World Health Organization Regional Office Research Articles

Autochthonous Hepatitis E Virus Infection in Europe: A Matter of Concern for Public Health?

Human hepatitis E virus (HHEV) is the proposed name for a diverse group of RNA viruses from the family Hepeviridae that cause acute hepatitis among humans. Waterborne strains are regularly imported into Europe by international travelers, and virus transmission of zoonotic strains via contaminated aliments is involved in autochthonous cases. Therefore, in Europe, hepatitis E displays a unique dual character, having features of both imported and autochthonous infections. Environmental involvement of waterborne and zoonotic diseases puts alimentary safety at risk. In addition, it may lead to serious health problems derived from persistent infection among patients with immune impairment due to organ transplant, cancer, or human immunodeficiency virus infection. Although the European health authorities know at present that HHEV represents a problem worthy of consideration, the actual incidence of the disease in Europe is unknown, and attempts to ascertain the prevalence of the infection is hampered by unresolved technical issues. In order to determine the burden of hepatitis E in Europe, the World Health Organization Regional Office and the European Centre for Disease Prevention and Control should pay specific attention to hepatitis E, and research efforts in the continent should be transnational and collaborative. Development of a specific European network for hepatitis E would help to achieve these goals.

Strengthening national health laboratories in sub‐Saharan Africa: a decade of remarkable progress

Efforts to combat the HIV/AIDS pandemic have underscored the fragile and neglected nature of some national health laboratories in Africa. In response, national and international partners and various governments have worked collaboratively over the last several years to build sustainable laboratory capacities within the continent. Key accomplishments reflecting this successful partnership include the establishment of the African-based World Health Organization Regional Office for Africa (WHO-AFRO) Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA); development of the Strengthening Laboratory Management Toward Accreditation (SLMTA) training programme; and launching of a Pan African-based institution, the African Society for Laboratory Medicine (ASLM). These platforms continue to serve as the foundations for national health laboratory infrastructure enhancement, capacity development and overall quality system improvement. Further targeted interventions should encourage countries to aim at integrated tiered referral networks, promote quality system improvement and accreditation, develop laboratory policies and strategic plans, enhance training and laboratory workforce development and a retention strategy, create career paths for laboratory professionals and establish public-private partnerships. Maintaining the gains and ensuring sustainability will require concerted action by all stakeholders with strong leadership and funding from African governments and from the African Union.

Deaths due to dengue fever at a tertiary care hospital in Lahore, Pakistan

We conducted this study to review deaths due to dengue fever (DF) during a large outbreak of DF in Lahore, Pakistan. We reviewed deaths due to DF at Jinnah Hospital Lahore between August and November 2011. Clinical and laboratory data were abstracted. The 2011 World Health Organization Regional Office for South-East Asia (WHO SEARO) guidelines were used to classify the disease. Out of 128,634 probable DF patients who visited the outpatient department, 2313 patients were hospitalized; 1699 (73.3%) were male. RT-PCR was positive in 92 of 114 hospitalized patients (DENV-2 in 91 patients and DENV-3 in 1 patient). Sixty dengue-related deaths were reported; 41 (68.3%) were male. The mean age (± standard deviation) was 44 (± 20.5) y. The diagnosis at the time of presentation was DF in 5 (8.3%), dengue haemorrhagic fever without shock in 16 (26.6%), dengue shock syndrome in 20 (33%), and expanded dengue syndrome in 19 (31.7%) patients. Expanded dengue syndrome included encephalopathy in 12 (20%) patients, intracerebral bleed in 3 (5%), multiorgan failure in 3 (5%), and Guillain-Barré syndrome in 1 (1.6%). Twenty-nine (48.3%) patients had at least 1 comorbidity. Dengue shock syndrome and expanded dengue syndrome were the most common causes of death.

Laboratory preparedness in EU/EEA countries for detection of novel avian influenza A(H7N9) virus, May 2013

Following human infections with novel avian influenza A(H7N9) viruses in China, the European Centre for Disease Prevention and Control, the World Health Organization (WHO) Regional Office for Europe and the European Reference Laboratory Network for Human Influenza (ERLI-Net) rapidly posted relevant information, including real-time RT-PCR protocols. An influenza RNA sequence-based computational assessment of detection capabilities for this virus was conducted in 32 national influenza reference laboratories in 29 countries, mostly WHO National Influenza Centres participating in the WHO Global Influenza Surveillance and Response System (GISRS). Twenty-seven countries considered their generic influenza A virus detection assay to be appropriate for the novel A(H7N9) viruses. Twenty-two countries reported having containment facilities suitable for its isolation and propagation. Laboratories in 27 countries had applied specific H7 real-time RT-PCR assays and 20 countries had N9 assays in place. Positive control virus RNA was provided by the WHO Collaborating Centre in London to 34 laboratories in 22 countries to allow evaluation of their assays. Performance of the generic influenza A virus detection and H7 and N9 subtyping assays was good in 24 laboratories in 19 countries. The survey showed that ERLI-Net laboratories had rapidly developed and verified good capability to detect the novel A(H7N9) influenza viruses.

Novel coronavirus infection: time to stay ahead of the curve

1Regional Director, World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt. 2Director, Department of Communicable Disease Prevention and Control, World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt. 3Deputy Minister of Health for Public Health, Ministry of Health, Riyadh; Professor, College of Medicine, Al Faisal University, Riyadh, Kingdom of Saudi Arabia (Correspondence to Ziad A. Memish: zmemish@yahoo.com). In 2003, the World Health Organization (WHO) steered an unprecedented global response to successfully control severe acute respiratory syndrome (SARS), a new disease caused by a previously unknown coronavirus. This became the first major international health emergency in the 21st century [1]. Almost 10 years later in June 2012, the discovery of another novel strain of SARS-like coronavirus [2] sparked similar alarm. This virus belongs to the same family of viruses that caused SARS in 2003. It also causes unusually severe pneumonia and death in a majority of patients [3]. Because a significant proportion of cases have been acquired in our region, it has had a significant impact on the countries of the Eastern Mediterranean. By April 2013, as the number of fatalities from the Eastern Mediterranean region rose to 9 and with 14 confirmed cases [4], the situation raised some pressing questions. This virus had not been detected in humans or animals previously [5], and although most cases were sporadic, recent evidence of limited person-to-person transmission from index case to family members heightened concerns. The latest cluster involved a United Kingdom (UK) resident who seemed to have acquired his infection in south Asia or the Middle East. Two family members who became ill on his return were subsequently diagnosed with novel coronavirus infection. The fact that neither had travelled outside of the UK provided the first convincing evidence of person-to-person transmission [6]. The origin of this virus remains unknown. Early scientific evidence suggests that the virus might already be widespread in animals [7] but much about this virus remains to be understood. Important questions to be answered include the origins of the outbreak, how widespread it is in nature, whether it is a zoonotic infection, and how it emerged in humans as a virulent pathogen. Most important of all is whether infection can be sustained through human-to-human transmission. Its risk to global health will be fully understood once the scale and evolution of this virus is known. Geographic monitoring is a priority, particularly mapping across jurisdictions. In January this year, experts from WHO and other international health bodies assembled in Cairo to discuss what is currently known about this virus. Efforts to answer important questions have been made as shown by Angus Nicoll, Anthony Mounts and colleagues in this issue of the EMHJ. Articles from Richard Pebody, Bassam Hijawi and others have also contributed important new data. The papers published in this issue of the Journal provide a convincing demonstration of the global health community working together to build the evidence base that will guide and inform public health decisions. Our experience with novel coronavirus infection reinforces the benefits of regional engagement amongst WHO Member States. It also highlights the cooperation that is necessary to successfully combat international health threats within the spirit and framework of International Health Regulations (2005) [8]. WHO and international scientific communities have benefitted from the willingness of countries in our region to share viruses and information immediately. This has allowed timely sequencing studies and the rapid development of diagnostic tests. Ten years after the world successfully contained SARS, critical questions remain. How safe is the international community? Are we prepared for another global event like SARS? There are mounting concerns over a succession of new pathogens identified since the turn of the century [9]. The world has already experienced the century’s first influenza pandemic. This event was preceded by another outbreak of global importance – avian influenza caused by H5N1 virus. Lessons from avian influenza, pandemic influenza, the recent emergence of novel coronavirus infection in the Middle East and influenza A(H7N9) virus in China [10] demonstrate that all these diseases have in common “known unknowns”. New pandemic diseases will emerge again in the future. Novel microbes that are sustained in nature will eventually spill over again to infect human populations. When this happens, another

Russian city offers health pursuits for all ages

For 88-year-old Zoya Marinich, who lives in the south-western Russian city of Stavropol, the turning point came with a phone call. was invited to meet Vasily Skakun, a man who trained 17 world champion gymnasts recalls the retired teacher. Seventy-six at the time of the call, Zoya was not planning to take up vaulting, but she was interested in getting healthy again. Zoya had seen her share of physical hardship, including working hard on a farm as a girl before the Second World War and, during the war, torture as a partisan while the city was occupied from August 1942 to January 1943. But what had really taken its toll on her health were decades of physical inactivity and unhealthy eating, a combination that resulted in what Zoya calls a bouquet of health problems, including heart disease and chronic muscular pain. Zoya is one of thousands of people in the Russian Federation, a vast country of 141 million people stretching from central Europe to the Pacific Ocean, who have multiple chronic health problems. Noncommunicable diseases (NCDs) account for an estimated 82% of all deaths in the country. Cardiovascular disease, including heart disease and stroke, accounts for 62% of those deaths--higher than the global average of 48%--while cancer causes almost 15% of them. [ILLUSTRATION OMITTED] To treat her health problems, Zoya had always relied on medicines provided by her but she was not optimistic. realized that I would not survive on pills alone, she says. Then the telephone rang. One of the classes offered by the Vastly Skakun Academy was yoga, and Zoya Marinich hit the mat. Skakun's efforts are part of a citywide drive to reduce the high toll of NCDs. is one of about 100 cities in 30 countries across the European Region of the World Health Organization (WHO) that have joined the international Healthy Cities movement. The initiative, started by WHO's Regional Office for Europe in 1986, aims to promote healthy lifestyles, create healthy living conditions and combat the NCD epidemic in the 53-country region. Stavropol is a dynamic member of the Healthy Cities movement in the Russian Federation and in the European network as a whole, says Dr Agis Tsouros, the director of policy and governance for health and well-being at the WHO Regional Office for Europe. established a Healthy Cities project office in 2006. But, as Dr Karen Amlaev, WHO Healthy Cities campaign coordinator in points out, the city has been involved in activities of the Healthy Cities Association since 1996. would have been a sin not to do so, since the deputy mayor of on social issues was a doctor, he says, referring to Valentina Muravyova, who is now rector of the Medical University. Amlaev firmly believes that these activities, which are funded by the city authorities and provided free of charge to all, are already making a difference to the population's health. The main thrust of Stavropol's efforts is to reduce risk factors for NCDs by raising awareness among people of all ages regarding unhealthy behaviours such as smoking and by providing free health services, such as drop-in clinics to measure blood pressure. The Russian Federation has one of the highest smoking rates in the world, at around 40%, and each year an estimated 398 000 Russian citizens die from tobacco-related causes, according to the WHO global report: mortality attributable to tobacco--the equivalent of the entire population of the city of Stavropol. The Healthy Cities campaign is reaching children by distributing a comic with anti-tobacco messaging. It has been such a success that it is now in its fourth edition. The involvement of local media has been central to the campaign, including interviews with health experts on local radio stations and a regular column in Vecherny Stavropol, a local evening newspaper on health issues. …

The European “Year of the Air”: fact, fake or vision?

(EEB) or the EC Joint Research Centre (JRC) as well as international organizations like WHO or Health Effects Institute (HEI) provide extensive pooled information on air pollution-related health effects, partially looking at certain air pollutants or specific situations and their impact. Nevertheless, speakers at the current HEI′s Annual meeting in San Francisco summarized and concluded that many components of the particulate matter mixture appear to be associated with some effects, but no specific component has been associated with all effects (EEA 2013; European Commission 2013; HEI 2010a, b, 2013; IIASA 2013; WHO Regional Office for Europe 2013a, b). The WHO Regional Office for Europe is implementing two projects: (a) evidence on health aspects of air pollution, to review EU policies—REVIHAAP; and (b) health risks of air pollution in Europe—HRAPIE; with financial support from the European Commission (EC). (WHO Regional Office for Europe 2013a). Furthermore, Thematic Strategy on Air Pollution (TSAP) was started (IIASA 2013): “The European Commission is currently reviewing the EU air policy and in particular the 2005 Thematic Strategy on Air Pollution. It is envisaged that in 2013 the Commission will present proposals for revisions of the Thematic Strategy.” Following REVIHAAP’s (WHO Regional Office for Europe 2013a) decision, the HRAPIE project (WHO Regional Office for Europe 2013b) concluded for TSAP (IIASA 2013): “The core cost-effectiveness analysis is to include estimates of impact of long term (annual average) exposure to PM2.5 on all-cause (natural) mortality in adult populations (age 30+), based on a linear CRF (cumulative risk function), with relative risk of 1.062 (95 % CI 1.040– 1.083) per 10 μg/m. The impacts are to be calculated at all levels of PM2.5.” These mortality coefficient estimates for the CRF were taken from the meta-analysis of Hoek et al. (2013). The European Commission (EC) has announced 2013 the “Year of the Air” declaring that air pollution remains a concern for public health and the environment despite obvious progress in the reduction of emissions of different air pollutants over the last decades. To improve the situation, the EC is currently reviewing their strategy on air pollution and related policies, also supported, for example, by results from a public survey based on 25,000 responses out of 506 million citizens in Europe (European Commission 2013). Specific action seems to be necessary, because current EU standards for ambient air quality are weaker than those recommended by the World Health Organization (WHO) who intends to minimize health effects of air pollutants worldwide. EU affiliated organizations such as European Environment Agency (EEA), European Environmental Bureau

Emerging issues on risks to health from air pollution: results from the WHO-HRAPIE survey of experts

Background: The World Health Organization (WHO) Regional Office for Europe is currently implementing project “Health Risks of Air Pollution in Europe – HRAPIE” with financial support from the Europ...

Quo vadis Germania? Die Nationale Kommission zur Verifizierung der Elimination der Masern und Röteln

Since 1984, the World Health Organization (WHO) European Region has pursued the goal of eliminating measles. In 2005, it was decided to also stop the endemic transmission of rubellavirus, thereby eliminating congenital rubella syndrome. Both infections are to be eliminated by 2015. To document the progress and verify the elimination at country level, national verification committees should be established in WHO EU memberstates. In December 2012, the German Ministry of Health appointed the German National Verification Committee for Measles and Rubella Elimination. The commission meets at least twice a year to compile and analyze data on the epidemiology of measles and rubella in Germany and on the vaccination coverage/ immunity of the German population against these infections to assess progress in the elimination goals. Furthermore, the commission indicates whether the available data are sufficient or contain inconsistencies, evaluates the success of key strategies implemented, and advises on activities related to the verification of the elimination process in the country. A scientific report on the commission's findings is to be submitted annually to the WHO regional office. Germany is committed to the aim of eliminating measles and rubella. Thus, every possible effort should be made to reach this goal by the responsible players in the German immunization system. The commission - as an independent group of experts - will critically accompany and evaluate this process.

Healthy Cities in Europe: Editorial

This special supplement evaluates work undertaken in phase IV (2003–2008) of the European Healthy Cities Network (WHO-EHCN) supported by the World Health Organization regional office for Europe with contextual references to development in the current phase V (2009–2013) of the EHCN and its goals and priorities in phase VI (2014–2018). The network has grown through five phases, spanning 25 years since its inception in 1987 and, as our first article indicates, has had a significant influence on the development of Health 2020: the new European policy for health and well-being.1 Approved by central government representatives of member states of the European Region in 2012, Health 2020 nevertheless emphasizes the leadership and unique position of local governments in addressing the wider determinants of health. Twelve articles convey the scope and substance of policy development and implementation in the 77 member cities of the WHO-EHCN located by the map overleaf, and the 13th article summarizes activities of national networks of healthy cities, with over 1,500 members. All 13 convey both continuity and innovation. As in our evaluation of phase III of the WHO-EHCN summarized in a special supplement of Health Promotion International (issue 24, 2009), there is continuity, first, in membership of the network and, second, in enduring values such as equity and sustainability, political preconditions such as intersectoral partnerships, democratic governance, and strong municipal leadership for health and work on themes such as healthy urban planning and healthy aging. The methodology for evaluating complex cities with concurrent interventions and multiple outcomes was developed by Evelyne de Leeuw for phase III and is further developed both in this special supplement and in a complementary article in the Journal of Urban Health.2 In practice, much of the evidence for our evaluation is derived from the 59 valid city responses to a General Evaluation Questionnaire and a similar number completing an annual reporting template. We are hopeful that the methodology of realist evaluation and synthesis will challenge or at least complement more traditional public health research paradigms. Innovation has developed sequentially within the rapidly evolving socioeconomic landscape of Europe and compelling new evidence on the wider determinants of health inequalities. Innovative City Health Plans of phase II evolved into City Health Development Plans in phase III, with more precision about investing for health in phase IV. The innovative tool of health impact assessment disseminated in phase III was fully operational by phase IV. The imperative of active living evolved from phase III, influencing the innovative theme of healthy aging in phase IV, now high on the agenda of European policy makers in phase V (2009–2013). The framework next phase of the WHO-EHCN (phase VI, 2014–2018) is shaped around the goals and objectives of the new European policy and strategy for health and well-being. Health 2020 reinforces the values and principles on which healthy cities is based and offers the potential to strengthen the policy standing and to broaden both the strategic and operational scope of the work of healthy cities. The adoption of Health 2020 by all 53 member states of the European Region provides a supportive and encouraging environment for implementing Healthy 2020 locally. Most importantly, Health 2020 recognizes the important role of local governments in developing health and especially focused on whole-of-government and whole-of-society approaches to health. The 8th Global Conference on Health Promotion in Finland in June 2013 reiterated the importance of health in all policies in addressing the consequences of public policies on health determinants, aiming to improve the accountability of policy makers for health impacts at all levels of policy making and emphasized the need for strengthening governance for health. Phase VI is an adaptable and practical framework for delivering Health 2020 at the local level. It provides a unique platform for joint learning and sharing of expertise and experience between cities, the sub-national level, and countries. It recognizes that every city is unique and will pursue the overarching goals and core themes of phase VI according to the city’s situation. In delivering Health 2020, phase VI will support and encourage cities to strengthen their efforts to bring key stakeholders together to work for health and well-being, harnessing their potential for innovation and change and resolving local public health challenges. The future prosperity of urban populations depends on the willingness and ability to seize new opportunities to enhance the health and well-being of present and future generations. Map

The school canteen facilities: an instrument for the Mediterranean nutrition education

The school canteens are an important mean for the education and well-being promotion addressed to children, that involve teachers and parents as well; for this reason they should not be considered as a mere fulfillment of the nutritional needs. Considering the complexity of the structures involved, the kind of consumers and the possible consequences of related and incidental pathological events, the importance of the canteen facilities stands clear with respect to a health and social program focused to the development of a correct feeding aimed to assure, at the same time, food safety and nutritional quality. The situation of school canteens is different: in Italy, for instance, the canteens for nursery schools, pre-schools, primary and secondary schools pertain to the Municipal Authorities. Considering the huge number of municipalities, more than 8,000 where, per each town, there is at least one school, the services are rather disjointed and unorganized. The refectories can be directly managed by the municipalities themselves, or can be assigned to one or more external companies contracted with a tender; finally, some refectories can be managed by the local authority together with a contract company, i.e., a mixed management. On the basis of the data provided by Bio Bank (2010), the contract system is largely diffused, as it is chosen by 74 % of the canteens (6), whereas 15 % choose the direct management and only 9 % the mixed system. The epidemiological characteristics related to the nutritional status and the lifestyles of the samples of school population are surveyed with the monitoring of national or international projects. The National Guidelines for school canteen facilities are suggested by the need to facilitate, since the early childhood, the adoption of correct eating habits in order to promote a healthy well-being and to prevent chronic and degenerative diseases (like diabetes, cardiovascular disease, obesity, osteoporosis, etc.) where a wrong diet represents one of the main risk factors. On the other hand, the radical lifestyle changes of families and individuals have brought to the need of having at least one meal outside, using the available food services. It is well-known that the promotion of a correct and healthful lifestyle is the primary target, even at the international level. The access and the practice of a healthful diet is one of the fundamental rights to achieve the highest attainable standard of health, particularly in the first years of one’s life. The ‘‘Convention of the Childhood rights’’, held in 1989 by the UN, ratified the right of the child of having a healthful and appropriate diet in order to achieve the highest attainable standard of health and the ‘‘European Social Charter’’, reviewed in 1996, stated that ‘‘every human being has the right to benefit from any measures that enable him to achieve the best level of good health obtainable’’. In 2006, The WHO (World Health Organization) Regional Office for Europe approved the ‘‘Gaining health Program’’, that provided a multi-sectorial strategy aimed at the prevention and control of the chronic disease. At the end of 2007, the WHO, together with the European Commission and 27 State Members of the Union, adopted the declaration about ‘‘The health in every policy’’, as to promote the development and implementation of policies S. Sukkar (&) IRCCS San Martino-IST, Genoa, Italy e-mail: samirsukkar@yahoo.it

Is tuberculosis crossing borders at the Eastern boundary of the European Union?

Background: The Eastern border of the European Union (EU) consists of 10 countries after the expansion of the EU in 2004 and 2007. These 10 countries border to the East to countries with high tuberculosis (TB) notification rates. We analyzed the notification data of Europe to quantify the impact of cross-border TB at the Eastern border of the EU. Methods: We used TB surveillance data of 2010 submitted by 53 European Region countries to the European Centre for Disease Prevention and Control and the World Health Organization Regional Office for Europe. Notified TB cases were stratified by origin of the case (national/foreign). We calculated the contribution of foreign to overall TB notification. Results: In the 10 EU countries located at the EU Eastern border, 618 notified TB cases (1.7% of all notified TB cases) were of foreign origin. Of those 618 TB cases, 173 (28.0%) were from countries bordering the EU to the East. More specifically, 90 (52.0%) were from Russia, 33 (19.1%) from Belarus, 33 (19.1%) from Ukraine, 13 (7.5%) from Moldova and 4 (2.3%) from Turkey. Conclusions: Currently, migrants contribute little to TB notifications in the 10 EU countries at the Eastern border of the EU, but changes in migration patterns may result in an increasing contribution. Therefore, EU countries at the Eastern border of the EU should strive to provide prompt diagnostic services and adequate treatment of migrants.

Ongoing outbreak of rubella among young male adults in Poland: increased risk of congenital rubella infections

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World Health Organization Regional Assessments of the Risks of Poliovirus Outbreaks

While global polio eradication requires tremendous efforts in countries where wild polioviruses (WPVs) circulate, numerous outbreaks have occurred following WPV importation into previously polio-free countries. Countries that have interrupted endemic WPV transmission should continue to conduct routine risk assessments and implement mitigation activities to maintain their polio-free status as long as wild poliovirus circulates anywhere in the world. This article reviews the methods used by World Health Organization (WHO) regional offices to qualitatively assess risk of WPV outbreaks following an importation. We describe the strengths and weaknesses of various risk assessment approaches, and opportunities to harmonize approaches. These qualitative assessments broadly categorize risk as high, medium, or low using available national information related to susceptibility, the ability to rapidly detect WPV, and other population or program factors that influence transmission, which the regions characterize using polio vaccination coverage, surveillance data, and other indicators (e.g., sanitation), respectively. Data quality and adequacy represent a challenge in all regions. WHO regions differ with respect to the methods, processes, cut-off values, and weighting used, which limits comparisons of risk assessment results among regions. Ongoing evaluation of indicators within regions and further harmonization of methods between regions are needed to effectively plan risk mitigation activities in a setting of finite resources for funding and continued WPV circulation.

Quantitative and qualitative differences in use and trends of hematopoietic stem cell transplantation: a Global Observational Study

Fifty-five years after publication of the first hematopoietic stem cell transplantation this technique has become an accepted treatment option for defined hematologic and non-hematologic disorders. There is considerable interest in understanding differences in its use and trends on a global level and the macro-economic factors associated with these differences. Data on the numbers of hematopoietic stem cell transplants performed in the 3-year period 2006-2008 were obtained from Worldwide Network for Blood and Marrow Transplantation member registries and from transplant centers in countries without registries. Population and macro-economic data were collected from the World Bank and from the International Monetary Fund. Transplant rates were analyzed by indication, donor type, country, and World Health Organization regional offices areas and related to selected health care indicators using single and multiple linear regression analyses. Data from a total of 146,808 patients were reported by 1,411 teams from 72 countries over five continents. The annual number of transplants increased worldwide with the highest relative increase in the Asia Pacific region. Transplant rates increased preferentially in high income countries (P=0.02), not in low or medium income countries. Allogeneic transplants increased for myelodysplasia, chronic lymphocytic leukemia, acute leukemias, and non-malignant diseases but decreased for chronic myelogenous leukemia. Autologous transplants increased for autoimmune and lymphoproliferative diseases but decreased for leukemias and solid tumors. Transplant rates (P<0.01), donor type (P<0.01) aand disease indications (P<0.01) differed significantly between countries and regions. Transplant rates were associated with Gross National Income/capita (P<0.01) but showed a wide variation of explanatory content by donor type, disease indication and World Health Organization region. Hematopoietic stem cell transplantation activity is increasing worldwide. The preferential increase in high income countries, the widening gap between low and high income countries and the significant regional differences suggest that different strategies are required in individual countries to foster hematopoietic stem cell transplantation as an efficient and cost-effective treatment modality.

Rapid Assessment Survey of The Prevalence of Buruli Ulcer in The Health District of South Maniema, Maniema Province, The Democratic Republic of The Congo

Background: Buruli ulcer (BU) is endemic in more than 30 countries worldwide. Africa is the most affected continent with 16 confirmed endemic countries and 7 suspected or potential endemic countries. In the Democratic Republic of the Congo, a survey in 2004 showed the presence of suspected cases of BU in five of the country’s 11 provinces. The current survey was carried out in 2010 to confirm the endemicity of BU is the southern part of the Maniema Province and to provide support for case management and control measures if necessary. Method: The method of the survey was based on the protocol of rapid prevalence assessment survey (RPAS), proposed by the Buruli ulcer control Program of the World Health Organization (WHO) Regional Office for Africa to confirm BU endemic in countries. It included: awareness campaign and sensitization of health workers and communities in suspected endemic areas, followed by clinical screening of patients with suspected BU lesions and sampling of suspicious lesions by swab or fine needle aspiration (FNA) for laboratory confirmation of diagnosis, mainly by PCR. WHO-recommended treatment is proposed for cases which clinical features were in favor of the diagnosis of Buruli ulcer. Results: The survey in the Southern part of Maniema province targeted six of the nine health zones of Kasongo district. The three other health zones in the district were not be visited for accessibility and security reasons. A total of 66 suspected cases of Buruli ulcer were found at the Hospital of Kindu and in the six visited health zones. The lab tests with Ziehl-Nielsen (ZN) technique have confirmed 9 cases of BU. PCR tests confirmed eight cases of BU, including three who were not positive to the ZN tests. This makes a total of 12 BU patients confirmed by ZN and/or PCR and gives a proportion of laboratory confirmation of 18%. Discussions: Based on the results of this survey all health zones in South Maniema were classified as Buruli ulcer endemic areas, because of the same geo-climatic features that characterize all of them. These findings are similar to those of previous studies in the same province. The low confirmation rate of BU suspected cases by laboratory tests (18%) could be explained by the fact that many of the suspicious lesions which were sampled were very old wounds and had been evolving for several years. The WHO Regional Office for Africa has developed a plan of surveys, using the same rapid assessment protocol to confirm the endemicity of Buruli ulcer in other suspected endemic provinces of the DRC and in other member states of WHO African Region.

The second international conference on reducing burden of traffic accidents, Shiraz, Iran

Road crashes kill nearly 1.3 million people every year, and leave millions moreinjured or permanently disabled. Impaired driving, unsafe roads and other dangersshatter lives in a matter of seconds. The Decade can help thwart this needless loss of life. “I call on Member States, international agencies, civil society organizations, businesses and community leaders and people everywhere to ensure that the decade leadsto real improvements.” Mr. Ban Ki-moon, United Nations (UN) Secretary-General.1 According to the World Health Organization (WHO) report, mortality from traffic accidents have increased from almost 999,000 in 1990 to more than one million in 2002 and is projected to approach 2 million death annually by 2020.2 While only 40% of the world’s motor vehicles are owned by inhabitants of developing countries, 85% of total mortality of traffic accidents occur in these countries.3,4 This decade from 2011 to 2020 has been called as the “Decade of Action” for road safety by World Health Organization (WHO).5-7 This is an opportunity to have more intersectoral collaboration for this important goal both within and between countries. In concordance with the UN announcement of “Decade of Action for Road Safety 2011-2020”, and for promoting a collaborative action for reducing traffic accidents’ burden, Health Policy Research Centre, organized this international conference for second time.8 Authorities and Participants The second international conference on reducing burden of traffic accidents; challenges and strategies was held by Health Policy Research Centre affiliated with Shiraz University of Medical Sciences, Shiraz, Iran in collaboration with several other organizations and agencies including Iranian Police, Iranian emergency medical services, Iranian Forensic Medicine Organization and Oklahoma State University, (Oklahoma, USAon 2012 March 10th and 11th at Velayat Conventional Centre, Shiraz, Iran. The main themes of the conference were evidence based review of: • Interventions and projects to reduce traffic accidents • Environmental determinants of traffic accidents • Enhancing safety of pedestrians and road users • Comprehensive traffic accident registration • Socio-cultural factors affecting traffic accidents Sessions and Speeches Overall 350 abstracts in different subjects of traffic accidents were sent to the seminar secretariat out of which 123 were selected by scientific board of the conference after peer review for presentation (26 oral and 97 poster presentations). During the congress representative form WHO regional office at the Eastern Mediterranean presented the WHO strategy for the policy formulation at national level as well as how road traffic accidents become a global health concern during recent years. She also stated that road safety is a shared responsibility between government and legislative bodies, media, professionals, NGOs(and special interest groups), police, industry, health, users and citizens. The head commander of the traffic sector of the police headquarter stated that the number of cars in Islamic Republic of Iran will reach 15 million at the end of 2011. This number was 4 million and 8 million by the years of 2001 and 2005 respectively and it will exceed 30 million by end of this decade. The importance of utilizing structured guidelines in the management of victims of traffic accidents was emphasized in this conference. The role of infrastructures in developing countries in increased accidents and their burden in developing countries was highlighted in several presentations. The psychology of response to accidents and the way they could be promoted also was discussed in this meeting. Challenges of trauma care centers and emergency medical services in handling traffic accidents was the theme of a panel of physicians, surgeons and EMS technicians in collaboration with representatives from Fars governor. It was stressed thatcoordinated teamwork is the most needy action to increase the survival of the multiple trauma patients. Policies and barriers of trauma research were also addressed. One of the important aspects of this conference was on line launching of the unified, comprehensive traffic accident registry in Shiraz metropolitan. This project was started two years before by the Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Take-home Message Traffic injuries are among emerginghealth issues. Coordinated regional, national and international dynamic plan is needed to meet therequirements of developing effective and timely policies in pre-injury, injury and post-injury phases. These policies should be based on best available evidences. But all policies should be practical. This practicality is related to consideration of available resources, cultures, intersectoral collaboration and more involvement of community. Acknowledgments We thank all the staff members of Health Policy Research Centre, Shiraz, Iran for their kind cooperation and collaboration for holding the conference.

Laboratory capability for molecular detection and confirmation of novel coronavirus in Europe, November 2012

A rapid survey by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe ascertained the availability of national reference laboratory testing for a recently detected novel coronavirus as of 28 November 2012. Screening by internal quality controlled upE-RT-PCR assay was available in 23/46 of responding countries in the WHO European Region, of which 19/30 in European Union (EU) and European Economic Area (EEA) countries. Confirmation of positive screened samples by either ORF1b - RT-PCR, or other target RT-PCR assays with sequence analysis or whole-genome sequence analysis was available in 22/46 responding countries of which 18/30 in EU/EEA countries.

The World Health Organization–United Nations Population Fund Strategic Partnership Programme's implementation of family planning guidelines and tools in Asia–Pacific countries

The aim of this study was to assess the impact of the Strategic Partnership Programme, a collaboration between the World Health Organization and the United Nations Population Fund to improve evidence-based guidance for country programs through the introduction of selected practice guidelines to improve sexual and reproductive health. Information for this report is from questionnaires sent to Ministries of Health in 2004 (baseline assessment) and in 2007 (assessment of outcome), annual country reports and personal communication with focal points from Ministries of Health and World Health Organization regional and country offices. Following the Strategic Partnership Programme, family planning guidance was used extensively to: formulate and update reproductive health policy; update standards and guidelines; improve training curricula; conduct training activities; develop advocacy and communication materials; and promote change in service. The Strategic Partnership Programme was successful in promoting the introduction of evidence-based guidelines for reproductive health in several Asian countries. The countries that adapted the family planning guidance observed an increase in demand for contraceptives commodities.

International primary care and the RCGP: the College’s role in global health

In 1978 the World Health Organization (WHO) made a public declaration in Alma-Ata advocating the use of primary healthcare systems globally.1 Twenty-two years later the United Nations (UN) agreed eight Millennium Development Goals (MDGs) to be attained by 2015.2,3 Core to the delivery of them, although not explicitly mentioned, is the primary healthcare model as set out in the Alma-Ata Declaration. In 2008 the WHO Regional Office for Europe reiterated that effective primary health care was essential to the delivery of quality health services for individuals and populations by publishing the Talinn Charter.4 This too included a commitment to attain the Charter’s targets by 2015. As we approach the 2015 deadlines for both the MDGs and the Talinn Charter, governments and policy makers are increasingly interested in primary health care. At the Royal College of General Practitioners (RCGP) we observe this by a steadily growing number of international requests to support primary care development. We are entering a critical window of political activity in health funding and global health systems reform. The MDGs committed world leaders to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. The goals related to the eradication of disease specifically drew international attention to communicable diseases (including HIV/AIDS, malaria, and tuberculosis) and focused resources on vertical models of health care for disease-specific diagnoses and treatment. This diverted attention away from the implementation of a horizontal model of primary health care with its less immediate yet longer-term benefits as demonstrated so clearly by Barbara Starfield.5 This imbalance in systems reform was recognised in 2012 when the UN General Assembly published a political declaration on the prevention and control of non-communicable diseases (NCDs).6 The document acknowledges the need to address the …