Health

ME exercise therapy guidance scrapped by Health watchdog Nice

Published

8 months ago

October 29, 2021

THN

ME exercise therapy guidance scrapped by Health watchdog Nice

A disputed therapy that encourages people with ME to gradually increase physical activity will no longer be officially recommended, a health watchdog said, marking a victory for campaigners.

The controversial treatment, called graded exercise therapy, has been removed from guidance given by the National Institute for Health and Care Excellence (Nice) for diagnosing and managing myalgic encephalomyelitis, which is also known as chronic fatigue syndrome.

The long-awaited landmark guidance had been due in August but was put on hold following concerns from some groups over its contents. It is thought some health professionals had been unhappy with some of the recommendations made by Nice.

The campaign group ME Action UK had urged Nice to publish the guideline – which said graded exercise should not be recommended – without delay, saying evidence demonstrated that graded exercise “harms most people with ME” and that any evidence supporting its use “was deemed to be of low or very low quality by the independent Nice guideline committee”.

Charities and patient groups had been fighting for greater recognition of the condition as a medical illness rather than psychological problem. Graded exercise therapy (GET) involves incremental increases in physical activity to gradually build up tolerance. Patient groups have argued that its use suggests those with ME have symptoms due to inactivity.

ME is thought to affect about 250,000 people in the UK and has been estimated to cost the economy billions of pounds annually. The condition includes sufferers experiencing mental fogginess, pain and a debilitating loss of energy.

It can affect anyone, including children, but is more common in women, and tends to develop when people are in the mid-20s to mid-40s age bracket. Treatments have included, besides graded exercise therapy, medication to control pain, nausea and sleeping problems, as well as cognitive behavioural therapy.

Sian Leary, from ME Action UK, said not publishing the guideline in August had been “devastating to thousands of people with ME” whom she said had been “seriously harmed by graded exercise therapy”.

Nice held a roundtable meeting in London in October with professional organisations and representatives from interested patient groups to discuss key issues around the guideline.

The new guideline says that ME/CFS is a complex condition where there is no “one size fits all” approach to managing symptoms, and adds that any therapy would depend on patient preferences and should not represent a fixed increase in activity.

The guideline says people should be given a personalised plan that is reviewed regularly. Nice said this was designed to help people understand their energy limits so they could reduce the risk of over-exertion worsening their symptoms.

The guideline also recommends a route to earlier diagnosis for those with ME/CFS, reducing the time-span for persistent symptoms from four months to three before a diagnosis is made.

Lady Finlay, consultant in palliative medicine and vice-chair of the guideline committee, said: “ME/CFS is a complex long-term condition that causes disordered energy metabolism and can be profoundly disabling. Those with ME/CFS need to be listened to, understood and supported to adapt their lives.

“The committee members involved in this guideline have worked particularly hard to ensure care becomes more empathetic and focused on the individual’s needs.”

Prof Chris Ponting, at the Institute of Genetics and Molecular Medicine, University of Edinburgh, said: “The new Nice guidelines will improve the lives of people with ME worldwide, well beyond England and Wales. They will improve awareness that graded exercise often makes ME symptoms worse.

“Nice took due care and attention developing these guidelines, applying their rigorous methods and listening to highly regarded professionals and lay people. Low and very low-quality scientific evidence was rightly discarded.

“Graded exercise therapy and cognitive behavioural therapy cannot now be offered as cures. The new guidelines vindicate the longstanding views of many people with ME, their carers and families.”

Prof Peter White, emeritus professor of psychological medicine, at Queen Mary University of London, said: “Having looked after many patients with this illness I worry that this guideline seems to suggest that patients need to learn to live with CFS/ME, rather than be helped to recover from it.

“Nice have banned graded exercise therapy, in spite of it being found to be helpful in a major Cochrane systematic review, while recommending an energy management programme which involves ‘staying within your energy limits’, for which there is little evidence for it helping, and some evidence that it doesn’t.”

Health

Covid Vaccines Saved 20 Million Lives In First Year – Study

Published

5 days ago

June 24, 2022

Harmattan News

Covid Vaccines Saved 20 Million Lives In First Year – Study

Covid vaccines prevented nearly 20 million deaths in the first year after they were introduced, according to the first large modelling study on the topic released Friday.

The study, published in The Lancet Infectious Diseases, is based on data from 185 countries and territories collected from December 8, 2020 to December 8, 2021.

It is the first attempt to estimate the number of deaths prevented directly and indirectly as a result of Covid-19 vaccinations.

It found that 19.8 million deaths were prevented out of a potential 31.4 million deaths that would have occurred if no vaccines were available.

It was a 63 percent reduction, the study found.

The study used official figures — or estimates when official data was not available — for deaths from Covid, as well as total excess deaths from each country.

Excess mortality is the difference between the total number of people who died from all causes and the number of deaths expected based on past data.

These analyses were compared with a hypothetical alternative scenario in which no vaccine was administered.

The model accounted for variation in vaccination rates across countries, as well as differences in vaccine effectiveness based on the types of vaccines known to have been primarily used in each country.

China was not included in the study because of its large population and strict containment measures, which would have skewed the results, it said.

The study found that high- and middle-income countries accounted for the largest number of deaths averted, 12.2 million out of 19.8 million, reflecting inequalities in access to vaccines worldwide.

Nearly 600,000 additional deaths could have been prevented if the World Health Organization’s (WHO) goal of vaccinating 40 percent of each country’s population by the end of 2021 had been met, it concluded.

“Millions of lives have probably been saved by making vaccines available to people around the world,” said lead study author Oliver Watson of Imperial College London.

“We could have done more,” he said.

Covid has officially killed more than 6.3 million people globally, according to the WHO.

But the organisation said last month the real number could be as high as 15 million when all direct and indirect causes are accounted for.

The figures are extremely sensitive due to how they reflect on the handling of the crisis by authorities around the world.

The virus is on the rise again in some places, including in Europe, which is seeing a warm-weather resurgence blamed in part on Omicron subvariants.

AFP

Health

WHO considers declaring monkeypox a global health emergency

Published

6 days ago

June 23, 2022

Harmattan News

WHO considers declaring monkeypox a global health emergency

As the World Health Organization convenes its emergency committee Thursday to consider if the spiraling outbreak of monkeypox warrants being declared a global emergency, some experts say WHO’s decision to act only after the disease spilled into the West could entrench the grotesque inequities that arose between rich and poor countries during the coronavirus pandemic.

Declaring monkeypox to be a global emergency would mean the U.N. health agency considers the outbreak to be an “extraordinary event” and that the disease is at risk of spreading across even more borders. It would also give monkeypox the same distinction as the COVID-19 pandemic and the ongoing effort to eradicate polio.

Many scientists doubt any such declaration would help to curb the epidemic, since the developed countries recording the most recent cases are already moving quickly to shut it down.

Last week, WHO Director-General Tedros Adhanom Ghebreyesus described the recent monkeypox epidemic identified in more than 40 countries, mostly in Europe, as “unusual and concerning.” Monkeypox has sickened people for decades in central and west Africa, where one version of the disease kills up to 10% of people. In the epidemic beyond Africa so far, no deaths have been reported.

“If WHO was really worried about monkeypox spread, they could have convened their emergency committee years ago when it reemerged in Nigeria in 2017 and no one knew why we suddenly had hundreds of cases,” said Oyewale Tomori, a Nigerian virologist who sits on several WHO advisory groups. “It is a bit curious that WHO only called their experts when the disease showed up in white countries,” he said.

Until last month, monkeypox had not caused sizeable outbreaks beyond Africa. Scientists haven’t found any major genetic changes in the virus and a leading adviser to WHO said last month the surge of cases in Europe was likely tied to sexual activity among gay and bisexual men at two raves in Spain and Belgium.

To date, the U.S. Centers for Disease Control and Prevention has confirmed more than 3,300 cases of monkeypox in 42 countries where the virus hasn’t been typically seen. More than 80% of cases are in Europe. Meanwhile, Africa has already seen more than 1,400 cases this year, including 62 deaths.

David Fidler, a senior fellow in global health at the Council on Foreign Relations, said WHO’s newfound attention to monkeypox amid its spread beyond Africa could inadvertently worsen the divide between rich and poor countries seen during COVID-19.

“There may be legitimate reasons why WHO only raised the alarm when monkeypox spread to rich countries, but to poor countries, that looks like a double standard,” Fidler said. He said the global community was still struggling to ensure the world’s poor were vaccinated against the coronavirus and that it was unclear if Africans even wanted monkeypox vaccines, given competing priorities like malaria and HIV.

“Unless African governments specifically ask for vaccines, it might be a bit patronizing to send them because it’s in the West’s interest to stop monkeypox from being exported,” Fidler said.

WHO has also proposed creating a vaccine-sharing mechanism to help affected countries, which could see doses go to rich countries like Britain, which has the biggest monkeypox outbreak beyond Africa — and recently widened its use of vaccines.

To date, the vast majority of cases in Europe have been in men who are gay or bisexual, or other men who have sex with men, but scientists warn anyone in close contact with an infected person or their clothing or bedsheets is at risk of infection, regardless of their sexual orientation. People with monkeypox often experience symptoms like fever, body aches and a rash; most recover within weeks without needing medical care.

Even if WHO announces monkeypox is a global emergency, it’s unclear what impact that might have.

In January 2020, WHO declared that COVID-19 was an international emergency. But few countries took notice until March, when the organization described it as a pandemic, weeks after many other authorities did so. WHO was later slammed for its multiple missteps throughout the pandemic, which some experts said might be prompting a quicker monkeypox response.

“After COVID, WHO does not want to be the last to declare monkeypox an emergency,” said Amanda Glassman, executive vice president at the Center for Global Development. “This may not rise to the level of a COVID-like emergency, but it is still a public health emergency that needs to be addressed.”

Salim Abdool Karim, an epidemiologist and vice chancellor at the University of KwaZulu-Natal in South Africa, said WHO and others should be doing more to stop monkeypox in Africa and elsewhere, but wasn’t convinced that a global emergency declaration would help.

“There is this misplaced idea that Africa is this poor, helpless continent, when in fact, we do know how to deal with epidemics,” said Abdool Karim. He said that stopping the outbreak ultimately depends on things like surveillance, isolating patients and public education.

“Maybe they need vaccines in Europe to stop monkeypox, but here, we have been able to control it with very simple measures,” he said.

Health

NMA urges NCDC to step up fight against Monkeypox

Published

4 weeks ago

May 31, 2022

THN

NMA urges NCDC to step up fight against Monkeypox

The Nigerian Medical Association (NMA) has urged the Nigeria Centre for Disease Control (NCDC) to step-up its efforts in educating and protecting Nigerians from the increasing cases of the ravaging Monkeypox disease.

It stressed that the Agency, which is saddled with the responsibility of disease prevention and control, must not lose sight of other infectious diseases like monkeypox, even as it focuses on COVID-19.

The doctors’ association, while urging Nigerians to adhere strictly to the preventive measures of personal hygiene, especially hand hygiene because like monkeypox, COVID-19 is still very much in the country, and the situation can become worse if not handled properly, implored religious institutions – churches and mosques – to take up the responsibility of sensitising their followers about the disease.

Recall that yesterday the NCDC announced that the country has recorded 21 confirmed cases of the Monkeypox disease in the last five (5) months, with one death. Also, in the month of May, a total six (6) new confirmed positive cases were reported from four (4) states – Bayelsa (2), Adamawa (2), Lagos (1), and Rivers (1).

Globally, according to reports from the World Health Organization (WHO), as of 26 May, there have been a cumulative total of 257 laboratory confirmed cases, with around 120 suspected cases reported, from 23 non-endemic countries. However, no deaths have been reported.

Speaking with The Nation, the newly elected President of the NMA, Dr Uche Ojinmah, said: “We have the Nigeria Centre for Disease Control (NCDC) that has the responsibility of not just monitoring and controlling COVID-19, but every infectious disease. Therefore, they should step up to the plate. It is the business of the NCDC; they can link up with the Ministry of Information and get people aware.

“They need to start giving us data on this Monkeypox as it happens across the country. With the current awareness coming from a reputable government institution like that, people will sit up. We need to start directing our calls to the appropriate institution, which is the NCDC. We don’t expect President Muhammadu Buhari to give us information on this. Let the NCDC step up to the plate and do their job.

“The Nigeria Centre for Disease Control needs to understand that it is not only COVID-19; it is important. It is however necessary to be combined in the sensitisation of the people. The media also have a role to play in sensitisation. The government needs to bring the will, but we all in our little ways can contribute.

“We have a bit of a problem in this country; we initiate measures, achieve a positive response, and we drop our guards. In 2015 when Ebola came, we took it on as a nation, and we got rid of it, and everybody went back to their normal lives. COVID-19 has come and with us, if you check even in flights now, you force people to wear their masks. Nigerians, therefore, need to be serious and the government needs to play a role.

“Monkeypox is here now and everybody pretends they don’t know – until it becomes a problem. I also expected that the government, civil society, and non- governmental organisations should have started spreading the message by now. Our churches and mosques should take up this course now that it has not become a disaster.

“Doctors should also start to educate patients they see that do not have it. We need to start now to prepare the minds of our people; it may not be as bad as Ebola or COVID-19, but it is still a problem. So, the earlier we start preventive measures, the better we will be.”