Emerging Disease Surveillance Research Articles

Public health consequences of armed conflict in Sudan in the face of global donor fatigue

AbstractSudan, a country located in northeastern Africa, is grappling with a profound health crisis resulting from the recent war that erupted on April 15, 2023. This conflict has inflicted significant damage on the country's health system, particularly through the destruction of healthcare infrastructure. Approximately 61% of health facilities have been destroyed, leaving only 16% operating optimally in Khartoum. Hospitals and clinics, vital for public health, have become targets of violence, exacerbating the challenges faced by the nation. The World Health Organization has noted the closure of roughly 16 hospitals since the start of the conflicts due to staff safety concerns as well as a shortage of hospital supplies, consumables, and medication. There has also been a gradual waning of donor support and resources allocated to address protracted crises and emergencies worldwide Sudan receives very little funding from donor organizations to maintain its healthcare system, which worsens the nation's general public health architecture. This makes the country vulnerable to serious challenges like disease outbreaks, starvation, infectious diseases, deteriorating health infrastructure, and mental health issues. To successfully reduce the severity of negative impacts on public health, the crisis must be ceased and facilities reopened. An emergency disease surveillance system for infectious diseases should be established, women and child health should be prioritized, and mental health awareness programs and services should be implemented. The global community must support the efforts to mitigate the devastating effects of this crisis. This article aims to highlight the critical impact of the recent war on Sudan's healthcare, advocating for urgent measures, including facility reopening, disease surveillance, and global support to mitigate devastating consequences.

Exploring senior managers’ experiences preparedness to respond to COVID-19: a qualitative study in Iran

BackgroundEpidemics caused by emerging respiratory viruses are challenging for the health system of most societies, and preparedness of the health system in responding to such epidemics is important. Therefore, the aim of this study was identifying different fields and key issues of the senior managers’ experiences preparedness to respond to the COVID-19 epidemic from the Iranian senior managers’ point of view.MethodsThis is a qualitative descriptive study. Eighteen in-depth and semi-structured individual interviews were conducted for data collection. For this purpose, 18 senior managers with work experience in managing the COVID-19 crisis were enrolled in the study using purposive sampling. The collected data were analyzed according to Graneheim and Lundman’s approach.ResultsAnalysis of the data resulted in the emergence of five themes and twelve sub-themes. The main themes and sub-themes included: (1) capacity improvement consisting of performance improvement and logistic improvement; (2) resource and infrastructure management including supply and support of human resources, infrastructure improvement, and supply of equipment; (3) an increase in epidemiology capacity including epidemiology improvement and emerging disease surveillance; (4) application of the principles of disaster and emergency management including intra- and extra-organizational interaction management, disaster risk management, and data management; and (5) society resilience increase including improving adaptation skill and maintaining health and social participation.ConclusionThe results of this study present the key issues for the management of future emergency situations. Health system managers and policymakers in Iran and other countries should be aware of these key issues and apply them in practice to prepare the health systems to respond to next outbreaks. Indeed, the study results can help policymakers and health system managers to plan to achieve acceptable preparedness for the management of such outbreaks.

SARS-CoV-2 seroprevalence in blood donors before and after the first wave in Catalonia (Spain).

Due to the COVID-19 pandemic, a national lockdown was applied in Spain from March to May 2020. It is uncertain when SARS-CoV-2 started to circulate in Catalonia, and only a few cases were diagnosed in this period. We assessed the SARS-CoV-2 seroprevalence in blood donors before and after the first wave and compared it with public health service (PHS) data. Retrospective archive or prospective fresh blood samples were obtained from blood donors aged 18 to 70 and anonymized after demographic data had been recorded (gender, age, place of residence, blood collection date). Two CE-marked enzyme-linked immunosorbent assays were used to test for anti-SARS-CoV-2. A SARS-CoV-2 IgM test was additionally performed in positive samples. Individuals aged 18 to 70 from among the general population diagnosed as having SARS-CoV-2 by the PHS were included for comparison with blood donor results. A total of 10,170 blood donations were included in the first period, between 24 February and 9 March 2020, and 6,829 in the second period, between 16 May and 17 June 2020. The observed SARS-CoV-2 seroprevalence among blood donors rose from 0.27% (95% CI: 0.18-0.39) before the first wave to 5.55% (95% CI: 5.03-6.12) after it, and was even higher (6.90% [95% CI: 5.64-8.41]) among blood donors aged 18 to 29. The seroprevalence among blood donors was higher in more populated areas (Barcelona: 7.69%). A comparison of blood donor data with officially diagnosed cases showed a global 87.44% underestimation of SARS-CoV-2 in June 2020. We analyzed the explosive 3-month increase in blood donor SARS-CoV-2 seroprevalence (from 0.27% to 5.55%) and show that more than 87% of cases went undiagnosed, despite the unprecedented deployment of testing measures. SARS-CoV-2 IgM results suggest that the virus was circulating among blood donors in February 2020. Blood donors are definitively proven to be a valuable resource for emerging disease surveillance studies.

Hospital coronavirus disease 2019 (COVID-19) public health reporting: Lessons from validation of an automated surveillance tool to facilitate data collection.

A comparison of computer-extracted and facility-reported counts of hospitalized coronavirus disease 2019 (COVID-19) patients for public health reporting at 36 hospitals revealed 42% of days with matching counts between the data sources. Miscategorization of suspect cases was a primary driver of discordance. Clear reporting definitions and data validation facilitate emerging disease surveillance.

Could Emergency Diseases Surveillance Systems Be Transitioned to Routine Surveillance Systems? A Proposed Transition Strategy for Early Warning, Alert, and Response Network.

In humanitarian emergencies, traditional disease surveillance systems either do not exist to begin with or come under stress due to a huge influx of internal or external migrants. However, cramped camps with an unreliable supply of safe water and weak sanitation systems are the ideal setting for major disease outbreaks of all kinds. The Early Warning, Alert and Response Network (EWARN) has been supported by the WHO since the late 1990s to ensure health system capacity to identify and control risks early before they become major epidemics. These systems have been proven to be an excellent asset in reducing morbidity and mortality in humanitarian crises around the world. However, there is also a global challenge of transitioning them back to a regular or national monitoring system in their respective countries. This article is the result of in-country consultations arranged by the Eastern Mediterranean office of the World Health Organization. In these consultations, the unique local conditions and limitations of different countries were discussed to identify a way forward for transitioning these emergency disease surveillance systems into regular systems. After these discussions, different options were presented which could be further modified according to local needs. As there has not been any documented evidence of a successful transition of any emergency surveillance system, it is difficult to discuss or determine the gold standard for transition. As with any public health program being practiced in the field, local decision-making with some broad guidelines will be the best approach available. This article provides these guidelines and practical steps which could be further modified according to country needs.

Monitoring the Spatial Spread of COVID-19 and Effectiveness of Control Measures Through Human Movement Data: Proposal for a Predictive Model Using Big Data Analytics.

BackgroundHuman movement is one of the forces that drive the spatial spread of infectious diseases. To date, reducing and tracking human movement during the COVID-19 pandemic has proven effective in limiting the spread of the virus. Existing methods for monitoring and modeling the spatial spread of infectious diseases rely on various data sources as proxies of human movement, such as airline travel data, mobile phone data, and banknote tracking. However, intrinsic limitations of these data sources prevent us from systematic monitoring and analyses of human movement on different spatial scales (from local to global).ObjectiveBig data from social media such as geotagged tweets have been widely used in human mobility studies, yet more research is needed to validate the capabilities and limitations of using such data for studying human movement at different geographic scales (eg, from local to global) in the context of global infectious disease transmission. This study aims to develop a novel data-driven public health approach using big data from Twitter coupled with other human mobility data sources and artificial intelligence to monitor and analyze human movement at different spatial scales (from global to regional to local).MethodsWe will first develop a database with optimized spatiotemporal indexing to store and manage the multisource data sets collected in this project. This database will be connected to our in-house Hadoop computing cluster for efficient big data computing and analytics. We will then develop innovative data models, predictive models, and computing algorithms to effectively extract and analyze human movement patterns using geotagged big data from Twitter and other human mobility data sources, with the goal of enhancing situational awareness and risk prediction in public health emergency response and disease surveillance systems.ResultsThis project was funded as of May 2020. We have started the data collection, processing, and analysis for the project.ConclusionsResearch findings can help government officials, public health managers, emergency responders, and researchers answer critical questions during the pandemic regarding the current and future infectious risk of a state, county, or community and the effectiveness of social/physical distancing practices in curtailing the spread of the virus.International Registered Report Identifier (IRRID)DERR1-10.2196/24432

Legislation and policy changes for Tuberculosis Surveillance in Mongolia: A qualitative analysis

ObjectiveIn order to track progress towards TB goals, we investigated the legal framework for disease surveillance, specifically policy changes for TB surveillance in Mongolia during the MDGs and the SDGs era.IntroductionMongolia is one of countries in the WHO Western Pacific Region with a high TB burden. The National Stop TB Strategy 2010-2015 implemented and developed strong surveillance and response system in the country. However, new TB incidence and deaths have not decreased significantly.Political commitment is critical for effective TB surveillance and that commitment can be demonstrated by a country’s legal framework, which governs the practice of prevention and control. Therefore, this study is aimed at investigating the legal underpinnings for disease surveillance to help identify what policy changes have occurred in Tuberculosis surveillance.MethodsWe conducted a literature review that included government strategy, programme guidelines and procedures, to examine the overall disease surveillance system in Mongolia, and used a framework analysis to investigate operation of the TB surveillance system (CDC 2001 guideline). First, nine of core functions and six of support functions for the TB surveillance system were placed on the Y axis, and the national TB strategies, programme, guidelines and procedures were placed on the X axis. Next, the strategies, programme, guidelines and procedures were unpacked and allocated to cells based on whether they were consistent with the essential functions of the surveillance system. These data points were then used to develop a matrix to enable understanding of correspondence and changes between the legal documents during MDGs to SDGs.ResultsResult 1. Mongolia has an Emerging Disease Surveillance and Response unit and A National Centre for Communicable Disease responsible for implementing the International Health Regulations in the country. The legal framework for the surveillance system was updated regularly and overall, 11 legal instruments were identified.Result 2. However, currently there is no specific national TB strategy since 2015. Recently, National Programme of Prevention and Control on Communicable disease 2017-2020 and Guidelines for TB Care 2017 were approved. The result of framework analysis shows that during MDGs era, the legal documents had weaknesses that were related to “feedback” from the core and “training and resources” from the support functions. On other hand, the weaknesses of the legal documents for SDGs were related to “outbreak preparedness and response” from the core and “training and supervision” from the support functions.ConclusionsThere is an urgency to update the legal framework to enable a comprehensive strategy specifically for TB surveillance nationwide. Also, additional studies should be done continuously and should incorporate other parts of the assessment, including co-ordination, laboratories,to help determine the factors that influence the overall structure of Tuberculosis surveillance in the country.

Health-Care Workers' Perspectives on Preparedness of Health-Care Facilities for Outbreak of Communicable Diseases in Nigeria: A Qualitative Study.

A high probability of another outbreak of communicable disease exists in sub-Saharan African countries, after the Ebola virus disease outbreak of 2014. Thus, health-care facility (HCF) preparedness for a prompt and effective response to disease outbreaks needs to be ascertained. In this study, Nigerian health-care workers' (HCWs) knowledge of preparedness, perception of the level of preparedness existing in these HCFs, militating factors, and possible ways to improve, were evaluated through qualitative data collection, using focus group discussion and in-depth interview. Among the 193 HCWs which participated in the study, the perception of 190 (98.4%) was that their HCFs were insufficiently equipped to respond to disease outbreaks. None of the facilities had an emergency operation unit (EOU). Most HCWs perceived preparedness as observation of universal precautions. Other aspects of preparedness, such as training, routine emergency drills, disease surveillance, waste management, and design and location of HCFs were minimally mentioned. None of the participants had undergone any form of emergency drill training. Among the suggestions of how to improve on preparedness were immunization of staff, improved inter-departmental communication within the HCF, and routine training. The overall poor level of preparedness which exists in the HCFs means that they cannot prevent or contain a communicable disease outbreak. There is a need to improve universal precautions, communication within the HCFs, and routine interpretation of surveillance data by epidemiologists. There is also a need for the establishment of EOU in every HCF, a system that responds to, and manages emergency response to disease outbreaks, which also must be functional during non-outbreak periods.

Earth observation for public health: Biodiversity change and emerging disease surveillance

One Health is an emerging concept in the health sciences that approaches human, animal and environmental health from a single framework. This policy approach is grounded in the knowledge that approximately 70 percent of emerging diseases in humans originate from other species, and that this species crossover is precipitated by stresses to environmental systems such as habitat change and biodiversity loss. Remote sensing tools apply well to this approach due to the multitude of variables that can be measured across borders in real-time. This paper explores the challenges and opportunities of using satellite remote sensing to monitor biodiversity loss in real time, with a goal of predictive surveillance for emerging disease events. Key findings include that (1) certain emerging disease events are preceded by biodiversity changes that can be observed from space; (2) refining quantitative assessments of biodiversity loss is a critical next step; and (3) biodiversity loss as observed from space merits inclusion in emerging disease surveillance programs as a complement to in situ and epidemiological surveillance data.

Driving improvements in emerging disease surveillance through locally relevant capacity strengthening.

Emerging infectious diseases (EIDs) threaten the health of people, animals, and crops globally, but our ability to predict their occurrence is limited. Current public health capacity and ability to detect and respond to EIDs is typically weakest in low- and middle-income countries (LMICs). Many known drivers of EID emergence also converge in LMICs. Strengthening capacity for surveillance of diseases of relevance to local populations can provide a mechanism for building the cross-cutting and flexible capacities needed to tackle both the burden of existing diseases and EID threats. A focus on locally relevant diseases in LMICs and the economic, social, and cultural contexts of surveillance can help address existing inequalities in health systems, improve the capacity to detect and contain EIDs, and contribute to broader global goals for development.

The challenge of nomadic and remote populations to emergency response, emerging disease surveillance, and eradication

The challenge of nomadic and remote populations to emergency response, emerging disease surveillance, and eradication

The impact of infection with Schmallenberg virus on weaning rate in Irish sheep flocks

Schmallenberg virus (SBV) disease emerged in Europe in 2011, with the virus initially identified in Germany, and the first confirmed case of SBV infection in Ireland diagnosed in a dairy calf in October 2012. SBV was subsequently confirmed by RT-PCR in 49 cattle herds and 39 sheep flocks. While these studies provide a good representation of the spatial distribution of SBV in Ireland, they do not quantify the impact of SBV on productivity. The objectives of this study were to assess the impact of SBV on weaning rate in Irish sheep flocks, based on data reported by Irish sheep farmers, and to evaluate weaning rate in sheep flocks as an indicator to be used in emerging disease surveillance systems. A questionnaire on productivity and management practices in sheep flocks was developed to gather data from sheep farmers. Valid responses from 267 sheep farmers were received. Negative binomial regression indicated that flocks with a confirmed SBV diagnosis had a weaning rate 0.9 times that of flocks free of SBV. The 10% reduction in weaning rates as a result of SBV is a justifiable concern for farmers and should be considered in formulating flock breeding policy. This study shows the value of a production database as an indicator of an emerging disease and the economic impact of that disease in Irish sheep flocks.

One Medicine One Science and policy

Today, humans, animals, and the environment are remarkably interconnected and interdependent at a global level through international commerce and movement. Thus, we have access to safe and nutritious food that fuels health, medicines and vaccines that protect us and our animals, and natural resources that support good living standards. However, conflicts arise as exponentially growing populations require more food, demand better living standards, and act to preserve the environment. How do we simultaneously produce more food, reduce disease, afford equitable living standards, and create an environment fit for humans, our animals, and wildlife? Science has played a critical role in finding solutions to many of these challenges, but difficult conflicts continue to emerge. For example, strategies that promote efficient production of food—such as concentrated farming systems, monoculture cropping, and chemical inputs of fertilizer, pesticides, and herbicides—have unintended consequences that threaten human, animal, and environmental health ([ 1 ][1]). A more integrated, holistic problem-solving approach informed by science is needed for development of public policies that address these complex problems. A growing “one health” dialogue has focused on emerging disease surveillance, public health preparedness, and policy issues, with less attention being given to connecting these issues to the scientific foundations that underpin pathogen emergence, global health threats, food security, and environmental health. The imbalance has resulted in a compartmentalization of research and policy, sometimes diluting or compromising the efficacy of the one health movement. For example, lack of balanced scientific input imperils policies affecting antibiotic use for efficient food production and, more seriously, modification of plants for improved production of foods under adverse conditions in impoverished countries. There is value in looking back at instances of scientifically informed decision-making that have broadly benefited human, animal, and environmental health, such as the U.S. Clean Air Act of 1970 and the U.S. Clean Water Act of 1972. Human health security today relies on finding common ground at the intersection of humans, animals, and the environment among diverse opinions and values. The concept of One Medicine One Science–based forums that bring together a diversity of scientists, policy professionals, medical experts, food producers, and other relevant stakeholders provides an important opportunity to present scientific knowledge that objectively informs public policy development ([ 2 ][2]). In the absence of scientific information, for instance, concerns about foods genetically modified for enhanced traits have resulted in European markets being closed to African farmers trying to better their standard of living. It has also led to at-risk pregnant women and children lacking access to golden rice, whose high vitamin A content could alleviate as many as 500,000 cases of irreversible blindness in pregnant women and children every year ([ 3 ][3]). Scientifically informed public policies are also needed to find solutions to foreseeable food supply limitations, prepare for existing foreign animal and human disease pathogens (e.g., African swine fever virus and Chikungunya virus), and deal with environmental implications of extreme energy production (e.g., fracking effects on water quality) or industrial pollution of agricultural land in China (4). Overall, balancing competing priorities is a major challenge as societies seek to maximize human health, animal health and welfare, and environmental integrity. Reductionism may be a natural reaction to complexity, but we are in need of evolving ways to discuss, understand, and address these complex challenges. ![Figure][4] Strategies to increase food production, such as pesticide use, have unintended consequences. PHOTO: LENS/GETTY IMAGES 1. [↵][5] 1. R. S. DeFries, 2. J. A. Foley, 3. G. P. Asner , Front. Ecol. Environ. 2, 249 (2004). [OpenUrl][6][CrossRef][7][Web of Science][8] 2. [↵][9] 1. D. A. Travis 2. et al ., Ann. N.Y. Acad. Sci. 1334, 26 (2014). [OpenUrl][10][CrossRef][11][PubMed][12] 3. [↵][13] Golden Rice Project ([www.goldenrice.org][14]). 4. 1. C. Larson , Science 343, 1415 (2014). [OpenUrl][15][Abstract/FREE Full Text][16] [1]: #ref-1 [2]: #ref-2 [3]: #ref-3 [4]: pending:yes [5]: #xref-ref-1-1 View reference 1 in text [6]: {openurl}?query=rft.jtitle%253DFront.%2BEcol.%2BEnviron.%26rft.volume%253D2%26rft.spage%253D249%26rft_id%253Dinfo%253Adoi%252F10.1890%252F1540-9295%25282004%2529002%255B0249%253ALCBHNA%255D2.0.CO%253B2%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [7]: /lookup/external-ref?access_num=10.1890/1540-9295(2004)002[0249:LCBHNA]2.0.CO;2&link_type=DOI [8]: /lookup/external-ref?access_num=000223960800016&link_type=ISI [9]: #xref-ref-2-1 View reference 2 in text [10]: {openurl}?query=rft.jtitle%253DAnn.%2BN.Y.%2BAcad.%2BSci.%26rft.volume%253D1334%26rft.spage%253D26%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fnyas.12601%26rft_id%253Dinfo%253Apmid%252F25476836%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [11]: /lookup/external-ref?access_num=10.1111/nyas.12601&link_type=DOI [12]: /lookup/external-ref?access_num=25476836&link_type=MED&atom=%2Fsci%2F347%2F6219%2F242.1.atom [13]: #xref-ref-3-1 View reference 3 in text [14]: http://www.goldenrice.org [15]: {openurl}?query=rft.jtitle%253DScience%26rft.stitle%253DScience%26rft.issn%253D0036-8075%26rft.aulast%253DLarson%26rft.auinit1%253DC.%26rft.volume%253D343%26rft.issue%253D6178%26rft.spage%253D1415%26rft.epage%253D1416%26rft.atitle%253DChina%2BGets%2BSerious%2BAbout%2BIts%2BPollutant-Laden%2BSoil%26rft_id%253Dinfo%253Adoi%252F10.1126%252Fscience.343.6178.1415%26rft_id%253Dinfo%253Apmid%252F24675928%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [16]: /lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6Mzoic2NpIjtzOjU6InJlc2lkIjtzOjEzOiIzNDMvNjE3OC8xNDE1IjtzOjQ6ImF0b20iO3M6MjQ6Ii9zY2kvMzQ3LzYyMTkvMjQyLjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9

Use of monthly collected milk yields for the detection of the emergence of the 2007 French BTV epizootic

Two culicoides-borne diseases, Bluetongue (BTV) and Schmallenberg, have emerged in the European cattle population since 2006. Other diseases transmitted by these vectors could emerge. This justifies the development of syndromic surveillance programs whereby one or several indicators would be routinely monitored for the early detection of emerging diseases. The aim of this study was to evaluate milk yield from milk recording in dairy cattle as an indicator to be included in an emerging disease surveillance system. It was hypothesized that emergences would result in episodes of low milk production clustered in space and time. The 2007 BTV epizootic in France was used as a case study. Because it had already emerged in neighbouring countries, the disease emergence was expected and notification was mandatory. Herd-test-day milk productions were predicted for the entire country for 2006 and 2007 from herd historical data using linear mixed models. The differences between observed and predicted milk productions were averaged per week and per municipality and used as input for a space-time prospective scan statistic. Log likelihood ratios (LLR) associated with clusters were used to define alarms. The threshold chosen was a trade-off between detection timeliness and the number of false alarms per week. The first four BTV notifications occurred on the 12th (two notifications), 13th and 27th of July 2007. The 12th of July was considered to be the date of emergence. Alarms occurring before the 1st of March 2007 were considered to be false alarms. Using an LLR of 50, there were an average of 1.7 false alarms per week and the BTV emergence was detected seven weeks after emergence. Using an LLR of 100, there were an average of 0.8 false alarms per week and the BTV emergence was detected 9 weeks after emergence. Detection may have been delayed because of a discontinuation of milk recording between mid-July and mid-August. The first cluster with an LLR>100 located in the emergence area was further investigated. A difference between observed and predicted production of >1kg/cow/day was observed around the time of emergence. However, a difference of equal magnitude was observed during the year preceding the outbreak. Milk production predicted from herd history alone did not allow the detection of the 2007 BTV emergence in France. Further research should be conducted on improving the prediction of test-day milk yield and on combining it with other indicators based on routinely collected data.

Human infections with avian influenza A(H7N9) virus in China: preliminary assessments of the age and sex distribution

WPSAR Vol 4, No 2, 2013 | doi: 10.5365/wpsar.2013.4.2.005 www.wpro.who.int/wpsar 1 a Emerging Disease Surveillance and Response, Division of Health Security and Emergencies, World Health Organization Regional Offi ce for the Western Pacifi c, Manila, Philippines. b Emerging Disease Surveillance and Response, World Health Organization China Offi ce, Beijing, China. * Members of the World Health Organization Regional Offi ce for the Western Pacifi c Event Management Team: Nyka Alexander, Jang Hwan Bae, Joy Rivaca Caminade, Erica Dueger, Xavier Dufrenot, Norikazu Isoda, Frank Konings, Chin-Kei Lee, Ailan Li, Michelle McPherson, Satoko Otsu, Karl Schenkel and Huu Thuan Vo. Submitted: 13 April 2013; Published: 20 April 2013 doi: 10.5365/wpsar.2013.4.2.005 Since 31 March 2013, the Government of China has been notifying the World Health Organization (WHO) of human infections with the avian influenza A(H7N9) virus,1 as mandated by the International Health Regulations (2005).2 While human infections with other subgroups of H7 influenza viruses (e.g. H7N2, H7N3 and H7N7) have previously been reported,3 the current event in China is of historical significance as it is the first time that A(H7N9) viruses have been detected among humans and the first time that a low pathogenic avian influenza virus is being associated with human fatalities.4 In this rapidly evolving situation, detailed epidemiologic and clinical data from reported cases are limited—making assessments challenging— however, some key questions have arisen from the available data. Age and sex data, as one of the first and Human infections with avian infl uenza A(H7N9) virus in China: preliminary assessments of the age and sex distribution

Influences of farmer and veterinarian behaviour on emerging disease surveillance in England and Wales

Surveillance for new and re-emerging animal diseases in England and Wales is based on post-mortem and syndromic analysis of laboratory data collated in a central database by the Animal Health and Veterinary Laboratories Agency (AHVLA), with the aim of providing early warning of disease events prior to clinical diagnosis. Understanding the drivers for participation in such systems is critical to the success of attempts to improve surveillance sensitivity. The aim of this study was to investigate the decision-making process governing the submission of biological samples on which this surveillance system is based by use of questionnaires. Data extracted were used to structure and parameterize scenario trees modelling the probability of generating an entry in the surveillance database. The mean probability for database entry per case ranged from 0.085 for neurological disorders to 0.25 for enteric disease. These findings illustrate the importance of on-farm decision making to the generation of surveillance data.

Issues in the Development of a Research and Education Framework for One Health

Issues in the Development of a Research and Education Framework for One Health

Sex, gender and emerging infectious disease surveillance: a leptospirosis case study

WPSAR Vol 3, No 3, 2012 | doi: 10.5365/wpsar.2012.3.3.001 www.wpro.who.int/wpsar 1 a Emerging Disease Surveillance and Response, Division of Health Security and Emergencies, Western Pacifi c Regional Offi ce, World Health Organization, Manila, Philippines. Submitted: 1 June 2012; Published: 2 August 2012 doi: 10.5365/wpsar.2012.3.3.001 Whatever the population, wherever the place, whenever the period, sex has been an essential demographic variable for surveillance. However, the distinction between “sex” and “gender” has not always been well understood or acknowledged by those of us engaged in public health surveillance. Sex refers to the biological and physiological factors that define males and females, while gender refers to socially constructed roles and attributes that a particular society considers appropriate for men and women.1 While both sex and gender factors contribute to reported surveillance data, their full contributions are often not recognized. When such data are then used to ascertain sex/gender differential in disease risk without caution, the complete picture behind the observed distribution may be missed or misinterpreted. Using leptospirosis as a case example, we describe the importance of interpreting surveillance data with a Sex, gender and emerging infectious disease surveillance: a leptospirosis case study

The agents of Sever Acute Respiratory Infection cases in Ben Tre province 2008-2010

Since 2003, Southern Vietnam has become the most serious affected area by various emerging diseases such as: A/H5N1, SARS, Rubella, etc. Therefore, the establishment of emerging disease surveillance is essential and necessary to provide scientific information for good understand on the emerging diseases and for effective outbreak response. A specific surveillance system for Severe Acute Respiratory Infection (SARI) was established in 02 sentinel hospitals in Ben Tre province from August 2008 to June 2010. Patient’s signature on written ICF had been required before the enrollment. All of the enrolled SARI cases were investigated and their throat swabs were collected for testing. Multiplex RT-PCR was applied to determine 17 viral agents. In addition, blood culture has been performed since August 2009 in order to detect bacterial agents on these SARI cases. Out of 1,842 SARI cases enrolled into the surveillance system, 969 (52.61%) cases had positive testing results, including: 913 (49.75%) cases had positive testing results with viral agents and 56 (9.89%) of 566 blood culture specimens had positive testing results with bacterial agents. Moreover, the proportion of co-infection between virus and bacteria was 0.98%. There were 14 viral agents had been detected including: Inf A/H1N1pdm (1.41%), Inf A (2.61%), Inf B (0.98%), Inf C (0.11%), hRV (18.1%), RSV (14.13%), Boca (3.32%), Adeno (1.68%), Entero (0.65%), Corona HKUI (0.11%), hMPV (2.28%), Parainfluenza type 1 (1.58%), Parainfluenza type 3 (2.23%) and Parainfluenza type 4 (0.33%) viruses. A remarkable attention is that hRV and RSV which were identified as the cause of some sudden deaths in infants in China, Philippines and respiratory outbreak in Cambodia in 2008 were 02 predominant agents. The major concern is that Inf A virus in the South predominates in summer season and this is very different from other regions in Vietnam and even other parts of the world. In addition, viral agents were shifted by seasons: Boca virus (January to April), Inf A (May to July) and RSV (August to November). The results of the surveillance show that the viral pathogens of SARI are variety and most of them have never been detected in the South of Vietnam. In addition, all types of Influenza virus are detected on SARI cases and the viral pathogens vary by the seasons.

Chronic Traumatic Encephalopathy, Suicides and Parasuicides in Professional American Athletes

We present 5 cases of professional American contact sport athletes who committed parasuicides and suicides aged 50, 45, 44, 36, and 40 years old. Full forensic autopsies and immunohistochemical analyses of the brains revealed chronic traumatic encephalopathy (CTE). The brains appeared grossly normal at autopsy without gross evidence of remote traumatic injuries or neurodegenerative disease. Brain immunohistochemical analyses revealed widespread cerebral taupathy in the form of neurofibrillary tangles and neuritic threads without neuritic amyloid plaques. CTE refers to chronic cognitive and neuropsychiatric symptoms of chronic neurodegeneration following a single episode of severe traumatic brain injury or repeated episodes of mild traumatic brain injury. CTE can only be definitively diagnosed by direct tissue examination. Without full autopsies and immunohistochemical brain analyses these cases would never have been identified. Forensic pathologists will play a vital and central role in the emerging disease surveillance of CTE in professional American athletes, in the identification of CTE cases, and in the establishment of the epidemiology of CTE, with the goal of eventually developing preventive and interventional therapeutic protocols for CTE outcomes.