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Cholera: ancient scourge on the rise. WHO announces global plan for cholera control. (25 April 1991).
WHO FEATURES. 1991 Apr; (154):1-3.Vibrio cholerae spreads quickly via contaminated water and food, especially in areas with a poor health and sanitation infrastructure. Its enterotoxin induces vomiting and huge amounts of watery diarrhea leading to severe dehydration. 80-90% of cholera victims during an epidemic can use oral rehydration salts. A cholera epidemic is now spreading through Latin America threatening 90-120 million people (started in January 1991), particularly those in urban slums and rural/mountainous areas. As of mid April 1991, there were more than 177,000 new reported cases in 12 countries and 78% of these cases and more than 1200 deaths were limited to 5 countries: Brazil, Chile, Colombia, Ecuador, and Peru, WHO's Global Cholera Control Task Force coordinates global cholera control efforts to prevent deaths in the short term and to support infrastructure development in the long term. Its members are specialists in disease surveillance, case management, water and sanitation, food safety, emergency intervention, and information and education. WHO's Director General is asking for the support of the international community in cholera control activities. These activities' costs are considerable. For example, Peru needs about US$ 60 million in 1992 to fulfill only the most immediate demands of rehabilitation and reconstruction of the infrastructure. Costs of infrastructure capital throughout Latin America is almost US$ 5 thousand million/year over the next 10 years. It is indeed an effective infrastructure which ultimately prevents cholera. Cholera is evidence of inadequate development, so to fight it, we must also fight underdevelopment and poverty.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1974; (552):1-40.This document represents the work of a World Health Organization (WHO) Expert Committee on Tuberculosis, which met in Geneva in 1973. Chapters in this volume focus on epidemiology, Bacillus Calmette-Guerin (BCG) vaccination, case finding and treatment, national tuberculosis programs, research, WHO activities in this field, and the activities of the International Union against Tuberculosis and voluntary groups. The Committee emphasized that tuberculosis still ranks among the world's major health problems, particularly in developing countries. Even in many developed countries, tuberculosis and its sequelae are a more important cause of death than all the other notifiable infectious diseases combined. The previous WHO report, issued in 1964, set forth the concept of a comprehensive tuberculosis control program on a national scale. The implementation of this approach has encountered many problems, including deficiencies in the health infrastructure of many countries (shortages of financial, material, and physical resources and a lack of trained manpower) and resistance to change. However, many countries have instituted comprehensive programs and tuberculosis control has become a widely applied community health activity. A priority will be control of pulmonary tuberculosis. The Committee stressed that national programs must be countrywide, permanent, adapted to the expressed demands of the population, and integrated in the community health structure. Steps involved in setting up such programs include planning and programming, selection of technical policies, implementation, and evaluation. Research priority areas identified by the Committee include epidemiology, bacteriology and immunology, immunization, chemotherpy, the systems analysis approach to tuberculosis control, and training methods and instructional materials.
Report of the First Meeting of the Scientific Working Group on Bacterial Enteric Infections: Microbiology, Epidemiology, Immunology, and Vaccine Development, Geneva, April 1980.
Geneva, Switzerland, WHO, 1980. 17 p.The group developed a five year research plan (1980-84). Topics were given priority based on the following group-established criteria: 1) the extent of the problem to be studied; 2) the chance of its early success given the limited funds available; and 3) the availability of good research workers with an interest in the problem. The epidemiology and microbiology of Vibrio cholerae 01 and Enterotoxigenic Escherichia coli (ETEC) are given first priority for study, as are immunology and vaccine development against cholera and ETEC diarrhoea. The immunology study will involve: 1) identification of protective antigens, 2) tests for antibody measurement and 3) measurement of acquired immunity. Methods of stimulating mucosal immunity are given first priority, as is the testing of existing candidate cholera vaccines such as B-subunit cholera vaccine and living vaccines made from non-toxigenic V. cholerae. Other organisms which will be studied are Campylobaster jejuni (which can account for up to 15% of acute diarrhoea cases in some settings), Salmonella, (including S. typhi), Shigella and Yersinia enterocolitica. Once there is a better understanding of the modes of transmission of the bacterial enteric pathogens, a study of specific cost effective methods of interrupting their transmission through environmental intervention is suggested, with emphasis on modifications in water supply and water usage, defecation practices, and personal and domestic hygiene. Identification of institutions to undertake research, and funding distribution, were also considered.
Prevention and control of enterohaemorrhagic Escherichia coli (EHEC) infections: memorandum from a WHO meeting.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1998; 76(3):245-55.This memorandum was developed at a World Health Organization Consultation on Prevention and Control of Escherichia coli (EHEC) Infections, held in Geneva, Switzerland, April 28 to May 1, 1997. Since EHEC O157:H7 was recognized as a human pathogen in 1982, it has been a steadily increasing cause of food-borne illness worldwide. In view of the magnitude and severity of recent outbreaks of food-borne diseases caused by EHEC O157:H7, there is an urgent need for public health and environmental health agencies, farmers, animal producers, food processors and caterers, and researchers to collaborate to reduce or eliminate the health impact of this hazard. The memorandum presents a global overview of EHEC infections, then addresses surveillance of EHEC infections, outbreak identification, and control measures. Recommended prevention and control measures include: use of potable water in food production, presentation of clean animals at slaughter, improved hygiene throughout the slaughter process, appropriate use of food processing measures, thorough cooking of food, and education of food handlers and others on the principles and application of food hygiene.
Human immunodeficiency virus (HIV) infection codes and new codes for Kaposi's sarcoma. Official authorized addenda ICD-9-CM (revision no. 2). Effective October 1, 1991.
MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT. 1991 Jul 26; 40(RR-9):1-19.The addenda for Volumes 1 and 2 of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) were reported by the Collaborating Center for Classification of Diseases for North America at the National Center for Health Statistics. This was the second revision of these codes for the classification of HIV infection. THe addenda, effective October 1, 1991, replace the addendum containing codes for human immunodeficiency virus (HIV) infection that went into effect January 1, 1988. The structure of the classification, the codes within the classification, and the use of the codes remained the same. 3 basic modifications were accepted. A new 3-digit category was created for Kaposi's sarcoma; several new clinical conditions were added (acute or subacute endocarditis, microsporidiosis, acute or subacute myocarditis, bacterial and pneumococcal pneumonia, histiocytic or large cell lymphoma, secondary cardiomyopathy and nephritis and nephropathy); and several categories of HIV manifestations were expanded to include similar conditions (viral pneumonia, encephalitis, encephalomyelitis and myelitis). These modifications will improve the accuracy of reporting and allow public health officials, clinical researchers, and agencies which finance health care to monitor diagnoses of AIDS and other manifestations of HIV infection. HIV infection is divided into 3 categories: HIV infection with specified secondary infections or malignant neoplasms, or AIDS; HIV infection with other specified manifestations; and other HIV infections not classifiable above. AIDS is not synonymous with HIV infection or with such terms as pre-AIDS or AIDS-related complex. To use these codes correctly, the physician must provide complete information and state the relationship between HIV infection and other conditions.
SCIENTIFIC AMERICAN. 1988 Nov; 259(5):126-33.Despite the tremendous strides in global immunization in less developed countries (LDCs) in the last 25 years, much remains to be done and the momentum has slowed. Vaccination programs continue to prove that they are less expensive, easier to implement, and in some cases more effective than other public health programs. Therefore it is imperative to produce and deliver new or improved vaccines to LDCs to prevent many infectious diseases and save the lives of children. Yet economic and political obstacles impede the development of these vaccines, even though the scientific know-how already exists. Manufacturers of vaccines that have been around for a long time and used widely in developed nations have often sold these vaccines to international agencies, such as WHO, at production cost. They do this because they have already recouped research & development (R&D) costs. When it comes to R&D of new vaccines, however, manufacturers are generally unwilling to invest time and money into R&D since they may not recoup their costs and make a profit. International agencies do not have the money to pay the high prices charged by manufacturers. Instead of the public health community in LDCs deciding on the development of new vaccines, the decision is left almost entirely in the hands of a few institutes or commercial manufacturers in the developed world. Other than continuing with the status quo, however, possible solutions do exist. For example, the UN could create an institute to develop and manufacture its own vaccines. Another possibility is that R&D and production of vaccines for diseases prevalent in an LDC or region could take place within that specified area.
Lancet. 1989 Feb 18; 1(8634):396.The World Health Organization (WHO) issued a consensus statement about AIDS and sexually transmitted diseases (STD) and partner notification for patients with HIV infection. Evidence that genital ulcer disease (GUD) is a risk factor and facilitator for HIV-1 infection in heterosexual people is strong, especially in developing countries. A few studies have shown an association of antibodies to herpes simplex virus type 2 (HSV-2) and Treponema pallidum (the chief cause of genital and anorectal ulcers in developing countries). A consistent relation between HIV-1 and HSV-2 and T. pallidum has been demonstrated in seroepidemiological studies. Data assessing the link between other STD pathogens and HIV-1 transmission are insufficient, but it is plausible that all STD pathogens that cause genital ulcers or inflammation are risk factors for increased susceptibility to HIV-1 infection. Investigating this possibility should be a research priority, as genital ulcer diseases intervention may help to prevent sexual transmission of HIV-1 infection. Partner notification programs, as part of a comprehensive AIDS prevention and control program, should be carefully designed. Because the notification procedure can cause individual and social harm and detract from other AIDS prevention and control activities, a careful assessment of medical, legal, logistic, social, and ethical issues needs to be made. Other variables, such as cost, local environment, and epidemiology need to be taken into account. Issues of patient referral, target populations, training of notification personnel, patient consent, diagnostic accuracy, and the logistics of notification need to be addressed. WHO suggests that the following criteria be monitored when assessing efficiency of partner notification activities: number of index persons; number of partners identified; number of partners notified and their seroprevalence; cost; satisfaction; compliance and acceptability; counseling and support; staff training; confidentiality; and adequacy of follow-up.
[Acquired immunodeficiency syndrome (AIDS): WHO meeting and consultation on the safety of blood and blood products] Syndrome d'immunodeficit acquis (SIDA): reunion et consultation de l'OMS sur la securite du sang et des produits sanguins.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1986 May; 61(18):138-40.The World Health Organization (WHO) convened a meeting of experts on April 14-16, 1986, to review the available information on the safety of blood and blood products in relation to acquired immunodeficiency syndrome (AIDS). It was attended by over 100 participants from 34 countries and followed by a consultation which took into consideration previous recommendations, new information, and many different circumstances which exist regarding AIDS at the global level. This discussion reports the main conclusions and recommendations of the consultation. Tests to detect antibody to the AIDS virus now are available to assist in the elimination of potentially infectious units of blood and plasma, yet it is important to recognize that information and education remain crucial elements in any AIDS prevention program and that they continue to be relevant to the safety of blood and blood products. In that respect, measures to limit the transmission of LAV/HTLV-III by whatever means will be most effective in communities which are as well informed as possible about the disease, how it is transmitted, and how donors can assist in assuring a safe blood supply by being alert to donor suitability criteria. In some countries risk factors for AIDS have been identified in homosexual and bisexual men, intravenous drug abusers, and their sexual partners. Self-exclusion systems in which persons with risk factors refrain from giving blood, and blood screening programs for virus antibody have been effective in contributing to a safe blood supply. Experience also has shown that frequently when persons infected with the AIDS virus have donated blood, risk factors could later be identified, but many of those donors may not have recognized or acknowledged that they carried a risk. The value of specific screening and control measures which have been found useful in many developed countries should be assessed by other countries in the context of their overall health programs and the availability of human and material resources. Well-accepted general principles concerning the use of blood and blood products need to be emphasized since they can contribute to the control of AIDS. The most important principles are: strategies of health services such as improved antenatal care can reduce the demand for blood and should be encouraged; when appropriate and safer components and derivatives can be produced and are available, they are preferable to whole blood or plasma; and whole blood or plasma should be transfused only when medically justified. Decisions to institute laboratory screening of donors should be made with full awareness that there are several essential components of such a program. Information and education for donors about AIDS, its risk factors, and blood transmission is one of the basic considerations. Exclusion based on a current history of possible exposures to known risk factors as well as symptoms can help to reduce the number of infected donors.
[Unpublished] 1985. 15 p.This paper reviews the development of the global Expanded Program on Immunization (EPI) initiative, reports on program progress since the 1984 EPI conference, and identifies actions needed to meet the goal of providing immunization services to all children of the world by 1990. The central EPI strategy to date has been to deliver immunization in consonance with other health services, particularly those aimed at mothers and children. The long-term goal of such efforts is to strengthen the health infrastructure so as to ensure the continuous provision of immunization and other primary health care services. Simply by reinforcing existing health services, a coverage level of 60-70% will be achieved in developing countries by 1990. If universal coverage is to be achieved, external funds will have to be provided to meet operational costs and train national managers. Acceleration of existing efforts constitutes the main EPI priority at present. Specific areas suggested for immediate action include provision of information about immunization at every health contact; a reduction in the drop-out rates between 1st and last immunization; increased attention to the control of measles, poliomyelitis, and neonatal tetanus; improved immunization services to the disadvantaged in urban areas; and, where appropriate, acceleration of the EPI through approaches such as national immunization days. Ongoing actions that need to be pursued include strengthening disease surveillance and outbreak control, reinforcing training and supervision, and pursuing applied research and development. Overall, management capacity within national programs remains the most severe constraint for the EPI.
In: Quest for the killers, [by] June Goodfield. Boston, Massachusetts, Birkhauser, 1985. 191-244. (Pro Scientia Viva Title)This article relates the final phase of the campaign to eradicate smallpox from Bangladesh in the early 1970s under the leadership of Donald Henderson. The article is based on informal interviews with many of the participants in this campaign who shared their recollections of the drama and problems of these years. Bangladesh was the last country in the world to be free of smallpox. In retrospect, those involved in the campaign agreed that an unfortunate defect of the campaign was that the rapid importation of international advisors did not allow the slow build-up of national staffs. If was not a developmental effort, and organizers were forced to initiate activities that could not be sustained. On the other hand, the campaign's success achieved a number of very important ends over and above the eradication of a disease. It particularly boosted the authority of health ministries in Bangladesh and contributed to the society's understanding of disease control. The episodes in this campaign are a moving testimony to the power of international cooperation.
WORLD HEALTH. 1986 Nov; 3-4.The emergence of acquired immunodeficiency syndrome (AIDS) has led to a marked decline in sexual promiscuity among population groups at risk of infection with the AIDS virus and may produce a decline in the incidence of other sexually transmitted diseases. STDs are a major public health concern because of their impact on maternal and child health, their economic cost in terms of health care expenditures, and their social consequences. 8-20% of women with untreated gonococcal or chlamydial infection develop pelvic inflammatory disease (PID), and 13% become sterile after only 1 episode of PID. The rapid development of gonococcal and chancroid strains completely or partially resistant to a variety of antibiotics had made established low-cost treatment regimens ineffective. 2 established means of combatting STDs--control of prostitutes and special STD clinics--have not been successful. The World Health Organization has given priority to developing methods that enable health are units to provide effective treatment of STDs, even where there is minimal laboratory diagnostic support, as an alternative to specialized medical facilities that may connote stigma to potential patients. In this simplified STD control approach, simple area-specific instructions for patient management are provided to clinicians and community health workers.
[Expanded Programme on Immunization: Global Advisory Group] Programme Elargi de Vaccination: Groupe consultatif mondial.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1984 Mar 23; 59(12):85-9.In addition to the conclusions and recommendations reached at the 6th meeting of the Expanded Program on Immunization (EPI) Global Advisory Group and summarized in this report, the Group reviewed at length the status of the program in the Western Pacific Region and made a series of recommendations specifically directed to activities in the Region. Of particular significance for the operational progress of the global program are the recommendations concerning "Administration of EPI Vaccines," which were subsequently endorsed by the Precongress workshop on Immunization held before the XVIIth International Congress of Pediatrics in Manila in November 1983. These recommendations are not listed here. In his report to the World Health Assembly in 1982, the Director-General summarized the major problems which threaten the success of efforts to achieve the World Health Organization (WHO) goal of reducing morbidity and mortality by providing immunization for all children of the world by 1990. The 5-Point Action Program adopted at that time remains a relevant guide for countries and for WHO as they work to resolve those problems. The EPI is concerned about the prevention of the target diseases, not merely with the administration of vaccine. In addition to working toward increases in immunization coverage, the EPI must assure the strenghtening of surveillance systems so that the magnitude of the health problem represented by the target diseases is known at the community, district, regional, and national levels; immunization strategies are continuously adapted in order to reach groups at highest risk; and the target diseases are reduced to a minimum. The development of surveillance systems is one of the priorities in the development of effective primary health care services. Disease surveillance in its various forms should be used at all management levels for monitoring immunization programs performance and for measuring program impact. Specific recommendations regarding disease surveillance to be undertaken at global and regional levels and at the national level are listed. The results of more than 100 lameness surveys conducted in 25 developing countries confirm that paralytic poliomyelitis constitutes an important public health problem in any area in which the disease is endemic. In most programs, initial emphasis should be placed on the develpment of sentinel surveillance sites to monitor disease incidence trends. Some progress has been made in acting on the recommendations made at the meeting on the prevention of neonatal tetanus held in Lahore in 1982, but intensification of activities is required. In many developing countries, the surveillance and control of diphtheria must be improved. All aspects of progress and problems in the global program are reflected at least somewhere in the Western Pacific Region, and most of the findings and recommendations generally are valid beyond the regional boundaries.
Strategy for rapid elimination and continuing control of poliomyelitis and other vaccine preventable diseases of children in developing countries.
BMJ. British Medical Journal. 1986 Feb 22; 292(6519):531-3.Estimates of a recent yearly incidence of 400,000 cases of paralytic poliomyelitis, 2.5 million deaths from measles and its complications, over 1 million deaths from neonatal tetanus, and 735,000 deaths from pertussis in Asia, Africa, and Latin America now pose a greater challenge for new action than did the worldwide eradication of smallpox several years ago. By virtue of the conditions obtaining in the developing countries mere expansion or acceleration of what is being done now -- even with modifications that may achieve a temporary increase in vaccine coverage -- cannot achieve the desired rapid elimination and continuing control of these diseases. A new strategy -- namely, bringing the vaccine to the people during annual national days of vaccination -- has already been used successfully in some small and large developing countries of Latin America for the rapid elimination and continuing control of polio. This strategy could be adapted to include vaccination against measles, pertussis, and neonatal tetanus by additional training of community volunteers in the large auxiliary health armies that work with the existing health services each year. (author's)