Hiding in plain sight, in every hospital in the world, is a product that embodies both the extraordinary benefits and the unsettling risks that plastics can pose to human health.
This product is the blood bag.
Introduced in 1950, as the United States was about to enter the Korean War, the plastic blood bag was a life-saving solution to a medical problem. Doctors had been collecting blood and performing transfusions since World War I, but the process was just beginning to be scaled up. The glass bottles used to hold blood were far from ideal. Not only did they break easily; they were hard to keep sterile, and air bubbles trapped in the rigid containers could complicate transfusions.
The new bags, invented by two American scientists, had a host of advantages: They were lightweight, cheap, couldnt shatter and took up about half the space in a refrigerator as a bottle holding the same amount of blood. They could also be easily made and kept sterile and thrown away after a single use.
Later, their popularity was boosted by a serendipitous discovery. It turns out that a chemical used to soften the plastic — di(2-ethylhexyl) phthalate, or DEHP — had a conservatory effect on red blood cells, meaning the blood could be stored longer. It was only a matter of time before plastic blood bags could be found in clinics, hospitals and blood banks across the globe.
“The discovery of plastics revolutionized blood storage and transport,” Ole Grøndahl Hansen, project manager at PVCMed Alliance, a consortium of leading companies from the medical PVC sector, wrote of the discovery. It saved “the lives of millions of people around the world.”
Plastics had a similar effect across the health care industry. Shatter-proof, cheap, disposable and hypo-allergenic, the material has become indispensable, used for everything from intravenous (IV) tubes to artificial hearts.
But lately, experts are warning that the widespread use of plastics in medical devices can also pose a risk to their users. Because plastic is so crucial to the industry, medical devices have received waivers from regulations banning chemicals as potentially dangerous to human health, despite their intimate association with the body.
“Its always been treated like there are so many benefits of using plastic, it outweighs anything else,” said Dorota Napierska, a chemicals policy officer at the advocacy group Health Care Without Harm.
Take blood bags. DEHP, the chemical that interacts with the red blood cells to extend their shelf time, is whats known as a phthalate, part of a class of chemicals used to soften polyvinyl chloride (PVC) plastics. It makes up as much as 40 percent of the weight of blood bags and 80 percent of IV tubes.
DEHP makes up as much as 40 percent of the weight of blood bags | Gerard Julien/AFP via Getty Images
DEHP doesnt stay put in the plastic. It leaches from the blood bags and tubes into the blood they hold. One study found that DEHP tubing loses 6 to 12 percent of its weight during its use.
Thats worrying because DEHP is an endocrine disrupter, according to the EUs chemical agency, which means it can interfere with normal hormone functioning. Researchers have linked DEHP to asthma, breast cancer, obesity and type 2 diabetes, low IQ scores, brain development issues, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, and lowered male fertility.
Measures have been taken in Europe to protect people from being exposed to DEHP and other harmful phthalates. Endocrine-disrupting chemicals like DEHP are most dangerous at the stage where the body is developing — so babies and pregnant women are particularly advised to stay away. For this reason, there are specific measures in place banning phthalates in toys.
And since 2012, several phthalates including DEHP, which was the most widely used over the last decades, have been subject to authorization in the EU. This means theyre banned from use unless a company applies specifically for permission.
Medical devices, however, are exempt entirely from this ban.
This is partly because their regulation has been fragmented and dealt with by different laws, and partly because theyre seen as essential components of certain devices. The risks, regulators judge, are outweighed by the benefits.
Researchers have been flagging that were particularly at risk from DEHP exposure through medical devices for 20 years.
In 2008, an EU scientific committee found that the exposure to the chemical among hospital patients rose with the frequency of medical care. The more visits to hospital, being treated with DEHP-coated IVs or receiving blood thats been stored in bags softened by DEHP, the more at risk people were.
Nonetheless, the scientific analysis ultimately concluded that the potential harm caused by DEHP exposure “is justified by the beneficial effects of these [medical] procedures.”
In 2015, the committee updated its analysis and found concrete evidence that patients on dialysis could have side-effects from DEHP. Still, it said, “the potential for replacement of DEHP in these products should be considered against their efficiency in the treatment.”
Individual countries and hospitals have started trying to find alternatives to products with DEHP.
Most people are exposed to trace amounts of phthalates like DEHP through particles in food or indoor air — its been used in everything from traffic cones to fake leather bags to sealants for doors — but average daily exposure is thought to be lower than the level that EU scientists OKed, which is 4.8 milligrams per kilogram of body weight every day.
For patients who need regular blood transfusions, levels of 22 mg/kg of body weight were estimated. For premature infants in the neonatal unit, “being dependent on multiple medical procedures,” their exposure levels could reach 35 mg/kg — more than seven times the limit deemed safe for adults.
Indeed, studies have found that in hospitals, particularly vulnerable groups like premature babies and pregnant women are exposed to high levels of a chemical in plastics that could affect their hormones years later.
In 2016, researchers from Leuven University in Belgium kept tabs on hundreds of children who were often put in intensive care units as babies and were exposed to high amounts of DEHP in their blood. The study tested them four years later and found that they had more attention deficit disorders than their healthy counterparts.
Researchers at the University of Leuven conducted a study into the effects of DEHP on babies | Mark Renders/Getty Images
After carrying out statistical analysis and controlling for other factors, the researchers said that phthalate exposure explained half of the attention deficit in the children.
“The discussion so far has been, well, you have to help these children, theyre very critically ill, and its probably more important to use these medical devices to save their lives than to be worried about long-term consequences of the DEHP leaching [out],” said Greet Van den Berghe, the lead author of the study and head of the intensive care unit at the university of KU Leuven, in Belgium.
“But the long-term neurocognitive legacy is also really, really important,” she said.
Individual countries and hospitals have started trying to find alternatives to products with DEHP.
France banned tubes containing the chemical in maternity, pediatric and neonatal departments of hospitals in 2015. And individual hospitals in several European countries have started phasing out medical devices containing PVC entirely.
The EU is also starting to take action. It reformed its regulation on medical devices in 2017, and as part of the revamp it has proposed increasingly stringent standards for proving that phthalates should be in devices.
Firms that use DEHP and other hazardous chemicals in medical devices will now have to publish a detailed explanation of how and why the chemical is used, an assessment of how the benefits outweigh the risks and an explanation of how possible alternatives could work. A draft of these guidelines was published in early March, and the Commission was asking for feedback on them until the end of April.
“If you get rid of [DEHP] and use another chemical in there, you need to make sure that flexibility is still good enough. Otherwise you may choke the patient” — OliRead More – Source
World Bank and WHO Statement on Partnership & Deployment of Financing to WHO for Ebola Response in DRC
WASHINGTON, August 23, 2019—The World Bank and the World Health Organization (WHO), along with the G..
WASHINGTON, August 23, 2019—The World Bank and the World Health Organization (WHO), along with the Government and other key partners, are working in close partnership on the Ebola Crisis Response in the Democratic Republic of the Congo (DRC). Central to this partnership is the assessment of the financing needs, and deployment of resources, with the goal to put an end to the current deadly outbreak.
The World Bank is today announcing that US$50 million in funding is to be released to WHO for its lifesaving operational work on the frontlines of the outbreak. The WHO is announcing that this US$50 million in funds will close the financing gap for its emergency health response in DRC through to the end of September 2019, and is calling on other partners to mirror this generous support in order to fund the response through to December.
The funding comprises US$30 million from the Pandemic Emergency Financing Facility (PEF) and US$20 million from the World Bank. The US$50 million in grant funding is part of the larger financial package of approximately US$300 million that the World Bank announced last month to support the fourth Strategic Response Plan for the DRC Ebola outbreak.
“WHO is very grateful for the World Banks support, which fills a critical gap in our immediate needs for Ebola response efforts in DRC, and will enable the heroic workers on the frontlines of this fight to continue their lifesaving work,” said Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization. “We keenly await further funding from other partners to sustain the response through to the end of the year.”
The DRC government, working in collaboration with the World Bank, WHO, and other key partners, has finalized the Fourth Strategic Response Plan (SRP4), which outlines the total resources needed for the DRC Ebola Crisis Response from July to December 2019. The financing announced today is part of the World Banks previously announced financial package of up to US$300 million and covers over half of SRP4s needs, with the remainder requiring additional funding from other donors and partners.
“The World Bank is working closely with WHO, the Government of DRC, and all partners to do everything we can to put an end to the latest Ebola outbreak,” said Annette Dixon, Vice President, Human Development at the World Bank. “The partnership between our organizations and the Government is critical for responding to the emergency as well as rebuilding systems for delivery of basic services and to restoring the trust of communities.”
The Government of DRC requested US$30 million from the PEF Cash Window to be paid directly to WHO. The PEF Steering Body approved the request bringing the PEFs total contribution to fighting Ebola in DRC to US$61.4 million. The PEF is a financing mechanism housed at the World Bank; its Steering Body is co-chaired by the World Bank and WHO, and comprises donor country members from Japan, Germany and Australia. The quick and flexible financing it provides saves lives, by enabling governments and international responders to concentrate on fighting Ebola—not fundraising.
Borno State launches first Malaria Operational Plan, reawakens fight against malaria
Maiduguri, 13 August 2019 – Following recommendations from malaria interventions in Borno State Nige..
Maiduguri, 13 August 2019 – Following recommendations from malaria interventions in Borno State Nigeria, the Malaria Annual Operational Plan (MAOP) was developed and launched on 08 August 2019 with technical support from the World Health Organization (WHO) and partners. Aligned to the National Malaria Strategic Plan (2014 -2020), MAOP was developed through a broad-based stakeholders workshop involving malaria stakeholders, reviewed on different thematic areas and endorsed by the Commissioner for Health and Permanent Secretary, Borno State Ministry of Health.
Speaking during the launch, the Borno state Malaria Programme Manager, Mr Mala Waziri described the MAOP as the first to be endorsed and disseminated in Borno State. “WHO has made us proud by supporting the first ever Malaria Operational Plan right from development, review, printing to dissemination.”
Dr Ibrahim Kida, the Ministerial Secretary Borno State Ministry of Health and Incident Manager of the state, described the launch as “an historic event as stakeholders across the health sector made commitments to use the document as an implementation guide for all malaria programs”. The plan was also described as an advocacy tool for planning domestic funds mobilization.
The MAOP has seven objectives among which are: provide at least 50% of targeted population with appropriate preventive measures by 2020; ensure that all persons with suspected malaria who seek care are tested with Rapid Diagnostic Test (RDT) or microscopy by 2020 and all persons with confirmed malaria seen in private or public health facilities receive prompt treatment with an effective anti-malarial drug by 2020.
The MAOP will further ensure that at least 50% of the population practice appropriate malaria prevention and management by 2020, ensuring timely availability of appropriate anti-malarial medicines and commodities required for prevention, diagnosis and treatment of malaria in Borno State by 2020.
In addition, it seeks to ensure that all health facilities report on key malaria indicators routinely by 2020 and finally strengthen governance and coordination of all stakeholders for effective program implementation towards an A rating by 2020 on a standardized scorecard. These strategic objectives have specific targets and the MAOP takes into account the humanitarian response.
“Malaria remains a leading cause of poor health in Nigeria. According to the 2018 WHO Malaria Report, 53million cases are recorded annually in Nigeria, roughly 1 in 4 persons is infected with malaria contributing 25% of the global burden,” says Dr Nglass Ini Abasi, WHO Malaria Consultant for the North East.
“Furthermore, 81,640 deaths are recorded annually (9 deaths every hour), which accounts for 19% of global malaria deaths (1 in 5 global malaria deaths) and 45% malaria deaths in West Africa. The Nigeria Malaria Strategic Plan (NMSP) 2014-2020 has a goal to reduce malaria burden to pre-elimination levels and bring malaria-related mortality to zero and WHO is working assiduously with Government to ensure the burden is reduced accordingly.”
Results from WHO’s Early Warning, Alert and Response System (EWARS) week 30 report from 223 sites, (including 32 IDP camps) show that malaria was the leading cause of morbidity and mortality accounting for 35% of cases and 46% of reported deaths. In addition, results from the Nigeria Humanitarian Response Strategy (NHRS 2019-2021) indicate 7.1million people are in dire need of healthcare and 6.2million are targeted for immediate attention.
Despite recent improvements, insecurity remains a challenge limiting access to the functional health facilities. Easily preventable and treatable diseases such as malaria, acute respiratory infection and diarrheal diseases account for the greatest proportion of morbidity and mortality among the vulnerable population. Furthermore, Malaria is endemic in North East Nigeria and the transmission is perennial with a marked seasonal peak from July to November every year. (more…)
Nearly half of all dengue deaths in the Philippines are children under nine years old
Manila, August 16 – At least 300 children aged 5-9 have died in the recent Dengue outbreak in the Ph..
Manila, August 16 – At least 300 children aged 5-9 have died in the recent Dengue outbreak in the Philippines, Save the Children said today, amid fears the epidemic could claim many more lives before its brought under control. In the first seven months of 2019, some 170,000 people were infected with the disease, killing 720 people – 42 percent were children between 5 and 9 years old. Compared to the same period in 2018, this years dengue caseload is 97 per cent higher. The virus is disproportionately affecting children and young people with a staggering 73 per cent of recorded cases under the age of 19.
Albert Muyot, ceo of Save the Children in the Philippines, said: “Hundreds of children have sadly already died, we expect the numbers to rise. The rainy season started late and will continue this month, creating the perfect breeding ground for dengue mosquitoes.
“Children are particularly a vulnerable to the disease because their immune systems are weaker than adults and they tend to play outside where theres less protection against the mosquitos. Schools in particular are a hotbed of dengue because many have open windows and lack mosquito repellents.
“It is extremely important that health authorities step up their information campaigns in schools, communities and other places where people come together, so people know what to do if they suspect dengue. Also, the government must step up their fumigation campaign to kill adult dengue mosquitoes in densely populated areas.
“In the Philippines, we are working with schools and communities to improve awareness on how to prevent infection. To save lives, children need extra protection. Wearing long sleeves and trousers is one of the simple measures to protect against being bitten. Early diagnosis is critical and we are raising awareness of those symptoms, like fever and body pain, and encouraging all parents to take their children to hospital immediately if they have concerns.
“Save the Children is referring child dengue cases to health centers in vulnerable communities in Navotas, Caloocan and Malabon as well as in conflict-affected provinces in Bangsamoro Automous Region in Muslim Mindanao (BARMM).”
Notes to editors:
- Dengue causes flu-like illness, including a sudden high fever coming in separate waves, pain behind the eyes, muscle, joint and bone pain, severe headache, and a skin rash with red spots. People with symptoms get ill between 4 to 7 days after a bite from an infected Aedes mosquito.
- The illness can become the fatal Severe Dengue, characterised by severe abdominal pain, vomiting, diarrhoea, convulsions, bruising, uncontrolled bleeding, and high fever which can last from 2 to 7 days.
- Complications can lead to circulatory system failure, shock, and death.
- There were 167,607 dengue cases between January-July 2019, up from 85,011 in the same period in 2018.
- Of the 167,607 recorded cases of dengue between January and July 2019, 121,942 were under the age of 19.
- On August 6th, the government declared a national dengue epidemic.
- Read from source
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