World Health Organization Guidance Research Articles

Gross alpha/beta activity concentrations in imported bottled drinking water in Saudi Arabia

This research assessed the gross alpha and beta activity levels in bottled drinking water imported to Saudi Arabia, applying the evaluation process recommended by the World Health Organization (WHO). The WHO's approach for examining alpha and beta activity in drinking water consists of an initial phase of screening for gross alpha and beta levels to determine the need for further analysis. This is followed by a detailed assessment of specific radionuclide concentrations if initial screening levels are surpassed. The study utilized the evaporation method as a standard procedure to quantify the gross alpha and beta activity levels. Each water sample underwent evaporation, after which the activity levels of the residual matter were measured. Gross alpha activity was analyzed using a ZnS (Ag) scintillator detector system, while gross beta activity levels were gauged using a proportional counting system. The methodologies for determining gross alpha and beta activities align with the International Organization for Standardization (ISO) standards ISO 9696 and ISO 9697, respectively. The research identified the maximum alpha and beta activity levels to be 0.18 Bq/L and 0.34 Bq/L, respectively. These values were evaluated against the WHO guidance threshold values of 0.5 Bq/L for gross alpha and 1.0 Bq/L for gross beta activities, confirming that the exposure remains below the individual dose criterion of 0.1mSv/year. The estimated committed effective doses fell under the WHO's advised cap of 0.1 mSv annually, indicating the safety of the water samples for consumption. The study recommends the analysis of a larger set of samples over extended periods for increased assurance.

Lessons learned from a cluster of immunization errors in newborns.

Vaccines are safe and effective, but adverse reactions can occur. Immunization errors (IEs) are one of the types of adverse events following immunization. The Moroccan Pharmacovigilance Centre (MPC) received a cluster of IEs from a maternity university hospital (MUH) regarding six newborns who were inadvertently administered rocuronium instead of hepatitis B (HepB) vaccine. The newborns experienced respiratory distress and one had a fatal outcome. The study aimed to describe the investigation findings, the underlying causes, and contributing factors of the IEs cluster, and proposed risk minimization actions. We carried out a descriptive analysis of the cluster of IEs related to the HepB vaccine reported to the MPC. An investigation was conducted by the Ministry of Health according to the World Health Organization guidance. The root cause analysis was performed to identify underlying causes and contributing factors that lead to IE occurrence. The cluster analysis showed that the main contributing factors were the look-alike rocuronium and HepB vaccine packaging, the first-time running HepB vaccination for newborns in the MUH, the lack of a full-time pharmacist, and the unsafe storage of rocuronium and vaccines. The administration of Sugammadex to the newborns followed by their transfer to the neonatal care unit resulted in the recovery of five of the six newborns. Proposed recommendations included (1) raising awareness of healthcare professionals to the risk related to look-alike medications, (2) training nurses to ensure vaccination to implement procedures related to immunization practices, (3) nomination of a full-time pharmacist, (4) reassessment of the safety of drug storage and dispensing at the hospital pharmacy, particularly for high-alert medications. Reporting IEs, particularly serious ones, allows us to identify causes and contributing factors that led to their occurrence. Lessons learned from errors are key to take risk minimization actions to improve vaccine safety worldwide.

Acute and sub-chronic toxicological evaluation of Boga -TN tablets in experimental animals

Boga-TN is a formula originating from herbal medicines that are used to treat liver disorders; however, its toxicity is not yet investigated. Therefore, this study was conducted to assess the acute and sub-chronic toxicity of Boga-TN tablets in experimental animals. Acute toxicity study was performed via Swiss mice, with a single oral dose, and followed up to seven days according to World Health Organization Guidance. No sign of acute oral toxicity was detected, and the LD50 Boga-TN was estimated to be more than 60.38 g/kg. Based onobtained results , the sub-chronic toxicity study was carried out in Wistar rats for 4 consecutive weeks by oral administration at the doses of 0.77 and 2.31 g/kg/day. After treatment, no significant treatment-related abnormalities were observed at both doses of Boga-TN, compared to the control group, except lower neutrophil but higher lymphocyte values were observed in the treated animals. Histopathology assessment did not show any significant variation between control and treatment groups during the study period.

COVID-19 vaccine effectiveness against severe COVID-19 requiring oxygen therapy, invasive mechanical ventilation, and death in Japan: A multicenter case-control study (MOTIVATE study)

IntroductionSince the SARS-CoV-2 Omicron variant became dominant, assessing COVID-19 vaccine effectiveness (VE) against severe disease using hospitalization as an outcome became more challenging due to incidental infections via admission screening and variable admission criteria, resulting in a wide range of estimates. To address this, the World Health Organization (WHO) guidance recommends the use of outcomes that are more specific to severe pneumonia such as oxygen use and mechanical ventilation. MethodsA case-control study was conducted in 24 hospitals in Japan for the Delta-dominant period (August-November 2021; “Delta”) and early Omicron (BA.1/BA.2)-dominant period (January-June 2022; “Omicron”). Detailed chart review/interviews were conducted in January-May 2023. VE was measured using various outcomes including disease requiring oxygen therapy, disease requiring invasive mechanical ventilation (IMV), death, outcome restricting to “true” severe COVID-19 (where oxygen requirement is due to COVID-19 rather than another condition(s)), and progression from oxygen use to IMV or death among COVID-19 patients. ResultsThe analysis included 2125 individuals with respiratory failure (1608 cases [75.7%]; 99.2% of vaccinees received mRNA vaccines). During Delta, 2 doses provided high protection for up to 6 months (oxygen requirement: 95.2% [95% CI:88.7–98.0%] [restricted to “true” severe COVID-19: 95.5% {89.3–98.1%}]; IMV: 99.6% [97.3–99.9%]; fatal: 98.6% [92.3–99.7%]). During Omicron, 3 doses provided high protection for up to 6 months (oxygen requirement: 85.5% [68.8–93.3%] [“true” severe COVID-19: 88.1% {73.6–94.7%}]; IMV: 97.9% [85.9–99.7%]; fatal: 99.6% [95.2–99.97]). There was a trend towards higher VE for more severe and specific outcomes. ConclusionMultiple outcomes pointed towards high protection of 2 doses during Delta and 3 doses during Omicron. These results demonstrate the importance of using severe and specific outcomes to accurately measure VE against severe COVID-19, as recommended in WHO guidance in settings of intense transmission as seen during Omicron.

Overpromoted and underregulated: National binding legal measures related to commercially produced complementary foods in seven Southeast Asian countries are not fully aligned with available guidance.

The market for commercially produced complementary foods (CPCF) is rapidly expanding in Southeast Asia; however, the existence and content of mandatory national policies, standards and legislation (binding legal measures) for CPCF in the region is unclear. To assess the status of national binding legal measures for CPCF in Southeast Asia, a legal and policy desk review was conducted in seven countries (Cambodia, Laos People's Democratic Republic, Indonesia, Malaysia, Philippines, Thailand and Viet Nam). The alignment of the national binding legal measures relevant to CPCF was assessed against guidance on CPCF nutrient composition and labelling requirements provided by Codex Alimentarius and the World Health Organization (WHO). Each of the seven countries had at least two national binding legal measures related to the nutrient composition or labelling of CPCF; however, there was limited alignment with the guidance from Codex and WHO. No country was fully aligned with the three CPCF-specific Codex standards/guidelines and only one country was in full alignment with the recommendations related to the protection of breastfeeding from the 'WHO Guidance on ending the inappropriate promotion of foods for infants and young children'. The findings of the review indicate that the existing national binding legal measures are insufficient to ensure that the CPCF sold as suitable for older infants and young children are nutritionally adequate and labelled in a responsible manner that does not mislead caregivers. Improved and enforced national binding legal measures for CPCF, in alignment with global guidance, are required to ensure that countries protect, promote and support optimal nutrition for children 6-36 months of age.

Monitoring hearing and vision functions in older adults: rationale and process.

Hearing and vision impairment are highly prevalent in ageing individuals and are significant public health concerns given their meaningful impacts on individuals and society. Yet, many cases of both visual and hearing impairment remain unidentified and thus, unaddressed. This article describes the rationale and process of monitoring for visual and hearing impairment in older adults, by summarising guidance and resources available from the World Health Organisation (WHO) that were developed based upon the best current available evidence. It is recommended that vision screening be offered at least annually to adults aged over 50years and hearing screening be offered every 5years to adults aged 50-64years, and every 1-3years to adults aged 65years or older. Both hearing and vision screening can be conducted in community, home or clinical settings by trained health workers with simple equipment. More specifically, vision screening can be conducted with a simple eye chart. Hearing screening can be conducted without specialised equipment by using pure tones set to a fixed level, an automated mobile- or web-based digits-in-noise test, or the whispered voice test. Hearing screening can also be conducted in audiology clinics using pure-tone air conduction threshold testing. There exists WHO guidance to support the monitoring of hearing and vision impairment, which, when warranted, can facilitate referral for comprehensive assessment and prompt appropriate, person-centred interventions to mitigate the negative consequences of hearing and vision impairment.

Stepwise options for preparing therapeutic plasma proteins from domestic plasma in low- and middle-income countries.

Industrial plasma fractionation, a complex and highly regulated technology, remains largely inaccessible to many low- and middle-income countries (LMICs). This, combined with the limited availability and high cost of plasma-derived medicinal products (PDMPs), creates deficiency of access to adequate treatment for patients in resource-limited countries, and leads to their suffering. Meanwhile, an increasing number of LMICs produce surplus plasma, as a by-product of red blood cell preparation from whole blood, that is discarded because of the lack of suitability for fractionation. This article reviews pragmatic technological options for processing plasma collected from LMICs into therapies and supports a realistic stepwise approach aligned with recent World Health Organization guidance and initiatives launched by the Working Party for Global Blood Safety of the International Society of Blood Transfusion. When industrial options based on contract or toll plasma fractionation programme and, even more, domestic fractionation facilities require larger volumes of quality plasma than is produced, alternative methods should be considered. In-bag minipool or small-scale production procedures implementable in blood establishments or national service centres are the only realistic options available to gradually reduce plasma wastage, provide safer treatments for patients currently treated with non-pathogen-reduced blood products and concurrently improve Good Manufacturing Practice (GMP) levels with minimum capital investment. As a next step, when the available volume of quality-assured plasma reaches the necessary thresholds, LMICs could consider engaging with an established fractionator in a fractionation agreement or a contract in support of a domestic fractionation facility to improve the domestic PDMP supply and patients' treatment.

Establishment and application of national reference panels for SARS-CoV-2 antigen detection kit

To develop a national reference panel for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen detection kit and establish a quality standard. The cultures of SARS-CoV-2 and other pathogens were collected to establish a national reference panel for SARS-CoV-2 antigen detection. The stability and homogeneity of the reference panel were evaluated. Based on World Health Organization (WHO) guidance and nucleic acid quantitative results, a quality standard reference panel was established. Currently, three generations of SARS-CoV-2 antigen national reference materials with batch numbers 370095–202001, 370095–202202, and 370095–202203 have been successfully established. These national reference panels comprised 8 positive samples, 20 negative samples, 1 repetitive sample, and 1 lower detection limit sample. The stability and homogeneity of the reference panel meet the requirements. The quality standards are as follows: the positive and negative coincidence rates are 8/8 and 20/20, respectively. The 10 test results of the medium and low-concentration repetitive reference materials should be positive, and the color rendering should be uniform (or the coefficient of variance should not be higher than 20.0%). The lower detection limit should be at least 5 × 105 U/mL (equivalent to copies/mL), and higher concentrations above the lower detection limit must be positive. A national reference panel for the SARS-CoV-2 antigen detection kit has been established. As the standard of SARS-CoV-2 antigen reagents, the reference panel has played a crucial role in the pre-marketing quality evaluation and post-marketing quality supervision in China.

Emissions of ultrafine particles from civil aircraft: dependence upon aircraft type and passenger load

Very high concentrations of ultrafine particles (UFP) were measured at Heathrow Airport London. Exposure to UFP is strongly linked to adverse health effects and guidance for exposure limits has recently been provided by the World Health Organization (WHO). Using 1 s resolution UFP measurements and aircraft GPS data, measurements were assigned to individual aircraft and their operating mode, and this information was used to model UFP emission rates. In all cases, the highest emission rates were associated with departing aircraft, with rates for larger aircraft higher than smaller aircraft. Emission rates per passenger is influenced by the number of passengers carried, especially for arriving aircraft. Calculated emission rates are significantly higher than stated literature values, due to the inclusion of condensable particles in the measurements. These condensable particles are specifically not included in the regulated emission rates. Measured UFP concentrations within the airport boundary (and therefore not accessible to the general public) exceed the WHO guidance, indicating that UFP concentrations outside of the airport boundary could also be of concern. Assessing population exposure close to airports will be of increasing importance in future.

Smartphone applications for measuring noise in the intensive care unit: A feasibility study

PurposeThis study aims to explore the suitability of using smartphone applications with low-cost external microphones in measuring noise levels in intensive care units. MethodsFour apps and two external microphones were tested in a laboratory by generating test signals at five noise levels. The average noise levels were measured using the apps and a professional device (i.e. a sound level meter). A field test was performed in an intensive care unit with two apps and one microphone. Noise levels were measured in terms of average and maximum noise levels according to the World Health Organisation's guidance. All the measurements in both tests were conducted after acoustic calibration using a sound calibrator. ResultsOverall, apps with low-cost external microphones produced reliable results of averaged noise levels in both the laboratory and field settings. The differences between the apps and the sound level meter were within ±2 dB. In the field test, the best combination of app and microphone showed negligible difference (< 2 dB) compared to the sound level meter in terms of the average noise level. However, the maximum noise level measured by the apps exhibited significant differences from those measured by the sound level meter, ranging from −0.9 dB to −4.7 dB. ConclusionSmartphone apps and low-cost external microphones can be used reliably to measure the average noise level in the intensive care unit after acoustic calibration. However, professional equipment is still necessary for accurate measurement of the maximum noise level.

Alcohol zero: the end, the beginning of the end, or just the end of the beginning?

Alcohol drinks, especially wine, have been described since 6,000 B.C. For many years in modern medicine, wine in moderation has been considered healthy for cardiovascular prevention, i.e., recommended by nutrition committees. Some regional guidelines still recommend one to two standard drinks per day. By the very recent (January 2023), World Health Organization and Canadian Guidance on alcohol emphasize that any alcoholic drink is hazardous to the health and the safe amount is zero. The risk starts with every single drop. It was also nicely summarized in the manuscript “Alcohol-dose question and the weakest link in a chemical interplay” (Explor Cardiol. 2023;1:15–25. doi: 10.37349/ec.2023.00003) especially from the standpoint of a researcher in the cardiovascular arena. The newest recommendations are based on observational studies and their meta-analysis, therefore establishing associations, pointing out that alcohol may somewhat prevent cardiovascular diseases and diabetes type 2, but with a significant increase in non-cardiovascular morbidity and mortality, especially cancers. Previous recommendations, therefore, may be obsolete as they were based on studies where abstainers from alcoholic beverages had inherent higher risks. The current controversy with conflicting guidelines for alcoholic beverage consumption in the era of precision medicine may stimulate more fundamental investigations up to genetic ones and find the cause-effect relations. In the era of precision medicine, it may come closer to discovering the causes of cancers and many other diseases, enabling predictions of reactions to alcoholic beverages by each person, not just in the population.

Ontological insecurity in the post-covid-19 fallout: using existentialism as a method to develop a psychosocial understanding to a mental health crisis.

In the wake of the Covid-19 pandemic we are witnessing a significant rise in mental illness diagnosis and corresponding anti-depressant prescription uptake. The drug response to this situation is unsurprising and reinforces the dominant role (neuro)biology continues to undertake within modern psychiatry. In contrast to this biologically informed, medicalised approach, the World Health Organisation (WHO) issued a statement stressing the causal role of psychological and social factors.Using the concept of ontological insecurity, contextualised within the WHO guidance, the interrelation of psychological and social factors is illuminated, and a psychosocial framework is produced as a means of understanding the mental health consequence of the post-Covid-19 fallout.The psychosocial framework generated provides a rationale to revise and reprioritise how we engage with the biopsychosocial model that is intended to underpin modern psychiatry. This framework establishes a connection between psychological and social theory which are too often addressed as disparate terrains within mental health services and policy creation.

"Our interventions are still here to support communities during the pandemic": Resuming mass drug administration for neglected tropical diseases after COVID-19 implementation delays.

The COVID-19 pandemic disrupted essential health services, including those provided by national neglected tropical disease (NTD) programs. Most mass drug administration (MDA) programs were postponed for 6-12 months following World Health Organization guidance released in April 2020 to temporarily halt NTD programs and launch necessary COVID-19 precautions. While NTD-endemic countries have since resumed MDA activities, it is critical to understand implementers' perspectives on the key challenges and opportunities for program relaunch, as these insights are critical for maximizing gains towards disease control and elimination during public health emergencies. Using data from using online surveys and focus group discussions, this mixed-methods study sought perspectives from Ministry of Health NTD Program Managers and implementing partners from non-governmental organizations working in sub-Saharan Africa. Data analysis revealed that findings converged around several main themes: disruptions for MDA programs included resource shortages due to prioritization of pandemic response, challenges adhering to COVID-19 safety protocols, and community hesitancy due to coronavirus transmission fears. Identified solutions for restarting MDA programs focused on adapting intervention delivery and packaging to minimize disease transmission, embracing technology to optimize intervention planning and delivery, and identifying opportunities to promote program integration between pandemic response strategies and NTD campaign delivery. Findings identifies key challenges due to disruptions to NTD program delivery and provide strategic recommendations for endemic countries to build resilient programs that can continue to perform during and beyond global pandemics.

WHO Guidance on Research Methods for Health Emergency and Disaster Risk Management

Introduction:The World Health Organization (WHO) has developed and supported numerous initiatives to build capacity and awareness about health emergency and disaster risk management (Health EDRM). These include establishing the Health EDRM Research Network (Health EDRM RN) in 2018 and the publication of the Health EDRM Framework in 2019. These initiatives recognize that research is vital to generating the evidence to inform decision making and research that is integral to disaster preparedness, response and recovery will be vital to delivering the aspirations associated with caring, coping and overcoming in an increasingly challenging world.Method:To strengthen the capacity for conduct and use of research, resources were developed by the WHO Guidance on Research Methods for Health EDRM.Results:This first WHO textbook on Health EDRM research methods was published in 2021 and updated in 2022 with a chapter on Health EDRM research in the context of COVID-19. The 44 chapters offer practical advice about how to plan, conduct and report on a variety of quantitative and qualitative studies that can inform questions about policies and programs for health-related emergencies and disasters across different settings and level of resources. Case studies of direct relevance to Health EDRM provide real-life examples of research methods and how they have modified policies.More than 160 authors in 30 countries contributed to the guidance, which is relevant to researchers, would-be researchers, policy makers and practitioners. It should help improve the quality of Health EDRM research; the quality of policy, practice and guidance supported by the evidence generated; and research capacity, collaboration and engagement among researchers, the research community, policy-makers, practitioners and other stakeholders.Conclusion:The Guidance is being supplemented by additional resources, including audio podcasts, slideshows, video presentations and webinars, and the content as a whole will be discussed in this presentation.

Climate, Weather Extremes and Health: Latest WHO-WMO Resources and Tools for Health Emergency Managers

Introduction:As populations worldwide are experiencing more frequent and intense weather and climate extremes, many professionals of the WADEM community are at the frontline of managing compounding and cascading impacts on physical and mental health. Vulnerable, isolated, and marginalized people are the most affected by climate and weather threats. The elderly and children faced 3.7 billion more life-threatening heatwave days in 2021 than annually in 1986-2005 increasing the need for emergency care on a large scale.Method:The World Health Organization (WHO) and World Meteorological Organization (WMO), together with partners from health agencies, climate services, academia and other sectors are collaborating to accelerate the use of climate, weather and environmental science and services for better health protection. A selection of key resources and tools will be highlighted that can be used by the WADEM community to better understand, anticipate, and manage health risks from extreme weather and climate.Results:Participants will learn about the new WHO-WMO ClimaHealth Portal, a global knowledge and action hub with huge potential for facilitating learning and action to better protect health from climate risks. Tools and resources include the Global Heat Health Information Network (GHHIN) Checklist and Technical Brief for improved heatwave preparedness and response in the context of COVID-19, and a new WHO Guidance Document on Measuring the Climate Resilience of Health Systems providing a framework and indicators for assessing and protecting health systems from climate threats.Conclusion:As extreme weather intensifies, integrated climate-informed services for the health sector including multi-hazard early warning systems and action plans, as well as strengthened partnerships between the health community and hydrometeorological services are indispensable to further restrict adverse health impacts. Accelerating the uptake and upscale of existing tools and resources is urgently needed to meet the increasing health and societal challenges caused by climate change and weather extremes.

What's the ideal World Health Organization (WHO)?

The World Health Organization (WHO) is tasked with the 'attainment by all peoples of the highest possible level of health', yet, it is widely struggling to meet this mandate, and COVID-19 has revealed significant limitations of the organisation. Despite clear guidance provided by the institution as to how best to respond to the pathogen, many governments departed from WHO's guidance in their response efforts. Is this a new crisis for WHO? Does WHO need to restore its legitimacy in the eyes of the global community? As renewed calls for changes to WHO emerge, in this perspective we lay out the obstacles WHO face to become the WHO 'we' need. The assumption is that UN member states need an empowered and well-funded organisation. Yet, many years of discussion of reform of WHO have failed to lead to meaningful change, and glaring challenges remain in its financing, governance and politics, which are considered in turn. The reality may be that we have the WHO that UN member states need - one that can provide guidance and advice, but also take criticism for health governance failures when states want to avoid blame or responsibility. We discuss this, by analysing three key areas of WHO'S challenges: mandate and scope; structure, governance and money and domestic vs international.

Acute and sub-chronic oral toxicity studies of “Tri 02” powder in experimental animals

This study aims to assess the acute and sub-chronic oral toxicity of “Tri 02” powder in experimental animals. According to World Health Organization Guidance, acute toxicity study was conducted using Swiss mice. LD50 was determined by Litchfield-Wilcoxon method, and sub-chronic toxicity of “Tri 02” at two doses (2.4 g/kg b.w/day and 7.2 g/kg b.w/day) was assessed in Wistar rats for four uninterrupted weeks. Abnormal behavior, toxic symptoms, and death were observed for 7 consecutive days to assess the effects of acute toxicity. The general behavior of the rats was observed daily, and their body weight was recorded weekly. Hematological analysis and biochemical analysis were conducted before treatment, and at 2 and 4 weeks of treatment. Macroscopic examination and histopathological examination of several organs were conducted at the end of the treatment period. The results suggested that “Tri 02” at the highest dose used for mice (187.5 g/kg b.w) did not show acute toxicity and the LD50 was determined. In terms of the sub-chonic toxicity test, after oral administration of “Tri 02” powder, hematological parameters, hepato-renal functions and microscopic images of liver and kidney at both doses were similar to the control group. In conclusion, “Tri 02” powder did not produce the acute and subchronic oral toxicity in experimental animals.

The dilemma of improving rational antibiotic use in pediatric community-acquired pneumonia.

Pneumonia is the number one cause of disease and deaths in children under five years old, outside the neonatal period, with the greatest number of cases reported from resource-limited settings. The etiology is variable, with not much information on the local etiology drug resistance profile in many countries. Recent studies suggest an increasing contribution from respiratory viruses, also in children with severe pneumonia, with an increased relative contribution in settings that have good vaccine coverage against common bacterial pathogens. Respiratory virus circulation was greatly reduced during highly restrictive measures to contain the spread of COVID-19 but rebounded once COVID-19 restrictions were relaxed. We conducted a comprehensive literature review of the disease burden, pathogens, case management and current available prevention of community acquired childhood pneumonia, with a focus on rational antibiotic use, since the treatment of respiratory infections is the leading cause of antibiotic use in children. Consistent application of revised World Health Organisation (WHO) guidance that children presenting with coryzal symptoms or wheeze can be managed without antibiotics in the absence of fever, will help to reduce unnecessary antibiotic use, as will increased availability and use of bedside inflammatory marker tests, such as C-reactive protein (CRP) in children with respiratory symptoms and fever.

Genotype MTBDRsl version 2 and phenotypic drug resistance detection of Mycobacterium tuberculosis for fluoroquinolones and aminoglycosides.

Information on genotypic with comparison of phenotypic drug sensitivity test of anti-tuberculosis (TB) has been reported in several studies, which have variable results. The present study aimed to assess the Genotype MTBDRsl version 2.0/Line probe assay (LPA) for the detection of fluoroquinolones (FQ) and aminoglycosides (AMGs) resistance mutations among drug-resistant Mycobacterium TB (MTB) strains and also to compare the patterns of genotypic mutations of gyrA/B, rrs, and eis with mycobacteria growth indicator tube (MGIT 960). A total of 1416 samples were subjected to Genotype MTBDRsl version 2.0 assay. One hundred and twenty sputum smear positive MTB isolates and 37 sputum smear negative MTB isolates confirmed multiple drug resistance resistant to FQ and AMG by the Genotype MTBDRsl version 2.0 were subjected to phenotypic drug susceptibility testing (DST) were analyzed. The association sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the resistance detection between MGIT (DST) and the Genotype MTBDRsl version 2.0 assay was significant (P < 0.01) of moxifloxacin (MFX) concentration. Sensitivity and specificity value for kanamycin (KAN) resistance was 76% and 89%; 47% and 94% for capreomycin (CAP); and 60% and 76% for low-level KAN, respectively. Our results indicate that MFX (0.25and 1 μg/mL), KAN (2.5 μg/mL), and CAP (2.5 μg/mL) significantly (P < 0.01) and support the World Health Organization guidance to test FQ and AMG by genotypic test.

Analysis of a Sabin-Strain Inactivated Poliovirus Vaccine Response to a Circulating Type 2 Vaccine-Derived Poliovirus Event in Sichuan Province, China 2019-2021

The Sabin-strain inactivated poliovirus vaccine (IPV) may be a tool for polio outbreak response in certain situations. To investigate the response to a type 2 vaccine-derived poliovirus (VDPV2) outbreak. This case series was conducted in China after a VDPV2 was detected in stool specimens from a child with acute flaccid paralysis (AFP) in Sichuan Province in 2019, 3 years after the global withdrawal of live, attenuated type 2 oral poliovirus vaccine (OPV). Investigation followed National Health Commission and World Health Organization guidance and included searching hospitals for unreported AFP cases; testing stool specimens from the child, his contacts, and local children; enhanced environmental surveillance for VDPV2s in wastewater; and measuring vaccination coverage. Sabin-strain IPV campaigns were conducted in a wide geographic area. Any VDPV2 detection after completion of the supplementary immunization activities. A 28-nucleotide-change VDPV2 was isolated from a young boy. Three VDPV2s were detected in healthy children; 2 were contacts of the original child, and none had paralysis. A search of 31 million hospital records found 10 unreported AFP cases; none were polio. No type 2 polioviruses were found in wastewater. Prior to the event, polio vaccine coverage was 65% among children younger than 5 years. Sabin-strain IPV campaigns reached more than 97% of targeted children, administering 1.4 million doses. No transmission source was identified. More than 1 year of enhanced poliovirus environmental and AFP surveillance detected no additional VDPVs. These findings suggest that the circulating VPDV2 outbreak in 2019 was associated with low vaccine coverage. An investigation discovered 3 infected but otherwise healthy children and no evidence of the virus in wastewater. Following Sabin-strain IPV-only campaigns expanding from county to prefecture, the poliovirus was not detected, and the outbreak response was considered by an expert panel and the World Health Organization to have been successful. This success suggests that the Sabin-strain IPV may be a useful tool for responding to circulating VDPV2 outbreaks when high-quality supplementary immunization activities can be conducted and carefully monitored in settings with good sanitation.