In the Literature

We are now approximately halfway to the 2015 target date set by the United Nations in 2000 in the Millennium Declaration and the Millennium Development Goals. The United Nations has released a report assessing progress toward these goals. I will provide brief summaries of the assessments relevant to some specific infectious diseases. Target: Reduce by two-thirds, between 1990 and 2015, the under-5 mortality rate. Measles is among the leading causes of childhood death due to vaccinepreventable diseases. As a consequence of improved provision of vaccination, the number of deaths due to measles decreased worldwide by 160% between 2000 and 2005, with Africa leading the way with a 75% decrease. Furthermore, measles vaccination campaigns have provided a structure for the provision of other measures, such as bed netting, deworming medicine, and vitamin A supplementation. Target: To have halted by 2015 and to begin to reverse the spread of HIV/AIDS. The total number of AIDS-related deaths increased to 2.9 million in 2006, and in 2005, 115 million children had lost at least 1 parent to AIDS. The total number of people with HIV infection increased from 39.2 million in 2001 to 39.5 million in 2006, with the majority of cases occurring in sub-Saharan Africa. There were 4.3 million new infections in 2006, with the highest rates of increase of new infections in East Asia and the Commonwealth of Independent States. An estimated 2 million people in developing regions were receiving antiretroviral therapy as of December 2006—less than one-third of the 7.1 million people for whom it is currently indicated. Only approximately one-fourth of HIV-infected candidates for treatment in sub-Saharan Africa were receiving antiretroviral therapy. If current trends continue, the number of people in need of therapy will increase faster than the speed at which treatment services can be expanded. Only 11% of HIV-infected pregnant women in lowand middle-income countries were receiving services to prevent mother-to-infant transmission in 2005. Target: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases. Although a number of African countries have made progress in the provision of insecticide-impregnated bed nets, this progress has been slow and uneven. Only 5% of children aged !5 years in sub-Saharan Africa sleep under such nets. Children in urban areas were 2.5 times more likely to be sleeping under impregnated bed nets than were those in rural areas. Chloroquine continues to be commonly used to treat malaria in sub-Saharan Africa, despite plasmodial resistance to this drug. The incidence of new cases of tuberculosis has begun to decrease in most regions. However, because of population growth, the absolute number of new cases was still slowly increasing. Of the estimated 8.8 million cases in 2005, 7.3 million occurred in sub-Saharan Africa and Asia. There were 1.6 million deaths due to tuberculosis in 2005, with approximately one-eighth occurring in individuals who were coinfected with HIV. Target: Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation. Poor hygiene, open defecation, and lack of safe drinking water together contribute to ∼88% of deaths due to diarrheal illness in children aged !5 years. Unfortunately, only eastern, southeastern, and western Asia, together with northern Africa, Latin America, and the Caribbean, are on track to achieve the Millennium target. In fact, the number of people without access to sanitation increased by 1100 million by the end of 2004. This report indicates that progress in achieving the Millennium goals has been, at best, uneven. The most striking improvement in the area of infectious diseases has been the reduction in childhood mortality due to measles. No other area among the infectious-related disease goals can be considered to represent great progress, and some areas have gone backward, as in the cases of the availability of safe drinking water and sanitation in sub-Saharan Africa. An immediate and meaningful recommitment to the stated goals is necessary to have even a glimmer of hope that they will be achieved by 2015.