The never-ending story of the fight against tuberculosis: from Koch's bacillus to global control programs

MA, Tovar-Rosero YY, Oñate AA, O'Ryan M. Two centuries of vaccination: historical and conceptual approach and future perspectives

Over the past two centuries, vaccines have been critical for the prevention of infectious diseases and are considered milestones in the medical and public health history. The World Health Organization estimates that vaccination currently prevents approximately 3.5-5 million deaths annually, attributed to diseases such as diphtheria, tetanus, pertussis, influenza, and measles. Vaccination has been instrumental in eradicating important pathogens, including the smallpox virus and wild poliovirus types 2 and 3. This narrative review offers a detailed journey through the history and advancements in vaccinology, tailored for healthcare workers. It traces pivotal milestones, beginning with the variolation practices in the early 17th century, the development of the first smallpox vaccine, and the continuous evolution and innovation in vaccine development up to the present day. We also briefly review immunological principles underlying vaccination, as well as the main vaccine types, with a special mention of the recently introduced mRNA vaccine technology. Additionally, we discuss the broad benefits of vaccines, including their role in reducing morbidity and mortality, and in fostering socioeconomic development in communities. Finally, we address the issue of vaccine hesitancy and discuss effective strategies to promote vaccine acceptance. Research, collaboration, and the widespread acceptance and use of vaccines are imperative for the continued success of vaccination programs in controlling and ultimately eradicating infectious diseases.

Mpox: "the stigma is as dangerous as the virus". Historical, social, ethical issues and future forthcoming

Objectives

The authors aim to show the possibility of stigma that hits affected Mpox patients because of the statements of society involving their sexual sphere.

Introduction

23 July 2022, the Director-General of the WHO, Thedos Ghebreyesus, issued an international public health alert regarding cases of Mpox (formerly known as Monkeypox). Although Mpox has been present in an endemic form for years in some Central African countries, the spread of the disease outside Africa has aroused considerable alarm in populations already sorely afflicted by the COVID-19 pandemic. Aside from the data, what is striking is that Mpox, like other infectious diseases, seems to have become a problem only when it began to cross the borders of Africa. Some may justify this attitude simply by ascribing it to the fear of an epidemic outside the areas where the virus is endemic. However, in such cases, and especially after the COVID-19 experience, other factors are also involved: lack of information and, even more so, the human capacity to utilise diseases to reinforce arguments against the tendencies, inclinations, orientations and behaviours of some social groups. Such information, albeit basically correct, is nevertheless incomplete. Moreover, it tends to prompt a view of this disease that may give rise to highly dangerous and embarrassing situations, engendering the risk of repeating the error that was made about AIDS. Mpox is the latest in a series of epidemics that have struck humanity in the space of very few years.

Material and methods

Setting and partecipants: people and social groups who, due to sexual orientations and behaviours, are considered to be at risk of being infected with Mpox. Main outcomes measures: - outcomes directly related to mental health of Mpox patients: anxiety, fear and depression, emotional difficulties, feelings of loneliness and isolation; - well-being outcomes of people with Mpox; - risk of not being able to reduce the epidemic among those groups don't feel as though they belong to LGBTQ and therefore do not implement any kind of prevention.

Results

Limit the contagion from Mpox through specific health and communication campaigns. Remove any stigma related to Mpox disease.

Conclusions

In the face of this disease, it is absolutely essential that we do not needlessly isolate groups of people by feeding stigma, prejudice and discrimination, which can have devastating effects not only on individuals but also on society as a whole. As the full inclusion of persons of LGBTQ community is probably still a long way off, we must surely wonder when we will be ready enough to achieve the important objective of equality for all.

History of primary health care in Iran

Background

The history of the primary healthcare system in Iran portrays a journey of strategic development and implementation that has resulted in significant advancements in healthcare access and overall population well-being. Starting in the early 1980s, Iran embarked on a comprehensive approach to health care delivery prioritizing universal access, equity, and community participation.

Introduction

The foundation of this system was established during the Alma-Ata Conference in 1978, which placed a strong emphasis on the role of primary health care in attaining health for all.Iran's unwavering commitment to this approach led to the creation of an extensive network of rural and urban health centers designed to offer essential health services and preventive care to all citizens.

Discussion

Over the years, the expansion of Iran's primary healthcare system has yielded noteworthy accomplishments. Maternal and child mortality rates have seen substantial declines, attributed to improved access to maternal care and immunization services. The effectiveness of the system in reaching diverse populations has been enhanced through community engagement and the integration of traditional medicine. Furthermore, Iran's focus on health education and disease prevention has resulted in heightened public awareness and the adoption of healthier lifestyles. Despite these achievements, challenges continue to persist. Disparities in the quality and accessibility of services between urban and rural areas remain a concern. Moreover, the ongoing necessity for infrastructure development, training of the health workforce, and efficient resource allocation underscore the continuous efforts required to strengthen the primary healthcare system.

Conclusions

The history of Iran's primary health care system is marked by progress and achievements, underscored by an unwavering commitment to providing comprehensive, community-based care. Iran's journey serves as an exemplary model, highlighting the positive impact of prioritizing primary health care in achieving better health outcomes for its population. As Iran continues to evolve its health system, addressing challenges and building upon successes, the history of its primary health care system serves as a valuable lesson in the pursuit of accessible and equitable health care for all.

Multidrug-Resistant TB (MDR-TB) and Extensively Drug-Resistant TB (XDR-TB) Among Children: Where We Stand Now

Drug-resistant tuberculosis (DR-TB) has continued to be a global health cataclysm. It is an arduous condition to tackle but is curable with the proper choice of drug and adherence to the drug therapy. WHO has introduced newer drugs with all-oral shorter regimens, but the COVID-19 pandemic has disrupted the achievements and raised the severity. The COVID-19 controlling mechanism is based on social distancing, using face masks, personal protective equipment, medical glove, head shoe cover, face shield, goggles, hand hygiene, and many more. Around the globe, national and international health authorities impose lockdown and movement control orders to ensure social distancing and prevent transmission of COVID-19 infection. Therefore, WHO proposed a TB control program impaired during a pandemic. Children, the most vulnerable group, suffer more from the drug-resistant form and act as the storehouse of future fatal cases. It has dire effects on physical health and hampers their mental health and academic career. Treatment of drug-resistant cases has more success stories in children than adults, but enrollment for treatment has been persistently low in this age group. Despite that, drug-resistant childhood tuberculosis has been neglected, and proper surveillance has not yet been achieved. Insufficient reporting, lack of appropriate screening tools for children, less accessibility to the treatment facility, inadequate awareness, and reduced funding for TB have worsened the situation. All these have resulted in jeopardizing our dream to terminate this deadly condition. So, it is high time to focus on this issue to achieve our Sustainable Development Goals (SDGs), the goal of ending TB by 2030, as planned by WHO. This review explores childhood TB's current position and areas to improve. This review utilized electronic-based data searched through PubMed, Google Scholar, Google Search Engine, Science Direct, and Embase.

The history of vaccinology and hygiene through Achille Sclavo and the cultural patrimony conserved in the archives and museums: the key role of medical museology

Over the centuries, the oldest universities have amassed an extraordinary patrimony of material and immaterial cultural assets, which have been created or acquired for the purposes of research or teaching. Now on display in museums, they testify to the evolution of knowledge and its diversification in various disciplines. In order to safeguard, conserve and study this precious heritage, we need to implement a cultural project that activates that "process of awareness" on which cataloging is based. This is a "reasoned awareness" that enables an object to be framed within a system of scientific knowledge and historical-critical relationships, which are essential to its conservation and, consequently, to its public exploitation. Through this process, we can uncover the history of an object, its characteristics and its uniqueness. This is the case, for example, of an optical microscope on display in the Museo di Strumentaria medica (Medical Equipment Museum), which is part of the Museum System of the University of Siena.

Analogues of Pyrimidine Nucleosides as Mycobacteria Growth Inhibitors

Tuberculosis (TB) is the oldest human infection disease. Mortality from TB significantly decreased in the 20th century, because of vaccination and the widespread use of antibiotics. However, about a third of the world’s population is currently infected with Mycobacterium tuberculosis (Mtb) and the death rate from TB is about 1.4–2 million people per year. In the second half of the 20th century, new extensively multidrug-resistant strains of Mtb were identified, which are steadily increasing among TB patients. Therefore, there is an urgent need to develop new anti-TB drugs, which remains one of the priorities of pharmacology and medicinal chemistry. The antimycobacterial activity of nucleoside derivatives and analogues was revealed not so long ago, and a lot of studies on their antibacterial properties have been published. Despite the fact that there are no clinically used drugs based on nucleoside analogues, some progress has been made in this area. This review summarizes current research in the field of the design and study of inhibitors of mycobacteria, primarily Mtb.

Extracellular Vesicles in Mycobacteria and Tuberculosis

Tuberculosis (TB) remains a public health issue causing millions of infections every year. Of these, about 15% ultimately result in death. Efforts to control TB include development of new and more effective vaccines, novel and more effective drug treatments, and new diagnostics that test for both latent TB Infection and TB disease. All of these areas of research benefit from a good understanding of the physiology of Mycobacterium tuberculosis (Mtb), the primary causative agent of TB. Mtb secreted protein antigens have been the focus of vaccine and diagnosis research for the past century. Recently, the discovery of extracellular vesicles (EVs) as an important source of secreted antigens in Mtb has gained attention. Similarly, the discovery that host EVs can carry Mtb products during in vitro and in vivo infection has spiked interest because of its potential use in blood-based diagnostics. Despite advances in understanding the content of Mtb and Mtb-infected host extracellular vesicles, our understanding on the biogenesis and role of Mtb and host extracellular vesicles during Mtb infection is still nascent. Here, we explore the current literature on extracellular vesicles regarding Mtb, discuss the host and Mtb extracellular vesicles as distinct entities, and discuss current gaps in the field.

The avid eaters of lives. New and old infectious diseases in Italy at the time of World War I: a historical overview of military medicine and public health

World War I hit Italy from different perspectives. The one here described under an historical point of view regards the health of military and civil population, with a special focus on infective diseases. The 20th Century was the fuse of degeneration and eugenetics theories; which grew in the melée of war and technological innovation. Indeed, war is interestingly depicted as an entity capable of emphasizing the differences between those who wore a uniform and those who did not. As a matter of fact, some infections spared the civilian population while others felt with greater vengeance on this subgroup. Moreover, the incidence of different feared diseases was brought back to the rates of the late 19th Century. Thanks to a statistician, Giorgio Mortara (1885-1967) the impact of infective diseases in Wolrd War I on Italian demography is well established. Moreover, different military and civilian sources contribute to enrich the picture of the consequences of war. In conclusion World War I could see considered as a litmus paper. The litmus paper of successes and failures of italian public health management to face new medical challenges exacerbated by the crisis.

Edoardo Maragliano (1849-1940) and the immunogenicity of the tubercle bacillus: the pathway of a great italian physician

Edoardo Maragliano (1849-1940) was an Italian physician; he played a central role in medicine's "renaissance" in Italy and Europe. After beginning his academic career as a professor of pathology, he became full professor of internal medicine in 1881. While he studied all fields of internal medicine, his research focused mainly on tuberculosis. Thanks to his experiments in the medical clinic, Maragliano announced the possibility of immunization against Mycobacterium tuberculosis. Although criticized for using an inactivated vaccine, Maragliano continued to advocate vaccination with any type of vaccine. Maragliano keenly contributed to the still ongoing process of understanding the difficult interaction between Mycobacterium tuberculosis and the infected host.

How to improve TB outpatient service in a TB low-endemic country during SARS-CoV-2 pandemic

Despite notable progresses in the recent decades, tuberculosis (TB) continues to remain a public health concern even in Europe. TB prevention and care should be people-centred, improving ambulatory models across countries, in order to expand access to diagnosis and treatment for both TB infection and disease. Even more, during emergencies such as the current pandemic, when seeking of TB care has been replaced by the fear of coronavirus disease 2019 (COVID-19), TB patient’s care is fundamental. In this short communication, we document how was possible to implement a TB outpatient service meanwhile a local outbreak of SARS-CoV-2 transmission was ongoing.

Computational exploration and anti-mycobacterial activity of potential inhibitors of Mycobacterium tuberculosis acetyl coenzyme A carboxylase as anti-tubercular agents

Acetyl Coenzyme A Carboxylase (AccD6) is a homodimeric protein which is involved in the carboxylation of acetyl coenzyme A to produce malonyl coenzyme A, which plays an important role in the biosynthesis of fatty acid chain. However, studies suggest that AccD6 in combination with AccA3 produces malonyl co-A. Certain herbicides are known to inhibit plant ACC. Among these herbicides, haloxyfop was found to inhibit AccD6 at IC50 of 21.1 ± 1 µM. In this study, we have performed molecular docking of the Maybridge database consisting of ~55,000 compounds in the active site of the protein with haloxyfop as a reference molecule, followed by molecular dynamics study and biological activity determination of prioritized compounds. Out of the nine compounds selected for biological evaluation, three compounds - CD07230, HTS08529 and KM08871 - were found to exhibit anti-mycobacterial activity.

Tuberculosis: a timeless challenge for medicine

This overview shows how tuberculosis has represented and still represents a continuous challenge for Medicine. Starting from the dawn of medicine, when tuberculosis was called “phthisis” by Hippocrates, passing through the discovery of the tubercles and the creation of the word “tuberculosis”, following the application of the anatomo-clinical method, until the discovery of a microscopic enemy: Mycobacterium tuberculosis. The progressive discovery of the pathological basis of tuberculosis has allowed to devise important therapeutic strategies in Pre-Antibiotic and Post-Antibiotic Era. In particular, “antibiotic therapy” had to be the end of the challenge between man and tuberculosis. However it was only an illusion. Despite progress in care and prevention, tuberculosis remains one of the world’s leading causes of ill-health and the first cause of death from infectious disease. Nowadays, the drug resistance, individuals with immune deficiencies, the ageing and globalization are just some of the causes responsible for the increasing of the challenge between man and tuberculosis.