Bulletin of the World Health Organization最新文献

Objective: To describe a multi-agency public response to an outbreak of avian influenza virus in poultry farms in Victoria, Australia, in 2024.

Methods: After detecting an outbreak of high-pathogenicity avian influenza at a poultry farm and notifying the Victorian health department, Agriculture Victoria identified a further seven infected premises through tracing and surveillance activities. Testing at the Australian Centre for Disease Preparedness identified high-pathogenicity H7N3 at seven premises in the Golden Plains Shire, and high-pathogenicity H7N9 at a property in the Terang region in the Corangamite Shire. The Victorian health department established a multi-agency incident management team, and we defined, identified and managed contacts and suspected cases. Public health actions included influenza vaccination, antiviral prophylaxis, active surveillance of high-risk contacts, and supporting infection prevention and control measures.

Findings: We identified a total of 212 (165 high- and 47 low-risk) unique human contacts with residence locations spread across 25 local government areas. We identified 20 suspected cases from six of the eight infected premises, all of whom tested negative for influenza A. Of the 172 unique high-risk contacts and suspected cases, local health services and clinics reported that 19.2% (33) received antiviral medication and 27.3% (47) received the seasonal influenza vaccine.

Conclusion: Our rapid, coordinated, multi-agency response was a success; however, governments, agricultural industries and health workers must strengthen preparedness and response strategies across national, state, regional and local levels to improve surveillance, foster collaboration and address gaps in preventive health care.

Objective: To understand and simulate international spread of the disease mpox, considering variations in sexual activity levels and international travel among men who have sex with men.

Methods: We developed a mathematical model that considers differing sexual networks and the volume of international travel among men who have sex with men, calibrated to disease incidence data in Japan. We then used our model to simulate the potential international spread of mpox across 42 countries and territories on the Asian continent, assuming Japan as the origin of spread.

Findings: Our simulations identified countries and territories at a high risk of mpox introduction, many being low- and middle-income countries and territories in the Western Pacific and South-East Asia regions. We found that the simulated risk of importation gradually shifted over time from the Western Pacific to the South-East Asia region, and later to the Eastern Mediterranean and European regions. This simulated pattern broadly aligns with actual mpox spread patterns observed between 2023 and 2024.

Conclusion: Our multicountry model for mpox outbreaks can help project the possible trajectory of mpox spread across countries and territories on the Asian continent. Our findings warrant global efforts to contain mpox outbreaks, particularly support for low- and middle-income countries and territories which are at higher risk of introduction, so that the risk of continued spread across the Asian continent and beyond is reduced.

Objective: To determine factors associated with inpatient death among a cohort of children aged 6-59 months with severe acute malnutrition in north-western Nigeria.

Methods: Our observational study used routine programmatic data of all children aged 6-59 months admitted to two inpatient facilities in Katsina State with severe acute malnutrition in 2022. We assessed nutritional status at admission by weight-for-height z-score (WHZ), mid-upper-arm circumference (MUAC) and bilateral nutritional oedema using World Health Organization definitions. We used Cox-proportional hazard models to identify predictors of mortality, with and without adjustment for sex, age group, nutritional status at admission, major clinical complications and comorbidities.

Findings: Of 12 771 children included in the analysis, we observed an overall inpatient mortality of 8.4%. Compared with children admitted by the MUAC criterion alone, we noted that children admitted by the WHZ criterion alone had twice the risk of death; children admitted with kwashiorkor and low WHZ had more than four times the risk. Older children with marasmus had a higher risk of death than younger children (adjusted hazard ratio: 1.74; 95% confidence interval: 1.50-2.03). We did not observe any significant association between stunting and mortality. Our findings were not altered by any of the complications or comorbidities recorded.

Conclusion: Children with a low WHZ at admission have a higher risk of death than those with a low MUAC, and should be subject to special considerations when associated with oedema. MUAC alone is an insufficient criterion to identify all the children at risk of death from malnutrition.

Objective: To assess the quality and consistency of reported age patterns of female genital mutilation in self- and proxy-reported survey data.

Methods: We used 10 Demographic and Health Surveys (DHS) from 2005 to 2023 in Senegal. These surveys contained information on female genital mutilation status and age at experiencing this practice for women who reported data on themselves and daughters for whom data were reported by their mothers. We assessed data quality by completeness of information on age at female genital mutilation in a logistic regression analysis. We compared the occurrence of age heaping across DHS and individual survey characteristics such as education, age cohort and completeness of date of birth reporting. We estimated the median age at female genital mutilation of daughters and women to assess the consequences of differences in data quality for the interpretation of survey data on this practice.

Findings: Self-reported data were more prone to incomplete reporting of age at female genital mutilation and age heaping than proxy-reported data. These findings held true across individual survey characteristics and different DHS. The estimates for median age at female genital mutilation were susceptible to differences in data quality of age at female genital mutilation of daughters and women.

Conclusion: Self-reported data on age at female genital mutilation are of lower quality than proxy-reported data. These differences potentially distort trend estimates of age at female genital mutilation. Caution is needed when combining self- and proxy-reported survey data on female genital mutilation.

Objective: To gain insight into how governments regulate their health laboratory sector, by reviewing health laboratory licensing legislation across different health-care systems in a diverse range of 18 countries worldwide.

Method: We selected countries for a diverse range of health-care systems, geography, income level, licensing legislation and standards adhered to. We selected aspects of health laboratory licensing that were consistently present in different countries and suitable for meaningful comparison, focusing on legislative approaches, certification and accreditation models, regulation, quality assurance, and biosafety and biosecurity requirements.

Findings: Our analysis revealed that the licensing legislation for health laboratories typically encompasses two principal components: administrative procedural law and substantive law. We observed that the different ways in which countries regulate their health laboratories could be categorized within three distinct legislative approaches, namely: standalone licensing act, general licensing act and one based on a health insurance contract. Most countries used a two-step application process, comprising registration and licensing steps. License validity periods ranged over 1-5 years, with some countries opting for permanent licenses. Countries adopted diverse standards and requirements, with some mandating accreditation.

Conclusion: Our findings highlight the diverse legislative approaches to health laboratory licensing, reflecting varying national capacities and regulatory priorities. Integrating robust quality standards, especially those aligned with International Organization for Standardization standard no. 15189, is essential for strengthening laboratory oversight and public health response. Effective licensing frameworks not only enhance domestic laboratory systems but also contribute to global health security through alignment with international obligations.

Objective: To evaluate a combined hearing and eye screening model for newborns attending immunization clinics in Cameroon.

Methods: We analysed data from a screening project that took place between November 2021 and February 2024, which assessed both the hearing and eyes of newborns using otoacoustic emission and fundal reflex tests, respectively. We then evaluated sensitivity, specificity and predictive values of screening conducted by trained auxiliary staff versus specialists.

Findings: We screened 1807 newborns, of which 54% (976) were female. The median age at screening was 13 days. Eight percent of newborns (141/1807) did not pass the otoacoustic emission test; screeners scheduled these newborns for a second-line otoacoustic emission test within three months. Only 28% (39/141) returned for the repeat otoacoustic emission test. Of the returning babies, 33% (13/39) still did not pass, and screeners referred them for an auditory brainstem response threshold test. Screeners detected an absent fundal reflex in 2% (27) of babies. Compared to specialists, trained auxiliary staff showed 82% sensitivity and 99% specificity in hearing screening; predictive values were 90% (positive) and 99% (negative). For eye screening, sensitivity was 67% and specificity 99%, with predictive values of 86% (positive) and 98% (negative).

Conclusion: Combined screening performed by trained auxiliary staff in immunization clinics offers a promising approach to screening newborns' hearing and eyes, enabling broader population coverage with fewer resources. Combined screening conducted at immunization clinics includes both hospital- and community-born babies and is therefore suitable for countries with a high number of out-of-hospital births.

Although most countries have ethical oversight systems for health-related research involving human participants, mechanisms for assessing the quality of those systems are not regularly used, particularly in low-resource settings. To address this gap, the Regulatory System Strengthening, Regulation and Safety unit and Health Ethics and Governance unit of the World Health Organization (WHO) recently released a tool for benchmarking ethics oversight of health-related research involving human participants. The tool provides a simple, easy-to-measure set of indicators for assessing the quality of research ethics oversight systems without the need to invest a great deal of resources. The tool comprises 48 indicators divided across three areas: (i) the national context; (ii) research ethics committees; and (iii) institutions that conduct health-related research involving humans, such as academic medical centres. Indicators related to the national context are intended to be evaluated in a single assessment applicable to the country as a whole, whereas indicators related to research ethics committees and research institutions are evaluated on an entity-by-entity basis. Some countries may choose to assess a representative sample of research ethics committees and institutions; alternatively, national authorities might ask research ethics committees and institutions to undertake self-assessments and report the results. Research ethics committees or institutions could also use WHO's tool on their own as part of a process of quality improvement. WHO is working with global partners to disseminate the tool and support global implementation. Widespread use of the tool is expected to enhance policy coherence in ethics oversight and facilitate multinational research.