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Lassa Fever: A WHO Review

WHO

Key Facts

  • Lassa fever is an acute viral haemorrhagic illness of 2-21 days duration that occurs in West Africa.
  • The Lassa virus is transmitted to humans via contact with food or household items contaminated with rodent urine or faeces.
  • Person-to-person infections and laboratory transmission can also occur, particularly in hospitals lacking adequate infection prevention and control measures.
  • Lassa fever is known to be endemic in Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Nigeria, but probably exists in other West African countries as well.
  • The overall case-fatality rate is 1%. Observed case-fatality rate among patients hospitalized with severe cases of Lassa fever is 15%.
  • Early supportive care with rehydration and symptomatic treatment improves survival.
Background

Though first described in the 1950s, the virus causing Lassa disease was not identified until 1969. The virus is a single-stranded RNA virus belonging to the virus family Arenaviridae.

About 80% of people who become infected with Lassa virus have no symptoms. 1 in 5 infections result in severe disease, where the virus affects several organs such as the liver, spleen and kidneys.

Lassa fever is a zoonotic disease, meaning that humans become infected from contact with infected animals. The animal reservoir, or host, of Lassa virus is a rodent of the genus Mastomys, commonly known as the “multimammate rat.” Mastomys rats infected with Lassa virus do not become ill, but they can shed the virus in their urine and faeces.

Because the clinical course of the disease is so variable, detection of the disease in affected patients has been difficult. When presence of the disease is confirmed in a community, however, prompt isolation of affected patients, good infection prevention and control practices, and rigorous contact tracing can stop outbreaks.

Lassa fever is known to be endemic in Benin (where it was diagnosed for the first time in November 2014), Ghana (diagnosed for the first time in October 2011), Guinea, Liberia, Mali (diagnosed for the first time in February 2009), Sierra Leone, and Nigeria, but probably exists in other West African countries as well.

Symptoms of Lassa fever

The incubation period of Lassa fever ranges from 6–21 days. The onset of the disease, when it is symptomatic, is usually gradual, starting with fever, general weakness, and malaise. After a few days, headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough, and abdominal pain may follow. In severe cases facial swelling, fluid in the lung cavity, bleeding from the mouth, nose, vagina or gastrointestinal tract and low blood pressure may develop.

Protein may be noted in the urine. Shock, seizures, tremor, disorientation, and coma may be seen in the later stages. Deafness occurs in 25% of patients who survive the disease. In half of these cases, hearing returns partially after 1–3 months. Transient hair loss and gait disturbance may occur during recovery.

Death usually occurs within 14 days of onset in fatal cases. The disease is especially severe late in pregnancy, with maternal death and/or fetal loss occurring in more than 80% of cases during the third trimester.

Transmission

Humans usually become infected with Lassa virus from exposure to urine or faeces of infected Mastomys rats. Lassa virus may also be spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of a person infected with Lassa fever. There is no epidemiological evidence supporting airborne spread between humans. Person-to-person transmission occurs in both community and health-care settings, where the virus may be spread by contaminated medical equipment, such as re-used needles. Sexual transmission of Lassa virus has been reported.

Lassa fever occurs in all age groups and both sexes. Persons at greatest risk are those living in rural areas where Mastomys are usually found, especially in communities with poor sanitation or crowded living conditions. Health workers are at risk if caring for Lassa fever patients in the absence of proper barrier nursing and infection prevention and control practices.

Diagnosis

Because the symptoms of Lassa fever are so varied and non-specific, clinical diagnosis is often difficult, especially early in the course of the disease. Lassa fever is difficult to distinguish from other viral haemorrhagic fevers such as Ebola virus disease as well as other diseases that cause fever, including malaria, shigellosis, typhoid fever and yellow fever.

Definitive diagnosis requires testing that is available only in reference laboratories. Laboratory specimens may be hazardous and must be handled with extreme care. Lassa virus infections can only be diagnosed definitively in the laboratory using the following tests:

  • reverse transcriptase polymerase chain reaction (RT-PCR) assay
  • antibody enzyme-linked immunosorbent assay (ELISA)
  • antigen detection tests
  • virus isolation by cell culture.
Treatment and prophylaxis

The antiviral drug ribavirin seems to be an effective treatment for Lassa fever if given early on in the course of clinical illness. There is no evidence to support the role of ribavirin as post-exposure prophylactic treatment for Lassa fever.

There is currently no vaccine that protects against Lassa fever.

Prevention and control

Prevention of Lassa fever relies on promoting good “community hygiene” to discourage rodents from entering homes. Effective measures include storing grain and other foodstuffs in rodent-proof containers, disposing of garbage far from the home, maintaining clean households and keeping cats. Because Mastomys are so abundant in endemic areas, it is not possible to completely eliminate them from the environment. Family members should always be careful to avoid contact with blood and body fluids while caring for sick persons.

In health-care settings, staff should always apply standard infection prevention and control precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.

Health-care workers caring for patients with suspected or confirmed Lassa fever should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding. When in close contact (within 1 metre) of patients with Lassa fever, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Lassa virus infection should be handled by trained staff and processed in suitably equipped laboratories under maximum biological containment conditions.

On rare occasions, travellers from areas where Lassa fever is endemic export the disease to other countries. Although malaria, typhoid fever, and many other tropical infections are much more common, the diagnosis of Lassa fever should be considered in febrile patients returning from West Africa, especially if they have had exposures in rural areas or hospitals in countries where Lassa fever is known to be endemic. Health-care workers seeing a patient suspected to have Lassa fever should immediately contact local and national experts for advice and to arrange for laboratory testing.

Lassa Fever in Sierra Leone


WHO: Global Burn Registry

WHO

The Global Burn Registry is based upon a brief data collection form that has been developed by WHO and a global network of experts and widely pilot tested. It provides the opportunity to move from a range of fragmented approaches to an improved, standardized, and global data collection system for this important public health problem.

Registering to participate in the Global Burn Registry is straight forward and carried out through this website on the pages that follow. Upon registration, the data collection form and guidance on how to use it are sent to the focal person who registered the health facility to participate. The form is available in English, French and Spanish and takes approximately 5 minutes to complete or upload.

Data can be accessed through the online Global Burn Registry interface maintained by WHO. The interface allows users to view data from their health facility as well as all other participating health facilities. The data gives health facilities a clear picture of the major risk factors and populations at risk for burns in their setting, as well as how these compare and contrast with other settings. This information is key to identifying and prioritizing programmes to prevent burn injuries. Data can be viewed online or exported for further analysis.

WHO recommends that all persons interested in either accessing and using the data in the Global Burn Registry, or registering their health facility to participate in the Global Burn Registry, should first read a brief Frequently Asked Questions (FAQ) document which provides answers to the most commonly asked questions about the Global Burn Registry. At the bottom of the FAQ there is a link for those who wish to register their health facility to participate in the Global Burn Registry as well as a link for those persons who wish to know more about accessing and using the data in the Global Burn Registry.

 

 

 


Donors pledge over US$15 million to WHO’s Contingency Fund for Emergencies

WHO

WHO

27 March 2018 – Donors have pledged an additional US$15.3 million to support quick action by the World Health Organization to tackle disease outbreaks and humanitarian health crises through its emergency response fund in 2018, the Contingency Fund for Emergencies (CFE).

Canada, Denmark, Estonia, Germany, the Republic of Korea, Kuwait, Luxembourg, Malta, Netherlands, Norway, and the United Kingdom of Great Britain and Northern Ireland announced contributions ranging from US$20,000 to US$5.6 million at a conference hosted at WHO headquarters in Geneva, Switzerland on Monday (March 26) – increasing CFE funding levels to US$23 million.

This will enable the rapid financing of health response operations in the coming months – filling that critical gap between the moment the need for an emergency response is identified and the point at which funds from other sources can be released. WHO will seek to secure further donor commitments to achieve its US$100 million funding target for the 2018/2019 biennium.

First-time pledges were made by Denmark, Kuwait, Luxembourg, Malta and Norway. The UK has increased its overall commitment to the fund from US$10.5 million to US$16 million, making it the second largest donor after Germany.

“For the UK, the CFE is an extraordinarily good investment. We are convinced it has a vital and unique role to play in the global effort to prevent and mitigate health emergencies. Today we pledge an additional £4 million (US$5.6 million) for the Contingency Fund and pledge to work with WHO to better profile to a wider audience the huge value it brings. The G7 and the G20 share the UK’s desire for an adequately funded CFE. We urge our fellow Member States and donors to heed WHO’s call and to step forward to provide financial support for the Contingency Fund for Emergencies,” said Alistair Burt, UK Minister of State for International Development.

The CFE’s ability to release funds within 24 hours sets it apart from complementary financing mechanisms that have different funding criteria and slower disbursement cycles. While other funding mechanisms allow for the scale up of response operations, none are designed to deliver an immediate and early response. The CFE has demonstrated that a small investment can save lives and dramatically reduce the direct costs of controlling outbreaks and responding to emergencies.

“Without the CFE, recent outbreaks of Ebola in DRC, Marburg virus Disease in Uganda and pneumonic plague in Madagascar could have gotten out of control. By acting decisively and quickly, we can stop disease outbreaks and save thousands of lives for a fraction of the cost of a late response. The CFE has proven its value as a global public good that should be underwritten by long term investment,” said Dr Peter Salama, WHO Deputy Director General for Emergency Preparedness and Response.

Since 2015, the CFE has enabled WHO, national authorities and health partners to get quick starts on more than 50 disease outbreaks, humanitarian crises and natural disasters, allocating more than US$46 million. It has supported the rapid deployment of experts; better disease detection and reporting; the delivery of essential medicines, supplies and personal protective equipment; the strengthening of surveillance and vaccination; improved access to water, sanitation and health services; community engagement; and more.

Madagascar’s health minister Dr Lalatiana Andriamanarivo called for increased support for the CFE, saying it was instrumental to containing an unprecedented outbreak of pneumonic plague that rapidly spread across the island nation in 2017.

“We call on our international partners to support the Contingency Fund for Emergencies to enable WHO to respond to outbreaks everywhere across the world, and to reinforce national capacities to manage health emergencies in the future,” said Dr Andriamanarivo.

In 2017, the CFE provided nearly US$21 million for operations in 23 countries, with most allocations released within 24 hours. Over half (56%) of allocations funded responses in the WHO Africa region, with 28% going to responses in countries in the WHO Eastern Mediterranean Region and 11% to the South East Asia Region.

Note to editors

The WHO Health Emergencies Programme has three funding categories: the core budget that covers essential functions; the appeals budget that covers the additional work done in response to acute and protracted health emergencies; and the WHO Contingency Fund for Emergencies.

The Contingency Fund for Emergencies is replenished through donor contributions outside of the WHO Health Emergencies Programme core budget. Contributions are pooled and flexible, rather than earmarked for specific activities.

For more information, please contact:

Tarik Jašarević
Communications Officer
Telephone : +41 22 791 5099
Mobile: +41 793 676 214
E-mail: jasarevict@who.int

Pledges announced at the CFE Pledging Conference 26 March 2018


OpenWHO is WHO’s new interactive, web-based, knowledge-transfer platform offering online courses to improve the response to health emergencies.

WHO

OpenWHO enables the Organization and its key partners to transfer life-saving knowledge to large numbers of frontline responders.


WHO: List of Blueprint priority diseases

WHO

List of Blueprint priority diseases

2018 annual review of the Blueprint list of priority diseases

For the purposes of the R&D Blueprint, WHO has developed a special tool for determining which diseases and pathogens to prioritize for research and development in public health emergency contexts. This tool seeks to identify those diseases that pose a public health risk because of their epidemic potential and for which there are no, or insufficient, countermeasures. The diseases identified through this process are the focus of the work of R& D Blueprint. This is not an exhaustive list, nor does it indicate the most likely causes of the next epidemic.

The first list of prioritized diseases was released in December 2015.

Using a published prioritization methodology, the list was first reviewed in January 2017.

The second annual review occurred 6-7 February, 2018. Experts consider that given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines, there is an urgent need for accelerated research and development for*:

  • Crimean-Congo haemorrhagic fever (CCHF)
  • Ebola virus disease and Marburg virus disease
  • Lassa fever
  • Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
  • Nipah and henipaviral diseases
  • Rift Valley fever (RVF)
  • Zika
  • Disease X

Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease, and so the R&D Blueprint explicitly seeks to enable cross-cutting R&D preparedness that is also relevant for an unknown “Disease X” as far as possible.

A number of additional diseases were discussed and considered for inclusion in the priority list, including: Arenaviral hemorrhagic fevers other than Lassa Fever; Chikungunya; highly pathogenic coronaviral diseases other than MERS and SARS; emergent non-polio enteroviruses (including EV71, D68); and Severe Fever with Thrombocytopenia Syndrome (SFTS).

These diseases pose major public health risks and further research and development is needed, including surveillance and diagnostics. They should be watched carefully and considered again at the next annual review. Efforts in the interim to understand and mitigate them are encouraged.

Although not included on the list of diseases to be considered at the meeting, monkeypox and leptospirosis were discussed and experts stressed the risks they pose to public health. There was agreement on the need for: rapid evaluation of available potential countermeasures; the establishment of more comprehensive surveillance and diagnostics; and accelerated research and development and public health action.

Several diseases were determined to be outside of the current scope of the Blueprint: dengue, yellow fever, HIV/AIDs, tuberculosis, malaria, influenza causing severe human disease, smallpox, cholera, leishmaniasis, West Nile Virus and plague. These diseases continue to pose major public health problems and further research and development is needed through existing major disease control initiatives, extensive R&D pipelines, existing funding streams, or established regulatory pathways for improved interventions. In particular, experts recognized the need for improved diagnostics and vaccines for pneumonic plague and additional support for more effective therapeutics against leishmaniasis.

The experts also noted that:

  • For many of the diseases discussed, as well as many other diseases with the potential to cause a public health emergency, there is a need for better diagnostics.
  • Existing drugs and vaccines need further improvement for several of the diseases considered but not included in the priority list.
  • Any type of pathogen could be prioritised under the Blueprint, not only viruses.
  • Necessary research includes basic/fundamental and characterization research as well as epidemiological, entomological or multidisciplinary studies, or further elucidation of transmission routes, as well as social science research.
  • There is a need to assess the value, where possible, of developing countermeasures for multiple diseases or for families of pathogens.

The impact of environmental issues on diseases with the potential to cause public health emergencies was discussed. This may need to be considered as part of future reviews.

The importance of the diseases discussed was considered for special populations, such as refugees, internally displaced populations, and victims of disasters.

The value of a One Health approach was stressed, including a parallel prioritization processes for animal health. Such an effort would support research and development to prevent and control animal diseases minimising spill-over and enhancing food security. The possible utility of animal vaccines for preventing public health emergencies was also noted.

Also there are concerted efforts to address anti-microbial resistance through specific international initiatives. The possibility was not excluded that, in the future, a resistant pathogen might emerge and appropriately be prioritized.

 

*The order of diseases on this list does not denote any ranking of priority.


Influenza update – 19 February 2018

WHO

Summary

Influenza activity remained high in the temperate zone of the northern hemisphere while in the temperate zone of the southern hemisphere activity was at inter-seasonal levels. Worldwide, influenza A accounted still for the majority of influenza detections but influenza B (mostly B-Yamagata lineage) increased in recent weeks.

Up to now, the majority of countries which are in the influenza season, reported influenza- like illness reaching moderate levels in comparison with previous years, with few reaching levels exceeding those of previous years. Some countries however have reported levels of hospitalization and ICU admissions reaching or exceeding peak levels of previous influenza seasons. WHO recommends countries with current influenza activity or entering their season to adopt necessary measures for ensuring appropriate case management, compliance with infection control measures and seasonal influenza vaccination for high risk groups(see also the fact sheet given below).

  • Overall, influenza virus activity remained high in the region. In Canada, influenza activity remain elevated while influenza-like illness (ILI) activity continued to increase and was above the 5-year average for this time of the year. Influenza B detections increased in recent weeks reaching equal proportion as influenza A detections. In the United States of America (USA), influenza activity remained high, with influenza A (H3N2) viruses most frequently detected followed by influenza B viruses. Hospitalization cumulative rate for influenza were reported at high levels, and above levels observed during the same period over the previous seven seasons. In both Canada and the USA, adults aged 65 years and older accounted for the majority of influenza cases and influenza-related hospitalizations. In Mexico, influenza activity decreased slightly, with influenza A(H3N2) virus predominantly detected.
  • In Europe, influenza activity remained high in most countries. All seasonal influenza subtypes co-circulated across the region, but influenza B virus predominated in most countries. ILI and influenza detections increased further in most countries in Eastern and Northern Europe, and appeared to have peaked in few countries in Southwestern Europe. Influenza B detections increased in Denmark, Estonia, Norway, and Sweden. Influenza illness indicators appeared to decrease in Ireland and the United Kingdom, but influenza-related hospitalizations remain high in England.
  • In Northern Africa, influenza detections remained high in Algeria, Egypt and Morocco, and continued to decrease in Tunisia. Influenza A(H1N1)pdm09 virus predominated in Algeria and Tunisia, and detections of influenza A(H1N1)pdm09 and influenza B were reported in Egypt and Morocco.
  • In Western Asia, influenza activity continued to be reported across the region. In some countries of the Arabian Peninsula, influenza activity appeared to have peaked, while increased influenza A(H1N1)pdm09 detections were reported in Iraq. In Israel, influenza activity remained high with influenza B viruses predominating. Detections of influenza B-Yamagata lineage and influenza A(H1N1)pdm09 were reported in Armenia.
  • In Central Asia, influenza A and B detections increased across the region in recent weeks.
  • In East Asia, influenza activity remained high across the region. ILI activity appeared to decrease in Northern and Southern China but influenza detections remained elevated, with influenza B-Yamagata lineage and influenza A(H1N1)pdm09 viruses predominating. ILI consultation rate remained high in Hong Kong SAR, China, with influenza B most frequently detected. Decreased detections of influenza A(H1N1)pdm09 were reported in the Democratic People’s Republic of Korea. In Mongolia, respiratory illness indicators and influenza detections appeared to decrease whit influenza B-Yamagata lineage virus predominately detected in recent weeks. In the Republic of Korea, ILI activity decreased although influenza A(H3N2) and B virus detections remained high.
  • In Southern Asia, influenza activity remained low in general. Detection of influenza A(H1N1)pdm09 and influenza A(H3N2) viruses continued to increase in Pakistan, while activity decreased in the Islamic Republic of Iran.
  • In South East Asia, low levels of influenza activity were reported in most countries. Increased detections of influenza A(H1N1)pdm09 and influenza B-Yamagata lineage viruses were reported in Singapore.
  • In Western Africa, little to no influenza activity was reported across the region. In Middle Africa, there were no updates available for this reporting period. In Eastern Africa, increased influenza A(H1N1)pdm09 detections were reported in Madagascar.
  • In the Caribbean and Central American countries, respiratory illness indicators and influenza activity remained low in general. Influenza activity increased in Puerto Rico, with influenza A(H3N2) and B viruses co-circulating. Increased detections of influenza B virus were reported in Suriname. Influenza activity decreased in Jamaica.
  • In the tropical countries of South America, influenza activities and respiratory illness indicators were generally low with a few exceptions. Influenza A(H3N2) detections slightly increased in Colombia. Influenza activity remained elevated in Ecuador, with influenza A(H1N1)pdm09 virus predominating.
  • In the temperate zone of the Southern Hemisphere, influenza activity remained overall at inter-seasonal levels.
  • National Influenza Centres (NICs) and other national influenza laboratories from 104 countries, areas or territories reported data to FluNet for the time period from 22 January 2018 to 04 February 2018 (data as of 2018-02-16 04:33:50 UTC).The WHO GISRS laboratories tested more than 302596 specimens during that time period. 98068 were positive for influenza viruses, of which 54142 (55.2%) were typed as influenza A and 43926 (44.8%) as influenza B. Of the sub-typed influenza A viruses, 10290 (58%) were influenza A(H1N1)pdm09 and 7441 (42%) were influenza A(H3N2). Of the characterized B viruses, 7553 (92.5%) belonged to the B-Yamagata lineage and 615 (7.5%) to the B-Victoria lineage.

UN Environment and WHO agree to major collaboration on environmental health risks

UN/WHO

10 Jan 2018
UN Environment and World Health Organization agree to major collaboration on environmental health risks

10 January 2018 / Nairobi–UN Environment and the World Health Organization have agreed a new, wide-ranging collaboration to accelerate action to curb environmental health risks that cause an estimated 12.6 million deaths a year.

Today in Nairobi, Mr. Erik Solheim, head of UN Environment, and Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO, signed an agreement to step up joint actions to combat air pollution, climate change and antimicrobial resistance, as well as improve coordination on waste and chemicals management, water quality, and food and nutrition issues. The collaboration also includes joint management of the BreatheLife advocacy campaign to reduce air pollution for multiple climate, environment and health benefits.

Although the two agencies cooperate in a range of areas, this represents the most significant formal agreement on joint action across the spectrum of environment and health issues in over 15 years.

“There is an urgent need for our two agencies to work more closely together to address the critical threats to environmental sustainability and climate – which are the foundations for life on this planet.  This new agreement recognizes that sober reality,” said UN Environment’s Solheim.

“Our health is directly related to the health of the environment we live in. Together, air, water and chemical hazards kill some 12.6 million people a year. This cannot and must not continue,” said WHO’s Tedros.

He added: “Most of these deaths occur in developing countries in Asia, Africa and Latin America where environmental pollution takes its biggest health toll.”

The new collaboration creates a more systematic framework for joint research, development of tools and guidance, capacity building, monitoring of Sustainable Development Goals, global and regional partnerships, and support to regional health and environment fora.

The two agencies will develop a joint work programme and hold an annual high-level meeting to evaluate progress and make recommendations for continued collaboration.

The WHO-UN Environment collaboration follows a Ministerial Declaration on Health, Environment and Climate Change calling for the creation of a global “Health, Environment and Climate Change” Coalition, at the United Nations Framework Convention on Climate Change (UNFCCC) COP 22 in Marrakesh, Morocco in 2016.

Just last month, under the overarching topic “Towards a Pollution-Free Planet”, the United Nations Environment Assembly (UNEA), which convenes environment ministers worldwide, adopted a resolution on Environment and Health, called for expanded partnerships with relevant UN agencies and partners, and for an implementation plan to tackle pollution.

Note to Editors 

Priority areas of cooperation between WHO and UN Environment include:

  • Air Quality – More effective air quality monitoring including guidance to countries on standard operating procedures; more accurate environment and health assessments, including economic assessment; and advocacy, including the BreatheLife campaign promoting air pollution reductions for climate and health benefits.
  • Climate – Tackling vector-borne disease and other climate-related health risks, including through improved assessment of health benefits from climate mitigation and adaptation strategies.
  • Water – Ensuring effective monitoring of data on water quality, including through data sharing and collaborative analysis of pollution risks to health.
  • Waste and chemicals – Promotion of more sustainable waste and chemicals management, particularly in the area of pesticides, fertilizers, use of antimicrobials. The collaboration aims to advance the goal of sound lifecycle chemicals management by 2020, a target set out at the 2012 United Nations Conference on Sustainable Development.

Ongoing WHO/UN Environment collaboration includes:

  • Ministerial Declaration on Health, Environment and Climate Change –WHO/UN Environment announcement at COP22  – http://www.who.int/globalchange/mediacentre/events/Ministerial-declaration-EN.pdf
  • BreatheLife campaign has engaged countries, regions and cities in commitments to reduce air pollution for climate and health benefits, covering more than 120 million people across the planet, including Santiago, Chile; London, England; Washington DC, USA, and Oslo, Norway, with major cities in Asia and Africa set to join. www.breathelife2030.org
  • Strategic Approach to International Chemicals Management (SAICM) – which has included effective past actions to phase out lead paint, mercury emissions and persistent organic pollutants. http://www.saicm.org/

Media contacts

UN Environment News & Media, unepnewsdesk@unep.org, +254 715 618 081

Sarah Cumberland, Communications officer, WHO, cumberlands@who.int, +41 79 206 1403

Related Sustainable Development Goals

Goal 3

Good Health and Well-Being
+

Goal 7

Affordable and Clean Energy
+

Goal 11

Sustainable Cities and Communities
+

Goal 12

Sustainable Consumption and Production
+

Goal 13

Climate Action
+

WHO: An estimated 1 in 10 medical products circulating in low- and middle-income countries is either substandard or falsified

WHO

1 in 10 medical products in developing countries is substandard or falsified

WHO urges governments to take action

News release

An estimated 1 in 10 medical products circulating in low- and middle-income countries is either substandard or falsified, according to new research from WHO.

This means that people are taking medicines that fail to treat or prevent disease. Not only is this a waste of money for individuals and health systems that purchase these products, but substandard or falsified medical products can cause serious illness or even death.

“Substandard and falsified medicines particularly affect the most vulnerable communities,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Imagine a mother who gives up food or other basic needs to pay for her child’s treatment, unaware that the medicines are substandard or falsified, and then that treatment causes her child to die. This is unacceptable. Countries have agreed on measures at the global level – it is time to translate them into tangible action.”

Since 2013, WHO has received 1500 reports of cases of substandard or falsified products. Of these, antimalarials and antibiotics are the most commonly reported. Most of the reports (42%) come from the WHO African Region, 21% from the WHO Region of the Americas, and 21% from the WHO European Region.

This is likely just a small fraction of the total problem and many cases may be going unreported. For example, only 8% of reports of substandard or falsified products to WHO came from the WHO Western Pacific Region, 6% from the WHO Eastern Mediterranean Region, and just 2% from the WHO South-East Asia Region.

“Many of these products, like antibiotics, are vital for people’s survival and wellbeing,” says Dr Mariângela Simão, Assistant Director-General for Access to Medicines, Vaccines and Pharmaceuticals at WHO. “Substandard or falsified medicines not only have a tragic impact on individual patients and their families, but also are a threat to antimicrobial resistance, adding to the worrying trend of medicines losing their power to treat”.

Prior to 2013, there was no global reporting of this information. Since WHO established the Global Surveillance and Monitoring System for substandard and falsified products, many countries are now active in reporting suspicious medicines, vaccines and medical devices. WHO has trained 550 regulators from 141 countries to detect and respond to this issue. As more people are trained, more cases are reported to WHO.

WHO has received reports of substandard or falsified medical products ranging from cancer treatment to contraception. They are not confined to high-value medicines or well-known brand names and are split almost evenly between generic and patented products.

In conjunction with the first report from the Global Surveillance and Monitoring System published today, WHO is publishing research that estimates a 10.5% failure rate in all medical products used in low- and middle-income countries.

This study was based on more than 100 published research papers on medicine quality surveys done in 88 low- and middle-income countries involving 48 000 samples of medicines. Lack of accurate data means that these estimates are just an indication of the scale of the problem. More research is needed to more accurately estimate the threat posed by substandard and falsified medical products.

Based on 10% estimates of substandard and falsified medicines, a modelling exercise developed by the University of Edinburgh estimates that 72 000 to 169 000 children may be dying each year from pneumonia due to substandard and falsified antibiotics. A second model done by the London School of Hygiene and Tropical Medicine estimates that 116 000 (64 000 – 158 000) additional deaths from malaria could be caused every year by substandard and falsified antimalarials in sub-Saharan Africa, with a cost of US$ 38.5 million (21.4 million – 52.4 million) to patients and health providers for further care due to failure of treatment.

Substandard medical products reach patients when the tools and technical capacity to enforce quality standards in manufacturing, supply and distribution are limited. Falsified products, on the other hand, tend to circulate where inadequate regulation and governance are compounded by unethical practice by wholesalers, distributors, retailers and health care workers. A high proportion of cases reported to WHO occur in countries with constrained access to medical products.

Modern purchasing models such as online pharmacies can easily circumvent regulatory oversight. These are especially popular in high-income countries, but more research is needed to determine the proportion and impact of sales of substandard or falsified medical products.

Globalization is making it harder to regulate medical products. Many falsifiers manufacture and print packaging in different countries, shipping components to a final destination where they are assembled and distributed. Sometimes, offshore companies and bank accounts have been used to facilitate the sale of falsified medicines.

“The bottom line is that this is a global problem,” says Dr Simão. “Countries need to assess the extent of the problem at home and cooperate regionally and globally to prevent the traffic of these products and improve detection and response.”

Note to editors

WHO is publishing two reports today:

  • WHO launched its Global Surveillance and Monitoring System for substandard and falsified medicines, vaccines and in-vitro diagnostic tests in July 2013. This first report is based on data collected during the first 4 years of operation up to 30 June 2017.
  • A study on the public health and socioeconomic impact of substandard or falsified medical products conducted by WHO and the Member State Mechanism.

This study is based on 100 literature reviews and two peer-reviewed models developed by the University of Edinburgh and The London School of Hygiene and Tropical Medicine. The 100 papers reviewed provide data for more than 48 000 samples of medicines from 88 countries. Because only 178 samples were taken in high-income countries, prevalence estimates of substandard or falsified medical products were limited to low- and middle-income countries.

Despite these limitations, these two reports represent the most comprehensive compilation to date of data related to substandard and falsified medical products and are a first step towards better understanding their public health and socioeconomic impact.

For more information, please contact:

Daniela Bagozzi
Senior Information/Communications Manager
Telephone: +41 22 791 1990
Mobile: +41 79 603 7281
E-mail: bagozzid@who.int

Christian Lindmeier
Communications Officer
Telephone: +41 22 791 1948
Mobile: +41 79 500 6552
E-mail: lindmeierch@who.int


WHO: Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities

WHO 

Focus on AMR – evidence, guidelines and publications

Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities

The eight recommendations are:

  • Adopt multipart strategies to prevent and control CRE, CRAB, or CRPsA infection or colonization that includes at least hand hygiene, surveillance (especially for CRE), contact precautions, patient isolation (single room or cohorting), and environmental cleaning
  • Implement hand hygiene best practices spelled out in earlier WHO guidance
  • Conduct surveillance for CRE-CRAB-CRPsA infection and colonization, especially targeting those with previous CRE colonization, contacts of CRE patients, or those with a history of recent hospitalization in CRE-endemic settings
  • Implement contact precautions when caring for infected or colonized patients
  • Isolate infected or colonized patients, either in a single room or with others who have the same pathogen
  • Comply with environmental cleaning protocols in the “patient zone” of infected or colonized patients, though the optimal cleaning agent was not identified
  • Take surveillance cultures of the environment to detect contamination
  • Monitor the impact of the interventions

Carbapenem-resistant gram-negative bacteria, namely, carbapenem-resistant Enterobacteriaceae (CRE), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPsA), are an emerging cause of health-care acquired infection that pose a significant threat to public health. The first ever global guidelines for the prevention and control of CRE-CRAB-CRPsA in health care facilities were published on 14 November 2017. They include 8 recommendations distilled by the world’s leading experts from a review of the latest evidence. They are designed to provide evidence-based recommendations on the early recognition and specific required infection prevention and control practices (IPC) and procedures to effectively prevent the occurrence and control the spread of CRE-CRAB-CRPsA colonization and/or infection in acute health care facilities. They provide an evidence-based framework to help inform the development and/or strengthening of national and facility IPC policies and programmes to control the transmission of CRE-CRAB-CRPsA in a variety of health care settings. The recommendations included in these guidelines build upon the overarching standards set by the WHO publication Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level.



These guidelines are intended to support IPC improvement at the facility level, targeting infection prevention leads, senior managers, other health care professionals and patients alike. They are also relevant to policy makers, regulatory and professional bodies at the national level, among others. We encourage you all to use and promote these guidelines.


Teleclass: Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities

President Robert Mugabe as WHO Goodwill Ambassador for Noncommunicable Diseases in Africa? What was I thinking?

WHO

Director-General rescinds Goodwill Ambassador appointment

WHO statement
22 October 2017

Over the last few days, I have reflected on my appointment of H.E. President Robert Mugabe as WHO Goodwill Ambassador for Noncommunicable Diseases in Africa. As a result I have decided to rescind the appointment.

I have listened carefully to all who have expressed their concerns, and heard the different issues that they have raised. I have also consulted with the Government of Zimbabwe and we have concluded that this decision is in the best interests of the World Health Organization.

It is my aim to build a worldwide movement for global health. This movement must work for everyone and include everyone.

For me, what is important is to build political leadership and create unity around bringing health to all, based on WHO’s core values.

I remain firmly committed to working with all countries and their leaders to ensure that every one has access to the health care they need.

We must build bridges that bring us together and help us move forward in our quest to achieve universal health coverage.

I thank everyone who has voiced their concerns and shared their thoughts. I depend on constructive debate to help and inform the work I have been elected to do.

 


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