Epidemic Control Research Articles

Policies and Practices Facilitating Access to and Uptake of HIV Testing Services among Adolescents in Sub-Sahara Africa: A Narrative Review.

Expanding access to HIV testing services and linking newly diagnosed positive adolescents to antiretroviral therapy is critical to epidemic control. However, testing coverage and treatment initiation rates continue to lag behind adult counterparts. This article synthesizes evidence on facilitative policies and service delivery practices focused on adolescents to inform programming. Our narrative review found that national policies are growing more adolescent-inclusive but barriers around the age of consent, waiver frameworks and dissemination constrain translate into practice. Facility-based provider-initiated testing through integrated sexual health services and dedicated youth centres demonstrates uptake effectiveness if confidentiality and youth-friendly adaptations are assured. Supportive policies, youth-responsive adaptations across testing models and strengthening age-disaggregated monitoring are vital to improving adolescents' engagement across the HIV testing and treatment cascade. Further implementation research is imperative to expand the reach of adolescent HIV testing in sub-Saharan Africa.

Retention in care and antiretroviral therapy adherence among Medicaid beneficiaries with HIV, 2001–2015

ABSTRACT Disparities in HIV care by socioeconomic status, place of residence, and race/ethnicity prevent progress toward epidemic control. No study has comprehensively characterized the HIV care cascade among people with HIV enrolled in Medicaid – an insurance source for low-income individuals in the US. We analyzed data from 246,127 people with HIV enrolled in Medicaid 2001–2015, aged 18–64, living in 14 US states. We estimated the monthly prevalence of four steps of the care cascade: retained in care/adherent to ART; retained/not adherent; not retained/adherent; not retained/not adherent. Beneficiaries were retained in care if they had an outpatient care encounter every six months. Adherence was based on medication possession ratio. We estimated prevalence using a non-parametric multi-state approach, accounting for death as a competing event and for Medicaid disenrollment using inverse probability of censoring weights. Across 2001–2015, the proportion of beneficiaries with HIV who were retained/ART adherent increased, overall and in all subgroups. By 2015, approximately half of beneficiaries were retained in care, and 42% of beneficiaries were ART adherent. We saw meaningful differences by race/ethnicity and region. Our work highlights an important disparity in the HIV care cascade by insurance status during this time period.

A narrative review of wastewater surveillance: pathogens of concern, applications, detection methods, and challenges.

The emergence and resurgence of pathogens have led to significant global health challenges. Wastewater surveillance has historically been used to track water-borne or fecal-orally transmitted pathogens, providing a sensitive means of monitoring pathogens within a community. This technique offers a comprehensive, real-time, and cost-effective approach to disease surveillance, especially for diseases that are difficult to monitor through individual clinical screenings. This narrative review examines the current state of knowledge on wastewater surveillance, emphasizing important findings and techniques used to detect potential pathogens from wastewater. It includes a review of literature on the detection methods, the pathogens of concern, and the challenges faced in the surveillance process. Wastewater surveillance has proven to be a powerful tool for early warning and timely intervention of infectious diseases. It can detect pathogens shed by asymptomatic and pre-symptomatic individuals, providing an accurate population-level view of disease transmission. The review highlights the applications of wastewater surveillance in tracking key pathogens of concern, such as gastrointestinal pathogens, respiratory pathogens, and viruses like SARS-CoV-2. The review discusses the benefits of wastewater surveillance in public health, particularly its role in enhancing existing systems for infectious disease surveillance. It also addresses the challenges faced, such as the need for improved detection methods and the management of antimicrobial resistance. The potential for wastewater surveillance to inform public health mitigation strategies and outbreak response protocols is emphasized. Wastewater surveillance is a valuable tool in the fight against infectious diseases. It offers a unique perspective on the spread and evolution of pathogens, aiding in the prevention and control of disease epidemics. This review underscores the importance of continued research and development in this field to overcome current challenges and maximize the potential of wastewater surveillance in public health.

Vaping habits and respiratory symptoms using a smartphone app platform

BackgroundWidespread use of e-cigarette (EC) or vaping products causes respiratory disorders including the nationwide outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) in 2019. Chronic adverse health effects are now being reported as well. To address this important public health issue, an innovative approach of epidemic control and epidemiologic study is required. We aimed to assess the association between short-term and long-term use of EC products and respiratory health in adults using smartphone app data.MethodsA population-based, repeated measures, longitudinal smartphone app study that performed 8-day survey participation over 60 days for each participant from August 2020 to March 2021, including 306 participants aged 21 years and older in the US. The participants were asked to complete the respiratory health questionnaire daily, weekly, and monthly on their smartphone app. We analyzed the association between vaping habits and respiratory health using generalized linear mixed models (GLMMs).ResultsEC use in the previous 7 days was associated with frequent cough (OR: 5.15, 95% CI: 2.18, 12.21), chronic cough (OR: 3.92, 95% CI: 1.62, 9.45), frequent phlegm (OR: 3.99, 95% CI: 1.44, 11.10), chronic phlegm (OR: 3.55, 95% CI: 1.41, 8.96), episodes of cough and phlegm (OR: 4.68, 95% CI: 1.94, 11.28), mMRC grade 3–4 dyspnea (OR: 3.32, 95% CI: 1.35 to 8.13), chest cold (OR: 3.07, 95% CI: 1.29, 7.33), eye irritation (OR: 2.94, 95% CI: 1.34, 6.47) and nose irritation (OR : 2.02, 95% CI: 0.95, 4.30). Relatively long-term effects of the past 90 days EC use was associated with an increased risk of wheeze (OR: 3.04, 95% CI: 1.31, 7.03), wheeze attack (OR: 2.78, 95% CI: 1.07, 7.24), mMRC grade 3–4 dyspnea (OR: 2.54, 9% CI: 1.05 to 6.18), eye irritation (OR: 3.16, 95% CI: 1.49, 6.68), and eye irritation during the past month (OR: 3.50, 95% CI: 1.52, 8.04).ConclusionsIn this smartphone app-based repeated measures study, short-term and relatively long-term use of EC increased the risk of respiratory symptoms.

Community overview on the differential prevalence of Hepatitis E in two sub-counties in Kitgum District, Uganda: a mixed study design

BackgroundAn epidemic of Hepatitis E infection occurred in Kitgum district, northern Uganda in 2009. In that epidemic, more than 10,422 people were infected, and over 166 deaths were registered. Kitgum District Health Management Information Systems (HMIS) showed that Hepatitis E cases continued to occur in Mucwini more than in Kitgum Matidi sub-county despite instituting similar epidemic control measures in the two communities. The tenacity of the virus in Mucwini sub-county had remained unclear. This study aimed to assess communities’ views and perspectives on the differential prevalence of Hepatitis E in the two sub-counties of Kitgum Matidi and Mucwini in northern Uganda.MethodsA mixed study using qualitative and quantitative methods was used. Four Focus group discussions and six key informant interviews were conducted with the village health teams, local council chairpersons, health workers, and community members. These participants were chosen purposively because of their expertise and experience in community health services. Face-to-face interview guides were administered to obtain detailed information on factors associated with the differential occurrence of Hepatitis E in the two sub-counties. This study was approved by a local IRB and the Uganda National Council of Science and Technology (UNCS&T).ResultsThe most substantial findings were the differences in prevention and control practices in the two communities. Residents of Mucwini were less compliant with infection, prevention, and control guidelines, and disagreements between local councilors and village health teams in Mucwini over allowances led to poor implementation and non-adherence to guidelines on community control of the epidemic.ConclusionA differentially higher prevalence of Hepatitis E in Mucwini than in Kitgum Matidi resulted from poor personal and community hygiene and non-adherence to behavior change communication among residents of Mucwini than their counterparts in Kitgum Matidi. The authors recommend a more proactive approach to managing an epidemic by securing the willingness of the affected community to adopt appropriate infection prevention and control guidelines. In addition, disagreements among stakeholders should be resolved quickly so that all community members adhere to control measures.

Predictability of human mobility during the COVID-19 pandemic in the United States.

Human mobility is fundamental to a range of applications including epidemic control, urban planning, and traffic engineering. While laws governing individual movement trajectories and population flows across locations have been extensively studied, the predictability of population-level mobility during the COVID-19 pandemic driven by specific activities such as work, shopping, and recreation remains elusive. Here we analyze mobility data for six place categories at the US county level from 2020 February 15 to 2021 November 23 and measure how the predictability of these mobility metrics changed during the COVID-19 pandemic. We quantify the time-varying predictability in each place category using an information-theoretic metric, permutation entropy. We find disparate predictability patterns across place categories over the course of the pandemic, suggesting differential behavioral changes in human activities perturbed by disease outbreaks. Notably, predictability change in foot traffic to residential locations is mostly in the opposite direction to other mobility categories. Specifically, visits to residences had the highest predictability during stay-at-home orders in March 2020, while visits to other location types had low predictability during this period. This pattern flipped after the lifting of restrictions during summer 2020. We identify four key factors, including weather conditions, population size, COVID-19 case growth, and government policies, and estimate their nonlinear effects on mobility predictability. Our findings provide insights on how people change their behaviors during public health emergencies and may inform improved interventions in future epidemics.

Stated preferences for new HIV prevention technologies among men who have sex with men in India: A discrete choice experiment.

India has the second largest HIV epidemic in the world. Despite successes in epidemic control at the population level, a concentrated epidemic persists among gay and other men who have sex with men (MSM). However, India lags in implementation of biomedical prevention technologies, such as HIV pre-exposure prophylaxis (PrEP). In order to inform scale-up of new HIV prevention technologies, including those in the development pipeline, we assessed willingness to use oral PrEP, rectal microbicides, and HIV vaccines, and choices among product characteristics, among MSM in two major Indian cities. A cross-sectional survey was conducted with a discrete choice experiment (DCE), an established methodology for quantitively estimating end-user preferences in healthcare. Survey participants were randomly assigned to one of three questionnaire versions, each of which included a DCE for one prevention technology. Participants were recruited using chain-referral sampling by peer outreach workers, beginning with seeds in community-based organizations and public sex environments, in Chennai and Mumbai. DCE data were analyzed using random-parameters (mixed) logit (RPL) models. Among participants (n = 600), median age was 25 years, with median monthly income of INR 9,000 (~US$125). Nearly one-third (32%) had completed a college degree and 82% were single/never married. A majority of participants (63%) reported condomless anal sex in the past month. The acceptability of all three products was universally high (≥90%). Across all three products, four attributes were significant predictors of acceptability-with efficacy consistently the most important attribute, and in decreasing order of preference, side-effects, dosing schedule, and venue. MSM varied in their preferences for product attributes in relation to their levels of education and income, and engagement in sex work and HIV risk behavior. This study provides empirical evidence to facilitate the integration of end users' preferences throughout design, testing, and dissemination phases of HIV prevention technologies. The findings also suggest action points and targets for interventions for diverse subgroups to support the effectiveness of combination HIV prevention among MSM in India.

Unraveling Urban Retail Realities: Assessing Revenue Shifts and Policy Effects in Seoul, South Korea, Pre- and During the COVID-19 Pandemic

The post-2020 revenue trends in Seoul’s retail areas, influenced by government policies to curb the epidemic, exhibit diverse impacts across regions. Progressing through three stages—imposing gathering restrictions, easing business limits with reinforced movement constraints, and relaxing epidemic control—the measures, while uniformly applied, yield varied effects based on retail area characteristics. Using Dynamic Time Warping Clustering, this study assessed 1637 Seoul retail areas over 45 months, categorizing revenue changes into highly grown, grown, recovered, and stagnated types. Areas with increased pre-pandemic revenue displayed lower F&B sector proportions, higher sales/experiential sector proportions, and increased spending by 30s/corporate entities. These areas were characterized by lower-income residents and reduced accessibility to public facilities. Conversely, areas with high 20s consumption, lower corporate demand, and proximity to crowd-pulling facilities exhibited lower revenue recovery resilience. The study emphasizes the need for effective urban spatial management to facilitate the recovery of elastic retail area amid mobility and interaction constraints, advocating for fine-tuned measures to minimize pandemic-induced economic impacts on urban retail areas.

Enhancing the capacity of community health workers in prevention and control of epidemics and pandemics in Wakiso district, Uganda: evaluation of a pilot project

BackgroundCommunity Health Workers (CHWs) play a crucial role in outbreak response, including health education, contact tracing, and referral of cases if adequately trained. A pilot project recently trained 766 CHWs in Wakiso district Uganda on epidemic and pandemic preparedness and response including COVID-19. This evaluation was carried out to generate evidence on the outcomes of the project that can inform preparations for future outbreaks in the country.MethodsThis was a qualitative evaluation carried out one year after the project. It used three data collection methods: 30 in-depth interviews among trained CHWs; 15 focus group discussions among community members served by CHWs; and 11 key informant interviews among community health stakeholders. The data was analysed using a thematic approach in NVivo (version 12).ResultsFindings from the study are presented under four themes. (1) Improved knowledge and skills on managing epidemics and pandemics. CHWs distinguished between the two terminologies and correctly identified the signs and symptoms of associated diseases. CHWs reported improved communication, treatment of illnesses, and report writing skills which were of great importance including for managing COVID-19 patients. (2) Enhanced attitudes towards managing epidemics and pandemics as CHWs showed dedication to their work and more confidence when performing tasks specifically health education on prevention measures for COVID-19. (3) Improved health practices such as hand washing, vaccination uptake, and wearing of masks in the community and amongst CHWs. (4) Enhanced performance in managing epidemics and pandemics which resulted in increased work efficiency of CHWs. CHWs were able to carry out community mobilization through door-to-door household visits and talks on community radios as part of the COVID-19 response. CHWs were also able to prioritize health services for the elderly, and support the management of patients with chronic diseases such as HIV, TB and diabetes by delivering their drugs.ConclusionsThese findings demonstrate that CHWs can support epidemic and pandemic response when their capacity is enhanced. There is need to invest in routine training of CHWs to contribute to outbreak preparedness and response.

DNA tweezer-assembled, regenerated nanosensor for one-step and sustainable detection of viral RNA and Hg2+

Transcription-polymerase chain reaction (RT-qPCR) is the golden standard to detect viral RNA. However, it suffers from several inherent defects such as high false-negative rates, time-consuming and expensive. To exploit better analytical methods for future global pandemics, it is vital to develop rapid, sustainable, and environmentally-friendly sensing methods. Here, a one-step, regenerated nanosensor assembled by DNA tweezers is developed for rapid and sustainable detection of viral RNA. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is selected as model analyte. The DNA tweezer is designed with a central strand and two arm strands containing overhangs complementary to SARS-CoV-2 RNA. The SARS-CoV-2 RNA hybridizes with the two arm overhangs and strains the DNA tweezer to closed conformation, resulting in the close proximity of the donor and acceptor fluorophores. With the addition of an anti-strand complementary to the SARS-CoV-2 RNA, the closed DNA tweezer is relaxed to open conformation through a strand displacement process, leading to the separation of the dual fluorophores. Thus, the DNA tweezer is revived for fresh SARS-CoV-2 RNA. The proposed nanosensor can be regenerated for three cycles with the same performance. Moreover, the viral RNA can be detected within 30 min with a detection limit of 0.04 nM. By altering the sequences of the DNA tweezer, rapid, sensitive, and sustainable detection of Hg2+ is achieved. The proposed nanosensor provides a novel approach for rapid, flexible, and sustainable detection of viral RNA and Hg2+, exhibiting great potential for routine preliminary coronavirus disease tests, epidemic control, and environmental monitoring.

Label-Free and DNAzyme-Mediated Biosensor with a High Signal-to-Noise Ratio for a Lumpy Skin Disease Virus Assay.

Lumpy skin disease virus (LSDV) is a severe and highly contagious form of cowpox. As LSDV continues to mutate and there is no vaccine and treatment in nonendemic countries, early detection of LSDV becomes an important basis for epidemic prevention and control, especially for detection of conserved sequences. A new label-free and sensitive fluorescence method was developed based on a light-up RNA aptamer for detecting LSDV. The method integrated recombinase polymerase amplification (RPA), CRISPR/Cas12a, 10-23 DNAzyme, and Baby Spinach RNA aptamer for triple cascade signal amplification. Based on highly sensitive and specific RPA and CRISPR/Cas12a, DNAzyme achieved a third signal amplification. Additionally, the Baby Spinach RNA aptamer had stronger fluorescence signals and higher quantum yields. The label-free method had ultrahigh sensitivity with the actual detection limit as 1.29 copies·μL-1. The method was 100-fold more sensitive compared to RPA with Cas12a. Moreover, it had no cross-reactivity with viruses belonging to the Capripoxvirus, such as sheep pox virus and goat pox virus with genetic homology as 97%. Furthermore, the method displayed 100% accuracy in 50 actual samples. Therefore, the method based on RPA, Cas12a, and 10-23 DNAzyme had advantages in LSDV detection and provided a new solution for LSD prevention and control.

Analyzing foreland dynamics in China's port clusters under global major events (2019–2022) by AIS trajectory data

Port foreland, serves as the maritime mirror of the hinterland, encompasses the ports and overseas markets interconnected through shipping services. During major global events, understanding port foreland structures becomes imperative for nations and port authorities to anticipate future trade trends and potential coastal management risks. However, systematic approaches for accurately identifying foreland structures remain lacking, particularly given liner shipping complexities. In response, this paper develops two algorithms to analyze changes in the foreland structure of five port clusters in China for the years 2019 and 2022, leveraging over 2.1 billion global vessel AIS trajectory signals. We aim to understand the foreland dynamics of China's ports amidst the broader impacts of the China-US trade war, the COVID-19 pandemic, and the Russia-Ukraine (RU) conflict, and provide insights for maintaining the global trade continuity. Our findings show that geopolitical events and bilateral relations highly influence port foreland structures, yet global supply chain requirements prompt stakeholders to adopt alternative transport strategies. In 2022, China's foreland structures remain stable despite its strict epidemic control measures. Positive developments in China's port forelands with the US are driven by improving bilateral relations and reduced impacts of the US-China trade war, while conflicts in RU cause shrinkage in Europe. On this basis, we provide three constructive opinions on the development of China's port clusters.

The depression and anxiety status and influencing factors survey of international students during COVID-19 outbreak period in Hunan, China: A cross-sectional study

International students are susceptible to several mental health disorders, including anxiety and depression amid the COVID-19 pandemic due to the implementation of epidemic control measures such as lockdown, quarantine, etc. The study aimed to investigate the depression and anxiety status as well as influencing factors of international students in Hunan, China during the COVID-19 outbreak lockdown. An online cross-sectional survey was conducted between May and June 2020. A snowball sampling technique was used to recruit participants. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) were used to assess depression and anxiety status, respectively. 450 participants completed the online survey. The overall prevalence of depression and anxiety was 28.7 % and 36.9 %, respectively. Multivariate logistic regression analyses showed that having suspected symptoms of COVID-19 (aOR = 3.54, 95 %CI = 1.30–9.64) and having family members or friends infected with COVID-19 (aOR = 1.51, 95 %CI = 1.31–3.84) were positively associated with depression. Being single was positively associated with anxiety (aOR = 3.10, 95 %CI = 1.46–6.57). Also, obtaining news or updates about the COVID-19 daily (aOR = 1.76, 95 %CI = 1.13–3.75), and using electronic devices for 5–6 h every day (aOR = 2.21, 95 %CI = 1.17–4.17) showed a positive association with anxiety. Furthermore, having a high coping strategy was negatively associated with anxiety (aOR = 0.33, 95 %CI = 0.12–0.92). Although implementing lockdown was an excellent measure, it resulted in a high prevalence of depression and anxiety symptoms. The findings support previous studies that reported an increased in depression and anxiety status due to the COVID-19 pandemic. Therefore, mental health education and psychological support should be provided to this population during the pandemic or future epidemic diseases.

Resilience analysis of urban commercial area under the COVID-19 epidemic using night-time light remote sensing data

ABSTRACT The global outbreak of the novel coronavirus has had a great impact on commercial areas, particularly in Wuhan, the first city in China affected by the epidemic. Exploring the changing pattern of these areas during the epidemic period is crucial for effectively restoring the urban economic level and promoting economic development on the basis of epidemic prevention and control in the post-epidemic era. The paper proposes a resilience analysis of urban commercial areas during the COVID-19 epidemic using time-series night-time light remote sensing data. Based on the constructed time-series night-time light remote sensing dataset and considering the urban impervious surface, the urban commercial area was extracted under multi-scale segmentation. Based on night-time light data before and after the epidemic, the resilience of representative commercial areas in Wuhan City, Hubei Province during the COVID-19 epidemic was analysed using a modified improved resilience assessment framework. The results showed that the lighting values of commercial areas and impervious areas decreased by up to 30% following the implementation of city lockdown measures. The change of light brightness in the commercial areas was more prominent, and the range of change is larger than that in the non-commercial areas. The lighting brightness of the commercial areas exhibited a significant downward trend throughout the entire lockdown period, and the downward trend will still remain for a period of time after unlocking. Among all the commercial areas, Wuguang commercial area demonstrated the highest recovery rate during the lockdown period and instantaneous recovery rate after the lockdown, with relatively low closure loss and the highest level of resilience.

Impacts of Major Changes in China's COVID-19 Prevention and Control Policies on Emergency Department Visits: A Quasi-Experiment.

This study aims to evaluate the impact of COVID-19 prevention and control policies on the frequency of emergency department (ED) visits in a large tertiary hospital in central China, from January 2018 to September 2023. We conducted a multi-stage interrupted time series analysis to investigate the impact of various epidemic control policies on weekly ED visits at a tertiary hospital in Hunan Province, China. The study period ranged from January 1, 2018, to September 30, 2023, and was divided into four distinct periods: pre-epidemic, pandemic, normalized control, and end of control. Using a quasi-Poisson regression model, we examined the specific effects of these policies on emergency visits, with a particular focus on stratifying patients based on respiratory versus non-respiratory diseases. Compared to the pre-pandemic period, the number of ED visits in a tertiary hospital decreased by 38.5% (95% CI: 25.1% to 49.8%) during the COVID-19 pandemic, of which the number of ED visits for respiratory diseases increased by 79.4% (95% CI: 13.2% to 177.2%) and the number of ED visits for non-respiratory diseases decreased by 45.9% (95% CI: -55.7% to -34.2%). After the end of the epidemic control, the total number of ED visits increased by 31.5% (95% CI: 19.1% to 45.0%), with the number of ED visits for respiratory diseases rising by 379.2% (95% CI: 275.9% to 511.8%), but with no significant change in the number of ED visits for non-respiratory emergencies. Control policies were associated with people avoiding emergency care for non-respiratory related reasons during the pandemic, while the end of control policies was associated with a sharp rise in emergency care for respiratory diseases. This study provides a scientific basis for the different changes in ED visits under the implementation of varying epidemic prevention and control policies.

Health System Responses to Address Treatment Gaps of Unsuppressed Adolescents on HIV Treatment in Public Primary Health Care Facilities in Windhoek, Namibia.

Adolescents living with HIV (ALHIV) face unique challenges that result in persistent gaps in achieving and maintaining suppressed viral load. Although effective evidence-based interventions to address treatment gaps in adolescents are readily available, health systems in resource-constrained, high HIV prevalence settings are challenged to implement them to achieve epidemic control. Here, we describe the health system responses to address the treatment gap of unsuppressed ALHIV on antiretroviral therapy in Windhoek, Namibia. We conducted a qualitative descriptive and exploratory study in Windhoek between June and October 2023. Nineteen purposively selected key informants, ranging from pediatric HIV program managers to healthcare providers, were interviewed. In-depth interviews were audio-recorded and transcribed verbatim. The transcripts were uploaded to ATLAS.ti and subjected to thematic analysis. The four main themes elucidated challenges related to adherence and retention as well as health system responses in the form of interventions and support programs. The predominant adherence and retention challenges faced by ALHIV were mental health issues, behavioral and medication-related challenges, and inadequate care and social support. The health system responses to the identified challenges included providing psychosocial support, peer support, optimization of treatment and care, and the utilization of effective service delivery models. Key health system support elements identified included adequately capacitated human resources, efficient medication supply chain systems, creating and maintaining an enabling environment for optimum care, and robust monitoring systems as essential to program success. The health system responses to address the remaining treatment gaps of unsuppressed ALHIV in Windhoek are quite varied and, although evidence-based, appear to be siloed. We recommend harmonized, multifaceted guidance, integrating psychosocial, treatment, care, and peer-led support, and strengthening client-centred differentiated service delivery models for unsuppressed adolescents.

Would you bet on the vet? Influences on dairy farmers' vaccination choices, with a spotlight on the Veterinarian impact

Ensuring effective vaccination is crucial for epidemic control, particularly in voluntary vaccination scenarios. Though highly important for planning voluntary vaccination programs, we lack insights into the effectiveness of veterinarian communication and the impact of disease-specific traits on farmer vaccination intentions. To fill this void, our study compared five diseases affecting Israeli dairy cattle (Botulism, Bovine Ephemeral Fever (BEF), Brucellosis, Lumpy Skin Disease (LSD), and Rabies). Using questionnaires grounded in the theory of planned behavior, we surveyed 340 Israeli dairy farmers to understand their vaccination intentions for each disease.Simultaneously, veterinarians overseeing these farms provided insights into their opinions and perceived influence on vaccination decisions. Results revealed varying levels of farmer vaccination intention, with Botulism showing the highest and BEF the lowest. Social pressure significantly influenced farmers' vaccination intentions, with distinct patterns across diseases. Veterinarian opinions had the highest influence only for LSD, while other factors played crucial roles in different diseases. Intriguingly, there was no correlation between veterinarians' recommendations and farmers' perceptions of these recommendations. In conclusion, the optimization of voluntary vaccination programs necessitates tailoring interventions to the unique characteristics of each disease. Additionally, improving communication between veterinarians and farmers is essential, with an emphasis on effective risk communication training.

Natural Plague, Manmade Dilemmas: Satirical Art in Disorder in Cholera

More than two decades after the publication of Disorder in Cholera by Chi Li, a sudden pandemic has brought this satirical work to the attention of literary enthusiasts. Deriving from the past experience of Chi Li as an epidemiologist, this novella recounts fragments of the lives and experiences of members of a small epidemic prevention station during a cholera epidemic, and reveals the multiple pitfalls of epidemic prevention and governance systems in China. This study tries to look into the satirical art from the perspective of Wen Da, interpret the multiple manmade dilemmas during the natural epidemic, and finally, offer insights for modern epidemic prevention and control.

A Data-Driven Pandemic Simulator with Reinforcement Learning

After the coronavirus disease 2019 (COVID-19) outbreak erupted, it swiftly spread globally and triggered a severe public health crisis in 2019. To contain the virus’s spread, several countries implemented various lockdown measures. As the governments faced this unprecedented challenge, understanding the impact of lockdown policies became paramount. The goal of addressing the pandemic crisis is to devise prudent policies that strike a balance between safeguarding lives and maintaining economic stability. Traditional mathematical and statistical models for studying virus transmission only offer macro-level predictions of epidemic development and often overlook individual variations’ impact, therefore failing to reflect the role of government decisions. To address this challenge, we propose an integrated framework that combines agent-based modeling (ABM) and deep Q-network (DQN) techniques. This framework enables a more comprehensive analysis and optimization of epidemic control strategies while considering real human behavior. We construct a pandemic simulator based on the ABM method, accurately simulating agents’ daily activities, interactions, and the dynamic spread of the virus. Additionally, we employ a data-driven approach and adjust the model through real statistical data to enhance its effectiveness. Subsequently, we integrated ABM into a decision-making framework using reinforcement learning techniques to explore the most effective strategies. In experiments, we validated the model’s effectiveness by simulating virus transmission across different countries globally. In this model, we obtained decision outcomes when governments focused on various factors. Our research findings indicate that our model serves as a valuable tool for decision-makers, enabling them to formulate prudent and rational policies.

A Retrospective Study of COVID-19 Based on A Dual-Stage Model

This study proposed initial stage SEI1I2I3RD and final stage SEQ I1I2I3RD models to deeply analyze the transmission dynamics of COVID-19 at different stages and propose scientific prevention and control strategies. The initial stage SE I1I2I3RD model divides infected individuals into mild, moderate, and severe cases during the early stage of the epidemic, effectively predicting the number of new infections and cumulative recoveries. The final stage SEQ I1I2I3RD model builds on the initial stage SE I1I2I3RD model by adding a quarantine compartment, which reflects the impact of nucleic acid testing and quarantine measures on epidemic control. By introducing dynamic parameters and nonlinear processing, the final stage SEQ I1I2I3RD model significantly improves prediction accuracy. The study demonstrates that increasing the isolation rate, reducing the daily contact rate of infected persons, and improving the recovery rate of mildly infected persons are effective control strategies. Based on the model's predictions, policy recommendations such as enhancing public health education, strictly implementing isolation measures, restricting population movement, and optimizing medical resource allocation are proposed to effectively control the spread of the epidemic, reduce the burden on the healthcare system, and create favorable conditions for economic recovery.