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Commemorating Smallpox Eradication – a legacy of hope, for COVID-19 and other diseases

On 8 May 1980, the 33rd World Health Assembly officially declared: ‘The world and all its peoples have won freedom from smallpox.’

The declaration marked the end of a disease that had plagued humanity for at least 3 000 years, killing 300 million people in the 20th century alone.

It was ended, thanks to a 10-year global effort, spearheaded by the World Health Organization, that involved thousands of health workers around the world to administer half a billion vaccinations to stamp out smallpox.

The US$ 300m price-tag to eradicate smallpox saves the world well over US$ 1 billion every year since 1980.

Speaking at a virtual event hosted at WHO-HQ, involving key players in the eradication effort, WHO Director-General, Dr Tedros Adhanom Ghebreyesus said, “As the world confronts the COVID-19 pandemic, humanity’s victory over smallpox is a reminder of what is possible when nations come together to fight a common health threat.”

The world got rid of smallpox thanks to an incredible demonstration of global solidarity, and because it had a safe and effective vaccine. Solidarity plus science equalled solution!

Dr Tedros highlighted that smallpox eradication also offers hope for efforts to eliminate other infectious diseases, including polio, which is now endemic in just two countries. To date, 187 countries, territories and areas have been certified free of Guinea worm disease, with seven more to go. And the fight against malaria has so far resulted in 38 countries and territories certified as malaria-free. In the case of Tuberculosis (TB), 57 countries and territories with low TB incidence are on track to reach TB elimination.

At the event, Dr Tedros unveiled a commemorative postal stamp to recognize the global solidarity that drove the initiative and honour the efforts of health workers who ensured its success.

The stamp, developed by the United Nations Postal Administration (UNPA), in collaboration with WHO, signifies what national unity and global solidary can achieve. Numerous countries, such as Guinea, India, Nigeria, Philippines, Togo and others issued smallpox stamps to show support for, and raise awareness about WHO’s Intensified Smallpox Eradication Programme launched in 1967.

WHO Regional Director for Africa, Dr Matshidiso Moeti’s earliest memories of smallpox is of her father. “I was visiting WHO headquarters, and I saw a photo of my Dad, standing with the other experts on the Global Commission. I remember him going out, doing follow-up visits with patients. He often would go with a driver and disappear into the bush for days. I felt in awe of his tireless work. The strategies used to eradicate smallpox still apply today.”

“Lessons learned from smallpox are used today to respond to disease outbreaks. For example, house-to-house active case-finding underpins the polio eradication programme, and ring vaccination of contacts is helping to combat the spread of the Ebola virus disease. Similarly, surveillance, case-finding, testing, contact-tracing, quarantine, and communication campaigns to dispel misinformation are central to controlling COVID-19, “ explained David Heymann, Professor of Infectious Disease Epidemiology at The London School of Hygiene & Tropical Medicine (LSHTM) and Distinguished Fellow, Global Health Security at Chatham House, London.

Following smallpox eradication, WHO and UNICEF launched the Expanded Programme on Immunization, under which 85% of the world’s children are vaccinated and protected from debilitating diseases.

With the potential of a COVID-19 vaccine ahead, ensuring sufficient supplies and reaching people in hard to reach places is a high priority. Addressing vaccine hesitancy poses a significant challenge to stop the virus. Access to accurate public health information and education is critical to ensure that the public has the facts to keep themselves and others safe.

To permanently commemorate the eradication of smallpox and the lessons learned on a global scale, rather than every 10-years, WHO is calling museums, exhibition companies, designers, curators and associations to develop an immersive, interactive and educational exhibition on smallpox and its relevance for COVID-19 and global health security. The exhibition, which will be unveiled later this year, will promote a better understanding of public health and empower people to keep informed and safe during a pandemic.

Notes to the media

Smallpox stamp

The smallpox stamp is in the denomination of CHF 1,70. It was designed by Sergio Baradat (United Nations) in collaboration with the World Health Organization and is available for purchase at unstamps.org. The stamp can be used to mail postcards and letters around the world, provided that they are sent from the UN headquarters in New York, Geneva or Vienna respectively.

Smallpox Eradication dates

On 9 December 1979, a global commission certified that smallpox had been eradicated, and this certification was officially accepted by the 33rd World Health Assembly in 1980.

Museum Exhibition

Exhibition design companies, museums, curators and other companies/organizations in this field are invited to express their interest to develop an immersive, educational exhibition on smallpox and its relevance for COVID-19 and global health security by writing to privatesectorpartners@who.int

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May 9, 2020
Compendium of research projects at the interface of tuberculosis and COVID-19

As the world comes together to tackle the COVID-19 pandemic, it is important to ensure that tuberculosis (TB) prevention and care approaches are adapting appropriately to ensure continuous and safe delivery of high-quality TB services. Considering the overlaps in TB and COVID-19 in disease presentation and transmission, the pandemic presents many questions for the TB field that may require learning through research and innovation.

To better understand challenges and opportunities in this space, the World Health Organization Global TB Programme is collating information on ongoing research at the interface of TB and COVID-19 (i.e. research which would improve TB prevention and care approaches in the context of the COVID-19 pandemic). We are developing a living compendium (listing), which will be updated periodically to make ongoing research projects and publications visible on its website. With your consent we would like to include any study you have in this compendium.

To fulfill these objectives, we need the cooperation of organizations and individuals engaged in TB/COVID-19 research to complete this one page template before 20 May 2020. We encourage you to please share this in your network, so we can reach all stakeholders widely.

We thank you in advance for your cooperation, and please do not hesitate to contact us if you have any questions.

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May 9, 2020
Statement on the third meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of coronavirus disease (COVID-19)
The third meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) (IHR) regarding the coronavirus disease (COVID-19), took place on Thursday, 30 April 2020, from 12:00 to 17:45 Geneva
time (CEST).

Proceedings of the meeting

Members and advisors of the Emergency Committee were convened by teleconference. Membership of the Emergency Committee was expanded
to reflect the nature of the pandemic and the need to include additional areas of expertise.

The Director-General welcomed the Committee, thanked them for their commitment to enhancing global public health, and provided an overview of the major achievements in the COVID-19 response since the last Emergency Committee meeting on 30 January 2020.
Representatives of the legal department and the Department of Compliance, Risk Management, and Ethics (CRE) briefed the members on their roles and responsibilities.

The Ethics Officer from CRE provided the members and advisers with an overview of the WHO Declaration of Interest process. The members and advisers were made aware of their individual responsibility to disclose to WHO, in a timely manner, any interests
of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or direct conflict of interest. They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and
the work of the committee. Only those committee members and advisers who were not considered to have any perceived or direct conflict of interest participated in the meeting.

The Secretariat turned the meeting over to the Chair, Professor Houssin. He also welcomed the Committee and reviewed the objectives and agenda of the meeting.

The WHO Regional Emergency Directors and the Executive Director of the WHO Health Emergencies Programme (WHE) provided regional and the global situation overview. After ensuing discussion, the Committee unanimously agreed that the outbreak still constitutes
a public health emergency of international concern (PHEIC) and offered advice to the Director-General.

The Director-General declared that the outbreak of COVID-19 continues to constitute a PHEIC. He accepted the advice of the Committee to WHO and issued the Committee’s advice to States Parties as Temporary Recommendations under the IHR.

The Emergency Committee will be reconvened within three months or earlier, at the discretion of the Director-General. The Director-General thanked the Committee for its work.

Advice to WHO

Coordination, planning, and monitoring
- Continue to lead and coordinate the global response to the COVID-19 pandemic in collaboration with countries, the United Nations (UN), and other partners.
- Work with fragile states and vulnerable countries that require additional technical, logistical and commodity support.
- Establish mechanisms to compile lessons learned from country and partner experiences and WHO missions and share the best practices and updated recommendations.
- Provide further guidance to countries about adjusting public health measures, taking into account the different epidemiological situations of the pandemic.
- Promote the inclusion of all interested countries, including low- and middle-income countries from all regions, in the Solidarity clinical trials for therapeutics and vaccines.
- Continue efforts with partners to obtain equitable access to personal protective equipment, diagnostics, and biomedical equipment essential to the pandemic COVID-19 response.
- Continue to coordinate global expert networks in epidemiology, laboratory, vaccines, clinical care, infection prevention and control, social sciences, and operational research; modelling; and other technical support.
One Health
- Work with the World Organisation for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO), and countries to identify the zoonotic source of the virus and the route of introduction to the human population, including
  the possible role of intermediate hosts. This should be accomplished through efforts such as scientific and collaborative field missions, which will enable targeted interventions and a research agenda to reduce the risk of similar events.
- Work closely with OIE and FAO to provide guidance on how to prevent SARS-CoV-2 infections in animals and humans and prevent the establishment of new zoonotic reservoirs.
- Work with partner organizations and countries to strengthen the global food supply chain, protect food workers, properly manage food markets, and mitigate possible disruptions to the food supply.
Essential Health Services
- Support countries to assess and manage the unintended consequences of public health measures implemented to control the COVID-19 pandemic, including gender-based violence and child neglect.
- Support countries to monitor their ability to provide and strengthen essential health services throughout a likely extended COVID-19 response. This should include, but is not limited to, essential prevention for communicable diseases, particularly
  vaccination; services related to reproductive health, including care during pregnancy and childbirth; care of vulnerable populations, such as young infants and older adults; provision of medications and supplies for the ongoing management of chronic
  diseases, including mental health conditions; continuity of critical inpatient therapies; management of emergency health conditions and common acute presentations that require time-sensitive intervention; and auxiliary services, such as basic
  diagnostic imaging, laboratory services, and blood bank services.
- Support countries to address shortages of essential medicines and health products, personal protective equipment, and other medical supplies and to establish sustainable risk management practices to prevent future shortages.
Risk communication and community engagement
- Continue risk communications and community engagement activities through the WHO Information Network for Epidemics (EPI-WIN) and other platforms to counter rumours and misinformation.
- Continue to regularly communicate clear messages, guidance, and advice about the evolution of the COVID-19 pandemic, how to reduce transmission, and save lives.
- Work with partners and countries to articulate potential long-term consequences of COVID-19 pandemic, emphasizing the need for strengthened cross-sectoral preparedness, transparency and global coordination.
Surveillance
- Clarify the testing strategy, support countries to increase testing capacity, and aim to provide equitable access to diagnostic tests and supplies in light of market failures and global shortages.
- Continue to provide guidance on monitoring disease trends using Severe Acute Respiratory Infections (SARI) and Influenza Like Illness (ILI) surveillance systems in anticipation of the co-circulation of influenza viruses.
- Develop qualitative and quantitative indicators that countries can use to assess and monitor SARS-CoV-2 transmission at all levels of public health response.
- Continue to support countries and partners by providing technical and operational guidance, training platforms, and tools such as Go.Data,to enhance case identification and contact tracing capacity, strengthen the public health workforce, and engage
  communities for contact tracing.
- Provide clear qualitative and quantitative indicators to monitor SARS-CoV-2 transmission to inform the adjustment of public health and social measures.
Travel and Trade
- Continue working with countries and partners to enable essential travel needed for pandemic response, humanitarian relief, repatriation, and cargo operations.
- Develop strategic guidance with partners for the gradual return to normal operations of passenger travel in a coordinated manner that provides appropriate protection when physical distancing is not feasible.
- Update recommendations on appropriate travel measures and analyze their effects on international transmission of COVID-19, with consideration of the balance between benefits and unintended consequences, including entry and exit screening, education
  of travelers on responsible travel behaviour, case finding, contact tracing, isolation, and quarantine, by incorporating evidence on the potential role of pre-symptomatic and asymptomatic transmission.
To all States Parties

Coordination and Collaboration
- Support WHO leadership and continue to collaborate with WHO at all levels of the organization and with other countries to enable effective global COVID-19 pandemic preparedness and response.
- Participate in global solidarity efforts to enable access to essential supplies for all.
- Document and share lessons learned from efforts to control the pandemic, including the timing, pace, and sequencing of the application and lifting of public health measures.
Preparedness
- Strengthen preparedness for health emergencies, and build resilient health systems, incorporating lessons learned during different stages of the pandemic, and sharing experiences with other countries.
Surveillance
- Work with WHO and multisectoral partners to interrupt transmission by maintaining robust surveillance systems; enhancing capacities for case detection, testing, isolation of cases, contact tracing, quarantine of contacts, and rapid response; strengthening
  the public health workforce; and actively engaging communities for contact tracing, with a particular focus on high risk areas.
- In settings where testing a large proportion of suspected cases is not possible, monitor overall trends; undertake early detection through laboratory confirmation of a limited number of cases with a focus on health workers; and rapidly implement
  public health measures.
- Share with WHO all data necessary to conduct global risk assessments through data platforms, such as the Global Influenza Surveillance and Response System and the IHR mechanism. These data should include SARI and ILI where available.
- Use the WHO qualitative and quantitative indicators to assess and monitor SARS-CoV-2 transmission at all levels of public health response.
Additional Health Measures
- Avoid restrictions on international transport of food, medical and other essential supplies and permit the safe movement of essential personnel required for an effective pandemic response.
- Implement appropriate travel measures with consideration of their public health benefits, including entry and exit screening, education of travelers on responsible travel behaviour, case finding, contact tracing, isolation, and quarantine, by
  incorporating evidence on the potential role of pre-symptomatic and asymptomatic transmission.
- Implement and monitor case finding and contact tracing of travellers, using digital tools where appropriate.
- Continue to review travel and trade measures based on regular risk assessments, transmission patterns at origin and destination, cost-benefit analysis, evolution of the pandemic, and new knowledge of COVID-19.
- Engage in global efforts to respond to the challenges of COVID-19 in managing maritime vessels.
- Do not implement trade restrictions beyond those considered to be of public health importance in accordance with relevant international agreements.
- Continue to provide appropriate public health rationale to WHO for additional health measures in accordance with IHR.
Health Workers
- Prioritize the protection of the health workforce through access to training and provision of personal protective equipment, infection prevention and control measures, improved working conditions, application of WHO recommended testing strategies,
  and prevention of stigma and attacks on health workers.
Food Security
- Work with WHO and partners to strengthen the global food supply chain, protect food workers, properly manage food markets, and mitigate possible disruptions to the food supply, especially for vulnerable populations.
One Health
- Promote sound practices to manage risks of trade of live animals in food markets and regulate trade of exotic wildlife.
Risk Communications and Community Engagement
- Continue to engage communities to address rumours and misinformation and keep the public informed, with a focus on vulnerable populations.
Research and development
- Address research gaps such as: routes of transmission, including the role of asymptomatic and pre-symptomatic infection droplet, contact, fomite and aerosol transmission; and viral shedding; and animal source and intermediate hosts, in collaboration
  with partners.
- Continue to support and conduct COVID-19 research, in line with the WHO Research and Development Blueprint, and the road map for COVID-19 vaccines, diagnostics, and therapeutics.
- Continue sharing full genome sequences to increase global understanding of virus evolution and phylogenetics and their application to public health practices.
Essential Health Services
- Maintain essential health services throughout a likely extended COVID-19 response. This should include essential prevention for communicable diseases, particularly vaccination; services related to reproductive health, including care during pregnancy
  and childbirth; care of vulnerable populations, such as young infants and older adults; provision of medications and supplies for the ongoing management of chronic diseases, including mental health conditions; continuity of critical inpatient
  therapies; management of emergency health conditions and common acute presentations that require time-sensitive intervention; and auxiliary services, such as basic diagnostic imaging, laboratory services, and blood bank services.
- Continue to track and document the impact of COVID-19 on essential health services.
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May 9, 2020
Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem

Indonesia recently completed the last of its annual large-scale treatment for lymphatic filariasis (also known as elephantiasis or Penyakit Kaki Gajah) in Malaka District located in its southernmost province, East Nusa Tenggara. Unprecedented
progress by the National Lymphatic Filariasis Elimination Programme has strongly placed the country on the path to achieving the elimination of lymphatic filariasis as a public health problem.

“We reached an estimated number of 40.7 million people living in the 118 high-risk districts during this month-long treatment campaign in October 2019” said Dr Anung Sugihantono, who recently retired as Director General of Diseases
Prevention and Control, Ministry of Health Indonesia. “Single doses of diethylcarbamazine citrate and albendazole facilitated by WHO were delivered to all eligible populations.”

In 2010, an estimated 125 million Indonesians were still at risk of the disease and required treatment.

But things changed considerably in 2015 when Indonesia mounted an annual national campaign to resolutely address transmission of the disease and to tackle the morbidity and disability associated with it. The results were apparent as early as 2017, with
remarkable progress.

In Indonesia, LF is considered a significant public health concern. In 2009, risk mapping identified a population of 124.5 million people needing treatment for LF. The country initiated a national level LF elimination campaign in 2015, addressing both
disease prevention and management.

“In 2017 and in just two years we managed to achieve 100% geographical coverage of all people requiring treatment” said Dr Sugihantono. “It meant achieving more than 78% epidemiological coverage – much higher than the generally recommended 65% to stop transmission.”

Transmission of lymphatic filariasis can be stopped through large-scale treatment (or mass drug administration – MDA) of entire at- risk communities with recommended medicines once a year. These medicines kill the microfilariae in an infected patient’s
blood preventing mosquitoes to transmit¹ the disease to others. Through mass treatment, the aim is to reduce the reservoir of microfilariae in the blood to a level insufficient to maintain transmission by the mosquito vector.

This strategy to interrupt transmission is the corner-stone of the World Health Organization’s (WHO) Global Program to Eliminate Lymphatic Filariasis (GPELF). Indonesia has been using the GPELF’s strategy since 2002 using a district or city
as its implementation unit.

In 2005, it listed the elimination of LF as a national priority for controlling infectious diseases and the medicines it has been using in large-scale treatment programmes are diethylcarbamazine citrate (DEC) and albendazole² which are
largely distributed by volunteer community health workers³.

“Community health volunteers are themselves members of the community and know how to reach people effectively to improve compliance” said Dr. Stefanus Bria Seran, the Regent of Malaka District, one of LF endemic district in Indonesia. “Besides ensuring every single person ingests the medicine given to them, these community workers help in disseminating information well before a large-scale treatment campaign and also assist in reporting activities related to each treatment campaign”.

Indonesia’s efforts to eliminate lymphatic filariasis began in the 1970s but faced numerous challenges including programme coordination in the many inhabited islands, conducting information, education and awareness programmes, lack of capacity and
insufficient medicines.

Furthermore, the situation in Indonesia is unusual than in many other countries endemic for lymphatic filariasis as the country is endemic for all three species of thread-like filarial worms – Brugia malayi, Brugia timori, and Wuchereria bancrofti –
that cause the disease. Most of the infections in Indonesia, however, are caused by B. malayi.

In the past, some of the factors that prevented access to the medicines (DEC and albendazole) were social stigmatization linked to the disease, the vast geography of the territory and challenges in reaching remote populations.

With an estimated population of 242 million, Indonesia is the world’s largest island nation and consists of approximately 17,000 islands, of which 5,000–6,000 are inhabited. It is the fourth most populated nation behind China, India, and the United
States.

Indonesia is endemic for many other neglected tropical diseases and an estimated 110 million Indonesians are believed to suffer from at least one neglected tropical disease (NTD), including lymphatic filariasis and soil-transmitted helminth infections.
Leptospirosis (not classified as NTD) is also widespread.

Indonesia is the only country of WHO’s South East Asia Region with endemic schistosomiasis. Like many other countries of the Region, it also faces recurrent threats of dengue outbreaks.

Global progress

The world has made significant progress towards the elimination of lymphatic filariasis as a public health problem.

Sixteen countries⁴ and one territory are now acknowledged by WHO to have achieved elimination of lymphatic filariasis as a public health problem.

Seven additional countries have successfully implemented recommended strategies, stopped large-scale treatment and are under surveillance to demonstrate that elimination has been achieved.

The disease

Lymphatic filariasis is caused by infection with parasitic worms living in the lymphatic system. The larval stages of the parasite (microfilaria) circulate in the blood and are transmitted from person to person by mosquitoes.

Infection involves asymptomatic, acute, and chronic conditions. Most infections are asymptomatic, showing no external signs while contributing to transmission of the parasite. Although asymptomatic, these infections still cause damage to the lymphatic
system and the kidneys and alter the body’s immune system.

When lymphatic filariasis develops into chronic conditions it leads to lymphoedema (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs and hydrocele (scrotal swelling). Involvement of breasts and genital organs are common.

Manifestation of the disease after infection takes time and can result in an altered lymphatic system, causing abnormal enlargement of body parts, and leading to severe disability and social stigmatization of those affected.

¹Lymphatic filariasis is transmitted by different types of mosquitoes – e.g the Culex mosquito which widespread across urban and semi-urban areas; Anopheles, mainly found in rural areas; and, Aedes, mainly
in endemic islands in the Pacific.

²In 2017, WHO recommended an alternative three drug treatment to accelerate the global elimination of lymphatic filariasis. The treatment, known as IDA, involves a combination of ivermectin, diethylcarbamazine citrate and albendazole.
It is recommended annually in settings where its use is expected to have the greatest impact.

³Community health workers, also called ‘cadres’, are volunteers who form part of the communities they serve and work with local
communities to educate families. Their contribution in promoting health has been significant in the country.

⁴Cambodia, The Cook Islands, Egypt, Kiribati, Maldives, Marshall Islands, Niue, Palau, Sri Lanka, Thailand, Togo, Tonga, Vanuatu, Viet Nam, Wallis and Futuna, and Yemen

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May 9, 2020
New estimates highlight need to step up the response to hepatitis D

Lyon, France, 29 April 2020 – In a study published in the Journal of Hepatology,¹ Professor Anna Maria Geretti and Dr Alexander Stockdale from the University of Liverpool (United Kingdom), in collaboration with researchers
from the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC), estimate that worldwide, hepatitis D virus (HDV) affects nearly 5% of people who have a chronic infection with hepatitis B virus (HBV) and that HDV
co-infection could explain about 1 in 5 cases of liver disease and liver cancer in people with HBV infection..

To map the epidemiology of HDV infection in the world, Professor Geretti and Dr Stockdale joined forces with the WHO Global Hepatitis Programme and IARC, alongside investigators in Germany, Malawi, and the United Kingdom. “Infection with HDV occurs
in about 1 in 22 cases of chronic HBV infection in the world,” Dr Stockdale says. “More high-quality data are needed, but we have identified several geographical hotspots of high prevalence of HDV infection: in Mongolia, the Republic of
Moldova, and countries in Western and Middle Africa.”

“Although it is less common than hepatitis B, hepatitis D is a serious disease that often affects underprivileged and vulnerable populations,” says Dr Meg Doherty, Director of the WHO Global Hepatitis Programme. Those who are more likely to
have HBV and HDV co-infection include people who inject drugs and people with hepatitis C virus or HIV infection. The risk of co-infection also appears to be higher in recipients of haemodialysis, men who have sex with men, and commercial sex workers.
Dr Doherty points out, “This information helps in identifying the groups with HBV among whom we should be looking for HDV.”

HDV (formerly known as the Delta agent) is a small virus – one of the smallest that is known to cause disease in humans – and can replicate only in the presence of HBV, from which HDV borrows some of its structures. Compared with people with
HBV infection alone, those who have a chronic infection with both HBV and HDV have a much higher risk of developing disease in the form of cirrhosis and liver cancer. “HDV is a significant contributor to severe liver disease and liver cancer,”
says IARC scientist Dr Catherine de Martel. “The findings from this study inform our work on the association between viral infections and cancer, which is focused on developing improved prevention strategies.”

Professor Geretti concludes, “HDV has long been neglected, because for decades the prevalence of infection remained uncertain and effective treatment was lacking. Mapping the epidemiology of the infection is just the first step. More efforts are
needed to reduce the global burden of chronic hepatitis B and develop medicines that are safe and effective against hepatitis D and are affordable enough to be deployed on a large scale to those who are most in need.”

¹ Stockdale AJ, Kreuels B, Henrion MYR, Giorgi E, Kyomuhangi I, de Martel C, Hutin Y, Geretti AM (2020). The global prevalence of hepatitis D virus infection: systematic review and meta-analysis. J Hepatol. Published online 23 April 2020;
https://doi.org/10.1016/j.jhep.2020.04.008

For more information, please contact

Véronique Terrasse, Communications Group, at +33 (0)6 45 28 49 52 or terrassev@iarc.fr or IARC Communications, at com@iarc.fr

The International Agency for Research on Cancer (IARC) is part of the World Health Organization. Its mission is to coordinate and conduct research on the causes of human cancer, the mechanisms of carcinogenesis, and to develop scientific strategies for
cancer control. The Agency is involved in both epidemiological and laboratory research and disseminates scientific information through publications, meetings, courses, and fellowships. If you wish your name to be removed from our press release emailing
list, please write to com@iarc.fr.

About University of Liverpool

Founded in 1881 as the original ‘red brick’, the University of Liverpool is one of the UK’s leading research-intensive higher education institutions. Consistently ranked in the top 200 universities worldwide, we are a member of the prestigious
Russell Group and have a global reach and influence that reflects our academic heritage as one of the country’s largest civic institutions. For more information please visit us at www.liverpool.ac.uk

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May 9, 2020
WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic
On World Day for Safety and Health at Work, the World Health Organization calls upon all governments, employers and workers organizations and the global community to take urgent measures for strengthen countries’ capacities to protect occupational health and safety of health workers and emergency responders respect their rights to decent working conditions, and develop national programmes for occupational health of health workers and to provide them with occupational health services. Amidst the COVID-19 pandemic, ILO has dedicated World Day for Safety and Health at Work 2020 in addressing the outbreak of infectious diseases at work, in particular, on the COVID-19 pandemic.

Health workers are at the front line of the COVID-19 outbreak response and as such are exposed to hazards that put them at risk of infection. Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence.

Infections with COVID-19, insufficient measures for infection prevention and control, occupational safety and health, mental health and psychosocial support for health workers result in high rates of absenteeism and deplete the health workforce – the most precision resources for stopping the COVID outbreak.

Key Messages and Facts

COVID-19 infections among health workers:
- As of 21 April 2020 countries reported to WHO that over 35, 000 health workers were infected with COVID19. This number is significantly higher because of underreporting.
- The major occupational risks for COVID19 infection among health workers are: late recognition or suspicion of COVID-19 in patients, working in a higher-risk department, longer duty hours, sub-optimal adherence to infection prevention and control measures, such as hand hygiene practices, and lack of or improper use of personal protective equipment (PPE). Other factors have also been documented, such as inadequate or insufficient IPC training for respiratory pathogens, including the COVID-19 virus, as well as long exposure in areas in healthcare facilities where large numbers of COVID-19 patients were being cared for.
- The prevention of infections requires the use of appropriate infection prevention and control measures by all health workers, with a special focus on the adherence to hand hygiene and personal protective equipment when caring for COVID-19 patients, as well as a combination of environmental and administrative controls
- Health workers infected with COVID-19 following exposure in the workplace should have the right to employment injury benefits for occupational disease, including compensation, rehabilitation, and curative services.
Violence and stigma against health workers:
- Health workers are at high risk of violence all over the world. Between 8% and 38% of health workers suffer physical violence at some point in their careers. Many more are threatened or exposed to verbal aggression and social stigma because of their work.
- In the COVID19 crisis, shortage of staff and resources and increasing social tensions result in increased level of violence against health workers and even attacks against health care facilities. Doctors, nurses, security personnel and those who are assisting in testing, tracing contacts and enforcing physical distancing measures to stop COVID-19 experience threats and aggression.
- WHO calls upon governments, employers and workers organizations to institute measures for zero-tolerance to violence against health workers at the workplace and at the way to and from their workplace, and for intensifying social support and respect for health workers and their families.
Long working hours and psychosocial hazards for health workers:
- Many health workers have to work longer or irregular hours because of the increasing demand for health services. In addition, many countries experience shortage of health workers, or junior staff are working in demanding new roles.
- Health workers face psychosocial hazards, which are exacerbated during emergencies where demands increase and they have to experience risk of infection witness higher suffering or mortality.
- Long working hours, shift work, high workload and other psychosocial hazards can lead to fatigue, occupational burnout, increased psychological distress or declining mental health – affecting the health of health workers, and the quality and safety of care delivered.
- WHO calls for adequate staffing levels and clinical rotation in healthcare facilities, measures to minimize psychosocial hazards, and provision of access to mental health and psychosocial support for health workers.
The annual World Day for Safety and Health at Work on 28 April promotes the prevention of occupational accidents and diseases globally. It is an awareness-raising campaign intended to focus international attention on the magnitude of the problem and on how promoting and creating a safety and health culture can help reduce the number of work-related deaths and injuries.

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May 9, 2020
Maternal infections in health facilities

A clearer picture of the global impact

New research from the Global Maternal Sepsis Study (GLOSS), a major WHO/HRP initiative, shows that infection has a much larger impact on global maternal mortality and morbidity than previously thought.

The
results from GLOSS, published in The Lancet Global Health, are the first to provide data on frequency of maternal infections and
sepsis across the pregnancy and post-pregnancy period, in a large number of health facilities around the world.

Around 11 women per 1000 live births had an infection which resulted in or contributed to what is known as a severe maternal outcome – either they died or nearly died – during their hospitalization.

Urgent improvement is needed to manage this life-threatening risk faced by all pregnant and recently pregnant women, wherever they are in the world.

What is maternal sepsis and how does it lead to maternal death?

Maternal sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs during pregnancy, child-birth, post-abortion or the postpartum period.

The latest global estimates place sepsis due to obstetric infections as the third most common cause of maternal mortality. However, this only includes infections as a direct result of pregnancy, such as endometritis or post-caesarean wound infections.

Few
previous studies include post-abortion infections. Neither do they address indirect infections such as respiratory and meningitis, which are aggravated by pregnancy but not directly caused by it.

A better understanding of maternal infection

GLOSS was a massive facility-based data collection effort led by WHO, accompanied by a ‘STOP SEPSIS!’ campaign to increase awareness among healthcare providers.

The study gathered data on women who were admitted with suspected or confirmed infection during pregnancy or post-pregnancy over a one-week period in 2017. More than 2800 women participated in the study in 52 countries.

GLOSS included healthcare facilities that care for women during pregnancy, childbirth or at the end of pregnancy, as well as facilities without maternity service but where women could be hospitalized during or after pregnancy, and data on infections
which are not usually recorded as maternal sepsis, including post-abortion and indirect infections.

The result is a more complete understanding of the frequency and impact of maternal infections in health facilities.

GLOSS calls attention not only to the wider range of risks faced by pregnant women but also to the long period of time during which they are at risk.

Putting global numbers on maternal infection and sepsis

Overall, around 70 pregnant or recently-pregnant women per 1000 live births were found to have a maternal infection needing hospital management.

Across the study, 11 women with either direct or indirect infection per 1000 live births developed a severe maternal outcome, but in low- and middle-income countries up to 15 women per 1000 births were affected.

Infections were the underlying cause of most of the deaths recorded during the study, primarily post-abortion infection and indirect infections. Infections were also present in about a third of deaths attributed to other causes, such as postpartum
haemorrhage.

This suggests that the contribution of infection to global maternal mortality and morbidity may be larger than current reports of maternal sepsis mortality suggest.

Preventing, identifying and treating maternal infection and sepsis

Some of the most common maternal infections found in the study, such as urinary tract infections, post-caesarean and post-abortion infections, are largely preventable and treatable.

GLOSS results suggest that current levels of monitoring and clinical care across health facilities are not enough to prevent, identify and treat levels of maternal infection effectively.

For instance, a complete set of vital signs was not reported for a third of the women in the study, on the day their infection was suspected or diagnosed. Delays in antimicrobial therapy were frequent.

GLOSS also shows marked differences across countries, with the highest burden in low- and middle-income countries, compared with high-income countries.

This may reflect the impact of broader health determinants in different country contexts. Challenges of overcrowding, limited access to water and sanitation and constraints to safe births by skilled birth attendants can reduce the ability of healthcare
providers to manage the frequency and outcome of maternal infections.

An opportunity to implement evidence-based practice

GLOSS gives healthcare providers, policy-makers, and the public at large an opportunity: to mobilise around these data improve evidence-based practice, and save lives.

WHO has produced a number of resources which can support timely action to prevent, diagnose and treat maternal infection, as well as activities such as the upcoming SAVE LIVES: Clean Your Hands campaign
on 5 May which celebrates the central role played by nurses and midwives in clean health care.

In addition, WHO will publish a global sepsis epidemiology report around the 73rd World Health Assembly (WHA) in May, as requested in the
2017
WHA Resolution on Improving the prevention, diagnosis and clinical managementof sepsis.

Understanding why and how infection affects women is essential for equipping healthcare providers with life-saving knowledge and enabling health care systems to bring down global maternal mortality and morbidity.

Related publications

WHO recommendations for prevention and treatment of maternal peripartum infections

WHO Clinical practice handbook for safe abortion

Global guidelines on the prevention of surgical site infection

WHO statement on maternal sepsis

World Health Assembly resolution on Improving the prevention, diagnosis and clinical management of sepsis

Health Topics

Antimicrobial resistance

Infection Prevention and Control

Water Sanitation Hygiene

Other links

Global Maternal Sepsis Study

SAVE LIVES: Clean Your Hands 5 May 2020

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https://www.who.int/news-room/detail/27-04-2020-maternal-infections-in-health-facilities

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May 9, 2020
Hard fought gains in immunization coverage at risk without critical health services, warns WHO

Shutting down immunization services in the COVID-19 pandemic risks triggering a resurgence of diseases that can be prevented with safe and effective vaccines, warns WHO in the lead-up to World Immunization Week (24-30 April).

When immunization services are disrupted, even for brief periods during emergencies, the risk of vaccine-preventable disease outbreaks, such as measles and polio, increase. Last year’s deadly measles outbreak in the Democratic Republic of the
Congo, which took more than 6000 lives in a country already facing its largest Ebola outbreak, highlights the importance of maintaining essential health services, such as immunization in times of emergency. Further disease outbreaks will also overwhelm
health systems already battling the impacts of COVID-19.

“Disease outbreaks must not remain a threat when we have safe and effective vaccines to protect us,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “While the world strives to develop a new vaccine for COVID-19 at record speed,
we must not risk losing the fight to protect everyone, everywhere against vaccine-preventable diseases. These diseases will come roaring back if we do not vaccinate.”

WHO is working with partners all over the world to accelerate research and development of a safe and effective vaccine and ensure equitable access for the billions of people who will need it.

But even with an expedited process, development of a vaccine for COVID-19 will take time. Precautionary measures are essential now to help keep us safe from disease, including diseases for which vaccines already protect children and adults.

Too many people are still excluded from the benefits of vaccines

Prior to the COVID-19 pandemic, the world had made immense progress in ensuring that children are vaccinated. In 2018, 86 percent of children under the age of five globally were vaccinated with three doses of diphtheria, tetanus and pertussis (DTP3) and
one dose of the measles vaccine, up from 72 percent in 2000 and 20 percent in 1980. The number of children paralyzed by polio has been reduced by 99.9 percent worldwide.

Yet, global vaccination coverage is still far from the 95 per cent coverage needed to fully protect communities against outbreaks of this vaccine-preventable disease.

In 2018 nearly 20 million children worldwide – more than 1 in 10 – missed out on lifesaving vaccines, such as measles, diphtheria and tetanus. Roughly, 13 million of the children have never received any vaccines, putting them and their communities
at risk of disease and death. The majority of these children live in countries with already fragile health systems, further limiting their access to essential health services when they fall sick.

Measles continues to remain an ever-present threat, especially if vaccination rates drops. Current projections indicate that the number of reported measles cases for 2019 will be at least 800 000. In 2020 there are increasing concerns about another
resurgence, especially if vaccination rates fall due to delay or suspension of scheduled immunization activities as a result of COVID-19.

Outbreaks of polio, diphtheria and yellow fever are also of high concern, especially in the countries least able to respond quickly and decisively to address an emerging outbreak, as seen in previous emergencies such as the polio outbreak in Syria in
2013.

Maintaining immunization services during COVID-19

As the response to COVID-19 continues, countries must act now protect immunization services, in order to further minimize disease outbreaks and loss of life. This includes, facilitating urgent catch up programmes in places where
services have been disrupted, ensuring strong supply chains, disease surveillance and trained health workers. Caregivers should also make sure they continue to vaccinate their children in line with national policies.

New WHO guidelines on immunization and COVID-19 recommend that governments temporarily pause preventive immunization
campaigns where there is no active outbreak of a vaccine-preventable disease. But it urges countries prioritize the continuation of routine immunization of children in essential service delivery, as well as adult vaccinations such as influenza
for groups most at risk. If immunization services must be suspended, urgent catch-up vaccinations should be rescheduled as soon as possible, prioritizing those most at risk.

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https://www.who.int/news-room/detail/23-04-2020-hard-fought-gains-in-immunization-coverage-at-risk-without-critical-health-services-warns-who

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May 9, 2020
MIEA warns public to beware of property scams

KUALA LUMPUR: The Malaysian Institute of Estate Agents (MIEA) is advising the public to be cautious in buying and selling properties during the Movement Control Order (MCO) period to avoid falling prey to scams.

MIEA noted that amid the MCO, the majority of Malaysians who are keen to buy or sell property will be relying on online platforms.

“Be extra vigilant as there are still a high number of cases where the general public has fallen prey to these property pitfalls,” it said yesterday.

MIEA president Lim Boon Ping highlighted that registered estate agents (REA) and negotiators (REN) are recognised as professionals under Malaysian law and that there are firm requirements that need to be adhered to when publishing an advertisement in order to protect the public’s interest.

Among others, they are required to include their name, REN/REA number, contact number and the real estate firm they represent with its E registration number and the firm’s telephone number, which the public can verify on www.lppeh.gov.my.

“There will a sudden surge on online and offline advertisement by those illegal brokers who will take advantage on the Covid-19 rise in low priced property deals and these advertisements will not contain the before-mentioned authenticity information and the public should avoid calling them,“ warned Lim.

He reminded that if one sees an advertisement or a property deal that looks “too good to be true”, be extra cautious and do your research”.

“Always engage a registered estate agent or a certified negotiator to verify these potential property deals,“ added Lim. — Bernama

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https://www.thesundaily.my/local/miea-warns-public-to-beware-of-property-scams-AB2245651

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April 11, 2020
New Ebola case confirmed in the Democratic Republic of the Congo

A new case of Ebola virus disease was confirmed today in the city of Beni in the Democratic Republic of the Congo (DRC).

“While not welcome news, this is an event we anticipated. We kept response teams in Beni and other high risk areas for precisely this reason,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

As part of the active Ebola surveillance system in place to respond to this ongoing outbreak in DRC, thousands of alerts are still being investigated every day. An alert is a person who has symptoms that could be due to Ebola, or any death in a high risk area that could have been as result of Ebola.

As with all confirmed cases, efforts are already underway to find everyone who may have been in contact with the person in order to offer them the vaccine and monitor their health status.

“WHO has worked side by side with health responders from the DRC for over 18 months and our teams are right now supporting the investigation into this latest case,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Although the ongoing COVID-19 pandemic adds challenges, we will continue this joint effort until we can declare the end of this Ebola outbreak together.”

The news of the confirmed case came minutes after the conclusion of a meeting of the International Health Regulations Emergency Committee on Ebola in DRC. The Emergency Committee will reconvene next week in order to re-evaluate their recommendations in light of this new information.

Prior to this, the last person who was confirmed to have Ebola in DRC tested negative twice and was discharged from a treatment centre on 3 March 2020.

As of 10 April 2020, 3456 confirmed and probable cases and 2276 deaths have occurred as a result of the outbreak.

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https://www.who.int/news-room/detail/10-04-2020-new-ebola-case-confirmed-in-the-democratic-republic-of-the-congo

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April 11, 2020