Medici senza Frontiere AZIONE UMANITARIA INDIPENDENTE MSF interviene in una crisi basandosi sulla valutazione dei bisogni della popolazione, svincolata da  Interessi politici  Interessi economici  Determinanti religiose Indipendente perché oltre l’80% dei fondi proviene da privati donatori

Presenti in più di 70 Paesi /oltre 380 progetti più di 7000 partenze all’anno CHI SIAMO E COSA FACCIAMO

CONTESTI DI INTERVENTO – rifugiati/sfollati

CONTESTI DI INTERVENTO - catastrofi

CONTESTI DI INTERVENTO - conflitti

CONTESTI DI INTERVENTO - Vaccinazioni

CONTESTI DI INTERVENTO – Epidemie

8 CONTESTI DI INTERVENTO – rottura di equilibrio Myanmar-TBMDRKhost-Afghanistan -Maternity

Virus e parassiti emergenti e ri-emergenti Colera Morbillo Malaria Meningite

Spesa sanitaria pubblica Mortalità < 5 anni

….. batteri, virus, protozoi….. microrganismi «vecchi» epidemie «croniche» grave danno su (già deboli) sistemi sanitari nazionali migliaia di vite sono a rischio (invalidità/morte) i mezzi per prevenire queste morti esistono come possiamo fare meglio?

Cholera in Maiduguri, Nigeria

Cholera Key facts can kill within hours if left untreated. 1.4 to 4.3 million cases, and to deaths worldwide due to cholera every year. Up to 80% of cases can be successfully treated with oral rehydration salts. Provision of safe water and sanitation is critical to control cholera and other waterborne diseases. Oral cholera vaccines are an additional way to control cholera, but should not replace conventional control measures.

Oral cholera vaccines 2 OCVs: Dukoral® and Shanchol® public health tool (mass vaccination campaigns) in protecting populations at high risk of cholera. OCV has role in the prevention and control of cholera when used in conjunction with accessible healthcare and improvements in water and sanitation.

Zambia: OCV campaign in Lusaka  Zambian Ministry of Health, WHO & MSF: Aprile 2016  to vaccinate more than half a million people to curb the outbreak that began in February in the city’s overcrowded township areas  working to improve sanitation and hygiene conditions in the informal settlements by disinfecting homes, carrying out health education, and distributing chlorine solution

Measles cases and VC, World 1980 – 2011

Measles cases and VC, AFRO 1980 – 2010 EPI introduction Catch-up SIAs Follow-up SIAs Cases ↓ Deaths ↓ 78% (‘00-’08) Routine measles VC ↑ 52% → 73%

2000–2012, la CV nel mondo é cresciuta, 77% riduzione di casi di morbillo riportati (incidenza) e 78% riduzione nella mortalita. Durante questo perido la vaccinazione antimorbillo ha prevenuto 13.8 milioni di morti. WER, No 6, 7 Febbraio 2014

Controllo Mantenere un'alta copertura vaccinale con due dosi di MCV –1 dose con VC >90% con vaccinazione di routine ( seconda dose in paesi con buona copertura vaccinale) –>95 % di copertura in Supplementary Immunisation Activities (SIAs): Catch-up campaigns (in general: 9m to 14y) Follow-up campaigns (in general: 9m to 59m) Eliminazione Interruzione della transmissione di morbillo in un'area definita per un periodo di tempo determinato, no casi. Eradicazione Stoppare globalmente la transmissione del virus, no reservoir no casi Definizioni:

Morbillo outbreaks ongoing Romania - as of 28 April 2016, 129measles cases reached (104 cases were unvaccinated) The UK over than 60 cases of measles reported in the last two months USA in Tennessee with two confirmed and three probable cases in the Memphis area. New Zealand- outbreak in Waikato that started at the end of March with eight confirmed and five suspected cases. Africa 2016 Liberia (1 341 cases, 34 deaths)Chad (5 832, 79 deaths), Benin (85 cases, 0 deaths),Nigeria (3 804 cases, 26 deaths) CAR (31 cases, 0 deaths)Burkina Faso (1 258 cases, 10 deaths), Cameroon (1 338 cases, 6 deaths)Côte d'Ivoire (491 cases, 3 deaths) Guinea (1,013 cases, 2 deaths) DR Congo (3 976 cases, 13 deaths) Mali (774 cases, 1 death)Mauritania (863 cases, 9 deaths) Senegal (560 cases, 0 deaths)Niger (352 cases, 1 death) Togo (295 cases, 0 deaths)Sierra Leone (351 cases, 1 deaths)

Other diseases with epidemic potential - such as HIV/AIDS, Tuberculosis, Malaria, Avian influenza and Dengue - were not included in the list because there are major disease control and research networks for these infections, and an existing pipeline for improved interventions.

The Anopheles mosquito is a ruthless serial killer. Responsible for approximately 590,000 annual deaths it by far bypasses other animals more popularly seen as dangerous such as the shark (10 deaths), crocodile (1,000 deaths) and snake (50,000 deaths). However, just as most serial killers are harmless without a weapon, the Anopheles mosquito is harmless without the malaria parasite. Without malaria, it is merely left as a nuisance that keeps you up at night.

The war on the anophelines to harness any weaknesses in their biology chemical warfare anophelines have evolved resistance against many insecticides genetic warfare: not yet been implemented on grand scale

…risposta globale all’HIV entro il 2020? Africa Occidentale e Centrale, vasta regione che comprende 25 paesi tre persone su quattro non accedono alle cure per l’HIV – che corrisponde a 5 dei 15 milioni stigmatizzazione, scarso rifornimento di scorte e medicinali, costi dei farmaci insostenibili per i pazienti e la scarsa qualità del servizio crisi ricorrenti causate dalla violenza o dalle epidemie

first outbreak reported in Angola since 1988 Angola As of 26 April, suspected cases and 258 deaths were reported in Angola, of which 653 were laboratory-confirmed cases (70% were from Luanda province). Democratic Republic of Congo (DRC) A yellow fever outbreak was officially declared by the national government on 23 April Uganda As of 27 April, 39 suspect cases of yellow fever cases have been reported in seven districts. Yellow fever cases in people who travelled from Angola have been reported : China, Kenya, Morocco and Mauritania.

C’è bisogno d’investimenti per prevenire e rispondere alle epidemie: Migliori infrastrutture sanitarie, competenze, educazione sanitaria per le comunità locali Sistemi di allerta rapidi e attività celeri di risposta attraverso cure mediche gratuite e di qualità Ricerca e sviluppo orientati ad un maggior benessere comune

Grazie!