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Progress with Scale-Up of HIV Viral Load Monitoring - Seven Sub-Saharan African Countries, January 2015-June 2016.
MMWR. Morbidity and Mortality Weekly Report. 2016 Dec 02; 65(47):1332-1335.The World Health Organization (WHO) recommends viral load testing as the preferred method for monitoring the clinical response of patients with human immunodeficiency virus (HIV) infection to antiretroviral therapy (ART) (1). Viral load monitoring of patients on ART helps ensure early diagnosis and confirmation of ART failure and enables clinicians to take an appropriate course of action for patient management. When viral suppression is achieved and maintained, HIV transmission is substantially decreased, as is HIV-associated morbidity and mortality (2). CDC and other U.S. government agencies and international partners are supporting multiple countries in sub-Saharan Africa to provide viral load testing of persons with HIV who are on ART. This report examines current capacity for viral load testing based on equipment provided by manufacturers and progress with viral load monitoring of patients on ART in seven sub-Saharan countries (Cote d'Ivoire, Kenya, Malawi, Namibia, South Africa, Tanzania, and Uganda) during January 2015-June 2016. By June 2016, based on the target numbers for viral load testing set by each country, adequate equipment capacity existed in all but one country. During 2015, two countries tested >85% of patients on ART (Namibia [91%] and South Africa [87%]); four countries tested <25% of patients on ART. In 2015, viral suppression was >80% among those patients who received a viral load test in all countries except Cote d'Ivoire. Sustained country commitment and a coordinated global effort is needed to reach the goal for viral load monitoring of all persons with HIV on ART.
Targeted Spontaneous Reporting: Assessing Opportunities to Conduct Routine Pharmacovigilance for Antiretroviral Treatment on an International Scale.
Drug Safety. 2016 Jun 9; 1-18.Introduction: Targeted spontaneous reporting (TSR) is a pharmacovigilance method that can enhance reporting of adverse drug reactions related to antiretroviral therapy (ART). Minimal data exist on the needs or capacity of facilities to conduct TSR. Objectives: Using data from the International epidemiologic Databases to Evaluate AIDS (IeDEA) Consortium, the present study had two objectives: (1) to develop a list of facility characteristics that could constitute key assets in the conduct of TSR; (2) to use this list as a starting point to describe the existing capacity of IeDEA-participating facilities to conduct pharmacovigilance through TSR. Methods: We generated our facility characteristics list using an iterative approach, through a review of relevant World Health Organization (WHO) and Uppsala Monitoring Centre documents focused on pharmacovigilance activities related to HIV and ART and consultation with expert stakeholders. IeDEA facility data were drawn from a 2009/2010 IeDEA site assessment that included reported characteristics of adult and pediatric HIV care programs, including outreach, staffing, laboratory capacity, adverse event monitoring, and non-HIV care. Results: A total of 137 facilities were included: East Africa (43); Asia–Pacific (28); West Africa (21); Southern Africa (19); Central Africa (12); Caribbean, Central, and South America (7); and North America (7). Key facility characteristics were grouped as follows: outcome ascertainment and follow-up; laboratory monitoring; documentation—sources and management of data; and human resources. Facility characteristics ranged by facility and region. The majority of facilities reported that patients were assigned a unique identification number (n = 114; 83.2 %) and most sites recorded adverse drug reactions (n = 101; 73.7 %), while 82 facilities (59.9 %) reported having an electronic database on site. Conclusion: We found minimal information is available about facility characteristics that may contribute to pharmacovigilance activities. Our findings, therefore, are a first step that can potentially assist implementers and facility staff to identify opportunities and leverage their existing capacities to incorporate TSR into their routine clinical programs.
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.
Geneva, Switzerland, WHO, 2013.  p. (WHO/HTM/NTD/WHOPES/2013.3)Guidelines for testing long-lasting insecticidal nets (LNs) were first published by WHO in 2005. The revised guidelines were reviewed by a WHOPES informal consultation on innovative public health pesticide products, held at WHO headquarters on 22-26 October 2012. Industry was invited to attend the first 2 days of the meeting to exchange information and provide their views, after which their comments were further reviewed by a group of WHO-appointed experts, who finalized the guidelines by consensus. The purpose of this document is to provide specific, standardized procedures and guidelines for testing LNs for personal protection and malaria vector control. It is intended to harmonize testing procedures in order to generate data for registration and labelling of such products by national authorities and provide a framework for industry in developing novel LN products. This document replaces the previous guidelines, published by WHOPES in 2005. (Excerpts)
Gonorrhoea surveillance, laboratory diagnosis and antimicrobial susceptibility testing of Neisseria gonorrhoeae in 11 countries of the eastern part of the WHO European region.
APMIS Acta Pathologica Microbiologica Et Immunologica Scandinavica. 2011 Sep; 119(9):643-649.Quality-assured worldwide surveillance of antimicrobial resistance (AMR) in Neisseria gonorrhoeae is crucial for public health purposes. In the countries of the eastern part of the WHO European region the knowledge regarding gonococcal AMR is limited, and antimicrobials of many different types, sources and quality are used for gonorrhoea treatment. This study surveyed gonorrhoea incidence, laboratory diagnosis and gonococcal AMR testing in 11 independent countries of the former Soviet Union. The national gonorrhoea incidences remain mainly high. In general, gonococcal culture and AMR testing were rarely performed, poorly standardized and rarely quality assured. To establish a gonococcal AMR surveillance programme in Eastern Europe, i.e. the geographical area of the former Soviet Union, several actions have recently been undertaken by the Eastern European Sexual and Reproductive Health (EE SRH) Network and the WHO. The information provided herein will be useful in this respect.
Virological failure and HIV type 1 drug resistance profiles among patients followed-up in private sector, Douala, Cameroon.
AIDS Research and Human Retroviruses. 2011 Feb; 27(2):221-30.The rate of virological failure was assessed in 819 patients followed up by the private sector of Douala, the economic capital of Cameroon, and treated according to the World Health Organization (WHO) recommendations. In addition, genotypic resistance testing was carried out in the subgroup of 75 selected patients representative of the 254 patients in virological and/or immunological failure receiving a first-line (83%) or second-line (17%) regimen. Overall, 36% of patients treated by antiretroviral drugs (ARV) were in virological failure, as assessed by plasma viral load above 3.7 log(10) copies/ml under treatment for more than 6 months. According to the immunological status, 17% of patients showed a CD4 T cell count under 200 cells/mm(3) and 37% under 350 cells/mm(3), indicating either ongoing immunorestoration or immunological failure under treatment. Twenty percent of patients in virological failure showed wild-type viruses susceptible to all ARV, likely indicating poor adherence. However, 80% of them displayed plasma virus resistant at least to one ARV drug, mostly to the nucleoside reverse transcriptase inhibitors (NRTIs) class (80%), followed by the non-NRTI class (76%) and the protease inhibitor class (19%), thus reflecting the therapeutic usage of ARV drugs in Cameroon as recommended by the WHO. Whereas the second-line regimen proposed by the 2009 WHO recommendations could be effective in more than 75% of patients in virological failure with resistant viruses, the remaining patients showed a resistance genotypic profile highly predictive of resistance to the usual WHO second-line regimen, including in some patients complex genotypic profiles diagnosed only by genotypic resistance tests. In conclusion, our observations highlight the absolute need for improving viral load assessment in resource-limited settings to prevent and/or monitor therapeutic failure.
Antiretroviral resistance patterns and HIV-1 subtype in mother-infant pairs after the administration of combination short-course zidovudine plus single-dose nevirapine for the prevention of mother-to-child transmission of HIV.
Clinical Infectious Diseases. 2009 Jul 15; 49(2):299-305.BACKGROUND: World Health Organization guidelines for prevention of mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) recommend administration of zidovudine and single-dose nevirapine (NVP) for HIV-1-infected women who are not receiving treatment for their own health or if complex regimens are not available. This study assessed antiretroviral resistance patterns among HIV-infected women and infants receiving single-dose NVP in Thailand, where the predominant circulating HIV-1 strains are CRF01_AE recombinants and where the minority are subtype B. METHODS: Venous blood samples were obtained from (1) HIV-infected women who received zidovudine from 34 weeks' gestation and single-dose NVP plus oral zidovudine during labor and (2) HIV-infected infants who received single-dose NVP after birth plus zidovudine for 4 weeks after delivery. HIV-1 drug resistance testing was performed using the TruGene assay (Bayer HealthCare). RESULTS: Most mothers and infants were infected with CRF01_AE. NVP resistance was detected in 34 (18%) of 190 women and 2 (20%) of 10 infants. There was a significantly higher proportion of NVP mutations in women with delivery viral loads of >50,000 copies/mL (adjusted odds ratio, 8.5; 95% confidence interval, 2.2-32.8, [Formula: see text] for linear trend) and in those with subtype B rather than CRF01_AE infections (38% vs. 16%; adjusted odds ratio, 3.6; 95% confidence interval, 1.1-11.8; P = .038). CONCLUSIONS: The lower frequency of NVP mutations among mothers infected with subtype CRF01_AE, compared with mothers infected with subtype B, suggests that individuals infected with subtype CRF01_AE may be less susceptible to the induction of NVP resistance than are individuals infected with subtype B.
Journal of Communicable Diseases. 2008 Mar; 40(1):5-11.The need of a clinical case definition (CCD) for Acquired Immunodeficiency Syndrome (AIDS) was felt by public health agencies to monitor diseases resulting from human immunodeficiency virus (HIV) infection. To test the statistical significance of the existing World Health Organization (WHO) CCD for the diagnosis of AIDS in areas where diagnostic resources are limited in India, a prospective study was conducted in the Paediatrics department at Dr. Ram Manohar Lohia Hospital, New Delhi. 360 cases between 18 months-12 years of age satisfying WHO case definitions of AIDS were included in the study group. Informed consent was taken from the parents. The serum of patients was subjected to ELISA to conform the diagnosis of HIV infection. Our study detected 16.66% (60) of HIV prevalence in children visiting paediatrics outpatient clinic. 20% cases manifested 3 major and 2 minor signs. This definition had a sensitivity of 73.33%, specificity of 90.66%, positive predictive value (PPV) of 61.11% and negative predictive value (NPV) of 94.44%. On using stepwise logistic regression analysis weight loss, chronic fever > 1 month and total lymphocyte count of less than 1500 cells/mm3 emerged as important predictors. Cases showing 2 major and 2 minor signs were 86 (23.89%) with a sensitivity and specificity of 86.66% and 88.66% respectively. Based on these findings, we propose a clinical case definition based on 13 clinical signs and symptoms for paediatric AIDS in India with better sensitivity and PPV than the WHO case definition but with almost similar specificity. Thus multicentric studies are further required to modify these criteria in Indian set up.
International Journal of Tuberculosis and Lung Disease. 2008 Jan; 12(1):108-110.The information provided in the guidelines of the World Health Organization and the International Union Against Tuberculosis and Lung Disease for Ziehl-Neelsen staining is not practical on a number of points. The advice given here is meant to supplement the guidelines. It is based on experiments on and field experience of basic fuchsin stain and staining solutions.
American Journal of Tropical Medicine and Hygiene. 2007 Nov; 77(5):793-794.The World Health Organization (WHO) estimates that Streptococcus pneumoniae is responsible for up to one million deaths annually among children less than five years of age. Pneumococcus is a leading cause of bacterial pneumonia, meningitis, and sepsis. However, due to diagnostic challenges, the burden of pneumococcal disease is largely invisible. In this issue of the journal, Abdullah Brooks and others uncover the substantial disease burden affecting children living in an impoverished urban community in Dhaka, Bangladesh. This is the most rigorous study of the pneumococcal disease burden in an Asian setting. The overall incidence of invasive pneumococcal disease among children less than five 5 years of age was 447 episodes per 100,000 child years, which is comparable to incidence rates found among children coming to hospitals in rural African settings and more than five times higher than rates seen prior to widespread vaccination in the United States, a setting in which blood cultures are frequently performed on febrile children. Before this study, direct evidence for the high pneumococcal disease burden in Asia lagged behind that for Africa, despite the importance of pneumonia as a leading cause of childhood mortality in both regions. (excerpt)
Geneva, Switzerland, UNAIDS, 1996 Jan. 35 p. (UNAIDS/96.5)These guidelines are destined for policy makers and programme planners wishing to introduce national external quality assessment schemes (NEQAS) for serological testing for human immunodeficiency viruses (HIV). They describe some important basic principles and the main practical aspects of NEQAS. The objectives of external quality assessment schemes are briefly discussed below and elsewhere (References 1 and 2 in bibliography, Annex 2). It is now widely accepted that quality assurance, quality control and quality assessment constitute an essential part of HIV testing and of diagnostic testing in general. Quality assessment is one component of a total quality assurance programme. The availability of excellent HIV tests does not automatically guarantee reliable laboratory results. Many steps are involved between the moment when a specimen enters the laboratory and the moment when the result of the test is reported to the physician, and at each step something can go wrong. Therefore each government should ensure that sufficient support is made available for a National Reference Laboratory to provide a suitable programme to monitor and if necessary improve the quality of HIV testing in the country. A well-functioning national programme is an important step towards achieving high-quality laboratory performance nationwide. (excerpt)
Geneva, Switzerland, UNAIDS, 1997 Nov. 7 p. (UNAIDS Best Practice Collection; UNAIDS Technical Update)Since 1985, HIV testing has been essential in securing the safety of blood supplies, monitoring the progress of the epidemic and diagnosing individuals infected with the virus. Various assays are now available, allowing testing strategies to be tailored to the epidemiological conditions and budgets of national health systems. New techniques -- including simple tests giving instant results -- hold great promise, but also raise some serious issues for governments and for individuals. HIV infection is most frequently diagnosed by detecting antibodies which the body produces as it tries to resist the virus. These antibodies usually begin to be produced within 3 to 8 weeks after the time of infection. The period following infection but before the antibodies become detectable is known as the .window period.. Antibodies are much easier to detect than the virus itself. It is sometimes possible to detect HIV antigen during the window period if, by coincidence, an individual is tested during the short peak of high levels of circulating virus particles. After this peak, the level of p24 antigen steeply declines to the point where it is no longer detectable. It fluctuates or rises steeply again, usually years later, when the clinical situation of the patient starts to deteriorate with the onset of AIDS. (excerpt)
The added value of a CD4 count to identify patients eligible for highly active antiretroviral therapy among HIV-positive adults in Cambodia.
Journal of Acquired Immune Deficiency Syndromes. 2006 Jul; 42(3):322-324.In a retrospective study of 648 persons with HIV infection in Cambodia, we determined the sensitivity, specificity, and accuracy of the 2003 World Health Organization (WHO) criteria to start antiretroviral treatment based on clinical criteria alone or based on a combination of clinical symptoms and the total lymphocyte count. As a reference test, we used the 2003 WHO criteria, including the CD4 count. The 2003 WHO clinical criteria had a sensitivity of 96%, a specificity of 57%, and an accuracy of 89% to identify patients who need highly active antiretroviral therapy (HAART). In our clinic, with a predominance of patients with advanced disease, the 2003 WHO clinical criteria alone was a good predictor of those needing HAART. A total lymphocyte count as an extra criterion did not improve the accuracy. Nine percent of patients were wrongly identified to be in need of HAART. Among them, almost 50% had a CD4 count of more than 500 cells/KL, and 73% had weight loss of more than 10% as a stage-defining condition. Our data suggest that, in settings with limited access to CD4 count testing, it might be useful to target this test to patients in WHO stage 3 whose staging is based on weight loss alone, to avoid unnecessary treatment. (author's)
Indian Journal of Tuberculosis. 2000; 47(1):27-33.Surveillance of drug resistance was carried out at State level to obtain data which are standardised and compaiable using guidelines prescribed by the WHO/IUATLD Working Group on Anti-tuberculosis Drug Resistance Surveillance. The objective was to determine the proportion of initial and acquired drug resistance in cases of pulmonary tuberculosis in Tamil Nadu, m order to use the level of drug resistance as a performance indicator of the National Tuberculosis Programme. Two specimens of sputum from each of a total of 713 patients attending 145 participating centres all over the state were tested by smear and culture examination and drug susceptibility tests of Isoniazid, Rifampicin, Ethambutol and Streptomycin. Out of 400 patients for whom drug susceptibility results were available, 384 (96%) had no history of previous anti-tuberculosis treatment. Of these, 312 (81%) were susceptible to all the drugs tested. Resistance to Isoniazid was seen in 15.4% of patients and to Rifampicin in 4.4%, including resistance to Isoniazid and Rifampicin in 3.4%. There has been a gradual increase in initial drug resistance over the years in this part of the country. (author's)
Epidemic meningitis: surveillance and response activities during the 2002–2003 season in the countries of the African meningitis belt. Report on an informal WHO consultation, Geneva, 24–25 July 2003.
Geneva, Switzerland, WHO, Department of Communicable Disease Surveillance and Response, 2004.  p. (Global Health Security. Epidemic Alert and Response; WHO/CDS/CSR/GAR/2003.13)During the 2002–2003 epidemic season, epidemics of meningitis were detected in Burkina Faso, in Niger and in northern Nigeria, together with an epidemic focus in northern Ghana. From bacteriological analyses, serogroup A was by far the predominant pathogen (40–70% isolates) followed by pneumococcus and serotype W135 (10–20% isolates). Molecular biology analyses have demonstrated the predominance of ST-7 and ST-11 clones in serotypes A and W135 respectively. In most countries in the region, the proportion of serogroup W135 among the germs isolated increased. Serogroup W135 has epidemic potential in future years in countries such as Mali, Niger and Nigeria. Reinforced surveillance of meningitis has been extended to nine countries in the African belt, and a regional technical team has been established in Ouagadougou. Epidemiological surveillance has proved effective in three countries –: Burkina Faso, Mali and Niger – despite the absence of standardized notification and occasionally inappropriate use of thresholds at the district level. Surveillance remained inadequate in the six other countries. (excerpt)
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.
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)
Initiative for Vaccine Research. Task Force on Clinical Trials of Dengue Vaccines, 14 November 2002.
Geneva, Switzerland, WHO, 2002. 12 p. (VAB/IVR/VIR2002.03.1)The second meeting of the WHO Task Force on Clinical Trials of Dengue Vaccines was held on 14 November 2002 in Denver, Colorado, USA. The Task Force was established to accelerate the development, evaluation, and introduction of urgently needed dengue vaccine candidates. The main objective of the Task Force is to continue to analyze results on safety, immunogenicity, and efficacy of currently available vaccine candidates in clinical trials and to provide scientific advice on the next steps to be taken, giving special attention to vaccine safety. The meeting reviewed the progress in clinical trials of four live attenuated vaccine candidates. The task force recommended specific activities in support of future development and clinical studies and identified the role of WHO in this process. The meeting was co-sponsored by the Pediatric Dengue Vaccine Initiative. (excerpt)
Measuring morbidity in schistosomiasis mansoni: relationship between image pattern, portal vein diameter and portal branch thickness in large-scale surveys using new WHO coding guidelines for ultrasound in schistosomiasis.
Tropical Medicine and International Health. 2003 Feb; 8(2):109-117.Objective: World Health Organization consensus meetings on “Ultrasound in Schistosomiasis” in 1996 and 1997 anticipated further challenges in the global implementation of a standardized protocol for morbidity assessment in schistosomiasis mansoni. We evaluated the performance of the qualitative and quantitative components of the new Niamey criteria. Method: Use of the Niamey protocol among 3954 subjects in two linked, cross-sectional ultrasound surveys of Schistosoma mansoni-endemic populations in Egypt and Kenya. Results: There were significant differences between Egyptian and Kenyan sites in prevalence and age distribution of S. mansoni-related hepatic fibrosis (36% vs. 3%, P < 0.001). Protocol image pattern scoring could be performed quickly and was stable to interobserver variation. However, there were unintended but systematic differences between study sites in the measurement of portal vein diameter (PVD) and wall thickness. By Niamey criteria, a high prevalence of portal dilation was scored for normal Egyptian subjects, which reduced the predictive value of image pattern for portal hypertension. Using alternative height-indexing of PVD, image pattern plus PVD findings predicted 15% of Egyptians and 2.5% of Kenyans were at risk for variceal bleeding, whereas locally derived PVD norms estimated 25% of Egyptians and 12% of Kenyans to be at possible risk. Conclusion: Niamey scoring criteria performed acceptably as a relative grading system for disease in schistosomiasis mansoni, but failed to account fully for site-to-site variation in test performance and morbidity prevalence. Consequently, standardized image pattern scoring appears to provide the most useful tool for detection and comparison of S. mansoni-associated morbidity in large-scale surveys. (author's)
Statement by the chairman of the Technical Working Group on Diagnosis of HIV Infection in Women and Children.
In: International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989. Geneva, Switzerland, WHO, Global Programme on AIDS, 1989. 39-40. (WHO/GPA/DIR/89.12)According to World Health Organization estimates, there are about 2 million women and children throughout the world infected with the human immunodeficiency virus (HIV), most of whom remain asymptomatic and unidentified. At least 30% of infants whose mothers are HIV-positive will become infected before, during, or soon after birth. At present, HIV antibody tests are unable to diagnose perinatally acquired HIV infection in infants under 18 months of age. In such cases, the diagnosis can be made only on the basis of clinical signs and symptoms such as unexplained neurological abnormalities, developmental regression, recurrent severe bacterial infections that fail to respond to conventional therapy, lymphocytic interstitial pneumonitis, or opportunistic infections related to cellular immunodeficiency. Given the importance of timely diagnosis of HIV infection, research focused on both the development of sensitive, specific laboratory tests for the diagnosis of HIV in infants under 18 months of age and refinement of the case definition of pediatric acquired immunodeficiency syndrome (AIDS) should be prioritized. Policy decisions as to whether women of reproductive age should be tested for HIV infection should be based on laboratory testing and counseling resources, the availability of medical and social services for women and children, and the overall prevalence of HIV infection in the locality or country.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1987; 65(5):601-6.The 3rd meeting of the WHO Collaborating Centres on AIDS, held 6 June 1987, updated Centre representatives on the activities of WHO's Special Programme on AIDS and discussed technical matters such a definition, testing and diagnosis of AIDS. The special program is concentrating on the African and American regions, visiting countries, and holding workshops on topics such as training, case management and epidemiological surveillance. There will be 20 professional staff at WHO headquarters and 16 in the field. An advisory group on behavioral research met to establish social and behavioral priorities. A protocol for studies of seroprevalence is being developed. The technical topics discussed included widening the definition of AIDS cases to include wasting syndrome and dementia, as well as diagnosis of presumptive AIDS without availability of standardized tests. 3 Consensus statements were adopted, on HIV transmission, HIV infection in health workers, and on present and future status of laboratory tests for HIV. HIV should be continually isolated in various regions of the world to ensure that diagnostic tests reflect local virus strains. An agenda was proposed, including the next meeting to be held in Stockholm in June, 1988.
The global eradication of smallpox. Final report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979.
Geneva, Switzerland, WHO, 1980. 122 p. (History of International Public Health No. 4)The Global Commission for the Certification of Smallpox Eradication met in December 1978 to review the program in detail and to advise on subsequent activities and met again in December 1979 to assess progress and to make the final recommendations that are presented in this report. Additionally, the report contains a summary account of the history of smallpox, the clinical, epidemiological, and virological features of the disease, the efforts to control and eradicate smallpox prior to 1966, and an account of the intensified program during the 1967-79 period. The report describes the procedures used for the certification of eradication along with the findings of 21 different international commissions that visited and reviewed programs in 61 countries. These findings provide the basis for the Commission's conclusion that the global eradication of smallpox has been achieved. The Commission also concluded that there is no evidence that smallpox will return as an endemic disease. The overall development and coordination of the intensified program were carried out by a smallpox unit established at the World Health Organization (WHO) headquarters in Geneva, which worked closely with WHO staff at regional offices and, through them, with national staff and WHO advisers at the country level. Earlier programs had been based on a mass vaccination strategy. The intensified campaign called for programs designed to vaccinate at least 80% of the population within a 2-3 year period. During this time, reporting systems and surveillance activities were to be developed that would permit detection and elimination of the remaining foci of the disease. Support was sought and obtained from many different governments and agencies. The progression of the eradication program can be divided into 3 phases: the period between 1967-72 when eradication was achieved in most African countries, Indonesia, and South America; the 1973-75 period when major efforts focused on the countries of the Indian subcontinent; and the 1975-77 period when the goal of eradication was realized in the Horn of Africa. Global Commission recommendations for WHO policy in the post-eradication era include: the discontinuation of smallpox vaccination; continuing surveillance of monkey pox in West and Central Africa; supervision of the stocks and use of variola virus in laboratories; a policy of insurance against the return of the disease that includes thorough investigation of reports of suspected smallpox; the maintenance of an international reserve of freeze-dried vaccine under WHO control; and measures designed to ensure that laboratory and epidemiological expertise in human poxvirus infections should not be dissipated.
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.
Insufficiencies of the new WHO Western blot criteria in the diagnosis of HIV-1 and HIV-2 infections [letter]
VOX SANGUINIS.. 1992 Apr; 62(3):191-2.This letter to the editor reports the results of a multicenter study on the prevalence of HIV infections in Spain. In 1990, 902 serum samples from high-risk individuals were collected and tested for HIV-1/HIV-2 combined enzyme immunoassay. All repeatedly reactive samples were analyzed in parallel using specific Western blot (WB) assays, and, in addition, all these samples were tested by an enzyme immunodot assay (EIDA) using synthetic peptides from the transmembrane protein of each virus. Results revealed that a total of 12 individuals were positive for HIV-2 using the new WHO-WB criteria: 7 African immigrants from Gambia and Senegal and 5 drug abusers from Barcelona. The 5 drug abusers were also positive for HIV-1 by WB. The EIDA confirmed this dual reactivity in only 2 of them, suggesting co-infection, and it showed only HIV-1 reactivity in the other 3. The results of the EIDA of the African samples were also discordant compared with the results from the WB assay. In conclusion, this study provides evidence that the new WHO criteria for interpreting WB do not appropriately distinguish HIV-1 and HIV-2 infections.
In: International Symposium on Biomedical Research Issues of HIV Infection in Thailand. Bangkok, Thailand, January 31 - February 2, 1994. Sponsors: Thailand Health Research Institute, Harvard AIDS Institute, Ministry of Public Health of Thailand, Center for Vaccine Development, Mahidol University. Cambridge, Massachusetts, Harvard AIDS Institute, 1994. 4-6.HIV-1 is a complex retrovirus characterized by extensive genetic variation due to numerous errors in reverse transcription and involving different geneses of the mutations. At least six nearly equidistant genetic clades, or subtypes, can be identified based upon the phylogenetic analysis of the env coding sequences. HIV-1 variability may make it difficult to develop vaccines which are effective against the various HIV-1 strains prevalent in different geographic locations. With the goal of establishing a mechanism for monitoring HIV-1 variability on a global basis, the Global Program on AIDS of the World Health Organization (WHO) established the WHO Network for HIV-1 Isolation and Characterization. The network constitutes an integral part of the WHO Strategy for HIV-1 Vaccine Development. It is formed by primary laboratories in Brazil, Rwanda, Thailand, and Uganda, the WHO-sponsored sites for the development and field evaluation of HIV-1 vaccines; 15 secondary/expert laboratories in France, Germany, Spain, Sweden, the Netherlands, the UK, and the US which conduct detailed characterization of HIV-1 strains; centralized facilities in Germany and the UK for the isolation of HIV-1 strains following standard procedures; repositories for the storage and distribution of viral isolates and other reagents in the UK and the US; and data management facilities in collaboration with the Los Alamos HIV-1 Database in the US. Five of the six known HIV-1 genetic subtypes were found through genetic screening of HIV-1 strains collected from the four sites. In most cases, more than one subtype was present in the same country. Biologic characterization of the HIV-1 isolates determined that most of the viral strains collected in Brazil, Rwanda, and Thailand can be defined as slow/low phenotypes and were non-syncytia inducing. The Ugandan isolates belonging to subtype D, but not to subtype A, were characterized by the highest replicative capacities and were syncytia-inducing viruses. There is as yet no explanation for this latter finding.
In: Annual technical report, 1992, [of the] World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction. Geneva, Switzerland, WHO, 1993. 273-80. (WHO/HRP/ATR/92/93)During 1992, the World Health Organization's (WHO) Special Programme of Research, Development, and Research Training in Human Reproduction continued to supply standardized matched reagents for the radioimmunoassay (RIA) of reproductive hormones (follicle stimulating hormone [FSH], luteinizing hormone [LH], prolactin, estradiol, progesterone, testosterone, and cortisol) to 70 of its collaborating research laboratories in 25 countries. The quality of the hormone assay was evaluated in 74 laboratories through an external quality assessment scheme to insure the comparability of the multicenter research. Also during 1992, work continued on the enzyme immunoassay (EIA) kits which are being developed to replace RIA methodology by 1998. Kits using EIA to measure FSH, LH, and prolactin were field tested at 10 sites in developing countries. Because the use of EIA is superior to and less expensive than RIA, these three kits will be launched in 1993 in laboratories equipped for EIA. Plans for 1993 also include the production and evaluation of additional EIA kits. The WHO Collaborating Centre for Research and Reference Services in the Immunoassay of Hormones in Human Reproduction trained six scientists from developing countries in assay techniques, production technology, and quality assessment procedures. Internal quality control guidelines were prepared for use by the laboratories until a new, user-friendly computer program is prepared in 1994.