Reaching drug users in urban contexts is as much a challenge as it is a social and health requirement. In Maputo, the capital of Mozambique, Médecins Sans Frontières has developed a medical approach adapted to a population at high risk, stigmatised and criminalised.
Michael Jacobs and colleagues (The Lancet, 2016, Vol. 388, p. 498-503) provide clinical and virological evidence of a relapse of Ebola virus disease (EVD) presenting as acute meningo-encephalitis 9 months after recovery from an acute infection. However exceptional, this case adds to an increasing number of reports suggesting that Ebola virus can persist for months in immune-privileged anatomical sites, such as semen, ocular tissues, breastmilk, and the central nervous system.
2016 will already be remembered as a year of great setbacks in the pursuit of global health and wellbeing; mass social upheaval in the Middle East and north Africa, driven by conflict and a legacy of persistent structural violence, continues to challenge the notion of our shared humanity, while the end of the world's worst Ebola virus outbreak in west Africa has prompted sombre reflection and fierce critique of systemic failures in global outbreak response.
In 2014, the World Health Organization (WHO) declared two "public health emergencies of international concern", in response to the worldwide polio situation and the Ebola epidemic in West Africa respectively. Both emergencies can be seen as testing moments, challenging the current model of epidemic governance, where two worldviews co-exist: global health security and humanitarian biomedicine.
Tara Mangal and colleagues present compelling evidence that lends support to the suggestion that the efficacy of the oral poliovirus vaccine varies depending on its composition, thus reinforcing similar findings reported by Jenkins and colleagues in 2008. However, the persistence of polio in the northern states of Nigeria cannot be adequately explained by the chemical properties of the vaccine and therefore warrants further exploration.
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.
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.