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  1. 1

    Zika virus infection. Step-by-step guide to risk communication and community engagement.

    Pan American Health Organization [PAHO]

    Washington, D.C., PAHO, 2017. 38 p.

    This document provides technical content on ZIKV, its manifestations, complications, modes of transmission, and prevention measures to be used in answering frequently asked questions and conveying messages in information and communication materials, community talks, press conferences, etc. Recommendations for the preparation of risk communication and action plans to respond to ZIKV are included. This guide to activities and recommendations for managing risk communication on ZIKV is designed for spokespersons, health authorities and health workers, other sectors, and partners inside and outside the health sector to assist them in tailoring communication initiatives to the needs of each country and target audience. The elimination of mosquito breeding sites remains the most important strategy for the prevention and control of ZIKV (as well as dengue and chikungunya) infection. Therefore, communication plans for the response to ZIKV should include intersectoral action and community engagement to modify behaviors and encourage sustained practices to eliminate breeding sites and control the mosquito, as well as to inform and educate target audiences about the steps they can take to prevent ZIKV transmission. The fourth meeting of the Emergency Committee under the International Health Regulations agreed that, “due to continuing geographic expansion and considerable gaps in understanding of the virus and its consequences, Zika virus infection and its associated congenital malformations and other related neurological disorders, ZIKV continues to be a public health emergency of intenational concern.
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  2. 2

    Emergency Plan of Action (EPoA), Honduras: Health emergency -- Zika.

    International Federation of Red Cross and Red Crescent Societies

    [Geneva, Switzerland], International Federation of Red Cross and Red Crescent Societies, 2016 Feb 29. [14] p.

    This document is an emergency plan of action created by International Federation of Red Cross and Red Crescent Societies for the country of Honduras. The document includes a situational analysis of the Zika emergency in Honduras and an operational strategy and plan to combat the outbreak.
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  3. 3

    Situation report: Zika virus, microcephaly, Guillain-Barre syndrome.

    World Health Organization [WHO]

    [Geneva, Switzerland], WHO, 2016 Jun 9. [6] p.

    As of 8 June 2016, 60 countries and territories report continuing mosquito-borne transmission of which: 46 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitos. 14 countries reported evidence of Zika virus transmission between 2007 and 2014, with ongoing transmission. In addition, four countries or territories have reported evidence of Zika virus transmission between 2007 and 2014, without ongoing transmission: Cook Islands, French Polynesia, ISLA DE PASCUA -Chile and YAP (Federated States of Micronesia). Ten countries have reported evidence of person-to-person transmission of Zika virus, probably via a sexual route. In the week to 8 June 2016, no new country reported mosquito-borne or person-to-person Zika virus transmission. As of 8 June 2016, microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported by eleven countries or territories. Three of those reported microcephaly borne from mothers with a recent travel history to Brazil (Slovenia, United States of America) and Colombia (Spain), for one additional case the precise country of travel in Latin America is not determined. In the context of Zika virus circulation, 13 countries and territories worldwide have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases. As of 8 June, Cabo Verde has reported a total of six cases of microcephaly and other neurological abnormalities with serological indication of previous Zika infection. Based on research to date, there is scientific consensus that Zika virus is a cause of microcephaly and GBS. The global Strategic Response Framework launched by the World Health Organization (WHO) in February 2016 encompasses surveillance, response activities and research. An interim report has been published on some of the key activities being undertaken jointly by WHO and international, regional and national partners in response to this public health emergency. A revised strategy for the period July 2016 to December 2017 is currently being developed with partners and will be published in mid-June. WHO has developed new advice and information on diverse topics in the context of Zika virus. WHO’s latest information materials, news and resources to support corporate and programmatic risk communication, and community engagement are available online. (Excerpt)
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  4. 4

    Pregnancy management in the context of Zika virus infection. Interim guidance update.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2016 May 13. [14] p. (WHO/ZIKV/MOC/16.2 Rev.1)

    The mosquito vector that carries the Zika virus thrives in warm climates and particularly in areas of poor living conditions. Pregnant women living in or travelling to such areas are at equal risk as the rest of the population of being infected by viruses borne by this vector. Maternal infection with Zika virus may go unnoticed as some people will not develop symptoms. Although Zika virus infection in pregnancy is typically a mild disease, an unusual increase in cases of congenital microcephaly, Guillain-Barré syndrome and other neurological complications in areas where outbreaks have occurred, has significantly raised concern for pregnant women and their families, as well as health providers and policy-makers. The aim of this document is to provide interim guidance for interventions to reduce the risk of maternal Zika virus infection and to manage potential complications during pregnancy. This guidance is based on the best available research evidence and covers areas prioritized by an international, multidisciplinary group of health care professionals and other stakeholders. Specifically, it presents guidance for preventing Zika virus infection; antenatal care and management of women with infection; and care during pregnancy for all pregnant women living in affected areas, with the aim of optimizing health outcomes for mothers and newborns. The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission. It is not intended to provide a comprehensive practical guide for the prevention and management of Zika virus.
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  5. 5
    Peer Reviewed

    WHO meeting thrashes out R&D strategy against Zika.

    Maurice J

    Lancet. 2016 Mar 19; 387:1147.

    WHO convened a multidisciplinary consultation last week to identify the tools and interventions needed to outsmart the Zika epidemic. Towards the end of the meeting, delegates representing the major regulatory agencies in the USA, Europe, and Brazil, committed to putting Zika-related products on a regulatory fast-track. They also agreed that instead of waiting, as they usually do, for manufacturers to approach them, they would take the initiative and approach companies working on promising products. Their gesture, in a sense, encapsulates the success of the meeting in bringing together so many minds from so many disciplines to focus, for 3 intensive days, on a single issue of vital importance. (Excerpts)
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  6. 6

    Zika virus infection: global update on epidemiology and potentially associated clinical manifestations.

    Releve Epidemiologique Hebdomadaire. 2016 Feb 19; 91(7):73-81.

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  7. 7

    Pregnancy management in the context of Zika virus. Interim guidance.

    World Health Organization [WHO]

    [Geneva, Switzerland], WHO, 2016 Mar 2. [7] p. (WHO/ZIKV/MOC/16.2)

    The mosquito vector that carries the Zika virus thrives in warm climates and particularly in areas of poor living conditions. Pregnant women living in or travelling to such areas are at equal risk as the rest of the population of being infected by viruses borne by this vector. Maternal infection with Zika virus may go unnoticed as some people will not develop symptoms. Although Zika virus infection in pregnancy is typically a mild disease, an unusual increase in cases of congenital microcephaly, Guillain-Barré syndrome and other neurological complications in areas where outbreaks have occurred, has significantly raised concern for pregnant women and their families, as well as health providers and policy-makers. The aim of this document is to provide interim guidance for interventions to reduce the risk of maternal Zika virus infection and to manage potential complications during pregnancy. This guidance is based on the best available research evidence and covers areas prioritized by an international, multidisciplinary group of health care professionals and other stakeholders. Specifically, it presents guidance for preventing Zika virus infection; antenatal care and management of women with infection; and care during pregnancy for all pregnant women living in affected areas, with the aim of optimizing health outcomes for mothers and newborns. The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission. It is not intended to provide a comprehensive practical guide for the prevention and management of Zika virus infections.
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  8. 8

    Zika virus. Fact sheet. Updated.

    World Health Organization [WHO]

    [Geneva, Switzerland], WHO, 2016 Feb. [5] p.

    This fact sheet on Zika virus contains a list of key facts and information on its signs and symptoms, potential complications, transmission, diagnosis, prevention, treatment, and WHO response.
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  9. 9
    Peer Reviewed

    Iodine deficiency: Consequences and progress toward elimination.

    Maberly GF; Haxton DP; van der Haar F

    Food and Nutrition Bulletin. 2003; 24 Suppl 4:S91-S98.

    While traditionally associated with cretinism and goiter, iodine deficiency has broad effects on central nervous system development that can occur in the absence of either condition. Any maternal iodine deficiency results in a range of intellectual, motor, and hearing deficits in offspring. This loss in intellectual capacity limits educational achievement of populations and the economic prowess of nations. Progress made since the historic World Summit for Children in 1990 has been outstanding. Approximately 70% of households in the world used iodized salt by 2000, compared with less than 20% in 1990. It is estimated that at least 85 million newborns out of 130 million annual births are protected from a loss in learning ability that would otherwise have occurred. The elimination of iodine deficiency, by expedient production, marketing, and universal consumption of iodized salt, represents a significant development effort in public nutrition. Although globally iodine nutrition has greatly improved, 20% to 30% of pregnancies and thus newborns still do not fully benefit from the use of iodized salt. Countries where success is in evidence could rapidly revert back to deficiency if vigilance is not maintained. Just as success came through concerted public-private-civic actions, making sure that this is expanded and will steadily go on requires continuous collaboration. (author's)
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  10. 10

    The use of polysaccharide trivalent ACW vaccine for the control of epidemic meningococcal disease outbreaks in countries of the African meningitis belt. Recommendations from an international informal consultation.

    World Health Organization [WHO]. Department of Communicable Disease Surveillance and Response

    Geneva, Switzerland, WHO, Department of Communicable Disease Surveillance and Response, 2003. 8 p. (WHO/CDS/CSR/GAR/2003.14)

    Epidemic meningococcal disease (EMD) outbreaks are usually due to Neisseria meningitidis (Nm) serogroups A or C. However Nm serogroup W135 has recently emerged as a cause of epidemic disease. In 2002, the first major W135 meningococcal disease outbreak occurred in Burkina Faso, with 13 125 suspected meningitis cases and 1510 deaths. The response to the 2002 epidemic in Burkina Faso was hindered by the lack of a serogroup W135- containing meningococcal vaccine due to both limited worldwide production and high cost. In response to the unexpected W135 outbreak in 2002, the World Health Organization (WHO) sounded the alarm to the pharmaceutical industry, asking their assistance to make a W135-containing polysaccharide (PS) vaccine available at an affordable price for African countries. GlaxoSmithKline (GSK) responded favourably and developed 3 million doses of a new ACW meningococcal PS vaccine for evaluation and limited use in Africa in 2003. This vaccine was licensed by the Belgian National Regulatory Authority by the end of January 2003 and can be exported to countries that authorize its use. During the 2002-2003 season, Burkina Faso was affected by a mixed Nm A-W135 epidemic (7900 cases). In response to the outbreak, two million people were vaccinated with the new trivalent vaccine. At the same time, an increased proportion of Nm W135 isolates was reported by several African meningitis belt countries, suggesting that W135 could be the cause of further outbreaks in the region (alone or together with serogroup A). WHO recently reached an agreement with GSK for the production of 6 million doses of PS trivalent ACW vaccine at 1 Euro per dose. However to ensure production, WHO would have to raise the required funds before the beginning of the epidemic season. The funds obtained will be used for establishing a revolving emergency stock. No additional supply of this vaccine is expected to be available for the 2003–2004 epidemic season. The recommended strategy for EMD outbreak control in the African meningitis belt is based on reactive mass vaccination with the meningococcal PS vaccine and effective case management. While the case management strategy does not differ according to the strain, the vaccination strategy to be adopted is less clear. Indeed, in the current context of a limited supply of PS trivalent ACW vaccine, the use of the vaccine must be carefully evaluated. In making informed and optimal decisions regarding outbreak response, two issues must therefore be urgently addressed: (i) determining the most appropriate meningococcal PS vaccine to be used in the affected areas; and (ii) developing an optimal vaccination strategy for the use of the PS trivalent ACW vaccine in the field. The recommendations presented in this document are the result of an informal consultation organized by WHO in March 2003 to obtain technical advice from various experts on the two issues mentioned above. (excerpt)
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  11. 11
    Peer Reviewed

    Variation in incidence of serious adverse events after onchocerciasis treatment with ivermectin in areas of Cameroon co-endemic for loiasis.

    Twum-Danso NA; Meredith SE

    Tropical Medicine and International Health. 2003 Sep; 8(9):820-831.

    Objective: To determine the incidence of serious adverse events (SAEs) after mass treatment with ivermectin in areas co-endemic for loiasis and onchocerciasis, and to identify potential risk factors associated with the development of these SAEs, in particular encephalopathic SAEs. Methods: We retrospectively analysed SAEs reported to have occurred between 1 December 1998 and 30 November 1999 in central-southern Cameroon by chart review, interview and examination of a subset of patients. Results: The overall incidence of SAEs for the three provinces studied was 6 per 100,000. However, for Central Province alone the incidence of SAEs was 2.7 per 10,000 overall, and 1.9 per 10,000 for encephalopathic SAEs associated with Loa loa microfilaremia (PLERM). The corresponding rates for the most severely affected district within Central Province (Okola) were 10.5 per 10,000 and 9.2 per 10,000 respectively. Symptoms began within the first 24–48 h of ivermectin administration but there was a delay of approximately 48–84 h in seeking help after the onset of symptoms. First-time exposure to ivermectin was associated with development of PLERM. Conclusion: In Cameroon, the incidence of SAEs following ivermectin administration in general, and PLERM cases in particular, varies substantially by district within the areas co-endemic for loiasis and onchocerciasis. More intense surveillance and monitoring in the first 2 days after mass distribution in ivermectin-naïve populations would assist in early recognition, referral and management of these cases. The increased reporting of SAEs from Okola is unexpected and warrants further investigation. Research is urgently needed to find a reliable screening tool to exclude individuals (rather than communities) at risk of PLERM from the mass treatment program. (author's)
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  12. 12

    Epilepsy in the developing countries.

    World Health Organization [WHO]. Study Group on Epilepsy in the Developing Countries

    WHO Chronicle 33(5):183-186. May 1979.

    Epilepsy is more prevalent in developing countries than in developed countries. The high incidence is assumed to be associated with poor antenatal and maternal care, prematurity, birth injuries, childhood febrile convulsions, malnutrition, and infections. Accurate diagnostic equipment, such as the computerized axial tomography, is often beyond the reach of developing countries. The 7 drugs considered essential to the management of epilepsy are phenobarbitol; phenytoin; carbamazepine; ethosuximide; sodium valproate; and diazepam and clonazepam. Surgery is indicated in symptomatic epilepsy due to a local lesion, e.g., a neoplasm. In developing countries, superstition, cultural beliefs, and ignorance add to the social morbidity of the epileptic. Although epilepsy is a chronic condition which can seldom be cured, it can be controlled to the point where it becomes a minor inconvenience.
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  13. 13

    Steroid contraception and the risk of neoplasia.

    World Health Organization [WHO]. Scientific Group

    Geneva, Switzerland, WHO, 1978. (World Health Organization Technical Report Series No. 619) 54 p

    Studies on steroid contraception (SC) and risk of neoplasia are reviewed. Methodological issues in neoplasia etiology studies include: 1) possibility of a latent period between exposure to cause and disease development; 2) cumulative effects of prolonged or repeated SC exposure; 3) discontinued drugs or dosage schedules; 4) time of exposure (adolescence or prenatal, e.g.); 5) isolation of specific causes among multiple risks; and 6) variations in neoplasma diagnoses. The 4 epidemiological approaches to SC-associated neoplasia studies have inherent shortcomings, but cohorts yield significant associations. Relative risk (ratio of disease incidence among exposed vs. nonexposed persons) is an index of association only, not evidence of cause and effect. Benign breast neoplasia risk was reduced by current SC use of >2 years, and weak evidence points to a residual protective effect, apparently associated with progestogen dose. Aggregated breast cancer data show no clear adverse or beneficial effect of SC use; however, evidence suggests SCs may increase breast cancer risk in population subgroups (e.g., young women). Only short-term evidence is available; hence, no inference of long-term SC breast cancer effects is possible. No beneficial effect of SCs on uterine fibroids is evident, but sequential SCs, no longer marketed, may have increased risk to endometrial carcinoma. Inconclusive data suggest SCs may decrease ovarian cancer risk. Increased risk of cervical dysplasia and carcinoma in situ is associated with SC use, especially long-term use by women with predisposing factors. Risk of hepatocellular adenoma of the liver increases with prolonged SC exposure, especially high dose. Relevance of existing data from more developed countries to disease risk in less developed ones is discussed, and recommendations made.
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  14. 14

    Organization of mental health services in developing countries.

    World Health Organization [WHO]. Expert Committee on Mental Health

    Geneva, WHO, 1975. (WHO Technical Report Series No. 564) 41 p.

    Studies indicate that seriously debilitating mental illness is likely to affect at least 1% of any population at any one time and at least 10% at some time in their life. Since about half the population in many developing countries is under age 15 there is a high quantity of child and adolescent disorders. The prevalence of organic brain damage will diminish with the introduction of public health services, but the same measures are liable to increase the number of surviving children with brain damage. The World Health Organization recommends the pooling of mental health experts to aid the developing countries lacking personnel and resources to cope with mental disorders. Pilot programs in mental care are also recommended to create awareness in communities that mental illness exists and can be treated.
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  15. 15

    Neuroendocrinology and reproduction in the human.

    World Health Organization [WHO]. Scientific Group

    Geneva, Switzerland, WHO, 1965. 19 p. (WHO Technical Report Series No. 304)

    This WHO technical report focuses on the 1) psychosomatic factors in human reproduction; 2) hypothalamo-hypophyseal system; 3) mechanism of sexual rhythm; 4) nervous influences on the hypothalamus; 5) hormonal influences on the hypothalamus; 6) neuroendocrine aspects of sexual behavior; and 7) effects of drugs on reproduction. After summarizing current research status on the above-mentioned topics, the following research needs are suggested: 1) assays of individual human endogenous gonadotropins, suitable for clinical application; 2) autoradiography, fluorescent-antibody, spectrophometric interference and histochemical and biochemical techniques for studying cells that supply axons to the primary capillary plexus of the hypophyseal portal system and for studying effects of different hormonal status on hypothalmic structure and function; 3) computer techniques for evaluating electrophysiological data; 4) improved lesioning techniques; 5) comparative studies of reproductive activity patterns, exteroceptive factors, neuroendocrine factors in sexual and related social behavior, and long-term or delayed effects of drugs administered during gestation on subsequent sexual development; 6) studies of synaptic connections of hypothalamic neurones; 7) studies of endogenous gonadal and gonadotropin production in prepuberal animals; 8) functional significance of regional distribution of hypophyseal portal system; 9) mechanisms involved in selective uptake of labeled hormones; 10) hypothalamic lesions in species with spontaneous ovulation and active luteal function; 11) direct effect of gonadal hormones on single hypothalamic neurones studied with combination of microinjection and unit recording devices; 12) studies of the possibility of a direct feedback of gonadotropic hormones on the hypothalamus; 13) studies of the receptor mechanisms involved in neuroendocrine reflexes; 14) wider exploration of brain structures, with regard to feedback action of gonadal hormones; 15) studies of pineal function; 16) further investigation of a possible role of the peripheral autonomic pathways in reproductive processes; and 17) research on the application of tissue culture techniques for studying problems of the origin and metabolic effects of neurohormonal mediators and the biochemcial and morphological changes induced by sex hormones.
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  16. 16

    Physiology of lactation.


    World Health Organization, (Technical Report Series.). 1965; 22.

    A report of the Scientific Group on the Physiology of Lactation which met in Geneva, December 2-7, 1963, is presented. Major aspects covered include: 1) growth of the mammary gland; 2) milk secretion; 3) biochemical activities of the mammary gland; 4) the physiology of suckling; and 5) factors of human lactation and breast feeding. It is recommended that WHO should: 1) provide grants and research fellowships to enable research workers in the field of lactation to extend their experience by working for a time in other appropriate research centers; 2) support the establishment of laboratories in certain countries for the titration of hormones in cases of normal and abnormal lactation; 3) make contact with organizations engaged in the collection of primate pituitary tissues to obtain their advice and help in organizing the extension of the collection to other parts of the world and in arranging for the preparation of extracts, especially of human prolactin and somatotrophin for international use; 4) make contact with individuals and organizations engaged in the collection of hypothalamic tissue with the object of improving facilities for collection; and 5) encourage studies on human lactation in relation to malnutrition and undernutrition in developing countries.
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  17. 17

    Biology of human reproduction.


    Geneva, World Health Organization, 1964. (Technical Report Series No. 280.) 30 p.

    A WHO Scientific Group on the Biology of Human Reproduction was convened in Geneva from April 2-8, 1963, for the purpose of advising the Director-General on developments and major research needs in that field. The biology of human reproduction is an extremely broad scientific topic, which impinges to some degree on virtually all the basic medical disciplines. Major topics included in the report are: 1) comparative aspects of reproduction; 2) neuroendocrine aspects of reproduction; 3) biology of the gonads and gametes; 4) gestation; 5) biochemistry of the sex steroids; 6) immunological aspects of reproduction; and 7) pharmacological aspects of reproduction. The Group recommends: 1) that WHO assist in the development of fundamental knowledge of the biology of human reproduction and of other fields on which that knowledge is based and 2) that WHO convene meetings of appropriate specialist groups to consider practical methods of implementing certain proposals concerning organization of surveys, provision of services, and promotion of relevant research.
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  18. 18
    Peer Reviewed

    A rebuttal: Epidemic and endemic meningococcal meningitis in sub-Saharan Africa can be prevented now by routine immunization with group A meningococcal capsular polysaccharide vaccine.

    Robbins JB; Schneerson R; Gotschlich EC

    Pediatric Infectious Disease Journal. 2000 Oct; 19(10):945-53.

    The WHO strategy of instituting mass vaccination to combat meningococcal meningitis in sub-Saharan Africa has failed to control huge epidemics in 1996 and 1997. At best, it would only prevent 50% of cases during the epidemic even under optimal conditions of detection and mobilization of personnel and resources. It also ignores the endemic prevalence of disease that would be categorized as epidemic in other parts of the world. In this respect, this paper attempts to change the recommendation of the WHO for group A meningococcal meningitis. It recommends mass vaccination followed by routine vaccination and offers an agenda for the introduction of conjugate vaccines. Routine immunization with group A meningococcal polysaccharide has been noted to be effective. This approach serves as a means for rational development and field testing of the infrastructure for the deployment of a conjugate vaccine. The addition of meningococcal polysaccharide vaccines to routine immunization in African countries is recommended.
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  19. 19

    Meningococcal immunisation in Ghana [letter]

    McDamien D; Boelaert M; Van Damme W; Van der Stuyft P

    Lancet. 2000 Jun 24; 355(9222):2252.

    This is a brief critique on the conclusion drawn by Christopher Woods and colleagues that the WHO’s threshold-based meningitis control strategy is the best strategy. The critics outline the reasons for the unfeasibility of the WHO strategy in meeting the demands of meningitis vaccination. Moreover, they stress their concerns over the delays in vaccination coverage. The delays were due, between the crossing of the threshold and the declarations of the epidemic, to weaknesses in the surveillance system. The paper further implicates that support should be given to all initiatives that strive for universal access to essential drugs while promoting research for better and affordable meningococcal vaccines.
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  20. 20

    WHO donates vaccines.

    GHANA OFFICIAL NEWS BULLETIN. 1997 Mar 16-31; 2(6):6.

    Considered a national disaster, the epidemic of cerebrospinal meningitis (CSM) in Ghana merits the mobilization of all available resources against it. Dr. Sylvester Anemana, Northern Regional Director of Health Services, announced at a meeting of the Regional Coordinating Council, District Chief Executives, and Heads of Departments in Tamale that the Northern Region of the country has received its first consignment of 500,000 doses of vaccines against CSM from the World Health Organization (WHO). Use of the doses will initially be concentrated in the endemic districts of East and West Mamprusi, Saboba/Chereponi, Yendi, Tamale, Savelugu/Nanton, Tolon/Kumbungu, and Gushiegu/Karaga. However, as soon as the rest of the vaccines arrive, a mass immunization program will be undertaken to immunize everyone in the region within 2 weeks. Needles, syringes, and other medical supplies will also be sent to the districts. The CSM vaccines will be administered only by trained personnel, such as student-nurses. The District Chief Executives were asked to raise awareness about the disease and measures in place to control it, and to help dispel the notion in some communities that deaths resulting from the disease are caused by witchcraft. District assemblies were also urged to help transport medical teams to immunization sites. Funds will be given to districts for fuel and field worker allowances.
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  21. 21
    Peer Reviewed

    Salt solution for Ghana's plague of goitres.

    Nelson H

    Lancet. 1996 Sep 28; 348(9031):883.

    UNICEF and other international agencies are taking action to iodize salt in 118 countries where 1.5 billion people are at risk of iodine-deficiency disorders (IDD), the greatest preventable cause of mental retardation worldwide. Most of these target countries are developing countries. Only 46 of the 118 countries had a national salt-iodization program in 1990. That number has since increased to 83 (mid-1996). Salt iodization efforts focus on women of reproductive age, since IDD adversely affects fetal brain and nervous system development. Children with IDD also have fewer defenses against infections and other nutritional problems. UNICEF estimates that IDD is responsible for about 5.7 million cases of cretinism, 43 million cases of people with some degree of intellectual handicap, and 655 million cases of goiter. West Africa is endemic for IDD. In 1993, in central Guinea, 70% of adults had goiter and 2% of goiter cases were affected by cretinism. 55% of school children had thyroid swelling. 69% of all people had an iodine excretion level below the threshold of 20 mcg/l. The president of Guinea issued a decree in November 1995 for the iodization of salt. In Mamadou, Guinea, the health director is organizing religious and business leaders, teachers, and parents to educate them to the need for iodized salt. Knowledge about the importance of iodine and about the fact that cassava and fonio facilitate goiter growth is low. Soon after the 1993 survey, UNICEF distributed iodine capsules for the most severely affected people. It takes time to pass laws requiring the iodization of all salt. In Ghana, red tape has delayed passage of such a bill for many months. As a consequence, salt producers in Ghana are exporting 70% of their iodized salt to Mali and Burkina Faso, where salt iodization is required by law. Potassium iodate is more stable under different climatic conditions than potassium iodide. Thyrotoxicosis is a concern, but it usually stops 1-2 years after implementation of salt iodization. Salt iodization is the norm in Algeria, Cameroon, Eritrea, Kenya, Namibia, Nigeria, South Africa, Zambia, and Zimbabwe.
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  22. 22

    Rabies in endemic countries. Problems with canine carriers of the virus and the cost of safe, post-exposure prophylaxis.

    Dutta JK; Dutta TK

    BMJ. British Medical Journal. 1994 Feb 19; 308(6927):488-9.

    Rabies kills 25,000 people annually in India. Stray dogs are usually the disease carrier. Approximately 500,000 people receive prophylactic treatment after being bitten. In developing countries including India, there are documented cases of the responsible canine outliving its victims, which suggests a chronic excretor state for the virus. Some dogs live a month; 1 dog, which was studied at the Pasteur Institute in Coonoor, lived 3 years. Of 913 saliva samples from the dog, based on fluorescence antibody testing and animal inoculation testing, 14 were positive. This included 1 after a week of prednisolone treatment. Deaths from the bites of chronic excretors have rarely been reported in the United States. Prolonged excretion of rabies virus has been reported in the saliva of asymptomatic dogs, including 5 unvaccinated dogs in an Ethiopian study. These rare, chronic strains of canine rabies may be less virulent. However, human deaths following bites by prolonged excretors would indicate that fatal strains of rabies also have a chronic carrier state. The World Health Organization currently recommends a 10 day observation period for an animal that has bitten someone. This may be insufficient. Also, whether a bitten person should automatically be immunized in areas where rabies is endemic is in question. In developing countries, the animal often escapes and cannot be observed; people are unaware that the animal should be impounded; and inadequate laboratory facilities do not permit proper examination of killed animals. In cases of transdermal bites or scratches, and of contamination of mucous membranes by saliva, patients should immediately receive tissue culture vaccine, regardless of knowledge of the animal's condition. Since neurotissue vaccines are cheap, they are still being used in developing countries. The occurrence of serious neuroparalytic complications following immunization with neurotissue vaccine has been reported to be from 1/220 to 1/12,000. In view of this, immunization after all cases of animal bites would be dangerous. Without laboratory confirmation, the following needs to be considered: 1) the pattern of rabies in the area; 2) the animal species involved; 3) the state of the animal's health at or after the time of the bite; and 4) the site and the severity of the bite. If the new tissue culture vaccines are used, immunization on days 0, 3, 7, and 10 would probably be sufficient when the animal is an excretor. Also, the new vaccines can be given after the 10-day observation period, if the animal is a nonexcretor. If administered intradermally, which requires technical skill, the cost of treatment with the new vaccines is less.
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  23. 23

    Goal for 1990: polio eradication in the Americas.

    EPI NEWSLETTER. 1985 Jun; 7(3):1-2.

    The Pan American Helath Organization (PAHO) has announced a campaign to enadicate the indigenous transmission of wild polio virus from all countries of the Americas by 1990. This 5-year drive is viewed as a vital part of the broader World Health Organization Expanded program me on Immunization goal to achieve universal immunization against childhood diseases by 1990. Special vaccination strategies will be adapted to the neess of each country. suported by effective disease surveillance and control, proper laboratory support for diagnosis, and training of program managers and field epidemiologists. Program costs over the next 5 years are expected to total US$110 million, about 1/3 of which will come from donor countries. PAHO has emphasized that immunization programs should not be implemented at the expense of efforts to develop the health service infrastructure and that campaigns and national vaccination days should be viewed as ad hoc measures to be gradually replaced by routine immunization services. In the 1969-84 period, a total of 53,251 cases of polio were reported in the Americas. By 1984, 26 countries had achieved polio control.
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  24. 24

    Combined oral contraceptives.


    In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagen, Denmark, Scriptor, 1977. p. 253-282

    This review of combined oral contraceptive (OC) preparations presents formulations, pregnancy rates, biochemical parameter changes, morbidity, and OC indications in 15 tables. The OC preparations are based on 2 different estrogens and 14 progestagens. Though steroid content differs among products, all act primarily to inhibit ovulation by suppression of midcycle release of pituitary gonadotropins. Variable-dose products are associated with higher pregnancy rates than fixed-dose preparations. Side effects of OCs, while difficult to identify, fall into 2 categories: 1) common adverse associations similar to responses to inert placeboes; and 2) serious biochemical and physiological alterations. There is no evidence of any increase in morbidity due to OC use, whereas avoidance of risks associated with pregnancy is beneficial. No convincing evidence of carcinogenic hazard is presented. Some evidence of reduced systemic side effects by lower-dose products is presented, though gynecological side effects, such as irregular bleeding, may increase. Drug interaction with OCs is described; rifampicin causes the most serious of these. OCs induce wide-ranging metabolic changes in many organ systems. These may relate to undesirable side effects (psychological or neurological signs, skin disorders, and blood pressure changes).
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  25. 25
    Peer Reviewed

    Multinational comparative clinical evaluation of two long-acting injectable contraceptive steroids: norethisterone oenanthate and medroxyprogesterone acetate: 2. bleeding patterns and side effects.

    World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on Long-Acting Systemic Agents for Fertility Regulation

    Contraception. 1978 May; 17(5):395-406.

    A WHO sponsored comparative trail (9 centers) studied the bleeding patterns and side effects experienced by 1678 women using injectable (every 12 weeks) norethisterone enanthate (NOR) and depot-medroxyprogesterone (DMPA). 388.8 women-years of menstrual experience with NOR and 372.5 with DMPA were studied. The percentage of women with total amenorrhea with DMPA was significantly higher than with NOR for all injection intervals. The porportion of women with total amenorrhea increased significantly over time with both drugs (chi-square=33.9 for NOR and 73.4 for DMPA; P < .001). After 1 year, 35% of DMPA and 8.6% of NOR users had total amenorrhea. With NOR, the cycle length distribution changed markedly over time, with the percentage of short cycles under 25 days diminishing as the percentage of long cycles in excess of 46 days increased. In contrast, DMPA held cycle length patterns more or less constant. Length of bleeding and spotting episodes were significantly greater with DMPA. The mean number of bleeding/spotting days decreased over time with both drugs; the difference from the 1st to 4th injection was statistically significant (P < .001). Though the overwhelming majority of women experienced abnormal cycles with both drugs, the percentage of normal cycles remained fairly constant during consecutive intervals. Headache was the most frequently reported complaint: 10.7% of DMPA and 6.9% of NOR users. Other nonmenstrual side effects were reported with similar frequencies in both groups.
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