4th edition
The WHO Laboratory Biosafety Manual (LBM) has been in broad use at all levels of clinical and public health laboratories, and other biomedical sectors globally, serving as a de facto global standard that presents best practices and sets trends in biosafety.
LBM encouraged countries t...o accept and implement basic concepts in biological safety and to develop national codes of practice for the safe handling of biological agents in laboratories within their geographical borders.
This fourth edition of the manual builds on the risk assessment framework introduced in the third edition. A thorough, evidence-based and transparent assessment of the risks allows safety measures to be balanced with the actual risk of working with biological agents on a case-by-case basis.
This novel evidence- and risk-based approach will allow optimised resource use and sustainable laboratory biosafety and biosecurity policies and practices that are relevant to their individual circumstances and priorities, enabling equitable access to clinical and public health laboratory tests and biomedical research opportunities without compromising safety.
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This updated Comprehensive Mental Health Action Plan 2013-2030 builds upon its predecessor and sets out clear actions for Member States, the WHO Secretariat and international, regional and national partners to promote mental health and well-being for all, to prevent mental health conditions for thos...e at-risk and to achieve universal coverage for mental health services. While the updated action plan includes new and updated indicators and implementation options, the original four major objectives remain unchanged: more effective leadership and governance for mental health; the provision of comprehensive, integrated mental health and social care services in community-based settings; implementation of strategies for promotion and prevention; and strengthened information systems, evidence and research.
In English, French, Spanish, Arabic and Russian available
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Interim guidance, 6 October 2021
Direct detection of SARS-CoV-2 viral proteins (antigens) in nasal swabs and other respiratory secretions using lateral flow immunoassays (also known as rapid diagnostic tests, RDTs) offers a faster and less expensive method to test for SARS-CoV-2 than the reference ...method, nucleic acid amplification tests (NAATs). This interim guidance offers recommendations on the priority uses of antigen-detecting rapid diagnostic tests (Ag-RDTs) in specific populations and settings, including (i) for primary case detection in symptomatic individuals suspected to be infected and asymptomatic individuals at high risk of COVID-19, (ii) for contact tracing, (iii) during outbreak investigations and (iv) to monitor trends of disease incidence in communities. Ag-RDTs meeting minimum performance requirements can be used outside of clinical and laboratory settings, including in communities, by trained operators in accordance with instructions. The guidance additionally provides recommendations on implementation, product selection and storage.
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21 January 2022
The overall threat posed by Omicron largely depends on four key questions: (i) how transmissible the variant is; (ii) how well vaccines and prior infection protect against infection, transmission, clinical disease and death; (iii) how virulent the variant is compared to other varian...ts; and (iv) how populations understand these dynamics, perceive risk and follow control measures, including public health and social measures (PHSM).
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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 use of traditional HIV prevention me...thods. 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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Interim guidance, 26 October 2021
This interim guidance has been developed on the basis of the advice issued by the Strategic Advisory Group of Experts (SAGE) on Immunization at its meeting on 5 October 2021.
SAGE said moderately and severely immunocompromised persons should be offered an addition...al dose of all WHO approved vaccines “since these individuals are less likely to respond adequately to vaccination following a standard primary vaccine series and are at high risk of severe COVID-19 disease.”
People aged 60 and older who received the Sinovac and Sinopharm vaccines should get a third dose too, the experts added, though use of other vaccines may also be considered depending on supply and access.
“When implementing this recommendation, countries should initially aim at maximizing 2-dose coverage in that population, and thereafter administer the third dose, starting in the oldest age groups”, they said.
SAGE has also reviewed a vaccine developed by Indian company Bharat Biotech and will issue a policy recommendation after WHO greenlights it for emergency use.
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This second edition of the Infection prevention and control in the context of coronavirus disease (COVID-19): A living guideline provides the most up to date technical guidance on mask use in community settings in the context of COVID-19.
In this edition, new information includes updated mask re...commendations for children in community settings including updated age specific recommendations, statements for children with disabilities and those at high risk for complications related to COVID-19 infection. Updated implementation considerations for mask use in school settings are also included.
This living guideline is being published using the MAGICApp online publishing platform https://app.magicapp.org/#/guideline/Lr2a8L , as well as in PDF copy on the WHO website.
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This paper explores access to water, sanitation, and health in pastoral communities in northern Tanzania. It argues that the concept of gender, used on its own, is not enough to understand the complexities of sanitation, hygiene, water, and health. It explores pastoralists’ views and perspectives ...on what is ‘clean’, ‘safe’, and ‘healthy’, and their need to access water and create sanitary arrangements that work for them, given the absence of state provision of modern water, sanitation, and hygiene (WASH) infrastructure. Although Tanzania is committed to enhancing its citizens’ access to WASH services, pastoral sanitation and hygiene tend to be overlooked and little attention is paid to complex ways in which access to ‘clean’ water and ‘adequate sanitation’ is structured in these communities. This paper offers an intersectional analysis of water and sanitation needs, showing how structural discrimination in the form of a lack of appropriate infrastructure, a range of sociocultural norms and values, and individual stratifiers interact to influence the sanitation and health needs of pastoralist men, women, boys, and girls.
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Tuberculosis (TB) is the deadliest infectious disease in most low- and middle-income countries, claiming more than 4,000 lives each day. The unprecedented COVID-19 pandemic has seriously impacted people with pre-existing health conditions. People with TB are usually more vulnerable to other infectio...ns, including the novel coronavirus, due to pre-existing lung damage. They are also at higher risk of developing complications from COVID-19.
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The practical guidance in the operational handbook aims to inform the development or revision of national policies and related implementation guidance on the management of TB in children and adolescents under programmatic circumstances and at different levels of the health system. The operational ha...ndbook can also help countries adequately plan for the uptake of interventions to better address the specific needs of children and adolescents with or at risk of TB. It can contribute to national efforts to build capacity among national and subnational programme managers and among health workers at all levels of the health care system.
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The overall goal of surveillance, case investigation and contact tracing in this context is to stop human-to-human transmission to control the outbreak. The key objectives of surveillance and case investigation are to rapidly identify cases and clusters in order to provide optimal clinical care; to ...isolate cases to prevent further transmission; to identify, manage and follow up contacts to recognize early signs of infection; to protect frontline health workers; to identify risk groups; and to tailor effective control and prevention measures.
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Lancet Oncol 2022; 23: e251–312Published OnlineMay 9, 2022 https://doi.org/10.1016/S1470-2045(21)00720-8
In sub-Saharan Africa (SSA), urgent action is needed to curb a growing crisis in cancer incidence and mortality.
Without rapid interventions, data estimates show a major increase in cancer mo...rtality from 520 348 in 2020 to about
1 million deaths per year by 2030. Here, we detail the state of cancer in SSA, recommend key actions on the basis of
analysis, and highlight case studies and successful models that can be emulated, adapted, or improved across the
region to reduce the growing cancer crises. Recommended actions begin with the need to develop or update national
cancer control plans in each country. Plans must include childhood cancer plans, managing comorbidities such as
HIV and malnutrition, a reliable and predictable supply of medication, and the provision of psychosocial, supportive,
and palliative care. Plans should also engage traditional, complementary, and alternative medical practices employed
by more than 80% of SSA populations and pathways to reduce missed diagnoses and late referrals. More substantial
investment is needed in developing cancer registries and cancer diagnostics for core cancer tests.
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On September 10, 2022, the Ministry of Health (MOH) announced a cholera outbreak in Aleppo governorate with 15 laboratory confirmed cases reported between August 25 and September 9, 2022. Activities under this plan seek to address the immediate needs stemming from this outbreak and highlight respons...e priorities across all areas of the response and key sectors involved. This plan initially focuses on the Health, Water Sanitation and Hygiene (WASH), and Risk Communication and Community Engagement (RCCE) responses for an initial period of 90 days. The activities detailed in this plan are also within the programmatic scope of the 2022-2023 Humanitarian Response Plan (HRP).
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The WHO BioHub Biosafety & Biosecurity: criteria and operational modalities sets out the requirements to which laboratories wishing to receive biological materials as part of this international exchange system should abide, to ensure safe and secure operations. These provisions are in accordance wit...h the recommendations of the WHO Laboratory Biosafety Manual 4th edition (LBM4), adopting an evidence- and risk-based approach to enable scalable and adaptable biosafety provisions and actions, proportionate to the assessed risk
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This brief advocacy document highlights the burden, risks and prevention of injuries and violence, which took the lives of 4.4 million people in 2019 and constitute 8% of all deaths. Among the injury-related causes of death include road traffic crashes, drowning, falls, burns, poisoning and violence... against oneself or others. For people age 5-29 years, three of the top five causes of death are injury-related, including road traffic injuries, homicide, and suicide. Injuries and violence are not evenly distributed across or within countries – some people are more vulnerable than others depending on the conditions in which they are born, grow, work, live and age; in general, being young, male and of low socioeconomic status all increase the risk of injury. This document, aimed at public health professionals; injury prevention researchers, practitioners and advocates; and donors, draws attention to specific strategies based on sound scientific evidence that are effective and cost-effective at preventing injuries and violence; it is critical that these strategies are more widely implemented.
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This document focus on the direct consequences of the virus (morbidity and mortality) in specific populations and on the results of measures aimed at mitigating the spread of the virus, with indirect impacts on socio-economic conditions. In this complex scenario, the gender approach has not received... due attention during the pandemic. Gender is one of the structural determinants of health, but it does not appear in analyses of the direct and indirect effects of the pandemic, despite being essential in the recognition and analysis of the differential impacts on men and women and their interaction with the different determinants of health.
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Chagas disease (CD) is endemic in the Americas, being present in 21 countries, where it affects about 6 million
people.(1) With such relevant numbers of people affected and disability adjusted life years lost, CD is a poverty-related
and poverty-promoting disease.
Although data describe a relevan...t ongoing public health problem for the American continent, significant results
in the interruption of transmission has been achieved by coordinated multi-country programs. In particular, the
Southern Cone Initiative (SCI), officially formalised in November 1991 by the Ministers of Health of Argentina, Brazil, Bolivia, Chile, Paraguay and Uruguay, has shown how a well-designed control program can significantly reduce
CD transmission.(2) Before this initiative, in these countries, there were 11 million infected persons and 50 million at
risk, 62% of the infected individuals of the whole continent.
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The sub-Saharan African region, carries 90% of the over 250 million cases of schistosomiasis occurring worldwide. In this region, after Nigeria, Tanzania is second country having the highest cases of schistosomiasis and approximately 51.5%0 of the Tanzanian population is either exposed or live in ar...eas with high risk of exposure. The country is endemic to both Schistosoma mansoni and Schistosoma haematobium, these infections are common in communities characterised with limited access to water, sanitation, hygienic practices and health services. Schistosoma mansoni infection is associated with hepatosplenic disease characterised with hepatomegaly, splenomegaly, progressive periportal fibrosis (PPF) which can lead to portal hypertension and its related sequelae, mainly ascites, liver surface irregularities, oesophageal varices and haematemesis. The main consequences of S. haematobium infection are haematuria, dysuria, nutritional deficiencies, urinary bladder lesions, hydronephrosis, urinary bladder squamous cell carcinoma and in children, growth retardation. Preventive chemotherapy using mass drug administration (MDA) of praziquantel targeting primary school aged children is the main strategy for controlling schistosomiasis in Tanzania.
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Over the past twenty years, huge efforts made by a broad coalition of stakeholders curbed the last epidemic and brought the disease to the brink of elimination. In this paper, the latest figures on disease occurrence, geographical distribution and control activities are presented. Strong evidence in...dicates that the elimination of sleeping sickness ‘as a public health problem’ by 2020 is well within reach. In particular, fewer than one thousand new cases were reported in 2018, and the area where the risk of infection is estimated as moderate, high or very high has shrunk to less than 200,000 km2. More than half of this area is in the Democratic Republic of the Congo. The interruption of transmission of the gambiense form, targeted by the World Health Organization (WHO) for 2030, will require renewed efforts to tackle a range of expected and unexpected challenges. The rhodesiense form of the disease represents a small part of the overall HAT burden. For this form, the problem of under detection is on the rise and, because of an important animal reservoir, the elimination of disease transmission is not envisioned at this stage.
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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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