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Malaria vaccine: WHO position paper - March 2022
recommended
Weekly Epidemiological Record No 9, 2022, 97, 61–80
This position paper supersedes the 2016 publication, “Malaria vaccine: WHO position paper-2016.”1 It includes the updated WHO recommendations on the wider use of the RTS,S/AS01 vaccine for t
...
he reduction of malaria morbidity and mortality in children living in areas of moderate to high malaria transmission. It also incorporates findings from the evaluation of the WHO-coordinated Malaria Vaccine Implementation Programme (MVIP), recommended by SAGE and MPAG in 2015, and from additional studies since 2015.
This paper does not include findings on vaccine efficacy in infants first vaccinated at 6–12 weeks of age. Because of the lower vaccine efficacy observed in this age category, WHO did not recommend pilot implementation or RTS,S/AS01 vaccine introduction for these young infants. Recommendations2 on the use of RTS,S/AS01 vaccine were discussed by SAGE and MPAG during a joint session in October 2021; evidence presented at the meeting can be accessed at https://terrance.who.int/mediacentre/data/ sage/SAGE_eYB_Oct2021.pdf
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Policy Brief November 2021 Available in English, Spanish and Portuguese
The COVID-19 pandemic has fueled the ongoing antimicrobial resistance (AMR) global crisis due to the increase in the use of antibiotics to treat COVID-19 patients, disruptions
...
to infection prevention and control practices in overwhelmed health systems, and diversion of human and financial resources away from monitoring and responding to AMR threats. Moreover, AMR is likely to have caused more COVID-19 deaths, as secondary bacterial infections can worsen the outcome of severe and critical COVID-19 illness. Therefore, it is more urgent than ever to prioritize efforts towards AMR containment and support countries to improve the detection, characterization and rapid response to emerging AMR.
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Severe bacterial infections are a leading cause of morbidity and mortality among people with advanced HIV disease, after tuberculosis and cryptococcal disease. For countries to reach the end-AIDS targets for 2030, there is a need to establish a roadmap for managing severe bacterial infections and re
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duce mortality. The purpose of the meeting was to
Review the current research and implementation data on the use of prophylactic antibiotics (specifically azithromycin/macrolides) as part of the AHD package of care; To review options for preventing SBIs that are in line with goals of reducing AMR; Present the current evidence on diagnostics for SBI; Discuss research gaps and implementation challenges.
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To support its R&D activities on Chagas disease, DNDi launched the Chagas Clinical Research Platform (CCRP). The platform brings together partners, experts, and stakeholders to provide support for evaluation and development of new treatments for Chagas disease. The patient-centred platform aims to f
...
acilitate clinical research, provide a forum for technical discussions, develop a critical mass of expertise, and strengthen institutional research capacities. In addition, it identifies and reviews priority needs, works towards standardization of methodology to assess drug efficacy and reviews alternatives for using current approved drugs (new schemes, doses, combination) and special scenarios (resistance).
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WHO has published the first-ever guidance on the clinical management of diphtheria. The only previously available guidance was an operational protocol. The new guidance followed the rigorous process for developing guidance at WHO.
It addresses the use
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of Diphtheria Antitoxin (DAT) in the treatment of diphtheria. There is a worldwide shortage of DAT and evidence based recommendations on the use of DAT were requested by many Member States.
The guidance also includes new recommendations on antibiotics. In patients with suspected or confirmed diphtheria, WHO recommends using macrolide antibiotics (azithromycin, erythromycin) rather than penicillin antibiotics.
This clinical practice guideline has been rapidly developed recognizing the global increase in diphtheria outbreaks. Outbreaks of diphtheria in Nigeria, Guinea and neighbouring countries in 2023 have highlighted the urgent need for evidence-based clinical practice guidelines for the treatment of diphtheria. Given the sporadic nature of outbreaks, many clinicians in the affected regions have never managed acute diphtheria and its related complications. Diphtheria remains a neglected disease and vaccination is the top priority. At the same time, for patients with diphtheria, access to antibiotics, DAT and supportive care can be lifesaving.
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National action plans on antimicrobial resistance (AMR) often overlook the critical intersection of gender, despite evidence that exposure and susceptibility to infection, health-seeking behaviours, as well as antimicrobial prescribing and use patte
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rns are all influenced by gender.
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This report provides an update on the key facets of HIV treatment access, including the latest HIV treatment guidelines from World Health Organization (WHO), an overview on pricing for first-line, second-line, and salvage regimens, and a summary of the opportunities for – and threats to – expand
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ing access to affordable antiretroviral therapy (ART).
The report is supplemented by 11 drug profiles that contain more detailed information on pricing trends and patent barriers for key antiretroviral drugs and fixed-dose combinations. Also included is an annex of conditions that define eligibility for reduced prices from 15 pharmaceutical companies.
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These consolidated guidelines on HIV testing services (HTS) bring together existing and new guidance on HTS across different settings and populations.
The World Health Organization (WHO) first released consolidated guidelines on HTS in 2015, in response to requests from Member States, national pr
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ogramme managers and health workers for support to achieve the United Nations (UN) 90–90–90 global HIV targets – and specifically the first target of diagnosing 90% of all people with HIV. In 2016, based on new evidence, WHO released a supplement to address important new HIV testing approaches – HIV self-testing (HIVST) and provider-assisted referral.
Since the release of 2015 and 2016 HTS guidelines, new issues and more evidence have emerged. To address this, WHO has updated guidance on HIV testing services. In this guideline, WHO updates recommendation on HIVST and provides new recommendations on social network-based HIV testing approaches and western blotting (see box, next page). This guideline seeks to provide support to Member States, programme managers, health workers and other stakeholders seeking to achieve national and international goals to end the HIV epidemic as a public health threat by 2030.
These guidelines also provide operational guidance on HTS demand creation and messaging; implementation considerations for priority populations; HIV testing strategies for diagnosis HIV; optimizing the use of dual HIV/syphilis rapid diagnostic tests; and considerations for strategic planning and rationalizing resources such as optimal time points for maternal retesting
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These WHO guidelines which were updated in 2018, are valid for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.
The 2018 edition of the guidelines includes the re
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vision of the recommendation regarding the use of 80% fraction of inspired oxygen (high FiO2) in surgical patients under general anaesthesia with tracheal intubation and the update of the section on implementation. Between 2017 and 2018, WHO re-assessed the evidence on the use of high FiO2 by updating the systematic review related to the effectiveness of this intervention to reduce SSI and commissioning an independent systematic review on adverse events potentially associated with it. Based on the updated evidence, the GDG decided to revise the strength of the recommendation from strong to conditional.
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This publication provides guidance to governments, civil society organizations (nongovernmental organizations and community-based organizations) and other partners implementing HIV prevention, care and treatment programs with key populations. This guide is designed to assist these programs in the de
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velopment of monitoring systems for frontline workers (such as peer outreach workers, staff outreach supervisors and program managers) to understand performance. It includes comprehensive tools and forms that various levels of staff can use to collect and analyze data to manage and improve a program.
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The guidelines are to be used to guide the management of adults with lower respiratory tract infection (LRTI). As will be seen in the following text, this diagnosis, and the other clinical syndromes within this grouping, can be difficult to make accurately. In the absence of agreed definitions of th
...
ese syndromes these guidelines are to be used when, in the opinion of a clinician, an LRTI syndrome is present. The following are put forward as def-initions to guide the clinician, but it will be seen in the ensuingtext that some of these labels will always be inaccurate. These definitions are pragmatic and based on a synthesis of available studies. They are primarily meant to be simple to apply in clinical practice, and this might be at the expense of scientific accuracy. These definitions are not mutually exclusive, with lower respiratory tract infection being an umbrella term that includes all others, which can also be used for cases that cannot be classified into one of the other groups. No new evidence has been identified that would lead to a change in the clinical definitions,which are therefore unchanged from the 2005 publication.
Clin Microbiol Infect 2011;17(Suppl. 6): 1–24 The full version of these guidelines can be found on Wiley Online Library.
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This manual presents a compelling case for action on carbapenem-resistant organisms (CROs) and describes the linkages between the prevention and control of CROs and the Global Action Plan on Antimicrobial Resistance (AMR). It describes how the eight recommendations contained within the World Health
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Organization (WHO) guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities relate to general measures (that is, the core components of infection prevention and control [IPC] programmes) that need to be in place in all countries and health care facilities to prevent and control health care-associated infections (HAIs). The use of a stepwise approach is proposed to support implementation and improvement, based on the evidence and experience of what has worked in several health care settings worldwide. The focus is on adoptable and adaptable information.
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Poor sanitary conditions in disaster-stricken areas result in higher risk for diarrheal illness in vulnerable populations, especially children. This disease negatively impacts the nutritional status of affected children and causes significant morbidity and mortality. Early di
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agnosis and treatment are thus essential to reduce the impact of diarrheal diseases on people affected by disasters. Early identification of cases allows the implementation of measures needed to prevent or lessen outbreaks that can occur in displaced populations in this context. The use of primary care management tools, such as the Integrated Management of Childhood Illness (IMCI) strategy is highly important.This module will first discuss diarrheal diseases and their management, and dehydration and its treatments.
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The Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, presents evidence-
based recommendations on the preferred methods for cleaning, disinfection and sterilization of patient-
care medical devices and for cleaning and disinfecting the healthcare environment. This docume
...
nt
supercedes the relevant sections contained in the 1985 Centers for Disease Control (CDC) Guideline for
Handwashing and Environmental Control. 1 Because maximum effectiveness from disinfection and
sterilization results from first cleaning and removing organic and inorganic materials, this document also
reviews cleaning methods. The chemical disinfectants discussed for patient-care equipment include
alcohols, glutaraldehyde, formaldehyde, hydrogen peroxide, iodophors, ortho-phthalaldehyde, peracetic
acid, phenolics, quaternary ammonium compounds, and chlorine. The choice of disinfectant,
concentration, and exposure time is based on the risk for infection associated with use of the equipment
and other factors discussed in this guideline. The sterilization methods discussed include steam
sterilization, ethylene oxide (ETO), hydrogen peroxide gas plasma, and liquid peracetic acid. When
properly used, these cleaning, disinfection, and sterilization processes can reduce the risk for infection
associated with use of invasive and noninvasive medical and surgical devices. However, for these
processes to be effective, health-care workers should adhere strictly to the cleaning, disinfection, and
sterilization recommendations in this document and to instructions on product labels.
LAST UPDATE 2019
more
Adolescent girls and young women (AGYW) remain disproportionately affected by HIV in Eastern and Southern Africa (ESA), with 26 per cent of new infections attributed to this population. AGYW face many personal, social and structural barriers to access, uptake and
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use of traditional HIV prevention methods. Oral Pre-exposure Prophylaxis (PrEP) is proven to be highly effective as an additional prevention choice for reducing the risk of HIV acquisition, including for AGYW. Successful uptake and adherence to PrEP is critical in its effectiveness as an HIV prevention method, however, the current demand for PrEP by AGYW is low with suboptimal adherence.
Within the ESA region, there is currently great impetus to address these challenges and scale up PrEP for AGYW. A critical aspect of this is to leverage the learnings and evidence from implementation of how to improve the demand and quality of PrEP programming for this population. Improving the Quality of Pre-Exposure Prophylaxis Implementation for Adolescent Girls and Young Women in Eastern and Southern Africa examines the current efforts in the region to accelerate and scale up evidence-based PrEP delivery platforms. The implementation brief provides current knowledge and builds on WHO guidance to provide key considerations for implementation, including driving demand and improving quality, as well as focus on wider combination prevention and integration agendas.
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Development of one or more vaccines for Neisseria gonorrhoeae is an important objective for sexual and reproductive health worldwide, and for the fight against antimicrobial resistance.
WHO preferred product characteristics (PPCs) provide strategic guidance as to WHO’s preferences for new vacci
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nes in priority disease areas. PPCs are intended to encourage innovation and development of vaccines for use in settings most relevant to the global unmet public health need.
Gonococcal vaccine PPCs describe global public health goals for gonococcal vaccines and preferred parameters pertaining to vaccine indications and target populations, safety and efficacy considerations, and immunization strategies.
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In 2007, WHO warned that infectious diseases are emerging and re-emerging at a rate that has not been seen before. The potential for infectious diseases to spread rapidly results in high morbidity and mortality, causing a potential global public health treat of major concern.
Several factors are
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contributing to the (re)emergence of infectious diseases such as population growth, living in close contact with animals, frequent travelling, poverty, destructive ecological changes due to economic development and land use and climate change result in global warming.
Especially Africa is at a threat for (re)emerging infectious diseases due to the huge population growth (expected to reach 2.5 billion by 2050) with rapid urbanisation. Additionally, people across and beyond the continent are excessively mobile which is combined with a weak health system. Moreover, the risk of (re)emerging infectious disease is further heightened by three newly adopted continental initiatives: African Continental Free Trade Area, Free Movement of Persons and African Passport and Single African Air Transport Market.
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This document sets out, therefore, to explain the socioeconomic value of investing in the fight against NTDs and highlights priorities for global investment attention. Our work was guided by the need not only for
additional funding and funders but also for the need to understand the current funding
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climate, in which value for money and the efficient use of resources to fill the most critical of gaps are more relevant than ever.
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Nat Commun 9, 5370 (2018). https://doi.org/10.1038/s41467-018-07804-8. Mycobacterium ulcerans is the causative agent of Buruli ulcer, a neglected tropical skin disease that is most commonly found in children from West and Central Africa. Despite the severity of the infection, therapeutic options are
...
limited to antibiotics with severe side effects. Here, we show that M. ulcerans is susceptible to the anti-tubercular drug Q203 and related compounds targeting the respiratory cytochrome bc1:aa3. While the cytochrome bc1:aa3 is the primary terminal oxidase in Mycobacterium tuberculosis, the presence of an alternate bd-type terminal oxidase limits the bactericidal and sterilizing potency of Q203 against this bacterium. M. ulcerans strains found in Buruli ulcer patients from Africa and Australia lost all alternate terminal electron acceptors and rely exclusively on the cytochrome bc1:aa3 to respire. As a result, Q203 is bactericidal at low dose against M. ulcerans replicating in vitro and in mice, making the drug a promising candidate for Buruli ulcer treatment.
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This chapter discusses the antibacterial treatment of leprosy infections. Antibiotic treatment is
a key component of leprosy treatment, as it is vital to prevent the progression of the infection.
Treatment with rifampin and other antibiotics is highly effective and cures 98% of patients with
the
...
leprosy infection. Furthermore, the relapse rate is very low, at about 1% over 5–10 years.
There is little M. leprae drug resistance in leprosy and few reports of multi-drug resistance (1, 2, 3,
4, 5, 6, 7, 8). An antibiotic treatment may take months or years to produce clinical improvement,
especially in patients with an initial high bacterial index (BI).
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