This Year in Medicine
2014: news round up of the year
Combating resistance 2014 could be remembered as the year in which the fight against antibiotic resistance finally started receiving the attention it deserves. In July, an unprecedented collaboration was announced between all seven UK research councils and the Wellcome Trust for research aimed at tackling antibiotic resistance. Coordinated by the Medical Research Council and also involving government departments and other organisations, the collaboration will oversee research covering the laboratory, the clinic, and the wider environment. In September, the Obama administration in the USA published a national strategy to combat antibiotic resistance and set up a task force charged with developing a comprehensive implementation plan. The admin istration also announced a competition with a US$20 million prize for the development of rapid diagnostic tests for antibiotic-resistant infections. www.thelancet.com Vol 384 December 20/27, 2014
HIV setback Last year’s announcement that a baby girl was believed to have been cured of HIV after being given antiretroviral therapy soon after birth generated much hope and excitement. The so-called Mississippi baby was given a three-drug regimen of zidovudine, lamivudine, and nevirapine from 30 hours after birth, and was lost to care at age 18 months, but maintained viraemic control in the absence of treatment when assessed at age 30 months. However, at a news conference in July this year, researchers announced that detectable concentrations of HIV had returned after 2 years off treatment, prompting resumption of antiretroviral therapy. The new development will be taken into account by investigators of a planned clinical trial based on the approach. Bio-dangers Controversy hit the US Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) this year, with both organisations under fire for major biosafety lapses. The transfer of a preparation of Bacillus anthracis from a CDC Biosafety Level 3 laboratory in Atlanta, GA, to a Level 2 laboratory left more than 80 staff potentially exposed when inadequate procedures were used to inactivate the bacteria. Meanwhile, staff at an FDA laboratory in Bethesda, MD, discovered vials of variola, the virus that causes smallpox, among hundreds of other forgotten pathogen samples in an old cold storage room. Only the CDC in Atlanta and a Russian laboratory in Siberia are meant to have the smallpox virus.
Malaysia Airlines flight MH17 was shot down over Ukraine on July 17. Joep Lange, Jacqueline van Tongeren, Pim de Kuijer, Martine de Schutter, Lucie van Mens, and Glenn Thomas were among the 283 passengers and 15 crew who died in the crash. They were on their way to attend the International AIDS Society (IAS) meeting in Melbourne, VIC, Australia, which took place on July 20–25. At the opening session of the conference, IAS president Françoise Barré-Sinoussi paid tribute to the delegates who had died in the crash. “We remember their legacy forever and keep them in our hearts”, she said. Sustaining development In July, the UN Open Working Group published its proposal for a set of Sustainable Development Goals that look set to shape the international development agenda after 2015, when most of the existing Millennium Development Goals are due to expire. The proposal, which consisted of 17 goals with 169 targets covering a wide range of issues including poverty, gender inequality, climate change, and food security, was discussed by world leaders at the UN General Assembly in September. Health-related targets
For more on Ebola see http:// ebola.thelancet.com/ For more on the UK antibiotic resistance initiative see Lancet 2014; 384: 391 For more on US plans to tackle antibiotic resistance see Lancet 2014; 384: 1083–84 For more on biosafety errors in the USA see Lancet 2014; 384: 294 For more on the MH17 tragedy see Lancet 2014; 384: 293
Kristin Palitza/dpa/Corbis
Ebola crisis This year has seen the worst ever epidemic of Ebola virus disease, mainly affecting three countries in west Africa—beginning in Guinea in December, 2013, the disease then spread to neighbouring Liberia and Sierra Leone. As of midDecember, 2014, more than 18 000 cases have been reported, resulting in more than 6500 deaths. The scale of the crisis has prompted unprecedented efforts to develop vaccines against the disease that could potentially be used to halt the epidemic, with clinical trials beginning in west Africa in December. Fast-track trials are also planned to test several experimental treatments, including antiviral drugs and convalescent whole blood and plasma.
Alex Milan Tracy/Sipa USA
Neil Bennet looks back at the major medical, health, and humanitarian stories from 2014—a year in which Ebola took hold in west Africa and transplantation doctors celebrated advances.
MH17 tragedy The HIV research community mourned the loss of six of their colleagues who died when 2187
Associated Press
This Year in Medicine
The first baby to be born to a woman after uterine transplantation
For more on health and the Scottish independence referendum see Lancet 2014; 383: 397–98 For more on the Climate Summit 2014 see Lancet 2014; 384: 1071 For more on the livebirth after uterus transplantation see Lancet 2014; published online Oct 6. http://dx.doi.org/10.1016/ S0140-6736(14)61728-1 For more on the situation in Syria see Lancet 2014; 384: 221–22 For more on the situation in South Sudan see Lancet 2014; 384: 1252 For more on the situation in the Central African Republic see Lancet 2014; 383: 860 For more on enterovirus D68 in North America see Lancet 2014; 384: 1250
include a commitment to achieving universal health coverage and specific targets for maternal mortality and deaths from non-communicable diseases. Negotiations will continue into next year, with a final set of goals due to be presented at a special session of the General Assembly in September, 2015. Healthy independence The future of the National Health Service (NHS) was a major topic of debate in the run-up to the Scottish independence referendum on Sept 18. Supporters argued that independence was needed to protect the NHS in Scotland from future funding cuts and the UK Government’s privatisation agenda, as well as to give the Scottish Parliament greater power over welfare and public health. Meanwhile, opponents suggested that tax cuts promised by the Scottish National Party (SNP) could lead to reductions in health spending. Ultimately, the no side won the referendum 55% to 45%. However, independence remains on the political agenda, with membership of the SNP and other pro-independence groups growing by thousands in the months after the referendum.
Ulet Ifansasti/Stringer
Changing climate Global discussions about how to tackle climate change have been heating up in 2014, with a major UN Climate Summit hosted by Secretary-General Ban Ki-moon 2188
more than 200 000 deaths and has devastated the country’s health-care system. Meanwhile, more than 10 000 people have died in the continuing conflict in South Sudan, and in the Central African Republic about 508 000 people remain internally displaced after 2 years of fighting.
taking place in New York, NY, USA in September. The meeting brought together governments, the private sector, and civil society groups, with outcomes including financial commitments and a pledge to halt the loss of natural forests by 2030. Then in early December, the 20th annual session of the Conference of the Parties (COP 20) to the UN Framework Convention on Climate Change took place in Lima, Peru, where negotiations continued towards a new global agreement to be approved by COP 21 in Paris, France, in December, 2015. Pledges for a new Green Climate Fund reached US$10 billion at COP 20 and a path to COP 21 was agreed. However, campaigners criticised the final Lima agreement for being too vague. Transplant success In exciting news for reproductive medicine, 2014 saw the first successful livebirth after uterine transplantation in a patient with absolute uterine factor infertility, which was reported in The Lancet. A 35-year-old woman with congenital absence of the uterus (Rokitansky syndrome) received a donated uterus from a living 61-year-old family friend in an operation last year and gave birth to a baby boy via in-vitro fertilisation. The patient was one of nine who underwent the transplantation procedure as part of a clinical trial at Sahlgrenska University Hospital in Gothenburg, Sweden. Doctors plan to remove the transplanted uterus to reduce the risk of continuing immunosuppression. Continuing conflicts Wars and conflicts continued to rage in the Middle East and Africa in 2014. The civil war in Syria entered its fourth year in the spring, and in the summer the Islamic State extremist group advanced and now control a large part of the country. The conflict, which began with protests against President Bashar al-Assad’s government in 2011, has led to
Unexpected outbreak An outbreak of enterovirus D68 in the USA and Canada has been causing severe respiratory illness in children. Between mid-August and Dec 11, 1149 people in 48 US states and the District of Columbia had confirmed enterovirus D68 infection, according to the CDC. Many of the children admitted to hospital with the infection had asthma or other underlying respiratory problems; many other children have probably been affected by milder forms of illness. Enterovirus D68 might also be linked to recent cases of unexplained acute flaccid myelitis in US children, with symptoms including full or partial paralysis of the arms or legs, although the association with the virus is unconfirmed. Heart-shaped box Surgeons in Australia announced in October that they had successfully transplanted donor hearts that had stopped beating into patients for the first time. The team at St Vincent’s Hospital, Sydney, NSW, completed three operations— two of the patients were reported to have recovered well and the third, who had undergone the procedure recently, was still in intensive care at the time of the announcement. The donor hearts, which had stopped beating for 20 min, were reactivated in a console referred to by the surgeons as a heart-in-a-box machine, where they were maintained for about 4 hours before transplantation. If adopted as standard practice, the approach could substantially increase the number of donor hearts available for transplantation.
Neil Bennet www.thelancet.com Vol 384 December 20/27, 2014
2014: news round up of the year
Combating resistance 2014 could be remembered as the year in which the fight against antibiotic resistance finally started receiving the attention it deserves. In July, an unprecedented collaboration was announced between all seven UK research councils and the Wellcome Trust for research aimed at tackling antibiotic resistance. Coordinated by the Medical Research Council and also involving government departments and other organisations, the collaboration will oversee research covering the laboratory, the clinic, and the wider environment. In September, the Obama administration in the USA published a national strategy to combat antibiotic resistance and set up a task force charged with developing a comprehensive implementation plan. The admin istration also announced a competition with a US$20 million prize for the development of rapid diagnostic tests for antibiotic-resistant infections. www.thelancet.com Vol 384 December 20/27, 2014
HIV setback Last year’s announcement that a baby girl was believed to have been cured of HIV after being given antiretroviral therapy soon after birth generated much hope and excitement. The so-called Mississippi baby was given a three-drug regimen of zidovudine, lamivudine, and nevirapine from 30 hours after birth, and was lost to care at age 18 months, but maintained viraemic control in the absence of treatment when assessed at age 30 months. However, at a news conference in July this year, researchers announced that detectable concentrations of HIV had returned after 2 years off treatment, prompting resumption of antiretroviral therapy. The new development will be taken into account by investigators of a planned clinical trial based on the approach. Bio-dangers Controversy hit the US Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) this year, with both organisations under fire for major biosafety lapses. The transfer of a preparation of Bacillus anthracis from a CDC Biosafety Level 3 laboratory in Atlanta, GA, to a Level 2 laboratory left more than 80 staff potentially exposed when inadequate procedures were used to inactivate the bacteria. Meanwhile, staff at an FDA laboratory in Bethesda, MD, discovered vials of variola, the virus that causes smallpox, among hundreds of other forgotten pathogen samples in an old cold storage room. Only the CDC in Atlanta and a Russian laboratory in Siberia are meant to have the smallpox virus.
Malaysia Airlines flight MH17 was shot down over Ukraine on July 17. Joep Lange, Jacqueline van Tongeren, Pim de Kuijer, Martine de Schutter, Lucie van Mens, and Glenn Thomas were among the 283 passengers and 15 crew who died in the crash. They were on their way to attend the International AIDS Society (IAS) meeting in Melbourne, VIC, Australia, which took place on July 20–25. At the opening session of the conference, IAS president Françoise Barré-Sinoussi paid tribute to the delegates who had died in the crash. “We remember their legacy forever and keep them in our hearts”, she said. Sustaining development In July, the UN Open Working Group published its proposal for a set of Sustainable Development Goals that look set to shape the international development agenda after 2015, when most of the existing Millennium Development Goals are due to expire. The proposal, which consisted of 17 goals with 169 targets covering a wide range of issues including poverty, gender inequality, climate change, and food security, was discussed by world leaders at the UN General Assembly in September. Health-related targets
For more on Ebola see http:// ebola.thelancet.com/ For more on the UK antibiotic resistance initiative see Lancet 2014; 384: 391 For more on US plans to tackle antibiotic resistance see Lancet 2014; 384: 1083–84 For more on biosafety errors in the USA see Lancet 2014; 384: 294 For more on the MH17 tragedy see Lancet 2014; 384: 293
Kristin Palitza/dpa/Corbis
Ebola crisis This year has seen the worst ever epidemic of Ebola virus disease, mainly affecting three countries in west Africa—beginning in Guinea in December, 2013, the disease then spread to neighbouring Liberia and Sierra Leone. As of midDecember, 2014, more than 18 000 cases have been reported, resulting in more than 6500 deaths. The scale of the crisis has prompted unprecedented efforts to develop vaccines against the disease that could potentially be used to halt the epidemic, with clinical trials beginning in west Africa in December. Fast-track trials are also planned to test several experimental treatments, including antiviral drugs and convalescent whole blood and plasma.
Alex Milan Tracy/Sipa USA
Neil Bennet looks back at the major medical, health, and humanitarian stories from 2014—a year in which Ebola took hold in west Africa and transplantation doctors celebrated advances.
MH17 tragedy The HIV research community mourned the loss of six of their colleagues who died when 2187
Associated Press
This Year in Medicine
The first baby to be born to a woman after uterine transplantation
For more on health and the Scottish independence referendum see Lancet 2014; 383: 397–98 For more on the Climate Summit 2014 see Lancet 2014; 384: 1071 For more on the livebirth after uterus transplantation see Lancet 2014; published online Oct 6. http://dx.doi.org/10.1016/ S0140-6736(14)61728-1 For more on the situation in Syria see Lancet 2014; 384: 221–22 For more on the situation in South Sudan see Lancet 2014; 384: 1252 For more on the situation in the Central African Republic see Lancet 2014; 383: 860 For more on enterovirus D68 in North America see Lancet 2014; 384: 1250
include a commitment to achieving universal health coverage and specific targets for maternal mortality and deaths from non-communicable diseases. Negotiations will continue into next year, with a final set of goals due to be presented at a special session of the General Assembly in September, 2015. Healthy independence The future of the National Health Service (NHS) was a major topic of debate in the run-up to the Scottish independence referendum on Sept 18. Supporters argued that independence was needed to protect the NHS in Scotland from future funding cuts and the UK Government’s privatisation agenda, as well as to give the Scottish Parliament greater power over welfare and public health. Meanwhile, opponents suggested that tax cuts promised by the Scottish National Party (SNP) could lead to reductions in health spending. Ultimately, the no side won the referendum 55% to 45%. However, independence remains on the political agenda, with membership of the SNP and other pro-independence groups growing by thousands in the months after the referendum.
Ulet Ifansasti/Stringer
Changing climate Global discussions about how to tackle climate change have been heating up in 2014, with a major UN Climate Summit hosted by Secretary-General Ban Ki-moon 2188
more than 200 000 deaths and has devastated the country’s health-care system. Meanwhile, more than 10 000 people have died in the continuing conflict in South Sudan, and in the Central African Republic about 508 000 people remain internally displaced after 2 years of fighting.
taking place in New York, NY, USA in September. The meeting brought together governments, the private sector, and civil society groups, with outcomes including financial commitments and a pledge to halt the loss of natural forests by 2030. Then in early December, the 20th annual session of the Conference of the Parties (COP 20) to the UN Framework Convention on Climate Change took place in Lima, Peru, where negotiations continued towards a new global agreement to be approved by COP 21 in Paris, France, in December, 2015. Pledges for a new Green Climate Fund reached US$10 billion at COP 20 and a path to COP 21 was agreed. However, campaigners criticised the final Lima agreement for being too vague. Transplant success In exciting news for reproductive medicine, 2014 saw the first successful livebirth after uterine transplantation in a patient with absolute uterine factor infertility, which was reported in The Lancet. A 35-year-old woman with congenital absence of the uterus (Rokitansky syndrome) received a donated uterus from a living 61-year-old family friend in an operation last year and gave birth to a baby boy via in-vitro fertilisation. The patient was one of nine who underwent the transplantation procedure as part of a clinical trial at Sahlgrenska University Hospital in Gothenburg, Sweden. Doctors plan to remove the transplanted uterus to reduce the risk of continuing immunosuppression. Continuing conflicts Wars and conflicts continued to rage in the Middle East and Africa in 2014. The civil war in Syria entered its fourth year in the spring, and in the summer the Islamic State extremist group advanced and now control a large part of the country. The conflict, which began with protests against President Bashar al-Assad’s government in 2011, has led to
Unexpected outbreak An outbreak of enterovirus D68 in the USA and Canada has been causing severe respiratory illness in children. Between mid-August and Dec 11, 1149 people in 48 US states and the District of Columbia had confirmed enterovirus D68 infection, according to the CDC. Many of the children admitted to hospital with the infection had asthma or other underlying respiratory problems; many other children have probably been affected by milder forms of illness. Enterovirus D68 might also be linked to recent cases of unexplained acute flaccid myelitis in US children, with symptoms including full or partial paralysis of the arms or legs, although the association with the virus is unconfirmed. Heart-shaped box Surgeons in Australia announced in October that they had successfully transplanted donor hearts that had stopped beating into patients for the first time. The team at St Vincent’s Hospital, Sydney, NSW, completed three operations— two of the patients were reported to have recovered well and the third, who had undergone the procedure recently, was still in intensive care at the time of the announcement. The donor hearts, which had stopped beating for 20 min, were reactivated in a console referred to by the surgeons as a heart-in-a-box machine, where they were maintained for about 4 hours before transplantation. If adopted as standard practice, the approach could substantially increase the number of donor hearts available for transplantation.
Neil Bennet www.thelancet.com Vol 384 December 20/27, 2014
