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Tag: Infection

  • Billions worldwide living with herpes

    Billions worldwide living with herpes

    About half a billion people worldwide are living with genital herpes, and several billion have an oral herpes infection, new estimates show, highlighting the need to improve awareness and scale up services to prevent and treat herpes.

    About 13% of the world’s population aged 15 to 49 years were living with herpes simplex virus type 2 (HSV-2) infection in 2016, the latest year for which data is available.  HSV-2 is almost exclusively sexually transmitted, causing genital herpes. Infection can lead to recurring, often painful, genital sores in up to a third of people infected.

    Herpes simplex virus type 1 (HSV-1) is mainly transmitted by oral to oral contact to cause oral herpes infection – sometimes leading to painful sores in or around the mouth (“cold sores”). However, HSV-1 can also be transmitted to the genital area through oral sex, causing genital herpes.

    Around 67% of the world’s population aged 0 to 49 had HSV-1 infection in 2016 – an estimated 3.7 billion people. Most of these infections were oral; however, between 122 million to 192 million people were estimated to have genital HSV-1
    infection.

    Genital herpes is a substantial health concern worldwide – beyond the potential pain and discomfort suffered by people living with the infection, the associated social consequences can have a profound effect on sexual and reproductive
    health” says Dr Ian Askew, Director of the Department of Sexual and Reproductive Health and Research at the World Health Organization (WHO). 

    Herpes and HIV

    People with HSV-2 infection are at least three times more likely to become infected with HIV, if exposed. Thus, HSV-2 likely plays a substantial role in the spread of HIV globally. Women are more susceptible to both HSV-2 and HIV. Women living in
    the WHO Africa Region have the highest HSV-2 prevalence and exposure to HIV – putting them at greatest risk of HIV infection.

    No cure: vaccine needed

    There is no cure for herpes. Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, can help to reduce the severity and frequency of symptoms but cannot cure the infection.

    Better awareness, improved access to antiviral medications and heightened HIV prevention efforts for those with genital HSV symptoms are needed globally. In addition, development of better treatment and prevention interventions is needed, particularly
    HSV vaccines.  

    “A vaccine against HSV infection would not only help to promote and protect the health and well-being of millions of people, particularly women, worldwide – it could also potentially have an impact on slowing the spread of HIV, if developed
    and provided alongside other HIV prevention strategies” says Dr Meg Doherty, Director of the WHO Department of Global HIV, Hepatitis, and STI Programmes.

    Authored by staff at the University of Bristol, the WHO, and Weill Cornell Medical College-Qatar, and published in the Bulletin of the World Health Organization, this new study estimates the global infection prevalence and incidence of HSV-1 and HSV-2
    in 2016. 

    Billions worldwide living with herpes
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  • Massive proportion of world’s population are living with herpes infection

    Massive proportion of world’s population are living with herpes infection

    Virus causing genital herpes may put millions of people at greater risk of infection with HIV

    About half a billion people worldwide are living with genital herpes, and several billion have an oral herpes infection, new estimates show.

    Authored by staff at the University of Bristol, World Health Organization (WHO), and Weill Cornell Medical College-Qatar, and published in the Bulletin of the World Health Organization,
    the new study estimates the global infection prevalence and incidence of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) in 2016. 

    “Herpes infection affects millions of people across the globe and can have far-reaching health effects. We need more investment and commitment to develop better treatment and prevention tools for this infection.” says Dr Sami Gottlieb, Medical
    Officer at WHO and an author of the study.

    Prevalence and incidence

    An estimated 491.5 million people were living with HSV-2 infection in 2016, equivalent to 13.2% of the world’s population aged 15 to 49 years. HSV-2 is almost exclusively sexually transmitted, causing infection in the genital or anal area (genital
    herpes).

    An estimated 3.7 billion people had HSV-1 infection during the same year – around 66.6% of the world’s population aged 0 to 49. HSV-1 is mainly transmitted by oral to oral contact to cause infection in or around the mouth (oral herpes). However,
    HSV-1 can also be transmitted to the genital area through oral-genital contact – during oral sex – to cause genital herpes. Most HSV-1 infections were oral; however, between 122 million to 192 million people were estimated to have genital
    HSV-1 infection, depending on the assumptions used in the estimation model.

    Because herpes is a lifelong infection, estimated prevalence increased with age; HSV-2 prevalence was also higher among women and in the WHO African Region.

    Health and social impacts

    Most people living with herpes, caused by either HSV-1 or 2, are unaware they have the infection.

    When symptoms do occur however, oral herpes infection can lead to painful sores around the mouth (“cold sores”). Genital herpes infection can cause recurring, often painful, genital sores, often referred to as genital ulcer disease. 

    WHO and partners published a study in March 2020 estimating that around 5% of the world’s population (187 million people) suffered from at least one episode of herpes-related genital ulcer disease in 2016 (1). Most of these episodes were due to
    HSV-2, which can recur frequently over many years.

    Recurrent symptoms of genital herpes can lead to stigma and psychological distress, and can have an important impact on quality of life and sexual relationships. However, in time, most people with herpes adjust to living with the infection.

    “Genital herpes is a substantial health concern worldwide – beyond the potential pain and discomfort suffered by people living with the infection, the associated social consequences can have a profound effect on sexual and reproductive health”
    says Dr Ian Askew, Director of the Department of Sexual and Reproductive Health and Research at WHO. 

    Herpes and HIV

    A strong association exists between HSV-2 infection and HIV infection. In 2019, WHO commissioned a modeling study to estimate how much HSV-2 infection might contribute to HIV incidence. The study estimated that almost 30% of new sexually acquired HIV
    infections in 2016 worldwide were likely attributable to HSV-2 infection (2). 

    Evidence shows that people with HSV-2 infection are at least three times more likely to become infected with HIV, if exposed. HSV-2 leads to inflammation and small breaks in the genital and anal skin that can make it easier for HIV to cause infection.
    In addition, people with both HIV and HSV-2 infection are more likely to spread HIV to others.

    Women have higher biologic susceptibility to both HSV-2 and HIV. Women living in the WHO Africa Region have the highest HSV-2 prevalence and exposure to HIV – putting them at greatest risk of HIV infection, with negative implications for their health
    and well-being. 

    For people living with HIV (or who are living with other conditions that compromise their immune systems) as well as HSV-2, the symptoms of herpes can be more severe and more frequent. 

    Neonatal herpes

    Neonatal herpes can occur when an infant is exposed to HSV in the genital tract during delivery. This is a rare condition, occurring in an estimated 10 out of every 100,000 births globally, but can lead to lasting neurologic disability or death. The risk
    for neonatal herpes is greatest when a mother acquires HSV infection for the first time in late pregnancy. Women who have genital herpes before they become pregnant are at very low risk of transmitting HSV to their infants.

    No cure – better treatment and prevention needed

    There is no cure for herpes. At present, antiviral medications, such as acyclovir, famciclovir, and valacyclovir, can help to reduce the severity and frequency of symptoms but cannot cure the infection.

    As well as increasing awareness about HSV infection and its symptoms, improved access to antiviral medications and heightened HIV prevention efforts for those with genital HSV symptoms are needed globally. 

    In addition, development of better treatment and prevention interventions is needed, particularly HSV vaccines. WHO and partners are working to accelerate research to develop new strategies for prevention and control of HSV infections. Such research includes
    the development of HSV vaccines and topical microbicides. Several candidate vaccines and microbicides are currently being studied.

    “A vaccine against HSV infection would not only help to promote and protect the health and well-being of millions of people, particularly women, worldwide – it could also potentially have an impact on slowing the spread of HIV, if developed
    and provided alongside other HIV prevention strategies” says Dr Meg Doherty, Director of the WHO Department of Global HIV, Hepatitis, and STI Programmes.

    Related publications

    WHO guidelines for the treatment of Genital Herpes Simplex Virus

    WHO preferred product characteristics for herpes simplex virus vaccines

     

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    (1) Looker KJ, Johnston C, Welton NJ, et al. The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study. BMJ Glob Health. 2020;5(3):e001875. doi: 10.1136/bmjgh-2019- 001875.

    (2) Looker KJ, Welton NJ, Sabin KM, et al.Global and regional estimates of the contribution of herpes simplex virus type 2 infection to HIV incidence: a population attributable fraction analysis using published epidemiological data. Lancet Infect Dis.2020;20(2):240-249. doi: 10.1016/S1473-3099(19)30470-0.

    Massive proportion of world’s population are living with herpes infection
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  • Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem

    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

    Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem
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  • 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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  • New FAQs address healthcare workers questions on breastfeeding and COVID-19

    New FAQs address healthcare workers questions on breastfeeding and COVID-19

    Mothers and healthcare workers who support them have many questions and concerns about whether it is safe for mothers with confirmed or suspected COVID-19 to be close to and breastfeed their babies during the pandemic.

    To address their questions, WHO has released a list of Frequently asked questions: Breastfeeding and COVID-19. The FAQ complements the WHO interim guidance: Clinical management of severe acute respiratory infection when COVID-19 is suspected and draws upon other WHO recommendations on infant and young child feeding.

    The FAQs aim to provide information to healthcare workers supporting mothers and families in maternity services and community settings, and communicate how the interim guidance should be implemented. Additionally, the FAQs provide information about the protective effects of breastfeeding and skin-to-skin contact, and the harmful effects of inappropriate use of infant formula milk.

    Accompanying the FAQs is a decision tree which provides step-by-step guidance to health workers on how to support mothers with confirmed or suspected COVID-19 to breastfeed. It provides advice on what to do if mothers are not well enough to breastfeed, as well as appropriate hygiene measures for mothers, including wearing a medical mask if available, to reduce the possibility of the COVID-19 virus being spread to her infant.

    Benefits of breastfeeding outweigh potential risks

    The COVID-19 virus has not been detected in the breastmilk of any mother with confirmed and suspected COVID-19 and there is no evidence so far that the virus is transmitted through breastfeeding. Researchers continue to test breastmilk from mothers with the infection.

    WHO recommends that all mothers with confirmed or suspected COVID-19 continue to have skin-to-skin contact and to breastfeed. In all socio-economic settings, breastfeeding improves survival and provides lifelong health and development advantages to newborns and infants. Breastfeeding also reduces the risk of breast and ovarian cancer for the mother. Skin-to-skin contact, including kangaroo mother care, reduces neonatal mortality, especially for low birth weight newborns.

    While infants and children can contract COVID-19, they are at low risk of infection. The few confirmed cases of COVID-19 in young children to date have experienced only mild or asymptomatic illness.

    WHO’s recommendations on the care and feeding of infants whose mothers have confirmed or suspected COVID-19 aim to improve the immediate and lifelong survival, health and development of their newborns and infants. These recommendations consider the likelihood and potential risks of COVID-19 in infants and also the risks of serious illness and death when infants are not breastfed or when infant formula milk are used inappropriately.

    WHO’s Q&A on breastfeeding and COVID-19 also provides additional infection prevention advice to mothers with confirmed or suspected COVID-19.

    New FAQs address healthcare workers questions on breastfeeding and COVID-19
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  • WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic

    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.

     

    WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic
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  • Maternal infections in health facilities

    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.

    Logo of the Lancet Global HealthThe
    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

     

     

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

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  • WHO urges countries to move quickly to save lives from malaria in sub-Saharan Africa

    WHO urges countries to move quickly to save lives from malaria in sub-Saharan Africa

    Severe disruptions to insecticide-treated net campaigns and in access to antimalarial medicines could lead to a doubling in the number of malaria deaths in sub-Saharan Africa this year compared to 2018, according to a new modelling analysis released by
    WHO and partners ahead of World Malaria Day (25 April).

    WHO urges countries to move fast and distribute malaria prevention and treatment tools at this stage of the COVID-19 outbreak in sub-Saharan Africa, and to do their utmost to safely maintain these essential malaria control services.

    The analysis considers nine scenarios for potential disruptions in access to core malaria control tools during the pandemic in 41 countries, and the resulting increases that may be seen in cases and deaths. 

    Under the worst-case scenario, in which all insecticide-treated net (ITN) campaigns are suspended and there is a 75% reduction in access to effective antimalarial medicines, the estimated tally of malaria deaths in sub-Saharan Africa in 2020 would reach
    769 000, twice the number of deaths reported in the region in 2018. This would represent a return to malaria mortality levels last seen 20 years ago.

    According to the World malaria report 2019, sub-Saharan Africa accounted for approximately 93% of all malaria cases and 94% of deaths in 2018. More than two-thirds of deaths were among children under the age of five.

    A window of opportunity

    To date, the number of reported cases of COVID-19 in sub-Saharan Africa has represented only a small proportion of the global total, though cases are increasing every week. This means that countries across the region have a critical window of opportunity
    to minimize disruptions in malaria prevention and treatment and save lives at this stage of the COVID-19 outbreak.

    Mass vector control campaigns should be accelerated, while ensuring that they are deployed in ways that protect health workers and communities against potential COVID-19 transmission. WHO and partners commend the leaders of Benin, the Democratic Republic of the Congo, Sierra Leone and Chad
    for initiating ITN campaigns during the pandemic. Other countries are adapting their net distribution strategies to ensure households receive the nets as quickly and safely as possible.

    Preventive therapies for pregnant women and children must be maintained. The provision of prompt diagnostic testing and effective antimalarial medicines are also essential to prevent a mild case of malaria from progressing to severe illness and death.

    WHO and partners have developed guidance to ensure that those suffering from malaria can safely receive the care they need within the package of essential health services to be delivered in COVID-19 settings. Tailoring malaria interventions in COVID-19 response includes guidance on the prevention of infection through vector control and chemoprevention, testing, treatment of cases, clinical services, supply chain and laboratory activities.

    Note to the editor

    The modelling analysis was conducted by WHO in close collaboration with partners, including PATH, the Malaria Atlas Project and the Bill & Melinda Gates Foundation. 

    The analysis is subject to uncertainties. It does not consider, for example, the effects of an interruption in indoor residual spraying or seasonal malaria chemoprevention (except in Burkina Faso); a suspension of these core malaria prevention tools would
    also lead to considerable loss of life.

    In addition, there is limited understanding of the spread of COVID-19, its epidemiology and interactions with malaria. The model will be updated as such data become available, and countries will be provided with relevant information to tailor their responses
    accordingly.

    WHO urges countries to move quickly to save lives from malaria in sub-Saharan Africa
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    https://www.who.int/news-room/detail/23-04-2020-who-urges-countries-to-move-quickly-to-save-lives-from-malaria-in-sub-saharan-africa

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  • What matters to women in the postnatal period?

    What matters to women in the postnatal period?

    The right to a positive maternity healthcare experience at every stage 

    Each pregnancy is unique and clinical needs can change across the pregnancy, childbirth and postnatal periods. One thing that never changes is the right to a positive experience at every stage. 

    Achieving the best possible physical, emotional, and psychological outcomes for every individual and newborn requires health systems to take a human rights-based approach: not only preventing maternal death and morbidity, but prioritising person-centred
    care and well-being.

    WHO is developing new guidelines for a positive experience of postnatal care, due to be published next year. To inform these guidelines and ensure that postnatal services can better meet the needs of women and their babies, WHO undertook a qualitative
    systematic review on what matters to women in the postnatal period.

    Joys and challenges in the postnatal period

    There is limited research about values and preferences in the postnatal period, defined by WHO as the first six weeks after childbirth. Studies have often focused on the results of specific postnatal interventions, rather than on the individuals who use
    them. 

    ‘What matters to women in the postnatal period: A meta-synthesis of qualitative studies,’ published in PLOS ONE, gives long-overdue respect to the authority of women’s own experiences. The authors review first-hand data from 15 countries
    and 36 studies published after the year 2000 relating to women’s beliefs, expectations and values at this significant time of life.  

    These studies affirm that a positive postnatal experience can result in joy, self-confidence and enhanced capacity to thrive as both a person and a parent.

    They are also vocal about the potential challenges of adjusting to a ‘new normal’ following childbirth, including changes in self-identity, relationships, and sexual behaviour.

    What is a positive postnatal experience? 

    A positive postnatal experience for a woman will be one that responds to her specific context and preferences. 

    It will provide the confidence, knowledge and skills women need in the weeks following childbirth, supporting them to adjust to any changes in their intimate relationships and build new family ones. Women will be better equipped to navigate physical and
    emotional challenges and to experience the dynamic achievement of personal growth. 

    This should be a shared responsibility, not a solitary one. Community has a critical role in enabling a positive postnatal experience, including partners, family and elders.

    It is crucial that healthcare providers meet each woman’s needs, as well as those of their babies. 

    Supporting choices and rights to improve postnatal health outcomes

    There are an estimated 303 000 maternal deaths annually, according to recent WHO figures. Most of these deaths occur postnatally. 

    The postnatal period is therefore a vital opportunity to improve both maternal and neonatal health and wellbeing: supporting healthy behaviors, providing life-skills education, facilitating breastfeeding, counselling women about family planning options,
    supporting good mental health, preventing and treating childbirth-related complications. 

    Health care systems that empower individuals by supporting their values, preferences and rights are fundamental to improving maternal and newborn health outcomes. 

    WHO’s guidance for positive maternity care

    WHO has recently released recommendations on antenatal care for a positive pregnancy experience, and on intrapartum care for a positive childbirth experience.

    These publications made important clinical updates, including an increase from four to eight recommended antenatal contacts, and a revision to the decision-making process for interventions to accelerate labour. 

    They also uphold every woman’s right to a positive maternity care experience: one where her pregnancy does not erase her competency, autonomy and right to participate in decision-making for her own care and the care of her newborn. 

    Women’s choices and rights to sexual and reproductive health care, including maternity care, should be respected at every stage of the continuum of maternal and newborn care. This is true across all income settings, as well as in humanitarian settings
    and during public health emergencies.

    When WHO’s postnatal guidelines are released next year, they will complete the maternity care series built around what matters to women.

    Rather than dividing care into three periods of antenatal, intrapartum and postnatal, these publications can be used to establish a model in which health systems support women, their baby and wider network physically, psychologically, socially and emotionally
    through this significant life event. 

    Other resources

     

    What matters to women in the postnatal period?
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    https://www.who.int/news-room/detail/22-04-2020-what-matters-to-women-in-the-postnatal-period

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