The Leprosy Programme and Transmission Assessment (LPTA) is an activity that is carried out by internal teams towards the end of Phase 1 (see Leprosy Elimination Framework in the Annex) when a subnational jurisdiction (typically second-tier) reaches the milestone for interruption of transmission, i....e., zero autochthonous child cases for a consecutive period of five years. It also needs to be done at the end of Phase 2, when the second milestone of elimination of leprosy disease has been reached. An LPTA will be carried out to document that all relevant programme criteria have been met and examine trends of epidemiological indicators in such jurisdiction to confirm that the milestone has been achieved. The LPTA includes assessment of health facilities that provide leprosy services. LPTA comprises of review of epidemiological data, health facility assessment and data validation and verification of the programme criteria through observation during a field visit. The evidence collected in this way in subnational health administrative units is compiled in a Leprosy Elimination Dossier to be submitted to WHO when the country reaches the milestone for elimination of disease in the country as whole. Countries that have not detected any new leprosy cases in the past three years or more can use the LPTA at national level prior to or as part of the verification process. Countries likely to be among the first to apply for verification may have had no new cases detected for more than 10 years.
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Human African trypanosomiasis (HAT), also called sleeping sickness, is a parasitic infection that almost invariably progresses to death, unless treatment is provided. HAT caused devastating epidemics during the 20th century. Thanks to sustained and coordinated efforts during the past 15 years the nu...mber of reported cases has fallen to a historic low. Fewer than 3,000 cases were reported in 2015, and the disease is targeted for elimination by the World Health Organization. Despite recent success, HAT still poses a heavy burden on the rural communities where this highly focal disease occurs, most notably in Central Africa. Since patients are also reported from non-endemic countries outside Africa, HAT should be considered in differential diagnosis for all travellers, tourists, migrants and expatriates who have visited or lived in endemic areas. In the absence of a vaccine, disease control relies on case detection and treatment, and vector control. Available drugs are sub-optimal, but ongoing clinical trials give hope for safer and simpler treatments.
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This facilitator’s manual is designed to support the implementation of the Dengue Clinical Management training course. The guide contains specific instructions for the facilitator and provides:
- a detailed description of the clinical course of dengue illness, which reflects the dynamic and sys...temic nature of dengue that has crucial bearing on the patient’s management;
- a detailed description of the basic pathophysiological changes of severe dengue (i.e. plasma leakage and hypovolaemia/shock) and guidance on the recognition of these changes and appropriate action of management;
- a brief discussion on WHO classification (1997) and its limitations;
- guidance on the differential diagnoses that can be confused with dengue or vice versa; they were described according to the stage of disease;
- a more focused guide on the disease monitoring in accordance with the dynamic changes as the disease progresses;
- emphasis on the importance of monitoring the plasma leakage (haemodynamic status of the patient, clinical signs of plasma leakage and haematocrit);
- a clearer algorithm for fluid management in cases of severe dengue; and
- emphasis on the importance of recognizing or suspecting significant occult bleed. Keep the facilitator’s manual with you each day as you prepare and deliver the information. Use it as a reference when delivering classroom presentations, but avoid reading directly from it during sessions.
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Chikungunya virus (CHIKV) is a re-emerging mosquito borne alphavirus responsible
for the recent outbreak in the Americas. Immunologically naïve population in the Americas favors the spread of epidemics. Chikungunya fever is characterized by an abrupt febrile illness, polyarthralgia and maculopapul...ar rash. In chikungunya fever, shock or severe hemorrhage is very rarely observed; the onset is more acute and the duration of fever is shorter than dengue disease. The pain is much more pronounced and localized to the joints and tendons in chikungunya fever, in comparison to dengue fever. There is no specific and effective antiviral therapy and vaccines are still in trails. The only effective preventive measures consist of individual protection against mosquito bites and vector control. Disease prevention is important due to the
economic burden it entails. Clinicians need to distinguish chikungunya fever between dengue fever and other diseases to give a successful treatment and prevent disease spreading.
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Schistosomiasis, also known as bilharzia, is an infection caused by a parasitic worm that lives in fresh water in subtropical and tropical regions.
Yaws forms part of a group of chronic bacterial infections commonly known as the endemic treponematoses. These diseases are caused by spiral bacteria of the genus Treponema, which also includes endemic syphilis (bejel) and pinta. Yaws is the most common of these three infections.
Snakebite is an acute life threatening time limiting medical emergency. It is a preventable public
health hazard often faced by rural population in tropical and subtropical countries with heavy
rainfall and humid climate.
In 2018, we are celebrating 20 years of progress in eliminating trachoma, the world’s leading infectious cause of blindness. Set up in 1998 by Pfizer Inc. and the Edna McConnell Clark Foundation, the International Trachoma Initiative (ITI) supports Ministries of Health in over 30 countries around ...the world by making Zithromax® available for use in public health campaigns to eliminate trachoma. The 20th anniversary of our founding gives us an opportunity to reflect on the distance we’ve traveled in fighting this disease, and raise the ambition for accelerating to a world where diseases like trachoma are a distant memory. We have not traveled alone these past 20 years – a broad coalition of actors including NGOs, the World Health Organization (WHO), Ministries of Health, health workers, and community members have made these incredible achievements possible. Our 20th anniversary gives us an opportunity to celebrate this coalition of partners, colleagues, and friends
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Classical rabies caused by RABV occurs worldwide besides some isolated countries and Western Europe that are regarded rabies free. Carnivores, especially of the canidae family represent the principal reservoir species and are responsible for the maintenance of the infectious cycle and hence for the ...presence of the disease (see Epidemiology of rabies). While wildlife rabies maintained by different reservoirs hosts predominantly occurs in the Northern hemisphere, canine rabies is by far more important for public health in the developing world.
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All lyssaviruses have evolved closely with distinct natural reservoir hosts. The latter are animals species in which a pathogen of an infectious disease are maintained independently. For lyssaviruses, these are a wide range of mammalian species within the Carnivora and Chiroptera (bats) orders with ...a global distribution.
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Leishmaniasis is still considered to be a global health problem, which spreads in most countries in the world. Leishmania is an intracellular obligate protistan parasite that causes different clinical symptoms in infected humans and other animals. There are clinically different types of the disease ...including: visceral, cutaneous or muco-cutaneous leishmaniasis. Approximately, two million new infections occurring annually; 0.7 to 1.2 million cases are recorded with cutaneous leishmaniasis and 200,000–400,000 cases return for visceral leishmaniasis. However, Cutaneous leishmaniasis considers one of uncontrolled wobbling endemic diseases, especially in Iraq, which occurs at the skin to cause a dermal lesion. Usually, the lesion is spontaneously healed to leave a colorless depressed scar and permanent immunity.
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Course information
Yaws is targeted for eradication by WHO in the 2021-2030 NTD Roadmap. It is therefore crucial to know how to identify cases, design and implement activities to eradicate the disease at the community level.
In the context of integration of skin NTDs it is vital to learn to recogn...ize a disease targeted for eradication. At the individual level yaws lesions may mimic other skin diseases. At the community level, it is key to know how to design and implement the total community treatment strategy and monitor its impact. This course aims at providing health workers with the basic knowledge to understand the epidemiology, diagnosis, treatment, impact, eradication strategy and reporting of yaws.
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Course information
Yaws is targeted for eradication by WHO in the 2021-2030 NTD Roadmap. It is therefore crucial to know how to identify cases, design and implement activities to eradicate the disease at the community level.
In the context of integration of skin NTDs it is vital to learn to recogn...ize a disease targeted for eradication. At the individual level yaws lesions may mimic other skin diseases. At the community level, it is key to know how to design and implement the total community treatment strategy and monitor its impact. This course aims at providing health workers with the basic knowledge to understand the epidemiology, diagnosis, treatment, impact, eradication strategy and reporting of yaws.
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Yaws is a non-venereal endemic treponemal infection caused by Treponema pallidum sub-species pertenue, a bacterium closely related to Treponema pallidum ssp. pallidum, the agent of venereal syphilis. Yaws predominantly affects children living in tropical regions of the world. It causes lesions of th...e skin, mucous membranes and bones which, without treatment, can become chronic and destructive. There is no widely available test to distinguish yaws from syphilis. Thus, migration of people from yaws-endemic areas to developed countries may present clinicians with diagnostic dilemmas. The other endemic treponemal infections are bejel (endemic syphilis) caused by Treponema pallidum ssp. endemicum and pinta caused by Treponema carateum.
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Human African trypanosomiasis (HAT), or sleeping sickness, is a painful and protracted disease transmitted through the bite of infected tsetse flies and it is found in rural parts of sub-Saharan Africa. Sleeping sickness has two clinical phases but this review focuses only on treatment of the second...-stage, which is characterized by neurological changes and almost invariably fatal without treatment. There are only a few drugs currently available for second-stage sleeping sickness, all with considerable adverse events and variable efficacy.
The review includes nine trials with 2577 participants. Each trial reported different comparisons of the drugs currently available to treat second stage HAT (melarsoprol, eflornithine, nifurtimox) so no meta-analysis was possible.
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In order to target resources and drugs to reach trachoma elimination targets by the year 2020, data on the burden of disease are required. Using prevalence data in African countries derived from the Global Atlas of Trachoma (GAT), the distribution of trachoma continues to be focused in East and West... Sub-Saharan Africa, North Africa and a few endemic countries in Central Sub-Saharan Africa. Currently, 129.4 million people are estimated to live in areas that are confirmed to be trachoma endemic and 98 million are known to require access to the SAFE strategy. The maps and information presented in this work highlight the GAT as important open-access planning and advocacy tool for efforts to finalize trachoma mapping and assist national programmes in planning interventions.
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Technical Update
Areas of Africa endemic for Buruli ulcer (BU), caused by Mycobacterium ulcerans, also have a high prevalence of human immunodeficiency virus (HIV), with adult prevalence rates between 1% and 5% (Maps). However, there is limited information on the prevalence of BU–HIV coinfection.... Preliminary
evidence suggests that HIV infection may increase the risk of BU disease (1–3). In the Médecins Sans Frontières project in Akonolinga, Cameroon, HIV prevalence was approximately 3–6 times higher among BU patients than the regional estimated HIV prevalence (2). Similarly in Benin and Ghana, BU
patients were 8 times and 3 times respectively more likely to have HIV infection than those without BU (1, 3). Further study is needed to clarify this association and enhance knowledge about the prevalence ofBU–HIV coinfection in endemic areas.
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Open Online Courses include topics in Global Health, are short and designed for self-study. They are available free and can be accessed by anyone. Most offer a certificate. The course topics are: Climate Change; Public Health; Refugee Health; Diseases in Developing Countries; Basic Epidemiology, etc....
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For the Fiscal Year 2014-2015, the Health Sector continued to implement interventions and strategies meant to improve the availability, accessibility and utilization of quality healthcare services across public and private health facilities; and to ensure the reduction of the burden of communicable ...and non-communicable diseases in Rwanda. This annual report highlights key achievements registered by the health sector during the Fiscal Year 2014-2015. Achievements are highlighted under three big components: Health Programs, Health Systems Support and Budget Execution.
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Chagas disease (CD) is caused by the parasite Trypanosoma cruzi, and it is endemic in Central, South America, Mexico and the
South of the United States. It is an important cause of early mortality and morbidity, and it is associated with poverty and stigma. A third of
the cases evolve into chronic... cardiomyopathy and gastrointestinal disease. The infection is transmitted vertically and by blood/organ
donation and can reactivate with immunosuppression. Case identification requires awareness and screening programmes targeting the
population at risk (women in reproductive age, donors, immunocompromised patients). Treatment with benznidazole or nifurtimox is most
effective in the acute phase and prevents progression to chronic phase when given to children. Treating women antenatally reduces but does
not eliminate vertical transmission. Treatment is poorly tolerated, contraindicated during pregnancy, and has little effect modifying the
disease in the chronic phase. Screening is easily performed with serology. Migration has brought the disease outside of the endemic
countries, where the transmission continues vertically and via blood and tissue/organ donations. There are more than 32 million migrants
from Latin America living in non-endemic countries. However, the infection is massively underdiagnosed in this setting due to the lack of
awareness by patients, health authorities and professionals. Blood and tissue donation screening policies have significantly reduced
transmission in endemic countries but are not universally established in the non-endemic setting. Antenatal screening is not commonly
done. Other challenges include difficulties accessing and retaining patients in the healthcare system and lack of specific funding for the
interventions. Any strategy must be accompanied by education and awareness campaigns directed to patients, professionals and policy
makers. The involvement of patients and their communities is central and key for success and must be sought early and actively. This review
proposes strategies to address challenges faced by non-endemic countries
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