Giuliana Miranda

The number of deaths from viral hepatitis worldwide increased from 1.1 million in 2019 to 1.3 million in 2022. These figures equate to approximately 3500 deaths per day due to the disease, which is the second leading cause of mortality from infectious agents globally.

These data are part of the recently released Global Hepatitis Report 2024, which was published by the World Health Organization (WHO) during the World Hepatitis Summit in Lisbon, Portugal.

The report reveals that despite advances in diagnostic tools and treatment options, global treatment rates and coverage for detection tests have stagnated.

“This report paints a concerning picture: Despite global progress in preventing hepatitis infections, deaths are increasing because very few people with hepatitis are being diagnosed and treated,” said WHO Director-General Tedros Adhanom Ghebreyesus, PhD.

Hepatitis B significantly is associated with the highest mortality rate. It accounted for 83% of deaths from the disease in 2022. Meanwhile, hepatitis C was responsible for 17% of deaths. The mortality of other, less common types of hepatitis was not considered in the ranking.

The report also indicates that more than 6000 people worldwide are infected with viral hepatitis every day. The 2.2 million new cases in 2022 represent a slight decrease from 2.5 million in 2019, but the WHO considers the incidence high.

The organization’s updated statistics indicate that about 254 million people had hepatitis B in 2022, while 50 million had type C.

“Besides the deaths, the number of new cases every year is also striking. These are diseases that continue to spread. In the case of hepatitis C, the spread results from lack of access to disposable or properly sterilized sharp materials,” said Thor Dantas, MD, PhD, a physician and director of the Brazilian Society of Hepatology’s Viral Hepatitis Committee.

The situation of hepatitis B is particularly problematic, given that there is a safe and effective vaccine against it, said Dantas. “It’s remarkable that we continue to have so many new cases worldwide. This shows that we are failing in access to preventive measures for control and spread.”

Half of chronic hepatitis B and C cases occur in people between ages 30 and 54 years, while 12% affect children. There are more infections among men, who represent 58% of all cases.

The WHO also drew attention to the difficulty of accessing diagnosis and treatment. Only 13% of people with chronic hepatitis B infection were diagnosed, while only 3% — equivalent to 7 million people — received antiviral therapy by the end of 2022. This result is well below the WHO’s global target, which aims to treat 80% of cases by 2030.

Brazil has a higher diagnostic rate than the global average but is still below the target. According to the report, in 2022, the country diagnosed 34.2% of all hepatitis B infections. However, treatment coverage remains low: 3.6% of the total.

For hepatitis C, the scenario is somewhat different. During the same period, Brazil diagnosed 36% of total cases, with a treatment rate of 24%.

In 2022, Brazil had 2578 deaths from hepatitis B and 2977 from hepatitis C.

Because hepatitis is a silent disease, diagnosis often comes late, when the disease is already quite advanced, said Dr. Dantas. “Viral hepatitis evolves over the years essentially asymptomatically. Malaria shows symptoms, and tuberculosis shows symptoms. Viral hepatitis does not. They are only discovered through active searching.”

The WHO report shows significant regional differences in infection rates. Almost two thirds of cases are concentrated in the following 10 countries: China, India, Indonesia, Nigeria, Pakistan, Ethiopia, Bangladesh, Vietnam, the Philippines, and Russia.

In terms of hepatitis C incidence, Brazil ranks 15th globally, with 536,000 cases in 2022, representing 1.1% of the global total. The list is led by Pakistan, with 8.8 million cases, equivalent to 17.8% of the total. Next are India, with 5.5 million (11.2%), and China, with 4 million (8.1%).

In addition to regional differences, the report also reveals profound disparities in the prices paid for major treatments.

“Price disparities between, and even within, WHO regions persist, with many countries paying above global reference values, including for nonpatented medications,” according to the report.
 

This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.A version of this article appeared on Medscape.com.

The number of deaths from viral hepatitis worldwide increased from 1.1 million in 2019 to 1.3 million in 2022. These figures equate to approximately 3500 deaths per day due to the disease, which is the second leading cause of mortality from infectious agents globally.

These data are part of the recently released Global Hepatitis Report 2024, which was published by the World Health Organization (WHO) during the World Hepatitis Summit in Lisbon, Portugal.

The report reveals that despite advances in diagnostic tools and treatment options, global treatment rates and coverage for detection tests have stagnated.

“This report paints a concerning picture: Despite global progress in preventing hepatitis infections, deaths are increasing because very few people with hepatitis are being diagnosed and treated,” said WHO Director-General Tedros Adhanom Ghebreyesus, PhD.

Hepatitis B significantly is associated with the highest mortality rate. It accounted for 83% of deaths from the disease in 2022. Meanwhile, hepatitis C was responsible for 17% of deaths. The mortality of other, less common types of hepatitis was not considered in the ranking.

The report also indicates that more than 6000 people worldwide are infected with viral hepatitis every day. The 2.2 million new cases in 2022 represent a slight decrease from 2.5 million in 2019, but the WHO considers the incidence high.

The organization’s updated statistics indicate that about 254 million people had hepatitis B in 2022, while 50 million had type C.

“Besides the deaths, the number of new cases every year is also striking. These are diseases that continue to spread. In the case of hepatitis C, the spread results from lack of access to disposable or properly sterilized sharp materials,” said Thor Dantas, MD, PhD, a physician and director of the Brazilian Society of Hepatology’s Viral Hepatitis Committee.

The situation of hepatitis B is particularly problematic, given that there is a safe and effective vaccine against it, said Dantas. “It’s remarkable that we continue to have so many new cases worldwide. This shows that we are failing in access to preventive measures for control and spread.”

Half of chronic hepatitis B and C cases occur in people between ages 30 and 54 years, while 12% affect children. There are more infections among men, who represent 58% of all cases.

The WHO also drew attention to the difficulty of accessing diagnosis and treatment. Only 13% of people with chronic hepatitis B infection were diagnosed, while only 3% — equivalent to 7 million people — received antiviral therapy by the end of 2022. This result is well below the WHO’s global target, which aims to treat 80% of cases by 2030.

Brazil has a higher diagnostic rate than the global average but is still below the target. According to the report, in 2022, the country diagnosed 34.2% of all hepatitis B infections. However, treatment coverage remains low: 3.6% of the total.

For hepatitis C, the scenario is somewhat different. During the same period, Brazil diagnosed 36% of total cases, with a treatment rate of 24%.

In 2022, Brazil had 2578 deaths from hepatitis B and 2977 from hepatitis C.

Because hepatitis is a silent disease, diagnosis often comes late, when the disease is already quite advanced, said Dr. Dantas. “Viral hepatitis evolves over the years essentially asymptomatically. Malaria shows symptoms, and tuberculosis shows symptoms. Viral hepatitis does not. They are only discovered through active searching.”

The WHO report shows significant regional differences in infection rates. Almost two thirds of cases are concentrated in the following 10 countries: China, India, Indonesia, Nigeria, Pakistan, Ethiopia, Bangladesh, Vietnam, the Philippines, and Russia.

In terms of hepatitis C incidence, Brazil ranks 15th globally, with 536,000 cases in 2022, representing 1.1% of the global total. The list is led by Pakistan, with 8.8 million cases, equivalent to 17.8% of the total. Next are India, with 5.5 million (11.2%), and China, with 4 million (8.1%).

In addition to regional differences, the report also reveals profound disparities in the prices paid for major treatments.

“Price disparities between, and even within, WHO regions persist, with many countries paying above global reference values, including for nonpatented medications,” according to the report.
 

This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.A version of this article appeared on Medscape.com.

The number of deaths from viral hepatitis worldwide increased from 1.1 million in 2019 to 1.3 million in 2022. These figures equate to approximately 3500 deaths per day due to the disease, which is the second leading cause of mortality from infectious agents globally.

These data are part of the recently released Global Hepatitis Report 2024, which was published by the World Health Organization (WHO) during the World Hepatitis Summit in Lisbon, Portugal.

The report reveals that despite advances in diagnostic tools and treatment options, global treatment rates and coverage for detection tests have stagnated.

“This report paints a concerning picture: Despite global progress in preventing hepatitis infections, deaths are increasing because very few people with hepatitis are being diagnosed and treated,” said WHO Director-General Tedros Adhanom Ghebreyesus, PhD.

Hepatitis B significantly is associated with the highest mortality rate. It accounted for 83% of deaths from the disease in 2022. Meanwhile, hepatitis C was responsible for 17% of deaths. The mortality of other, less common types of hepatitis was not considered in the ranking.

The report also indicates that more than 6000 people worldwide are infected with viral hepatitis every day. The 2.2 million new cases in 2022 represent a slight decrease from 2.5 million in 2019, but the WHO considers the incidence high.

The organization’s updated statistics indicate that about 254 million people had hepatitis B in 2022, while 50 million had type C.

“Besides the deaths, the number of new cases every year is also striking. These are diseases that continue to spread. In the case of hepatitis C, the spread results from lack of access to disposable or properly sterilized sharp materials,” said Thor Dantas, MD, PhD, a physician and director of the Brazilian Society of Hepatology’s Viral Hepatitis Committee.

The situation of hepatitis B is particularly problematic, given that there is a safe and effective vaccine against it, said Dantas. “It’s remarkable that we continue to have so many new cases worldwide. This shows that we are failing in access to preventive measures for control and spread.”

Half of chronic hepatitis B and C cases occur in people between ages 30 and 54 years, while 12% affect children. There are more infections among men, who represent 58% of all cases.

The WHO also drew attention to the difficulty of accessing diagnosis and treatment. Only 13% of people with chronic hepatitis B infection were diagnosed, while only 3% — equivalent to 7 million people — received antiviral therapy by the end of 2022. This result is well below the WHO’s global target, which aims to treat 80% of cases by 2030.

Brazil has a higher diagnostic rate than the global average but is still below the target. According to the report, in 2022, the country diagnosed 34.2% of all hepatitis B infections. However, treatment coverage remains low: 3.6% of the total.

For hepatitis C, the scenario is somewhat different. During the same period, Brazil diagnosed 36% of total cases, with a treatment rate of 24%.

In 2022, Brazil had 2578 deaths from hepatitis B and 2977 from hepatitis C.

Because hepatitis is a silent disease, diagnosis often comes late, when the disease is already quite advanced, said Dr. Dantas. “Viral hepatitis evolves over the years essentially asymptomatically. Malaria shows symptoms, and tuberculosis shows symptoms. Viral hepatitis does not. They are only discovered through active searching.”

The WHO report shows significant regional differences in infection rates. Almost two thirds of cases are concentrated in the following 10 countries: China, India, Indonesia, Nigeria, Pakistan, Ethiopia, Bangladesh, Vietnam, the Philippines, and Russia.

In terms of hepatitis C incidence, Brazil ranks 15th globally, with 536,000 cases in 2022, representing 1.1% of the global total. The list is led by Pakistan, with 8.8 million cases, equivalent to 17.8% of the total. Next are India, with 5.5 million (11.2%), and China, with 4 million (8.1%).

In addition to regional differences, the report also reveals profound disparities in the prices paid for major treatments.

“Price disparities between, and even within, WHO regions persist, with many countries paying above global reference values, including for nonpatented medications,” according to the report.
 

This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.A version of this article appeared on Medscape.com.

A new study conducted by the World Health Organization (WHO) suggests that in addition to providing significant improvements in public health, investment in the diagnosis and prevention of tuberculosis also generates economic benefits.

According to a survey conducted by governments and researchers from Brazil, Georgia, Kenya, and South Africa, even modest increases in funding for measures against tuberculosis can bring gains. Every $1 invested produces returns of as much as $39, it found.

The findings may remind governments and policymakers about the importance of investing in public health policies. According to the WHO, the study “provides strong economic arguments” about the true costs of tuberculosis and proves the benefits of increasing funding to accelerate the diagnosis and preventive treatment of the disease.
 

UN Targets Tuberculosis

In September 2023, during the last meeting of the United Nations General Assembly, following a widespread worsening of disease indicators because of the COVID-19 pandemic, world leaders signed a declaration committing to the expansion of efforts to combat tuberculosis during the next 5 years. The current WHO study was developed to provide a road map for the implementation of key measures against the disease.

The survey highlights two fundamental actions: The expansion of screening, especially in populations considered more vulnerable, and the provision of tuberculosis preventive treatment (TPT), which entails administering drugs to people who have been exposed to the disease but have not yet developed it.

“TPT is a proven and effective intervention to prevent the development of tuberculosis among exposed people, reducing the risk of developing the disease by about 60%-90% compared with individuals who did not receive it,” the document emphasized.

Investments Yield Returns

To achieve the necessary coverage levels, the study estimated that Brazil would need to increase annual per capita investment by $0.28 (about R$1.41) between 2024 and 2050. Brazilian society, in turn, would receive a return of $11 (R$55.27) for every dollar invested.

For South Africa, whose per capita investment increase is estimated at $1.10 per year, the return would be even more significant: $39 for every dollar allocated.

The WHO emphasized that funding for combating the disease is much lower than the value of the damage it causes to nations. “Tuberculosis has high costs for society. Only a small proportion of these costs go directly to the health system (ranging from 1.7% in South Africa to 7.8% in Kenya). Most are costs for patients and society.”

The study projected that between 2024 and 2050, the total cost of tuberculosis to Brazilian society would be $81.2 billion, with an average annual value of $3.01 billion. This figure represents, in 2024, 0.16% of the country’s gross domestic product.

Achieving screening and preventive treatment goals in Brazil would lead to a reduction of as much as 18% in the national incidence of the disease, as well as 1.9 million fewer deaths, between 2024 and 2050.

Although treatable and preventable, tuberculosis remains the leading cause of death from infectious agents worldwide. It is estimated that over 1.3 million people died from the disease in 2022.

The document provides the “health and economic justification for investing in evidence-based interventions recommended by WHO in tuberculosis screening and prevention,” according to WHO Director-General Tedros Adhanom Ghebreyesus, PhD.

“Today we have the knowledge, tools, and political commitment that can end this age-old disease that continues to be one of the leading causes of death from infectious diseases worldwide,” he added.

Emerging Concerns

Although the WHO highlighted the global increase in access to tuberculosis diagnosis and treatment in 2022, which coincided with the recovery of healthcare systems in several countries after the beginning of the pandemic, it emphasized that the implementation of preventive treatment for exposed individuals and high-vulnerability populations remains slow.

Another concern is the increase in drug resistance. Multidrug-resistant tuberculosis is considered a public health crisis. It is estimated that about 410,000 people had multidrug-resistant tuberculosis or rifampicin-resistant tuberculosis in 2022, but only two of every five patients had access to treatment.This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article appeared on Medscape.com .

A new study conducted by the World Health Organization (WHO) suggests that in addition to providing significant improvements in public health, investment in the diagnosis and prevention of tuberculosis also generates economic benefits.

According to a survey conducted by governments and researchers from Brazil, Georgia, Kenya, and South Africa, even modest increases in funding for measures against tuberculosis can bring gains. Every $1 invested produces returns of as much as $39, it found.

The findings may remind governments and policymakers about the importance of investing in public health policies. According to the WHO, the study “provides strong economic arguments” about the true costs of tuberculosis and proves the benefits of increasing funding to accelerate the diagnosis and preventive treatment of the disease.
 

UN Targets Tuberculosis

In September 2023, during the last meeting of the United Nations General Assembly, following a widespread worsening of disease indicators because of the COVID-19 pandemic, world leaders signed a declaration committing to the expansion of efforts to combat tuberculosis during the next 5 years. The current WHO study was developed to provide a road map for the implementation of key measures against the disease.

The survey highlights two fundamental actions: The expansion of screening, especially in populations considered more vulnerable, and the provision of tuberculosis preventive treatment (TPT), which entails administering drugs to people who have been exposed to the disease but have not yet developed it.

“TPT is a proven and effective intervention to prevent the development of tuberculosis among exposed people, reducing the risk of developing the disease by about 60%-90% compared with individuals who did not receive it,” the document emphasized.

Investments Yield Returns

To achieve the necessary coverage levels, the study estimated that Brazil would need to increase annual per capita investment by $0.28 (about R$1.41) between 2024 and 2050. Brazilian society, in turn, would receive a return of $11 (R$55.27) for every dollar invested.

For South Africa, whose per capita investment increase is estimated at $1.10 per year, the return would be even more significant: $39 for every dollar allocated.

The WHO emphasized that funding for combating the disease is much lower than the value of the damage it causes to nations. “Tuberculosis has high costs for society. Only a small proportion of these costs go directly to the health system (ranging from 1.7% in South Africa to 7.8% in Kenya). Most are costs for patients and society.”

The study projected that between 2024 and 2050, the total cost of tuberculosis to Brazilian society would be $81.2 billion, with an average annual value of $3.01 billion. This figure represents, in 2024, 0.16% of the country’s gross domestic product.

Achieving screening and preventive treatment goals in Brazil would lead to a reduction of as much as 18% in the national incidence of the disease, as well as 1.9 million fewer deaths, between 2024 and 2050.

Although treatable and preventable, tuberculosis remains the leading cause of death from infectious agents worldwide. It is estimated that over 1.3 million people died from the disease in 2022.

The document provides the “health and economic justification for investing in evidence-based interventions recommended by WHO in tuberculosis screening and prevention,” according to WHO Director-General Tedros Adhanom Ghebreyesus, PhD.

“Today we have the knowledge, tools, and political commitment that can end this age-old disease that continues to be one of the leading causes of death from infectious diseases worldwide,” he added.

Emerging Concerns

Although the WHO highlighted the global increase in access to tuberculosis diagnosis and treatment in 2022, which coincided with the recovery of healthcare systems in several countries after the beginning of the pandemic, it emphasized that the implementation of preventive treatment for exposed individuals and high-vulnerability populations remains slow.

Another concern is the increase in drug resistance. Multidrug-resistant tuberculosis is considered a public health crisis. It is estimated that about 410,000 people had multidrug-resistant tuberculosis or rifampicin-resistant tuberculosis in 2022, but only two of every five patients had access to treatment.This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article appeared on Medscape.com .

A new study conducted by the World Health Organization (WHO) suggests that in addition to providing significant improvements in public health, investment in the diagnosis and prevention of tuberculosis also generates economic benefits.

According to a survey conducted by governments and researchers from Brazil, Georgia, Kenya, and South Africa, even modest increases in funding for measures against tuberculosis can bring gains. Every $1 invested produces returns of as much as $39, it found.

The findings may remind governments and policymakers about the importance of investing in public health policies. According to the WHO, the study “provides strong economic arguments” about the true costs of tuberculosis and proves the benefits of increasing funding to accelerate the diagnosis and preventive treatment of the disease.
 

UN Targets Tuberculosis

In September 2023, during the last meeting of the United Nations General Assembly, following a widespread worsening of disease indicators because of the COVID-19 pandemic, world leaders signed a declaration committing to the expansion of efforts to combat tuberculosis during the next 5 years. The current WHO study was developed to provide a road map for the implementation of key measures against the disease.

The survey highlights two fundamental actions: The expansion of screening, especially in populations considered more vulnerable, and the provision of tuberculosis preventive treatment (TPT), which entails administering drugs to people who have been exposed to the disease but have not yet developed it.

“TPT is a proven and effective intervention to prevent the development of tuberculosis among exposed people, reducing the risk of developing the disease by about 60%-90% compared with individuals who did not receive it,” the document emphasized.

Investments Yield Returns

To achieve the necessary coverage levels, the study estimated that Brazil would need to increase annual per capita investment by $0.28 (about R$1.41) between 2024 and 2050. Brazilian society, in turn, would receive a return of $11 (R$55.27) for every dollar invested.

For South Africa, whose per capita investment increase is estimated at $1.10 per year, the return would be even more significant: $39 for every dollar allocated.

The WHO emphasized that funding for combating the disease is much lower than the value of the damage it causes to nations. “Tuberculosis has high costs for society. Only a small proportion of these costs go directly to the health system (ranging from 1.7% in South Africa to 7.8% in Kenya). Most are costs for patients and society.”

The study projected that between 2024 and 2050, the total cost of tuberculosis to Brazilian society would be $81.2 billion, with an average annual value of $3.01 billion. This figure represents, in 2024, 0.16% of the country’s gross domestic product.

Achieving screening and preventive treatment goals in Brazil would lead to a reduction of as much as 18% in the national incidence of the disease, as well as 1.9 million fewer deaths, between 2024 and 2050.

Although treatable and preventable, tuberculosis remains the leading cause of death from infectious agents worldwide. It is estimated that over 1.3 million people died from the disease in 2022.

The document provides the “health and economic justification for investing in evidence-based interventions recommended by WHO in tuberculosis screening and prevention,” according to WHO Director-General Tedros Adhanom Ghebreyesus, PhD.

“Today we have the knowledge, tools, and political commitment that can end this age-old disease that continues to be one of the leading causes of death from infectious diseases worldwide,” he added.

Emerging Concerns

Although the WHO highlighted the global increase in access to tuberculosis diagnosis and treatment in 2022, which coincided with the recovery of healthcare systems in several countries after the beginning of the pandemic, it emphasized that the implementation of preventive treatment for exposed individuals and high-vulnerability populations remains slow.

Another concern is the increase in drug resistance. Multidrug-resistant tuberculosis is considered a public health crisis. It is estimated that about 410,000 people had multidrug-resistant tuberculosis or rifampicin-resistant tuberculosis in 2022, but only two of every five patients had access to treatment.This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article appeared on Medscape.com .

After years of declining vaccination coverage worldwide, measles deaths increased by 43% in 2022, compared with 2021. The number of total reported cases rose by 18% over the same period, accounting for approximately 9 million cases and 136,000 deaths globally, mostly among children. This information comes from a new report by the World Health Organization (WHO), published in partnership with the US Centers for Disease Control and Prevention (CDC).

More Measles Outbreaks

The report also notes an increase in the number of countries experiencing significant measles outbreaks. There were 37 such countries in 2022, compared with 22 the previous year. The most affected continents were Africa and Asia.

“The rise in measles outbreaks and deaths is impressive but, unfortunately, not surprising, given the decline in vaccination rates in recent years,” said John Vertefeuille, PhD, director of the CDC’s Global Immunization Division.

Vertefeuille emphasized that measles cases anywhere in the world pose a risk to “countries and communities where people are undervaccinated.” In recent years, several regions have fallen short of their immunization targets.

Vaccination Trends

In 2022, there was a slight increase in measles vaccination after a decline exacerbated by the COVID-19 pandemic and its impact on global healthcare systems. However, 33 million children did not receive at least one dose of the vaccine last year: 22 million missed the first dose, and 11 million missed the second.

For communities to be considered protected against outbreaks, immunization coverage with the full vaccine cycle should be at least 95%. The global coverage rate for the first dose was 83%, and for the second, it was 74%.

Nevertheless, immunization recovery has not reached the poorest countries, where the immunization rate stands at 66%. Brazil is among the top 10 countries where more children missed the first dose in 2022. These nations account for over half of the 22 million unadministered vaccines. According to the report, half a million children did not receive the vaccine in Brazil.

Measles in Brazil

Brazil’s results highlight setbacks in vaccination efforts. In 2016, the country was certified to have eliminated measles, but after experiencing outbreaks in 2018, the certification was lost in 2019. In 2018, Brazil confirmed 9325 cases. The situation worsened in 2019 with 20,901 diagnoses. Since then, numbers have been decreasing: 8100 in 2020, 676 in 2021, and 44 in 2022.

Last year, four Brazilian states reported confirmed virus cases: Rio de Janeiro, Pará, São Paulo, and Amapá. Ministry of Health data indicated no confirmed measles cases in Brazil as of June 15, 2023.

Vaccination in Brazil

Vaccination coverage in Brazil, which once reached 95%, has sharply declined in recent years. The rate of patients receiving the full immunization scheme was 59% in 2021.

Globally, although the COVID-19 pandemic affected measles vaccination, measures like social isolation and mask use potentially contributed to reducing measles cases. The incidence of the disease decreased in 2020 and 2021 but is now rising again.

“From 2021 to 2022, reported measles cases increased by 67% worldwide, and the number of countries experiencing large or disruptive outbreaks increased by 68%,” the report stated.

Because of these data, the WHO and the CDC urge increased efforts for vaccination, along with improvements in epidemiological surveillance systems, especially in developing nations. “Children everywhere have the right to be protected by the lifesaving measles vaccine, no matter where they live,” said Kate O’Brien, MD, director of immunization, vaccines, and biologicals at the WHO.

“Measles is called the virus of inequality for a good reason. It is the disease that will find and attack those who are not protected.”
 

This article was translated from the Medscape Portuguese edition.

After years of declining vaccination coverage worldwide, measles deaths increased by 43% in 2022, compared with 2021. The number of total reported cases rose by 18% over the same period, accounting for approximately 9 million cases and 136,000 deaths globally, mostly among children. This information comes from a new report by the World Health Organization (WHO), published in partnership with the US Centers for Disease Control and Prevention (CDC).

More Measles Outbreaks

The report also notes an increase in the number of countries experiencing significant measles outbreaks. There were 37 such countries in 2022, compared with 22 the previous year. The most affected continents were Africa and Asia.

“The rise in measles outbreaks and deaths is impressive but, unfortunately, not surprising, given the decline in vaccination rates in recent years,” said John Vertefeuille, PhD, director of the CDC’s Global Immunization Division.

Vertefeuille emphasized that measles cases anywhere in the world pose a risk to “countries and communities where people are undervaccinated.” In recent years, several regions have fallen short of their immunization targets.

Vaccination Trends

In 2022, there was a slight increase in measles vaccination after a decline exacerbated by the COVID-19 pandemic and its impact on global healthcare systems. However, 33 million children did not receive at least one dose of the vaccine last year: 22 million missed the first dose, and 11 million missed the second.

For communities to be considered protected against outbreaks, immunization coverage with the full vaccine cycle should be at least 95%. The global coverage rate for the first dose was 83%, and for the second, it was 74%.

Nevertheless, immunization recovery has not reached the poorest countries, where the immunization rate stands at 66%. Brazil is among the top 10 countries where more children missed the first dose in 2022. These nations account for over half of the 22 million unadministered vaccines. According to the report, half a million children did not receive the vaccine in Brazil.

Measles in Brazil

Brazil’s results highlight setbacks in vaccination efforts. In 2016, the country was certified to have eliminated measles, but after experiencing outbreaks in 2018, the certification was lost in 2019. In 2018, Brazil confirmed 9325 cases. The situation worsened in 2019 with 20,901 diagnoses. Since then, numbers have been decreasing: 8100 in 2020, 676 in 2021, and 44 in 2022.

Last year, four Brazilian states reported confirmed virus cases: Rio de Janeiro, Pará, São Paulo, and Amapá. Ministry of Health data indicated no confirmed measles cases in Brazil as of June 15, 2023.

Vaccination in Brazil

Vaccination coverage in Brazil, which once reached 95%, has sharply declined in recent years. The rate of patients receiving the full immunization scheme was 59% in 2021.

Globally, although the COVID-19 pandemic affected measles vaccination, measures like social isolation and mask use potentially contributed to reducing measles cases. The incidence of the disease decreased in 2020 and 2021 but is now rising again.

“From 2021 to 2022, reported measles cases increased by 67% worldwide, and the number of countries experiencing large or disruptive outbreaks increased by 68%,” the report stated.

Because of these data, the WHO and the CDC urge increased efforts for vaccination, along with improvements in epidemiological surveillance systems, especially in developing nations. “Children everywhere have the right to be protected by the lifesaving measles vaccine, no matter where they live,” said Kate O’Brien, MD, director of immunization, vaccines, and biologicals at the WHO.

“Measles is called the virus of inequality for a good reason. It is the disease that will find and attack those who are not protected.”
 

This article was translated from the Medscape Portuguese edition.

After years of declining vaccination coverage worldwide, measles deaths increased by 43% in 2022, compared with 2021. The number of total reported cases rose by 18% over the same period, accounting for approximately 9 million cases and 136,000 deaths globally, mostly among children. This information comes from a new report by the World Health Organization (WHO), published in partnership with the US Centers for Disease Control and Prevention (CDC).

More Measles Outbreaks

The report also notes an increase in the number of countries experiencing significant measles outbreaks. There were 37 such countries in 2022, compared with 22 the previous year. The most affected continents were Africa and Asia.

“The rise in measles outbreaks and deaths is impressive but, unfortunately, not surprising, given the decline in vaccination rates in recent years,” said John Vertefeuille, PhD, director of the CDC’s Global Immunization Division.

Vertefeuille emphasized that measles cases anywhere in the world pose a risk to “countries and communities where people are undervaccinated.” In recent years, several regions have fallen short of their immunization targets.

Vaccination Trends

In 2022, there was a slight increase in measles vaccination after a decline exacerbated by the COVID-19 pandemic and its impact on global healthcare systems. However, 33 million children did not receive at least one dose of the vaccine last year: 22 million missed the first dose, and 11 million missed the second.

For communities to be considered protected against outbreaks, immunization coverage with the full vaccine cycle should be at least 95%. The global coverage rate for the first dose was 83%, and for the second, it was 74%.

Nevertheless, immunization recovery has not reached the poorest countries, where the immunization rate stands at 66%. Brazil is among the top 10 countries where more children missed the first dose in 2022. These nations account for over half of the 22 million unadministered vaccines. According to the report, half a million children did not receive the vaccine in Brazil.

Measles in Brazil

Brazil’s results highlight setbacks in vaccination efforts. In 2016, the country was certified to have eliminated measles, but after experiencing outbreaks in 2018, the certification was lost in 2019. In 2018, Brazil confirmed 9325 cases. The situation worsened in 2019 with 20,901 diagnoses. Since then, numbers have been decreasing: 8100 in 2020, 676 in 2021, and 44 in 2022.

Last year, four Brazilian states reported confirmed virus cases: Rio de Janeiro, Pará, São Paulo, and Amapá. Ministry of Health data indicated no confirmed measles cases in Brazil as of June 15, 2023.

Vaccination in Brazil

Vaccination coverage in Brazil, which once reached 95%, has sharply declined in recent years. The rate of patients receiving the full immunization scheme was 59% in 2021.

Globally, although the COVID-19 pandemic affected measles vaccination, measures like social isolation and mask use potentially contributed to reducing measles cases. The incidence of the disease decreased in 2020 and 2021 but is now rising again.

“From 2021 to 2022, reported measles cases increased by 67% worldwide, and the number of countries experiencing large or disruptive outbreaks increased by 68%,” the report stated.

Because of these data, the WHO and the CDC urge increased efforts for vaccination, along with improvements in epidemiological surveillance systems, especially in developing nations. “Children everywhere have the right to be protected by the lifesaving measles vaccine, no matter where they live,” said Kate O’Brien, MD, director of immunization, vaccines, and biologicals at the WHO.

“Measles is called the virus of inequality for a good reason. It is the disease that will find and attack those who are not protected.”
 

This article was translated from the Medscape Portuguese edition.

Postpartum hemorrhage (PPH) is the leading cause of maternal deaths worldwide, particularly in the least developed and developing countries. Of the 14 million female patients affected each year, approximately 70,000 cases result in death. However, according to a new study conducted by the World Health Organization and the University of Birmingham (England), a simple and affordable strategy may reduce the occurrence of severe cases during vaginal delivery.

Using the E-MOTIVE intervention reduced severe cases of PPH by 60%. These cases are defined as entailing blood loss greater than or equal to 1,000 mL in the 24 hours following delivery. This intervention also substantially reduced the need for blood transfusions, which are often costly and difficult to obtain.

In this trial, 80 secondary-level hospitals in Kenya, Nigeria, South Africa, and Tanzania, in which 210,132 patients underwent vaginal delivery, were randomly assigned to the intervention group or the usual-care group. Researchers identified that, among hospitals and patients with data, a primary outcome event occurred in 1.6% of the patients in the intervention group, compared with 4.3% of those in the usual-care group. In addition, PPH was detected in 93.1% of the patients in the intervention group and in 51.1% of those in the usual-care group. The treatment bundle was used in 91.2% and 19.4%, respectively.

The E-MOTIVE intervention, which is intended for use by health care professionals, consists of three elements:

• A strategy for early detection of PPH, which allows triggering of the “first response” treatment bundle
• A first response bundle called MOTIVE, which is based on WHO guidelines and consists of uterine massage, oxytocic drugs, tranexamic acid, IV fluids, and examination of the genital tract and escalation
• An implementation strategy that focuses on simulation-based training with peer-assisted learning, local E-MOTIVE champions, feedback of actionable data to providers, calibrated drape with trigger line, and MOTIVE emergency trolley or carry case

During a WHO press conference, study author Arri Coomarasamy, MD, said, “This new approach to treating postpartum hemorrhage could radically improve women’s chances of surviving childbirth globally, helping them get the treatment they need when they need it.”

Dr. Coomarasamy, who is also co-director of the WHO Collaborating Centre on Global Women’s Health at the University of Birmingham, added, “Time is of the essence when responding to postpartum bleeding, so interventions that eliminate delays in diagnosis or treatment should be game-changers for maternal health.”
 

PPH a ‘preventable’ problem

In Brazil, maternal mortality is still one of the most significant challenges in public health. In recent years, the COVID-19 pandemic exacerbated the difficulties and weaknesses in the health care system for pregnant women and new mothers.

The maternal mortality ratio (MMR) is the number of maternal deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy. In 2021, the MMR was 113. This figure was almost double the 55.3 maternal deaths per 100,000 live births reported in 2019, which was before the pandemic. Preliminary data from the Brazilian Ministry of Health collected by the Brazilian Obstetric Observatory (OOBr) indicate that the MMR in 2022 decreased to 50.6 maternal deaths per 100,000 live births. However, these numbers could increase, because the maternal mortality committees are still reviewing cases.

Rossana Pulcineli Vieira Francisco, MD, PhD, a professor of obstetrics and gynecology at the University of São Paulo School of Medicine and obstetrics coordinator of the OOBr, affirmed that although these numbers have dropped, they are still much higher than the targets set by health authorities. Brazil is a participant of the UN agreement that aims to reduce MMR to a maximum of 30 maternal deaths per 100,000 live births per year by 2030. “We still have a long way to go to reach this goal within the next 7 years,” Dr. Francisco warned.

She compared rates in Brazil with those of more developed regions. According to the data, the mean MMR in Europe is 13 maternal deaths per 100,000 live births. “Portugal was shocked when maternal deaths surpassed 20 [maternal deaths per 100,000 live births in 2020] amidst the COVID-19 pandemic. The ratio in Brazil, even before the pandemic, was 55,” she said.

“Maternal mortality and infant mortality ratios are powerful indicators of the quality of the health care system,” added the OOBr coordinator, who asserted that investing in primary and prenatal care is essential. Dr. Francisco also pointed out the preventable nature of maternal mortality in Brazil. “The three main causes of direct maternal mortality in Brazil are high blood pressure, postpartum hemorrhage, and infection, particularly in the postpartum period. These issues are all considered preventable.”

Although it is difficult to prevent preeclampsia, hospital care and maternity care measures can significantly reduce the number of deaths caused by this condition. “For high blood pressure, what we most miss is having specialized prenatal care for at-risk women when the problem is diagnosed during pregnancy.”

Regarding PPH, Dr. Francisco calls attention to the importance of training teams to treat the problem. “In Brazil, the lack of training [for professionals] is still a serious problem.”

According to her, investments in rapid response systems are also needed. “As the baby needs nutrients and oxygen, the uterus becomes full of blood vessels at the end of pregnancy. As a result, a PPH leads to significant blood loss. In Brazil, some hospitals don’t even have blood bags. And in some cases, there may not be enough time to get a blood bag from somewhere else.”

Dr. Francisco also points out that, although it may not be feasible for all of Brazil’s health care units to have blood banks, integrated structures could be created to facilitate access to blood in case of emergency.

A grant from the Bill & Melinda Gates Foundation supported the E-MOTIVE project.

A version of this article first appeared on Medscape.com.

Postpartum hemorrhage (PPH) is the leading cause of maternal deaths worldwide, particularly in the least developed and developing countries. Of the 14 million female patients affected each year, approximately 70,000 cases result in death. However, according to a new study conducted by the World Health Organization and the University of Birmingham (England), a simple and affordable strategy may reduce the occurrence of severe cases during vaginal delivery.

Using the E-MOTIVE intervention reduced severe cases of PPH by 60%. These cases are defined as entailing blood loss greater than or equal to 1,000 mL in the 24 hours following delivery. This intervention also substantially reduced the need for blood transfusions, which are often costly and difficult to obtain.

In this trial, 80 secondary-level hospitals in Kenya, Nigeria, South Africa, and Tanzania, in which 210,132 patients underwent vaginal delivery, were randomly assigned to the intervention group or the usual-care group. Researchers identified that, among hospitals and patients with data, a primary outcome event occurred in 1.6% of the patients in the intervention group, compared with 4.3% of those in the usual-care group. In addition, PPH was detected in 93.1% of the patients in the intervention group and in 51.1% of those in the usual-care group. The treatment bundle was used in 91.2% and 19.4%, respectively.

The E-MOTIVE intervention, which is intended for use by health care professionals, consists of three elements:

• A strategy for early detection of PPH, which allows triggering of the “first response” treatment bundle
• A first response bundle called MOTIVE, which is based on WHO guidelines and consists of uterine massage, oxytocic drugs, tranexamic acid, IV fluids, and examination of the genital tract and escalation
• An implementation strategy that focuses on simulation-based training with peer-assisted learning, local E-MOTIVE champions, feedback of actionable data to providers, calibrated drape with trigger line, and MOTIVE emergency trolley or carry case

During a WHO press conference, study author Arri Coomarasamy, MD, said, “This new approach to treating postpartum hemorrhage could radically improve women’s chances of surviving childbirth globally, helping them get the treatment they need when they need it.”

Dr. Coomarasamy, who is also co-director of the WHO Collaborating Centre on Global Women’s Health at the University of Birmingham, added, “Time is of the essence when responding to postpartum bleeding, so interventions that eliminate delays in diagnosis or treatment should be game-changers for maternal health.”
 

PPH a ‘preventable’ problem

In Brazil, maternal mortality is still one of the most significant challenges in public health. In recent years, the COVID-19 pandemic exacerbated the difficulties and weaknesses in the health care system for pregnant women and new mothers.

The maternal mortality ratio (MMR) is the number of maternal deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy. In 2021, the MMR was 113. This figure was almost double the 55.3 maternal deaths per 100,000 live births reported in 2019, which was before the pandemic. Preliminary data from the Brazilian Ministry of Health collected by the Brazilian Obstetric Observatory (OOBr) indicate that the MMR in 2022 decreased to 50.6 maternal deaths per 100,000 live births. However, these numbers could increase, because the maternal mortality committees are still reviewing cases.

Rossana Pulcineli Vieira Francisco, MD, PhD, a professor of obstetrics and gynecology at the University of São Paulo School of Medicine and obstetrics coordinator of the OOBr, affirmed that although these numbers have dropped, they are still much higher than the targets set by health authorities. Brazil is a participant of the UN agreement that aims to reduce MMR to a maximum of 30 maternal deaths per 100,000 live births per year by 2030. “We still have a long way to go to reach this goal within the next 7 years,” Dr. Francisco warned.

She compared rates in Brazil with those of more developed regions. According to the data, the mean MMR in Europe is 13 maternal deaths per 100,000 live births. “Portugal was shocked when maternal deaths surpassed 20 [maternal deaths per 100,000 live births in 2020] amidst the COVID-19 pandemic. The ratio in Brazil, even before the pandemic, was 55,” she said.

“Maternal mortality and infant mortality ratios are powerful indicators of the quality of the health care system,” added the OOBr coordinator, who asserted that investing in primary and prenatal care is essential. Dr. Francisco also pointed out the preventable nature of maternal mortality in Brazil. “The three main causes of direct maternal mortality in Brazil are high blood pressure, postpartum hemorrhage, and infection, particularly in the postpartum period. These issues are all considered preventable.”

Although it is difficult to prevent preeclampsia, hospital care and maternity care measures can significantly reduce the number of deaths caused by this condition. “For high blood pressure, what we most miss is having specialized prenatal care for at-risk women when the problem is diagnosed during pregnancy.”

Regarding PPH, Dr. Francisco calls attention to the importance of training teams to treat the problem. “In Brazil, the lack of training [for professionals] is still a serious problem.”

According to her, investments in rapid response systems are also needed. “As the baby needs nutrients and oxygen, the uterus becomes full of blood vessels at the end of pregnancy. As a result, a PPH leads to significant blood loss. In Brazil, some hospitals don’t even have blood bags. And in some cases, there may not be enough time to get a blood bag from somewhere else.”

Dr. Francisco also points out that, although it may not be feasible for all of Brazil’s health care units to have blood banks, integrated structures could be created to facilitate access to blood in case of emergency.

A grant from the Bill & Melinda Gates Foundation supported the E-MOTIVE project.

A version of this article first appeared on Medscape.com.

Postpartum hemorrhage (PPH) is the leading cause of maternal deaths worldwide, particularly in the least developed and developing countries. Of the 14 million female patients affected each year, approximately 70,000 cases result in death. However, according to a new study conducted by the World Health Organization and the University of Birmingham (England), a simple and affordable strategy may reduce the occurrence of severe cases during vaginal delivery.

Using the E-MOTIVE intervention reduced severe cases of PPH by 60%. These cases are defined as entailing blood loss greater than or equal to 1,000 mL in the 24 hours following delivery. This intervention also substantially reduced the need for blood transfusions, which are often costly and difficult to obtain.

In this trial, 80 secondary-level hospitals in Kenya, Nigeria, South Africa, and Tanzania, in which 210,132 patients underwent vaginal delivery, were randomly assigned to the intervention group or the usual-care group. Researchers identified that, among hospitals and patients with data, a primary outcome event occurred in 1.6% of the patients in the intervention group, compared with 4.3% of those in the usual-care group. In addition, PPH was detected in 93.1% of the patients in the intervention group and in 51.1% of those in the usual-care group. The treatment bundle was used in 91.2% and 19.4%, respectively.

The E-MOTIVE intervention, which is intended for use by health care professionals, consists of three elements:

• A strategy for early detection of PPH, which allows triggering of the “first response” treatment bundle
• A first response bundle called MOTIVE, which is based on WHO guidelines and consists of uterine massage, oxytocic drugs, tranexamic acid, IV fluids, and examination of the genital tract and escalation
• An implementation strategy that focuses on simulation-based training with peer-assisted learning, local E-MOTIVE champions, feedback of actionable data to providers, calibrated drape with trigger line, and MOTIVE emergency trolley or carry case

During a WHO press conference, study author Arri Coomarasamy, MD, said, “This new approach to treating postpartum hemorrhage could radically improve women’s chances of surviving childbirth globally, helping them get the treatment they need when they need it.”

Dr. Coomarasamy, who is also co-director of the WHO Collaborating Centre on Global Women’s Health at the University of Birmingham, added, “Time is of the essence when responding to postpartum bleeding, so interventions that eliminate delays in diagnosis or treatment should be game-changers for maternal health.”
 

PPH a ‘preventable’ problem

In Brazil, maternal mortality is still one of the most significant challenges in public health. In recent years, the COVID-19 pandemic exacerbated the difficulties and weaknesses in the health care system for pregnant women and new mothers.

The maternal mortality ratio (MMR) is the number of maternal deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy. In 2021, the MMR was 113. This figure was almost double the 55.3 maternal deaths per 100,000 live births reported in 2019, which was before the pandemic. Preliminary data from the Brazilian Ministry of Health collected by the Brazilian Obstetric Observatory (OOBr) indicate that the MMR in 2022 decreased to 50.6 maternal deaths per 100,000 live births. However, these numbers could increase, because the maternal mortality committees are still reviewing cases.

Rossana Pulcineli Vieira Francisco, MD, PhD, a professor of obstetrics and gynecology at the University of São Paulo School of Medicine and obstetrics coordinator of the OOBr, affirmed that although these numbers have dropped, they are still much higher than the targets set by health authorities. Brazil is a participant of the UN agreement that aims to reduce MMR to a maximum of 30 maternal deaths per 100,000 live births per year by 2030. “We still have a long way to go to reach this goal within the next 7 years,” Dr. Francisco warned.

She compared rates in Brazil with those of more developed regions. According to the data, the mean MMR in Europe is 13 maternal deaths per 100,000 live births. “Portugal was shocked when maternal deaths surpassed 20 [maternal deaths per 100,000 live births in 2020] amidst the COVID-19 pandemic. The ratio in Brazil, even before the pandemic, was 55,” she said.

“Maternal mortality and infant mortality ratios are powerful indicators of the quality of the health care system,” added the OOBr coordinator, who asserted that investing in primary and prenatal care is essential. Dr. Francisco also pointed out the preventable nature of maternal mortality in Brazil. “The three main causes of direct maternal mortality in Brazil are high blood pressure, postpartum hemorrhage, and infection, particularly in the postpartum period. These issues are all considered preventable.”

Although it is difficult to prevent preeclampsia, hospital care and maternity care measures can significantly reduce the number of deaths caused by this condition. “For high blood pressure, what we most miss is having specialized prenatal care for at-risk women when the problem is diagnosed during pregnancy.”

Regarding PPH, Dr. Francisco calls attention to the importance of training teams to treat the problem. “In Brazil, the lack of training [for professionals] is still a serious problem.”

According to her, investments in rapid response systems are also needed. “As the baby needs nutrients and oxygen, the uterus becomes full of blood vessels at the end of pregnancy. As a result, a PPH leads to significant blood loss. In Brazil, some hospitals don’t even have blood bags. And in some cases, there may not be enough time to get a blood bag from somewhere else.”

Dr. Francisco also points out that, although it may not be feasible for all of Brazil’s health care units to have blood banks, integrated structures could be created to facilitate access to blood in case of emergency.

A grant from the Bill & Melinda Gates Foundation supported the E-MOTIVE project.

A version of this article first appeared on Medscape.com.