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Selected Topics - Communicable Diseases
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Communicable Diseases at UNSW
Events
Global policies and related documents
- Global Tuberculosis Control: surveillance, planning, financing: WHO Report 2006
"The 10th WHO annual report on surveillance, planning and financing for global tuberculosis (TB) control includes data on case notifications, treatment outcomes, activities, budgets, costs and expenditures. Results are given for all national TB control programmes (NTPs) that have reported to WHO, although the emphasis is on progress in 22 highburden countries (HBCs)."
- Global Tuberculosis Control, Epidemiology, Strategy, Financing: WHO Report 2009
"…WHO's report on Global TB Control compiles data from over 200 countries and territories each year, monitoring the scale and direction of TB epidemics, implementation and impact of the Stop TB Strategy, and progress towards the Millennium Development Goals. The report presents WHO’s latest assessment of the epidemiological burden of TB (numbers of cases and deaths), as well as progress towards the 2015 targets for global TB control that have been established within the context of the Millennium Development Goals (MDGs). It also includes a thorough analysis of implementation and financing of the WHO’s Stop TB Strategy and the Stop TB Partnership’s Global Plan to Stop TB, since in combination these have set out how TB control needs to be implemented and funded to achieve the 2015 targets. The report gives particular attention to the period 2006–2009, but selected epidemiological, implementation and financial data are presented for previous years as well. This includes epidemiological data back to 1990 and financial data back to 2002. Bringing together data reported by 196 out of 212 countries and territories in 2008, as well as data collected from these countries and territories in previous years, Global tuberculosis control 2009 is the definitive source of information about the national and international response to the worldwide TB epidemic…".
- WHO Global Program for Vaccines and Immunization - Vaccines and Biologicals documentation page
This is a rich source of WHO-related documentation on Vaccines and Immunisation.
- WHO Report 2008 - Global tuberculosis control - surveillance, planning, financing
"…WHO's report on Global TB Control compiles data from over 200 countries and territories each year, monitoring the scale and direction of TB epidemics, implementation and impact of the Stop TB Strategy, and progress towards the Millennium Development Goals. Tuberculosis (TB) is a major cause of illness and death worldwide, especially in Asia and Africa. Globally, 9.2 million new cases and 1.7 million deaths from TB occurred in 2006, of which 0.7 million cases and 0.2 million deaths were in HIV-positive people. Population growth has boosted these numbers compared with those reported by the World Health Organization (WHO) for previous years. More positively, and reinforcing a finding first reported in 2007, the number of new cases per capita appears to have been falling globally since 2003, and in all six WHO regions except the European Region where rates are approximately stable. If this trend is sustained, Millennium Development Goal 6, to have halted and begun to reverse the incidence of TB, will be achieved well before the target date of 2015. Four regions are also on track to halve prevalence and death rates by 2015 compared with 1990 levels, in line with targets set by the Stop TB Partnership. Africa and Europe are not on track to reach these targets, following large increases in the incidence of TB during the 1990s. At current rates of progress these regions will prevent the targets being achieved globally…". The key findings also available in different languages: Arabic, Chinese, French, Russian and Spanish.
- WHO’s Pandemic Influenza Preparedness Framework: A Milestone in Global Governance for Health
In May 2008, the World Health Organization (WHO) adopted the Pandemic Influenza Preparedness Framework for the Sharing of Influenza Viruses and Access to Vaccines and Other Benefits (PIP Framework). The PIP Framework’s adoption ended years of difficult negotiations, which began after Indonesia refused to share samples of avian influenza A (H5N1) with the WHO in late 2006. Indonesia justified its actions on the need to create more equitable access for developing countries to benefits, such as vaccines and antivirals, derived from research and development on shared influenza virus samples. The global health community feared that failure to share influenza virus samples would jeopardize surveillance and response efforts against the threat of pandemic influenza. The PIP Framework seeks to improve pandemic influenza preparedness by addressing virus and benefit sharing on an equal footing and establishing mechanisms to achieve more equitable access to benefits. To facilitate virus sharing, the PIP Framework encourages WHO member states to share influenza virus specimens. It also creates a virus tracking mechanism that features two standard material transfer agreements to increase transparency concerning the use of shared viruses. This mechanism represents the Framework’s most significant contribution to strengthening pandemic influenza surveillance and response. The Framework’s benefit-sharing system contains many components, but its most notable accomplishment for increasing equitable access to benefits is the pharmaceutical industry’s agreement to provide monetary and in-kind contributions. The PIP Framework is a landmark for global governance for health because it is the first international agreement facilitating influenza virus and benefit sharing. However, the Framework is not legally binding, avoids intellectual property issues that complicated the negotiations, does not include commitments from developed countries to donate portions of influenza vaccines they purchase, and faces implementation challenges in an increasingly difficult global health environment. [306(2) JAMA 200 (July 13, 2011) [Georgetown Law and Economics Research Paper No. 11-14]]
Reports, guidelines and projects
- An estimate of the global prevalence and incidence of herpes simplex virus type 2 infection
Objective: To estimate the global prevalence and incidence of herpes simplex virus type 2 (HSV-2) infection in 2003. Methods: A systematic review was undertaken of published seroprevalence surveys describing the prevalence or incidence of HSV-2 by age and gender. For each of 12 regions, pooled prevalence values by age and gender were generated in a random-effect model. HSV-2 incidence was then estimated from these pooled values using a constant-incidence model. Values of the HSV-2 seroprevalence from the model fits were applied to the total population to estimate the numbers of people infected. Findings: The total number of people aged 15–49 years who were living with HSV-2 infection worldwide in 2003 is estimated to be 536 million, while the total number of people who were newly infected with HSV-2 in 2003 is estimated to be 23.6 million. While the estimates are limited by poor availability of data, general trends are evident. For example, more women than men were infected, and the number infected increased with age. Although prevalence varied substantially by region, predicted prevalence was mostly higher in developing regions than developed regions. Conclusion: The prevalence of HSV-2 is relatively easy to measure since infection is lifelong and has a specific serological test. The burden of disease is less easy to quantify. Despite the often sparse data on which these estimates are based, it is clear that HSV-2 infection is widespread. The dramatic differences in prevalence between regions are worthy of further exploration. [author abstract] [Bulletin of the World Health Organization 2008; 86: 805–812.]
- Avian Flu Resources
This Global Health Council page provides up-to-date resources on Avian Flu, including links to reports, web pages, experts, presentations and other material.
- Barriers and Facilitators to Influenza Vaccination Among High-Risk Groups Aged Less Than 65 Years
Influenza vaccination has not been well accepted by people less than 65 years of age. This 2006 study by N. Zwar, I. Hasan, M. Harris and V. Traynor for the National Institute of Clinical Studies, Australia has identified a number of barriers to the uptake of the vaccine. Removal of those barrier and implementation of the proposed strategies has the potential of improving the influenza vaccination rate among under-65 high-risk groups.
- Blood Services in Central Asian Health Systems: A Clear and Present Danger of Spreading HIV/AIDS and Other Infectious Diseases
“The [World Bank] report discusses inter-related parts of blood transfusions systems, and presents an overview of the parts that need to be strengthened in Central Asia. Numerous parts are in serious need of organizational restructuring, new investment and increased budgetary support for operation and maintenance… Evaluating communicable diseases rates in blood donors is essential for monitoring the safety of the blood supply and donor screening effectiveness. This assessment found that the current screening for blood borne pathogens of donated blood in Central Asia may be providing a false sense of security -- the risk of receiving an infected blood unit and acquiring a transfusion transmitted infection in the countries of the region is real. More ominous is the fact that some health facilities in Central Asia do not test blood donations at all. This means that the transmission risks indicated in this study may be conservative estimates, as they are based on a sample that excludes the blood that never reaches the existing screening system.”
- Canada Communicable Disease Report
Canada Communicable Disease Report (CCDR) distributes current information on infectious diseases in Canada to public-health professionals, both nationally and internationally. It specializes in surveillance of infectious diseases, outbreak investigations, immunization, infection control, and tropical health and quarantine information, and other disease control activities.
- Civil Society Perspectives on TB/HIV: Highlights from a joint initiative to promote community-led advocacy
"Over the past two decades, the HIV epidemic has contributed to a global resurgence of tuberculosis (TB). HIV weakens the immune system, greatly reducing an individual’s ability to fi ght off serious coinfections such as TB, as well as many opportunistic infections. In some high HIV-burden African countries, up to 50 percent of HIV-positive people develop active TB, and TB is now among the most common causes of death by infectious disease among people living with HIV. It makes little sense from any perspective—public health, human rights, social or legal—to confront the two diseases separately. Yet there have been too few collaborative responses from HIV/AIDS and TB programs. In many countries, national TB and HIV/AIDS programs and policies are designed and implemented independently of each other. Lack of coordination greatly reduces access to comprehensive treatment and prevention services for people living with HIV and/or TB. In recognition of these limitations, the World Health Organization (WHO) adopted its Interim Policy on Collaborative TB/HIV Activities in 2004. The TB/HIV Policy provides guidelines on measures that can be coordinated jointly by national HIV/AIDS programs and national TB programs to reduce the burden of TB among people with HIV and the burden of HIV among TB patients. It emphasizes the importance of building upon existing programs, systems, and resources, and of involving governments, health care providers, patients, and communities in designing and implementing a collective response to the dual epidemic. The TB/HIV Policy explicitly recognizes community-led monitoring and advocacy as an important way to promote and increase public demand for accelerated and improved TB/HIV services." [Public Health Watch & Treatment Action Group, New York, 2006]
- Communicable Disease & Prevention Control
"Provides summaries and sometimes the full text of infectious/communicable disease reports that are available on the Internet and are relevant for the prevention and control of communicable diseases. CDPC also includes sections on current global, regional, and country estimates and projections of HIV infections and AIDS cases."
- Control of Extensively Drug-Resistant Tuberculosis (XDRTB): A Root Cause Analysis
The threat of global infectious agents has the potential to cripple national and global economies, as the outbreaks of SARS, Avian Flu, H1N1, and XDR-TB have demonstrated. This article offers a Root Cause Analysis (RCA) of one public health case study – the Speaker case of XDR-TB – pinpointing the underlying causal relationships associated with this global health incident and proposing recommendations for preventing its recurrence. An RCA approach identifies corrective actions directed at the root causes of the problem and advances them as necessary to eliminate global contagion with its major international public health risks. To my knowledge, this is the first root cause analysis of a global health problem. The reform this article proposes would be to add a standardized procedure akin to the informed consent process in clinical ethics, but within a shared health governance framework. This approach, addressing infectious agents at their origins or source, is potentially a more effective strategy to reduce uncertainty and avert global health threats. [author abstract] [Global Health Governance, volume III, no. 2 (Spring 2010), pp.1-20]
- Controlling Infectious Diseases
This special issue of the Population Bulletin examines the current global state of infectious diseases. It contends that although "...improvements in sanitation and the development of vaccines and antibiotics accelerated the decline of infectious and parasitic diseases (IPDs) in the 20th century with a few exceptions, communicable diseases have not been vanquished. The microbes that cause these diseases continue to evolve, sometimes requiring new drugs and methods to combat them. New pathogens emerge, or make the jump from infecting animals to infecting humans. The most recent global estimates show that communicable diseases cause about one-third of all deaths...."
- Crimean-Congo Hemorrhagic Fever
"Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease that is asymptomatic in infected animals, but a serious threat to humans. Human infections begin with nonspecific febrile symptoms, but progress to a serious hemorrhagic syndrome with a high case fatality rate. Although the causative virus is often transmitted by ticks, animal-to-human and human-to-human transmission also occur. This disease is a particular threat to farmers and other agricultural workers, veterinarians, laboratory workers and hospital personnel. Crimean-Congo hemorrhagic fever is one of the most widely distributed viral hemorrhagic fevers. This disease occurs in much of Africa, the Middle East and Asia, as well as parts of Europe. Changes in climatic conditions could expand the range of its tick vectors, and increase the incidence of disease. The CCHF virus is also a potential bioterrorist agent; it has been listed in the U.S. as a CDC/NIAID Category C priority pathogen." [Center for Food Security and Public Health, Iowa State University, 1 August 2007]
- Diagnostics for tuberculosis: global demand and market potential
“....A key challenge for the public health community in the management of tuberculosis is to be able to effectively diagnose patients so that valuable resources and medicines are not wasted on misdiagnosis and repeat treatments. The lack of accurate diagnosis leads to an unacceptable burden of human suffering and to a waste of precious resources in poor countries. Without the right diagnostic tools, we cannot stop the TB epidemic. Developing new diagnostics is one of the six elements of the Global Plan to Stop TB: 2006-2015. This report identifies potential future markets for a range of diagnostics in three major testing areas developed and tested for use in resource poor settings….”
- Disease Control in Developing Countries
Written by more than 350 specialists in diverse fields from around the world Disease Control Priorities in Developing Countries (2nd Edition), provides the results of in-depth research, offers analyses, and proposes context-sensitive policy recommendations to significantly reduce the burden of disease in developing countries and to improve the quality of life for all people.
- Disease Control Priorities Project
The Disease Control Priorities Project (DCPP) is an ongoing effort to assess disease control priorities and produce evidence-based analysis and resource materials to inform health policymaking in developing countries. The Disease Control Priorities Project (DCPP) is a joint enterprise of The World Bank, the Fogarty International Center (FIC) of the National Institutes of Health (NIH), the World Health Organization (WHO), and the Population Reference Bureau. The NIH National Library of Medicine (NLM) is also a partner. DCPP is funded principally through a grant from the Bill & Melinda Gates Foundation.
- DOTS strategy and community participation: an experience in the Ecuadorian Andes
Setting: The Chine community in Angamarca parish, Cotopaxi Province, in the Ecuadorian Andes. Objective: To relate the DOTS [Directly Observed Treatment, Short-course] strategy to the world view of the indigenous community in the diagnosis and treatment of smear-positive pulmonary tuberculosis (TB) patients. Design: Cross-sectional study involving all inhabitants of Chine. Results: Aspects of the community’s world view were considered in the community-based application of DOTS. A cure rate of 100% was attained, with 0% defaulting from treatment. Conclusion: The results obtained indicate that involving the world view of the community in the management of tuberculosis has several advantages. [publication summary] [Int J Tuberc Lung Dis, 13(12): 1569–1571, 2009]
- Economic Benefit of Tuberculosis Control
"Tuberculosis is the most important infectious cause of adult deaths after HIV/AIDS in low- and middle-income countries. This paper evaluates the economic benefits of extending the World Health Organization’s DOTS Strategy (a multi-component approach that includes directly observed treatment, short course chemotherapy and several other components) as proposed in the Global Plan to Stop TB, 2006-2015. The authors use a model-based approach that combines epidemiological projections of averted mortality and economic benefits measured using value of statistical life for the Sub-Saharan Africa region and the 22 high-burden, tuberculosis-endemic countries in the world."
- Emergence and spread of oseltamivir-resistant A(H1N1) influenza viruses in Oceania, South East Asia and South Africa
The neuraminidase inhibitors (NAIs) are an effective class of antiviral drugs for the treatment of influenza A and B infections. Until recently, only a low prevalence of NAI resistance (<1%) had been detected in circulating viruses. However, surveillance in Europe in late 2007 revealed significant numbers of A(H1N1) influenza strains with a H274Y neuraminidase mutation that were highly resistant to the NAI oseltamivir. We examined 264 A(H1N1) viruses collected in 2008 from South Africa, Oceania and SE Asia for their susceptibility to NAIs oseltamivir, zanamivir and peramivir in a fluorescence-based neuraminidase inhibition assay. Viruses with reduced oseltamivir susceptibility were further analysed by pyrosequencing assay. The frequency of the oseltamivir-resistant H274Y mutant increased significantly after May 2008, resulting in an overall proportion of 64% (168/264) resistance among A(H1N1) strains, although this subtype represented only 11.6% of all isolates received during 2008. H274Y mutant viruses demonstrated on average a 1466-fold reduction in oseltamivir susceptibility and 527-fold reduction in peramivir sensitivity compared to wild-type A(H1N1) viruses. The mutation had no impact on zanamivir susceptibility. Ongoing surveillance is essential to monitor how these strains may spread or persist in the future and to evaluate the effectiveness of treatments against them. [author abstract] [Antiviral Research 83 (2009) 90–93]
- Emerging and Re-emerging Infectious Diseases: The Perpetual Challenge
"Among the infectious diseases throughout the world there is the baseline matrix of infectious diseases that constitutes an ongoing threat. Then there are diseases that occur intermittently, some as little blips on the radar screen and some as major public health issues. At some point in time the matrix diseases have all been emerging diseases. But after a while they become so entrenched that they are considered part of the background matrix and not emerging or re-emerging diseases. So as we eradicate diseases such as polio and smallpox, something else emerges and takes their place. This is the nature of the perpetual challenge of infectious diseases, as stated in this article's title."
- Emerging Trends in International Law Concerning Global Infectious Disease Control
David P. Fidler, Indiana University School of Law, Bloomington, Indiana, USA; Emerg Infect Dis March 10, 2003;8 - "International cooperation has become critical in controlling infectious diseases. In this article, the author examine emerging trends in international law concerning global infectious disease control."
- Equitable Access to Health Care and Infectious Disease Control: Concepts, Measurement and Interventions
The objective of the symposium was to stimulate critical debate on current concepts and measurement tools related to access to health care, its relationship to social determinants of health, and the focus on pro-poor programmes. To this end, sessions were devoted to reviewing approaches, definitions and measurements of access in relation to various dimensions of health care; discussing the relationship between access to health care and social determinants of health; reviewing operational approaches for measuring and improving inequities in access; summarizing existing approaches within the United Nations (UN) system to the construction of indicators and measurement tools around access; highlighting the critical role of research on access to health care for reaching the Millennium Development Goals; and identifying research gaps from a social science research perspective.
- Establishment of public health security in Saudi Arabia for the 2009 Hajj in response to pandemic influenza A H1N1
Mass gatherings of people challenge public health capacities at host locations and the visitors’ places of origin. Hajj — the yearly pilgrimage by Muslims to Saudi Arabia — is one of the largest, most culturally and geographically diverse mass gatherings in the world. With the 2009 pandemic influenza A H1N1 and upcoming Hajj, the Saudi Arabian Ministry of Health (MoH) convened a preparedness consultation in June, 2009. Consultants from global public health agencies met in their official capacities with their Saudi Arabian counterparts. The MoH aimed to pool and share public health knowledge about mass gatherings, and review the country’s preparedness plans, focusing on the prevention and control of pandemic influenza. This process resulted in several practical recommendations, many to be put into practice before the start of Hajj and the rest during Hajj. These preparedness plans should ensure the optimum provision of health services for pilgrims to Saudi Arabia, and minimum disease transmission on their return home. Review of the implementation of these recommendations and their effect will not only inform future mass gatherings in Saudi Arabia, but will also strengthen preparedness efforts in other settings. [publication summary] [www.thelancet.com Published online November 14, 2009 DOI:10.1016/S0140-6736(09)61927-9]
- Expansion of seasonal influenza vaccination in the Americas
Background: Seasonal influenza is a viral disease whose annual epidemics are estimated to cause three to five million cases of severe illness and 250,000 to 500,000 deaths worldwide. Vaccination is the main strategy for primary prevention. Methods: To assess the status of influenza vaccination in the Americas, influenza vaccination data reported to the Pan American Health Organization (PAHO) through 2008 were analyzed. Results: Thirty-five countries and territories administered influenza vaccine in their public health sector, compared to 13 countries in 2004. Targeted risk groups varied. Sixteen countries reported coverage among older adults, ranging from 21% to 100%; coverage data were not available for most countries and targeted populations. Some tropical countries used the Northern Hemisphere vaccine formulation and others used the Southern Hemisphere vaccine formulation. In 2008, approximately 166.3 million doses of seasonal influenza vaccine were purchased in the Americas; 30 of 35 countries procured their vaccine through PAHO's Revolving Fund. Conclusion: Since 2004 there has been rapid uptake of seasonal influenza vaccine in the Americas. Challenges to fully implement influenza vaccination remain, including difficulties measuring coverage rates, variable vaccine uptake, and limited surveillance and effectiveness data to guide decisions regarding vaccine formulation and timing, especially in tropical countries. [author abstract] [BMC Public Health 2009, 9: 361]
- Global Health Surveillance and the New International Health Regulations
"The new International Health Regulations adopted by the World Health Assembly in May 2005 (IHR 2005) represents a major development in the use of international law for public health purposes. One of the most important aspects of IHR 2005 is the establishment of a global surveillance system for public health emergencies of international concern. This article assesses the surveillance system in IHR 2005 by applying well-established frameworks for evaluating public health surveillance. The assessment shows that IHR 2005 constitutes a major advance in global surveillance from what has prevailed in the past. Effectively implementing the IHR 2005 surveillance objectives requires surmounting technical, resource, governance, legal, and political obstacles. Although IHR 2005 contains some provisions that directly address these obstacles, active support by the World Health Organization and its member states is required to strengthen national and global surveillance capabilities."
- Global Plan to Stop TB 2006-2015
Launched by the StopTB Partnership which was established in 2000 by a network of international organizations, countries, donors from the public and private sectors, governmental and non-governmental organizations and individuals, the Global Plan to Stop TB 2006 - 2015, is a comprehensive assessment of the action and resources needed to implement the Stop TB strategy and make an impact on the global TB burden.
- Global Threat of New and Re-emerging Infectious Diseases: Reconciling U.S. National Security and Public Health Policy
Jennifer Brower and Peter Chalk, Rand Science and Technology, 2003 - “This study offers a more comprehensive analysis of the security implications of the spread of infectious diseases than has been done to date. The study examines the impact of the HIV/AIDS epidemic in South Africa, highlighting this particular crisis as a graphic example of the devastating effects that infectious disease can have on virtually every aspect of a state's functioning viability. It also makes a detailed analysis of the United States, delineating the threat posed by specific diseases; assessing the effectiveness of the existing public health infrastructure; and offering specific actions that can be taken to improve the country's ability to meet this emerging challenge.”
- Globalization and Infectious Diseases in Women
Carol Bellamy, United Nations Children's Fund, New York, New York, USA; Emerging Infectious Diseases, Vol. 10, No. 11, Nov 2004 - "Women have an enhanced vulnerability to disease, especially if they are poor. Indeed, the health hazards of being female are widely underestimated. Economic and cultural factors can limit women's access to clinics and health workers. The World Health Organization (WHO) reports that less is spent on health care for women and girls worldwide than for men and boys. The 2003 World Health Report showed that, globally, the leading causes of death among women are HIV/AIDS, malaria, complications of pregnancy and childbirth, and tuberculosis".
- Health service providers in Somalia: their readiness to provide malaria case-management
Background: Studies have highlighted the inadequacies of the public health sector in sub-Saharan African countries in providing appropriate malaria case management. The readiness of the public health sector to provide malaria case-management in Somalia, a country where there has been no functioning central government for almost two decades, was investigated. Methods: Three districts were purposively sampled in each of the two self-declared states of Puntland and Somaliland and the south-central region of Somalia, in April-November 2007. A survey and mapping of all public and private health service providers was undertaken. Information was recorded on services provided, types of anti-malarial drugs used and stock, numbers and qualifications of staff, sources of financial support and presence of malaria diagnostic services, new treatment guidelines and job aides for malaria case-management. All settlements were mapped and a semi-quantitative approach was used to estimate their population size. Distances from settlements to public health services were computed. Results: There were 45 public health facilities, 227 public health professionals, and 194 private pharmacies for approximately 0.6 million people in the three districts. The median distance to public health facilities was 6 km. 62.3% of public health facilities prescribed the nationally recommended anti-malarial drug and 37.7% prescribed chloroquine as first-line therapy. 66.7% of public facilities did not have in stock the recommended first-line malaria therapy. Diagnosis of malaria using rapid diagnostic tests (RDT) or microscopy was performed routinely in over 90% of the recommended public facilities but only 50% of these had RDT in stock at the time of survey. National treatment guidelines were available in 31.3% of public health facilities recommended by the national strategy. Only 8.8% of the private pharmacies prescribed artesunate plus sulphadoxine/pyrimethamine, while 53.1% prescribed chloroquine as first-line therapy. 31.4% of private pharmacies also provided malaria diagnosis using RDT or microscopy. Conclusion: Geographic access to public health sector is relatively low and there were major shortages of appropriate guidelines, anti-malarials and diagnostic tests required for appropriate malaria case management. Efforts to strengthen the readiness of the health sector in Somalia to provide malaria case management should improve availability of drugs and diagnostic kits; provide appropriate information and training; and engage and regulate the private sector to scale up malaria control. [author abstract] [Malaria Journal 2009, 8:100 doi:10.1186/1475-2875-8-100]
- Hepatitis C Virus Infection in Samoa and American Samoa
In this short report by Gregory l. Armstrong, Ian T. Williams, Utoofili Asofa’afetai Maga, Satupaitea Viali, Wendi l. Kuhnert, and Stephen T. McGarvey, it is revealed that “little is known about the prevalence of hepatitis C virus (HCV) in Pacific islands. In this study, serum specimens collected in 1985 and 2002 among the general populations of Samoa and American Samoa were tested for antibody to HCV by a third-generation enzyme immunoassay and a recombinant immunoblot assay. Of the 3,466 specimens tested, 8 (0.2%; 95% confidence interval _ 0.07–0.4%) were positive for antibody to HCV. Prevalence did not vary by location or demographic characteristic. Thus, HCV is present in the Samoas but at a low prevalence.” (au)
- High adherence to anti-tuberculosis treatment among patients attending a hospital and slum health centre in Nairobi, Kenya
We conducted a study among patients with tuberculosis (TB) attending two health facilities*a hospital and a slum health centre*in Nairobi, in order to: (a) assess adherence to anti-TB treatment; and (b) identify reasons for non-adherence. Urine Isoniazid (INH), used as a proxy for overall adherence, was detected in 142 (97% {95% CI 92_99}) of the 147 patients involved in the study. Five patients had no INH detected in urine and had run out of pills within the previous three days. The reasons included: not having enough pills to last until the appointment date (1); delays due to work or family reasons (2); needing to seek money for transport (1); and losing some pills (1). Anti-TB treatment adherence is high, and this is reassuring information as Kenya plans to change to a superior first-line regimen based on rifampicin throughout the course of anti-TB treatment. Providing patients with a three-day “excess stock” of pills would provide a “safety net” for continued treatment. [author abstract] [Global Public Health, 3: 4, 433-439 (2008)]
- How health systems can address inequities in priority public health conditions: the example of tuberculosis
"The literature and case study synthesis undertaken by the Network showed that social determinants shape the spread of TB at multiple levels. These determinants are differentially distributed, with the poor and socially excluded disproportionately exposed. Government policies, global economic trends and other structural factors shape poverty and the strength of health care systems. These in turn contribute to downstream factors, such as the prevalence of TB in the wider community, living conditions, tobacco use and prevalence of diseases of the poor that increase TB vulnerability. Downstream factors interact with biology to shape the likelihood of exposure to TB droplets and, when exposed and infected, the likelihood of developing active disease… Analysis of these social determinants has policy implications. Current strategies need to be reinvigorated and combined with new strategies to directly tackle known social determinants. This requires: (i) strengthening and improving the coverage of existing TB programmes to reduce TB morbidity and mortality; (ii) taking a social determinants of health approach to better prevent and address the consequences of TB, including risk factors that lie outside of the health system; and (iii) strengthening health systems, particularly through a primary health care approach. Operationalization of these three principles might include improving universal social protection systems, using targeting only for those who fall through the cracks of universal services, and enhanced availability, accessibility, acceptability and quality of primary health care, TB and other services. Intersectoral action for health would also be required, entailing health impact assessments, providing examples of good practice to other sectors, supporting civil society groups to advocate for enhanced action by all on the social determinants of health and providing evidence regarding the relationship between health outcomes and social determinants." [WHO Regional Office for Europe, 2010]
- Immunoglobulin G in Ebola Outbreak Survivors, Gabon
"Three well-documented outbreaks of Ebola hemorrhagic fever occurred from 1996 through 2001 in Gabon in central Africa (1). All were caused by the highly pathogenic species Zaire ebolavirus, which is associated with an ≈80% case-fatality rate… A total of 207 human cases were recorded during these 3 outbreaks; 149 persons died… Because of the lack of available samples from survivors, little is known about the duration of IgG antibody response. However, studies of 20 survivors convalescing after the 1995 Kikwit outbreak in the Democratic Republic of the Congo (DRC) showed that Zaire ebolavirus IgG appeared 5 to 18 days after symptom onset and persisted at least 21 months." [Emerging Infectious Diseases, Volume 15, Number 7–July 2009]
- Incorporating a Rapid Impact Package for Neglected Tropical Diseases with Programs for HIV/AIDS, Tuberculosis and Malaria
This article, published in PLOS Medicine asserts that "...an increasing body of evidence indicates that “neglected tropical diseases” may not only threaten the health of the poor as much as HIV/AIDS, tuberculosis, or malaria, but even more importantly, may have effective treatment and prevention strategies that can be delivered for less than US$1 per capita per year. Furthermore, new evidence points to substantial geographic overlap between the neglected tropical diseases and the big three, with emerging data suggesting that control of the neglected tropical diseases could actually become a powerful tool for combating HIV/AIDS, tuberculosis, and malaria."
- Infectious Diseases: Preparing for the Future - Risk Analysis
This document reports on the "...UK Foresight 'Infectious Diseases: preparing for the future' project that aimed to produce a vision of future systems for the detection, identification and monitoring of infectious diseases, and to assess how they might transform our capabilities in managing the future threat."
- Integrating TB and HIV Care in Mozambique: Lessons from an HIV Clinic in Beira
Mozambique ranks among the top ten nations in the world in terms of the number of people living with HIV/AIDS, with an estimated 1,300,000 people infected with HIV in 2003. The overall estimated sero-prevalence of HIV among adults aged 15–29 years was estimated at 12%, with the central region being the most affected area in the country with an estimated seroprevalence of 17%. Sofala Province, in central Mozambique, has the highest sero-prevalence of any province at 27%, with some prenatal care sites in Beira city (Sofala’s largest city and provincial capital) registering HIV-positive rates as high as 35%. Mozambique also ranks among the 20 highest tuberculosis (TB) burden countries in the world, with an estimated 81,000 cases and an incidence rate of 436 per 100,000 people in 2002. The incidence of TB has been steadily growing over the last 10 years largely due to the high prevalence of HIV; an estimated 47% of adult TB cases are estimated to be HIV-positive. In 2003 and 2004 in Beira city, approximately 3,200 new cases of TB were registered per year, which corresponds to an incidence rate of 566 per 100,000 people. The pathophysiological links between TB and HIV are well recognized, as co-infection with HIV significantly increases the chance of developing active TB.1 In sub-Saharan Africa, TB is felt to be the most commonly diagnosed opportunistic infection, and it is also the most frequent cause of death among those infected with HIV. The immune stimulation caused by TB may also increase the HIV viral load, rate of HIV disease progression, and mortality, particularly among those with higher CD4 counts. Because of the large number of patients with both TB and HIV, the World Health Organization (WHO) has encouraged efforts to increase the linkages between TB and HIV programs in sub-Saharan Africa. These linkages could facilitate quick and efficient diagnosis of dual TB-HIV infection, provide beneficial interventions such as prophylactic cotrimoxazole that could reduce mortality among dually infected HIV-TB patients, and coordinate the complex treatment issues that may arise with concomitant administration of TB treatment and HAART, where available. This paper describes one strategy of integrating TB and HIV care during the development of a new MOH HIV treatment center in Beira city, Mozambique.
- Intensifying the fight against malaria: the World Bank's booster program for malaria control in Africa
"This [2008 World Bank] document describes the purpose and context of the Booster Program, its first three years of operation and the proposed design of phase two of the program. Phase two seeks to build on the successes of and lessons learned from phase one and to enable the World Bank to play its expected role in scaling up and sustaining malaria control interventions to reach the new ambitious but achievable global goal set by the Roll Back Malaria (RBM) Partnership, of eliminating malaria as a major public health problem in Africa by 2015. The Bank has subscribed fully to this agenda, as illustrated by statements made by senior management in several public forums."
- Jordan Report 2007: Accelerated Development of Vaccines (USA)
"It has been almost 25 years since the first vaccine research and development “state of the science” report, otherwise known as The Jordan Report, was published by the National Institute of Allergy and Infectious Diseases (NIAID), part of the [US] National Institutes of Health. Since that time, significant scientific progress has been made in developing new and better vaccines against a wide array of infectious diseases, including those that are emerging or re-emerging."
- Leishmaniasis: an overlooked public health concern
Leishmaniasis is a protozoan disease that represents an emergent threat with high morbidity and mortality rates. The disease is endemic in areas of the tropics, subtropics and in the southern Europe. Currently, leishmaniasis has a wider geographical distribution than before and this is mainly attributed to the constant increase of leishmaniasis’ risk factors that include migration, environmental changes, deforestation, urbanization, immunosuppression and malnutrition. Thus, leishmaniasis is a potential threat for several areas. This article reviews on the clinical and epidemiological features of leishmaniasis. Based on disease epidemiology and analyzing the associated risk factors, several prevention measures are being discussed in detail. Taking into consideration the lack of a commercially available vaccine, the lack of access to efficient drug therapy mainly in the developing countries, the limited local resources of the affected countries, it is concluded that elimination of the disease is still a challenge for the international health community. [author abstract] [HSJ – Health Science Journal, Volume 2, Issue 4 (2008), pp.196-205]
- Lessons from the Pacific programme to eliminate lymphatic filariasis: a case study of 5 countries
Background: Lymphatic Filariasis (LF) is an important Neglected Tropical Disease, being a major cause of disability worldwide. The Global Programme to Eliminate Lymphatic Filariasis aims to eliminate LF as a public health problem by the year 2020, primarily through repeated Mass Drug Administration (MDA). The Pacific region programme commenced in 1999. By June 2007, five of the eleven countries classified as endemic had completed five MDA campaigns and post-MDA prevalence surveys to assess their progress. We review available programme data and discuss their implications for other LF elimination programs in developing countries. Methods: Reported MDA coverage and results from initial surveys and post-MDA surveys of LF using the immunochromatographic test (ICT) from these five Pacific Island countries (Tonga, Niue, Vanuatu, Samoa and Cook Islands) were analysed to provide an understanding of their quality and programme progress towards LF elimination. Denominator data reported by each country programme for 2001 was compared to official sources to assess the accuracy of MDA coverage data. Results: Initial survey results from these five countries revealed an ICT prevalence of between 2.7 and 8.6 percent in individuals tested prior to commencement of the programme. Country MDA coverage results varied depending on the source of denominator data. Of the five countries in this case study, three countries (Tonga, Niue and Vanuatu) reached the target prevalence of <1% antigenaemia following five rounds of MDA. However, endpoint data could not be reliably compared to baseline data as survey methodology varied. Conclusion: Accurate and representative baseline and post-campaign prevalence data is crucial for determining program effectiveness and the factors contributing to effectiveness. This is emphasised by the findings of this case study. While three of the five Pacific countries reported achieving the target prevalence of <1% antigenaemia, limitations in the data preclude identification of key determinants of this achievement. [author abstract] [BMC Infectious Diseases 2009, 9: 92]
- Limitations on human rights: are they justifiable to reduce the burden of TB in the era of MDR- and XDR-TB?
"Tuberculosis, in all its forms, poses a serious, demonstrable threat to the health of countless individuals as well as to health as a public good. MDR-TB [Multi-drug resistant tuberculosis] and, in particular, the emergence of XDR-TB [Extensively drug-resistant tuberculosis], have re-opened the debate on the importance, and nature, of treatment supervision for basic TB control and the management of drug-resistant TB. Enforcing compulsory measures regarding TB patients raises questions of respect for human rights. Yet, international law provides for rights-limiting principles, which would justify enforcing compulsory measures against TB patients who refuse to have diagnostic procedures or who refuse to be monitored and treated once disease is confirmed. This article analyzes under what circumstances compulsory measures for TB patients may be enforced under international law. Compulsory measures for TB patients may, in fact, be justified on legal grounds provided that these measures are foreseen in the law, that they are used as a last resort, and that safeguards are in place to protect affected individuals. The deadly nature of the disease, its epidemiology, the high case fatality rate, and the speed at which the disease leads to death when associated with HIV are proven."
- Major Issues and Challenges of Influenza Pandemic Preparedness in Developing Countries
"Better preparedness for an influenza pandemic mitigates its impact. Many countries have started developing and implementing national influenza pandemic preparedness plans. However, the level of preparedness varies among countries. Developing countries encounter unique and difficult issues and challenges in preparing for a pandemic. Deaths attributable to an influenza pandemic could be substantially higher in developing countries than in industrialized countries. Pharmaceutical interventions such as vaccines and antiviral agents are less likely to be available in developing countries. The public health and clinical infrastructure of developing countries are often inadequate to deal with a widespread health crisis such as an influenza pandemic. Such an event will inevitably have a global effect. Therefore, improving pandemic preparedness in every country, particularly developing ones, is urgently needed."
- Malaria control in complex emergencies: An inter-agency field handbook
This interagency handbook was developed by the Roll Back Malaria (RBM) Technical Support Network on Complex Emergencies. It focuses on effective malaria control responses to complex emergencies, and provides policy-makers, planners, field programme managers and medical coordinators with practical guidance on designing and implementing measures to reduce malaria morbidity and mortality.
- Malaria Rapid Diagnostic Test Performance: Results of WHO product testing of malaria RDTs: Round 1 (2008)
"The World Health Organization estimates that 3.3 billion persons were at risk of acquiring malaria in 2006, with 247 million of these developing clinical malaria (86% in Africa), and nearly 1 million (mostly African children) dying from the disease. Malaria remains endemic in 109 countries, and while parasite-based diagnosis is increasing, most suspected cases of malaria are still not properly identified, with accurate diagnosis and disease monitoring consequently remaining elusive… This report, which presents the results of the first round of WHO product testing of malaria antigen-detecting RDTs, was completed in November 2008 in collaboration with FIND, the US Centers for Disease Control and Prevention (CDC) and other partners… The evaluation is designed to provide comparative data on the performance of the submitted production lots of each product. Such data will be used to guide procurement decisions of WHO and other UN agencies and national governments. Product testing is part of a continuing programme of work to improve the quality of RDTs that are used, and to support broad implementation of reliable malaria diagnosis in areas where malaria is prevalent. A second round of product testing began in April 2009."
- Malaria Rapid Diagnostic Test Performance: Results of WHO product testing of malaria RDTs: Round 2 (2009)
This report presents "the results of the first and second rounds of WHO product testing of malaria antigen-detecting RDTs completed in 2008 and 2009 respectively, and is published in conjunction with the release of the results of Round 2. The results of the two rounds of testing should be considered as a single data set, and the full reports of both Rounds 1 and 2 consulted for further detail on product performance, and on the interpretation and use of these results. The RDT evaluations summarized here were performed as a collaboration between WHO, TDR, FIND, the US Centers for Disease Control and Prevention (CDC) and other partners. The evaluation is designed to provide comparative data on the performance of the submitted production lots of each product." Summary. [Evaluation conducted by WHO Regional Office for the Western Pacific (WPRO), Global Malaria Programme (GMP), Special Programme for Research and Training in Tropical Diseases (TDR), and the Foundation for Innovative New Diagnostics (FIND)]
- Outbreak(s) of Ebola Hemorrhagic Fever, Congo and Gabon, October 2001 to July 2002
"Congo, Gabon and others countries in Central Africa should ensure, as a priority, the design and implementation of national plans to improve preparedness for epidemic-prone diseases, including Ebola, and to strengthen an integrated disease surveillance system." [Canada Communicable Diseases Report, Volume 29-15, 1 August 2003]
- Pandemic flu: planning and responding to primary care capacity challenges
"The current swine flu pandemic is likely to present Primary Care Trusts (PCTs) and primary care services with increasingly significant capacity challenges: not only in terms of demand pressures from patients who present with influenza-like illness or secondary complications arising from swine flu, but also potentially in terms of supply pressures due to illness amongst primary care staff themselves. This first practical guide to support PCTs in relation to primary care during a pandemic situation covers primary medical care: those services provided by GP practices, GP led health centres and Out of Hours Providers (OOH). Further practical guides will be produced for other independent contractors and to support any vaccination programmes that relate to this pandemic. A guide for pharmacy services and access to medicines is already in development." [UK Department of Health, 20 August 2009]
- Pandemic H1N1 influenza lessons from the southern hemisphere
Early in the 2009 H1N1 influenza pandemic, an editorial in Eurosurveillance noted the importance of observing experience with this novel virus in the southern hemisphere during their usual winter influenza season [1]. This special issue of Eurosurveillance is a timely response to that call. It contains reports from the island of Réunion, South Africa, South America (Brazil, Peru), and Australia (New South Wales and Victoria). It also includes an overview of the effect of the pandemic on indigenous people. This editorial summarises some of the key findings from these papers, reviews features of pandemic H1N1 influenza epidemiology in these countries, and lists some potential lessons for the northern hemisphere (and possible future waves in the southern hemisphere). [publication summary] [Eurosurveillance, 2009; 14 (42): pii=19370]
- Pandemic influenza as 21st century urban public health crisis
The percentage of the world’s population living in urban areas will increase from 50% in 2008 to 70% (4.9 billion) in 2025. Crowded urban areas in developing and industrialized countries are uniquely vulnerable to public health crises and face daunting challenges in surveillance, response, and public communication. The revised International Health Regulations require all countries to have core surveillance and response capacity by 2012. Innovative approaches are needed because traditional local-level strategies may not be easily scalable upward to meet the needs of huge, densely populated cities, especially in developing countries. The responses of Mexico City and New York City to the initial appearance of influenza A pandemic (H1N1) 2009 virus during spring 2009 illustrate some of the new challenges and creative response strategies that will increasingly be needed in cities worldwide. [author abstract] [Emerging Infectious Diseases, Dec 2009]
- Pandemic Influenza Planning in the United States from a Health Disparities Perspective
"We explored how different socioeconomic and racial/ethnic groups in the United States might fare in an influenza pandemic on the basis of social factors that shape exposure, vulnerability to influenza virus, and timeliness and adequacy of treatment. We discuss policies that might differentially affect social groups' risk for illness or death. Our purpose is not to establish the precise magnitude of disparities likely to occur; rather, it is to call attention to avoidable disparities that can be expected in the absence of systematic attention to differential social risks in pandemic preparedness plans. Policy makers at the federal, state, and local levels should consider potential sources of socioeconomic and racial/ethnic disparities during a pandemic and formulate specific plans to minimize these disparities." [Author Abstract]
- Pandemic influenza preparedness in Latin America: analysis of national strategic plans
"The threat of a human pandemic of influenza has prompted the development of national influenza pandemic preparedness plans over the last 4 years. Analyses have been carried out to assess preparedness in Europe, Asia and Africa. We assessed plans to evaluate the national strategic pandemic influenza preparedness in the countries of Latin America. Published national pandemic influenza preparedness plans from Latin American countries were evaluated against criteria drawn from the World Health Organization checklist. Plans were eligible for inclusion if formally published before 16 November 2007. Fifteen national plans were identified and retrieved from the 17 Latin American countries surveyed. Latin American countries demonstrated different degrees of preparedness, and that a high level of completeness of plans was correlated to a country's wealth to a certain extent. Plans were judged strong in addressing surveillance requirements, and provided appropriate communication strategies directed to the general public and health care personnel. However, gaps remained, including the organization of health care services’ response; planning and maintenance of essential services; and the provision of containment measures such as the stockpiling of necessary medical supplies including vaccines and antiviral medications. In addition, some inconsistencies and variations which may be important, such as in border control measures and the capacity to contain outbreaks, exist between country plans—issues that could result in confusion in the event of a pandemic. A number of plans remain developmental in nature and, as elsewhere, more emphasis should be placed on strengthening the operability of plans, and in testing them. Whilst taking account of resources constraints, plans should be further developed in a coherent manner with both regional and international imperatives."
- Pandethics
This paper explains the ethical importance of infectious diseases, and reviews four major ethical issues associated with pandemic influenza: the obligation of individuals to avoid infecting others, healthcare workers' 'duty to treat', allocation of scarce resources, and coercive social distancing measures. In each case, ways in which the ethical issues turn on both philosophical and empirical questions are highlighted. The paper concludes that ethicists should play a greater role in identifying ethically important empirical questions, and that scientists should take the ethical as well as the scientific importance of such questions into consideration when choosing research projects. [publication summary] [Public Health 123 (2009): 255–259]
- Performance-Based Incentives for Health: A Way to Improve Tuberculosis Detection and Treatment Completion?
Tuberculosis is a public health emergency in Africa, Eastern Europe, and Central Asia. Of the estimated 1.7 million deaths from TB, 98 percent are in the developing world, the majority being among the poor. In order to reach the MDG and the Stop TB partnership targets for 2015, TB detection rates need to double, treatment success rates must increase to more than 7075 percent, and strategies to address HIV-associated TB and multi-drug resistant TB must be aggressively expanded. DOTS, the internationally-recommended TB control strategy is the foundation of TB control efforts worldwide. A standard recording and monitoring system built on routine service-based data allows nearly all countries in the world to track progress in case detection and treatment completion through routine monitoring. This provides a good base for measuring the impact of different strategies for improving TB control outcomes. Performance-based incentives in TB control programs include financial and material incentives directed to patients, individual health workers (in the public and private sectors), and entire health care facilities. Those directed toward patients encourage individuals to seek care (a diagnosis) and are conditional on completing steps in the treatment process to ensure adherence to the lengthy treatment schedule. Incentives directed at providers seek to improve the quality of diagnosis, expand access to treatment, improve teamwork, and encourage system changes to improve outcomes. Since multiple program strengthening interventions are implemented simultaneously, it is difficult to fully attribute performance changes to the incentives. However, evidence indicates that performance-based incentives for patients and providers directly contribute to increases in case detection and treatment completion rates. Experience in a number of countries points to the importance of careful design and implementation, particularly where it concerns the distribution of money and/or food. While more evidence is needed on the direct correlation between the incentives and performance, existing evidence suggests that incentives should be an integral element of a TB control strategy. [publication abstract] [Center for Global Development Working Paper #122, April 2007]
- Polio Vaccines difficult to swallow: The story of a controversy in Northern Nigeria
This paper by Maryam Yahya of the Institute of Development Studies examines the Oral Polio Vaccine (OPV) controversy in Nigeria, where rumours that the vaccine was part of a Western tool to sterilise Muslims prompted a boycott of the vaccine by Muslim leaders. The paper examines the roles, responsibilities and actions of global and national actors in implementing effective immunisation campaigns, including the manner in which health care issues are prioritised, managed, and financed. The author identifies sustained communication as the centrepiece of a successful immunisation campaign, something which is often neglected in immunisation budgets.
- Poor Countries Need Relief from the World Bank's 'Help' on Malaria
This American Enterprise Institute for Public Policy Research (AEI) Working Paper by Roger Bate examines the World Bank's efforts to control malaria in poor countries. It asserts that these "...efforts have been diluted by irresponsible forays into disease control financing without a commensurate increase in institutional competence with only limited technical staff capacity. Instead of deferring to the World Health Organization for technical advice on malaria control, Bank staff members have promoted ineffectual malaria prevention and treatment, causing countries to move away from best practices in disease control."
- Preventing avian influenza in humans: the role of simple public health interventions
An influenza pandemic due to influenza virus A H5N1 subtype is considered highly likely. Strategies for prevention and control of a pandemic include actions that need to be taken by the national authorities and communities. The availability of a vaccine and antiviral drugs in sufficient quantities for billions of people in the developing world is doubtful. Simple cost effective public health interventions can significantly reduce the risk of contracting infection. These interventions include precautions that will prevent people from contracting infection from sick or dying poultry and their products, human cases and a contaminated environment. Specific measures are based on principles of cutting short the transmission of infection in humans and inactivating the virus at its source. The paper describes context specific actions that can be implemented in both rural and urban settings by the communities themselves. [author abstract] [Southeast Asian Journal of Tropical Medicine & Public Health, Vol 37, No. 6, pp.1229-1236 (November 2006)]
- Public Health Responses to Urgent Case Reports
This report published in Health Affairs 30 Aug 2005, evaluates the ability of local public health agencies (LPHAs) in the U.S. to meet a preparedness standard set by the U.S. Centers for Disease Control and Prevention (CDC): to receive and respond to urgent case reports of communicable diseases twenty-four hours a day, seven days a week.
- Reconstructing Tuberculosis Services after Major Conflict: Experiences and Lessons Learned in East Timor
Tuberculosis (TB) is a major public health problem in developing countries. Following the disruption to health services in East Timor due to violent political conflict in 1999, the National Tuberculosis Control Program was established, with a local non-government organisation as the lead agency. Within a few months, the TB program was operational in all districts. Using the East Timor TB program as a case study, this article published in PLOS Medicine 3(10), Oct. 2006, examines the enabling factors for the implementation of this type of communicable disease control program in a post-conflict setting.
- Review of leprosy cases in Benghazi, Libyan Arab Jamahiriya, 1994-98
This reports on a descriptive study which was “conducted using case records from the Leprosy Clinic, Benghazi for the period 1994-98. A constant decline in the number of leprosy cases registered for multidrug treatment (MDT) was observed, from 18 in 1994 to 4 in 1998. The ratio of multibacillary to paucibacillary cases was 1.3:1. Most of the patients were young male adults who were socially and economically productive. An hypopigmented patch was the most common lesion present on easily accessible sites. Early registration, compliance with MDT and follow-up will enhance the cure rate and lead to a reduction in disability rates. Despite elimination surveillance for new leprosy cases is essential.”
- Risk Factors Associated with Development of Dengue Haemorrhagic Fever or Dengue Shock Syndrome in Adults in Hospital Tengku Ampuan Afzan Kuantan
A retrospective study was conducted to investigate 183 serologically-confirmed cases of dengue fever (DF) admitted from October 2004 to March 2005 in a large hospital in Pahang. Clinical and laboratory features, progress and outcome of these patients were analysed in order to identify risk factors associated with development of dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Individually, we found that older patients, secondary dengue infection, high baseline haematocrit levels, low platelet levels and prolonged activated partial thromboplastin time (APTT) ratio were significant associations with bleeding tendencies. Of these risk factors, haematocrit and APTT ratio were two independent significant risk factors on multivariate analysis. Older patients with primary infection and younger patients with secondary infection had significant bleeding tendencies. We also verified the validity of the haematocrit levels suggested as cut-off levels for plasma leakage for the Malaysian population by Malaysian Clinical Practice Guidelines for Dengue Infection in Adults (2003). [author abstract] [Med J Malaysia Vol 64 No 4 December 2009, pp.316-320]
- Science, Economics and Politics of Malaria Vaccine Policy
This report, by Andrew Farlow forms a submission to UK Department for International Development and The Malaria Vaccine Technology Roadmap and a response to the Tremonti Report to G8 Finance Ministers. "The report is especially interested in evaluating the proposal of two malaria vaccine goals – one earlier lower efficacy vaccine and one later higher efficacy vaccine based on product-and region-specific characteristics, as suggested in the recently-initiated 'Malaria Vaccine Technology Roadmap' – in combination with an elaborate subsidy/R&D funding scheme called an 'Advance Purchase Commitment/Contract' (APC)…."
- Small islands and pandemic influenza: Potential benefits and limitations of travel volume reduction as a border control measure
Background: Some island nations have explicit components of their influenza pandemic plans for providing travel warnings and restricting incoming travellers. But the potential value of such restrictions has not been quantified. Methods: We developed a probabilistic model and used parameters from a published model (i.e., InfluSim) and travel data from Pacific Island Countries and Territories (PICTs). Results: The results indicate that of the 17 PICTs with travel data, only six would be likely to escape a major pandemic with a viral strain of relatively low contagiousness (i.e., for R0 = 1.5) even when imposing very tight travel volume reductions of 99% throughout the course of the pandemic. For a more contagious viral strain (R0 = 2.25) only five PICTs would have a probability of over 50% to escape. The total number of travellers during the pandemic must not exceed 115 (for R0 = 3.0) or 380 (for R0 = 1.5) if a PICT aims to keep the probability of pandemic arrival below 50%. Conclusion: These results suggest that relatively few island nations could successfully rely on intensive travel volume restrictions alone to avoid the arrival of pandemic influenza (or subsequent waves). Therefore most island nations may need to plan for multiple additional interventions (e.g., screening and quarantine) to raise the probability of remaining pandemic free or achieving substantial delay in pandemic arrival. [author abstract] [BMC Infectious Diseases (September 2009), 9: 160]
- Strategies to Eradicate Rubella in the English-Speaking Caribbean
Objective: This report presents the strategies used to eradicate rubella in the Caribbean region and the challenges faced by that effort. Methods: Using the surveillance system for measles cases that was instituted in all countries in the Caribbean Community (CARICOM), 12 countries confirmed cases of rubella between 1992 and 1996. Rubella infections occurred in epidemic proportions in 6 countries during that period. Results: On the basis of the rubella prevalence data, rubella–congenital rubella syndrome (CRS) cost–benefit analysis, and cost-effectiveness of the mass campaign, the Council for Human and Social Development of CARICOM resolved, on April 21, 1998, that every effort would be made to eradicate rubella, as well as to prevent the occurrence of new cases of CRS by the end of 2000. Using the Pan American Health Organization’s template for measles eradication, CARICOM proposed and implemented the main strategies for rubella and CRS eradication, and rubella mass campaigns were conducted in 18 countries. The target population, which included males and females (aged 20–40 years), was approximately 2.2 million. Conclusion: The major challenges for rubella eradication are attaining high vaccine coverage in the adult population and maintaining an effective surveillance system able to detect rubella activity. [author abstract] [Am J Public Health, October 2000; 90(10): 1545–1549]
- TB policy in Bangladesh: A civil society perspective [84pp]
"TB is a leading cause of adult mortality and preventable death in Bangladesh. An estimated 70,000 individuals die from TB each year in Bangladesh—one death every 10 minutes. TB hits the poor and the most economically productive age group hardest, wreaking devastating economic and social impact. Yet many Bangladeshis are unaware of the fact that TB is curable and that treatment is available at public health facilities free of charge… To increase public awareness of TB, the report argues that a multifaceted advocacy and social mobilization strategy is needed."
- The association of TB with HIV infection in Oromia Regional National State, Ethiopia in 2006/7
Background: Infection with Human Immunodeficiency Virus (HIV) is an established risk factor for tuberculosis infection. Population-based data on associations between HIV and tuberculosis (TB) can provide an epidemiological assessment of the impact of HIV infection on TB in environments where individual based data are difficult to collect. Method: We used an ecological study to assess the association between infection with HIV and tuberculosis in Oromia Region National State, Ethiopia in 2006/7. Result: The prevalence of HIV infection was significantly associated with the incidence of TB across the areas in Oromia region (r=0.69, p<0.01). Similar associations were also seen for the prevalence of HIV infection with the incidence of smear positive tuberculosis, smear negative tuberculosis and extra-pulmonary tuberculosis. Conclusion: Ecological association between HIV and TB is strong in Oromia Regional state. Therefore, in areas where there are high TB case notification rates, it is important to consider the possibility that the prevalence of HIV may also be increasing, and take appropriate public health measures to assess and address these issues. [Ethiop.J.Health Dev. 2009;23(1):63-67]
- The Global Burden of Trachoma: A Review
This review examines the various attempts to estimate the burden of disease from trachoma, the commonest infectious cause of blindness worldwide. Reports vary considerably because of differences in methodology and changing estimates of the number of people affected. Currently about 1.3 million are blind from trachoma and it causes about 1.3 million Disability-Adjusted Life Years (DALYs). The limited amount of survey data available from endemic regions remains a problem in generating accurate estimates. The effect of the disease may be underestimated as some of the disabling sequelae are not included in the calculation. [author summary] [PLoS Negl Trop Dis 3(10): e460]
- The Neglected Tropical Diseases of Latin America and the Caribbean: A Review of Disease Burden and Distribution and a Roadmap for Control and Elimination
"The neglected tropical diseases (NTDs) represent some of the most common infections of the poorest people living in the Latin American and Caribbean region (LAC). Because they primarily afflict the disenfranchised poor as well as selected indigenous populations and people of African descent, the NTDs in LAC are largely forgotten diseases even though their collective disease burden may exceed better known conditions such as of HIV/AIDS, tuberculosis, or malaria. Based on their prevalence and healthy life years lost from disability, hookworm infection, other soil-transmitted helminth infections, and Chagas disease are the most important NTDs in LAC, followed by dengue, schistosomiasis, leishmaniasis, trachoma, leprosy, and lymphatic filariasis."
- The Public Health Burden of Plasmodium falciparum Malaria in Africa: Deriving the Numbers
"In 2001, malaria was ranked the 8th highest contributor to the global Disability Adjusted Life Year (DALY) and 2nd in Africa (WHO, 2002). The malaria DALY was largely estimated from the combined effects of Plasmodium falciparum infection as a direct cause of death and the much smaller contributions of short duration, self-limiting or treated surviving mild morbid events, malaria-specific anemia and neurological disability following cerebral malaria… The estimate derives from an assumption that each illness event or death can only be attributed to a single cause that can be measured reliably and for which data do exist. In this review we re-analyze more contemporary evidence on the direct health consequences of malaria infection in Africa and examine the broader contribution of malaria infection to indirect causes of mortality, morbidity and disability." [Working Paper No. 11, Disease Control Priorities Project. Bethesda, Maryland: Fogarty International Center, National Institutes of Health. August 2003]
- Water for Life: Making it Happen
This report published by WHO as we enter the International Decade for Action Water for Life 2005-2015 asserts that every day, diarrhoeal diseases from easily preventable causes claim the lives of approximately 5 000 people, most of them young children. Sufficient and better quality drinking water and basic sanitation can cut this toll dramatically, and simple, low-cost household water treatment has the potential to save further lives.
- Wild Poliovirus Type 1, Central African Republic
"In this article we summarize the investigation and response to the reemergence of wild poliovirus (WPV) type 1 in the Central African Republic (CAR) in 2003. Since 2000, reported annual routine vaccination coverage with >3 doses of oral polio vaccine (OPV) has been very low in CAR (<50%); National Immunization Days have been conducted every year since 1996, except in 2002." [Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 11, No. 9, September 2005]
- World Disasters Report 2008
"The AIDS epidemic is a disaster on many levels. In the most affected countries in sub-Saharan Africa, where prevalence rates reach 20 per cent, development gains are reversed and life expectancy may be halved. For specific groups of marginalized people – injecting drug users, sex workers and men who have sex with men – across the world, HIV rates are on the increase. Yet they often face stigma, criminalization and little, if any, access to HIV prevention and treatment services. As this report explains, HIV is a challenge to the humanitarian world whose task is to improve the lives of vulnerable people and to support them in strengthening their capacities and resilience. Disasters, man-made and ‘natural’, exacerbate other drivers of the epidemic and can also increase people’s vulnerability to infection."
- World Malaria Report 2005
"The World Malaria Report 2005 is the first comprehensive effort by the Roll Back Malaria Partnership to take stock of where the world stands in relation to one of its most devastating diseases. It reveals that the tide may be beginning to turn against malaria as control and prevention programmes start to take effect."
- Young people’s HIV/AIDS & reproductive health needs and utilization of services in selected regions of Ethiopia
"This report summarizes important work into the sexual and reproductive health needs of young Ethiopians. The generation of young people now in their late teens and early twenties is faced by unprecedented choice, but also daunting challenges. The combined effects of rapid urbanization and loosening cultural ties influence these young men and women at the same time that the impact of HIV/AIDS is being felt throughout Ethiopian society. The central findings of this study are that young people lack understanding of reproductive health issues, experience significant problems related to their sexual and reproductive health, and yet are reluctant to seek help for these problems. If available at all, the reproductive services provided in most regions are not designed with young people in mind and so may appear unwelcoming or unattractive. Health personnel are often ill-equipped to provide management and advice tailored to the needs of young people. However, there are positive elements to the study findings. The mould-breaking Model Youth Centers of the Family Guidance Association of Ethiopia demonstrate that it is possible to achieve accessible, attractive centers in which young peoples’ sexual and reproductive needs are tended to in the context of the wellbeing of the whole individual."
Educational resources
- Advocacy for Immunization
This step-by-step guide to advocacy for immunisation is published by the Global Alliance for Vaccines and Immunization. It covers preparation (building a plan, gathering information, creating messages and materials), outreach (building a coalition, engaging policymakers, working with the media, involving the public) and monitoring and evaluating. It includes a brief section of further sources of information (manuals, guides and websites) as well as examples and case studies.
- Avian Influenza
CIDRAP at the University of Minnesota's mission is to prevent illness and death from infectious diseases through epidemiologic research and the rapid translation of scientific information into real-world practical applications and solutions. The Avian Influenza page provides the latest news on outbreaks of the disease as well as a bibliography of relevant articles.
- Epidemiologic Case Studies
"These case studies are interactive exercises developed to teach epidemiologic principles and practices. They are based on real-life outbreaks and public health problems and were developed in collaboration with the original investigators and experts from the Centers for Disease Control and Prevention. The case studies require students to apply their epidemiologic knowledge and skills to problems confronted by public health practitioners at the local, state, and national level every day..."
- GlobalHealthFacts.org
GlobalHealthFacts.org, a project of the Henry J. Kaiser Family Foundation and companion site to GlobalHealthReporting.org, provides free, up-to-date and easy-to-access data by country on HIV/AIDS, tuberculosis, malaria and other key health and socioeconomic indicators.
- Global Map of Pandemic Risk
" Maplecroft Map's Global map of pandemic risk provides a perspective of the risk from emerging diseases in 161 countries across the world. It explores the risk posed to human health and, by association, economic activity in each country by an outbreak of a pandemic disease. Levels of risk shown on the map have been determined based on Maplecroft’s Pandemic Risk Index (PRI) which analyses three components of pandemic risk: The risk of emergence of a new human disease in each country, The risk of the spread of such a disease to and within each country, The capacity of each country to contain an outbreak of disease."
- HEALTHmap: Global Disease Alert Mapping System
HEALTHmap brings together disparate data sources to achieve a unified and comprehensive view of the current global state of infectious diseases and their effect on human and animal health. This freely available Web site integrates outbreak data of varying reliability, ranging from news sources (such as Google News) to curated personal accounts (such as ProMED) to validated official alerts (such as World Health Organization).
- Malaria Database (WHO/TDR)
This site is maintained by the Department of Microbiology. Monash University and the Walter Eliza Hall Institute of Medical Research, Melbourne. It is an information resource for scientists working in malaria research, containing a wide variety of information ranging from sequences to conference news.
- WHO Avian Influenza Page
The WHO Avian Influenza page provides situation updates, a timeline, travel warnings, FAQs, guidelines, recommendations and protocols as well as information on infection control, vaccines and anti-virals.
- WHO - Stop TB Initiative
Stop TB is a global movement to accelerate social and political action to stop the unnecessary spread of tuberculosis around the world. Its vision is a TB-free world: the first children born in this millennium will see TB eliminated in their lifetime.
- WHO-Program on: Emerging and other Communicable Diseases Surveillance and Control (EMC)
- WWW Virtual Library: Epidemiology
Organisations and Networks
UN and multinational
- WHO-PAHO, Communicable Diseases Program
Working with the WHO-coordinated Special Program for Research and Training in Tropical Diseases (TDR) to build research capacity in the Americas.
- PATH
"The Program for Appropriate Technology in Health (PATH) is an international, non-profit organization. Its mission is to improve health, especially the health of women and children. PATH works in partnership with host-country governments and local agencies to assess health problems and identify and implement creative and effective user-based solutions. PATH programs address a wide variety of topic areas: child and maternal health, reproductive health and family planning, communicable diseases, and financing"
- Malaria Foundation International
"This organisation aims to facilitate the development and implementation of solutions to the health, economic and social problems caused by malaria"
- Population Council: Horizons
HIV/AIDS poses a grave threat to families, societies, and economies worldwide. Nowhere is this truer than in developing countries, where more than 90 percent of all HIV infections have occurred. Since 1997, the Population Council has implemented Horizons under a cooperative agreement with the United States Agency for International Development (USAID). Horizons is one component of a larger USAID initiative to reduce HIV transmission and mitigate its effects in developing countries. Horizons also partners with other international organizations as well as national and community groups in countries around the world."
Government
- Australian Quarantine and Inspection Service (AQIS)
AQIS is Australia's first line of defence, protecting the Australian environment against exotic pests and diseases, it inspects incoming luggage, cargo, mail, animals and plants and their products, and provide inspection and certification for a range of exports.
- CDC National Centre for Infectious Disease
- CDC National Prevention Information Network
This is the United State’s largest collection of information and resources on HIV, STD and TB Prevention.
- Communicable Diseases Intelligence
A service on communicable diseases provided by the Australian National Centre for Disease Control
- Communicable Disease Surveillance Centre (Northern Ireland)
Communicable disease surveillance produces timely information for action, and the control of communicable disease involving not only doctors and nurses, but individuals from a wide variety of backgrounds e.g. farmers, vets, water engineers, environmental health officers and those working in the food industry.
- Health Canada - Information: Quarantine Services
This site describes the role of Canada's Quarantine Service, including the responsibilities of quarantine officers.
- Ministry of Agriculture and Forestry Quarantine Service
This site provides extensive information on the operation of New Zealand's Quarantine Service. It includes sections on live animals and plants, foodstuffs and diseases, quarantine restrictions and inspections and biosecurity.
- PandemicFlu.com
With the recent rise in flu outbreaks both across the United States and the rest of the world, the United States government has developed a broad range of strategies for keeping citizens up to date on the current status of these developments. The Pandemic Flu website is the official US government website for information on the subject (along with coverage of avian influenza).
- Victorian Infectious Diseases Reference Laboratory (Australia)
"Victoria's largest public health reference laboratory. Considerable expertise in the laboratory science of infectious diseases and public health are concentrated in this laboratory complex, together with specialist facilities and valuable reference collections of clinical material, reagents and epidemiological records"
Non Government
- Infectious Diseases Society of America
"An organization of physicians, scientists and other health care professionals dedicated to the promotion and recognition of excellence in research, patient care, public health, disease prevention and education in the field of infectious diseases"
- Epidemic!
The World of Infectious Diseases - an exhibition by the American Museum of Natural History
- HepNet
"HepNet focuses on the needs of the medical community, providing updates on patient care issues, serology, new clinical papers and news releases, as well as links to many other excellent hepatitis related sites"
- ProMED
"The global electronic reporting system for outbreaks of emerging infectious diseases & toxins, open to all sources. ProMED-mail, the Program for Monitoring Emerging Diseases, is a program of the International Society for Infectious Diseases."
- TropNetEurop
"TropNetEurop is an electronic network of clinical sites related to imported infectious diseases. The network is designed to effectively detect emerging infections of potential regional, national or global impact at their point of entry into the domestic population. Sentinel Surveillance reporting is carried out by participating sites by use of a standardised and computerised reporting system"
Academic Institutions with particular focus in this area
Conference reports
Journals, Newsletters, Forums
Bibliographies, Libraries
Public health bookshops
Original website founded Lucien E. Schlosser and Eberhard Wenzel, 1997.
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