Vol 43 # 2 June 2011 - Kma.org.kw

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168 WHO-Facts Sheet June 2011 • About 440,000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually, causing at least 150,000 deaths. • Resistance to earlier generation antimalarial medicines such as chloroquine and sulfadoxinepyrimethamine is widespread in most malariaendemic countries. • A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA). • Inappropriate and irrational use of antimicrobial medicines provides favourable conditions for resistant microorganisms to emerge, spread and persist. Why is antimicrobial resistance a global concern AMR kills: Infections caused by resistant microorganisms often fail to respond to the standard treatment, resulting in prolonged illness and greater risk of death. AMR hampers the control of infectious diseases: AMR reduces the effectiveness of treatment because patients remain infectious for longer, thus potentially spreading resistant microorganisms to others. AMR threatens a return to the pre-antibiotic era: Many infectious diseases risk becoming uncontrollable and could derail the progress made towards reaching the targets of the health-related United Nations Millennium Development Goals set for 2015. AMR increases the costs of health care: When infections become resistant to first-line medicines, more expensive therapies must be used. The longer duration of illness and treatment, often in hospitals, increases health-care costs and the financial burden to families and societies. AMR jeopardizes health-care gains to society: The achievements of modern medicine are put at risk by AMR. Without effective antimicrobials for care and prevention of infections, the success of treatments such as organ transplantation, cancer chemotherapy and major surgery would be compromised. AMR threatens health security, and damages trade and economies: The growth of global trade and travel allows resistant microorganisms to be spread rapidly to distant countries and continents. Facts on antimicrobial resistance About 440,000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually, causing at least 150,000 deaths. Extensively drug-resistant tuberculosis (XDR-TB) has been reported in 64 countries to date. Resistance to earlier generation antimalarial medicines such as chloroquine and sulfadoxinepyrimethamine is widespread in most malariaendemic countries. Falciparum malaria parasites resistant to artemisinins are emerging in South-East Asia; infections show delayed clearance after the start of treatment (indicating resistance). A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci. Resistance is an emerging concern for treatment of HIV infection, following the rapid expansion in access to antiretroviral medicines in recent years; national surveys are underway to detect and monitor resistance. Ciprofloxacin is the only antibiotic currently recommended by WHO for the management of bloody diarrhoea due to Shigella organisms, now that widespread resistance has developed to other previously effective antibiotics. But rapidly increasing prevalence of resistance to ciprofloxacin is reducing the options for safe and efficacious treatment of shigellosis, particularly for children. New antibiotics suitable for oral use are badly needed. AMR has become a serious problem for treatment of gonorrhoea (caused by Neisseria gonorrhoeae), involving even “last-line” oral cephalosporins, and is increasing in prevalence worldwide. Untreatable gonococcal infections would result in increased rates of illness and death, thus reversing the gains made in the control of this sexually transmitted infection. New resistance mechanisms, such as the betalactamase NDM-1, have emerged among several gramnegative bacilli. This can render powerful antibiotics, which are often the last defence against multi-resistant strains of bacteria, ineffective. What drives antimicrobial resistance Inappropriate and irrational use of medicines provides favourable conditions for resistant microorganisms to emerge and spread. For example, when patients do not take the full course of a prescribed antimicrobial or when poor quality antimicrobials are used, resistant microorganisms can emerge and spread. Underlying factors that drive AMR include: • inadequate national commitment to a comprehensive and coordinated response, illdefined accountability and insufficient engagement of communities; • weak or absent surveillance and monitoring systems; • inadequate systems to ensure quality and uninterrupted supply of medicines • inappropriate and irrational use of medicines, including in animal husbandry:
June 2011 KUWAIT MEDICAL JOURNAL 169 • poor infection prevention and control practices; • depleted arsenals of diagnostics, medicines and vaccines as well as insufficient research and development on new products. Combat drug resistance: no action today, no cure tomorrow The emergence of AMR is a complex problem driven by many interconnected factors; single, isolated interventions have little impact. A global and national multi-sectoral response is urgently needed to combat the growing threat of AMR. WHO’s response WHO is engaged in guiding the response to AMR through: • policy guidance, support for surveillance, technical assistance, knowledge generation and partnerships, including through disease prevention and control programmes; • essential medicines quality, supply and rational use; • infection prevention and control; • patient safety; • laboratory quality assurance. WHO has selected combating antimicrobial resistance as the theme for World Health Day 2011. On this day, WHO issues an international call for concerted action to halt the spread of antimicrobial resistance and recommends a six-point policy package for governments. WHO calls on all key stakeholders, including policy-makers and planners, the public and patients, practitioners and prescribers, pharmacists and dispensers, and the pharmaceutical industry, to act and take responsibility for combating antimicrobial resistance. For further information: WHO Media centre ; Telephone: +41 22 791 2222; E-mail: mediainquiries@who.int 3. VISUAL IMPAIRMENT AND BLINDNESS Definitions There are four levels of visual function, according to the International Classification of Diseases -10 (Update and Revision 2006): • normal vision • moderate visual impairment • severe visual impairment • blindness. Moderate visual impairment combined with severe visual impairment are grouped under the term “low vision”: low vision taken together with blindness represents all visual impairment. Key facts • About 284 million people are visually impaired worldwide: 39 million are blind and 245 have low vision. • About 90% of the world’s visually impaired live in developing countries. • Globally, uncorrected refractive errors are the main cause of visual impairment but in middle and lowincome countries cataracts remain the leading cause of blindness. • The number of people visually impaired from infectious diseases has greatly reduced in the last 20 years. • 80% of all visual impairment can be avoided or cured. The causes of visual impairment Globally the major causes of visual impairment are: • uncorrected refractive errors (myopia, hyperopia or astigmatism), 43 % • cataract, 33% • glaucoma, 2%. Who is at risk Approximately 90% of visually impaired people live in developing countries. People aged 50 and over About 65 % of all people who are visually impaired are aged 50 and older, while this age group comprises about 20 % of the world’s population. With an increasing elderly population in many countries, more people will be at risk of age-related visual impairment. Children below age 15 An estimated 19 million children are visually impaired. Of these, 12 million children are visually impaired due to refractive errors, a condition that could be easily diagnosed and corrected. 1.4 million are irreversibly blind for the rest of their lives. Changes over the last twenty years Overall, visual impairment worldwide has decreased since the early 1990s. This is despite an aging global elderly population. This decrease is principally the result of a reduction in visual impairment from infectious diseases through concerted public health action. The global response to prevention of blindness Globally, 80% of all visual impairment can be
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