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Surveillance architectureFollowing the declaration of an outbreak of Ebola virus disease (EVD) in Equateur Province, Democratic Republic of the Congo (DRC), in May 2018, WHO supported the DRC Ministry of [...]

Introduction: Setting and monitoring progress towards targets for HIV controlis criticalin ensuring responsive programmes. Here, we explore how to apply targets for reduction in HIV incidence to localsettings and which indicators give the strongest signal of a change in incidence in the population and are therefore most important to monitor. Methods: We use location-specific HIV transmission models, tailored to the epidemics in the counties and major cities in Kenya, to project a wide range of plausible future epidemic trajectories through varying behaviours, treatment coverage and prevention interventions. We look at the change in incidence across modelled scenarios in each location between 2015 and 2030 to inform local target setting. We also simulate the measurement of a library of potential indicators and assess which are most strongly associated with a change in incidence. Results: Considerable variation was observed in the trajectory of the local epidemics under the plausible scenarios defined (only 10 of 48 locations saw a median reduction in incidence of greater than or equalto an 80% target by 2030). Indicators that provide strong signals in certain epidemic types may not perform consistently well in settings with different epidemiological features. Predicting changes in incidence is more challenging in advanced generalized epidemics compared to concentrated epidemics where changes in high-risk sub-populations track more closely to the population as a whole. Many indicators demonstrate only limited association with incidence (such as 'condom use' or 'pre-exposure prophylaxis coverage'). This is because many other factors (low effectiveness, impact of other interventions, countervailing changes in risk behaviours, etc.) can confound the relationship between interventions and their ultimate long-term impact, especially for an intervention with low expected coverage. The population prevalence of viral suppression shows the most consistent associations with long-term changes in incidence even in the largest generalized epidemics. Conclusions: Target setting should be appropriate for the local epidemic and what can feasibly be achieved. There is no one universally reliable indicator to predict future HIV incidence across settings. Thus, the signature of epidemic controlmust contain indications of success across a wide range of interventions and outcomes. Keywords: programme evaluation; population surveillance; models; theoretical; HIV Infections; epidemiology; forecasting, Additional Supporting Information may be found online in the Supporting information tab for this article. 1 INTRODUCTION From early in the HIV pandemic, efforts have been made to measure and [...]

The leishmaniases are diseases caused by protozoan parasites from over 20 Leishmania species that are transmitted to humans by the bite of infected female phlebotomine sandfly species (98 of which [...]

PERFORMANCE OF ACUTE FLACCID PARALYSIS (AFP) SURVEILLANCE AND INCIDENCE OF POLIOMYELITIS (DATA RECEIVED IN WHO HEADQUARTERS AS OF 26 JUNE 2018) FONCTIONNEMENT DE LA SURVEILLANCE DE LA PARALYSIE FLASQUE AIGUE [...]

Influenza B virus, first identified in 1940 (7), is associated with considerable hospital admissions and deaths worldwide every year (2). During the early 1980s, influenza B viruses split into 2 [...]

During the last decade, the Region of the Americas has experienced several large epidemics, including cholera, influenza A(H1N1), chikungunya virus, Zika virus, yellow fever. Natural disasters also occur frequently, including [...]

In 2005, the Regional Committee of the WHO Western Pacific Region (WPR) (1) established a goal for eliminating measles (2) by 2012. (3) To achieve this goal, the 37 countries [...]

Global efforts to eradicate polio began in 1988 and, to date, 4 of the 6 WHO regions currently have achieved polio-free certification. Within the remaining 2 regions with endemic poliomyelitis [...]

Background The main pathogen responsible for epidemic bacterial meningitis is Neisseria meningitidis (N.m.). Of the 13 subtypes or serogroups of N.m. identified, 4 (N.m. A, B, C and W) are [...]

Introduction: The HIV Strategy in New South Wales (NSW) Australia aims to virtually eliminate HIV transmission by 2020. We estimated the 2016 HIV diagnosis and care cascade for the state of NSW, with a focus on introducing population-based data to improve data quality and assess progress towards the UNAIDS 90-90-90 targets. Methods: To estimate the number of people living with diagnosed HIV (PLDHIV) we used NSW data from the Australian National HIV Registry, enhanced by surveillance among people recently diagnosed with HIV to improve migration estimates. The number of undiagnosed PLHIV was estimated using back-projection modelling by CD4 count at diagnosis. De-duplicated prescription claims data were obtained from the Australian Pharmaceutical Benefits Scheme (PBS), and were combined with an estimate for those ineligible, to determine the number of PLDHIV on antiretroviral therapy (ART). Data from a clinic network with 87% coverage of PLDHIV in NSW enabled the estimation of the number on ART who had HIV suppression. Results and discussion: We estimated that 10,110 PLHIV resided in NSW in 2016 (range 8400 to 11,720), among whom 9230 (91.3%) were diagnosed, and 8490 (92.0% of those diagnosed) were receiving ART. Among PLDHIV receiving ART, 8020 (94.5%) had suppressed viral load ( Conclusion: NSW has met each of the UNAIDS 90-90-90 targets. The enhanced surveillance methods and data collection systems improved data quality. Measuring and meeting the 90-90-90 targets is feasible and could be achieved in comparable parts of the world. Keywords: 90-90-90; antiretroviral treatment; continuum of care; HIV; treatment cascade, 1 | INTRODUCTION In 2014, the Joint United Nations Programme on HIV and AIDS (UNAIDS) launched the 90-90-90 targets that by 2020, 90% of people living with HIV (PLHIV) will [...]

Nearly 3 decades after the World Health Assembly launched the Global Polio Eradication Initiative in 1988, 4 of the 6 WHO regions have been certified polio-free. (1) Nigeria is one [...]

Introduction: Cross-sectional methods can be used to estimate HIV incidence for surveillance and prevention studies. We evaluated assays and multi-assay algorithms (MAAs) for incidence estimation in subtype C settings. Methods: We analysed samples from individuals with subtype C infection with known duration of infection (2442 samples from 278 adults; 0.1 to 9.9 years after seroconversion). MAAs included 1-4 of the following assays: Limiting Antigen Avidity assay (LAg-Avidity), BioRad-Avidity assay, CD4 cell count and viral load (VL). We evaluated 23,400 MAAs with different assays and assay cutoffs. We identified the MAA with the largest mean window period, where the upper 95% confidence interval (CI) of the shadow was 1000 copies/mL), and two MAAs previously optimized for subtype B settings. We compared these cross-sectional incidence estimates to observed incidence in an independent longitudinal cohort. Results: The optimal MAA was LAg-Avidity 400 copies/mL. This MAA had a mean window period of 248 days (95% CI: 218, 284), a shadow of 306 days (95% CI: 255, 359), and provided the most accurate and precise incidence estimate for the independent cohort. The widely used LAg algorithm had a shorter mean window period (142 days, 95% CI: 118, 167), a longer shadow (410 days, 95% CI; 318, 491), and a less accurate and precise incidence estimate for the independent cohort. Conclusions: An optimal MAA was identified for cross-sectional HIV incidence in subtype C settings. The performance of this MAA is superior to a testing algorithm currently used for global HIV surveillance. Keywords: Cross-sectional incidence testing; Southern Africa; Subtype C; Women; Epidemiology, 1 | INTRODUCTION Accurate methods for estimating HIV incidence are critical for HIV surveillance and for evaluating the effectiveness of HIV prevention efforts [1]. Traditional longitudinal cohort studies are costly [...]

IntroductionOn 8 May 2018, the Government of the Democratic Republic of the Congo (DRC) reported an outbreak of Ebola virus disease (EVD) in Equateur Province in the northwest of the [...]

The leishmaniases are a group of diseases caused by protozoan parasites from >20 Leishmania species that are transmitted to humans by the bite of infected female phlebotomine sandflies (98 of [...]

Afghanistan, Pakistan and Nigeria remain the only countries where the transmission of endemic wild poliovirus type 1 (WPV1) continues. (1) This report describes the activities, challenges, and progress towards polio [...]

In 2016, a total of 7509 suspected and 1080 laboratory-confirmed cases of yellow fever (YF), including 171 deaths, were reported to WHO during YF outbreaks in 6 countries. In the [...]

Japanese encephalitis (JE) virus is the most important vaccine-preventable cause of encephalitis in the AsiaPacific region. WHO recommends integration of JE vaccination into national immunization schedules in all areas where [...]

The more potent immunosuppressive therapy that has successfully reduced the incidence of acute rejection and improved graft outcomes has also resulted in a higher incidence of viral complications. Sensitive molecular methods now allow for the detection of subclinical viral infection, which is increasingly recognized due to the adoption of routine post-transplant viral surveillance protocols. The goal of viral surveillance is the detection of subclinical viral infection that triggers an intervention; one that either prevents progression to viral disease or leads to early diagnosis of viral disease, which is associated with improved outcomes. Knowledge of the epidemiology and natural history of subclinical viral infection and viral disease, as well as patient-specific risk factors, is required to establish the optimal surveillance schedule which achieves the goal of early diagnosis. Evidence that detection of subclinical viral infection can impact viral disease is variable depending on the virus. This review will summarize the current data on the role of viral surveillance for BK virus (BKV), cytomegalovirus (CMV), and the Epstein-Barr virus (EBV) in the pediatric kidney transplant population., Author(s): Jodi M. Smith[sup.1] , Vikas R. Dharnidharka[sup.2] Author Affiliations: (1) Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, OC.9.820, 98105, Seattle, WA, USA (2) Department of [...]

Background Patients with a genetic variant associated with Lynch syndrome (LS) are recommended to undergo frequent and repeated cancer surveillance activities to minimize cancer-related morbidity and mortality. Little is known about how patients and primary care providers (PCPs) track and manage these recommendations. We conducted a small exploratory study of patient and PCP experiences with recommended LS surveillance activities and communication with family members in an integrated health care system. Methods We used in-depth interviews with patients and providers to understand how surveillance is coordinated and monitored following confirmation of LS. We recruited patients with a range of ages/gender, and providers with at least at least one patient with a molecular diagnosis of LS. All interviews were recorded, transcribed, and content analyzed by a trained qualitative methodologist. Results Twenty-two interviews were completed with 12 patients and 10 providers. Most patients (10) had detailed knowledge of surveillance recommendations, but were less sure of time intervals. While all patients reported receiving initial education about their surveillance recommendations from a genetic counselor, seven did not follow-up with a genetic counselor in subsequent years. A third of patients described taking sole responsibility for managing their LS surveillance care. Lack of routine communication from the health system (e.g., prompts for surveillance activities), and provider engagement were surveillance barriers. PCPs were generally aware of LS, but had limited familiarity with surveillance recommendations. Most PCPs (7) viewed LS as rare and relied on patient and specialist expertise and support. Providers typically had 1 patient with LS in a panel of 1800 patients overall. Providers felt strongly that management of LS should be coordinated by a dedicated team of specialists. Most patients (92%) had at least one family member that sought LS testing, and common barriers for family members included lack of insurance, affordability, and fear of result. Conclusion The maximal benefits of screening for confirmation of LS will only be realized with adherence to recommended preventive care. Important factors to ensure patients receive recommended LS care include a comprehensive and coordinated monitoring program that includes reminder prompts, and increased PCP education of LS and associated surveillance recommendations. Keywords: Lynch syndrome, Surveillance recommendations, Patient and provider perspectives, Qualitative, Author(s): Jennifer L. Schneider[sup.1] , Katrina A. B. Goddard[sup.1] , Kristin R. Muessig[sup.1] , James V. Davis[sup.1] , Alan F. Rope[sup.1] , Jessica E. Hunter[sup.1] , Susan K. Peterson[sup.2] , [...]

In order to monitor the progress accomplished towards dracunculiasis eradication, district-wise surveillance indicators, a line list of cases and a line list of villages with cases are sent to WHO [...]

In order to monitor the progress accomplished towards dracunculiasis eradication, district-wise surveillance indicators, a line list of cases and a line list of villages with cases are sent to WHO [...]

In order to monitor the progress accomplished towards dracunculiasis eradication, district-wise surveillance indicators, a line list of cases and a line list of villages with cases are sent to WHO [...]

The WHO Expert Working Group on Surveillance of Influenza Antiviral Susceptibility (AVWG), supports the WHO Global Influenza Surveillance and Response System (GISRS) by providing practical guidance for monitoring antiviral susceptibility [...]

In order to monitor the progress accomplished towards dracunculiasis eradication, district-wise surveillance indicators, a line list of cases and a line list of villages with cases are sent to WHO [...]