Bulletin of the World Health Organization

Public health round-up

Bulletin of the World Health Organization 2013;91:547-548. doi: http://dx.doi.org/10.2471/BLT.13.010813 [PDF]

WHO mobile clinic in Homs

WHO

A doctor treats a patient at the mobile health clinic in the Syrian city of Homs. The clinic was renovated and equipped by WHO. According to the Syrian Arab Red Crescent, a quarter of a million people living in the Homs Governorate need humanitarian aid.

Meeting on new virus

A committee of experts gathered in Geneva last month to provide its view to WHO Director-General Dr Margaret Chan on whether WHO should declare the occurrence of a new virus in the Middle East “a public health emergency of international concern” and what recommendations, if any, to take.

The committee made up of some of the world’s leading experts in various fields, met to examine current evidence on the Middle East Respiratory Syndrome – coronavirus (MERS-CoV).

MERS-CoV is a virus whose origin is unknown and for which no vaccine or antivirals exist. No one knows how humans become infected with the virus. But more than half of the people who have become infected with the virus have died.

All the 80 cases (as of 7 July) identified so far have had some connection with the Middle East. While cases so far number fewer than 100 and are not widespread, there is concern – especially in the context of upcoming mass gatherings – that the number of cases of disease caused by this virus, and their geographical spread, could increase considerably.

It was only the second time since the International Health Regulations mechanism came into force in 2007 that an Emergency Committee was convened to advise whether a disease is a public health emergency of international concern.

The first Emergency Committee was on influenza A (H1N1) and it met nine times over the course of the 2009 pandemic to assess the situation and recommend action to the Director-General.

New food standards on Codex’s 50th anniversary

The United Nations food standards body, the Codex Alimentarius Commission, agreed on new standards last month to protect the health of consumers around the world. These include standards on fruit, vegetables, fish and fishery products and animal feed.

Codex also adopted codes on the prevention and reduction of ochratoxin A, a carcinogenic contaminant, in cocoa and guidance on how to avoid microbiological contamination of berries.

It also issued guidance on the use of claims for packaged and processed food products that are labelled “non-addition of sodium salts” including “no added salt” to help consumers who are keen to have a healthy diet.

The Codex Alimentarius Commission, which is jointly run by the United Nations Food and Agriculture Organization and WHO, sets international food safety and quality standards to promote safer and more nutritious food for consumers worldwide. Codex standards serve in many cases as a basis for national legislation and provide the food safety benchmarks for international food trade.

At its annual meeting, held in Rome last month, Codex celebrated its 50th anniversary. The session was attended by 620 delegates from 128 member countries and one member organization, one observer country and 41 international governmental and nongovernmental organizations, including United Nations agencies.

Tobacco control measures catch on

Complete bans on tobacco advertising, promotion and sponsorship – one of the most powerful measures to control tobacco use – have been rolled out in 24 countries covering a total of 694 million people while a further 100 countries are close to a complete ban, according to a new report.

The Report on the Global Tobacco Epidemic 2013 is the fourth in a WHO series that tracks the tobacco epidemic and the impact of measures to stop it worldwide.

It found that 67 countries either do not ban tobacco advertising, promotion and sponsorship activities at all or have a ban that excludes advertising in national broadcast and print media.

The report also found that 43 countries, with more than 1.1 billion people, do not have comprehensive smoke-free legislation covering all work places, public places and public transport.

Effective health warning labels on tobacco packaging continued to be established by more countries and a total of 30 countries with just over one billion people put strong pictorial warning label requirements in place.

More than half a billion people in nine countries have gained access to appropriate cessation services in the past five years. However, progress has been slower since 2010, as only four additional countries with a combined population of 85 million were given access to such cost-covered services, including a toll-free national quit line.

Cover photo

The Global Fund/John Rae

HIV education is part of the curriculum throughout the Tanzanian archipelago of Zanzibar. This young girl is a pupil at a madrassa (school) in Zanzibar.

Updated WHO medicine lists released

The 18th WHO Model List of Essential Medicines and the 4th WHO Model List of Essential Medicines for Children were released last month; the children’s list is a subset of the 18th list and adds two new medicines for neonatal care.

One medicine, dithranol, was removed from the adults’ list.

Three new indications for three medicines (dexamethasone for accelerated foetal lung maturation in anticipated preterm birth, nifurtimox + eflornithine for Human African Trypanosomiasis in children and spironolactone in heart failure for adults) already listed were included, while a new dosage form or strength was added for four medicines already on the list (benznidazole, chlorhexidine, levodopa + carbidopa and morphine).

Health authorities use the list as a basis for their own national lists to improve health care, optimize pharmaceutical spending and, more recently, to support countries moving towards universal coverage of health-care services.

The WHO list forms the basis of national essential medicines lists in countries and is also a component of the National Medicines Policy.

The latest list is based on the review of the Expert Committee on Selection and Use of Essential Medicines that met in April, which takes into consideration the latest scientific evidence on the efficacy, safety and cost-effectiveness of medicines. The first list was published in 1977 and has since been updated every two years.

New WHO guidelines call for earlier HIV treatment

WHO issued new HIV recommendations calling for patients to be offered antiretroviral therapy (ART) at an early stage of their illness, based on recent evidence that this helps people with HIV to live longer, healthier lives, while substantially reducing the risk of transmitting HIV.

The new WHO recommendations encourage countries to initiate treatment in adults living with HIV when their CD4 cell count falls to 500 cells/mm³ or less – when their immune systems are still strong.

The previous WHO recommendation, set in 2010, was to offer treatment at 350 CD4 cells/mm³ or less. For some groups, such as children living with HIV under 5 years, HIV-positive pregnant women, and people co-infected with tuberculosis or hepatitis B, WHO now recommends ART regardless of CD4 count. New recommendations will increase total global eligibility for ART from currently 17 to 26 million people.

The new recommendations are presented in a document entitled Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, released together with the Global HIV Treatment 2013 Update showing that a total of 9.7 million people were taking these lifesaving medicines at the end of 2012.

The guidelines outline a variety of strategies to facilitate future ART scale-up, including a move to simpler, once-daily first-line therapy and harmonization of treatment regimens across age groups. New clinical recommendations are complemented by operational and programmatic guidance on how they can be implemented.

If countries can integrate the recommended changes within their national HIV policies and back them up with the necessary resources, annual rates of HIV-related deaths and new HIV infections can drop by more than one third compared to what was deemed achievable based on previous recommendations, the new document said.

http://www.who.int/hiv/pub/guidelines/arv2013

http://www.who.int/hiv/pub/progressreports/update2013

Looking ahead

15 August: launch of the 2013 World health report: research for universal coverage in Beijing, China http://who.int/whr

10 September: World Suicide Prevention Day http://www.iasp.info/wspd

23 September: High-level Meeting of the United Nations General Assembly in New York on the realization of the Millennium Development Goals and other internationally agreed development goals for persons with disabilities http://www.un.org/en/ga/info/meetings/67schedule.shtml

29 September: World Heart Day http://www.world-heart-federation.org/what-we-do/awareness/world-heart-day

8–11 October: Budapest Water Summit, Hungary http://www.budapestwatersummit.hu/budapest-water-summit/overview/

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