The WHO has categorized antibiotics into 3 groups
‘ACCESS’, ‘WATCH’ and ‘RESERVE’. In the new Essential Medicines List
(EML) 2017 published recently, it seeks to combat the menace of
antibiotic resistance. The EML this year has 433 drugs with 20 new drugs
added in the list for children. This list is often used by countries to
prioritize their public health spending.
In the ACCESS group of antibiotics, the WHO has
placed antibiotics that must be readily available and used for a wide
range of common infections, including amoxicillin, amoxicillin-clavulanic
acid and cephalexin. WATCH group includes antibiotics that are
first-line or second-line for a small number of infections; e.g.,
ceftriaxone for acute bacterial meningitis, piperacillin-tazobactum for
hospital-acquired pneumonia, and azithromycin, ciprofloxacin, cefixime,
vancomycin and meropenem for various listed infections. RESERVE category
has drugs that must be considered last resort drugs – to be used only
when all else have failed. This includes colistin, imipenem, aztreonam,
and fifth generation cephalosporins – ceftaroline and cefipime.
Other drugs in this year’s EML are pre-exposure
prophylaxis with tenofovir alone, or in combination with emtricitabine
or lamivudine, to prevent HIV infection, and delamanid and clofazimine
for the treatment of children with multidrug-resistant tuberculosis. The
final decision about whether to categorize oseltamavir in the EML is not
yet taken.
The strategy is another attempt to change prescriber
behavior and curtail antibiotic resistance. (http://www.who.int/medicines/publications/essentialmedicines/6th_EMLc2017.
pdf?ua=1)
First Cases of Zika Virus in India
Three persons from Ahmedabad were confirmed to be
positive for the Zika virus in January 2017. They were notified to the
WHO on 15th May 2017. The delay in reporting has created a furor in
public health circles. All three cases were confirmed during routine
surveillance in which about 50,000 samples have been tested so far. The
cases included a 34-year-old pregnant woman who developed a low grade
fever after delivery. Blood sent for dengue testing was found to be
positive for Zika virus. Both mother and child are healthy. Another
pregnant woman, picked up to be positive for Zika virus infection on
antenatal surveillance, has also delivered a healthy baby. The third
patient picked up on Acute Febrile Illness (AFI) surveillance is
asymptomatic. None of the patients had travelled outside India.
Those infected with the virus may have mild fever,
skin rashes, conjunctivitis, muscle and joint pain, or headache. These
symptoms normally last for 2-7 days. Exposure to the Dengue virus is
considered to increase the risk of developing Zika infection.
In February 2016, Zika was declared a public health
emergency of international concern, due to the suspected causal
association between Zika virus and microcephaly and Guillain-Barre
Syndrome. In India, the WHO has been supporting the Ministry of Health
and Family Welfare for enhancing Zika virus surveillance and scaling-up
vector control measures among other activities. In addition to National
Institute of Virology (Pune) and National Center for Disease Control
(Delhi), 25 laboratories have also been strengthened by Indian Council
of Medical Research (ICMR) for laboratory diagnosis, while three
entomological laboratories are conducting Zika virus testing on mosquito
samples. ICMR has tested 34,233 human samples and 12,647 mosquito
samples for the presence of Zika virus. Among those, close to 500
mosquitoes samples were collected from Bapunagar area of Ahmedabad
district in Gujarat, and were found negative for Zika.
Under the Rashtriya Bal Swasthya Karyakram (RBSK),
monitoring for microcephaly has been established at 55 sentinel sites.
No increase in number of cases/clustering of microcephaly has been
reported from these centers so far. (The Hindu 28 May 2017;
http://www.searo.who.int/india/mediacentre/news/2017/preventing_zika/en/)
Maternity Leave Increased to 26 Weeks
A landmark bill was passed in parliament to ensure
paid maternity leave for 26 weeks to all women working in the organized
sector in India. It will apply to all organizations hiring more than 10
people. The entitlement will be for the first two children; the third
child will entitle the mother for 12 weeks leave.
The Maternity Benefit (Amendment) Bill also provides
maternity benefits for women who legally adopt a child below 3 months of
age, and to a mother who uses her eggs to have a surrogate child. Every
establishment with more than 50 employees will also have to have a
crèche within a prescribed distance. Mothers will be allowed four visits
to such creche during working hours.
India now comes third in duration of maternity leave after Canada (50
weeks) and Norway (44 weeks). In the US, there is no provision for paid
maternity leave. Though business analysts predict a fall in recruitment
of women by business houses, a commentary in the Fortune magazine says
that India has put the US to shame in showing the way forward by
prioritizing mother and child welfare. (The Times of India 10 March
2017)