Government takeover of home mortgage lenders

Government takeover of home mortgage lenders

Main article: Federal takeover of Fannie Mae and Freddie Mac

The United States director of the Federal Housing Finance Agency (FHFA), James B. Lockhart III, on September 7, 2008 announced his decision to place two United States Government sponsored enterprises (GSEs), Fannie Mae (Federal National Mortgage Association) and Freddie Mac (Federal Home Loan Mortgage Corporation), into conservatorship run by FHFA.^[18][19][20] United States Treasury Secretary Henry Paulson, at the same press conference stated that placing the two GSEs into conservatorship was a decision he fully supported, and said that he advised "that conservatorship was the only form in which I would commit taxpayer money to the GSEs." He further said that "I attribute the need for today's action primarily to the inherent conflict and flawed business model embedded in the GSE structure, and to the ongoing housing correction."^[18] The same day, Federal Reserve Bank Chairman Ben Bernanke stated in support: "I strongly endorse both the decision by FHFA Director Lockhart to place Fannie Mae and Freddie Mac into conservatorship and the actions taken by Treasury Secretary Paulson to ensure the financial soundness of those two companies."^[21]

[edit] Major financial firm crisis

The collapse of Lehman Brothers was a symbol of the global financial crisis

On Sunday, September 14, it was announced that Lehman Brothers would file for bankruptcy after the Federal Reserve Bank declined to participate in creating a financial support facility for Lehman Brothers. The significance of the Lehman Brothers bankruptcy is disputed with some assigning it a pivotal role in the unfolding of subsequent events. The principals involved, Ben Bernanke and Henry Paulson, dispute this view, citing a volume of toxic assets at Lehman which made a rescue impossible.^[22][23] Immediately following the bankruptcy, JPMorgan Chase provided the broker dealer unit of Lehman Brothers with $138 billion to "settle securities transactions with customers of Lehman and its clearance parties" according to a statement made in a New York City Bankruptcy court filing.^[24]

The same day, the sale of Merrill Lynch to Bank of America was announced.^[25] The beginning of the week was marked by extreme instability in global stock markets, with dramatic drops in market values on Monday, September 15, and Wednesday, September 17. On September 16, the large insurer American International Group (AIG), a significant participant in the credit default swaps markets, suffered a liquidity crisis following the downgrade of its credit rating. The Federal Reserve, at AIG's request, and after AIG has shown that it could not find lenders willing to save it from insolvency, created a credit facility for up to US$85 billion in exchange for a 79.9% equity interest, and the right to suspend dividends to previously issued common and preferred stock.^[26]

Money market funds insurance and short sales prohibitions

On September 16, the Reserve Primary Fund, a large money market mutual fund, lowered its share price below $1 because of exposure to Lehman debt securities. This resulted in demands from investors to return their funds as the financial crisis mounted.^[27] By the morning of September 18, money market sell orders from institutional investors totalled $0.5 trillion, out of a total market capitalization of $4 trillion, but a $105 billion liquidity injection from the Federal Reserve averted an immediate collapse.^[28][29] On September 19 the U.S. Treasury offered temporary insurance (akin to FDIC insurance of bank accounts) to money market funds.^[30] Toward the end of the week, short selling of financial stocks was suspended by the Financial Services Authority in the United Kingdom and by the Securities and Exchange Commission in the United States.^[31] Similar measures were taken by authorities in other countries.^[32] Some restoration of market confidence occurred with the publicity surrounding efforts of the Treasury and the Securities Exchange Commission^[33][34]

Global banking reshaped

Global banking reshaped

This multimedia snapshot brings together coverage of the mounting crisis and its impact on the markets through links to in depth packages, interactive maps, audio, video and blogs.

The rising defaults on subprime mortgages in the US triggered a global crisis for the money markets. Many of the world’s leading investment banks have collapsed as a result and the US government has proposed a massive bail-out.

The crisis has become one of the most radical reshapings of the global banking sector, as governments and the private sector battle to shore up the financial system following the disappearance of Lehman and Merrill as independent entities and the $85bn government rescue of AIG.

Dealing with recession

Dealing with recession

Most economic regions are now facing recession, or are in it. This includes the US, the Eurozone, and many others.

At such times governments attempt to stimulate the economy. Standard macroeconomic policy includes policies to

• Increase borrowing,
• Reduce interest rates,
• Reduce taxes, and
• Spend on public works such as infrastructure.

Borrowing at a time of recession seems risky, but the idea is that this should be complimented with paying back during times of growth.

Likewise, reducing interest rates sounds like there would be less incentive for people to save money, when banks need to build up their capital reserves. However, as the real economy starts to feel the pinch, reduced interest rates is an attempt to encourage people to take part in the economy.

Tax reduction is something that most people favor, and yet during times of economic downturn it would seem that a reduction in tax would result in reduced government revenues just when they need it and then spending on health, education, etc, would be at risk. However, because higher taxes during downturns means more hardship for more people, increased borrowing is supposed to offset the reduction in taxes, hopefully affording people a better chance to weather the economic storm.

Finally it is at this time that public infrastructure work, which can potentially employ many, many people, is palatable. Often, under free market ideals, government involvement in such activities is supposed to be minimal. Even the other forms of “interference” is usually frowned upon. However, most states realize that markets are not always able to function on their own (the current financial crisis, starting in the US, being the prime example); pragmatic and sensible adoption of market systems means governments can guide development and progress as required.

Nonetheless, many governments have started to contemplate these kinds of measures. For example, South Korea reduced its interest rates, as has Japan, China, England, various European countries, and many others.

Many have looked to borrow billions or in some way come up with stimulus packages to try and kick-start ailing economies.

While these might be reasonably standard things to do, it requires that during economic good times, a reversal of some of these policies are required; interest rates may need to increase (one reason for the housing booms in the US, UK and elsewhere was that interest rates were too low during good times), borrowing should be reduced and debts should start to be repaid, infrastructure investments may not need to be as direct from government and private enterprise may be able to contribute, and most politically sensitive of all, taxes should increase again to offset the reduction in borrowing.

Some are also against government-based stimulus packages, arguing instead that tax cuts alone should do the job; individuals make better choices on consumption than governments. Nobel prize winner for economics, Paul Krugman addresses this noting the difference between private consumption and government stimulus:

But [private spending is] not what we’re talking about when we talk about stimulus spending: we’re not talking about the government buying consumption goods for the public at large. Instead, we’re talking about spending more on public goods: goods that the private market won’t supply, or at any rate won’t supply in sufficient quantities. things like roads, communication networks, sewage systems, and so on. And every Econ 101 textbook explains that the provision of public goods is a necessary function of government.

— Paul Krugman, Bad anti-stimulus arguments, New York Times, December 22, 2008

Each of these measures should no doubt come under scrutiny from opposition parties and the media, to ensure they are appropriate, but some, such as tax hikes during good times can be so politically sensitive, that governments may be afraid to make such choices, thus making economic policies during bad times even riskier as a result.

Even then, the severity of these economic problems means that these strategies are not guaranteed to work, or it may take even longer to take effect. For example, as quarterly figures for various companies start to come out, more and more companies are announcing losses, closures, layoffs or other problems; people are becoming very nervous about the economy and spending less.

The automobile industry in the US, for example, is feeling immense pressure with some of the largest companies in the world facing huge problems and are asking the government for some kind of bailout or assistance. Yet, the US public generally seems against this, having already bailed out the banks with enormous sums of money. If the automobile industry is bailed out, then other industries will all cry for more money; when would it stop?

In addition, as Joseph Stiglitz warns, some nations are turning to the IMF which is prescribing the opposite policies:

Many are already turning to the International Monetary Fund (IMF) for help. The worry is that, at least in some cases, the IMF will go back to its old failed recipes: fiscal and monetary contraction, which would only increase global inequities. While developed countries engage in stabilizing countercyclical policies, developing countries would be forced into destabilizing policies, driving away capital when they need it most.

— Joseph Stiglitz, Let’s throw away the rule book; Bretton Woods II must establish economic doctrines that work in emerging economies as well as in capitalism’s heartland, The Guardian, November 6, 2008

In Iceland, where the economy was very dependent on the finance sector, economic problems have hit them hard. The banking system virtually collapsed and the government had to borrow from the IMF and other neighbors to try and rescue the economy. However, Iceland has raised its interest rates to some 18%, partly on advice from the IMF. It would appear to be an example where high interest rates may be inappropriate. The economic problems have led to political challenges including protests and clashes.

It may be that this time round a more fundamental set of measures need to be considered, possibly global in scope. The very core of the global financial system is something many are now turning their attention to.

A crisis of poverty for much of humanity

Almost daily, some half of humanity or more, suffer a daily financial, social and emotional, crisis of poverty. In poorer countries, poverty is not always the fault of the individual alone, but a combination of personal, regional, national, and—importantly—international influences. There is little in the way of bail out for these people, many of whom are not to blame for their own predicament, unlike with the financial crisis.

There are some grand strategies to try and address global poverty, such as the UN Millennium Development Goals, but these are not only lofty ideals and under threat from the effects of the financial crisis (which would reduce funds available for the goals), but they only aim to halve poverty and other problems. While this of course is better than nothing it signifies that many leading nations have not had the political will to go further and aim for more ambitious targets, but are willing to find far more to save their own banks, for example.

A global food crisis affecting the poorest the most

While the media’s attention is on the global financial crisis (which predominantly affects the wealthy and middle classes), the effects of the global food crisis (which predominantly affects the poorer and working classes) seems to have fallen off the radar. The two are in fact inter-related issues, both have their causes rooted in the fundamental problems associated with a neoliberal, one-size-fits-all, economic agenda imposed on virtually the entire world.

Poor nations will get less financing for development

The poorer countries do get foreign aid from richer nations, but it cannot be expected that current levels of aid (low as they actually are) can be maintained as donor nations themselves go through financial crisis. As such the Millennium Development Goals to address many concerns such as halving poverty and hunger around the world, will be affected.

Almost an aside, the issue of tax havens is important for many poor countries. Tax havens result in capital moving out of poor countries into havens. An important source of revenue, domestic tax revenues account for just 13% of low income countries’ earnings, whereas it is 36% for the rich countries.

A UN-sponsored conference slated for November 2008 to address this issue is unlikely to get much attention or be successful due to the recession fears and the financial crisis. But this capital flight is estimated to cost poor countries from $350 billion to $500 billion in lost revenue, outweighing foreign aid by almost a factor of 5.

This lost tax revenue is significant for poor countries. It could reduce, or eliminate the need for foreign aid (which many in rich countries do not like giving, anyway), could help poor countries pay off (legitimate) debts, and also help themselves become more independent from the influence of wealthy creditor nations.

Politically, it may be this latter point that prevents many rich countries doing more to help the poor, when monetarily it would be so easy to do so.

A crisis that need not have happened

This problem could have been averted (in theory) as people had been pointing to these issues for decades. Yet, of course, during periods of boom no-one (let alone the financial institutions and their supporting ideologues and politicians largely believed to be responsible for the bulk of the problems) would want to hear of caution and even thoughts of the kind of regulation that many are now advocating. To suggest anything would be anti-capitalism or socialism or some other label that could effectively shut up even the most prominent of economists raising concerns.

Of course, the irony that those same institutions would now themselves agree that those “anti-capitalist” regulations are required is of course barely noted. Such options now being considered are not anti-capitalist. However, they could be described as more regulatory or managed rather than completely free or laissez faire capitalism, which critics of regulation have often preferred. But a regulatory capitalist economy is very different to a state-based command economy, the style of which the Soviet Union was known for. The points is that there are various forms of capitalism, not just the black-and-white capitalism and communism. And at the same time, the most extreme forms of capitalism can also lead to the bigger bubbles and the bigger busts.

Quoting Stiglitz again, he captures the sentiments of a number of people:

We had become accustomed to the hypocrisy. The banks reject any suggestion they should face regulation, rebuff any move towards anti-trust measures — yet when trouble strikes, all of a sudden they demand state intervention: they must be bailed out; they are too big, too important to be allowed to fail.

…

America’s financial system failed in its two crucial responsibilities: managing risk and allocating capital. The industry as a whole has not been doing what it should be doing … and it must now face change in its regulatory structures. Regrettably, many of the worst elements of the US financial system … were exported to the rest of the world.

— Joseph Stiglitz, The fruit of hypocrisy; Dishonesty in the finance sector dragged us here, and Washington looks ill-equipped to guide us out, The Guardian, September 16, 2008

Some of these regulatory measures have been easy to get around for various reasons. Some reasons for weak regulation that entrepreneur Mark Shuttleworth describes include that regulators

• Are poorly paid or are not the best talent
• Often lack true independence (or are corrupted by industries lobbying for favors)
• May lack teeth or courage in face of hostile industries and a politically hostile climate to regulation.

Given its crucial role, it is extremely important to invest in it too, Shuttleworth stresses.

However, this crisis wasted almost a generation of talent:

It was all done in the name of innovation, and any regulatory initiative was fought away with claims that it would suppress that innovation. They were innovating, all right, but not in ways that made the economy stronger. Some of America’s best and brightest were devoting their talents to getting around standards and regulations designed to ensure the efficiency of the economy and the safety of the banking system. Unfortunately, they were far too successful, and we are all — homeowners, workers, investors, taxpayers — paying the price.

— Joseph Stiglitz, The fruit of hypocrisy; Dishonesty in the finance sector dragged us here, and Washington looks ill-equipped to guide us out, The Guardian, September 16, 2008

Paul Krugman also notes the wasted talent, at the expense of other areas in much need:

How much has our nation’s future been damaged by the magnetic pull of quick personal wealth, which for years has drawn many of our best and brightest young people into investment banking, at the expense of science, public service and just about everything else?

— Paul Krugman, The Madoff Economy, New York Times, Opinion, December 19, 2008

The wasted capital, labor and resources all add up.

British economist John Maynard Keynes, is considered one of the most influential economists of the 20th century and one of the fathers of modern macroeconomics. He advocated an interventionist form of government policy believing markets left to their own measure (i.e. completely “freed”) could be destructive leading to cycles of recessions, depressions and booms. To mitigate against the worst effects of these cycles, he supported the idea that governments could use various fiscal and monetary measures. His ideas helped rebuild after World War II, until the 1970s when his ideas were abandoned for freer market systems.

Keynes’ biographer, professor Robert Skidelsky, argues that free markets have undermined democracy and led to this crisis in the first place:

What creates a crisis of the kind that now engulfs us is not economics but politics. The triumph of the global “free” market, which has dominated the world over the last three decades has been a political triumph.

It has reflected the dominance of those who believe that governments (for which read the views and interests of ordinary people) should be kept away from the levers of power, and that the tiny minority who control and benefit most from the economic process are the only people competent to direct it.

This band of greedy oligarchs have used their economic power to persuade themselves and most others that we will all be better off if they are in no way restrained—and if they cannot persuade, they have used that same economic power to override any opposition. The economic arguments in favor of free markets are no more than a fig leaf for this self-serving doctrine of self-aggrandizement.

— Bryan Gould, Who voted for the markets? The economic crisis makes it plain: we surrendered power to wealthy elites and fatally undermined democracy, The Guardian, November 26, 2008

Furthermore, he argues that the democratic process has been abused and manipulated to allow a concentration of power that is actually against the idea of free markets and real capitalism:

The uncomfortable truth is that democracy and free markets are incompatible. The whole point of democratic government is that it uses the legitimacy of the democratic mandate to diffuse power throughout society rather than allow it to accumulate—as any player of Monopoly understands—in just a few hands. It deliberately uses the political power of the majority to offset what would otherwise be the overwhelming economic power of the dominant market players.

If governments accept, as they have done, that the “free” market cannot be challenged, they abandon, in effect, their whole raison d'etre. Democracy is then merely a sham. … No amount of cosmetic tinkering at the margins will conceal the fact that power has passed to that handful of people who control the global economy.

— Bryan Gould, Who voted for the markets? The economic crisis makes it plain: we surrendered power to wealthy elites and fatally undermined democracy, The Guardian, November 26, 2008

Despite Keynesian economics getting a bad press from free market advocates for many years, many are now turning to his policies and ideas to help weather the economic crisis.

We are all Keynesians now. Even the right in the United States has joined the Keynesian camp with unbridled enthusiasm and on a scale that at one time would have been truly unimaginable.

… after having been left in the wilderness, almost shunned, for more than three decades … what is happening now is a triumph of reason and evidence over ideology and interests.

Economic theory has long explained why unfettered markets were not self-correcting, why regulation was needed, why there was an important role for government to play in the economy. But many, especially people working in the financial markets, pushed a type of “market fundamentalism.” The misguided policies that resulted — pushed by, among others, some members of President-elect Barack Obama’s economic team — had earlier inflicted enormous costs on developing countries. The moment of enlightenment came only when those policies also began inflicting costs on the US and other advanced industrial countries.

…

The neo-liberal push for deregulation served some interests well. Financial markets did well through capital market liberalization. Enabling America to sell its risky financial products and engage in speculation all over the world may have served its firms well, even if they imposed large costs on others.

Today, the risk is that the new Keynesian doctrines will be used and abused to serve some of the same interests.

— Joseph Stiglitz, Getting bang for your buck, The Guardian, December 5, 2008

Some of the world’s top financiers and officials are reluctantly accepting that the version of capitalism that has long favored them may not be good for everyone.

Stiglitz observed this remarkable resignation at the annual Davos forum, usually a meeting place of rich world leaders and the corporate elite, who usually together reassert ways to go full steam ahead with a form of corporate globalization that has benefited those at the top. This time, however, Stiglitz noted that

[There was a] striking … loss of faith in markets. In a widely attended brainstorming session at which participants were asked what single failure accounted for the crisis, there was a resounding answer: the belief that markets were self-correcting.

The so-called “efficient markets” model, which holds that prices fully and efficiently reflect all available information, also came in for a trashing. So did inflation targeting: the excessive focus on inflation had diverted attention from the more fundamental question of financial stability. Central bankers’ belief that controlling inflation was necessary and almost sufficient for growth and prosperity had never been based on sound economic theory.

… no one from either the Bush or Obama administrations attempted to defend American-style free-wheeling capitalism.… Most American financial leaders seemed too embarrassed to make an appearance. Perhaps their absence made it easier for those who did attend to vent their anger. Labor leaders working for the … business community were particularly angry at the financial community’s lack of remorse. A call for the repayment of past bonuses was received with applause.

— Joseph Stiglitz, Fear and loathing in Davos, The Guardian, February 6, 2009

Some at the top, however, have tried to play the role of victim:

Indeed, some American financiers were especially harshly criticized for seeming to take the position that they, too, were victims … and it seemed particularly galling that they were continuing to hold a gun to the heads of governments, demanding massive bailouts and threatening economic collapse otherwise. Money was flowing to those who had caused the problem, rather than to the victims.

Worse still, much of the money flowing into the banks to recapitalize them so that they could resume lending has been flowing out in the form of bonus payments and dividends.

— Joseph Stiglitz, Fear and loathing in Davos, The Guardian, February 6, 2009

And as much as this crisis affects wealthier nations, the poorest will suffer most in the long run:

… This crisis raises fundamental questions about globalization, which was supposed to help diffuse risk. Instead, it has enabled America’s failures to spread around the world, like a contagious disease. Still, the worry at Davos was that there would be a retreat from even our flawed globalization, and that poor countries would suffer the most.

But the playing field has always been uneven. If developing countries can’t compete with America's subsidies and guarantees, how could any developing country defend to its citizens the idea of opening itself even more to America’s highly subsidized banks? At least for the moment, financial market liberalization seems to be dead.

— Joseph Stiglitz, Fear and loathing in Davos, The Guardian, February 6,

Alcohol problems:

How to stop drinking

You can take steps today to stop drinking. Your first step might be to see your doctor, contact a support group, or set a date in the near future to stop. While some people can stop drinking on their own, others need medical help to manage the physical process of withdrawal.
If you think you have an addiction to alcohol, talk to your doctor about whether you need to withdraw from alcohol under medical supervision. Your doctor can give you medicine that will help you safely withdraw from alcohol. Other medicines might be prescribed later to help you stay sober. With a doctor's help, withdrawal from alcohol is safer.
Stopping alcohol use can:
Prevent or reduce health problems that are made worse by alcohol use, such as liver damage.
Prevent harm to your unborn baby if you are pregnant.
Reduce related family concerns or relationship problems.
Increase your ability to be productive at work, school, and home.
Reduce legal problems that you might have as a result of misuse of alcohol.

WHY MUST I STOP ALCOHOL.

Stopping your use of alcohol can improve your general health and quality of life. It can also increase the quality of life of the people you live with and those who care about you. You decrease your chances of developing serious health problems associated with alcohol abuse or dependence. You reduce your chances of injuring yourself or others in alcohol-related accidents. You might also improve relationships with your parents, children, and spouse or other close loved ones. Not drinking also is a good way for you to model responsible behavior for younger people, particularly children and teens.
You can take steps today to stop drinking. Your first step might be to contact a support group, see your doctor, or set a date in the near future to stop. While some people can stop drinking on their own, others need medical help to manage the physical process of withdrawal.
If you think you have an addiction to alcohol, talk to your doctor about whether you need to withdraw from alcohol under medical supervision. Your doctor can give you medicine that will help you safely withdraw from alcohol. Other medicines might be prescribed later to help you stay sober. With a doctor's help, withdrawal from alcohol is safer.

DECIDE NOW

So you’ve come to the decision to stop drinking alcohol. Maybe you’ve tried a few times to just cut down, and drink more sensibly like others around you seem to.
But you’ve had limited success, perhaps you manage it for a week or so, then you’re drinking more again. Then the blackouts and awful hangovers start. Finally you decide its time to quit.

Now i know (there's no hope)

you don't even know the pain i feel when i start to question what is real i know you're the cause my lust for you gnaws its way, through my brain and i'm here, alone standing by myself, with tears of understanding rolling down my cheeks now i know my bended heart won't be mended by your love.... no longer will i cry or ask for help from up above i don't blame thee i blame myself for my insecurities this time i'm really confused about what i should do i have this fear of never being satisfied i can't find stable happiness, i've tried and tried this isn't easy, i'm the butt of my own joke i want some affection, this is all i hope now i know my bended heart won't be mended by your love.... no longer will i cry or ask for help from up above and i'll live my life until i die wondering if i'll ever be satisfied it's not easy being the butt of your own joke i want some affection, this is all i hope

thought it was love
i thought it was love it was just bad luck and i came to the conclusion my love life really sucks i'm not sure of my problem it's gotta be me maybe i'm too afraid to face reality i thought it was love just my hormones kickin' i look back at yesterday oh what was i thinking my fingers no longer count the mistakes i have made tears labeled why seemed to end my day and a beautiful girl enters the room her caring smile ends my gloom i get some affection no longer am i broken hearted it seems the cycle was just restarted

will i ever love again
will i ever love againa question on my mindwill i ever love anotherlike you in this lifeif it was meant to be it'll happenthis is what i am toldbut i fear i won't find anotherand will die alone
will i ever love againi really miss you nowwill i ever love againthinking about it just brings me down i wake up at nightwith sweat in my eyesmy heart starts poundingand i begin to crywell it's better to have lovedand i still have my memoriesthey'll always make me happyand set my heart at ease

FRIENDSHIP
Friendship isn't always easily described. The Eskimos, they say, have a hundred different words for snow. Unfortunately, the English language isn't quite as innovative, though it has vast opportunities to differentiate meaning. Certainly, Love is one of those opportunities. And so, too, is Friendship.
Instead of different words, however, we're stuck with simple adjectives. Close friend. Best friend. Childhood friend. Intimate friend. Trusted friend. Beloved friend. But whether you use adjectives or different words, few could deny the nearly infinite meaning in such a simple word.
Friends are special people. We can't pick our family, and we're sorely limited in the number of them at any rate. Society and mores (and often our own conscience) dictate we select a single mate. But our friends can be as diverse and infinite as the adjectives we choose. Our friends, in a very real sense, reflect the choices we make in life.
Dance Upon The Wind.
I wasn't looking for it, but some how it came, and found me.Before I had a chance to react, it wrapped it's warmth around me.Like a thief in the night, it has come and gone.I have nothing, but that vision to reflect upon.Until chance comes again, I'll let my thoughts dance upon the wind.All day long, in my mind, I walk love's lonely street.Like a tired man that longs to sit, but just can't find a seat.Then, there it was again, up ahead, to light my way.Only to vanish once more, just like all my yesterdays.Until chance comes again, I'll let my thoughts dance upon the wind.I don't know where I'm going, and where I've been isn't much to speak of.I just know my heart is always showing, leading me to some far off love.Just when I give up the fight.Here it comes to make the bad things good, and the wrong things right.Only to leave me lost and lonely again.Drifting away as my thoughts dance upon the wind.

Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. It occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse, erectile dysfunction and other symptoms. However those symptoms are present only in an advanced stage of the disease.
Rates of prostate cancer vary widely across the world. Although the rates vary widely between countries, it is least common in South and East Asia, more common in Europe, and most common in the United States.[1] Prostate cancer develops most frequently in men over fifty. This cancer can occur only in men, as the prostate is exclusively of the male reproductive tract. It is one of the most common types of cancer in men. However, many men who develop prostate cancer never have symptoms, undergo no therapy, and eventually die of other causes. That is because malignant neoplasms of the prostate are, in most cases, slow-growing, and because most of those affected are over 60. Hence they often die of causes unrelated to the prostate cancer, such as heart/circulatory disease, pneumonia, other unconnected cancers, or old age. Many factors, including genetics and diet, have been implicated in the development of prostate cancer.
Prostate cancer is most often discovered by PSA (prostate specific antigen) screening and less commonly by physical examination or by symptoms. There is some current concern about the accuracy of the PSA test and its usefulness. Suspected prostate cancer is typically confirmed by taking a biopsy of the prostate and examining it under a microscope. Further tests, such as CT scans and bone scans, may be performed to determine whether prostate cancer has spread.
Treatment options for prostate cancer with intent to cure are primarily surgery and radiation therapy. Other treatments such as hormonal therapy, chemotherapy, proton therapy, cryosurgery, high intensity focused ultrasound (HIFU) also exist depending on the clinical scenario and desired outcome. Abiraterone acetate is showing promise in reducing tumor size and PSA levels in aggressive end-stage prostate cancers.[2] The age and underlying health of the man as well as the extent of spread, appearance under the microscope and response of the cancer to initial treatment are important in determining the outcome of the disease. The decision whether or not to treat localized prostate cancer (a tumor that is contained within the prostate) with curative intent is a patient trade-off between the expected beneficial and harmful effects in terms of patient survival and quality of life

Symptoms
Early prostate cancer usually causes no symptoms. Often it is diagnosed during the workup for an elevated PSA noticed during a routine checkup. Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as benign prostatic hypertrophy. These include frequent urination, increased urination at night, difficulty starting and maintaining a steady stream of urine, blood in the urine, and painful urination. Prostate cancer is associated with urinary dysfunction as the prostate gland surrounds the prostatic urethra. Changes within the gland therefore directly affect urinary function. Because the vas deferens deposits seminal fluid into the prostatic urethra, and secretions from the prostate gland itself are included in semen content, prostate cancer may also cause problems with sexual function and performance, such as difficulty achieving erection or painful ejaculation.[7].
Advanced prostate cancer can spread to other parts of the body and this may cause additional symptoms. The most common symptom is bone pain, often in the vertebrae (bones of the spine), pelvis or ribs. Spread of cancer into other bones such as the femur is usually to the proximal part of the bone. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence.[8]

[edit] Causes
The specific causes of prostate cancer remain unknown.[9] A man's risk of developing prostate cancer is related to his age, genetics, race, diet, lifestyle, medications, and other factors. The primary risk factor is age. Prostate cancer is uncommon in men less than 45, but becomes more common with advancing age. The average age at the time of diagnosis is 70.[10] However, many men never know they have prostate cancer. Autopsy studies of Chinese, German, Israeli, Jamaican, Swedish, and Ugandan men who died of other causes have found prostate cancer in thirty percent of men in their 50s, and in eighty percent of men in their 70s.[11] In the year 2005 in the United States, there were an estimated 230,000 new cases of prostate cancer and 30,000 deaths due to prostate cancer.[12]

[edit] Biopsy
Main article: Prostate biopsy
If cancer is suspected, a biopsy is offered. During a biopsy a urologist or radiologist obtains tissue samples from the prostate via the rectum. A biopsy gun inserts and removes special hollow-core needles (usually three to six on each side of the prostate) in less than a second. Prostate biopsies are routinely done on an outpatient basis and rarely require hospitalization. Fifty-five percent of men report discomfort during prostate

Goitre (Thyroid Swelling)

What is a goitre?

A goitre is an enlarged thyroid gland. A goitre can mean that all the thyroid gland is swollen or enlarged, or one or more swellings or lumps develop in a part or parts of the thyroid.The thyroid gland is in the lower part of the front of the neck. It lies just in front of the trachea (windpipe). It has a right and left lobe which are connected together by a narrower band of thyroid tissue. (It is roughly the shape of a butterfly.) You cannot usually see or feel a normal thyroid gland. If the thyroid enlarges it causes a swelling in the neck which you can see - a goitre.The thyroid gland makes thyroid hormones - called thyroxine (T4) and triiodothyronine (T3). These hormones are carried round the body in the bloodstream. Thyroxine and T3 help to keep the body's functions (the metabolism) working at the correct pace. Many cells and tissues in the body need thyroxine and T3 to keep them working correctly.

Goitres and thyroid function (production of thyroid hormones)
In many people with a goitre the goitre does not affect the amount of thyroxine or T3 that you make. You are then 'euthyroid' which means you make the correct amount of these hormones.
In some people, the goitre is associated with an abnormality of thyroid function. You may make too much thyroxine or T3 (hyperthyroidism or overactive thyroid) or too little thyroxine or T3 (hypothyroidism or underactive thyroid). See separate leaflets called about these conditions.
Note: you can also develop an overactive or underactive thyroid without having a goitre.

What are the symptoms of a goitre
In many cases there are no symptoms apart from the appearance of a swelling in the neck. The size of a goitre can range from very small and barely noticeable, to very large.
Most goitres are painless. However, an inflamed thyroid (thyroiditis) can be painful.
If your thyroid makes too much or too little thyroxine or T3, this can cause a range of symptoms. See separate leaflets called 'Hyperthyroidism (Overactive Thyroid)' and 'Hypothyroidism (Underactive Thyroid)' for more detail.
A large goitre may press on the trachea (windpipe) or even the oesophagus (gullet) behind the trachea. This may cause difficulty with breathing or swallowing.
Assessing the situation
When you have a goitre a doctor will usually do some blood tests to check if you are making too much or too little thyroxine or T3. Blood tests may also help to find out the cause of some goitres. Other tests may be done to find out the cause of the goitre. For example:
An ultrasound scan of the thyroid. This may be done if you have a single nodule. An ultrasound scan is a safe and painless test which uses sound waves to create images of organs and structures inside your body. It can tell if a nodule is a cyst or a solid lump.
A small piece of tissue (a biopsy) may be taken from a nodule to look at under the microscope. The biopsy is done by inserting a thin needle into the nodule. (It is a bit like taking a blood sample but the needle is smaller.) It is a simple and safe procedure.
A radioactive iodine scan or similar test. This may be done to see if any nodules are making too much thyroxine or T3. (The radioiodine concentrates in tissue that makes thyroid hormones.) See separate leaflet called 'Radionuclide (Isotope) Scan' for more detail.
In some situations a chest X-ray is done if it is suspected that a goitre extends downwards into the chest.

What is the treatment for a goitre?
Treatment depends on the cause, the size of the goitre, and whether it is causing symptoms. For example:
If you have a small goitre that is not due to a cancerous nodule, and your thyroid is making the correct amount of thyroxine and T3, then you may not need any treatment.
You will need treatment if you make too much or too little thyroxine or T3.
An operation to remove some or all of the thyroid may be an option in some cases.
Radioactive iodine treatment may be an option for a goitre causing an overactive thyroid. This involves taking a drink, or swallowing a capsule, which contains radioactive iodine. The radioactive iodine builds up in the thyroid gland. As the radioactivity is concentrated in the thyroid gland, it destroys some thyroid tissue. You may need to take thyroxine tablets after having radioactive iodine if too much of the thyroid is destroyed.
If you have cancer of the thyroid, you will probably need an operation to remove the cancer and some of the thyroid gland.
Iodine replacement, if the goitre is due to lack of iodine in the diet.

Smallpox
Historical significance
Smallpox is an acute contagious disease caused by variola virus, a member of the orthopoxvirus family.
Smallpox, which is believed to have originated over 3,000 years ago in India or Egypt, is one of the most devastating diseases known to humanity. For centuries, repeated epidemics swept across continents, decimating populations and changing the course of history.
In some ancient cultures, smallpox was such a major killer of infants that custom forbade the naming of a newborn until the infant had caught the disease and proved it would survive.
Smallpox killed Queen Mary II of England, Emperor Joseph I of Austria, King Luis I of Spain, Tsar Peter II of Russia, Queen Ulrika Elenora of Sweden, and King Louis XV of France.
The disease, for which no effective treatment was ever developed, killed as many as 30% of those infected. Between 65–80% of survivors were marked with deep pitted scars (pockmarks), most prominent on the face.
Blindness was another complication. In 18th century Europe, a third of all reported cases of blindness was due to smallpox. In a survey conducted in Viet Nam in 1898, 95% of adolescent children were pockmarked and nine-tenths of all blindness was ascribed to smallpox.
As late as the 18th century, smallpox killed every 10th child born in Sweden and France. During the same century, every 7th child born in Russia died from smallpox.
Edward Jenner's demonstration, in 1798, that inoculation with cowpox could protect against smallpox brought the first hope that the disease could be controlled.
In the early 1950s – 150 years after the introduction of vaccination – an estimated 50 million cases of smallpox occurred in the world each year, a figure which fell to around 10–15 million by 1967 because of vaccination.
In 1967, when WHO launched an intensified plan to eradicate smallpox, the "ancient scourge" threatened 60% of the world's population, killed every fourth victim, scarred or blinded most survivors, and eluded any form of treatment.
Through the success of the global eradication campaign, smallpox was finally pushed back to the horn of Africa and then to a single last natural case, which occurred in Somalia in 1977. A fatal laboratory-acquired case occurred in the United Kingdom in 1978. The global eradication of smallpox was certified, based on intense verification activities in countries, by a commission of eminent scientists in December 1979 and subsequently endorsed by the World Health Assembly in 1980.
Forms of the disease
Smallpox had two main forms: variola major and variola minor. The two forms showed similar lesions. The disease followed a milder course in variola minor, which had a case-fatality rate of less than 1 per cent. The fatality rate of variola major was around 30%.
There are two rare forms of smallpox: haemorrhagic and malignant. In the former, invariably fatal, the rash was accompanied by haemorrhage into the mucous membranes and the skin. Malignant smallpox was characterized by lesions that did not develop to the pustular stage but remained soft and flat. It was almost invariably fatal.
Clinical features
The incubation period of smallpox is usually 12–14 days (range 7–17) during which there is no evidence of viral shedding. During this period, the person looks and feels healthy and cannot infect others.
The incubation period is followed by the sudden onset of influenza-like symptoms including fever, malaise, headache, prostration, severe back pain and, less often, abdominal pain and vomiting. Two to three days later, the temperature falls and the patient feels somewhat better, at which time the characteristic rash appears, first on the face, hands and forearms and then after a few days progressing to the trunk. Lesions also develop in the mucous membranes of the nose and mouth, and ulcerate very soon after their formation, releasing large amounts of virus into the mouth and throat.
The centrifugal distribution of lesions, more prominent on the face and extremities than on the trunk, is a distinctive diagnostic feature of smallpox and gives the trained eye cause to suspect the disease. Lesions progress from macules to papules to vesicles to pustules. All lesions in a given area progress together through these stages. From 8 to 14 days after the onset of symptoms, the pustules form scabs which leave depressed depigmented scars upon healing.
In the past, smallpox was sometimes confused with chickenpox, a worldwide infection of children that is seldom lethal. Chickenpox can be distinguished from smallpox by its much more superficial lesions, their presence more on the trunk than on the face and extremities, and by the development of successive crops of lesions in the same area.
Smallpox is a disease which can be easily diagnosed by trained health workers without the need for laboratory support. During the eradication campaign, WHO produced training materials designed to help health staff recognize smallpox, distinguish it from chickenpox, and avoid common diagnostic errors. These materials are now available electronically.
Infectivity
Persons carrying the virus during the incubation period cannot infect others.
The frequency of infection is highest after face-to-face contact with a patient after fever has begun and during the first week of rash, when the virus is released via the respiratory tract.
Although patients remain infectious until the last scabs fall off, the large amounts of virus shed from the skin are not highly infectious. Exposure to patients in the late stages of the disease is much less likely to produce infection in susceptible contacts.
As a precaution, WHO isolation policy during the eradication campaign required that patients remain in isolation, in hospital or at home, until the last scab had separated.
Transmission
In the absence of immunity induced by vaccination, human beings appear to be universally susceptible to infection with the smallpox virus.
There is no animal reservoir. Insects play no role in transmission.
Smallpox is transmitted from person to person by infected aerosols and air droplets spread in face-to-face contact with an infected person after fever has begun, especially if symptoms include coughing. The disease can also be transmitted by contaminated clothes and bedding, though the risk of infection from this source is much lower.
In the past, patients suffering from variola major (the more severe form of the disease) became bedridden early (in the phase before the eruption of rash) and remained so throughout the illness. Spread of infection was limited to close contacts in a small vicinity. Variola minor, however, was so mild that patients infected with this form frequently remained ambulatory during the infectious phase of their illness and thus spread the virus far more widely.
During the eradication campaign, investigations of outbreaks caused by importations of cases into industrialized countries in temperate areas showed that, in a closed environment, airborne virus could sometimes spread within buildings via the ventilation system and infect persons in other rooms or on other floors in distant and apparently unconnected spaces. This mode of transmission is not important in those tropical areas where houses and hospitals do not use ventilation systems.
Epidemics develop comparatively slowly. The interval between each generation of cases is 2–3 weeks.
When natural outbreaks occurred, the initial, or "index", case rarely infected as many as 5 other persons, even during the peak transmission season. On some occasions, such as the outbreak that followed importation of a case into Yugoslavia in 1972, index cases infected more than a dozen people.
Unfortunately, historical data are available only from periods with substantial population immunity either from vaccination or from having survived natural infection. In the absence of natural disease and vaccination, the global population is significantly more susceptible. Some experts have estimated today's rate of transmission to be more on the order of 10 new infections per infected person.
Treatment
Vaccine administered up to 4 days after exposure to the virus, and before the rash appears, provides protective immunity and can prevent infection or ameliorate the severity of the disease.
No effective treatment, other than the management of symptoms, is currently available.
A number of compounds are under investigation as chemotherapeutic agents. One of these, Cidofovir, has produced promising results in laboratory studies.

Poliomyelitis
Polio (poliomyelitis) mainly affects children under five years of age.
One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.
Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases then, to 1997 reported cases in 2006. The reduction is the result of the global effort to eradicate the disease.
In 2008, only four countries in the world remain polio-endemic, down from more than 125 in 1988. The remaining countries are Afghanistan, India, Nigeria and Pakistan.
Persistent pockets of polio transmission in northern India, northern Nigeria and the border between Afghanistan and Pakistan are the current focus of the polio eradication initiative.
As long as a single child remains infected, children in all countries are at risk of contracting polio. Between 2003 and 2005, 25 previously polio-free countries were re-infected due to imports of the virus.
In most countries, the global effort has expanded capacities to tackle other infectious diseases by building effective surveillance and immunization systems. Knowledge of the poliovirus has expanded with aggressive research carried out under the eradication effort.
Success for the effort hinges on closing a substantial funding gap to finance next steps of the global eradication initiative.
Polio and its symptoms
Polio is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.
People most at risk
Polio mainly affects children under five years of age.
Prevention
There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.
Global caseload
Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then, to 1997 reported cases in 2006. In 2008, only parts of four countries in the world remain endemic for the disease - the smallest geographic area in history.
The Global Polio Eradication Initiative
Launch
In 1988, the forty-first World Health Assembly, consisting then of delegates from 166 Member States, adopted a resolution for the worldwide eradication of polio. It marked the launch of the Global Polio Eradication Initiative, spearheaded by the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF. This followed the certification of the eradication of smallpox in 1980, progress during the 1980s towards elimination of the poliovirus in the Americas, and Rotary International’s commitment to raise funds to protect all children from the disease.
Progress
Overall, in the 20 years since the Global Polio Eradication Initiative was launched, the number of cases has fallen by over 99%. In 2008, only four countries in the world remain polio-endemic.
In 1994, the World Health Organization (WHO) Region of the Americas (36 countries) was certified polio-free, followed by the WHO Western Pacific Region (37 countries and areas including China) in 2000 and the WHO European Region (51 countries) in June 2002.
In 2007, more than 400 million children were immunized in 27 countries during 164 supplementary immunization activities (SIAs). Globally, polio surveillance is at historical highs, as represented by the timely detection of cases of acute flaccid paralysis.
Persistent pockets of polio transmission in northern India, northern Nigeria and the border between Afghanistan and Pakistan are key epidemiological challenges.
Objectives
The objectives of the Global Polio Eradication Initiative are:
To interrupt transmission of the wild poliovirus as soon as possible;
To achieve certification of global polio eradication;
To contribute to health systems development and strengthening routine immunization and surveillance for communicable diseases in a systematic way.
Strategies
There are four core strategies to stop transmission of the wild poliovirus in areas that are affected by the disease or considered at high risk of re-infection:
high infant immunization coverage with four doses of oral poliovirus vaccine (OPV) in the first year of life;
supplementary doses of OPV to all children under five years of age during SIAs;
surveillance for wild poliovirus through reporting and laboratory testing of all acute flaccid paralysis (AFP) cases among children under fifteen years of age;
targeted “mop-up” campaigns once wild poliovirus transmission is limited to a specific focal area.
Before a WHO region can be certified polio-free, three conditions must be satisfied: (a) there are at least three years of zero polio cases due to wild poliovirus; (b) disease surveillance efforts in countries meet international standards; and (c) each country must illustrate the capacity to detect, report and respond to “imported” polio cases. Laboratory stocks must be contained and safe management of the wild virus in inactivated polio vaccine (IPV) manufacturing sites must be assured before the world can be certified polio-free.
The Advisory Committee on Polio Eradication, the independent, technical body providing strategic guidance to the Global Polio Eradication Initiative, is overseeing a programme of research and consensus-building that will lead to the development of post-eradication polio immunization policy options, which will be considered by the World Health Assembly.
Coalition
The Global Polio Eradication Initiative (GPEI) is spearheaded by WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and the United Nations Children’s Fund (UNICEF).
The polio eradication coalition includes governments of countries affected by polio; private sector foundations (e.g. United Nations Foundation, Bill & Melinda Gates Foundation); development banks (e.g. the World Bank); donor governments (e.g. Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, Luxembourg, Malaysia, Monaco, the Netherlands, New Zealand, Norway, Oman, Portugal, Qatar, the Republic of Korea, the Russian Federation, Saudi Arabia, Spain, Sweden, Switzerland, Turkey, United Arab Emirates, the United Kingdom and the United States of America); the European Commission; humanitarian and nongovernmental organizations (e.g. the International Red Cross and Red Crescent societies) and corporate partners (e.g. Sanofi Pasteur, De Beers and Wyeth). Volunteers in developing countries also play a key role: 20 million people have participated in mass immunization campaigns.
Countries at risk
As long as a single child remains infected with polio, children in all countries are at risk of contracting the disease. The poliovirus can easily be imported into a polio-free country and can spread rapidly among unimmunised populations. Between 2003 and 2005, 25 previously polio-free countries were re-infected due to importations.
The four polio-endemic countries are Afghanistan, India, Nigeria and Pakistan.
Priorities for polio eradication
To stop transmission of the wild poliovirus and optimize the benefits of polio eradication, the global priorities are:
Closing the funding gap: Substantial external financial resources are required to support the efforts of endemic countries to eradicate polio. Economic modelling in 2007 demonstrated the financial and humanitarian benefits of polio eradication. Success in carrying out the necessary vaccination campaigns and surveillance hinges on sufficient funds being made available by the financial stakeholders.
Stopping wild poliovirus transmission in endemic countries: Polio is today more geographically restricted than ever before. The highest priority is reaching all children during SIAs in the remaining four endemic countries. To succeed, high levels of political commitment must be maintained at national, state/provincial and district levels. In 2007 an intensified effort to eradicate polio occurred in each of these four countries, with tailored eradication approaches to address the unique challenges of each of the infected areas. Efforts fully exploited new monovalent vaccines and diagnostics that are significantly more effective in detecting and stopping polio transmission.
IMPACT OF THE INITIATIVE
The Global Polio Eradication Initiative was launched in 1988. More than five million people who would otherwise have been paralysed are today walking because they have been immunized against polio since the initiative began.
By preventing a debilitating disease, the Global Polio Eradication Initiative is helping to reduce poverty, and is giving children and their families a greater chance of leading healthy and productive lives.
By establishing the capacity to access children everywhere, more than two billion children worldwide have been immunized during SIAs, demonstrating that well-planned health interventions can reach even the most remote, conflict-affected or poorest areas.
Planning for SIAs provides key demographic data – “finding” children in remote villages and households for the first time, and "mapping" their location for future health services.
In most countries, the Global Polio Eradication Initiative has expanded the capacity to tackle other infectious diseases, such as avian influenza or Ebola, by building effective disease-reporting and surveillance systems, training local epidemiologists and establishing a global laboratory network. This capacity has also been deployed in post-disaster health emergencies such as the aftermath of the 2004 tsunami in south-east Asia.
Routine immunization services have been strengthened by bolstering the cold chain, transport and communications systems for immunization. Improving these services helped to lay the groundwork for highly successful measles vaccination campaigns that have saved millions of young lives.
Vitamin A is often administered during polio SIAs. Since 1988, more than 1.2 million childhood deaths have been prevented through provision of vitamin A during polio SIAs.
On average, one in every 250 people in a country has been involved in polio immunization campaigns. More than 20 million health workers and volunteers have been trained to deliver OPV and vitamin A, fostering a culture of disease prevention.
Through the synchronization of SIAs, many countries have established a new mechanism for coordinating major cross-border health initiatives aimed at reaching all people – a model for regional and international cooperation for health.
Future benefits of polio eradication
Once polio is eradicated, the world can celebrate the delivery of a major global public good – something that will equally benefit all people, no matter where they live. Economic modelling published in 2007 established that significant financial benefits will also accrue from eradication.

PUBLIC HEALTH
Immunization
Immunization, is the process by which an individual's immune system becomes fortified against an agent (known as the immunogen).
Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease.
Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert over 2 million deaths each year. It is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities; and vaccination does not require any major lifestyle change.
When an immune system is exposed to molecules that are foreign to the body (non-self), it will orchestrate an immune response, but it can also develop the ability to quickly respond to a subsequent encounter (through immunological memory). This is a function of the adaptive immune system. Therefore, by exposing an animal to an immunogen in a controlled way, their body can learn to protect itself: this is called active immunization.
The most important elements of the immune system that are improved by immunization are the B cells (and the antibodies they produce) and T cells. Memory B cell and memory T cells are responsible for a swift response to a second encounter with a foreign molecule. Passive immunization is when these elements are introduced directly into the body, instead of when the body itself has to make these elements.
Immunization can be done through various techniques, most commonly vaccination. Vaccines against microorganisms that cause diseases can prepare the body's immune system, thus helping to fight or prevent an infection. The fact that mutations can cause cancer cells to produce proteins or other molecules that are unknown to the body forms the theoretical basis for therapeutic cancer vaccines. Other molecules can be used for immunization as well, for example in experimental vaccines against nicotine (NicVAX) or the hormone ghrelin (in experiments to create an obesity vaccine).
Passive and active immunization
Immunization can be achieved in an active or passive fashion: vaccination is an active form of immunization.
Active immunization
Active immunization entails the introduction of a foreign molecule into the body, which causes the body itself to generate immunity against the target. This immunity comes from the T cells and the B cells with their antibodies.
Active immunization can occur naturally when a person comes in contact with, for example, a microbe. If the person has not yet come into contact with the microbe and has no pre-made antibodies for defense (like in passive immunization), the person becomes immunized. The immune system will eventually create antibodies and other defenses against the microbe. The next time, the immune response against this microbe can be very efficient; this is the case in many of the childhood infections that a person only contracts once, but then is immune.
Artificial active immunization is where the microbe, or parts of it, are injected into the person before they are able to take it in naturally. If whole microbes are used, they are pre-treated. Depending on the type of disease, this technique also works with dead microbes, parts of the microbe, or treated toxins from the microbe.
Passive immunization
Main article: Passive immunity
Passive immunization is where pre-made elements of the immune system are transferred to a person, and the body doesn't have to create these elements itself. Currently, antibodies can be used for passive immunization. This method of immunization begins to work very quickly, but it is short lasting, because the antibodies are naturally broken down, and if there are no B cells to produce more antibodies, they will disappear.
Passive immunization can be naturally acquired when antibodies are being transferred from mother to fetus during pregnancy, to help protect the fetus before and shortly after birth.
Artificial passive immunization is normally given by injection and is used if there has been a recent outbreak of a particular disease or as an emergency treatment to poisons (for example, for tetanus). The antibodies can be produced in animals or in vitro.

Immunization, Vaccines and Biologicals.
IVB topics
Here is a list of topics and concerns that IVB deal with. Click on a heading to receive further information on that topic.
Diseases and Vaccines
Tuberculosis
An estimated one third of humanity (approximately two billion people) is infected with tuberculosis (TB). Amongst those carrying the pathogen, around 8 million persons come down with clinical disease every year; and out of these, about 1.6 million die, not counting tuberculosis-related deaths in TB-HIV co-infected individuals. Over 1.5 million new TB cases per year occur in sub-Saharan Africa, nearly three million in South-East Asia and over a quarter of a million in Eastern Europe. In 1993, WHO declared tuberculosis a global emergency, reflecting the magnitude of the concern about the TB epidemic. It is estimated that between 2000 and 2020, nearly one billion people will be newly infected, 200 million will get sick, and 35 million will die from TB – if control measures are not significantly improved.
Cholera
Cholera is an acutely dehydrating, watery diarrhoeal disease caused by intestinal infection with Vibrio cholerae. It probably has existed on the Indian subcontinent for thousands of years as can be judged from ancient manuscripts. Cholera was repeatedly one of the most dreaded pandemic diseases in history, being able to spread rapidly to large numbers of people, of whom a high proportion died. Before the advent of an effective rehydration therapy, cholera epidemics were associated with case–fatality rates exceeding 40% and led to tens of thousands of deaths. Cholera remains today an important disease in areas where population overcrowding and poor sanitation are common, such as in slums and refugee camps in developing countries. The year 1991 was marked by the entry of V. cholerae into Peru and other Andean countries, from which it has since spread throughout South and Central America. This was the first time cholera had invaded the Americas in more than 100 years. More
Dengue
Dengue fever, a usually mild albeit debilitating viral fever (breakbone fever), is prevalent throughout the tropics, where the urban-dwelling mosquito Aedes aegypti is a major vector. The dengue viruses are the most widespread arthropod-borne viruses (arboviruses).. During the 20th century, the distribution and density of Aedes aegypti expanded dramatically in tropical areas, beginning in large cities then spreading to the countryside. This was followed by global circulation of the four virus types.
Because there is no cross protection between different dengue viruses, an individual can be sequentially infected by different virus types. Most primary infections cause a debilitating, but nonfatal, form of illness. Some patients, particularly children but increasingly adults, experience more severe and occasionally fatal forms of the disease, including dengue haemorrhagic fever. The presence of antibodies to one type of dengue virus is believed to facilitate the occurrence of dengue haemorrhagic fever in certain individuals through immune-enhancement when infected by a second serotype. It is estimated that from 50–100 million cases of dengue fever, 500 000 cases of severe forms and more than 20 000 deaths occur each year.
While vector control can show impact if systematically applied, most hopes rely on vaccines for the prevention of the disease. Vaccine development has been ongoing for decades, and has been hampered by the need to protect against all four viruses, as well as by concerns of immune-enhancement. Much progress has been reported over the past years, and several vaccine candidates are now in clinical development.
Diphtheria
Diphtheria is caused by the bacterium Corynebacterium diphtheriae. This germ produces a toxin that can harm or destroy human body tissues and organs. One type of diphtheria affects the throat and sometimes the tonsils. Another type, more common in the tropics, causes ulcers on the skin.
Diphtheria affects people of all ages, but most often it strikes unimmunized children. In temperate climates, diphtheria tends to occur during the colder months. In 2000, 30 000 cases and 3000 deaths of diphtheria were reported worldwide.
Enterotoxigenic Escherichia coli
Disease caused by ETEC follows ingestion of contaminated food or water and is characterized by profuse watery diarrhoea lasting for several days. It may lead to dehydration and malnutrition in young children in developing countries. ETEC is the most frequently isolated enteropathogen in community-based studies of children aged less than 5 years in the developing world, and probably accounts for approximately 200 million diarrhoea episodes and 380 000 deaths annually. The peak incidence of ETEC diarrhoea in these settings occurs in the first two years of life, with a declining incidence with age thereafter. Surveillance of hospitalized cases of ETEC diarrhoea has however shown that almost half the cases occur in individuals over 10 years of age. In children, the tendency of ETEC to cause dehydrating diarrhoea is lower (approximately 5% of episodes) than that of rotavirus (approximately 36% of episodes).
Epstein Barr virus
The primary site of Epstein-Barr virus (EBV) infection is the oropharyngeal cavity. Children and teenagers are commonly afflicted usually after oral contact, hence the name “kissing disease”. Based on serology, about 95% of the world adult population has been infected with EBV and, following primary infection, remains lifelong carriers of the virus. In developed countries, exposure to EBV occurs relatively late: only 50–70% of adolescents and young adults are EBV seropositive. About 30% of the seronegative group will develop infectious mononucleosis as a result of primary EBV infection. The disease is characterized by fever, sore throat, generalized lymphadenopathy, splenomegaly, intense asthenia, hyper-lymphocytosis (>50%) with atypical lymphocytes and elevated transaminase levels. In developing countries, EBV antibodies are acquired early in life and the disease is mostly asymptomatic.
Hepatitis B
Hepatitis B virus causes a life-threatening liver infection that often leads to chronic liver disease and puts people at high risk of death from cirrhosis of the liver and liver cancer. Hepatitis B virus infection is a major global health problem. Worldwide, an estimated two billion people have been infected with the hepatitis B virus (HBV), and more than 350 million have chronic (long-term) liver infections.
A vaccine against hepatitis B has been available since 1982. Hepatitis B vaccine is 95% effective in preventing HBV infection and its chronic consequences, and is the first vaccine against a major human cancer. The vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries where 8% to 15% of children used to become chronically infected with HBV, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.
As at December 2007, 171 countries reported that they had included the hepatitis B vaccine into their national infant immunization programmes (two of these countries reported introducing in part of the country only). This is a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B.
Hepatitis C
Herpes virus type 2
Herpes simplex virus type 2 (HSV-2) is the cause of genital herpes. The hallmark of herpesvirus infections is the establishment of a lifelong, latent infection that can reactivate to cause one or more rounds of disease. Latent HSV-2 infection occurs primarily in neurons found in the sacral root ganglia. The clinical spectrum of HSV-2 includes primary infection, characterized by the appearance of vesicles on the vulva or the penis that soon break to leave shallow, painful ulcerating lesions. The ulcers heal in 2–3 weeks, although healing may be very slow in immunocompromised patients. Primary infection is then followed by recurrent episodes of clinical disease (4–5 per year). The proportion of symptomatic infections is estimated to be between 13% and 37%, and probably higher in HIV positive individuals. Subclinical infection may be associated with infectious viral shedding. The virus is transmitted in genital secretions. Transmission of HSV-2 to newborns at the time of delivery may lead to devastating systemic infection with encephalitis. The risk of neonatal herpes fortunately is low among HIV-negative pregnant women living in industrialized countries (less than 3%), but few data are available on neonatal herpes in developing countries.
Haemophilus influenzae type b (Hib)
Haemophilus influenzae type b (Hib) is a bacteria responsible for severe pneumonia, meningitis and other invasive diseases almost exclusively in children aged less than 5 years. It is transmitted through the respiratory tract from infected to susceptible individuals.
In 2000, Hib was estimated to have caused two to three million cases of serious disease, notably pneumonia and meningitis, and 386 000 deaths in young children. Hib disease is observed in all parts of the world but is difficult to confirm because it requires prompt laboratory investigation in patients that have not received prior antibiotic treatment.
The vaccine is now used in the routine immunization schedule of more than 100 countries and WHO recommends the use of Hib conjugate vaccines in all countries. The vaccine is available in monovalent presentation or combined with DTP and other vaccine combinations including with hepatitis B and inactivated polio vaccines.
HIV / AIDS
Introduction
According to the 2007 WHO/UNAIDS estimates, at the end of 2007, 33.2 million people were living with HIV. Some 2,5 million people became newly infected that year and 2.1 million died of AIDS, which maintains AIDS as a leading cause of death in Africa.
More than 95% of HIV infections are in developing countries, two-thirds of them in sub-Saharan Africa, where over 28 million people are living with HIV. While infection rates are lower in Asia and the Pacific, where over 7 million are infected, there is a risk that localized epidemics involving mainly high-risk groups could spark off major epidemics in some of the world’s most populous countries. The disease is having a major impact on social and economic development. Poverty is increasing in many countries as households lose one or more breadwinners to AIDS. And both public services and private companies are reeling from the impact of HIV-related sickness and deaths among their workforce.
Human papillomavirus (HPV)
Human papillomaviruses are common throughout the world. Although most infections with HPV cause no symptoms, persistent genital HPV infection can cause cervical cancer in women. HPV can also cause other types of anogenital cancer, head and neck cancers, and genital warts, in both men and women. HPV are transmitted through sexual contact. HPV are estimated to cause about half a million cases of cervical cancer every year, and are the leading cause of death from cancer for women in the developing world.
For many years, the main way to prevent cervical cancer has been through screening programmes. Unfortunately, these have not been successfully implemented in most low-resource settings.
There are two HPV vaccines now being marketed in many countries throughout the world. Both vaccines are highly efficacious in preventing infection with virus types 16 and 18, which are together responsible for approximately 70% of cervical cancer cases globally. They are also highly efficacious in preventing precancerous cervical lesions caused by these types. One vaccine is also highly efficacious in preventing anogenital warts, a common genital disease which is virtually always caused by infection with HPV types 6 and 11. The primary target group in most of the countries recommending HPV vaccination is young adolescent girls. Data from clinical trials and initial post-marketing surveillance conducted in several continents show both vaccines to be safe.
As of mid-2008, HPV vaccines had been recommended for use in females through the national immunization programmes of more than 15 high-income countries and at least two middle-income countries.
Influenza
The burden of influenza in the USA is currently estimated to be 25–50 million cases per year, leading to 150 000 hospitalizations and 30 000–40 000 deaths. If these figures are extrapolated to the rest of the world, the average global burden of inter-pandemic influenza may be on the order of ~1 billion cases of flu, ~3–5 million cases of severe illness and 300 000–500 000 deaths annually. Epidemics and outbreaks of influenza occur in different seasonal patterns depending on the region in the world. In temperate climate zones, seasonal epidemics typically begin in the late fall and peak in mid- to late winter. In tropical zones, seasonal patterns appear to be less pronounced, with year-round isolation of virus.
In developed countries, annual influenza epidemics infect about 10–20% of the population each season, and cause febrile illnesses that range in severity from mild to debilitating and can lead in some instances to hospitalization and even cause death. The latter mostly occur as a consequence of primitive fulminant influenza virus pneumonia or of secondary respiratory bacterial infections and are facilitated by underlying pulmonary or cardiopulmonary pathologies. The risk of developing serious complications is aggravated in the very young and in the elderly. Data collected in Michigan (USA) and in Japan indicate that the mass vaccination of school-aged children correlates with a reduced rate of respiratory illness in all age groups, suggesting that larger-scale immunization in childhood could favorably affect influenza epidemics.
Malaria
Malaria is by far the world's most important tropical parasitic disease, killing more people than any other communicable disease except TB. Worldwide prevalence of the disease is in the order of 350–500 million clinical cases each year, with an estimated annual death toll of over 1.1 million deaths. The vast majority of deaths occur among children under five years of age, especially in remote rural areas with poor access to health services. One century ago, malaria was endemic across every continent except Antarctica. Control programmes based on the use of insecticides led to its elimination from Australia, Europe and the USA by the 1950s, but the disease still remains endemic in some 100 countries in Africa, the Americas, the Eastern Mediterranean Region, the South-East Asia Region, and the Western Pacific Region. These countries are inhabited by more than 2.4 billion people – 40% of the world's population
Measles
Measles is a highly contagious, serious disease caused by a virus. It remains a leading cause of death among young children globally, despite the availability of a safe and effective vaccine.
Measles is transmitted via droplets from the nose, mouth or throat of infected persons. Initial symptoms, which usually appear 10–12 days after infection, include high fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards.
Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases. Complications associated with measles cause most deaths. Complications are more common in children under the age of five or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia.
Mumps
Mumps is an infection caused by a virus. It is sometimes called infectious parotitis, and it primarily affects the salivary glands.
Mumps is mostly a mild childhood disease. It most often affects children between five and nine years old. But the mumps virus can infect adults as well. When it does, complications are more likely to be serious. As more children receive mumps vaccine, it is expected that cases will become more common in older children than in younger ones
Respiratory synctial virus (RSV)
RSV is the single most important cause of severe LRIs in infants and young children. RSV disease spectrum includes a wide array of respiratory symptoms, from rhinitis and otitis media to pneumonia and bronchiolitis, the latter two diseases being associated with substantial morbidity and mortality. Humans are the only known reservoir for RSV. Spread of the virus from contaminated nasal secretions occurs via large respiratory droplets, so close contact with an infected individual or contaminated surface is required for transmission. RSV can persist for several hours on toys or other objects, which explains the high rate of nosocomial RSV infections, particularly in paediatric war
Schistosomiasis
Schistosomiasis, also known as bilharziasis, is second only to malaria in public health importance. It is estimated that 200 million people worldwide are infected with the snail-transmitted, water-borne parasitic helminth, and that 20 000 deaths are associated with the severe consequences of infection, including bladder cancer or renal failure (Schistosoma haematobium) and liver fibrosis and portal hypertension (S. mansoni). In sub-Saharan Africa where schistosomiasis constitutes an important public health problem, a survey in 2000 of disease-specific mortality reported that 70 million individuals out of 682 million had experienced haematuria and 32 million dysuria associated with S. haematobium infection. It was estimated that 18 million suffered bladder wall pathology and 10 million hydronephrosis. Infection with S. mansoni was estimated to cause diarrhoea in 0.78 million individuals, blood in stool in 4.4 million and hepatomegaly in 8.5 million. Using the very limited data available, mortality rates due to non-functioning kidney (from S. haematobium) and haematemesis (from S. mansoni) have been estimated at 150 000 and 130 000 per year, respectively. Although these are global estimates of the schistosomiasis disease burden, the public health impact of schistosomiasis in the field has been poorly evaluated and is still subject to controversy. Apart from a few situations where schistosomiasis is or was recognized as an obvious public health problem, as in Brazil, China, Egypt, the Philippines, northern Senegal and Uganda, the disease is often not a priority for health authorities. Moreover, the lack of a simple clinical case definition does not enable rapid identification of the disease by health personnel. More
Streptococcus A
Group A streptococci (hemolytic Streptococcus pyogenes) cause a broad spectrum of diseases, ranging from simple and uncomplicated pharyngitis and skin infection to life-threatening invasive illness that includes pneumonia, bacteraemia, necrotizing fasciitis, streptococcal toxic shock syndrome (TSS), and nonsuppurative sequelae such as acute rheumatic fever and glomerulonephritis. Streptococcal pharyngitis continues to be one of the most common childhood illnesses throughout the world. The incidence of rheumatic fever has declined in industrialized countries since the 1950s and now has an annual incidence of around 0.5 cases per 100 000 children of school age. In contrast, it remains an endemic disease in developing countries, with annual incidence rates ranging from 100 to 200 cases per 100 000 school-aged children. It also is a major cause of cardiovascular mortality.
Australia's aboriginal population suffers the highest incidence worldwide. Group A streptococci, S. pneumoniae and Staphylococcus aureus are important causes of severe infection in young children in the Papua New Guinea highlands. It has recently been estimated that there currently are more than 18 million cases of severe group A streptococcal disease such as rheumatic heart disease in the world, with more than 500 000 deaths each year. Prospective, longitudinal studies are clearly needed to better understand the epidemiology of streptococcal infections in developing countries and implement more effective public health prevention programmes
Streptococcus B
Group B streptococci are one of the most important infectious causes of neonatal morbidity and mortality. Women vaginally or rectally colonized with Group B streptococci during pregnancy are at increased risk of transmitting the bacteria to their newborn infant during labour and delivery. Pregnancy-associated streptococcal infection can result in maternal sepsis. It also is the leading cause of chorioamniotitis and one of several infections now thought to enhance the risk of preterm rupture of membranes. In the newborn, early onset of the disease is recognized as pneumonia and bacteraemia within the first seven days of life, whereas late onset disease primarily occurs in the form of meningitis between 7 and 90 days of age. Vaginal group B streptococcal colonization has been reported to occur in about 12–27% of women in North Africa, India, the Middle East, Pakistan, Saudi Arabia and the USA. Surprisingly, a WHO collaborative study on serious infections in young infants conducted in four developing countries showed that Group B streptococci were found in only 2 of 167 blood culture isolates and 1 of 40 CSF isolates, whereas Group A streptococci were recovered from 29/167 blood isolates and 3/40 CSF isolates. These data may have been biased by the fact that infants who develop streptococcal sepsis on the day of birth will usually not survive. It might also be that Group B streptococcal-related morbidity in developing counties often manifests itself through miscarriage or preterm delivery, in which case infants may not survive to develop confirmed sepsis. More
Tetanus
Tetanus is acquired when the spores of the bacterium Clostridium Tetani infect a wound or the umbilical stump. Spores are universally present in the soil. People of all ages can get tetanus but the disease is particularly common and serious in newborn babies ("neonatal tetanus"). It requires treatment in a medical facility, often in a referral hospital. Neonatal tetanus, which is mostly fatal, is particularly common in rural areas where deliveries are at home without adequate sterile procedures. WHO estimated that neonatal tetanus killed about 180 000 babies in 2002.
Tetanus can be prevented through immunization with tetanus-toxoid (TT) -containing vaccines. Neonatal tetanus can be prevented by immunizing women of childbearing age with tetanus toxoid, either during pregnancy or outside of pregnancy. This protects the mother and - through a transfer of tetanus antibodies to the fetus - also her baby. Additionally, clean practices when a mother is delivering a child are also important to prevent neonatal and maternal tetanus. People who recover from tetanus do not have natural immunity and can be infected again and therefore need to be immunized. To be protected throughout life, an individual should receive 3 doses of DTP in infancy, followed by a TT-containing booster at school-entry age (4-7 years), in adolescence (12-15 years), and in early adulthood.
Worldwide, all countries are committed to "elimination" of maternal and neonatal tetanus (MNT), i.e. a reduction of neonatal tetanus incidence to below one case per 1000 live births per year in every district. As of December 2007, 47 countries remain that have not eliminated MNT.
Tick-born Encephalitis
The endemic area for tick-borne encephalitis (TBE) spreads from Alsace-Lorraine in the west to Vladivostok and north-eastern regions of China in the east, and from Scandanavia to Italy, Greece and Crimea in the south. TBE also is endemic in North Japan, where the virus has repeatedly been isolated from blood samples of sentinel dogs, ticks, and rodent spleens. TBE is a serious acute central nervous system infection which may result in death or long-term neurological sequelae in 35–58% of patients. The fatality rate associated with clinical infection is 0.5–20%. The proportion of cases involving subclinical infection varies between 70% and 98%. Symptomatic infection occurs in all age groups.More

Typhoid
Typhoid fever is caused by Salmonella typhi, the typhoid bacillus. It is characterized by the sudden onset of sustained fever, severe headache, nausea, loss of appetite, constipation or sometimes diarrhoea. Severe forms have been described with mental dullness and meningitis. Case-fatality rates of 10% can be reduced to less than 1% with appropriate antibiotic therapy. However, strains resistant to chloramphenicol and other recommended antibiotics (ampicillin, cotrimoxazole and even ciprofloxacin) have become prevalent in several areas of the world. Paratyphoid fever can be caused by any of three serotypes of S. paratyphi A, B and C. It is similar in its symptoms to typhoid fever, but tends to be milder, with a lower fatality rate.
INFECTIOUS DISEASES
Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another. Zoonotic diseases are infectious diseases of animals that can cause disease when to transmitted humans.