World health organization 2021

WHO TB guidelines: recent updates

The World Health Organization (WHO) has a mandate to develop and disseminate evidence-based policy, norms and standards for tuberculosis (TB) prevention, diagnosis, treatment and care. Hence, the WHO Global TB Programme performs regular reviews of evidence and assessments of country needs for policy updates across the cascade of TB prevention and care. TB guidelines and operational handbooks are now organized under five modules: prevention, screening, diagnosis, treatment and comorbidities, vulnerable populations and people-centred care.

Updated WHO guidelines and handbooks published since the release of the Global tuberculosis report 2020 are summarized here by module, along with a summary of the key recommendations.

Screening

In March 2021, WHO released the WHO consolidated guidelines on tuberculosis. Module 2: Screening – systematic screening for tuberculosis disease (1). These guidelines include 17 new and updated recommendations for the screening of TB disease. Populations identified as priorities for TB screening include contacts of TB patients, people living with HIV, people exposed to silica, prisoners and other key populations. The following screening tools are recommended: symptom screening, chest radiography, computer-aided detection (CAD) software, molecular WHO-approved rapid diagnostic tests and testing for C-reactive protein. This is the first time that CAD has been recommended for use in interpreting chest radiography for TB.

The new guidelines are accompanied by the WHO operational handbook on tuberculosis. Module 2: Screening – systematic screening for tuberculosis disease (2). The handbook provides practical advice on how to put the guideline recommendations in place at the scale needed to achieve national and global impact. It is intended to support policy-makers and health professionals to choose the best approach to planning and implementing TB screening and active TB case-finding, depending on the context. The handbook provides a sound basis for the development or updating of national guidelines for TB screening according to the epidemiology of TB in different risk groups and the health care delivery system in the country. This will contribute to finding people with TB who may be missed by passive TB case detection and finding people with TB earlier in the course of their disease, thus reducing transmission, morbidity, mortality and financial hardship.

Diagnosis

In July 2021, WHO released the WHO consolidated guidelines on tuberculosis. Module 3: Diagnosis – rapid diagnostics for tuberculosis detection 2021 update (3). Three new classes of nucleic acid amplification test (NAAT) are now endorsed by WHO:

The new recommendations on diagnostics are accompanied by a WHO operational handbook on tuberculosis. Module 3: Diagnosis – rapid diagnostics for tuberculosis detection (4). The handbook aims to facilitate the implementation of WHO guidelines by countries, technical partners and others involved in managing patients with TB and drug-resistant TB. It provides practical information on new and existing tests recommended by WHO and model diagnostic algorithms. The handbook also has step-by-step advice on implementing and scale-up of testing to achieve local and national impact, and an overview of budgetary considerations and information sheets for each of the newly recommended tests.

In June 2021, WHO released a catalogue of Mycobacterium tuberculosis mutations as a reference standard for the interpretation of mutations conferring resistance to all first-line and a variety of second-line TB drugs (5). The report summarises the analysis of over 38,000 isolates with matched data on whole genome sequencing and phenotypic drug susceptibility testing from over 40 countries for 13 anti-TB medicines. It lists over 17,000 mutations, their frequency and association with resistance and includes methods used, mutations identified and summaries of important findings for each drug. This resource will allow laboratories around the world to better interpret the genome sequencing results. The catalogue can also guide the development of new molecular drug susceptibility tests, including next-generation sequencing.

Treatment

In April 2021, WHO convened a guideline development group (GDG) to review data from a trial conducted in 13 countries that compared 4-month rifapentine-based regimens with a standard 6-month regimen in people with drug-susceptible TB (6). The GDG considered a 4-month regimen composed of rifapentine, isoniazid, pyrazinamide and moxifloxacin that met the non-inferiority criteria set in the trial protocol. The available evidence supports the use of this regimen as a possible alternative to the current standard 6-month regimen. The shorter regimen showed similar performance to the current standard regimen in terms of both efficacy and safety. The 4-month regimen – which is shorter, effective and all-oral – would be preferred by many patients, allowing faster cure and easing the burden on both patients and the health care system. However, implementation and uptake of the new regimen in the short to medium term will be more feasible if the cost of rifapentine is reduced and availability improved. A rapid communication presents key findings and considerations on the use of the 4-month regimen following the GDG assessment (7). The full guidelines will be finalized by the end of 2021 and will be incorporated under Module 4: Treatment of the consolidated guidelines and operational handbook.

Comorbidities, vulnerable populations and people-centred care

In May to June 2021, WHO convened a GDG to review updated evidence on the management of TB in children and adolescents (aged 0–9 and 10–19 years, respectively). A rapid communication that summarizes the main updates to guidance on the management of TB in children and adolescents was released by WHO in August 2021 (8). The communication includes new information about treatment decision algorithms, the use of Xpert MTB/RIF Ultra to diagnose pulmonary TB using gastric aspirate and stool specimens, a 4-month regimen to treat non-severe, drug-susceptible pulmonary TB, the use of bedaquiline and delamanid to treat drug-resistant TB, a shortened intensified regimen for TB meningitis, and optimal models of care for the delivery of child and adolescent TB services. The aim is to inform staff from ministries of health, technical partners and other stakeholders about the key findings, considerations and changes related to the diagnosis, treatment and care of TB for children and adolescents, to allow for planning at the country level. Based on the outcomes of the GDG meeting, detailed recommendations will be published as part of the WHO consolidated guidelines on tuberculosis. Module 5: Co-morbidities, vulnerable populations and people-centred care, alongside an operational handbook; both documents will be published by the end of 2021.

Refugees and other displaced populations in humanitarian emergencies face significant threats to health and survival, including poverty, crowded living conditions, undernutrition and poor access to health care. These conditions predispose people to an increased risk of TB infection and development of disease. WHO, in collaboration with the United Nations (UN) High Commissioner for Refugees (UNHCR) and the United States Centers for Disease Control and Prevention (US CDC), will shortly release a field guide to address the challenge of TB in refugees. This guide will include new strategic approaches, guidance and innovations on TB prevention and care interventions in humanitarian crisis situations, to prevent and alleviate the suffering and deaths caused by TB among refugees and displaced populations. Its relevance is underlined by the continued large-scale population movements worldwide induced by conflict, poverty, natural disasters and a changing climate.

Other actions to support TB policy guidance

To exchange views on emerging areas where there is a need for global TB policy guidance, in March 2021, WHO convened a consultation on the translation of TB research into global policy guidelines, attended by scientists, public health experts, partners, civil society and countries (9).

In June 2021, WHO launched a TB Knowledge Sharing Platform to bring all WHO TB guidelines, operational handbooks and training material together in one place (10). In addition to the desktop site, the content is also available on applications for smartphones and tablet computers.[1] It is envisaged that the Knowledge Sharing Platform will become the main portal for dissemination of WHO’s TB guideline-related content, ensuring that the latest guidance and implementation aids are available in one place.

Throughout the year, the Global TB Programme continued to update its repository of WHO recommendations relevant to TB care on its WHO endTB Guidelines website (11). The database provides health care workers, decision-makers, researchers and other users with an efficient way to search and locate the latest TB guidance based on their questions of interest, with built-in search, filter and cross-tabulate functions (12). The site also gives access to evidence to decision (EtD) frameworks, study citations, and summaries of findings, providing a transparent link to the data and GDG judgements underpinning each recommendation.

[1] Find the WHO TB Guide on Google Play or the Apple App Store.

Global tuberculosis report 2021

Overview

Each year, the WHO Global TB Report provides a comprehensive and up-to-date assessment of the TB epidemic, and of progress in prevention, diagnosis and treatment of the disease, at global, regional and country levels. This is done in the context of global TB commitments, strategies and targets.

The 2021 edition of the report has been produced in a new and more web-centric format. This is designed to make the content available in smaller (more “bite-sized”) chunks that are easier to read, digest, navigate and use. There is a short and slim report PDF with 30 pages of main content plus six short annexes. This is accompanied by expanded and more detailed digital content on web pages. The total amount of content remains similar to that of previous years.

Please note that direct comparisons between estimates of TB disease burden in the latest report and previous reports are not appropriate. The most recent time-series of estimates are published in this global TB report.

Global TB reports from previous years can be found here.

World Health Organization Secretariat announcement regarding the election of the next WHO Director-General

The appointment of the next Director-General of the World Health Organization will take place at the Seventy-fifth World Health Assembly in May 2022 (WHA75). The Director-General is WHO’s chief technical and administrative officer.

The election process began when Member States, through a circular letter sent by the WHO Secretariat in April 2021, were invited to submit proposals for candidates for the Director-General position. The deadline for submission of proposals was 23 September 2021. The date on which WHO is scheduled to publish information on candidates, including the curricula vitae and other particulars of their qualifications and experience as received from Member States, is to follow the closure of the last WHO Regional Committee meeting of the year.

As today marks the closure of the last Regional Committee meeting, WHO can announce that a single candidate was proposed by Member States by the 23 September 2021 deadline: Dr Tedros Adhanom Ghebreyesus, who is the incumbent Director-General.

Proposals from 28 WHO Member States, from all WHO regions, were received by the deadline: Austria, Bahrain, Barbados, Botswana, Cook Islands, Croatia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Indonesia, Ireland, Kazakhstan, Kenya, Luxembourg, Malta, Netherlands, Oman, Portugal, Rwanda, Slovakia, Spain, Sweden, Tonga, and Trinidad and Tobago.

During the 150th session of the Executive Board in January 2022, the Board will conduct an initial screening to ensure that the candidate meets the criteria decided by the Health Assembly, interview him and then decide on the nomination by secret ballot. The nomination will be submitted to WHA75.

The appointment will take place at WHA75 in May 2022, also by secret ballot. The term of office of the next Director-General will start on 16 August 2022.

A Director-General can be re-appointed once. Therefore, Dr Tedros Adhanom Ghebreyesus, the incumbent Director-General, is eligible to be proposed for a second term of five years.

Note to media: The term “appointment” derives from WHO’s Constitution, Chapter V11, Article 31, here.

Typically, candidates are proposed by one Member State, although (as has happened on this occasion) the same candidate may be proposed by multiple Member States.

Online resources:

Proposals from the 28 Member States and the candidate’s CV and statement can be found here.

Information on process and timelines for the election of WHO Director-General, April 2021-May 2022, can be found here:

Documents concerning the election process for the WHO Director-General are available here.

72nd session of the
WHO Regional Committee for Europe

Tel Aviv, Israel, 12-14 September 2022

Monkeypox

Ukraine emergency

COVID-19

Latest news

Statement: Control, elimination, eradication: three actions we need to take on three different public health emergencies in the European Region in the coming months

New policy briefs support country strategies to control and eliminate monkeypox in the WHO European Region

Sex-on-premises venues playing their part to end the monkeypox outbreak

Out-of-pocket payments for health care in Romania undermine progress towards universal health coverage

Multimedia

Solidarity and social contracts in the context of the UN Sustainable Development Goals (SDGs)

Healthy Cities in ONE word

Podcasts

Statements from the Regional Director

Statement: Control, elimination, eradication: three actions we need to take on three different public health emergencies in the European Region in the coming months

Statement: Vaccines alone won’t end the monkeypox outbreak – at-risk individuals will have to take action too

Heatwave in Europe: local resilience saves lives – global collaboration will save humanity

Rapidly escalating COVID-19 cases amid reduced virus surveillance forecasts a challenging autumn and winter in the WHO European Region

Всемирная ассамблея здравоохранения постановила начать процесс разработки исторического глобального договора по предотвращению пандемий, обеспечению готовности и принятию мер реагирования

Сегодня Всемирная ассамблея здравоохранения приняла консенсусное решение, направленное на защиту мирового сообщества от будущих кризисов, связанных с распространением инфекционных болезней, в котором согласилась дать старт глобальному процессу разработки и согласования конвенции, соглашения или другого международного документа, предусмотренного Уставом Всемирной организации здравоохранения, в целях укрепления механизмов предотвращения пандемий, обеспечения готовности и принятия мер реагирования.

По словам Генерального директора ВОЗ д-ра Тедроса Адханома Гебрейесуса, данное решение Всемирной ассамблеи здравоохранения является историческим по характеру, жизненно важным по своей миссии и дает нынешнему поколению уникальную возможность усовершенствовать глобальную архитектуру здравоохранения в интересах защиты и укрепления благополучия всех людей.

«Пандемия COVID-19 пролила свет на многочисленные недостатки в глобальной системе защиты людей от пандемий: необеспеченность вакцинами наиболее уязвимых групп населения; отсутствие у работников здравоохранения технических средств, позволяющих им выполнять свою работу по спасению жизней; и эгоцентричные подходы, сводящие на нет общемировую солидарность, которая требуется для борьбы с глобальной угрозой», – заявил д-р Тедрос.

«Но в то же время мы наблюдаем воодушевляющие проявления научного и политического сотрудничества – от быстрой разработки вакцин до сегодняшнего обязательства стран вести переговоры о заключении глобального соглашения, которое поможет укреплять защиту будущих поколений от воздействия пандемий».

Делегаты Ассамблеи здравоохранения встретились на второй с момента основания ВОЗ в 1948 г. специальной сессии и приняли лишь одно решение, озаглавленное «Объединяя усилия мира». В решении Ассамблея постановила учредить межправительственный переговорный орган (МППО) для подготовки и согласования проекта конвенции, соглашения или другого международного документа ВОЗ по предотвращению пандемий, обеспечению готовности к ним и принятию мер реагирования, с тем чтобы он был принят на основании статьи 19 Устава ВОЗ или других положений Устава в зависимости от того, что МППО сочтет уместным.

Статья 19 Устава ВОЗ наделяет Всемирную ассамблею здравоохранения полномочиями принимать конвенции или соглашения по любому вопросу, входящему в компетенцию ВОЗ. Единственным инструментом, принятым к настоящему времени в соответствии со статьей 19, является Рамочная конвенция ВОЗ по борьбе против табака, которая вскоре после вступления в силу в 2005 г. значительно способствовала защите людей от табака.

Согласно принятому сегодня решению, МППО проведет свое первое совещание до 1 марта 2022 г. (для согласования методов и сроков работы), а свое второе совещание – до 1 августа 2022 г. (для обсуждения хода подготовки рабочего проекта документа). Он также проведет открытые слушания, которые могут быть учтены в рамках его обсуждений; направит семьдесят шестой сессии Всемирной ассамблеи здравоохранения в 2023 г. доклад о достигнутом прогрессе; и представит конечный результат своей работы семьдесят седьмой сессии Всемирной ассамблеи здравоохранения в 2024 г.

Кроме того, в своем решении Всемирная ассамблея здравоохранения поручила Генеральному директору ВОЗ обеспечивать созыв совещаний МППО и содействовать ему в ходе работы, в том числе путем координации участия в процессе других органов системы Организации Объединенных Наций, негосударственных структур и других соответствующих заинтересованных сторон в той степени, в которой МППО сочтет это целесообразным.

World health organization 2021

Cемьдесят четвертая сессия Всемирной ассамблеи здравоохранения

Семьдесят четвертая сессия Всемирной ассамблеи здравоохранения, созванная в виртуальном формате в свете продолжающейся пандемии COVID-19, проведет свои заседания с 24 мая по 1 июня 2021 года. За ходом работы заседаний Ассамблеи можно следить в прямом эфире по веб-трансляции ниже.

Предварительная повестка дня

Дневник

Прямая трансляция заседаний

Заседания 74-й сессии Всемирной ассамблеи здравоохранения можно смотреть в прямом эфире 24 мая-1 июня 2021 года. Видеозаписи доступны в списке боковой панели.

Устный перевод на заседаниях служит для того, чтобы содействовать коммуникации, и не является аутентичной или стенографической записью заседаний. Аутентичным является только исходное выступление.

Общая информация

Всемирная ассамблея здравоохранения является директивным органом ВОЗ. В ее работе участвуют делегации от всех государств – членов ВОЗ, и она рассматривает вопросы здравоохранения, включенные в ее повестку дня Исполнительным комитетом.

В основные функции Всемирной ассамблеи здравоохранения входит определение политики Организации, назначение Генерального директора, осуществление надзора за финансовой политикой и рассмотрение и утверждение программного бюджета. Сессии Ассамблеи здравоохранения проводятся ежегодно в Женеве, Швейцария.

Справочная информация

Новости

Всемирная ассамблея здравоохранения: в центре внимания ликвидация текущей и обеспечение готовности к следующей пандемии

World health organization 2021

Seventy-fourth World Health Assembly

The WHA74 commenced on 24 May 2021 and concluded its sessions on 31 May 2021. In light of the ongoing COVID-19 pandemic the event was held virtually. You can replay the proceedings on the webcast below.

Theme: Ending this pandemic, preventing the next: building together a healthier, safer and fairer world.

Watch live WHA74 sessions

The interpretation of proceedings serves to facilitate communication and does not constitute an authentic or verbatim record of the proceedings. Only the original speech is authentic.

Strategic Briefings

During the Seventy-fourth World Health Assembly, a series of Strategic Briefings are being held virtually. During these sessions, WHA delegates, experts from WHO, partner agencies, and civil society will discuss current priorities and next solutions on these vital issues for global public health.

About the World Health Assembly

The World Health Assembly is the decision-making body of WHO. It is attended by delegations from all WHO Member States and focuses on a specific health agenda prepared by the Executive Board. The main functions of the World Health Assembly are to determine the policies of the Organization, appoint the Director-General, supervise financial policies, and review and approve the proposed programme budget. The Health Assembly is held annually in Geneva, Switzerland.

Documents

Key documents

Background information

Photos from the virtual Seventy-fourth World Health Assembly

WHO Director-General, Dr Tedros Adhanom Ghebreyesus.

President of the Assembly, Mrs Dechen Wangmo from Bhutan.

Chair of Committee A, Dr Adriana Amarilla from Paraguay.

Executive Board Room in WHO Headquarters, Geneva.

Long working hours increasing deaths from heart disease and stroke: WHO, ILO

Long working hours led to 745 000 deaths from stroke and ischemic heart disease in 2016, a 29 per cent increase since 2000, according to the latest estimates by the World Health Organization and the International Labour Organization published in Environment International today.

In a first global analysis of the loss of life and health associated with working long hours, WHO and ILO estimate that, in 2016, 398 000 people died from stroke and 347 000 from heart disease as a result of having worked at least 55 hours a week. Between 2000 and 2016, the number of deaths from heart disease due to working long hours increased by 42%, and from stroke by 19%.

This work-related disease burden is particularly significant in men (72% of deaths occurred among males), people living in the Western Pacific and South-East Asia regions, and middle-aged or older workers. Most of the deaths recorded were among people dying aged 60-79 years, who had worked for 55 hours or more per week between the ages of 45 and 74 years.

With working long hours now known to be responsible for about one-third of the total estimated work-related burden of disease, it is established as the risk factor with the largest occupational disease burden. This shifts thinking towards a relatively new and more psychosocial occupational risk factor to human health.

The study concludes that working 55 or more hours per week is associated with an estimated 35% higher risk of a stroke and a 17% higher risk of dying from ischemic heart disease, compared to working 35-40 hours a week.

Further, the number of people working long hours is increasing, and currently stands at 9% of the total population globally. This trend puts even more people at risk of work-related disability and early death.

The new analysis comes as the COVID-19 pandemic shines a spotlight on managing working hours; the pandemic is accelerating developments that could feed the trend towards increased working time.

“The COVID-19 pandemic has significantly changed the way many people work,“ said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. «Teleworking has become the norm in many industries, often blurring the boundaries between home and work. In addition, many businesses have been forced to scale back or shut down operations to save money, and people who are still on the payroll end up working longer hours. No job is worth the risk of stroke or heart disease. Governments, employers and workers need to work together to agree on limits to protect the health of workers.”

“Working 55 hours or more per week is a serious health hazard,” added Dr Maria Neira, Director, Department of Environment, Climate Change and Health, at the World Health Organization. “It’s time that we all, governments, employers, and employees wake up to the fact that long working hours can lead to premature death”.

Governments, employers and workers can take the following actions to protect workers’ health:

Note for editors:

Two systematic reviews and meta-analyses of the latest evidence were conducted for this study. Data from 37 studies on ischemic heart disease covering more than 768 000 participants and 22 studies on stroke covering more than 839 000 participants were synthesized. The study covered global, regional and national levels, and was based on data from more than 2300 surveys collected in 154 countries from 1970-2018.

UN Decade of Healthy Ageing

What is the UN Decade of Healthy Ageing?

The United Nations Decade of Healthy Ageing (2021–2030) is a global collaboration, aligned with the last ten years of the Sustainable Development Goals, that brings together governments, civil society, international agencies, professionals, academia, the media, and the private sector to improve the lives of older people, their families, and the communities in which they live.

Populations around the world are ageing at a faster pace than in the past and this demographic transition will have an impact on almost all aspects of society. Already, there are more than 1 billion people aged 60 years or older, with most living in low- and middle-income countries. Many do not have access to even the basic resources necessary for a life of meaning and of dignity. Many others confront multiple barriers that prevent their full participation in society.

The COVID-19 pandemic has highlighted the seriousness of existing gaps in policies, systems and services. A decade of concerted global action on healthy ageing is urgently needed to ensure that older people can fulfil their potential in dignity and equality and in a healthy environment.

Decade Action Areas

To foster healthy ageing and improve the lives of older people and their families and communities, fundamental shifts will be required not only in the actions we take but in how we think about age and ageing.

The Decade will address four areas for action:

Physical, social and economic environments are important determinants of healthy ageing and powerful influences on the experience of ageing and the opportunities that ageing offers. Age-friendly environments are better places in which to grow, live, work, play and age. They are created by removing physical and social barriers and implementing policies, systems, services, products and technologies that address the social determinants of healthy ageing and enable people, even when they lose capacity, to continue to do the things they value.

Despite the many contributions of older people to society and their wide diversity, negative attitudes about older people are common across societies and are seldom challenged. Stereotyping (how we think), prejudice (how we feel) and discrimination (how we act) towards people on the basis of their age, ageism, affects people of all ages but has particularly deleterious effects on the health and well-being of older people.

Older people require non-discriminatory access to good-quality essential health services that include prevention; promotion; curative, rehabilitative, palliative and end-of-life care; safe, affordable, effective, good-quality essential medicines and vaccines; dental care and health and assistive technologies, while ensuring that use of these services does not cause the user financial hardship.

Significant declines in physical and mental capacity can limit older people’s ability to care for themselves and to participate in society. Access to rehabilitation, assistive technologies and supportive, inclusive environments can improve the situation; however, many people reach a point in their lives when they can no longer care for themselves without support and assistance. Access to good-quality long-term care is essential for such people to maintain their functional ability, enjoy basic human rights and live with dignity.

Decade Enablers

The UN Decade of Healthy Ageing requires a whole-of-government and whole-of-society response. An online knowledge exchange Platform has been established to connect and convene the stakeholders who promote the four action areas at country level and to support those seeking to find and share knowledge that can improve the lives of older people, their families and communities.

Voice and engagement

Engagement with older people themselves will be critical to each of the action areas, as they are agents of change as well as service beneficiaries. Their voices must be heard, their inherent dignity and individual autonomy respected and their human right to participate fully in their societies promoted and protected.

Leadership and capacity building

Fostering healthy ageing and reducing inequity require effective governance and leadership to develop appropriate laws, policies, national frameworks, financial resources and accountability mechanisms across all sectors and at all administrative levels. Capacity building can support different stakeholders to develop the relevant competences and ensure that older people experience health and well-being and enjoy their human rights.

World health organization 2021

В декабре 2019 г. в Ухане (Китайская Народная Республика) были обнаружены первые случаи пневмонии неизвестной этиологии. Позже пневмонию связали с новым коронавирусом, и в феврале 2020 г. Всемирная организация здравоохранения (ВОЗ) дала новой болезни название COVID-19, а Международный Комитет по Таксономии Вирусов (ICTV) вирусу, вызывающему ее, дал название SARS-CoV-2. К 11 марта 2020 г., когда вирус распространился на 114 стран, число диагностированных больных достигло 118 тыс., а число умерших — 4 тыс., ВОЗ объявила вспышку заболевания пандемией. К 16 апреля 2020 г. число диагностированных больных превысило 2 млн, а число смертей — 134 тыс. В данном обзоре мы суммировали актуальную информацию о возникновении и распространении SARS-CoV-2, его эпидемиологии, диагностике, клиническом течении и лечении COVID-19.

Льежский университет, Льеж, Бельгия

Новосибирский государственный университет, Новосибирск, Россия, 630090

Институт химической биологии и фундаментальной медицины Сибирского отделения РАН, Новосибирск;
Институт цитологии и генетики Сибирского отделения РАН, Новосибирск

Возникновение и распространение COVID-19

В декабре 2019 г. в Китайской Народной Республике (КНР) в провинции Хубэй появились случаи пневмонии неизвестной этиологии. Почти все первые случаи заболевания были обнаружены у людей, работающих на рынке или посещающих рынок морепродуктов в городе Ухань. В январе 2020 г. у больных пневмонией выявили новый коронавирус [1]. В феврале 2020 г. Всемирная организация здравоохранения (ВОЗ) дала новой болезни название COVID-19, а Международный комитет по таксономии вирусов (ICTV) дал вирусу название SARS-CoV-2.

К 15 февраля 2020 г. число людей с диагнозом COVID-19 в Китае превысило 50 тыс., в то время как в других странах наблюдались немногочисленные (меньше 50, за исключением Сингапура и круизного судна «Diamond Princess») случаи заболевания [2]. Несмотря на принятые карантинные меры, заболевание стремительно распространилось. 11 марта 2020 г. ВОЗ объявила вспышку заболевания пандемией [3]; к этому времени вирус распространился на 114 стран, число диагностированных больных достигло 118 тыс., а число умерших — 4 тыс. [4]. К моменту написания этой статьи, 16 апреля 2020 г., пандемия охватила 213 стран; в мире насчитывается более 2 млн заболевших и более 134 тыс. умерших от COVID-19 [5]. Во многих странах число заболевших и умерших растет экспоненциально. Текущую статистику можно посмотреть на сайте ВОЗ (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/), на российском сайте (https://www.coronavirus-monitor.ru) и на веб-агрегаторе, поддерживаемом Университетом Джонса Хопкинса, США (https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6).

На середину апреля помимо КНР наибольшее количество случаев пришлось на США, Италию, Испанию, Германию, Францию и Великобританию.В то время как в КНР на этот момент эпидемия была взята под контроль и выявлялось менее 100 новых больных в день, центр пандемии переместился в США и Европу, где ежедневно суммарно диагностировались десятки тысяч новых заболевших каждый день. В Российской Федерации по состоянию на 16 апреля 2020 г. насчитывалось более 24 000 заболевших и более 200 умерших [5].

Репродуктивное число (число вторичных случаев заражения, вызванных одним инфицированным человеком, R₀) для COVID-19 оценивается как 2,2 (95% доверительный интервал от 1,4 до 3,9) [6]. Для сравнения, сезонный грипп имеет, как правило, репродуктивное число около 1,3 [7].

COVID-19 передается воздушно-капельным, воздушно-пылевым и контактно-бытовым способами. Показано, что инфекция может передаваться в том числе от бессимптомных носителей и зараженных людей уже в инкубационном периоде их заболевания и даже в течение нескольких дней после клинического выздоровления [8—10]. Вне организма человека вирус SARS-CoV-2 может сохранять способность к заражению до 3 дней на поверхностях, сделанных из пластика и нержавеющей стали, до 24 ч — на картоне и до 4 ч — на медьсодержащих поверхностях [11].

Вирус SARS-CoV-2

Впервые геном вируса был секвенирован в КНР и выложен в Genbank 10 января 2020 г. [12]. Первые 10 секвенированных геномов оказались одинаковыми на 99,98%, что говорит об одном исходном источнике эпидемии. Последовательность SARS-CoV-2 на 96% оказалась идентичной таковой для вируса летучих мышей CoV RaTG13, на 92% идентичной таковой для вируса яванского панголина Pangolin-CoV [13], на 79% — вируса SARS-CoV и на 50% — MERS-CoV. Сейчас предполагается, что именно летучие мыши являются природным резервуаром вируса, но, по всей видимости, существует промежуточный хозяин, который в настоящее время не выявлен; на подозрении — панголины, кошки и собаки. Филогенетический анализ геномов изолятов вируса в сравнении с геномными последовательностями более 1000 природных штаммов и сконструированными лабораторными штаммами подтверждает, что вирус SARS-CoV-2 имеет естественное природное происхождение [14—16].

Вирус SARS-CoV-2 относится к царству Riboviria, отряду Nidovirales, подотряду Cornidovirineae, семейству Coronaviridae, подсемейству Orthocoronavirinae, роду Betacoronavirus, подроду Sarbecovirus, виду SARS-coronavirus [17]. К тому же роду, подроду и виду относятся вирусы SARS-CoV и MERS-CoV, вызывающие тяжелый острый респираторный синдром (Severe Acute Respiratory Syndrome, SARS) и ближневосточный респираторный синдром (Middle East Respiratory Syndrome, MERS). Коронавирусы имеют геном в виде одноцепочечной плюс-РНК величиной от 26 до 32 Кб [15, 16] и подразделяются на 4 рода: α, β, γ и δ [17]. Из них α- и β-коронавирусы в основном являются патогенами млекопитающих, а вирусы γ- и δ- поражают млекопитающих и птиц. SARS-CoV-2 относится к группе β-коронавирусов. Вирус SARS-CoV-2 — седьмой из известных коронавирусов, которые могут вызывать заболевания человека. Из них вирусы α-CoVs HCoV-229E, HCoV-NL63, β-CoVs HCoV-HKU1 и HCoV-OC43 обладают, как правило, низкой патогенностью и вызывают в основном легкие или средней тяжести респираторные заболевания, сходные с гриппом, хотя иногда могут вызывать и тяжелые пневмонии. К роду β-коронавирусов также относят вирусы SARS-CoV-1 и MERS-CoV. Вирус SARS-CoV-1 вызвал вспышку атипичной пневмонии в 2002—2003 гг. [18], а вирус MERS-CoV вызвал вспышку ближневосточного респираторного синдрома в 2012 г. и последующих годах [19].

Для проникновения в клетки человека SARS-CoV-2 использует тот же рецептор, что и SARS-CoV-1, а именно — ангиотензин-превращающий фермент 2 (ACE2). Слияние мембран клетки и вируса проходит при участии клеточной сериновой протеазы TMPRSS2 [20].

In vitro вирусные частицы SARS-CoV-2 могут проникать в те же клеточные культуры, что и SARS-CoV-1, например, культуры клеток человека HEK-293T, клеток зеленой мартышки Vero Е6 и Vero CCL81, клеток собаки MDCKII, клеток аденокарциномы человека (A549) и клеток печени (HUH7.0)[20]. В исследованиях вирусной репликации и цитотоксичности ряд клеточных линий был инокулирован вирусом с высокой множественностью и был изучен через 24 ч после этого. Никакого цитопатического эффекта не наблюдалось, за исключением клеток Vero, в которых титры вируса достигали >10 7 PFU через 24 ч после инфицирования. В противоположность этому клетки HUH7.0 и HEK-293T продемонстрировали только небольшой уровень репликации, а клетки A549 вообще не инфицировались вирусом.

При наблюдении бляшки были более различимы и видимы на культуре Vero E6. Через два дня после инфицирования, при более сильном разведении клетки VeroE6, производили отдельно различимые бляшки, хорошо видимые при окрашивании нейтральным красным. В противоположность этому на клетках Vero CCL81 получались менее прозрачные бляшки, более различимые при окрашивании нейтральным красным через 3 дня после заражения [20].

Для in vivo исследований SARS-Cov-2 возможно применение таких животных, как резус-макаки и трансгенная (гуманизированная) линия лабораторной мыши hACE2. Однако как у макак, так и у мышей не развивается тяжелая респираторная форма инфекции [21]. Показано, что SARS-CoV-2 может реплицироваться в верхних дыхательных путях хорьков и домашних кошек. При этом кошки способны заражать других кошек. В то же время собаки, свиньи, курицы и утки мало восприимчивы к заражению [22].

Эпидемиология и факторы риска

По результатам исследований китайских ученых, большинство заболевших, 87%, были в возрасте 30—79 лет, 1% — менее 9 лет, 1% — 10—19 лет и 3% — старше 80 лет [23, 24]. Оценка коэффициента летальности (case-fatality rate; доля умерших, деленная на общее число заболевших) заболевания варьирует от 1 до 7% [24, 25] в зависимости от поло-возрастного состава населения, стратегий тестирования, диагностики, лечения, бюрократических особенностей здравоохранения в конкретной стране и загруженности систем здравоохранения. 3 марта 2020 г. ВОЗ оценила летальность как 3,4% [26]. Однако результаты наблюдений за экипажем и пассажирами круизного лайнера «Diamond Princess», на котором из 712 заболевших умерло 11 человек [5], приводят к оценке коэффициента летальности в 1,5% (95% доверительный интервал от 0,6 до 2,4%).

Уже многие исследования показали, что течение заболевания и смертность сильно зависят от возраста больного и наличия других заболеваний. У детей пока зарегистрированы единичные случаи летального исхода. В группе до 30 лет смертность составляет около 0,2%; после 40 лет риск увеличивается в 3—4 раза с каждой дополнительной декадой, достигая примерно 8% у заболевших возраста 70—79 лет и 15—20% после 80 лет [23—25].

В группу высокого риска кроме пожилых людей входят также люди с хроническими заболеваниями. Показано, что артериальная гипертензия, болезни сердца, диабет и ожирение с индексом массы тела выше 40 ухудшают прогноз [24, 27].

В то же время тяжелое течение с летальным исходом наблюдается и у лиц среднего (от 30 лет) возраста без сопутствующих заболеваний; возможно, данные лица имеют неизвестные на данный момент факторы риска, например, неблагоприятный генотип.

В настоящее время недостаточно данных о протекании COVID-19 у беременных женщин и влиянии заболевания на развитие плода и новорожденных. Предварительные данные на маленьких выборках не показали более тяжелое протекание болезни во время беременности. У большинства беременных женщин [28] и новорожденных [29—32] течение болезни было легким или средним. Пока нет сведений о влиянии COVID-19 на развитие плода в I и II триместрах беременности.

Клиническое течение

Инкубационный период COVID-19 составляет от 2 до 14 дней со средним сроком появления симптомов около 5 дней [6]. Описаны случаи наступления заболевания с инкубационным периодом более 14 дней [23], но они единичны, и возможно, в этих случаях имелись повторные не отслеженные контакты с вирусоносителями.

Клиническая картина заболевания варьирует от бессимптомных случаев до тяжелых, требующих больничного и реанимационного лечения. Характерными клиническими симптомами COVID-19 являются: повышение температуры тела, сухой кашель, одышка, миалгии и утомляемость. Другие симптомы включают головную боль, спутанность сознания, боль в грудине и диарею [33]. В более тяжелых случаях развивается двусторонняя пневмония, острый респираторный дистресс-синдром (ОРДС), полиорганная недостаточность и сепсис [34]. По тяжести течения формы заболевания классифицируются на легкие, среднетяжелые и крайне тяжелые [35].

Большинство клинических случаев (81%) COVID-19 классифицируются как легкие и средние. У 14% пациентов заболевание протекает в тяжелой форме с наличием одышки, частотой дыхания ≥30/мин, насыщением крови кислородом ≤93%, наличием инфильтратов в легких >50% в течение 24—48 ч. Около 5% переносят заболевание в крайне тяжелой форме. У них наблюдаются развитие дыхательной недостаточности, септический шок, недостаточность других органов [23, 24].

После выписки некоторые пациенты по-прежнему являются вирусоносителями, что подтверждается положительными результатами лабораторных тестов. Более того, у некоторых пациентов наблюдается рецидив заболевания [36]. Таким образом, по крайней мере у части заболевших иммунный ответ не развивается в достаточной для элиминации вируса мере. Это может означать, что для определенной группы людей вакцинация может быть неэффективной.

Диагностика

По клиническим симптомам COVID-19 невозможно отличить от других острых респираторных инфекций, в частности, от простуды и других ОРВИ. Ключевым фактором в дифференциальной диагностике является сбор эпидемиологических данных — история путешествий, контакты больного, др. Окончательный диагноз ставится по результатам лабораторных тестов, таких как полимеразная цепная реакция (ПЦР), серологические тесты и инструментальная диагностика (компьютерная томография).

ПЦР-диагностика

Диагностика основана на амплификации (размножении) специфичных участков генома вируса методом ПЦР с обратной транскрипцией (ОТ-ПЦР) [37, 38]. Основным биоматериалом для этого исследования является мазок из носоглотки и/или ротоглотки. ПЦР-диагностика в настоящее время используется для многих инфекционных заболеваний. Ее преимущества заключаются в возможности быстрой разработки и производства теста сразу, как только становится известна геномная последовательность вируса, а также в очень высокой чувствительности (вплоть до всего 10 молекул РНК в пробе) и специфичности тестов. Тестирование SARS-CoV-2 производят на гены N, S [39], ORF1ab, E и их комбинации. Например, Китайский центр по контролю и предотвращению заболеваний рекомендует использование праймеров к генам ORF1ab и N. Тест считается положительным, если определяются оба участка генома [40]. Ряд российских производителей зарегистрировал свои тест-системы в конце марта и уже наладил их производство.

Серологические тесты

С помощью серологических тестов можно выявить наличие специфических антител к вирусу или наличие антигена в организме. При этом чаще всего применяется комбинированное тестирование крови на IgM- и IgG-антитела к вирусу. Тестирование на иммуноглобулины M позволяет определить факт недавнего заражения вирусом, а тестирование на иммуноглобулины G выявляет либо позднюю стадию инфекции, либо иммунный ответ после выздоровления. Тест на антитела весьма полезен при оценке иммунного статуса популяции и может позволить индивидуальный выход из карантина, а также нужен для оценки иммунного статуса после вакцинации. Минимальное время тестирования составляет 15 мин, а итоговые чувствительность и специфичность во время испытаний составили 88,66 и 90,63% соответственно [41].

Иммуноферментный тест на антиген вируса, особенно его экспресс-версия, помогают выявить коронавирусную этиологию в острой фазе инфекции. Но точная информация об этих тестах, их чувствительности и специфичности на момент написания статьи была недоступна. Что касается возможности дифференциации различных коронавирусов человека с помощью серологических тестов, то этих данных в опубликованной литературе пока нет.

Другие тесты

В настоящее время разрабатываются тесты, основанные на методе CRISPR, например, SHERLOCK и DETECTR. Тесты основаны на способности системы CRISPR узнавать специфические геномные участки и вырезать их.

Метод SHERLOCK (Specific High Sensitivity Enzymatic Reporter UnLOCKing) основан на использовании Cas13 для детекции РНК вируса в концентрации от 10—100 молекул РНК на микролитр. Визуализация результатов производится с помощью индикаторной тест-полоски, в течение часа. Метод DETECTR использует Cas12 для детекции кДНК и является более быстрым в исполнении (около 30 мин), но менее чувствительным, определяя наличие вирусного генома в пробе с исходной концентрацией 70—300 молекул РНК вируса на микролитр. На момент написания статьи оба теста проходили клинические испытания [42].

Также разработаны быстрые тесты на основе как простой ПЦР, так и изотермической ПЦР, в том числе — картриджные, для полевого применения. Однако их чувствительность может быть меньше, чем у стандартных ПЦР-тестов. Время анализа для этих тестов составляет около 30 мин, что приемлемо для тестирования пассажиров в аэропортах.

Томографическое обследование

Для диагностики пневмонии, вызванной COVID-19, также используют компьютерную томографию [43]. При пневмонии, вызванной коронавирусом, выявляют двусторонние инфильтраты в виде «матового стекла» или консолидации, имеющие преимущественное распространение в нижних и средних зонах легких [44].

Лечение

На данный момент отсутствует какая-либо специфическая противовирусная терапия для лечения COVID-19. Легкие случаи не требуют специального лечения. При развитии дыхательной недостаточности и пневмонии больного госпитализируют и оказывают симптоматическую терапию. В тяжелых случаях лечение направлено на поддержание функций жизненно важных органов. При присоединении вторичных бактериальных инфекций могут быть назначены антибиотики [33]. Основным симптоматическим лечением в тяжелых случаях является кислородная терапия. На фоне вирусной инфекции у тяжелых больных может развиться ОРДС. Таких больных переводят на механическую вентиляцию легких (аппарат ИВЛ), а в более тяжелых случаях применяется экстракорпоральная мембранная оксигенация. При тяжелой форме заболевания медиана от первых симптомов до развития одышки составляет 5 дней, до госпитализации — 7 дней и до развития ОРДС — 8 дней [37].

В настоящее время проводится большое число клинических испытаний для целого ряда лекарств. Особо интересны испытания лекарств, широко используемых для лечения других заболеваний. Эти лекарства были выбраны из препаратов с потенциальной противовирусной активностью или на основании гипотез о механизме действия вируса. В частности, широко исследуется действие таких препаратов, как фавипиравир (ингибитор вирусных РНК-полимераз, выпускаемый в Японии), ремдесивир (или GS-5743, нуклеотидный аналог, ингибитор вирусной РНК-полимеразы, разработанный компанией Gilead Sciences, США, но пока находящийся на более ранней, по сравнению с другими препаратами, стадии клинических испытаний) [45], комбинация лопинавира и ритонавира (ингибиторы протеаз, используемые при лечении гепатита С и ВИЧ-инфекции) и противомалярийные препараты хлорохин и гидроксихлорохин (повышают эндосомный pH и нарушают терминальное гликозилирование ACE2). Предварительные исследования не подтвердили эффективность лечения лопинавиром и ритонавиром [46]. Эффективность ремдезивира и хлорохина была показана в in vitro экспериментах [47]. Эффективность гидроксихлорохина была показана в предварительных, пока весьма ограниченных клинических испытаниях [48], которые сейчас критикуются за недостоверность. Следует отметить, что гидроксихлорохин может иметь серьезные побочные эффекты и взаимодействовать с другими лекарственными препаратами. В настоящее время ВОЗ инициировала глобальное клиническое исследование данных препаратов под названием Solidarity [49].

Ученые из разных стран занимаются разработками вакцины от заболевания, вызванного SARS-CoV-2. Существует несколько подходов к разработке противовирусных вакцин. В частности, проходят доклинические испытания вакцин на основе ослабленного или инактивированного вируса, вирусных векторов, рекомбинантных мРНК и ДНК и рекомбинантных белков [50]. Начаты клинические испытания I фазы на добровольцах в США вакцины на основе рекомбинантной мРНК (компания Moderna) и в КНР, на основе рекомбинантного живого аденовируса 5-го серотипа (компания CanSino Biologics). В случае успеха на I фазе испытаний, II и III фазы будут проведены в очагах вспышек в США и КНР уже летом. Полные циклы тестирования эффективности и безопасности вакцин займут по меньшей мере год.

Обсуждение

В настоящий момент нет ответов на многие вопросы о заболевании COVID-19 и самом вирусе SARS-CoV-2. Нет точных оценок того, какая доля инфицированных вирусом являются бессимптомными носителями или переносят заболевание в легкой форме, не попадая в официальную статистику. Если эта доля большая и такие люди передают заболевание, то, с одной стороны, инфекцию будет очень трудно остановить принимаемыми в настоящее время карантинными мероприятиями, которые во многих странах опираются на изоляцию симптоматических случаев и их контактов.

С другой стороны, это будет означать, что оценки количества заболевших, нуждающихся в госпитальном лечении, и показатель летальности завышены. По одной из оценок доля бессимптомных носителей может составлять даже до 60% от общего числа инфицированных [51], при этом по крайней мере некоторые асимптоматические зараженные могут инфицировать других людей [10].

Хотя существующие оценки показателя летальности и доли пациентов, нуждающихся в госпитализации и интенсивной терапии, могут быть завышены, понятно, что число больных COVID-19, которые одномоментно нуждаются в госпитализации и реанимационных мероприятиях, в разы превышает показатели «привычных» инфекций, таких как сезонный грипп. Это ясно из того, что системы здравоохранения областей Хубэй и северной Италии, в которых SARS-CoV-2 какое-то время распространялся бесконтрольно, были близки к коллапсу.

На количество заболевших, одновременно нуждающихся в медицинской помощи, влияют вирулентность и скорость распространения инфекции в популяции. Точная оценка эпидемиологических параметров COVID-19 важна для разработки математических моделей, которые применяются экспертами для прогнозирования развития ситуации. Одной из основных задач, решаемых этими моделями, является определение набора карантинных мер. Карантинные меры направлены на подавление или замедление скорости распространения вируса, таким образом оптимизируя возможности здравоохранения и минимизируя смертность и экономический эффект от пандемии [52].В частности, важным целевым параметром является число больных, нуждающихся в госпитализации. Их число не должно превышать число доступных больничных мест в системе здравоохранения.

Достоверное выявление динамики количества инфицированных чрезвычайно важно для принятия правительственных решений и понимания того, насколько принимаемые меры эффективны. В настоящий момент ВОЗ призывает проводить как можно больше тестов на SARS-CoV-2 для контроля за распространением заболевания [53], так как, судя по всему, без этого с пандемией не справиться. Установление точного числа инфицированных чрезвычайно сложно в связи с трудностями тотального и неоднократного скрининга населения. Интересен опыт Нидерландов и Дании, где мониторинг динамики числа инфицированных проводится с помощью определения содержания вирусной РНК в канализации [54]. Однако эффективность и точность этого подхода для борьбы с эпидемией пока неясны.

Нет четкого ответа и на вопрос, насколько устойчив иммунитет к COVID-19. Новостные сайты распространяли информацию о нескольких случаях, когда пациент повторно заболевал COVID-19 [55]. Являются ли эти случаи повторно инфицированными, рецидивом заболевания или ложноположительным результатом тестирования в первый раз, неясно. Однако недавно проведенное исследование на резус-макаках показало, что повторная инфекция маловероятна [56] (следует отметить, что на момент написания этого обзора данная статья появилась в форме репринта и еще не прошла рецензирования).

Остается неясным вопрос о сезонности COVID-19. Есть предположение, что с наступлением лета в северном полушарии репродуктивное число может снизиться, что приведет к замедлению распространения инфекции. Есть также предположение о том, что ввиду изоляции тяжелобольных, наиболее патогенные варианты вируса не будут распространяться и их вытеснят слабо патогенные варианты от бессимптомных больных. Тогда нынешний вирус просто станет очередным коронавирусом, вызывающим обычныеОРВИ. Эти предположения будут проверены природой и самой жизнью в ближайшие 3—4 мес.

Интересно отметить, что дети, хотя и заражаются вирусом, болеют в более легкой форме по сравнению со взрослыми [57]; на данный момент нет данных о смертях детей моложе 10 лет [25]. Предполагают, что дети могут иметь более свежий иммунный ответ на антигенно сходную инфекцию, а также другой уровень ACE2-рецепторов на клетках легких [58]. Эксперименты на модельных животных действительно показали, что удельное количество ACE2-рецепторов играет важную роль в предотвращении развития острой дыхательной недостаточности [59], а уровень ACE2 уменьшается с возрастом [60, 61]. Однако у человека в исследованиях ОРДС изменений активности ACE2 с возрастом не наблюдалось [62]. Применение рекомбинантного ACE2 не было эффективным при лечении ОРДС человека [63].

В дальнейшем важно будет исследовать связь симптоматики и тяжести течения заболевания с различными эпидемиологическими и клиническими факторами риска, вариациями в геномных последовательностях вариантов вируса и особенностями геномов и иммунных систем заболевших.

Благодарности. Авторы выражают благодарность Базыкину Г.А. и Мошковскому С.А. за обсуждение и Аульченко Н.В. за помощь с оформлением статьи.

Финансирование. Работа Ю.С. Аульченко была выполнена при поддержке Министерства науки и высшего образования РФ через ИЦиГ СО РАН (Бюджетный проект 0324-2019-0040-С-01/AAAA-A17-117092070032-4). Работа С.В.Нетёсова была выполнена при поддержке Министерства науки и высшего образования РФ по Программе повышения конкурентоспособности ведущих российских университетов среди ведущих мировых научно-образовательных центров (проект 5-100).

Авторы заявляют об отсутствии конфликта интересов.

14.9 million excess deaths associated with the COVID-19 pandemic in 2020 and 2021

New estimates from the World Health Organization (WHO) show that the full death toll associated directly or indirectly with the COVID-19 pandemic (described as “excess mortality”) between 1 January 2020 and 31 December 2021 was approximately 14.9 million (range 13.3 million to 16.6 million).

“These sobering data not only point to the impact of the pandemic but also to the need for all countries to invest in more resilient health systems that can sustain essential health services during crises, including stronger health information systems,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO is committed to working with all countries to strengthen their health information systems to generate better data for better decisions and better outcomes.”

Excess mortality is calculated as the difference between the number of deaths that have occurred and the number that would be expected in the absence of the pandemic based on data from earlier years.

Excess mortality includes deaths associated with COVID-19 directly (due to the disease) or indirectly (due to the pandemic’s impact on health systems and society). Deaths linked indirectly to COVID-19 are attributable to other health conditions for which people were unable to access prevention and treatment because health systems were overburdened by the pandemic. The estimated number of excess deaths can be influenced also by deaths averted during the pandemic due to lower risks of certain events, like motor-vehicle accidents or occupational injuries.

Most of the excess deaths (84%) are concentrated in South-East Asia, Europe, and the Americas. Some 68% of excess deaths are concentrated in just 10 countries globally. Middle-income countries account for 81% of the 14.9 million excess deaths (53% in lower-middle-income countries and 28% in upper-middle-income countries) over the 24-month period, with high-income and low-income countries each accounting for 15% and 4%, respectively.

“Measurement of excess mortality is an essential component to understand the impact of the pandemic. Shifts in mortality trends provide decision-makers information to guide policies to reduce mortality and effectively prevent future crises. Because of limited investments in data systems in many countries, the true extent of excess mortality often remains hidden,” said Dr Samira Asma, Assistant Director-General for Data, Analytics and Delivery at WHO. “These new estimates use the best available data and have been produced using a robust methodology and a completely transparent approach.”

“Data is the foundation of our work every day to promote health, keep the world safe, and serve the vulnerable. We know where the data gaps are, and we must collectively intensify our support to countries, so that every country has the capability to track outbreaks in real-time, ensure delivery of essential health services, and safeguard population health,” said Dr Ibrahima Socé Fall, Assistant Director-General for Emergency Response.

The production of these estimates is a result of a global collaboration supported by the work of the Technical Advisory Group for COVID-19 Mortality Assessment and country consultations.

This group, convened jointly by the WHO and the United Nations Department of Economic and Social Affairs (UN DESA), consists of many of the world’s leading experts, who developed an innovative methodology to generate comparable mortality estimates even where data are incomplete or unavailable.

This methodology has been invaluable as many countries still lack capacity for reliable mortality surveillance and therefore do not collect and generate the data needed to calculate excess mortality. Using the publicly available methodology, countries can use their own data to generate or update their own estimates.

“The United Nations system is working together to deliver an authoritative assessment of the global toll of lives lost from the pandemic. This work is an important part of UN DESA’s ongoing collaboration with WHO and other partners to improve global mortality estimates,” said Mr Liu Zhenmin, United Nations Under-Secretary-General for Economic and Social Affairs.

Mr Stefan Schweinfest, Director of the Statistics Division of UN DESA, added: “Data deficiencies make it difficult to assess the true scope of a crisis, with serious consequences for people’s lives. The pandemic has been a stark reminder of the need for better coordination of data systems within countries and for increased international support for building better systems, including for the registration of deaths and other vital events.”

Note for editors:

The methods were developed by the Technical Advisory Group for COVID-19 Mortality Assessment, co-chaired by Professor Debbie Bradshaw and Dr. Kevin McCormack with extensive support from Professor Jon Wakefield at the University of Washington. The methods rely on a statistical model derived using information from countries with adequate data; the model is used to generate estimates for countries with little or no data available. The methods and estimates will continue to be updated as additional data become available and in consultation with countries.

Новые Глобальные рекомендации ВОЗ по качеству воздуха призваны способствовать защите здоровья миллионов людей от загрязнения воздуха

Наряду с изменением климата загрязнение воздуха является одной из самых серьезных экологических угроз для здоровья человека.

В подготовленных Всемирной организацией здравоохранения (ВОЗ) новых Глобальных рекомендациях по качеству воздуха (ГРКВ) представлены четкие доказательства вреда, который загрязнение воздуха наносит здоровью человека, причем даже при более низких концентрациях загрязняющих веществ, чем считалось ранее. В документе рекомендованы новые целевые показатели качества воздуха, соблюдение которых позволит обеспечить защиту здоровья населения посредством снижения концентрации основных загрязняющих веществ, некоторые из которых также способствуют изменению климата.

Со времени последнего обновления глобальных рекомендаций ВОЗ в 2005 г. объем научных данных о негативном влиянии загрязнения воздуха на различные аспекты здоровья человека заметно возрос. По этой причине и после систематического обзора накопленного массива данных ВОЗ скорректировала практически все рекомендованные предельные значения загрязнения воздуха в сторону уменьшения, предупреждая о том, что превышение новых значений предельно допустимой концентрации загрязняющих веществ в воздухе создает значительные риски для здоровья населения. Соблюдение этих рекомендаций, напротив, могло бы спасти миллионы жизней.

Каждый год воздействие загрязнения воздуха, по оценкам, является причиной преждевременной смерти 7 миллионов человек и приводит к потере миллионов здоровых лет жизни. У детей негативные последствия загрязнения воздуха, в частности, приводят к нарушению развития и функции легких, респираторным инфекциям и обострениям астмы. У взрослых наиболее распространенными причинами преждевременной смерти, обусловленными загрязнением атмосферного воздуха, являются ишемическая болезнь сердца и инсульт, а новые данные также указывают на наличие связи между загрязнением воздуха и другими нарушениями здоровья, такими как диабет и нейродегенеративные заболевания. Бремя болезней, связанных с загрязнением воздуха, ставит этот источник негативного воздействия на здоровье в один ряд с другими основными источниками риска во всем мире, такими как нездоровое питание и табакокурение.

Наряду с изменением климата загрязнение воздуха является одной из самых серьезных экологических угроз для здоровья человека. Улучшение качества воздуха может способствовать усилиям по смягчению последствий изменения климата, а снижение выбросов, в свою очередь, позволит улучшить качество воздуха. Принимая меры по достижению рекомендованных параметров качества воздуха, страны будут как способствовать охране здоровья населения, так и смягчать последствия глобального изменения климата.

В новых рекомендациях ВОЗ приводятся рекомендованные значения допустимой концентрации шести загрязняющих веществ, о негативном влиянии которых на здоровье накоплено наибольшее количество данных. Принятие мер в отношении этих так называемых «классических» загрязнителей – мелкодисперсных частиц (МЧ), озона (O₃), диоксида азота (NO₂) диоксида серы (SO₂) и угарного газа (CO) – также оказывает положительное влияние на концентрацию других вредных загрязняющих веществ.

Особый интерес с точки зрения санитарно-эпидемиологического благополучия населения представляют риски для здоровья, ассоциируемые с мелкодисперсными частицами диаметром менее 10 и 2,5 микрон (мкм) (PM₁₀ и PM₂_.₅, соответственно). Как PM₂_.₅, так и PM₁₀ способны проникать глубоко в легкие, однако частицы PM₂_.₅ могут попадать даже в кровоток, что в первую очередь вредит сердечно-сосудистой и дыхательной системам, а также наносит вред другим органам. Главным источником загрязнения воздуха мелкодисперсными частицами является сжигание топлива в различных секторах экономики, включая транспорт, энергетику, промышленность и сельское хозяйство, а также в быту. В 2013 г. загрязненный атмосферный воздух и мелкодисперсные частицы были классифицированы Международным агентством ВОЗ по изучению рака (МАИР) как канцерогены.

В рекомендациях также приводится информация о передовых методах регулирования концентрации некоторых видов мелкодисперсных частиц (таких как сажа/углерод, ультратонкие частицы, частицы, образующиеся в результате песчаных и пыльных бурь), объем имеющихся данных о которых в настоящее время недостаточен для расчета рекомендованных значений концентрации. Рекомендации касаются как атмосферного воздуха, так и воздуха внутри помещений во всем мире и применимы ко всем странам.

«Загрязнение воздуха ставит под угрозу здоровья населения во всех странах мира, однако в наибольшей степени от него страдает население стран с низким и средним уровнем дохода, — отметил Генеральный директор ВОЗ Д-р Тедрос Адханом Гебрейесус. – Новые рекомендации ВОЗ по качеству воздуха представляют собой научно обоснованный и практический инструмент для улучшения качества воздуха, от которого зависит вся жизнь на планете. Я настоятельно призываю все страны и всех, кто борется за охрану окружающей среды, к внедрению этих рекомендаций в интересах облегчения страданий и спасения жизни людей».

Неравномерное распределение бремени болезни

Во всем мире растет неравенство в том, что касается подверженности воздействию загрязнения воздуха, особенно в странах с низким и средним уровнем дохода, где уровень загрязнения воздуха растет на фоне масштабной урбанизации и реализации модели экономического развития, в значительной степени основанной на использовании ископаемого топлива.

«По оценкам ВОЗ, ежегодно последствия загрязнения воздуха, главным образом неинфекционные заболевания, приводят к смерти миллионов людей. Возможность дышать чистым воздухом должна быть одним из основных прав человека и необходимым условием существования здорового и производительного общества. Однако, несмотря на некоторое улучшение качества воздуха за последние три десятилетия, миллионы людей по-прежнему преждевременно умирают, причем зачастую страдают наиболее уязвимые и маргинализированные слои населения, – сказал директор Европейского регионального бюро ВОЗ д-р Ханс Анри П. Клюге. – Нам известны масштабы проблемы, и мы знаем, как ее решать. В новых рекомендациях политикам предоставлены убедительные доказательства и необходимые инструменты для борьбы с этим источником долгосрочного бремени болезни».

Глобальные оценки загрязнения атмосферного воздуха указывают на то, что только этот вид загрязнения приводит к сотням миллионов утраченных лет здоровой жизни, причем наибольшее бремя болезни приходится на страны с низким и средним уровнем дохода. Чем интенсивнее люди подвергаются воздействию загрязнения воздуха, тем более серьезным является вред здоровью, особенно здоровью людей с хроническими заболеваниями (такими как астма, хроническая обструктивная болезнь легких и болезни сердца), а также пожилых людей, детей и беременных женщин.

В 2019 г. более 90% населения планеты проживало в районах, где концентрация частиц PM₂_.₅ превышала рекомендованные параметры, установленные ВОЗ в 2005 г. В странах, где активно проводится политика, направленная на улучшение качества воздуха, нередко отмечается заметное снижение уровня загрязнения воздуха, тогда как в регионах с уже высокими показателями качества воздуха в течение последних 30 лет снижение уровня загрязнения было менее заметным.

Путь к достижению рекомендованных показателей качества воздуха

Цель данной публикации – помочь всем странам в достижении рекомендованных показателей качества воздуха. Сознавая, что для многих стран и регионов, в которых отмечаются высокие уровни загрязнения воздуха, это будет трудной задачей, ВОЗ предложила промежуточные целевые показатели для содействия поэтапному улучшению качества воздуха и обеспечения постепенного, но заметного улучшения здоровья населения.

Согласно результатам выполненного ВОЗ экспресс-анализа возможных сценариев, почти 80% случаев смерти, обусловленных воздействием частиц класса PM₂_.₅, во всем мире можно было бы предотвратить за счет снижения текущих уровней загрязнения воздуха до рекомендованных в обновленном руководстве. В то же время, достижение промежуточных целевых показателей позволило бы снизить бремя болезни, особенно в странах с высокими концентрациями мелкодисперсных частиц (PM₂_.₅) и многочисленным населением.

Примечания для редакторов

Как и все руководства ВОЗ, рекомендации по качеству воздуха не являются юридически обязательным документом, однако они представляют собой научно обоснованный инструмент, которым лица, ответственные за разработку политики, могут руководствоваться при принятии законодательных и прочих нормативных мер, направленных на снижение уровня загрязнения воздуха и уменьшение бремени заболеваний, обусловленных воздействием загрязнения воздуха, во всем мире. В процессе работы над документом применялась тщательно выверенная методология, подготовленная группой по разработке руководящих принципов. В основу рекомендаций легли научные данные, полученные по итогам шести систематических обзоров, в рамках которых было охвачено в общей сложности более 500 научных публикаций. Процесс подготовки Глобальных рекомендаций по качеству воздуха осуществлялся под надзором руководящей группы, возглавляемой Европейским центром ВОЗ по окружающей среде и охране здоровья.

Mental health

In recent years, there has been increasing acknowledgement of the important role mental health plays in achieving global development goals, as illustrated by the inclusion of mental health in the Sustainable Development Goals. Depression is one of the leading causes of disability. Suicide is the fourth leading cause of death among 15-29-year-olds. People with severe mental health conditions die prematurely – as much as two decades early – due to preventable physical conditions.

Despite progress in some countries, people with mental health conditions often experience severe human rights violations, discrimination, and stigma.

Many mental health conditions can be effectively treated at relatively low cost, yet the gap between people needing care and those with access to care remains substantial. Effective treatment coverage remains extremely low.

Increased investment is required on all fronts: for mental health awareness to increase understanding and reduce stigma; for efforts to increase access to quality mental health care and effective treatments; and for research to identify new treatments and improve existing treatments for all mental disorders. In 2019, WHO launched the WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health to ensure access to quality and affordable care for mental health conditions in 12 priority countries to 100 million more people.

Mental health conditions are increasing worldwide. Mainly because of demographic changes, there has been a 13% rise in mental health conditions and substance use disorders in the last decade (to 2017). Mental health conditions now cause 1 in 5 years lived with disability. Around 20% of the world’s children and adolescents have a mental health condition, with suicide the second leading cause of death among 15-29-year-olds. Approximately one in five people in post-conflict settings have a mental health condition.

Mental health conditions can have a substantial effect on all areas of life, such as school or work performance, relationships with family and friends and ability to participate in the community. Two of the most common mental health conditions, depression and anxiety, cost the global economy US$ 1 trillion each year.

Despite these figures, the global median of government health expenditure that goes to mental health is less than 2%.

WHO works with Member States and partners to improve the mental health of individuals and society at large. This includes the promotion of mental well-being, the prevention of mental disorders, and efforts to increase access to quality mental health care that respects people’s human rights. In 2019, WHO launched the WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health to ensure access to quality and affordable care for mental health conditions in 12 priority countries to 100 million more people.

WHO’s mental health activities cover normative activities and country support activities. WHO has helped extend mental health care in more than 110 countries and is active in the following areas: integration in general health care (through the Mental Health Gap Action Programme, mhGAP) and in disease or topic-specific programmes such as those for HIV, tuberculosis and gender-based violence; suicide prevention; workforce development for mental health; promotion of the quality of care and the rights of people receiving care (QualityRights); mental health policy and legislation; mental health and psychosocial support in humanitarian emergencies; development and testing of innovative psychological interventions including digital interventions; mental health in the workplace; mental health economics; the mental health of children and adolescents; and mental health promotion.

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Obesity and overweight

Key facts

What are obesity and overweight

Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health.

Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m 2 ).

Adults

For adults, WHO defines overweight and obesity as follows:

BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals.

For children, age needs to be considered when defining overweight and obesity.

Children under 5 years of age

For children under 5 years of age:

Children aged between 5–19 years

Overweight and obesity are defined as follows for children aged between 5–19 years:

Facts about overweight and obesity

Some recent WHO global estimates follow.

In 2019, an estimated 38.2 million children under the age of 5 years were overweight or obese. Once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. In Africa, the number of overweight children under 5 has increased by nearly 24% percent since 2000. Almost half of the children under 5 who were overweight or obese in 2019 lived in Asia.

Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.

The prevalence of overweight and obesity among children and adolescents aged 5-19 has risen dramatically from just 4% in 1975 to just over 18% in 2016. The rise has occurred similarly among both boys and girls: in 2016 18% of girls and 19% of boys were overweight.

While just under 1% of children and adolescents aged 5-19 were obese in 1975, more 124 million children and adolescents (6% of girls and 8% of boys) were obese in 2016.

Overweight and obesity are linked to more deaths worldwide than underweight. Globally there are more people who are obese than underweight – this occurs in every region except parts of sub-Saharan Africa and Asia.

What causes obesity and overweight?

The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been:

Changes in dietary and physical activity patterns are often the result of environmental and societal changes associated with development and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing, and education.

What are common health consequences of overweight and obesity?

Raised BMI is a major risk factor for noncommunicable diseases such as:

The risk for these noncommunicable diseases increases, with increases in BMI.

Childhood obesity is associated with a higher chance of obesity, premature death and disability in adulthood. But in addition to increased future risks, obese children experience breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects.

Facing a double burden of malnutrition

Many low- and middle-income countries are now facing a «double burden» of malnutrition.

Children in low- and middle-income countries are more vulnerable to inadequate pre-natal, infant, and young child nutrition. At the same time, these children are exposed to high-fat, high-sugar, high-salt, energy-dense, and micronutrient-poor foods, which tend to be lower in cost but also lower in nutrient quality. These dietary patterns, in conjunction with lower levels of physical activity, result in sharp increases in childhood obesity while undernutrition issues remain unsolved.

How can overweight and obesity be reduced?

Overweight and obesity, as well as their related noncommunicable diseases, are largely preventable. Supportive environments and communities are fundamental in shaping people’s choices, by making the choice of healthier foods and regular physical activity the easiest choice (the choice that is the most accessible, available and affordable), and therefore preventing overweight and obesity.

At the individual level, people can:

Individual responsibility can only have its full effect where people have access to a healthy lifestyle. Therefore, at the societal level it is important to support individuals in following the recommendations above, through sustained implementation of evidence based and population based policies that make regular physical activity and healthier dietary choices available, affordable and easily accessible to everyone, particularly to the poorest individuals. An example of such a policy is a tax on sugar sweetened beverages.

The food industry can play a significant role in promoting healthy diets by:

WHO response

Adopted by the World Health Assembly in 2004 and recognized again in a 2011 political declaration on noncommunicable disease (NCDs), the «WHO Global Strategy on Diet, Physical Activity and Health» describes the actions needed to support healthy diets and regular physical activity. The Strategy calls upon all stakeholders to take action at global, regional and local levels to improve diets and physical activity patterns at the population level.

The 2030 Agenda for Sustainable Development recognizes NCDs as a major challenge for sustainable development. As part of the Agenda, Heads of State and Government committed to develop ambitious national responses, by 2030, to reduce by one-third premature mortality from NCDs through prevention and treatment (SDG target 3.4).

The « Global action plan on physical activity 2018–2030: more active people for a healthier world» provides effective and feasible policy actions to increase physical activity globally. WHO published ACTIVE a technical package to assist countries in planning and delivery of their responses. New WHO guidelines on physical activity, sedentary behavior and sleep in children under five years of age were launched in 2019.

The World Health Assembly welcomed the report of the Commission on Ending Childhood Obesity (2016) and its 6 recommendations to address the obesogenic environment and critical periods in the life course to tackle childhood obesity. The implementation plan to guide countries in taking action to implement the recommendations of the Commission was welcomed by the World Health Assembly in 2017.

New WHO Global Air Quality Guidelines aim to save millions of lives from air pollution

Air pollution is one of the biggest environmental threats to human health, alongside climate change.

New WHO Global Air Quality Guidelines (AQGs) provide clear evidence of the damage air pollution inflicts on human health, at even lower concentrations than previously understood. The guidelines recommend new air quality levels to protect the health of populations, by reducing levels of key air pollutants, some of which also contribute to climate change.

Since WHO’s last 2005 global update, there has been a marked increase of evidence that shows how air pollution affects different aspects of health. For that reason, and after a systematic review of the accumulated evidence, WHO has adjusted almost all the AQGs levels downwards, warning that exceeding the new air quality guideline levels is associated with significant risks to health. At the same time, however, adhering to them could save millions of lives.

Every year, exposure to air pollution is estimated to cause 7 million premature deaths and result in the loss of millions more healthy years of life. In children, this could include reduced lung growth and function, respiratory infections and aggravated asthma. In adults, ischaemic heart disease and stroke are the most common causes of premature death attributable to outdoor air pollution, and evidence is also emerging of other effects such as diabetes and neurodegenerative conditions. This puts the burden of disease attributable to air pollution on a par with other major global health risks such as unhealthy diet and tobacco smoking.

Air pollution is one of the biggest environmental threats to human health, alongside climate change. Improving air quality can enhance climate change mitigation efforts, while reducing emissions will in turn improve air quality. By striving to achieve these guideline levels, countries will be both protecting health as well as mitigating global climate change.

WHO’s new guidelines recommend air quality levels for 6 pollutants, where evidence has advanced the most on health effects from exposure. When action is taken on these so-called classical pollutants – particulate matter (PM), ozone (O₃), nitrogen dioxide (NO₂) sulfur dioxide (SO₂) and carbon monoxide (CO), it also has an impact on other damaging pollutants.

The health risks associated with particulate matter equal or smaller than 10 and 2.5 microns (µm) in diameter (PM₁₀ and PM₂_.₅, respectively) are of particular public health relevance. Both PM₂_.₅ and PM₁₀ are capable of penetrating deep into the lungs but PM₂_.₅ can even enter the bloodstream, primarily resulting in cardiovascular and respiratory impacts, and also affecting other organs. PM is primarily generated by fuel combustion in different sectors, including transport, energy, households, industry, and from agriculture. In 2013, outdoor air pollution and particulate matter were classified as carcinogenic by WHO’s International Agency for Research on Cancer (IARC).

The guidelines also highlight good practices for the management of certain types of particulate matter (for example, black carbon/elemental carbon, ultrafine particles, particles originating from sand and dust storms) for which there is currently insufficient quantitative evidence to set air quality guideline levels. They are applicable to both outdoor and indoor environments globally, and cover all settings.

“Air pollution is a threat to health in all countries, but it hits people in low- and middle-income countries the hardest,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “WHO’s new Air Quality Guidelines are an evidence-based and practical tool for improving the quality of the air on which all life depends. I urge all countries and all those fighting to protect our environment to put them to use to reduce suffering and save lives.”

An unequal burden of disease

Disparities in air pollution exposure are increasing worldwide, particularly as low- and middle-income countries are experiencing growing levels of air pollution because of large-scale urbanization and economic development that has largely relied on the burning of fossil fuels.

“Annually, WHO estimates that millions of deaths are caused by the effects of air pollution, mainly from noncommunicable diseases. Clean air should be a fundamental human right and a necessary condition for healthy and productive societies. However, despite some improvements in air quality over the past three decades, millions of people continue to die prematurely, often affecting the most vulnerable and marginalized populations,” said WHO Regional Director for Europe, Dr Hans Henri P. Kluge. “We know the magnitude of the problem and we know how to solve it. These updated guidelines give policy-makers solid evidence and the necessary tool to tackle this long-term health burden.”

Global assessments of ambient air pollution alone suggest hundreds of millions of healthy life years of life lost, with the greatest attributable disease burden seen in low and middle-income countries. The more exposed to air pollution they are, the greater the health impact, particularly on individuals with chronic conditions (such as asthma, chronic obstructive pulmonary disease, and heart disease), as well as older people, children and pregnant women.

In 2019, more than 90% of the global population lived in areas where concentrations exceeded the 2005 WHO air quality guideline for long term exposure to PM₂_.₅. Countries with strong policy-driven improvements in air quality have often seen marked reduction in air pollution, whereas declines over the past 30 years were less noticeable in regions with already good air quality.

The road to achieving recommended air quality guideline levels

The goal of the guideline is for all countries to achieve recommended air quality levels. Conscious that this will be a difficult task for many countries and regions struggling with high air pollution levels, WHO has proposed interim targets to facilitate stepwise improvement in air quality and thus gradual, but meaningful, health benefits for the population.

Almost 80% of deaths related to PM₂_.₅ could be avoided in the world if the current air pollution levels were reduced to those proposed in the updated guideline, according to a rapid scenario analysis performed by WHO. At the same time, the achievement of interim targets would result in reducing the burden of disease, of which the greatest benefit would be observed in countries with high concentrations of fine particulates (PM₂_.₅) and large populations.

Note to editors

Whilst not legally-binding, like all WHO guidelines, AQGs are an evidence-informed tool for policy-makers to guide legislation and policies, in order to reduce levels of air pollutants and decrease the burden of disease that results from exposure to air pollution worldwide. Their development has adhered to a rigorously defined methodology, implemented by a guideline development group. It was based on evidence obtained from six systematic reviews that considered more than 500 papers. The development of these global AQGs was overseen by a steering group led by the WHO European Centre for Environment and Health.

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WHO advice for international traffic in relation to the SARS-CoV-2 Omicron variant (B.1.1.529)

(updated with correction)

The World Health Organization (WHO) has designated the variant B.1.1.529 a variant of concern (VOC), named Omicron, on the basis of advice from WHO’s Technical Advisory Group on Virus Evolution (hereafter referred to as TAG-VE) on 26 November 2021. Following the group’s announcement an increasing number of countries are introducing temporary travel measures, including temporarily prohibiting the arrival of international travellers from Southern African countries and others where the new variant is being detected, including from South Africa, which first reported the variant to WHO on 24 November 2021.

WHO commends South Africa and Botswana for their capacities in surveillance and sequencing and for the speed and transparency with which they notified and shared information with the WHO Secretariat on the Omicron variant in accordance with the International Health Regulations (2005) (IHR). These actions have allowed other countries to rapidly adjust their response measures in the context of the COVID-19 pandemic. WHO calls on all countries to follow the IHR (2005) and to show global solidarity in rapid and transparent information sharing and in a joint response to Omicron (as with all other variants), leveraging collective efforts to advance scientific understanding and sharing the benefits of applying newly acquired scientific knowledge and tools.

As noted in the WHO announcement, the Omicron variant has a large number of mutations, some of which are concerning. Preliminary evidence suggests an increased risk of reinfection with this variant as compared to other VOCs. Current SARS-CoV-2 polymerase chain reaction (PCR) diagnostics continue to be effective in detecting this variant. A technical brief on the latest information on Omicron can be found here.

It is expected that the Omicron variant will be detected in an increasing number of countries as national authorities step up their surveillance and sequencing activities. WHO is closely monitoring the spread of the Omicron variant, and studies are ongoing to understand more about these mutations and their impact on transmissibility, virulence, diagnostics, therapeutics and vaccines. The TAG-VE will continue to evaluate the Omicron variant, and WHO will communicate new findings with IHR States Parties and the public as needed.

While scientific research is underway to understand how the variant behaves, WHO advises the following:

Essential international travel –including travel for emergency and humanitarian missions, travel of essential personnel, repatriations and cargo transport of essential supplies–should continue to be prioritized at all times during the COVID-19 pandemic.

Advice for the public: Coronavirus disease (COVID-19)

Advice for the public

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This page includes advice from WHO on ways to protect yourself and prevent the spread of COVID-19. The downloadable infographics below provide guidance on general and specific topics related to the pandemic.

Stay aware of the latest COVID-19 information by regularly checking updates from WHO in addition to national and local public health authorities.

Find out more about getting vaccinated:

Keep yourself and others safe: Do it all!

Protect yourself and those around you:

Wear a mask properly

To properly wear your mask:

More about masks:

Make your environment safer

The risks of getting COVID-19 are higher in crowded and inadequately ventilated spaces where infected people spend long periods of time together in close proximity.

Outbreaks have been reported in places where people have gather, often in crowded indoor settings and where they talk loudly, shout, breathe heavily or sing such as restaurants, choir practices, fitness classes, nightclubs, offices and places of worship.

To make your environment as safe as possible:

Keep good hygiene

By following good respiratory hygiene you protect the people around you from viruses that cause colds, flu and COVID-19.

To ensure good hygiene you should:

What to do if you feel unwell

If you feel unwell, here’s what to do.

The 2021 World Health Organization Classification of Tumors of the Central Nervous System: What Neuroradiologists Need to Know

Abstract

SUMMARY: Neuroradiologists play a key role in brain tumor diagnosis and management. Staying current with the latest classification systems and diagnostic markers is important to provide optimal patient care. Publication of the 2016 World Health Organization Classification of Tumors of the Central Nervous System introduced a paradigm shift in the diagnosis of CNS neoplasms. For the first time, both histologic features and genetic alterations were incorporated into the diagnostic framework, classifying and grading brain tumors. The newly published 2021 World Health Organization Classification of Tumors of the Central Nervous System, May 2021, 5th edition, has added even more molecular features and updated pathologic diagnoses. We present, summarize, and illustrate the most salient aspects of the new 5th edition. We have selected the key “must know” topics for practicing neuroradiologists.

ABBREVIATIONS:

Publication of the 2016 World Health Organization (WHO) Classification of Tumors of the Central Nervous System introduced a paradigm shift in the diagnosis of CNS neoplasms. For the first time, both histologic features and genetic alterations were incorporated into the diagnostic framework, classifying and grading brain tumors.

We present, summarize, and illustrate the most salient aspects of the new 5th edition. We have selected the key “must know” topics for practicing neuroradiologists. The 2021 WHO Classification of Tumors of the Central Nervous System can be ordered in either print or digital form from the WHO website and should be part of every neuroradiologist’s library.

General Features and Recommendations

Tumor Taxonomy and Nomenclature.

Prior editions used the terms “entities” and “variants.” The current edition uses the terms “types” and “subtypes” and keeps tumor names as simple as possible. Newly recognized or redefined types and subtypes are summarized in the Online Supplemental Data.

Tumor Grading.

The 5th edition uses Arabic numerals instead of Roman numerals to conform to other WHO grading systems and decrease the likelihood of typographic errors when grading within types. Tumor grades are now designated specifically as CNS WHO grades 1–4 (“CNS” is always added to distinguish the grading system from those of systemic neoplasms because CNS grading differs conceptually, eg, grading of diffuse astrocytomas from 2 to 4, without a 1).

Not Otherwise Specified and Not Elsewhere Classified.

Not otherwise specified (NOS) is used when molecular information is not available/not performed/not successful. Not elsewhere classified (NEC) is used when necessary diagnostic testing was successfully performed but the results do not readily permit a WHO diagnosis (eg, entities that are not yet recognized as part of the WHO Classification). 3 NOS and NEC can be used for any tumor type.

“Layered” Reports and Integrated Diagnosis.

A matrix approach to an integrated pathologic diagnosis is used throughout the 5th edition (Table). Features such as location (eg, cerebrum or cerebellum), histopathology, and molecular information (when available) are combined into the top layer (in reality the “bottom line”) to create an integrated diagnosis. Tumor grade reflects a combination of histologic features and genetically defined mutation status. If molecular information is unavailable, tumor entities are generally designated by NOS.

Layered neuropathology diagnosis a

General Taxonomy

The WHO 5th edition organizes CNS neoplasms into several major groups: gliomas, glioneuronal, and neuronal tumors; choroid plexus tumors; embryonal tumors; pineal tumors; cranial and paraspinal nerve tumors; meningioma; mesenchymal, nonmeningothelial tumors; melanocytic tumors; hematolymphoid tumors; germ cell tumors; tumors of the sellar region; and metastases to the CNS. In this overview, we will focus on the tumor groups with specific changes such as newly recognized tumor entities, revised nomenclature, and restructured tumor groupings.

Gliomas, Glioneuronal, and Neuronal Tumors

Gliomas, glioneuronal, and neuronal tumors, along with the embryonal tumors, have undergone the most important changes since the 2016 4th edition. There are now 14 newly recognized (“new”) gliomas and glioneuronal tumors in the 5th edition of the blue book. In addition, for the first time, the WHO classification divides diffuse gliomas into adult-type and pediatric-type neoplasms.

Gliomas

Neuropathologic Essentials.

Glioma characterization requires more than simply determining whether a tumor exhibits 1p/19q codeletion on fluorescence in situ hybridization (FISH) and is isocitrate dehydrogenase (IDH) mutant or IDH-wildtype on immunohistochemistry, to implement the 2021 WHO classification fully. For example, IDH-wildtype diffuse astrocytic gliomas in patients 55 years of age and younger should also be investigated for noncanonical (ie, non-R132H) IDH1 mutations and IDH2 mutations. In other molecular markers such as loss of ATRX expression or TERT promoter mutations, the presence of TP53 or histone H3 mutations, EGFR amplification, or CDKN2A/B alterations, and so forth need to be evaluated in specific diagnostic pathways.

Some genetic changes have convenient immunohistochemistry surrogate assays (eg, IDH1 R132H, ATRX, p53, BRAF V600E, H3K27M, H3 G34R/V), while others can be detected with FISH (eg, CDKN2A/B homozygous deletion, EGFR amplification, 1p/19q codeletion). Next-generation sequencing assays will detect many of these and other events such as mutations and fusions. Methylome profiling has also emerged as a powerful tool that can be used itself for classification and can also either directly or indirectly identify many of the above molecular alterations.

Four general groups of diffuse gliomas are recognized in the 2021 WHO classification: 1) adult-type diffuse gliomas, 2) pediatric-type diffuse low-grade gliomas, 3) pediatric-type diffuse high-grade gliomas, and 4) circumscribed astrocytic gliomas.

Adult-type diffuse gliomas are astrocytoma, IDH-mutant; oligodendroglioma, IDH-mutant and 1p/19q-codeleted; and glioblastoma, IDH-wildtype. IDH-mutant diffuse astrocytomas are now graded 2–4 within type; the terms IDH-mutant “anaplastic astrocytoma” and “glioblastoma” have been dropped. In addition, if an IDH-mutant diffuse astrocytoma exhibits CDKN2A/B homozygous deletion, it is designated as a CNS WHO grade 4 neoplasm, even if histologic features of malignancy such as necrosis and microvascular proliferation are absent.

Imaging features suggestive of an IDH-mutant diffuse astrocytoma grade 2 include a homogeneous T2-hyperintense circumscribed supratentorial mass typically in the frontal or temporal lobes without calcification or enhancement. The T2-FLAIR mismatch sign, characterized by T2 homogeneity of the mass with relatively hypointense signal throughout most of the lesion on FLAIR compared with T2 sequences except for a peripheral rim of hyperintense signal, is highly predictive of IDH-mutant diffuse astrocytoma. The T2-FLAIR mismatch sign has high specificity but low sensitivity for IDH-mutant diffuse astrocytomas. 12,13 Imaging features of IDH-mutant diffuse astrocytoma grade 3 may be indistinguishable from grade 2 IDH-mutant diffuse astrocytomas. However, grade 3 astrocytomas may have T2 heterogeneity and enhancement as well as elevated maximum relative CBV. The mean maximum relative CBV is significantly higher in WHO grade 3 astrocytomas than in WHO grade 2 astrocytomas. 14 Imaging features typical of oligodendroglioma, IDH-mutant and 1p/19q-codeleted, tumors include frontal lobe location, heterogeneity, and calcification with variable enhancement (Fig 1). 12

Adult-type diffuse gliomas. Series of 3 cases illustrates the importance of complete IDH mutation status determination and the investigation of other molecular markers in evaluation of adult-type diffuse astrocytomas. Axial FLAIR (A) and postcontrast T1WI (B) in a 54-year-old man with a first-time seizure shows a well-delineated left frontal lobe mass with a hyperintense rim surrounding a mixed signal mass. No enhancement is present. Pathology disclosed diffuse astrocytoma without necrosis or microvascular proliferation. Immunohistochemistry demonstrated that the tumor was IDH-mutant. Next generation sequencing disclosed CDKN2A/B homozygous loss, so the tumor was upgraded to WHO CNS grade 4. Axial FLAIR (C) and postcontrast T1WI (D) in a 44-year-old woman with a first-time seizure demonstrate a left frontal mass that was completely resected. Pathology findings were consistent with WHO CNS grade 3. Initial immunohistochemistry was negative for IDH1 mutation, but further investigation disclosed the presence of an IDH2 mutation. Final pathologic diagnosis is diffuse astrocytoma, IDH-mutant, grade 3. The patient is alive without evidence of disease 4 years after the initial diagnosis. Axial FLAIR (E) and postcontrast T1WI (F) in a 24-year-old woman with a first-time seizure show a well-delineated nonenhancing left frontal lobe mass that was surgically resected. Histologically, the tumor was WHO CNS grade 2 but IDH-wildtype on immunohistochemistry. No further investigation was conducted. One year later, the tumor recurred and re-resection demonstrated EGFR amplification and was, therefore, upgraded to glioblastoma (WHO CNS grade 4). The patient died of disseminated disease 18 months after the initial diagnosis.

The presence of any one of the following 5 criteria is sufficient to designate an IDH-wildtype diffuse astrocytic glioma as a glioblastoma. IDH-wildtype is characterized by the following: microvascular proliferation or necrosis or TERT promotor mutation or EGFR gene amplification or +7/–10 chromosome copy number changes. Such tumors are no longer called “diffuse astrocytic glioma, IDH-wildtype with molecular features of glioblastoma multiforme.” If an IDH-wildtype tumor exhibits none of these histologic or molecular features (eg, appears as a lower grade than a glioblastoma, CNS WHO grade 4), it would be classified as diffuse astrocytoma, NEC (Fig 1).

Pediatric-type diffuse low-grade gliomas are diffuse astrocytomas, MYB or MYBL1-altered; angiocentric gliomas (Fig 2); polymorphous low-grade neuroepithelial tumor of the young (a newly recognized entity exhibiting oligodendroglioma-like histology with variable morphology and MAPK-pathway alterations); 15 and diffuse low-grade gliomas, MAPK pathway–altered. Angiocentric gliomas are T2-hyperintense masses typically in the temporal or frontal lobe cortex in young patients with seizures (Fig 2). Polymorphous low-grade neuroepithelial tumors of the young are typically well-circumscribed T2-hyperintense lesions on MR imaging with central calcification and peripheral cystic components (Fig 3). They are commonly supratentorial, most often within the temporal lobe. 15,16 Diffuse low-grade glioma, MAPK pathway–altered, is a group of neoplasms that are IDH- and H3-wildtype and include most tectal gliomas. Up-regulation of the RAS/MAPK pathway is almost universal in these lesions, with a spectrum of FGFR1 and BRAF mutations. Histologic features of malignancy and molecular alterations such as CDKN2A/B mutations are absent. 17,18 The classic tectal gliomas are not considered a distinct WHO entity. Most fit histologically and genetically into either pilocytic astrocytoma with BRAF alterations and NRAS mutations or diffuse low-grade glioma, MAPK pathway–altered.

Pediatric-type diffuse low-grade glioma. Axial T2 (A) MR image in a 7-year-old boy with a diffuse astrocytoma, MYB-altered, shows a hyperintense mass in the pons with no significant surrounding edema. There was no enhancement and no diffusion restriction of the mass (not shown). Axial FLAIR (B), postcontrast T1 (C), and arterial spin-labeling (ASL) (D) in a 1-year-old child with an angiocentric glioma show a FLAIR hyperintense mass involving the cortex and subcortical white matter of the left frontal lobe. There is no enhancement (C) and decreased perfusion (D) on ASL imaging.

Two patients with the WHO 2021 new-entity polymorphous low-grade neuroepithelial tumor of the young (PLNTY). Axial FLAIR (A) and postcontrast T1-weighted (B) MR images in a 19-year-old man with refractory epilepsy show a hyperintense, nonenhancing mass in the cortex and subcortical white matter of the left temporal lobe. Axial FLAIR (C) and susceptibility-weighted (D) MR images and a noncontrast CT image (E) in a 19-year-old woman with progressive seizure show a FLAIR-hyperintense, SWI-hypointense mass with characteristic calcification seen on CT in the right medial temporal lobe (Case courtesy of M. Castillo, MD).

Pediatric-type diffuse high-grade gliomas are defined primarily by molecular features and include diffuse midline glioma, H3K27-altered (note that the term “mutant” has been changed) (Fig 4); diffuse hemispheric glioma, H3 G34-mutant (an H3F3A-mutant, IDH-wildtype tumor that exhibits glioblastoma-like histology, often with primitive embryonal regions) (Fig 5); diffuse pediatric-type high-grade glioma, H3-wildtype and IDH-wildtype (a group of tumors with different possible genotypes); and infant-type hemispheric glioma (Fig 6). 19,20 The classic diffuse intrinsic pontine gliomas seen on MR imaging as expansile T2-hyperintense lesions are most commonly diffuse midline gliomas, H3K27-altered pathologically, similar to the 2016 WHO description. However, other gliomas may affect the pons. 21 In addition to the more common pediatric brainstem glioma presentation, H3K27-altered high-grade gliomas occur in adults and have the same lethality as in their pediatric counterparts. 18 Unilateral thalamic or bithalamic lesions are common in H3K27-altered high-grade gliomas as is aggressive local spread and early metastatic dissemination.

Pediatric-type diffuse high-grade gliomas. Diffuse midline glioma, H3K27-altered in an 8-year-old girl with cranial neuropathies. Axial T2 (A) and FLAIR (B) MR images show an expansile, hyperintense pontine mass. Axial postcontrast T1 MR image (C) shows heterogeneous enhancement within the mass. Arterial spin-labeling (ASL) perfusion (D) shows increased perfusion. E, Axial FLAIR MR image shows a bithalamic hyperintense mass. Postcontrast T1WI showed no significant enhancement, and ASL perfusion showed increased perfusion within the bilateral thalami (not shown). These WHO grade 4 tumors have a poor prognosis.

Diffuse hemispheric glioma, H3 G34-mutant and IDH-wildtype tumor in an 8-year-old boy. A, Axial FLAIR shows a large, very heterogeneous right temporal lobe mass with minimal surrounding edema. B, An ADC map in the same case shows restricted diffusion consistent with a high-cellularity tumor. C, Arterial spin-labeling perfusion shows decreased perfusion in the tumor. In pediatric tumors, perfusion is often less helpful compared with diffusion-weighted imaging in discriminating tumor grade. Histology demonstrated necrosis, hemorrhage, and neovascularity in a glioblastoma-like pattern, consistent with grade 4 tumor.

Infant-type hemispheric glioma, NOS. A male neonate child with macrocephaly and bulging fontanelles had a large, heterogeneous-appearing mass on an emergent CT scan (not shown). Axial T2-weighted (A) and postcontrast T1-weighted (B) MR images show a very heterogeneous mass with enhancement involving almost the entirety of the left cerebral hemisphere.

Infant-type hemispheric gliomas are tumors of early childhood that exhibit high-grade astrocytic (often glioblastoma-like) histologic features with alterations in ALK/ROS1/NTRK/MET. A large, bulky nearly holohemispheric, heterogeneous-appearing tumor with intratumoral hemorrhage is typical.

Circumscribed astrocytic gliomas include long-recognized neoplasms (such as pilocytic and subependymal giant cell astrocytomas) and 2 new entities, high-grade astrocytomas with piloid features and astroblastoma, MN1-altered. While not designated as separate entities, the molecular characterization of low-grade gliomas has had a profound effect on their treatment. For instance, the identification of BRAF V600E mutations allows targeted disruption by using BRAF inhibitors, with favorable clinical results. 22

The diagnosis of high-grade astrocytoma with piloid features recognizes unusual cases in which a relatively circumscribed tumor with distinct piloid cytology occurs in the setting of a more malignant astrocytoma (WHO grades 3 or 4). 23 These tumors usually occur in adults, exhibit CDKN2A/B deletions, and have a distinct DNA methylation profile that differs from the typical childhood pilocytic astrocytomas. Most of these tumors occur in the posterior fossa (PF), are T2-hyperintense, and show heterogeneous enhancement. 23 The relationship with so-called “anaplastic pilocytic astrocytomas” and pre-existing pilocytic astrocytomas is currently undetermined.

Astroblastoma, MN1-altered, is newly classified as a circumscribed astrocytic glioma (in 2016 it was categorized with “other gliomas”). MN—1 alterations are present in 70%. 24 If MN-1 alteration is absent or not determined, the tumor is designated NEC or NOS, respectively. Most astroblastomas are located superficially in a cerebral hemisphere and are relatively well-circumscribed tumors that can be multicystic or “bubbly” in appearance. Edema is minimal or absent (Fig 7). 8,25,26 No formal grade for astroblastoma is assigned in the 5th edition.

Axial T2WI in a 19-month-old child with astroblastoma, MN1-altered. A, Axial T2WI shows a bubbly-appearing mixed-signal hemispheric mass with little surrounding edema. B, Postcontrast T1WI shows that the mass enhances strongly but heterogeneously.

Miscellaneous 5th Edition Glioma Items.

In 2021, pilomyxoid astrocytoma continues to be considered a variant of pilocytic astrocytoma, not a distinct entity. The location modifier (third ventricle) has been dropped from choroid glioma. Like medulloblastoma, it only occurs in 1 location; therefore, a location modifier is not necessary.

Glioneuronal and Neuronal Tumors

Ganglioglioma, desmoplastic infantile ganglioglioma/astrocytoma, dysembryoplastic neuroepithelial tumor, and other mixed glioneuronal tumors such as rosette-forming glioneuronal tumor are unchanged. Newly clarified and added tumor entities include diffuse glioneuronal tumor with oligodendroglioma-like features and nuclear clusters (DGONC), myxoid glioneuronal tumor (MGNT), and multinodular and vacuolating neuronal tumor (MVNT).

DGONC is included in the 5th edition as a provisional entity, defined primarily by a DNA methylation profile. As the name implies, histology is oligodendroglioma-like with large cells that have clusters of nuclei. DGONCs are primarily pediatric tumors but can occur at all ages. 27

MGNT is a CNS WHO grade 1 neoplasm that is stereotypically located in the septum pellucidum, though it can also occur in the corpus callosum and periventricular white matter. Oligodendrocyte-like tumor cells are embedded in a prominent myxoid stroma. Specific mutations in PDGFRA are definitional. 28,29 In addition to location, suggestive imaging findings include T2 hyperintensity, peripheral FLAIR hyperintensity, and lack of enhancement (Fig 8). MGNTs are considered CNS WHO grade 1 neoplasms, but many cases exhibit ventricular dissemination or local recurrence/progression. 8,29

Two cases of MGNT are illustrated. A, Axial T2WI in a 14-year-old boy shows an extremely hyperintense, slightly bubbly mass in the left juxtaventricular white matter. B, Axial FLAIR shows a hyperintense rim surrounding a largely isointense center of the mass. Smaller-but-similar-appearing lesions are adjacent to the mass. The mass did not enhance following contrast administration. C, Sagittal T1WI in a 39-year-old man shows a well-demarcated mass in the corpus callosum rostrum/septum pellucidum. D, The mass is extremely hyperintense on T2WI. E, FLAIR shows that the mass has a hyperintense rim with an isointense center. The mass is thought to represent an MGNT because of its classic location and signal characteristics but is not biopsy-proven.

MVNT was considered a pattern of ganglion cell tumors in the 2016 WHO. Whether MVNT represented a neoplastic or malformative process was then unknown. Now MVNTs are recognized as clonal neoplasms of the MAPK pathway with mutations in MAPK2K1 and BRAF (excluding V600E) as well as FGFR2 fusions. MVNTs are nonprogressive CNS WHO grade 1 lesions. MR imaging features are virtually pathognomonic with clusters of T2-FLAIR hyperintense nodules (little bubbles) along the undersurface of the cerebral cortex and subcortical white matter. 30,31 MVNT-like lesions have also been reported in the posterior fossa. 32

Ependymal Tumors

Ependymomas (EPNs) are the last of the glioma/glioneuronal/neuronal tumor groupings. The 2016 WHO divided ependymal tumors into 4 subgroups: subependymoma (CNS WHO grade I), myxopapillary ependymoma (CNS WHO grade I), ependymoma (CNS WHO grade II), and anaplastic ependymoma (CNS WHO grade III).

In a major departure since the 2016 WHO, ependymomas are now uniquely grouped by location. 8,9 The WHO recognized 3 distinct anatomic sites: supratentorial (ST), PF, and spinal cord (SC) EPNs. Within each specific anatomic site, molecularly defined subgroups are defined by gene and DNA methylation profiling. Each differs in location, age, prognosis, and clinicopathologic characteristics. 9

ST-EPN.

ZFTA fusion–positive ependymomas (formerly RELA-fusion ependymoma) are extraventricular hemispheric tumors that exhibit rearrangement of partners with the ZFTA (formerly C11orf95) genes (Fig 9). These tumors are the largest group of currently defined ST-EPNs. They occur in both children and adults and are designated CNS WHO grade 2 or 3 neoplasms. They appear as relatively well-defined mixed cystic-solid masses on imaging studies. YAP1-fusion ST-EPNs are found mostly in children younger than 3 years of age and have a better prognosis than ZFTA ependymomas. 33 Tumors that do not have the ZFTA- or YAP1-fusion events are termed ST-EPN are described by their histologic features.

ZFTA fusion–positive ependymoma in an 11-year-old girl. A, Axial T2WI shows a large, bulky, heterogeneous left frontal mass. B, Susceptibility-weighted scan shows intratumoral hemorrhage. C, Strong-but-very heterogeneous enhancement is seen on postcontrast T1WI.

PF-EPNs can now be divided molecularly into 2 subgroups: PF-EPN A and PF-EPN-B. 34 PF-A ependymomas occur mainly in infants, exhibit loss of H3K27me3 expression on immunohistochemistry, exhibit EZHIP overexpression, and have significantly worse outcome than PF-EPN-B tumors. PF-EPN-B tumors are more common in older children and adults. Posterior fossa ependymomas are characterized on MR imaging as a lobulated, heterogeneous mass in the body or inferior fourth ventricle, which often extends through the foramen of Magendie into the cisterna magna or through the foramina of Luschka into the cerebellopontine angle cisterns. Calcification and cystic changes are often seen. Both the histology and imaging features of the 2 posterior fossa ependymoma subgroups are similar, but PF-EPN-A tumors are more likely to have a lateral location within the posterior fossa and show cerebellar invasion. 9,35 Tumors that cannot be evaluated further are termed posterior fossa ependymomas and are described by their histologic features.

Spinal Ependymomas.

The 2021 WHO recognizes a new type of spinal cord ependymoma with MYCN–amplification. MYCN-amplified ependymoma is mostly found in adults and exhibits anaplastic histology. These tumors are typically located in the cervical or thoracic spinal cord and extend over many spinal segments. These spinal cord tumors are heterogeneously T2-hyperintense and enhancing and are typically extramedullary or have an exophytic portion if intramedullary and are characterized by leptomeningeal disease. Early dissemination and poor prognosis are typical. 9,36 Of note, myxopapillary ependymomas are now designated CNS WHO grade 2 neoplasms because their biologic behavior is more consistent with this designation. 9

Choroid Plexus Tumors

The classification of choroid plexus tumors remains unchanged in 2021, though these are now listed separately from the glial and glioneuronal neoplasms.

Embryonal Tumors

The 2021 WHO classifies CNS embryonal tumors into 2 groups: medulloblastoma and other CNS embryonal tumors (the term “primitive neuroectodermal tumor” has been abandoned since 2016).

Medulloblastoma

As in 2016, medulloblastomas (MBs) can be either molecularly or histologically defined. The molecularly-defined MB subgroups are defined by DNA methylation or transcriptome profiling and remain unchanged: medulloblastoma, WNT-activated; medulloblastoma, SHH-activated and TP53 wild-type; medulloblastoma, SHH-activated and TP53-mutant; and medulloblastoma, non-WNT/non-SHH. 11,37-39

Medulloblastoma, WNT-activated, represents approximately 10% of MBs. There are 2 age-determined subtypes: children and adults. WNT MBs can be found in all posterior fossa locations and are thought to arise from the lower rhombic lip. Imaging studies suggest that the cerebellar peduncle and cerebellopontine angle are the most characteristic but not the only location. WNT-activated MBs have the best prognosis of all 4 groups. Metastases are rare at diagnosis, and the 5-year survival rate is 95%. 11,37,38

Medulloblastoma, SHH-activated/TP53 wild-type, represents approximately 30% of MBs overall but accounts for nearly two-thirds of MBs occurring between 3–16 years of age. This MB subgroup has the most striking biologic, pathologic, and clinical heterogeneity of all 4 subgroups. SHH-activated MBs arise from granule neuron progenitor cells in the upper rhombic lip, so a cerebellar hemispheric location is typical. These MBs have 4 provisional molecular subtypes as defined by DNA methylation or transcriptome profiling: SHH-1 and SHH-2 are the most common subgroups to exhibit desmoplastic or medulloblastoma with extensive nodularity histology. Desmoplastic MBs are more common in adults and have a predilection for the lateral cerebellar hemisphere. 37 SHH-3 and SHH-4 most commonly exhibit classic or large-cell anaplastic histology and can be found in all locations. 39,40

Medulloblastoma, SHH-activated/TP53-mutant, is the rarest of the MB subtypes and has the worst overall prognosis. 11,40

Medulloblastoma, non-WNT/non-SHH, is the most common MB subtype, representing 50%–60% of all MBs. This subtype encompasses the former group 3 (20%) and group 4 (40%–50%) MBs. This subtype has 8 molecular subgroups (Gp3/4–1 to Gp3/4–8) as determined by methylation profiling. Non-SHH, non-WNT MBs can be found in all locations and often exhibit minimal or no enhancement. 11

Other CNS Embryonal Tumors

This group of “other” embryonal tumors includes atypical teratoid/rhabdoid tumor and the addition of several “new” tumor types: a provisional type called cribriform neuroepithelial tumor and CNS tumor with BCOR internal tandem duplication. One embryonal tumor with a newly identified genotype is CNS neuroblastoma, FOXR2-activated. This group also includes embryonal tumor with multilayered rosettes (ETMR).

Cribriform Neuroepithelial Tumor.

Cribriform neuroepithelial tumor (provisional diagnosis) is a nonrhabdoid neuroectodermal tumor characterized molecularly by loss of nuclear SMARCB1/INI1 expression and histologically by cribriform strands/ribbons. Cribriform neuroepithelial tumors occur near the ventricles in young children and have a better prognosis than atypical teratoid/rhabdoid tumors. 40

CNS Tumor with BCOR Internal Tandem Duplication.

CNS tumors with BCOR internal tandem duplication are mostly hemispheric malignant tumors of children and adolescents that are characterized by internal tandem duplication in the BCOR gene, similar to other systemic tumors. 41

ETMR was included in 2016 specifically as chromosome 19 microRNA cluster–altered. An additional subtype, DICER1-mutated ETMR, has been recently described. ETMRs subsume many prior entities such as embryonal tumor with abundant neuropil and true rosettes, medulloepithelioma, ependymoblastoma, and many tumors formerly known as CNS primitive neuroectodermal tumors. ETMRs are tumors of infants and children younger than 4 years of age. They are seen on imaging studies as large, cellular, relatively well-demarcated-but-heterogeneous-appearing masses. 42 While they do occur in the posterior fossa, most are supratentorial hemispheric lesions (70% of cases). Necrosis and intratumoral hemorrhage are common. Solid components of the tumors typically exhibit restricted diffusion. Enhancement varies from patchy, sparse to mostly absent (Fig 10). 42

Embryonal tumor with multilayered rosettes in a 1-year-old girl. A, An axial T2-weighted scan shows a large, left parieto-occipital mass with little surrounding edema. B, The mass exhibits hemorrhage on susceptibility-weighted imaging and no enhancement following contrast administration (C). D, Strikingly restricted diffusion is seen on the ADC map. E, Arterial spin-labeling perfusion shows decreased perfusion in the tumor.

CNS Neuroblastoma, FOXR2-Activated.

CNS neuroblastoma is a newly recognized embryonal tumor that has a characteristic histology and FOXR2 gene alterations. 43 These primary CNS neuroblastomas have a peak at 5 years of age and are characterized by neuronal differentiation, high vascularity, necrosis, and endothelial proliferation. Imaging shows a large, heterogeneous supratentorial mass with prominent cysts, necrosis, little surrounding edema, and variable enhancement.

Keep in mind that the imaging differential diagnosis of a large, bulky, heterogeneous hemispheric mass in an infant or young child includes ETMR, infant-type hemispheric glioma, ZFTA ependymoma, CNS neuroblastoma, FOXR2-activated and CNS embryonal tumor, NOS or NEC. The term primitive neuroectodermal tumor has been abandoned since 2016.

Pineal Tumors

With 1 exception, pineal tumors remain unchanged since 2016. A newly codified tumor, desmoplastic myxoid tumor of the pineal region, SMARCB1-mutant, is now recognized. This rare tumor of the pineal region (not specifically the pineal gland) has both desmoplastic and myxoid changes but no histopathologic signs of malignancy. 44 Only a limited number of cases have been reported with an age range of 15–61 years (median, 40 years). 11

Cranial and Paraspinal Nerve Tumors

The term malignant melanotic nerve sheath tumor, previously called melanotic schwannoma, has been changed, in part, because it behaves more aggressively than nonmelanotic schwannomas and also to conform with soft-tissue nomenclature.

Meningiomas

In terms of the overall classification, the meningioma tumor group remains unchanged. However, there are a number of molecular alterations that are now recognized as diagnostically and prognostically useful.

Mesenchymal, Nonmeningothelial Tumors

Mesenchymal, nonmeningothelial tumors are divided into 2 groups: soft-tissue tumors and chondro-osseous tumors. The only major changes in 2021 are with soft-tissue tumors.

Soft-Tissue Tumors

Soft-tissue tumors are subcategorized into fibroblastic and myofibroblastic tumors, vascular tumors, skeletal muscle tumors, and tumors of uncertain differentiation. The term hemangiopericytoma is now considered obsolete, and the preferred term “solitary fibrous tumor” is used to correspond to extracranial solitary, fibrous tumors. Solitary, fibrous tumors are the most common nonmeningothelial mesenchymal neoplasm and share the common molecular feature of NAB2-STAT6 gene fusions. Tumor grades vary from WHO 1–3 (WHO grade III solitary fibrous tumors were previously referred to as “anaplastic hemangiopericytomas”). Imaging features often resemble those of meningiomas.

There are 3 newly recognized intracranial soft-tissue tumors: intracranial mesenchymal tumor, FET-creB fusion-positive; CIC-rearranged sarcoma; and primary intracranial sarcoma, DICER1-mutant. 11,45

Intracranial mesenchymal tumor, FET-creB fusion-positive, often features specific EWSR1—creB1 fusions. These tumors can be extra-axial or intraventricular. The cerebral convexities are the most common location. They are typically T2-FLAIR hyperintense, exhibit strong enhancement, and often have a dural “tail.” The major differential diagnosis is atypical or anaplastic meningioma. 11,45

CIC-rearranged sarcoma corresponds to similar soft-tissue tumors. Multiple CIC-fusion partners have been identified. Round-cell sarcomas with myxoid features are typical. These tumors can occur at any age but are most common in adolescents and young adults. They are highly aggressive and are designated as WHO CNS grade 4 lesions. 11,45

Primary intracranial sarcoma, DICER1-mutant, is a highly-malignant CNS sarcoma that is part of the expanding spectrum of DICER1 and type 1 neurofibromatosis syndromes. This intracranial sarcoma primarily occurs in children and young adults, exhibiting malignant spindle cell morphology often with focal rhabdomyoblastic differentiation. 11,45

Hematolymphoid Tumors

Other than grouping lymphomas and histiocytic tumors together as hematolymphoid tumors, no significant changes occurred in the 2021 WHO.

Germ Cell Tumors

No significant 2021 changes were made in germ cell neoplasms.

Tumors of the Sellar Region

Pituitary adenomas are now designated as pituitary adenoma/pituitary neuroendocrine tumors to correspond to systemic neuroendocrine tumors. Pituitary neuroendocrine tumors are now also classified according to adenohypophyseal cell lineages, rather than just by the hormone produced. Pituicytoma, granular cell tumor of the sellar region and spindle cell oncocytoma remain unchanged from WHO 2016, and though they are classified as separate tumor types, they are considered a related group of tumor types with possibly morphologic variations of the same tumor. 11,46

One new tumor, pituitary blastoma, has been added to the 2021 WHO Classification of sellar region tumors. Pituitary blastomas are rare embryonal sellar neoplasms of infants (median age, 8 months) that are associated with somatic or germline DICER1 mutations. Pituitary blastomas are hypophyseal tumors that resemble a 10- to 12-week embryonic-stage pituitary gland. Primitive blastemal cells similar to those in pleuropulmonary blastomas, neuroendocrine cells, and Rathke-type epithelium in rosettes/glandular structures are characteristic. Pituitary blastomas are designated WHO CNS grade 4 neoplasms. 11,45

Summary

The 2021 5th edition WHO Classification of CNS neoplasms (the series popularly known as the Blue Books) builds on the trend of molecular tumor classification first introduced in the 2016 (4-plus) edition. Gliomas are divided into adult-type diffuse gliomas, pediatric-type diffuse low-grade gliomas, pediatric-type diffuse high-grade gliomas, and circumscribed astrocytic gliomas. WHO grades are now expressed in Arabic numbers instead of Roman numerals. The 5th edition introduces 14 new gliomas and glioneuronal tumors and 8 other new tumors into the neuropathologic lexicon. 36 The critical importance of identifying mutations other than the canonical IDH1 R132H mutation in diffuse gliomas, especially in patients younger than 55 years of age, is emphasized. Neuroradiologists must familiarize themselves with the updated WHO Classification of CNS neoplasms to function appropriately as part of the modern neuro-oncology clinical team.

World health organization 2021

Parliamentarians: Resilient health systems and preparedness for future emergencies critical to health security in Asia and the Pacific

Vanuatu leads the way for Pacific elimination of trachoma – the world’s biggest infectious cause of blindness

Bringing Hepatitis C detection and treatment closer to the community in Nghe An

Mongolia transforms food system to ensure safer food, increase health security

The Western Pacific Region is home to almost 1.9 billion people across 37 countries and areas.

WHO is working with governments and partners across the Western Pacific to make this the healthiest and safest Region.

People of the Western Pacific

A five year vision
for delivering better health
in the Western Pacific Region

Regional priorities 2020-25

In line with the regional vision «For the Future», four priorities must be addressed to reach our goal of making the Western Pacific the safest and healthiest region.

Strengthening Pacific health systems

Communicating for health impact

Monitoring country emergency preparedness

Supporting healthy ageing through social prescribing

Publications

Ending Violence against Children During Covid-19 and Beyond: Second Regional Conference to Strengthen.

UNICEF and WHO jointly organized Ending Violence Against Children During COVID-19 and Beyond: Second Regional Conference to Strengthen Implementation of.

Global reproductive, maternal, newborn, child and adolescent health policy survey: report for the Western.

The Global Reproductive, Maternal, Newborn, Child and Adolescent Health Policy Survey Report for the Western Pacific Region 2020 was developed by the WHO.

Third biennial progress report: 2018-2020 (‎Action Plan for Health Newborn Infants in the Western Pacific.

The Third Biennial Meeting on Accelerating Progress in early essential newborn care (‎EENC)‎: Synergies with Hospital Quality and Patient Safety.

Regional framework on nurturing resilient and healthy future generations in the Western Pacific

The Regional Framework on Nurturing Resilient and Healthy Future Generations in the Western Pacific recognised that investing in health and schools offers.

WHO sounds warning over fast-spreading Omicron

The World Health Organization logo is pictured at the entrance of the WHO building, in Geneva, Switzerland, December 20, 2021. REUTERS/Denis Balibouse

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WHO chief scientist Soumya Swaminathan added it would be «unwise» to conclude from early evidence that Omicron was a milder variant that previous ones.

«. with the numbers going up, all health systems are going to be under strain,» Soumya Swaminathan told Geneva-based journalists.

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The variant is successfully evading some immune responses, she said, meaning that the booster programmes being rolled out in many countries ought to be targeted towards people with weaker immune systems.

«There is now consistent evidence that Omicron is spreading significantly faster than the Delta variant,» WHO director-general Tedros Adhanom Ghebreyesus told the briefing.

«And it is more likely people vaccinated or recovered from COVID-19 could be infected or re-infected,» Tedros said.

Their comments echoed the finding of study by Imperial College London, which said last week the risk of reinfection was more than five times higher and it has shown no sign of being milder than Delta.

WHO officials said however that other forms of immunity vaccinations may prevent infection and disease.

While the antibody defences from some actions have been undermined, there has been hope that T-cells, the second pillar of an immune response, can prevent severe disease by attacking infected human cells.

WHO expert Abdi Mahamud added: «Although we are seeing a reduction in the neutralisation antibodies, almost all preliminary analysis shows T-cell mediated immunity remains intact, that is what we really require.»

However, highlighting how little is known about how to handle the new variant that was only detected last month, Swaminathan also said: «Of course there is a challenge, many of the monoclonals will not work with Omicron.»

She gave no details as she referred to the treatments that mimic natural antibodies in fighting off infections. Some drug makers have suggested the same.

ENDING THE PANDEMIC

In the short term, Tedros said that holiday festivities would in many places lead to «increased cases, overwhelmed health systems and more deaths» and urged people to postpone gatherings.

«An event cancelled is better than a life cancelled,» he said.

But the WHO team also offered some hope to a weary world facing the new wave that 2022 would be the year that the pandemic, which already killed more than 5.6 million people worldwide, would end.

It pointed towards the development of second and third generation vaccines, and the further development of antimicrobial treatments and other innovations.

«(We) hope to consign this disease to a relatively mild disease that is easily prevented, that is easily treated,» Mike Ryan, the WHO’s top emergency expert, told the briefing.

«If we can keep virus transmission to minimum, then we can bring the pandemic to an end.»

However Tedros also said China, where the SARS-CoV-2 coronavirus was first detected at the end of 2019, must be forthcoming with data and information related to its origin to help the response going forward.

«We need to continue until we know the origins, we need to push harder because we should learn from what happened this time in order to (do) better in the future,» Tedros said.

World Health Organization treatment outcome definitions for tuberculosis: 2021 update

Extract

Tuberculosis (TB) remains an important global health concern, even though it is largely curable with treatment that is affordable and widely accessible for diagnosed and notified TB patients. If not administered correctly, TB treatment regimens may fail to deliver a relapse-free cure, favouring continued transmission and the emergence of drug resistance. Monitoring the effectiveness of TB treatment is thus critically important in both clinical practice and surveillance, to maximise the quality of individual patient care and the effectiveness of public health action. Standardised TB treatment outcome definitions have been a feature of World Health Organization (WHO) policies and national TB surveillance systems for many years. This has allowed the monitoring of TB treatment outcomes over time at national and global levels.

Abstract

In 2021, WHO revised its tuberculosis treatment outcome definitions, making them uniformly applicable for different lengths of treatment for both drug-susceptible and drug-resistant disease https://bit.ly/3jFFgOu

Acknowledgements

We would like to acknowledge and thank the two co-chairs of this meeting, Charles Daley and Cathy Hewison, as well as the numerous experts who attended the meeting and who contributed to the discussions. The meeting participants were: Carole Mitnick, Christoph Lange, Giovanni Battista Migliori, Mario Raviglione, Jonathon Campbell, Hoang Thanh Thuy, Maria Rodriguez, Welile Sikhondze, Norbert Ndjeka, Anastasia Samoilova, Yuhong Liu, Kuldeep Sachdeva, Daniele Maria Pelissari, Andrei Mosneaga, Sreenivas Nair, Morten Ruhwald, Fraser Wares, Grania Brigden, Draurio Barreira, Mohammed Yassin, Marlena Kaczmarek, Mukadi Ya Diul, Dumitru Chesov, Chen Yuan Chiang, James Seddon, Tony Garcia-Prats, Daniela Cirillo, Harald Hoffman, Sarabjit Chadha, Dissou Affolabi, Thandar Hmun, Renzong Li, Sabira Tahseen, Amir Khan, Choub Sok Chamreun, Nino Lomtadze, Mon Basilio, Dan Everitt and Xia Hui. In addition, we thank the WHO staff who attended this meeting: Tauhid Islam, Mukta Sharma, Vineet Bhatia, Askar Yedilbayev, Rafael Lopez Olarte, Kenza Bennani, Michel Gasana, Jean Louis Abena, Kyung Oh, Ernesto Jaramillo, Anna Dean, Marek Lalli, Marie-Christine Bartens, Charalampos Sismannidis and Olga Tosas-Auguet.

Footnotes

All authors are staff members of the World Health Organization (WHO). They alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of WHO. The designations used and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area, or of its authorities, nor concerning the delimitation of its frontiers or boundaries.

Conflict of interest: N.N. Linh has nothing to disclose.

Conflict of interest: K. Viney has nothing to disclose.

Conflict of interest: M. Gegia has nothing to disclose.

Conflict of interest: D. Falzon has nothing to disclose.

Conflict of interest: P. Glaziou has nothing to disclose.

Conflict of interest: K. Floyd has nothing to disclose.

Conflict of interest: H. Timimi has nothing to disclose.

Conflict of interest: N. Ismail has nothing to disclose.

Conflict of interest: M. Zignol has nothing to disclose.

Conflict of interest: T. Kasaeva has nothing to disclose.

Conflict of interest: F. Mirzayev has nothing to disclose.

Vaccines and immunization

Immunization is a global health and development success story, saving millions of lives every year. Vaccines reduce risks of getting a disease by working with your body’s natural defences to build protection. When you get a vaccine, your immune system responds.

We now have vaccines to prevent more than 20 life-threatening diseases, helping people of all ages live longer, healthier lives. Immunization currently prevents 3.5-5 million deaths every year from diseases like diphtheria, tetanus, pertussis, influenza and measles.

Immunization is a key component of primary health care and an indisputable human right. It’s also one of the best health investments money can buy. Vaccines are also critical to the prevention and control of infectious disease outbreaks. They underpin global health security and will be a vital tool in the battle against antimicrobial resistance.

Yet despite tremendous progress, vaccination coverage has plateaued in recent years and dropped since 2020. The COVID-19 pandemic and associated disruptions over the past two year have strained health systems, with 25 million children missing out on vaccination in 2021, 6 million more than in 2019 and the highest number since 2009.

By the end of 2021, nearly all countries had introduced COVID-19 vaccination, and by early 2022 one billion doses of COVID-19 vaccine had been delivered through COVAX.

Vaccines train your immune system to create antibodies, just as it does when it’s exposed to a disease. However, because vaccines contain only killed or weakened forms of germs like viruses or bacteria, they do not cause the disease or put you at risk of its complications.

Vaccines protect against many different diseases, including:

Some other vaccines are currently being piloted, including those that protect against Ebola or malaria, but are not yet widely available globally.

Not all these vaccinations may be needed in your country. Some may only be given prior to travel, in areas of risk, or to people in high-risk occupations. Talk to your healthcare worker to find out what vaccinations are needed for you and your family.

WHO is working with countries and partners to improve global vaccination coverage, including through these initiatives adopted by the World Health Assembly in August 2020.

Immunization Agenda 2030

IA2030 sets an ambitious, overarching global vision and strategy for vaccines and immunization for the decade 2021–2030. It was co-created with thousands of contributions from countries and organizations around the world. It draws on lessons from the past decade and acknowledges continuing and new challenges posed by infectious diseases (e.g. Ebola, COVID-19).

The strategy has been designed to respond to the interests of every country and intends to inspire and align the activities of community, national, regional and global stakeholders towards achieving a world where everyone, everywhere fully benefits from vaccines for good health and well-being. IA2030 is operationalized through regional and national strategies and a mechanism to ensure ownership and accountability and a monitoring and evaluation framework to guide country implementation.

Infection prevention and control

Infection prevention and control (IPC) is a practical, evidence-based approach preventing patients and health workers from being harmed by avoidable infections. Effective IPC requires constant action at all levels of the health system, including policymakers, facility managers, health workers and those who access health services. IPC is unique in the field of patient safety and quality of care, as it is universally relevant to every health worker and patient, at every health care interaction. Defective IPC causes harm and can kill. Without effective IPC it is impossible to achieve quality health care delivery.

Infection prevention and control effects all aspects of health care, including hand hygiene, surgical site infections, injection safety, antimicrobial resistance and how hospitals operate during and outside of emergencies. Programmes to support IPC are particularly important in low- and middle-income countries, where health care delivery and medical hygiene standards may be negatively affected by secondary infections.

Much of the work done on infection prevention and control (IPC) is hidden, as by its nature it prevents issues rather than treating them after the fact. However, health care-associated infections (HAIs) are an ongoing problem that no health authority can afford to ignore. To help in this fight, WHO has created a number of programmes and campaigns that set standards for evidence-based recommendations and operating procedures and promote behaviours to limit avoidable infections.

The first WHO Global Patient Challenge laid the foundations for the IPC Global Unit, which works to support country capacity-building for IPC action. Through this programme, WHO provides technical assistance for developing local IPC policies and guidelines, performs in-country assessments, convenes meetings focused on guideline development and provides ongoing support for health care providers.

WHO also makes a global annual call to action for health workers though the SAVE LIVES: Clean Your Hands campaign held each May. This campaign seeks to educate health workers and patients on the importance of effective hand washing, the need for which has become more acute with the COVID-19 pandemic.

Ageing and health

Key facts

Overview

People worldwide are living longer. Today most people can expect to live into their sixties and beyond. Every country in the world is experiencing growth in both the size and the proportion of older persons in the population.

By 2030, 1 in 6 people in the world will be aged 60 years or over. At this time the share of the population aged 60 years and over will increase from 1 billion in 2020 to 1.4 billion. By 2050, the world’s population of people aged 60 years and older will double (2.1 billion). The number of persons aged 80 years or older is expected to triple between 2020 and 2050 to reach 426 million.

While this shift in distribution of a country’s population towards older ages – known as population ageing – started in high-income countries (for example in Japan 30% of the population is already over 60 years old), it is now low- and middle-income countries that are experiencing the greatest change. By 2050, two-thirds of the world’s population over 60 years will live in low- and middle-income countries.

Ageing explained

At the biological level, ageing results from the impact of the accumulation of a wide variety of molecular and cellular damage over time. This leads to a gradual decrease in physical and mental capacity, a growing risk of disease and ultimately death. These changes are neither linear nor consistent, and they are only loosely associated with a person’s age in years. The diversity seen in older age is not random. Beyond biological changes, ageing is often associated with other life transitions such as retirement, relocation to more appropriate housing and the death of friends and partners.

Common health conditions associated with ageing

Common conditions in older age include hearing loss, cataracts and refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression and dementia. As people age, they are more likely to experience several conditions at the same time.

Older age is also characterized by the emergence of several complex health states commonly called geriatric syndromes. They are often the consequence of multiple underlying factors and include frailty, urinary incontinence, falls, delirium and pressure ulcers.

Factors influencing healthy ageing

A longer life brings with it opportunities, not only for older people and their families, but also for societies as a whole. Additional years provide the chance to pursue new activities such as further education, a new career or a long-neglected passion. Older people also contribute in many ways to their families and communities. Yet the extent of these opportunities and contributions depends heavily on one factor: health.

Evidence suggests that the proportion of life in good health has remained broadly constant, implying that the additional years are in poor health. If people can experience these extra years of life in good health and if they live in a supportive environment, their ability to do the things they value will be little different from that of a younger person. If these added years are dominated by declines in physical and mental capacity, the implications for older people and for society are more negative.

Physical and social environments can affect health directly or through barriers or incentives that affect opportunities, decisions and health behaviour. Maintaining healthy behaviours throughout life, particularly eating a balanced diet, engaging in regular physical activity and refraining from tobacco use, all contribute to reducing the risk of non-communicable diseases, improving physical and mental capacity and delaying care dependency.

Supportive physical and social environments also enable people to do what is important to them, despite losses in capacity. The availability of safe and accessible public buildings and transport, and places that are easy to walk around, are examples of supportive environments. In developing a public-health response to ageing, it is important not just to consider individual and environmental approaches that ameliorate the losses associated with older age, but also those that may reinforce recovery, adaptation and psychosocial growth.

Challenges in responding to population ageing

There is no typical older person. Some 80-year-olds have physical and mental capacities similar to many 30-year-olds. Other people experience significant declines in capacities at much younger ages. A comprehensive public health response must address this wide range of older people’s experiences and needs.

Older people are often assumed to be frail or dependent and a burden to society. Public health professionals, and society as a whole, need to address these and other ageist attitudes, which can lead to discrimination, affect the way policies are developed and the opportunities older people have to experience healthy aging.

Globalization, technological developments (e.g., in transport and communication), urbanization, migration and changing gender norms are influencing the lives of older people in direct and indirect ways. A public health response must take stock of these current and projected trends and frame policies accordingly.

WHO response

The United Nations General Assembly declared 2021–2030 the Decade of Healthy Ageing and asked WHO to lead the implementation. The Decade of Healthy Ageing is a global collaboration bringing together governments, civil society, international agencies, professionals, academia, the media and the private sector for 10 years of concerted, catalytic and collaborative action to foster longer and healthier lives.

The Decade builds on the WHO Global Strategy and Action Plan and the United Nations Madrid International Plan of Action on Ageing and supports the realization of the United Nations Agenda 2030 on Sustainable Development and the Sustainable Development Goals.

The Decade of Healthy Ageing (2021–2030) seeks to reduce health inequities and improve the lives of older people, their families and communities through collective action in four areas: changing how we think, feel and act towards age and ageism; developing communities in ways that foster the abilities of older people; delivering person-centred integrated care and primary health services responsive to older people; and providing older people who need it with access to quality long-term care.

World Health Assembly agrees to launch process to develop historic global accord on pandemic prevention, preparedness and response

In a consensus decision aimed at protecting the world from future infectious diseases crises, the World Health Assembly today agreed to kickstart a global process to draft and negotiate a convention, agreement or other international instrument under the Constitution of the World Health Organization to strengthen pandemic prevention, preparedness and response.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said the decision by the World Health Assembly was historic in nature, vital in its mission, and represented a once-in-a-generation opportunity to strengthen the global health architecture to protect and promote the well-being of all people.

“The COVID-19 pandemic has shone a light on the many flaws in the global system to protect people from pandemics: the most vulnerable people going without vaccines; health workers without needed equipment to perform their life-saving work; and ‘me-first’ approaches that stymie the global solidarity needed to deal with a global threat,” Dr Tedros said.

“But at the same time, we have seen inspiring demonstrations of scientific and political collaboration, from the rapid development of vaccines, to today’s commitment by countries to negotiate a global accord that will help to keep future generations safer from the impacts of pandemics.”

The Health Assembly met in a Special Session, the second-ever since WHO’s founding in 1948, and adopted a sole decision titled: “The World Together.” The decision by the Assembly establishes an intergovernmental negotiating body (INB) to draft and negotiate a WHO convention, agreement, or other international instrument on pandemic prevention, preparedness and response, with a view to adoption under Article 19 of the WHO Constitution, or other provisions of the Constitution as may be deemed appropriate by the INB.

Article 19 of the WHO Constitution provides the World Health Assembly with the authority to adopt conventions or agreements on any matter within WHO’s competence. The sole instrument established under Article 19 to date is the WHO Framework Convention on Tobacco Control, which has made a significant and rapid contribution to protecting people from tobacco since its entry into force in 2005.

Under the decision adopted today, the INB will hold its first meeting by 1 March 2022 (to agree on ways of working and timelines) and its second by 1 August 2022 (to discuss progress on a working draft). It will also hold public hearings to inform its deliberations; deliver a progress report to the 76 th World Health Assembly in 2023; and submit its outcome for consideration by the 77 th World Health Assembly in 2024.

Through the decision, the World Health Assembly also requested the WHO Director-General to convene the INB meetings and support its work, including by facilitating the participation of other United Nations system bodies, non-state actors, and other relevant stakeholders in the process to the extent decided by the INB.

Diabetes

Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn’t make enough insulin. In the past three decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. There is a globally agreed target to halt the rise in diabetes and obesity by 2025.

About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades.

Symptoms of type 1 diabetes include the need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Symptoms for type 2 diabetes are generally similar to those of type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen. For this reason, it is important to be aware of risk factors.

Type 1 diabetes cannot currently be prevented. Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes. These include policies and practices across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids.

The starting point for living well with diabetes is an early diagnosis – the longer a person lives with undiagnosed and untreated diabetes, the worse their health outcomes are likely to be. Easy access to basic diagnostics, such as blood glucose testing, should therefore be available in primary health care settings. Patients will need periodic specialist assessment or treatment for complications.

A series of cost-effective interventions can improve patient outcomes, regardless of what type of diabetes they may have. These interventions include blood glucose control, through a combination of diet, physical activity and, if necessary, medication; control of blood pressure and lipids to reduce cardiovascular risk and other complications; and regular screening for damage to the eyes, kidneys and feet, to facilitate early treatment.

Всеобщий охват услугами здравоохранения

Что означает ВОУЗ?

ВОУЗ означает, что все люди и сообщества получают необходимые им медико-санитарные услуги, не испытывая при этом финансовых трудностей. Эти услуги включают весь комплекс основных качественных медико-санитарных услуг, от укрепления здоровья до профилактики, лечения, реабилитации и паллиативной помощи, получаемых на всех этапах жизненного цикла.

Для оказания этих услуг требуется наличие надлежащих компетентных медико-санитарных и социальных работников, обладающих оптимальным сочетанием профессиональных навыков на уровне медицинских учреждений, программ помощи и местных сообществ, при условии обеспечения их справедливого распределения, оказания им адекватной поддержки и создания достойных условий труда. Стратегии ВОУЗ открывают каждому человеку доступ к услугам, которые позволяют устранять самые серьезные причины заболеваний и случаев смерти, и гарантируют достаточно высокое качество этих услуг, позволяющее укреплять здоровье тех, кому они оказываются.

Защита от финансовых последствий оплаты медико-санитарных услуг из собственных средств снижает риск того, что люди окажутся за чертой бедности, поскольку в случае внезапной болезни им придется потратить все свои сбережения, продать имущество и влезть в долги, разрушив свое будущее, а зачастую и будущее своих детей.

Каким образом страны могут добиться прогресса в достижении ВОУЗ?

Многие страны уже продвигаются по пути к обеспечению ВОУЗ несмотря на то, что пандемия COVID-19 во всем мире повлияла на реализацию возможностей систем здравоохранения по бесперебойному оказанию медико-санитарных услуг. Несмотря на спад, обусловленный пандемией COVID-19, все страны способны предпринять усилия для более быстрого продвижения к цели ВОУЗ и сохранить уже достигнутые результаты. Правительствам стран, в которых услуги здравоохранения традиционно доступны и приемлемы по стоимости, становится все сложнее удовлетворять постоянно растущие потребности различных групп населения в условиях увеличения расходов на медико-санитарные услуги.

Для обеспечения ВОУЗ необходимо повышать эффективность систем здравоохранения во всех странах. Ключевую роль играют структуры устойчивого финансирования. В условиях, когда основную часть расходов на медико-санитарные услуги приходится оплачивать из собственных средств, малоимущие слои населения часто не могут получить многие из необходимых им услуг и даже богатые могут испытывать финансовые трудности в случае тяжелой и продолжительной болезни. Мобилизация средств из обязательных источников финансирования (в том числе из доходов правительств от налоговых поступлений) может помочь распределить финансовые риски, обусловленные уровнем заболеваемости в какой-либо группе населения.

Улучшение охвата медико-санитарными услугами и показателей здоровья зависит от наличия и доступности медико-санитарных и социальных работников и их способности оказывать качественную комплексную медицинскую помощь, ориентированную на нужды людей. Пандемия COVID-19 наглядно продемонстрировала неоценимую роль медико-санитарных и социальных работников и важность наращивания инвестиций в этой области. Для удовлетворения потребностей в медицинских кадрах в целях достижения ЦУР и обеспечения ВОУЗ к 2030 г. необходимо мобилизовать дополнительно свыше 18 миллионов работников здравоохранения. Пробелы в обеспечении медицинскими кадрами и удовлетворении спроса на них главным образом отмечаются в странах с низким уровнем дохода и уровнем дохода ниже среднего. Согласно прогнозам, к 2030 г. растущий спрос на медицинские кадры приведет к созданию в рамках глобальной экономики приблизительно 40 миллионов дополнительных рабочих мест за счет сектора здравоохранения. Государственный и частный секторы должны направлять средства на обучение медико-санитарных работников, а также на создание и заполнение финансируемых должностей в секторе здравоохранения и связанных с ним отраслях экономики. Пандемия COVID‑19, которая на начальном этапе в непропорционально большой степени затронула работников здравоохранения, выдвинула на первый план необходимость защиты медико-санитарных и социальных работников, приоритизации инвестиций в их обучение и обеспечение занятости, а также использования преимуществ партнерств в целях обеспечения достойных условий их труда.

ВОУЗ подразумевает не только то, какие услуги охвачены, но и то, как они финансируются, управляются и предоставляются. Необходимо коренным образом изменить систему предоставления услуг, с тем чтобы услуги были комплексными и ориентированными на нужды людей и сообществ. Такой подход в том числе предполагает переориентацию системы медико-санитарных услуг, с тем чтобы медицинская помощь оказывалась в наиболее подходящих условиях при правильном сочетании амбулаторной и стационарной медико-санитарной помощи и их большей координации. Медико-санитарные услуги, включая услуги в области народной и комплементарной медицины, оказываемые на основе всестороннего учета потребностей и интересов людей и сообществ, будут способствовать расширению их прав и возможностей и тем самым позволят им активнее заниматься своим здоровьем и участвовать в развитии системы здравоохранения.

Важнейшим условием обеспечения ВОУЗ во всем мире являются инвестиции в качественную первичную медико-санитарную помощь.

Для обеспечения ВОУЗ необходимы многосторонние подходы. Подход, опирающийся на систему первичной медико-санитарной помощи, и подходы с учетом всех этапов жизненного цикла имеют исключительно важное значение. Подход, опирающийся на систему первичной медико-санитарной помощи, направлен на организацию и укрепление систем здравоохранения, с тем чтобы люди могли получить доступ к соответствующим услугам для укрепления своего собственного здоровья и благополучия в зависимости от своих потребностей и интересов на как можно более раннем этапе в условиях повседневной жизни. Первичная медико-санитарная помощь (ПМСП) предполагает наличие трех взаимозависимых и взаимоусиливающих компонентов, в том числе комплексных интегрированных услуг здравоохранения, включая оказание первичной медико-санитарной помощи, а также блага и функции общественного здравоохранения в качестве центральных элементов; многосекторальных мер политики и усилий, направленных на решение проблем, связанных с первичными и более общими детерминантами здоровья; и вовлечения отдельных лиц, семей и местных сообществ и расширение их прав и возможностей в целях активизации их участия в жизни общества и повышения уровня самопомощи и самостоятельности в решении вопросов, касающихся здоровья. Применение подхода, учитывающего все этапы жизненного цикла, позволяет рационально поддерживать здоровье людей путем удовлетворения их потребностей и максимального использования различных возможностей на всех этапах их жизни, с тем чтобы они могли иметь соответствующие физические возможности и занимались тем, что они с полным основанием ценят в любом возрасте, неизменно руководствуясь принципами, способствующими обеспечению прав человека и гендерного равенства.

Как показала пандемия COVID-19, странам необходимо безотлагательно увеличить объемы своих инвестиций, направляемые на осуществление основных функций общественного здравоохранения, тех ключевых функций общественного здравоохранения, которые требуют совместных действий и могут финансироваться только правительствами или подвергаются риску в результате крупных сбоев в функционировании рынков. К таким функциям относятся разработка политики на основе фактических данных, осуществление коммуникации, включая оповещение о рисках, и работа с местным населением с целью предоставить отдельным лицам и семьям права и возможности для более эффективного поддержания своего здоровья, использования информационных систем, результатов анализа данных и эпиднадзора и лабораторной базы для тестирования; регулирование деятельности по обеспечению качества продуктов и здорового образа жизни, а также предоставление субсидий учреждениям и программам общественного здравоохранения.

Можно ли измерять ВОУЗ?

Да. При мониторинге прогресса в достижении ВОУЗ следует учитывать в основном два показателя:

Измерение уровня равноправия также имеет исключительно важное значение для понимания того, кто остается без внимания, где и почему.

Совместно со Всемирным банком ВОЗ разработала механизм для отслеживания прогресса в достижении ВОУЗ посредством мониторинга ситуации по обеим категориям с учетом общего уровня ВОУЗ и уровня обеспечения равноправия в рамках ВОУЗ, то есть обеспечения охватом услугами и финансовой защитой всех представителей в рамках соответствующей группы населения, в частности малоимущего населения и населения отдаленных сельских районов.

В качестве показателей уровня и равенства охвата в странах ВОЗ использует 16 основных медико‑санитарных услуг в 4 категориях:

Репродуктивное здоровье, здоровье матерей, новорожденных, детей и подростков:

Масштабы и доступность услуг:

Каждая страна уникальна и может иметь собственные приоритеты и разрабатывать свои способы измерения прогресса в достижении ВОУЗ. Однако свою ценность имеет также глобальный подход, основанный на применении международно признанных стандартизированных показателей, сопоставимых как между странами, так и во времени.

Роль ВОЗ

ВОЗ оказывает поддержку странам в их деятельности по развитию национальных систем здравоохранения в целях достижения и обеспечения ВОУЗ и мониторинга прогресса. Однако ВОЗ не одинока в своих усилиях: ВОЗ взаимодействует с многочисленными партнерами в различных ситуациях для достижения самых разных целей в интересах прогресса в обеспечении ВОУЗ во всем мире.

К партнерствам с участием ВОЗ в том числе относятся:

В 40-ю годовщину принятия исторической Алма-Атинской декларации, 25–26 октября 2018 г., ВОЗ в партнерстве с ЮНИСЕФ и Министерством здравоохранения Казахстана провела Глобальную конференцию по первичной медико-санитарной помощи. В ней приняли участие министры, работники здравоохранения, ученые, партнеры и представители гражданского общества, которые вновь заявили о своей приверженности делу обеспечения первичной медико-санитарной помощи как краеугольного камня ВОУЗ в новой амбициозной Астанинской декларации. Декларация призвана подтвердить политическую приверженность правительств, неправительственных и профессиональных организаций, а также научных кругов и глобальных организаций, занимающихся вопросами здравоохранения и развития, делу обеспечения первичной медико-санитарной помощи.

Все страны могут активизировать усилия для улучшения показателей здоровья и решения проблем малоимущего населения путем расширения охвата медико-санитарными услугами и сокращения масштабов обнищания, обусловленного расходами по оплате медико-санитарных услуг.

Origins of the SARS-CoV-2 virus

WHO-convened Global Study of the Origins of SARS-CoV-2 (including annexes)

WHO-convened global study of origins of SARS-CoV-2: China Part

In May 2020, the World Health Assembly in resolution WHA73.1 requested the Director-General of the World Health Organization (WHO) to continue to work.

WHO calls for further studies, data on origin of SARS-CoV-2 virus, reiterates that all hypotheses remain open

WHO Director-General’s remarks at the Member State Briefing on the report of the international team studying the origins of SARS-CoV-2

Members of the international team:

The international team also includes five WHO experts led by Dr Peter Ben Embarek; two Food and Agriculture Organization (FAO) representatives and two World Organisation for Animal Health (OIE) representatives.

Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)

Origin of SARS-CoV-2 (26 March 2020)

WHO recommendations to reduce risk of transmission of emerging pathogens from animals to humans in live animal markets or animal product markets (26 March 2020)

Mental disorders

Key facts

A mental disorder is characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour. It is usually associated with distress or impairment in important areas of functioning. There are many different types of mental disorders. Mental disorders may also be referred to as mental health conditions. The latter is a broader term covering mental disorders, psychosocial disabilities and (other) mental states associated with significant distress, impairment in functioning, or risk of self-harm. This fact sheet focuses on mental disorders as described by the International Classification of Diseases 11th Revision (ICD-11).

In 2019, 1 in every 8 people, or 970 million people around the world were living with a mental disorder, with anxiety and depressive disorders the most common (1). In 2020, the number of people living with anxiety and depressive disorders rose significantly because of the COVID-19 pandemic. Initial estimates show a 26% and 28% increase respectively for anxiety and major depressive disorders in just one year (2). While effective prevention and treatment options exist, most people with mental disorders do not have access to effective care. Many people also experience stigma, discrimination and violations of human rights.

Anxiety Disorders

In 2019, 301 million people were living with an anxiety disorder including 58 million children and adolescents (1). Anxiety disorders are characterised by excessive fear and worry and related behavioural disturbances. Symptoms are severe enough to result in significant distress or significant impairment in functioning. There are several different kinds of anxiety disorders, such as: generalised anxiety disorder (characterised by excessive worry), panic disorder (characterised by panic attacks), social anxiety disorder (characterised by excessive fear and worry in social situations), separation anxiety disorder (characterised by excessive fear or anxiety about separation from those individuals to whom the person has a deep emotional bond), and others. Effective psychological treatment exists, and depending on the age and severity, medication may also be considered.

Depression

In 2019, 280 million people were living with depression, including 23 million children and adolescents (1). Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. During a depressive episode, the person experiences depressed mood (feeling sad, irritable, empty) or a loss of pleasure or interest in activities, for most of the day, nearly every day, for at least two weeks. Several other symptoms are also present, which may include poor concentration, feelings of excessive guilt or low self-worth, hopelessness about the future, thoughts about dying or suicide, disrupted sleep, changes in appetite or weight, and feeling especially tired or low in energy. People with depression are at an increased risk of suicide. Yet, effective psychological treatment exists, and depending on the age and severity, medication may also be considered.

Bipolar Disorder

In 2019, 40 million people experienced bipolar disorder (1). People with bipolar disorder experience alternating depressive episodes with periods of manic symptoms. During a depressive episode, the person experiences depressed mood (feeling sad, irritable, empty) or a loss of pleasure or interest in activities, for most of the day, nearly every day. Manic symptoms may include euphoria or irritability, increased activity or energy, and other symptoms such as increased talkativeness, racing thoughts, increased self-esteem, decreased need for sleep, distractibility, and impulsive reckless behaviour. People with bipolar disorder are at an increased risk of suicide. Yet effective treatment options exist including psychoeducation, reduction of stress and strengthening of social functioning, and medication.

Post-Traumatic Stress Disorder (PTSD)

The prevalence of PTSD and other mental disorders is high in conflict-affected settings (3). PTSD may develop following exposure to an extremely threatening or horrific event or series of events. It is characterised by all of the following: 1) re-experiencing the traumatic event or events in the present (intrusive memories, flashbacks, or nightmares); 2) avoidance of thoughts and memories of the event(s), or avoidance of activities, situations, or people reminiscent of the event(s); and 3) persistent perceptions of heightened current threat. These symptoms persist for at least several weeks and cause significant impairment in functioning. Effective psychological treatment exists.

Schizophrenia

Schizophrenia affects approximately 24 million people or 1 in 300 people worldwide (1). People with schizophrenia have a life expectancy 10-20 years below that of the general population (4). Schizophrenia is characterised by significant impairments in perception and changes in behaviour. Symptoms may include persistent delusions, hallucinations, disorganised thinking, highly disorganised behaviour, or extreme agitation. People with schizophrenia may experience persistent difficulties with their cognitive functioning. Yet, a range of effective treatment options exist, including medication, psychoeducation, family interventions, and psychosocial rehabilitation.

Eating Disorders

In 2019, 14 million people experienced eating disorders including almost 3 million children and adolescents (1). Eating disorders, such as anorexia nervosa and bulimia nervosa, involve abnormal eating and preoccupation with food as well as prominent body weight and shape concerns. The symptoms or behaviours result in significant risk or damage to health, significant distress, or significant impairment of functioning. Anorexia nervosa often has its onset during adolescence or early adulthood and is associated with premature death due to medical complications or suicide. Individuals with bulimia nervosa are at a significantly increased risk for substance use, suicidality, and health complications. Effective treatment options exist, including family-based treatment and cognitive-based therapy.

Disruptive behaviour and dissocial disorders

40 million people, including children and adolescents, were living with conduct-dissocial disorder in 2019 (1). This disorder, also known as conduct disorder, is one of two disruptive behaviour and dissocial disorders, the other is oppositional defiant disorder. Disruptive behaviour and dissocial disorders are characterised by persistent behaviour problems such as persistently defiant or disobedient to behaviours that persistently violate the basic rights of others or major age-appropriate societal norms, rules, or laws. Onset of disruptive and dissocial disorders, is commonly, though not always, during childhood. Effective psychological treatments exist, often involving parents, caregivers, and teachers, cognitive problem-solving or social skills training.

Neurodevelopmental disorders

Neurodevelopmental disorders are behavioural and cognitive disorders, that? arise during the developmental period, and involve significant difficulties in the acquisition and execution of specific intellectual, motor, language, or social functions.

Neurodevelopmental disorders include disorders of intellectual development, autism spectrum disorder, and attention deficit hyperactivity disorder (ADHD) amongst others. ADHD is characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity that has a direct negative impact on academic, occupational, or social functioning. Disorders of intellectual development are characterised by significant limitations in intellectual functioning and adaptive behaviour, which refers to difficulties with everyday conceptual, social, and practical skills that are performed in daily life. Autism spectrum disorder (ASD) constitutes a diverse group of conditions characterised by some degree of difficulty with social communication and reciprocal social interaction, as well as persistent restricted, repetitive, and inflexible patterns of behaviour, interests, or activities.

Effective treatment options exist including psychosocial interventions, behavioural interventions, occupational and speech therapy. For certain diagnoses and age groups, medication may also be considered.

Who is at risk from developing a mental disorder?

At any one time, a diverse set of individual, family, community, and structural factors may combine to protect or undermine mental health. Although most people are resilient, people who are exposed to adverse circumstances – including poverty, violence, disability, and inequality – are at higher risk. Protective and risk factors include individual psychological and biological factors, such as emotional skills as well as genetics. Many of the risk and protective factors are influenced through changes in brain structure and/or function.

Health systems and social support

Health systems have not yet adequately responded to the needs of people with mental disorders and are significantly under resourced. The gap between the need for treatment and its provision is wide all over the world; and is often poor in quality when delivered. For example, only 29% of people with psychosis (5) and only one third of people with depression receive formal mental health care (6).

People with mental disorders also require social support, including support in developing and maintaining personal, family, and social relationships. People with mental disorders may also need support for educational programmes, employment, housing, and participation in other meaningful activities.

WHO response

WHO’s Comprehensive Mental Health Action Plan 2013-2030 recognizes the essential role of mental health in achieving health for all people. The plan includes 4 major objectives:

WHO’s Mental Health Gap Action Programme (mhGAP) uses evidence-based technical guidance, tools and training packages to expand services in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care. The WHO mhGAP Intervention Guide 2.0 is part of this Programme, and provides guidance for doctors, nurses, and other health workers in non-specialist health settings on assessment and management of mental disorders.

References

(1) Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx), (https://vizhub.healthdata.org/gbd-results/, accessed 14 May 2022).

(4) Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annual Review of Clinical Psychology, 2014;10,425-438.

(5) Mental health atlas 2020. Geneva: World Health Organization; 2021

Air pollution and climate change

Nine out of ten people breathe polluted air every day. In 2019, air pollution is considered by WHO as the greatest environmental risk to health. Microscopic pollutants in the air can penetrate respiratory and circulatory systems, damaging the lungs, heart and brain, killing 7 million people prematurely every year from diseases such as cancer, stroke, heart and lung disease. Around 90% of these deaths are in low- and middle-income countries, with high volumes of emissions from industry, transport and agriculture, as well as dirty cookstoves and fuels in homes.

The primary cause of air pollution (burning fossil fuels) is also a major contributor to climate change, which impacts people’s health in different ways. Between 2030 and 2050, climate change is expected to cause 250 000 additional deaths per year, from malnutrition, malaria, diarrhoea and heat stress.

In October 2018, WHO held its first ever Global Conference on Air Pollution and Health in Geneva. Countries and organizations made more than 70 commitments to improve air quality. This year, the United Nations Climate Summit in September will aim to strengthen climate action and ambition worldwide. Even if all the commitments made by countries for the Paris Agreement are achieved, the world is still on a course to warm by more than 3°C this century.

Noncommunicable diseases

Noncommunicable diseases, such as diabetes, cancer and heart disease, are collectively responsible for over 70% of all deaths worldwide, or 41 million people. This includes 15 million people dying prematurely, aged between 30 and 69.

Over 85% of these premature deaths are in low- and middle-income countries. The rise of these diseases has been driven by five major risk factors: tobacco use, physical inactivity, the harmful use of alcohol, unhealthy diets and air pollution. These risk factors also exacerbate mental health issues, that may originate from an early age: half of all mental illness begins by the age of 14, but most cases go undetected and untreated – suicide is the third leading cause of death among 15-19 year-olds.

Among many things, this year WHO will work with governments to help them meet the global target of reducing physical inactivity by 15% by 2030 – through such actions as implementing the ACTIVE policy toolkit to help get more people being active every day.

Global influenza pandemic

The world will face another influenza pandemic – the only thing we don’t know is when it will hit and how severe it will be. Global defences are only as effective as the weakest link in any country’s health emergency preparedness and response system.

WHO is constantly monitoring the circulation of influenza viruses to detect potential pandemic strains: 153 institutions in 114 countries are involved in global surveillance and response.

Every year, WHO recommends which strains should be included in the flu vaccine to protect people from seasonal flu. In the event that a new flu strain develops pandemic potential, WHO has set up a unique partnership with all the major players to ensure effective and equitable access to diagnostics, vaccines and antivirals (treatments), especially in developing countries.

Fragile and vulnerable settings

More than 1.6 billion people (22% of the global population) live in places where protracted crises (through a combination of challenges such as drought, famine, conflict, and population displacement) and weak health services leave them without access to basic care.

Fragile settings exist in almost all regions of the world, and these are where half of the key targets in the sustainable development goals, including on child and maternal health, remains unmet.

WHO will continue to work in these countries to strengthen health systems so that they are better prepared to detect and respond to outbreaks, as well as able to deliver high quality health services, including immunization.

Antimicrobial resistance

The development of antibiotics, antivirals and antimalarials are some of modern medicine’s greatest successes. Now, time with these drugs is running out. Antimicrobial resistance – the ability of bacteria, parasites, viruses and fungi to resist these medicines – threatens to send us back to a time when we were unable to easily treat infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis. The inability to prevent infections could seriously compromise surgery and procedures such as chemotherapy.

Resistance to tuberculosis drugs is a formidable obstacle to fighting a disease that causes around 10 million people to fall ill, and 1.6 million to die, every year. In 2017, around 600 000 cases of tuberculosis were resistant to rifampicin – the most effective first-line drug – and 82% of these people had multidrug-resistant tuberculosis.

Drug resistance is driven by the overuse of antimicrobials in people, but also in animals, especially those used for food production, as well as in the environment. WHO is working with these sectors to implement a global action plan to tackle antimicrobial resistance by increasing awareness and knowledge, reducing infection, and encouraging prudent use of antimicrobials.

Ebola and other high-threat pathogens

In 2018, the Democratic Republic of the Congo saw two separate Ebola outbreaks, both of which spread to cities of more than 1 million people. One of the affected provinces is also in an active conflict zone.

This shows that the context in which an epidemic of a high-threat pathogen like Ebola erupts is critical – what happened in rural outbreaks in the past doesn’t always apply to densely populated urban areas or conflict-affected areas.

At a conference on Preparedness for Public Health Emergencies held last December, participants from the public health, animal health, transport and tourism sectors focussed on the growing challenges of tackling outbreaks and health emergencies in urban areas. They called for WHO and partners to designate 2019 as a “Year of action on preparedness for health emergencies”.

WHO’s R&D Blueprint identifies diseases and pathogens that have potential to cause a public health emergency but lack effective treatments and vaccines. This watchlist for priority research and development includes Ebola, several other haemorrhagic fevers, Zika, Nipah, Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS) and disease X, which represents the need to prepare for an unknown pathogen that could cause a serious epidemic.

Weak primary health care

Primary health care is usually the first point of contact people have with their health care system, and ideally should provide comprehensive, affordable, community-based care throughout life.

Primary health care can meet the majority of a person’s health needs of the course of their life. Health systems with strong primary health care are needed to achieve universal health coverage.

Yet many countries do not have adequate primary health care facilities. This neglect may be a lack of resources in low- or middle-income countries, but possibly also a focus in the past few decades on single disease programmes. In October 2018, WHO co-hosted a major global conference in Astana, Kazakhstan at which all countries committed to renew the commitment to primary health care made in the Alma-Ata declaration in 1978.

In 2019, WHO will work with partners to revitalize and strengthen primary health care in countries, and follow up on specific commitments made by in the Astana Declaration.

Vaccine hesitancy

Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases. Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.

Measles, for example, has seen a 30% increase in cases globally. The reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy. However, some countries that were close to eliminating the disease have seen a resurgence.

The reasons why people choose not to vaccinate are complex; a vaccines advisory group to WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence are key reasons underlying hesitancy. Health workers, especially those in communities, remain the most trusted advisor and influencer of vaccination decisions, and they must be supported to provide trusted, credible information on vaccines.

In 2019, WHO will ramp up work to eliminate cervical cancer worldwide by increasing coverage of the HPV vaccine, among other interventions. 2019 may also be the year when transmission of wild poliovirus is stopped in Afghanistan and Pakistan. Last year, less than 30 cases were reported in both countries. WHO and partners are committed to supporting these countries to vaccinate every last child to eradicate this crippling disease for good.

Dengue

Dengue, a mosquito-borne disease that causes flu-like symptoms and can be lethal and kill up to 20% of those with severe dengue, has been a growing threat for decades.

A high number of cases occur in the rainy seasons of countries such as Bangladesh and India. Now, its season in these countries is lengthening significantly (in 2018, Bangladesh saw the highest number of deaths in almost two decades), and the disease is spreading to less tropical and more temperate countries such as Nepal, that have not traditionally seen the disease.

An estimated 40% of the world is at risk of dengue fever, and there are around 390 million infections a year. WHO’s Dengue control strategy aims to reduce deaths by 50% by 2020.

WHO/ILO: Almost 2 million people die from work-related causes each year

Work-related diseases and injuries were responsible for the deaths of 1.9 million people in 2016, according to the first joint estimates from the World Health Organization (WHO) and International Labour Organization (ILO).

Non-communicable diseases accounted for 81 per cent of the deaths. The greatest causes of deaths were chronic obstructive pulmonary disease (450,000 deaths); stroke (400,000 deaths) and ischaemic heart disease (350,000 deaths). Occupational injuries caused 19 per cent of deaths (360,000 deaths).

The study considers 19 occupational risk factors, including exposure to long working hours and workplace exposure to air pollution, asthmagens, carcinogens, ergonomic risk factors, and noise. The key risk was exposure to long working hours – linked to approximately 750,000 deaths. Workplace exposure to air pollution (particulate matter, gases and fumes) was responsible for 450,000 deaths.

“It’s shocking to see so many people literally being killed by their jobs,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. «Our report is a wake-up call to countries and businesses to improve and protect the health and safety of workers by honouring their commitments to provide universal coverage of occupational health and safety services.”

Work-related diseases and injuries strain health systems, reduce productivity and can have a catastrophic impact on household incomes, the report warns.

Globally, work-related deaths per population fell by 14 per cent between 2000 and 2016. This may reflect improvements in workplace health and safety, the report says. However, deaths from heart disease and stroke associated with exposure to long working hours rose by 41 and 19 per cent respectively. This reflects an increasing trend in this relatively new and psychosocial occupational risk factor.

This first WHO/ILO joint global monitoring report will enable policy makers to track work-related health loss at country, regional and global levels. This allows for more focused scoping, planning, costing, implementation and evaluation of appropriate interventions to improve workers’ population health and health equity. The report shows that more action is needed to ensure healthier, safer, more resilient and more socially just workplaces, with a central role played by workplace health promotion and occupational health services.

Each risk factor has a unique set of preventive actions, which are outlined in the monitoring report to guide governments, in consultation with employers and workers. For example, the prevention of exposure to long working hours requires agreement on healthy maximum limits on working time. To reduce workplace exposure to air pollution, dust control, ventilation, and personal protective equipment is recommended.

“These estimates provide important information on the work-related burden of disease, and this information can help to shape policies and practices to create healthier and safer workplaces,” said Guy Ryder, ILO Director-General. “Governments, employers and workers can all take actions to reduce exposure to risk factors at the workplace. Risk factors can also be reduced or eliminated through changes in work patterns and systems. As a last resort personal protective equipment can also help to protect workers whose jobs mean they cannot avoid exposure.”

“These almost 2 million premature deaths are preventable. Action needs to be taken based on the research available to target the evolving nature of work-related health threats,” said Dr. Maria Neira, Director of the Department of Environment, Climate Change and Health at WHO, “Ensuring health and safety among workers is a shared responsibility of the health and labour sector, as is leaving no workers behind in this regard. In the spirit of the UN Sustainable Development Goals, health and labour must work together, hand in hand, to ensure that this large disease burden is eliminated.”

“International labour standards and WHO/ILO tools and guidelines give a solid basis to implement strong, effective and sustainable occupational safety and health systems at different levels. Following them should help to significantly reduce these deaths and disabilities,” said Vera Paquete-Perdigao, Director of Director of the Governance and Tripartism Department at ILO.

A disproportionately large number of work-related deaths occur in workers in South-East Asia and the Western Pacific, and males and people aged over 54 years.

The report notes that total work-related burden of disease is likely substantially larger, as health loss from several other occupational risk factors must still be quantified in the future. Moreover, the effects of the COVID-19 pandemic will add another dimension to this burden to be captured in future estimates.

Note for editors:

In May 2021, WHO and ILO released the first ever study that quantified the burdens of heart disease and stroke attributable to exposure to long working hours (i.e., 750,000 deaths). This study established long working hours as the risk factor with the largest work-related disease burden.

Today, with the publication of the global monitoring report, WHO and ILO launch their global comparative risk assessment of the work-related burden of disease. This covers 19 occupational risk factors. It is WHO’s most comprehensive study of work-related burden of disease, and the first ever joint assessment of its kind with ILO. A visualization of country-level disease burden, with gender and age breakdowns, is available online.

WHO releases first-ever global guidance for country validation of viral hepatitis B and C elimination

New WHO Guidance for country validation of viral hepatitis B and C elimination is released during a joint EASL-CDC-ECDC and WHO symposium “Viral Hepatitis Elimination – Assessing the progress in 2021” at the EASL International Liver Congress 2021. This represents the first-ever global guidance for countries seeking to validate elimination of hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection as a public health problem.

In 2016, the WHO Global Health Sector Strategy (GHSS) on viral hepatitis provided the initial roadmap for the elimination of viral hepatitis as a public health problem by 2030 – a 90% reduction in incidence and a 65% reduction in mortality by 2030, compared with a 2015 baseline. This new guidance provides a framework for countries to measure their efforts in reducing both new infections of hepatitis B and C and deaths from liver cirrhosis and cancer alongside reaching high coverage (>90%) of programme interventions to ultimately confirm attainment of elimination. These include preventative interventions, such as hepatitis B infant and birthdose vaccination, blood and injection safety and harm reduction, as well as HBV/HCV testing and treatment, and must be maintained for 2 years. This interim guidance aims to promote a standardized public health approach for viral hepatitis elimination and recognizes regional and country context and burden of viral hepatitis B and C.

Countries are encouraged to pursue elimination of both viral hepatitis B and C together, however they may choose to apply separately for one of four certification options:

The guidance also provides countries with a range of options for how to measure the targets depending on available surveillance data and capacity, as well as a checklist of other considerations to assess their progress towards elimination. These include assessing quality of strategic information, laboratory processes, diagnostics and medicines, and health-care programmes, as well as adherence to the principles of equity, human rights and community engagement.

WHO already has an integrated approach to the elimination of mother-to-child transmission (EMTCT) of HIV, syphilis and hepatitis B pioneered jointly by the Pan American Health Organization, and the Regional Office for the Western Pacific Region. WHO also has strategies and targets for elimination or eradication of 30 other diseases. Where possible, the process for validation of elimination of viral hepatitis can be aligned. with these other disease elimination efforts to promote system efficiencies.

“This guidance is intended to motivate countries to take rapid and appropriate action toward viral hepatitis elimination. It is also important that the validation process is country-led and driven. There are important differences across countries in their hepatitis B and C epidemics, and they will need to adapt the process and national targets to their context and affected populations,” said Dr Meg Doherty, Director of WHO’s Global HIV, Hepatitis and Sexually Transmitted Infections Programmes.

“The guidance is a valuable practical tool for countries seeking to achieve elimination of hepatitis B and C. The epidemiology and progress toward elimination varies by country, and this document provides the flexibility for countries to adapt it to their context” said Dr Carolyn Wester, Director, Division of Viral Hepatitis, Centers for Disease Control and Prevention.

“To overcome the barriers to achieving viral hepatitis elimination, we must improve people’s access to treatment and care. To this end, all actors involved, including patient organisations, must work together and deliver care at the community level. In 2019, the major hepatology societies agreed that there is an urgent need to simplify viral hepatitis testing and linkage to care and today this remains a priority. Only by decentralizing viral hepatitis services to local level care and task-sharing care with primary care clinicians and other health care practitioners we can achieve our goal,” said Maria Buti, Chair of EU Policy and Public Health, European Association for the Study of the Liver (EASL).

WHO issues new recommendations on human genome editing for the advancement of public health

Two new companion reports released today by the World Health Organization (WHO) provide the first global recommendations to help establish human genome editing as a tool for public health, with an emphasis on safety, effectiveness and ethics.

The forward-looking new reports result from the first broad, global consultation looking at somatic, germline and heritable human genome editing. The consultation, which spanned over two years, involved hundreds of participants representing diverse perspectives from around the world, including scientists and researchers, patient groups, faith leaders and indigenous peoples.

“Human genome editing has the potential to advance our ability to treat and cure disease, but the full impact will only be realized if we deploy it for the benefit of all people, instead of fueling more health inequity between and within countries,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

Potential benefits of human genome editing include faster and more accurate diagnosis, more targeted treatments and prevention of genetic disorders. Somatic gene therapies, which involve modifying a patient’s DNA to treat or cure a disease, have been successfully used to address HIV, sickle-cell disease and transthyretin amyloidosis. The technique could also vastly improve treatment for a variety of cancers.

However, some risks exist, for example, with germline and heritable human genome editing, which alter the genome of human embryos and could be passed on to subsequent generations, modifying descendants’ traits.

The reports published today deliver recommendations on the governance and oversight of human genome editing in nine discrete areas, including human genome editing registries; international research and medical travel; illegal, unregistered, unethical or unsafe research; intellectual property; and education, engagement and empowerment. The recommendations focus on systems-level improvements needed to build capacity in all countries to ensure that human genome editing is used safely, effectively, and ethically.

The reports also provide a new governance framework that identifies specific tools, institutions and scenarios to illustrate practical challenges in implementing, regulating and overseeing research into the human genome. The governance framework offers concrete recommendations for dealing with specific scenarios such as:

“These new reports from WHO’s Expert Advisory Committee represent a leap forward for this area of rapidly emerging science,” said WHO’s Chief Scientist, Dr Soumya Swaminathan. “As global research delves deeper into the human genome, we must minimize risks and leverage ways that science can drive better health for everyone, everywhere.”

Meeting recording

Reports launch – Human Genome Editing: A Framework for Governance and Recommendations, July 14, 2021.

Panellists: Members of the WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing”

Immunization coverage

Key facts

While immunization is one of the most successful public health interventions, coverage has plateaued over the last decade. The COVID-19 pandemic and associated disruptions have strained health systems, with 25 million children missing out on vaccination in 2021, 5.9 million more than in 2019 and the highest number since 2009.

During 2021, about 81% of infants worldwide (105 million infants) received 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine, protecting them against infectious diseases that can cause serious illness and disability or be fatal.

Twenty five vaccine introductions were reported in 2021 (not including COVID-19 vaccine introductions). Although this is an increase from 17 introductions in 2020, it is well below the number of introductions of any year in the past two decades prior to 2020. This slowdown is likely to continue as countries focus on ongoing efforts to control the COVID-19 pandemic.

Global immunization coverage 2021

A summary of global vaccination coverage in 2021 follows.

Haemophilus influenzae type b (Hib) causes meningitis and pneumonia. Hib vaccine had been introduced in 192 Member States by the end of 2021. Global coverage with 3 doses of Hib vaccine is estimated at 71%. There is great variation between regions. The WHO Eastern Mediterranean Region and South-East Asia Region are each estimated to have 82% coverage, while it is only 29% in the WHO Western Pacific Region.

Hepatitis B is a viral infection that attacks the liver. Hepatitis B vaccine for infants had been introduced nationwide in 190 Member States by the end of 2021. Global coverage with 3 doses of hepatitis B vaccine is estimated at 80%. In addition, 111 Member States introduced nationwide 1 dose of hepatitis B vaccine to newborns within the first 24 hours of life. Global coverage is 42% and is as high as 78% in the WHO Western Pacific Region, while it is only estimated to be at 17% in the WHO African Region.

Human papillomavirus (HPV) is the most common viral infection of the reproductive tract and can cause cervical cancer in women, other types of cancer, and genital warts in both men and women. Including 5 new introductions, 116 Member States have introduced HPV vaccine by the end of 2021. Since many large countries have not yet introduced the vaccine and vaccine coverage decreased in 2021 in many countries, global coverage with the first dose of HPV among girls is now estimated at 15%. This is a proportionally large reduction from 20% in 2019.

Meningitis A is an infection that is often deadly and leaves 1 in 5 affected individuals with long-term devastating sequelae. Before the introduction of MenAfriVac in 2010 – a revolutionary vaccine – meningitis serogroup A accounted for 80–85% of meningitis epidemics in the African meningitis belt. By the end of 2021, 350 million people in 24 out of the 26 countries in the meningitis belt had been vaccinated with MenAfriVac through campaigns. Thirteen countries had included MenAfriVac in their routine immunization schedule by 2021..

Measles is a highly contagious disease caused by a virus, which usually results in a high fever and rash, and can lead to blindness, encephalitis or death. By the end of 2021, 81% of children had received 1 dose of measles-containing vaccine by their second birthday, and 183 Member States had included a second dose as part of routine immunization and 71% of children received 2 doses of measles vaccine according to national immunization schedules.

Mumps is a highly contagious virus that causes painful swelling at the side of the face under the ears (the parotid glands), fever, headache and muscle aches. It can lead to viral meningitis. Mumps vaccine had been introduced nationwide in 123 Member States by the end of 2021.

Pneumococcal diseases include pneumonia, meningitis and febrile bacteraemia, as well as otitis media, sinusitis and bronchitis. Pneumococcal vaccine had been introduced in 154 Member States by the end of 2021, including 2 in some parts of the country, and global third dose coverage was estimated at 51%. There is great variation between regions. The WHO European Region is estimated to have 82% coverage, while it is only 19% in the WHO Western Pacific Region.

Polio is a highly infectious viral disease that can cause irreversible paralysis. In 2021, 80% of infants around the world received 3 doses of polio vaccine. In 2021, the coverage of infants receiving their first dose of inactivated polio vaccine (IPV) in countries that are still using oral polio vaccine (OPV) is estimated at 79%. Targeted for global eradication, polio has been stopped in all countries except for Afghanistan and Pakistan. Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and immunization services and travel or trade links to endemic countries.

Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world. Rotavirus vaccine was introduced in 118 countries by the end of 2021, including 2 in some parts of the country. Global coverage was estimated at 49%.

Rubella is a viral disease which is usually mild in children, but infection during early pregnancy may cause fetal death or congenital rubella syndrome, which can lead to defects of the brain, heart, eyes and ears. Rubella vaccine was introduced nationwide in 173 Member States by the end of 2021, and global coverage was estimated at 66%.

Tetanus is caused by a bacterium which grows in the absence of oxygen, for example in dirty wounds or the umbilical cord if it is not kept clean. The spores of C. tetani are present in the environment irrespective of geographical location. It produces a toxin which can cause serious complications or death. Maternal and neonatal tetanus persist as public health problems in 12 countries, mainly in Africa and Asia.

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. As of 2021, yellow fever vaccine had been introduced in routine infant immunization programmes in 36 of the 40 countries and territories at risk for yellow fever in Africa and the Americas. In these 40 countries and territories, coverage is estimated at 47%.

Key challenges

In 2021, 18.2 million infants did not receive an initial dose of DTP vaccine, pointing to a lack of access to immunization and other health services, and an additional 6.8 million are partially vaccinated. Of the 25 million, more than 60% of these children live in 10 countries: Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Myanmar, Nigeria, Pakistan and the Philippines.

Monitoring data at subnational levels is critical to helping countries prioritize and tailor vaccination strategies and operational plans to address immunization gaps and reach every person with life-saving vaccines.

WHO response

WHO is working with countries and partners to improve global vaccination coverage, including through these initiatives adopted by the World Health Assembly in August 2020.

Immunization Agenda 2030

IA2030 sets an ambitious, overarching global vision and strategy for vaccines and immunization for the decade 2021–2030. It was co-created with thousands of contributions from countries and organizations around the world. It draws on lessons from the past decade and acknowledges continuing and new challenges posed by infectious diseases (e.g. Ebola, COVID-19).

The strategy has been designed to respond to the interests of every country and intends to inspire and align the activities of community, national, regional and global stakeholders towards achieving a world where everyone, everywhere fully benefits from vaccines for good health and well-being. IA2030 is operationalized through regional and national strategies and mechanisms to ensure ownership and accountability and a monitoring and evaluation framework to guide country implementation.

The global strategy towards eliminating cervical cancer as a public health problem

In 2020, the World Health Assembly adopted the global strategy towards eliminating cervical cancer. In this strategy, the first of the 3 pillars requires the introduction of the HPV vaccine in all countries and has set a target of reaching 90% coverage. With introduction currently in 57% of Member States, large investments towards introduction in low and middle-income countries will be required in the next 10 years as well as programme improvements to reach the 90% coverage targets in low and high-income settings alike will be required to reach the 2030 targets.

World Health Organization

World Health Organization
Organisation mondiale de la santé
Organización Mundial de la Salud
世界卫生组织

منظمة الصحة العالمية

Всеми́рная организа́ция здравоохране́ния (ВОЗ, англ. World Health Organization, WHO ) — специализированное учреждение Организации Объединённых Наций (самостоятельные международные организации, связанные с Организацией Объединённых Наций специальным соглашением о сотрудничестве), состоящее из 194 государств-членов, основная функция которого лежит в решении международных проблем здравоохранения населения Земли.

Всемирная организация здравоохранения была основана в 1948 году с главной конторой (офисом) в Женеве, в Швейцарии. В специализированную группу ООН, кроме ВОЗ, входят ЮНЕСКО (Организация Объединённых Наций по вопросам образования, науки и культуры), Международная организация труда (МОТ), ЮНИСЕФ (Фонд помощи детям) и другие (см. Специализированные учреждения ООН).

Государство-член ООН становится членом ВОЗ, приняв Устав. Государство не член ООН принимается в члены ВОЗ простым большинством голосов Генеральной ассамблеи. Территории, не правомочные выступать субъектами международных отношений, могут быть приняты в ВОЗ в качестве ассоциативных членов на основании заявлений, сделанных от их имени членом ВОЗ или другим полномочным органом, ответственным за международные отношения этих территорий.

Содержание

Предыстория создания ВОЗ [ | ]

Первым органом, занимавшимся межнациональным сотрудничеством в этом вопросе, был Константинопольский высший совет здравоохранения, образованный в 1839 году. Его основными задачами были контроль за иностранными судами в портах Османской империи и противоэпидемические мероприятия по предупреждению распространения чумы и холеры. Позднее подобные советы были созданы в Марокко (1840 год) и Египте (1846 год). В 1851 году в Париже прошла I Международная санитарная конференция ( всего их было 14 [en] ), в которой участвовали 12 государств, в том числе и Российская империя. Итогом работы этого форума предполагалось принятие Международной санитарной конвенции, которая определила порядок морского карантина в Средиземном море. Однако достигнуть этого результата удалось только в 1892 году в отношении холеры, а в 1897 — в отношении чумы.

История ВОЗ [ | ]

Приводится согласно официальному сайту [6] :

Структура ВОЗ [ | ]

Штаб-квартира ВОЗ [ | ]

Штаб-квартира ВОЗ находится в Женеве, Швейцария.

Руководство ВОЗ [ | ]

Генеральный директор ВОЗ [ | ]

Генеральные директора ВОЗ [ | ]

Задачи ВОЗ [ | ]

Сферы деятельности ВОЗ [ | ]

Региональные бюро ВОЗ [ | ]

В соответствии со статьёй 44 Устава ВОЗ в период с 1949 по 1952 год открыты региональные бюро ВОЗ:

Региональный директор является главой ВОЗ для своего региона. Региональный директор управляет и/или контролирует работников здравоохранения и других специалистов в региональных отделениях и в специализированных центрах. Наряду с Генеральным директором ВОЗ и руководителями региональных бюро ВОЗ, известных как представители ВОЗ в регионе, региональный директор также обладает функциями прямого надзорного органа в регионе.

Другие бюро ВОЗ [ | ]

Работа ВОЗ [ | ]

Работа ВОЗ организована в виде Всемирных Ассамблей здравоохранения, на которых ежегодно представители государств-членов обсуждают важнейшие вопросы охраны здоровья. Между Ассамблеями основную функциональную роль несёт Исполнительный комитет, включающий представителей 30 государств (среди них — 5 постоянных членов: США, Россия, Великобритания, Франция и Китай). Для обсуждения и консультаций ВОЗ привлекает многочисленных известных специалистов, которые готовят технические, научные и информационные материалы, организуют заседания экспертных советов. Широко представлена издательская деятельность ВОЗ, включающая отчёты Генерального директора о деятельности, статистические материалы, документы комитетов и совещаний, в том числе отчёты Ассамблеи, исполнительных комитетов, сборники резолюций и решений и т. д. Кроме того, выпускаются журналы ВОЗ: «Бюллетень ВОЗ», «Хроника ВОЗ», «Международный форум здравоохранения», «Здоровье мира», «Ежегодник мировой санитарной статистики», серия монографий и технических докладов. Официальными языками являются английский и французский, рабочими (кроме указанных) — русский, испанский, арабский, китайский, немецкий.

Деятельность ВОЗ осуществляется в соответствии с общими программами на 5—7 лет, планирование ведётся на 2 года. В настоящее время приоритетными направлениями являются:

ВОЗ удаётся решать многие важные вопросы. По инициативе ВОЗ и при активной поддержке национальных систем здравоохранения (в том числе и СССР) была проведена кампания по ликвидации оспы в мире (последний случай зарегистрирован в 1981 г.); ощутимой является кампания по борьбе с малярией, распространённость которой сократилась почти в 2 раза, программа иммунизации против 6 инфекционных заболеваний, организация выявления и борьба с ВИЧ, создание справочно-информационных центров во многих государствах, формирование служб первичной медико-санитарной помощи, медицинских школ, учебных курсов и т. д. Основная роль ВОЗ в достижении поставленных целей — консультативная, экспертная и техническая помощь странам, а также предоставление необходимой информации, чтобы научить страны помогать самим себе в решении ключевых проблем охраны здоровья. На сегодня ВОЗ определила наиболее важные направления деятельности национальных систем здравоохранения как: ВИЧ/СПИД, туберкулёз, малярия, содействие безопасной беременности — здоровье матери и ребёнка, здоровье подростков, психическое здоровье, хронические заболевания.

Финансирование ВОЗ [ | ]

Источники и объёмы финансирования ВОЗ публичны.

Всемирные дни ВОЗ, входящие в систему международных дней ООН [ | ]

Всемирные дни, поддерживаемые ВОЗ [ | ]

Эти всемирные дни не входят в систему международных дней ООН

Послы доброй воли [ | ]

Не стоит путать послов доброй воли с волонтерами-добровольцами, стать которыми может практически любой человек, соответствующий неприхотливым требованиям: возраст от 25 лет, высшее образование и стаж работы, а также знание английского языка. Достаточно, чтобы он подал заявление на сайт волонтёров ООН.

Реформа ВОЗ [ | ]

Приводится согласно официальному сайту [22] :

Критика [ | ]

Oral health

Oral health is a key indicator of overall health, well-being and quality of life. It encompasses a range of diseases and conditions that include dental caries, periodontal (gum) disease, tooth loss, oral cancer, oro-dental trauma, noma and birth defects such as cleft lip and palate. The Global Burden of Disease Study 2019 estimated that oral diseases affect close to 3.5 billion people worldwide. According to the International Agency for Research on Cancer, cancers of the lip and oral cavity are among the top 20 most common cancers worldwide, with nearly 180 000 deaths each year.

Most oral diseases and conditions share modifiable risk factors with the leading noncommunicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes). These risk factors include tobacco use, alcohol consumption and unhealthy diets high in free sugars, all of which are increasing at the global level. There is a proven relationship between oral and general health. It is reported, for example, that diabetes is linked with the development and progression of periodontitis. Moreover, there is a causal link between high consumption of sugars and diabetes, obesity and dental caries.

Poor oral health causes millions of people to suffer from devastating pain and increases the out-of-pocket financial burden for society. Oral diseases can affect an individual’s effectiveness in school and work settings and can cause social and personal problems. The psychosocial impact of many oral diseases significantly reduces quality of life.

While the global burden of untreated dental caries in primary and permanent teeth has remained relatively unchanged over the past 30 years, the overall burden of oral health conditions on services is likely to keep increasing because of population growth and ageing.

Oral diseases disproportionally affect the poor and socially-disadvantaged members of society. There is a very strong and consistent association between socioeconomic status (income, occupation and educational level) and the prevalence and severity of oral diseases. This association remains across the life course, from early childhood to older age, and across populations in high-, middle- and low-income countries.

Out-of-pocket costs for oral health care can be major barriers to accessing care. Paying for necessary oral health care is among the leading reasons for catastrophic health expenditures, resulting in an increased risk of impoverishment and economic hardship. The demand for oral health care is beyond the capacity of health-care systems in most low- and middle-income countries, and many people in some high-income countries are unable to afford proper care.

WHO’s oral health work is focused on strengthening cost-effective population-wide oral health promotion and oral health care within the primary care system, particularly among populations where access to oral health care is most limited.

In 2021, the World Health Assembly Resolution on oral health was adopted with Member States requesting WHO: to develop a draft global strategy on tackling oral diseases for consideration by WHO governing bodies in 2022 and by 2023: to translate the global strategy into an action plan for oral health; to develop “best buy” interventions on oral health; and to explore the inclusion of noma within the roadmap for neglected tropical diseases 2021-2030. WHO was asked to report back on progress and results until 2031 as part of the consolidated report on noncommunicable diseases.

FIFA supports World Health Organization 16-day campaign to raise awareness on domestic violence

FIFA and the World Health Organization have teamed up to raise awareness about domestic violence and support those at risk, during the 16 days of activism against gender-based violence. The campaign kicks off on today’s International Day for the Elimination of Violence against Women and will run until Human Rights Day on Friday 10 December.

“Violence is never the answer, especially at home, which should be a safe environment for everyone, and particularly for women and children,” said FIFA President Gianni Infantino. “It is FIFA’s statutory obligation to respect all internationally recognized human rights and as an organization, FIFA shall strive to promote the protection of these rights. The #SafeHome campaign is now in its second year, and FIFA will continue to make football’s voice heard to amplify this message until these acts are no longer part of our society.”

“The COVID-19 pandemic has exacerbated many health challenges and inequities, including violence against women,” said WHO’s Director-General, Dr Tedros Adhanom Ghebreyesus. “We all must come together to end all forms of violence and discrimination. WHO is pleased to team up with FIFA and football stars around the world to help prevent violence against women, and children, support survivors, and make our societies safer and healthier for all.”

Violence against women remains devastatingly pervasive and starts alarmingly young, according to data from WHO. Across their lifetime, 1 in 3 women aged 15 and over, around 736 million, are subjected to physical and/or sexual violence by an intimate partner or sexual violence from a non-partner – a number that has remained largely unchanged over the past decade.

This violence starts early: 1 in 4 young women (aged 15-24 years) who have been in a relationship will have already experienced violence by an intimate partner by the time they reach their mid-twenties. Data suggests women’s exposure to violence has likely increased during the COVID-19 pandemic due to lockdowns and disruptions to vital support services.

Violence – in all its forms – can impact a person’s health and well-being throughout their life. It is associated with increased risk of injuries, depression, anxiety disorders, unplanned pregnancies, sexually-transmitted infections including HIV and many other health problems, and comes with tremendous costs to households, communities and societies as a whole.

The five-part #SafeHome video campaign, which supports the WHO’s message to end violence against women and children, is being published in seven languages during the next 16 days. The campaign raises awareness of the risks and highlights actions that can be taken to prevent and mitigate these risks through survivor advice and support. There is also content that addresses perpetrator risk and calls for additional governmental effort to support those who are in a vulnerable situation.

#SafeHome passes messages from 23 past and present footballers, many of whom have previously voiced their condemnation of violence against women and children.

These players will publish their #SafeHome contribution on their channels, while the campaign will also feature on various FIFA and WHO digital platforms. Graphical toolkits are also being provided to the 211 FIFA member associations to further amplify messages in their territories.

“Once again, we call upon FIFA member associations to pro-actively publish details of national or local helplines and support services that can help anyone who feels threatened by violence,” added the FIFA President. “In this regard, we also call upon our members to review their own safeguarding measures using the FIFA Guardians toolkit, to ensure that football is fun and safe for everyone in our game, especially the youngest members of the football community. This is what FIFA stands for, and it is what all of football has to stand for.”

The World Health Organization (WHO) and FIFA signed a four-year collaboration in 2019 to promote healthy lifestyles through football globally. More information on the WHO-FIFA memorandum of understanding can be found here, while previous campaigns include #ReachOut prior to World Mental Health Day, Pass the message to kick out coronavirus and #BeActive on the UN International Day of Sport for Development and Peace.

Всемирный день здоровья 2022 г.

7 апреля 2022 г.
Наша планета, наше здоровье

Можем ли мы представить себе мир, в котором каждому будет доступен чистый воздух, вода и пища?

В котором экономика будет поставлена на службу здоровью и благополучию?

В котором города будут пригодны для полноценной жизни, а люди будут ответственно относиться в своему здоровью и здоровью планеты?

Во Всемирный день здоровья 2022 г., на фоне продолжающейся пандемии, планетарного экологического кризиса, натиска таких заболеваний, как рак, астма и болезни сердца, ВОЗ намерена обратить внимание мирового сообщества на срочные действия, необходимые для защиты здоровья человека и планеты, и укрепить движение за создание общества, ориентированного на благополучие человека.

Согласно оценкам ВОЗ, предотвратимые причины экологического характера ежегодно уносят жизни 13 миллионов человек в мире. К ним относятся и климатический кризис – самая большая угроза здоровью человека. Климатический кризис является также кризисом в области здравоохранения.

Климатический кризис и кризис в области здравоохранения вызваны нашими политическими, социальными и экономическими решениями. В результате сжигания ископаемых видов топлива 99% людей дышат вредным для здоровья воздухом. С повышением глобальных температур все быстрее и дальше распространяются болезни, передающиеся комарами. Экстремальные погодные явления, деградация земель и дефицит воды приводят к вынужденному перемещению и людей и ухудшению их здоровья. Загрязняющие вещества и пластик проникают в самые глубины мирового океана, на склоны высочайших гор, а также в системы производства пищевых продуктов. Производство вредных для здоровья продуктов питания и напитков с высокой степенью переработки, на долю которого приходится треть выбрасываемых в атмосферу парниковых газов во всем мире, приводит к массовому заболеванию ожирением, вызывает рост числа онкологических и сердечно-сосудистых заболеваний.

Нас уничтожают, а ВОЗ и ныне там

Что такое ВОЗ?

Россия вышла из ВОЗ?

Россия не собирается выходить, С декабря 1998 года ВОЗ существует в России и осуществляют следующие программы:

С первого взгляда всё красиво и пристойно. Представители 193 страны мира собрались консолидировано охранять здоровье населения планеты Земля. Но на деле, оказалось, благие намерения ВОЗ вымостили множество дорожек, ведущих в стороны противоположные здоровью и его защите.

К официальной медицине всегда было много нареканий, потому что люди, как это ни странно, всё равно болеют и умирают, несмотря на тонны активно рекламируемых лекарств и тонны долларов, потраченные на создание панацеи от СПИДа и рака. Но ВОЗ своей активной деятельностью привлекла внимание общественности многих стран не как медицинская структура, а, скорее, как политическая, юридическая и правозащитная организация.

Чем же на самом деле занимается ВОЗ и чьи интересы она продвигает?

Многое удивляет и настораживает уже на первой странице официального сайта организации. Например, 6 февраля 2011 года организация отметила «Международный день нетерпимости в отношении практики нанесения увечий женским гениталиям». От комментариев на столь серьёзную, для Всемирной Организации Здравоохранения, тему, я воздержусь, а вот явно нездоровый её интерес к проблеме туберкулёза, спида и гриппа стоит проанализировать.

«Несколько лет назад эксперты Всемирной организации здравоохранения и другие иностранные специалисты пытались убедить российских организаторов здравоохранения и фтизиатров в том, что основным методом выявления туберкулеза должно быть пассивное выявление возбудителя простым исследованием под микроскопом мазка мокроты. Потребовались время и усилия для того, чтобы доказать справедливость и необходимость российских принципов. Кстати, в 2000 г. именно лучевыми методами активно выявлена половина всех впервые взятых на учет больных. Одна треть из них оказалась бактериовыделителями».

«Вадим Покровский, глава Федерального центра по борьбе со СПИДом, и представители ВОЗ и ЮНЭЙДС утверждали, что в России, по меньшей мере, миллион ВИЧ-инфицированных. При этом данная цифра складывалась и из официально учтенных больных, и из потенциально заразившихся.

Чистякова, не согласная с точкой зрения экспертов, подчеркивает: «В нашей стране зарегистрировано около 500 тысяч ВИЧ-инфицированных, что составляет 0,3% населения страны. Этот показатель не превышает уровень заболеваемости в большинстве развитых стран и в два раза ниже, чем в США. Искажение же объективных статистических данных провоцирует в обществе панические настроения и не позволяет адекватно оценивать профилактические программы и закладывать бюджет на лекарства больным». (источник: http://medicine.newsru.com)

ВОЗ пандемия

Уже около 20 лет правозащитники и религиозные организации, в основном зарубежные, обвиняют ЮНИСЕФ и ВОЗ в спланированных кампаниях по стерилизации населения отдельных стран с помощью вакцинации от разных заболеваний. Например, в 1993 году ученые из Инсбрукского Института биомедицинских исследований Академии наук Австрии провели исследование и доказали причастность ВОЗ к разработкам вакцины для контроля за рождаемостью. Когда в 2004 году южные штаты Нигерии бойкотировали вакцинацию, подозревая ВОЗ в стерилизации населения репродуктивного возраста, образцы вакцины были проверены нигерийским доктором Харуна Каина, деканом факультета фармацевтики университета из города Заря (Zaria). Оказалось, что вакцина содержала эстрадиол, форму женского гормона эстрогена. По мнению экспертов, такая вакцина может привести к бесплодию.

Общественность давно получила весомое доказательство существования группы людей, имеющей глобальную планетарную власть. Это кучка олигархов-дегенератов, являющихся учредителями частного Федерального Резервного банка США, бесконтрольно печатающих доллары. Эти же люди полностью контролируют Всемирную Организацию Здравоохранения, чья деятельность начинает вызывать большую тревогу человечества. ВОЗ целенаправленно реализует план «золотого миллиарда» по сокращению численности населения планеты до одного миллиарда жителей. Несколько фармацевтических корпораций, фактически кулуарно, определяют политику этой, якобы, международной организации. Проведенные ВОЗ, мягко говоря, странные прививки в Африке, Азии, Латинской Америке вызвали тяжкие эпидемии со смертельными исходами.

Межконтинентальных преступников из ВОЗ, фактически, поймали за руку при попытке совершить бактериологическую диверсию против украинских детей. Они пытались поставить некий страшный эксперимент, навязав прививку от кори и краснухи. Заболели десятки детей. Были смертельные случаи. Пресса ударила в набат. Прививку остановили. Началось расследование. Арестован некий высокопоставленный чиновник. Получен документальный материал преступной деятельности украинского Министерства здравоохранения, тупо выполнявшего сомнительное распоряжение масонов из ВОЗ.

А что же такое ВОЗ на самом деле и кто её содержит?

Изучение списка донорских взносов и обязательств ГАВИ показывает, что Фонд Гейтсов дал более 1,14 миллиардов долларов США в период с 1999 по 2009 года, гораздо больше, чем правительство США, которое дало всего 569 миллионов долларов США в период с 2001/09 годы. Таким образом, можно предположить, что Фонд Гейтсов имеет больший авторитет в ГАВИ и ПОТЗ. Также вклад ГАВИ в ВОЗ может рассматриваться, как дальнейшее влияние Фонда Гейтсов на мировую организацию.

Для любых скептиков, сомневавшихся в намерениях таких инвесторов, было бы достаточно посмотреть и на работу и Фонда Рокфеллера со Всемирной организацией здравоохранения ООН в Мексике, Никарагуа, на Филиппинах и в других бедных развивающихся странах. Там Фонд Рокфеллера, как в поговорке, был пойман за руку. Фонд тихо финансировал программу ВОЗ по «репродуктивному здоровью», в рамках которой была разработана инновационная противостолбнячная вакцина.

Конечно, не остались в стороне и глобальные содомиты. Всемирно известный поющий педераст Элтон Джон принял решение о передаче средств, вырученных от своей концертной и благотворительной деятельности, Всемирной организации здравоохранения для поддержки ее усилий, направленных на борьбу с гепатитом «В».

После очередного прививочного скандала были проведены расследования католической организацией «Мексиканский комитет «За жизнь». Комиссия пришла к выводам, что Фонд Рокфеллера, работавший совместно с Советом по народонаселению Джона Д. Рокфеллера-третьего, Всемирным Банком, Программой развития ООН, Фондом Форда и другими организациями, в течение 20 лет совместно с ВОЗ работал над созданием контрацептивной вакцины, используя хорионический гонадотропин человека в противостолбнячной и других вакцинах. В список «других» организаций, участвовавших в финансировании исследований ВОЗ, входили Всеиндийский институт медицинских наук и ряд университетов, включая университет Упсала в Швеции, Университет Хельсинки и государственный Университет штата Огайо. В список также входило правительство США через Национальный институт здоровья ребенка и человеческого развития.

«В июне 2009 года министр здравоохранения и социального развития России Татьяна Голикова и генеральный директор Всемирной организации здравоохранения Маргарет Чен подписали Меморандум о взаимопонимании на 2009-2013 годы.

В документе обе стороны выразили заинтересованность в укреплении здоровья населения стран ВОЗ, а также во взаимных выгодах, которые могут быть получены в результате сотрудничества в этой области».

Вот такое вот, полное сотрудничество, взаимопонимание и выгоды нам грозят в ближайшем будущем.

В завершение предлагаю ознакомиться с 22 шокирующими цитатами «мировой элиты» о регулировании рождаемости.

Просьба при детях вслух не читать!

1) Резюме политики Подразделения ООН по вопросам народонаселения, март 2009 г.

«Чтобы предпринять, чтобы ускорить сокращение рождаемости в наименее развитых странах?»

2) Билл Гейтс, основатель «Майкрософт».

3) Джон Пи. Холдрен (John P. Holdren) советник по науке президента США Барака Обамы.

«Было бы легче осуществить программу по стерилизации женщин после рождения ими второго или третьего ребёнка, несмотря на относительно большую сложность операции по сравнению с вазэктомией, чем пытаться стерилизовать мужчин.

Разработка капсулы продолжительной стерилизации, которую можно было бы вшить под кожу и удалить, когда беременность желательна, открывает дополнительные возможности для принудительного регулирования рождаемости. Капсулу вшивали бы в период половой зрелости и изымали бы по официальному разрешению для ограниченного числа рождений детей».

4) Пол Эрлих (Paul Ehrlich), советник по науке экс-президента США Джорджа У. Буша.

«Каждый человек, который сейчас появляется на свет, вносит диспропорцию в окружающую среду и системы жизнеобеспечения планеты».

5) Судья Верховного суда США Рут Бейдер Гинзбург (Ruth Bader Ginsburg).

«Откровенно, я думала, что, когда принималось решение по делу Рау (Roe), была озабоченность ростом численности населения, и, в частности, ростом в той его части, в которой мы хотим меньше всего».

6) Доклад Фонда населения ООН «Перед лицом меняющегося мира: женщины, население и климат» («Facing a Changing World: Women, Population and Climate»).

«Ни один человек не является по-настоящему «нейтральным к углероду», особенно, когда все парниковые газы приведены в равновесие».

7) Дэвид Рокфеллер.

«Негативное влияние роста численности населения на все наши планетарные экосистемы становится ужасающе очевидным».

8) Жак Кусто (Jacques Cousteau).

«Для того, чтобы стабилизировать численность мирового населения, мы должны ежедневно уничтожать 350 тысяч человек».

9) Основатель информационного агентства «Си-Эн-Эн» Тед Тёрнер.

10)Дэйв Форман (Dave Foreman), соучредитель организации «Земля прежде всего!».

«Мои три главные цели были бы: сократить человеческую популяцию до 100 миллионов во всём мире, разрушить промышленную инфраструктуру и увидеть пустыню с её полным набором видов, возвращающихся по всему миру».

11) Принц Филипп, герцог Эдинбургский.

«Если бы я перевоплотился, то хотел бы вернуться на землю вирусом-убийцей, чтобы уменьшить человеческие популяции».

12) Дэвид Брауэр (David Brower), первый исполнительный директор природоохранной общественной организации «Клуб «Сьерра»« (Sierra Club).

«Деторождение [должно быть] наказуемым преступлением против общества, если родители не имеют лицензии правительства. Всех потенциальных родителей [обязали бы] использовать контрацептивные химические препараты, правительство выдаёт противоядия гражданам, выбранным для рождения ребёнка».

13) Основатель Американской федерации планирования семьи Маргарет Сэнджер (Margaret Sanger).

14) Основатель Американской федерации планирования семьи Маргарет Сэнджер (Margaret Sanger). «Женщина, мораль и регулирование рождаемости» (Woman, Morality, and Birth Control). Нью-Йорк. Издательство «Нью-Йорк», 1922 г. Страница 12.

«Регулирование рождаемости должно привести в итоге к более чистой расе».

15) Философ из Принстонского университета Питер Сингер (Peter Singer).

16) Томас Фергюсон, бывший чиновник госдепартамента США по делам населения.

17) Михаил Горбачёв.

18) Джон Гвиллебод (John Guillebaud), профессор в области планирования семьи в университетском колледже Лондона.

19) Преподаватель биологии в Техасском университете в Остине Эрик Ар. Пианка (Eric R. Pianka).

«Эта планета могла бы содержать полмиллиарда людей, которые жили бы в относительном комфорте, не нанося вреда природе. Народонаселение должно быть сильно уменьшено и как можно быстрее, чтобы уменьшить ущерб окружающей среде».

20) Глава Государственного департамента США Хиллари Клинтон.

21) Нина Фёдорова, советник Хиллари Клинтон.

«Нам нужно продолжать понижать темп роста численности населения мира; планета не сможет содержать больше людей».

«Пусть земное население никогда не превышает 500.000.000, пребывая в постоянном равновесии с природой».

Check World Health Organization Job Vacancy Portal 2021 www.who.int

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– World Health Organization Job –

The World Health Organization is currently recruiting graduates and undergraduates into various job positions. Get the latest information about the available jobs here. Interested applicants should follow the lead below for successful application.

World Health Organization has been undergoing massive recruitment intake annually for the past years.

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Application Closing Date: 16th December 2021; 11:59:00 PM.

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Mistake to Avoid While Applying

A lot of people fail in many applications not because they are not qualified, but because of numerous mistakes.

So take note of the following:

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Update For Shortlisted Applicants

If you’ve been shortlisted, then you’ve got your foot in the door. And it’s time for you to shine at the final stage – the interview.

However, when shortlisted:

• Endeavour to get information about the company.

• Also, ensure you have a clear vision. Try to figure out why you want the specific position. And how you would be a good fit.

• Also, go through your application.

• Additionally, be interactive. It’s an interview, not an interrogation. There is much more to you than your resume.

• The practice goes a long way. Thus, take mock interviews with your friends or practice speaking before a mirror.

• It’s rare, but sometimes you do get an offer letter directly based on your application.

• You start planning the celebration but remember some points before you go into that party mode: Get it in writing.

• Also, go over the written offer in detail. And make sure all important details are mentioned and ask questions if you don’t understand anything.

• Such as work profile, start date, duration, and stipend, etc.

• Send a thank-you letter to the employer, once you accept the offer.

• Also, follow up with an e-mail confirming your start date and expressing your enthusiasm for your new role.

From the above, you must note that we are not partnering with these companies.

We are only making this information available, to help you get that your dream job. As such, as you apply, ensure to do more research about the company. GOOD LUCK.

World Health Organization Recruitment 2021/2022 Application

APPLY NOW! 👉SCHOLARSHIPS IN YOUR FIELD OF STUDY

– World Health Organization Recruitment –

The World Health Organization is currently recruiting graduates and undergraduates into various job positions. Get the latest information about the available jobs here. Interested applicants should follow the lead below for successful application.

World Health Organization has been undergoing massive recruitment intake annually for the past years.

READ ALSO.

We’ve received numerous requests by aspirants on various platforms yearning for legit information about the World Health Organization Application form and guidelines for 2021.

World Health Organization Job Description

World Health Organization (WHO) is the directing and coordinating authority for health within the United Nations system.

It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

Available Vacant Positions

We are recruiting to fill the vacant position below:

♦ Monitoring & Evaluation Officer

♦ Data Management Officer

Deadline: 21st December 2021.

♦ Supply Chain Management Officer

Deadline: 21st December 2021.

♦ Administrative Assistant

Deadline: 21st December 2021.

♦ Driver (Multiple Duty Stations)

Deadline: 16th December 2021.

♦ Monitoring & Evaluation Officer

Deadline: 16th December 2021.

♦ Assistant (Programme)

Deadline: 16th December 2021.

♦ Surveillance Officer

Deadline: 16th December 2021.

♦ Driver

Deadline: 16th December 2021.

♦ Data Manager

Deadline: 16th December 2021.

General Qualifications and Requirements

Applicants applying for the World Health Organization recruitment must possess any of the following.

• Any added certificate either postgraduate or professional certification will be of advantage.

• West African School Certificate (WAEC) with Credits in not less than three (3) subjects including English and at least passes in two (2) other subjects.

• Candidates must have National Examination Council (NECO) with passes in four (4) subjects obtained at one sitting or five (5) subjects obtained at two sittings including the English Language.

• National Diploma (ND) obtained from a recognized institution.

• National Certificate of Education (NCE) from a recognized institution.

• All candidates must have a valid means of identification such as a valid driver license, National Identification Card, International passport, Voters card etc.

• Ability to work with basic computer applications (e.g. Word, Excel, PowerPoint etc.).

• Geographical mobility within and outside Nigeria.

Mistakes to Avoid While Applying

A lot of people fail in many applications not because they are not qualified, but because of numerous mistakes. So take note of the following:

1. Apply on time, do not wait for the deadline.

2. Do the application processes alone, don’t send anybody to avoid mistakes in your data

3. Keep yourself updated concerning the application

4. Make sure you supply all the necessary requirements

5. Take time to crosscheck your details before submission.

6. Candidates are to apply for one job position, Candidates who attempt to apply multiple times will have their application disqualified

7. The online application is free.

READ ALSO.

Update For Shortlisted Applicants

If you’ve been shortlisted, then you’ve got your foot in the door. And it’s time for you to shine at the final stage – the interview.

However, when shortlisted:

• Endeavour to get information about the company.

• Also, ensure you have a clear vision. Try to figure out why you want the specific position. And how you would be a good fit.

• Also, go through your application.

• Additionally, be interactive. It’s an interview, not an interrogation. There is much more to you than your resume.

• The practice goes a long way. Thus, take mock interviews with your friends or practice speaking before a mirror.

• It’s rare, but sometimes you do get an offer letter directly based on your application.

• You start planning the celebration but remember some points before you go into that party mode: Get it in writing.

• Also, go over the written offer in detail. And make sure all important details are mentioned and ask questions if you don’t understand anything.

• Such as work profile, start date, duration, and stipend, etc.

• Send a thank-you letter to the employer, once you accept the offer.

• Also, follow up with an e-mail confirming your start date and expressing your enthusiasm for your new role.

From the above, you must note that we are not partnering with these companies.

We are only making this information available, to help you get that your dream job. As such, as you apply, ensure to do more research about the company. GOOD LUCK.

Looking to the future: The Rockefeller Foundation and WHO identify priorities for global health collaboration

On 8-10 November 2021, Dr Naveen Rao, Senior Vice President, Health and other senior representatives from The Rockefeller Foundation joined World Health Organization (WHO) representatives to review the strategic directions of collaboration between the two Organizations. Notably they discussed support for the WHO Health Emergencies Programme and the Science Division, including the WHO Hub on for Pandemic and Epidemic Intelligence, genomic surveillance, infodemiology, vaccine equity and demand generation and WHO’s ongoing work with philanthropic organizations.

The Rockefeller Foundation’s collaboration with WHO dates back to when the WHO constitution was first created. Over the past two decades, The Rockefeller Foundation has continued to be a key collaborator, providing over US$ 25.3 million in support to WHO programmes.

Recent collaboration has focused on digital health building capacity in data and innovation to protect and promote health and well-being. Throughout the COVID-19 pandemic, the two Organizations worked together towards the goal of maintaining essential health services everywhere, expanding virus testing capacity, strengthening and accelerating the digitalization of WHO guidelines, and advancing approaches to using digital products to end the current pandemic and prevent future ones. The Rockefeller Foundation and WHO currently co-lead the Access to COVID-19 Tools Accelerator (ACT-A) Genomic Surveillance Working Group.

“The Rockefeller Foundation recognizes WHO’s unique and vital role in safeguarding global health and well-being,” said Dr Naveen Rao, Senior Vice President, Health, The Rockefeller Foundation. “We remain steadfast in our commitment to support WHO to be a strong and efficient Organization.”

The overall objectives of the strategic dialogue were for the two Organizations to gain a better understanding of each other’s current work and priorities, and explore expanded areas for collaboration based on a more deliberate and forward-looking relationship leveraging the comparative advantages of each Organization to maximize public health impact.

Часто задаваемые вопросы

Как ВОЗ определяет здоровье?

Здоровье является состоянием полного физического, душевного и социального благополучия, а не только отсутствием болезней и физических дефектов. Это определение приводится в Преамбуле к Уставу Всемирной организации здравоохранения, принятому Международной конференцией здравоохранения, Нью-Йорк, 19-22 июня 1946 г.; подписанному 22 июля 1946 г. представителями 61 страны (Официальные документы Всемирной организации здравоохранения, Nº 2, стр. 100) и вступившему в силу 7 апреля 1948 г. С 1948 г. это определение не менялось.

Дополнительная информация об Уставе ВОЗ

Публикации: где можно найти информацию о публикациях ВОЗ?

В верхнем меню веб-сайта ВОЗ есть ссылка Публикации, которая ведет к странице о публикациях ВОЗ. Здесь можно найти онлайновый книжный магазин, новости, информацию о подписке и информацию об основных публикациях и журналах.

Могу ли я дать на моем веб-сайте ссылку на веб-сайт ВОЗ? Как получить разрешение на размещение на веб-сайте ВОЗ ссылки на мой сайт?

В принципе любой внешний веб-сайт может добавлять гиперссылку на веб-сайт ВОЗ, не запрашивая на это разрешение. Однако такое использование не должно нарушать права интеллектуальной собственности ВОЗ, в частности, относящиеся к ее названию, эмблеме, авторскому праву или правам авторов. Обычно ВОЗ не дает ссылки на внешние веб-сайты, за исключением тех случаев, где очевидна связь с деятельностью ВОЗ. Для дополнительной информации, пожалуйста, обратитесь к страницам Разрешения и лицензии.

Где можно найти информацию о возможностях работы в ВОЗ?

На сайте Работа в ВОЗ можно найти список имеющихся на текущий момент вакантных должностей и типы контрактов по найму на работу. Чтобы подать заявление на указанную в списке должность, введите ваши данные в онлайновую систему по трудоустройству.

Я ищу информацию об интернатуре. Где ее можно найти?

Полную информацию об интернатуре можно найти на следующей странице:

Предоставляет ли ВОЗ стипендии и гранты для проведения исследований?

ВОЗ не имеет самостоятельной программы стипендий или грантов, однако некоторые специальные программы и департаменты ВОЗ финансируют исследования. Посетите страницу о возможностях для получения грантов на веб-сайте TDR (Исследования в области тропических болезней) или страницу о грантах на исследования на веб-сайте RHR (Репродуктивное здоровье и исследования). Вы также можете посетить веб-сайт регионального бюро ВОЗ, к которому относится ваша страна. Региональные бюро имеют программы стипендий, которые проводятся при сотрудничестве с министерствами здравоохранения стран.

Я провожу исследования. Где начинать поиск информации?

Если вы проводите исследования по определенным вопросам здравоохранения, начните поиск со списка вопросов здравоохранения. Каждая страница, посвященная определенному вопросу здравоохранения, содержит список соответствующих сайтов, ссылок и документов. Если вы ищете информацию по конкретной стране или конкретному региону ВОЗ, посетите веб-сайт соответствующего регионального бюро ВОЗ. Информацию о конкретной стране можно также найти с помощью ссылки Страны в верхнем меню. На странице Данные и статистика перечислены ресурсы, которые можно использовать при исследованиях. Это статистические и библиотечные базы данных.

Веб-сайты региональных бюро ВОЗ

Как можно запросить информацию о ВОЗ?

ВОЗ предоставляет сведения в соответствии со своей политикой раскрытия информации. Эта политика направлена на увеличение объема доступной информации и полностью вступит в силу в течение двухлетнего периода. Специальный электронный адрес для запросов [email protected] заработает к ноябрю 2017 года.

Почему используются именно такие названия государств?

Официальные названия государств-членов ВОЗ и их соответствующее положение в списках, составленных в алфавитном порядке, основаны на информации, полученной от самих государств-членов и Организации Объединенных Наций.

Почему на некоторых картах границы проведены пунктирными линиями?

Приводимые границы и названия и используемые на картах обозначения ни в коем случае не выражают мнения ВОЗ о юридическом статусе какой-либо страны, территории, города или района, их правительствах или их границах. Пунктирными линиями на картах показаны приблизительные границы, в отношении которых пока еще не достигнуто полного согласия.

Скоро я еду заграницу. Где можно найти информацию и/или советы в отношении рисков для здоровья?

Вы можете найти информацию о требуемой вакцинации, рисках для здоровья и мерах предосторожности во время поездки в интересующую вас страну на веб-сайте Международные поездки и здоровье.

World Health Day 2021: Together we can reach a fairer and healthier world

April 2021, Cairo – On 7 April 2021, World Health Day will be commemorated globally, under the theme “Together for a fairer, healthier world”. On this occasion, the World Health Organization (WHO) calls for urgent action to eliminate health inequities and mobilize action to attain better health for all and leave no one behind.

Inequities have always existed. Despite improvements in health outcomes globally and in the Eastern Mediterranean Region, these gains have not been shared equally across different countries or communities. The COVID-19 pandemic has had grave consequences for people already experiencing inequities. The pandemic has disproportionately impacted those people already socially, economically, or geographically disadvantaged, and evidence shows a worsening trend of dispararities and inequity across the Region.

«Health is a fundamental human right. Every person deserves to live a healthy life regardless of their age, gender, ethnicity, disability, economic situation or employment. Progress in tackling health disparities has been slow worldwide, including in the Region in which many countries are experiencing emergencies and conflict and we have the largest number of displaced people in the world,» said Dr Ahmed Al-Mandhari, WHO, Regional Director for the Eastern Mediterranean.

In addition to conflict, several factors contribute to inequities such as poverty, unemployment, environmental challenges, gender inequalities, and most recently, the COVID-19 pandemic. All of these factors and others have a negative affect on the provision of services to communities and ultimately on their health and well-being.

Working to tackle the root causes of inequity, last week, the WHO Regional Office launched the report of the Commission on Social Determinants of Health in the Eastern Mediterranean Region. «This report provides detailed analysis of inequities among and within countries of the Region and recommends fairer policies and actions to achieve health equity. I call on all our partners and stakeholders to take these recommendations forward and ensure that no one is left behind,» added Dr Ahmed Al-Mandhari.

On World Health Day 2021, WHO is calling on leaders to monitor health inequalities and address their root causes to ensure that everyone has access to the living and working conditions that are conducive to good health and to quality health services where and when they need them, and to invest in primary health care to achieve health for all by all.

The WHO Regional Director noted that the regional“Vision 2023: Health for all by all: a call for action and solidarity”, was aligned with this year’s theme and that achieving health for all by all was essential to meet the challenges of today and to build the resilience of tomorrow.

For more information, please contact:

Mona Yassin Communications Officer yassinm@who.int +201006019284 (WhatsApp)

World Health Day campaign page

Join a World Health Day live session with the Regional Director on 7 April at 11:00am.

World health organization 2021

Vision, goals and strategic directions

Structure of the stategies

Click on images to enlarge

Strategic directions

Use evidence-informed guidance and service delivery innovations to accelerate access to and the uptake of a continuum of high-quality essential services for HIV, viral hepatitis and sexually transmitted infections and other related health services, tailored to meet the needs of people in diverse populations and settings, ensuring that no one is left behind.

Take a systems-oriented approach that promotes synergies with primary health care, health governance, financing, workforce, commodities and service delivery while also fostering multisectoral responses to social and structural determinants of health. Align and collaborate with partners – including funders, academic and research institutions, professional bodies and private sector entities – for maximum impact.

Engage communities and civil society, including key and affected populations, and support their self-empowerment and pivotal role in advocacy, service delivery and policy- making, including to ensure that services are culturally appropriate and responsive to community needs, and to address stigma and discrimination and tackle social and structural barriers.

In collaboration with partners, contribute to defining and implementing national, regional and global research and innovation agendas that give priority to developing new technologies, service delivery models and health system practices that will overcome key barriers to achieving progress against HIV, viral hepatitis and sexually transmitted infections.

Theory of change

The vision, goals, strategic directions and actions of the strategies come together in a theory of change that demonstrates the pathway by which their implementation will lead to the desired results.

By implementing the 5 strategic directions through tailored shared and disease-specific country actions across the disease areas, and by placing people at the centre of all efforts, the global community can jointly contribute to ending the epidemics and advancing universal health coverage and health security.

World health organization 2021

Filling the need for trusted information on national health issues

Filling the need for trusted information on national health issues

The U.S. Government and the World Health Organization

Published: May 19, 2022

Key Facts

What is the World Health Organization (WHO)?

The WHO, founded in 1948, is a specialized agency of the United Nations (see Table 1). As outlined in its constitution, WHO has a broad mandate to “act as the directing and coordinating authority on international health work” within the United Nations system. It has 194 member states.

Mission and Priorities

WHO’s overarching mission is “attainment by all peoples of the highest possible level of health.” 1 It supports its mission through activities such as:

The organization also serves as a convener and host for international meetings and discussions on health issues. While WHO is generally not a direct funder of health services and programs in countries, it does provide supplies and other support during emergencies and carries out programs funded by donors.

WHO’s overarching objective for its work during the 2019-2023 period has been “ensuring healthy lives and promoting well-being for all at all ages.” In pursuit of this objective, it has been focusing on three strategic priorities (the “triple-billion targets”): 3

Achievements

The agency has played a key role in a number of global health achievements, such as the Alma-Ata Declaration on primary health care (1978), the eradication of smallpox (formally recognized in 1980), the Framework Convention on Tobacco Control (adopted in 2003), and the 2005 revision of the International Health Regulations (IHR), an international agreement that outlines roles and responsibilities in preparing for and responding to international health emergencies.

Organization

WHO has a headquarters office located in Geneva, Switzerland, six semi-autonomous regional offices that oversee activities in each region, and a network of country offices and representatives around the world. It is led by a Director-General (DG), currently Dr. Tedros Adhanom Ghebreyesus, who was first appointed in 2017 and is expected to be re-appointed to a second five-year term in May 2022. In addition to coordinating the ongoing COVID-19 response, Dr. Tedros has indicated that strengthening WHO in terms of its financing, staffing, and operations is a major focus for his tenure, and in light of the challenges from COVID-19, has proposed a more robust role for WHO in preparing for and responding to future pandemics. 4

World Health Assembly

The World Health Assembly (WHA), comprised of representatives from WHO’s 194 member states, is the supreme decision-making body for the agency and is convened annually. It is responsible for selecting the Director-General, setting priorities, and approving WHO’s budget and activities. Every six years, the WHA negotiates and approves a work plan for WHO (the most recent plan, known as the general programme of work, covers 2019-2023), 5 and every two years it approves a biennial budget for the work plan (the current budget is for 2022-2023). The annual WHA meeting in May also serves as a key forum for nations to debate and make decisions about health policy and WHO organizational issues.

Executive Board

WHO’s Executive Board, comprised of 34 members technically qualified in the field of health, facilitates the implementation of the agency’s work plan and provides proposals and recommendations to the Director-General and the WHA. 6 The 34 members are drawn from six regions: 7

Member states within each region designate members to serve on the Executive Board on a rotating basis. The U.S. is not a current member of the Executive Board but is expected to begin a new three-year term in May 2022. 8

Budget

Revenue

WHO has two primary sources of revenue:

A working group of WHO member states has been considering different proposals for how contributors might provide WHO with additional, and more predictable, funding and reduce its reliance on specified voluntary contributions. 14 One proposal to emerge from the working group is to increase the size of member states’ assessed contributions for “core” funding over time, the growth of which could be linked to WHO meeting certain organizational reform benchmarks. Many key governments, including the U.S., have expressed support for this proposal. 15 Member states have yet to officially approve a revised revenue approach, but working group recommendations will be discussed at upcoming WHO governance meetings including the World Health Assembly. 16

Activities

WHO’s activities, as identified in its programme budget for 2022-2023, are organized and funded around several core budget segments and key programs, such as polio eradication and emergency operations (see Table 2). 17

“Base programmes” refers to the core support provided for WHO headquarters and regional operations and efforts such as improving access to quality essential health services, essential medicines, vaccines, diagnostics, and devices for primary health care. “Emergency operations” includes WHO efforts to help countries prepare for and respond to health emergencies, including COVID-19. “Special programmes” includes a number of WHO-led initiatives such as the Research and Training in Tropical Diseases program and Pandemic Influenza Preparedness (PIP) Framework activities.

Challenges

WHO faces a number of institutional challenges, including:

Anaemia

Anaemia is a serious global public health problem that particularly affects young children and pregnant women. WHO estimates that 42% of children less than 5 years of age and 40% of pregnant women worldwide are anaemic.

Anaemia can cause a range of symptoms including fatigue, weakness, dizziness and drowsiness. Children and pregnant women are especially vulnerable, with an increased risk of maternal and child mortality. The prevalence of anaemia remains high globally, particularly in low-income settings, where a significant proportion of young children and women of childbearing age can be assumed to be anaemic. Iron deficiency anaemia has also been shown to affect cognitive and physical development in children and reduce productivity in adults.

Anaemia is an indicator of both poor nutrition and poor health. It is problematic on its own, but it can also impact other global nutritional concerns such as stunting and wasting, low birth weight and childhood overweight and obesity due to lack of energy to exercise. School performance in children and reduced work productivity in adults due to anaemia can have further social and economic impacts for the individual and family.

While iron deficiency anaemia is the most common form and is relatively easy to treat through dietary changes, other forms of anaemia require health interventions that may be less accessible. Accurate characterisation of anaemia is critical to understand the burden and epidemiology of this problem, for planning public health interventions, and for clinical care of people across the life course.

WHO oversees several programmes across all WHO Regions to help reduce the prevalence of anaemia through treatment and prevention. These guidelines, policies and interventions aim to increase dietary diversity, improve infant feeding practices and improve the bioavailability and intake of micronutrients through fortification or supplementation with iron, folic acid and other vitamins and mineral. Social and behaviour change communication strategies are used to change nutrition-related behaviours. Interventions to address the underlying and basic causes of anaemia look at issues such as disease control, water, sanitation and hygiene, reproductive health and root causes such as poverty, lack of education and gender norms.

In 2016, WHO started a five-year project to review its global guidelines for haemoglobin cut-offs used to define anaemia with the aim to provide evidence-informed recommendations on assessing anaemia in individuals and populations.

Oral health

Key facts

Oral health conditions

Most oral health conditions are largely preventable and can be treated in their early stages. The majority of cases are dental caries (tooth decay), periodontal diseases, oral cancers, oro-dental trauma, cleft lip and palate, and noma (severe gangrenous disease starting in the mouth mostly affecting children).

In most low- and middle-income countries, the prevalence of oral diseases continues to increase with growing urbanization and changes in living conditions. This is primarily due to inadequate exposure to fluoride (in the water supply and oral hygiene products such as toothpaste), availability and affordability of food with high sugar content and poor access to oral health care services in the community. Marketing of food and beverages high in sugar, as well as tobacco and alcohol, have led to a growing consumption of products that contribute to oral health conditions and other noncommunicable diseases.

Dental caries (tooth decay)

Dental caries result when plaque forms on the surface of a tooth and converts the free sugars (all sugars added to foods by the manufacturer, cook, or consumer, plus sugars naturally present in honey, syrups, and fruit juices) contained in foods and drinks into acids that destroy the tooth over time. A continued high intake of free sugars, inadequate exposure to fluoride and a lack of removal of plaque by toothbrushing can lead to caries, pain and sometimes tooth loss and infection.

Periodontal (gum) disease

Oral cancer

Oro-dental trauma

Noma is a severe gangrenous disease of the mouth and the face. It mostly affects children aged 2–6 years suffering from malnutrition, affected by infectious disease, living in extreme poverty with poor oral hygiene or with weakened immune systems.

Cleft lip and palate

Noncommunicable diseases and common risk factors

Most oral diseases and conditions share modifiable risk factors such as tobacco use, alcohol consumption and an unhealthy diet high in free sugars that are common to the 4 leading noncommunicable diseases (cardiovascular disease, cancer, chronic respiratory disease and diabetes).

Oral health inequalities

Prevention

The burden of oral diseases and other noncommunicable diseases can be reduced through public health interventions by addressing common risk factors.

Adequate exposure to fluoride is an essential factor in the prevention of dental caries.

Access to oral health services

WHO response

The World Health Assembly approved a Resolution on oral health in 2021 at the 74th World Health Assembly. The Resolution recommends a shift from the traditional curative approach towards a preventive approach that includes promotion of oral health within the family, schools and workplaces, and includes timely, comprehensive and inclusive care within the primary health-care system. The Resolution affirms that oral health should be firmly embedded within the noncommunicable disease agenda and that oral health-care interventions should be included in universal health coverage programs.

The World Health Assembly delegates asked WHO: to develop a draft global strategy on tackling oral diseases for consideration by WHO governing bodies in 2022; and by 2023: to translate the global strategy into an action plan for oral health; to develop “best buy” interventions on oral health; and to explore the inclusion of noma within the roadmap for neglected tropical diseases 2021-2030. WHO was asked to report back on progress and results until 2031 as part of the consolidated report on noncommunicable diseases.

References

1. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019). Seattle: Institute of Health Metrics and Evaluation (IHME); 2020. Available from http://ghdx.healthdata.org/gbd-results-tool.

3. Mehrtash H, Duncan K, Parascandola M, et al. Defining a global research and policy agenda for betel quid and areca nut. Lancet Oncol. 2017;18(12):e767-e775.

4. Mehanna H, Beech T, Nicholson T, et al. Prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer—systematic review and meta-analysis of trends by time and region. Head Neck. 2013;35(5):747-755.

6. Rickart, A. J., Rodgers, W., Mizen, K., Merrick, G., Wilson, P., Nishikawa, H., & Dunaway, D. J. (2020). Facing Africa: Describing Noma in Ethiopia. The American journal of tropical medicine and hygiene, 103(2), 613–618. https://doi.org/10.4269/ajtmh.20-0019

8. Birth defects surveillance. A manual for programme managers. Geneva: World Health Organization; 2020.

9. Salari N, Darvishi N, Heydari M, Bokaee S, Darvishi F, Mohammadi M. Global prevalence of cleft palate, cleft lip and cleft palate and lip: A comprehensive systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg. 2021;S2468-7855(21)00118X. doi:10.1016/j.jormas.2021.05.008.

10. Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate. Lancet. 2009;374(9703):1773-1785.

11. Wu, Cz., Yuan, Yh., Liu, Hh. et al. Epidemiologic relationship between periodontitis and type 2 diabetes mellitus. BMC Oral Health 20, 204 (2020). https://doi.org/10.1186/s12903-020-01180-w

12. Marco A Peres and Al. Oral diseases: a global public health challenge. Lancet. 2019 https://doi.org/10.1016/S0140-6736(19)31146-8

13. Walsh, T, et al. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev 2019; 3(3):Cd007868. doi:10.1002/14651858.CD007868.pub3.

14. Thomson S, Cylus J, Evetovits T. Can people afford to pay for heatlh care? New evidence on financial protection in Europe. Kopenhagen: WHO Regional Office for Europe (WHO EURO); 2019

Обновленная информация о варианте «омикрон»

Двадцать шестого ноября 2021 г. ВОЗ по рекомендации Технической консультативной группы по эволюции вируса SARS-CoV-2 (ТКГЭВ) объявила вариант B.1.1.529 вызывающим обеспокоенность и присвоила ему наименование «омикрон». Данное решение было принято на основе представленных ТКГЭВ фактических данных о том, что вариант «омикрон» имеет несколько мутаций, которые могут повлиять на его свойства, в частности на его способность к распространению или тяжесть вызываемого им заболевания. Ниже кратко приводится информация о том, что в настоящий момент известно о данном варианте.

Текущее состояние знаний о варианте «омикрон»

В настоящее время ученые в Южной Африке и по всему миру проводят исследования для углубления понимания многочисленных свойств варианта «омикрон» и продолжат представлять результаты этих исследований по мере их получения.

Контагиозность. В настоящий момент неясно, обладает ли вариант «омикрон» повышенной контагиозностью (т. е. способностью легче передаваться от человека к человеку) по сравнению с другими вариантами, включая вариант «дельта». Хотя в районах Южной Африки, в которых циркулирует данный вариант, увеличилось количество лиц с положительными результатом теста на вирус, в настоящее время проводятся эпидемиологические исследования для установления того, вызвано ли это вариантом «омикрон» или другими факторами.

Тяжесть заболевания. До сих пор не установлено, вызывает ли заражение вариантом «омикрон» более тяжелое течение заболевания по сравнению с другими вариантами, включая вариант «дельта». Согласно предварительным данным, частота госпитализации пациентов в Южной Африке растет, однако это может быть вызвано общим ростом количества инфицируемых, а не специфическим заражением вариантом «омикрон». В настоящее время не имеется информации, позволяющей полагать, что симптомы, связанные с инфицированием «омикрон» отличаются от симптомов, вызываемых другими вариантами. Первые зарегистрированные случаи заражения имели место среди студентов университета – молодых людей, у которых заболевание обычно проходит в более легкой форме, однако для понимания тяжести течения болезни при варианте «омикрон» потребуется от нескольких дней до нескольких недель. Все варианты вирусного возбудителя COVID-19, включая доминирующий во всем мире вариант «дельта», могут вызвать тяжелое течение болезни и приводить к летальному исходу, особенно среди наиболее уязвимых лиц, в связи с чем первоочередное значение во всех случаях имеет профилактика заражений.

Эффективность защиты при ранее перенесенной инфекции SARS-CoV-2

Предварительные данные, которые, впрочем, носят ограниченный характер, указывают на то, что по сравнению с другими вариантами, вызывающими обеспокоенность, вариант «омикрон» может повышать риск повторного заражения (т.е. люди с ранее перенесенной COVID-19 могут легче повторно инфицироваться вариантом «омикрон»). В ближайшие дни и недели будет дополнительная информация на этот счет.

Эффективность вакцин. ВОЗ осуществляет взаимодействие с техническими партнерами для определения того, как данный вариант может влиять на эффективность существующих средств противодействия инфекции, включая вакцины. Вакцины продолжают иметь важнейшее значение для сокращения тяжелой заболеваемости и смертности, в том числе вызванной преобладающим циркулирующим вариантом «дельта». Применяемые в настоящее время вакцины продолжают эффективно защищать от тяжелого течения заболевания и смерти от него.

Эффективность существующих тестов. Как и в случае других вариантов вируса, широко используемые ПЦР-тесты по-прежнему позволяют выявлять заражение, в том числе заражение вариантом «омикрон». В настоящее время ведутся исследования для определения того, влияет ли его появление на эффективность других типов тестов, включая экспресс-тесты на определение антигенов.

Эффективность существующих средств лечения. Для лечения больных с тяжелой формой COVID-19 могут и далее эффективно применяться кортикостероиды и блокаторы рецепторов к интерлейкину-6. В отношении других средств лечения будет проведен анализ того, сохраняют ли они свою эффективность с учетом мутаций в отдельных частях вирусного варианта «омикрон».

Текущие исследования

В настоящее время в целях углубленного изучения варианта «омикрон» ВОЗ координирует работу большого числа исследователей во всем мире. Уже проводимые или готовящиеся к проведению исследования направлены на оценку контагиозности, тяжести инфекции (в том числе ее симптоматики), эффективности вакцин и диагностических тестов и эффективности средств лечения.

ВОЗ призывает страны содействовать сбору данных по госпитализируемым пациентам и их распространению через Глобальную платформу ВОЗ для регистрации клинических данных по COVID-19, позволяющую быстро отслеживать клинические характеристики и исходы заболевания у пациентов.

Дополнительная информация будет получена в ближайшие дни и недели. ТКГЭВ ВОЗ продолжит отслеживать и оценивать данные по мере их появления и анализировать влияние мутаций в варианте «омикрон» на свойства вируса.

Практические рекомендации для стран

В связи с тем, что вариант «омикрон» признан вызывающим обеспокоенность, ВОЗ рекомендует странам принять ряд мер, в том числе усилить эпиднадзор за случаями заболевания и осуществлять более активное геномное секвенирование образцов; депонировать последовательности генома вируса в общедоступные базы данных, например GISAID; уведомлять ВОЗ о первых индивидуальных случаях и очагах групповой заболеваемости; проводить полевые эпидемиологические расследования и лабораторные исследования для изучения возможного воздействия варианта «омикрон» на эпидемиологию заболевания или на эффективность вакцин, средств лечения, средств диагностики и медико-санитарных и социальных мер. Дополнительную информацию можно найти в тексте заявления от 26 ноября.

Странам следует продолжать принимать эффективные противоэпидемические меры для сокращения общих масштабов циркуляции возбудителя COVID-19, руководствуясь анализом существующих рисков и научным подходом. Для подготовки к увеличению численности заболевших им следует расширять мощности структур общественного здравоохранения и медицинских учреждений. ВОЗ предоставляет странам поддержку и рекомендации по вопросам как обеспечения готовности к распространению инфекции, так и принятия противоэпидемических мер.

Кроме того, крайне необходимо безотлагательно перейти к устранению проявлений несправедливости в доступе к вакцинам против COVID-19, с тем чтобы повсеместно обеспечить получение первой и второй доз вакцины представителями уязвимых категорий населения, включая работников здравоохранения и пожилых лиц, наряду с предоставлением справедливого доступа к услугам в области лечения и диагностики.

Практические рекомендации для населения

Наиболее эффективные меры индивидуального уровня, позволяющие ограничить распространение вирусного возбудителя COVID-19, заключаются в том, чтобы держаться на физическом расстоянии не менее 1 м от окружающих; носить хорошо прилегающую маску; открывать окна для усиленной вентиляции помещений; избегать нахождения в плохо проветриваемых и переполненных людьми пространствах; соблюдать гигиену рук, кашлять и чихать в сгиб локтя или салфетку; и пройти вакцинацию, как только это станет возможно в установленном порядке очередности.

ВОЗ продолжит публиковать обновленную информацию по мере ее поступления, в том числе по результатам совещаний ТКГЭВ. Кроме того, информация будет распространяться по цифровым каналам ВОЗ размещаться на ее платформах в социальных сетях.

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