Thursday, 15 August 2013

The joy of studying harder and getting good grades amidst acid attacks; lessons from UK and Zanzibar

Student who had acid thrown into her face in Zanzibar learns she has won a place at Bristol moments before skin graft operation

  • Katie Gee and Kirstie Trup, both 18, were doused with acid on Zanzibar
  • Miss Trup will be reading history while Miss Gee wants to go to Leeds
  • Both are due to have grafts at  Chelsea and Westminster Hospital
  • Boy, 12, gets A* in maths while teenager gets 6A*s in her incredible results

One of the teenagers who had acid thrown on her in Zanzibar was told she had been given a place at university as she went into surgery for a skin graft this morning.
Kirstie Trup will be going to Bristol University and reading history after receiving her A level results like thousands of others today.
The 18-year-old found out the news at the burns unit in Chelsea and Westminster hospital this morning.
She and Katie Gee, also 18, were splashed with battery acid while volunteering on the African island, leaving them with burns on their faces, chests and hands.
Kirstie Trup, who was attacked in Zanzibar
Kirstie Trup's family released this photograph apparently showing one of the girls' injuries
Brave: Kirstie Trup, who was attacked in Zanzibar, received some good news today before she went into surgery for a skin graft, because she is off to university after getting good A-Level grades
Apprehension: Kirstie Trup, left, and Katie Gee, were flown home from the Indian Ocean island after the attack, and both will get exam results today like thousands of others
Apprehension: Kirstie Trup, left, and Katie Gee, were flown home from the Indian Ocean island after the attack, and both will get exam results today like thousands of others
Miss Gee is also expecting her results today and is about to undergo skin graft procedures at the Chelsea and Westminster as well.
Kirstie's family said today they received the news when the UCAS website indicated that she had been accepted by the university indicating that she had achieved the grades required.
 
She wants to study history while Katie's first choice is the University of Leeds.
Speaking from her bedside, her proud father Marc said: 'Kirstie got the good news before she went into theatre this morning.
Care: The two teenagers were both taken to Chelsea and Westminster Hospital after returning to the UK from Zanzibar on Friday
Care: The two teenagers were both taken to Chelsea and Westminster Hospital after returning to the UK from Zanzibar on Friday
'Beyond imagination': The teenage girls were covered by sheets as they were escorted out of an ambulance and into the hospital
'Beyond imagination': The teenage girls were covered by sheets as they were escorted out of an ambulance and into the hospital
Attack: Two men on a moped hurled acid in the girls' faces as they walked to meet friends for dinner in Stone Town, Zanzibar (pictured)
Attack: Two men on a moped hurled acid in the girls' faces as they walked to meet friends for dinner in Stone Town, Zanzibar (seen in a file photo)
'We haven't opened the letter with her results in yet, but Kirstie is very modest so I don't think she will want to tell the whole world if she has done well.
'We found out that she got a place to study History at Bristol University and will be starting in September, she will be very pleased.
'At the moment she is having an operation, a skin graft, and will probably be in hospital for a couple of days feeling a bit uncomfortable.
'At the moment my wife Rochelle and I are waiting for her to come out.
'She is incredibly positive, she is very strong, but we have never had any experience of this kind of thing before and nothing can prepare you for it.'
Kate Prescott, 18, from Swanmore, who will be going to Cambridge University to study natural sciences after receiving six A*s
Bright spark: Kate Prescott, 18, from Swanmore, will be going toCambridge University to study natural sciences after receiving six A*s this morning
Kate Prescott is celebrating getting six A*s in her A-levels and will now go to Cambridge University to study natural sciences.
The 18-year-old, from Swanmore in Hampshire, also scored three As in her AS-levels at state-run Peter Symonds' College in Winchester.
'I'm speechless really,' she said. 'I guess I did work a little bit. Really, I did work really hard - I didn't have much spare time, but I have achieved what I wanted.
'I'm surprised I have done so well because I had a lot of subjects, so, although I was predicted A*s, I could have slipped up with some of them.'
The keen sailor received the top grades at A-level in maths, further maths, chemistry, physics, general studies and the extended project. She got As at AS-level in biology, French and critical thinking.
'I don't think that A-levels are getting easier; perhaps people are just getting better,' she said. 
'Everyone works very hard to do well.'
She will now go to Cambridge in the autumn and will not take a gap year.
'I think I want to go into science research of some sort but I don't know which science yet,' she added.
Meanwhile child genius Andrew Ejemai picked up an A* in his A-Level maths - at the age of 12.
Usain Bolt fanatic Andrew proved he is as quick off the mark as his hero by acing the exam at Brentwood School, Essex, six years early.
Clever boy: 12-year-old Andrew Ejemai got an A* in A-Level maths at at Brentwood College, Essex
Clever boy: 12-year-old Andrew Ejemai got an A* in A-Level maths at at Brentwood College, Essex
Brainbox Andrew was offered a place at prestigious Eton College after earning an A* in GCSE maths when he was just NINE.
After collecting his result yesterday (Thursday), the wannabee computer engineer said: 'I started to enjoy maths when I was six or seven years old. 
'I like solving equations and algebra and feel happy when I solve a hard question.'
Jon Williams, head of maths at Brentwood, said: 'Andrew is a very talented young man with an exceptional ability in Mathematics. 
'To have completed his A Level by the age of 12 is impressive enough. To have achieved an A* grade is phenomenal.
'He is the most able student I have come across in 18 years of teaching.'


Read more: http://www.dailymail.co.uk/news/article-2394375/Student-acid-thrown-face-Zanzibar-learns-won-place-Bristol-moments-skin-graft-operation.html#ixzz2c2S0TDDT
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Wednesday, 14 August 2013

Lessons in introspective check-mating and leadership best practices from Clinton Foundation

Unease at Clinton Foundation Over Finances and Ambitions


Soon after the 10th anniversary of the foundation bearing his name,Bill Clinton met with a small group of aides and two lawyers from Simpson Thacher & Bartlett. Two weeks of interviews with Clinton Foundation executives and former employees had led the lawyers to some unsettling conclusions.
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Joao Silva/The New York Times
Bill Clinton and his daughter, Chelsea, in South Africa last week.

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The review echoed criticism of Mr. Clinton’s early years in the White House: For all of its successes, the Clinton Foundation had become a sprawling concern, supervised by a rotating board of old Clinton hands, vulnerable to distraction and threatened by conflicts of interest. It ran multimillion-dollar deficits for several years, despite vast amounts of money flowing in.
And concern was rising inside and outside the organization about Douglas J. Band, a onetime personal assistant to Mr. Clinton who had started a lucrative corporate consultingfirm — which Mr. Clinton joined as a paid adviser — while overseeing the Clinton Global Initiative, the foundation’s glitzy annual gathering of chief executives, heads of state, and celebrities.
The review set off more than a year of internal debate, and spurred an evolution in the organization that included Mr. Clinton’s daughter, Chelsea, taking on a dominant new role as the family grappled with the question of whether the foundation — and its globe-spanning efforts to combat AIDS, obesity and poverty — would survive its founder.
Now those efforts are taking on new urgency. In the coming weeks, the foundation, long Mr. Clinton’s domain since its formation in 2001, will become the nerve center ofHillary Rodham Clinton’s increasingly busy public life.
This fall, Mrs. Clinton and her staff will move into offices at the foundation’s new headquarters in Midtown Manhattan, occupying two floors of the Time-Life Building. Amid speculation about her 2016 plans, Mrs. Clinton is adding major new initiatives on women, children and jobs to what has been renamed the Bill, Hillary & Chelsea Clinton Foundation.
Worried that the foundation’s operating revenues depend too heavily on Mr. Clinton’s nonstop fund-raising, the three Clintons are embarking on a drive to raise an endowment of as much as $250 million, with events already scheduled in the Hamptons and London. And after years of relying on Bruce R. Lindsey, the former White House counsel whose friendship with Mr. Clinton stretches back decades, to run the organization while livingpart-time in Arkansas, the family has hired a New York-based chief executive with a background in management consulting.
“We’re trying to institutionalize the foundation so that it will be here long after the lives of any of us,” Mr. Lindsey said. “That’s our challenge and that is what we are trying to address.”
But the changing of the guard has aggravated long-simmering tensions within the former first family’s inner circle as the foundation tries to juggle the political and philanthropic ambitions of a former president, a potential future president, and their increasingly visible daughter.
And efforts to insulate the foundation from potential conflicts have highlighted just how difficult it can be to disentangle the Clintons’ charity work from Mr. Clinton’smoneymaking ventures and Mrs. Clinton’s political future, according to interviews with more than two dozen former and current foundation employees, donors and advisers to the family. Nearly all of them declined to speak for attribution, citing their unwillingness to alienate the Clinton family.
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Last Thursday, Mr. Clinton arrived two hours late to an exuberant welcome at a health clinic about 60 miles north of Johannesburg. Children in zebra-striped loincloths sang as Mr. Clinton and Ms. Clinton made their entrance, and the former president enthusiastically explained how his foundation had helped the South African government negotiate large reductions in the price of drugs that halt the progress of HIV. Aaron Motsoaledi, South Africa’s minister of health, heaped praise on the effort. “Because of your help we are able to treat three and a half times more people than we used to,” he told the crowd.
The project is typical of the model pioneered by the Clinton Foundation, built around dozens of partnerships with private companies, governments, or other nonprofit groups. Instead of handing out grants, the foundation recruits donors and advises them on how best to deploy their money or resources, from helping Procter & Gamble donate advanced water-purification packets to developing countries to working with credit card companies to expand the volume of low-cost loans offered to poor inner city residents.
Lydia Polgreen contributed reporting, and Kitty Bennett contributed research.

Ensure incarceration spaces are not exposing in-mates to HIV, TB, Malaria

HIV/AIDS affects over 10 million prisoners globally

Zambia Prisons Services Commissioner, Gibbie Nawa, says more than 10 million people in prisons across the world have been seriously affected by the HIV/AIDS pandemic.
Mr. Nawa said most countries in the sub-Saharan region have a higher HIV prevalence rate among their prison populations than the general population of the same countries.
He said a decade ago, the Zambia Prison Service carried out an HIV prevalence survey which showed that the prevalence rate of the pandemic in prisons varied from that of the outside population.
He was speaking at the official opening of a three-day training workshop held for prison service officers-in-charge on HIV/AIDS in Kabwe yesterday.
The training workshop is aimed at providing prisons leadership with information on how to reduce stigma and discrimination in order to help both prisoners and officers accept their status.
Mr. Nawa also noted that Zambian prisons officers are at high risk of contracting and spreading HIV due to the nature of their work.
ZANIS/AH/KSH/ENDS

Does condom distribution encourage sexual Intercourse among in-mates in Zambia?

Zambia Prisons Service bans distribution of condoms to prisoners, it encourages homosexuality

THE Zambia Prisons Service (ZPS) has said it will not condone distribution of condoms in prisons because doing so encourages homosexuality among inmates.
ZPS commissioner Perce Chato said the prisons authority had no intention of embarking on the distribution and supply of condoms to inmates.
Mr Chato said this in an interview in Kitwe shortly after he launched the Mobile Hospital at Kamfinsa State Prisons.
He said permitting distribution and supply of condoms would be encouraging Sodomy, an act which was illegal in the country.
“We have an obligation to protect and promote the Republican Constitution. If we permit distribution of condoms its like we are contradicting the provisions of the Constitution which prohibit homosexuality,” Mr.Chato said.
He said homosexuality under the Zambian law was illegal and that the prisons service had no intention of changing that.
Mr Chato also said the prisons service was determined to prevent acts of homosexuality inprisons because it was a known fact this was one of the major driver of HIV-AIDS.
He further stated that the service five years ago conducted a survey on the status of HIV/AIDS inprisons and it indicated that the prevalence rate stood at 27 percent in all facilities which was very high.
Mr Chato said a significant number of prisoners were today aware of the vice and this had helped to reduce the prevalence rate.
“Most inmates are now aware about the danger of indulging in homosexuality and its consequences. So the HIV-AIDS prevalence rate in most facilities across the country is now at minimal level.”Mr Chato said.
Mr Chato also called on concern non-governmental organizations (NGOs) and other relevant stake holders to come on board and conduct a research on homosexuality and HIV-Aids in all facilities across Zambia.

Tuesday, 13 August 2013

Tivicay is approved for use in a broad population of HIV-infected patients; Treating HIV

On August 12, 2013, FDA approved Tivicay (dolutegravir), a new antiretroviral agent to treat HIV-1 infection.
 
Tivicay is an integrase strand transfer inhibitor (INSTI) that interferes with one of the enzymes necessary for HIV to multiply. It is a new molecular entity, which comes in pill form, to be taken daily in combination with other antiretroviral drugs.
 
Tivicay is approved for use in a broad population of HIV-infected patients. It can be used to treat HIV-infected adults who have never taken HIV therapy (treatment-naïve) and HIV-infected adults who have previously taken HIV therapy (treatment-experienced), including those who have been treated with other integrase strand transfer inhibitors. Tivicay is also approved for children ages 12 years and older weighing at least 40 kilograms (kg) who are treatment-naïve or treatment-experienced but have never  taken other integrase strand transfer inhibitors (INSTI-naïve).
 
Tivicay’s safety and efficacy in adults was evaluated in 2,539 participants enrolled in four clinical trials. Depending on the trial, participants were randomly assigned to receive Tivicay or Isentress (raltegravir), each in combination with other antiretroviral drugs, or Atripla, a fixed-dose combination of efavirenz, emtricitabine and tenofovir. Results showed Tivicay-containing regimens were effective in reducing viral loads.
 
A fifth trial established the pharmacokinetics, safety and activity of Tivicay as part of treatment regimens for HIV-infected children ages 12 years and older weighing at least 40 kg who have not previously taken integrase strand transfer inhibitors.
 
Common side effects observed during clinical studies include difficulty sleeping (insomnia) and headache. Serious side effects include hypersensitivity reactions and abnormal liver function in participants co-infected with hepatitis B and/or C. The Tivicay label gives advice on how to monitor patients for the serious side effects.
INDICATION AND USAGE
Dolutegravir is indicated, in combination with other antiretroviral agents, for the treatment of HIV-1 infection in adults and pediatric patients aged 12 years and older and weighing at least 40 kg.
The following should be considered prior to initiating therapy with dolutegravir:
  • Poor virologic response was observed in subjects treated with dolutegravir 50 mg twice daily with an INSTI-resistance substitution at the 148 substitution plus 2 or more additional INSTI-resistance substitutions including L74I/M, E138A/D/K/T, G140A/S, Y143H/R, E157Q, G163E/K/Q/R/S, or G193E/R.
DOSAGE AND ADMINISTRATION
Dolutegravir is available as 50 mg tablets. Dolutegravir is taken orally without regard to meals. The dose recommendation is as follows:
  • For treatment-naïve adults as well as treatment-experienced adults who are INSTI-naïve: 50 mg tablet taken once daily
  • For treatment-experienced adults who are INSTI-experienced with certain INSTI-associated resistance substitutions or clinically suspected INSTI resistance: 50 mg tablet taken twice daily
  • For children ages 12 years and older and weighing at least 40 kg who are treatment-naïve or treatment-experienced INSTI-naïve: 50 mg tablet taken once daily.
Dolutegravir plasma concentrations are reduced when coadminsitered with potent UGT1A/CYP3A inducers including efavirenz, tipranavir/ritonavir, fosamprenavir/ritonavir, or rifampin.
  • For treatment-naïve or treatment-experienced INSTI-naïve patients taking efavirenz, tipranavir/ritonavir, fosamprenavir/ritonavir, or rifampin, the recommended dose is 50 mg taken twice daily.
  • For INSTI experienced patients with certain INSTI-associated resistance substitutions or clinically suspected INSTI resistance, alternative combinations that do not include metabolic inducers should be considered, where possible.
CLINICAL STUDIES
Adults
Treatment-naïve: The indication for treatment-naïve adults is supported by efficacy and safety analyses from 2 randomized, double blind, active controlled Phase 3 trials. In SPRING-2 trial, 822 treatment-naïve subjects were randomized. The comparator was raltegravir and the background nucleoside (tide) reverse transcriptase inhibitor [N(t)RTI] regimen was either abacavir/lamivudine or tenofovir/emtricitabine. In SINGLE trial, 833 subjects were randomized, the comparator was efavirenz (administered as fixed dose combination Atripla), and the background NRTI regimen was abacavir/lamivudine. In SPRING-2, the proportion of subjects with HIV-1 RNA less than 50 copies/ml at Week 48 for dolutegravir and raltegravir was 88% and 86%, respectively. The difference in virologic response was 2.6% (95% CI: -1.9%, 7.2%). In SINGLE, the proportion of subjects with HIV-1 RNA less than 50 copies/ml at Week 48 for dolutegravir and Atripla was 88% and 81%, respectively. The difference in virologic response was 7.4% (95% CI: 2.5%, 12.3%).
Treatment-experienced, INSTI-naïve: The safety and efficacy in treatment-experienced INSTI-naïve adults is supported by data from a randomized, double blind, active controlled Phase 3 trial, SAILING. A total of 719 subjects were randomized to receive dolutegravir or raltegravir, each with an optimized background regimen. At baseline, 51% of subjects had evidence of resistance to three or more antiretroviral drug classes. The proportion of subjects with HIV-1 RNA less than 50 copies/ml at Week 24 for dolutegravir and raltegravir was 79% and 70%, respectively. The difference in virologic response was 9.7% (95% CI: 3.4%, 15.9%).
Treatment-experienced, INSTI-experienced: The indication in the treatment-experienced, INSTI-experienced population is supported by data from VIKING-3, a multicenter open-label, single-arm trial. The trial enrolled 183 treatment-experienced adults with virological failure and current or historical evidence of resistance to raltegravir and/or elvitegravir. Subjects showed multiple-class antiretroviral treatment resistance at baseline: 79% had at least 2 NRTI, 75% at least 1 NNRTI, and 71% at least 2 protease inhibitor major substitutions. Subjects received dolutegravir 50 mg twice daily with the current failing background regimen for 7 days and with optimized background therapy from Day 8.
The mean reduction in HIV-1 RNA was 1.4 log10 copies/ml at Day 8. At week 24, 63% of subjects achieved HIV-1 RNA less than 50 copies/ml. Virologic outcomes at Week 24 were affected by certain INSTI-associated resistance substitutions present at baseline. The response was 18% in the presence of Q148H/R substitution plus 2 or more additional INSTI-resistance substitutions including L74I/M, E138A/D/K/T, G140A/S, Y143H/R, E157Q, G163E/K/Q/R/S, or G193E/R. The response was 80% in the presence of N155H substitution (without Q148), and 56% in the presence of Y143C/H/R substitution (without Q148).
Pediatrics
The pharmacokinetics, safety, tolerability and efficacy were evaluated in 23 treatment-experienced, INSTI-naïve subjects ages12 to less than 18 years in an open-label trial, IMPAACT P1093. The initial dose-finding stage included intensive pharmacokinetic evaluation in 10 subjects. Dose selection was based on achieving similar dolutegravir plasma exposure and trough concentration as seen in adults. At 24 weeks, 70% of subjects had achieved HIV-1 RNA less than 50 copies/ml. The safety and efficacy of dolutegravir in children of ages less than 12 years, weighing less than 40 kg, and/or INSTI-experienced with certain INSTI-associated resistance substitutions or clinically suspected INSTI resistance have not been established.
ADVERSE REACTIONS
Common adverse drug reactions of at least moderate severity and observed in at least 2% of dolutegravir subjects in the adult trials include insomnia and headache. The adverse reaction profile in pediatric subjects was similar to that of adults.
WARNINGS AND PRECAUTIONS
In addition to warnings for fat redistribution and immune reconstitution syndrome, the label carries the following warnings:
  • Hypersensitivity Reactions: These events were characterized by rash, constitutional findings and sometimes organ dysfunction including liver injury. Discontinue TIVICAY and other suspect agents immediately if signs or symptoms of hypersensitivity develop. Clinical status, including liver aminotransferases, should be monitored and appropriate therapy initiated. TIVICAY should not be used in patients who have experienced a previous hypersensitivity reaction to TIVICAY.
  • Effects on Serum Liver Biochemistries in Patients with Hepatitis B or C Co-infection: Patients with underlying hepatitis B or C may be at increased risk for worsening or development of transaminase elevations with use of TIVICAY. In some cases the elevations in transaminases were consistent with immune reconstitution syndrome or hepatitis B reactivation particularly in the setting where anti-hepatitis therapy was withdrawn. Appropriate laboratory testing prior to initiating therapy and monitoring for hepatotoxicity during therapy with TIVICAY are recommended.
CONTRAINDICATIONS
Coadministration of dolutegravir with dofetilide is contraindicated due to the potential for increased dofetilide plasma concentrations and the risk for serious and/or life-threatening events.
USE IN SPECIFIC POPULATIONS
Pregnancy: Pregnancy Category B. There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, and dolutegravir was shown to cross the placenta in animal studies, this drug should be used during pregnancy only if clearly needed.
Hepatic Impairment: No dosage adjustment is necessary for patients with mild to moderate hepatic impairment (Child-Pugh Score A or B). The effect of severe hepatic impairment (Child-Pugh Score C) on the pharmacokinetics of dolutegravir has not been studied. Therefore, TIVICAY is not recommended for use in patients with severe hepatic impairment.
Renal Impairment: No dosage adjustment is necessary for treatment-naïve or treatment-experienced INSTI-naïve patients with mild, moderate, or severe renal impairment. No dose adjustment is necessary for INSTI-experienced patients (with certain INSTI-associated resistance substitutions or clinically suspected INSTI resistance) with mild or moderate renal impairment. Caution is warranted for INSTI-experienced patients with severe renal impairment, as the decrease in dolutegravir concentrations may result in loss of therapeutic effect and development of resistance to TIVICAY or other coadministered antiretroviral agents. Dolutegravir has not been studied in patients requiring dialysis.
GlaxoSmithKline, the manufacturer of TIVICAY, is required to conduct additional studies in children and to submit 48 week safety and resistance analyses from the treatment-experienced adult Phase 3 trials.
The complete TIVICAY label will be available soon at Drugs@FDA, or at DailyMed.  
Richard Klein
Office of Health and Constituent Affairs
Food and Drug Administration

Charu Mullick
Division of Antiviral Products
Food and Drug Administration

Steve Morin
Office of Health and Constituent Affairs
Food and Drug Administration
If you are interested in receiving information about a broader range of FDA topics, consider subscribing to the FDA Patient Network News, a twice monthly newsletter containing FDA-related information on a variety of topics, including new product approvals, significant labeling changes, safety warnings, notices of upcoming public meetings, proposed regulatory guidances and opportunity to comment, and other information of interest to patients and patient advocates.

Long term mutual monogamous relations help reduce vulnerability to sexually transmitted infections

Encouraging MSM to negotiate clear sexual agreements with their primary partner should become a best practice, as well as partner reduction and practicing mutual monogamy. For more information: http://journals.lww.com/jaids/Abstract/publishahead/Factors_Associated_with_Regular_HIV_Testing_among.98119.aspx

Social networks can be motivators in adherence to prevention practices

http://journals.lww.com/jaids/Abstract/publishahead/Social_Network_Characteristics_and_HIV_Risk_among.98120.aspx

New Hampshire hospital technician pleads guilty in hepatitis outbreak

New Hampshire hospital technician pleads guilty in hepatitis outbreak

Friday, 9 August 2013

Uganda in the eyes of an International Epidemiologist

http://www.huffingtonpost.com/tom-frieden-md-mph/uganda-makes-impressive-p_b_3727715.html?utm_hp_ref=tw

Uganda Makes Impressive Progress on Health

Posted: 08/08/2013 3:40 pm

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Last month I was in Uganda. As I planned for this trip, I wasn't sure what to expect. Uganda is the only country served by the president's Emergency Plan for AIDS Relief (PEPFAR) with a rising HIV incidence; I anticipated that there might be problems.
What I saw instead was impressive progress.
Although Uganda will have challenges for many years as a result of increased HIV infections over the past decade, and has much more to do, I was struck by how much headway they've made in the past couple of years. The country has scaled up lifesaving anti-HIV treatment as well as voluntary medical male circumcisions, which sharply reduce the chance of becoming infected.
While in Uganda, I got to peer into a cave -- the same cave where two tourists got Marburg virus in 2007. This deadly virus, similar to Ebola, was unknown in this location until identified by CDC staff.

This is Python Cave -- and I was awed to see the python, which is at least 12 feet long and 24 inches in diameter, or at least it seemed that way to me! There are 10,000 bats in the cave, 5 percent of which are infected with Marburg, and they provide a buffet for the python. The bats, usually nocturnal, were very active at the time of our daytime visit because the python was hunting for a meal. This viewing station was built by CDC because no one without full spacesuit-like body protection should enter the cave.
Uganda is vulnerable to a wide range of infectious disease threats in addition to Marburg, including yellow fever, plague and Ebola, and is home to more than 60 mosquito- and tick-borne infections. West Nile and chikungunya, both potentially deadly viruses spread by mosquitos, were first identified there.

On this trip, we broke ground on a national reference laboratory building. The new lab, funded by PEPFAR, is critical to detecting and diagnosing these and other diseases. It is also tangible evidence of the importance of CDC's Global Health Security project to improve lab facilities throughout the nation. Stopping disease threats quickly is key to ensuring the health security of Ugandans -- and also of Americans, since diseases can cross any border.
One of the most exciting events in Uganda was my visit with Ambassador Scott DeLisi to launch a system to transport laboratory specimens by motorcycle and courier. Test results are returned by email and can be retrieved and printed immediately anywhere in the country, substantially reducing the time between disease detection and treatment. Hewlett-Packard donated the GSM printers, a great example of a public-private partnership in public health.
Perhaps the most impressive success is how quickly maternal health care services have improved. In one year, Uganda's "Saving Mothers, Giving Life" project has made striking progress in its goal to cut maternal deaths by half. In the districts where this program is being tested, there've been important improvements to medical facilities and services, a large increase in deliveries of infants at these facilities (eight-fold in one facility I visited), and increases in Caesarian sections. Unlike in the U.S., the lack of facilities in Uganda leads to far fewer Caesarian sections than medically indicated, a gap that results in mother and child deaths and many other serious health problems.

CDC is proud to work closely alongside Ugandans to build these programs. One leader told me, "When Ebola happens, people run away, but CDC runs toward us to help." The new Minister of Health Dr. Ruhakana Rugunda noted that CDC has embodied the "teach someone to fish, and they'll fish for a lifetime" approach in his country.
It was an honor to see first-hand how much progress is being made, and know that our work will improve the health of people not just in Uganda, but also throughout Africa and around the world.

CDC and Uganda's Viral Research Institute have partnered for many years to reduce plague in that country. Here, I'm learning fascinating things from the Ugandan team -- how to study fleas and rats and, more importantly, how to control them so that plague doesn't spread. The flashlight contraption is a way to catch and study fleas.
A homegrown way to rid rats of fleas using a tube and a wick also has promise to reduce plague. Last year, the staff of this station mobilized and, in less than 24 hours, confirmed that a woman had plague and gave preventive medicine to more than 130 exposed people, both from Uganda and neighboring Democratic Republic of Congo, following up the next day with spraying to further reduce risk. There were no further cases of plague. More than a decade of collaboration in this remote area is saving lives, building capacity and yielding innovations that can benefit the world.
 

Follow Tom Frieden, MD, MPH on Twitter: www.twitter.com/@DrFriedenCDC