Plasma fractionation in Asia–Pacific: challenges and perspectives

Patients in every country should have access to quality blood products. National health authorities play a critical role in ensuring that patients’ needs are met with safe and cost-effective products. Fractionated plasma products, as other blood products, are essential therapeutics used in the prevention, management, and treatment of life-threatening conditions resulting from trauma, metabolic congenital deficiencies, immunological disorders or infections. A few high development index (HDI) countries in the region have sufficient access to a broad portfolio of plasma products (coagulation factors, immunoglobulin, albumin) through domestic (e.g. Australia, Japan, Korea) or contract (e.g. Singapore, New Zealand) plasma fractionation programmes. China is gradually establishing a modern plasma fractionation industry. Other countries face plasma product shortages leading to inappropriate clinical use of plasma for transfusion and of non-virally inactivated cryoprecipitate, and ultimately to inappropriate treatment of patients. The volume of plasma fractionated in the region is too low to meet the needs. The volume (about 6 million l) represents 20% of the total volume fractionated worldwide for 60% of the world population. There is a rationale to encourage plasma contract fractionation programmes or operation of domestic facilities (when justified) to use local resources. However, many challenges are being faced as national plasma fractionation programmes require a mature blood collection infrastructure. Unfortunately, several LDI countries lack a mature national blood programme and a legislative framework on national policies and legislation on blood donations. They lack a safe blood donor base and a well-organized, nationally coordinated blood transfusion services; their blood collection system is scattered among different entities, resulting in non-uniform screening and testing procedures. Financial and human resources are lacking. Still, a few countries (e.g. Hong Kong, Malaysia, Singapore, Taiwan) have strengthened the national blood programmes, national blood policies have been implemented and the management of the blood transfusion service improved, allowing to implement contract plasma fractionation programme with established fractionators. Others are considering initiating (Indonesia and Malaysia) or enhancing (Thailand) domestic fractionation. Plasma fractionation programmes require good awareness and understanding by national regulatory authorities on quality criteria of plasma products. Local plasma product market and potential trends should be evaluated to determine plasma needs and the capacity to implement collection of plasma by apheresis from volunteer dedicated donors to supplement recovered plasma as a source material for fractionation. Appropriate choice of a contract fractionation partner should be made and contract terms discussed carefully. The fractionation technology and product portfolio should be evaluated to make sure that intended products can meet domestic needs (e.g. range, potency and formulation). A reimbursement policy (in particular for IVIG) for a range of proven indications should be established, as approved in the marketing authorization dossier. Confidence of clinicians and patients in the quality and safety of domestic vs. imported products should be built. With the economical development of the region and the ageing population trends, the needs for plasma products are expected to increase, justifying efforts to fractionate domestic plasma (e.g. initially through contract fractionation) and increase guarantee of supply in quality plasma products.     

The SMART‐COP score performs well for pneumonia risk stratification in Australia’s Tropical Northern Territory: a prospective cohort study

Objective To prospectively compare a modified pneumonia severity scoring system, SMARTACOP, with other severity scores in patients presenting with pneumonia to the emergency department (ED) of a tertiary referral hospital in tropical Australia. Methods We conducted a prospective observational study of adult patients presenting with radiologically confirmed pneumonia over a 12‐month period. The sensitivity of risk stratification scores were assessed against the need for intensive respiratory or vasopressor support (IRVS). Results There were 367 ED attendances for pneumonia of whom 77.1% were admitted to hospital, 10% required intensive respiratory or vasopressor support and 2.8% died. Mean age was 50.0 years, 52% were men and 59% were Indigenous. The sensitivity of a SMART‐COP score ≥3, a SMARTACOP score ≥3 and a pneumonia severity index (PSI) class ≥3 for predicting IRVS was 97%, 97% and 78% respectively. Conclusions We found no significant advantage of the SMARTACOP over the SMART‐COP score for the prediction of intensive respiratory or vasopressor support, but both scores significantly outperformed PSI. The SMART‐COP score should replace the PSI in tropical Australia and should be assessed in other tropical areas for pneumonia risk stratification in emergency departments.     

Understanding Pig and Poultry Trade Networks and Farming Practices Within the Pacific Islands as a Basis for Surveillance

Pacific Island countries have large pig and poultry populations. Yet little is known about patterns of contact between animals and how this influences disease spread in these islands. The objectives of this study were to examine farmer practices and the movements of pig and poultry within the Pacific Islands using questionnaires and social network analysis (SNA) tools to understand disease spread in the region. Questionnaire‐based surveys were conducted in Fiji, Papua New Guinea (PNG), Solomon Islands and Vanuatu with interviews of 310 pig farmers and 491 poultry farmers. Pacific Island farmers were found to have few animals (median = 7 pigs/farm, IQR 4–12), (median = 50 chicken/farm, IQR 23–52), (median = 10 ducks/farm, IQR 4–25), (median = 12 Muscovy ducks/farm, IQR 7–28) and a diversified number of species. A large proportion of farmers (44.6–61.3%) do not implement any preventive or control measures, yet the majority (80.6–88%) did not experience any animal diseases over the past 12 months. Most farmers never ask for veterinary care, never engage in laboratory testing and do not report when their animals show clinical signs. Many pig farmers (31.8%) trade within their communities only and sell (24.5%) directly to consumers which reduces the risk of diseases spreading. Our results show an association between farmers that report having had disease on their farm in the past 12 months and movements of animals on and off their farms. The capitals of the studied provinces in PNG, Vanuatu and Solomon Islands were identified as the most connected nodes of both pig and poultry trade, while Fiji networks appeared much less connected. Our study found that farmer practices increased the risk of disease spread, but this was currently limited by trading practices. The SNA results serve as a basis for more targeted disease surveillance and better use of available resources for disease prevention and control.     

Indexed in SCI Medline

<正>Asian Pacific Journal of Tropical Medicine(APJTM)is an international journal of tropical medicine that is edited by International Federation of Tropical Medicine(IFTM)and published by Elsevier.It is the only journal of tropical medicine included by SCI,Medline in China.It indicates APJTM has become one of the top international journals.Since the first issue in March 2008,it has been included by 12 international databases:Science Citation Index(SCI)     

Dengue Virus Type 3, South Pacific Islands, 2013

After an 18-year absence, dengue virus serotype 3 reemerged in the South Pacific Islands in 2013. Outbreaks in western (Solomon Islands) and eastern (French Polynesia) regions were caused by different genotypes. This finding suggested that immunity against dengue virus serotype, rather than virus genotype, was the principal determinant of reemergence.     

Competition for nitrogen between trees in a mixed-species plantation in the Solomon Islands

ABSTRACT

As part of an ACIAR project aiming at improving community forestry in Solomon Islands, mixed-species plantations were established to assess the feasibility of inter-planting teak (Tectona grandis L. f.) and flueggea (Flueggea flexuosa Muell. Arg). Flueggea is a native hardwood used for timber and fence construction, and early removal of flueggea from a mixed-species stand could have a similar silvicultural outcome to thinning a single-species stand of teak. Using ¹⁵N-labelled ammonium sulphate, we investigated the competition for nitrogen (N) between the two species. The ¹⁵N-labelled tracer was applied to the soil surface of plots containing pairs of trees, one of each species, in 2-year-old and 4-year-old mixed-species stands, after the pairs of trees were isolated from the rest of the stand by an impermeable membrane. After 12–18 months, the isolated trees were measured and harvested, and each tree component (roots, stem, branch and foliage) was weighed and analysed for total N and ¹⁵N enrichment. There was no significant difference in the amounts of ¹⁵N between teak and flueggea components at either age, suggesting equal uptake of added ¹⁵N-labelled tracer by both species. The ¹⁵N amount was greater in stem followed by root, foliage and branch for teak and branch followed by stem, root and foliage for flueggea. About 42% and 55% of the applied ¹⁵N tracer were recovered in the 2-year and 4-year plots respectively, suggesting that higher uptake occurs with well-established root structure and that N losses decreased following canopy closure. The amount of total nitrogen was not significantly different between teak and flueggea components at age 2 and 4 years, and may indicate equal access to growth resources, and similar allocation. Although teak had significantly greater stem growth (height, basal area and volume) than flueggea in the 4-year plots, ¹⁵N uptake were similar to flueggea, which may mean that competition for growth resources was still minimal or that access to the resources was equal and growth rates differed between species.     

Toward the elimination of lymphatic filariasis by 2020: treatment update and impact assessment for the endgame

Lymphatic filariasis (LF) is an important public health problem endemic in 73 countries, where it is a major cause of acute and chronic morbidity and a significant impediment to socioeconomic development. It is targeted for elimination by 2020, through preventive chemotherapy using albendazole in combination with either ivermectin or diethylcarbamazine citrate. Preventive chemotherapy enables the regular and coordinated administration of safe, single-dose medications delivered through mass drug administration (MDA). Many countries are now scaling down MDA activities after achieving 100% geographic coverage and instituting monitoring and evaluation procedures to establish the impact of several consecutive rounds of MDA and determine if transmission has been interrupted. At the same time, countries yet to initiate MDA for elimination of LF will adopt improved mapping and coverage assessment protocols to accelerate the efforts for achieving global elimination by 2020. This review provides an update on treatment for LF and describes the current global status of the elimination efforts, transmission control processes and strategies for measuring impact and continuing surveillance after MDA has ceased.