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    • The recently published global consensus recommendations on p

    2019-04-28

    The recently published global consensus recommendations on prevention and management of rickets advocate for the eradication of rickets and osteomalacia through implementation of national supplementation and food fortification programmes containing vitamin D, calcium, or both. On the basis of high-quality evidence, the consensus group issued a strong recommendation to provide vitamin D supplementation for: (1) all infants from birth to at least 12 months of age (minimum of 400 international units [IU] per day); (2) all pregnant women (minimum of 600 IU per day); and (3) all individuals from risk groups (minimum of 600 IU per day). Supplementation works best when integrated into public health programmes for infants alongside immunisation and antenatal care programmes. Raising awareness among risk groups and health-care professionals for the need to supplement risk groups poses challenges, resulting in poor uptake rates and difficulties reaching remote populations. In addition, insufficient legislation, infrastructure, and knowledge of health-care professionals involved in primary care hinder success of supplementation programmes. Even in Europe, substantial differences exist in uptake of infant vitamin D supplementation. Instigating supplementation programmes may be even more difficult within the refugee Silmitasertib where other pressing health problems require addressing. Food fortification with vitamin D (or calcium) is an attractive alternative to increasing levels of 25-hydroxyvitamin D (the main serum marker of vitamin D sufficiency) in the whole population. Fortification is easily implemented since the distribution of the micronutrient relies on an effective distribution chain already established by the food industry. In addition, no additional burden is posed on the health system because fortification is not dependent on uptake rates and, if the vehicle selected is adequate (ideally a staple food consumed regularly by risk groups), it provides wide coverage. The consensus recommendations therefore promote fortification of habitually consumed foods such as milk, cooking oil, or other vehicles as appropriate in each country, but advise that fortification requires governmental leadership with supportive legislation, and needs to be policy-driven and adequately monitored. Food fortification, as practised in Canada and the USA for decades, is safe, cost-effective, acceptable to manufacturers and the public, and has successfully prevented diseases, including rickets (calcium, vitamin D) and neural tube defects (folic acid). We call on national governments and international policy makers to recognise rickets and osteomalacia as fully preventable diseases with greatest risk in dark-skinned immigrant, refugee, and resident populations, and to provide appropriate legislation for implementation of effective supplementation and fortification programmes. Screening and prevention programmes for refugees from at-risk ethnic populations should include vitamin D supplementation on arrival, as well as during every winter and spring in all areas of northern or southern latitudes greater than 34 degrees. The consensus papers provide the evidence and the framework for designing such prevention programmes.
    Chagas disease is an emerging but still largely unrecognised infectious parasitic disease in European countries. It has important public health implications because, although the classic vector-borne route of transmission only occurs in endemic areas of Latin America, the less common transmission routes—blood transfusion, transplantation, and vertical transmission from mother to child—have been shown in Europe. Therefore, providing policy makers with accurate estimates of country-specific prevalence of Chagas disease should inform the design and implementation of the most cost-effective health interventions. We used demographic data from London, UK, and seroprevalence data from source countries to generate high-resolution estimates of the burden of undetected infection in London, and compared these estimates with the actual number of cases reported. The number of residents in London who were originally from the 21 endemic countries in Central and South America was calculated from the 2011 UK National Census and was stratified by borough. We did not include undocumented migrants and individuals born to mothers from endemic Latin American countries. To calculate the expected number of people infected with , the number of migrants from each country of origin was multiplied by that country\'s specific Chagas disease prevalence among migrants living in Europe, as estimated in a meta-analysis. For endemic Latin American countries without data in the meta-analysis, the prevalence was obtained from a report based on 2010 estimates of Chagas disease in Latin America. The minimum and maximum prevalence estimates for countries in the meta-analysis were derived from the 95% CIs. Finally, the total expected number of cases was divided by the total Latin American population living in each London borough.