The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013
With recent improvements in vaccines and treatments against viral hepatitis, an improved understanding of the burden of viral hepatitis is needed to inform global intervention strategies. We used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013.
We estimated mortality using natural history models for acute hepatitis infections and GBD's cause-of-death ensemble model for cirrhosis and liver cancer. We used meta-regression to estimate total cirrhosis and total liver cancer prevalence, as well as the proportion of cirrhosis and liver cancer attributable to each cause. We then estimated cause-specific prevalence as the product of the total prevalence and the proportion attributable to a specific cause. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs).
Between 1990 and 2013, global viral hepatitis deaths increased from 0·89 million (95% uncertainty interval [UI] 0·86–0·94) to 1·45 million (1·38–1·54); YLLs from 31·0 million (29·6–32·6) to 41·6 million (39·1–44·7); YLDs from 0·65 million (0·45–0·89) to 0·87 million (0·61–1·18); and DALYs from 31·7 million (30·2–33·3) to 42·5 million (39·9–45·6). In 2013, viral hepatitis was the seventh (95% UI seventh to eighth) leading cause of death worldwide, compared with tenth (tenth to 12th) in 1990.
Viral hepatitis is a leading cause of death and disability worldwide. Unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health.
Background Timely assessment of HIV/AIDS burden is essential for policy-setting and program evaluation. Based on the Global Burden of Disease study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, ART coverage and mortality for 195 countries and territories from 1980 to 2015. Methods For countries without high quality vital registration data, we estimated prevalence and incidence from antenatal clinic data and population-based sero-prevalence surveys and assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates, on and off antiretroviral therapy mortality (ART), and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. Estimation of incidence, prevalence and death uses GBD versions of the EPP and Spectrum software originally developed by UNAIDS. These versions have been recoded for speed and use updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high quality vital registration data, we developed the Cohort Incidence Bias Adjustment model to estimate HIV incidence and prevalence largely from the number of deaths due to HIV recorded in cause of death statistics. Cause of death statistics have been corrected for garbage coding and HIV misclassification. Findings Globally, HIV incidence reached its peak in 1997 at 3.3 million. Annual incidence has stayed relatively constant at about 2.5 million since 2005 after a period of faster decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38.8 million in 2015. At the same time, mortality due to HIV/AIDS has been declining at a steady pace from its peak at 1.8 million deaths in 2005 to 1.2 million deaths in 2015. There is substantial heterogeneity in the levels and trends of HIV/AIDS across countries. While success stories can be found in many countries with improved mortality due to HIV/AIDS and declines in annual new infections, slowdowns or increases in rate of change in annual new infections has been observed elsewhere. Manuscript Interpretation The global scale-up of ART and PMTCT has been one of the great successes of global health in the last two decades. In the last decade, progress reducing new infections has been very slow, development assistance for health devoted to HIV has stagnated, and low-income country resources for health have grown slowly. New ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90- 90 UNAIDS targets will be hard to achieve
Importance Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.
Objective To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.
Evidence Review Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.
Findings Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.
Conclusions and Relevance Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.
We describe the methods of diagnostic and vaccine prevention of mumps
Proceedings of the conference "Molecular basis of epidemiology, diagnosis, prevention and treatment of current infections" 4-6 December 2018
In the issue the place of health literacy in the actual Russian and foreign school curricula is discussed. The research focuses on the basics of epidemiology and virology as important areas that help student training to get them prepared for such actual challenges as mass infectious disease outbreaks caused by the specific traits of the nowadays reality. The publication represents an analysis of Russian educational programs and textbooks on biology subject, as well as life safety fundamentals, and social science subjects. On the basis of the research outcomes, the recommendations for updating the content of Russian educational programs in biology and life safety fundamentals were developed.
coBverage of specific reproductive health care services as well as assessment of observed versus expected maternal mortality as a function of Socio-Demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility.
Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographic disparities widened and, in 2015, there were still 24 countries with MMR greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated etiologic profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care (ANC) visit, 78% of four ANC visits, 81% of in-facility delivery (IFD), and 87% of skilled birth attendance (SBA).
Several challenges to improving reproductive health lie ahead in the SDG era. Countries should: a) establish or renew systems for collection and timely dissemination of health data; b) expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; c) invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including emergency obstetric care (EmOC); d) Adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; e) Examine their own performance with respect to their SDI level, using that information to formulate strategies for improving performance and ensuring optimum reproductive health of their population.
We consider certain spaces of functions on the circle, which naturally appear in harmonic analysis, and superposition operators on these spaces. We study the following question: which functions have the property that each their superposition with a homeomorphism of the circle belongs to a given space? We also study the multidimensional case.
We consider the spaces of functions on the m-dimensional torus, whose Fourier transform is p -summable. We obtain estimates for the norms of the exponential functions deformed by a C1 -smooth phase. The results generalize to the multidimensional case the one-dimensional results obtained by the author earlier in “Quantitative estimates in the Beurling—Helson theorem”, Sbornik: Mathematics, 201:12 (2010), 1811 – 1836.
We consider the spaces of function on the circle whose Fourier transform is p-summable. We obtain estimates for the norms of exponential functions deformed by a C1 -smooth phase.