Malaria in the WHO European Region: on the road to elimination 2000-2015: summary

This is an English version and summary of a Russian publication on the elimination of malaria in the WHO European Region. Through the considerable efforts of affected countries, WHO and the international community, the European Region became the first WHO region to interrupt transmission of indigenous malaria. The report summarizes the lessons learnt, experiences accumulated and results achieved in curbing epidemics and outbreaks after malaria resurgence, eliminating malaria and preventing the re-establishment of its transmission in malaria-affected countries and the entire Region. The publication was prepared by WHO staff members and international consultants of the WHO Regional Office for Europe and national malaria counterparts who have been committed to and involved in epidemic containment, malaria elimination and prevention over the past 16 years (2000–2015). The publication is intended for health managers and personnel, researchers, teachers, students and everyone who is interested in tropical diseases, medical parasitology and public health.

Стратегическая рамочная программа по борьбе с лейшманиозом в Европейском регионе ВОЗ, 2014‒2020 гг.

Лейшманиоз - одно из так называемых «забытых» и плохо регистрируемых заболеваний, бремя которого в большинстве стран Европейского региона ВОЗ является недооцененным или неопределенным. Стратегическая рамочная программа по борьбе с лейшманиозом была разработана в тесном сотрудничестве со всеми заинтересованными сторонами в целях повышения уровня эпиднадзора, контроля и профилактики лейшманиоза. Рамочная программа определяет региональные цели и задачи, которые должны быть достигнуты к 2020 году, а также рекомендуемые для этого стратегические подходы и приоритетные мероприятия, в которых особое внимание уделено руководству программой, выявлению и лечению случаев, эпиднадзору, контролю резервуарных хозяев, комплексной борьбе с переносчиками инфекции, операционным исследованиям, развитию потенциала, участию сообществ и санитарно-просветительской деятельности, трансграничному сотрудничеству и межсекторальному взаимодействию, партнерской работе, мониторингу и оценке.

Epidemiology of visceral leishmaniasis in Georgia.

This study investigated the transmission and prevalence of Leishmania parasite infection of humans in two foci of Visceral Leishmaniasis (VL) in Georgia, the well known focus in Tbilisi in the East, and in Kutaisi, a new focus in the West of the country. The seroprevalence of canine leishmaniasis was investigated in order to understand the zoonotic transmission. Blood samples of 1575 dogs (stray and pet) and 77 wild canids were tested for VL by Kalazar Detect rK39 rapid diagnostic tests. Three districts were investigated in Tbilisi and one in Kutaisi. The highest proportions of seropositive pet dogs were present in District #2 (28.1%, 82/292) and District #1 (26.9%, 24/89) in Tbilisi, compared to 17.3% (26/150) of pet dogs in Kutaisi. The percentage of seropositive stray dogs was also twice as high in Tbilisi (16.1%, n = 670) than in Kutaisi (8%, n = 50); only 2/58 wild animals screened were seropositive (2. 6%). A total of 873 Phlebotomine sand flies were collected, with 5 different species identified in Tbilisi and 3 species in Kutaisi; 2.3% of the females were positive for Leishmania parasites. The Leishmanin Skin Test (LST) was performed on 981 human subjects in VL foci in urban areas in Tbilisi and Kutaisi. A particularly high prevalence of LST positives was observed in Tbilisi District #1 (22.2%, 37.5% and 19.5% for ages 5-9, 15-24 and 25-59, respectively); lower prevalence was observed in Kutaisi (0%, 3.2% and 5.2%, respectively; P<0.05). This study shows that Tbilisi is an active focus for leishmaniasis and that the infection prevalence is very high in dogs and in humans. Although exposure is as yet not as high in Kutaisi, this is a new VL focus. The overall situation in the country is alarming and new control measures are urgently needed.

Strategic framework for leishmaniasis control in the WHO European Region 2014–2020

Leishmaniasis is a neglected and poorly reported disease with an underestimated or undetermined burden in most countries of the WHO European Region. This strategic framework for leishmaniasis control was developed in close collaboration with all stakeholders in order to improve the surveillance, control and prevention of leishmaniasis. The framework outlines the regional goal and objectives to be achieved by 2020 together with the recommended strategic approaches and priority interventions, with special attention to programme management, case detection and management, disease surveillance, control of reservoir hosts, integrated vector control, environmental operational research, capacity-building, community participation and health education, cross-border cooperation, intersectoral collaboration, partnership action and monitoring and evaluation.

Regional framework for prevention of malaria reintroduction and certification of malaria elimination 2014–2020

This framework for prevention of the reintroduction of malaria and certification of countries as free from malaria is intended for health policy-makers, heads of national malaria control programmes, heads of epidemiological, parasitological and entomological departments of the ministry of health epidemiological services, and specialists from other ministries and agencies involved in the implementation of programmes for malaria elimination and prevention of malaria reintroduction in central Asia, the south Caucasus, Turkey and some European countries. The document outlines the key issues related to possible resurgence of malaria in the post-elimination period, the goals and objectives of the programme, and key approaches and measures to prevent malaria reintroduction, as well as scientific, operational, organizational and methodological aspects of the process of certifying countries free from malaria. The guidelines described in the document are intended to help health policy-makers and managers of malaria control programmes to plan, organize and implement measures aimed at preventing malaria reintroduction and at the certification of malaria elimination.

Региональная рамочная программа по эпиднадзору и борьбе с инвазивными видами комаров-переносчиков и возвращающимися трансмиссивными болезнями: 2014–2020 гг.

Недавние вспышки лихорадки денге и лихорадки чикунгунья в Европейском регионе ВОЗ, а также укоренение в Европе инвазивных комаров Aedes, которые могут становиться их переносчиками, служат подтверждением возможности местной передачи этих болезней. В сложившейся ситуации возникла необходимость в создании региональной рамочной программы по дальнейшему совершенствованию профилактики и эпиднадзора за возвращающимися трансмиссивными болезнями и контроля в отношении инвазивных переносчиков этих болезней. Рамочная программа призвана помочь государствам-членам в разработке или совершенствовании национальных оперативных планов, в гармонизации планов и подходов между странами, проведении трансграничных мероприятий и мобилизации ресурсов для осуществления указанных планов.

Regional framework for surveillance and control of invasive mosquito vectors and re-emerging vector-borne diseases: 2014–2020

The introduction and establishment of Aedes mosquito species into the WHO European Region is an emerging problem. Factors such as globalization, the increasing volume of trade and travel, continuing urbanization and environmental/climate change have contributed to this spread. Aedes aegypti and Aedes albopictus mosquitoes are effective vectors of potentially severe diseases such as dengue and chikungunya fever. Travellers returning from disease-endemic countries are increasingly introducing these diseases into the Region. In areas where these invasive mosquitoes have been established or re-established, there is a risk of local transmission of these diseases. An increasing number of outbreaks of dengue and chikungunya in the Region have been reported in the last five years. This regional framework was developed after extensive consultation with all stakeholders in order to improve the prevention, surveillance and control of the invasive mosquito vectors and re-emerging diseases in Member States.

Global trends in the use of insecticides to control vector-borne diseases.

BACKGROUND: Data on insecticide use for vector control are essential for guiding pesticide management systems on judicious and appropriate use, resistance management, and reduction of risks to human health and the environment. OBJECTIVE: We studied the global use and trends of insecticide use for control of vector-borne diseases for the period 2000 through 2009. METHODS: A survey was distributed to countries with vector control programs to request national data on vector control insecticide use, excluding the use of long-lasting insecticidal nets (LNs). Data were received from 125 countries, representing 97% of the human populations of 143 targeted countries. RESULTS: The main disease targeted with insecticides was malaria, followed by dengue, leishmaniasis, and Chagas disease. The use of vector control insecticides was dominated by organochlorines [i.e., DDT (dichlorodiphenyltrichloroethane)] in terms of quantity applied (71% of total) and by pyrethroids in terms of the surface or area covered (81% of total). Global use of DDT for vector control, most of which was in India alone, was fairly constant during 2000 through 2009. In Africa, pyrethroid use increased in countries that also achieved high coverage for LNs, and DDT increased sharply until 2008 but dropped in 2009. CONCLUSIONS: The global use of DDT has not changed substantially since the Stockholm Convention went into effect. The dominance of pyrethroid use has major implications because of the spread of insecticide resistance with the potential to reduce the efficacy of LNs. Managing insecticide resistance should be coordinated between disease-specific programs and sectors of public health and agriculture within the context of an integrated vector management approach.

Status of legislation and regulatory control of public health pesticides in countries endemic with or at risk of major vector-borne diseases.

BACKGROUND: Legislation and regulation of pesticides used in public health are essential for reducing risks to human health and the environment. OBJECTIVE: We assessed the global situation on legislation and regulatory control of public health pesticides. METHODS: A peer-reviewed and field-tested questionnaire was distributed to 142 member states of the World Health Organization (WHO); 113 states completed the questionnaire. RESULTS: Legislation on public health pesticides was absent in 25% of the countries. Where present, legislation often lacked comprehensiveness, for example, on basic aspects such as labeling, storage, transport, and disposal of public health pesticides. Guidelines or essential requirements for the process of pesticide registration were lacking in many countries. The capacity to enforce regulations was considered to be weak across WHO regions. Half of all countries lacked pesticide quality control laboratories, and two-thirds reported high concern over quality of products on the market. National statistics on production and trade of pesticides and poisoning incidents were lacking in many countries. Despite the shortcomings, WHO recommendations were considered to constitute a supportive or sole basis in national registration. Also, some regions showed high participation of countries in regional schemes to harmonize pesticide registration requirements. CONCLUSIONS: Critical deficiencies are evident in the legislative and regulatory framework for public health pesticides across regions, posing risks to human health and the environment. Recent experience in some countries with situational analysis, needs assessment, action planning, and regional collaboration has signaled a promising way forward.

Status of pesticide management in the practice of vector control: a global survey in countries at risk of malaria or other major vector-borne diseases.

BACKGROUND: It is critical that vector control pesticides are used for their acceptable purpose without causing adverse effects on health and the environment. This paper provides a global overview of the current status of pesticides management in the practice of vector control. METHODS: A questionnaire was distributed to WHO member states and completed either by the director of the vector-borne disease control programme or by the national manager for vector control. In all, 113 countries responded to the questionnaire (80% response rate), representing 94% of the total population of the countries targeted. RESULTS: Major gaps were evident in countries in pesticide procurement practices, training on vector control decision making, certification and quality control of pesticide application, monitoring of worker safety, public awareness programmes, and safe disposal of pesticide-related waste. Nevertheless, basic conditions of policy and coordination have been established in many countries through which the management of vector control pesticides could potentially be improved. Most countries responded that they have adopted relevant recommendations by the WHO. CONCLUSIONS: Given the deficiencies identified in this first global survey on public health pesticide management and the recent rise in pesticide use for malaria control, the effectiveness and safety of pesticide use are being compromised. This highlights the urgent need for countries to strengthen their capacity on pesticide management and evidence-based decision making within the context of an integrated vector management approach.