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Rubella virus is a leading cause of vaccine-preventable birth defects. Infection during pregnancy can result in miscarriage, fetal death, stillbirth or a constellation of birth defects, known as congenital rubella syndrome (CRS), which includes cataracts, deafness, heart defects and developmental delay. A single dose of rubella-containing vaccine can provide lifelong protection against rubella. The Global Vaccine Action Plan 2011-2020 set a target to achieve elimination of rubella in at least 5 of the 6 WHO regions by 2020, and rubella elimination is a critical goal of the Immunization Agenda 2030. This report updates a previous report and describes progress towards rubella and CRS elimination in 2012-2022. During this period, the number of WHO Member States that included rubella-containing vaccine (RCV) in their immunization schedules increased from 132 (68%) to 175 (90%), and the percentage of the world's infants were vaccinated against rubella increased from 40% to 68%. The reported number of rubella cases decreased by 81%, from 93 816 in 2012 to 17 407 in 2022. Verification of rubella elimination was achieved in 98 (51%) of 194 countries by 2022, an increase from 84 (43%) countries in 2019. Despite significant progress in introduction of RCV into routine immunization programmes worldwide, nearly 25 million infants annually still do not receive RCV. Nevertheless, the increasing number of countries that have achieved and sustained rubella elimination, even in complex settings, represents progress towards global rubella elimination. L'infection par le virus de la rubeole est l'une des principales causes de malformations congenitales evitables par la vaccination. Lorsqu'elle survient pendant la grossesse, elle peut entrainer une fausse couche, la mort foetale, une mortinaissance ou une constellation de malformations congenitales (notamment cataracte, surdite, malformations cardiaques et retards de developpement) connue sous le nom de syndrome de rubeole congenitale (SRC). Une dose unique de vaccin a valence rubeole peut conferer une protection a vie contre la rubeole. Parmi les cibles fixees dans le Plan d'action mondial pour les vaccins 2011-2020 figurait l'elimination de la rubeole dans au moins 5 des 6 Regions de l'OMS a l'horizon 2020. L'elimination de la rubeole fait en outre partie des objectifs cles du Programme pour la vaccination a l'horizon 2030. Le present rapport actualise les informations fournies dans le rapport precedent et decrit les progres accomplis vers l'elimination de la rubeole et du SRC dans la periode 2012-2022. Au cours de cette periode, les nombre d'Etats Membres de l'OMS ayant inclus le vaccin a valence rubeole (RCV) dans leur calendrier de vaccination a progresse, passant de 132 (68%) a 175 (90%); et le pourcentage de nourrissons dans le monde vaccines contre la rubeole est passe de 40% a 68%. Le nombre de cas notifies de rubeole a recule de 81%, passant de 93 816 en 2012 a 17 407 en 2022. En 2022, l'elimination de la rubeole avait ete verifiee dans 98 (51%) des 194 Etats Membres de l'OMS, contre 84(43%) en 2019. Toutefois, meme si l'introduction du RCV dans les programmes de vaccination systematique a fortement progresse a l'echelle mondiale, pres de 25millions de nourrissons sont encore prives de ce vaccin chaque annee. Le nombre croissant de pays ayant reussi a eliminer durablement la rubeole, meme parmi ceux confrontes a des situations complexes, temoigne neanmoins des progres realises vers l'elimination de cette maladie a l'echelle mondiale., Introduction Rubella virus is a leading cause of vaccine-preventable birth defects and can cause epidemics. Rubella virus infection usually produces a mild febrile rash illness in children and adults; however, [...]

Measles is a highly contagious, vaccine-preventable disease that requires high population immunity in order for transmission to be interrupted. All 6 WHO regions have committed themselves to eliminating measles; however, no region has achieved and sustained elimination. This report describes progress in measles elimination during 2000-2022. Estimated coverage with the first dose of measles-containing vaccine (MCV) worldwide increased from 72% to 86% between 2000 and 2019 and then decreased to 81% in 2021 during the coronavirus disease 2019 (COVID-19) pandemic, the lowest coverage rate since 2008. In 2022, MCV1 coverage increased to 83%. Only 72 (50%) of 144 countries that reported measles cases achieved the measles surveillance indicator target of >2 discarded cases per 100 000 population in 2022. During 2021-2022, estimated measles cases increased by 18%, from 7 802 000 to 9 232 300, and the number of countries experiencing large or disruptive outbreaks increased from 22 to 37. The estimated number of measles deaths increased by 43% during 2021-2022, from 95 000 to 136 200. Nonetheless, an estimated 57 million measles deaths were averted by vaccination during 2000-2022. In 2022, measles vaccination coverage and global surveillance showed some recovery from the setbacks during the COVID-19 pandemic; however, coverage decreased in low-income countries, and, globally, years of suboptimal immunization coverage left millions of children unprotected. Setbacks in coverage during the COVID-19 pandemic must be reversed by renewed efforts to vaccinate all children with 2 MCV doses, strengthen surveillance, prevent outbreaks and accelerate progress towards elimination. La rougeole est une maladie a prevention vaccinale qui est hautement contagieuse et dont la transmission ne peut etre interrompue qu'en presence d'une forte immunite collective. Les 6 Regions de l'OMS se sont toutes engagees a eliminer la rougeole, mais a ce jour, aucune d'entre elles n'a atteint durablement cet objectif. Le present rapport decrit les progres accomplis vers l'elimination de la rougeole au cours de la periode 2000-2022. La couverture mondiale de la vaccination par la premiere dose de vaccin a valence rougeole (MCV) a progresse entre 2000 et 2019, passant de 72% a 86%, mais a ensuite recule pendant la pandemie de COVID-19 pour s'etablir a 81% en 2021, soit le taux le plus faible enregistre depuis 2008. En 2022, la couverture par le MCV1 est remontee a 83%. En 2022, seuls 72 (50%) des 144 pays ayant signale des cas de rougeole ont atteint la cible de l'indicateur de surveillance de la rougeole relatif au nombre de cas ecartes, a savoir >2 cas ecartes pour 100 000 habitants. Dans la periode 2021-2022, le nombre de cas de rougeole signales a augmente de 18%, passant de 7 802 000 a 9 232 300, et, le nombre de pays confrontes a des flambees epidemiques de grande ampleur ou perturbatrices de rougeole est passe de 22 a 37, et le nombre estime de deces dus a la rougeole a augmente de 43%, passant de 95 000 a 136 200. Neanmoins, on estime qu'entre 2000 et 2022, la vaccination a permis d'eviter 57 millions de deces dus a la rougeole. En 2022, on a constate des signes de relevement de la couverture vaccinale et de la surveillance mondiale de la rougeole apres les revers subis lors de la pandemie de COVID-19; la couverture vaccinale a toutefois diminuee dans les pays a faible revenu et, apres des annees de couverture sousoptimale, des millions d'enfants dans le monde restent sans protection contre la maladie. Il est urgent d'inverser le recul de la couverture enregistre pendant la pandemie de COVID-19 en redoublant d'efforts pour vacciner tous les enfants par 2 doses de MCV, renforcer la surveillance, prevenir les flambees epidemiques et accelerer les progres vers l'elimination., Introduction All 6 WHO regions have committed themselves to eliminating measles. (1) The Immunization Agenda 2030 (IA2030) 2 includes measles elimination as a core indicator of impact. IA2030 highlights the [...]

Worldwide, measles remains a major cause of disease and death; the highest incidence is in the WHO African Region (AFR). In 2011, the 46 Member States in the AFR established the goal of regional elimination of measles by 2020; this report describes progress during 2017-2021. Regional coverage with a first dose of measles-containing vaccine (MCV) decreased from 70% in 2017 to 68% in 2021, and the number of countries with [greater than or equal to] 95% coverage decreased from 6 (13%) to 2 (4%). The number of countries that provided a second MCV dose increased from 27 (57%) to 38 (81%), and coverage with a second-dose increased from 25% to 41%. Approximately 341 million people were vaccinated during supplementary immunization activities (SIAs), and an estimated 4.5 million deaths were averted by vaccination. The number of countries that met measles surveillance performance indicators decreased, however, from 26 (62%) to 9 (22%). Measles incidence increased from 69.2 per 1 million population in 2017 to 81.9 in 2021. The number of estimated annual measles cases and deaths increased by 22% and 8%, respectively. By December 2021, no country had received verification of measles elimination. To achieve a renewed regional goal of measles elimination in at least 80% of countries by 2030, intensified work is necessary to recover and surpass levels of surveillance performance and coverage with 2 MCV doses that were achieved before the coronavirus disease 2019 (COVID-19) pandemic. La rougeole demeure une cause majeure de maladie et de deces dans le monde entier, et la Region ou l'incidence est la plus elevee est la Region africaine de l'OMS. En 2011, les 46 Etats Membres de la Region africaine s'etaient fixe l'objectif d'eliminer la rougeole a l'horizon 2020. Le present rapport decrit les progres realises sur la periode 2017-2021. La couverture regionale par la premiere dose de vaccin a valence rougeole (MCV) a baisse, passant de 70% en 2017 a 68% en 2021, de meme que le nombre de pays assurant une couverture [greater than or equal to] 95% par la premiere dose, qui est passe 6 (13%) a 2 (4%). Le nombre de pays qui ont administre la deuxieme dose de MCV et la couverture par la deuxieme dose ont augmente, passant de 27 (57%) a 38 (81%) et de 25% a 41%, respectivement. Environ 341 millions de personnes ont ete vaccinees au cours des activites de vaccination supplementaire (AVS) et on estime que 4,5 millions de deces ont ete evites grace a la vaccination. Le nombre de pays qui ont satisfait aux indicateurs de performance de la surveillance de la rougeole a toutefois chute, passant de 26 (62%) a 9 (22%), tandis que l'incidence de la rougeole a augmente, passant de 69,2 cas par million d'habitants en 2017 a 81,9 en 2021; le nombre annuel estime de cas de rougeole et de deces associes a progresse de 22% et de 8%, respectivement. En decembre 2021, aucun pays n'avait obtenu la verification de l'elimination de la rougeole. Pour atteindre l'objectif regional renouvele consistant a eliminer la rougeole dans au moins 80% des pays de la Region d'ici a 2030, il est necessaire de redoubler d'efforts pour retrouver et depasser les niveaux de performance de la surveillance et de couverture par 2 doses de MCV qui avaient ete atteints avant la pandemie de maladie a coronavirus 2019 (COVID-19)., Introduction Measles remains a major cause of disease and death worldwide, and the highest numbers of cases and deaths occur in AFR. (1) In 2011, the 46 Member States (2) [...]

In 2013, the 11 Member States of the WHO South-East Asia Region (1) (SEAR) adopted the goals of measles elimination and control of rubella and congenital rubella syndrome (CRS) (2) [...]

All 6 WHO regions have committed themselves to eliminate measles. (1) The aim of the Immunization Agenda 2021-2030 (IA2030) (2) is to achieve regional targets as a core indicator of [...]

On 13 January 2021, a vaccine-derived poliovirus type 2 (VDPV2) was identified by the Regional Reference Laboratory (RRL) for polio in Moscow (1) in a specimen from a patient with [...]

In 2010, all 53 countries in the WHO European Region (EUR) (1) reaffirmed their commitment to eliminate measles, rubella and congenital rubella syndrome, (2,3) as stated in the European Vaccine [...]

In 2010, all 53 countries (1) in the WHO European Region (EUR) reconfirmed their commitment to eliminating measles and rubella and congenital rubella syndrome, (2) and this goal was included [...]

Type 2 diabetes may lead to a variety of symptoms such as excessive thirst, frequent urination, fatigue, and burning feet. These symptoms diminish quality of life, impair functional status, and [...]

OVERVIEW: Just as treatment guidelines for diabetes care were at the forefront of medical guideline development, (1) diabetes has been a prominent focus of performance measurement and quality improvement initiatives [...]

Unhealthy alcohol use, which includes the spectrum of drinking behaviors and consequences ranging from risky use to problem drinking, along with alcohol abuse and alcohol dependence (Saitz 2005), has been [...]

Growth hormone receptor gene--disrupted (GHR-/-) mice exhibit increased life span and adipose tissue mass. Although this obese phenotype has been reported extensively for young adult male GHR-/- mice, data for females and for other ages in either gender are lacking. Thus, the purpose of this study was to evaluate body composition longitudinally in both male and female GHR-/- mice. Results show that GHR-/- mice have a greater percent fat mass with no significant difference in absolute fat mass throughout life. Lean mass shows an opposite trend with percent lean mass not significantly different between genotypes but absolute mass reduced in GHR-/- mice. Differences in body composition are more pronounced in male than in female mice, and both genders of GHR-/- mice show specific enlargement of the subcutaneous adipose depot. Along with previously published data, these results suggest a consistent and intriguing protective effect of excess fat mass in the subcutaneous region. Key Words: Body composition--Growth hormone--Obesity--Adipose depots--Gender differences. doi: 10.1093/gerona/glp175

Methadone treatment reduces human immunodeficiency virus (HIV) risk, but the effects of primary-care-based buprenorphine/naloxone on HIV risk are unknown. The purpose of this study was to determine whether primary-care-based buprenorphine/naloxone was associated with decreased HIV risk behavior. We conducted a longitudinal analysis of 166 opioid-dependent persons (129 men and 37 women) receiving buprenorphine/naloxone treatment in a primary care clinic. We compared baseline and 12- and 24-week overall, drug-related, and sex-related HIV risk behaviors using the AIDS/HIV Risk Inventory (ARI). Buprenorphine/naloxone treatment was associated with significant reductions in overall and drug-related ARI scores from baseline to 12 and 24 weeks. Intravenous drug use in the past 3 months was endorsed by 37%, 12%, and 7% of patients at baseline and at 12 and 24 weeks, respectively (p < .001). Sex while you or your partner were 'high' was endorsed by 64%, 13%, and 15% of patients at baseline and at 12 and 24 weeks, respectively (p < .001). Inconsistent condom use during sex with a steady partner was high at baseline and did not change over time. We conclude that primary-care-based buprenorphine/naloxone treatment is associated with decreased drug-related HIV risk, but additional efforts may be needed to address sex-related HIV risk when present (ClinicalTrials.gov number, NCT00023283). Keywords: Buprenorphine; HIV/AIDS; Risk-reduction behavior; Treatment; Prevention

We evaluated the utility of sweat testing for monitoring of drug use in outpatient clinical settings and compared sweat toxicology with urine toxicology and self-reported drug use during a randomized clinical trial of the efficacy of buprenorphine for treatment of opioid dependence in primary care settings. All study participants (N = 63) were opiate-dependent, treatment-seeking volunteers. The results based on toxicology tests obtained from 188 properly worn and unadulterated patches (out of 536 applied) show that the level of agreement between positive sweat test results and positive urine results was 33% for opiates and 92% for cocaine. The findings of this study, that there is a low acceptability of sweat patch testing by patients (only 54.3% were brought back attached to the skin) and that weekly sweat testing is less sensitive than weekly urine testing in detecting opiate use, suggest limited utility of sweat patch testing in outpatient clinical settings. Keywords: Drug toxicology testing; Opiates; Heroin; Cocaine

Pressure is building for performance measures that can be collected inexpensively and repeatedly for internal and external accountability and quality improvement. The objective of this study was to develop and [...]

The objective of this study was to demonstrate a method to accurately identify patients with specific conditions from claims data for care improvement or performance measurement. In an iterative process [...]

We evaluated peak plasma concentrations, trough concentrations, and the 24-hour area under the concentration curve (AU[C.sub.o-24 h]) during maintenance with sublingual (SL) liquid or tablet formulations in 57 opiate-dependent volunteers. Study participants were assigned randomly to one of three SL daily buprenorphine dose pairs and maintained for 2 weeks with the liquid formulation followed by 2 weeks with the corresponding tablet dose. Plasma samples were obtained after at least 10 days of maintenance with the liquid formulation and after at least 10 days of that with the tablet formulation. The bioequivalence of the tablet compared with the liquid doses ranged from 57% to 75% based on peak concentrations, from 102% to 108% based on trough concentrations, and from 66% to 86%, based on 24-hour AUC, but there was a large intersubject and intrasubject variability in plasma concentrations, with greater variability following tablets than liquid. Measures of withdrawal symptoms or illicit opioid use were not associated with buprenorphine dose, formulation, or plasma buprenorphine levels. Keywords: Buprenorphine: Plasma concentration: Substance abuse; Opioid maintenance

This investigation was designed to determine the effect of eccentric strength testing on delayed-onset muscle pain in 20 untrained university students. Initially, eccentric strength testing (5-repetition maximum [5RM]) was performed bilaterally. Next, 1 arm completed 3 sets of 10 eccentric repetitions to induce delayed-onset muscle pain. Then, in a subsequent session, whichever arm previously performed only the 5RM test completed the 5RM test a second time and the 3 sets of 10 eccentric repetitions. Statistical analyses supported significantly increased pain intensity and unpleasantness across 48 hours post-5RM test alone. However, pain intensity and unpleasantness after the eccentric training bouts were significantly lower in the arm that performed 2 5RM tests than the arm that performed only 1. Thus, the eccentric strength testing produced delayed-onset muscle pain and protected against future delayed-onset muscle pain. These effects should be considered when such testing is used in baseline strength assessments. Key Words. muscle, eccentric, visual analog scale, lengthening contractions, soreness, reliability

Active drug users with HIV infection suffer from both low utilization of, and adherence to, primary care. Combining drug treatment and primary care on-site reduces these problems significantly because it creates a social support structure; treatment program staffs can monitor patients' adherence and provide ongoing encouragement. But in the United States, only a very small minority of HIV + drug users receive this demonstrably effective form of care. We report the results from a feasibility study of an alternative support structure, termed a 'peer-driven intervention', that serves as a functional equivalent to drug treatment for increasing drug users' adherence to HIV therapeutics. The six-month study included 14 adult active drug users receiving medical care for HIV disease in New Haven, Connecticut. As a health advocate, each subject was assigned and asked to meet with another subject once a week at the project's storefront to provide peer support and counseling. As a peer, each subject was assigned and asked to meet with another health advocate once a week to receive support in keeping up his or her medical care. No two subjects played both roles for one another. Advocates earned nominal monetary rewards for eliciting positive responses from their peers in keeping clinical appointments, responding to physicians' referrals, picking up prescriptions on time and attending weekly meetings with the advocate. The results of the study suggest that an alternative social support structure to drug treatment is feasible for increasing active drug users' adherence to medical care. Innovative mechanisms that harness drug users' peer pressure to promote positive behavioral changes deserve greater study. Keywords: HIV/AIDS; Adherence; Health care utilization; Injecting drug users; Substance abuse; Intervention; Antiretroviral therapy; Social supports; USA

Buprenorphine is an effective treatment for heroin dependence. The feasibility and potential efficacy of buprenorphine with brief counseling in primary care is unknown. We enrolled 14 heroin dependent patients in a 13-week clinical trial using thrice weekly buprenorphine along with brief counseling in the primary care center of an urban medical center. Primary outcomes included urine toxicology and treatment retention. Opioid-positive urine toxicology tests reduced over the 13-week period from 95 to 25% (p < 0.05). Eleven patients (79%) had greater than or equal to one week of opioid-free urine toxicologies. Nine patients (64%) had greater than or equal to three weeks of opioid-free urine toxicologies. Eleven patients (79%) were retained through the maintenance phase. We conclude that buprenorphine maintenance is feasible in a primary care setting., INTRODUCTION Heroin dependence remains a largely untreated medical condition in the United States. Recent research reveals that there are approximately 600,000 heroin dependent individuals who are not receiving drug-abuse treatment [...]

The purpose of this study was to evaluate the attitudes of drug treatment program providers concerning human immunodeficiency virus (HIV) post-exposure therapy (PET) for drug users enrolled in drug treatment. This was a cross-sectional evaluation of drug treatment program providers in four methadone maintenance programs (MMPs) in New Haven, Connecticut. Thirty-five MMP providers including: 29 MMP treatment staff (physicians, nurses, counselors) and 6 primary care provider staff (physicians, nurse practitioners, and nurses) participated in the study. The providers were presented with four case vignettes of individuals exposed to HIV through a needle stick ('stick'): a phlebotomist with occupational exposure (Case A) and three drug users with nonoccupational exposure to HIV (Cases B, C, and D). Case B had the same estimated future risk as Case A (three sticks/4 years) and the other cases had increased risk: Case C (four to six sticks/year) and Case D (monthly 'sticks'). For each vignette, providers were asked whether they would offer HIV PET ('yes' or 'no'). In addition, focus groups were held within each group of providers who were asked: 'What role should drug treatment programs play in the implementation of PET?' All MMP staff (29/29) and primary care providers (6/6) felt that the phlebotomist with occupational exposure should be offered PET. The percent of MMP and Primary care provider staff recommending PET for the other cases were: Case B (MMP staff: 86% [25/29], PCPs: 100% [6/6]), Case C (MMP staff: 69% [20/29], PCPs: 33% [2/6]), and Case D (MMP staff: 59% [17/29], PCPs: 17% [1/6]). The 'common themes' that were identified in the focus groups included: concern that MMPs lack resources to provide PET, the ethics of withholding PET, the 'limit' on the number of times PET should be offered, and the role of PET in the overall HIV prevention message. Both MMP staff and PCPs felt that MMPs should have an 'indirect' role in providing HIV PET by providing education and referral only. MMP staff and PCPs differed in their likelihood of offering HIV PET to drug users enrolled in MMPs. The possibility of HIV PET for drug users in treatment raises significant implementation issues for MMPs that will require further study if HIV PET becomes widely used in drug users.

This placebo-controlled, double blind, cross-over study tested the efficacy of two different doses of Peptide T in the treatment of nine intravenous drug users with early AIDS dementia who were also receiving methadone and AZT. Subjects received Peptide T doses of either 15 or 1.5 mg daily for four weeks. Neuropsychological performance improved in four of five patients treated with the high dose, but at the lower dose, three of four patients showed no improvement on Peptide T when compared with placebo. When subjects who received the high dose were compared with those who received the low dose, a significant dose effect was found only during the active phase of the trial even after correction for differences in level of functioning at baseline., INTRODUCTION Peptide T, an analog of vasoactive intestinal peptide (VIP), was developed to counter the neurotropic effect of the HIV virus and possibly reverse AIDS dementia complex (ADC) (1-6). This [...]

The treatment of heroin dependence with opioid maintenance has traditionally employed methadone and more recently buprenorphine administered in traditional drug treatment settings. In this pilot study we evaluated buprenorphine maintenance for the treatment of heroin dependence in a program administered by primary-care providers in a primary-care setting. Seven patients were admitted to this nonblinded open-label pilot study and were offered 6 months of primary-care-based buprenorphine maintenance. Buprenorphine was administered in doses of 16 mg on Monday and Wednesday and 32 mg on Friday. Patients were seen weekly by primary-care providers and attended self-help meetings. Of the seven patients admitted to the study, five (71%) completed the 6-month pilot study and two (29%) were removed from the study. Urine toxicology data showed that the majority of urines tested were clear of opioids in four out of five patients who remained in treatment. These results suggest that primary-care-based opioid maintenance using buprenorphine shows promise as a new approach to the treatment of heroin dependence., Key Words: Substance abuse; Opioid dependence; Buprenorphine maintenance INTRODUCTION Substance users frequently present to primary-care physicians for care of medical complications related to their drug use as well as for [...]