Recent WHO publications

RecentWHO publications/Publications recentesOMS Readers living in developing countries receive a 30% reduction on the prices indicated in Swiss francs. Les lecteurs r6sidant dans les pays en d6veloppement beneficient d'un rabais de 30% sur les tarifs indiqu6s en francs suisses. Adolescent health The health of young people A challenge and a promise Geneva, 1993, x + 109 pages ISBN 92 4 156154 8 Price: Sw.fr. 23.-/US$ 20.70 This book, which expands on the Technical Discus- sions held at the Forty-second World Health Assem- bly in 1989, issues a call for public health action that recognizes the health problems of young people and responds to their need for support. Recommended actions also underscore the contributions young people can and do make to their own health and development and that of their societies. While noting that this age group has been traditionally regarded as enjoying good health, the book draws attention to a number of changes in social conditions that have created new hazards in the very areas where youth are most vulnerable. These range from the increasing availability of drugs, alcohol, and tobacco to the pressures of urbanization and rising unemployment, from the breakdown of family and social supports to the risks posed by human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). Using facts and figures from around the world, the book illustrates the lines of ac- tion that can protect young people from these hazards, channel their energy in constructive ways, and help them secure a healthy future. Chemical toxicology, carcinogenicity Benomyla Geneva, 1993, 135 pages (Environmental Health Criteria, No. 148). ISBN 92 4 157148 9 Price: Sw.fr. 18.-/US$ 16.20 Benomyl is a fungicide registered for use in 50 coun- tries on over 70 crops, including cereals, cotton, a Published by WHO under the joint sponsorship of the United Nations Environment Programme, the International Labour Organisation, and WHO (International Programme on Chemical Safety -IPCS). soybeans, tobacco, mushrooms, grapes, bananas and other fruits. One of the most widely used members of the benzimidazole family of fungicides, benomyl is effective, at low usage rates, against more than 190 different fungal diseases. Because benomyl is rapidly converted into carbendazim in the environ- ment and is extensively metabolized to carbendazim by animals, data from studies of carbendazim, which is a fungicide in its own right (see next review), also need to be considered when evaluating the hazards of benomyl. Several studies have investigated the behaviour of this fungicide in soil and the uptake of soil resi- dues by crops. Although benomyl undergoes rapid degradation, carbendazim adsorbs strongly to soil organic matter and may remain in the soil for up to three years. Concerning hazards to environmental organisms, the report cites data from laboratory and field studies indicating that benomyl, applied at rec- ommended rates, has little effect on soil microbial activity, but some adverse effects on groups of fungi. It is toxic to earthworms in laboratory experiments at realistic exposure concentrations and as a result of recommended usage in the field. Although high toxicity to aquatic organisms has been demonstrated in laboratory tests, the report concludes that this effect is unlikely to be seen in the field, due to the low bioavailability of sediment-bound residues. Both benomyl and its degradation product are rapidly metabolized and eliminated from organisms, and neither compound has been shown to accumulate in any biological system. For the general population, the main source of potential exposure is noted to be through the ingestion of food crops containing resi- dues of benomyl and carbendazim. Though benomyl has been shown to cause contact dermatitis and der- mal sensitization in some farm workers, the report found no evidence that either of these compounds can cause systemic toxic effects in occupationally exposed subjects or the general population. Despite the paucity of studies in humans, the report cites findings from animal studies suggesting that both compounds pose a very low risk for acute poisoning in humans.b b A summary and conclusions in French and Spanish are included in the book. Bulletin of the World Health Organization, 1994, 72 (4): 685-691 685 Recent WHO publications Carbendazima Geneva, 1993, 132 pages (Environmental Health Criteria, No. 149). ISBN 92 4 157149 7 Price: Sw.fr. 22.-/US$ 19.80 Carbendazim, a systemic fungicide, is the most widely employed compound in the benzimidazole family of fungicides. It is used to control the fungi responsible for several important plant diseases. Plants protected by this fungicide include cereals, cotton, sugar beet, soybeans, vegetables, fruits, and other food crops. Because carbendazim is the main metabolite of benomyl in mammals and the degrada- tion product of benomyl in the environment, data from studies of both compounds are considered in the report. Studies show that carbendazim adsorbs strongly to soil and sediment, persists on leaf sur- faces and in leaf litter, and can be detected in soil for up to three years after application. Because of this strong adsorbtion, the report concludes that the bio- availability of carbendazim to terrestrial and aquatic organisms is limited, and that leaching to ground water is unlikely. A section of the book concentrates on the risks to the general population posed by the use of carbendazim on food crops, as well as to agri- cultural workers engaged in pesticide mixing and loading or re-entering treated fields. Maximum Resi- due Limits proposed by FAO and WHO for various food commodities are set out. A review of data on kinetics and metabolism supports the conclusion that carbendazim is extensively metabolized and rapidly excreted. Although studies show that carbendazim is well absorbed by the oral route, the report cites evi- dence of a much lower rate of absorption following dermal exposure. A section reviews experimental studies designed to investigate the toxicity of carben- dazim, including its effects on reproduction, embryo- toxicity, teratogenicity, neurotoxicity, and carcino- genicity, draws on the large body of experimental work, supported by knowledge of how carbendazim exerts its toxic effects in both target and non-target species, and concludes that the likelihood of system- ic toxicity following exposure in either the general population or workers is remote. Given current occu- pational exposures and the low rate of dermal absorption, the report further concludes that, when proper protective clothing is wom, health risks asso- ciated with agricultural exposure are low. Concern- ing effects on organisms in the environment, the report cites evidence that both benomyl and carben- dazim are highly toxic to certain aquatic organisms in laboratory tests, but concludes that this toxicity is not likely to occur under field conditions due to the compound's low bioavailability in surface waters. The report also cites evidence, from both laboratory and field investigations, that benomyl and carbenda- zim, applied at recommended rates, cause deaths and sublethal reproductive effects among earthworms. The compound has low toxicity for birds and is clas- sified as "relatively non-toxic" to honey-bees.b Benzenea Geneva, 1993, 156 pages (Environmental Health Criteria, No. 150). ISBN 92 4 157150 0 Price: Sw.fr. 23.-/US$ 20.70 Benzene is a naturally occurring chemical found in crude petroleum and manufactured in extremely large quantities worldwide. The occurrence of ben- zene in gasoline and in cigarette smoke, combined with its widespread use as an industrial solvent, has resulted in the presence of this chemical in the envi- ronment. Because benzene is a well-established human carcinogen, the book pays particular attention to data relating patterns, levels, and duration of exposure to health hazards in both the general popu- lation and exposed workers. A description of several established analytical methods used in studies of human exposure and in experiments designed to elu- cidate the biological effects of benzene is followed by a section on sources of exposure which identifies emissions from motor vehicles as the largest source of this chemical detected in the general environment. For indoor environments, data show that cigarette smoke results in the exposure of non-smokers as well as smokers to important levels of benzene. Because benzene is ubiquitous in the environment, most humans are exposed to trace levels, with much higher levels seen in cigarette smokers, those exposed to sidestream smoke, residents in areas of heavy automobile traffic, and workers involved in the production, handling, and use of benzene and its derivatives. Data on the uptake, metabolic fate, and excretion of benzene and its metabolites are re- viewed, identifying inhalation as the primary route of exposure and subsequent toxicity. A section reviews toxicity studies on laboratory mammals and in vitro test systems, including the results of short-term, long- term, and lifetime studies, particular attention being given to animal studies demonstrating carcinogenici- ty and exploring the mechanisms by which benzene damages bone marrow and exerts its other toxic effects. Other sections assess the risks to human health posed by benzene in both the general popula- tion and in exposed workers, giving attention to the epidemiological and case studies that have estab- lished benzene as a human leukaemogen. Because the health risk of low-level benzene exposure is not yet clearly established, the report concludes that exposure should be avoided as much as possible.b WHO Bulletin OMS. Vol 72 1994686 Recent WHO publications Beryllium, cadmium, mercury, and expo- sures in the glass manufacturing industry Lyon, International Agency for Research on Cancer, 1993, 444 pages (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 58). ISBN 92 832 1258 4 Price: Sw.fr. 75.-/US$ 67.50 More than 1200 references to the recent literature are included in this book, which evaluates the carcino- genic risks to humans of exposure to selected metals and their compounds. Separate monographs are presented for beryllium and beryllium compounds, cadmium and cadmium compounds, and mercury and inorganic and methylmercury compounds. The book also evaluates the carcinogenic risk posed by exposures in the glass manufacturing industry. The first monograph evaluates biological and epidemiological data on metallic beryllium, berylli- um-aluminium and beryllium-copper alloys, and some beryllium compounds. Detailed information about the production and use of beryllium and its compounds is presented in order to characterize the nature and extent of human exposures at different stages of production, manufacturing and use. While noting the wide use of these compounds in solid- state computer and communication systems and in the aircraft and aerospace industries, the book cites evidence of a reduction in occupational exposures over the past 40 years. Conceming the presence of beryllium in the general environment, the buming of coal is identified as the most important source of nonoccupational exposure. The evaluation of studies of cancer in humans gives particular attention to analyses of mortality among workers in beryllium plants. Data from these and other studies, supported by well-designed animal investigations, provide evi- dence of a causal relationship between certain occu- pational exposures and an increased risk of lung can- cer. The monograph concludes that beryllium and its compounds are carcinogenic to humans. The mono- graph on cadmium and cadmium compounds gives particular attention to analyses of epidemiological cohorts and the results of studies of carcinogenicity in experimental animals. Exposures to cadmium and its compounds occur mainly in smelting operations, pigment manufacture and use, nickel/cadmium bat- tery manufacture and cadmium alloy production. Data from a number of recent studies support the conclusion that cadmium and its compounds are car- cinogenic to humans. For mercury and mercury com- pounds, the monograph considers the risks to humans associated with exposures in mercury min- ing, chloralkali plants, the manufacture of thermome- ters, maintenance of mercury-containing instruments, and from dental amalgams and the consumption of contaminated food. Methylmercury compounds were classified as possibly carcinogenic to humans. The carcinogenicity to humans of metallic mercury and inorganic mercury compounds could not be classi- fied. The final monograph concentrates on several potential occupational health hazards, including exposure to silica dust, lead, and other metallic com- pounds, noting that glass blowing offers several opportunities for exposure to the metallic compounds present in glass and alloy materials. Citing evidence from recent studies, the monograph concludes that the manufacture of art glass, glass containers, and pressed ware entails exposures that are probably car- cinogenic to humans. Occupational exposures in flat- glass and special glass manufacture could not be classified as to their carcinogenicity to humans. Clinical technology Rehabilitation surgery for deformities due to poliomyelitis Techniques for the district hospital edited by J. Krol; illustrated by P. Virolle Geneva, 1993, 112 pages ISBN 92 4 154457 0 Price: Sw.fr. 25.-/US$ 22.50 Addressed to doctors providing surgical services in district hospitals, this book concentrates on simple procedures that can facilitate rehabilitation and improve the physical independence of poliomyelitis victims. The importance of including physical thera- py in the management of patients is repeatedly emphasized. This manual, which can be used for training purposes or as an aide-me&moire, features nine chapters presented in two parts. Chapters in the first part describe the disease and its sequelae, and provide advice on the tests to be used when evaluat- ing patients, identifying deformities, assessing func- tional abilities, deciding which patients qualify for surgery, and selecting the appropriate procedures. Information on a number of basic surgical techniques is also provided. Chapters in the second part describe specific surgical procedures for the hip, knee, foot and ankle, and elbow. Although some procedures involving bone are described, the handbook stresses that these techniques require more training and ex- perience and should thus be performed at the dis- trict hospital only by doctors with wide experience or under the immediate supervision of a specialist. The book is part of a series ofWHO handbooks cover- ing the surgical care of patients at small hospitals WHO Bulletin OMS. Vol 72 1994 687 Recent WHO publications where resources are constrained and where doctors have limited access to specialist services.C Communicable diseases AIDS: images of the epidemic Geneva, 1994, x + 142 pages ISBN 92 4 156163 7 Price: Sw.fr. 32.-/US$ 28.80 The book presents a portrait of the global acquired immunodeficiency syndrome (AIDS) epidemic in its public health, social, and human dimensions. Draw- ing upon eye-witness accounts as well as data from the WHO Global Programme on AIDS, the book goes beyond statistical forecasts to show how AIDS affects the lives of real people, why the infection continues to spread, and what can be done to fight back. Throughout, striking photographs and a prob- ing text are used to help readers come to terms with the complex nature of the challenge posed by AIDS. By revealing the multiple faces and facets of the epi- demic, the book aims to improve understanding of the many deep-rooted factors - from prejudice to poverty - that fuel this "catastrophe in slow motion" and complicate efforts to protect people from infection. While the overall picture is grim, with suffering and despair the dominant images, the book also presents evidence of a number of approaches that have proved successful in meeting the dual goals of prevention and compassionate care for those already infected. These successes, supported by what WHO has learned in coordinating the global fight against AIDS, serve as a practical guide to the best use of resources to combat the epidemic, whether at the local or the global level. Environment The urban health crisis Strategies for health for all in the face of rapid urbanization Geneva, 1993, xvi + 80 pages ISBN 92 4 156159 9 Price: Sw.fr. 20.-/US$ 18.- c Titles already published in this series are: Dobson MB. Anaesthesia at the district hospital (Geneva, WHO, 1988); Cook J et al. General surgery at the district hospital (Geneva, WHO, 1988); and Cook J et al. Surgery at the district hospital: obstet- rics, gynaecology, orthopaedics, and traumatology (Geneva, WHO, 1991). The last-mentioned title was reviewed in the Bulletin of the World Health Organization, 1991, 69: 504. This book responds to concern over the impending health crisis in urban areas, where population growth has outstripped the capacity of local authorities to provide basic services, and where conditions favour- ing poor health are the norm. Adopting a public health approach, the book aims to guide decision- makers in setting priorities and selecting the most realistic policy options, particularly in situations characterized by escalating problems and dwindling resources. In order to cope with the deteriorating sit- uation in many of the world's cities, the book calls for major changes in both the responsibilities in urban health departments and the approaches used to meet health needs. Attention is given to the need for innovations that can be carried out at low cost by neighbourhood action or by small-scale entrepren- eurs. Throughout, recommended lines of action are presented within the context of a "new public health", which recognizes the need for a balanced mix of environmental changes, personal prevention meas- ures, and appropriate therapeutic interventions. Since rapid migration to the cities is often accompanied by the breakdown of families and social supports, the book draws attention to the problems posed by AIDS, drug abuse, and a high prevalence of mental disorders. The book, which is also the report of the Technical Discussions at the Forty-fourth World Health Assembly in 1991, outlines twelve challenges that must be met in order to tackle the health prob- lems created by rapid urbanization. Pharmaceuticals, biologicals WHO Expert Committee on Biological Standardization Forty-third report Geneva, 1994, v + 218 pages (WHO Technical Report Series, No. 840). ISBN 92 4 120840 6 Price: Sw.fr. 31.-/US$ 27.90 This report presents the recommendations of a WHO Expert Committee commissioned to coordinate activ- ities leading to the adoption of international require- ments for the production and control of vaccines and other biologicals and the establishment of interna- tional biological reference materials. The report starts with a discussion of general issues brought to the Committee's attention and provides information on the status and development of reference materials for various antibiotics, antibodies, antigens, blood prod- ucts, cytokines, growth factors and endocrinological substances. The second part of the report, of particu- lar relevance to manufacturers and national control 688 WHO Bulletin OMS. Vol 72 1994 Recent WHO publications/Publications r6centes OMS authorities, contains three specific sets of require- ments: for the collection, processing and quality control of blood, blood components and plasma derivatives; for Vi polysaccharide typhoid vaccine; and for measles, mumps, rubella and combined vac- cines. Also included are amendments to the three sets of requirements concemed with rabies vaccines for human and veterinary use.d Traditional medicine Standard acupuncture nomenclature A brief explanation of 361 classical acupuncture point names and their multilingual comparative list Second edition Manila, WHO Regional Office for the Western Pacific, 1993, v + 266 pages ISBN 92 9061 105 7 Price: Sw.fr. 16.-/US$ 14.40 d See a note on WHO criteria for the establishment of diagnos- tic international reference reagents in the Bulletin of the World Health Organization, 1994, 72: 514-516. International academic exchange on acupuncture has increased with its widespread development and use in the world. There are now many acupuncture specialists, several international and national meetings have been held, and a multitude of publications have appeared. Translations of the original Han (Chinese) texts and characters have proliferated. Numerous problems due to differences of spelling and pronunciation have arisen. Today, the same acupunc- ture points may have a wide variety of names because of these differences. Furthermore, to help those who do not read Han characters, a variety of alphanumeric codes have been given to meridian and acupuncture points. The need for standardization has become increasingly pressing. In 1982, the WHO Regional Office for the Western Pacific convened a working group meeting in Manila on the standardization of acupuncture. This was followed by a series of meet- ings between 1985 and 1989 which ratified the deci- sions of the working group and made it possible to present the material as it appears in this revised edi- tion, where each of the 361 entries has three parts: the standardized name of the classical point; a brief expla- nation of the name of the point; and a multilingual comparative list of the names of the point. It is hoped that this book will contribute to further information exchange on acupuncture throughout the world. Environnement La lutte contre les insectes et les rongeurs par I'am6nagement de 1'environnement Programme d'action communautaire Publi par l'OMS en collaboration avec le Programme des Nations Unies pour l'Environnement Geneve, 1994, vii + 1 16 pages (plus 62 fiches et 7 jeux) ISBN 92 4 254411 6 Prix: Fr.s. 90.- Ce dossier-mallette contient une serie de materiaux destines a faciliter l'approche communautaire auto- nome dans la lutte contre l'infestation par les insectes et les rongeurs dans les taudis urbains et les bidonvilles. Etant donne que leurs habitants sont souvent les mieux places pour combattre les insectes et les rongeurs, le manuel vise a favoriser l'appli- cabilite d'une action communautaire immediate, en expliquant et en illustrant les nombreuses methodes de lutte faciles et peu cou'teuses qui peuvent etre appliquees moyennant un simple changement de comportement, ainsi que les ameliorations qui pour- raient etre apportees en matiere de logement, d'assai- nissement et de traitement des dechets. Dans tous les cas, les mesures et les actions qui sont suggerees mettent I'accent sur le nettoyage et l'hygiene de l'environnement, par opposition a l'utilisation de produits chimiques. Le manuel presente et explique aussi des mesures novatrices comme l'elevage de poissons qui se nourrissent des larves de moustiques et l'emploi de pieges a rongeurs et d'attrape- mouches de fabrication artisanale. Presente sous une forme attrayante, le dossier- mallette se compose d'un manuel de formation desti- ne aux membres de la communaute appeles a devenir des experts en matiere d'identification et de gestion des vecteurs de maladies, d'une serie de 62 fiches illustrees d'information et d'action, concues pour la formation des individus, des familles et des groupes communautaires et d'une serie de sept jeux qui pour- WHO Bulletin OMS. Vol 72 1994 689 Publications r6centes OMS raient aider a stimuler l'interet d'une communaute. Les fiches d'information et d'action sont des moyens visuels qui, avec l'aide d'un texte simple et d'illus- trations, cherchent a faire comprendre des faits essentiels sur le comportement d'especes indivi- duelles d'insectes et de rongeurs, leurs habitats pre- feres, les facteurs qui favorisent l'infestation et la propagation de la maladie, et les mesures que peu- vent prendre les individus et les communautes pour se debarrasser de ces animaux nuisibles. Sur chaque fiche, il sera possible d'ajouter un texte explicatif dans la langue ou le dialecte local. Les informations qui sont donnees dans ce dossier-mallette ont ete mises au point apres de multiples essais sur le terrain et ont utilisd les conseils et les connaissances d'un grand nombre de specialistes de l'entomologie medi- cale et du genie sanitaire, d'experts de la partici- pation communautaire et de la communication, et des autorites sanitaires de divers pays. Maladies transmissibles Le traitement de la tuberculose Principes A I'intention des programmes nationaux Geneve, 1994, vii + 46 pages ISBN 92 4 254451 5 Prix: Fr.s. 10.- A l'heure actuelle, 40 ans apres l'adoption de la chimiotherapie antituberculeuse, le nombre de nou- veaux cas de tuberculose (8 millions par an) n'a jamais ete aussi eleve. Mycobacterium tuberculosis tue chaque ann6e 2,9 millions de personnes, c'est-a- dire probablement plus que n'importe quel autre germe pathogene infectieux. Dans les pays en deve- loppement, oiu apparaissent environ 95% de ces cas, les taux de guerison restent inacceptablement bas et la transmission s'est accrue a mesure que les patients constituent un reservoir toujours plus grand d'infec- tion. De plus, la propagation du virus de l'immuno- deficience humaine (VIH) a contribue a l'augmen- tation du nombre de cas dans le monde entier. Les principes presentes dans cet ouvrage, qui sont fondes sur l'exp6rience acquise grace aux succes remportes a travers le monde par les programmes de lutte anti- tuberculeuse, ont pour but d'aider les responsables des programmes antituberculeux nationaux a etablir des schemas therapeutiques codifies courts et effi- caces pour lutter contre la maladie. Le lecteur trou- vera dans cette brochure la description des schemas actuellement recommandes selon la categorie a laquelle appartiennent les patients ainsi que d'autres schemas convenant mieux pour les patients seroposi- tifs pour le VIH. D'autres questions y sont egalement traitees, notamment la surveillance continue des patients, l'evaluation des programmes, l'assurance de la qualite des m6dicaments et le cou't des schemas thdrapeutiques recommandes.e Maladies tropicales Strat6gie mondiale de lutte antipaludique Geneve, 1994, xi + 36 pages ISBN 92 4 256161 4 Prix: Fr.s. 1 1.- Cette publication expose et explique une nouvelle strategie de lutte antipaludique. Notant que le proble- me du paludisme est grave et ne fait que s'amplifier, la publication donne les conseils techniques et pra- tiques necessaires pour relancer une offensive qui soit plus realiste, plus pragmatique et plus durable que par le passe. La strategie, qui a ete approuvee par une conference ministerielle,f preconise un cer- tain nombre de changements fondamentaux et invite a abandonner plusieurs concepts depasses, herites de l'epoque ou l'eradication du paludisme paraissait encore realisable. Elle met l'accent sur la necessite de programmes axes sur la maladie, le but essentiel etant de reduire la mortalite et la morbidite. En rai- son du caractCere complexe du paludisme, il est impossible de mettre au point une formule de lutte universellement valable; la publication se concentre donc sur les principes generaux qui peuvent orienter le choix de mesures applicables et efficaces par rap- port 'a leur coft, adaptees 'a la situation locale. Les lignes d'action recommandees s'inspirent des ensei- gnements de plusieurs decennies d'efforts de lutte contre cette maladie complexe, que l'on peut nean- moins prevenir et guerir. Le lecteur trouvera enfin le texte de la Declaration mondiale sur la lutte antipalu- dique adoptee 'a la Conference, qui a fait sienne la nouvelle strategie et souligne qu'il importait au plus haut point que les gouvemements, les agents de sante et de developpement et la communaute mondiale s'engagent dans la lutte contre le paludisme. e Voir note sur le traitement preventif de la tuberculose chez les sujets infectes par le VIH dans le Bulletin de lOrganisation mondiale de la Sant6, 1994, 72: 309-311. f Un article sur la strategie mondiale de lutte antipaludique- OMS, Service du Paludisme, fonde sur un document non publie de l'OMS (CTD/MAUEXP/92.3), etabli pour la Conference minis- terielle sur le paludisme tenue a Amsterdam les 26 et 27 octobre 1992, a paru dans le Bulletin de lOrganisation mondiale de la SantO, 71: 491-495 (1993). Voir egalement une note sur la situation du paludisme dans le monde en 1991 dans le Bulletin de l'Organisation mondiale de la Sant6, 1994, 72: 170-175, ainsi que I'analyse ci-apres. 690 WHO Bulletin OMS. Vol 72 1994 Publications recentes OMS Mise en ceuvre de la strat6gie mondiale de lutte antipaludique Rapport d'un Groupe d'Etude de l'OMS sur la Mise en Oeuvre du Plan mondial d'Action pour la Lutte contre le Paludisme 1993-2000 Geneve, 1993, v + 67 pages (OMS, S6rie de Rapports techniques, No 839). ISBN 92 4 220839 6 Prix: Fr.s. 10.- Ce rapport technique est un guide qui fait autorite pour les changements 'a apporter aux niveaux natio- nal et local en vue d'appliquer la nouvelle strategie mondiale de lutte contre le paludisme.9 Face 'a la deterioration de la situation du paludisme, cette stra- tegie preconise une redefinition fondamentale de la maniere dont le probleme du paludisme est aborde, en mettant l'accent sur la necessite de reduire la mortalite et la morbidite par l'application selective de mesures realisables, souples et rentables. Le rap- port vise donc a aider les planificateurs 'a com- prendre les incidences pratiques et techniques de la strategie consideree comme le cadre d'une nouvelle offensive contre le paludisme qui soit a la fois plus realiste et plus viable. Le rapport conclut sur un exa- men des principales priorites de la gestion des pro- grammes, expliquant comment traduire la strategie mondiale en plans et programmes nationaux effi- caces pour lutter contre le paludisme. Vaccination Voyages internationaux et sante Vaccinations exigees et conseils d'hygibne Situation au ler janvier 1994 Geneve, 1994, 104 pages ISBN 92 4 258019 8 Prix: Fr.s. 15.- Ce guide annuel, remis 'a jour en janvier, donne des avis autorises sur les precautions d'ordre medical et individuel que doivent prendre les voyageurs pour se proteger. Destine au corps medical, aux agences de tourisme et aux compagnies adriennes et maritimes, il presente les informations les plus recentes sur les precautions generales que devraient prendre tous les voyageurs, les risques pour la sante correspondant a chaque region geographique, les vaccinations recom- mandees ou conseilldes par l'OMS ainsi que les vac- cinations exigees par chaque pays pour l'entree sur 9 Voir l'analyse precedente. son territoire. Tout en mettant l'accent sur la preven- tion, il donne des renseignements sur les maladies courantes dans diff6rents pays, ce qui peut aider le medecin a determiner l'origine d'une maladie contractee a l'etranger. Pour la premiere fois, la presente edition indique le schema chimioprophylactique recommande pour chaque pays oiu il existe des zones impaludees. De plus amples renseignements sur les risques lies 'a l'environnement y figurent, mettant en garde le lec- teur contre les principales maladies transmises par les arthropodes, les aliments et l'eau et autres risques pour la sante rencontres frequemment dans diffe- rentes parties du monde. Les voyageurs y trouvent egalement des conseils sur ce qu'ils peuvent faire pendant un sejour 'a 1'etranger pour proteger leur sante soit contre les maladies transmises par des ali- ments ou de l'eau contamines, soit contre le risque d'infection par le virus de l'immunodeficience humaine (VIH) et autres maladies sexuellement transmissibles. Une liste complete de toutes les vac- cinations recommandees ou conseillees par l'OMS est presentee dans un tableau qui comprend des informations sur le vaccin, sur la limite d'age infe- rieure et sur le nombre de jours precedant le debut de l'efficacite du vaccin. Le chapitre contient les conseils de l'OMS sur la vaccination des voyageurs infectes par le VIH. En raison de la deterioration de la situation du paludisme, les conseils relatifs a la prophylaxie et a la chimiotherapie antipaludiques ont ete particuliere- ment detailles. Ils comprennent une liste de controle a l'intention des prescripteurs, une mise en garde destinee aux groupes chez qui certains medicaments sont contre-indiques, les posologies prophylactiques et therapeutiques recommand6es pour huit medica- ments antipaludiques et une recapitulation des conseils que les prescripteurs doivent donner aux femmes enceintes ou en age de procreer et aux parents de jeunes enfants. Une carte pliable resumant les posologies prophylactiques par zone et un tableau indiquant les fractions approximatives des doses d'antipaludiques pour adultes applicables aux enfants constituent un complement d'information. On trou- vera enfin une section sur le paludisme polypharma- coresistant.h hVoir la note sur la chimioprophylaxie du paludisme: sch6mas medicamenteux recommandes aux voyageurs dans le Bulletin de l'Organisation mondiale de la Sante, 1994, 72: 311-312, et p. 690, Maladies tropicales, dans cette rubrique. WHO Bulletin OMS. Vol 72 1994 691