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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)
Symptom-based screening of child tuberculosis contacts: improved feasibility in resource-limited settings.
Pediatrics. 2008 Jun; 121(6):e1646-52.OBJECTIVE: National tuberculosis programs in tuberculosis-endemic countries rarely implement active tracing and screening of child tuberculosis contacts, mainly because of resource constraints. We aimed to evaluate the safety and feasibility of applying a simple symptom-based approach to screen child tuberculosis contacts for active disease. METHODS: We conducted a prospective observational study from January through December 2004 at 3 clinics in Cape Town, South Africa. All of the children <5 years old in household contact with an adult tuberculosis source case were assessed by documenting current symptoms and tuberculin skin test and chest radiograph results. RESULTS: During the study period, 357 adult tuberculosis cases were identified; 195 cases (54.6%) had sputum smear and/or culture positive results and were in household contact with children aged <5 years. Complete information was available for 252 of 278 children; 176 (69.8%) were asymptomatic at the time of screening. Tuberculosis treatment was administered to 33 (13.1%) of 252; 27 were categorized as radiologically "certain tuberculosis," the majority (n = 22) of which had uncomplicated hilar adenopathy. The negative predictive value of symptom-based screening varied according to the case definition used, with 95.5% including all of the children treated for tuberculosis and 97.1% including only those with radiologically "certain tuberculosis." CONCLUSIONS: Our findings support current World Health Organization recommendations, demonstrating that symptom-based screening of child tuberculosis contacts should improve feasibility in resource-limited settings and seems to be safe.
Emerging Infectious Diseases. 2004 Sep; 10(9):1523-1528.The World Health Organization’s goal for tuberculosis (TB) control is to detect 70% of new, smear-positive TB cases and cure 85% of these cases. The case detection rate is the number of reported cases per 100,000 persons per year divided by the estimated incidence rate per 100,000 per year. TB incidence is uncertain and not measured but estimated; therefore, the case detection rate is uncertain. This article proposes a new indicator to assess case detection: the patient diagnostic rate. The patient diagnostic rate is the rate at which prevalent cases are detected by control programs and can be measured as the number of reported cases per 100,000 persons per year divided by the prevalence per 100,000. Prevalence can be measured directly through national prevalence surveys. Conducting prevalence surveys at 5- to 10-year intervals would allow countries with high rates of disease to determine their case detection performance by using the patient diagnostic rate and determine the effect of control measures. (author's)
Report of the European Region on Immunization Activities. (Global Advisory Group EPI, Alexandria, October 1984). WHO/Expanded Immunization Programme and the European Immunization Targets in the Framework of HFA 2000.
[Unpublished] 1984. Presented at the EPI Global Advisory Group Meeting, Alexandria, Egypt, 21-25 October 1984. 3 p. (EPI/GAG/84/WP.4)Current reported levels of morbidity and mortality from measles, poliomyelitis, diphtheria, tetanus, and tuberculosis in most countries in the European Region are at or near record low levels. However, several factors threaten successful achievement of the Expanded Program on Immunization (EPI) goal of making immunization services available to all the world's children by the year 2000, including changes in public attitudes as diseases pose less of a visible threat, declining acceptance rates for certain immunizations, variations in vaccines included in the EPI, and incomplete information on the incidence of diseases preventable by immunization and on vaccination coverage rates. To launch a more coordinated approach to the EPI goals, a 2nd Conference on Immunization Policies in Europe is scheduled to be held in Czechoslovakia. Its objectives are: 1) to review and analyze the current situation, including achievements and gaps, in immunization programs in individual countries and the European Region as a whole; 2) to determine the necessary actions to eliminate indigenous measles, poliomyelitis, neonatal tetanus, congenital rubella, and diphtheria; 3) to consider appropriate policies regarding the control by immunization of other diseases of public health importance; 4) to strengthen existing or establish additional systems for effective monitoring and surveillance; 5) to formulate actions necessary to improve national vaccine programs in order to achieve national and regional targets; 6) to reinforce the commitment of Member Countries to the goals and activities of the EPI; and 7) to define appropriate activities for the Regional Office for Europe of the World Health Organization to achieve coordinated action.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1980; (651):1-19.This document reports the discussions of a Scientific Group on Vaccination Against Tuberculosis, cosponsored by the Indian Council of Medical Research and the World Health Organization (WHO), that met in 1980. The objectives of the meeting were to review research on Bacillus Calmete-Guerin (BCG) vaccination, assess the present state of knowledge, and determine how to advance this knowledge. Particular emphasis is placed in this document on the trial of BCG vaccines in South India. In this trial, the tuberculin sensitivity induced by BCG vaccination was highly satisfactory at 2 1/2 months but had waned sharply by 2 1/2 years and the 7 1/2-year follow up revealed a high incidence of tuberculous infection in the study population. It is suggested that the protective effect of BCG may depend on epidemiologic, environmental, and immunologic factors affecting both the host and the infective agent. Studies to test certain hypotheses (e.g., the immune response of the study population was unusual, the vaccines were inadequate, the south Indian variant of M tuberculosis acted as an attenuating immunizing agent, and mycobacteria other than M tuberculosis may have partially immunized the study population) are recommended. A detailed analysis should be made when results from the 10-year follow up of the south Indian study population are available.
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.
INFECTION CONTROL. 1984 Nov; 5(11):538-41.In 1978 the Ministry of Health and Social Welfare (MHSW) of Liberia launched the Expanded Program on Immunization (EPI) with the 5-year objective of establishing an 80% reduction in child mortality and morbidity from measles, polio, diphtheria, neonatal tetanus, pertussis, and tuberculosis. The program at first adopted a strategy of using 15 mobile units in 11 operational zones to deliver vaccinations throughout the country. However, by 1980, despite support from the Baptist World Alliance, the UN International Children's Emergency Fund (UNICEF), and the World Health Organization (WHO), it became evident that the mobile strategy was neither economically feasible nor practical. Therefore, with support from the US Agency for International Development (USAID), the EPI shifted to a strategy of integrating immunization activities into the existing network of state health facilities. After 5 years, in 1982, the Program was evaluated by a team from the MHSW, WHO, USAID, and the Centers for Disease Control. The evaluating team felt that the EPI's strategy was good, but its goals were not being achieved due to deficiencies in funding, clinic supervision, and rural community outreach, as well as shortages of kerosene and spare parts needs to keep the essential refrigerators in operating condition. Measles remains endemic; in the capital, Monrovia, only 9% of the children have been vaccinated against it. Immunization coverage is particularly low in the capital the countries. Other reasons for low vaccination coverage in Liberia are lack of community awareness of existing facilities and the importance of vaccination and lack of coordination at the community level to use the existing facilities efficiently. International assistance is still needed, especially to develop heat-stable vaccines, so that maintenance of refrigerators will not be necessary.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1988; 41(1):19-25.Routine surveillance of the incidence of vaccine-preventable diseases has not proved sensitive enough to demonstrate the impact of the Expanded Program on Immunization (EPI) in many countries. In order to document progress since the start of the EPI in 1979, data are needed for several years prior to that. In most developing countries these can be found only in major cities or large hospitals. Therefore a system of sentinel surveillance, the Local Area Monitoring Project (LAM), is being set up in selected institutions in the major cities of the developing world. The primary goal of the LAM project is to provide disease-incidence data of sufficient quality to evaluate more fully the global impact of the EPI on the 6 target diseases--diptheria, pertusis, tetanus, poliomyelitis, measles, and tuberculosis. The goal is to include the major city of each of the 25 largest developing countries, with a total population of 115 million. These 25 countries together account for 85% of all births in the developing world. The program and coverage information is used to assess the impact of individual EPI programs on disease trends. Preliminary analysis of the 12 cities with the best data suggests that the impact of the EPI on the incidence of the target diseases has been greater than previously shown by the routine system. The LAM information is useful for global and regional analysis of program impact, but for the countries themselves its utility may be even greater. It is hoped that the project will help to improve a country's surveillance system by encouraging the use of sentinel reporting as a means of supplementing routine data. The information on the impact of the EPI may further increase political and public support for a program. (Summaries in ENG, FRE)
WHO Chronicle. 1980 Mar; 34(3):118-9.The World Health Organization (WHO) plan is to hold 2 meetings with tuberculosis experts for the purpose of examining the implications of a large scale trial in the south of India that has shown no protection against lung tuberculosis from BCG vaccination. Launched in 1971, the trial covered some 260,000 persons older than age 1 month. It was aimed at preventing lung tuberculosis in the population of 209 villages as well as in a town in the district of Chingleput, west of Madras. Results with the BCG vaccines have varied in the scientifically valid controlled studies that have been conducted. The success of BCG vaccines has varied by population group, ranging from good (80% effectiveness) to poor (as in the Indian trial). The following were among the questions raised by the findings of the Indian trial: were there procedural flaws; were the BCG vaccines used of adequate potency; could other factors have played a role; and should BCG vaccinations be stopped. According to the published report, there were no apparent flaws in the procedures followed in the Indian study. In the Indian trial, 2 BCG strains--Danish and French--were used in the highest tolerated doses. The strains were selected for their relatively high efficacy in experimental studies, and extensive laboratory control showed the vaccines to be of good quality. The WHO experts found the epidemiology of tuberculosis in the trial area to be peculiar in the sense that the tuberculosis occurred long after an individual was infected. Not far from the trial area, and also in south India, disease occurred soon after infection. The experts noted that this phenomenon, which requires further study, may influence the effectiveness of vaccination. According to the experts, the findings in the study population were not applicable in other parts of India. Where many factors may play a role and when the level of protection is nonexistent, as in the India trial, little can be deduced about the worth of the vaccine and its effect under different circumstances.
Brazzaville, Congo, World Health Organization, Regional Office for Africa, 1979. 283 p.From 1965 to 1978, the author made numerous formal addresses in conjunction with his duties as the World Health Organization's (WHO) Regional Director for Africa. The addresses provide a theoretical and practical foundation for the development of a health care strategy and are grouped in sections concerning general policy, ways and means, health services delivery and development, disease control, and training and development of health team personnel. Health development in African nations demands planning for the implementation of health services to meet local community needs and appropriate training and utilization of health care personnel. The ultimate goal of health development is social justice, defined as the proper amount of health care available to all. The benefits will be realized in increased labor productivity and economic development, better quality of life, and self reliance in African nations. To achieve social justice, African nations must abandon foreign concepts of medical care and develop their own solutions to health problems that are realistic for their populations. Through the application of the techniques of scientific management and the development of cooperative international forums, these solutions can be discovered. Planning, aided by the development of information systems, research, and regional cooperation, is vital to assure both curative and preventive health programs are delivered that meet the health services needs of the population. Disease control is important to the economic development of African nations. Preventive action can be realized through planning and organized delivery of health services, including immunization programs, which enhance the population's general health status. Where prevention is not possible, early detection followed by swift response is an objective of effective health services. Training of health care and service personnel should focus on preparing professionals to contribute to the welfare of the community and to African development. The development of the health care team, which encompasses traditional and nontraditional personnel, adequately utilizes available resources and is responsive to both curative and preventive health needs.
Chronicles. 1983 Jun; 3(1):11-4.Analyzes the anti-tuberculosis (BCG) vaccine controversy. The vaccine was highly controversial at the beginning due to difficulties in standardization, maintenance of efficacy, and in the methods of applying the vaccine. Nevertheless, BCG gained increasing acceptance and is used widely in France, Germany, Norway, Sweden and Japan. It is also 1 of the vaccines regularly employed in the worldwide immunization campaign of the World Health Organization. A number of well controlled prospective studies have been done in the last 50 years in several countries to determine the efficacy of BCG. The studies give contradictory results which may prove that under certain conditions, BCG has a clear protective effect against infection from human virulent tubercle bacilli. The 1982 evaluation after 10 years showed a 45% protective efficacy. On the basis of an extended review of BCG vaccination, it is recommended that the use of BCG be continued. However, there are situations where the effectiveness of BCG cannot be predicted with certainty, and it is recommended that every effort be made to identify local factors that may modify the outcome of BCG vaccination. The worldwide tuberculosis problem presents differing patterns in different countries, making a single recommendation for all situations unwise. The BCG program chosen should be based on the epidemiological situation in each country. The authors conclude that BCG vaccination, together with chemoprophylaxis and chemotherapy, can play an important role in controlling tuberculosis, which still constitutes 1 of the major world health problems. (summaries in SPA, POR, ARA)