GENEVA — U.N. agencies warn that the demolition of a critical water facility in Rafah in the southern Gaza Strip increases the risk of infectious diseases as people are forced to drink unsafe water while sanitary conditions continue to deteriorate.

“Until recently, that reservoir served thousands and thousands of internally displaced people who had sought refuge in Rafah in the area,” James Elder, UNICEF spokesperson, told journalists at a briefing in Geneva on Tuesday.

“Now without it, vulnerable children and families are likely to be forced again increasingly to resort to unsafe water, so putting them again at all those risks that we see time after time, day after day in Gaza — dehydration, malnutrition, diseases,” he said.

The Israeli daily Haaretz reported Monday that the troops blew up the central reservoir “on the orders of the brigade commanders” but without receiving permission from the senior level of the Southern Command. It added that the incident was being investigated by Israel’s Military Police as “a suspected violation of international law.”

Infections spreading

Elder said the destruction of the Canada Well reservoir “is yet another grim reminder of the assaults on families who already are in desperate need of water.”

“We have seen spikes in diarrhea, in skin infections — all due to a lack of access to hygiene and a lack of access to water,” he said, noting that people in emergencies require a minimum of 15 liters (almost 4 gallons) of water per person per day.

Now, the range of water availability in Gaza has been reduced to between 2 and 9 liters per person, per day, and some people are getting just a fraction of that, Elder said.

“Somehow, people are holding on, but of course, we are now in that deathly cycle whereby children are very malnourished. There is immense heat. There is [a] lack of water. There is a horrendous lack of sanitation, and that is the cycle,” he said.

The World Health Organization reports a surge in infectious diseases in the Gaza Strip. As of July 7, it has recorded nearly 1 million cases of acute respiratory infections, 577,000 cases of acute watery diarrhea, 107,000 of acute jaundice syndrome and 12,000 of bloody diarrhea. It also has recorded nearly 200,000 cases of scabies, lice, skin rashes, chicken pox and other illnesses.

Polio threat

The recent identification of circulating vaccine-derived poliovirus type 2 in Gaza’s sewage system is of particular concern. Under prevailing conditions in Gaza, there is a high risk of spread of this paralytic, deadly disease within the Palestinian enclave and across borders.

“Having a vaccine-derived polio virus in the sewage very likely means that it is out there somewhere in people,” WHO spokesperson Christian Lindmeier said. “It most likely is in the population, but that does not necessarily mean that we see an outbreak of cases.

“But of course, we need to be prepared. We need to be utterly prepared. And we need vaccinations, and we need vaccination campaigns,” he said.

WHO Director-General Tedros Adhanom Ghebteyesus has announced that the organization will be sending more than 1 million doses of polio vaccine to Gaza to avert the spread of the disease.

“While no cases of polio have been recorded yet, without immediate action, it is just a matter of time before it reaches the thousands of children who have been left unprotected,” he said, adding that infants under 2 are especially vulnerable “because many have not been vaccinated over the nine months of conflict.”

Before Israel began its military offensive in Gaza following a brutal attack on Israel by Hamas militants on October 7, nearly the whole population of Gaza had been immunized against polio.

However, due to the impact of the conflict, “coverage of polio now is around 89%, down from around 99% before the conflict,” UNICEF’s Elder said. “Hence, there is an increased risk for children. Now, if the child gets the full course of the vaccine, then the risk of the child getting paralyzed by polio is negligible.

“This is why it is so critical that all children are immunized. But the mass displacement, the decimation of the health infrastructure, the tremendously insecure operating environment — they all make it much more difficult, hence putting more children at risk,” he said.

Cases of polio have declined by 99% since WHO launched its global polio eradication campaign in 1988.

WHO reports polio now is endemic only in Pakistan and Afghanistan. However, more than 30 countries, including Egypt and Israel, are subject to outbreaks. The reemergence of polio tends to occur in areas of conflict or instability and within countries with poor health systems.

“We were very, very close to eradicating polio fully,” WHO spokesperson Lindmeier said. “As you know, wartime, unfortunately, creates the situation where it is very difficult to get that last mile. And it has been less than a mile that we needed to go.

“There are a few pockets around the world. Hopefully, Gaza will not become another one,” he said.
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Bangkok — Millions of lives could be put at risk unless urgent action is taken to curb the spread of drug-resistant malaria in Africa, according to a new paper published in the journal Science.

The paper says the parasite that causes malaria is showing signs of resistance to artemisinin, the main drug used to fight the disease, in several east African countries.

“Mutations indicating artemisinin-resistance have been found in more than 10% of malaria infected individuals in Ethiopia, Eritrea, Rwanda, Uganda, and Tanzania,” according to the report.

Artemisinin Combination Therapies, or ACTs, have been the cornerstone of malaria treatment in recent years — but there are worrying signs that they are becoming less effective, says report co-author Lorenz von Seidlein of the Mahidol Oxford Tropical Medicine Research Unit in Bangkok.

“We have increasing reports from eastern Africa saying that they have documented resistance against the first line treatments against malaria,” he says. “The first line treatments are artemisinin combination therapy – that has been used for the last 20 years and has worked excellently well. And it’s now not working quite as well as it used to do.”

It’s estimated that over one thousand children die every day from malaria in Africa. The World Health Organization estimates that the global death toll from malaria in 2022 — the most recent figures available — was 608,000.

Past lessons

Before artemisinin therapies were developed, chloroquine was the medicine most used to treat malaria. The report authors say that in the 1990s and early 2000s, signs that the malaria parasite was developing resistance to chloroquine were widely ignored.

“When chloroquine resistance slowly sneaked into Africa there was a whole wave of childhood mortality followed by it. So really, a large number of children — probably in the millions — died because chloroquine didn’t work as well as it used to do. And now we see these first signs that something similar is happening with the ACTs. And that is of course very worrying,” von Seidlein says.

Urgent action

The report authors urge policymakers and global funding bodies to act now to prevent artemisinin resistance taking hold.

Their recommendations include combining artemisinin drugs with other medicines.

“Combining an artemisinin derivative drug with two partner drugs in triple artemisinin combination therapies [TACTs] is the simplest, most affordable, readily implementable, and sustainable approach to counter artemisinin resistance,” the report says.

The authors also call for the rollout of new, more effective insecticides and mosquito nets; better training of community health workers; the rapid deployment of new malaria vaccines; and better monitoring of parasite mutations.

Southeast Asia

Many of these methods were used to halt the spread of artemisinin resistance in south-east Asia since 2014, notes von Seidlein.

“Ultimately, there was an understanding that this could be a major health emergency globally and so there were a lot of investments from funders for the from high-income countries towards these countries in the Greater Mekong sub-region to stop the spread of artemisinin resistant parasites,” he says.

The report says that sense of urgency must now be applied to tackling artemisinin resistance in Africa.

“We ask funders, specifically the Global Fund to Fight AIDS, Tuberculosis and Malaria [GFATM] and the U.S. Government’s President’s Malaria Initiative, to be visionary and to step up funding for malaria control and elimination programs to contain the spread of artemisinin resistance in Africa — as they have done effectively in Southeast Asia since 2014,” says report co-author Ntuli Kapologwe, the director of preventive services at Tanzania’s Ministry of Health.
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The malaria parasite is showing signs of resistance to artemisinin, the main drug used to fight the disease, in parts of Africa. A new report warns of potentially millions more deaths without immediate health policy changes. Henry Ridgwell has more from Bangkok.
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GALAPAGOS ISLANDS, Ecuador — Warm morning light reflects from the remains of a natural rock arch near Darwin Island, one of the most remote islands in the Galapagos. In clear, deep blue water, thousands of creatures — fish, hammerhead sharks, marine iguanas — move in search of food.

The 2021 collapse of Darwin’s Arch, named for the famed British naturalist behind the theory of evolution, came from natural erosion. But its demise underscored the fragility of a far-flung archipelago that’s coming under increased pressure both from climate change and invasive species.

Warming oceans affect the food sources of many of the seagoing animals in the Galapagos. Marine iguanas — one of many species that are endemic, or unique, to the Galapagos — have a harder time finding the red and green algae they prefer. Sea turtles struggle to nest in warmer temperatures. Raising young gets harder as water warms and fewer nutrients are available.

While the Galapagos are known for a great multitude of species, their numbers aren’t unlimited.

“We have something of everything here – that’s why people say the Galapagos is so diverse – but we have a small number of each thing,” said Natasha Cabezas, a naturalist guide.

The Galapagos have always been sensitive to changes in ocean temperature. The archipelago itself is located where major ocean currents converge — cool from the south, warm from the north, and a cold upwelling current from the west. Then there’s El Nino, the periodic and natural Pacific Ocean warming that affects weather worldwide.

While temperatures vary depending on the season and other naturally-occurring climate events, ocean temperatures have been rising because of human-caused climate change as oceans absorb the vast majority of excess heat in the atmosphere. The ocean experienced its warmest decade since at least the 1800s in the last 10 years, and 2023 was the ocean’s warmest year on record.

Early June brings winter in the Southern Hemisphere, and the Cromwell current brings whale sharks, hammerheads, and massive sunfish to the surface. It also provides nutrients for penguins, marine iguanas and sea lions in search of food. As more of those animals make themselves known this season, scientists are tracking how they fared in the warming of the past year’s El Nino.

El Nino can bring food shortages for some species like marine iguanas and sea turtles, as the warmer ocean means dwindling food sources. Scientists observing the species have noted a significant decline in population numbers during El Nino events.

Marine iguanas swim like snakes through the water from rock to rock as waves crash against the shore of Fernandina Island. They latch themselves onto the undersea rocks to feed on algae growing there, while sea lions spin around them like puppies looking for someone to play with.

The iguanas were “one of the most affected species from El Niño last year and right now they are still recovering,” said Galapagos Conservancy Director Jorge Carrión.

As rising ocean temperatures threaten aquatic or seagoing life, on land there’s a different problem. Feral animals — cats, dogs, pigs, goats and cattle, none of them native — are threatening the unique species of the islands.

After the COVID-19 pandemic, many people are abandoning the dogs and cats they wanted to keep them company, Cabezas said.

“If you don’t take care of them they become a problem and now it’s a shame to see dogs everywhere. We have a big problem right now I don’t know what we’re going to do,” she said.

The non-native animals are a special threat to the giant tortoises closely associated with the Galapagos. The tortoises declined dramatically in the 19th century due to hunting and poaching, and authorities have worked to protect them from humans. It’s been illegal to kill a giant tortoise since 1933.

“In one night, a feral pig can destroy all nesting sites in an area,” Carrión said. Park rangers try to visit areas with nesting sites once a day, and kill pigs when they find them. But the pigs are elusive, Carrion said.

Feral cats feed on marine iguana hatchings, and both pigs and cats compete for food with the tortoises.

If invasive species and warming oceans weren’t enough, there’s the plastic that is a widespread problem in the world’s oceans. One recent study reported microplastics in the bellies of Galapagos penguins.

“There are no animals in the Galapagos that do not have microplastics in their food,” Carrión said.
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Washington — New blood tests could help doctors diagnose Alzheimer’s disease faster and more accurately, researchers reported Sunday – but some appear to work far better than others.

It’s tricky to tell if memory problems are caused by Alzheimer’s. That requires confirming one of the disease’s hallmark signs — buildup of a sticky protein called beta-amyloid — with a hard-to-get brain scan or uncomfortable spinal tap. Many patients instead are diagnosed based on symptoms and cognitive exams.

Labs have begun offering a variety of tests that can detect certain signs of Alzheimer’s in blood. Scientists are excited by their potential, but the tests aren’t widely used yet because there’s little data to guide doctors about which kind to order and when. The U.S. Food and Drug Administration hasn’t formally approved any of them and there’s little insurance coverage.

“What tests can we trust?” asked Dr. Suzanne Schindler, a neurologist at Washington University in St. Louis who’s part of a research project examining that. While some are very accurate, “other tests are not much better than a flip of a coin.”

Demand for earlier Alzheimer’s diagnosis is increasing

More than 6 million people in the United States and millions more around the world  

have Alzheimer’s, the most common form of dementia. Its telltale “biomarkers” are brain-clogging amyloid plaques and abnormal tau protein that leads to neuron-killing tangles.

New drugs, Leqembi and Kisunla, can modestly slow worsening symptoms by removing gunky amyloid from the brain. But they only work in the earliest stages of Alzheimer’s and proving patients qualify in time can be difficult. Measuring amyloid in spinal fluid is invasive. A special PET scan to spot plaques is costly and getting an appointment can take months.

Even specialists can struggle to tell if Alzheimer’s or something else is to blame for a patient’s symptoms.

“I have patients not infrequently who I am convinced have Alzheimer’s disease and I do testing and it’s negative,” Schindler said.

New study suggests blood tests for Alzheimer’s can be simpler, faster

Blood tests so far have been used mostly in carefully controlled research settings. But a new study of about 1,200 patients in Sweden shows they also can work in the real-world bustle of doctors’ offices — especially primary care doctors who see far more people with memory problems than specialists but have fewer tools to evaluate them.

In the study, patients who visited either a primary care doctor or a specialist for memory complaints got an initial diagnosis using traditional exams, gave blood for testing and were sent for a confirmatory spinal tap or brain scan.

Blood testing was far more accurate, Lund University researchers reported Sunday at the Alzheimer’s Association International Conference in Philadelphia. The primary care doctors’ initial diagnosis was 61% accurate and the specialists’ 73% — but the blood test was 91% accurate, according to the findings, which also were published in the Journal of the American Medical Association.

Which blood tests for Alzheimer’s work best?

There’s almost “a wild West” in the variety being offered, said Dr. John Hsiao of the National Institute on Aging. They measure different biomarkers, in different ways.

Doctors and researchers should only use blood tests proven to have a greater than 90% accuracy rate, said Alzheimer’s Association chief science officer Maria Carrillo.

Today’s tests most likely to meet that benchmark measure what’s called p-tau217, Carrillo and Hsiao agreed. Schindler helped lead an unusual direct comparison of several kinds of blood tests, funded by the Foundation for the National Institutes of Health, that came to the same conclusion.

That type of test measures a form of tau that correlates with how much plaque buildup someone has, Schindler explained. A high level signals a strong likelihood the person has Alzheimer’s while a low level indicates that’s probably not the cause of memory loss.

Several companies are developing p-tau217 tests including ALZpath Inc., Roche, Eli Lilly and C2N Diagnostics, which supplied the version used in the Swedish study.

Who should use blood tests for Alzheimer’s?

Only doctors can order them from labs. The Alzheimer’s Association is working on guidelines and several companies plan to seek FDA approval, which would clarify proper use.

For now, Carrillo said doctors should use blood testing only in people with memory problems, after checking the accuracy of the type they order.

Especially for primary care physicians, “it really has great potential to help them in sorting out who to give a reassuring message and who to send on to memory specialists,” said Dr. Sebastian Palmqvist of Lund University, who led the Swedish study with Lund’s Dr. Oskar Hansson.

The tests aren’t yet for people who don’t have symptoms but worry about Alzheimer’s in the family — unless it’s part of enrollment in research studies, Schindler stressed.

That’s partly because amyloid buildup can begin two decades before the first sign of memory problems, and so far, there are no preventive steps other than basic advice to eat healthy, exercise and get enough sleep. But there are studies underway testing possible therapies for people at high risk of Alzheimer’s, and some include blood testing.
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