Global Health

Question 1

What is referred to by ‘global health’?

Answer 1

Health problems, issues & concerns that transcend national boundaries, and that are best addressed by cooperative action

Question 2

What are risk factors of disease outbreaks? (5)

Answer 2

1. Overpopulation
2. Malnutrition/limited access to clean water
3. Religious & political wars
4. Climate change
5. Inequality of wealth distribution

Question 3

Why do religious and political wars increase the risk of disease outbreaks?

Answer 3

1. Migration, allowing for migration of disease
2. Fragile states that provide poor healthcare

Question 4

How does climate change increase the risk of disease outbreaks?

Answer 4

Causes migration of human and animal populations

Question 5

What are the symptoms of poliomyelitis? (5)

Answer 5

1. Flu-like initial stage
2. Intense pain in arms & legs
3. Extreme sensitivity to touch
4. Tingling/pricking sensations
5. Muscle spams & difficulty swallowing

Question 6

What is the most common residual muscle paralysis after poliomyelitis?

Answer 6

Paralysis of one leg

Question 7

What is the mortality of acute flaccid poliomyelitis?

Answer 7

15-30%

Question 8

What is the attack rate of paralytic polio in all polio infections?

Answer 8

1 in every 100-1000 intestinal infections

Question 9

Which polio serotypes are there?

Answer 9

1, 2 & 3

Question 10

What was the amount of polio cases per year before vaccine introduction?

Answer 10

300.000/year

Question 11

Which polio vaccines are available?

Answer 11

1. IPV = inactivated intramuscular
2. OPV = live attenuated oral

Question 12

When was the WHO polio eradication campaign started?

Answer 12

1988

Question 13

When was the US polio-free?

Answer 13

1994

Question 14

When was Europe polio-free?

Answer 14

2002

Question 15

When were India & South-East Asia polio-free?

Answer 15

2014

Question 16

Which serotype in the oral polio vaccine is most likely to revert back to a pathogenic form?

Answer 16

Type 2

Question 17

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?

Answer 17

Type 2 removed from OPV -> causes decrease of vaccine-derived polio cases

Question 18

What is the current polio vaccination strategy? (2)

Answer 18

1. Oral polio vaccine for types 1 & 3
2. Intramuscular vaccine one year later for all types

Question 19

What are risk factors for polio outbreaks? (3)

Answer 19

1. Low immunization rates
2. Poor sanitation
3. High population densities

Question 20

What needs to be achieved to prevent all polio outbreaks?

Answer 20

Vaccinate all children <5 with OPV

Question 21

Which is the only polio strain that still occurs in the wild?

Answer 21

Type 1

Question 22

What are risk factors for circulating vaccine-derived poliovirus (cVDPV)? (4)

Answer 22

1. Low immunization
2. Poor sanitation
3. High population densities
4. Immunocompromised patients (individual risk)

Question 23

What needs to be achieved to prevent circulating vaccine-derived poliovirus outbreaks?

Answer 23

Remove type 2 from OPV, since it is responsible for the vast majority of cases

Question 24

What are the remaining hurdles & targets for poliovirus eradication? (2)

Answer 24

1. Eradicate WT1 polio in Afghanisation & Pakistan
2. Eradicate outbreaks of vaccine-derived polio

Question 25

Which steps need to be taken to eliminate WT1 polio in Afghanistan & Pakistan? (6)

Answer 25

1. Increase vaccination rate up to 90-95% 2. Provide clean drinking water & sanitation 3. Provide enhanced security measures for vaccination teams 4. Reach hard-to-reach populations & increase trust in vaccines 5. Increase the amount of female vaccination workers, since they have higher vaccination success 6. Couple polio vaccination to providing essential medical services

Question 26

Which steps need to be taken to eliminate outbreaks of vaccine-derived polio? (3)

Answer 26

1. Increase vaccination rate up to 90-95% 2. Use of new nOPV type 2, which is less likely to mutate 3. In case of outbreaks: combine nOPV & IPV

Question 27

Why are health care innovations of high income countries (HICs) usually not implemented in low- and middle income countries (LMICs)?

Answer 27

They are often high-cost & high-tech, and therefore too expensive or impractical to implement in low(er) resource settings

Question 28

What is reverse innovation?

Answer 28

Any innovation designed, implemented & adopted first in LMICs

Question 29

What are the characteristics of reverse innovations? (2)

Answer 29

1. Low-cost, high-impact 2. Frequently not used in HICs

Question 30

What is an example of a massively succesful reverse innovation?

Answer 30

Oral rehydration solution = ORS

Question 31

Where was Nipah virus first reported?

Answer 31

Malaysia & Singapore

Question 32

When was the first Nipah virus outbreak?

Answer 32

1998-1999

Question 33

What is the clinical presentation of Nipah virus?

Answer 33

Meningo-encephalitis

Question 34

What is the case fatality rate of Nihah virus meningo-encephalitis?

Answer 34

39-78%

Question 35

How is Nipah virus transmitted?

Answer 35

Direct contact with pigs

Question 36

What is the Nipah virus reservoir?

Answer 36

Fruit bats of the Pteropus species

Question 37

In which country do Nipah virus outbreaks frequently occur? Why?

Answer 37

Bangladesh; high amount of fruit bats carrying Nipah virus in this country

Question 38

How many % of bats in Bangladesh has been in contact with Nipah virus?

Answer 38

~50%

Question 39

How is Nipah virus transmitted from bats to humans in Bangladesh?

Answer 39

Bats drink raw date palm juice during harvesting and contaminate it

Question 40

Which intervention prevented further Nipah virus outbreaks in Bangladesh?

Answer 40

Shielding date palm juice collection with bambo nets