Environmental problems add to burden
GENEVA Emerging and transition economies including India and Russia are suffering from an added burden of illness due to growing environmental health problems, according to a study by the World Health Organization. However, poor countries suffer the most from ill health caused by a person's surroundings or social conditions, including poor quality water supplies, air pollution, work-related stress, unhealthy lifestyles, and road accidents, it said. China and India account for about 38 percent of the global deaths due to environmental health problems, according to fresh data released by the UN health agency. The problems faced by individual countries were revealed in a new breakdown of global figures released a year ago, including a worldwide annual death toll of 13 million due to environmental health problems. China and India together account for five million of those deaths. The worst affected countries are Angola, Burkina Faso, Mali, and Afghanistan-each with 316 years of ill health per 1,000 inhabitants caused by environmental factors. These countries suffered above all from poor water quality and supply, diarrheal illnesses, and respiratory diseases caused by the use of indoor wood or coal fires. The WHO highlighted the growing double burden due to environmental health issues. People in emerging nations "suffer both from the traditional problems seen in poor countries and new problems due to their environment, such as cardiovascular disease caused by sedentary lifestyles," said Maria Neira, WHO head of public and environmental health. An average of 68 years of ill health per 1,000 inhabitants are caused by environmental health issues in India compared to 54 in Russia, 37 in Brazil, and 34 in China. The best rated were Iceland and Israel with a score of 14 years per 1,000, ahead of Italy (16), Germany, Spain and France (17), Britain (18), and the United States (19). M AFP
GENEVA Revised International Health Regulations (IHR) enter into force on June 14, aiming to boost the world's capacity to deal with the growing threat that infectious diseases such as bird flu can spread globally. The rules will ensure "faster and better detection and evaluation of health emergencies with an international scope, those that have the potential to cross frontiers," said Guenael Rodier, the World Health Organisation's IHR coordination director. The WHO said the emergence of SARS, the deadly Ebola virus in Africa, and human cases of bird flu in recent years demonstrated the speed with which lethal diseases could appear and spread. "SARS was a wake-up call for all of us. It spread faster than we had predicted and was only contained through intensive cooperation between countries which prevented this new disease from gaining a foothold," said WHO director general Margaret Chan. "Today, the greatest threat to international public health security would be an influenza pandemic. The threat of a pandemic has not receded, but implementation of the regulations will help the world to be better prepared for the possibility of a pandemic," she added. The rules bolstering international cooperation to stifle health emergencies were agreed on by the WHO's 192 member states in 2005. Countries will have an obligation to alert the WHO about health threats that might have international implications, ranging from diseases to contaminated food, chemical agents, or radioactive material. It also lays out action like quarantines, surveillance of travelers, and a requirement for a 24-hour, seven-day-a-week alert system. The revision was partly motivated by fears that easier global air travel can help spread infections far and wide in short space of time. The previous regulations last updated in 1969 were limited in scope to four named diseases-cholera, plague, yellow fever, and smallpox-while the revised ones are open-ended and place individual countries under greater pressure to provide transparent information. "The world is such now that these events cannot be obscured," said Michael Ryan, WHO director of epidemic alert and response. "I'm sure we'll have many bumps on the way." In recent years, several countries including China were criticized for being slow or lacking transparency in the initial phases of SARS and bird flu, amid claims they failed to reveal the onset of then largely unknown illnesses to their neighbors. "We must move away from the idea that there's a global band aid that can make up for the deficiencies of national systems," Ryan underlined. The WHO estimates that about two-thirds of countries need to make major progress to be able to cope with the new requirements. David Heymann, WHO assistant director general for communicable diseases, said that the agency will help poorer nations that lack basic health facilities. "It will be a very great challenge for countries to develop their core capacities, especially the low-income countries," he said. M AFP
The growing resistance of Streptococcus pneumoniae to commonly used antibiotics underlines the urgent need for vaccination to stem the tide of invasive pneumococcal disease (IPD) and save thousands of children, according to the World Health Organization. Stressing that pneumococcal vaccines should be included in national immunization programs, Dr. Jean-Marc Olivé, WHO representative to the Philippines, said that while "we know that antibiotic works, there has been a lot of resistance to antibiotics," making prevention the best option to effectively deal with S. pneumoniae infections. Olivé spoke at a symposium, A Call for IPD Prevention: An Awakening, organized by the Philippine Foundation for Vaccination in April. He discussed the latest WHO recommendations on pneumococcal conjugate vaccine for childhood immunization released in March, which tags diseases caused by S. pneumoniae as a major public-health burden. "Infection with pneumococcus is a major cause of morbidity and mortality worldwide," the WHO said in its Weekly Epidemiological Record issued on March 23. Pneumonia, meningitis, meningitis, and febrile bacteremia are some of the serious diseases caused by this organism. Other common but less serious manifestations are otitis media, sinusitits, and bronchitis. The WHO estimates that 1.6 million deaths are caused by S. pneumoniae infections annually, 700,000 to one million of them involving children under five years old. The major burden in the developed world involves children less than two and the elderly. A heptavalent polysaccharide-protein conjugate vaccine (PCV-7) and an unconjugated polysaccharide covering 23 serotypes are currently being used to provide protection from these diseases. However, this 23-valent vaccine is not licensed for use in children under two. PCV-7, on the other hand, has been found to be highly immunogenic in all age groups. It is licensed for use only in children aged under five. The WHO said that "serotypes included in PCV-7 cover 65 to 80 percent of serotypes associated with IPD among young children in industrialized countries." This may, however, vary in different populations and may be lower in many developing countries. In young children, protection against IPD caused by some vaccine serotypes may exceed 90 percent, the WHO said. There are 90 distinct pneumococcal serotypes. Globally, about 20 of these are associated with more than 80 percent of IPD in all age groups; 13 most common serotypes cause at least 70 to 75 percent of IPD in children. The WHO recommends that pneumococcal vaccines be included in national immunization programs, particularly in countries where mortality among children less than five years old is more than 50 per 1,000 live births or where 50,000 children die yearly. Olivé, however, stressed the need for baseline monitoring and surveillance on the impact of vaccination, particularly in countries where the vaccine is used for the first time and in those with a high prevalence of HIV infection or other conditions known to increase the risk of pneumococcal disease. "When you introduce a new vaccine, you have to know the burden of the disease, the distribution of serotypes, and [the vaccine's] impact on the circulation of the serotypes because we are always worried that if you eliminate one serotype, it may give room to other serotypes," said Olivé. He added that vaccination must be analyzed in terms of effectiveness, safety, cost, practicability, feasibility, and impact to weigh its benefits, determine the best vaccine and the best immunization schedule. According WHO guidelines, vaccines to be used for large-scale public-health interventions should be safe and have a significant impact on all target populations, be affordable, be easily adapted to existing schedules of national childhood immunization, and not interfere significantly with the immune response to other vaccines. M Mabelle Aban
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