Leading causes of death53.9 million from all causes, worldwide, 1998

Cancers13%

Injuries11%

Maternal5%

Infectious diseases25%

Cardiovascular diseases

31%

Respiratory and digestive

9%

Others6%

13.3 million

Leading causes of death globally, 1999Leading causes of death globally, 1999

l 1 Ischaemic heart disease

l 2 Cerebrovascular disease

l 3 Acute lower respiratory infections

l 4 HIV/AIDS

l 5 Chronic obstructive pulmonary disease

l 6 Perinatal conditions

l 7 Diarrhoeal diseases

l 8 Tuberculosis

l 11 Malaria

12.7

9.9

7.1

4.8

4.8

4.2

4.0

3.0

1.9

Source: The World Health Report 2000, WHO

Rank % of total

Leading causes of death in Africa, 1999Leading causes of death in Africa, 1999

l 1 HIV/AIDS

l 2 Acute lower respiratory infections

l 3 Malaria

l 4 Diarrhoeal diseases

l 5 Perinatal conditions

l 6 Measles

l 7 Tuberculosis

l 8 Cerebrovascular disease

l 9 Ischaemic heart disease

l 10 Maternal conditions

20.6

10.3

9.1

7.3

5.9

4.9

3.4

3.2

3.0

2.4

Source: The World Health Report 2000, WHO

Rank % of total

Leading infectious killersMillions of deaths, worldwide, all ages, 1998

0,0

0,5

1,0

1,5

2,0

2,5

3,0

3,5

4,0

Acu

tere

spir

ator

yin

fect

ions

AID

S

Dia

rrho

eal

dise

ases T

B

Mal

aria

Mea

sles

Dea

ths

in m

illi

ons

Over age fiveUnder age five

Context of infectious diseases at the beginning of the 21st. century

• High disease burden in developing countries

• Emergence of new or newly recognised pathogens (e.g. Nipah, Ebola, Marburg, SARS)

• Recurrence of outbreak-prone diseases (e.g. cholera, dengue, influenza, measles)

• Emergence of resistance to many antimicrobial drugs, making treatment more difficult and expensive

A Changing World !A Changing World !

• Globalisation of travel and trade

• Development of antimicrobial resistance

• Animal diseases crossing into human populations

• Inappropriate social, political and economic responses to outbreaks

A Changing World !A Changing World !

• Collapse of public health infrastructure

• Poverty, urbanisation and population displacement

• Complex and natural disasters

• Environmental exploitation

and degradation

HIV/AIDS PANDEMIC

Global summary of the AIDS epidemic (December 2004)

Number of people living with HIV in 2004

Total

Adults

Women

Children under 15 years

39.4 milion (35.9- 44.3)

37.2 milion (33.8- 41.7)

17.6 milion (16.3-19.5)

2.2 milion (2.0-2.6)

People newly infected with HIV in 2004

Total

Adults

Children under 15 years

4.9 milion (4.3- 6.4)

4.3 milion (3.7- 5.7)

640.000 (570.000-750.000)

AIDS deaths in 2004 Total

Adults

Chilcren under 15 years

3.1 milion (2.8- 3.5)

2.6 milion (2.3- 2.9)

510.000 (460.000-600.000)

WHO; AIDS epidemic update: December 2004

Adults and children estimated to be living Adults and children estimated to be living with HIV as of end 2004with HIV as of end 2004

Total: 39.4 (35.9 – 44.3) million

Western & Central Europe

610 000610 000[480 000 – 760 000][480 000 – 760 000]

North Africa & Middle East540 000540 000

[230 000 – 1.5 million][230 000 – 1.5 million]

Sub-Saharan Africa25.4 million25.4 million

[23.4 – 28.4 million][23.4 – 28.4 million]

Eastern Europe & Central Asia1.4 million 1.4 million

[920 000 – 2.1 million][920 000 – 2.1 million]

South & South-East Asia7.1 million7.1 million[4.4 – 10.6 million][4.4 – 10.6 million]

Oceania35 00035 000

[25 000 – 48 000][25 000 – 48 000]

North America1.0 million1.0 million

[540 000 – 1.6 million][540 000 – 1.6 million]

Caribbean440 000440 000

[270 000 – 780 000][270 000 – 780 000]

Latin America1.7 million1.7 million

[1.3 – 2.2 million][1.3 – 2.2 million]

East Asia1.1 million1.1 million

[560 000 – 1.8 million][560 000 – 1.8 million]

Estimated number of adults and childrenEstimated number of adults and childrennewly infected with HIV during 2004newly infected with HIV during 2004

Total: 4.9 (4.3 – 6.4) million

Western & Central Europe21 00021 000

[14 000 – 38 000][14 000 – 38 000]

North Africa & Middle East92 00092 000

[34 000 – 350 000][34 000 – 350 000]

Sub-Saharan Africa3.1 million3.1 million

[2.7 – 3.8 million][2.7 – 3.8 million]

Eastern Europe & Central Asia210 000210 000[110 000 – 480 000][110 000 – 480 000]

East Asia290 000290 000

[84 000 – 830 000][84 000 – 830 000]South & South-East Asia

890 000890 000[480 000 – 2.0 million][480 000 – 2.0 million]

Oceania5 0005 000

[2 100 – 13 000][2 100 – 13 000]

North America44 00044 000

[16 000 – 120 000][16 000 – 120 000]

Caribbean53 00053 000

[27 000 – 140 000][27 000 – 140 000]

Latin America240 000240 000

[170 000 – 430 000][170 000 – 430 000]

Estimated adult and child deaths Estimated adult and child deaths from AIDS during 2004from AIDS during 2004

Total: 3.1 (2.8 – 3.5) million

Western & Central Europe6 5006 500[<8 500][<8 500]

North Africa & Middle East28 00028 000

[12 000 – 72 000][12 000 – 72 000]

Sub-Saharan Africa2.3 million2.3 million

[2.1 – 2.6 million][2.1 – 2.6 million]

Eastern Europe & Central Asia60 00060 000[39 000 – 87 000][39 000 – 87 000]

East Asia51 00051 000

[25 000 – 86 000][25 000 – 86 000]South & South-East Asia

490 000490 000[300 000 – 750 000][300 000 – 750 000]

Oceania700700

[<1 700][<1 700]

North America 16 00016 000

[8 400 – 25 000][8 400 – 25 000]

Caribbean36 00036 000

[24 000 – 61 000][24 000 – 61 000]

Latin America95 00095 000

[73 000 – 120 000][73 000 – 120 000]

ChildrenChildren (<15 years)(<15 years) estimated to be living estimated to be living with HIV as of end 2004with HIV as of end 2004

Western & Central Europe6 2006 200

[4 900 – 7 900][4 900 – 7 900]

North Africa & Middle East24 00024 000

[7 100 – 82 000][7 100 – 82 000]

Sub-Saharan Africa1.9 million1.9 million

[1.7 – 2.3 million][1.7 – 2.3 million]

Eastern Europe & Central Asia8 8008 800[7 100 – 13 000][7 100 – 13 000]

East Asia9 4009 400[3 300 – 27 000][3 300 – 27 000]South

& South-East Asia170 000170 000[95 000 – 320 000][95 000 – 320 000]

Oceania700700

[< 2 500][< 2 500]

North America11 00011 000

[5 600 – 17 300][5 600 – 17 300]

Caribbean23 00023 000

[12 000 – 49 000][12 000 – 49 000]

Latin America26 00026 000

[21 000 – 43 000][21 000 – 43 000]

Total: 2.2 (2.0 – 2.6) million

Estimated number of children (<15 years) newly infected with HIV during 2004

Western & Central Europe< 100< 100[< 200][< 200]

North Africa & Middle East9 1009 100

[2 800 – 30 000][2 800 – 30 000]

Sub-Saharan Africa560 000560 000

[500 000 – 650 000][500 000 – 650 000]

Eastern Europe & Central Asia1 8001 800[1 200 – 3 700][1 200 – 3 700] East Asia

4 1004 100[1 500 – 11 000][1 500 – 11 000]South

& South-East Asia51 00051 000[30 000 – 95 000][30 000 – 95 000]

Oceania< 300< 300[< 1 000][< 1 000]

North America< 100< 100[< 200][< 200]

Caribbean6 1006 100

[3 100 – 13 000][3 100 – 13 000]

Latin America6 8006 800

[5 400 – 11 000][5 400 – 11 000]

Total: 640 000 (570 000 – 750 000)

About 14 000 new HIV infections a day in 2004

• More than 95% are in low and middle income

countries

• Almost 2000 are in children under 15 years of age

• About 12 000 are in persons aged 15 to 49 years, of

whom:— almost 50% are women— about 50% are 15–24 year olds

AFRICA del SUD

• Circa 11.4 milioni di soggetti sieropositivi per HIV• Circa il 30% di tutti i soggetti sieropositivi del mondo è

concentrato in un’area geografica ove risiede solo il 2% di tutta la popolazione mondiale

• Maggiore prevalenza nella popolazione femminile: 13 donne sieropositive ogni 10 uomini sieropositivi

• Considerando le fasce d’età più giovani (15-24 anni): 36 giovani donne sieropositive ogni 10 giovani uomini sieropositivi

• Prevalenza in aumento fra le donne gravide: 27.9% nel 2003• Aumento della mortalità:

- aspettativa di vita alla nascita < 40anni- AIDS (con o senza TB), principale causa di morte

AIDS AND ORPHANS

• 1990: 1 MILLION OF SUB-SAHARAN AFRICAN CHILDREN < 15 Y ORPHANS TO HIV-AIDS

• 2001: 11 MILLIONS

2010: 20 MILLIONS (12% of all the region’s children)

• Sub-saharan Africa accounts for 90% of AIDS orphans and children infected with HIV

• In high prevalence countries (>30%) (Botswana, Lesotho, Swaziland), >1/5 children will be orphaned by 2010 (80% by AIDS).

• In Swaziland school enrollment has fallen by 36% because children stay at home to care for sick relatives.

USA• Prevalenti modalità di contagio:

- rapporti omosessuali non protetti- tossicodipendenza e.v.

• In aumento i contagi attraverso rapporti eterosessuali non protetti• Maggiore coinvolgimento dei neri americani: più della metà dei nuovi

casi di sieropositività, sebbene rappresentino solo il 12% della popolazione

• In aumento i casi tra le donne nere americane:- 72% delle nuove diagnosi in tutta la

popolazione femminile USA- principale fatt. di rischio: rapporti a rischio

non noti dei rispettivi partner • Mortalità: - in calo dopo l’introduzione dei nuovi ARV

- AIDS causa di morte 2 vv più freq. tra i neri che tra i bianchi

EUROPA CENTRO-OCCIDENTALE

• Migliaia di nuovi casi all’anno, spesso misconosciuti• La maggior parte dei nuovi casi in soggetti emigrati da

aree del mondo gravemente afflitte dall’epidemia di HIV: Africa sub-Sahariana, Caraibi

• In netto aumento i casi contratti attraverso rapporti eterosessuali non protetti: nel 1997 pari al 25%; nel 2002 pari al 38%

• Aumento del 22% dei casi contratti attraverso rapporti omosessuali non protetti

EUROPA CENTRO-OCCIDENTALE

• Tossicodipendenza per via parenterale: importante modalità di contagio in Italia, Spagna, Portogallo (circa il 20% dei tossicodipendenti e.v. risulta sieropositivo per HIV)

• La Polonia è il paese dell’Europa centrale con il più alto numero di nuove infezioni

• In Ungheria, Slovenia, Rep. Ceca e Rep. Slovacca i rapporti omosessuali non protetti costituiscono la principale via di contagio

• Asia orientale:

popolazione siropositiva per HIV aumentata di almeno il 50% dal 2002 al 2004 (Cina)

• Asia Centrale e Europa Orientale: popolazione siropositiva per HIV aumentata di almeno il 40% dal 2002 al 2004 (Ucraina, Federazione Russa)

• Principali vie di contagio: rapporti sessuali non protetti nella popolazione giovane; tossicodipendenza e.v.

• Caraibi:

- al secondo posto nel mondo per la più alta

prevalenza di pazienti sieropositivi per HIV

- AIDS principale causa di morte tra gli

adulti di età compresa tra i 15 e i 44 anni

HIV/AIDSHIV/AIDS• HAART decreased AIDS mortality by 90% in industrialized

countries

• Life-saving/extending drugsLife-saving/extending drugs (ANTIRETROVIRALS, ARVs) (ANTIRETROVIRALS, ARVs) are are only available for industrialized countriesonly available for industrialized countries and out of and out of reach for the vast majority of HIV positive peoplereach for the vast majority of HIV positive people

• < 5% of people requiring treatment worldwide have access to antiretroviral drugs (ARV)

• < 2% of HIV-positive Africans receive ARV• Until 2000 AIDS therapy cost 10.000 $ per patient per year; Until 2000 AIDS therapy cost 10.000 $ per patient per year;

now 295 $now 295 $

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