WHO Collaborating Research Articles

7.K. Round table: Approaching new public health frontiers: health literacy on a global level

Abstract This workshop will introduce the newly established WHO Collaborating Centre for Health Literacy (WHO CC HL) at TU Munich (TUM) in Germany and reflect on its goals and discuss the potential impact on European public health research, policy, and practice. With the launch of the WHO CC HL, TUM, WHO, and their collaborators, among which are the EUPHA Health Literacy Section, the International Health Literacy Association, and the Global Health Literacy Research Network, jointly aim at systematically developing health literacy as part of the WHO Sustainable Development and Well-being agenda. Health literacy represents the skills and attitudes to find, understand, appraise, and apply health information and services. Low health literacy is prevalent among all population and age groups and it is linked to worse health outcomes and health inequalities. Across the social gradient, people from low socioeconomic backgrounds are more likely to have low health literacy, which is why the European Commission and WHO both highlighted the need to invest in health literacy and, in particular, in school health literacy. Two emerging fields of study include data generation and interventions. Both of which are highly critical to monitoring change and providing evidence-based data on population and system-level health literacy within and between countries. However, there are no health literacy monitoring systems in place on a global scale nor is there robust evaluation data on school-based interventions. These shortcomings will be addressed through the WHO CC HL at TUM. In this round table workshop with five key health literacy and public health experts, the main goal is to present the WHO CC HL and its roadmap for the next four years and critically discuss how the work can influence European and Global public health: Dr. Faten Ben Abdelaziz, WHO; Anastasia Kyoylu, WHO/Europe; Dr Kristine Sorensen, Global Health Literacy Academy; Dr. Charlotte Marchandise, EUPHA; Prof. Dr. Orkan Okan, WHO Collaborating Centre for Health Literacy at Technical University of Munich. First, the chair will provide a short introduction to the WHO CC HL and will, together with the co-chair, facilitate the following panel discussion. The panel members will share a short 2-to-3-minute statement from their point of view in relation to planned activities of the WHO CC HL and highlight synergies to public health and health literacy development. Following the short statement, the chairs will prepare individual questions for each panellist and engage them in a discussion, which shortly after will open towards the audience for them to participate actively with the panellists in a 30-minutes discussion. Key messages • The round table workshop will introduce the newly established WHO CC HL, highlight its goals and impact on public health, and highlight collaboration opportunities. • The key experts will reflect about the WHO CC HL from their unique standpoints and reveal new perspectives on the way forward and how the work can benefit from ongoing public health initiatives. Speakers/Panelists Faten Ben Abdelaziz WHO, Geneva, Switzerland Anastasia Koylyu WHO, Copenhagen, Denmark Kristine Sørensen Global Health Literacy Academy, Risskov, Denmark Charlotte Marchandise EUPHA Orkan Okan Technical University of Munich, Munich, Germany

Tackling Health Inequalities in Times of Crisis

Abstract Across Europe, people are grappling with a multitude of challenges, spanning from the cost of living to housing, food insecurity, climate change, conflicts, and social unrest. These adversities significantly impact individuals’ health and wellbeing, and create the conditions for persisting health inequalities. At the root of these crises are unjust economic systems, in which the privileged few benefit while the majority face difficulties on a daily basis. Societies across Europe are witnessing rising polarisation and discrimination. Competitiveness and security are emerging as key priorities in the new European political landscape, with health and wellbeing pushed to the sidelines. Tackling health inequalities in times of crisis requires urgent, targeted action across societal sectors and levels. Education emerges as a crucial equaliser, alongside income and social safety nets. Moreover, effective climate strategies must prioritise the needs of the most vulnerable population groups. This plenary session lays the groundwork for understanding our contemporary, rapidly evolving landscape and its implications for addressing health inequalities. What lessons can we draw from new approaches across sectors that meet social and health needs, and how can we navigate these challenges – and sail those waves of innovation – to ensure equitable health and social justice for all? Moderators Caroline Costongs Director EuroHealthNet Cristina Abreu Santos Vice-President Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Portugal Keynote speakers Fran Baum The Stretton Institute, The University of Adelaide, Australia (by video message) Katarina Ivanković Knežević Director for Social Rights and Inclusion, Directorate-General Employment, Social Affairs and Inclusion, European Commission Panellists Didier Jourdan UNESCO Chair and WHO Collaborating Centre ‘Global Health and Education’, University of Clermont-Auvergne, France Jill Litt Professor of Environmental Health in the Environmental Studies Programme, University of Colorado, USA and Senior researcher, Barcelona Institute of Global Health (ISGlobal), Spain

Impact of the COVID-19 pandemic on lifestyle’s behaviours of school-aged children in Portugal

Abstract Background COVID-19 pandemic impacted children’s daily routines. Based on this, WHO Collaborating Centre for Nutrition and Childhood Obesity in collaboration with WHO Regional Office for Europe coordinated the study about the impact of COVID-19 on lifestyle’s behaviours of school-age children in Europe, where 17 Member States participated, including Portugal. Methods Cross-sectional study was conducted within the sixth round of COSI Portugal, following a WHO common methodological protocol, during 2021-2022 school year. A national representative sample of families with children 6-8 years old were included and asked to report on variables comparing two periods: pre and during the COVID-19 pandemic. Results 5139 families participated. 11.4% reported a worsening of their perceived wealth and the percentage of fathers and mothers working full- or part-time decreased (74.6% to 68.7% and 70.6% to 59.6%, respectively) during pandemic. Children’s consumption of sweets (19.4%), savoury snacks (13.8%), fruit (11.9%) and vegetables (7.1%) increased, and sugary soft drinks (13.8%) decreased during pandemic. Family behaviours with the highest increases during pandemic were “eating together as a family” (35.4%), “cooking meals together with your child” (33.6%), “buying food in large quantities” (33.6%) and “eating home-cooked meals” (29.1%). Approximately, one in four parents reported children’s physical activity decreased and almost one in two reported an increase in recreational screen time. Parents who perceived their child as overweight during pandemic doubled (f7.9% to 14.6%). Children’s well-being behaviours that worsened more during pandemic were “having fun with friends” (44.3%), “got on well at school” (27.9%), “feel full of energy” (23.8%) and “feel fit and well” (22.2%). Conclusions These observations underscore the need to “build back better” post-pandemic with a focus on preventing and controlling childhood obesity and its determinants. Key messages • Portuguese children experienced negative impacts of the pandemic in their lifestyle behaviours, particularly on their physical health and well-being, with a report of a poorer socioeconomic situation. • This study and its findings give us a first-of-its-kind view into the physical and mental outcomes of the pandemic on school-aged children with a focus on the long-term, high-risk disease of obesity

Guidance on health promoting and climate-friendly hospitals and health services

Abstract The negative impacts of climate change on health and the healthcare system are becoming increasingly evident. The healthcare sector, which accounts for nearly seven percent of Austria’s CO2 emissions, contributes to the exacerbation of climate change on one hand, but is also affected by its consequences on the other. To meet these challenges, it is necessary for healthcare facilities to both adopt climate-protective measures and adapt to the changed conditions. A project launched in 2023, supported by the Austrian Health Promotion Agenda and in cooperation with the Austrian Network of Health Promoting Hospitals and Health Services, has shown that there is a need for support in implementing climate protection measures in healthcare facilities. In response, the WHO Collaborating Centre for Health Promotion in Hospitals and Healthcare, located at the Competence Centre for Health Promotion and Healthcare at the Austrian National Public Health Institute, will work on the development of standards based on international models to support healthcare facilities in the introduction of climate-friendly practices until 2026. The methodology of the project includes the analysis of existing quality criteria and instruments, as well as a modified Delphi process with two rounds of online questionnaires directed at an international panel of experts. After each round, exchange meetings with a smaller group from the panel take place to achieve consensus. Based on the research findings and the Delphi consultations, a draft of standards and an implementation manual will be created. These drafts will be piloted in various healthcare facilities in Austria and other countries to assess their practicability and effectiveness. Following the pilot tests, the standards and the manual will be revised to integrate the practical insights gained. At the time of the conference, the initial results of the Delphi process will be presented, providing insights for the further development of the standards. Key messages • Integrating climate-friendly practices into all aspects of healthcare can reduce its environmental impact, improve health outcomes, and contribute to the broader sustainable development goals. • Climate-friendly approaches yield significant health, economic, and social co-benefits.

Resurgence of influenza with increased genetic diversity of circulating viruses during the 2022-2023 season.

Introduction. After two seasons of absence and low circulation, influenza activity increased significantly in the winter of 2022-2023. This study aims to characterize virological and epidemiological aspects of influenza infection in Bulgaria during the 2022-2023 season and perform a phylogenetic/molecular analysis of the hemagglutinin (HA) and neuraminidase (NA) sequences of representative influenza strains.Hypothesis/Gap Statement. Influenza A and B viruses generate new genetic groups/clades each season, replacing previously circulating variants. This results in increased antigenic distances from current vaccine strains. Strengthening existing influenza surveillance is essential to meet the challenges posed by the co-circulation of influenza and SARS-CoV-2.Methodology. We tested 2713 clinical samples from patients with acute respiratory illnesses using a multiplex real-time RT-PCR kit (FluSC2) to detect influenza A/B and Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) simultaneously. Representative Bulgarian influenza strains were sequenced at the WHO Collaborating Centres in London, UK, and Atlanta, USA.Results. Influenza virus was detected in 694 (25.6 %) patients. Of these, 364 (52.4 %), 213 (30.7 %) and 117 (16.9 %) were positive for influenza A(H1N1)pdm09, A(H3N2) and B/Victoria lineage virus, respectively. HA genes of the 47 influenza A(H1N1)pdm09 viruses fell into clades 5a.2. and 5a.2a.1 within the 6B.5A.1A.5a.2 group. Twenty-seven A(H3N2) viruses belonging to subclades 2b, 2a.1, 2a.1b and 2a.3a.1 within the 3C.2a1b.2a.2 group were analysed. All 23 sequenced B/Victoria lineage viruses were classified into the V1A.3a.2 group. We identified amino acid substitutions in HA and NA compared with the vaccine strains, including several substitutions in the HA antigenic sites.Conclusion. The study's findings showed genetic diversity among the influenza A viruses and, to a lesser extent, among B viruses, circulating in the first season after the lifting of anti-COVID-19 measures.

From static snapshots to dynamic panoramas: the evolution and future vision of palliative care atlas in cross-national perspectives

Palliative care is essential to global health services as it improves the quality of life of patients, their families and caregivers. The ATLANTES Global Observatory of Palliative Care (University of Navarra) was created a decade ago to promote a positive attitude towards patients with advanced illness in society and medicine. To do so, and over the past 15 years, ATLANTES has mapped palliative care data worldwide using public health, macro and comparative perspectives in different atlases. These have enabled data to be contextualised and good examples to be identified concisely and graphically. Atlases have been widely employed as advocacy tools within international institutions and ministries of health. While the aim and the perspective have remained unalterable over time, the methods and design have evolved throughout the publications from sober cartography and static infographics to big interactive data visualisation web tools. By embracing technology, ATLANTES has developed an open-access web mapping tool reuniting information from regional atlases, favouring global access to data. In 2022, matching the increasingly recognised need for robust monitoring of palliative care worldwide, ATLANTES became a WHO Collaborating Centre for the Global Monitoring of Palliative Care Development. This attempt to bridge the gap and ensure equitable care information in countries with limited palliative care access has resulted today in more accessible, self-explanatory, and visually appealing palliative care data.

EVALUATION OF ANTIBIOTIC USE USING THE ATC/DD AND DU 90% METHODS IN OUTPATIENT PATIENTS IN PUSKESMAS RI TENAYAN RAYA

Infectious diseases are one of the health problem that threaten developing countries, including Indonesia. Riau as one of the provinces with its coastal coverage is not spared from this problem. Inaccurate use of antibiotics is found in the wider community, which can be a cause of negative risks such as antibiotic resistance. Antibiotics are drugs that are used to treat diseases caused by microbes. The improper use of antibiotics can lead to a risk of resistance. Resistance can be avoided using antibiotics. This study aimed to classify antibiotic use using ATC codes and determine the quantity of antibiotic use in outpatients by calculating the DDD. This research method was observational, with a descriptive design and retrospective data collection using secondary data by searching medical records. The sample in this study consisted of outpatients at the Tenayan Raya Inpatient Health Center Outpatient Installation between January and December 2022 who received antibiotic therapy with an ATC code and DDD value in accordance with the provisions of the WHO Collaborating Center, using a total sampling technique.The results of the study showed that based on the ATC/DDD and DU 90% methods, there were 3 antibiotics with the highest quantity of use, namely amoxicillin at 165,92 DDD/1000 KPRJ with a percentage of 67,02%, ciprofloxacin at 41,07 DDD/1000 KPRJ with a percentage of 16,59 %, and cefixime as much as 14,69 DDD/1000 KPRJ with a percentage of 5,93%. Keywords: antibiotics, ATC/DD, DU 90%, resistance

Clinical practice guidelines for prevention and treatment of postoperative gastrointestinal disorder with Integrated Traditional Chinese and Western Medicine (2023).

Postoperative gastrointestinal disorder (POGD) was a common complication after surgery under anesthesia. Strategies in combination with Traditional Chinese Medicine and Western medicine showed some distinct effects but standardized clinical practice guidelines were not available. Thus, a multidisciplinary expert team from various professional bodies including the Perioperative and Anesthesia Professional Committees of the Chinese Association of Integrative Medicine (CAIM), jointly with Gansu Province Clinical Research Center of Integrative Anesthesiology/Anesthesia and Pain Medical Center of Gansu Provincial Hospital of Traditional Chinese Medicine and WHO Collaborating Center for Guideline Implementation and Knowledge Translation/Chinese Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Center/Gansu Provincial Center for Medical Guideline Industry Technology/Evidence-based Medicine Center of Lanzhou University, was established to develop evidence-based guidelines. Clinical questions (7 background and 12 clinical questions) were identified through literature reviews and expert consensus meetings. Based on systematic reviews/meta-analyses, evidence quality was analyzed and the advantages and disadvantages of interventional measures were weighed with input from patients' preferences. Finally, 20 recommendations were developed through the Delphi-based consensus meetings. These recommendations included disease definitions, etiologies, pathogenesis, syndrome differentiation, diagnosis, and perioperative prevention and treatment.

A Notable Increase in Human Rabies Mortality After Ten Years in Iran in 2022: A Case Series Study

Rabies virus is responsible for 60000 deaths annually worldwide, and over 95% of all human rabies deaths occur in developing countries. In Iran, the annual number of animal bites is 180 per 100000 people, and rabies control programs focus more on post-exposure prophylaxis (PEP). In this study, the data on people whose death was caused by rabies were obtained from the WHO Collaborating Center (CC) for Reference and Research on Rabies (Pasteur Institute of Iran) from 2011 to 2022. Data analysis showed a remarkable increase in human rabies mortality rate after 10 years in Iran in 2022, with 14 cases. Then, the causes were investigated despite prevention measures. The increase in human rabies cases in Iran indicates that the currently used control methods are insufficient. Controlling the population of stray dogs, sterilization, and vaccination coverage of 70% are the most essential and basic steps in preventing rabies.

30 by 2030 campaign

Primary Health Care (PHC) is a cornerstone of universal health coverage (UHC). To prevent diseases and holistically treat people, community-based primary healthcare systems need to be strengthened. PHC is an approach that aims to address physical, mental, and social health and well-being, and to provide comprehensive care for a person's health needs throughout life rather than focus on treating a specific set of diseases. To achieve this approach, we must strengthen horizontal PHC systems and encourage vertical programmes, including disease-specific programmes, to be developed, integrated, and implemented in the context of integrated Primary Health Care.
 In early 2020 the WHO Collaborating Centre on Family Medicine and Primary Health Care launched the 30by2030 campaign (https://www.30by2030.net), whereby signatories are asking donors of vertical disease-oriented projects to invest at least 30% of their budgets for vertical programs in strengthening coordinated and integrated primary health care. The initiative is a pull of efforts of different organizations such as Wonca: World Organisation of Family Doctors, The Network: Towards Unity for Health (TUFH), African Forum for Primary Health Care, European Forum for Primary Care, PRIMAFAMED network, among others.
 The 30 by 2030 has two aims: the first one is to inform and raise awareness of the impact of vertical programs on health systems. Most of the private and external funds, which represent one-third of the total spending of PHC, are channelled through programmes that focus on the health problems of specific population subgroups (e.g., HIV, tuberculosis, malaria) which also leads to inequity by disease. The second aim is to call for international donors to assign 30% of their vertical top-down, disease-oriented budgets to strengthen primary healthcare services through coordination, increased human resources and improved infrastructure.

Belgian Integrated Health Record (BIHR): from 2025, all well-being and health data will be available for all members of the care team, including the patient himself. 

•Why are you conducting a workshop? Please explain the problem, the context, or the case study,
 It would be an absolute added value for the BIHR-project to also hear the voice and opinion from other countries and experts: what went very smoothly? But also, what obstacles were they confronted with and how did they tackle these challenges.
 •Who is it for? Please explain who you would like to engage with.
 BIHR is a ‘Moonshot’: the expert group defined four major groups that are essential to bring BIHR to a successful project: the citizens, the healthcare providers, the various governments, and partners from the industry.
 In the panel debate we would like to have representatives from those different stakeholders around the table.
 It would also be an absolute added value to hear success stories from other countries and see if things could be realized in Belgium in the short and/or medium term.
 •Ilke Montag, MD, MSc: lead of the Belgian expert panel about BIHR 
 •Jan De Maeseneer, MD, PhD: Head of WHO Collaborating Centre on Family Medicine and Primary Health Care - Ghent University Belgium
 •Bart Van den Bosch, MD, PHD: CIO at University Hospital Leuven Belgium
 •A representative of the European Patients Forum (European Patients' Forum - Home (eu-patient.eu))
 •A representative of the International Hospital Federation (Home - IHF - International Hospital Federation (ihf-fih.org))
 •Someone who can explain the concept and the functioning of EHRs in the Canadian Primary Health Care Services
 •Someone who can explain the concept and the functioning of Slovenian Community health centers with multidisciplinary teams 
 •What are you going to do? Please explain the structure of the session. Please remember that workshops’ objective is to be interactive and engage with the audience - At least ½ of the time should be based on the interaction with the audience. 
 •How are you going to engage with the audience?
 •How are you going to summarize the take home messages?
 We will start with a short 15 min. presentation/introduction of the concept of BIHR. Afterwards, the moderator asks for a short reflection on this concept by the various panel members. The panel members are then asked to name both a success story and the lessons learnt from less successful projects. To involve the public in the debate, statements for debate will be used, each time from a unique perspective (citizens, care providers, governments, industry). The panel members will be confronted with the voting results on the statements. 
 The take home message will be a compilation of the success keys cited by each of the panel. There will also be a warm appeal to work together not only across the various levels in health care, but also across national borders.

The onset and progression of oral potentially malignant disorders in Fanconi anemia patients: Highlighting early detection of oral cancer

In 2020, Fanconi anemia (FA) was classified as a syndrome with insufficient epidemiological evidence in the oral potentially malignant disorder (OPMD) group by the WHO Collaborating Centre. The paucity of case reports on FA-associated OPMD limits evidence-based management, and such cases have not been analyzed collectively in detail. Hence, the objective of this short communication is to summarize the evidence on the onset and progression of OPMD in FA patients, so as to better understand the natural history of oral cancer development in patients affected by FA. A total of 11 eligible papers containing 1332 FA patients are involved in onset and progression of OPMD in FA patients. Of these, 186 (14.0%) were diagnosed with OPMD. With available data from 4 follow-up studies, 30 (41.1%) of 73 FA patients compatible with OPMD further developed into OSCC at young age (10–30 years old). The evidence on FA with malignant potential comprise clinical epidemiology, oral cytology abnormalities, DNA aneuploidy, loss of autofluorescence, loss of heterozygosity, high-risk human papillomavirus infection, DNA mutations in saliva and plasma samples. Collectively, these can consummate the evidence on FA as a syndrome that may potentiate cancer development in oral cavity mentioned by the WHO. Importantly, it highlights close surveillance is instrumental for FA patients with OPMD to early detect oral cancer.

Karel Maršál 1943-2023.

It is with sadness that we received the message that Karel Maršál passed away on March 6, 2023. Karel Maršál, MD, PhD, Professor Emeritus at Lund University and Director of the WHO Collaborating Center in Lund, was born in Prague, former Czechoslovakia, in 1943. After completing his undergraduate studies at Charles University in Prague, he and his fiancée Lida moved as political refugees to Sweden in 1968. They came to Malmö General Hospital in 1973, where Karel gained his specialty in obstetrics and gynecology. Already then, Malmö was a nursery for research on fetal physiology and monitoring, and Karel was soon involved. He defended his PhD thesis, “Ultrasonic Measurements of Fetal Breathing Movements in Man”, at Lund University in 1977. With the introduction of Doppler ultrasonography to measure blood flow velocity, an era of prolific research commenced, leading to a growing international collaboration under Karel's leadership. In a series of PhD theses, normal fetal circulation was mapped to form the basis for the clinical assessment of the compromised fetus, and for studying the effects of medications and smoking during pregnancy. Experimental work on fetal lambs added further insights into circulatory pathophysiology. The introduction of routine ultrasound in Malmö in 1972 paved the way for identifying and studying fetal growth restriction and its underlying circulatory changes, today a major clinical field. Karel was the Head of the Perinatal Division at the University Hospital in Malmö and his personality as an enthusiastic, persevering, and meticulous scientist earned him a professorship in Malmö in 1991. In 1997, Karel moved to Lund to become Professor in Obstetrics and Gynecology, and later head of the clinical department. In 1995, he became Honorary Professor at Charles University in Prague, Czech Republic. He also served as Director of the undergraduate program of the Medical School at Lund University and as Chief Medical Officer in the county of Skåne, Sweden. Karel was the main tutor of 21 PhD students and co-tutor of another 14 research students. He published 354 original papers, 132 book chapters and reviews, and 14 textbooks. He was editor or co-editor of the Journal of Maternal and Fetal Investigation, of Fetal and Maternal Medicine Review, and of Seminars in Fetal and Neonatal Medicine, and was a member of the editorial board of 10 international scientific journals. His primary areas of experience and research were in perinatology, obstetrics, fetal monitoring, obstetric and gynecologic ultrasound, Doppler ultrasound, fetal physiology, ultrasound safety, and obstetric quality assurance. Throughout the years, Karel's research was supported by numerous grants, among them from the prestigious Swedish Research Council. He was the principal investigator in numerous national and international multicenter studies, such as the EXPRESS study on extremely preterm infants in Sweden, and he was national coordinator for Sweden in three EU studies. Karel served as president of the International Society of Ultrasound in Obstetrics and Gynecology, he was an honorary member of various national and international institutions and a board member of European Federation of Societies for Ultrasound in Medicine and Biology, World Federation for Ultrasound in Medicine and Biology, and other societies. In the past, he was the main organizer of 15 international scientific congresses, including two world congresses on ultrasound in obstetrics and gynecology. He received several prestigious awards, such as the Ian Donald Gold Medal and the Haackert Gold Medal in Prenatal Medicine. Karel was elected Doctor Honoris Causae at universities in Olomouc, Czech Republic, and Poznan, Poland. He was course leader of 38 national and international postgraduate courses in perinatal medicine, obstetrics, ultrasound, and obstetric Doppler ultrasound. His last participation in such an event was in February 2023. Karel's wife, Lida, gave him unending support throughout his career. Had Karel not injured his leg in a skiing accident, their paths may never have crossed. He had to take a break from medical school, and when he returned to his studies, he and Lida became classmates. Innumerable mothers and children all over the globe have benefited from Karel's ground-breaking scientific work, leadership, and deeds. His 50-year career as a clinician, scientist, teacher, coach, role model, and—most of all—the best friend of the unborn baby is now at an end. Among his friends and co-workers, he will be vividly remembered as a quietly jovial, sharp-witted gentleman with a human perspective and a friendly attitude toward each of us. He is sorely missed.

Study Finds Higher-Dose Antipsychotic Polypharmacy Does Not Increase Hospitalization

Study Finds Higher-Dose Antipsychotic Polypharmacy Does Not Increase Hospitalization

8th ABM/EABM European Regional Conference May 11–13, 2023 Split, Croatia

8^th ABM/EABM European Regional Conference May 11–13, 2023 Split, Croatia

Molecular Diagnosis of Leishmaniasis in Spain: Development and Validation of Ready-To-Use Gel-Form Nested and Real-Time PCRs To Detect Leishmania spp.

Leishmaniasis is an endemic parasitic disease in at least 98 countries. In Spain, it is considered a zoonosis caused by Leishmania infantum, with an annual incidence of 0.62 cases/100,000 inhabitants. The predominant clinical manifestations are the cutaneous (CL) and visceral forms (VL), and the diagnosis is performed by parasitological, serological, and molecular tests. At the WHO Collaborating Center for Leishmaniasis (WHOCCLeish), routine diagnostic tests are based on a nested PCR (Ln-PCR), culture, and serological tests. To simplify our PCR protocol, we aimed to develop and validate a ready-to-use nested gel-form PCR (LeishGelPCR) and a duplex real-time PCR (qPCR) that allowed simultaneous detection of Leishmania and mammalian DNA as an internal control (Leish-qPCR). Clinical validation was performed in 200 samples from the WHOCCLeish collection; 92 and 85 out of 94 and 87 samples were positive by LeishGelPCR and Leish-qPCR, respectively, showing a sensitivity of 98% in both approaches. The specificity was 100% for LeishGelPCR and 98% for Leish-qPCR. The limits of detection of both protocols were similar (0.5 and 0.2 parasites/reaction). Parasite loads in VL and CL forms were similar, although high loads were observed when invasive samples were tested. In conclusion, LeishGelPCR and Leish-qPCR showed excellent performance in the diagnosis of leishmaniasis. These new forms of 18S rRNA gene PCR are equivalent to Ln-PCR and can be introduced in the algorithm for CL and VL diagnosis. IMPORTANCE Although the gold standard for diagnosis of leishmaniasis is the microscopic observation of amastigotes, molecular techniques are becoming a cost-efficient alternative. Currently, PCR is a routine resource that is used in many reference microbiology laboratories. In this article, we have described two ways to improve the reproducibility and usability of the molecular detection of Leishmania spp. These new approaches could be introduced even in middle- and low-resource laboratories; one is a ready-to-use gel-form system of a nested PCR and the other is a real-time PCR. We show why molecular diagnosis is the best methodology to confirm a clinical suspicion of leishmaniasis with higher sensitivity than traditional methods, thus facilitating early diagnosis and timely treatment of human leishmaniasis.

Co-circulation of dengue virus serotypes 1 and 3 in the Fatick region of senegal 2018

On 10th September 2018, the Syndromic Sentinel Surveillance network that monitors febrile illnesses in all 14 regions of Senegal detected a peak of fever in the Fatick region. On 13 September 2018, 10 samples were sent to the WHO Collaborating Centre for Arboviruses and Viral Haemorrhagic Fevers at the Institut Pasteur de Dakar (IPD). Laboratory investigations revealed an epidemic of dengue 1 genotype V and dengue 3 genotype III. Fatick neighbors the Holy City of Touba where 3.5 million people from all over the word gather every year for the Grand Magal pilgrimage. This article discusses the impact of mass gatherings and their role in the recent introduction of dengue serotypes in Senegal. Dengue is now endemic in Senegal and across many countries in Africa, highlighting the need for early detection, control measures and prevention of severe dengue cases in highly connected urban settings.

Report on influenza viruses received and tested by the Melbourne WHO Collaborating Centre for Reference and Research on Influenza during 2022.

As part of its role in the World Health Organization's (WHO) Global Influenza Surveillance and Response System (GISRS), the WHO Collaborating Centre for Reference and Research on Influenza in Melbourne received a record total of 12,073 human influenza positive samples during 2022. Viruses were analysed for their antigenic, genetic and antiviral susceptibility properties. Selected viruses were propagated in qualified cells or embryonated hen's eggs for potential use in seasonal influenza virus vaccines. In 2022, influenza A(H3N2) viruses predominated over influenza A(H1N1)pdm09 and B viruses, accounting for 77% of all viruses analysed. The majority of A(H1N1)pdm09, A(H3N2) and influenza B viruses analysed at the Centre were found to be antigenically and genetically similar to the respective WHO recommended vaccine strains for the southern hemisphere in 2022. Of 3,372 samples tested for susceptibility to the neuraminidase inhibitors oseltamivir and zanamivir, two A(H1N1)pdm09 viruses showed highly reduced inhibition against oseltamivir.

Editorial introductions.

Editorial introductions.

Analysis of a Dengue Virus Outbreak in Rosso, Senegal 2021.

Senegal is hyperendemic for dengue. Since 2017, outbreaks have been noticed annually in many regions around the country, marked by the co-circulation of DENV1-3. On 8 October 2021, a Dengue virus outbreak in the Rosso health post (sentinel site of the syndromic surveillance network) located in the north of the country was notified to the WHO Collaborating Center for arboviruses and hemorrhagic fever viruses at Institut Pasteur de Dakar. A multidisciplinary team was then sent for epidemiological and virologic investigations. This study describes the results from investigations during an outbreak in Senegal using a rapid diagnostic test (RDT) for the combined detection of dengue virus non-structural protein 1 (NS1) and IgM/IgG. For confirmation, samples were also tested by real-time RT-PCR and IgM ELISA at the reference lab in Dakar. qRT-PCR positive samples were subjected to whole genome sequencing using nanopore technology. Virologic analysis scored 102 positives cases (RT-PCR, NS1 antigen detection and/or IgM) out of 173 enrolled patients; interestingly, virus serotyping showed that the outbreak was caused by the DENV-1, a serotype different from DENV-2 involved during the outbreak in Rosso three years earlier, indicating a serotype replacement. Nearly all field-tested NS1 positives samples were confirmed by qRT-PCR with a concordance of 92.3%. Whole genome sequencing and phylogenetic analysis of strains suggested a re-introduction in Rosso of a DENV-1 strain different to the one responsible for the outbreak in the Louga area five years before. Findings call for improved dengue virus surveillance in Senegal, with a wide deployment of DENV antigenic tests, which allow easy on-site diagnosis of suspected cases and early detection of outbreaks. This work highlights the need for continuous monitoring of circulating serotypes which is crucial for a better understanding of viral epidemiology around the country.