Climate change and health

Climate changes are affecting our health
Now I'll give the article the facts about climate change and health. Consider the following article

  

Key facts

• Climate change affects the fundamental requirements for health – clean air, safe drinking water, sufficient food and secure shelter.
• The global warming that has occurred since the 1970s was causing over 140 000 excess deaths annually by the year 2004.
• Many of the major killers such as diarrhoeal diseases, malnutrition, malaria and dengue are highly climate-sensitive and are expected to worsen as the climate changes.
• Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to prepare and respond.
• Reducing emissions of greenhouse gases through better transport, food and energy-use choices can result in improved health.

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Climate change

Over the last 50 years, human activities – particularly the burning of fossil fuels – have released sufficient quantities of carbon dioxide and other greenhouse gases to trap additional heat in the lower atmosphere and affect the global climate.

In the last 100 years, the world has warmed by approximately 0.75^oC. Over the last 25 years, the rate of global warming has accelerated, at over 0.18^oC per decade¹.

Sea levels are rising, glaciers are melting and precipitation patterns are changing. Extreme weather events are becoming more intense and frequent.

What is the impact of climate change on health?

Although global warming may bring some localized benefits, such as fewer winter deaths in temperate climates and increased food production in certain areas, the overall health effects of a changing climate are likely to be overwhelmingly negative. Climate change affects the fundamental requirements for health – clean air, safe drinking water, sufficient food and secure shelter.

Extreme heat

Extreme high air temperatures contribute directly to deaths from cardiovascular and respiratory disease, particularly among elderly people. In the heat wave of summer 2003 in Europe for example, more than 70 000 excess deaths were recorded².

High temperatures also raise the levels of ozone and other pollutants in the air that exacerbate cardiovascular and respiratory disease. Urban air pollution causes about 1.2 million deaths every year.

Pollen and other aeroallergen levels are also higher in extreme heat. These can trigger asthma, which affects around 300 million people. Ongoing temperature increases are expected to increase this burden.

Natural disasters and variable rainfall patterns

Globally, the number of reported weather-related natural disasters has more than tripled since the 1960s. Every year, these disasters result in over 60 000 deaths, mainly in developing countries.

Rising sea levels and increasingly extreme weather events will destroy homes, medical facilities and other essential services. More than half of the world's population lives within 60 km of the sea. People may be forced to move, which in turn heightens the risk of a range of health effects, from mental disorders to communicable diseases.

Increasingly variable rainfall patterns are likely to affect the supply of fresh water. A lack of safe water can compromise hygiene and increase the risk of diarrhoeal disease, which kills 2.2 million people every year. In extreme cases, water scarcity leads to drought and famine. By the 2090s, climate change is likely to widen the area affected by drought, double the frequency of extreme droughts and increase their average duration six-fold³.

Floods are also increasing in frequency and intensity. Floods contaminate freshwater supplies, heighten the risk of water-borne diseases, and create breeding grounds for disease-carrying insects such as mosquitoes. They also cause drownings and physical injuries, damage homes and disrupt the supply of medical and health services.

Rising temperatures and variable precipitation are likely to decrease the production of staple foods in many of the poorest regions – by up to 50% by 2020 in some African countries⁴. This will increase the prevalence of malnutrition and undernutrition, which currently cause 3.5 million deaths every year.

Patterns of infection

Climatic conditions strongly affect water-borne diseases and diseases transmitted through insects, snails or other cold blooded animals.

Changes in climate are likely to lengthen the transmission seasons of important vector-borne diseases and to alter their geographic range. For example, climate change is projected to widen significantly the area of China where the snail-borne disease schistosomiasis occurs⁵.

Malaria is strongly influenced by climate. Transmitted by Anopheles mosquitoes, malaria kills almost 1 million people every year – mainly African children under five years old. The Aedes mosquito vector of dengue is also highly sensitive to climate conditions. Studies suggest that climate change could expose an additional 2 billion people to dengue transmission by the 2080s⁶.

Measuring the health effects

Measuring the health effects from climate change can only be very approximate. Nevertheless, a WHO assessment, taking into account only a subset of the possible health impacts, concluded that the modest warming that has occurred since the 1970s was already causing over 140 000 excess deaths annually by the year 2004⁷.

Who is at risk?

All populations will be affected by climate change, but some are more vulnerable than others. People living in small island developing states and other coastal regions, megacities, and mountainous and polar regions are particularly vulnerable.

Children – in particular, children living in poor countries – are among the most vulnerable to the resulting health risks and will be exposed longer to the health consequences. The health effects are also expected to be more severe for elderly people and people with infirmities or pre-existing medical conditions.

Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to prepare and respond.

WHO response

Many policies and individual choices have the potential to reduce greenhouse gas emissions and produce major health co-benefits. For example, promoting the safe use of public transportation and active movement – such as cycling or walking as alternatives to using private vehicles – could reduce carbon dioxide emissions and improve health.

In 2009, the World Health Assembly endorsed a new WHO workplan on climate change and health. This includes:

• Advocacy: to raise awareness that climate change is a fundamental threat to human health.
• Partnerships: to coordinate with partner agencies within the UN system, and ensure that health is properly represented in the climate change agenda.
• Science and evidence: to coordinate reviews of the scientific evidence on the links between climate change and health, and develop a global research agenda.
• Health system strengthening: to assist countries to assess their health vulnerabilities and build capacity to reduce health vulnerability to climate change. 

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Influenza (Seasonal)

We all must have been exposed to a disease called influenza. There is also a seasonal influenza, well I just heard. when I walk into the WHO site I found this article. Check out this article to find out

 Key facts

• Influenza is an acute viral infection that spreads easily from person to person.
• Influenza circulates worldwide and can affect anybody in any age group.
• Influenza causes annual epidemics that peak during winter in temperate regions.
• Influenza is a serious public health problem that causes severe illnesses and deaths for higher risk populations.
• An epidemic can take an economic toll through lost workforce productivity, and strain health services.
• Vaccination is the most effective way to prevent infection.

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Diabetes

Previously I've discussed about diabetes mellitus. Now I will discuss more about the facts and how to cure diabetes. Check out the article so

  Key facts

• 346 million people worldwide have diabetes.
• In 2004, an estimated 3.4 million people died from consequences of high blood sugar.
• More than 80% of diabetes deaths occur in low- and middle-income countries.
• WHO projects that diabetes deaths will double between 2005 and 2030.
• Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of type 2 diabetes.

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Violence against women

Violence against women often occurs in many countries. Even in developed countries is still no such thing as violence against women. Here I will discuss the facts about violence against women

 Key facts:

• Violence against women - both intimate partner violence and sexual violence against women - are major public health problems and violations of women's human rights.
• A WHO multi-country study found that between 15–71% of women reported experiencing physical and/or sexual violence by an intimate partner at some point in their lives.
• These forms of violence result in physical, mental, sexual, and reproductive health and other health problems, and may increase vulnerability to HIV.
• Risk factors for being a perpetrator include low education, past exposure to child maltreatment or witnessing violence between parents, harmful use of alcohol, attitudes accepting of violence and gender inequality. Most of these are also risk factors for being a victim of intimate partner and sexual violence.
• School-based programmes to prevent relationship violence among young people (or dating violence) are supported by the best evidence of effectiveness. Other primary prevention strategies, such as microfinance combined with gender equality training and community-based initiatives that address gender inequality and communication and relationship skills, hold promise.
• Situations of conflict, post conflict and displacement may exacerbate existing violence and present new forms of violence against women.

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High Cholestrol Causes and Treatment

How can cholesterol be? And how do I cure it? You are exposed to cholesterol-here I will give you information on how to cure cholesterol and for those not affected my cholesterol will also provide how cholesterol could occur in order to avoid cholesterol

 High Cholesterol Overview

Cholesterol is a waxy, fatlike substance that the body needs to function normally. Cholesterol is naturally present in cell walls or membranes everywhere in the body, including the brain, nerves, muscles, skin, liver, intestines, and heart.
The body uses cholesterol to produce many hormones, vitamin D, and the bile acids that help to digest fat. It takes only a small amount of cholesterol in the blood to meet these needs. If a person has too much cholesterol in the bloodstream, the excess may be deposited in arteries, including the coronary arteries of the heart, the carotid arteries to the brain, and the arteries that supply blood to the legs. Cholesterol deposits are a component of the plaques that cause narrowing and blockage of the arteries, producing signs and symptoms originating from the particular part of the body that has decreased blood supply.
Blockage to the leg arteries causes claudication (pain with walking) due to peripheral artery disease. Carotid artery blockage may cause stroke, and blockage of the coronary arteries leads to angina (chest pain) and heart attack.
Coronary heart disease (CHD) is caused by cholesterol and fat being deposited in the walls of the arteries that supply nutrients and oxygen to the heart. Like any muscle, the heart needs a constant supply of oxygen and nutrients, which are carried to it by the blood in the coronary arteries. Narrowing of the arteries decreases that supply and can cause angina (chest pain) when the heart muscle does not receive enough oxygen. Cholesterol plaques can rupture, resulting in a blood clot formation that completely blocks the artery, stopping all blood flow and causing a heart attack, in which heart muscle cells die from lack of oxygen and nutrients.

Who has high cholesterol?

• Throughout the world, blood cholesterol levels vary widely. Generally, people who live in countries where blood cholesterol levels are lower, such as Japan, have lower rates of heart disease. Countries with very high cholesterol levels, such as Finland, also have very high rates of coronary heart disease. However, some populations with similar total cholesterol levels have very different heart disease rates, suggesting that other factors also influence risk for coronary heart disease.
  
  
• High cholesterol is more common in men younger than 55 years and in women older than 55 years.
  
  
• The risk for high cholesterol increases with age.

High Cholesterol Causes

High cholesterol levels are due to a variety of factors including heredity, diet, and lifestyle. Less commonly, underlying illnesses affecting the liver, thyroid, or kidney may affect blood cholesterol levels.

• Heredity: Genes may influence how the body metabolizes LDL (bad) cholesterol. Familial hypercholesterolemia is an inherited form of high cholesterol that may lead to early heart disease.

• Weight: Excess weight may modestly increase your LDL (bad) cholesterol level. Losing weight may lower LDL and raise HDL (good) cholesterol levels.

• Physical activity/exercise: Regular physical activity may lower triglycerides and raise HDL cholesterol levels.

• Age and sex: Before menopause, women usually have lower total cholesterol levels than men of the same age. As women and men age, their blood cholesterol levels rise until about 60-65 years of age. After about age 50 years, women often have higher total cholesterol levels than men of the same age.

• Alcohol use: Moderate (1-2 drinks daily) alcohol intake increases HDL (good) cholesterol but does not lower LDL (bad) cholesterol. Doctors don't know for certain whether alcohol also reduces the risk of heart disease. Drinking too much alcohol can damage the liver and heart muscle, lead to high blood pressure, and raise triglyceride levels. Because of the risks, alcoholic beverages should not be used as a way to prevent heart disease.

• Mental stress: Several studies have shown that stress raises blood cholesterol levels over the long term. One way that stress may do this is by affecting your habits. For example, when some people are under stress, they console themselves by eating fatty foods. The saturated fat and cholesterol in these foods contribute to higher levels of blood cholesterol.

For most people, the first high cholesterol treatment to try is three lifestyle changes:

• Eating better
• Maintaining (or losing) weight
• Exercising more

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Tobacco for Health

Tobacco has been used to make cigarettes since ancient times. But do you know anything what the dangers of tobacco?
I will give you the facts about tobacco in this article

 Key facts

• Tobacco kills up to half of its users.
• Tobacco kills nearly six million people each year, of whom more than 5 million are users and ex users and more than 600 000 are nonsmokers exposed to second-hand smoke. Unless urgent action is taken, the annual death toll could rise to more than eight million by 2030.
• Nearly 80% of the world's one billion smokers live in low- and middle-income countries.
• Consumption of tobacco products is increasing globally, though it is decreasing in some high-income and upper middle-income countries.

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Leading cause of death, illness and impoverishment

The tobacco epidemic is one of the biggest public health threats the world has ever faced. It kills nearly six million people a year of whom more than 5 million are users and ex users and more than 600 000 are nonsmokers exposed to second-hand smoke. Approximately one person dies every six seconds due to tobacco and this accounts for one in 10 adult deaths. Up to half of current users will eventually die of a tobacco-related disease.

Nearly 80% of the more than one billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest.

Tobacco users who die prematurely deprive their families of income, raise the cost of health care and hinder economic development.

In some countries, children from poor households are frequently employed in tobacco farming to provide family income. These children are especially vulnerable to "green tobacco sickness", which is caused by the nicotine that is absorbed through the skin from the handling of wet tobacco leaves.

Gradual killer

Because there is a lag of several years between when people start using tobacco and when their health suffers, the epidemic of tobacco-related disease and death has just begun.

• Tobacco caused 100 million deaths in the 20th century. If current trends continue, it will cause up to one billion deaths in the 21st century.
• Unchecked, tobacco-related deaths will increase to more than eight million per year by 2030. More than 80% of those deaths will be in low- and middle-income countries.

Surveillance is key

Good monitoring tracks the extent and character of the tobacco epidemic and indicates how best to tailor policies. Only fifty-nine countries, representing under half of the world's population, monitor tobacco use by repeating nationally representative youth and adult surveys at least once every five years.

Second-hand smoke kills

Second-hand smoke is the smoke that fills restaurants, offices or other enclosed spaces when people burn tobacco products such as cigarettes, bidis and water pipes. There is no safe level of exposure to second-hand tobacco smoke.

Every person should be able to breathe smoke-free air. Smoke-free laws protect the health of non-smokers, are popular, do not harm business and encourage smokers to quit.¹

• Under 11% of the world's population are protected by comprehensive national smoke-free laws.
• The number of people protected from second-hand smoke more than doubled to 739 million in 2010 from 354 million in 2008.
• Almost half of children regularly breathe air polluted by tobacco smoke.
• Over 40% of children have at least one smoking parent.
• Second-hand smoke causes more than 600 000 premature deaths per year.
• In 2004, children accounted for 31% of the deaths attributable to second-hand smoke.
• There are more than 4000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 50 are known to cause cancer.
• In adults, second-hand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer. In infants, it causes sudden death. In pregnant women, it causes low birth weight.

Tobacco users need help to quit

Studies show that few people understand the specific health risks of tobacco use. For example, a 2009 survey in China revealed that only 37% of smokers knew that smoking causes coronary heart disease and only 17% knew that it causes stroke.²

Among smokers who are aware of the dangers of tobacco, most want to quit. Counselling and medication can more than double the chance that a smoker who tries to quit will succeed.

• National comprehensive health-care services supporting cessation are available in only 19 countries, representing 14% of the world's population.
• There is no cessation assistance in 28% of low-income countries and 7% of middle-income countries.

Picture warnings work

Hard-hitting anti-tobacco advertisements and graphic pack warnings – especially those that include pictures – reduce the number of children who begin smoking and increase the number of smokers who quit.

Studies carried out after the implementation of pictorial package warnings in Brazil, Canada, Singapore and Thailand consistently show that pictorial warnings significantly increase people's awareness of the harms of tobacco use.

Mass media campaigns can also reduce tobacco consumption, by influencing people to protect non-smokers and convincing youths to stop using tobacco.

• Just 19 countries, representing 15% of the world's population, meet the best practice for pictorial warnings, which includes the warnings in the local language and cover an average of at least half of the front and back of cigarette packs. No low-income country meets this best-practice level.
• Forty-two countries, representing 42% of the world’s population, mandate pictorial warnings.
• Graphic warnings can persuade smokers to protect the health of non-smokers by smoking less inside the home and avoiding smoking near children.
• More than 1.9 billion people, representing 28% of the world's population, live in the 23 countries that have implemented at least one strong anti-tobacco mass media campaign within the last two years.

Ad bans lower consumption

Bans on tobacco advertising, promotion and sponsorship can reduce tobacco consumption.

• A comprehensive ban on all tobacco advertising, promotion and sponsorship could decrease tobacco consumption by an average of about 7%, with some countries experiencing a decline in consumption of up to 16%.
• Only 19 countries, representing 6% of the world’s population, have comprehensive national bans on tobacco advertising, promotion and sponsorship.
• Forty-six per cent of the world's population lives in countries that do not ban free distribution of tobacco products.

Taxes discourage tobacco use

Tobacco taxes are the most effective way to reduce tobacco use, especially among young people and poor people. A tax increase that increases tobacco prices by 10% decreases tobacco consumption by about 4% in high-income countries and by up to 8% in low- and middle-income countries.

• Only 27 countries, representing less than 8% of the world's population, have tobacco tax rates greater than 75% of the retail price.
• Tobacco tax revenues are on average 154 times higher than spending on tobacco control, based on available data.

WHO response

WHO is committed to fight the global tobacco epidemic. The WHO Framework Convention on Tobacco Control entered into force in February 2005. Since then, it has become one of the most widely embraced treaties in the history of the United Nations with more than 170 Parties covering 87% of the world's population. The WHO Framework Convention is WHO's most important tobacco control tool and a milestone in the promotion of public health. It is an evidence-based treaty that reaffirms the right of people to the highest standard of health, provides legal dimensions for international health cooperation and sets high standards for compliance.

In 2008, WHO introduced a package of tobacco control measures to further counter the tobacco epidemic and to help countries to implement the WHO Framework Convention. Known by their acronym MPOWER, the measures are identified as "best buys" and "good buys" in tobacco control. Each measure corresponds to at least one provision of the WHO Framework Convention on Tobacco Control.

The six MPOWER measures are:

• Monitor tobacco use and prevention policies
• Protect people from tobacco use
• Offer help to quit tobacco use
• Warn about the dangers of tobacco
• Enforce bans on tobacco advertising, promotion and sponsorship
• Raise taxes on tobacco.

For more information contact:

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

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E.nana (Endolimax nana)

Ever heard e.nana? (the name of your blog) is not, it's e-nanra. It must have been, E.nanra is the name of a bacterium, and for more details, please read the following article that I get from my friends wiki

Endolimax is a genus of amoebozoa that are found in the intestines of various animals, including the species E. nana found in humans. Originally thought to be non-pathogenic, studies suggest it can cause intermittent or chronic diarrhea. Additionally, it is very significant in medicine because it can provide false positives for other tests, notably the similar species Entamoeba histolytica, the pathogen responsible for amoebic dysentery, and because its presence indicates the host has consumed fecal material. It forms cysts with four nuclei which excyst in the body and become trophozoites. Endolimax nana nuclei have a large endosome somewhat off-center and small amounts of visible chromatin or none at all.

Endolimax
Scientific classification
Domain:	Eukaryote
Kingdom:	Amoebozoa
Phylum:	Archamoebae
Genus:	Endolimax

Cyst

Cysts are small, with a spherical to ellipsoidal shape. Mature cysts contain four nuclei; immature cysts are rarely seen. These cysts measure 5-10 um, with a usual range of 6-8 um. In stained preparations, the nucleus has a distinct karysome that, while not as large as that seen in the trophozoite, is still larger than the karysome of the Entamoeba species. Peripheral chromatin is absent. Although the nuclei are not visible in unstained preparations, the karysomes are readily apparent in iodine-stained wet mounts. The cytoplasm may contain diffuse glycogen, and chromatid bodies are absent. Occasionally, small granules or inclusions may occur in the cytoplasm.

Trophozoite

This stage is small, measuring 6-12 µm, with an average range of 8-10 um. Living trophozoites are sluggish and generally non-progressive. The single nucleus sometimes is visible in unstained preparations. In stained organisms, the karyosome usually is large and irregularly shaped, but occasionally it may be fragmented or placed against one side of the nuclear membrane. There is no peripheral chromatin on the nuclear membrane. The cytoplasm, which is coarsely granular and often highly vacuolated, may contain bacteria.

Source : wikipedia.org

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Essential Medicines

Is it essential medicines? I also do not understand about it. Article I can from the web who. for more details please refer to this article

Key facts

• Essential medicines are medicines that satisfy the priority health care needs of a population. They are selected with regard to disease prevalence, safety, efficacy, and comparative cost-effectiveness.
• The WHO Model List of Essential Medicines includes over 350 medicines to treat priority conditions.
• The WHO Model List is updated every two years, using a transparent evidence-based process.
• The WHO Model List can be used by countries as a guide for the development of their own national essential medicines list.
• National lists of essential medicines can be used as the basis for procurement and supply of medicines in the public and private sector, schemes that reimburse medicine costs, medicine donations and to guide local medicine production.

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Essential medicines are medicines that satisfy the priority health care needs of a population. They are selected with regard to disease prevalence, evidence of efficacy, safety, and comparative cost-effectiveness.
Essential medicines are intended to be available in functioning health systems at all times in adequate amounts, in appropriate dosage forms, with assured quality, and at prices individuals and the community can afford. The availability of medicines in developing countries is compromised by several factors, such as poor medicine supply and distribution systems, insufficient health facilities and staff, low investment in health and the high cost of medicines. Identifying a list of essential medicines for the health care needs of the population can help countries prioritize the purchasing and distribution of medicines, thereby reducing costs to the health system.

What is the WHO Model List of Essential Medicines?

The WHO Model List of Essential Medicines is a list of over 350 medicines. The WHO Model List includes treatment options for priority conditions such as malaria, HIV/AIDS, tuberculosis, reproductive health and also chronic diseases, such as cancer and diabetes, based on evaluation of the best available evidence.
Essential medicines are listed by their International Non-proprietary Name (INN) or generic name, without specifying a manufacturer. The list is updated every two years by the Expert Committee for the Selection and Use of Essential Medicines, using a transparent, evidence-based process. In 2007, the first ever WHO Model List of Essential Medicines for Children was developed and published.

Selection of essential medicines

The medicines included in the WHO Model List of Essential Medicines are selected with regard to disease prevalence, evidence of safety and efficacy, and comparative cost-effectiveness. As costs of medicines change over time, the price of a medicine is not a reason to exclude it from the WHO Model List if it meets the other stated selection criteria. Cost-effectiveness comparisons are made between alternative medicines within the same therapeutic group.
Applications for inclusion, changes or deletions to the Model List are submitted to the secretary of the Expert Committee for the Selection and Use of Essential Medicines. The Expert Committee is responsible for reviewing the evidence provided in an application and deciding whether to include or delete a medicine. The Expert Committee also identifies knowledge gaps and makes recommendations for future research that may be needed about medicines for the treatment of priority health problems. A medicine will be considered for deletion from the WHO Model List if its public health relevance has been questioned and/or there are concerns about its safety and efficacy and comparative cost-effectiveness compared to other medicines for the same condition.

How is the WHO Model List used?

The WHO Model List of Essential Medicines is an evidence-based resource that can be used by countries as a guide to develop their own national essential medicines list. Since the first WHO Model List of Essential Medicines was developed in 1977, many countries have developed their own national list. National lists of essential medicines can be used as the basis for procurement and supply of medicines in the public and private sector, schemes that reimburse medicine costs, medicine donations and to guide local medicine production.
The WHO Model List has been used to develop international lists for special conditions, such as The Interagency Emergency Health Kit (2006) and Essential Medicines for Reproductive Health (2006). Many international organizations, such as the United Nations Children Fund (UNICEF), United Nations High Commission for Refugees (UNHCR) and United Nations Fund for Population Activities (UNFPA), as well as nongovernmental organizations and international non-profit supply agencies, have adopted the essential medicines concept and base their medicine supply system on the WHO Model List.
The WHO Model Formulary is a guide on how to make effective use of the medicines on the WHO Model List of Essential Medicines. It follows the structure and sections used in the WHO Model List and provides a source of independent information on essential medicines for pharmaceutical policy-makers and prescribers worldwide. Also available is a WHO Model Formulary specifically for children.
The WHO Essential Medicines Library is a web-based service that provides access to information concerning individual medicines recorded in the WHO Model List, including disease information and text from the WHO Model Formulary. For each medicine, there are links to clinical evidence about efficacy and safety, WHO or other clinical guidelines, and price information.

Benefits

Identifying a limited number of essential medicines may lead to a better supply, more rational use, and lower costs. The selection of medicines has a considerable impact on the quality of care and the cost of treatment, it is therefore one of the areas where intervention is most cost-effective. Careful selection of medicines, linked with clinical treatment guidelines and monitoring and evaluation of prescribing can contribute to better health care.

WHO response

For the past 30 years the WHO Model List has led to a global acceptance of the concept of essential medicines as a powerful means to promote health equity. WHO continues its work in this area by:

• reviewing evidence for the safety, efficacy and comparative cost-effectiveness of medicines;
• developing the WHO Essential Medicines List for Children in 2007;
• revising the Model Essential Medicines Lists and related essential medicine resources regularly;
• providing independent prescriber information in the form of the WHO Model Formulary and the WHO Model Formulary for Children;
• providing technical support to countries for the adoption and implementation of the Essential Medicine List and Formulary; and
• promoting essential medicines strategies in collaboration with other international organizations, including the Interagency Pharmaceutical Coordination group, United Nations Development Programme, International Federation Red Cross and Red Crescent Societies, Médecins sans Frontières, UNICEF, UNHCR, and UNFPA.

For more information contact:

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

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Traditional Medicine

Traditional medicine is widely used in continental Asia. This drug has been trusted by the people Asia to cure various diseases. One of the many uses of traditional medicine is China and Indonesia. For more details about this traditional medicine, please see the following article

 Key facts

• In some Asian and African countries, 80% of the population depend on traditional medicine for primary health care.
• Herbal medicines are the most lucrative form of traditional medicine, generating billions of dollars in revenue.
• Traditional medicine can treat various infectious and chronic conditions: new antimalarial drugs were developed from the discovery and isolation of artemisinin from Artemisia annua L., a plant used in China for almost 2000 years.
• Counterfeit, poor quality, or adulterated herbal products in international markets are serious patient safety threats.
• More than 100 countries have regulations for herbal medicines.

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Traditional medicine is the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses.

Traditional medicine that has been adopted by other populations (outside its indigenous culture) is often termed alternative or complementary medicine.

Herbal medicines include herbs, herbal materials, herbal preparations, and finished herbal products that contain parts of plants or other plant materials as active ingredients.

Who uses traditional medicine?

In some Asian and African countries, 80% of the population depend on traditional medicine for primary health care.

In many developed countries, 70% to 80% of the population has used some form of alternative or complementary medicine (e.g. acupuncture).

Herbal treatments are the most popular form of traditional medicine, and are highly lucrative in the international marketplace. Annual revenues in Western Europe reached US$ 5 billion in 2003-2004. In China sales of products totaled US$ 14 billion in 2005. Herbal medicine revenue in Brazil was US$ 160 million in 2007.

Challenges

Traditional medicine has been used in some communities for thousands of years. As traditional medicine practices are adopted by new populations there are challenges.

International diversity: Traditional medicine practices have been adopted in different cultures and regions without the parallel advance of international standards and methods for evaluation.

National policy and regulation: Not many countries have national policies for traditional medicine. Regulating traditional medicine products, practices and practitioners is difficult due to variations in definitions and categorizations of traditional medicine therapies. A single herbal product could be defined as either a food, a dietary supplement or an herbal medicine, depending on the country. This disparity in regulations at the national level has implications for international access and distribution of products.

Safety, effectiveness and quality: Scientific evidence from tests done to evaluate the safety and effectiveness of traditional medicine products and practices is limited. While evidence shows that acupuncture, some herbal medicines and some manual therapies (e.g. massage) are effective for specific conditions, further study of products and practices is needed. Requirements and methods for research and evaluation are complex. For example, it can be difficult to assess the quality of finished herbal products. The safety, effectiveness and quality of finished herbal medicine products depend on the quality of their source materials (which can include hundreds of natural constituents), and how elements are handled through production processes.

Knowledge and sustainability: Herbal materials for products are collected from wild plant populations and cultivated medicinal plants. The expanding herbal product market could drive over-harvesting of plants and threaten biodiversity. Poorly managed collection and cultivation practices could lead to the extinction of endangered plant species and the destruction of natural resources. Efforts to preserve both plant populations and knowledge on how to use them for medicinal purposes is needed to sustain traditional medicine.

Patient safety and use: Many people believe that because medicines are herbal (natural) or traditional they are safe (or carry no risk for harm). However, traditional medicines and practices can cause harmful, adverse reactions if the product or therapy is of poor quality, or it is taken inappropriately or in conjunction with other medicines. Increased patient awareness about safe usage is important, as well as more training, collaboration and communication among providers of traditional and other medicines.

WHO response

WHO and its Member States cooperate to promote the use of traditional medicine for health care. The collaboration aims to:

• support and integrate traditional medicine into national health systems in combination with national policy and regulation for products, practices and providers to ensure safety and quality;
• ensure the use of safe, effective and quality products and practices, based on available evidence;
• acknowledge traditional medicine as part of primary health care, to increase access to care and preserve knowledge and resources; and
• ensure patient safety by upgrading the skills and knowledge of traditional medicine providers. 

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Air quality and health

Air quality in our environment also affects our health. Here I will give you the facts about air quality for our health

Key facts

• Air pollution is a major environmental risk to health. By reducing air pollution levels, we can help countries reduce the global burden of disease from respiratory infections, heart disease, and lung cancer.
• The lower the levels of air pollution in a city, the better respiratory (both long- and short-term), and cardiovascular health of the population will be.
• Indoor air pollution is estimated to cause approximately 2 million premature deaths mostly in developing countries. Almost half of these deaths are due to pneumonia in children under 5 years of age.
• Urban outdoor air pollution is estimated to cause 1.3 million deaths worldwide per year. Those living in middle-income countries disproportionately experience this burden.
• Exposure to air pollutants is largely beyond the control of individuals and requires action by public authorities at the national, regional and even international levels
• The WHO Air quality guidelines represent the most widely agreed and up-to-date assessment of health effects of air pollution, recommending targets for air quality at which the health risks are significantly reduced. The Guidelines indicate that by reducing particulate matter (PM10) pollution from 70 to 20 micrograms per cubic metre, we can cut air quality related deaths by around 15%.

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Background

Air pollution, both indoors and outdoors, is a major environmental health problem affecting everyone in developed and developing countries alike. The 2005 WHO Air quality guidelines (AQGs) are designed to offer global guidance on reducing the health impacts of air pollution. The guidelines first produced in 1987¹ and updated in 1997² had a European scope. The new (2005) guidelines apply worldwide and are based on expert evaluation of current scientific evidence. They recommend revised limits for the concentration of selected air pollutants: particulate matter (PM), ozone (O3), nitrogen dioxide (NO2) and sulfur dioxide (SO2), applicable across all WHO regions.

Key findings in 2005 Air Quality Guidelines are as follows.

• There are serious risks to health from exposure to PM and O3 in many cities of developed and developing countries. It is possible to derive a quantitative relationship between the pollution levels and specific health outcomes (increased mortality or morbidity). This allows invaluable insights into the health improvements that could be expected if air pollution is reduced.
• Even relatively low concentrations of air pollutants have been related to a range of adverse health effects.
• Poor indoor air quality may pose a risk to the health of over half of the world’s population. In homes where biomass fuels and coal are used for cooking and heating, PM levels may be 10–50 times higher than the guideline values.
• Significant reduction of exposure to air pollution can be achieved through lowering the concentrations of several of the most common air pollutants emitted during the combustion of fossil fuels. Such measures will also reduce greenhouse gases and contribute to the mitigation of global warming.

In addition to guideline values, the AQGs give interim targets related to outdoor air pollution, for each air pollutant, aimed at promoting a gradual shift from high to lower concentrations. If these targets were to be achieved, significant reductions in risks for acute and chronic health effects from air pollution can be expected. Progress towards the guideline values, however, should be the ultimate objective.

Particulate matter

Guideline values

PM_2.5
10 μg/m³ annual mean
25 μg/m³ 24-hour mean
PM₁₀
20 μg/m³ annual mean
50 μg/m³ 24-hour mean

The 2005 AQG set for the first time a guideline value for particulate matter (PM). The aim is to achieve the lowest concentrations possible. As no threshold for PM has been identified below which no damage to health is observed, the recommended value should represent an acceptable and achievable objective to minimize health effects in the context of local constraints, capabilities and public health priorities.

Definition and principle sources
PM affects more people than any other pollutant. The major components of PM are sulfate, nitrates, ammonia, sodium chloride, carbon, mineral dust and water. It consists of a complex mixture of solid and liquid particles of organic and inorganic substances suspended in the air. The particles are identified according to their aerodynamic diameter, as either PM₁₀ (particles with an aerodynamic diameter smaller than 10 µm) or PM_2.5 (aerodynamic diameter smaller than 2.5 µm). The latter are more dangerous since, when inhaled, they may reach the peripheral regions of the bronchioles, and interfere with gas exchange inside the lungs.

Health effects
The effects of PM on health occur at levels of exposure currently being experienced by most urban and rural populations in both developed and developing countries. Chronic exposure to particles contributes to the risk of developing cardiovascular and respiratory diseases, as well as of lung cancer. In developing countries, exposure to pollutants from indoor combustion of solid fuels on open fires or traditional stoves increases the risk of acute lower respiratory infections and associated mortality among young children; indoor air pollution from solid fuel use is also a major risk factor for chronic obstructive pulmonary disease and lung cancer among adults. The mortality in cities with high levels of pollution exceeds that observed in relatively cleaner cities by 15–20%. Even in the EU, average life expectancy is 8.6 months lower due to exposure to PM_2.5 produced by human activities.

Ozone (O₃)

Guideline values

O₃
100 μg/m³ 8-hour mean

The previously recommended limit, which was fixed at 120 μg/m³ 8-hour mean, has been reduced to 100 μg/m³ based on recent conclusive associations between daily mortality and ozone levels occurring at ozone concentrations below 120 µg/m³.

Definition and principal sources
Ozone at ground level – not to be confused with the ozone layer in the upper atmosphere – is one of the major constituents of photochemical smog. It is formed by the reaction with sunlight (photochemical reaction) of pollutants such as nitrogen oxides (NO_x) from vehicle and industry emissions and volatile organic compounds (VOCs) emitted by vehicles, solvents and industry. The highest levels of ozone pollution occur during periods of sunny weather.

Health effects
Excessive ozone in the air can have a marked effect on human health. It can cause breathing problems, trigger asthma, reduce lung function and cause lung diseases. In Europe it is currently one of the air pollutants of most concern. Several European studies have reported that the daily mortality rises by 0.3% and that for heart diseases by 0.4 %, per 10 µg/m³ increase in ozone exposure.

Nitrogen dioxide (NO₂)

Guideline values

NO₂
40 μg/m³ annual mean
200 μg/m³ 1-hour mean

The current WHO guideline value of 40 µg/m³ (annual mean) set to protect the public from the health effects of gaseous NO₂ remains unchanged from the level recommended in the previous AQGs.

Definition and principle sources
As an air pollutant, NO₂ has several correlated activities.

• At short-term concentrations exceeding 200 μg/m³, it is a toxic gas which causes significant inflammation of the airways.
• NO₂ is the main source of nitrate aerosols, which form an important fraction of PM_2.5 and, in the presence of ultraviolet light, of ozone.

The major sources of anthropogenic emissions of NO₂ are combustion processes (heating, power generation, and engines in vehicles and ships).

Health effects
Epidemiological studies have shown that symptoms of bronchitis in asthmatic children increase in association with long-term exposure to NO₂. Reduced lung function growth is also linked to NO₂ at concentrations currently measured (or observed) in cities of Europe and North America.

Sulfur dioxide (SO₂)

Guideline values

SO₂
20 μg/m³ 24-hour mean
500 μg/m³ 10-minute mean

A SO₂ concentration of 500 µg/m³ should not be exceeded over average periods of 10 minutes duration. Studies indicate that a proportion of people with asthma experience changes in pulmonary function and respiratory symptoms after periods of exposure to SO₂ as short as 10 minutes.

The revision of the 24-hour guideline for SO₂ from 125 to 20 μg/m³ is based on the following considerations.

• Health effects are now known to be associated with much lower levels of SO₂ than previously believed.
• A greater degree of protection is needed.
• Although the causality of the effects of low concentrations of SO₂ is still uncertain, reducing SO₂ concentrations is likely to decrease exposure to co-pollutants.

Definition and principal sources
SO₂ is a colourless gas with a sharp odour. It is produced from the burning of fossil fuels (coal and oil) and the smelting of mineral ores that contain sulfur. The main anthropogenic source of SO₂ is the burning of sulfur-containing fossil fuels for domestic heating, power generation and motor vehicles.

Health effects
SO₂ can affect the respiratory system and the functions of the lungs, and causes irritation of the eyes. Inflammation of the respiratory tract causes coughing, mucus secretion, aggravation of asthma and chronic bronchitis and makes people more prone to infections of the respiratory tract. Hospital admissions for cardiac disease and mortality increase on days with higher SO₂ levels. When SO₂ combines with water, it forms sulfuric acid; this is the main component of acid rain which is a cause of deforestation.

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Epilepsy

Now I will discuss the facts about the disease and epilepsy. For those who do not know whether this disease? Please read this article

Key facts

• Epilepsy is a chronic neurological disorder that affects people of all ages.
• Around 50 million people worldwide have epilepsy.
• Nearly 90% of the people with epilepsy are found in developing regions.
• Epilepsy responds to treatment about 70% of the time, yet about three fourths of affected people in developing countries do not get the treatment they need.
• People with epilepsy and their families can suffer from stigma and discrimination in many parts of the world.

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Epilepsy is a chronic disorder of the brain that affects people in every country of the world. It is characterized by recurrent seizures - which are physical reactions to sudden, usually brief, excessive electrical discharges in a group of brain cells. Different parts of the brain can be the site of such discharges.

Seizures can vary from the briefest lapses of attention or muscle jerks, to severe and prolonged convulsions (i.e. violent and involuntary contractions, or a series of contractions, of the muscles). Seizures can also vary in frequency, from less than one per year to several per day.

Epilepsy is one of the world's oldest recognized conditions. Fear, misunderstanding, discrimination and social stigma have surrounded epilepsy for centuries. Some of the stigma continues today in many countries and can impact the quality of life for people with the disorder and their families.

Epilepsy increases a person's risk of premature death by about two to three times compared to the general population.

One seizure does not signal epilepsy (up to 10% of people worldwide have one seizure during their lifetimes). Epilepsy is defined by two or more unprovoked seizures.

Signs and symptoms

Characteristics of seizures vary and depend on where in the brain the disturbance first starts, and how far it spreads. Temporary symptoms can occur, such as loss of awareness or consciousness, and disturbances of movement, sensation (including vision, hearing and taste), mood or mental function.

People with seizures tend to have more physical problems (such as fractures and bruising), higher rates of other diseases or psychosocial issues.

Rates of disease

The estimated proportion of the general population with active epilepsy (i.e. continuing seizures or the need for treatment) at a given time is between 4 to 10 per 1,000 people. However, some studies in developing countries suggest that the proportion is between 6 to 10 per 1,000. Around 50 million people in the world have epilepsy.

In developed countries, annual new cases are between 40 to 70 per 100 000 people in the general population. In developing countries, this figure is often close to twice as high due to the higher risk of experiencing conditions that can lead to permanent brain damage. Close to 90% of epilepsy cases worldwide are found in developing regions.

Causes

The most common type - for six out of ten people with the disorder - is called idiopathic epilepsy and has no known cause.

Epilepsy with a known cause is called secondary epilepsy, or symptomatic epilepsy. The cause could be brain damage from a loss of oxygen or trauma during birth, a severe blow to the head, a stroke that starves the brain of oxygen, an infection of the brain such as meningitis, or a brain tumor.

Risk factors

• Head trauma, central nervous system infections and tumors are associated with secondary epilepsy.
• For the younger population, perinatal complications, congenital, developmental and genetic conditions are associated with epilepsy.
• Cerebrovascular disease - conditions that affect the brain and its blood supply - is the most common risk factor in the elderly.
• A family history of epilepsy seems to increase the influence of other risk factors.

Treatment

Recent studies in both developed and developing countries have shown that up to 70% of newly diagnosed children and adults with epilepsy can be successfully treated (i.e. their seizures completely controlled) with anti-epileptic drugs. After two to five years of successful treatment, drugs can be withdrawn in about 70% of children and 60% of adults without relapses.

• In developing countries, three fourths of people with epilepsy may not receive the treatment they need.
• About 9 out of 10 people with epilepsy in Africa go untreated.
• Surgical therapy might be beneficial to patients who respond poorly to drug treatments.

Prevention

Idiopathic epilepsy is not preventable. However, preventive measures can be applied to the known causes of secondary epilepsy.

• Preventing head injury is the most effective way to prevent post-traumatic epilepsy.
• Adequate perinatal care can reduce new cases of epilepsy caused by birth injury.
• The use of drugs and other methods to lower the body temperature of a feverish child can reduce the chance of a convulsion and subsequent epilepsy.
• Central nervous system infections are common causes of epilepsy in tropical areas, where many developing countries are concentrated. Elimination of parasites in these environments and education on how to avoid infections would be effective ways to reduce epilepsy worldwide.

Social and ecomomic impacts

Although the social effects vary from country to country, the discrimination and social stigma that surround epilepsy worldwide are often more difficult to overcome than the seizures themselves.

People with epilepsy can be targets of prejudice. The stigma of the disorder can discourage people from seeking treatment for symptoms and becoming identified with the disorder.

Epilepsy has significant economic implications in terms of health care-needs, premature death and lost work productivity. An Indian study calculated that the total cost per epilepsy case was US$ 344 per year (or 88% of the average income per capita). The total cost for an estimated five million cases in India was equivalent to 0.5% of gross national product.

Human rights

People with epilepsy experience reduced access to health and life insurance, a withholding of the opportunity to obtain a driving license, and barriers to enter particular occupations, among other limitations. In many countries legislation reflects centuries of misunderstanding about epilepsy. For example:

• In both China and India, epilepsy is commonly viewed as a reason for prohibiting or annulling marriages.
• In the United Kingdom, a law forbidding people with epilepsy to marry was repealed only in 1970.
• In the United States, until the 1970s, it was legal to deny people with seizures access to restaurants, theatres, recreational centres and other public buildings.

Legislation based on internationally accepted human rights standards can prevent discrimination and rights violations, improve access to health care services and raise quality of life.

WHO response

WHO and partners recognize that epilepsy is a major public health concern. WHO, the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) are carrying out a global campaign to provide better information and raise awareness about epilepsy, and strengthen public and private efforts to improve care and reduce the disorder's impact. 

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Yellow fever

Yellow fever is common for newborns. Is that yellow fever? Please read this article to find out

Key facts

• Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The "yellow" in the name refers to the jaundice that affects some patients.
• Up to 50% of severely affected persons without treatment will die from yellow fever.
• There are an estimated 200 000 cases of yellow fever, causing 30 000 deaths, worldwide each year.
• The virus is endemic in tropical areas of Africa and Latin America, with a combined population of over 900 million people.
• The number of yellow fever cases has increased over the past two decades due to declining population immunity to infection, deforestation, urbanization, population movements and climate change.
• There is no cure for yellow fever. Treatment is symptomatic, aimed at reducing the symptoms for the comfort of the patient.
• Vaccination is the most important preventive measure against yellow fever. The vaccine is safe, affordable and highly effective, and appears to provide protection for 30–35 years or more. The vaccine provides effective immunity within one week for 95% of persons vaccinated.

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Signs and symptoms

Once contracted, the virus incubates in the body for 3 to 6 days, followed by infection that can occur in one or two phases. The first, "acute", phase usually causes fever, muscle pain with prominent backache, headache, shivers, loss of appetite, and nausea or vomiting. Most patients improve and their symptoms disappear after 3 to 4 days.

However, 15% of patients enter a second, more toxic phase within 24 hours of the initial remission. High fever returns and several body systems are affected. The patient rapidly develops jaundice and complains of abdominal pain with vomiting. Bleeding can occur from the mouth, nose, eyes or stomach. Once this happens, blood appears in the vomit and faeces. Kidney function deteriorates. Half of the patients who enter the toxic phase die within 10 to 14 days, the rest recover without significant organ damage.

Yellow fever is difficult to diagnose, especially during the early stages. It can be confused with severe malaria, dengue hemorrhagic fever, leptospirosis, viral hepatitis (especially the fulminating forms of hepatitis B and D), other hemorrhagic fevers (Bolivian, Argentine, Venezuelan hemorrhagic fevers and others flavivirus as West Nile, Zika virus etc) and other diseases, as well as poisoning. Blood tests can detect yellow fever antibodies produced in response to the infection. Several other techniques are used to identify the virus in blood specimens or liver tissue collected after death. These tests require highly trained laboratory staff and specialized equipment and materials.

Populations at risk

Forty-five endemic countries in Africa and Latin America, with a combined population of over 900 million, are at risk. In Africa, an estimated 508 million people live in 32 countries at risk. The remaining population at risk are in 13 countries in Latin America, with Bolivia, Brazil, Colombia, Ecuador and Peru at greatest risk.

There are an estimated 200 000 cases of yellow fever (causing 30 000 deaths) worldwide each year. Small numbers of imported cases occur in countries free of yellow fever. Although the disease has never been reported in Asia, the region is at risk because the conditions required for transmission are present there. In the past centuries (XVII to XIX), outbreaks of yellow fever were reported in North America ( New York, Philadelphia, Charleston, New Orleans, etc) and Europe (Ireland, England, France, Italy, Spain and Portugal).

Transmission

The yellow fever virus is an arbovirus of the flavivirus genus, and the mosquito is the primary vector. It carries the virus from one host to another, primarily between monkeys, from monkeys to humans, and from person to person.

Several different species of the Aedes and Haemogogus mosquitoes transmit the virus. The mosquitoes either breed around houses (domestic), in the jungle (wild) or in both habitats (semi-domestic). There are three types of transmission cycles.

• Sylvatic (or jungle) yellow fever: In tropical rainforests, yellow fever occurs in monkeys that are infected by wild mosquitoes. The infected monkeys then pass the virus to other mosquitoes that feed on them. The infected mosquitoes bite humans entering the forest, resulting in occasional cases of yellow fever. The majority of infections occur in young men working in the forest (e.g. for logging).
• Intermediate yellow fever: In humid or semi-humid parts of Africa, small-scale epidemics occur. Semi-domestic mosquitoes (that breed in the wild and around households) infect both monkeys and humans. Increased contact between people and infected mosquitoes leads to transmission. Many separate villages in an area can suffer cases simultaneously. This is the most common type of outbreak in Africa. An outbreak can become a more severe epidemic if the infection is carried into an area populated with both domestic mosquitoes and unvaccinated people.
• Urban yellow fever: Large epidemics occur when infected people introduce the virus into densely populated areas with a high number of non-immune people and Aedes mosquitoes. Infected mosquitoes transmit the virus from person to person.

Treatment

There is no specific treatment for yellow fever, only supportive care to treat dehydration and fever. Associated bacterial infections can be treated with antibiotics. Supportive care may improve outcomes for seriously ill patients, but it is rarely available in poorer areas.

Prevention

1. Vaccination

Vaccination is the single most important measure for preventing yellow fever. In high risk areas where vaccination coverage is low, prompt recognition and control of outbreaks through immunization is critical to prevent epidemics. To prevent outbreaks throughout affected regions, vaccination coverage must reach at least 60% to 80% of a population at risk. Few endemic countries that recently benefited from a preventive mass vaccination campaign in Africa currently have this level of coverage.

Preventive vaccination can be offered through routine infant immunization and one-time mass campaigns to increase vaccination coverage in countries at risk, as well as for travelers to yellow fever endemic area. WHO strongly recommends routine yellow fever vaccination for children in areas at risk for the disease.

The yellow fever vaccine is safe and affordable, providing effective immunity against yellow fever within one week for 95% of those vaccinated. A single dose provides protection for 30–35 years or more, and probably for life. Serious side effects are extremely rare. Serious adverse events have been reported rarely following immunization in a few endemic areas and among vaccinated travelers (e.g. in Brazil, Australia, the United States, Peru and Togo). Scientists are investigating the causes.

The risk of death from yellow fever is far greater than the risks related to the vaccine. People who should not be vaccinated include:

• children aged less than 9 months for routine immunization (or less than 6 months during an epidemic);
• pregnant women – except during a yellow fever outbreak when the risk of infection is high;
• people with severe allergies to egg protein; and
• people with severe immunodeficiency due to symptomatic HIV/AIDS or other causes, or in the presence of a thymus disorder.

Travelers, particularly those arriving to Asia from Africa or Latin America must have a certificate of yellow fever vaccination. If there are medical grounds for not getting vaccinated, International Health Regulations state that this must be certified by the appropriate authorities.

2. Mosquito control

In some situations, mosquito control is vital until vaccination takes effect. The risk of yellow fever transmission in urban areas can be reduced by eliminating potential mosquito breeding sites and applying insecticides to water where they develop in their earliest stages. Application of spray insecticides to kill adult mosquitoes during urban epidemics, combined with emergency vaccination campaigns, can reduce or halt yellow fever transmission, "buying time" for vaccinated populations to build immunity.

Historically, mosquito control campaigns successfully eliminated Aedes aegypti, the urban yellow fever vector, from most mainland countries of central and South America. However, this mosquito species has re-colonized urban areas in the region and poses a renewed risk of urban yellow fever.

Mosquito control programmes targeting wild mosquitoes in forested areas are not practical for preventing jungle (or sylvatic) yellow fever transmission.

3. Epidemic preparedness and response

Prompt detection of yellow fever and rapid response through emergency vaccination campaigns are essential for controlling outbreaks. However, underreporting is a concern – the true number of cases is estimated to be 10 to 250 times what is now being reported.

WHO recommends that every at-risk country have at least one national laboratory where basic yellow fever blood tests can be performed. One confirmed case of yellow fever in an unvaccinated population should be considered an outbreak, and a confirmed case in any context must be fully investigated, particularly in any area where most of the population has been vaccinated. Investigation teams must assess and respond to the outbreak with both emergency measures and longer-term immunization plans.

WHO response

WHO is the Secretariat for the International Coordinating Group for Yellow Fever Vaccine Provision (ICG). The ICG maintains an emergency stockpile of yellow fever vaccines to ensure rapid response to outbreaks in high risk countries.

The Yellow Fever Initiative is a preventive vaccination effort led by WHO and supported by UNICEF and National Governments, with a particular focus on 12 participating African countries where the disease is most prominent. The Initiative recommends including yellow fever vaccines in routine infant immunizations (starting at age 9 months), implementing mass vaccination campaigns in high-risk areas for people in all age groups aged 9 months and older, and maintaining surveillance and outbreak response capacity. Between 2007 and 2010, ten countries have completed preventive yellow fever vaccination campaigns: Benin, Burkina Faso, Cameroon, Central African Republic, Guinea, Liberia, Mali, Senegal, Sierra Leone and Togo. The Yellow Fever Initiative is financially supported by the GAVI Alliance, ECHO, Ministries of Health, and country-level partners.

For more information contact:

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

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Ultraviolet radiation and human health

Ultraviolet light is harmful to the body, can cause skin cancer and so forth. Here I will provide information about the facts about UV rays

 KEY FACTS

• Skin cancer is caused primarily by exposure to ultraviolet (UV) radiation – either from the sun or from artificial sources such as sunbeds.
• Globally in 2000, over 200 000 cases of melanoma were diagnosed and there were 65 000 melanoma-associated deaths.
• Excessive sun exposure in children and adolescents is likely to contribute to skin cancer in later life.
• Worldwide approximately 18 million people are blind as a result of cataracts, of these 5% of all cataract related disease burden is directly attributable to UV radiation exposure.
• Sun protection is recommended when the ultraviolet index is 3 and above.

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Ultraviolet radiation

Ultraviolet (UV) radiation is a component of solar radiation. UV radiation levels are influenced by a number of factors.

• Sun elevation: the higher the sun in the sky, the higher the UV radiation level.
• Latitude: the closer to the equator, the higher the UV radiation levels.
• Cloud cover: UV radiation levels are highest under cloudless skies but even with cloud cover, they can be high.
• Altitude: UV levels increase by about 5% with every 1000 metres altitude.
• Ozone: ozone absorbs some of the UV radiation from the sun. As the ozone layer is depleted, more UV radiation reaches the Earth's surface.
• Ground reflection: many surfaces reflect the sun’s rays and add to the overall UV exposure (e.g. grass, soil and water reflect less than 10% of UV radiation; fresh snow reflects up to 80%; dry beach sand reflects 15%, and sea foam reflects 25%).

Health effects

Small amounts of UV radiation are beneficial to health, and play an essential role in the production of vitamin D. However, excessive exposure to UV radiation is associated with different types of skin cancer, sunburn, accelerated skin ageing, cataract and other eye diseases. There is also evidence that UV radiation reduces the effectiveness of the immune system.

Effects on the skin

Excessive UV exposure results in a number of chronic skin changes.

• Cutaneous malignant melanoma: a life-threatening malignant skin cancer.
• Squamous cell carcinoma of the skin: a malignant cancer, which generally progresses less rapidly than melanoma and is less likely to cause death.
• Basal cell carcinoma of the skin: a slow-growing skin cancer appearing predominantly in older people.
• Photoageing: a loss of skin tightness and the development of solar keratoses.

Effects on the eyes

Acute effects of UV radiation include photokeratitis and photoconjunctivitis (inflammation of the cornea and conjunctiva, respectively). These effects are reversible, easily prevented by protective eyewear and are not associated with any long-term damage.

Chronic effects of UV radiation include:

• Cataract: an eye disease where the lens becomes increasingly opaque, resulting in impaired vision and eventual blindness;
• Pterygium: a white or creamy fleshy growth on the surface of the eye;
• Squamous cell carcinoma of the cornea or conjunctiva: a rare tumour of the surface of the eye.

Other health effects

UV radiation appears to diminish the effectiveness of the immune system by changing the activity and distribution of the cells responsible for triggering immune responses. Immunosuppression can cause reactivation of the herpes simplex virus in the lip ("cold sores").

Disease burden

Excessive exposure to UV radiation caused the loss of approximately 1.5 million DALYs (disability-adjusted life years) and 60 000 premature deaths in the year 2000.

Between 50% and 90% of skin cancers are due to UV radiation. In 2000, there were 200 000 cases of melanoma and 65 000 melanoma-associated deaths worldwide. In addition, there were 2.8 million cases of squamous cell carcinoma and 10 million cases of basal cell carcinoma.

Some 18 million people worldwide are blind as a result of cataracts; of these, as many as 5% may be due to UV radiation. Cataracts attributable to UV radiation are estimated to have caused the loss of about 500 000 DALY’s in 2000.

Vulnerable groups

Children and adolescents are particularly vulnerable to the harmful effects of UV radiation. Excessive sun exposure in children is likely to contribute to skin cancer in later life. The mechanisms are unclear, but it may be that skin is more susceptible to the harmful effects of UV radiation during childhood.

A person's skin type is also important. Fair-skinned people suffer more from sunburn and have a higher risk of skin cancer than dark-skinned people. However, even though the incidence of skin cancer is lower in dark-skinned people, the cancers are often detected at a later, more dangerous stage. The risk of eye damage, premature ageing of the skin and immunosuppression is independent of skin type.

Protective measures

WHO recommends the following measures to protect against exposure to UV radiation.

• Limit time in the midday sun.
• Seek shade
• Wear protective clothing such as a broad brimmed hat to protect the eyes, face and neck.
• Wear sunglasses with side panels that provide 99 to 100 percent UV-A and UV-B protection.
• Use and liberally reapply broad-spectrum sunscreen of sun protection factor (SPF) 30+ on skin areas that cannot be covered by clothes. Sun protection is best achieved by seeking shade and wearing clothes rather than applying sunscreens. Sunscreens should not be used for extending time spent in the sun, and people using sunscreen during sun tanning should voluntarily limit their time spent in the sun.
• Avoid sunbeds: use of sunbeds before the age of 35 is associated with a 75% increase in the risk of melanoma. Unless under medical supervision, sunbeds or sunlamps should not be used. WHO recommends banning their use by people under 18 years old.
• Protect babies and young children: always keep babies in the shade.

Encouraging children to take the simple precautions above will prevent both short-term and long-term damage while still allowing them to enjoy the time they spend outdoors. Parents and guardians should ensure that children are protected adequately.

Preventing vitamin D deficiency

While protection against over-exposure to UV radiation is the main health concern, UV in small amounts is essential to good health as it leads to the production of vitamin D in the body. Vitamin D strengthens the bone and musculoskeletal system. People who have very low sun exposure – such as those in institutional care or are housebound, people with deeply pigmented skin living in high latitudes or those who, for religious or cultural reasons cover their entire body surface when they are outdoors – should, in consultation with their doctor, consider oral vitamin D supplementation.

WHO response

The Global Solar UV Index

The UV index (UVI) is the international standard for UV measurement, developed by WHO, the United Nations Environment Program and the World Meteorological Organization. It is designed to indicate the potential for adverse health effects and to encourage people to protect themselves. The higher the UVI value, the greater the potential for damage to the skin and eye, and the less time it takes for harm to occur. Sun protection should be used when the UV index reaches 3 or above.

The Global UV Index, from low (green) to extreme (purple)

WHO encourages the media and the tourism industry to publish UVI forecasts and promote sun protection messages.

INTERSUN Programme

WHO, through the global INTERSUN programme, aims to reduce the burden of disease resulting from exposure to UV radiation. The project encourages research and develops an appropriate response to health risks through guidelines, recommendations and information dissemination. Beyond its scientific objectives, INTERSUN provides guidance to national authorities and other agencies about effective sun awareness programmes. These address different target audiences such as occupationally exposed people, tourists, school children and the general public.

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