Protect Yourself: Advice For The Public Myth Busters Questions and Answers Situation Reports All Information On The COVID-19 Outbreak

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus.
Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without
requiring special treatment. Older people, and those with underlying medical problems like cardiovascular disease,
diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness.
The best way to prevent and slow down transmission is to be well informed about the COVID-19 virus, the disease it causes
and how it spreads. Protect yourself and others from infection by washing your hands or using an alcohol based rub
frequently and not touching your face.
The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs
or sneezes, so it’s important that you also practice respiratory etiquette (for example, by coughing into a flexed elbow).
Stay informed:
 Protect yourself: advice for the public

 Myth busters
 Questions and answers
 Situation reports
 All information on the COVID-19 outbreak
To prevent infection and to slow transmission of COVID-19, do the following:
 Wash your hands regularly with soap and water, or clean them with alcohol-based hand rub.
 Maintain at least 1 metre distance between you and people coughing or sneezing.
 Avoid touching your face.
 Cover your mouth and nose when coughing or sneezing.
 Stay home if you feel unwell.
 Refrain from smoking and other activities that weaken the lungs.
 Practice physical distancing by avoiding unnecessary travel and staying away from large groups of people.
COVID-19 affects different people in different ways. Most infected people will develop mild to moderate illness and recover
without hospitalization.
Most common symptoms:
 fever.
 dry cough.
 tiredness.
Less common symptoms:

 aches and pains.
 sore throat.
 diarrhoea.
 conjunctivitis.
 headache.
 loss of taste or smell.
 a rash on skin, or discolouration of fingers or toes.
Serious symptoms:
 difficulty breathing or shortness of breath.

 chest pain or pressure.
 loss of speech or movement.
Seek immediate medical attention if you have serious symptoms. Always call before visiting your doctor or health facility.
People with mild symptoms who are otherwise healthy should manage their symptoms at home.
On average it takes 5–6 days from when someone is infected with the virus for symptoms to show, however it can take up to
14 days.
The COVID-19 pandemic is a Public Health Emergency of International Concern (PHEIC), which has claimed lives, and severely
disrupted communities. Climate change is a gradually increasing stress that may be the defining public health threat of the
21st century. Nonetheless, common lessons can be drawn:
 Ensuring universal health coverage (UHC), through well-resourced, equitable health systems, is essential to protect
the public from both short and long-term health threats.
 Guaranteeing global health security requires an all-hazards approach to preparedness, from infectious disease
outbreaks, to extreme weather events, to climate change.
 Ensuring access to the environmental determinants of health, such as clean air, water and sanitation, safe and
nutritious food, is an essential protection against all health risks. WHO estimates that avoidable environmental
risks cause about a quarter of the global health burden.
 Early action saves lives. Delay in responding to clear evidence of threats, whether from pandemics, or from climate
change, increases human and socioeconomic costs.
 Inequality is a major barrier in ensuring health and wellbeing, especially for the most vulnerable in society. Social
and economic inequality manifests in unequal health risks. When faced with public health threats of a global scale,
such as COVID-19 or climate change, we are only as strong as our weakest health system.
How does water scarcity affect infectious diseases like COVID-19?
 Access to adequate and safe water and sanitation is essential for communities to practice basic hygiene and reduce
transmission of COVID-19. Access to these services in health facilities is crucial to preventing infections, reducing
the spread of antimicrobial resistance and providing quality care.

 One in four health care facilities around the world lacks basic water services, directly impacting over two billion
people. Around 80% of the world’s population is already experiencing some level of water scarcity. Climate change
further threatens the availability of water for consumption, food production, personal hygiene, and medical care,
including for infectious disease.
Key facts
 Climate change affects the social and environmental determinants of health – clean air, safe drinking water,
sufficient food and secure shelter.
 Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths per year,
from malnutrition, malaria, diarrhoea and heat stress.
 The direct damage costs to health (i.e. excluding costs in health-determining sectors such as agriculture and water
and sanitation), is estimated to be between USD 2-4 billion/year by 2030.
 Areas with weak health infrastructure – mostly in developing countries – will be the least able lto cope without
assistance to prepare and respond.
 Reducing emissions of greenhouse gases through better transport, food and energy-use choices can result in
improved health, particularly through reduced air pollution.
Climate change
Over the last 50 years, human activities – particularly the burning of fossil fuels – have released sufficient quantities of
carbon dioxide and other greenhouse gases to trap additional heat in the lower atmosphere and affect the global climate.
In the last 130 years, the world has warmed by approximately 0.85 oC. Each of the last 3 decades has been successively
warmer than any preceding decade since 1850(1).
Sea levels are rising, glaciers are melting and precipitation patterns are changing. Extreme weather events are becoming
more intense and frequent.
What is the impact of climate change on health?
Although global warming may bring some localized benefits, such as fewer winter deaths in temperate climates and
increased food production in certain areas, the overall health effects of a changing climate are overwhelmingly negative.
Climate change affects many of the social and environmental determinants of health – clean air, safe drinking water,
sufficient food and secure shelter.
Extreme heat
Extreme high air temperatures contribute directly to deaths from cardiovascular and respiratory disease, particularly among
elderly people. In the heat wave of summer 2003 in Europe for example, more than 70 000 excess deaths were recorded(2).
High temperatures also raise the levels of ozone and other pollutants in the air that exacerbate cardiovascular and
respiratory disease.
Pollen and other aeroallergen levels are also higher in extreme heat. These can trigger asthma, which affects around
300 million people. Ongoing temperature increases are expected to aggravate this burden.
Natural disasters and variable rainfall patterns
Globally, the number of reported weather-related natural disasters has more than tripled since the 1960s. Every year, these
disasters result in over 60 000 deaths, mainly in developing countries.
Rising sea levels and increasingly extreme weather events will destroy homes, medical facilities and other essential services.
More than half of the world's population lives within 60 km of the sea. People may be forced to move, which in turn
heightens the risk of a range of health effects, from mental disorders to communicable diseases.
Increasingly variable rainfall patterns are likely to affect the supply of fresh water. A lack of safe water can compromise
hygiene and increase the risk of diarrhoeal disease, which kills over 500 000 children aged under 5 years, every year. In
extreme cases, water scarcity leads to drought and famine. By the late 21st century, climate change is likely to increase the
frequency and intensity of drought at regional and global scale.(1)
Floods and extreme precipitation are also increasing in frequency and intensity.(1) Floods contaminate freshwater supplies,
heighten the risk of water-borne diseases, and create breeding grounds for disease-carrying insects such as mosquitoes. They
also cause drownings and physical injuries, damage homes and disrupt the supply of medical and health services.
Rising temperatures and variable precipitation are likely to decrease the production of staple foods in many of the poorest
regions. This will increase the prevalence of malnutrition and undernutrition, which currently cause 3.1 million deaths every
year.
Patterns of infection
Climatic conditions strongly affect water-borne diseases and diseases transmitted through insects, snails or other cold-
blooded animals.
Changes in climate are likely to lengthen the transmission seasons of important vector-borne diseases and to alter their
geographic range. For example, climate change is projected to widen significantly the area of China where the snail-borne
disease schistosomiasis occurs(3).

Malaria is strongly influenced by climate. Transmitted by Anopheles mosquitoes, malaria kills over 400 000 people every year
– mainly children under 5 years old in certain African countries. The Aedes mosquito vector of dengue is also highly sensitive
to climate conditions, and studies suggest that climate change is likely to continue to increase exposure to dengue.
Measuring the health effects
Measuring the health effects from climate change can only be very approximate. Nevertheless, a WHO assessment, taking
into account only a subset of the possible health impacts, and assuming continued economic growth and health progress,
concluded that climate change is expected to cause approximately 250 000 additional deaths per year between 2030 and
2050; 38 000 due to heat exposure in elderly people, 48 000 due to diarrhoea, 60 000 due to malaria, and 95 000 due to
childhood undernutrition.
Who is at risk?
All populations will be affected by climate change, but some are more vulnerable than others. People living in small island
developing states and other coastal regions, megacities, and mountainous and polar regions are particularly vulnerable.
Children – in particular, children living in poor countries – are among the most vulnerable to the resulting health risks and
will be exposed longer to the health consequences. The health effects are also expected to be more severe for elderly people
and people with infirmities or pre-existing medical conditions.
Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to
prepare and respond.
WHO response
Many policies and individual choices have the potential to reduce greenhouse gas emissions and produce major health co-
benefits. For example, cleaner energy systems, and promoting the safe use of public transportation and active movement –
such as cycling or walking as alternatives to using private vehicles – could reduce carbon emissions, and cut the burden of
household air pollution, which causes some 4.3 million deaths per year, and ambient air pollution, which causes about
3 million deaths every year.
In 2015, the WHO Executive Board endorsed a new work plan on climate change and health. This includes:
 Partnerships: to coordinate with partner agencies within the UN system, and ensure that health is properly
represented in the climate change agenda.
 Awareness raising: to provide and disseminate information on the threats that climate change presents to human
health, and opportunities to promote health while cutting carbon emissions.
 Science and evidence: to coordinate reviews of the scientific evidence on the links between climate change and
health, and develop a global research agenda.
 Support for implementation of the public health response to climate change: to assist countries in building capacity
to reduce health vulnerability to climate change, and promote health while reducing carbon emissions.
 Healthy communities rely on well-functioning ecosystems. They provide clean air, fresh water, medicines and food
security. They also limit disease and stabilize the climate. But biodiversity loss is happening at unprecedented
rates, impacting human health worldwide, according to a state of knowledge report jointly published by the
Convention on Biological Diversity (CBD) and the World Health Organization (WHO).
 What is biodiversity?
 Biodiversity underpins all life on Earth, and refers to biological variety in all its forms, from the genetic make up of
plants and animals to cultural diversity.

 What does biodiversity mean for human health?
 People depend on biodiversity in their daily lives, in ways that are not always apparent or appreciated. Human
health ultimately depends upon ecosystem products and services (such as availability of fresh water, food and fuel
sources) which are requisite for good human health and productive livelihoods. Biodiversity loss can have
significant direct human health impacts if ecosystem services are no longer adequate to meet social needs.
Indirectly, changes in ecosystem services affect livelihoods, income, local migration and, on occasion, may even
cause or exacerbate political conflict.
 Additionally, biological diversity of microorganisms, flora and fauna provides extensive benefits for biological,
health, and pharmacological sciences. Significant medical and pharmacological discoveries are made through
greater understanding of the earth's biodiversity. Loss in biodiversity may limit discovery of potential treatments
for many diseases and health problems.

 Threats to biodiversity and health
 There is growing concern about the health consequences of biodiversity loss. Biodiversity changes affect ecosystem
functioning and significant disruptions of ecosystems can result in life sustaining ecosystem goods and services.
Biodiversity loss also means that we are losing, before discovery, many of nature's chemicals and genes, of the kind
that have already provided humankind with enormous health benefits.

 Nutritional impact of biodiversity
 Biodiversity plays a crucial role in human nutrition through its influence on world food production, as it ensures the
sustainable productivity of soils and provides the genetic resources for all crops, livestock, and marine species
harvested for food. Access to a sufficiency of a nutritious variety of food is a fundamental determinant of health.
 Nutrition and biodiversity are linked at many levels: the ecosystem, with food production as an ecosystem service;
the species in the ecosystem and the genetic diversity within species. Nutritional icomposition between foods and
among varieties/cultivars/breeds of the same food can differ dramatically, affecting micronutrient availability in
the diet. Healthy local diets, with adequate average levels of nutrients intake, necessitates maintenance of high
biodiversity levels.
 Intensified and enhanced food production through irrigation, use of fertilizer, plant protection (pesticides) or the
introduction of crop varieties and cropping patterns affect biodiversity, and thus impact global nutritional status
and human health. Habitat simplification, species loss and species succession often enhance communities
vulnerabilities as a function of environmental receptivity to ill health.

 Importance of biodiversity for health research and traditional medicine
 Traditional medicine continue to play an essential role in health care, especially in primary health care. Traditional
medicines are estimated to be used by 60% of the world’s population and in some countries are extensively
incorporated into the public health system. Medicinal plant use is the most common medication tool in traditional
medicine and complementary medicine worldwide. Medicinal plants are supplied through collection from wild
populations and cultivation. Many communities rely on natural products collected from ecosystems for medicinal
and cultural purposes, in addition to food.
 Although synthetic medicines are available for many purposes, the global need and demand for natural products
persists for use as medicinal products and biomedical research that relies on plants, animals and microbes to
understand human physiology and to understand and treat human diseases.

 Infectious diseases
 Human activities are disturbing both the structure and functions of ecosystems and altering native biodiversity.
Such disturbances reduce the abundance of some organisms, cause population growth in others, modify the
interactions among organisms, and alter the interactions between organisms and their physical and chemical
environments. Patterns of infectious diseases are sensitive to these disturbances. Major processes affecting
infectious disease reservoirs and transmission include, deforestation; land-use change; water management e.g.
through dam construction, irrigation, uncontrolled urbanization or urban sprawl; resistance to pesticide chemicals
used to control certain disease vectors; climate variability and change; migration and international travel and
trade; and the accidental or intentional human introduction of pathogens.

 Climate change, biodiversity and health
 Biodiversity provides numerous ecosystem services that are crucial to human well-being at present and in the
future. Climate is an integral part of ecosystem functioning and human health is impacted directly and indirectly by
results of climatic conditions upon terrestrial and marine ecosystems. Marine biodiversity is affected by ocean
acidification related to levels of carbon in the atmosphere. Terrestrial biodiversity is influenced by climate
variability, such as extreme weather events (ie drought, flooding) that directly influence ecosystem health and the
productivity and availability of ecosystem goods and services for human use. Longer term changes in climate affect
the viability and health of ecosystems, influencing shifts in the distribution of plants, pathogens, animals, and even
human settlements.

Key Facts
 Biodiversity provides many goods and services essential to life on earth. The management of natural resources can
determine the baseline health status of a community. Environmental stewardship can contribute to secure
livelihoods and improve the resilience of communities. The loss of these resources can create the conditions
responsible for morbidity or mortality.
 Biodiversity supports human and societal needs, including food and nutrition security, energy, development of
medicines and pharmaceuticals and freshwater, which together underpin good health. It also supports economic
opportunities, and leisure activities that contribute to overall wellbeing.
 Land use change, pollution, poor water quality, chemical and waste contamination, climate change and other
causes of ecosystem degradation all contribute to biodiversity loss and, can pose considerable threats to human
health.
 Human health and well-being are influenced by the health of local plant and animal communities, and the integrity
of the local ecosystems that they form.
 Infectious diseases cause over one billion human infections per year, with millions of deaths each year globally.
Approximately two thirds of known human infectious diseases are shared with animals, and the majority of
recently emerging diseases are associated with wildlife.
 Heat and Health
1 June 2018
Key facts
 Population exposure to heat is increasing due to climate change, and this trend will continue. Globally, extreme
temperature events are observed to be increasing in their frequency, duration, and magnitude. Between 2000 and
2016, the number of people exposed to heat waves increased by around 125 million. In 2015 alone, 175 million
additional people were exposed to heat waves compared to average years.
 Single events can last weeks, occur consecutively, and result in significant excess mortality. In 2003, 70,000 people
in Europe died as a result of the June-August event, in 2010, 56,000 excess deaths occurred during a 44-day heatwave
in the Russian Federation.
 Exposure to excessive heat has wide ranging physiological impacts for all humans, often amplifying existing
conditions and resulting in premature death and disability.
 The negative health impacts of heat are predictable and largely preventable with specific public health actions.
WHO has issued public health guidance for the general public and medical professionals on coping with extreme heat.
Overview
Global temperatures and the frequency and intensity of heatwaves will rise in the 21st century as a result of climate change.
Extended periods of high day and nighttime temperatures create cumulative physiological stress on the human body which
exacerbates the top causes of death globally, including respiratory and cardiovascular diseases, diabetes mellitus and renal
disease. Heatwaves can acutely impact large populations for short periods of time, often trigger public health emergencies,
and result in excess mortality, and cascading socioeconomic impacts (e.g. lost work capacity and labor productivity). They
can also cause loss of health service delivery capacity, where power-shortages which often accompany heatwaves disrupt
health facilities, transport, and water infrastructure.
Awareness remains insufficient of the health risks posed by heatwaves and prolonged exposure to increased temperatures.
Health professionals must adjust their planning and interventions to account for increasing temperatures and heatwaves.
Practical, feasible, and often low-cost interventions at the individual, community, organizational, governmental and societal
levels, can save lives
Who is affected?
Rising global ambient temperatures affect all populations. However, some populations are more exposed to, or more
physiologically or socio-economically vulnerable to physiological stress, exacerbated illness, and an increased risk of death
from exposure to excess heat. These include the elderly, infants and children, pregnant women, outdoor and manual
workers, athletes, and the poor. Gender can play an important role in determining heat exposure
How does heat impact health?

Heat gain in the human body can be caused by a combination of external heat from the environment and internal body heat
generated from metabolic processes. Rapid rises in heat gain due to exposure to hotter than average conditions
compromises the body’s ability to regulate temperature and can result in a cascade of illnesses, including heat cramps, heat
exhaustion, heatstroke, and hyperthermia.
Deaths and hospitalizations from heat can occur extremely rapidly (same day), or have a lagged effect (several days later)
and result in accelerating death or illness in the already frail, particularly observed in the first days of heatwaves. Even small
differences from seasonal average temperatures are associated with increased illness and death. Temperature extremes can
also worsen chronic conditions, including cardiovascular, respiratory, and cerebrovascular disease and diabetes-related
conditions.
Heat also has important indirect health effects. Heat conditions can alter human behavior, the transmission of diseases,
health service delivery, air quality, and critical social infrastructure such as energy, transport, and water. The scale and
nature of the health impacts of heat depend on the timing, intensity and duration of a temperature event, the level of
acclimatization, and the adaptability of the local population, infrastructure and institutions to the prevailing climate. The
precise threshold at which temperature represents a hazardous condition varies by region, other factors such as humidity
and wind, local levels of human acclimatization and preparedness for heat conditions.
What actions should the public take?
Keep your home cool
 Aim to keep your living space cool. Check the room temperature between 08:00 and 10:00, at 13:00 and at night
after 22:00. Ideally, the room temperature should be kept below 32 °C during the day and 24 °C during the night. This
is especially important for infants or people who are over 60 years of age or have chronic health conditions.
 Use the night air to cool down your home. Open all windows and shutters during the night and the early morning,
when the outside temperature is lower (if safe to do so).
 Reduce the heat load inside the apartment or house. Close windows and shutters (if available) especially those
facing the sun during the day. Turn off artificial lighting and as many electrical devices as possible.
 Hang shades, draperies, awnings or louvers on windows that receive morning or afternoon sun.
 Hang wet towels to cool down the room air. Note that the humidity of the air increases at the same time.
 If your residence is air conditioned, close the doors and windows and conserve electricity not needed to keep you
cool, to ensure that power remains available and reduce the chance of a community-wide outage.
 Electric fans may provide relief, but when the temperature is above 35 °C, may not prevent heat-related illness. It is
important to drink fluids.
Keep out of the heat
 Move to the coolest room in the home, especially at night.

 If it is not possible to keep your home cool, spend 2–3 hours of the day in a cool place (such as an airconditioned
public building).
 Avoid going outside during the hottest time of the day.
 Avoid strenuous physical activity if you can. If you must do strenuous activity, do it during the coolest part of the
day, which is usually in the morning between 4:00 and 7:00.
 Stay in the shade.
 Do not leave children or animals in parked vehicles.
Keep the body cool and hydrated
 Take cool showers or baths. Alternatives include cold packs and wraps, towels, sponging, foot baths, etc.
 Wear light, loose-fitting clothes of natural materials. If you go outside, wear a wide-brimmed hat or cap and
sunglasses.
 Use light bed linen and sheets, and no cushions, to avoid heat accumulation.
 Drink regularly, but avoid alcohol and too much caffeine and sugar.
 Eat small meals and eat more often. Avoid foods that are high in protein
Help others
 Plan to check on family, friends, and neighbours who spend much of their time alone. Vulnerable people might
need assistance on hot days.
 Discuss extreme heat-waves with your family. Everyone should know what to do in the places where they spend
time.
 If anyone you know is at risk, help him or her to get advice and support. Elderly or sick people living alone should
be visited at least daily.
 If a person is taking medication, ask the treating doctor how it can influence thermoregulation and the fluid
balance.
 Get training. Take a first-aid course to learn how to treat heat emergencies and other emergencies. Everyone
should know how to respond.
If you have health problems
 Keep medicines below 25 °C or in the refrigerator (read the storage instructions on the packaging).
 Seek medical advice if you are suffering from a chronic medical condition or taking multiple medications.
If you or others feel unwell
 Try to get help if you feel dizzy, weak, anxious or have intense thirst and headache; move to a cool place as soon as
possible and measure your body temperature.
 Drink some water or fruit juice to rehydrate.
 Rest immediately in a cool place if you have painful muscular spasms (particularly in the legs, arms or abdomen, in
many cases after sustained exercise during very hot weather), and drink oral rehydration solutions containing
electrolytes. Medical attention is needed if heat cramps last more than one hour.
 Consult your doctor if you feel unusual symptoms or if symptoms persist. If one of your family members or people
you assist presents hot dry skin and delirium, convulsions and/or unconsciousness, call a doctor/ambulance
immediately. While waiting for help, move the person to a cool place, put him or her in a horizontal position and
elevate legs and hips, remove clothing and initiate external cooling, for example, by placing cold packs on the neck,
axillae and groin, fanning continuously and spraying the skin with water at 25–30 °C. Measure the body temperature.
Do not give acetylsalicylic acid or paracetamol. Position an unconscious person on his or her side.
Climate change
 Overview
 WHO response
 WHO Resolutions

Climate change is impacting human lives and health in a variety of ways. It threatens the essential ingredients of good health
- clean air, safe drinking water, nutritious food supply, and safe shelter - and has the potential to undermine decades of
progress in global health.

Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths per year, from
malnutrition, malaria, diarrhoea and heat stress alone. The direct damage costs to health is estimated to be between USD 2-
4 billion per year by 2030.

Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to
prepare and respond. WHO supports countries in building climate-resilient health systems and tracking national progress in
protecting health from climate change.

Reducing emissions of greenhouse gases through better transport, food and energy-use choices results in improved health,
particularly through reduced air pollution. The Paris Agreement on climate change is therefore potentially the strongest
health agreement of this century. WHO supports countries in assessing the health gains that would result from the
implementation of the existing Nationally Determined Contributions to the Paris Agreement, and the potential for larger
gains from more ambitious climate action.
Many policies and individual choices have the potential to reduce greenhouse gas emissions and produce major health co-
benefits. The phase out of polluting energy systems, for example, or the promotion of public transportation and active
movement, could both reduce carbon emissions and cut the burden of household and ambient air pollution, which cause 7
million premature deaths per year.

WHO’s work plan on climate change and health includes:
 Advocacy & Partnerships: to coordinate with partner agencies within the UN system, and ensure that health is
properly represented in the climate change agenda, as well as to provide and disseminate information on the
threats that climate change presents to human health, and opportunities to promote health while cutting carbon
emissions;
 Monitoring science and evidence: to coordinate reviews of the scientific evidence on the links between climate
change and health; assess country's preparedness and needs when facing climate change; and to develop a global
research agenda;
 Supporting countries to protect human health from climate change: strengthening national capacities and
improving the resilience and adaptive capacity of health systems to deal with the adverse health effects of climate
change
 Building capacity on climate change and human health: to assist countries to build capacity to reduce health
vulnerability to climate change, and promote health while reducing carbon emissions.

HO considers climate change an urgent, global health challenge that requires prioritized action now and in the decades to
come. Through its resolutions, strategies and workplans, WHO and its Member States work multilaterally towards protecting
the health and well-being of all people from the impacts of climate change.
WHO global strategy on health, environment and climate change 2019 – 2023: A new WHO global strategy on health,
environment and climate change was approved by member states in 2019 at the 72nd Annual World Health Assembly for the
period 2019–2023, outlining the transformation needed to improve lives and well-being sustainably through healthy
environments.
WHO plan of action on climate change and health in small island developing States 2019 – 2023: With small island
developing States (SIDS) being extremely vulnerable to the health impacts of climate change, WHO’s member states
approved a WHO global plan of action on climate change and health in small island developing States in 2019 for the period
2019–2023.
WHO 13th General Programme of Work 13 (2019 - 2023): As part of WHO’s General Programme of Work 13 (2019 - 2023),
WHO is contributing to the global agenda on health, environment and climate change through it strategic priority of
Promoting Healthier Populations.
Report on Health, Environment and Climate Change by the Director-General (2018): Report by the Director-General outlining
the combination of both new and long-standing environmental and health challenges Member States are facing.
WHO workplan on climate change and health 2014 - 2019: WHO’s climate change and health workplan for 2014 – 2019
prioritized climate action through four main objectives: 1.advocate and raise awareness, 2. strengthen partnerships, 3.
enhance scientific evidence, 4. strengthen health system
EB139 Progress Report on Climate Change and Health: A 2016 progress report on climate change and health by the Executive
Board highlighted the role of the global health community in implementing the Paris Agreement.
WHO workplan on climate change and health 2008 – 2013: WHO’s climate change and health workplan for 2014 – 2019
defined activities under the objectives of advocacy, partnerships, science and evidence, and health system strengthening.
The workplan was developed on request by Member States urging increased action.
Climate change and health resolution WHA 61.19 (2008): Resolution on climate change and health at the Sixty-first World
Health Assembly on the serious risk of climate change to global health and necessary actions by WHO and Member States.
Report by the Secretariat on Climate Change & Health (2008): Report by the WHO Secretariat highlighting the profoundly
adverse ways in which climate change will affect some of the most fundamental determinants of health, and the
international response necessary to protect health from climate change.

Global Health Estimates: Life expectancy and leading causes of death and disability
WHO’s Global Health Estimates provide the latest available data on causes of death and disability globally, by WHO region
and country, by age, sex and by income group.
These estimates are produced using data from multiple sources, including national vital registration data, latest estimates
from WHO technical programmes, United Nations partners and inter-agency groups, the Global Burden of Disease and other
scientific studies. Before publishing, the GHE are reviewed by WHO Member States via consultation with national focal
points and WHO country and regional offices.
Top 10 global causes of death in 2019
1. Ischaemic heart disease

2. Stroke
3. Chronic obstructive pulmonary disease
4. Lower respiratory infections
5. Neonatal conditions
6. Trachea, bronchus, lung cancers
7. Alzheimer disease and other dementias
8. Diarrhoeal diseases
9. Diabetes mellitus
10. Kidney diseases
Top 10 global causes of disability-adjusted life years (DALYs) in 2019

1. Neonatal conditions
2. Ischaemic heart disease
3. Stroke
4. Lower respiratory infections
5. Diarrhoeal diseases
6. Road injury
7. Chronic obstructive pulmonary disease
8. Diabetes mellitus
9. Tuberculosis
10. Congenital anomalies
Causes of death by sex
For death and disability disaggregated by sex, annual global deaths and DALYs among women were around 15% lower than
for men. However, women collectively spent about 20% more years living with disability (YLDs). In the past two decades, the
greatest increase in female deaths has been from Alzheimer’s disease and other dementias, with nearly a threefold increase.
These neurological disorders kill more females than males, with about 80% more deaths and 70% more DALYs for women
than for men.
Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness affecting humans and
other primates.
The virus is transmitted to people from wild animals (such as fruit bats, porcupines and non-human primates) and then
spreads in the human population through direct contact with the blood, secretions, organs or other bodily fluids of infected
people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.
The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.
The first EVD outbreaks occurred in remote villages in Central Africa, near tropical rainforests. The 2014–2016 outbreak in
West Africa was the largest and most complex Ebola outbreak since the virus was first discovered in 1976. There were more
cases and deaths in this outbreak than all others combined. It also spread between countries, startlingly in Guinea then
moving across land borders to Sierra Leone and Liberia.
It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts.
Ebola virus disease
23 February 2021
 Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a rare but severe, often fatal illness in
humans.
 The virus is transmitted to people from wild animals and spreads in the human population through human-to-
human transmission.
 The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past
outbreaks.
 Community engagement is key to successfully controlling outbreaks.
 Good outbreak control relies on applying a package of interventions, namely case management, infection
prevention and control practices, surveillance and contact tracing, a good laboratory service, safe and dignified burials
and social mobilisation.
 Vaccines to protect against Ebola have been developed and have been used to help control the spread of Ebola
outbreaks in Guinea and in the Democratic Republic of the Congo (DRC).
 Early supportive care with rehydration, symptomatic treatment improves survival. Two monoclonal antibodies
(Inmazeb and Ebanga) were approved for the treatment of Zaire ebolavirus (Ebolavirus) infection in adults and
children by the US Food and Drug Administration in late 2020.
 Pregnant and breastfeeding women with Ebola should be offered early supportive care. Likewise vaccine
prevention and experimental treatment should be offered under the same conditions as for non-pregnant population.
The Ebola virus causes an acute, serious illness which is often fatal if untreated. EVD first appeared in 1976 in 2 simultaneous
outbreaks, one in what is now Nzara, South Sudan, and the other in Yambuku, DRC. The latter occurred in a village near the
Ebola River, from which the disease takes its name.
The 2014–2016 outbreak in West Africa was the largest Ebola outbreak since the virus was first discovered in 1976. The
outbreak started in Guinea and then moved across land borders to Sierra Leone and Liberia.
The virus family Filoviridae includes three genera: Cuevavirus, Marburgvirus, and Ebolavirus. Within the genus Ebolavirus, six
species have been identified: Zaire, Bundibugyo, Sudan, Taï Forest, Reston and Bombali.
Transmission
It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the human
population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as fruit
bats, chimpanzees, gorillas, monkeys, forest antelope or porcupines found ill or dead or in the rainforest.
Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes)
with:
 Blood or body fluids of a person who is sick with or has died from Ebola
 Objects that have been contaminated with body fluids (like blood, feces, vomit) from a person sick with Ebola or
the body of a person who died from Ebola
Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This occurs
through close contact with patients when infection control precautions are not strictly practiced.
Burial ceremonies that involve direct contact with the body of the deceased can also contribute in the transmission of Ebola.
People remain infectious as long as their blood contains the virus.
Pregnant women who get acute Ebola and recover from the disease may still carry the virus in breastmilk, or in pregnancy
related fluids and tissues. This poses a risk of transmission to the baby they carry, and to others. Women who become
pregnant after surviving Ebola disease are not at risk of carrying the virus.
If a breastfeeding woman who is recovering from Ebola wishes to continue breastfeeding, she should be supported to do so.
Her breast milk needs to be tested for Ebola before she can start.
Symptoms
The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is from 2 to 21 days. A
person infected with Ebola cannot spread the disease until they develop symptoms.
Symptoms of EVD can be sudden and include:

 Fever
 Fatigue
 Muscle pain
 Headache
 Sore throat
This is followed by:
 Vomiting
 Diarrhoea
 Rash
 Symptoms of impaired kidney and liver function
 In some cases, both internal and external bleeding (for example, oozing from the gums, or blood in the stools).
 Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.
Diagnosis
It can be difficult to clinically distinguish EVD from other infectious diseases such as malaria, typhoid fever and meningitis.
Many symptoms of pregnancy and Ebola disease are also quite similar. Because of risks to the pregnancy, pregnant women
should ideally be tested rapidly if Ebola is suspected.
Confirmation that symptoms are caused by Ebola virus infection are made using the following diagnostic methods:
 antibody-capture enzyme-linked immunosorbent assay (ELISA)

 antigen-capture detection tests
 serum neutralization test
 reverse transcriptase polymerase chain reaction (RT-PCR) assay
 electron microscopy
 ·virus isolation by cell culture.
Careful consideration should be given to the selection of diagnostic tests, which take into account technical specifications,
disease incidence and prevalence, and social and medical implications of test results. It is strongly recommended that
diagnostic tests, which have undergone an independent and international evaluation, be considered for use.
Diagnostic tests evaluated through the WHO Emergency Use Assessment and Listing process
Current WHO recommended tests include:
 Automated or semi-automated nucleic acid tests (NAT) for routine diagnostic management.
 Rapid antigen detection tests for use in remote settings where NATs are not readily available. These tests are
recommended for screening purposes as part of surveillance activities, however reactive tests should be confirmed
with NATs.
The preferred specimens for diagnosis include:

 Whole blood collected in ethylenediaminetetraacetic acid (EDTA) from live patients exhibiting symptoms.
 Oral fluid specimen stored in universal transport medium collected from deceased patients or when blood
collection is not possible.
Samples collected from patients are an extreme biohazard risk; laboratory testing on non-inactivated samples should be
conducted under maximum biological containment conditions. All biological specimens should be packaged using the triple
packaging system when transported nationally and internationally.
Treatment
Supportive care - rehydration with oral or intravenous fluids - and treatment of specific symptoms improves survival. A range
of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated.
In the 2018-2020 Ebola outbreak in DRC, the first-ever multi-drug randomized control trial was conducted to evaluate the
effectiveness and safety of drugs used in the treatment of Ebola patients under an ethical framework developed in
consultation with experts in the field and the DRC.
Two monoclonal antibodies (Inmazeb and Ebanga) were approved for the treatment of Zaire ebolavirus (Ebolavirus)
infection in adults and children by the US Food and Drug Administration in late 2020.
Vaccines
The Ervebo vaccine has been shown to be effective in protecting people from the species Zaire ebolavirus, and is
recommended by the Strategic Advisory Group of Experts on Immunization as part of a broader set of Ebola outbreak
response tools. In December 2020, the vaccine was approved by the US Food and Drug Administration and prequalified by
WHO for use in individuals 18 years of age and older (except for pregnant and breastfeeding women) for protection against
Ebola virus disease caused by Zaïre Ebola virus.
The vaccine had been administrated to more than 350 000 people in Guinea and in the 2018-2020 Ebola virus disease
outbreaks in the Democratic Republic of the Congo under “compassionate use” protocol. The vaccine has shown to safe and
effective against the species Zaire ebolavirus. A global stockpile of the Ervebo vaccine has become available starting January
2021.
In May 2020, the European Medicines Agency recommended granting marketing authorization for a 2-component vaccine
called Zabdeno-and-Mvabea for individuals 1 year and older.
The vaccine is delivered in 2 doses: Zabdeno is administered first and Mvabea is given approximately 8 weeks later as a
second dose. This prophylactic 2-dose regimen is therefore not suitable for an outbreak response where immediate
protection is necessary.
Prevention and control
Good outbreak control relies on applying a package of interventions, including case management, surveillance and contact
tracing, a good laboratory service, safe burials and social mobilisation. Community engagement is key to successfully
controlling outbreaks. Raising awareness of risk factors for Ebola infection and protective measures (including vaccination)
that individuals can take is an effective way to reduce human transmission. Risk reduction messaging should focus on several
factors:
 Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats, monkeys, apes, forest
antelope or porcupines and the consumption of their raw meat. Animals should be handled with gloves and other
appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.
 Reducing the risk of human-to-human transmission from direct or close contact with people with Ebola symptoms,
particularly with their bodily fluids. Gloves and appropriate personal protective equipment should be worn when
taking care of ill patients. Regular hand washing is required after visiting patients in hospital, as well as after taking
care of patients at home.
 Outbreak containment measures, including safe and dignified burial of the dead, identifying people who may have
been in contact with someone infected with Ebola and monitoring their health for 21 days, the importance of
separating the healthy from the sick to prevent further spread, and the importance of good hygiene and maintaining a
clean environment.
 Reducing the risk of possible sexual transmission, based on further analysis of ongoing research and consideration
by the WHO Advisory Group on the Ebola Virus Disease Response, WHO recommends that male survivors of EVD
practice safer sex and hygiene for 12 months from onset of symptoms or until their semen tests negative twice for
Ebola virus. Contact with body fluids should be avoided and washing with soap and water is recommended. WHO
does not recommend isolation of male or female convalescent patients whose blood has been tested negative for
Ebola virus.
 Reducing the risk of transmission from pregnancy related fluids and tissue, Pregnant women who have survived
Ebola disease need community support to enable them to attend frequent antenatal care (ANC) visits, to handle any
pregnancy complications and meet their need for sexual and reproductive care and delivery in a safe way. This should
be planned together with the Ebola and Obstetric health care expertise. Pregnant women should always be respected
in the sexual and reproductive health choices they make.
Controlling infection in health-care settings
Health-care workers should always take standard precautions when caring for patients, regardless of their presumed
diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or
other contact with infected materials), safe injection practices and safe burial practices.
Health-care workers caring for patients with suspected or confirmed Ebola virus should apply extra infection control
measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as
clothing and bedding. When in close contact (within 1 metre) of patients with EVD, health-care workers should wear face
protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for
some procedures).
Healthcare staff working with ANC or obstetric care should be informed about risks of persisting virus in pregnancy related
fluids and encouraged to follow protocol for their own safety and the safety of the women they are caring for.
Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Ebola infection should be
handled by trained staff and processed in suitably equipped laboratories.
Care for people who recovered from EVD

A number of medical complications have been reported in people who recovered from Ebola, including mental health issues.
Ebola virus may persist in some body fluids, including semen, pregnancy-related fluids and breast milk.
Ebola survivors need comprehensive support for the medical and psychosocial challenges they face and also to minimize the
risk of continued Ebola virus transmission. To address these needs, a dedicated programme can be set up for care for people
who recovered from Ebola.
 For more, read the Guidance on clinical care for survivors of Ebola virus disease
Ebola virus is known to persist in immune-privileged sites in some people who have recovered from Ebola virus disease.
These sites include the testicles, the inside of the eye, and the central nervous system. In women who have been infected
while pregnant, the virus persists in the placenta, amniotic fluid and fetus. In women who have been infected while
breastfeeding, the virus may persist in breast milk.
 For more information on pregnant and breastfeeding women recovering from Ebola virus disease please read the
Guideline
Relapse-symptomatic illness in someone who has recovered from EVD due to increased replication of the virus in a specific
site is a rare event, but has been documented. Reasons for this phenomenon are not yet fully understood.
Studies of viral persistence indicate that in a small percentage of survivors, some body fluids may test positive on reverse
transcriptase polymerase chain reaction (RT-PCR) testing for Ebola virus for longer than 9 months.
More surveillance data and research are needed on the risks of sexual transmission, and particularly on the prevalence of
viable and transmissible virus in semen over time. In the interim, and based on present evidence, WHO recommends that:
 All Ebola survivors and their sexual partners should receive counselling to ensure safer sexual practices until their
semen has twice tested negative. Survivors should be provided with condoms.
 Male Ebola survivors should be offered semen testing at 3 months after onset of disease, and then, for those who
test positive, every month thereafter until their semen tests negative for virus twice by RT-PCR, with an interval of one
week between tests.
 Ebola survivors and their sexual partners should either:
o abstain from all types of sex, or
o observe safer sex through correct and consistent condom use until their semen has twice tested negative.
 Having tested negative, survivors can safely resume normal sexual practices without fear of Ebola virus
transmission.
 Based on further analysis of ongoing research and consideration by the WHO Advisory Group on the Ebola Virus
Disease Response, WHO recommends that male survivors of Ebola virus disease practice safe sex and hygiene for 12
months from onset of symptoms or until their semen tests negative twice for Ebola virus.
 Until such time as their semen has twice tested negative for Ebola, survivors should practice good hand and
personal hygiene by immediately and thoroughly washing with soap and water after any physical contact with semen,
including after masturbation. During this period, used condoms should be handled safely, and safely disposed of, so as
to prevent contact with seminal fluids.
 All survivors, their partners and families should be shown respect, dignity and compassion.
Interim advice on the sexual transmission of the Ebola virus disease

WHO response
WHO aims to prevent Ebola outbreaks by maintaining surveillance for Ebola virus disease and supporting at-risk countries to
develop preparedness plans. This document provides overall guidance for control of Ebola and Marburg virus outbreaks:
 Ebola and Marburg virus disease epidemics: preparedness, alert, control, and evaluation
When an outbreak is detected WHO responds by supporting community engagement, disease detection, contact tracing,
vaccination, case management, laboratory services, infection control, logistics, and training and assistance with safe and
dignified burial practices.
WHO has developed detailed advice on Ebola infection prevention and control:
 Infection prevention and control guidance for care of patients with suspected or confirmed Filovirus haemorrhagic
fever in health-care settings, with focus on Ebola
 Table: Chronology of previous Ebola virus disease outbreaks
Year Country EVD Cases Deaths Case fatality

2021 Guinea Zaire Ongoing
Democratic Republic of the
2021 Zaire Ongoing
Congo
2020 Zaire 130 55 42%
Congo
2018-2020 Zaire 3481 2299 66%
Congo
2018 Zaire 54 33 61%
Congo
2017 Zaire 8 4 50%
Congo
2015 Italy Zaire 1 0 0%
2014 Spain Zaire 1 0 0%
2014 UK Zaire 1 0 0%
2014 USA Zaire 4 1 25%
2014 Senegal Zaire 1 0 0%
2014 Mali Zaire 8 6 75%
2014 Nigeria Zaire 20 8 40%
2014-2016 Sierra Leone Zaire 14124* 3956* 28%
2014-2016 Liberia Zaire 10675* 4809* 45%
2014-2016 Guinea Zaire 3811* 2543* 67%
2014
Congo
2012 Bundibugyo 57 29 51%
Congo
2012 Uganda Sudan 7 4 57%
2008 Zaire 32 14 44%
Congo
2007 Uganda Bundibugyo 149 37 25%
2007 Zaire 264 187 71%
Congo
2005 Congo Zaire 12 10 83%
2004 Sudan Sudan 17 7 41%
2003 (Nov-Dec) Congo Zaire 35 29 83%
2003 (Jan-Apr) Congo Zaire 143 128 90%
2001-2002 Congo Zaire 59 44 75%
2001-2002 Gabon Zaire 65 53 82%
2000 Uganda Sudan 425 224 53%
1996 South Africa (ex-Gabon) Zaire 1 1 100%
1996 (Jul-Dec) Gabon Zaire 60 45 75%
1996 (Jan-Apr) Gabon Zaire 31 21 68%
1995 Zaire 315 254 81%
Congo
1994 Côte d'Ivoire Taï Forest 1 0 0%
1994 Gabon Zaire 52 31 60%
1979 Sudan Sudan 34 22 65%
1977 Zaire 1 1 100%
Congo
1976 Sudan Sudan 284 151 53%
1976 Zaire 318 280 88%
Congo
* Include Suspect, Probable and Confirmed EVD cases.
Air pollution kills an estimated seven million people worldwide every year. WHO data shows that 9 out of 10 people breathe
air that exceeds WHO guideline limits containing high levels of pollutants, with low- and middle-income countries suffering
from the highest exposures. WHO is supporting countries to address air pollution.
From smog hanging over cities to smoke inside the home, air pollution poses a major threat to health and climate. The
combined effects of ambient (outdoor) and household air pollution cause about seven million premature deaths every year,
largely as a result of increased mortality from stroke, heart disease, chronic obstructive pulmonary disease, lung cancer and
acute respiratory infections.
Hepatitis is an inflammation of the liver that is caused by a variety of infectious viruses and noninfectious agents leading to a
range of health problems, some of which can be fatal. There are five main strains of the hepatitis virus, referred to as types
A, B, C, D and E. While they all cause liver disease, they differ in important ways including modes of transmission, severity of
the illness, geographical distribution and prevention methods. In particular, types B and C lead to chronic disease in
hundreds of millions of people and together are the most common cause of liver cirrhosis, liver cancer and viral hepatitis-
related deaths. An estimated 354 million people worldwide live with hepatitis B or C, and for most, testing and treatment
remain beyond reach.
Some types of hepatitis are preventable through vaccination. A WHO study found that an estimated 4.5 million premature
deaths could be prevented in low- and middle-income countries by 2030 through vaccination, diagnostic tests, medicines and
education campaigns. WHO’s global hepatitis strategy, endorsed by all WHO Member States, aims to reduce new hepatitis
infections by 90% and deaths by 65% between 2016 and 2030.
Hepatitis A
27 July 2020
Key facts
 Hepatitis A is an inflammation of the liver that can cause mild to severe illness.
 The hepatitis A virus (HAV) is transmitted through ingestion of contaminated food and water or through direct
contact with an infectious person.
 Almost everyone recovers fully from hepatitis A with a lifelong immunity. However, a very small proportion of
people infected with hepatitis A could die from fulminant hepatitis.
 The risk of hepatitis A infection is associated with a lack of safe water and poor sanitation and hygiene (such as
contaminated and dirty hands).
 A safe and effective vaccine is available to prevent hepatitis A.
Overview
Hepatitis A is an inflammation of the liver caused by the hepatitis A virus (HAV). The virus is primarily spread when an
uninfected (and unvaccinated) person ingests food or water that is contaminated with the faeces of an infected person. The
disease is closely associated with unsafe water or food, inadequate sanitation, poor personal hygiene and oral-anal sex.
Unlike hepatitis B and C, hepatitis A does not cause chronic liver disease but it can cause debilitating symptoms and rarely
fulminant hepatitis (acute liver failure), which is often fatal. WHO estimates that in 2016, 7134 persons died from hepatitis A
worldwide (accounting for 0.5% of the mortality due to viral hepatitis).
Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. Epidemics related to
contaminated food or water can erupt explosively, such as the epidemic in Shanghai in 1988 that affected about 300 000
people (1). They can also be prolonged, affecting communities for months through person-to-person transmission. Hepatitis
A viruses persist in the environment and can withstand food production processes routinely used to inactivate or control
bacterial pathogens.
Geographical distribution
Geographical distribution areas can be characterized as having high, intermediate or low levels of hepatitis A virus infection.
However, infection does not always mean disease because infected young children do not experience any noticeable
symptoms.
Infection is common in low- and middle-income countries with poor sanitary conditions and hygienic practices, and most
children (90%) have been infected with the hepatitis A virus before the age of 10 years, most often without symptoms (2).
Infection rates are low in high-income countries with good sanitary and hygienic conditions. Disease may occur among
adolescents and adults in high-risk groups, such as persons who inject drugs (PWID), men who have sex with men (MSM),
people travelling to areas of high endemicity and in isolated populations, such as closed religious groups. In the United States
of America, large outbreaks have been reported among persons experiencing homelessness. In middle-income countries and
regions where sanitary conditions are variable, children often escape infection in early childhood and reach adulthood
without immunity.
Transmission
The hepatitis A virus is transmitted primarily by the faecal-oral route; that is when an uninfected person ingests food or
water that has been contaminated with the faeces of an infected person. In families, this may happen though dirty hands
when an infected person prepares food for family members. Waterborne outbreaks, though infrequent, are usually
associated with sewage-contaminated or inadequately treated water.
The virus can also be transmitted through close physical contact (such as oral-anal sex) with an infectious person, although
casual contact among people does not spread the virus.
Symptoms
The incubation period of hepatitis A is usually 14–28 days.
Symptoms of hepatitis A range from mild to severe and can include fever, malaise, loss of appetite, diarrhoea, nausea,
abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the eyes and skin). Not everyone who is infected will
have all the symptoms.

Adults have signs and symptoms of illness more often than children. The severity of disease and fatal outcomes are higher in
older age groups. Infected children under 6 years of age do not usually experience noticeable symptoms, and only 10%
develop jaundice. Hepatitis A sometimes relapses, meaning the person who just recovered falls sick again with another acute
episode. This is normally followed by recovery.
Who is at risk?
Anyone who has not been vaccinated or previously infected can get infected with the hepatitis A virus. In areas where the
virus is widespread (high endemicity), most hepatitis A infections occur during early childhood. Risk factors include:
 poor sanitation;
 lack of safe water;
 living in a household with an infected person;
 being a sexual partner of someone with acute hepatitis A infection;
 use of recreational drugs;
 sex between men; and
 travelling to areas of high endemicity without being immunized.
Diagnosis
Cases of hepatitis A are not clinically distinguishable from other types of acute viral hepatitis. Specific diagnosis is made by
the detection of HAV-specific immunoglobulin G (IgM) antibodies in the blood. Additional tests include reverse transcriptase
polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA and may require specialized laboratory facilities.
Treatment
There is no specific treatment for hepatitis A. Recovery from symptoms following infection may be slow and can take several
weeks or months. It is important to avoid unnecessary medications. Acetaminophen, paracetamol and medication against
vomiting should be avoided.
Hospitalization is unnecessary in the absence of acute liver failure. Therapy is aimed at maintaining comfort and adequate
nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.
Prevention
Improved sanitation, food safety and immunization are the most effective ways to combat hepatitis A.
The spread of hepatitis A can be reduced by:

 adequate supplies of safe drinking water;
 proper disposal of sewage within communities; and
 personal hygiene practices such as regular handwashing before meals and after going to the bathroom.
Several injectable inactivated hepatitis A vaccines are available internationally. All provide similar protection from the virus
and have comparable side effects. No vaccine is licensed for children younger than 1 year of age. In China, a live attenuated
vaccine is also available.
WHO response
In May 2016, the World Health Assembly adopted the first Global health sector strategy on viral hepatitis, 2016-2021. The
strategy highlights the critical role of universal health coverage and the targets of the strategy are aligned with those of the
Sustainable Development Goals. The strategy has a vision of eliminating viral hepatitis as a public health problem. This is
reflected in the global targets of reducing new viral hepatitis infections by 90% and reducing deaths due to viral hepatitis by
65% by 2030. Actions to be taken by countries and WHO Secretariat to reach these targets are outlined in the strategy.
WHO is working in the following areas to support countries in moving towards achieving the global hepatitis goals under the
Sustainable Development Agenda 2030:
 raising awareness, promoting partnerships and mobilizing resources;

 formulating evidence-based policy and data for action;
 increasing health equities within the hepatitis response;
 preventing transmission; and
 scaling up screening, care and treatment services.
WHO published the Progress report on HIV, viral hepatitis and sexually transmitted infections, 2021 outlining its progress
towards elimination. The report sets out global statistics on viral hepatitis B and C, the rate of new infections, the prevalence
of chronic infections and mortality caused by these 2 high-burden viruses, as well as coverage of key interventions, all
current as of the end of 2020.
Since 2011, together with national governments, civil society and partners, WHO has organized annual World Hepatitis Day
campaigns (as 1 of its 9 flagship annual health campaigns) to increase awareness and understanding of viral hepatitis.
Hepatitis B
27 July 2020
Key facts
 Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
 The virus is most commonly transmitted from mother to child during birth and delivery, as well as through contact
with blood or other body fluids during sex with an infected partner, unsafe injections or exposures to sharp
instruments.
 Hepatitis B can be prevented by vaccines that are safe, available and effective.
 WHO estimates that 296 million people were living with chronic hepatitis B infection in 2019, with 1.5 million new
infections each year.
 In 2019, hepatitis B resulted in an estimated 820 000 deaths, mostly from cirrhosis and hepatocellular carcinoma
(primary liver cancer).
Overview
Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It is a major global health
problem. It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer.
A safe and effective vaccine that offers 98% to 100% protection against hepatitis B is available. Preventing hepatitis B
infection averts the development of complications including chronic disease and liver cancer.
The burden of hepatitis B infection is highest in the WHO Western Pacific Region and the WHO African Region, where 116
million and 81 million people, respectively, are chronically infected. Sixty million people are infected in the WHO Eastern
Mediterranean Region, 18 million in the WHO South-East Asia Region, 14 million in the WHO European Region and 5 million
in the WHO Region of the Americas.
Transmission
In highly endemic areas, hepatitis B is most commonly spread from mother to child at birth (perinatal transmission) or
through horizontal transmission (exposure to infected blood), especially from an infected child to an uninfected child during
the first 5 years of life. The development of chronic infection is common in infants infected from their mothers or before the
age of 5 years.
Hepatitis B is also spread by needlestick injury, tattooing, piercing and exposure to infected blood and body fluids, such as
saliva and menstrual, vaginal and seminal fluids. Transmission of the virus may also occur through the reuse of contaminated
needles and syringes or sharp objects either in health care settings, in the community or among persons who inject drugs.
Sexual transmission is more prevalent in unvaccinated persons with multiple sexual partners.
Hepatitis B infection acquired in adulthood leads to chronic hepatitis in less than 5% of cases, whereas infection in infancy
and early childhood leads to chronic hepatitis in about 95% of cases. This is the basis for strengthening and prioritizing infant
and childhood vaccination.

The hepatitis B virus can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it
enters the body of a person who is not protected by the vaccine. The incubation period of the hepatitis B virus ranges from
30 to 180 days. The virus may be detected within 30 to 60 days after infection and can persist and develop into chronic
hepatitis B, especially when transmitted in infancy or childhood.
Symptoms
Most people do not experience any symptoms when newly infected. However, some people have acute illness with
symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea,
vomiting and abdominal pain. People with acute hepatitis can develop acute liver failure, which can lead to death. Among
the long-term complications of HBV infections, a subset of persons develops advanced liver diseases such as cirrhosis and
hepatocellular carcinoma, which cause high morbidity and mortality.
HBV-HIV coinfection
About 1% of persons living with HBV infection (2.7 million people) are also infected with HIV. Conversely, the global
prevalence of HBV infection in HIV-infected persons is 7.4%. Since 2015, WHO has recommended treatment for everyone
diagnosed with HIV infection, regardless of the stage of disease. Tenofovir, which is included in the treatment combinations
recommended as first-line therapy for HIV infection, is also active against HBV.
Diagnosis
It is not possible on clinical grounds to differentiate hepatitis B from hepatitis caused by other viral agents, hence laboratory
confirmation of the diagnosis is essential. Several blood tests are available to diagnose and monitor people with hepatitis B.
They can be used to distinguish acute and chronic infections. WHO recommends that all blood donations be tested for
hepatitis B to ensure blood safety and avoid accidental transmission.
As of 2019, 30.4 million people (10.5% of all people estimated to be living with hepatitis B) were aware of their infection,
while 6.6 million (22%) of the people diagnosed were on treatment. According to latest WHO estimates, the proportion of
children under five years of age chronically infected with HBV dropped to just under 1% in 2019 down from around 5% in the
pre-vaccine era ranging from the 1980s to the early 2000s.
Treatment
There is no specific treatment for acute hepatitis B. Therefore, care is aimed at maintaining comfort and adequate nutritional
balance, including replacement of fluids lost from vomiting and diarrhoea. Most important is the avoidance of unnecessary
medications. Acetaminophen, paracetamol and medication against vomiting should be avoided.
Chronic hepatitis B infection can be treated with medicines, including oral antiviral agents. Treatment can slow the
progression of cirrhosis, reduce incidence of liver cancer and improve long term survival. In 2021 WHO estimated that 12% to
25% of people with chronic hepatitis B infection will require treatment, depending on setting and eligibility criteria.
WHO recommends the use of oral treatments (tenofovir or entecavir) as the most potent drugs to suppress hepatitis B virus.
Most people who start hepatitis B treatment must continue it for life.
In low-income settings, most people with liver cancer die within months of diagnosis. In high-income countries, patient
present to hospital earlier in the course of the disease, and have access to surgery and chemotherapy which can prolong life
for several months to a few years. Liver transplantation is sometimes used in people with cirrhosis or liver cancer in high-
income countries, with varying success.
Prevention
WHO recommends that all infants receive the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours,
followed by 2 or 3 doses of hepatitis B vaccine at least 4 weeks apart to complete the vaccination series. Protection lasts at
least 20 years and is probably lifelong. WHO does not recommend booster vaccinations for persons who have completed the
3-dose vaccination schedule.
In addition to infant vaccination, WHO recommends the use of antiviral prophylaxis for the prevention of hepatitis B
transmission from mother-to-child. Implementation of blood safety strategies and safer sex practices, including minimizing
the number of partners and using barrier protective measures (condoms), also protect against transmission.
WHO response
strategy highlights the critical role of universal health coverage and sets targets that align with those of the Sustainable
Development Goals. The 74th World Health Assembly in 2021 adopted a previous decision of the Executive Board to request
that Global Health Sector Strategies on HIV, viral hepatitis and sexually transmitted infections are developed for the period
2022-2030.
Hepatitis D
27 July 2020
Key facts
 Hepatitis D virus (HDV) is a virus that requires hepatitis B virus (HBV) for its replication. HDV infection occurs only
simultaneously or as super-infection with HBV.
 Hepatitis D virus (HDV) affects globally nearly 5% of people who have a chronic infection with hepatitis B virus
(HBV).
 Populations that are more likely to have HBV and HDV co-infection include indigenous populations, recipients of
haemodialysis and people who inject drugs.
 Worldwide, the number of HDV infections has decreased since the 1980s, due mainly to a successful global HBV
vaccination programme.
 The combination of HDV and HBV infection is considered the most severe form of chronic viral hepatitis due to
more rapid progression towards liver-related death and hepatocellular carcinoma.
 Hepatitis D infection can be prevented by hepatitis B immunization, but treatment success rates are low.
Overview
Hepatitis D is an inflammation of the liver caused by the hepatitis D virus (HDV), which requires HBV for its replication.
Hepatitis D infection cannot occur in the absence of hepatitis B virus. HDV-HBV co-infection is considered the most severe
form of chronic viral hepatitis due to more rapid progression towards hepatocellular carcinoma and liver-related death.
Vaccination against hepatitis B is the only method to prevent HDV infection.
In a study published in the Journal of Hepatology in 2020 (1), conducted in collaboration with WHO, it was estimated that
hepatitis D virus (HDV) affects nearly 5% of people globally who have a chronic infection with hepatitis B virus (HBV) and that
HDV co-infection could explain about 1 in 5 cases of liver disease and liver cancer in people with HBV infection. The study has
identified several geographical hotspots of high prevalence of HDV infection including Mongolia, the Republic of Moldova,
and countries in western and central Africa.
Transmission
The routes of HDV transmission, like HBV, occur through broken skin (via injection, tattooing etc.) or through contact with
infected blood or blood products. Transmission from mother to child is possible but rare. Vaccination against HBV prevents
HDV coinfection and hence expansion of childhood HBV immunization programmes has resulted in a decline in hepatitis D
incidence worldwide.
Chronic HBV carriers are at risk of infection with HDV. People who are not immune to HBV (either by natural disease or
immunization with the hepatitis B vaccine) are at risk of infection with HBV, which puts them at risk of HDV infection.
Those who are more likely to have HBV and HDV co-infection include indigenous people, people who inject drugs and people
with hepatitis C virus or HIV infection. The risk of co-infection also appears to be potentially higher in recipients of
haemodialysis, men who have sex with men and commercial sex workers.
Symptoms
In acute hepatitis, simultaneous infection with HBV and HDV can lead to a mild-to-severe hepatitis with signs and symptoms
of indistinguishable from those of other types of acute viral hepatitis infections. These features typically appear 3–7 weeks
after initial infectionor and include fever, fatigue, loss of appetite, nausea, vomiting, dark urine, pale-colored stools and
jaundice (yellow eyes). even fulminant hepatitis, but recovery is usually complete and development of fulminant hepatitis is
infrequent and chronic hepatitis D is rare (less than 5% of acute hepatitis).
In a superinfection, HDV can infect a person already chronically infected with HBV. The superinfection of HDV on chronic
hepatitis B accelerates progression to a more severe disease in all ages and in 70‒90% of persons. HDV superinfection
accelerates progression to cirrhosis almost a decade earlier than HBV mono-infected persons. Patients with HDV induced
cirrhosis are at an increased risk of hepatocellular carcinoma (HCC); however, the mechanism in which HDV causes more
severe hepatitis and a faster progression of fibrosis than HBV alone remains unclear.
Diagnosis
HDV infection is diagnosed by high levels of anti-HDV immunoglobulin G (IgG) and immunoglobulin M (IgM), and confirmed
by detection of HDV RNA in serum.
However, HDV diagnostics are not widely available and there is no standardization for HDV RNA assays, which are used for
monitoring response to antiviral therapy.
Treatment
Pegylated interferon alpha is the generally recommended treatment for hepatitis D virus infection. Treatment should last for
at least 48 weeks irrespective of the patient’s response. The virus tends to give a low rate of response to the treatment;
however, the treatment is associated with a lower likelihood of disease progression.
This treatment is associated with significant side effects and should not be given to patients with decompensated cirrhosis,
active psychiatric conditions and autoimmune diseases.
More efforts are needed to reduce the global burden of chronic hepatitis B and develop medicines that are safe and effective
against hepatitis D and are affordable enough to be deployed on a large scale to those who are most in need.
Prevention
While WHO does not have specific recommendations on hepatitis D, prevention of HBV transmission through hepatitis B
immunization, including a timely birth dose, additional antiviral prophylaxis for eligible pregnant women, blood safety, safe
injection practices in health care settings and harm reduction services with clean needles and syringes are effective in
preventing HDV transmission. Hepatitis B immunization does not provide protection against HDV for those already infected
with HBV.
WHO response
2030 Sustainable Development Goals. The strategy has a vision of eliminating viral hepatitis as a public health problem and
this is reflected in the global targets of reducing new viral hepatitis infections by 90% and reducing deaths due to viral
hepatitis by 65% by 2030. Actions to be taken by countries and WHO Secretariat to reach these targets are outlined in the
strategy.
Furthermore, to support countries in moving towards achieving the global hepatitis goals under the 2030 Sustainable
Development Agenda, WHO is working in the following areas:

For World Hepatitis Day 2021, WHO is highlighting on the theme “Hepatitis Can’t wait” to acknowledge the urgency of
hepatitis elimination with a view to achieving the 2030 elimination targets.
Hepatitis C
27 July 2020
Key facts
 Hepatitis C is a liver disease caused by the hepatitis C virus (HCV): the virus can cause both acute and chronic
hepatitis, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness.
 Hepatitis C is a major cause of liver cancer.
 The hepatitis C virus is a bloodborne virus: the most common modes of infection are through exposure to small
quantities of blood. This may happen through injection drug use, unsafe injection practices, unsafe health care,
transfusion of unscreened blood and blood products, and sexual practices that lead to exposure to blood.
 Globally, an estimated 58 million people have chronic hepatitis C virus infection, with about 1.5 million new
infections occurring per year.
 WHO estimated that in 2019, approximately 290 000 people died from hepatitis C, mostly from cirrhosis and
hepatocellular carcinoma (primary liver cancer).
 Antiviral medicines can cure more than 95% of persons with hepatitis C infection, but access to diagnosis and
treatment is low.
 There is currently no effective vaccine against hepatitis C.
Overview
Hepatitis C virus (HCV) causes both acute and chronic infection. Acute HCV infections are usually asymptomatic and most do
not lead to a life-threatening disease. Around 30% (15–45%) of infected persons spontaneously clear the virus within 6
months of infection without any treatment.
The remaining 70% (55–85%) of persons will develop chronic HCV infection. Of those with chronic HCV infection, the risk of
cirrhosis ranges from 15% to 30% within 20 years.
HCV occurs in all WHO regions. The highest burden of disease is in the Eastern Mediterranean Region and European Region,
with 12 million people chronically infected in each region. In the South-East Asia Region and the Western Pacific Region, an
estimated 10 million people in each region are chronically infected. Nine million people are chronically infected in the
African Region and 5 million the Region of the Americas.
Transmission
The hepatitis C virus is a bloodborne virus. It is most commonly transmitted through:
 the reuse or inadequate sterilization of medical equipment, especially syringes and needles in healthcare settings;
 the transfusion of unscreened blood and blood products; and
 injecting drug use through the sharing of injection equipment.
HCV can be passed from an infected mother to her baby and via sexual practices that lead to exposure to blood (for example,
people with multiple sexual partners and among men who have sex with men); however, these modes of transmission are
less common.
Hepatitis C is not spread through breast milk, food, water or casual contact such as hugging, kissing and sharing food or
drinks with an infected person.
Symptoms
The incubation period for hepatitis C ranges from 2 weeks to 6 months. Following initial infection, approximately 80% of
people do not exhibit any symptoms. Those who are acutely symptomatic may exhibit fever, fatigue, decreased appetite,
nausea, vomiting, abdominal pain, dark urine, pale faeces, joint pain and jaundice (yellowing of skin and the whites of the
eyes).
Testing and diagnosis
Because new HCV infections are usually asymptomatic, few people are diagnosed when the infection is recent. In those
people who go on to develop chronic HCV infection, the infection is often undiagnosed because it remains asymptomatic
until decades after infection when symptoms develop secondary to serious liver damage.
HCV infection is diagnosed in 2 steps:
1. Testing for anti-HCV antibodies with a serological test identifies people who have been infected with the virus.
2. If the test is positive for anti-HCV antibodies, a nucleic acid test for HCV ribonucleic acid (RNA) is needed to confirm
chronic infection because about 30% of people infected with HCV spontaneously clear the infection by a strong
immune response without the need for treatment. Although no longer infected, they will still test positive for anti-
HCV antibodies.
After a person has been diagnosed with chronic HCV infection, an assessment should be conducted to determine the degree
of liver damage (fibrosis and cirrhosis). This can be done by liver biopsy or through a variety of non-invasive tests. The degree
of liver damage is used to guide treatment decisions and management of the disease.
Early diagnosis can prevent health problems that may result from infection and prevent transmission of the virus. WHO
recommends testing people who may be at increased risk of infection.
In settings with high HCV antibody seroprevalence in the general population (defined as >2% or >5% HCV antibody
seroprevalence), WHO recommends that all adults have access to and be offered HCV testing with linkage to prevention,
care and treatment services.

About 2.3 million people (6.2%) of the estimated 3.7 million living with HIV globally have serological evidence of past or
present HCV infection. Chronic liver disease represents a major cause of morbidity and mortality among persons living with
HIV globally.
Treatment
A new infection with HCV does not always require treatment, as the immune response in some people will clear the
infection. However, when HCV infection becomes chronic, treatment is necessary. The goal of hepatitis C treatment is to cure
the disease.
WHO recommends therapy with pan-genotypic direct-acting antivirals (DAAs) for persons over the age of 12 years. DAAs can
cure most persons with HCV infection, and treatment duration is short (usually 12 to 24 weeks), depending on the absence or
presence of cirrhosis.
Pan-genotypic DAAs remain expensive in many high- and upper-middle-income countries. However, prices have dropped
dramatically in many countries (primarily low-income and lower-middle-income countries) due to the introduction of generic
versions of these medicines.
Access to HCV treatment is improving but remains too limited. Of the 58 million persons living with HCV infection globally in
2019, an estimated 21% (15.2 million) knew their diagnosis, and of those diagnosed with chronic HCV infection, around 62%
(9.4 million) persons had been treated with DAAs by the end of 2019.
Prevention
There is no effective vaccine against hepatitis C so prevention depends on reducing the risk of exposure to the virus in health
care settings and in higher risk populations. This includes people who inject drugs and men who have sex with men,
particularly those infected with HIV or those who are taking pre-exposure prophylaxis against HIV.
Primary prevention interventions recommended by WHO include:
 safe and appropriate use of health care injections;

 safe handling and disposal of sharps and waste;
 provision of comprehensive harm-reduction services to people who inject drugs;
 testing of donated blood for HBV and HCV (as well as HIV and syphilis);
 training of health personnel; and
 prevention of exposure to blood during sex.
WHO response
Development Goals. The strategy aims to eliminate viral hepatitis as a public health problem by reducing new viral hepatitis
infections by 90% and reduce deaths due to viral hepatitis by 65% by 2030.
WHO is working in the following areas to support countries in moving towards achieving the global hepatitis goals under the
Sustainable Development Agenda 2030:

 increase health equities within the hepatitis response;
WHO organizes the annual World Hepatitis Day campaign (as 1 of its 9 flagship annual health campaigns) to increase
awareness and understanding of viral hepatitis. For World Hepatitis Day 2021, WHO is focusing on the theme “Hepatitis
Can’t wait” to highlight the urgency of hepatitis elimination with a view to achieving the 2030 elimination targets.
Hepatitis D
27 July 2020
Key facts
 Hepatitis D virus (HDV) is a virus that requires hepatitis B virus (HBV) for its replication. HDV infection occurs only
simultaneously or as super-infection with HBV.
 Hepatitis D virus (HDV) affects globally nearly 5% of people who have a chronic infection with hepatitis B virus
(HBV).
 Populations that are more likely to have HBV and HDV co-infection include indigenous populations, recipients of
haemodialysis and people who inject drugs.
 Worldwide, the number of HDV infections has decreased since the 1980s, due mainly to a successful global HBV
vaccination programme.
 The combination of HDV and HBV infection is considered the most severe form of chronic viral hepatitis due to
more rapid progression towards liver-related death and hepatocellular carcinoma.
 Hepatitis D infection can be prevented by hepatitis B immunization, but treatment success rates are low.
Overview
Hepatitis D is an inflammation of the liver caused by the hepatitis D virus (HDV), which requires HBV for its replication.
Hepatitis D infection cannot occur in the absence of hepatitis B virus. HDV-HBV co-infection is considered the most severe
form of chronic viral hepatitis due to more rapid progression towards hepatocellular carcinoma and liver-related death.
Vaccination against hepatitis B is the only method to prevent HDV infection.
In a study published in the Journal of Hepatology in 2020 (1), conducted in collaboration with WHO, it was estimated that
hepatitis D virus (HDV) affects nearly 5% of people globally who have a chronic infection with hepatitis B virus (HBV) and that
HDV co-infection could explain about 1 in 5 cases of liver disease and liver cancer in people with HBV infection. The study has
identified several geographical hotspots of high prevalence of HDV infection including Mongolia, the Republic of Moldova,
and countries in western and central Africa.
Transmission
The routes of HDV transmission, like HBV, occur through broken skin (via injection, tattooing etc.) or through contact with
infected blood or blood products. Transmission from mother to child is possible but rare. Vaccination against HBV prevents
HDV coinfection and hence expansion of childhood HBV immunization programmes has resulted in a decline in hepatitis D
incidence worldwide.
Chronic HBV carriers are at risk of infection with HDV. People who are not immune to HBV (either by natural disease or
immunization with the hepatitis B vaccine) are at risk of infection with HBV, which puts them at risk of HDV infection.
Those who are more likely to have HBV and HDV co-infection include indigenous people, people who inject drugs and people
with hepatitis C virus or HIV infection. The risk of co-infection also appears to be potentially higher in recipients of
haemodialysis, men who have sex with men and commercial sex workers.
Symptoms
In acute hepatitis, simultaneous infection with HBV and HDV can lead to a mild-to-severe hepatitis with signs and symptoms
of indistinguishable from those of other types of acute viral hepatitis infections. These features typically appear 3–7 weeks
after initial infectionor and include fever, fatigue, loss of appetite, nausea, vomiting, dark urine, pale-colored stools and
jaundice (yellow eyes). even fulminant hepatitis, but recovery is usually complete and development of fulminant hepatitis is
infrequent and chronic hepatitis D is rare (less than 5% of acute hepatitis).

In a superinfection, HDV can infect a person already chronically infected with HBV. The superinfection of HDV on chronic
hepatitis B accelerates progression to a more severe disease in all ages and in 70‒90% of persons. HDV superinfection
accelerates progression to cirrhosis almost a decade earlier than HBV mono-infected persons. Patients with HDV induced
cirrhosis are at an increased risk of hepatocellular carcinoma (HCC); however, the mechanism in which HDV causes more
severe hepatitis and a faster progression of fibrosis than HBV alone remains unclear.
Diagnosis
HDV infection is diagnosed by high levels of anti-HDV immunoglobulin G (IgG) and immunoglobulin M (IgM), and confirmed
by detection of HDV RNA in serum.
However, HDV diagnostics are not widely available and there is no standardization for HDV RNA assays, which are used for
monitoring response to antiviral therapy.
Treatment
Pegylated interferon alpha is the generally recommended treatment for hepatitis D virus infection. Treatment should last for
at least 48 weeks irrespective of the patient’s response. The virus tends to give a low rate of response to the treatment;
however, the treatment is associated with a lower likelihood of disease progression.
This treatment is associated with significant side effects and should not be given to patients with decompensated cirrhosis,
active psychiatric conditions and autoimmune diseases.
More efforts are needed to reduce the global burden of chronic hepatitis B and develop medicines that are safe and effective
against hepatitis D and are affordable enough to be deployed on a large scale to those who are most in need.
Prevention
While WHO does not have specific recommendations on hepatitis D, prevention of HBV transmission through hepatitis B
immunization, including a timely birth dose, additional antiviral prophylaxis for eligible pregnant women, blood safety, safe
injection practices in health care settings and harm reduction services with clean needles and syringes are effective in
preventing HDV transmission. Hepatitis B immunization does not provide protection against HDV for those already infected
with HBV.
WHO response
2030 Sustainable Development Goals. The strategy has a vision of eliminating viral hepatitis as a public health problem and
this is reflected in the global targets of reducing new viral hepatitis infections by 90% and reducing deaths due to viral
hepatitis by 65% by 2030. Actions to be taken by countries and WHO Secretariat to reach these targets are outlined in the
strategy.
Furthermore, to support countries in moving towards achieving the global hepatitis goals under the 2030 Sustainable
Development Agenda, WHO is working in the following areas:

For World Hepatitis Day 2021, WHO is highlighting on the theme “Hepatitis Can’t wait” to acknowledge the urgency of
hepatitis elimination with a view to achieving the 2030 elimination targets.
Hepatitis E
27 July 2020
Key facts
 Hepatitis E is an inflammation of the liver caused by infection with the hepatitis E virus (HEV).
 Every year there are an estimated 20 million HEV infections worldwide, leading to an estimated 3.3 million
symptomatic cases of hepatitis E.
 WHO estimates that hepatitis E caused approximately 44 000 deaths in 2015 (accounting for 3.3% of the mortality
due to viral hepatitis).
 The virus is transmitted via the fecal-oral route, principally via contaminated water.
 Hepatitis E is found worldwide, but the disease is most common in East and South Asia.
 A vaccine to prevent hepatitis E virus infection has been developed and is licensed in China, but is not yet available
elsewhere.
Overview
Hepatitis E is inflammation of the liver caused by the hepatitis E virus (HEV). The virus has at least 4 different types:
genotypes 1, 2, 3 and 4. Genotypes 1 and 2 have been found only in humans. Genotypes 3 and 4 circulate in several animals
including pigs, wild boars and deer without causing any disease, and occasionally infect humans.
The virus is shed in the stools of infected persons and enters the human body through the intestine. It is transmitted mainly
through contaminated drinking water. The infection is usually self-limiting and resolves within 2–6 weeks. Occasionally a
serious disease known as fulminant hepatitis (acute liver failure) develops, which can be fatal.
Transmission
Hepatitis E infection is found worldwide and is common in low- and middle-income countries with limited access to essential
water, sanitation, hygiene and health services. In these areas, the disease occurs both as outbreaks and as sporadic cases.
The outbreaks usually follow periods of faecal contamination of drinking water supplies and may affect several hundred to
several thousand persons. Some of these outbreaks have occurred in areas of conflict and humanitarian emergencies such as
war zones and camps for refugees or internally displaced populations, where sanitation and safe water supply pose special
challenges.
Sporadic cases are also believed to be related to contamination of water, albeit at a smaller scale. The cases in these areas
are caused mostly by infection with genotype 1 virus, and much less frequently by genotype 2 virus.
In areas with better sanitation and water supply, hepatitis E infection is infrequent, with only occasional sporadic cases.
Most of these cases are caused by genotype 3 virus and are triggered by infection with virus originating in animals, usually
through ingestion of undercooked animal meat (including animal liver, particularly pork). These cases are not related to
contamination of water or other foods.
Symptoms
The incubation period following exposure to HEV ranges from 2 to 10 weeks, with an average of 5 to 6 weeks. The infected
persons excrete the virus beginning from a few days before to 3-4 weeks after onset of the disease.
In areas with high disease endemicity, symptomatic infection is most common in young adults aged 15–40 years. In these
areas, although infection does occur in children, it often goes undiagnosed because they typically have no symptoms or only
a mild illness without jaundice.

Typical signs and symptoms of hepatitis include:
 an initial phase of mild fever, reduced appetite (anorexia), nausea and vomiting lasting for a few days;
 abdominal pain, itching , skin rash, or joint pain;
 jaundice (yellow colour of the skin), dark urine and pale stools; and
 a slightly enlarged, tender liver (hepatomegaly).
These symptoms are often indistinguishable from those experienced during other liver illnesses and typically last 1–6 weeks.
In rare cases, acute hepatitis E can be severe and result in fulminant hepatitis (acute liver failure). These patients are at risk
of death. Pregnant women with hepatitis E, particularly those in the second or third trimester, are at increased risk of acute
liver failure, fetal loss and mortality. Up to 20–25% of pregnant women can die if they get hepatitis E in third trimester.
Cases of chronic hepatitis E infection have been reported in immunosuppressed people, particularly organ transplant
recipients on immunosuppressive drugs, with genotype 3 or 4 HEV infection. These remain uncommon.
Diagnosis
Cases of hepatitis E are not clinically distinguishable from other types of acute viral hepatitis. However, diagnosis can often
be strongly suspected in appropriate epidemiologic settings, for example when several cases occur in localities in known
disease-endemic areas, in settings with risk of water contamination when the disease is more severe in pregnant women or
if hepatitis A has been excluded.
Definitive diagnosis of hepatitis E infection is usually based on the detection of specific anti-HEV immunoglobulin M (IgM)
antibodies to the virus in a person’s blood; this is usually adequate in areas where the disease is common. Rapid tests are
available for field use.
Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis E virus RNA in blood
and stool. This assay requires specialized laboratory facilities. This test is particularly needed in areas where hepatitis E is
infrequent and in uncommon cases with chronic HEV infection.
Treatment
There is no specific treatment capable of altering the course of acute hepatitis E. As the disease is usually self-limiting,
hospitalization is generally not required. Most important is the avoidance of unnecessary medications. Acetaminophen,
paracetamol and medication against vomiting should be used sparingly or avoided.
Hospitalization is required for people with fulminant hepatitis and should also be considered for symptomatic pregnant
women.
Immunosuppressed people with chronic hepatitis E benefit from specific treatment using ribavirin, an antiviral drug. In some
specific situations, interferon has also been used successfully.
Prevention
Prevention is the most effective approach against the infection. At the population level, transmission of HEV and hepatitis E
infection can be reduced by:
 maintaining quality standards for public water supplies; and

 establishing proper disposal systems for human faeces.
On an individual level, infection risk can be reduced by:
 maintaining hygienic practices; and

 avoiding consumption of water and ice of unknown purity.
WHO response
WHO has issued the technical report Waterborne outbreaks of hepatitis E: recognition, investigation and control. The manual
gives information about the epidemiology, clinical manifestations and diagnosis of hepatitis E. It also provides guidance for
public health authorities on how to respond to outbreaks of hepatitis E infection.
WHO is currently working with experts and global partners to develop a generic protocol for use of the hepatitis E vaccine as
an outbreak response intervention. There is also ongoing work with similar groups to create a simplified algorithm for the
diagnosis, triage and management of hepatitis E during an outbreak.
Development Goals.
To support countries in achieving the global hepatitis elimination targets under the Sustainable Development Agenda 2030,
WHO is working to:
 raise awareness, promote partnerships and mobilize resources;

 formulate evidence-based policy and data for action;
 increase health equities within the hepatitis response;
 prevent transmission; and
 scale up screening, care and treatment services.
WHO organizes annual World Hepatitis Day campaigns (as 1 of its 9 flagship annual health campaigns) to increase awareness
and understanding of viral hepatitis. For World Hepatitis Day 2021, WHO is focusing on the theme “Hepatitis Can’t wait” to
acknowledge the urgency of hepatitis elimination with a view to achieving the 2030 elimination targets.
15 July 2021
Key facts
 Global coverage dropped from 86% in 2019 to 83% in 2020

 An estimated 23 million children under the age of one year did not receive basic vaccines, which is the highest
number since 2009
 In 2020, the number of completely unvaccinated children increased by 3.4 million.
 Only 19 vaccine introductions were reported in 2020, less than half of any year in the past two decades.
 1.6 million more girls were not fully protected against human papillomavirus (HPV) in 2020, compared to the
previous year
Overview
While immunization is one of the most successful public health interventions, coverage has plateaued over the last decade.
The COVID-19 pandemic and associated disruptions have strained health systems, with 23 million children missing out on
vaccination in 2020, 3.7 million more than in 2019 and the highest number since 2009.
During 2020, about 83% of infants worldwide (113 million infants) received 3 doses of diphtheria-tetanus-pertussis (DTP3)
vaccine, protecting them against infectious diseases that can cause serious illness and disability or be fatal.
Only 19 vaccine introductions were reported in 2020 (not including COVID-19 vaccine introductions), less than half of any
year in the past two decades. This slowdown is likely to continue as countries focus on ongoing efforts to control the Covid-
19 pandemic, and on the introduction of Covid-19 vaccines.
Global immunization coverage 2020
A summary of global vaccination coverage in 2020 follows.
Haemophilus influenzae type b (Hib) causes meningitis and pneumonia. Hib vaccine had been introduced in 192 Member
States by the end of 2020. Global coverage with 3 doses of Hib vaccine is estimated at 70%. There is great variation between
regions. The WHO Region of South-East Asia is estimated to have 83% coverage, while it is only 25% in the WHO Western
Pacific Region.
Hepatitis B is a viral infection that attacks the liver. Hepatitis B vaccine for infants had been introduced nationwide in 190
Member States by the end of 2020. Global coverage with 3 doses of hepatitis B vaccine is estimated at 83%. In addition, 113
Member States introduced one dose of hepatitis B vaccine to newborns within the first 24 hours of life. Global coverage
is 42% and is as high as 84% in the WHO Western Pacific Region, while it is only estimated to be at 6% in the WHO African
region
Human papillomavirus (HPV) is the most common viral infection of the reproductive tract and can cause cervical cancer in
women, other types of cancer, and genital warts in both men and women. The HPV vaccine was introduced in 111 Member
States by the end of 2020. Since many large countries have not yet introduced the vaccine and vaccine coverage decreased
in 2020 in many countries - global coverage with the final dose of HPV is now estimated at 13%. This is a proportionally large
reduction from 15% in 2019.
Meningitis A is an infection that is often deadly and leaves one in five affected individuals with long-term devastating
sequelae. Before the introduction of MenAfriVac in 2010 – a revolutionary vaccine– meningitis serogroup A accounted for
80–85% of meningitis epidemics in the African meningitis belt. By the end of 2020 almost 350 million people in 24 out of the
26 countries in the meningitis belt had been vaccinated with MenAfriVac through campaigns. 11 countries had included
MenAfriVac in their routine immunization schedule by 2020.
Measles is a highly contagious disease caused by a virus, which usually results in a high fever and rash, and can lead to
blindness, encephalitis or death. By the end of 2020, 84% of children had received one dose of measles-containing vaccine by
their second birthday, and 179 Member States had included a second dose as part of routine immunization and 70% of
children received two doses of measles vaccine according to national immunization schedules.
Mumps is a highly contagious virus that causes painful swelling at the side of the face under the ears (the parotid glands),
fever, headache and muscle aches. It can lead to viral meningitis. Mumps vaccine had been introduced nationwide in 123
Member States by the end of 2020.
Pneumococcal diseases include pneumonia, meningitis and febrile bacteraemia, as well as otitis media, sinusitis and
bronchitis. Pneumococcal vaccine had been introduced in 151 Member States by the end of 2020, including three in some
parts of the country, and global third dose coverage was estimated at 49%.
Polio is a highly infectious viral disease that can cause irreversible paralysis. In 2020, 83% of infants around the world
received three doses of polio vaccine. In 2020, the coverage of infants receiving their first dose of inactivated polio vaccine
(IPV) in countries that are still using oral polio vaccine (OPV) is estimated at 80%. Targeted for global eradication, polio has
been stopped in all countries except for Afghanistan and Pakistan. Until poliovirus transmission is interrupted in these
countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and
immunization services and travel or trade links to endemic countries.

Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world. Rotavirus
vaccine was introduced in 114 countries by the end of 2020, including three in some parts of the country. Global coverage
was estimated at 46%.
Rubella is a viral disease which is usually mild in children, but infection during early pregnancy may cause fetal death or
congenital rubella syndrome, which can lead to defects of the brain, heart, eyes, and ears. Rubella vaccine was introduced
nationwide in 173 Member States by the end of 2020, and global coverage was estimated at 70%.
Tetanus is caused by a bacterium which grows in the absence of oxygen, for example in dirty wounds or the umbilical cord if
it is not kept clean. The spores of C. tetani are present in the environment irrespective of geographical location. It produces a
toxin which can cause serious complications or death. Maternal and neonatal tetanus persist as public health problems in 12
countries, mainly in Africa and Asia.
Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. As of 2019, yellow fever vaccine had
been introduced in routine infant immunization programmes in 36 of the 40 countries and territories at risk for yellow fever
in Africa and the Americas. In these 40 countries and territories, coverage is estimated at 45%.
Key challenges
In 2020 17.1 million infants did not receive an initial dose of DTP vaccine pointing to lack of access to an immunization and
other health services and an additional 5.6 million are partially vaccinated. Of the 23 million more than 60% of these children
live in 10 countries: Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Mexico, Nigeria,
Pakistan and the Philippines.
Monitoring data at subnational levels is critical to helping countries prioritize and tailor vaccination strategies and
operational plans to address immunization gaps and reach every person with life-saving vaccines.
WHO response
WHO is working with countries and partners to improve global vaccination coverage, including through these initiatives
adopted by the World Health Assembly in May 2012.
Immunization Agenda 2030
IA2030 sets an ambitious, overarching global vision and strategy for vaccines and immunization for the decade 2021–2030. It
was co-created with thousands of contributions from countries and organizations around the world, and came into effect
after World Health Assembly endorsement. It draws on lessons from the past decade and acknowledges continuing and new
challenges posed by infectious diseases (e.g. Ebola, COVID-19).

The strategy intends to inspire and align the activities of community, national, regional and global stakeholders, towards
achieving a world where everyone, everywhere fully benefits from vaccines for good health and wellbeing. IA2030 will
become operational during 2020-21 through regional and national strategies, a mechanism under development to ensure
ownership and accountability and a monitoring and evaluation framework to guide country implementation.
 Immunization Agenda 2030: A Global Strategy to Leave No One Behind
The global strategy towards eliminating cervical cancer as a public health problem
In 2020 the WHA adopted the global strategy towards eliminating cervical cancer. In this strategy, the first of the three
pillars requires the introduction of the HPV vaccine in all countries and has set a target of reaching 90% coverage. With
introduction currently in 57% of Member states, in the next 10 years, large investments towards introduction in low and
middle-income countries will be required as well as programme improvements to reach the 90% coverage targets in low and
high-income settings alike will be required to reach the 2030 targets.
The top 10 causes of death
9 December 2020
In 2019, the top 10 causes of death accounted for 55% of the 55.4 million deaths worldwide.
The top global causes of death, in order of total number of lives lost, are associated with three broad topics: cardiovascular
(ischaemic heart disease, stroke), respiratory (chronic obstructive pulmonary disease, lower respiratory infections) and
neonatal conditions – which include birth asphyxia and birth trauma, neonatal sepsis and infections, and preterm birth
complications.
Causes of death can be grouped into three categories: communicable (infectious and parasitic diseases and maternal,
perinatal and nutritional conditions), noncommunicable (chronic) and injuries.
Leading causes of death globally
At a global level, 7 of the 10 leading causes of deaths in 2019 were noncommunicable diseases. These seven causes
accounted for 44% of all deaths or 80% of the top 10. However, all noncommunicable diseases together accounted for 74% of
deaths globally in 2019.

The world’s biggest killer is ischaemic heart disease, responsible for 16% of the world’s total deaths. Since 2000, the largest
increase in deaths has been for this disease, rising by more than 2 million to 8.9 million deaths in 2019. Stroke and chronic
obstructive pulmonary disease are the 2nd and 3rd leading causes of death, responsible for approximately 11% and 6% of
total deaths respectively.
Lower respiratory infections remained the world’s most deadly communicable disease, ranked as the 4th leading cause of
death. However, the number of deaths has gone down substantially: in 2019 it claimed 2.6 million lives, 460 000 fewer than
in 2000.
Neonatal conditions are ranked 5th. However, deaths from neonatal conditions are one of the categories for which the
global decrease in deaths in absolute numbers over the past two decades has been the greatest: these conditions killed 2
million newborns and young children in 2019, 1.2 million fewer than in 2000.
Deaths from noncommunicable diseases are on the rise. Trachea, bronchus and lung cancers deaths have risen from 1.2
million to 1.8 million and are now ranked 6th among leading causes of death.
In 2019, Alzheimer’s disease and other forms of dementia ranked as the 7th leading cause of death. Women are
disproportionately affected. Globally, 65% of deaths from Alzheimer’s and other forms of dementia are women.
One of the largest declines in the number of deaths is from diarrhoeal diseases, with global deaths falling from 2.6 million in
2000 to 1.5 million in 2019.
Diabetes has entered the top 10 causes of death, following a significant percentage increase of 70% since 2000. Diabetes is
also responsible for the largest rise in male deaths among the top 10, with an 80% increase since 2000.
Other diseases which were among the top 10 causes of death in 2000 are no longer on the list. HIV/AIDS is one of them.
Deaths from HIV/AIDS have fallen by 51% during the last 20 years, moving from the world’s 8th leading cause of death in
2000 to the 19th in 2019.
Kidney diseases have risen from the world’s 13th leading cause of death to the 10th. Mortality has increased from 813 000 in
2000 to 1.3 million in 2019.
Leading causes of death by income group
The World Bank classifies the world's economies into four income groups – based on gross national income – low, lower-
middle, upper-middle and high.
People living in a low-income country are far more likely to die of a communicable disease than a noncommunicable disease.
Despite the global decline, six of the top 10 causes of death in low-income countries are communicable diseases.
Malaria, tuberculosis and HIV/AIDS all remain in the top 10. However, all three are falling significantly. The biggest decrease
among the top 10 deaths in this group has been for HIV/AIDS, with 59% fewer deaths in 2019 than in 2000, or 161 000 and
395 000 respectively.
Diarrhoeal diseases are more significant as a cause of death in low-income countries: they rank in the top 5 causes of death
for this income category. Nonetheless, diarrhoeal diseases are decreasing in low-income countries, representing the second
biggest decrease in fatalities among the top 10 (231 000 fewer deaths).
Deaths due to chronic obstructive pulmonary disease are particularly infrequent in low-income countries compared to other
income groups. It does not appear in the top 10 for low-income countries yet ranks in the top 5 for all other income groups.
Lower-middle-income countries have the most disparate top 10 causes of death: five noncommunicable, four communicable,
and one injury. Diabetes is a rising cause of death in this income group: it has moved from the 15th to 9th leading cause of
death and the number of deaths from this disease has nearly doubled since 2000.
As a top 10 cause of death in this income group, diarrhoeal diseases remain a significant challenge. However, this category of
diseases represents the biggest decrease in absolute deaths, falling from 1.9 million to 1.1 million between 2000 and 2019.
The biggest increase in absolute deaths is from ischaemic heart disease, rising by more than 1 million to 3.1 million since
2000. HIV/AIDS has seen the biggest decrease in rank among the previous top 10 causes of death in 2000, moving from 8th to
15th.
In upper-middle-income countries, there has been a notable rise in deaths from lung cancer, which have increased by 411
000; more than double the increase in deaths of all three other income groups combined. In addition, stomach cancer
features highly in upper-middle-income countries compared to the other income groups, remaining the only group with this
disease in the top 10 causes of death.

One of the biggest decreases in terms of absolute number of deaths is for chronic obstructive pulmonary disease, which has
fallen by nearly 264 000 to 1.3 million deaths. However, deaths from ischaemic heart disease have increased by more than
1.2 million, the largest rise in any income group in terms of absolute number of deaths from this cause.
There is only one communicable disease (lower respiratory infections) in the top 10 causes of death for upper-middle-income
countries. Notably, there has been a 31% fall in deaths from suicide since 2000 in this income category, decreasing to 234 000
deaths in 2019.
In high-income countries, deaths are increasing for all top 10 diseases except two. Ischaemic heart disease and stroke are the
only causes of death in the top 10 for which the total numbers have gone down between 2000 and 2019, by 16% (or 327 000
deaths) and by 21% (or 205 000 deaths) respectively. High-income is the only category of income group in which there have
been decreasing numbers of deaths from these two diseases. Nonetheless ischaemic heart disease and stroke have remained
in the top three causes of death for this income category, with a combined total of over 2.5 million fatalities in 2019. In
addition, deaths from hypertensive heart disease are rising. Reflecting a global trend, this disease has risen from the 18th
leading cause of death to the 9th.
Deaths due to Alzheimer’s disease and other dementias have increased, overtaking stroke to become the second leading
cause in high-income countries, and being responsible for the deaths of 814 000 people in 2019. And, as with upper-middle-
income countries, only one communicable disease, lower respiratory infections, appears in the top 10 causes of death.
Why do we need to know the reasons people die?
It is important to know why people die to improve how people live. Measuring how many people die each year helps to
assess the effectiveness of our health systems and direct resources to where they are needed most. For example, mortality
data can help focus activities and resource allocation among sectors such as transportation, food and agriculture, and the
environment as well as health.
COVID-19 has highlighted the importance for countries to invest in civil registration and vital statistics systems to allow daily
counting of deaths, and direct prevention and treatment efforts. It has also revealed inherent fragmentation in data
collection systems in most low-income countries, where policy-makers still do not know with confidence how many people
die and of what causes.
To address this critical gap, WHO has partnered with global actors to launch Revealing the Toll of COVID-19: Technical
Package for Rapid Mortality Surveillance and Epidemic Response. By providing the tools and guidance for rapid mortality
surveillance, countries can collect data on total number of deaths by day, week, sex, age and location, thus enabling health
leaders to trigger more timely efforts for improvements to health.
Furthermore, the World Health Organization develops standards and best practices for data collection, processing and
synthesis through the consolidated and improved International Classification of Diseases (ICD-11) – a digital platform that
facilitates reporting of timely and accurate data for causes of death for countries to routinely generate and use health
information that conforms to international standards.
The routine collection and analysis of high-quality data on deaths and causes of death, as well as data on disability,
disaggregated by age, sex and geographic location, is essential for improving health and reducing deaths and disability across
the world.

Editor’s note
WHO’s Global Health Estimates, from which the information in this fact sheet is extracted, present comprehensive and
comparable health-related data, including life expectancy, healthy life expectancy, mortality and morbidity, and burden of
diseases at global, regional and country levels disaggregated by age, sex and cause. The estimates released in 2020 report on
trends for more than 160 diseases and injuries annually from 2000 to 2019.

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Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus.

frequently and not touching your face.

 Protect yourself: advice for the public

To prevent infection and to slow transmission of COVID-19, do the following:

Most common symptoms:

Less common symptoms:

 difficulty breathing or shortness of breath.

21st century. Nonetheless, common lessons can be drawn:

How does water scarcity affect infectious diseases like COVID-19?

the spread of antimicrobial resistance and providing quality care.

including for infectious disease.

warmer than any preceding decade since 1850(1).

more intense and frequent.

What is the impact of climate change on health?

sufficient food and secure shelter.

300 million people. Ongoing temperature increases are expected to aggravate this burden.

Natural disasters and variable rainfall patterns

disasters result in over 60 000 deaths, mainly in developing countries.

frequency and intensity of drought at regional and global scale.(1)

disease schistosomiasis occurs(3).

Measuring the health effects

and people with infirmities or pre-existing medical conditions.

prepare and respond.

3 million deaths every year.

plants and animals to cultural diversity.

cause or exacerbate political conflict.

for many diseases and health problems.

that have already provided humankind with enormous health benefits.

vulnerabilities as a function of environmental receptivity to ill health.

and cultural purposes, in addition to food.

understand human physiology and to understand and treat human diseases.

trade; and the accidental or intentional human introduction of pathogens.

responsible for morbidity or mortality.

opportunities, and leisure activities that contribute to overall wellbeing.

of the local ecosystems that they form.

recently emerging diseases are associated with wildlife.

 Heat and Health

health facilities, transport, and water infrastructure.

levels, can save lives

How does heat impact health?

exhaustion, heatstroke, and hyperthermia.

Keep your home cool

 Move to the coolest room in the home, especially at night.

Keep the body cool and hydrated

If you have health problems

If you or others feel unwell

Promoting Healthier Populations.

enhance scientific evidence, 4. strengthen health system

international response necessary to protect health from climate change.

and country, by age, sex and by income group.

points and WHO country and regional offices.

Top 10 global causes of death in 2019

1. Ischaemic heart disease

Top 10 global causes of disability-adjusted life years (DALYs) in 2019

Causes of death by sex

than for men.

moving across land borders to Sierra Leone and Liberia.

Ebola River, from which the disease takes its name.

People remain infectious as long as their blood contains the virus.

Symptoms of EVD can be sudden and include:

This is followed by:

should ideally be tested rapidly if Ebola is suspected.

 antibody-capture enzyme-linked immunosorbent assay (ELISA)