Assessment of serosurveys for H5N1.

BACKGROUND: It has been suggested that the true case-fatality rate of human H5N1 influenza infection is appreciably less than the figure of approximately 60% that is based on official World Health Organization (WHO)-confirmed case reports because asymptomatic cases may have been missed. A number of seroepidemiologic studies have been conducted in an attempt to identify such missed cases. METHODS: We conducted a comprehensive literature review of all English-language H5N1 human serology surveys with detailed attention to laboratory methodology used (including whether investigators used criteria set by the WHO to define positive cases), laboratory controls used, and the clades/genotypes involved. RESULTS: Twenty-nine studies were included in the analysis. Few reported using unexposed control groups and one-third did not apply WHO criteria. Of studies that used WHO criteria, only 4 found any seropositive results to clades/genotypes of H5N1 that are currently circulating. No studies reported seropositive results to the clade 2/genotype Z viruses that have spread throughout Eurasia and Africa. CONCLUSIONS: This review suggests that the frequency of positive H5 serology results is likely to be low; therefore, it is essential that future studies adhere to WHO criteria and include unexposed controls in their laboratory assays to limit the likelihood of false-positive results.

Prioridades de salud: problemas por resolver y nuevos retos / Unfinished problems and new challenges

En los últimos 25 años hemos sido testigos de cambios verdaderamente revolucionarios en el campo de la salud, en especial en los países de ingresos bajos y medios. En este artículo se discuten algunos de los problemas de salud que se deben resolver y los retos que habrán de enfrentarse. Dentro de ellos destacan el financiamiento de los servicios de salud, la atención a una población con un problema de edad cada vez mayor, la mejoría en la calidad de los servicios y la capacitación de recursos humanos para enfrentar futuras necesidades de salud dentro de un contexto de recursos cada vez mas limitados

In the last 25 years we have witnessed revolutionary changes in the field of health, particularly in the low and middle income countries. This paper discusses some of the new problems which need to be solved and some of the challenges which lie ahead Among the former we can mention the financing of health care services and the provision of health care to an aging population. Among the latter we include the need for improvement of the quality of health services and the training of appropriate health manpower.