WHO Collaborating Centre Research Articles

Prevention of Mother-To-Child Transmission of Hepatitis B Virus: Guidelines on Antiviral Prophylaxis in Pregnancy

Most HBV-associated deaths among adults are secondary to infections acquired at birth or in the first five years of life. To extend the guideline for the prevention of mother-to-child transmission of the hepatitis B virus to include antiviral prophylaxis. The guideline was developed by the World Health Organization (WHO) in accordance with WHO standards. The summary was translated into German by employees of the WHO Collaborating Centre at Danube University Krems (Austria). In addition to the recommendation to test pregnant women for heptatitis B virus (HBV) and vaccinate newborns against hepatitis B as soon as possible after birth, two new recommendations have been formulated: pregnant women testing positive for HBV infection should receive tenofovir prophylaxis to prevent mother-to-child transmission of HBV. WHO recommends that in settings in which antenatal HBV DNA testing is not available, HBeAg testing can be used as an alternative to determine eligibility for tenofovir prophylaxis.

P187 Paratracheal abscess by plant fungus Chondrostereum purpureum. First case report of human infection

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectiveTo identify the etiological agent of paratracheal abscess applying molecular techniques.MethodsA 61-year-old male, plant Mycologist, who specially works with mushrooms presented to the OPD with hoarseness of voice and difficulty in swallowing for the last 3 months. CT scan demonstrated the presence of a right paratracheal abscess. CT-guided aspiration of the abscess was performed. The pus was sent for microbiological evaluation.ResultsThe pus culture done on Sabouraud dextrose agar grew a creamy pasty colony with buff-colored pigmentation on reverse side (Fig. 1). On LCB mount preparation it was found to be a yeast-like structure with slender hyphae as shown in Fig. 2. The fungus could not be identified phenotypically, so it was sent to the ‘WHO Collaborating Centre for Reference and Research on Fungi of Medical importance’. It was identified as Chondrostereum purpureum by DNA sequencing. Patient was treated with oral voriconazole following drainage of the pus and the outcome was favorable. The patient denied having worked with such a plant pathogen but he confirmed d that he was working with decaying material and other plant fungi for a long time as part of his research activities.ConclusionSilver leaf is a fungal disease of trees caused by the fungus plant pathogen Chondrostereum purpureum. The disease is progressive and often fatal for the plants. It is spread by airborne spores landing on freshly exposed sapwood. No human infection was reported till date. The case report demonstrates the crossover of plant pathogens into humans when working in close contact with plant fungi.

S3.1a Update in mycetoma control

S3.1 Neglected implantation mycoses, September 21, 2022, 4:45 PM - 6:15 PMMycetoma is a badly neglected tropical disease, reported globally but endemic in many tropical and subtropical, and Sudan has the highest disease burden. Mycetoma epidemiological features remain uncharacterized. Hence, there is no preventive or control program for mycetoma worldwide. To reduce the disease burden and its socio-economic impacts on patients, families, communities, and the health system in the endemic regions, the Mycetoma Research Center, University of Khartoum, Sudan, WHO Collaborating Center on Mycetoma has adopted a unique holistic approach to management and mycetoma patients, and it gained a great experience on that.In this presentation, we will share the MRC's experience in dealing with the patients at the endemic villages level, supporting the affected communities and collaborating with the local health authorities to improve the life quality of the affected patients.

20 Years of ICF-International Classification of Functioning, Disability and Health: Uses and Applications around the World.

The International Classification of Functioning Disability and Health (ICF) was approved in 2001 and, since then, several studies reported the increased interest about its use in different sectors. A recent overview that summarizes its applications is lacking. This study aims to provide an updated overview about 20 years of ICF application through an international online questionnaire, developed by the byline authors, and sent to each World Health Organization Collaborating Centers of the Family of International Classifications (WHO-FIC CCs). Data was collected during October 2020 and December 2021 and descriptive content analyses were used to report main results. Results show how, in most of the respondent countries represented by WHO-FIC CCs, ICF was mainly used in clinical practice, policy development and social policy, and in education areas. Despite its applications in different sectors, ICF use is not mandatory in most countries but, where used, it provides a biopsychosocial framework for policy development in health, functioning and disability. The study provides information about the needs related to ICF applications, that can be useful to organize targeted intervention plans. Furthermore, this survey methodology can be re-proposed periodically to monitor the use of the ICF in the future.

ANTIBACTERIAL THERAPY FOR PATIENTS WITH BURN INJURIES

Background. Treatment of burn wound infection is an urgent issue of contemporary medicine, including surgery, combustiology and microbiology. It is established that infectious complications are a challenge for burn patients. In the course of wound reparation, infectious complications may worsen. Along with surgical treatment, mechanical removal of pathogens from burn wounds is also important as well as antimicrobials for patients with severe burns. Objective. The aim of the study was to define the most common pathogens of purulent-inflammatory complications of burn wounds and their susceptibility to antibiotics. Methods. The study involved patients treated at the Center of Thermal Trauma and Plastic Surgery of Lviv I-Territorial Medical Association, the unit of St. Luke Hospital of Lviv. Collection of material from wound secretions of burn wounds was performed with sterile swab. The study was performed before prescription of antibiotics, at the end of the first and second weeks of the disease. The pathogens were isolated and identified. Antibiotic susceptibility was studied using standard research methods. The obtained results were analyzed by means of the software package of the microbiological monitoring system WHONET 5.2 (WHO Collaborating Centre for Surveillance of Antimicrobial Resistance) and the program Microsoft Office Excel 2007. Results. The study of smears from burn wounds proved that 240 strains of gram-positive and gram-negative microorganisms that caused purulent-inflammatory processes were isolated. Among the selected causative agents of a burn wound complicated by a purulent-inflammatory process, gram-negative bacteria predominated (60.8% of all detected microorganisms). Gram-positive flora of S. epidermidis and S. aureus were more common in the wound surface during the first week of the disease. In most patients with severe burns, bacterial associations were isolated from the wound surface (66.3%) in two and three weeks, and in three weeks Candida spp. were isolated. Non-fermenting rods A. baumannii and P. aeruginosa dominated among the gram-negative flora isolated from the wound surface of burns. The analysis of susceptibility of microorganisms isolated from patients with burns to antibiotics showed that almost all of the cultures were polyresistant. Conclusions. Gram-negative microorganisms, strains of non-fermenting bacteria predominated among the pathogens isolated from burn wounds complicated by purulent inflammation; Staphylococcus aureus prevailed among the gram-positive ones. The most significant clinical strains were highly polyresistant to antibiotics.

Best Practices of the World Health Organization Collaborating Centres (WHOCCs) in the Eastern Mediterranean Region.

BackgroundWorld Health Organization Collaborating Centres (WHOCCs) cooperate with the WHO on a range of strategic areas such as nursing, nutrition, mental health, chronic diseases, education, and health technologies, depending on their speciality areas. As of 2021, WHO has 47 CCs in the Eastern Mediterranean Region (EMR) collaborating on diverse areas. Four CCs in the EMR located in Egypt, Kingdom of Bahrain, Sudan, and Pakistan focus primarily on medical education (ME).ObjectiveThe objective of this review of the literature is to describe the best practices in ME based on published research from the four WHOCCs in EMR. The secondary objective is to classify them based on the level of Kirkpatrick’s model (KM) of educational outcomes.MethodsThe contributions of WHOCCs are categorised in to five domains namely “Curriculum Development and Course Design”, “Student Assessment”, “Quality, Accreditation, and Program Evaluation”, “Teaching and Learning” and “Innovation in Medical Education”. Initial extraction yielded 96 articles for review, while the second level of analysis reduced the number of publications to 37 based on the date of publication within the last 5 years. Numerous best practices in ME emerged from the recently published works of these WHOCCs in the areas of learning and teaching, curriculum development, innovations in medical education, quality, and assessments in medical education. Literature from the WHOCCs on assessment and curriculum design are limited, possibly indicating opportunities for additional research.ConclusionThe researchers conclude that the WHOCCs in the EMR show transformational impact on all principal areas of research and at multiple levels.

International Classification of Diseases clinical coding training: An international survey.

The International Classification of Diseases (ICD) is widely used by clinical coders worldwide for clinical coding morbidity data into administrative health databases. Accordingly, hospital data quality largely depends on the coders' skills acquired during ICD training, which varies greatly across countries. To characterise the current landscape of international ICD clinical coding training. An online questionnaire was created to survey the 194 World Health Organization (WHO) member countries. Questions focused on the training provided to clinical coding professionals. The survey was distributed to potential participants who met specific criteria, and to organisations specialised in the topic, such as WHO Collaborating Centres, to be forwarded to their representatives. Responses were analysed using descriptive statistics. Data from 47 respondents from 26 countries revealed disparities in all inquired topics. However, most participants reported clinical coders as the primary person assigning ICD codes. Although training was available in all countries, some did not mandate training qualifications, and those that did differed in type and duration of training, with college or university degree being most common. Clinical coding certificates most frequently entailed passing a certification exam. Most countries offered continuing training opportunities, and provided a range of support resources for clinical coders. Variability in clinical coder training could affect data collection worldwide, thus potentially hindering international comparability of health data. These findings could encourage countries to improve their resources and training programs available for clinical coders and will ultimately be valuable to the WHO for the standardisation of ICD training.

Interreg and WHO-CC : a Fruitful Collaboration in the Service of E-Mental Health

Within the IT4Anxiety project, the World Health Organisation Collaborating Centre (WHOCC) for research and training in mental health of Lille, is the leader of the work package “identification of needs among the different actors in the mental health field”. The complexity of our object of study - the use of new technologies for people’s mental health - requires undertaking a multi-disciplinary approach, considering both the clinical and the socio-anthropological aspects. A mixed-methods research conducted with pepole people experiencing anxiety, carers and professionnals, aims to describe the use, acceptability and needs of the different categories of actors concerned by the use of new technologies. The quantitative part is a cross-sectional, descriptive, observational study. A anonymous self-administered questionnaire is distributed online and in hard copy in the 5 partner countries (Belgium, France, Germany, the Netherlands and the UK) to the three study populations. It consists of access to digital tools or technological solutions, experience related to these and the contribution and perceived effect of users to e-mental health related projects. The qualitative approach includes a detailed understanding of the potential therapeutic and socio-anthropological changes that these tools can bring. It explores : description of used technologies, the representations and emerging needs in relation to the management of anxiety and the improvement of mental health ; the clinical impact perceived by all stakeholders and the implementation of new ways of living with the tools. This international research will enable a comparative study to be carried out on the dynamics of appropriation of these e-(mental) health devices in different countries of the North-Western European region.DisclosureNo significant relationships.

Evaluation of the effectiveness of Interprofessional Education at Gunma University as the WHO Collaborating Centre: case series

Evaluation of the effectiveness of Interprofessional Education at Gunma University as the WHO Collaborating Centre: case series

Lola Kola: developing mHealth for mental health in west Africa

Lola Kola's passion is global mental health research that harnesses the potential “of psychological interventions for improving outcomes for patients when delivered by trained lay health-care workers” and “the use of technology to support the delivery of such interventions”, she says. Based in Ibadan, Nigeria, Kola is Senior Research Fellow at the University of Ibadan's WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse in the Department of Psychiatry, College of Medicine, and Adjunct Associate Professor at the Department of Sociology and Psychology at the Lead City University. Kola is also affiliated with the Behavioral Research in Technology and Engineering (BRiTE) Center at the University of Washington (UW), Seattle, WA, USA, and the University of Ibadan's Centre for Child and Adolescent Mental Health in the College of Medicine. With colleagues at the BRiTE Center, and supported by an NIH Global Emerging Leader grant, Kola has led the design and development of a mobile phone app for the self-management of perinatal depression in adolescent mothers as an adjunct intervention to WHO's Mental Health Gap Action Programme (mhGAP) within routine antenatal and perinatal services in primary care. This population has “a greater risk of depression and anxiety than their adult counterparts, which in turn predisposes them to serious physical health complications”, she says. These “young mothers did not like going for treatment in primary care because of self-stigma and social stigma”, Kola explains, and “the app brings care closer to them”. The app uses short, age-appropriate animated videos to deliver mental health and wellbeing messages, including encouraging treatment attendance. Kola and her colleagues have recently completed the field trial of the app and she is now working with a colleague in Kenya to explore funding for use of the app in other African countries, starting with Kenya.

NA0D - The new Traumatic Dental Injury classification of the World Health Organization.

An accurate, clear, and easy-to-use traumatic dental injury (TDI) classification and definition system is a prerequisite for proper diagnosis, study, and treatment. However, more than 50 classifications have been used in the past. The ideal solution would be that TDIs are adequately classified within the International Classification of Diseases (ICD), endorsed by the World Health Organization (WHO). TDI classification provided by the 11th Revision of the ICD (ICD-11), released in 2018, and previous Revisions, failed to classify TDIs satisfactorily. Therefore, in December 2018, a proposal was submitted by Dr's Stefano Petti, Jens Ove Andreasen, Ulf Glendor, and Lars Andersson, to the ICD-11, asking for a change of the existing TDI classification. Proposal #2130 highlighted the TDI paradox, the fifth most frequent disease/condition neglected by most public health agencies in the world, and the limits of ICD-11 classification. Namely, injuries of teeth and periodontal tissues were located in two separate blocks that did not mention dental/periodontal tissues; infraction, concussion, and subluxation were not coded; most TDIs lacked description; and tooth fractures were described through bone fracture descriptions (e.g., comminuted, compression, and fissured fractures). These limitations led to TDI mis-reporting, under-reporting, and non-specific reporting by untrained non-dental healthcare providers. In addition, no scientific articles on TDIs, present in PubMed, Scopus, and Web-of-Science, used the ICD classification. Proposal #2130 suggested to adopt the Andreasen classification, the most widely acknowledged classification used in dental traumatology. The Proposal was reviewed by two WHO teams, two scientific Committees, one WHO Collaborating Center, and the Department of Non-Communicable Disease Prevention at WHO headquarters, and it underwent two voting sessions. In March 2022, the Andreasen classification was accepted integrally. A new entity was generated, called NA0D, "Injury of teeth or supporting structures" (https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1413338122). Hopefully, this will contribute to increasing the public awareness, and the dental profession's management, of TDIs.

Brief CBT Interventions May Stop Depression Before It Starts

Brief CBT Interventions May Stop Depression Before It Starts

Financing the future of WHO

Financing the future of WHO

Kanta Subbarao—confronting influenza and COVID-19

Kanta Subbarao—confronting influenza and COVID-19

Characterization of influenza B viruses with reduced susceptibility to influenza neuraminidase inhibitors

A total of 3425 influenza B viruses collected from the Asia-Pacific region were tested against the four registered neuraminidase inhibitors (NAIs) (oseltamivir carboxylate, zanamivir, peramivir and laninamivir) as part of the routine surveillance work at the WHO Collaborating Centre for Research and Reference on Influenza, Melbourne between 2016 and 2020. Forty-five influenza B viruses with reduced susceptibility to one or more NAIs were identified. While the majority of these had neuraminidase (NA) mutations that were known to confer NAIs resistance, fifteen had NA mutations that had not been confirmed as being responsible for reduced NAIs susceptibility. Eleven of these NA mutations of concern were investigated using reverse genetics (RG) techniques to verify that these mutations were the cause of the reduced NAI susceptibility. All mutations were introduced separately into the NA of B/Brisbane/27/2016 (a B Victoria-lineage virus) or B/Yamanashi/166/98 (a B Yamagata-lineage virus) and the effects of these were analysed by an in vitro NAI assay. The T146K substitution in the NA of B Victoria and Yamagata-lineages resulted in a large increase in the IC50 for peramivir (>1000-fold increase in the mean IC50 of sensitive viruses with T146) with smaller increases for zanamivir and oseltamivir. A proline substitution (T146P) had a slightly lower (>700-fold) effect on the peramivir IC50 and also on the other NAIs. The presence of a second NA mutation at N169S combined with the T146P further increased the IC50 of peramivir (>7000-fold) and the other NAIs. A synergistic effect was also confirmed for dual NA mutations with G247D + I361V which showed a modest increase in the IC50 for oseltamivir (6-fold). Only one of two RG-viruses with the mutation G108E could be rescued and it had a high IC50 against zanamivir (>4000-fold) and laninamivir (>7000-fold), but a lower IC50 against oseltamivir (>200-fold). NA mutations H101L, A200T, D432G, H439P and H439R were also confirmed to somewhat reduce the in vitro susceptibility of influenza B viruses to the NAIs. Overall, this study identifies the potential impact of selected mutations on the clinical performance of NAIs when used to treat influenza B infection in humans.

Management of Medication-Induced Psychiatric Disorders.

Management of Medication-Induced Psychiatric Disorders.

Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019

SummaryBackgroundHand hygiene is at the core of effective infection prevention and control (IPC) programmes. 10 years after the development of the WHO Multimodal Hand Hygiene Improvement Strategy, we aimed to ascertain the level of hand hygiene implementation and its drivers in health-care facilities through a global WHO survey.MethodsFrom Jan 16 to Dec 31, 2019, IPC professionals were invited through email and campaigns to complete the online Hand Hygiene Self-Assessment Framework (HHSAF). A geospatial clustering algorithm selected unique health-care facilities responses and post-stratification weighting was applied to improve representativeness. Weighted median HHSAF scores and IQR were reported. Drivers of the HHSAF score were determined through a generalised estimation equation.Findings3206 unique responses from 90 countries (46% WHO Member States) were included. The HHSAF score indicated an intermediate hand hygiene implementation level (350 points, IQR 248–430), which was positively associated with country income level and health-care facility funding structure. System Change had the highest score (85 points, IQR 55–100), whereby alcohol-based hand rub at the point of care has become standard practice in many health-care facilities, especially in high-income countries. Institutional Safety Climate had the lowest score (55 points, IQR 35–75). From 2015 to 2019, the median HHSAF score in health-care facilities participating in both HHSAF surveys (n=190) stagnated.InterpretationMost health-care facilities had an intermediate level of hand hygiene implementation or higher, for which health-care facility funding and country income level were important drivers. Availability of resources, leadership, and organisational support are key elements to further improve quality of care and provide access to safe care for all.FundingWHO, Geneva University Hospitals and Faculty of Medicine, and WHO Collaborating Center on Patient Safety, Geneva, Switzerland.

Development and implementation of the Bachelor of Nursing (Conversion) course in Vanuatu.

Vanuatu, a Pacific Island nation in the Western Pacific region, has to date educated its nurses by diploma program. Research evidence in developed countries has consistently shown that nurses educated by bachelor degree improve patient health outcomes and reduce hospital length of stay. In seeking to improve health outcomes, the Vanuatu Ministry of Health decided to introduce a new Bachelor of Nursing degree to provide a skilled, safe nursing workforce for the provision of health care to its peoples{1-3}. The curriculum for this degree was to be developed by Ni-Vanuatu nurse educators with the collaboration of educators from the WHO Collaborating Centre, University of Technology Sydney. However, it was first necessary to upgrade (from diploma to bachelor level) the qualifications of teachers and senior nursing practitioners who would lead the new degree course by introducing a Bachelor of Nursing (Conversion) course. In order to design and implement a Bachelor of Nursing (Conversion) course that would be relevant for the educational and healthcare context in Vanuatu and that would meet qualification requirements of the local regulatory bodies, it was essential to build collaborative relationships with key stakeholders in Vanuatu. A second key concern was to design a program that would cater for participants who were working full time, who were not all living in the same physical location, and who had limited access to internet technology and resources. The course also needed to take into account that participants were multilingual, and that English was not their first language. Lessons learned included the importance of coming to understand the sociocultural nexus within which this course was developed and implemented, as well as appreciating the constraints that affect nursing education within the Pacific.

Seasonality and Annual Utilization Patterns of Antibacterials at Muhimbili National Hospital, Dar es Salaam, Tanzania: A 2015 Monthly Survey

IntroductionAntibacterial utilization studies can help identify areas of intervention of antimicrobial stewardship programs (ASP) to facilitate rational use and prevent the emergence of antimicrobial resistance (AMR). Assessment and comparison of antibacterial utilization depend on the Anatomical Therapeutic Chemical (ATC) classification system and Defined Daily Dose (DDD) recommended by the World Health Organization (WHO) collaborative center for international drug monitoring. This study aimed to determine the DDD of each prescribed antibacterial group and the proportions of wide-spectrum antibacterials used at Muhimbili National Hospital (MNH) in Tanzania to allow baseline data for hospital ASPs.MethodsA retrospective analytical study using data collected from 1st January 2015 to 31st December 2015 was undertaken at MNH. Data on antibacterials prescribed and dispensed were obtained from the MNH database. The ATC/DDD system was used to classify and quantify the antibacterial utilization patterns.ResultsA total of 10,643.1 DDDs were used in thirteen ward units at the Kibasila, Mwaisela and Sewahaji blocks of the MNH. Eighteen different antibacterials were prescribed and dispensed to 1496 patients. Capsules were the most dispensed dosage form. The drug ciprofloxacin was the leading antibacterial prescribed, with a DDD of about 3780 (35.5%) per year. This was followed by metronidazole and amoxicillin. The proportion of wide-spectrum antibacterials was as high as 66%. Utilization peaks were noted in April, July and September. There was a significant monthly increase in antibacterials utilization between January and December 2015 (p-value = 0.002, R-square = 0.64). The trends forecasted increased through June 2016.ConclusionsUtilization trends indicated a significant monthly increase in 2015 at MNH wards in Tanzania. The use of wide-spectrum antibacterials was widespread. This calls for continued antibacterial utilization surveillance and implementation of hospital-based ASP to mitigate the rapidly rising global threat of AMR.

Report of the National Influenza Surveillance Scheme, 2011 to 2018.

This report describes influenza surveillance activities in Australia for the period 2011 to 2018. Data were extracted from several sources constituting the National Influenza Surveillance Scheme (NISS). Laboratory-confirmed influenza notification rates (per 100,000 population) increased from 122 in 2011 to 1,021 in 2017, before declining to 235 in 2018. The highest laboratory-confirmed notification rates during the eight-year period were from the smaller jurisdictions (South Australia and the Northern Territory), except in 2016 when Queensland reported the highest rate. Similar trends were observed in community reports of influenza-like illness (ILI), presentations of ILI to sentinel general practice (GP) sites, and influenza hospitalisations. Children aged 14 years or younger, and adults 65 years of age or older, had the highest notification rates of laboratory-confirmed influenza. Adults aged 65 years or older and patients with comorbidities had higher rates of influenza-associated hospitalisations and mortality. Over half of eligible patients admitted to sentinel hospitals (57%) received oseltamivir treatment, with 17% receiving the treatment within 48 hours of symptom onset. Influenza type A predominated over the eight years, except in 2015 when type B predominated. This trend was consistent with Australian World Health Organization Collaborating Centre (WHOCC) data for influenza isolates tested. Of influenza viruses circulating during the reporting period, A(H1N1) viruses were mostly antigenically similar to the vaccine strain A/California/7/2009 (H1N1), except in 2017 and 2018 when they were mostly similar to A/Michigan/45/2015. The A(H3N2) strains varied over the years but included the vaccine strains A/Perth/16/2009, A/Switzerland/9715293/2013, A/Hong Kong/4801/2014, and A/Singapore/INFIMH/2016. The B/Victoria/2/87 lineage (represented by the 2016 vaccine strain B/Brisbane/60/2008) and the B/Yamagata/16/88 lineage (represented by the southern hemisphere 2015 vaccine strain B/Phuket/3073/2013) were the circulating influenza B viruses during the reporting period. Influenza B accounted for just under a third of notifications (32%) from 2011 to 2018. Fifty-four per cent of influenza B viruses characterised by the Australian WHOCC site during the eight-year period were from the Yamagata lineage, although the proportion was higher (67%) when analysing the most recent four years (2015 to 2018). In contrast, during the 2010 season, 99% of all influenza B viruses characterised by the Australian WHOCC site were in the B-Victoria lineage. During the 2018 season the Australian WHOCC site detected, for the first time, swine A(H3N2)v virus from a human patient in Australia, highlighting the need to maintain vigilance for zoonotic infections.