5 are still at the Tigoi Health Centre receiving treatment, and 1 at critical condition was referred to the county hospital in Mbale.

The school has a problem with their water source as the Sosian Water Supply is not reliable, and is currently relying on supply from Kisumu by water bowsers. The water harvesting tanks in school are being tested for signs of pathogens.

Earlier this March, cholera cases were reported in another part of the Hamisi constituency, the Tambua ward.

References

Lungai, E., 2016. Standard Digital News. [Online]
Available at: http://www.standardmedia.co.ke/health/article/2000208540/cholera-outbreak-at-nyang-ori-high-school-as-98-students-seek-treatment
[Accessed 18 July 2016].

 

Situation in Haiti since 2010 earthquake

The cholera outbreak in Haiti began shortly after its disastrous 2010 earthquake. The incidence rate has since decreased by 90% due to efforts of the Haitian government, the UN, the UNICEF, and their various partners. However, more funds are needed to completely eliminate the disease as well as provide Haitians with clean water access and good sanitation facilities.

Rapid response teams

To combat the cholera situation in Haiti, $3.5-4 million a year is needed to maintain a rapid response mechanism comprised of 50 teams. These teams are dispatched to every reported case to help sanitise the affected area and provide oral rehydration. They also help with Zika and other infectious diseases. With these teams, the number of cases went down by 90% to 36,000 last year.

Efforts made

UNICEF and their partners are working on implementing cholera treatment centres in isolated areas; with the government to improve the overall health-care system; and with the population to reduce open defecation. The UN and the prime minister of Haiti launched a campaign in 2014, resulting in a total of 31 communities becoming open defecation free.

Challenges

However, urban areas still need improving as they have become the centre of cholera circulation. UNICEF would like to invest in reducing contamination there as well as repairing the water system. About $5 million is needed to map out weaknesses in water system.

In total

Up to May this year, about 780,000 cases have been reported, with over 9,000 deaths. As of June this year, $67 million was used in projects reaching 400,000 beneficiaries. There is still a long way to go to stop cholera in Haiti as well as provide the country with a good, stable health-care system.

References

United Nations News Centre, 2016. United Nations News Centre. [Online]
Available at: http://www.un.org/apps/news/story.asp?NewsID=54383#.V4KSYLh942y
[Accessed 10 July 2016].

Cholera outbreak in India (follow up, 30/6)

The outbreak of cholera in the northern Indian state of Karnataka started back in May and has since seen more than 120 cases reported. The number of cases in Humnabad taluka has increased to 40, and other cases have been reported in Mustapur wadi village, Kallur, and Sindhankera.

Emergency response teams have been sent to the affected areas and the public is being encouraged to build and use toilets, as the spread of cholera is increased by open defecation.

References

Herriman, R., 2016. Outbreak News Today. [Online]
Available at: http://outbreaknewstoday.com/cholera-outbreak-downs-more-than-120-in-karnataka-90232/
[Accessed 30 June 2016].

Cholera affects Ossi Primary School in Uganda

Located in the Parombo sub-county, 10 pupils in Ossi Primary School have been infected with the disease. This have led to the subsequent closure of the school by the Nebbi District authorities to help control the spread of the disease.

This outbreak initially started last month in the Panyimur sub-county, spreading to both Parombo and Erussi sub-counties. 169 cases have been registered in health units and Nebbi hospital so far with 5 deaths.

References

Adubango, I., 2016. All Africa. [Online]
Available at: http://allafrica.com/stories/201606220167.html
[Accessed 25 June 2016].

 

Cholera outbreak in India, 15 June 2016

A village in the town Humnabad, in the Indian state of Karnataka, have reported at least 34 cases of cholera infection in 10 days. No one has died of the disease. A team of five doctors and officers are in the village to treat the patients, including Dr Jabbar, a District Disease Surveillance Officer.

Some possible causes include contaminated drinking water sources by open defecation, as well as leakages in pipes carrying water to cisterns. Measures are being taken to reduce spread of the disease, like large-scale disinfection using bleaching powders and testing the water quality in wells.

References:

The Hindu, 2016. The Hindu. [Online]
Available at: http://www.thehindu.com/news/national/karnataka/cholera-outbreak-confirmed-in-humnabad-taluk/article8732815.ece
[Accessed 20 June 2016].

Brief Background of Cholera

Cholera is an infectious disease caused by the bacteria Vibrio cholera, usually ingested through contaminated food or water. It infects the intestine, causing severe watery diarrhoea and dehydration, leading to death if left untreated.

Cholera is quite widespread, with about 1.4 to 4.3 million cases and 28,000 to 142,000 deaths a year (World Health Organisation, 2015). It is also endemic in many countries, like India, Ethiopia, and Haiti (Mohammad, et al., 2015). This is usually due to poor water and sanitation facilities.

Cholera can be treated successfully through oral rehydration salts while severely dehydrated patients would need intravenous fluids and appropriate antibiotics. There are currently two oral cholera vaccines available, used in mass vaccination campaigns with the World Health Organisation support.

References

Mohammad, A., Nelson, A. R., Lopez, A. L. & Sack, D. A., 2015. National Center for Biotechnology. [Online]
Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455997/
[Accessed 25 May 2016].

World Health Organisation, 2015. World Health Organisation. [Online]
Available at: http://www.who.int/mediacentre/factsheets/fs107/en/
[Accessed 25 May 2016].