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  • CHIR-99021 A second methodological issue concerns the accura

    2019-04-15

    A second methodological issue concerns the accuracy of the exposure measurement. Without accurate measurement, different methods for calculating attributable risk that are equivalent in theory are not guaranteed to give compatible results in practice. Previous experience with carcinogenic infections has shown that biomarkers that are both sensitive and able to distinguish high-risk from low-risk infections are essential to elucidate the true strength of cancer risk. For liver flukes, diagnosis is based on detection of eggs in faeces, sputum, or other biofluids, whereas immunodiagnostic techniques and molecular methods are comparatively rare. The RR of cholangiocarcinoma might be substantially underestimated by current methods of exposure assessment. Some evidence for this underestimate comes from the CHIR-99021 between analytical and descriptive epidemiology. The RR of 4·47 for from pooled case control studies is unable to account for the 60-fold variation in cholangiocarcinoma incidences between geographical regions. It is therefore plausible that all statistical methods are underestimating the burden with currently available data.
    Bernadette Abela-Ridder and colleagues (November, 2016) describe the commendable joint efforts of WHO, the Food and Agriculture Organization, the World Organisation for Animal Health, and the Global Alliance for Rabies Control to control rabies on a global level, including their endorsement of a global framework to eliminate human deaths from dog-mediated rabies by 2030. Domestic dogs are the main reservoir of infection in regions of Africa and Asia in which human deaths from rabies are highest. As Abela-Ridder and colleagues reinforce, preventing the transmission of rabies in canine populations is crucial. Additionally, surveillance and monitoring of rabies incidence within dog populations will become increasingly important. The global health community\'s focus for gauging the threat of rabies should not only include the tragic outcome of human deaths, but also the origin of the problem: unvaccinated canine populations in marginalised communities without access to veterinary care. Most free-roaming dogs in rabies-endemic areas are not feral, and belong to a household, forming an integral part of human communities as working animals and pets. Control and epidemic preparedness requires ongoing awareness of rabies in dogs, as sustainable elimination of human rabies cannot be achieved without elimination of the disease in the world\'s domestic dogs. Together with mass vaccination of domestic dogs, goals and targets for the elimination of dog rabies must be set, alongside the newly endorsed goal of eradicating human dog-mediated rabies by 2030.
    The Global Conference on Rabies recognised the important need for a multipronged initiative to reduce the rabies burden, which not only bridges the animal-human interface but also mandates a broad and inclusive multisectoral programme of work, as reflected in the . The target of achieving zero human rabies deaths by 2030 includes mass vaccination of dogs as one of the essential building blocks. Decades of experience highlighted at the conference has shown that investment in controlling rabies at its source via canine vaccination, is the key for preventing disease transmission. Achieving appropriate levels of dog vaccination (70% coverage) in highly enzootic areas is a major public health intervention in addition to improving health and welfare of animals.
    The considerable health workforce challenges in sub-Saharan Africa demand robust and transformative interventions. Between 2010 and 2015, the US President\'s Emergency Plan for AIDS Relief (PEPFAR) and the US National Institutes of Health (NIH) sponsored the Medical Education Partnership Initiative (MEPI)—a grant-awarding programme aimed at enhancing the quantity and quality of education and research in African universities. Through MEPI, 13 medical schools in sub-Saharan Africa were competitively awarded grants to work with existing and new partners to develop bold and innovative programmes. Here we present the achievements of the University of Zimbabwe College of Health Sciences (UZCHS) under the MEPI programme.