World Health Organization Goal Research Articles

Exploring the health education model for chronic hepatitis C micro-elimination in Guizhou Province from a global perspectives

The micro-elimination strategy is an effective approach to rapidly reduce the incidence and mortality of specific populations infected with hepatitis C virus (HCV). This article combines the current status of hepatitis C prevention and treatment in Guizhou Province, and introduces the current domestic and foreign hepatitis C micro-elimination models. It is worth mentioning that the Guizhou Provincial Medical Quality Control Center for Infectious Diseases jointly formulated the "Guizhou Province Chronic Hepatitis C Health Education Standards" to improve the awareness of health care workers and patients about the disease, increase the screening rate, and increase the patients willingness to receive treatment and accomplish the World Health Organization's goal of eliminating hepatitis C threat by 2030.

Antiviral treatment for hepatitis C among injecting drug users in the era of direct-acting antiviral agents

HCV prevalence among people who inject drugs (PWID) is up to 67%. PWID is a population that needs priority attention to achieve the World Health Organization's goal of eliminating viral hepatitis as a public health threat by 2030. Although the SVR of HCV patients treated with direct-acting antiviral drugs (DAAs) can reach over 95%, especially in medical practice, there are still major obstacles to PWID treatment, because PWID is usually accompanied with concurrent infection, multiple-genotype infections, low compliance, substance abuse, methadone maintenance therapy, and risky behavior and re-infection conditions. Therefore, physicians often concern that these factors will affect the treatment efficacy, and refuse to provide hepatitis C treatment in PWID. This article reviews the relevant studies status and effects of hepatitis C treatment in PWID with different infection states and special behavior characteristics, and further highlights that the multidisciplinary cooperation for hepatitis C treatment in PWID is safe and effective, and can ensure treatment compliance.

The oral health status of children aged 12 years in Seychelles in the years 1994 and 2000

The results of two national oral health surveys in 1993/4 led the Seychelles School Dental Service (SDS) to implement an oral health improvement strategy through the adoption of a targeted population approach. The aim was to attain the World Health Organization's (WHO) goal for 12-year-olds, of a DMFT (decayed, missing, filled permanent teeth) of less than 3.0, by the year 2000. Primary 5 (P5) children from all state schools were selected as the target population. Although all the children (1538) were exposed to the targeted service interventions, 500 were sampled out for study, through random sampling of school class lists. Data was collected at the beginning of 1998 and end of 2000, through clinical examination and self-administered questionnaires. All examinations and interventions were carried out by dental therapists (DTs), in their respective clinics. For the purpose of this paper comparisons made between 12-year-olds of 1994 and those of 2000 are based only on the dental examination data. Interventions were spread over three years from 1998 to 2000. These included an initial dental examination followed by any dental treatment required, an annual recall visit, dental health education at class and individual level, and weekly school-based fluoride mouth rinses. Parameters investigated were 1) community periodontal index of treatment needs (CPITN), 2) dental health status (DMFT), 3) enamel defect, and 4) clinic attendance. All parameters improved significantly between the cohort of 1994 and that of 2000. The proportion of children and of sextants with healthy gingivae increased from 3.4% to 51.8% and from 25.9% to 70.9% respectively. Children with no enamel defects increased from 51.1% to. 92.6%, while children with newly decayed teeth decreased from 61% to 33%. The mean number of newly decayed teeth fell from 2.0 to 0.8. The proportion of children attending their clinic at least once a year for check up increased from 51% in 1994 through 73% in 1998 to almost 100% in 2000. The WHO goal for children aged 12 years to have a DMFT of less than 3 was met, with a change from 3.2 in 1994 to 1.9 in 2000.

Implementing active surveillance for TB-The views of managers in a resource limited setting, South Africa.

The achievement of the World Health Organization's END TB goals will depend on the successful implementation of strategies for early diagnosis and retention of patients on effective therapy until cure. An estimated 150,000 cases are missed annually in South Africa. It is necessary to look at means for identifying these missed cases. This requires the implementation of active surveillance for TB, a policy adopted by the National Department of Health. To explore the views of managers of the TB program on the implementation of active surveillance for TB in the resource constrained setting of the Eastern Cape, South Africa. A descriptive, explorative, thematically analysed qualitative study based on 10 semi-structured interviews of managers of the TB program. Interviews were transcribed verbatim and analysed using the framework method and Atlas-ti. Active case finding of people attending health facilities was the dominant approach, although screening by community health workers (CHWs) was available. Both government and non-government organisations employed CHWs to screen door to door and sometimes as part of campaigns or community events. Some CHWs focused only on contact tracing or people that were non-adherent to TB treatment. Challenges for CHWs included poor coordination and duplication of services, failure to investigate those identified in the community, lack of transport and supportive supervision as well as security issues. Successes included expanding coverage by government CHW teams, innovations to improve screening, strategies to improve CHW capability and attention to social determinants. A multifaceted facility- and community-based approach was seen as ideal for active surveillance. More resources should be targeted at strengthening teams of CHWs, for whom this would be part of a comprehensive and integrated service in a community-orientated primary care framework, and community engagement to strengthen community level interventions.

Estudo do perfil epidemiológico da tuberculose em Araraquara, SP, no período 2012 - 2017

Introdução: A tuberculose (TB) afeta 1/3 da população mundial e cerca de 10 milhões de pessoas desenvolvem TB a cada ano, resultando em mais de dois milhões de mortes. Objetivos: O principal objetivo deste trabalho é apresentar um estudo do perfil epidemiológico da TB em Araraquara (SP) e comparar o perfil epidemiológico da TB em Araraquara com os padrões da doença no mundo, Américas, Brasil e Estado de São Paulo. Método: As pesquisas e informações foram coletadas do relatório anual da Organização Mundial da Saúde (OMS), do Ministério da Saúde do Brasil, da Secretaria do Estado de São Paulo, da Secretaria Municipal de Saúde e do Serviço Especial de Saúde de Araraquara (SESA). O período de 2012 a 2017 foi analisado considerando-se as projeções das metas da OMS para o fim da TB de 2015 a 2035. Resultados: Todos os dados apresentados, com exceção da cidade de Araraquara, estão acima da projeção requerida pela OMS. Embora ligeiramente abaixo da projeção citada, Araraquara está se encaminhando para reduzir a incidência de TB até o ponto de erradicar a doença. conclusões: Os baixos níveis atuais de infecção por TB em Araraquara podem ser explicados por fatores como, um dos maiores Índices de Desenvolvimento Humano (IDH) do País, a existência de um sanatório especializado no tratamento da doença, políticas públicas e uma eficiente rede de informações sobre TB . Araraquara pode ser um modelo no combate à doença no nível nacional e erradicar a doença até antes do prazo estabelecido pela OMS.

17.D. Workshop: Healthier populations through addressing environmental health topics and the SDGs

Abstract The strategic priority of promoting healthier populations with 1 billion more people enjoying better health and well-being as expressed in the General Programme of Work (GPW) 13 by the World Health Organization (WHO) emphasizes the need of multisectoral action to address the social and environmental determinants of health including climate change. WHO data from 2016 show that approximately one quarter of the global burden of disease are caused by known avoidable environmental risks to health, with at least 12.6 million premature deaths every year. Out of this total, 7 million deaths a year are attributable to both ambient and household air pollution, placing it among the top global preventable health risks. As human influence on the environment continues to grow, global environmental challenges will escalate, including climate change and rapid urbanization. Many of the resulting risks exacerbate disease and injuries, while impacting our quality of life, reducing our productivity, and weighing on our health systems. The global endorsement of the sustainable development agenda with its Sustainable Development Goals (SDGs) provides a clear signal that the world expects greater cohesion between people and the planet, with benefits for health and health equity. More sustainable ways of functioning go hand in hand with creating healthier and more sustainable environments, with enhanced focus on prevention through action on the root causes of disease. The SDGs set a broad agenda to advance health and equity by 2030. Health is centrally positioned within the SDGs, with SDG 3 - Ensure healthy lives and promote well-being for all ages. However, achieving this goal means more than just improving health care. It involves action in key economic development sectors, like housing and transport, as well as in the settings where people live and work in cities and rural areas. These areas are covered by SDGs such as: Achieving Affordable and Clean Energy (SDG 7), Sustainable Cities and Communities (SDG 11), and Climate action (SDG 13). Progress on these SDGs will not only significantly reduce but also support primary prevention of some of the world's most serious disease threats - including heart and lung diseases, cancers, stroke, injuries, and more. At the workshop different topics and tools that support the achievement of WHOs one billion goal of achieving healthier populations and through this the SDGs will be discussed. Key messages By addressing environmental health risks through progress on SDGs supports also the 1 billion goal to achieve healthier populations. Multisectoral action and turning this action into everyday practice is needed to support achieving the SDGs and the 1 billion goal of WHO.

The World Health Organization's changing goals and expectations concerning malaria, 1948-2019.

From its inception, in 1948, the World Health Organization made control of malaria a high priority. Early successes led many to believe that eradication was possible, although there were serious doubts concerning the continent of Africa. As evidence mounted that eradicating malaria was not a simple matter, the malaria eradication programme was downgraded to a unit in 1980. Revived interest in malaria followed the Roll Back Malaria Initiative adopted in 1998. This article presents an historical account of the globally changing ideas on control and elimination of the disease and argues that insufficient attention was paid to strengthening health services and specialized human resources.

A halve salt reduction intervention doesn’t affect the acceptance of school lunch

Abstract Background Considering the high salt consumption by children and their impact on future health, is utmost importance the salt reduction on school meals. Though, it is essential to evaluate the acceptance of less salty meals to guarantee that nutritional requirements are not compromised. Methods This case study was performed at a Portuguese primary school, in city of Porto, including all children aged between 3 and 10 years. Added salt per meal was determined for dishes and soups, during 5 consecutive days in 1st and 2nd phases, by weighing salt added during meals preparation and considering the average portion served to children. An intervention for salt reduction was performed by halve the added salt through cooks training. Meals acceptance was evaluated by plate waste determination, using the aggregated weighing method, in order to compare differences in acceptance of school lunch before and after salt reduction. Results A total of 475 meals was evaluated. Before intervention, it was observed a mean value for added salt of 0.786g (±0.073g) for soup and 1.156g (±0.411g) for dish, totalized 1.942g (±0.393g) of salt added per meal, value higher than recommended for lunch (about 1.5g). During intervention, it was experienced a reduction of added salt between 45.7% and 52.8% for soup and between 41.3% and 50.6% for dish. The salt mean value added per meal was 1.010g (±0.170g), allowed the achievement of recommendations. There were no differences neither in the dish plate waste (p = 0.094) nor in the soup waste (p = 0.838) between the two phases. Conclusions This study showed that a 50% reduction of added salt doesn't affect the acceptance of school lunch by children aged between 3 and 10 years old. The success of this intervention could be important for developing school food policies in order to offer balanced meals either with an adequate salt content to achieve World Health Organization goals for salt reduction and consequently enhance public health. Key messages It has been possible to halve added salt on school lunch without affect children’s consumption. School policies aiming to promote healthy eating habits by reducing meals salt availability could be effective.

Clinical considerations in the design of clinical trial for innovative hepatitis B drugs

The research and development of chronic hepatitis B (CHB) therapeutic drugs has been undergoing rapid development in recent years in order to achieve the World Health Organization's goal of eliminating viral hepatitis as a major public health threat by 2030. The focus of early stage clinical trials (including the first human trial) is the selection of subjects, study design, dose selection, administration method, dose escalation, monitoring, observation and reporting procedures for adverse events/reactions (tolerability evaluation), and criteria for subjects to continue and discontinue administration. Therefore, quantitative pharmacology knowledge is required to analyze the relationship between in vivo drug exposure, efficacy and adverse reactions, and the inclusion of exploratory indicators such as HBV RNA, hepatitis B virus core-related antigen (HBcrAg), etc., to analyze the mechanism and target of innovative drugs and the efficacy of cccDNA in anti-hepatocytes. On the other hand, Phase II-III clinical trials prioritize the optimal dose, efficacy and safety indicators to verify the efficacy and safety of new drugs in a wider range of subjects. This paper refers to the relevant domestic and foreign literature, combined with the author's practical experience in early clinical research, and then briefly introduces the clinical issues that should be paid attention to in the design of clinical trials of CHB innovative drugs.

A Treatment-as-Prevention Trial to Eliminate Hepatitis C Among Men Who Have Sex With Men Living With Human Immunodeficiency Virus (HIV) in the Swiss HIV Cohort Study.

In 2016, the World Health Organization (WHO) introduced global targets for the elimination of hepatitis C virus (HCV) by 2030. We conducted a nationwide HCV micro-elimination program among men who have sex with men (MSM) living with human immunodeficiency virus (HIV) from the Swiss HIV Cohort Study (SHCS) to test whether the WHO goals are achievable in this population. During phase A (10/2015-06/2016), we performed a population-based and systematic screening for HCV-RNA among MSM from the SHCS. During phase B (06/2016-02/2017) we offered treatment with HCV direct-acting antiviral (DAA) agents to MSM identified with a replicating HCV infection. During phase C (03/2017-11/2017), we offered rescreening to all MSM for HCV-RNA and initiated DAA treatment in MSM with replicating infections. We screened 3715/4640 (80%) MSM and identified 177 with replicating HCV infections (4.8%); 150 (85%) of whom started DAA treatment and 149 (99.3%) were cured. We rescreened 2930/3538 (83%) MSM with a prior negative HCV-RNA and identified 13 (0.4%) with a new HCV infection. At the end of the micro-elimination program, 176/190 MSM (93%) were cured, and the HCV incidence rate declined from .53 per 100 patient-years (95% CI, .35-.83) prior to the intervention to .12 (95% CI, .03-.49) by the end of 2019. A systematic, population-based HCV micro-elimination program among MSM living with HIV was feasible and resulted in a strong decline in HCV incidence and prevalence. Our study can serve as a model for other countries aiming to achieve the WHO HCV elimination targets. NCT02785666.

Point of Care Diagnostic Testing for Hepatitis B Virus

As we strive to reach the World Health Organization (WHO) goal of eliminating viral hepatitis as a public health threat by 2030, point of care tests (POCTs) will be important in low- to middle-income and developed countries. This review aims to investigate available POCT choices for hepatitis B virus (HBV) and to provide an algorithm for screening, assessing, and monitoring chronic HBV. There are 3 WHO pre-qualified rapid diagnostic assays for hepatitis B surface antigen (HBsAg) that are sensitive, specific, and reliable in screening for HBV: SD Bioline, Determine 2, and VIKIA. POCTs for other biomarkers are less reliable and sensitive but have some applicability. The Xpert® HBV Viral Load assay is sensitive and specific with a wide dynamic range. While POCT for HBeAg and HBV antibodies require improvement, HBsAg POCT and the Xpert® HBV Viral Load assay are reliable and available now.

Anthelmintic drug discovery: target identification, screening methods and the role of open science.

Helminths, including cestodes, nematodes and trematodes, are a huge global health burden, infecting hundreds of millions of people. In many cases, existing drugs such as benzimidazoles, diethylcarbamazine, ivermectin and praziquantel are insufficiently efficacious, contraindicated in some populations, or at risk of the development of resistance, thereby impeding progress towards World Health Organization goals to control or eliminate these neglected tropical diseases. However, there has been limited recent progress in developing new drugs for these diseases due to lack of commercial attractiveness, leading to the introduction of novel, more efficient models for drug innovation that attempt to reduce the cost of research and development. Open science aims to achieve this by encouraging collaboration and the sharing of data and resources between organisations. In this review we discuss how open science has been applied to anthelmintic drug discovery. Open resources, including genomic information from many parasites, are enabling the identification of targets for new antiparasitic agents. Phenotypic screening remains important, and there has been much progress in open-source systems for compound screening with parasites, including motility assays but also high content assays with more detailed investigation of helminth physiology. Distributed open science compound screening programs, such as the Medicines for Malaria Venture Pathogen Box, have been successful at facilitating screening in diverse assays against many different parasite pathogens and models. Of the compounds identified so far in these screens, tolfenpyrad, a repurposed insecticide, shows significant promise and there has been much progress in creating more potent and selective derivatives. This work exemplifies how open science approaches can catalyse drug discovery against neglected diseases.

Policy implications of the potential use of a novel vaccine to prevent infection with Schistosoma mansoni with or without mass drug administration

Schistosomiasis is one of the most important neglected tropical diseases (NTDs) affecting millions of people in 79 different countries. The World Health Organization (WHO) has specified two control goals to be achieved by 2020 and 2025 - morbidity control and elimination as a public health problem (EPHP). Mass drug administration (MDA) is the main method for schistosomiasis control but it has sometimes proved difficult to both secure adequate supplies of the most efficacious drug praziquantel to treat the millions infected either annually or biannually, and to achieve high treatment coverage in targeted communities in regions of endemic infection. The development of alternative control methods remains a priority.In this paper, using stochastic individual-based models, we analyze whether the addition of a novel vaccine alone or in combination with drug treatment, is a more effective control strategy, in terms of achieving the WHO goals, as well as the time and costs to achieve these goals when compared to MDA alone. The key objective of our analyses is to help facilitate decision making for moving a promising candidate vaccine through the phase I, II and III trials in humans to a final product for use in resource poor settings.We find that in low to moderate transmission settings, both vaccination and MDA are highly likely to achieve the WHO goals within 15 years and are likely to be cost-effective. In high transmission settings, MDA alone is unable to achieve the goals, whereas vaccination is able to achieve both goals in combination with MDA. In these settings Vaccination is cost-effective, even for short duration vaccines, so long as vaccination costs up to US$7.60 per full course of vaccination. The public health value of the vaccine depends on the duration of vaccine protection, the baseline prevalence prior to vaccination and the WHO goal.

Assessment of Treatment Strategies to Achieve Hepatitis C Elimination in Canada Using a Validated Model

Achievement of the World Health Organization (WHO) target of eliminating hepatitis C virus (HCV) by 2030 will require an increase in key services, including harm reduction, HCV screening, and HCV treatment initiatives in member countries. These data are not available for Canada but are important for informing a national HCV elimination strategy. To use a decision analytical model to explore the association of different treatment strategies with HCV epidemiology and HCV-associated mortality in Canada and to assess the levels of service increase needed to meet the WHO elimination targets by 2030. Study participants in this decision analytical model included individuals with hepatitis C virus infection in Canada. Five HCV treatment scenarios (optimistic, very aggressive, aggressive, gradual decrease, and rapid decrease) were applied using a previously validated Markov-type mathematical model. The optimistic and very aggressive treatment scenarios modeled a sustained annual treatment of 10 200 persons and 14 000 persons, respectively, from 2018 to 2030. The aggressive, gradual decrease, and rapid decrease scenarios assessed decreases in treatment uptake from 14 000 persons to 10 000 persons per year, 12 000 persons to 8500 persons per year, and 12 000 persons to 4500 persons per year, respectively, between 2018 and 2030. Hepatitis C virus prevalence and HCV-associated health outcomes were assessed for each of the 5 treatment scenarios with the goal of identifying strategies to achieve HCV elimination by 2030. An estimated mean 180 142 persons (95% CI, 122 786-196 862 persons) in Canada had chronic HCV infection at the end of 2017. The optimistic and gradual decrease scenarios estimated a decrease in HCV prevalence from 180 142 persons to 37 246 persons and 37 721 persons, respectively, by 2030. Relative to 2015, this decrease in HCV prevalence was associated with 74%, 69%, and 69% reductions in the prevalence of decompensated cirrhosis, hepatocellular carcinoma, and liver-associated mortality, respectively, leading to HCV elimination by 2030. More aggressive treatment uptake (very aggressive scenario) could result in goal achievement up to 3 years earlier than 2030, although a rapid decrease in the initiation of treatment (rapid decrease scenario) would preclude Canada from reaching the HCV elimination goal by 2030. The study findings suggest that Canada could meet the WHO goals for HCV elimination by 2030 by sustaining the current national HCV treatment rate during the next decade. This target will not be achieved if treatment uptake is allowed to decrease rapidly.

Insights from quantitative and mathematical modelling on the proposed 2030 goal for gambiense human African trypanosomiasis (gHAT).

Gambiense human African trypanosomiasis (gHAT) is a parasitic, vector-borne neglected tropical disease that has historically affected populations across West and Central Africa and can result in death if untreated. Following from the success of recent intervention programmes against gHAT, the World Health Organization (WHO) has defined a 2030 goal of global elimination of transmission (EOT). The key proposed indicator to measure achievement of the goal is zero reported cases. Results of previous mathematical modelling and quantitative analyses are brought together to explore both the implications of the proposed indicator and the feasibility of achieving the WHO goal. Whilst the indicator of zero case reporting is clear and measurable, it is an imperfect proxy for EOT and could arise either before or after EOT is achieved. Lagging reporting of infection and imperfect diagnostic specificity could result in case reporting after EOT, whereas the converse could be true due to underreporting, lack of coverage, and cryptic human and animal reservoirs. At the village-scale, the WHO recommendation of continuing active screening until there are three years of zero cases yields a high probability of local EOT, but extrapolating this result to larger spatial scales is complex. Predictive modelling of gHAT has consistently found that EOT by 2030 is unlikely across key endemic regions if current medical-only strategies are not bolstered by improved coverage, reduced time to detection and/or complementary vector control. Unfortunately, projected costs for strategies expected to meet EOT are high in the short term and strategies that are cost-effective in reducing burden are unlikely to result in EOT by 2030. Future modelling work should aim to provide predictions while taking into account uncertainties in stochastic dynamics and infection reservoirs, as well as assessment of multiple spatial scales, reactive strategies, and measurable proxies of EOT.

Diagnosis Rates of Chronic Hepatitis B in Privately Insured Patients in the United States

To achieve the World Health Organization goal of viral hepatitis elimination by 2030, it is important to estimate current rates of chronic hepatitis B (CHB) diagnosis and treatment. To provide an accurate accounting of the number of patients with CHB aged 6 years or older who have not yet been diagnosed in the United States. This cross-sectional study used the commercial US Truven Health MarketScan Database (138 634 154 privately insured individuals in January 2007 to December 2014) to identify patients with CHB diagnosis and the National Health and Nutrition Examination Survey to estimate the actual number of privately insured persons with CHB. Based on sex and age distribution derived from the US Census Bureau, we calculated the total population with CHB and the proportion of those who remained undiagnosed among the 198 073 302 privately insured individuals. Next, we identified diagnosed CHB patients who received 1 or more prescription for CHB medications to calculate the treatment rate for those with severe disease states, such as cirrhosis and hepatocellular carcinoma, that would warrant treatment. Analyses were performed from October 2017 to January 2020. The rate and number of patients with CHB who remained undiagnosed and treatment rates for patients with CHB who have cirrhosis or hepatocellular carcinoma. Among the 198 073 302 privately insured individuals (48.55% male; 15.52% aged 6-17 years; 84.48% aged ≥18 years), there were 511 029 (95% CI, 317 733-704 325) individuals with CHB, but only 95 075 of these had been diagnosed, yielding a diagnosis rate of only 18.60% (95% CI, 13.50%-29.92%), meaning that 81.40% (95% CI, 70.08%-86.50%) were undiagnosed. The treatment rates were 34.79% (95% CI, 33.31%-36.27%) for those with cirrhosis and 48.64% (95% CI, 45.59%-51.69%) for those with hepatocellular carcinoma. In this study, only approximately 1 in 5 privately insured patients with CHB had been diagnosed. Only one-third of patients with CHB who had cirrhosis and one-half who had hepatocellular carcinoma received antiviral therapy. Further efforts are needed to improve the current situation of poor connection to care for patients with CHB, especially for those with advanced liver disease.

Complications of Cesarean Birth: Clinical Recommendations for Prevention and Management.

The increase in severe maternal morbidity and mortality in the United States correlates with a significant rise in U.S. cesarean birth rates from 5.5% in 1970 to a rate of 31.9% of all births in 2018, far beyond the World Health Organization goal of 10% to 15%. Three key contributors to maternal morbidity and mortality related to cesarean birth include complications of hemorrhage, surgical site infection, and venous thromboembolism. All women should be screened for risk factors associated with these major complications during the antepartum, intrapartum, and postpartum period to assure the availability of immediate resources based on the assessment. Implementing evidence-based maternity care safety bundles, toolkits, and protocols to manage these complications can reduce adverse outcomes.

Highlights of the guidelines of prevention and treatment for hepatitis C (2019 version)

The key points from the updated guideline of prevention and treatment for hepatitis C (2019 version) is compared with the previous hepatitis C guideline. A new terminology and the World Health Organization's goal of eliminating viral hepatitis as a public-health threat by 2030 are stressed. In the prevention section, the screening for hepatitis C virus infection in high-risk population is the primary means of prevention, emphasizing that treatment, is prevention. In the aspect of treatment, pangenotypic interferon-free scheme are initial recommendations. In addition, it also introduces our country independent research and development on direct-acting antiviral agents, and antiviral therapy schedule for many special populations, including decompensated liver cirrhosis, chronic kidney disease, children and adolescents combined with chronic kidney injury, HBV infection-before and after liver transplantation, treatment failure, and acute hepatitis C. A simplified on-treatment monitoring schedule, especially genotype 3 prevalent in Southwest part of our country is introduced.

Highlights of the guidelines of prevention and treatment for chronic hepatitis B (2019 version)

为进一步规范我国慢性乙肝的预防诊断和治疗，中华医学会感染学分会和肝病学分会发表了《慢性乙型肝炎防治指南（2019年版）。本文介绍了本版指南在流行病学、自然史、预防、诊断和治疗方面的十大亮点。其最突出的变化是放宽了慢性乙型肝炎及肝硬化的抗病毒治疗适应证；进一步明确推荐高效低耐药的恩替卡韦、替诺福韦酯或丙酚替诺福韦；推荐高病毒载量的孕妇于妊娠中晚期开始服用替诺福韦酯或替比夫定以进一步提供母婴阻断率。.

Análise epidemiológica de casos de tuberculose nas regiões de saúde do estado do Piauí

Objetivo: Analisar o perfil epidemiológico de indivíduos com tuberculose nas regiões de saúde do estado do Piauí através de variáveis como sexo, faixa etária, ano de ocorrência, zona de residência, coinfecção Tuberculose/Vírus da Imunodeficiência Humana, forma da doença e situação de encerramento, nos últimos três anos. Metodologia: Trata-se de um estudo epidemiológico transversal, retrospectivo e descritivo, referente aos casos notificados e diagnosticados de tuberculose nas regiões de saúde do estado do Piauí, nos últimos três anos. A coleta de dados foi feita através do Sistema de Informação de Agravos de Notificação e do Departamento de Informática do Sistema Único de Saúde, nos anos de 2016 a 2018. As análises foram realizadas no IBM SPSS Statistics for Windows. Resultados: O número de casos diagnosticados durante o período estabelecido manteve-se constante, em um total de 2.334 casos. Destes, a maior frequência foi em indivíduos do sexo masculino, com 64,41% dos casos. Verificou-se que o maior número de casos de Tuberculose foi em HIV negativos. O perfil etário que mais apresentou casos foi o de 45 a 54 anos. Conclusão: Portanto, observa-se a importância do estudo de casos de tuberculose nas regiões de saúde do estado do Piauí, justificada pela quantidade de casos diagnosticados, pela morbidade, mortalidade e transmissão. Logo, percebe-se a importância de seguir e colocar em prática as metas da Organização Mundial de Saúde para o fim da TB, que é diminuir os casos de Tuberculose em até 90% e de óbitos em 95%, até o ano de 2035.