The West African nation of Burkina Faso in December became the first country to begin a nationwide campaign to introduce a new meningitis vaccine that promises to rid the entire region of the primary cause of epidemic meningitis. The first vaccine designed specifically for Africa, MenAfriVac is expected to help health workers eliminate meningococcal A epidemics in the 25 countries of the meningitis belt, stretching from Senegal in the west to Ethiopia in the east.
Developed by the Meningitis Vaccine Project (MVP) a partnership between WHO and PATH, with support from the Bill & Melinda Gates Foundation the new meningococcal A conjugate vaccine MenAfriVac provides African health authorities, for the first time, with an affordable, long-term solution that protects even young children against meningitis A (group A Neisseria meningitidis).
Priced at less than US$0.50 per dose, MenAfriVac is a highly affordable solution to one of the region’s biggest health problems. Using a unique public-private partnership model, the development of MenAfriVac cost only $50 million – a fraction of the amount usually required to develop and bring a new vaccine to market.
For more than 100 years, sub-Saharan Africa has suffered from epidemics that exact a terrible and deadly toll. As many as 450 million people are at risk from the disease across Africa. Major group A epidemics occur every 7-14 years and are particularly devastating to children and young adults. The sickest patients typically die within 24 to 48 hours of the onset of symptoms, and of those who survive, 10-20% suffer brain damage, hearing loss or a learning disability. In 2009, the seasonal outbreak of menin gitis across a large swathe of sub- Saharan Africa infected at least 88 000 people and led to more than 5 000 deaths.
Seydou Bouda, Minister of Health of
Burkina Faso, said: “This historic event
signals the beginning of the end of a
disease that has brought sickness and
suffering to generations of Africans. The
unique collaborative effort that has made
this breakthrough possible is both testament
to the commitment of ministers of
health across Africa and the relentless
dedication of our technical partners in
developing a vaccine that specifically
meets the needs of countries in the
African meningitis belt.”
Health workers are at the frontline in providing prevention, treatment and care for people living with HIV and TB throughout the world. They are at risk of occupational exposure to HIV and TB but often themselves lack adequate access to protection and treatment. To address this gap, new international guidelines were launched in November 2010 by the International Labour Organization (ILO), WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS).
The new guidelines are important particularly for health workers in areas with high prevalence of HIV and TB, such as doctors, nurses and midwives, technical staff such as pharmacists and laboratory technicians, as well as health managers, cleaners, security guards and other support workers. There are an estimated 60 million health workers throughout the world.
“These guidelines directly aim to ensure that health workers have access to universal and standard precautions, preventive therapy for tuberculosis, HIV post-exposure prophylaxis, treatment, compensation schemes for occupational infection, and social security or occupational insurance at the workplace,” said Assane Diop, ILO Executive Director for the Social Protection Sector.
While UNAIDS, ILO and WHO have been championing universal access and making sure people have the right to access prevention, treatment, care and support for HIV and TB services, not enough attention has been paid to the needs of health workers. These guidelines help fill the response gap to reach towards the universal access objective.
“WHO recognises health workers’ risk of acquiring HIV or TB and the need for comprehensive occupational health and safety procedures,” said Dr Hiroki Nakatani, WHO assistant director- general for HIV/AIDS, Tuberculosis and Malaria. “These new guidelines provide key recommendations to protect health workers, patients and their families from the significant threat of HIV and TB in all our health facilities.”
The 14 action points provided in the guidelines are based on respect for workers’ rights as well as practical workplace health and safety programmes to ensure a safer work environment, active participation of health workers as well as public and private health services employers. The guidelines also address challenges such as the high level of stigma and discrimination associated with both diseases.
“Health workers are one of our most precious resources in the global response to both HIV and TB,” said Dr Paul De Lay, UNAIDS deputy executive director. “These new guidelines can ensure that health staff have access to the highest standards of TB and HIV prevention, treatment and care so they can stay healthy and continue caring for others.”
Sharan Burrow, general secretary of the International Trade Union Confederation, called them “a major breakthrough,” adding, “With these guidelines, the ILO, WHO and UNAIDS are providing an important and scientifically sound basis for safe working environments that prevent health workers’ infections caused by exposure at work.”
The guidelines which were developed jointly by experts from ILO,WHO and UNAIDS are based on systematic literature reviews, international consultations and an assessment of current practices in 21 country-based studies. They bring together a vast body of evidence and existing guidelines from the ILO, WHO and UNAIDS that now includes a specific and coherent focus on protecting health workers.
The Guidelines to protect health- workers
The US FDA in November last year launched an initiative aimed at facilitating the development of safer, more effective external defibrillators used to treat abnormal heart rhythms through improved design and manufacturing practices.
External defibrillators are used successfully thousands of times each year to treat sudden cardiac arrest. They are found increasingly in homes and in public settings such as airports and office buildings.
However, the FDA reports that during the past five years its Center for Devices and Radiological Health (CDRH) has received more than 28,000 medical device reports associated with the failures of external defibrillators and noted that manufacturers conducted dozens of recalls involving hundreds of thousands of the devices.
Many of the types of problems that CDRH has identified are preventable, correctable, and can impact patient safety. These problems include engineering design and manufacturing practices related to the adequate control of components bought from other suppliers.
“These devices play an important role in health care,” said CDRH director Jeffrey Shuren, MD. “The purpose of our initiative is to improve these technologies so we can save more lives.”
As a part of a broad initiative, CDRH
is taking steps to work with manufacturers,
users and experts in the field to
improve the engineering design and
manufacturing practices of these devices,
and facilitate the development of their
A first of its kind review of available scientific data on health care-associated infections in countries with limited resources shows this is a major patient safety problem in the developing world and indicates that better surveillance and reporting is essential to understand the magnitude of the problem and address it, according to a new study published 10 December 2010 in The Lancet.
These infections can prolong hospital stays, create long-term disability, increase resistance to life-saving medications, drive up costs for patients and their family, and even lead to death.
Although health care-associated infections are estimated to affect hundreds of millions of people globally, precise numbers remain unknown because of the difficulty in gathering reliable data worldwide. While national surveillance systems exist in many high-income countries, they are non-existent in the vast majority of middle- and low-income countries.
“Health care-associated infections have long been established as the biggest cause of avoidable harm and unnecessary death in the health systems of high income countries. We now know that the situation in developing countries is even worse. There, levels of health care-associated infection are at least twice as high,” says Dr Benedetta Allegranzi, technical lead for the Clean Care is Safer Care programme at the WHO and author of the study. “One in three patients having surgery in some settings with limited resources becomes infected. Solutions exist, and the time to act is now. The cost of delay is even more lives tragically lost.”
Several factors increase the risk of health care-associated infections, including:
. poor hygiene and waste disposal, . inadequate infrastructure and equipment . understaffing . overcrowding . lack of basic infection control knowledge and implementation, . unsafe procedures, and . a lack of guidelines and policies.
At the moment, however, there is no system in place in low- and middle- income settings to determine the likelihood and magnitude of the risk of infection associated with each of these factors.
“The number of health care-associated
infections should be much lower in high-
income countries, because we know what
works and we have the means to act.
Low- and middle-income countries face
many more challenges, but this does not
mean the problem is insurmountable.
Several interventions are simple and
low-cost,” says Professor Didier Pittet,
head of the Collaborating Centre on
Patient Safety at the University of
Geneva Hospitals and author on The
Globally, more than 600,000 deaths every year are caused by passive smoking (1% of all deaths) and around 165,000 of those killed are children, according to research published 22 November 2010 in The Lancet.
The University of Auckland’s Professor Alistair Woodward was a co-author of this study and the first to describe the health effects of second-hand smoke world-wide.
“The 1.2 billion smokers around the world are not only putting themselves at risk; they are harming the health of billions of non-smokers, and it is children who suffer most,” said Prof Woodward. The authors gathered information from 192 countries, and estimated the effects of passive smoking on both deaths and years lost of life in good health (DALYs).
Worldwide, they estimated 40% of children, 33% of male non-smokers, and 35% of female non-smokers were regularly exposed to second-hand smoke in 2004.
Prof Woodward and his colleagues estimate this exposure led to approximately 379,000 deaths from ischaemic heart disease, 165,000 from lower respiratory infections, 36,900 from asthma, and 21,400 from lung cancer.
In total, 603,000 deaths were attributable to second-hand smoke. 47% of those deaths occurred in women, 28% in children, and 26% in men.
DALYs lost because of exposure to second-hand smoke amounted to 10.9 million, which was about 0.7% of total worldwide burden of diseases in DALYs in 2004.
Women suffered most from secondhand smoke as they are 60% more likely to be non-smokers than men (men are more often ‘first-hand’ smokers) and women are 50% more likely to be exposed to second-hand smoke than men.
Children were more heavily exposed to second-hand smoke than any other age-group, and they are not able to avoid the main source of exposure – mainly their close relatives who smoke at home. In terms of years of life in good health lost due to passive smoking, children were most affected. This is a result of pneumonia and other acute respiratory illnesses that are much more common amongst children living with adults who smoke.
“Passive smoking is a global health issue,” said Prof Woodward. “We have made great progress in New Zealand and many other high income countries. But billions of people are still exposed, needlessly, to second hand smoke. This paper puts a figure on the cost, globally, in premature deaths and loss of good health. We hope our findings will spur policy makers to take action. We know what works in tobacco control – what is needed is leadership and political commitment.”
The authors made three key recommendations: . The immediate enforcement of WHO’s Framework Convention on Tobacco Control.
. The inclusion for complementary educational strategies, like voluntary smoke-free home policies for those countries which already have smoke- free laws.
The need to dispel the myth that
developing countries can wait to deal
with tobacco-related diseases until
they have dealt with infectious
diseases. Together, tobacco smoke and
infections lead to substantial, avoidable
mortality and loss of active life-
years of children.
Physicians, nurses and other health care providers can have some of the most upto- date information on the growing diabetes epidemic at their fingertips, thanks to the release of a new Johns Hopkins guide to the disease now available on all smart phone devices.
The POC-IT Diabetes Guide is a portable, easily searchable and quickly navigated resource written by Johns Hopkins physicians to help providers, particularly during patient visits, make the best clinical decisions, its developers say. The guide provides real-time evidence-based advice on everything from diabetes management to complications to medications.
“It offers almost instant, at-a-glance access to the latest consensus guidelines and expert opinions on a broad spectrum of topics in diabetes care,” says Rita Rastogi Kalyani, MD, an assistant professor of medicine in the Division of Endocrinology at the Johns Hopkins University School of Medicine and the guide’s managing editor. “Hopkins’ mission is to share its knowledge with the world and this is a practical way to do that.”
The Johns Hopkins Point-of-Care
Information Technology Center (POCIT)
produces electronic clinical decision support resources to help health care
professionals raise the standard of care
and improve patient safety. The POC-IT
Diabetes Guide was developed by Johns
Hopkins clinical experts with funding
support from the Trinidad and Tobago
Health Sciences Initiative, a project
under the management of Johns Hopkins
The Diabetes Guide is available on
smart phones and the Web. A print
version will be released in the spring of
2011. The electronic guide will be regularly
updated with the latest developments
in diabetes care. This is the third
POC-IT guide developed at Johns
Hopkins, with successful guides on
antibiotics and HIV already on the
Parties to the World Health Organisation Framework Convention on Tobacco Control (WHO FCTC) unanimously adopted a number of decisions in late November strengthening tobacco- control efforts worldwide.
The fourth session of the Conference of the Parties (COP4) comes as a number of countries are facing growing pressure from the tobacco industry.
In response, Parties to the Convention adopted a Declaration proposed by the host country, Uruguay, reaffirming their strong commitment to prioritise health measures and to exchange information on the industry’s activities which attempt to interfere with the implementation of public health policies.
The Uruguay meeting reviewed the progress in implementation of the Convention and adopted new guidelines that provide further direction to Parties on how to implement several of the treaty’s provisions.
The Conference decided that: . flavouring ingredients that increase attractiveness of tobacco products should be regulated in order to reduce the number of new smokers, especially among youth;
. smoking cessation services should be integrated into national health systems to make them more available for increasing number of smokers who wish to quit; and
. parties should establish an infrastructure and build capacity to support education, communication and training, thereby raising public awareness and promoting social change. The report on price and taxation policy of tobacco products was discussed and delegations agreed to establish a working group tasked with further work and possibly preparing the guidelines for implementation.
The work on economically sustainable alternatives to tobacco growing will be extended in order to find appropriate policy options and recommendations.
The delegations also decided that negotiations on a protocol to combat illicit trade in tobacco products should continue with the aim of completion in 2012.
In addition, Parties adopted decisions engaging cooperation with international organisations and bodies in promoting treaty implementation and strengthening assistance to developing countries to meet their obligation under the Convention.
The Conference of the Parties also decided to harmonise the data collection initiatives in the area of tobacco control and to synchronise the cycle of Parties' implementation reports to the biennial cycle of the sessions of the COP.
The Conference is the governing body of the WHO FCTC and, as of November 2010, is comprised of 171 Parties to the Convention. The WHO FCTC is the first international treaty negotiated under the auspices of WHO and provides a new legal dimension for international health cooperation.
WHO Framework Convention
on Tobacco Control
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