Vol 44 # 2 June 2012 - Kma.org.kw

More documents

Recommendations

Info

171 WHO-Facts Sheet June 2012 was vaccinated but did not develop immunity) can become infected. Measles is still common in many developing countries – particularly in parts of Africa and Asia. More than 20 million people are affected by measles each year. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures. Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection. Transmission The highly contagious virus is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. The virus remains active and contagious in the air or on infected surfaces for up to two hours. It can be transmitted by an infected person from four days prior to the onset of the rash to four days after the rash erupts. Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children. In countries where measles has been largely eliminated, cases imported from other countries remain an important source of infection. Treatment Severe complications from measles can be avoided though supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia. All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%. Prevention Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. The measles vaccine has been in use for over 40 years. It is safe, effective and inexpensive. It costs less than one US dollar to immunize a child against measles. The measles vaccine is often incorporated with rubella and/or mumps vaccines in countries where these illnesses are problems. It is equally effective in the single or combined form. In 2010, about 85% of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity, as about 15% of vaccinated children fail to develop immunity from the first dose. WHO response The fourth Millennium Development Goal (MDG 4) aims to reduce the under-five mortality rate by two-thirds between 1990 and 2015. Recognizing the potential of measles vaccination to reduce child mortality, and given that measles vaccination coverage can be considered a marker of access to child health services, routine measles vaccination coverage has been selected as an indicator of progress towards achieving MDG 4. Overwhelming evidence demonstrates the benefit of providing universal access to measles and rubella-containing vaccines. Globally, an estimated 535,300 children died of measles in 2000. By 2010, the global push to improve vaccine coverage resulted in a 74% reduction in deaths. These efforts, supported by the Measles & Rubella Initiative (MR Initiative), contributed 23% of the overall decline in under-five deaths between 1990 and 2008 and are driving progress towards meeting MDG4. The MR Initiative is a collaborative effort of WHO, UNICEF, the American Red Cross, the United States Centers for Disease Control and Prevention, and the United Nations Foundation to control measles and rubella. In April 2012, the MR Initiative launched a new Global Measles and Rubella Strategic Plan which covers the period 2012 - 2020. 2. AVIAN INFLUENZA Influenza pandemics (outbreaks that affect a large proportion of the world) are unpredictable but recurring events that can have health, economic and social consequences worldwide. An influenza pandemic occurs when key factors converge: an influenza virus emerges with the ability to cause sustained transmission from human-to-human, and there is very low, or no, immunity to the virus among most people. In the interconnected world of today, a localized epidemic can transform into a pandemic rapidly, with little time to prepare a public health response to halt the spread of illness. Avian influenza (AI) viruses are divided into two groups based on their ability to cause disease in poultry: high pathogenicity or low pathogenicity. Highly pathogenic viruses result in high death rates (up to 100% mortality within 48 hours) in some poultry species. Low pathogenicity viruses also cause outbreaks in poultry but are not generally associated with severe clinical disease.
June 2012 KUWAIT MEDICAL JOURNAL 172 Key facts • Avian influenza, commonly called bird flu, is an infectious viral disease of birds. • Most avian influenza viruses do not infect humans; however some, such as H5N1, have caused serious infections in people. • Outbreaks of AI in poultry may raise global public health concerns due to their effect on poultry populations, their potential to cause serious disease in people, and their pandemic potential. • Reports of highly pathogenic AI epidemics in poultry can seriously impact local and global economies and international trade. • The majority of human cases of H5N1 infection have been associated with direct or indirect contact with infected live or dead poultry. There is no evidence that the disease can be spread to people through properly cooked food. • Controlling the disease in animals is the first step in decreasing risks to humans. • Avian influenza (AI) is an infectious viral disease of birds (especially wild water fowl such as ducks and geese), often causing no apparent signs of illness. AI viruses can sometimes spread to domestic poultry and cause large-scale outbreaks of serious disease. Some of these AI viruses have also been reported to cross the species barrier and cause disease or subclinical infections in humans and other mammals. Avian influenza H5N1 background The H5N1 virus subtype - a highly pathogenic AI virus- first infected humans in 1997 during a poultry outbreak in Hong Kong SAR, China. Since its widespread re-emergence in 2003 and 2004, this avian virus has spread from Asia to Europe and Africa and has become entrenched in poultry in some countries, resulting in millions of poultry infections, several hundred human cases, and many human deaths. Outbreaks in poultry have seriously impacted livelihoods, the economy and international trade in affected countries. Ongoing circulation of H5N1 viruses in poultry, especially when endemic, continues to pose threats to public health, as these viruses have both the potential to cause serious disease in people and may have the potential to change into a form that is more transmissible among humans. Other influenza virus subtypes also circulate in poultry and other animals, and may also pose potential threats to public health. Avian influenza H5N1 infections and clinical features in humans The case fatality rate for H5N1 virus infections in people is much higher compared to that of seasonal influenza infections. Clinical features In many patients, the disease caused by the H5N1 virus follows an unusually aggressive clinical course, with rapid deterioration and high fatality. Like most emerging disease, H5N1 influenza in humans is poorly understood. The incubation period for H5N1 avian influenza may be longer than that for normal seasonal influenza, which is around two to three days. Current data for H5N1 infection indicate an incubation period ranging from two to eight days and possibly as long as 17 days. WHO currently recommends that an incubation period of seven days be used for field investigations and the monitoring of patient contacts. Initial symptoms include a high fever, usually with a temperature higher than 38 ºC, and other influenzalike symptoms. Diarrhea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients. One feature seen in many patients is the development of lower respiratory tract infection early in the illness. On present evidence, difficulty in breathing develops around five days following the first symptoms. Respiratory distress, a hoarse voice, and a crackling sound when inhaling are commonly seen. Sputum production is variable and at times, bloody. Antiviral treatment Evidence suggests that some antiviral drugs, notably oseltamivir, can reduce the duration of viral replication and improve prospects of survival. In suspected cases, oseltamivir should be prescribed as soon as possible (ideally, within 48 hours following symptom onset) to maximize its therapeutic benefits. However, given the significant mortality currently associated with H5N1 infection and evidence of prolonged viral replication in this disease, administration of the drug should also be considered in patients presenting later in the course of illness. In cases of severe infection with the H5N1 virus, clinicians may need to consider increasing the recommended daily dose or/and the duration of treatment. In severely ill H5N1 patients or in H5N1 patients with severe gastrointestinal symptoms, drug absorption may be impaired. This possibility should be considered when managing such patients. Risk factors for human infection The primary risk factor for human infection appears to be direct or indirect exposure to infected live or dead poultry or contaminated environments. Controlling circulation of the H5N1 virus in poultry is essential to reducing the risk of human infection. Given the persistence of the H5N1 virus in some poultry populations, control will require long-term
Page 1 and 2:
VOLUME 44 NUMBER 2 KMJ KUWAIT MEDIC
Page 3 and 4:
Kuwait Medical Journal (KMJ) Publis
Page 5 and 6:
Instructions for Authors (if applic
Page 7 and 8:
June 2012 KUWAIT MEDICAL JOURNAL 90
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
June 2012 In many subjects with poo
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
June 2012 students experience lower
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38: June 2012 KUWAIT MEDICAL JOURNAL 12
Page 59 and 60: June 2012 Timely diagnosis and drai
Page 87: June 2012 KUWAIT MEDICAL JOURNAL 17
show all

Vol 44 # 2 June 2012 - Kma.org.kw

Create successful ePaper yourself

Delete template?

Save as template?