Bulletin of the World Health Organizationhttps://www.scielosp.org/feed/bwho/2014.v92n5/2016-01-01T00:02:00ZUnknown authorVol. 92 No. 5 - 2014WerkzeugIn this month’s Bulletin10.2471/BLT.14.0005142016-01-01T00:02:00Z2001-01-28T00:08:00ZInternational Health Regulations (2005): taking stock10.2471/BLT.14.1389902016-01-01T00:02:00Z2001-01-28T00:08:00ZNuttall, Isabelle
<em>Nuttall, Isabelle</em>;
<br/><br/>
Influenza seasonality: timing and formulation of vaccines10.2471/BLT.14.1394282016-01-01T00:02:00Z2001-01-28T00:08:00ZCox, Nancy
<em>Cox, Nancy</em>;
<br/><br/>
Public health round-up10.2471/BLT.14.0105142016-01-01T00:02:00Z2001-01-28T00:08:00ZThe immunization programme that saved millions of lives10.2471/BLT.14.0205142016-01-01T00:02:00Z2001-01-28T00:08:00Z
What started as an ambitious effort to tackle six vaccine-preventable diseases has become one of the world’s most successful public health programmes. This month the Expanded Programme on Immunization marks its 40 years. Michael Reid and Fiona Fleck report.Collaboration is key for new global tuberculosis strategy10.2471/BLT.14.0305142016-01-01T00:02:00Z2001-01-28T00:08:00Z
This month the World Health Assembly discusses the post-2015 global tuberculosis strategy and accompanying set of targets. Giovanni Battista Migliori tells Fiona Fleck how his institute – one of WHO’s thousands of partners across the globe – can contribute in future to its implementation, once it is approved.Influenza seasonality and vaccination timing in tropical and subtropical areas of southern and south-eastern Asia10.2471/BLT.13.1244122016-01-01T00:02:00Z2001-01-28T00:08:00ZSaha, SiddharthaChadha, MandeepAl Mamun, AbdullahRahman, MahmudurSturm-Ramirez, KatharineChittaganpitch, MalineePattamadilok, SirimaOlsen, Sonja JSampurno, Ondri DwiSetiawaty, ViviPangesti, Krisna Nur AndrianaSamaan, GinaArchkhawongs, SibounhomVongphrachanh, PhengtaPhonekeo, DarounyCorwin, AndrewTouch, SokBuchy, PhilippeChea, NoraKitsutani, PaulMai, Le QuynhThiem, Vu DinhLin, RaymondLow, ConstanceKheong, Chong CheeIsmail, NorizahYusof, Mohd ApandiTandoc III, AmadoRoque Jr, VitoMishra, AkhileshMoen, Ann CWiddowson, Marc-AlainPartridge, JeffreyLal, Renu B
<em>Saha, Siddhartha</em>;
<em>Chadha, Mandeep</em>;
<em>Al Mamun, Abdullah</em>;
<em>Rahman, Mahmudur</em>;
<em>Sturm-Ramirez, Katharine</em>;
<em>Chittaganpitch, Malinee</em>;
<em>Pattamadilok, Sirima</em>;
<em>Olsen, Sonja J</em>;
<em>Sampurno, Ondri Dwi</em>;
<em>Setiawaty, Vivi</em>;
<em>Pangesti, Krisna Nur Andriana</em>;
<em>Samaan, Gina</em>;
<em>Archkhawongs, Sibounhom</em>;
<em>Vongphrachanh, Phengta</em>;
<em>Phonekeo, Darouny</em>;
<em>Corwin, Andrew</em>;
<em>Touch, Sok</em>;
<em>Buchy, Philippe</em>;
<em>Chea, Nora</em>;
<em>Kitsutani, Paul</em>;
<em>Mai, Le Quynh</em>;
<em>Thiem, Vu Dinh</em>;
<em>Lin, Raymond</em>;
<em>Low, Constance</em>;
<em>Kheong, Chong Chee</em>;
<em>Ismail, Norizah</em>;
<em>Yusof, Mohd Apandi</em>;
<em>Tandoc Iii, Amado</em>;
<em>Roque Jr, Vito</em>;
<em>Mishra, Akhilesh</em>;
<em>Moen, Ann C</em>;
<em>Widdowson, Marc-Alain</em>;
<em>Partridge, Jeffrey</em>;
<em>Lal, Renu B</em>;
<br/><br/>
Objective To characterize influenza seasonality and identify the best time of the year for vaccination against influenza in tropical and subtropical countries of southern and south-eastern Asia that lie north of the equator. Methods Weekly influenza surveillance data for 2006 to 2011 were obtained from Bangladesh, Cambodia, India, Indonesia, the Lao People's Democratic Republic, Malaysia, the Philippines, Singapore, Thailand and Viet Nam. Weekly rates of influenza activity were based on the percentage of all nasopharyngeal samples collected during the year that tested positive for influenza virus or viral nucleic acid on any given week. Monthly positivity rates were then calculated to define annual peaks of influenza activity in each country and across countries. Findings Influenza activity peaked between June/July and October in seven countries, three of which showed a second peak in December to February. Countries closer to the equator had year-round circulation without discrete peaks. Viral types and subtypes varied from year to year but not across countries in a given year. The cumulative proportion of specimens that tested positive from June to November was > 60% in Bangladesh, Cambodia, India, the Lao People's Democratic Republic, the Philippines, Thailand and Viet Nam. Thus, these tropical and subtropical countries exhibited earlier influenza activity peaks than temperate climate countries north of the equator. Conclusion Most southern and south-eastern Asian countries lying north of the equator should consider vaccinating against influenza from April to June; countries near the equator without a distinct peak in influenza activity can base vaccination timing on local factors.Can vouchers deliver? An evaluation of subsidies for maternal health care in Cambodia10.2471/BLT.13.1291222016-01-01T00:02:00Z2001-01-28T00:08:00ZVan de Poel, EllenFlores, GabrielaIr, PorO?Donnell, OwenVan Doorslaer, Eddy
<em>Van De Poel, Ellen</em>;
<em>Flores, Gabriela</em>;
<em>Ir, Por</em>;
<em>O?donnell, Owen</em>;
<em>Van Doorslaer, Eddy</em>;
<br/><br/>
Objective To evaluate the effect of vouchers for maternity care in public health-care facilities on the utilization of maternal health-care services in Cambodia. Methods The study involved data from the 2010 Cambodian Demographic and Health Survey, which covered births between 2005 and 2010. The effect of voucher schemes, first implemented in 2007, on the utilization of maternal health-care services was quantified using a difference-in-differences method that compared changes in utilization in districts with voucher schemes with changes in districts without them. Findings Overall, voucher schemes were associated with an increase of 10.1 percentage points (pp) in the probability of delivery in a public health-care facility; among women from the poorest 40% of households, the increase was 15.6 pp. Vouchers were responsible for about one fifth of the increase observed in institutional deliveries in districts with schemes. Universal voucher schemes had a larger effect on the probability of delivery in a public facility than schemes targeting the poorest women. Both types of schemes increased the probability of receiving postnatal care, but the increase was significant only for non-poor women. Universal, but not targeted, voucher schemes significantly increased the probability of receiving antenatal care. Conclusion Voucher schemes increased deliveries in health centres and, to a lesser extent, improved antenatal and postnatal care. However, schemes that targeted poorer women did not appear to be efficient since these women were more likely than less poor women to be encouraged to give birth in a public health-care facility, even with universal voucher schemes.Monitoring progress towards the elimination of measles in China: an analysis of measles surveillance data10.2471/BLT.13.1301952016-01-01T00:02:00Z2001-01-28T00:08:00ZMa, ChaoHao, LixinZhang, YanSu, QiruRodewald, LanceAn, ZhijieYu, WenzhouMa, JingWen, NingWang, HuilingLiang, XiaofengWang, HuaqingYang, WeizhongLi, LiLuo, Huiming
<em>Ma, Chao</em>;
<em>Hao, Lixin</em>;
<em>Zhang, Yan</em>;
<em>Su, Qiru</em>;
<em>Rodewald, Lance</em>;
<em>An, Zhijie</em>;
<em>Yu, Wenzhou</em>;
<em>Ma, Jing</em>;
<em>Wen, Ning</em>;
<em>Wang, Huiling</em>;
<em>Liang, Xiaofeng</em>;
<em>Wang, Huaqing</em>;
<em>Yang, Weizhong</em>;
<em>Li, Li</em>;
<em>Luo, Huiming</em>;
<br/><br/>
Objective To analyse the epidemiology of measles in China and determine the progress made towards the national elimination of the disease. Methods We analysed measles surveillance data – on the age, sex, residence and vaccination status of each case and the corresponding outcome, dates of onset and report and laboratory results – collected between January 2005 and October 2013. Findings Between 2005 and October 2013, 596 391 measles cases and 368 measles-related deaths were reported in China. Annual incidence, in cases per 100 000 population, decreased from 9.95 in 2008 to 0.46 in 2012 but then rose to more than 1.96 in 2013. The number of provinces that reported an annual incidence of less than one case per million population increased from one in 2009 to 15 in 2012 but fell back to one in 2013. Median case age decreased from 83 months in 2005 to 14 months in 2012 and 11 months in January to October 2013. Between 2008 and 2012, the incidence of measles in all age groups, including those not targeted for vaccination, decreased by at least 93.6%. However, resurgence started in late 2012 and continued into 2013. Of the cases reported in January to October 2013, 40% were aged 8 months to 6 years. Conclusion Although there is evidence of progress towards the elimination of measles from China, resurgence in 2013 indicated that many children were still not being vaccinated on time. Routine immunization must be strengthened and the remaining immunity gaps need to be identified and filled.Effect of having a subsequent child on the mental health of women who lost a child in the 2008 Sichuan earthquake: a cross-sectional study10.2471/BLT.13.1246772016-01-01T00:02:00Z2001-01-28T00:08:00ZXu, YaoHerrman, HelenBentley, RebeccaTsutsumi, AtsuroFisher, Jane
<em>Xu, Yao</em>;
<em>Herrman, Helen</em>;
<em>Bentley, Rebecca</em>;
<em>Tsutsumi, Atsuro</em>;
<em>Fisher, Jane</em>;
<br/><br/>
Objective To assess whether having a subsequent child had an effect on the mental health of Chinese mothers who lost a child during an earthquake. Methods A cross-sectional survey of bereaved mothers was conducted 30 to 34 months after the 2008 Sichuan earthquake using individual structured interviews to assess sociodemographic characteristics, post-disaster experiences and mental health. The interviews incorporated standardized psychometric measures of anxiety, depression, post-traumatic stress disorder (PTSD) and complicated grief (CG). Social support was also assessed. An adjusted model taking potential confounders into account was used to explore any association between psychological symptoms and the birth of a subsequent child. Findings The prevalence of psychological symptoms was higher in mothers who did not have a child after losing the first one. In an adjusted model, symptoms of anxiety (odds ratio, OR: 3.37; 95% confidence interval, CI: 1.51–7.50), depression (OR: 9.47; 95% CI: 2.58–34.80), PTSD (OR: 5.11; 95% CI: 2.31–11.34) and CG (OR: 10.73; 95% CI: 1.88–61.39) were significantly higher among the 116 women without a subsequent child than among the 110 mothers who had another child after bereavement. More than two thirds of the mothers with new infants had clinically important psychological symptoms. Conclusion Women who have lost an only child in a natural disaster are especially vulnerable to long-term psychological problems, especially if they have reached an age when conception is difficult. Research should focus on developing and evaluating interventions designed to provide women with psychosocial support and reproductive services.Prevention and control of neglected tropical diseases: overview of randomized trials, systematic reviews and meta-analyses10.2471/BLT.13.1296012016-01-01T00:02:00Z2001-01-28T00:08:00ZKappagoda, ShanthiIoannidis, John PA
<em>Kappagoda, Shanthi</em>;
<em>Ioannidis, John Pa</em>;
<br/><br/>
Objective To analyse evidence from randomized controlled trials (RCTs) on the prevention and control of neglected tropical diseases (NTDs) and to identify areas where evidence is lacking. Methods The Cochrane Central Register of Controlled Trials and PubMed were searched for RCTs and the Cochrane Database of Systematic Reviews and PubMed were searched for meta-analyses and systematic reviews, both from inception to 31 December 2012. Findings Overall, 258 RCTs were found on American trypanosomiasis, Buruli ulcer, dengue, geohelminth infection, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, rabies, schistosomiasis or trachoma. No RCTs were found on cysticercosis, dracunculiasis, echinococcosis, foodborne trematodes, or human African trypanosomiasis. The most studied diseases were geohelminth infection (51 RCTs) and leishmaniasis (46 RCTs). Vaccines, chemoprophylaxis and interventions targeting insect vectors were evaluated in 113, 99 and 39 RCTs, respectively. Few addressed how best to deliver preventive chemotherapy, such as the choice of dosing interval (10) or target population (4), the population coverage needed to reduce transmission (2) or the method of drug distribution (1). Thirty-one publications containing 32 systematic reviews (16 with and 16 without meta-analyses) were found on American trypanosomiasis, dengue, geohelminths, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, schistosomiasis or trachoma. Together, they included only 79 of the 258 published RCTs (30.6%). Of 36 interventions assessed, 8 were judged effective in more than one review. Conclusion Few RCTs on the prevention or control of the principal NTDs were found. Trials on how best to deliver preventive chemotherapy were particularly rare.The global burden of disabling hearing impairment: a call to action10.2471/BLT.13.1287282016-01-01T00:02:00Z2001-01-28T00:08:00ZOlusanya, Bolajoko ONeumann, Katrin JSaunders, James E
<em>Olusanya, Bolajoko O</em>;
<em>Neumann, Katrin J</em>;
<em>Saunders, James E</em>;
<br/><br/>
At any age, disabling hearing impairment has a profound impact on interpersonal communication, psychosocial well-being, quality of life and economic independence. According to the World Health Organization’s estimates, the number of people with such impairment increased from 42 million in 1985 to about 360 million in 2011. This last figure includes 7.5 million children less than 5 years of age. In 1995, a “roadmap” for curtailing the burden posed by disabling hearing impairment was outlined in a resolution of the World Health Assembly. While the underlying principle of this roadmap remains valid and relevant, some updating is required to reflect the prevailing epidemiologic transition. We examine the traditional concept and grades of disabling hearing impairment – within the context of the International Classification of Functioning, Disability and Health – as well as the modifications to grading that have recently been proposed by a panel of international experts. The opportunity offered by the emerging global and high-level interest in promoting disability-inclusive post-2015 development goals and disability-free child survival is also discussed. Since the costs of rehabilitative services are so high as to be prohibitive in low- and middle-income countries, the critical role of primary prevention is emphasized. If the goals outlined in the World Health Assembly’s 1995 resolution on the prevention of hearing impairment are to be reached by Member States, several effective country-level initiatives – including the development of public–private partnerships, strong leadership and measurable time-bound targets – will have to be implemented without further delay.Community-based prevention of hepatitis-B-related liver cancer: Australian insights10.2471/BLT.13.1303442016-01-01T00:02:00Z2001-01-28T00:08:00ZRobotin, Monica CKansil, Melanie QPorwal, MamtaPenman, Andrew GGeorge, Jacob
<em>Robotin, Monica C</em>;
<em>Kansil, Melanie Q</em>;
<em>Porwal, Mamta</em>;
<em>Penman, Andrew G</em>;
<em>George, Jacob</em>;
<br/><br/>
Problem Although most primary hepatocellular cancers (HCCs) are attributable to chronic viral hepatitis and largely preventable, such cancers remain a leading cause of cancer-related mortality wherever chronic hepatitis B is endemic. Approach Many HCCs could be prevented by increasing awareness and knowledge of hepatitis B, optimizing the monitoring of chronic hepatitis B and using antiviral treatments – but there are gaps in the implementation of such strategies. Local setting The “B Positive” programme, based in Sydney, Australia, is designed to improve hepatitis-B-related health outcomes among immigrants from countries with endemic hepatitis B. The programme offers information about disease screening, vaccination and treatment options, as well as optimized access to care. Relevant changes The B Positive programme has been informed by economic modelling. The programme offers culturally tailored education on chronic hepatitis B to target communities and their health practitioners and regular follow-up through a population-based registry of cases. Lessons learnt As the costs of screening for chronic hepatitis B and follow-up are relatively low and less than one in every four cases may require antiviral drugs, optimizing access to treatment seems an appropriate and cost-effective management option. The identification and accurate staging of cases and the judicious use of antiviral medications are predicated upon an informed and educated health workforce. As establishing community trust is a lengthy process, delaying the implementation of programmes against chronic hepatitis B until antiviral drugs become cheaper is unwarranted.Intimate partner violence against women and victim-blaming attitudes among Europeans10.2471/BLT.13.1313912016-01-01T00:02:00Z2001-01-28T00:08:00ZGracia, Enrique
<em>Gracia, Enrique</em>;
<br/><br/>
Health system cost of delivering routine vaccination in low- and lower-middle income countries: what is needed over the next decade?10.2471/BLT.13.1301462016-01-01T00:02:00Z2001-01-28T00:08:00ZLydon, PatrickGandhi, GianVandelaer, JosOkwo-Bele, Jean-Marie
<em>Lydon, Patrick</em>;
<em>Gandhi, Gian</em>;
<em>Vandelaer, Jos</em>;
<em>Okwo-Bele, Jean-Marie</em>;
<br/><br/>