Global Health Flashcards
What is referred to by ‘global health’?
Health problems, issues & concerns that transcend national boundaries, and that are best addressed by cooperative action
What are risk factors of disease outbreaks? (5)
- Overpopulation
- Malnutrition/limited access to clean water
- Religious & political wars
- Climate change
- Inequality of wealth distribution
Why do religious and political wars increase the risk of disease outbreaks?
- Migration, allowing for migration of disease
- Fragile states that provide poor healthcare
How does climate change increase the risk of disease outbreaks?
Causes migration of human and animal populations
What are the symptoms of poliomyelitis? (5)
- Flu-like initial stage
- Intense pain in arms & legs
- Extreme sensitivity to touch
- Tingling/pricking sensations
- Muscle spams & difficulty swallowing
What is the most common residual muscle paralysis after poliomyelitis?
Paralysis of one leg
What is the mortality of acute flaccid poliomyelitis?
15-30%
What is the attack rate of paralytic polio in all polio infections?
1 in every 100-1000 intestinal infections
Which polio serotypes are there?
1, 2 & 3
What was the amount of polio cases per year before vaccine introduction?
300.000/year
Which polio vaccines are available?
- IPV = inactivated intramuscular
- OPV = live attenuated oral
When was the WHO polio eradication campaign started?
1988
When was the US polio-free?
1994
When was Europe polio-free?
2002
When were India & South-East Asia polio-free?
2014
Which serotype in the oral polio vaccine is most likely to revert back to a pathogenic form?
Type 2
Type 2 poliovirus has a high risk of reverting back to a pathogenic form after administration of oral polio vaccine. Which action was taken to kerb this? Was it successful?
Type 2 removed from OPV -> causes decrease of vaccine-derived polio cases
What is the current polio vaccination strategy? (2)
- Oral polio vaccine for types 1 & 3
- Intramuscular vaccine one year later for all types
What are risk factors for polio outbreaks? (3)
- Low immunization rates
- Poor sanitation
- High population densities
What needs to be achieved to prevent all polio outbreaks?
Vaccinate all children <5 with OPV
Which is the only polio strain that still occurs in the wild?
Type 1
What are risk factors for circulating vaccine-derived poliovirus (cVDPV)? (4)
- Low immunization
- Poor sanitation
- High population densities
- Immunocompromised patients (individual risk)
What needs to be achieved to prevent circulating vaccine-derived poliovirus outbreaks?
Remove type 2 from OPV, since it is responsible for the vast majority of cases
What are the remaining hurdles & targets for poliovirus eradication? (2)
- Eradicate WT1 polio in Afghanisation & Pakistan
- Eradicate outbreaks of vaccine-derived polio
Which steps need to be taken to eliminate WT1 polio in Afghanistan & Pakistan? (6)
- Increase vaccination rate up to 90-95%
- Provide clean drinking water & sanitation
- Provide enhanced security measures for vaccination teams
- Reach hard-to-reach populations & increase trust in vaccines
- Increase the amount of female vaccination workers, since they have higher vaccination success
- Couple polio vaccination to providing essential medical services
Which steps need to be taken to eliminate outbreaks of vaccine-derived polio? (3)
- Increase vaccination rate up to 90-95%
- Use of new nOPV type 2, which is less likely to mutate
- In case of outbreaks: combine nOPV & IPV
Why are health care innovations of high income countries (HICs) usually not implemented in low- and middle income countries (LMICs)?
They are often high-cost & high-tech, and therefore too expensive or impractical to implement in low(er) resource settings
What is reverse innovation?
Any innovation designed, implemented & adopted first in LMICs
What are the characteristics of reverse innovations? (2)
- Low-cost, high-impact
- Frequently not used in HICs
What is an example of a massively succesful reverse innovation?
Oral rehydration solution = ORS
Where was Nipah virus first reported?
Malaysia & Singapore
When was the first Nipah virus outbreak?
1998-1999
What is the clinical presentation of Nipah virus?
Meningo-encephalitis
What is the case fatality rate of Nihah virus meningo-encephalitis?
39-78%
How is Nipah virus transmitted?
Direct contact with pigs
What is the Nipah virus reservoir?
Fruit bats of the Pteropus species
In which country do Nipah virus outbreaks frequently occur? Why?
Bangladesh; high amount of fruit bats carrying Nipah virus in this country
How many % of bats in Bangladesh has been in contact with Nipah virus?
~50%
How is Nipah virus transmitted from bats to humans in Bangladesh?
Bats drink raw date palm juice during harvesting and contaminate it
Which intervention prevented further Nipah virus outbreaks in Bangladesh?
Shielding date palm juice collection with bambo nets
