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Influenza epidemiology and immunization during pregnancy: Final report of a World Health Organization working group.
Vaccine. 2017 Oct 13; 35(43):5738-5750.From 2014 to 2017, the World Health Organization convened a working group to evaluate influenza disease burden and vaccine efficacy to inform estimates of maternal influenza immunization program impact. The group evaluated existing systematic reviews and relevant primary studies, and conducted four new systematic reviews. There was strong evidence that maternal influenza immunization prevented influenza illness in pregnant women and their infants, although data on severe illness prevention were lacking. The limited number of studies reporting influenza incidence in pregnant women and infants under six months had highly variable estimates and underrepresented low- and middle-income countries. The evidence that maternal influenza immunization reduces the risk of adverse birth outcomes was conflicting, and many observational studies were subject to substantial bias. The lack of scientific clarity regarding disease burden or magnitude of vaccine efficacy against severe illness poses challenges for robust estimation of the potential impact of maternal influenza immunization programs. Copyright (c) 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
Journal of Human Lactation. 2017 Feb; 33(1):140-148.BACKGROUND: Extended breastfeeding duration is common in India. Extended breastfeeding protects the infant from infectious disease and promotes child spacing. In the 1990s, the median breastfeeding duration in India was 24 months. Research aim: This study aimed to investigate the median duration of breastfeeding in India and to identify the factors associated with extended breastfeeding to 24 months as recommended by the World Health Organization. METHODS: This cross-sectional data analysis used nationally representative data from the 2011-2012 Indian Human Development Survey II. The outcome in this study was extended breastfeeding defined as breastfeeding to 24 months or more. Multivariate logistic regression was used to identify the factors associated with extended breastfeeding. RESULTS: The median duration of breastfeeding was 12 months; approximately 25% of women breastfed 24 months or more. Women were at greater odds of breastfeeding 24 months or more if the infant was a boy compared with a girl, if the women lived in a rural area compared with an urban area, if the women were married at a young age (< 17 vs. 20 years or older at marriage), and if the delivery was assisted by a friend or relative compared with a doctor. CONCLUSION: The median duration of breastfeeding has decreased by 50% from 1992-1993 to 2011-2012. The women who continue to breastfeed 24 months or more tend to be more traditional (i.e., living in rural areas, marrying young, and having family/friends as birth attendants). Further research to study the health effect of decreased breastfeeding duration is warranted.
Neglected chronic disease: The WHO framework on non-communicable diseases and implications for the global poor.
Global Public Health. 2017 Apr; 12(4):396-415.The current global framework on noncommunicable disease (NCD), as exemplified by the WHO Action Plan of 2012, neglects the needs of the global poor. The current framework is rooted in an outdated pseudo-evolutionary theory of epidemiologic transition, which weds NCDs to modernity, and relies on global aggregate data. It is oriented around a simplistic causal model of behavior, risk and disease, which implicitly locates ‘risk’ within individuals, conveniently drawing attention away from important global drivers of the NCD epidemic. In fact, the epidemiologic realities of the bottom billion reveal a burden of neglected chronic diseases that are associated with ‘alternative’ environmental and infectious risks that are largely structurally determined. In addition, the vertical orientation of the framework fails to centralize health systems and delivery issues that are essential to chronic disease prevention and treatment. A new framework oriented around a global health equity perspective would be able to correct some of the failures of the current model by bringing the needs of the global poor to the forefront, and centralizing health systems and delivery. In addition, core social science concepts such as Bordieu's habitus may be useful to re-conceptualizing strategies that may address both behavioral and structural determinants of health.
Geneva, Switzerland, WHO, 2016.  p.Since the publication of the WHO Guidelines for the management of sexually transmitted infections in 2003, changes in the epidemiology of STIs and advancements in prevention, diagnosis and treatment necessitate changes in STI management. These guidelines provide updated treatment recommendations for common infections caused by C. trachomatis based on the most recent evidence; they form one of several modules of guidelines for specific STIs. It is strongly recommended that countries take updated global guidance into account as they establish standardized national protocols, adapting this guidance to the local epidemiological situation and antimicrobial susceptibility data. The objectives of these guidelines are: to provide evidence-based guidance on treatment of infection with C. trachomatis; and to support countries to update their national guidelines for treatment of chlamydial infection.
Geneva, Switzerland, WHO, 2016.  p.Since the publication of the WHO Guidelines for the management of sexually transmitted infections in 2003, changes in the epidemiology of STIs and advancements in prevention, diagnosis and treatment necessitate changes in STI management. These guidelines provide updated treatment recommendations for treatment of Treponema pallidum (syphilis) based on the most recent evidence. They form one of several modules of guidelines for specific STIs. It is strongly recommended that countries take updated global guidance into account as they establish standardized national protocols and adapt it to the local epidemiological situation and antimicrobial susceptibility data. The objectives of these guidelines are: to provide evidence-based guidance on treatment of infection with Treponema pallidum; and to support countries to update their national guidelines for treatment of Treponema pallidum.
Geneva, Switzerland, WHO, 2016.  p.Since the publication of the WHO Guidelines for the management of sexually transmitted infections in 2003, changes in the epidemiology of STIs and advancements in prevention, diagnosis and treatment necessitate changes in STI management. There is an urgent need to update treatment recommendations for gonococcal infections to respond to changing antimicrobial resistance (AMR) patterns of N. gonorrhoeae. High-level resistance to previously recommended quinolones is widespread and decreased susceptibility to the extended-spectrum (third-generation) cephalosporins, another recommended first-line treatment in the 2003 guidelines, is increasing and several countries have reported treatment failures. These guidelines for the treatment of common infections caused by N. gonorrhoeae form one of several modules of guidelines for specific STIs. It is strongly recommended that countries take updated global guidance into account as they establish standardized national protocols, adapting this guidance to the local epidemiological situation and antimicrobial susceptibility data. The objectives of these guidelines are: to provide evidence-based guidance on treatment of infection with N. gonorrhoeae; and to support countries to update their national guidelines for treatment of gonococcal infection.
Zika virus infection: global update on epidemiology and potentially associated clinical manifestations.
Releve Epidemiologique Hebdomadaire. 2016 Feb 19; 91(7):73-81.Add to my documents.
[Geneva, Switzerland], WHO, 2016 Feb.  p.WHO has launched a global Strategic Response Framework and Joint Operations Plan to guide the international response to the spread of Zika virus infection and the neonatal malformations and neurological conditions associated with it. The strategy focuses on mobilizing and coordinating partners, experts and resources to help countries enhance surveillance of the Zika virus and disorders that could be linked to it, improve vector control, effectively communicate risks, guidance and protection measures, provide medical care to those affected and fast-track research and development of vaccines, diagnostics and therapeutics.
Population and Development Review. 2015 Sep 15; 41(3):507-532.Chronic noncommunicable diseases (NCDs) in low- and middle-income countries have recently provoked a surge of public interest. This article examines the policy literature-notably the archives and publications of the World Health Organization (WHO), which has dominated this field-to analyze the emergence and consolidation of this new agenda. Starting with programs to control cardiovascular disease in the 1970s, experts from Eastern and Western Europe had by the late 1980s consolidated a program for the prevention of NCD risk factors at the WHO. NCDs remained a relatively minor concern until the collaboration of World Bank health economists with WHO epidemiologists led to the Global Burden of Disease study that provided an “evidentiary breakthrough” for NCD activism by quantifying the extent of the problem. Soon after, WHO itself, facing severe criticism, underwent major reform. NCD advocacy contributed to revitalizing WHO's normative and coordinative functions. By leading a growing advocacy coalition, within which The Lancet played a key role, WHO established itself as a leading institution in this domain. However, ever-widening concern with NCDs has not yet led to major reallocation of funding in favor of NCD programs in the developing world.
Releve Epidemiologique Hebdomadaire / Section D'hygiene Du Secretariat De La Societe Des Nations. 2014 Oct 31; 89(44):493-9.Add to my documents.
Morbidity and Mortality Weekly Report. 2014 Jul 25; 63(29):634-637.Since 2008, the World Health Organization (WHO) has coordinated the Global Rotavirus Surveillance Network, a network of sentinel surveillance hospitals and laboratories that report to ministries of health (MoHs) and WHO clinical features and rotavirus testing data for children aged <5 years hospitalized with acute gastroenteritis. In 2013, WHO conducted a strategic review to assess surveillance network performance, provide recommendations for strengthening the network, and assess the network’s utility as a platform for other vaccine-preventable disease surveillance. The strategic review team determined that during 2011 and 2012, a total of 79 sites in 37 countries met reporting and testing inclusion criteria for data analysis. Of the 37 countries with sites meeting inclusion criteria, 13 (35%) had introduced rotavirus vaccine nationwide. All 79 sites included in the analysis were meeting 2008 network objectives of documenting presence of disease and describing disease epidemiology, and all countries were using the rotavirus surveillance data for vaccine introduction decisions, disease burden estimates, and advocacy; countries were in the process of assessing the use of this surveillance platform for other vaccine-preventable diseases. However, the review also indicated that the network would benefit from enhanced management, standardized data formats, linkage of clinical data with laboratory data, and additional resources to support network functions. In November 2013, WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) endorsed the findings and recommendations made by the review team and noted potential opportunities for using the network as a platform for other vaccine-preventable disease surveillance. WHO will work to implement the recommendations to improve the network’s functions and to provide higher quality surveillance data for use in decisions related to vaccine introduction and vaccination program sustainability.
Geneva, Switzerland, WHO, 2013.  p.The World Malaria Report 2013 summarizes information received from malaria-endemic countries and other sources, and updates the analyses presented in the 2012 report. It highlights the progress made towards global malaria targets set for 2015, and describes current challenges for global malaria control and elimination.
Releve Epidemiologique Hebdomadaire. 2013 Jul 12; 88(28):285-96.This epidemiologic record discusses recent data about yellow fever outbreaks and cases in Africa and South America between 2011 and 2012. During this period, major outbreaks were reported in Sudan and Uganda while significant clusters of cases were reported in Cameroon, Chad and Cote d’Ivoire, necessitating an extended vaccination response. In addition, some isolated cases occurred in districts reporting high yellow fever vaccination coverage (Burkina Faso, Central African Republic, Togo), for which no vaccination response was undertaken. In South America, the World Health Organization American Region reported 32 cases (2011-2012), including 9 deaths, in Brazil, Ecuador, Plurinational State of Bolivia and Peru. As of 2012, most countries in the Caribbean and Latin America with enzootic areas had introduced the yellow fever vaccine into their national routine immunization schedules. The 2008 outbreaks in the Southern Cone expanded the area considered at risk to include northern Argentina and Paraguay. Building upon the yellow fever investment case strategy, which has reduced the frequency and size of disruptive outbreaks, the Yellow Fever Strategic Framework 2012-2020 prioritizes endemic countries according to their epidemic risk. This framework will enable WHO and partners to identify the populations’ high priority needs through a systematic approach so that limited resources can be allocated most effective to reduce the burden of yellow fever in Africa. Following a request from the countries, a form of yellow fever experts met in Panama to discuss how countries can make scientific evidence-based risk assessments and suggested that endemic countries should strive to enhance yellow fever surveillance systems.
Releve Epidemiologique Hebdomadaire. 2013 Jun 14; 88(24):241-2.In May 2013, eight total cases of wild poliovirus type 1 (WPV1) were isolated in Mogadishu and Bay Region, becoming the first polio cases reported in Somalia since March 2007. That same month, the Kenyan Ministry of Public Health and Sanitation confirmed a WPV1 case in an infant girl from the Dadaab refugee camps near the Somalia border. Genetic sequence analysis of WPV1 from both countries shows that they are closely related, with evidence of the virus’ single introduction into the region and subsequent local transmission. In Somalia and Kenya, rapid response polio supplementary immunization activities (SIA) were conducted. Preventive SIAs are being conducted in areas of Ethiopia and Yemen, and surveillance for acute flaccid paralysis (AFP) is being strengthened in all countries in the Horn of Africa.
Tropical Medicine and International Health. 2012 Jun; 17(6):760-6.OBJECTIVE: To review the activities, progress, achievements and challenges of the Zambia Ministry of Health tuberculosis (TB)/HIV collaborative activities over the past decade. METHODS: Analysis of Zambia Ministry of Health National TB and HIV programme documents and external independent programme review reports pertaining to 2000-2010. RESULTS: The number of people testing for HIV increased from 37 557 persons in 2003 to 1 327 995 persons in 2010 nationally. Those receiving anti-retroviral therapy (ART) increased from 143 in 2003 to 344 304 in 2010. The national HIV prevalence estimates declined from 14.3% in 2001 to 13.5% in 2009. The proportion of TB patients being tested for HIV increased from 22.6% in 2006 to 84% in 2010 and approximately 70% were HIV positive. The proportion of the HIV-infected TB patients who: (i) started on ART increased from 38% in 2006 to 50% in 2010; (ii) commenced co-trimoxazole preventive therapy (CPT) increased from 31% in 2006 to 70% in 2010; and (iii) were successfully treated increased to an average of 80% resulting in decline of deaths from 13% in 2006 to 9% in 2010. CONCLUSIONS: The scale-up of TB/HIV collaborative programme activities in Zambia has steadily increased over the past decade resulting in increased testing for TB and HIV, and anti-retroviral (ARV) rollout with improved treatment outcomes among TB patients co-infected with HIV. Getting service delivery points to adhere to WHO guidelines for collaborative TB/HIV activities remains problematic, especially those meant to reduce the burden of TB in people living with HIV/AIDS (PLWHA). (c) 2012 Blackwell Publishing Ltd.
The impact of the new WHO antiretroviral treatment guidelines on HIV epidemic dynamics and cost in South Africa.
PloS One. 2011; 6(7):e21919.BACKGROUND: Since November 2009, WHO recommends that adults infected with HIV should initiate antiretroviral therapy (ART) at CD4+ cell counts of =350 cells/microl rather than =200 cells/microl. South Africa decided to adopt this strategy for pregnant and TB co-infected patients only. We estimated the impact of fully adopting the new WHO guidelines on HIV epidemic dynamics and associated costs. METHODS AND FINDING: We used an established model of the transmission and control of HIV in specified sexual networks and healthcare settings. We quantified the model to represent Hlabisa subdistrict, KwaZulu-Natal, South Africa. We predicted the HIV epidemic dynamics, number on ART and program costs under the new guidelines relative to treating patients at =200 cells/microl for the next 30 years. During the first five years, the new WHO treatment guidelines require about 7% extra annual investments, whereas 28% more patients receive treatment. Furthermore, there will be a more profound impact on HIV incidence, leading to relatively less annual costs after seven years. The resulting cumulative net costs reach a break-even point after on average 16 years. CONCLUSIONS: Our study strengthens the WHO recommendation of starting ART at =350 cells/microl for all HIV-infected patients. Apart from the benefits associated with many life-years saved, a modest frontloading appears to lead to net savings within a limited time-horizon. This finding is robust to alternative assumptions and foreseeable changes in ART prices and effectiveness. Therefore, South Africa should aim at rapidly expanding its healthcare infrastructure to fully embrace the new WHO guidelines.
[Clinical, epidemiological and microbiological characteristics of a cohort of pulmonary tuberculosis patients in Cali, Colombia] Caracteristicas clinicas, epidemiologicas y microbiologicas de una cohorte de pacientes con tuberculosis pulmonar en Cali, Colombia.
Biomedica. 2010 Oct-Dec; 30(4):482-91.INTRODUCTION: The World Health Organization recommended strategy for global tuberculosis control is a short-course, clinically administered treatment, This approach has approximately 70% coverage in Colombia. OBJECTIVE: The clinical, epidemiological and microbiological characteristics along with drug therapy outcomes were described in newly diagnosed, pulmonary tuberculosis patients. MATERIALS AND METHODS: This was a descriptive study, conducted as part of a multicenter clinical trial of tuberculosis treatment. A cohort of 106 patients with pulmonary tuberculosis were recruited from several public health facilities in Cali between April 2005 and June 2006. Sputum smear microscopy, culture, drug susceptibility tests to first-line anti-tuberculosis drugs, chest X- ray and HIV-ELISA were performed. Clinical and epidemiological information was collected for each participant. Treatment was administered by the local tuberculosis health facility. Food and transportation incentives were provided during a 30 month follow-up period. RESULTS: The majority of patients were young males with a diagnostic delay longer than 9 weeks and a high sputum smear grade (2+ or 3+). The initial drug resistance was 7.5% for single drug treatment and 1.9% for multidrug treatments. The incidence of adverse events associated with treatment was 8.5%. HIV co-infection was present in 5.7% of the cases. Eighty-six percent of the patients completed the treatment and were considered cured. The radiographic presentation varied within a broad range and differed from the classic progression to cavity formation. CONCLUSION: Delay in tuberculosis diagnosis was identified as a risk factor for treatment compliance failure. The study population had similar baseline epidemiologic characteristics to those described in other cohort studies.
Wei Sheng Yan Jiu. 2007 Mar; 36(2):203-6.OBJECTIVE: To compare children's growth patterns and estimates of malnutrition using the WHO standards versus the NCHS reference in China. METHODS: Data originated from China children nutrition surveillance in 2005, Z-scores and prevalence of malnutrition were compared between standards. RESULTS: There was substantial difference in Z-scores between standards in rural (P < 0.0001). According to the WHO standards, prevalence of underweight in rural was lower than that of underweight based on the NCHS reference (6.1% . vs. 8.6%, P < 0.0001). Except for children under 6 months, all age groups underweight rates were lower according to the WHO standards. Prevalence of stunting in rural was higher based on the WHO standards (16.3% . vs. 13.0%, P < 0.0001), prevalences of stunting under 6 months were 2.1 times of that based on NCHS reference. As for wasting, there were no differences between standards, but wasting was substantially higher during the first half of infancy. Overweight rates based on the WHO standards were higher than those based on NCHS reference in urban (6.7% . vs. 5.4%, P < 0.0001). CONCLUSION: In comparison with NCHS reference, population estimates of malnutrition would vary by age, growth indicator based on WHO standards. The WHO standards could provide a better tool to monitor the rapid and changing rate of growth in early infancy, further analysis on existing data was needed.
Bulletin of the World Health Organization. 2010 Mar; 88(3):232-4.Add to my documents.
[Implementation of the Integrated Management of Childhood Illnesses strategy in Northeastern Brazil] Implementacao da estrategia Atencao Integrada as Doencas Prevalentes na Infancia no Nordeste, Brasil.
Revista De Saude Publica. 2008 Aug; 42(4):598-606.OBJECTIVE: The majority of child deaths are avoidable. The Integrated Management of Childhood Illnesses strategy, developed by the World Health Organization and the United Nations Children's Fund, aims to reduce child mortality by means of actions to improve performance of health professionals, the health system organization, and family and community practices. The article aimed to describe factors associated with the implementation of this strategy in three states of Northeastern Brazil. METHODS: Ecological study conducted in 443 municipalities in the states of Northeastern Brazil Ceara, Paraiba and Pernambuco, in 2006. The distribution of economic, geographic, environmental, nutritional, health service organization, and child mortality independent variables were compared between municipalities with and without the strategy. These factors were assessed by means of a hierarchical model, where Poisson regression was used to calculate the prevalence ratios, after adjustment of confounding factors. RESULTS: A total of 54% of the municipalities studied had the strategy: in the state of Ceara, 65 had it and 43 did not have it; in the state of Paraiba, 27 had it and 21 did not have it; and in the state of Pernambuco, 147 had it and 140 did not have it. After controlling for confounding factors, the following variables were found to be significantly associated with the absence of the strategy: lower human development index, smaller population, and greater distance from the capital. CONCLUSIONS: There was inequality in the development of the strategy, as municipalities with a higher risk to child health showed lower rates of implementation of actions. Health policies are necessary to help this strategy to be consolidated in the municipalities that are at a higher risk of child mortality.
Measles outbreaks and progress towards meeting measles pre-elimination goals: WHO African Region, 2009-2010. Flambees de rougeole et progres accomplis en vue d'atteindre les objectifs de preelimination de la rougeole: Region africaine de l'OMS, 2009-2010.
Releve Epidemiologique Hebdomadaire. 2011 Apr 1; 86(14):129-36.This report summarizes the progress made during 2009-2010 towards meeting the pre-elimination goals after a historically low incidence of measles cases was reported in 2008. In addition, it provides information on measles outbreaks occurring during the same period which highlights the urgent need for renewed political will from governments and their partners to ensure that national multiyear vaccination plans, budgetary line-items and financial commitments exist for routine immunization services and measles-control activities. To assist countries in resonding to measles outbreaks, WHO guidelines were published in 2009.
Journal of the History of Medicine and Allied Sciences. 2010 Jul; 65(3):287-326.In 1971 Abdel R. Omran published his classic paper on the theory of epidemiologic transition. By the mid-1990s, it had become something of a citation classic and was understood as a theoretical statement about the shift from infectious to chronic diseases that supposedly accompanies modernization. However, Omran himself was not directly concerned with the rise of chronic disease; his theory was in fact closely tied to efforts to accelerate fertility decline through health-oriented population control programs. This article uses Omran's extensive published writings as well as primary and secondary sources on population and family planning to place Omran's career in context and reinterpret his theory. We find that "epidemiologic transition" was part of a broader effort to reorient American and international health institutions towards the pervasive population control agenda of the 1960s and 1970s. The theory was integral to the WHO's then controversial efforts to align family planning with health services, as well as to Omran's unsuccessful attempt to create a new sub-discipline of "population epidemiology." However, Omran's theory failed to displace demographic transition theory as the guiding framework for population control. It was mostly overlooked until the early 1990s, when it belatedly became associated with the rise of chronic disease.
PloS One. 2010; 5(1):e8796.BACKGROUND: The tight epidemiological coupling between HIV and its associated opportunistic infections leads to challenges and opportunities for disease surveillance. METHODOLOGY/PRINCIPAL FINDINGS: We review efforts of WHO and collaborating agencies to track and fight the TB/HIV co-epidemic, and discuss modeling--via mathematical, statistical, and computational approaches--as a means to identify disease indicators designed to integrate data from linked diseases in order to characterize how co-epidemics change in time and space. We present R(TB/HIV), an index comparing changes in TB incidence relative to HIV prevalence, and use it to identify those sub-Saharan African countries with outlier TB/HIV dynamics. R(TB/HIV) can also be used to predict epidemiological trends, investigate the coherency of reported trends, and cross-check the anticipated impact of public health interventions. Identifying the cause(s) responsible for anomalous R(TB/HIV) values can reveal information crucial to the management of public health. CONCLUSIONS/SIGNIFICANCE: We frame our suggestions for integrating and analyzing co-epidemic data within the context of global disease monitoring. Used routinely, joint disease indicators such as R(TB/HIV) could greatly enhance the monitoring and evaluation of public health programs.
Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response.
Geneva, Switzerland, WHO, 2010.  p.This new report on anti-tuberculosis (TB) drug resistance by the World Health Organization (WHO) updates "Anti-tuberculosis drug resistance in the world: Report No. 4" published by WHO in 2008. It summarizes the latest data and provides latest estimates of the global epidemic of multidrug and extensively drug-resistant tuberculosis (M/XDR-TB). For the first time, this report includes an assessment of the progress countries are making to diagnose and treat MDR-TB cases. (Excerpt)
Symposium proceedings. HPV Vaccines: New Tools in the Prevention of Cervical Cancer and Other HPV Disease in Asia and the Pacific, Bangkok, Thailand, 2 November 2006.
Bangkok, Thailand, Family Health International [FHI], Asia / Pacific Regional Office, 2007. 55 p.Cervical cancer -- the most preventable and treatable of all cancers -- is the most common cancer among women in developing countries. This report presents the proceedings of a November 2006 symposium organized by FHI in Bangkok, Thailand, that brought together leading specialists in immunization, cancer prevention, and other disciplines to start building consensus on a comprehensive approach to programming for the prevention and early detection of cervical cancers in the Asia region. Presentations covered such topics as improved screening methods for cervical cancer, the latest research on human papillomavirus (HPV) vaccines, and country and social perspectives related to HPV vaccination. Participants concluded that there is a need to 1) further educate health professionals, especially so they can influence policymakers and service planners, and 2) devise communication strategies that will shape debates on HPV vaccines.