Threats posed by new, emerging or re-emerging communicable diseases are taking a global dimension, to which the World Health Organization (WHO) Secretariat has been responding with determination since 1995. Key to the global strategy for tackling epidemics across borders is the concept of global public health surveillance, which has been expanded and formalized by WHO and its technical partners through a number of recently developed instruments and initiatives.
It is generally assumed by the donor community that the targeted funding of global, regional or cross-border surveillance programmes is an efficient way to support resource-poor countries in developing their own national public health surveillance infrastructure, to encourage national authorities to share outbreak intelligence, and ultimately to ensure compliance of World Health Organization (WHO) Member States with the revised (2005) International Health Regulations. At country level, a number of factors and constraints appear to contradict this view.
Extensively drug-resistant tuberculosis (XDR-TB) is the latest emerging disease recognized as a global health threat. It has so far been identified in at least 27 countries covering all regions of the world except Oceania. A cohort of patients was investigated in 2005-2006 in the KwaZulu-Natal province of South Africa, revealing an exceedingly high mortality rate and a rapidly fatal evolution among identified XDR-TB cases. Such alarming features of this new form of tuberculosis seem to relate at least partly to HIV co-infection.
The ongoing conflict in Ituri, Democratic Republic of Congo (DRC), has led to more than 50,000 deaths, more than 500,000 displaced civilians and continuing, unacceptably high, mortality since 1999. In February 2005, after a resurgence of violence and further displacements, Médecins Sans Frontières (MSF) launched an emergency response in three internally displaced persons (IDP) camps in Ituri. We performed a rapid health assessment in April 2005 in one of the IDP camps to evaluate mortality (due to violence or disease) and camp living conditions.
Bunia, located in the Ituri District of eastern Democratic Republic of Congo, is an area that has been the center for the multidimensional inter-ethnic confrontations ravaging the region since 1999. The peak of violence was in May of 2003 when, upon the withdrawal of Ugandan troops, a confrontation between two parties representing main warring ethnic tribes resulted in the death and displacement of thousands of civilians.
The Palestinian Authority was deeply weakened during the Second intifâda, which started in September 2000. The policy of having the Israeli army destroy structures, isolate the Occupied Territories and build the wall kept the Palestinian Authority from efficiently helping the population. Consequently, Palestinian nongovernmental organizations involved in development programs played a major role. Despite difficult conditions, they adopted new strategies. In the farming sector, PARC is a good example of this change in strategy.
Control measures to limit the spread of a cholera outbreak in Pohnpei Island (Micronesia), included mass vaccination with the single-dose live-attenuated oral cholera vaccine CVD 103-HgR as a potential adjunct measure. The outbreak provided a unique opportunity to evaluate the practicality of use and effectiveness of this vaccine. Under field conditions encountered in Pohnpei, crude vaccine efficacy was estimated at 79.2% (95% CI: 71.9–84.6%) in the target population.