Brazil yellow fever: WHO warns travellers to Sao Paulo

The Brazilian state of Sao Paulo, the country's most populous, is at risk of yellow fever, the World Health Organization (WHO) is warning.

The WHO is recommending that travellers to the state and its capital, Sao Paulo, get a yellow fever vaccine before visiting.

The warning comes after a significant rise in numbers of suspected and confirmed cases was reported.

Local officials say travellers will not be at risk if they stay in cities.

Brazilian Health Minister Antonio Nardi said the WHO advice stemmed from "an excess of concern".

What is yellow fever?

  • Caused by a virus that is transmitted to humans by mosquitoes
  • Difficult to diagnose and often confused with other diseases or fevers
  • Most people recover after the first phase of infection that usually involves fever, muscle and back pain, headache, shivers, loss of appetite, and nausea or vomiting
  • About 15% of people face a second, more serious phase involving high fever, jaundice, bleeding and deteriorating kidney function
  • Half of those who enter the "toxic" phase usually die within 10 to 14 days

Source: WHO

He said that while there had been an increase in the number of reported cases it did not constitute an "outbreak".

He also said that most people attending Brazil's famous carnival celebrations in February should be safe as they are held in large cities and not the rural and forested areas which have seen the biggest increase in yellow fever cases.

However, the WHO's advice is for all travellers to the state to get a vaccination at least 10 days prior to travel and to take measures to avoid mosquito bites.

Brazilian health authorities said that since July 2017, 35 cases of yellow fever had been confirmed. Of those, 20 cases proved fatal. Sao Paulo has been the worst-affected state, with 20 confirmed cases.

Mr Nardi said Sao Paulo state authorities would speed up their vaccination campaign with the aim of vaccinating half of the state's population by the end of February.

More than 45 million people live in the state of Sao Paulo.



83 countries affected by Lactalis salmonella scandal: CEO

PARIS - A salmonella scandal at French dairy group Lactalis has affected 83 countries, where 12 million boxes of powdered baby milk are being recalled, the company's CEO said Sunday in an interview with French media.

Emmanuel Besnier, scion of the secretive family behind one of the world's biggest dairy groups, was speaking publicly for the first time since an outcry erupted over claims the company hid the salmonella outbreak at a plant making the product.

"We must take account the scale of this operation: more than 12 million boxes are affected," he said, adding that distributors would no longer have to sort through the produce to find the contaminated powder.

"They know that everything has to be removed from the shelves," Besnier said.

Besnier, who was summoned to the French finance ministry on Friday, promised compensation for all the families affected. He said that the consequences of this health crisis for consumers, including babies under six months, were at the forefront of his mind.

"It is for us, for me, a great concern," he told the Journal du Dimanche.

Hundreds of lawsuits have been filed against the group by families who say their children got salmonella poisoning after drinking powdered milk made by the company.

So far French officials have reported 35 cases of infants getting salmonella from the powder, while one case has been reported in Spain and another is being investigated in Greece.

An association representing victims says the authorities are underestimating the number of cases.

"There are complaints and there will be an investigation with which we will fully collaborate. We never thought to act otherwise," Besnier said.

Created in 1933 by Besnier's grandfather, Lactalis has become an industry behemoth with annual sales of some 17 billion euros (S$27.5 billion), with products including Galbani ricotta and mozzarella in Italy.

With 246 production sites in 47 countries, its list of products also features household names like President butter and Societe roquefort.

Two of those brands, Picot and Milumel baby milk, were the subject of chaotic international recalls issued in mid-December after dozens of children fell sick.

The scandal deepened this month when French investigative weekly Le Canard Enchaine reported that state inspectors had given a clean bill of health to the Lactalis site in Craon, northwest France, in early September.

They failed to find the salmonella bacteria that had been detected by Lactalis's own tests in August and November, which were not reported to the authorities.

The company said it was not legally bound to report the contamination.



Addictive gaming to be recognized as disease: World Health Organization

"Gaming disorder" will be recognized as a disease later this year following expert consensus over the addictive risks associated with playing electronic games, the World Health Organization said Friday.

The disorder will be listed in the 11th edition of the International Classification of Diseases (ICD), to be published in June, WHO spokesman Tarik Jasarevic told reporters in Geneva.

WHO is leading the process of updating ICD-11, which includes input from global health practitioners.

The current working definition of the disorder is "a pattern of gaming behaviour, that can be digital gaming or video gaming, characterised by impaired control over gaming, increased priority given to gaming over other activities to the extent that gaming takes precedence over other interests, Jasarevic said.

Other symptoms include "the continuation and escalation of gaming despite the occurrence of negative consequences".

The provisional guidelines say that an individual should demonstrate an abnormal fixation on gaming for at least a year before being diagnosed with the disorder, which will be classified as an "addictive behaviour", Jasarevic said.

Anecdotal evidence suggests that the condition disproportionately effects younger people more connected to the ever-expanding online gaming world.

But the WHO spokesman cautioned that it was premature to speculate on the scope of the problem.

"Gaming disorder is a relatively new concept and epidemiological data at the population level are yet to be generated", he said.

Despite the lack of hard data, "health experts basically agree that there is an issue" and that official inclusion in the ICD is the next appropriate step, Jasarevic said.

"There are people who are asking for help", he added, noting that formal recognition of the condition will help spur further research and resources committed to combatting the problem.


US funding can save millions of lives through public health programs in 2018

As director of the federal Centers for Disease Control and Prevention (CDC) from 2009 until the beginning of this year, I saw the world make progress against a number of diseases. But in 2018 we will be challenged to make additional progress in protecting public health on multiple fronts – particularly preventing heart attacks, strokes, drug overdoses and epidemics.

Here is an overview of what was achieved this year and what needs to be done in the year ahead.

Opioid overdoses

In 2017 we saw broad recognition that – as we at CDC said back in 2011 – there is a terrible epidemic of opioid overdoses affecting families and communities throughout the United States. The risk is that the continued spread of illicit fentanyl and a lack of concerted action and funding will make it possible for the epidemic to continue.

Preventing epidemics

Many countries improved their ability to track and respond to disease clusters before they become epidemics. However, additional funding for the CDC to partner with other countries to help them develop their ability to stop epidemics will end next year.

If Congress doesn’t provide funding, the U.S. will be forced to abandon these critical efforts, giving our microbial enemies an opening to attack. If in 2018 CDC is forced to retreat from the front lines, the chance that an epidemic like Ebola could happen again will increase.

Programs to prevent epidemics keep Americans safe. They must be continued. Like the war against terrorism, the war against terrible organisms protects our nation from a deadly threat.

Polio eradication

Fewer than 20 cases of polio have been reported around the world so far in 2017.

However, conflicts in Nigeria, Pakistan and Afghanistan – and the need for universal excellence in program operations – may lead to a stalemate in the effort to eradicate polio and protect all children against this dreadful disease forever.

Evaluating preparedness

An additional 40 countries participated in the Joint External Evaluation (JEE) process in 2017, bringing the total to 67. The JEE is a report card for countries to assess how prepared they are to deal with an epidemic. It identifies gaps that need to be addressed.

Unless countries themselves, the World Bank and donor agencies rapidly fill the identified gaps, we will all remain at risk, and countries may lose interest in continuing to assess their status openly and transparently.

This work will be much more difficult if funding cuts force the U.S. to retreat from the field of epidemic prevention.

In 2018, Resolve to Save Lives – the nonprofit organization I now lead – will serve as a catalyst to help countries obtain the technical, operational and financial support they need to address gaps and implement lifesaving programs.

This work is part of our mission to save 100 million lives around the world by implementing proven solutions to prevent heart disease and stroke, the world’s leading causes of death. We are also helping the world prevent the next disease outbreak by catalyzing country action to find, stop and prevent new disease threats.

Blood pressure

Around the world, just one in seven people has their blood pressure under control. The result is literally millions of preventable heart attacks, strokes and deaths, as well as increased medical costs.

Fortunately, the best medicines in the world for the treatment of high blood pressure are generic, safe, effective, once-daily and inexpensive.

This year the American Heart Association and the American College of Cardiology released new guidelines for treating high blood pressure in the U.S.

In our country, life expectancy decreased for the second year in a row – something that hasn’t happened since the 1960s. Opioid use drove this trend, but it was made possible by a stall in the decades-long decrease in cardiovascular deaths.

Better management of blood pressure and cholesterol, and continued decreases in smoking, will be essential to sustaining health progress in the United States. Access to medication and medical care globally will be a major focus of Resolve to Save Lives in 2018.


Global HEARTS is a new initiative from the World Health Organization and the CDC that helps countries scale up prevention and control of cardiovascular disease. This year saw the release of the first draft of the HEARTS technical package details, bringing the world closer than ever to having a playbook to stop the leading cause of death.

Countries now need to implement the HEARTS initiative, increasing the number of people treated for high blood pressure by literally hundreds of millions and reducing sodium intake for billions of people.

Resolve to Save Lives is working with countries around the world to help them achieve their goals of preventing heart attacks and strokes as part of non-communicable disease reduction initiatives.

India Hypertension Management Initiative

In November the government of India and partners took an unprecedented first step toward controlling high blood pressure – a disease that affects more than 200 million adults in India. The India Hypertension Management Initiative gives patients and health-care providers the tools they need for better blood pressure management and control.

However, scaling up effective programs throughout India, particularly for patients cared for by the fragmented private sector, will be difficult.

Trans fat restrictions

This year further demonstrated the public health benefits of reducing artificial trans fat consumption. One study showed there was a significant decline in heart attacks and strokes among New York residents living in areas with trans fat restrictions.

This toxic chemical can be removed from food without altering taste, while drastically improving heart health.

However, only a few countries around the world have policies in place to restrict trans fats. This is something we at Resolve to Save Lives hope to change in 2018.

Resolve to Save Lives was launched this year as an initiative of the global health organization Vital Strategies. We have the tools to address the health issues discussed above and prevent millions of deaths. But unless urgent action is taken, millions of people will continue to die preventable deaths.

We hope that, five years from now, we’ll look back at 2017 as the year these critical public health issues began to improve – similar to improvements we’ve seen in recent decades in progress against HIV/AIDS, polio and smoking.


World Health Organisation (WHO) with Mekong countries call for accelerated action to eliminate malaria before 2030

Representatives from Cambodia, China, the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam today called for accelerated action to eliminate malaria in the Greater Mekong Subregion (GMS) by the year 2030. The call comes amid concern over resistance of malaria parasites to antimalarial drugs, including artemisinin—the core compound of the best available antimalarial medicines. To date, resistance has been detected in five of the six GMS countries. The best way to address the threat posed by drug resistance is to eliminate malaria altogether from the countries of the Mekong.

At a high-level meeting convened by the Ministry of Health and Sports of Myanmar in collaboration with the World Health Organization (WHO) and the Asia Pacific Leaders Malaria Alliance (APLMA), representatives from the six GMS countries stressed that eliminating malaria in the Subregion requires urgent and coordinated action, with support from implementing agencies, funders and other partners.

Ministers from the six countries pledged to:

ensure activities to eliminate malaria in the subregion are fully funded, including with more domestic funds;
improve cross-border collaboration and establish an independent oversight body, for which WHO will act as the secretariat;
strengthen systems for the identification and timely reporting of malaria infections, including drug-resistant forms;
provide the best possible prevention, diagnosis and care for all people at risk of malaria, including free services for ethnic minorities and mobile and migrant populations, as part of universal health coverage;
ensure available antimalarial medicines are safe and effective for use;
bring all concerned sectors together to translate policies into time-bound and results-oriented actions; and
engage communities in malaria elimination using innovative communication tools.
Countries requested support from WHO to achieve their malaria elimination goals.

“Malaria is a disease that we can—and must—eliminate from the Greater Mekong Subregion. The drive to achieve this goal by 2030 demonstrates the joint commitment of health leaders from across the subregion to secure the health and well-being of vulnerable populations and ensure no one is left behind,” said Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia.

“The malaria parasite doesn’t need a passport or a visa to cross borders. You must work more closely together as one region, with one strategy to drive elimination. Accelerating malaria elimination in the Greater Mekong will not only improve lives today. It will also free future generations from the plague of malaria, and set an example for the rest of the world,” said Dr Shin Young-soo, WHO Regional Director for the Western Pacific.

WHO helps governments achieve malaria elimination by:

setting and disseminating guidance and policies on malaria control and elimination;
supporting countries as they adapt, adopt and implement WHO global norms and standards for malaria control and elimination;
assisting countries in the implementation of national malaria strategic plans;
helping countries develop robust malaria surveillance systems; and
responding to requests from countries to address threats, operational emergencies and bottleneck issues.
Recent efforts to fight malaria in the GMS have yielded impressive results. According to the latest WHO estimates, malaria cases in the six countries fell by an estimated 74% between 2012 and 2016. Deaths due to malaria fell by 91% over the same period.

This progress was made possible through greater access to effective malaria control tools, particularly artemisinin-based combination therapies for malaria treatment, rapid diagnostic tests, and insecticide-treated nets. Since 2012, targeted provision of these tools to vulnerable populations has increased substantially across the subregion, leading to acceleration in the pace of progress. Resistance to antimalarial drugs, unless addressed with urgency, could undermine these gains.

Malaria is a life-threatening disease caused by Plasmodium parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. WHO-recommended malaria control tools include: long-lasting insecticidal bed-nets, spraying inside walls of dwellings with insecticides, preventive treatment for infants and during pregnancy, prompt diagnostic testing, and treatment of confirmed cases with effective anti-malarial medicines.



World Health Organization: Malaria treatment stalls as funding flatlines

The global fight against malaria is grinding to a halt, the World Health Organization warned on Wednesday, amid flat-lining funding and political complacency.

Malaria infected an estimated 216 million people last year — about 5 million more than in 2015 — potentially reversing a six-year trend of decreasing infection cases. The majority of the 440,000 lives claimed by the mosquito-borne disease were young children in sub-Saharan Africa.

WHO Director General Tedros Adhanom Ghebreyesus said "progress appears to have stalled" in the fight against the tropical disease.

"Although there are some bright spots in the data, the overall decline in the global malaria burden has unquestionably levelled off," Ghebreyesus said. "And, in some countries and regions, we are beginning to see reversals in the gains achieved."

Fall in funding

Experts fear financial shortfalls and government complacency have thrown progress off track.

"At the current level of funding and coverage of current tools, we have reached the limits of what can be achieved in the fight against the disease," said Abdisalan Noor, lead author of the WHO's annual malaria report.

Investment into malaria prevention — a third of which came from the US last year — has leveled off since 2010. Analysis by the WHO found that funding in countries with a high risk of malaria had dropped to an average of less than two dollars per person per year.

The WHO says a minimum annual investment of $6.5 billion (€5.5 billion) is required to meet its ambitious 2030 targets.

Funding in 2016 stood at just $2.7 billion.

Change in fortunes

The long-term global decline in malaria-related deaths has helped cut child mortality, driving a sharp increase in global life expectancy.

The WHO has repeatedly made announcement on "the massive roll-out of effective disease-cutting tools" and "impressive reductions in cases and deaths."
Mosquito nets soaked in insecticide — mostly delivered through mass distribution campaigns — are the primary method of protection. But in sub-Saharan Africa fewer than half of households have sufficient access to them.

"If we continue with a business-as-usual approach — employing the same level of resources and the same interventions — we will face near-certain increases in malaria cases and deaths," Ghebreyesus said.

Uneven coverage

Some 80 percent of malaria deaths take place in just 15 countries — 14 sub-Saharan African nations and India.

Emergency work is underway in Nigeria, South Sudan, Venezuela and Yemen, where ongoing humanitarian crises pose further public health risks.
Several countries in the Middle East and central Asia have been certified as malaria-free in the last decade, including Morocco, Armenia and Turkmenistan. Last year, Kyrgyzstan and Sri Lanka joined their ranks, having gone three years without recording an indigenous case of malaria.

"We are up against a tough adversary," Ghebreyesus said. "But I am also convinced that this is a winnable battle."


Hot topics in public health go global in Berlin at the World Health Summit

The burning issue at this year’s World Health Summit in Berlin was health security. At this 8th WHS it was clearer than ever that the walls between the traditional disciplines of ‘global health’ and (European) ‘public health’ are rapidly coming down, with health threats anywhere in the world becoming a domestic challenge as well as an international development issue. The topics driving the agenda in Berlin are increasingly preoccupying European Heads of State as well as their G7 and G20 counterparts. It is a welcome signal that the patrons of the WHS, Chancellor Merkel and European Commission President Juncker, are joined by France’s President Macron. Nevertheless, in a blistering keynote speech MSF International President Joanne Liu challenged the mostly-European audience to protect health wherever and whenever threats arise and not only when they reach our shores.

Antimicrobial resistance (AMR) emerged as one of the principal topics under discussion at the 2017 World Health Summit in Berlin, with a number of sessions looking at it from a global, “One Health” perspective and in the broader context of international policy action in support of achieving the Sustainable Development Goals.

Ahead of the WHS, the UK government, with the Wellcome Trust and the governments of Ghana and Thailand, organised another event in Berlin hosted by Professor Dame Sally Davies. EPHA Secretary General Nina Renshaw was invited to present and spoke about the importance of binding measures to tackle pollution in the antibiotic supply chain, as a major accelerator of resistant bacteria in the local environment of pharmaceutical factories which can then spread rapidly.

At the WHS session on AMR, Dr Rüdiger Krech (WHO), underlined the global scope of the AMR problem, recalling that gonorrhoea is becoming increasingly resistant to antibiotics, while also mentioning multi-drug resistant TB, E.Coli and hospital infections including MRSA.

EPHA’s points appear to be echoed by attendees at both events. Notably, Thomas Cueni (Director General, International Federation of Pharmaceutical Manufacturers & Associations) recognised the problem of environmental spill-over in e.g. India in the supply chain of cheaply produced generic drugs, with public procurement (e.g. certified suppliers) and consumer choice as powerful tools that could be exploited. He also stated that if voluntary initiatives don’t work, regulatory approaches could be considered, with some companies willing to share data with WHO.

Jeremy Knox of the Wellcome Trust emphasised that the evidence base regarding behaviour change is not as developed as it should be. He pointed out that Wellcome is developing a new policy and advocacy stream on AMR working in collaboration with civil society, while at the same time making a major investment in the CARB-X Global Partnership.

Discussion turned to the question of developing and managing antimicrobials effectively as a “global public good” and the flawed business model for antibiotics, with companies not following rhetoric with action, according to Dr Krech, keen on investing in more profitable medicines and on avoiding any regulation. In turn, Cueni explained some key industry obstacles, noting high risk of failure in the development process. He argued for a globally funded model but was sceptical that this would happen anytime soon. Mr Knox stated that it was high time that governments and companies began to experiment with available innovation models, the best of which combine push and pull incentives.

Another problem highlighted by participants was that antibiotics are cheaper than diagnostics, which means it is easier to omit testing before prescribing them.

Representing the German Federal Ministry of Health, Karin Knufmann-Happe also mentioned the environmental dimension of AMR – specifically, antibiotic waste and residues in water – as a key element of Germany’s inter-sectoral national strategy (2015), designed to be closely aligned with the WHO Global Action Plan. She revealed that Germany’s efforts to influence the G7 and G20 agendas is motivated by the recognition that some issues cannot be tackled at the national level alone, and that tackling AMR also involves health systems strengthening. A new global AMR R&D hub is planned to be established in Germany to pursue a long-term vision.

Vaccination also featured strongly at the WHS, including as a measure to reduce antibiotic use, especially reflecting growing concerns over vaccine hesitancy and recent vaccine-preventable disease outbreaks, including measles in Europe. 


Obesity a bigger threat to world health than malnutrition: Global Nutrition Report 2017

Overweight and obesity are on the rise in almost every country, with 2 billion of the world’s 7 billion people being overweight or obese, says The Global Nutrition Report 2017.

In India, 16% of adult men and 22% of adult women are overweight.

The study, conducted across 140 countries, says there is a less than 1% chance of meeting the global target of halting the rise in obesity and diabetes by 2025.

Undernutrition in children is decreasing globally, but progress is not fast enough to meet internationally-agreed nutrition goals, including the Sustainable Development Goals (SDG) target to end all forms of malnutrition by 2030.

According to the report, 155 million under-fives are stunted; and 52 million children worldwide are defined as wasted, meaning they do not weigh enough for their height.

The report brings to light the crucial need to tackle the double burden of undernutrition and obesity, in order to address India’s national nutrition strategy.

Thirty-eight percent children in India under the age of 5 are affected by stunting, and 21% of under 5s are defined as ‘wasted’ or ‘severely wasted’, meaning they do not weigh enough for their height.

Rising rates of anaemia in women of reproductive age is also a big concern, with the report showing more than half of India’s women and almost one in three women affected worldwide and no country on track to meet global targets.

A staggering 88% of countries studied face a serious burden of two or three forms of malnutrition.

“The world can’t afford not to act on nutrition or we risk putting the brakes on human development as a whole,” said Corinna Hawkes, co-chair, Global Nutrition Report’s Independent Expert Group, and director, of the Centre for Food Policy at City, University of London.

“We will not achieve any of the Global Goals for SDGs by the 2030 deadline unless there is a critical step change in our response to malnutrition in all its forms. Equally, we need action throughout the goals to tackle the many causes of malnutrition.”

Where India stands

  • 38%: Stunted under-5 children
  • 21%: Wasted’ or ‘severely wasted’ under-5 children who weigh less for their height
  • 16%: Overweight adult men
  • 22%: Overweight adult women
  • 51%: Anaemia in women of reproductive age

Source: The Global Nutrition Report 2017