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1.
MMWR Morb Mortal Wkly Rep ; 68(43): 979-984, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31671082

RESUMO

Dracunculiasis (also known as Guinea worm disease) is caused by the parasite Dracunculus medinensis and is acquired by drinking water containing copepods (water fleas) infected with D. medinensis larvae. The worm typically emerges through the skin on a lower limb approximately 1 year after infection, resulting in pain and disability (1). There is no vaccine or medicine to treat the disease; eradication efforts rely on case containment* to prevent water contamination and other interventions to prevent infection, including health education, water filtration, chemical treatment of unsafe water with temephos (an organophosphate larvicide to kill copepods), and provision of safe drinking water (1,2). In 1986, with an estimated 3.5 million cases† occurring each year in 20 African and Asian countries§ (3), the World Health Assembly called for dracunculiasis elimination (4). The global Guinea Worm Eradication Program (GWEP), led by The Carter Center and supported by the World Health Organization (WHO), CDC, the United Nations Children's Fund, and other partners, began assisting ministries of health in countries with dracunculiasis. This report, based on updated health ministry data, describes progress to eradicate dracunculiasis during January 2018-June 2019 and updates previous reports (2,4,5). With only five countries currently affected by dracunculiasis (Angola, Chad, Ethiopia, Mali, and South Sudan), achievement of eradication is within reach, but it is challenged by civil unrest, insecurity, and lingering epidemiologic and zoologic questions.


Assuntos
Erradicação de Doenças , Dracunculíase/prevenção & controle , Saúde Global/estatística & dados numéricos , Dracunculíase/epidemiologia , Humanos
2.
BMJ ; 367: l5873, 2019 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-31672760

RESUMO

OBJECTIVE: To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. DESIGN: International cross sectional survey. SETTING: International Society of Nephrology (ISN) survey of 182 countries from July to September 2018. PARTICIPANTS: Key stakeholders identified by ISN's national and regional leaders. MAIN OUTCOME MEASURES: Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management. RESULTS: Responses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world's population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management-namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (<10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level. CONCLUSIONS: These comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy.


Assuntos
Saúde Global/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Falência Renal Crônica/terapia , Nefrologia/estatística & dados numéricos , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Transversais , Países em Desenvolvimento/estatística & dados numéricos , Humanos
3.
Lancet ; 394(10204): 1140-1141, 2019 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-31571598
4.
Lancet ; 394(10204): 1141-1142, 2019 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-31571599
5.
Rev Sci Tech ; 38(1): 303-314, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31564720

RESUMO

Under the International Health Regulations (IHR, 2005), a legally binding document adopted by 196 States Parties, countries are required to develop their capacity to rapidly detect, assess, notify and respond to unusual health events of potential international concern. To support countries in monitoring and enhancing their capacities and complying with the IHR (2005), the World Health Organization (WHO) developed the IHR Monitoring and Evaluation Framework (IHR MEF). This framework comprises four complementary components: the State Party Annual Report, the Joint External Evaluation, after-action reviews and simulation exercises. The first two are used to review capacities and the second two to help to explore their functionality. The contribution of different disciplines, sectors, and areas of work, joining forces through a One Health approach, is essential for the implementation of the IHR (2005). Therefore, WHO, in partnership with the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), and other international and national partners, has actively worked on facilitating the inclusion of the relevant sectors, in particular the animal health sector, in each of the four components of the IHR MEF. Other tools complement the IHR MEF, such as the WHO/OIE IHR-PVS [Performance of Veterinary Services] National Bridging Workshops, which facilitate the optimal use of the results of the IHR MEF and the OIE Performance of Veterinary Services Pathway and create an opportunity for stakeholders from animal health and human health services to work on the coordination of their efforts. The results of these various tools are used in countries' planning processes and are incorporated in their National Action Plan for Health Security to accelerate the implementation of IHR core capacities. The present article describes how One Health is incorporated in all components of the IHR MEF.


Assuntos
Regulamento Sanitário Internacional , Saúde Única , Animais , Surtos de Doenças/prevenção & controle , Saúde Global , Humanos , Cooperação Internacional , Saúde Única/normas , Organização Mundial da Saúde
6.
Rev Sci Tech ; 38(1): 291-302, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31564721

RESUMO

Animals, and the health systems which ensure their protection, play a vital role in the security and economic and social well-being of humanity, and are therefore a key component of the One Health concept. For global and national health security, prevention is better than cure, and targeting 'risk at source' in animal populations is a vital strategy in safeguarding the planet from risks of emerging zoonoses and antimicrobial resistance (AMR). Neglected zoonoses - such as rabies and brucellosis - continue to have a significant global impact on human health and are also best managed at their animal source. The World Organisation for Animal Health (OIE) has built international consensus on the principles of good governance and the quality of Veterinary Services, which are incorporated within its international standards. The OIE has a proven track record in the provision of Member Country support based on these standards, especially since the advent of its flagship Performance of Veterinary Services (PVS) Pathway programme in 2006-2007. To date, approximately 140 countries have benefited from the structured and sustainable process of animal health systems evaluation and planning afforded by the PVS Pathway. The PVS Tool, the basic methodology upon which the PVS Pathway is based, addresses One Health by evaluating the Veterinary Authority's ability to coordinate with other Competent Authorities that have a role to play in One Health, most notably public health, food safety, and environmental authorities. Despite the undoubted success of the PVS Pathway, the OIE felt that it was time to consider how the programme might be developed to adapt to new challenges. Consequently, during 2017-2018, the OIE embarked on a process of PVS evolution, during which it carried out extensive consultation and further tailored the PVS Pathway to a changing global context. These improvements, which include both fundamental adaptations to the PVS Pathway methods and the development of new PVS Pathway activities targeting topics such as multisectoral collaboration, rabies and AMR, have further strengthened and embedded the One Health approach within the PVS Pathway.


Assuntos
Saúde Única , Saúde Pública , Medicina Veterinária , Animais , Inocuidade dos Alimentos , Saúde Global , Humanos , Saúde Pública/tendências , Medicina Veterinária/tendências , Zoonoses/prevenção & controle
7.
Rev Sci Tech ; 38(1): 155-171, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31564733

RESUMO

In order to manage global and transnational health threats at the human- animal-environment interface, a multisectoral One Health approach is required. Threats of this nature that require a One Health approach include, but are not limited to, emerging, endemic and re-emerging zoonotic diseases, food safety, antimicrobial resistance (AMR), vector-borne and neglected infectious diseases, toxicosis and pesticides. Relevant Kenyan authorities formally institutionalised One Health in 2011 through the establishment of the Zoonotic Disease Unit (ZDU) and its advisory group, the Zoonoses Technical Group. At that time, the One Health agenda focused on zoonotic diseases. As the issue of AMR began to gain traction globally, a One Health approach to its management was advocated in Kenya in 2015. This paper summarises a series of interviews (with respondents and key informants) that describe how AMR institutionalisation evolved in Kenya. It also examines how responses to other health threats at the human-animal- environment interface were coordinated and used to identify gaps and make recommendations to improve One Health coordination at the national level in Kenya. Results showed that the road to the institutionalisation of AMR through the National Action Plan on Prevention and Containment of Antimicrobial Resistance, 2017-2022 and a formally launched One Health coordination mechanism, the National Antimicrobial Stewardship Interagency Committee (NASIC), took ten years. Moreover, supplementary actions are still needed to further strengthen AMR coordination. In addition to the ZDU and NASIC, Kenya has established two other formal multisectoral and multidisciplinary coordination structures, one for aflatoxicosis and the other for health threats associated with pesticide use. The country has four distinct and separate One Health coordination mechanisms: for zoonoses, for AMR, for aflatoxicosis and for the health threats associated with pesticide use. The main gap lies in the lack of overall coordination between these topic-specific structures. An overall coordination mechanism for all One Health issues is therefore needed to improve synergy and complementarity. None of the topic-specific mechanisms plays a critical role in the policy development process, institutionalisation or implementation of activities related to the other topic areas. The authors recommend renaming the ZDU as the One Health Office, and expanding it to include AMR and food safety teams, and their associated technical working groups. Through this restructuring, the One Health Office would become an umbrella organisation dealing with all four issues mentioned above. Based on Kenya's experience, the authors recommend that other countries also consider expanding the scope of multisectoral One Health coordination mechanisms to include other shared health threats.


Assuntos
Saúde Global , Saúde Única , Animais , Antibacterianos , Farmacorresistência Bacteriana , Saúde Global/normas , Política de Saúde , Humanos , Quênia , Zoonoses/microbiologia , Zoonoses/prevenção & controle
8.
Rev Sci Tech ; 38(1): 123-133, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31564735

RESUMO

In 2015, the United Nations General Assembly agreed upon 17 global Sustainable Development Goals. The first of these is: 'End poverty in all its forms everywhere'. The second is to: 'End hunger, achieve food security and improved nutrition, and promote sustainable agriculture'. Food safety is a global priority, since every global citizen has the right to have access to safe and nutritious food. Safe food contributes to people's health and productivity, as well as providing a strong foundation for development and poverty alleviation. Every year, numerous people are affected by foodborne illnesses in developed countries, while widespread illness is even more likely in developing countries. Among society's major concerns are the health risks posed by microbial pathogens and chemicals in food. A One Health approach is crucial to achieving the global goal of food safety and security for all and will improve health outcomes for every citizen.


Assuntos
Abastecimento de Alimentos , Saúde Única , Agricultura , Animais , Abastecimento de Alimentos/normas , Saúde Global , Humanos , Fome , Nações Unidas
9.
Rev Sci Tech ; 38(1): 21-50, 2019 May.
Artigo em Inglês, Francês, Espanhol | MEDLINE | ID: mdl-31564742

RESUMO

One Health has gained momentum in every region across the world over the past decade. The human, animal and environmental health sectors of countries worldwide have increasingly requested support for the implementation of a multisectoral, One Health approach to best address health threats at the human-animal-environment interface. Such threats include zoonotic diseases, emerging infectious diseases, antimicrobial resistance (AMR), food safety, wildlife diseases and other issues that affect health, such as poverty. A variety of successes covering One Health topics at the sub-national, national, regional and global levels ranging from AMR to zoonoses are highlighted in this issue of the World Organisation for Animal Health (OIE) Scientific and Technical Review. Authors contributing to this Review were asked to highlight One Health success stories and discuss remaining challenges that might help in achieving a better understanding of the most efficient way to implement a One Health approach. The series of articles in this issue is not meant to form an exhaustive reference of every known health issue that might benefit from a One Health approach, but rather is a collection of ideas for further reflection that contributes to a better understanding of how to successfully advance the approach. This publication also highlights the challenges remaining in One Health, and its numerous authors share success stories and point out gaps so as to help others to implement One Health effectively. At the same time, these authors advocate the value of using a One Health approach to improve the health of humans and animals living in a shared environment. Readers will notice that a number of key themes are raised time and again, most notably, the value of taking a One Health approach to coordination, collaboration and communication, and the steps required to make One Health sustainable. These steps include formalising multisectoral, One Health coordination mechanisms and using One Health tools developed by national and global partners to support the approach and its implementation. The One Health approach brings together all relevant sectors and disciplines across the human-animal-environment interface in a collaboration that is more effective, efficient and sustainable than might be achieved without the shared goal of improving health for all, both humans and animals.


Assuntos
Saúde Global , Saúde Única , Animais , Doenças Transmissíveis Emergentes , Humanos , Saúde Única/tendências , Zoonoses
10.
Rev Sci Tech ; 38(1): 145-154, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31564744

RESUMO

The One Health approach supports global health security by improving coordination, collaboration and communication at the human-animal-environment interface to address shared health threats such as zoonotic diseases, antimicrobial resistance, food safety and others. Over the past decade, country after country has implemented the One Health approach and demonstrated recognised benefits. However, in order to build sustainability of One Health in these efforts, One Health champions and implementers need to collect and provide government decision-makers with country-level data on One Health's impact to help justify policy decisions and resource allocations. Due to the broad, often seemingly all encompassing, nature of One Health in promoting synergies of multiple disciplines and sectors, the One Health community has faced difficulties in determining specific One Health impact indicators for formally evaluating One Health successes. In this paper, the author a) briefly reviews the ongoing commentary on the recognised benefits of the implementation of a One Health approach in the global health security context, b) discusses challenges in measuring the impact of One Health, and c) proposes possible solutions for evaluating the impact of One Health on global health security.


Assuntos
Saúde Global , Saúde Única , Desenvolvimento Sustentável , Animais , Saúde Global/normas , Metas , Humanos , Saúde Única/normas , Saúde Única/tendências , Zoonoses/prevenção & controle
14.
Rev Prat ; 69(5): 546-549, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31626465

RESUMO

This paper introduces few concepts to help clinicians to get an idea of the health systems of the migrants they care for, on a daily basis. Health systems are complex to analyze, and is an open, dynamic system, facing diverse influences from multiple levels. Recent globalization has complexified an already complex system. The paper first sets some definitions and then describes succinctly the history of international health financing. It eventually compares several countries' health systems, drawing on few health indicators. Despite significant progresses in terms of global health, the gap between countries, and, within countries between wealthier and poorer people, is increasing. This is particularly worrying while the global aim is health equity.


Assuntos
Países em Desenvolvimento , Necessidades e Demandas de Serviços de Saúde , Migrantes , Saúde Global , Humanos
16.
MMWR Morb Mortal Wkly Rep ; 68(39): 855-859, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581161

RESUMO

Rubella is a leading cause of vaccine-preventable birth defects. Although rubella virus infection usually causes a mild febrile rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects known as congenital rubella syndrome (CRS). A single dose of rubella-containing vaccine (RCV) can provide lifelong protection (1). In 2011, the World Health Organization (WHO) updated guidance on the use of RCV and recommended capitalizing on the accelerated measles elimination activities as an opportunity to introduce RCV (1). The Global Vaccine Action Plan 2011-2020 (GVAP) includes a target to achieve elimination of rubella in at least five of the six WHO regions by 2020 (2). This report on the progress toward rubella and CRS control and elimination updates the 2017 report (3), summarizing global progress toward the control and elimination of rubella and CRS from 2000 (the initiation of accelerated measles control activities) and 2012 (the initiation of accelerated rubella control activities) to 2018 (the most recent data) using WHO immunization and surveillance data. Among WHO Member States,* the number with RCV in their immunization schedules has increased from 99 (52% of 191) in 2000 to 168 (87% of 194) in 2018†; 69% of the world's infants were vaccinated against rubella in 2018. Rubella elimination has been verified in 81 (42%) countries. To make further progress to control and eliminate rubella, and to reduce the equity gap, introduction of RCV in all countries is important. Likewise, countries that have introduced RCV can achieve and maintain elimination with high vaccination coverage and surveillance for rubella and CRS. The two WHO regions that have not established an elimination goal (African [AFR] and Eastern Mediterranean [EMR]) should consider establishing a goal.§.


Assuntos
Erradicação de Doenças , Saúde Global/estatística & dados numéricos , Vigilância da População , Síndrome da Rubéola Congênita/prevenção & controle , Rubéola (Sarampo Alemão)/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Rubéola (Sarampo Alemão)/epidemiologia , Síndrome da Rubéola Congênita/epidemiologia , Vacina contra Rubéola/administração & dosagem
18.
MMWR Morb Mortal Wkly Rep ; 68(40): 880-884, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31600182

RESUMO

During May 19-September 28, 2019,* low levels of influenza activity were reported in the United States, with cocirculation of influenza A and influenza B viruses. In the Southern Hemisphere seasonal influenza viruses circulated widely, with influenza A(H3) predominating in many regions; however, influenza A(H1N1)pdm09 and influenza B viruses were predominant in some countries. In late September, the World Health Organization (WHO) recommended components for the 2020 Southern Hemisphere influenza vaccine and included an update to the A(H3N2) and B/Victoria-lineage components. Annual influenza vaccination is the best means for preventing influenza illness and its complications, and vaccination before influenza activity increases is optimal. Health care providers should recommend vaccination for all persons aged ≥6 months who do not have contraindications to vaccination (1).


Assuntos
Saúde Global/estatística & dados numéricos , Vacinas contra Influenza/química , Influenza Humana/epidemiologia , Vigilância da População , Farmacorresistência Viral , Humanos , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Vírus da Influenza A Subtipo H3N2/efeitos dos fármacos , Vírus da Influenza A Subtipo H3N2/genética , Vírus da Influenza A Subtipo H3N2/isolamento & purificação , Vírus da Influenza B/efeitos dos fármacos , Vírus da Influenza B/genética , Vírus da Influenza B/isolamento & purificação , Influenza Humana/virologia , Estações do Ano , Estados Unidos/epidemiologia
19.
Global Health ; 15(1): 58, 2019 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601233

RESUMO

BACKGROUND: After Action Reviews (AARs) provide a means to observe how well preparedness systems perform in real world conditions and can help to identify - and address - gaps in national and global public health emergency preparedness (PHEP) systems. WHO has recently published guidance for voluntary AARs. This analysis builds on this guidance by reviewing evidence on the effectiveness of AARs as tools for system improvement and by summarizing some key lessons about ensuring that AARs result in meaningful learning from experience. RESULTS: Empirical evidence from a variety of fields suggests that AARs hold considerable promise as tools of system improvement for PHEP. Our review of the literature and practical experience demonstrates that AARs are most likely to result in meaningful learning if they focus on incidents that are selected for their learning value, involve an appropriately broad range of perspectives, are conducted with appropriate time for reflection, employ systems frameworks and rigorous tools such as facilitated lookbacks and root cause analysis, and strike a balance between attention to incident specifics vs. generalizable capacities and capabilities. CONCLUSIONS: Employing these practices requires a PHEP system that facilitates the preparation of insightful AARs, and more generally rewards learning. The barriers to AARs fall into two categories: concerns about the cultural sensitivity and context, liability, the political response, and national security; and constraints on staff time and the lack of experience and the requisite analytical skills. Ensuring that AARs fulfill their promise as tools of system improvement will require ongoing investment and a change in mindset. The first step should be to clarify that the goal of AARs is organizational learning, not placing blame or punishing poor performance. Based on experience in other fields, the buy-in of agency and political leadership is critical in this regard. National public health systems also need support in the form of toolkits, guides, and training, as well as research on AAR methods. An AAR registry could support organizational improvement through careful post-event analysis of systems' own events, facilitate identification and sharing of best practices across jurisdictions, and enable cross-case analyses.


Assuntos
Planejamento em Desastres/organização & administração , Surtos de Doenças/prevenção & controle , Saúde Global , Saúde Pública , Humanos
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