[Public Health]- Ebola, Cavilon, Kala-Azar Revised strategy, Free Rotavirus vaccine, XDR-TB, BRCA genes, NOTTO

1. Mains Questions
2. GS4: Ethics Case study on Ebola
   1. H1: Ebola virus outbreak
   2. H2: Kala Azar-revised strategy
   3. H3: Cavilon for Boxers
   4. H4: Free Rotavirus vaccine
   5. H5: Sickle Cell Anemia
   6. H6: XDR-TB
   7. H7: TB: Email + Survey
   8. H8: BRCA genes Patented in Australia
   9. H9: Eye donation
   10. H10: NOTTO
   11. H11: Misc. Developments
3. Mock MCQs
4. Correct Answers for the MCQs

Mains Questions

100 words each

1. What do you understand by Cavilon application in Boxing?
2. Discuss in brief, the salient features of revised strategy against Kala Azar.
3. Write a shortnote on Ebola outbreak.
4. What is Sickle Cell Anemia? How can stem cell research help in combating it?
5. NOTTO: structure and functions.

GS4: Ethics Case study on Ebola

You are Head of Centre for Disease Control. After the “PATH” clinical trials that misused norms to test drugs on innocent children, there has been new regulations that prevent use of unknown drugs on people. Now, there is a severe outbreak of Ebola-disease. No vaccine known. Only experimental drug in the market. It has shown some severe side effects. Patients hanging within the limits of death and life, can even die just because a wrong drug was given to them. A false symptom due to some other disease can lead to complications with the administering of this new experimental drug. There is no time for a systematic clinical trial and introduction of the Anti-Ebola drug.

What will you do, justify with reasons?

1. There is a difference between giving experimental drugs and illegal trials of drugs. Lives can be saved, therefore experimental drug should be permitted in this case.
2. There are lot of risks. People can lose lives. This is just like the “PATH”clinical trials. There is a process for everything.
3. Something else.

H1: Ebola virus outbreak

• It’s called “Ebola” because first cases reported near Ebola River in Congo back in mid 70s.
• Ebola virus, causes hemorrhagic fever. Death rate upto 90%
• Symptoms: fever, gum-bleeding,nose-bleeding, red spots on body, blood in stool and vomit.
• Similar symptoms seen in malaria, cholera, typhoid etc. Hence need to perform ELISA test or other Antigen detection tests to confirm Ebola.
• Affects: humans, monkeys, gorillas and chimpanzees.

Ebola: Myths and truths

spreads via	doesn’t spread via
Fruit bats considered to be natural hosts of this virus. Virus spread from wild animals like primates, bats, antelopes and porcupines to people. Then from people to people via blood and secretions. Even by physical contact with dead body! Even via semen / sexual intercourse- 7 weeks after recovery. Nations affected – Liberia, Sierra Leone, Guinea, Nigeria.	Doesn’t spread by Air-unlike flu (Stanford univ) Mosquito bite money, swimming pool, groceries Ebola easily killed by soap, bleach, sunlight or drying. (says PIB)

Ebola Treatment?

• Several vaccines are being tested, but none are available for clinical use.
• WHO had allowed use of experimental drugs to save lives but it is not successful yet.
• World and UNICEF donated supplies worth million$.
• In India, the Tourist returning from the affected countries are being observed for symptoms and their blood is being tested. So far everyone is healthy.

H2: Kala Azar-revised strategy

• Also known visceral leishmaniasis. caused by Parasite: Leishmania
• Spread by female sand-fly (it bites for blood meal)
• Affects spleen, liver and bone marrow. (Parasite cannot synthesize iron containing haem molecule on its own. So, it attacks those organs in search of hemoglobin.)
• In terms of death record by parasitic diseases: #1 Malaria and #2 is Kala Azar.

 

Revised strategy by Health ministry

Treatment	Kala Azar drugs are expensive (and toxic). But WHO will give free supply of Liposomal Amphoterecin B. This is an intravenous drug, helps reducing human reservoir of infection. Indian Council of Medical Research (ICMR) has developed Rapid Diagnosis kits for Kala Azar. Commercial vaccines still under trial.
Pyrethroid	Sand fly is the vector of Kala Azar. Government will supply this Pyrethoid insecticide to spray on walls, to kill sand flies.
Notifiable disease	Government has declared Kala Azar a notifiable disease Meaning, all sarkaari & private doctrs have to alert the state health authorities whenever they encounter a Kala-Azar patient.
Focus	four states – Bihar, Jharkhand, West Bengal and Eastern UP. Bihar alone counts for 80% cases Government will focus in these regions.
Social support	To recover, you’ve to finish 28 days’ drug course. This requires social support- similar to TB-DOTS workers.

H3: Cavilon for Boxers

Important because remember that stupid cricket related Q in mains-2013. (+ the fact that Mary Kom in news due to bollywood movie.)

• Back in mid-80s, commonwealth games introduced protective headgears in boxing matches.
• 2013: AIBA  decided to do away with headguards for elite men category.
• Logic? without headgear there will be lesser concussions as lesser force is needed to knockout. Headgears are still allowed for women, as they cannot hit with so much force like men.
• Nonetheless, some boxes and coaches worried abt injury.
• That’s why AIBA made Cavilon compulsory.
• Cavilon is brand name of a cut-prevention cream / spray.
• Boxers have to apply minimum 3 layers of this cream on entire face.
• This cream helps in preventing cuts, provides moisture and increases medical tape’s adherence.
• Can last upto 72 hours, contains no petroloeum jelly.

H4: Free Rotavirus vaccine

What is Rotavirus?

• Grows in the intestinal cells, Causes diarrhea.
• Called rotavirus because under microscope, it looks like a tiny wheel with spokes.

Why nuisance?

• Kills 52 infants per 1000 livebirths per year
• Causes diarrhea that indirectly kills atleast 1 lakh each year.
• Vaccine too expensive, aam-juntaa can’t afford it.

What’s the Solution to Rotavirus problem?

• Government decided to add Rotavirus vaccine in the Universal Immunization Programme (UIP) from 2015 onwards.
• Rota-vaccine will be given as an additional dose along with the DPT (diphtheria, pertussis, tetanus)’s first, second and third doses.

H5: Sickle Cell Anemia

• Sickle Cell Anemia is a hereditary disease and stays for whole lifetime.
• Prevalent among Indian tribals.
• Normal Red blood corpuscles(RBCs) have disk/donut shape.
• But in this diseases, body produces sickle shaped Red Blood Cells (RBCs).
• These RBCs have abnormal life cycle, oxygen carrying capacity etc.
• During his Japan visit, Modi met Shinya Yamanaka asked him to work on Sickle Cell Anemia.
• Shinya Yamanaka has won Nobel Prize for Medicine (2012), for his research in stem-cells. More details in this old article click me.

But How can stem cell therapy help?

• Sickle cell can be used by bone-marrow transplant.
• New bone marrow will begin synthesizing health (donut) shaped RBC.
• But this transplant is very costly and riskly.
• Yamanaka’s Noble winning research had created iPS cell- these cells behave like stem cells.
• We can program iPS cells to create a mass of bone marrow.
• Then, Transplant it into patient and his sickle cell anemia will be cured.

H6: XDR-TB

“Normal” TB	Caused by TB bacteria. Can be treated with first generation drugs.
MDR-TB	Multi-drug resistant TB. It develops when first line drugs are not taken properly. MDR-TB has to be treated with second line drugs, Patient takes longer time to recover.
XDR-TB	Develops when second-line drugs are misused. (e.g. patient not finishing entire course, or doctor giving inappropriate amount of drug)

H7: TB: Email + Survey

TB email

• Health ministry wants to create an Email repository between doctors and government.
• Help TB patients if doctors know of the latest treatment and protocols.
• Help to devise new strategies to combat MDR TB
• Research data transmission between ICMR, Doctors and international bodies.

TB survey

• first TB survey conducted in India in 1914-16
• In entire world ~4 lakh TB patients are multi-drug resistant (MDR-TB).
• 25% of them in India alone.
• Now, an even bigger “Extensively drug-resistant TB” (XDR-TB) has emerged.
• Health ministry will launch a new survey, with help of with WHO and USAID
• This survey will have ever sample size (5000+ patients) all over India.
• The patients to be surveyed are both first time and retreatment cases.
• Their resistance levels against 13 anti-TB drugs would be observed.

H8: BRCA genes Patented in Australia

• BRCA1 and BRCA2 human genes used for diagnosing breast and ovarian cancers. (BRCA= BReast CAncer).
• If a woman has mutation (fault) in BRCA 1 or 2= higher risk of breast/ovarian cancer.
• Mid 90s: Myriad Genetics ltd. Got its patent, and established monopoly for selling BRCA gene testing. Each test costs >3000$.
• Through this test, Hollywood Actress Angelina Jolie  found she had BRCA1 gene=> underwent mastectomy surgery to remove her Brests.
• 2013: US Supreme court nullified this patent saying that isolating a DNA from human body doesn’t count as “innovation” therefore, doesn’t deserve patent rights.
• Now Myriad Genetics applied for same patent in Australia and Australian court has awarded the patent.

H9: Eye donation

 

Why problem?

World	4.5 crore blind. WHO says by 2020, this number will double because of higher population and life expectancy.
India	1.2 crore blind. (largest population in world)

 

Cornea donation can help them BUT

Every year	# of corneas
what we need	1 lakh
What we get	17,000 only. And out them, hardly 50% used.

What are the Solutions to Eye donation shortage?

• National Organ and Tissue Transplant Organization (NOTTO) setup under DG health services under Helath ministry.
• Soon, NOTTO will launch a dedicated webportal to provide transparent interface between donors and recipients of all organs including cornea.
• Health ministry also asked HRD ministry to include organ-donation topic in school text books
• National Eye Donation Fortnight: It’s an annual event organised by the National Programme for Control of Blindness, during August-September.

What do you know about Eye donation?

• Takes hardly 10-15 minutes
• Doctor can visit home and remove it. No need to bring dead body to the eye bank or hospital.
• Leaves no scar marks on deadbody
• One healthy person can thus give eye sight to two blind persons.

H10: NOTTO

• National Organ and Tissue Transplantation organization- HQ: Safdarjung Hospital,Delhi.  ~150 crores.
• It’ll provide ICT-enabled interface between organ donor and recipient, via call centre and webportal.
• In first phase- will cover only Kidney cases.
• Will provide a state-of-the-art transplantation operation.
• Govt will also setup regional bodies with similar features. NOTTO will coordinate among them.

H11: Misc. Developments

Leprosy	Bacterial disease. Also called “Hansen’s disease”. Multi-drug therapy available in ’81. Yet, patients continue to suffer and face social stigma. Supreme Court has asked the government to explain is this happening?
Suicide	National Institute of Mental Health and Neuro Sciences (NIMHANS) on launched a website dedicated to suicide prevention. in collaboration with the White Swan Foundation.

Mock MCQs

Q1. Consider following statements

1. Ebola virus got its name because of a river in Congo
2. Both sand flies and mosquitos are vectors of Ebola Virus.
3. Ebola can spread via sexual intercourse.

Answer choices

1. Only 1 and 2
2. Only 2 and 3
3. Only 1 and 3
4. None of them

Q2. Which of the following are vulnerable to Ebola virus

1. Humans
2. Gorillas
3. Chimpanzees

Answer:

1. Only 1 and 2
2. Only 2 and 3
3. Only 1 and 3
4. All of them

Q3. Consider following statements about Kala Azar:

1. Kala Azar is caused by Leishmania bacteria which are spread to humans via male sand flies
2. In India, the worst affected states are Telangana, Andhra Pradesh, Maharashtra and Odisha.
3. Kala Azar is a notifiable disease in India.

incorrect statements are

1. Only 1 and 2
2. Only 2 and 3
3. Only 1 and 3
4. None of them

Q4. Consider following statements about Rotavirus

1. Rotavirus causes diarrhea
2. These virus primarily affect the medular region of the brain in infants.
3. Rotavirus vaccine is yet to be developed.

the incorrect statements are

1. Only 1 and 2
2. Only 2 and 3
3. Only 1 and 3
4. None of them

Q5. What is XDR TB?

1. TB that is resistant to first line antibiotics
2. TB that is resistant to second line antibiotics
3. TB developed because of HIV
4. None of above.

Q6. What is Cavilon?

1. Name of an anti-Ebola vaccine going under clinical trials.
2. An insecticide to kill sandflies which are responsible for Kala Azar
3. A new drug as a replacement of Diclofenac, to save vulture population
4. A cut prevention cream for boxers.

Q7. What are BRCA genes?

1. Genes only found in Caucasian people and responsible for their fair skin.
2. Genes only found in Indian tribal and responsible for their sickle cell anemia.
3. Their mutation indicates possibility of Brest or ovarian cancer in future.
4. None of Above.

Q8. Hensen’s disease is caused by

1. virus
2. parasite
3. bacteria
4. fungi

Q9. Health minister recently talked about a NOTTO web portal. What is the purpose of it?

1. Facilitating the doctors to report the notifiable dieses to Government authorities online.
2. Registration of transgendered people for medical checkup before granting them OBC certificate.
3. Checking up the Travelers from Liberia, Sierra-Leon etc. for possible Ebola cases.
4. Providing transparent interact between organ donors and recipients

Q10: which of the following is/are incorrectly matched?

1. Liberia: Bomako
2. Sierra Leone: Conakry
3. Guinea: Free town
4. Nigeria: Abuja

Incorrect pairs are

1. Only 1 and 2
2. Only 1, 2 and 3
3. Only 2, 3 and 4
4. None of them

Q11. which of the following can kill Ebola virus?

1. Chewing neem or tulsi leaves
2. Soap
3. bleach
4. sunlight

Correct choices

1. Only 1 and 2
2. Only 1, 2 and 3
3. Only 2, 3 and 4
4. None of them

Correct Answers for the MCQs

1. C: 1 and 3 correct.
2. D: All of them can get Ebola
3. A: 1 and 2 are incorrect about Kala Azar.
4. B: 2 and 3 are incorrect.
5. B 2nd line
6. D cut prevention
7. C cancer
8. C bacteria
9. D organ donation
10. 1, 2 and 3 are wrong. Refer to school atlas for correct pairs.
11. C: 2,3 and 4 are correct as per PIB. There is *no* scientific proof that chewing neem/tulsi leaves can kill Ebola, except chain-message in whatsapp and random readers’ comments below newswebsite-articles.