Posts tagged ‘WHO’
Against the backdrop of four new H7N9 influenza illnesses reported from China today, a detailed look at the second wave of the outbreak reveals that cases are trending slightly younger, with a lower case fatality rate (CFR), though severe pneumonia is still one of the disease’s hallmarks.
So far more than 80 new cases—the large majority from the first of the year—have been reported in the outbreak’s second spike that began in October. Over the past few weeks China has often reported five to seven new cases each day, equaling the pace seen during last spring’s first-wave peak.
Cases trending younger, less deadly?
World Health Organization (WHO) experts said today in their latest risk assessment that most cases in the first wave involved middle-aged or older men, but the age distribution in the new wave isn’t as skewed toward older age-groups. The mean age in the new surge of cases is slightly lower than the first wave: 52 years compared with 58 years.
H7N9 is still striking males more frequently than females, and the CFR is not as high as the outbreak’s first wave, the WHO said. It cautioned, however, that CFR patterns need to be monitored closely, because many of the recently infected patients are still hospitalized. Some milder cases have been reported, but it’s clear that H7N9 infections are marked by rapidly progressing severe pneumonia, according to the risk assessment.
Lab analysis of H7N9 samples from patients, animals, and the environment collected during the second wave shows that the hemagglutinin (HA) and neuraminidase (NA) genes are similar to viruses from the first wave, the report said. It added that they are also similar to the influenza A/Anhui/1/2013 strain recommended for H7N9 vaccine development.
Tests on a subset of recent viruses to monitor for antiviral resistance have identified no markers linked to resistance to neuraminidase inhibitors, including oseltamivir (Tamiflu) and zanamivir (Relenza).
Resistance to frontline treatments such as oseltamivir and zanamivir has been a worry since the outbreak’s early days, when an NA resistance marker was found in one of the first three lab-confirmed H7N9 cases. The resistant viruses have also been linked to treatment failures in some severely ill patients.
Several questions remain about the source of human infections, though most of the evidence points to exposure to infected live poultry and their contaminated environments, the WHO said. It added that most patients who were sickened by H7N9 were exposed to birds or live-poultry markets, that H7N9 viruses from humans are genetically similar to ones collected from birds and the environment, and that live-poultry markets linked to human infections are more likely to yield positive H7N9 samples.
The WHO’s analysis found no increase in the number of illness clusters, including healthcare-associated ones, that would point to any increased risk of human-to-human transmission. It said an investigation into a recent infection in one health worker, presumably that of a 31-year-old doctor from Shanghai whose H7N9 death was reported this week, found that the patient may have been exposed to poultry or a contaminated environment. So far no other H7N9 cases linked to the patient have been identified.
Though the virus doesn’t seem to transmit easily among humans, the detection of several less severe cases during flulike illness surveillance, along with continuing severe cases, shows that continued vigilance is needed, the WHO said. Overall, the public health risk hasn’t changed from the WHO’s last assessment in December.
More sporadic H7N9 cases are expected to be reported in humans, especially with increases in poultry production, trade, and transport in advance of China’s Lunar New Year holiday season and because H7N9 seems to be following a more active winter seasonal pattern seen with other avian influenza viruses, the WHO said. Travel-associated cases could occur, but the agency said the threat of international spread is low, unless the virus adapts for more efficient human-to-human transmission.
China reports four more cases
The four new case-patients from China include a 71-year-old man from Jiangsu province whose illness was reported late yesterday and three from Zhejiang province: a 53-year-old man, a 71-year-old man, and a 63-year-old woman.
According to a translation of a provincial health ministry report posted by the Avian Flu Diary infectious disease news blog, the patients from Zhejiang province are all hospitalized in critical condition. A statement from Hong Kong’s Centre for Health Protection (CHP) said the patient from Jiangsu province is also hospitalized.
The new cases boost the outbreak total to 220, according to a running tally updated each day with patients’ details by the FluTrackers infectious disease message board. The group’s total includes the case of an asymptomatic child that’s not included in WHO totals. The unofficial number of deaths is 57.
In a related development today, the WHO released more details about five more lab-confirmed cases it received from China on Jan 20. Hong Kong’s CHP had announced only basic information about the cases on Jan 20.
The patients include two people from Shanghai who died from their infections, the 31-year-old male doctor noted above and a 77-year-old man, as well as three patients from Zhejiang province, all who are hospitalized. They are a 55-year-old man, a 71-year-old woman, and a 63-year-old man. One is in serious and two in critical condition. All had been exposed to poultry before they got sick.
Poultry and environmental H7N9 findings
The WHO’s Western Pacific Region office (WPRO) today released a situation update, noting that continued vigilance is needed as case numbers rise, given the Lunar New Year activities and the unpredictable nature of flu viruses.
It also includes the results from China’s agriculture ministry on the latest H7N9 tests in birds and their environments from two of the outbreak’s hot spots: Guangdong and Zhejiang provinces.
In Zhejiang province, tests of 18 of 200 samples from three agricultural products markets and a wholesale market were positive for the H7N9 virus. Serologic testing of 85 samples yielded 7 positives.
In Guangdong province, testing at 151 sites found only 2 positives from two agricultural markets. Serologic testing of 2,192 samples in Guangdong found no positive specimens. The report also mentions positive tests reported earlier this month from a restaurant and live markets in Guangdong province.
Experts are concerned that polio may have made a return to war-torn Syria.
The World Health Organization says it has received reports of the first suspected outbreak in the country in 14 years.
Syrian’s Ministry of Public Health is launching an urgent response, but experts fear the disease will be hard to control amid civil unrest.
Immunisation is almost impossible to carry out in regions under intense shellfire.
As a result, vaccination rates have been waning – from 95% in 2010 to an estimated 45% in 2013.
At least a third of the country’s public hospitals are out of service, and in some areas, up to 70% of the health workforce has fled.
Outbreak risks have also increased due to overcrowding, poor sanitation and deterioration in water supply.
- Caused by a highly-infectious virus
- Mainly affects children under five years
- Can lead to irreversible muscle paralysis
- A course of vaccines against polio can protect a child for life
- Global eradication efforts continue
- The disease remains endemic in only a few countries – Afghanistan, Nigeria and Pakistan
- Mass vaccination is needed to eradicate polio
More than four million Syrians who have relocated to less volatile areas of the country are mostly living in overcrowded, unsanitary conditions.
The WHO says it is already seeing increased cases of measles, typhoid and hepatitis A in Syria.
Dr Jaouad Mahjour, director of the department for communicable diseases at WHO’s regional office for the Eastern Mediterranean, said: “Given the scale of population movement both inside Syria and across borders, together with deteriorating environmental health conditions, outbreaks are inevitable.”
The cluster of suspected polio cases was detected in early October 2013 in Deir al-Zour province.
Initial results from a laboratory in Damascus indicate that at least two of the cases could indeed be polio.
A surveillance alert has been issued for the region to actively search for additional potential cases. Supplementary immunisation activities in neighbouring countries are currently being planned.
WHO’s International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio.
Most people infected with the poliovirus have no signs of illness and are never aware they have been infected. These symptomless people carry the virus in their intestines and can “silently” spread the infection to thousands of others before the first case of polio paralysis emerges.
Polio is spread by eating food or drink contaminated with faeces or, more rarely, directly from person-to-person via saliva.
PETALING JAYA, July 2 (Bernama) — There has been no report of Malaysians, including umrah pilgrims, returning from Saudi Arabia and displaying symptoms of the deadly Middle East Respiratory Syndrome (Mers).
Nevertheless, the health ministry exercises caution and takes the relevant measures, which includes checking the body temperatures of those arriving at the airport.
Minister Datuk Seri Dr S. Subramaniam said, any person found to display symptoms of fever, would be asked to go for further medical examination.
Dr Subramaniam said this when commenting on the spread of the Mers virus which took the lives of 33 people in Saudi Arabia since September last year.
Fifty-five others fell ill as a result of the virus, in that country, he added.
He was speaking to reporters after launching the Malaysian Private Hospitals Association International Health Exhibition 2013 here Tuesday.
The World Health Organisation (WHO) has yet to find a vaccine to prevent Mers, as well as the cause of the deadly infectious disease.
Fever, breathing difficulty, diarrhoea and vomiting are among the symptoms of Mers.
Dr Subramaniam said Kuala Lumpur would continue to monitor developments in Jeddah and follow suggestions and opinions given by the Saudi Arabian authorities on ways to avoid the infection.
Earlier in his speech, the minister told the audience that the Malaysian healthcare industry was one of the most dynamic and vibrant sectors in the country as it was supported by the private healthcare sector.
Touching on healthcare technology, Dr Subramaniam said it had come into every aspect of daily life, way before the onset of illness.
“In the event of illness, healthcare technology will assist in decision-making and selection of appropriate medical practitioners through a central directory in the wellness data base,” he added.
30 JUNE 2013 | GENEVA – New HIV treatment guidelines by WHO recommend offering antiretroviral therapy (ART) earlier. Recent evidence indicates that earlier ART will help people with HIV to live longer, healthier lives, and substantially reduce the risk of transmitting HIV to others. The move could avert an additional 3 million deaths and prevent 3.5 million more new HIV infections between now and 2025.
The new recommendations are presented in WHO’s “Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection”, as new data reveal a total of 9.7 million people were taking these lifesaving drugs at the end of 2012.
“These guidelines represent another leap ahead in a trend of ever-higher goals and ever-greater achievements,” says WHO Director-General Dr Margaret Chan. “With nearly 10 million people now on antiretroviral therapy, we see that such prospects – unthinkable just a few years ago – can now fuel the momentum needed to push the HIV epidemic into irreversible decline.”
Call to initiate treatment at 500 CD4 cells/mm³ or less
The new recommendations encourage all countries to initiate treatment in adults living with HIV when their CD4 cell count falls to 500 cells/mm³ or less – when their immune systems are still strong. The previous WHO recommendation, set in 2010, was to offer treatment at 350 CD4 cells/mm³ or less. 90% of all countries have adopted the 2010 recommendation. A few, such as Algeria, Argentina and Brazil, are already offering treatment at 500 cells/mm3.
WHO has based its recommendation on evidence that treating people with HIV earlier, with safe, affordable, and easier-to-manage medicines can both keep them healthy and lower the amount of virus in the blood, which reduces the risk of passing it to someone else. If countries can integrate these changes within their national HIV policies, and back them up with the necessary resources, they will see significant health benefits at the public health and individual level, the report notes.
The new recommendations also include providing antiretroviral therapy – irrespective of their CD4 count – to all children with HIV under 5 years of age, all pregnant and breastfeeding women with HIV, and to all HIV-positive partners where one partner in the relationship is uninfected. The Organization continues to recommend that all people with HIV with active tuberculosis or with hepatitis B disease receive antiretroviral therapy.
Another new recommendation is to offer all adults starting to take ART the same daily single fixed-dose combination pill. This combination is easier to take and safer than alternative combinations previously recommended and can be used in adults, pregnant women, adolescents and older children.
“Advances like these allow children and pregnant women to access treatment earlier and more safely, and move us closer to our goal of an AIDS-free generation,” said UNICEF Executive Director, Anthony Lake. “Now, we must accelerate our efforts, investing in innovations that allow us to test new born babies faster and giving them the appropriate treatment so that they enjoy the best possible start in life.”
The Organization is further encouraging countries to enhance the ways they deliver HIV services, for example by linking them more closely with other health services, such as those for tuberculosis, maternal and child health, sexual and reproductive health, and treatment for drug dependence.
“The new WHO guidelines are very timely in view of the rapid progress we have made in expanding programmes for prevention and treatment,” says Dr Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “This is an example of how the Global Fund and the WHO work together to support countries as we move towards removing HIV as a threat to public health.” Since its creation in 2002, the Global Fund has supported more than 1,000 programmes in 151 countries, providing HIV treatment for 4.2 million people.
Challenges still remain. Alongside the new treatment guidelines, a treatment progress update by WHO, UNAIDS, UNICEF identified areas in need of attention.
While the number of all eligible children on ART has increased by 10% between 2011 and 2012, this is still too slow compared to the 20% increase in adults. A further complication is that many key populations such as people who inject drugs, men who have sex with men, transgender people and sex workers, continue to face legal and cultural barriers that prevent them getting treatment that otherwise would be more easily available. Another factor that needs to be addressed is the significant proportion of people who, for many reasons, ‘drop out’ of treatment.
Data reinforces feasibility of recommendations
Despite this, the Global update on HIV treatment: results, impact and opportunities contains encouraging data that reinforces the feasibility of the new WHO recommendation on earlier ART, which would expand the global number of people eligible for antiretroviral therapy to 26 million.
Between 2011 and 2012, the largest acceleration ever of people enrolled on ART was achieved, with an extra 1.6 million people benefitting from antiretroviral therapy, increasing the total to 9.7 million people. Furthermore, increased coverage of treatment occurred in every region of the world, with Africa leading. Four out of 5 people who started treatment in 2012 were living in sub-Saharan Africa.
“Today nearly 10 million people have access to lifesaving treatment. This is a true development triumph,” says Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). “But we now have a new challenge – ensuring that all 26 million people eligible for treatment have access – not one person less. Any new HIV infection or AIDS-related death due to lack of access to antiretroviral therapy is unacceptable.”
Today’s recommendations were released by WHO on the opening day of the International AIDS Society 2013 conference in Kuala Lumpur. Among those endorsing the recommendations at the launch were representatives from countries, where such earlier ART intervention is already national policy, along with development agencies who are providing technical and financial support.
The International AIDS Society conference is held every two years and attracts leading scientists, clinicians, public health experts and community leaders to examine the latest developments in HIV-related research, and to explore how scientific advances can inform the global response to HIV/AIDS.
KUALA LUMPUR June 11: Global efforts to promote health face serious challenges, including from ‘big businesses’, according to the World Health Organisation WHO director general Dr Margaret Chan.
In a statement on the United Nations’ UN website on June 10, Chan was quoted as saying efforts to promote good health were more vital than ever given that non-communicable diseases have overtaken infectious diseases as the leading cause of death, in her address to the 8th Global Conference on Health Promotion held in Helsinki, Finland.
“Economic growth, modernization, and urbanization have opened wide the entry point for the spread of unhealthy lifestyles,” she was quoted as saying.
She said that getting people to lead healthy lifestyles and adopt healthy behaviours faced opposition from forces that were “not so friendly.”
“Efforts to prevent non-communicable diseases go against the business interests of powerful economic operators. In my view, this is one of the biggest challenges facing health promotion,” she said.
“It is not just Big Tobacco anymore. Public health must also contend with Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics,” said Chan.
Chan said these tactics included front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that “confuses the evidence and keeps the public in doubt.”
They also include gifts, grants, and contributions to worthy causes that cast these industries as respectable corporate citizens in the eyes of politicians and the public, she added.They include arguments that place the responsibility for harm to health on individuals, and portray Government actions as interference in personal liberties and free choice.
“This is formidable opposition. Market power readily translates into political power. Few Governments prioritize health over big business. As we learned from experience with the tobacco industry, a powerful corporation can sell the public just about anything,” said Chan.
Chan also voiced concern about two recent and related trends.
“The first relates to trade agreements. Governments introducing measures to protect the health of their citizens are being taken to court, and challenged in litigation. This is dangerous,” she stated.
“The second is efforts by industry to shape the public health policies and strategies that affect their products. When industry is involved in policy-making, rest assured that the most effective control measures will be downplayed or left out entirely. This, too, is well documented, and dangerous.
“In the view of WHO, the formulation of health policies must be protected from distortion by commercial or vested interests,” said Chan.