26/03/2016 Health Check

Now on BBC News, Health Check.

Hello, and welcome to Health Check, your monthly dose of global health

stories, I'm Claudia Hammond. And I'm Ayan Panja.

This month, we're looking at the most important health stories

in the news right now.

Also coming up: The volunteers who give a parasitic worm

a home in the name of science.

How bugs could help to beat malnutrition in Cameroon.

And how hiding information in an Indian necklace

helps to save lives.

But first, the Zika virus is spreading around the world.

In Brazil, it appears to be linked with a rise in the number of babies

born with brains that are too small.

And the United States could be next.

America's Centers for Disease Control is warning

that the US territory of Puerto Rico is at risk of infection,

and they're tackling this threat from their headquarters in Atlanta,

as Tulip Mazumdar reports.

It might not look like it, but this tropical island

is in a state of emergency.

Welcome to the front line of the US's fight against Zika.

Millions of American tourists come here every year.

A major concern, though, is what they are taking

back with them.

These are the Zika transmitting Aedes aegypti mosquitoes,

and it's feeding time.

On the menu, pig's blood served at skin temperature.

They are being bred in this lab for research into insecticides.

These tiny creatures have been here in Puerto Rico spreading

dengue for many centuries.

Then, a couple of years ago, they started spreading

a new virus called Chikungunya.

After that, at the start of this year, Zika came along with that link

to babies being born brain-damaged.

Worryingly, the insecticides used to kill these mosquitoes

are no longer working as well as they used to.

These mosquitoes' are resistant to one of the most commonly used

insecticides, which is permethrin, and permethrin is an insecticide

which has been used in Puerto Rico but also the rest of the Americas

for many years.

Scientists are now racing to find other chemicals

that can kill mosquitoes.

The insects can breed and thrive in just a few drops of water.

Permethrin might not be 100% effective, but fumigators

are out on the streets are spraying entire neighbourhoods.

It's the best they can do right now.

Here we are talking about if you are pregnant,

what to do about the Zika and how to protect your baby...

Zika isn't considered particularly harmful to most people.

Authorities are focusing on protecting pregnant women

because of that link to babies being born

with under-developed brains.

This is a baby with a normal head,

with microcephaly...

I'm very worried, I use repellent everyday.

I woke up I put repellent, I go outside, I put repellent.

I am very worried about this.

1500 miles away at the Centers for Disease Control's headquarters

in Atlanta, the man who is advising

the president on this global health emergency

is preparing for the worst.

In Puerto Rico, we expect that there will likely be hundreds

of thousands of infections, and potentially hundreds

or thousands of women who are pregnant too

will become infected.

What's new and different and frightening is this rate

of birth defects, and there's a lot we don't know.

Back at the lab, scientists continue the fight

against these bloodthirsty insects.

They need answers fast to stop the spread of these

potentially devastating virus.

Well, I'm joined now by Jimmy Whitworth,

who is a professor of international public health at the London School

of Hygiene and Tropical Medicine.

Thank you for joining us. Hello.

How surprised are you by the spread of the Zika virus?

It was something that was hardly heard of six months ago.

That absolutely true, nobody predicted that we would

have an outbreak of Zika virus in South America.

For at least 50 years, it was entirely within Africa.

It then started to spread into Asia, and it was really only in the last

few years that we have had actual outbreaks of disease

associated with this.

First of all in Southeast Asia, and then in French Polynesia,

and now the biggest outbreak we've ever seen occurring in Brazil

and surrounding countries.

What kind of symptoms does the virus did you?

Most of the time, this is a very mild illness.

Most people, in fact, don't even recognise that

they've been ill.

If they are, they usually have things like a itchy rash,

mild fever, joint pains, muscle pains, and sometimes red eyes.

And how confident are you that there is a link between the Zika virus

and babies with the small head size, with microcephaly?

Personally, I'm convinced that there's a link between Zika

and microcephaly that we are seeing.

In formal terms, we haven't absolutely nailed down

the association there, but the evidence that we have

is compelling and very strong now.

But what we don't know and is really important is,

what is the risk?

We know if a person who is pregnant as Zika, what the likelihood

is that they without a baby that is affected?

We simply don't know if that is one in three or one in 1,000.

When do you think the danger period is in pregnancy in terms

of becoming infected?

Honestly, at the moment, we simply don't know.

We suspect, from what we know of other viruses that cause similar

birth defects that the early stages of pregnancy will be the most risky.

But some of the research findings that we are seeing

suggests that there is a risk right the way through pregnancy.

That could be quite significant in terms of the public

health advice given out.

Well, at the moment, the advice that is being given,

say, in the UK about travelling to affected countries,

is that women who are pregnant or even thinking of being pregnant

should avoid travelling to those areas.

So at the moment, it is pretty blanket advice not to travel.

Hookworms make their home in the human gut,

and infection can cause severe disability and anaemia.

The parasites can be treated with drugs, but doctors are trying

to develop vaccines to avoid repeated infections.

The trouble is that testing these vaccines in the vulnerable

communities where hookworms thrive is difficult,

so researchers in Washington DC are infecting volunteers,

as Lizzie Crouch reports.

Jessica is keeping a video diary for us.

As of tomorrow, I will have been dosed with hookworms

for a clinical study.

There is a definite ick factor that I've found with this study so far.

People are not super crazy

about the idea of 50 parasites living in my intestines.

But to be honest, I am not freaked out about that at all.

Infecting yourself with parasites might sound odd, but this will allow

researchers to better test hookworm vaccines.

Hookworms infect hundreds of millions of people

around the world.

The problem in endemic areas where there is hookworm

transmission, such as in Brazil and Africa, parts of Asia,

is that when people are infected, these people are often vulnerable

in terms of their nutrition, and hookworms take a blood meal.

Due to malnutrition and other variations,

it can be hard to test a new vaccine.

By understanding how healthy volunteers react to hookworm

infections, the researchers can then test vaccines more accurately.

I am on my way to go get my hookworms.

I am honestly not at all nervous, I'm really excited.

I get to put some parasites in my arm and let them

make their way to my intestines.

As hookworm larvae entered through the skin, they are put

on a patch that is then placed against the volunteer's arm.

I just left the office, where I got dosed.

I got kind of itchy, for sure, and it is itching.

I can show you my arm right now, the gauze is off.

Volunteers are being exposed to different doses of hookworm

to see how they are tolerated.

What we are doing now is doing increasing doses of the infective

larvae so we can find a place, the proper dose where we get

a good enough infection but with limited side-effects.

This will allow the researchers to develop the first human model

of hookworm infection to test vaccines.

But they are also looking

at how these parasites might work as medicine.

So imagine if we could engineer these worms to produce things

we wanted them to produce, like, for instance, insulin,

and we could infect a diabetic.

These worms would sit there for years

churning out the insulin.

It could then help this person manage their blood sugar better.

Many different possibilities of things if we can understand how

to make these worms work for us.

Volunteers experienced little or no side-effects and take simple

medication after four months to get rid of their parasitic friends.

Honestly, most of the time of the past four months,

I forgot that I even had hookworms.

I think, through me doing this, my family and friends kind of got

a better idea also about parasites and the global impact,

and also how doing things like this, despite the ick factor off the bat

can be really helpful for people.

Although infecting people may sound bizarre,

this trial could help millions.

From those suffering from hookworm infection

to people in need of new treatments.

Lizzie Crouch reporting from Washington DC

with a very brave volunteer.

Now, something to think about next time you are cleaning your home.

Could you be wiping out good bugs as well as the bad ones?

Can being too clean make us ill?

When Germany was split in two, doctors noticed children living

in Munich had more asthma and hay fever than those living in Leipzig.

If

After the Berlin Wall fell, cleaner lifestyles meant fewer bugs.

Children in Leipzig started to get more of these illnesses.

This trend was seen around the world.

More allergies and autoimmune diseases as infections decreased.

Scientists think this is because the human immune systems

grew used to the bugs, and when we became cleaner,

killing off many of the bugs, this made our immune system become

overactive, sometimes even attacking the body itself.

Researchers called this the hygiene hypothesis.

Some say they prove this by infecting people

with our old friends, the bugs, and noticed that they get better.

Such as hookworms being given to multiple sclerosis patients.

Whether or not the hygiene hypothesis turns out to be true,

maybe kids should play outdoors more with the bugs

to keep them healthier.

When an earthquake hit Taiwan last month,

more than a hundred people were killed.

Relatives and rescue workers can experience a whole range of emotions

in the days and weeks following a quake.

Cindy Sui has been to visit the survivors from a previous quake

in Taiwan to find out what the best way is of helping people

deal with a natural disaster.

An entire building complex lying on its side.

More than 100 people were killed

when a magnitude 6.4 earthquake struck Tainan City in February.

But Taiwan has seen even deadlier tremors.

In 1999, a magnitude 7.3 earthquake destroyed or damaged

more than 100,000 buildings and killed more than 2,400 people.

Those lucky enough to survive

suffered the pain of losing loved ones trapped under the rubble.

Many suffered injuries that forever changed their lives.

Before the quake, this man was looking forward

to getting married, but a staircase collapsed on him.

He became crippled, losing his job and his girlfriend.

TRANSLATION: I kept asking myself, how could this happen to me?

One day I'm walking, and the next day I'm

in a wheelchair.

I felt very depressed and depended on my father to take care of me.

After my father died, I realised I had to take care of myself.

I also felt I would be unkind to the many charity workers

who showed concern for me if I didn't become independent again.

He later turned to growing plants and vegetables to support himself.

Today, the same volunteers from the charity

still visit him every month.

This kind of community support is routinely found in Taiwan.

Studies have found that being traumatised after experiencing

a disaster is a normal human response, and most people

will recover without getting any professional psychological help.

What helps many people get back on their feet

is the need to survive, and getting some minimal practical support,

including loans and subsidies, and more importantly

feeling cared for by one's community and not forgotten.

It is the best strategy to help survivors

of natural disasters to rebuild their lives,

an approach endorsed by the World Health Organisation.

TRANSLATION: When faced with a disaster,

everyone's reaction is normal.

If you treat people's natural response as abnormal,

that can slow down the recovery, and they can use it as an excuse

not to recover.

What they need are relief supplies, information about services,

and subsidies to help them stabilise their lives.

And more importantly, someone to listen to them

and understand them.

It doesn't take professionals to do that.

After the latest deadly quake struck in Tainan City,

Taiwan used the experience it gained from previous disasters

to help the victims.

Psychologists did not rush to the scene.

Assistance was coordinated.

Each family was assigned one social worker or volunteer

to help them with various needs.

And those who lost loved ones

were sometimes simply left alone to grieve.

Some survivors from the 1999 earthquake, like this woman,

who lost her home, became volunteers themselves.

That has helped their recovery.

Mr Chen has also begun using his experience

to motivate others, showing that, through the right kind of support,

even those traumatised by disasters

can replant and revitalise their lives.

One in three children who live in Cameroon is malnourished,

which causes stunting and ill-health.

One nutritious source of protein is found in the African palm weevil.

They live in raffia palms which are being cut down in large

numbers, destroying their habitats.

Tamsin Ford has been to find out about a new sustainable way

of farming the grubs to ensure the future of this important food.

Palm weevil grubs - the juicy little bugs that everyone is after.

You can either eat them fried or raw.

Either way, they are a great source of protein.

They have more unsaturated fatty acids, they are the good ones,

and more polyunsaturated fatty acids, the really good ones,

than either chicken or fish.

So here in Cameroon, where one in three children

is malnourished, these are a great source of protein.

But demand for the grubs is outstripping supply.

Prices are soaring.

At around $4 a cup,

they are the most expensive meat on the market.

It is because they are not easy to find.

They live in raffia palms deep in the forest.

But a new grub farming project is hoping to change that.

It is a success story,

because first of all nobody ever knew that grubs could be farmed.

And when we came with the idea, a local authority

would not believe us.

It will really change people's lives, because it will permit people

to have more protein, and at the end of the day it

will permit people to have a better living standards than before.

All you need is a plastic box.

One stem of raffia palms inside the box produces 8-10 times

more grubs than it does in the wild.

TRANSLATION: I go to the forest four times a month now,

whereas before I had to go everyday.

The boxes of grubs do not need all my attention, so it has

given me all my time back.

I am proud, I am proud to produce palm weevil grubs.

Michel likes eating them raw,

but his family prefer them after they are cooked.

One in three children in Cameroon is stunted.

It means they are too short for their age

because of bad nutrition.

Tragically, after the child reaches 18 months, it is irreversible.

Cognitive and physical abilities are affected permanently.

TRANSLATION: If all children ate the palm weevil grubs,

there would be no more malnutrition.

Because the grubs are classified as the animals

with the most protein, malnutrition could disappear.

This is just a pilot project in three small villages,

but its success means it could be used across sub-Saharan Africa,

potentially changing the lives of future generations.

Around 1.5 million children around the world die every year

from diseases which could be prevented through vaccination,

such as measles and pneumonia.

The WHO wants to get 90% of children vaccinated,

but some countries lag behind, such as India, with rates under 60%.

But in a rural project in Rajasthan, they are reminding parents

of the importance of jabs.

We've been finding out how combining tradition and technology has created

a wearable solution.

They call her Gudiya, a name given to so many infants

in this remote part of Rajasthan, but this Gudiya is lucky.

The eight-month-old has had all the required immunisations

for her age, and so far she is healthy and happy.

1.5 million children die every year from vaccine preventable diseases

around the world.

India has one of the lowest vaccine coverage rates, just 50-60%

of children are immunised, well below the WHO's 90% target.

TRANSLATION: Vaccines were not available here in the past,

but now they are.

They help so much to protect children and entire

families from diseases.

And so the child can grow.

The reason why families have and always got their children

vaccinated are complicated.

They might live in a rural area, days away from a clinic.

They might not have been told about the benefits.

Some simply don't understand.

But this, based on traditional jewellery worn by infants,

could be the answer.

Local mothers were involved in the design of this necklace.

It is similar to those worn by infants in parts of India.

Known as Khushi Baby, or happy baby, a computer chip

embedded in the pendant stores vaccination data,

along with her mother's health records.

The health worker then takes the Khushi Baby pendant and touches

it to the back of the tablet, which enables the information

to sync and get stored into the chip that is in the pendant.

So the next time when the baby comes to the camp, all the health worker

needs to do is scan the pendant, and all the information

that had been entered previously is available, and the health worker

is able to tell which vaccine is due for the child and when.

1,500 babies are already in the Khushi Baby system,

and initial data is showing improved vaccination rates.

Health workers hope to scale up the project

a

to include all one million people in Rajasthan's health programme.

Well, that is all we have time for this month.

But don't forget, you can catch Claudia's radio programme

on the BBC World Service.

And you can follow all the stories online by going to the BBC website.

From now, it is goodbye from me, from Claudia and the rest

of the Health Check team. Goodbye.