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R L D H E A L T H ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU R~GIONAL DU PACIFIQUE OCCIDENTAL
•
ORGANISATION MONDiALE DE LA SANTE
REGIONAL COMMITTEE Thirty-eighth session Beijing 8-14 September 1987 Provisional agenda item 7
WPR/RC38/INF.DOC./l Corr.l 26 October 1987 ORIGINAL: ENGLISH
REPORT OF THE REGIONAL DIRECTOR ON THE WORK OF WHO IN THE WESTERN PACIFIC REGION 1 JULY 1985 - 30 JUNE 1987 Corrigendum ANNEX 2 ,
page 9
After Commonwealth of Northern Mariana Islands, insert Cook Islands - 0 After Singapore, insert Solomon Islands - 0 After Tonga, insert Vanuatu - 0 Annex 2, page 10 Delete entry for Fiji The next entry should read French Polynesia The last line should read TOTAL 733 599 187 30
13 118
W 0 R L D H E A L T H· ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR
THE WESTERN PACIFIC
BUREAU R~GIONAL OU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Thirty-eighth session Beijing 8-14 September 1987 Provisional agenda item 7
WPR/RC38/INF.DOC./1 3 September 1987 ORIGINAL: ENGLISH
REPORT OF THE REGIONAL DIRECTOR ON THE WORK OF WHO IN THE WESTERN PACIFIC REGION 1 JULY 1985 - 30 JUNE 1987
The Regional Director has the honour to transmit to the Regional Committee for the Western Pacific, for its information, a document concerning AIDS programme activities in the Region.
WPR/RCJ8/INF.DOC./1 page 2
1.
INTRODUCTION
At its thirty-sixth session in 1985, the Regional Committee adopted resolution WPR/RCJ6.R2 on acquired immunodeficiency syndrome (AIDS), urging Member States to provide appropriate information and health education to the public, to seek the cooperation of the media, to initiate surveillance and reporting of the disease, and to set up counselling services , where needed, for those found to be positive for human immunodeficiency virus (HIV) antibodies. The Regional Director was requested to take action in a number of areas (see Annex 1).
2.
ACTION TAKEN
The following action aforementioned resolution. 2.1 Exchange of information
has
been
taken
in
relation
to
the
Information received from the Special Programme on AIDS (SPA), including updates on the number of cases of AIDS, has been forwarded to Member States. The governments were informed by circular letters in June 1987 that WHO would like to publish a surveillance report on a regular basis, which would include an update of AIDS cases, the results of serological surveys for HIV antibodies, information about recently adopted legislation, government directives or circulars on AIDS, and important developments such as implementation of AIDS health education programmes. In response to the above circular letter, information has been provided, which is being consolidated for subsequent dissemination. 2.2 Laboratory diagnostic capability
In the Western Pacific Region, all activities on AIDS have been conducted under the programme Other communicable disease prevention and control activities. During the meeting of the regional Scientific Working Group on Hepatitis B, Non-A Non-B and Delta Hepatitis, and Blood-borne Retroviruses, held in Tokyo in October 1985, attention was called to the importance of blood-borne retroviruses. Training courses in the detection of HIV antibodies have been conducted in Malaysia, the Philippines and Tonga since as early as December 1985. AIDS diagnostic test kits (gelatin agglutination test) have been provided to Cook Islands, Fiji, Malaysia, the Philippines, Samoa, Tonga and Vanuatu. The · laboratory diagnosis of AIDS by enzyme-linked immunosorbent assay (ELISA), immunofluorescence (IF) test, radio
WPR/RC38/INF.DOC./1 page 3
immunoprecipitation test and Western blot technique was demonstrated during the regional seminar on the diagnosis and control of sexually transmitted diseases, held in Singapore in April/May 1986. national reference laboratory for The established in the Philippines in May 1987. 2.3 Collaborating centres HIV testing was
Two collaborating centres have been designated: the National AIDS Reference Laboratory, Fairfield Hospital, Victoria, Australia, and the Institute of Virus Research, KyotoUniversity, Kyoto, Japan. These collaborating centres have conducted confirmation tests for HIV infection and training in response to the requests of countries in the Region. Other collaborating centres in China and elsewhere will be set up in 1988. 2.4 Information and technology transfer
Test kits developed in Japan for the detection of HIV antibodies have been supplied to Cook Islands, Fiji, Malaysia, the Philippines, Samoa, Tonga and Vanuatu through WHO collaboration. Fellows have been sent from Singapore to the United States of America for training in clinical diagnosis and management. Health education materials from Australia, Fiji, Hong Kong, Malaysia and the Philippines have been provided to Member States upon request. 2.5 Research
Serological surveys for HIV antibody among high-risk groups and blood donors in the Philippines have been carried out with the support of WHO. Action-oriented research, particularly on behavioural aspects, will be undertaken in Australia, Japan and the Philippines. 2.6 Extrabudgetary resources mobilizing of of the Special
It is understood that the securing and extrabudgetary resources will mainly be a function Programme on AIDS.
Several bilateral and multilateral agencies have expressed their interest in providing support to activities in the Region. 2.7 National AIDS committees
Since 1986, fifteen countries have set up national AIDS committees. The activities of some of these committees were presented at the WHO/Australian Interregional Ministerial Meeting on AIDS in Sydney, Australia, in July 1987.
WPR/RCJB/INF.DOC./1 page 4
J.
AIDS PREVENTION AND CONTROL PROGRAMME IN THE REGION
3.1
Epidemiological surveillance
Determining whether HIV infection or AIDS is present in a country and ascertaining the nature and extent of the infection are both fundamental to the formulation of an AIDS control programme. This calls for the development of laboratory diagnostic capability for detecting HIV infection and the establishment · of a good surveillance system. Screening activities for HIV infection should be directed, initially, towards high-risk groups such as prostitutes, homosexuals and those attending STD clinics and, at a later stage, to special population groups, including blood donors. Surveillance of drug addicts is being carried out in some countries in conjunction with the mental health programme. Such screening activities should conform with the recommendations adopted during the WHO meeting on criteria for HIV screening programmes, held in Geneva in May 1987. 3.2 Health education HIV infection
Health education will focus on the prevention of and care of AIDS .patients and infected persons. 3.2.1 Combating ignorance
In adopting resolution WPR/RC36.R2, the Regional Committee expressed its deep concern at the lack of information on AIDS and the need to remedy this by making the population AIDS-conscious. Correct, explicit and simple facts about the seriousness of the disease and the mechanisms for transmission: and prevention should be disseminated. Information should be adapted to the type of audience to which it is directed and presented in such a way as not to clash with the sociocultural characteristics of the population. 3.2.2 Proper social and sexual behaviour
In preventing the sexual transmission of the disease, emphasis should be placed on proper social behaviour and the promotion of sound sexual morality. High-risk behaviour such as resorting to multiple partners should be avoided and safe sexual practices, particularly the use of condoms, should be promoted. The safety of blood and blood products must be assured and the sharing of contaminated needles avoided. 3.2.3 Care of AIDS patients and HIV-infected persons
Sound case-management for AIDS patients and HIV-infected individuals needs to be developed, which should provide for adeq-uate counselling, attention and care~ Promoting the social acceptance of infected cases so as to overcome prejudice and ensure acceptance not only by members of their own family but also by schools, places of work and the community at large is also of great importance.
WPR/RC38/INF.DOC./1 page 5/6
).2.4
Role of the medical community and related professional groups
Medical practitioners, in particular those in the private sector, must play a leading role, and not merely a passive supporting role, in the prevention and control of AIDS, particularly with regard to screening, reporting of HIV infection and counselling of HIV-infected cases in the community. They should mobilize support for the programme with the help of their prestige and knowledge and also enlist the services of related professional groups. They can do much to break down the barriers of ignorance which have hampered efforts to ensure acceptance of AIDS cases by society as a whole.
J.J
Research
Research on the behavioural, epidemiological and clinical aspects of AIDS and the elaboration of simple, low-cost, sensitive and specific laboratory diagnostic tests should be encouraged and supported. Research on the development of vaccines, as well as antiviral drugs and immunomodulators, in particular those derived from plants, also needs to be supported.
).4
Information
A sound communication network is essential to facilitate the rapid transfer of information and technology. This will enable countries to share experiences and quickly learn about new developments, particularly in AIDS prevention and control. More emphasis needs to be placed on the role of the mass media in the efficient and effective dissemination of accurate information to the public.
).5
Integrated approach
It is important to design an integrated approach to the control of di seases such as hepatitis B, human T lymphotropic virus type I (HLTV-I) and HIV infections since hepatitis B is highly endemic in many countries and HTLV-I infection is highly prevalent in several countries of the Region. In addition, these diseases are commonly transmitted through blood and blood products. AIDS-related activities should be undertaken within primary health care. They will be supported by WHO as far as possible. This approach will be considered during the WHO/Japan Joint Conference on an Integrated Strategy for the Control of AIDS and Other Human Retroviral Infections and Hepatitis B, to be held in Tokyo from 5 to 9 October 1987. 0
0
0
The tables attached to this information document as Annex 2 provide the most recent information available on the number of AIDS and HIV antibody positive cases in the Western Pacific Region.
WPR/RC38/INF.DOC./l page 7 ANNEX
1
RESOLUT N•OtOMAL COMWITTCC Po• THC ~CfiiN f!tACI"C:
0
N coall Ttr; R.(JIOM4&. OU PAGII'IQUC OCCINMTA&.
wa/ac36 .1.2 19 Sept..Oer 1985
ACQUIRED
~
DEFICIENCY SYIOIOKB (AIDS)
The
Regional Cc:aaittee,
Taking note of the appearance of acquired immune deficiency syndrome (AIDS), a relatively new aod hiahly fatal disease caused by lymphadenopathy-associated virua/human T-ly.pbotropic virus type III (LAV/HTLV-111), against which no effective treataent aa yet exilta;
Considering that to date some 14 000 AIOS eases have been reported on a global level, including 138 cases in the Western Pacific Region; Expressing its concern about the recent. appearance of the disease in some countries of the Region; Recognizing that in due course the disease may be widespread and·become a serious public health problem in the Region;
Considering· the need to intensify studies and reseat:-ch in order to know more about AIDS; 1. URGES Member States~
(1)
to provide appropriate information and health education to the
public concerning the disease known as acquired immune deficiency syndrome (AIDS), in particular the mode of transmission and methods of prevention; (2) to seek the cooperation of the media in conveying unemotive and
informed advice to the community;
... /
WPR/RC38/IIF.DOC./1 Annex 2 pase 10
IN THE WESTERN ·PACIFIC REGION As ot 1 September 1987
H~V AITI.BODY 'POSITIVE CASJS
Countrz:lArea
Number ot HIV antibodz: positive cases
Number screened tor HIV antibodz:
American Samoa Brunei Darussalam China Cook Islands Fiji French Guam Hong Kong Japan Malaysia New Caledonia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Solo110n hlands Tonga Viet Nam TOTAL Po~nesia
0 2
995 3 926 6 500 7 392 8000 303 279 786
4
0 0 16 2 85 255
15 8 256
102 060 7 571
3
50 8
55 577.
14 909 110 788 1 264 1
14 0 1
841 150
0 719
594 069
WPR/RC38/INF.DOC./1 page 9 ANNEX 2
AIDS CASES IN THE WESTERN PACIFIC REGION As·of 1 September 1987
Country/Area Australia China Commonwealth of Northern Mariana Islands French Polynesia Guam Hong Kong Japan Malaysia New Zealand Philippines Republic of Korea Singapore Tonga TOTAL
Number of cases 562 2
2 1 2
4 43 1
50 7 1
1
677
WPR/RC38/INF.DOC./1 Annex 2 page 10
HIV ANTIBODY POSITIVE CASES IN THEWESTERN' PACI'FIC REGION As of 1 September 198?
Country/Area
Number of HIV antibody positive cases 0 2
Number screened for HIV ahtibody 995
American Samoa Brunei Darussalam China Cook Islands Fiji French Polynesia Guam Hong Kong Japan Malaysia New Caledonia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Solomon Islands Tonga Viet Nam TOTAL
3 926 6 500 7
4 0 0
392 8 000
16 2
303 279 786
85 255 15 8
102 060 7 ' 571
256
3 50 8
55 577
14 909 110 788
14 0
1 264 841 150
1 0
719
594 069
TOTAL NUMBER OF HIV ANTIBODY POSITIVE CASES AND TOTAL NUHRER SCREENED AMONG BLOOD DONORS AND HIGH RISK GROUPS IN FIVE COUNTRIES/AREAS OF THE WESTERN PACIFIC REGION As of 1 September 1987
Country/Area
Blood d'Onors.!l
4
Haemophi liacsa/
%
Homo-/ bisexual •en.!I
%
IV drug abusers.!/
%
Female Prostitutesa/
%
Others.!/
%
Total.!/
%
Brunei Darussalam 0/3909 Hong Kong ·New Zealand Philippines Singapore 4/232945
0 0.002
2/10 45/106 24/ -
20 42.45
*
•
* -*
• 0/3220 3/107833 0
*
• * 0
-· 100/ 1/867 9/183
* *
* - *
-· - * 0.115 4.918
*
- *
6/ -
-· -. • 0
-· -· 0
0/ 7 36/45479 126/ -
0 0.079
2/3926 85/279786 256/ - . 50/55577 14/110788
0.051
- * 46/ 50788 0/2466
-*
*
•
-·
0.030
* 0.090 0.013
* 0/220
0.09
3/749 2/ -
0.40
0.003
0/84
•
•
.! Total number of HIV antibody positive cases/Total number screened for HIV antibody
1
* .
No data available
.........
8 . ....
WPR/RCJB/INF.DOC./1 Annex 2 page 12
AIDS CASES IN THE WORLD As of 26 August 1987
Continent Africa America Asia Europe Oceania TOTAL
Number of cases 5 491 45 622 181 6 660 613 58 567
Number of countries 44 44 25
28 4 145