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Zika: Rare birth defect on the rise in Angola

LUANDA (Reuters): Emiliano Cula starts to cry as his tiny fingers, curled into a tight fist, are stretched by a physical therapist to stimulate motor control.

Born in a poor neighborhood of Angola’s capital Luanda, the 10-month old boy has microcephaly, a birth defect marked by a small head and serious developmental problems. He still can’t sit upright and has difficulty seeing and hearing.

“They don’t know what caused it,” Cula’s mother Marie Boa says, sheltering under a blue umbrella from the summer rains.

“The doctor said it might have been caused by a mosquito, but I don’t know if that’s true.”  The 18-year-old does not know whether her first child will ever walk or talk.

Cula is one of at least 72 babies born with microcephaly in Angola between February 2017 and May 2018, suspected victims of an emerging Zika outbreak.

The cases have gone largely unreported, but an internal World Health Organization report reviewed by Reuters concluded in April that two cases of a potentially dangerous strain of Zika confirmed in early 2017, along with the microcephaly cases identified since then, provided “strong evidences” of a Zika-linked microcephaly cluster in Angola.

It was the Asian strain that caused at least 3,762 cases of Zika-related birth defects, including microcephaly, in Brazil since 2015, as well as serious outbreaks in other Latin American countries. Doctors and researchers now fear it could spread from Angola to other countries on the African continent.

In an emailed response to questions, Angola’s ministry of health said it had reports of 41 cases of Zika and 56 cases of microcephaly since January 2017, when it began gathering data. It was not immediately clear why the figures differed from the internal WHO report.

“Probably not all the cases of microcephaly can be attributed to Zika,” the ministry said, listing a series of other potential causes such as syphilis and rubella.

Only one laboratory in Angola is currently testing for Zika, according to the health ministry. In order to improve the speed and accuracy of diagnoses, it said laboratories beyond the capital would need to be given testing capacity.

First discovered in Uganda’s tropical Zika forest in 1947, Zika circulated quietly for years, causing mild, flu-like symptoms in parts of Africa and Asia. Over time, the virus diverged into two genetically distinct lines – the African and the Asian lineages – and neither was initially associated with large epidemics.

In late 2007, the Asian strain triggered the first large outbreak of Zika in humans on the island of Yap in Micronesia, infecting 73 percent of residents over age 3. In 2013, an outbreak in French Polynesia was the first linked to microcephaly.

The first lab-confirmed case of the Asian strain in Brazil was in 2015. By 2016 the virus, transmitted by the same mosquito that carries dengue and Yellow fever, had spread to nearly all of the states in Brazil, hitting hardest in the tropical Northeast. In its wake, thousands of babies were born with small, misshapen heads.

In Angola, it has been difficult to directly link microcephaly cases to Zika because of limited access to advanced testing that can confirm the disease even after the acute phase passes.

In Brazil, the epicenter of the largest and most severe Zika outbreak to date, the virus has now virtually disappeared. The high rate of infections two years ago has left much of the population immune, making it harder for the disease to spread.

Many families affected by the disease still struggle. Jackeline Vieira de Souza, 28, who lives in the Brazilian state of Pernambuco, describes a grueling daily routine for her son Daniel, born in 2015 with microcephaly: “My day to day is to wake up and take care of him. Therapies and doctors.”

In Angola, the journey of such mothers is just beginning. There is no public health program to help the children, who need regular physical therapy and other care.

Families are often referred to The Center for Neurosurgery and Treatment for Hydrocephaly in Luanda, even though the center lacks funding to address the problem. Families are expected to pay for consultations, costing between $7 and $21, which is far beyond the means of many in a country where 30 percent of the population lives on less than $1.90 per day.

“The majority come once and never come back,” said physiotherapist Adelina Martins. “They don’t have the means to keep coming.”

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Scotland winter death rates reach highest level since 1999  

LONDON (BBC): The number of people who died in Scotland last winter hit a 18-year high, new statistics have revealed.

There were 23,137 deaths between December 2017 and March 2018, according to the National Records of Scotland – the highest figure since 1999/2000.

It also revealed that the seasonal increase in mortality – the number of “additional” deaths in winter – was significantly higher than in 2016/17.

The main underlying causes of the deaths were influenza and pneumonia.

Last winter saw the highest rates of flu-like illness in Scotland for seven years, according to the Scottish government.

In January Nicola Sturgeon said Scotland’s health service was facing “exceptional” pressures as the number of flu cases were double the previous year.

Many patients had to wait longer for treatment but the first minister said at the time that hard-working staff were ensuring that the NHS was “coping well”.

The government said it was providing a new flu vaccine to protect the over 75s this year, and investing an extra £10m to support winter resilience planning.

Why did more people die last winter?

The NRS report found that the total number of deaths in 2017/18 increased by 10.5% on the previous winter, when 20,946 deaths were recorded.

Last winter’s death total was the largest number since 23,379 deaths were recorded in 1999/2000.

Anne Slater, the chief executive of the National Records of Scotland (NRS), said there was a long-term downward trend of winter deaths since the early 1950s.

“However, the average value for the latest five years (which smoothes out much of the year-to-year fluctuation) is now above the level that had applied since the early 2000s,” she said.

“It is too soon to say whether there has been a change in the long-term trend: it could just be a short-term rise, like that seen roughly 20 years ago, after which the average fell for several years.”

It also found that there were 4,797 additional deaths last winter, compared to the average number of deaths in the four months before December 2017 and after March 2018.

It was the largest increase in seasonal mortality since 1999/2000 when the figure stood at 5,190, and a significant increase on the 2,730 recorded in 2016/17.

The NRS said the seasonal increase was larger than in most of the previous 66 winters and exceeded the level seen in 19 of the previous 20 winters.

Around 80% of additional deaths were among people aged 75 and older.

The underlying causes of most of the “additional” deaths included respiratory diseases, heart disease, stroke and dementia.

Very few deaths were caused by hypothermia and only a small proportion directly by influenza.

The Scottish Liberal Democrats’ health spokesman, Alex Cole-Hamilton, called on the Scottish government to ensure the NHS was ready for this winter.

“While our NHS staff have done fantastic work in ensuring that the long term winter mortality rate is in decline, last year’s steep rise in winter deaths is a cause for concern,” he said.

“There are staff shortages across health and social care and this is clearly having an impact.

“The health secretary must set out what lessons have been learned from these tragic deaths and what changes have been made to ensure that our NHS is ready for another cold winter.”

The Scottish government said it has commissioned work to investigate the link between winter deaths and flu, and to explore potential factors behind the rise in mortality.

Scotland’s Chief Medical Officer Dr Catherine Calderwood said: “Every year in Scotland, around two thirds of people who get severe flu and need intensive care treatment have a health condition such as chronic lung or heart disease.

“Last winter, Scotland had its highest flu rates for seven years, a pattern seen across Europe and the United States, and it is likely that flu was a significant factor in many deaths, particularly among older people and those with long-term conditions.

“Flu vaccines are available free to all eligible adults, including everybody aged 65 and older, and protects against a number of different flu strains. Vaccination remains our best defence against flu, and I urge people to take up the offer of a free vaccine.”

 

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Dengue claims life in Karachi

F.P. Report

KARACHI: This year’s second death from dengue fever reported at Aga Khan Hospital where a 60-year old man succumbed to the deadly virus. A 60-year old man, Muhammad Khalil s/o Muhammad Shakil, a resident of North Karachi, was brought to Aga Khan Hospital on October 11, who died same day.  The man was suffering high-grade fever when shifted in hospital and diagnosed dengue fever.

In April, An elderly woman, namely Akraman Mai, resident of Surjani Town, of Karachi was died in Jinnah Postgraduate Medical Centre (JPMC) due to dengue fever. 25 more dengue cases surface in the city. As many as 25 more dengue fever cases were detected thorough Karachi city in a week, taking the reported cases toll to 969 since 1st January 2018. According to the weekly report issued by Prevention and Control Program for Dengue in Sindh, at least 25 new dengue fever cases were recorded across Karachi city in a week. No new case was reported from others districts of the province.

 

 

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Anti-measles campaign launch in Lakki Marwat

Ghulam Mursalin Marwat

LAKKI MARWAT: The 12 day anti measles campaign was launched in a ceremony held at the office of deputy commissioner in district headquarters complex Tajazai on Monday. Local deputy commissioner Muhammad Kabir Afridi, DHO Dr Abdugul and EPI coordinator Dr Omer Faisal attended the occasion wherein a health provider Muhammad Yousaf administered anti measles vaccine to several kids below the age of five years.

The deputy commissioner said on the occasion that around 174000 kids aging between 9 months to 5 years would be vaccinated against the epidemic disease during the campaign. He said that the health department had formed 215 teams to ensure vaccination of targeted population. Afridi said that besides extending all out support to health department the administration would supervise the campaign and performance of teams.

“The performance of health providers will be evaluated on daily basis and those found indulged in negligence and poor performance will face action”, he made clear, calling upon people especially parents to cooperate with health workers and vaccinate their children against measles.

He expressed satisfaction over arrangements made by health department and said that all out efforts would be made to achieve the immunisation of kids against the epidemic successfully.

 

 

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Jurors deadlock in J&J talc powder cancer case

Monitoring Desk

CALIFORNIA: Following a record verdict in a trial in Missouri, litigation against Johnson & Johnson over its talcum powder ended in a mistrial in California.

“A state judge in Pasadena, California, declared a mistrial Monday after jurors deadlocked on Carolyn Weirick’s request for at least $25 million in damages over her mesothelioma, a cancer linked to asbestos exposure,” Bloomberg News reports. “Weirick said she developed the disease from asbestos-laced baby powder.”

Previously, a jury in Missouri awarded a record $4.69 billion in July to more than 20 women who traced the source of their cancer to the company’s baby powder. This verdict is under appeal by Johnson & Johnson.

“The world’s largest health-care products maker faces more than 10,000 other suits claiming its baby powder caused cancer,” Bloomberg reports.

 

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Fat tissue could be a source of diabetes

Monitoring Desk

MELBOURNE: A new study by Australian researchers, out today, is challenging what we know about the causes of diabetes. The new research points to fat tissue as a source of disease, and widens our understanding beyond the traditional focus on liver and pancreas as the main culprits.

The findings, uncovered in mice, are published in the high-impact journal Cell Metabolism.

The new research is centred around the surprising finding that protein kinase C epsilon (PKCε), known to be involved in diabetes, isn’t acting in the liver or the pancreas as was once assumed.

Researchers have long known that PKCε is important for the development of diabetes. Mice that have no PKCε produced anywhere in the body don’t develop diabetes-like symptoms – even under conditions where other mice become diabetic.

“We have known for some time that if you remove PKCε entirely from mice and feed them a high-fat diet they do not become glucose intolerant. In fact, they are protected from becoming diabetes-like,” says Associate Professor Carsten Schmitz-Peiffer (Garvan Institute of Medical Research), who led the research.

Diabetes researchers use a high-fat diet (HFD) to induce type 2 diabetes in mice. Following a HFD, most mice become ‘glucose intolerant’ – they are unable to control their blood sugar after eating. In particular, the liver becomes ‘insulin resistant’ – it no longer responds to the pancreatic hormone insulin.

“The big surprise was that when we removed PKCε production specifically in the liver – the mice were not protected. For over a decade, it’s been assumed that PKCε is acting directly in the liver – by that logic, these mice should have been protected against diabetes.”

“We were so surprised by this, that we thought we had developed our mice incorrectly. We confirmed the removal and tested it in several different ways, but they still became glucose intolerant when given a HFD.”

If not the liver, then where? The hunt was on to determine where PKCε was working to progress glucose intolerance.

“What we found,” explains A/Prof Schmitz-Peiffer, “is that if we removed PKCε production solely from fat tissue, the mice were protected from becoming glucose intolerant, similar to when we removed PKCε from the entire animal. So PKCε isn’t progressing diabetes from the liver, but in fact, it is acting from fat tissue to worsen the disease.”

PKCε has been known to be expressed in multiple tissues, but Prof Schmitz-Peiffer’s findings now point to a new function in fat tissue.

A close examination of the fat tissue revealed a striking difference in the shape and size of the fat cells in the presence and absence of PKCε.

“Under the microscope, the fat cells looked very different,” A/Prof Schmitz-Peiffer says. “In HFD-fed mice with PKCε removed from the fat tissue, we saw mostly small, healthy fat cells. And in HFD-fed mice with PKCε intact – which are glucose intolerant – we saw more of the unhealthy, engorged fat cells, that tend to have less access to oxygen and become inflamed.”

For A/Prof Schmitz-Peiffer, it is clear this could have wide-ranging and complex implications for diabetes.

“We know that fat tissue is a lot more than just an inert mass for storing fat,” explains A/Prof Schmitz-Peiffer, “it’s a very dynamic organ, it sends many messages and releases factors that communicate with the rest of the body, including the liver.”

“If PKCε is changing the nature of fat and affecting the overall health of fat cells, it’s changing the types of messages it sends and factors it releases – which could be acting on the liver and possibly other organs to interfere with glucose metabolism.”

This discovery is the latest in a long line of contributions made in this field by A/Prof Schmitz-Peiffer.

“10 years ago, we showed that removing PKCε entirely protected mice against glucose intolerance. We just never knew where PKCε was acting. But we knew we might be onto something therapeutically important, if we could find a way to block PKCε”.

Today, Prof Schmitz-Peiffer is collaborating with Professor Ray Norton and Professor Jonathan Baell at the Fragment Based Drug Discovery Platform at the Monash Institute of Pharmaceutical Sciences to develop an orally available peptide that can disrupt PKCε activity.

“These results give us an even better idea about how to target PKCε to develop the most effective treatments possible. And therapeutically targeting PKCε would be a new possible approach for diabetes treatment.”

 

 

 

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Rare ‘Polio-Like’ illness surface in US

Monitoring Desk

WASHINGTON: More and more cases of a rare polio-like illness are being reported across the country, according to news reports.

In recent weeks, six cases of the illness, known as acute flaccid myelitis (AFM), have been diagnosed in children in Minnesota — a state the typically sees less than one case of AFM per year, according to the Minnesota Department of Health. On Tuesday (Oct. 9), a hospital in Pittsburgh said it is currently treating three children with suspected AFM, according to local news outlet KDKA. And yesterday (Oct. 10), the Illinois said it had received recent reports of nine children diagnosed with the condition.

Also this week, the Colorado Department of Public Health and Environment announced that 14 cases of AFM have occurred in the state this year.

AFM is a condition that affects the nervous system and causes muscle weakness, according to the Center for Disease Control and Prevention (CDC). In particular, the condition can cause weakness in the arms and legs along with loss of muscle tone and problems with reflexes. Other symptoms include facial drooping, difficulty moving the eyes, difficulty swallowing and slurred speech, the CDC says. Most cases are in children.

The condition is not new, but officials started to see a rise in cases in 2014. Since then, more than 350 cases of the illness have been reported in the U.S. over a four-year period. So far this year, there have been 38 cases in 16 states, the CDC says.

The cause of AFM, and the reason for the rise in cases starting in 2014, is not known. However, the 2014 cases coincided with a national outbreak of a respiratory illness caused by a virus called enterovirus D68. It’s possible that AFM has a variety of causes, including viruses (such as poliovirus and enteroviruses), environmental toxins and genetic disorders, the CDC says.

The condition is still very rare, occurring in fewer than one in a million people in the U.S. each year, the CDC says.

 

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World Mental Health Day observed in KTH

F.P. Report

PESHAWAR: Khyber Teaching Hospital Department of Psychiatry celebrated World Mental Health Day on Wednesday. The chief guest of the event was Member BoG Prof Dr Shahjahan. Dean KMC Prof Dr Noor ul Eman, Chairman Department of Psychiatry Prof Dr Sayed Muhammad Sultan and other prominent psychiatrists were present in the event.

World Mental Health Day is observed across the World on 10th of October with an aim to raise awareness about Mental Health issues and eventually help those with Mental Health problems. Treatment gap for psychiatric condition in the developed World is reported to be 50% while this figure reaches to startling 90% in the developing countries including Pakistan.

This year, the theme of the World Mental Health Day is “Young People and Mental health in a Changing World”. In the early years of adulthood and adolescence, people undergo a number of physiological, psychological and more importantly social role changes like changing school or moving on to Colleges, Universities and different jobs. These changes may bring excitement as well as distress and apprehension. Apart from usual distress as a result of need of autonomy, peer pressure and identity crises many adolescents are at risk of neglect, abuse and bullying making them particularly vulnerable to mental illness. Internet and mobile addiction these days is another major threat to the mental health of these young people.

According to the World Health Organization, half of all mental health disorders begin by the age of 14 and 75% of most Psychiatric Illness start in the late adolescent and early adult life. Depression is quite common in this age group while suicide is the second leading cause of death in young people age 15 to 29.

Mental health problems are common in Pakistan as elsewhere and it is estimated that about one in every 4 persons suffer from some kind of mental health problem. This amounts to a total of about 55 million people in our country of 210 million population. In fact, 34% of the people in Pakistan have been found to suffer from depression and anxiety alone. Similarly, the rates of emotional problems among children and adolescents is quite high and 15 to 20 % of our children who are the architects of our future suffer from various Psychiatric Disorder. Apart from emotional problems children and adolescents suffer from Conduct Disorder, Hyperactivity Disorder, Anxiety Disorders, Autism, Psychotic Disorders and Drug Abuse. In addition, 5% of our children and adults suffer from various degrees of Mental Retardation. There are no specialised treatment centers for Children with Psychiatric disorder in Khyber Pakhtunkhwa and there are only a few of these in the whole country. This is an alarming situation, the government of Pakistan to pay attention to.

In the end, Prof Dr Sayed M. Sultan Chairman Dept of Psychiatry presented some demands to the BoG MTI KTH that psychiatry dept KTH is one of the best teaching departments in Pakistan and people from Punjab come for training and revision courses to this department so this department need to be strengthened by creating the post of at least two associate professor and three assistant professor in the department.

Clinical psychology and psychotherapy is part and parcel of psychiatry department that section of the department need to be expanded and strengthened by creating 8 clinical psychologists posts. He also added that mental health act which was promulgated in KP needs to be implemented in its true spirit so that the marginalized population gets the rights. Psychiatric services and drug abuse treatment center need to be established at district.

 

 

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Healthy diet likely to boost treatment of Bipolar disorder

Monitoring Desk

ISLAMABAD: Diet quality can affect many aspects of one’s physical health and psychological well-being. New research investigates whether or not these factors can also affect the effectiveness of treatments for mood disorders particularly bipolar.

The moods of people who have bipolar disorder fluctuate between two extremes.

These are the “highs,” during which the person feels euphoric and may engage in dangerous behaviors, and the “lows,” characterized by depression and lethargy.

Since two opposite mood extremes characterize this disorder, it is often difficult to treat both the “highs” (or “manic episodes”) and the “lows” (or “depressive episodes”) with the same efficacy.

New research presented at the European College of Neuropsycho pharmacology congress, held in Barcelona, Spain, now suggests that weight and dietary habits may influence how effective treatments for bipolar disorder actually are.

In particular, a healthful diet may aid therapy for depressive episodes, note the study authors. They also explain that, conversely, a poor diet could contribute to heightened inflammation, which may have a negative impact on a person’s symptoms.

“If we can confirm these results, then it’s good news for people with bipolar disorder, as there is a great need for better treatments for the depressive phase of bipolar disorder,” states lead researcher Melanie Ashton, from Deakin University in Geelong, Australia.

The team comprised scientists from numerous academic and research institutions across Australia, Germany, and the United States.

Ashton and colleagues conducted a clinical trial for which they recruited 181 participants, of whom 133 provided all the data necessary for the final analysis. All the participants experienced bipolar depression, which is the depressive phase of bipolar disorder.

For a period of 16 weeks, the team randomly allocated all the participants to receive one of three types of treatment:

  • a mix of nutraceuticals(or natural nutrients sometimes used as alternatives to drugs and that may help treat or prevent chronic diseases), including the anti-inflammatory substance n-acetylcysteine (NAC)

 

The investigators administered these treatments alongside the participants’ normal medication for bipolar disorder.

At the start of the trial, the team also collected relevant information from the volunteers, including: their body mass indexes (BMIs), measures of depression, and to what extent they were able to function normally on a day-to-day basis.

The researchers assessed the volunteers’ progress every 4 weeks including 4 weeks after the cessation of the experimental treatment. They also asked them to answer questionnaires that evaluated dietary habits.

This allowed them to give scores to each participant depending on how healthful their regular diets were.

Good-quality diets included high consumption of fruit and vegetables, whereas poor diets relied on food high in saturated fats and refined carbohydrates, as well as excess alcohol consumption.

Ashton and her team categorized healthful diets as anti-inflammatory and poor-quality diets as pro-inflammatory, based on their contents.

“We found that people who had a better-quality diet, a diet with anti-inflammatory properties, or a lower BMI, showed better response to add-on nutraceutical treatment than did those who reported a low-quality diet, or a diet including foods that promote inflammation, or who were overweight.”

The investigators believe that, if these results could be replicated in larger clinical trials, specialists may want to start handing out dietary advice to people diagnosed with bipolar disorder.

Ashton emphasizes the necessity of repeating this study, saying, “This is a randomized, controlled trial, but what we found were exploratory outcomes; in other words, it wasn’t the main result that we were testing.”

“Our result is statistically significant, but because the study wasn’t specifically designed to test the effect of diet quality, inflammatory diets, and BMI on drug response in general,” she explains, “it is necessary to see the work replicated in a larger study before any firm conclusions can be formed.”

 

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Beat polio with consistent quality vaccination: ACS

F.P. Report

PESHAWAR: Additional Chief Secretary Khyber Pakhtunkhwa Tribal Districts lauded efforts of EOC, health department, UN partners, District Health Officers and Deputy Commissioners over exemplary progress of maintaining zero case status in tribal districts for more than two years. He said that the communities in the tribal districts shall cooperate with health staff in polio campaigns and in upcoming measles campaign, as it is the only way to secure healthy future for our children. He said that we can beat polio, measles and all other vaccine preventable diseases through essential immunization.

Additional Chief Secretary (ACS) KP Tribal Districts Sikandar Qayum Khan while reviewing progress of polio program and preparation for upcoming measles campaign at FATA Secretariat today, said, “We have achieved a lot but our focus should be on adding value to polio program by addressing challenges emerging every now and then, so that we can achieve the ultimate goal polio eradication”.

He expressed satisfaction over preparation for measles campaign starting from Oct 15, 2018 in Tribal Districts and advised that “close coordination between EOC KP TD team, essential immunization teams, DHOs and Deputy Commissioners will be significant in assuring vaccination of target children”. He added that polio platform be utilized for measles campaign implementation. ACS KP Tribal Districts assured full support in addressing challenges and tackling hurdles in both polio and essential immunization program. He advised Deputy Commissioners and Health Staff to ensure presence for addressing issues discussed at evening meetings held at District Polio Control Rooms during campaigns.

Coordinator EOC KP TD Mahmood Aslam Wazir briefed forum on polio program progress and challenges faced during the past few months. He emphasized that “EOC KP TD priority is to vaccinate every child and reach children missed during polio campaigns”. He suggested that Deputy Commissioners and District Health Officers can help vaccinate all the children, with improved teams’ performance. It was emphasized to stop circulation of polio virus detected through environmental sampling in Bajaur Agency by vaccinating every child including population on the move, in upcoming anti polio campaigns.

Program Manager EPI Tribal Districts Dr. Iftikhar Ali updated chair regarding preparations for measles campaign in tribal districts. He informed chair that all the pre-campaign activities have been ensured and daily meetings are conducted to monitor progress.

ACS KPTD advised to strengthen the accountability mechanism, identify poor performing or absent staff, and bring it to the notice of ACS Office for strict action.  He stressed that lapses at any level will be dealt with seriously.

Deputy Commissioners, District Health Officers, Program Manager EPI Dr. Iftikhar Ali, Technical Focal Person KPTD Dr. Nadeem Jan, Team Leader UNICEF-KPTD Dr. Tufail Ahmad, National Consultant Measles-WHO Islamabad Dr. Poonum Durdana, Team Lead WHO-KPTD Dr. Hamid Momand and other relevant officials attended the meeting.