Public Health Round-up

The World Health Organization (WHO) and its partners are working with the government of the Democratic Republic of the Congo in response to a new outbreak of Ebola virus disease. This outbreak has now been declared a Grade 3 Emergency as per WHO’s Emergency Response Framework. It is the country’s 10th Ebola outbreak, but the first such outbreak in a densely populated active conflict zone, North Kivu province. North Kivu hosts over 1 million displaced people and shares borders with Rwanda and Uganda, where there is a great deal of cross border movement and trade. On those borders, 28 key points of entry have been identified and surveillance stations, to detect any new Ebola and viral haemorrhagic fever cases, were put in place. WHO is also working with neighbouring countries to ensure that the health authorities are prepared to detect cases. “All of those participating in the response must be able to move freely and safely in conflict areas to do the work that is needed to bring the outbreak under control,” said WHO DirectorGeneral Tedros Adhanom Ghebreyesus, when he visited the country last month to support the response. WHO deployed a mobile laboratory to provide on-the-spot testing for Ebola to the city of Beni on 2 August. As of 15 August, more than 100 WHO staff had arrived in the affected areas. Treatment centres have been set up by the nongovernmental organizations Alima and Médecins Sans Frontières France in Beni and Mangina, respectively. With support from WHO, the government of the Democratic Republic of the Congo launched an Ebola vaccination campaign for high-risk populations in North Kivu Province on 8 August. Thousands of doses of the rVSV-ZEBOV Ebola vaccine are available in the country, with more ready to be delivered if needed. Safe burials have been carried out in Beni with systems being put in place by the International Federation for the Red Cross and Red Crescent and partners supporting the health ministry to ensure that safe and dignified burials will be conducted throughout the affected zones. http://bit.ly/2MKIay9


WHO response in Yemen
Last month the World Health Organization (WHO) provided hospitals in Yemen with medical supplies, an emergency medical team, and financial incentives to ensure continuation of emergency obstetric and gynaecological care.
A new medical oxygen filling station has been constructed and completed by WHO supporting 3 hospitals in Al Hudayah to fill a much need service gap. As well as supporting the drilling of a new water well with a capacity of 13,000 litres per hour for Al-Thawra hospital, WHO has provided 30 cholera kits, 8 supplementary kits and 3 trauma kits.
Dr Nevio Zagaria, WHO Representative in Yemen, reports "The situation in Al-Hudaydah city grows more dangerous every day. As the fate of this country is being discussed on the international stage, the reality on the ground is much darker. While the conflict escalates, so must the health response. Basic health services must be guaranteed for the most vulnerable, such as mothers and children, and patients suffering from chronic conditions like diabetes and hypertension. " "Yemen's health system is extremely fragile, so any additional incident has the potential to overwhelm existing capacities. Population movement out of Al-Hudaydah is creating pressure on operating health facilities and water and sanitation networks in host communities. Local water supplies have been damaged by the conflict, increasing the risk of cholera and waterborne diseases, as people turn to potentially unsafe sources of water." WHO Director-General Tedros Adhanom Ghebreyesus called for "all parties to protect health workers and their facilities from harm, as well as to ensure unimpeded access for medical teams seeking to treat the wounded." http://bit.ly/2NOWira The panel decided that Australia's policy on plain packaging is consistent with WTO law. The ruling is likely to accelerate implementation of plain packaging around the globe.

Illicit trade in tobacco
In December 2012, Australia was the first country to fully implement plain packaging for cigarettes and other tobacco products. Plain packaging prohibits the use of logos, colours, brand images and promotional information other than brand and product names in a standardized colour and font.
Today, six additional countries have implemented plain packaging laws (France, Hungary, Ireland, New Zealand, Norway and the United Kingdom of Great Britain and Northern Ireland), six more have passed laws yet to be implemented (Burkina Faso, Canada, Georgia, Romania, Slovenia and Thailand) and a number of other countries are examining the policy.

WHO best buys for noncommunicable diseases
Significant health and economic benefits could be achieved by implementing a core set of interventions to reduce noncommunicable diseases in low-and lower-middle-income countries, according to a WHO report released in May. WHO best buys are a list of 16 interventions covering a number of factors relating to noncommunicable disease prevention and management, such as tobacco use, unhealthy diet, lack of physical exercise and the provision of basic treatment for existing conditions.
The report Saving lives, spending less: a strategic response to noncommunicable diseases reveals, for the first time, the financing needs and returns on investment which could be achieved by implementing these interventions in all low-and lower-middle-income countries. It argues that in doing so these interventions could save 8.2 million lives and yield a return of 7 United States dollars (US$) for every US$1 invested by 2030.
The report is available in English, French and Russian: bit.ly/2ufEaP9

Intrapartum care
WHO issued new and consolidated recommendations on intrapartum care in February to ensure good quality care throughout labour and childbirth in healthy pregnant women.
WHO recommendations: intrapartum care for a positive childbirth experience contains 56 recommendations focused on improving the quality of care around the time of birth for healthy pregnant women and their babies. Specialized care for pregnant women who develop complications and the management of high-risk pregnancies are outside the scope of this guideline. bit.ly/2uteRYS

International food standards
The Codex Alimentarius Commission has set maximum residue limits of pesticides in various foods and feeds and a limit for methylmercury in fish destined for human consumption. Mercury can have toxic effects on the nervous, digestive and immune systems of humans, and on lungs, kidneys, skin and eyes. To reduce exposure to methylmercury, the Commission set limits for several fish species, ranging from 1.2 to 1.7 mg per kg of fish.
The commission agreed to eight measures on nutrition labelling, maximum residue levels of various substances in fish and animal products, maximum persistent organic pollutant levels in food and feed, maximum levels of cadmium in chocolate and to the revision of the food additive section of 15 commodity standards to align these with the Codex General Standard for Food Additives. bit.ly/2uoJ6QV

Extending hepatitis C treatment
WHO has recommended extending treatment to individuals aged 12 and above with chronic hepatitis C virus, irrespective of disease stage, in a new guideline released last month entitled, Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection. WHO recommends the use of pangenotypic direct-acting antiviral regimens for the treatment of persons with chronic hepatitis C virus infection aged 18 years and above. In adolescents, aged 12-17 years or weighing at least 35 kg with chronic hepatitis C virus infection, WHO recommends: sofosbuvir/ ledipasvir for 12 weeks in genotypes 1, 4, 5 and 6; sofosbuvir/ribavirin for 12 weeks in genotype 2; and sofosbuvir/ ribavirin for 24 weeks in genotype 3. In children, WHO recommends deferring treatment until 12 years of age.
Interferon-based regimens should no longer be used.

Ebola
WHO has revised its assessment of the public health risk for the current outbreak of Ebola in the Democratic Republic of the Congo to moderate at the national level, and low at the regional and global levels.
Last month, WHO reviewed the level of public health risk associated with the current outbreak. The latest assessment concluded that the current Ebola virus disease outbreak has largely been contained, considering that over 21 days have elapsed since the person with the last laboratory-confirmed infection was discharged and that contact-tracing activities ended 27 June 2018. However, there remains a risk of resurgence from potentially undetected transmission chains and possible sexual transmission of the virus by male survivors. It is therefore critical to maintain all key response pillars until the end of the outbreak is declared. Strengthened surveillance mechanisms and a survivor monitoring program are in place to mitigate, rapidly detect and respond to any additional events. http://bit.ly/2NKGhm3

Paraguay malaria-free
The World Health Organization (WHO) certified Paraguay as having eliminated malaria, the first country in the WHO Region of the Americas to be granted this status since Cuba in 1973. In 2016, WHO identified Paraguay as one of 21 countries with the potential to eliminate malaria by 2020. Through the E-2020 initiative, WHO is supporting these countries as they scale up activities to become malaria-free. Other E-2020 countries in the WHO Region of the Americas include Belize, Costa Rica, Ecuador, El Salvador, Mexico and Suriname.
A progress update on elimination efforts in E-2020 countries, provides, for the first time, preliminary case numbers for 2017. Ten more countries are on track to eliminate malaria by 2020. However, eight other E-2020 countries saw increases in indigenous malaria cases in 2017, reflecting the global malaria trends reported in the latest WHO World malaria report.

Cover photo
Lera Nagormay, 10, in school in Mariinka, Donetsk Oblast, Ukraine. When conflict broke out in 2013, Mariinka was heavily contested. The conflict has taken a severe toll on the education system, affecting students, teachers, administration and education facilities, hundreds of which have sustained damage.