Bulletin of the World Health Organization

Public health round-up

Plain packaging upheld

Australia has become the first country in the world to adopt mandatory cigarette packaging which removes brand colours and logos.

The law, which was originally passed last year, had been challenged by cigarette companies including Philip Morris and British American Tobacco on the grounds that it was unconstitutional. The decision by Australia’s high court means cigarettes have to be sold in olive green packets, with graphic warnings of the consequences of smoking.

The law will come into force on 1 December 2012.

In a statement, the court said: “At least a majority of the court is of the opinion that the Act is not contrary to [the constitution].”

The court is expected to give its reasons for the decision at a later date.

FGM outlawed

Female genital mutilation has been outlawed in Somalia. Part of the country’s provisional constitution, drawn up by the new Somali government, reads: “Circumcision of girls is a cruel and degrading customary practice, and is tantamount to torture. The circumcision of girls is prohibited.”

Female genital mutilation comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.

According to the World Health Organization, an estimated 92 million girls aged 10 years old and above in Africa have undergone the procedure, which can cause severe bleeding and problems urinating, cysts, infections, infertility as well as complications in childbirth and an increased risk of newborn deaths.

Nodding syndrome agenda

A standard case definition for nodding syndrome has been established and critical next steps in a research agenda that will guide future scientific studies have been identified following a meeting in Uganda in early August.

Over two days, the meeting participants heard presentations from representatives who have conducted studies in Uganda, South Sudan and the United Republic of Tanzania. These presentations provided insight into the different research activities that have taken place in each country and progress made to date.

The key objective achieved by the meeting was a standardized case definition for suspect and probable cases of nodding syndrome. Although those working in the field have referred to this illness as ‘nodding disease’ and ‘head nodding disease’ in the past, a consensus was reached to refer to the combination of signs and symptoms as nodding syndrome.

This term will provide consistency across all research related to nodding syndrome in the future. The researchers and representatives from the three countries identified key strategic steps that the meeting participants should take to move forward on this research. For example, researchers should conduct systematic surveys to determine its prevalence, burden and geographic distribution. Other topics for next steps include clinical case management, collaborative research with conference participants, and the involvement of additional specialty fields in research including anthropology.

Anthony Mbonye, of Uganda’s Ministry of Health, said at the conclusion of the meeting: “When we came here, we aimed to have a case definition. We aimed to have a research agenda. We aimed to have research collaboration. I think we achieved these things.”

Ebola update

Frederick Murphy

The Ministry of Health in Uganda has reported 53 suspected cases of Ebola haemorrhagic fever including 16 deaths, as of 3 August. Of these 53, five cases have been laboratory-confirmed by the Uganda Virus Research Institute (UVRI) in Entebbe (this includes three fatal cases and two cases currently being treated in the isolation facility).

As of mid-August, 32 cases had been admitted to an isolation facility in Kagadi hospital, Kibaale district, and a total of 312 contacts had been identified, of whom 253 were being monitored on a regular basis. So far all samples from other districts have tested negative for the virus, suggesting that the outbreak has not expanded beyond Kibaale District apart from a clinical officer who attended to a case in that district and who was transferred to Mulago Hospital in Kampala for treatment and later died.

Gonorrhea treatment

The oral antibiotic cefixime is no longer recommended by the Centers for Disease Control and Prevention (CDC) as a first-line treatment option for gonorrhea in the United States of America because the bacterium that causes gonorrhea may be becoming resistant to the drug.

The change was prompted by recent trends in laboratory data showing that cefixime, marketed under the brand name Suprax, is becoming less effective in treating the sexually transmitted infection.

This change leaves only one recommended drug proven effective for treating gonorrhea, the injectable antibiotic ceftriaxone.

According to the revised guidelines, published in August in CDC’s Morbidity and Mortality Weekly Report, the most effective treatment for gonorrhea is a combination therapy: the injectable antibiotic ceftriaxone along with one of two other oral antibiotics, either azithromycin or doxycycline.

In the past, gonorrhea has developed resistance to every antibiotic recommended for its treatment, leaving the cephalosporins, which include cefixime and ceftriaxone, as the final recommended class of drugs. In light of this history and the recent laboratory data, researchers are concerned that continued use of cefixime may prompt gonorrhea to develop resistance to all cephalosporins. Limiting the use of cefixime now may help preserve ceftriaxone as a treatment option for a little longer, CDC said.

French breathalyzers

France has just passed a law making it mandatory for all cars to carry breathalyzers, which measure blood alcohol content.

The new legislation, which came into effect on 1 July, means that every car driving through France has to be equipped with two single-use devices as part of a government campaign to reduce the number related collisions.

The new regulations, which exclude mopeds, will also cover foreign drivers visiting the country or in transit from 1 November following a six-month grace period.

Trace pharmaceuticals in drinking-water

Reports of trace concentrations of pharmaceuticals in the water cycle have raised concerns over potential human health risks from exposure to very low levels of pharmaceuticals in drinking-water in recent years.

WHO released a new publication last month entitled Pharmaceuticals in drinking-water to address those concerns.

The publication provides practical guidance and recommendations based on the best available scientific knowledge and evidence on how to deal with the problem. It describes how countries can assess and control the risk of pharmaceuticals appearing in drinking-water, and explains in detail the various control measures that can be taken.

Pharmaceuticals can be introduced into water sources through sewage, which carries the excreta of individuals and patients who have taken these, from uncontrolled drug disposal and from agricultural runoff comprising livestock manure.

Research scan

Exercise cuts diabetes

Men who do weight training regularly – for example, for 30 minutes per day, five days per week – may be able to reduce their risk of type 2 diabetes by up to 34%, according to a new study by researchers from the Harvard School of Public Health (HSPH) and the University of Southern Denmark. And if they combine weight training and aerobic exercise, such as brisk walking or running, they may be able to reduce their risk even further – up to 59%.

This is the first study to examine the role of weight training in the prevention of type 2 diabetes. The results suggest that, because weight training appears to confer significant benefits that are independent of aerobic exercise, weight training can be a valuable alternative for people who have difficulty with the latter.

The study was published online in the Archives of Internal Medicine on 6 August.

“Until now, previous studies have reported that aerobic exercise is of major importance for type 2 diabetes prevention,” said lead author Anders Grøntved, visiting researcher in the Department of Nutrition at HSPH and a doctoral student in exercise epidemiology at the University of Southern Denmark. “But many people have difficulty engaging in or adhering to aerobic exercise. These new results suggest that weight training, to a large extent, can serve as an alternative to aerobic exercise for type 2 diabetes prevention.”

Type 2 diabetes is a major public health concern and it is on the rise. An estimated 346 million people worldwide have type 2 diabetes, and diabetes-related deaths are expected to double between 2005 and 2030, according to the World Health Organization. More than 80% of these deaths occur in low- and middle-income countries.

The researchers followed 32 002 men from the Health Professionals Follow-up Study from 1990 to 2008. Information on how much time the men spent each week on weight training and aerobic exercise came from questionnaires they filled out every two years. The researchers adjusted for other types of physical activity, television viewing, alcohol and coffee intake, smoking, ethnicity, family history of diabetes, and several dietary factors. During the study period, there were 2278 new cases of diabetes among the men followed.


Looking ahead

10 September: World Suicide Prevention Day http://www.iasp.info/wspd

28 September: World Rabies Day http://www.worldrabiesday.org

29 September: World Heart Day http://www.world-heart-federation.org/what-we-do/awareness/world-heart-day

10 October: World Mental Health Day http://www.wfmh.org/00WorldMentalHealthDay.htm

13 October: World Sight Day http://www.who.int/mediacentre/events/annual/world_sight_day

12 November: World Pneumonia Day http://www.worldpneumoniaday.org