Field Epidemiology Research Articles

Epidemiology of boxwood blight in western North Carolina and Virginia and evaluation of the boxwood blight infection risk model.

Boxwood blight, caused by Calonectria pseudonaviculata, is a highly invasive emerging disease. Since the first US report in North Carolina and Connecticut in 2011, boxwood blight has spread to over 30 US states, risking more than 90% of boxwood production. Our study investigated the disease field epidemiology and evaluated the boxwood blight infection risk model's prediction by analysing weekly blight monitoring data collected on detector plants exposed to the prevailing environmental conditions at two different locations (western Virginia and North Carolina) from spring through fall of 2014 to 2017. Boxwood blight was recorded in 61 of 86 weeks, with the highest infected leaf counts recorded in late summer or early fall. Rainfall, high relative humidity outside rainy periods and optimal temperatures (13.6-22.7°C) during prolonged leaf wetness (> 65h per week) had a significant positive effect on boxwood blight development. Classification analyses showed that disease predictions from the model using leaf wetness estimated by leaf wetness sensor were more closely aligned with observations from the field than predictions based on algorithms. This study improved our understanding of disease field epidemiology, provided leads to improve the existing model, and generated essential knowledge for formulating effective strategies for blight mitigation.

Building Resilience: Strengthening European public health workforce through ECDC Fellowship Programs

Abstract The European Centre for Disease Prevention and Control (ECDC) Fellowship programmes offer a two-year training in field epidemiology (EPIET) and in public health microbiology (EUPHEM) aiming to create and maintain a network of highly trained field epidemiologists and public health microbiologists and strengthen the public health epidemiology workforce in the European Union (EU) and beyond. The Mediterranean and Black Sea Programme for Intervention Epidemiology Training (MediPIET) also aims to strengthen the public health workforce in countries neighboring the EU. During the training, fellows who are based in different public health institutes in the EU and neighboring countries, set-up, implement and evaluate surveillance of communicable diseases, investigate outbreaks and conduct operational research directly linked to public health actions. The programmes facilitate knowledge exchange and collaboration across borders, building a foundation for participants and their institutions and promoting long-term collaboration through the alumni network. Participants from diverse disciplinary and cultural backgrounds enable interdisciplinary and multi-sectoral knowledge transfer, enhancing the effectiveness of public health responses. By facilitating collaboration and networking, exchanging experiences, disseminating best practices and assimilating lessons learned, these programmes contribute to addressing contemporary health challenges, including emerging vector-borne diseases and strengthening public health systems in Europe and neighboring regions. In the face of global challenges such as climate change and globalization, the fellowships exemplify how collaboration can strengthen Europe’s defenses against emerging health threats.

Cost of COVID-19 vaccine delivery in nine States in Nigeria via the U.S. Government Initiative for Global Vaccine Access

BackgroundIn 2022, the U.S. Centers for Disease Control and Prevention collaborated with implementing partners, African Field Epidemiology Network and Sydani Group, to support COVID-19 vaccination efforts in Nigeria. To characterize the costs of COVID-19 vaccination, this study evaluated financial costs per dose for activities implemented to support the intensification campaign for COVID-19 vaccination.MethodsThis retrospective evaluation collected secondary data from existing expenditure and programmatic records on resource utilization to roll out COVID-19 vaccination during 2022. The study included incremental financial costs of the activities implemented to support an intensification campaign for COVID-19 vaccination across nine states and six administrative levels in Nigeria from the perspective of the external donor (U.S. Government). Costs for vaccines and injection supplies, transport of vaccines, and any economic costs, including government in-kind contributions, were not included. All costs were converted from Nigerian Naira to 2022 U.S. Dollars (US$).ResultsThe estimated financial delivery cost of the COVID-19 vaccination intensification campaign was US$0.84 per dose (total expenditure of US$6.29 million to administer 7,461,971 doses). Most of the financial resources were used for fieldwork activities (86%), followed by monitoring and supervision activities (8%), coordination activities (5%), and training-related activities (1%). Labor (58%) and travel (37%) were the resource inputs that accounted for the majority of the cost, while shares of other resource inputs were marginal (1% for each). Most labor costs (79%) were spent on payments for mass vaccination campaign teams, including pay-for-performance incentives. By administrative level, the largest share of costs (46%) was for pay-for-performance incentives at the community, health facility, or campus levels combined, followed by local government area level (24%), community level only (15%), state level (9%), national level (3%), campus level only (1%), and health facility level only (< 1%).ConclusionsFindings from the evaluation can help to inform resources needed for vaccination activities to respond to future outbreaks and pandemics in resource-limited settings, particularly to reach new target populations not regularly included in routine childhood immunization delivery.

Sorcery and witchcraft beliefs on the front line of public health response in Papua New Guinea and beyond.

Many communities refer to sorcery or witchcraft to explain misfortunes such as sickness, death and disability. The effects of these beliefs on public health service delivery have long been overlooked. Beliefs in sorcery and witchcraft are significant challenges for health-care workers to understand to deliver better health outcomes and avoid inadvertently triggering accusations of witchcraft that may lead to violence. This paper examines the impacts of accusations of sorcery and related violence on the provision of health care in Papua New Guinea. The discussion focuses on a workshop held in Papua New Guinea in September 2022 with health extension officers on the topic of health-care delivery and sorcery accusations. The workshop confirmed the challenges that beliefs in sorcery and witchcraft present for health extension officers and suggested several strategies that could be used to navigate them. It identified several possible future measures that those on the front line of community health-care delivery considered most important in responding to the issue. These included educating health-care workers on how to effectively address sorcery beliefs when delivering health care and developing communication techniques on the causes of death and sickness that avoid triggering sorcery accusations. This paper reviews the findings of the workshop in the broader context of the effects of beliefs in witchcraft on public health delivery globally. Because of the close connections between sorcery beliefs and health, equipping health-care workers and field epidemiologists with strategies to address these beliefs effectively is critical to delivering better health care, facilitating timely response to public health events, and helping to prevent violence related to sorcery accusations. This need exists in all countries where sorcery beliefs related to health, illness, disability and death are prevalent.

Epidemiology of Viral Infectious Diseases Reported in Saudi Arabia.

Efficient epidemiological monitoring of virus diseases is crucial in evaluating general public health, the prevalence of specific diseases, the pattern of spread, and implementing preventative and control strategies into action. This study analyzed data obtained from the Field Epidemiology Program (FETP) which is part of the Ministry of Health (MOH) in Saudi Arabia, which contained reported cases of infectious diseases over four years, from January 2018 to December 2021, to investigate and highlight the significant trend and incidence rate for each viral infectious disease. Of the reported viral infectious diseases, hepatitis B and C, dengue fever (DF), influenza, chickenpox, and measles were the highest reported viral cases over four years. For the aforementioned diseases, males were often more susceptible to viral infections than females. Except for DF, this viral infection was more common in Saudi citizens. Viral illnesses like hand, foot, and mouth disease were less prevalent, while neurological viral disorders such as acute flaccid paralysis were rarely detected. There was an overall reduction in viral cases recorded during 2020-2021, which may be attributed to the implementation of preventive measures during the Coronavirus Disease 2019 (COVID-19) pandemic or an underreporting of cases during the lockdown of that time. The prevalence of these common viral infections in the Saudi population suggests that understanding the mechanisms influencing changes in these viruses, methods of transmission, and the burden of these diseases is a priority for health policy. This understanding is necessary to develop effective intervention and preventive strategies.

Evaluation of the blended public health empowerment program-basic field epidemiology in the Eastern Mediterranean Region.

The COVID-19 pandemic encouraged the shift toward technology-based learning globally, impacting education systems profoundly. In response to this emerging need, the Eastern Mediterranean Public Health Network (EMPHNET) adapted its Public Health Empowerment Program-Basic Field Epidemiology (PHEP-BFE) to a Blended Learning Model. This study evaluates the Blended PHEP-BFE program in Iraq, Egypt, and Lebanon, focusing on participant reactions and learning outcomes. A descriptive evaluation was conducted, aligned with the first two levels of Kirkpatrick's model. Online questionnaires were administered to participants and facilitators through EMPHNET's Learning Management System (LMS). Qualitative and quantitative data were analyzed to assess program effectiveness, satisfaction, and challenges. A total of 138 PHEP-BFE participants (119 (86.2%) males and 19 (13.8%) females) from Iraq (n = 61), Egypt (n = 66), and Lebanon (n = 11) responded to the questionnaire. The majority of the participants (96.4%) reported that they were satisfied with PHEP-BFE. Notably, 77.5% of participants rated the blended learning program as very good or excellent, 18.1% rated it good, and 3.6% found it average, with a minimal 0.7% expressing dissatisfaction. The majority of participants agreed that the blended PHEP-BFE enhanced their capacity to conduct, review and monitor surveillance data (95.7%), perform descriptive data analysis (94.2%), effectively communicate information with agency staff and the local community (95.7%), write summaries of surveillance findings or outbreak investigations (95.7%), use MS Excel to enter, analyze, and display public health surveillance data (91.3%), prepare and administer an oral presentation for fieldwork (94.9%), and increase their knowledge of fundamental field epidemiology (94.9%). The participants responded positively to the program's content, training duration, learning platform, facilitators and mentors, and fieldwork. The study showcases the success of the blended PHEP-BFE in diverse contexts, emphasizing positive participant reactions and improved competencies. The evaluation underscores the program's success in advancing public health training in the EMR. Blended learning models prove promising for future FETP initiatives, contributing valuable insights to public health workforce development. Positive outcomes and identified challenges, provide a roadmap for continuous improvement.

Tanzania's first Marburg Viral Disease outbreak response: Describing the roles of FELTP graduates and residents.

Viral Haemorrhagic Fever Outbreak presents a significant public health threat, requiring a timely, robust, and well-coordinated response. This paper aims to describe the roles of the Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) graduates and residents in responding to Tanzania's first Marburg Viral Disease (MVD) outbreak. We performed a secondary data analysis using a range of documents, such as rosters of deployed responders and the TFELTP graduate and resident database, to count and describe them. Additionally, we conducted an exploratory textual analysis of field deployment reports and outbreak situational reports to delineate the roles played by the residents and graduates within each response pillar. A total of 70 TFELTP graduates and residents from different regions were involved in supporting the response efforts. TFELTP graduates and residents actively participated in several interventions, including contact tracing and follow up, sensitising clinicians on surveillance tools such as standard case definitions, alert management, supporting the National and Kagera Regional Public Health Emergency Operations Centres, active case search, risk communication, and community engagement, coordination of logistics, passenger screening at points of entry, and conducting Infection Prevention and Control (IPC) assessments and orientations in 144 Health Facilities. The successes achieved and lessons learned from the MVD response lay a foundation for sustained investment in skilled workforce development. FELTP Training is a key strategy for enhancing global health security and strengthening outbreak response capabilities in Tanzania and beyond.

Case Ascertainment of Measles during a Large Outbreak-Laboratory Compared to Epidemiological Confirmation.

Measles is a highly contagious viral disease, and hence, sufficient herd immunity is obligatory to prevent infection transmission. Measles is still a cause of considerable disease burden globally, mainly in children. During a national measles outbreak in Israel in 2018-2019, the peak incidence rates occurred in the Jerusalem district. Most measles cases in the Jerusalem district (75.5%, 1702) were observed in children younger than 15 years of age, 49.2% (1109) were in children under 5 years of age, and 18.9% (425) were in infants under 1 year of age. The routine measles vaccination schedule includes two doses at 1 and 6 years of age. Most cases (1828, 81.1%) were unvaccinated (zero measles vaccine doses). These cases comprised the 425 affected infants under 1 year of age, who were ineligible for vaccination, along with the 1403 children over 1 year of age, who were otherwise unvaccinated. This study aimed to describe the epidemiologic and laboratory features of this measles outbreak, and to investigate case ascertainment (laboratory confirmed compared to epidemiologically confirmed cases). The study population included 2254 measles cases notified during the period spanning June 2018 to May 2019 in the Jerusalem district (incidence rate 176 per 10,000 population). Of the 2254 cases, 716 (31.8%) were laboratory confirmed, and 1538 (68.2%) were confirmed as epidemiologically linked. Most laboratory confirmed cases (420, 58.7%) underwent real-time PCR tests. Serological tests (measles IgM and IgG) were used in 189 (26.4%) cases, and a combination of RT-PCR and serology was used in 107 (14.9%) cases. In a multivariate model analysis, the variables significantly associated (after adjustment) with higher odds for laboratory confirmation included month of disease onset (late), additional measles cases in the household (single case), place of medical treatment (hospital; either emergency department, or hospitalization) and vaccination status (at least one prior vaccine dose). The measles outbreak described demonstrates the urgency of addressing vaccination gaps with appropriate outbreak prevention programs. The road to measles elimination needs to be paved with robust public health infrastructure, excellent field epidemiology for outbreak surveillance, investigation, and control, and laboratory proficiency.

Whole-genome analysis of the recombination and evolution of newly identified NADC30-like porcine reproductive and respiratory syndrome virus strains circulated in Gansu province of China in 2023.

Porcine reproductive and respiratory syndrome virus (PRRSV) remains one of the major threats to swine industry, resulting in huge economic losses worldwide. Currently, PRRSV has diversified into multiple lineages with characteristics of extensive recombination in China. In this research, three virus strains were isolated and four virus whole genome sequences were generated and analyzed from clinical samples collected in Gansu province of China in 2023. The four virus strains were designated GSTS4-2023, GSLX2-2023, GSFEI2-2023 and GSBY4-2023. Phylogenetic analysis based on ORF5 sequences showed that GSTS4-2023, GSLX2-2023, GSFEI2-2023 and GSBY4-2023 shared 91.7, 91.2, 93.2 and 92.9% homology with NADC30 strain respectively, and belonged to lineage 1 of PRRSV-2. In addition, one amino acid deletion was observed at position 33 in ORF5 of GSTS4-2023, GSLX2-2023 and GSFEI2-2023. Moreover, amino acid alignment of the four strains showed a typical discontinuous 131-amino acid (aa) deletion in NSP2 for NADC30-like virus strains. Recombination analysis revealed that all four strains originated from NADC30 (lineage 1), with their minor parents coming from JXA1-like strains (lineage 8), VR-2332-like strains (lineage5) and QYYZ-like strains (lineage3). Finally, the three isolated virus strains, GSTS4-2023, GSLX2-2023 and GSFEI2-2023 showed relatively low levels of replication in cell culture. Our findings provide important implications for the field epidemiology of PRRSV.

Too few epidemiologists in humanitarian crises: a critical gap that needs addressing. A new course organised by the Italian Association of Epidemiology

The current humanitarian crises in Ukraine and Gaza, along with the chronic crises, and the climate-related disasters, have exposed the limitations of the humanitarian system. Within these contexts, humanitarian organisations frequently struggle with collecting, analysing, interpreting, and utilising health data, due to the challenging environments in which they operate and funding constraints. It is precisely in these contexts that field epidemiology plays a crucial, but often overlooked role.Field epidemiologists face unique challenges, including rapidly changing conditions, poor-quality data, and biases. Despite these difficulties, accurate epidemiological data are essential for needs assessment, guidance on interventions, and advocacy. Conventional methods often need adaptation for crisis settings, and there are still gaps in measurement.This article discusses the role of epidemiology in such contexts, noting a shortage of trained 'humanitarian epidemiologists' and specialised training as major issues.To address these needs, the Italian Association of Epidemiology organised a course in early 2024 to enhance the epidemiological skills of staff working in humanitarian crises and introduce traditional epidemiologists to crisis-specific challenges. The course covered key concepts and methods of field epidemiology, emphasising the use of secondary health data. Its positive reception underscored the demand for such specialised training.Improving public health information collection and use in humanitarian crises is an ethical and practical necessity. Indeed, investing in field epidemiology and recognising its importance can enhance humanitarian interventions and better serve vulnerable populations.

Electronic Partner Notification for Sexually Transmitted Infections: A Qualitative Assessment of Patient, Clinical Staff, and State Field Epidemiologist Perspectives.

In Massachusetts (MA), partner notification is routinely offered for new HIV and infectious syphilis cases, but there are no formal partner notification services for gonorrhea and chlamydia. Electronic partner notification (ePN), which allows patients to anonymously notify their partners of sexually transmitted infection exposure, could fill this gap. We evaluated the acceptability of and ideal characteristics for a statewide ePN service in MA. We performed semistructured interviews with patients at a Boston area sexual health clinic and conducted focus groups with clinicians and Massachusetts Department of Public Health Field Epidemiologists (FEs). We developed a codebook and thematically analyzed interview and focus group data; 25% of interviews were double coded. We identified six main themes from our data: (1) partner notification is a relational process and (2) partner notification is situation dependent. There are three pairs of challenges and core values for an effective ePN system: (3) stigmatization versus inclusivity, (4) trust versus mistrust, and (5) privacy versus helpful information sharing. Therefore, (6) a statewide ePN platform must be customizable at each possible step. Although ePN was acceptable across all three groups, the likelihood of individual use was grounded in a patient's sociocultural context, interpersonal relationships, trust in the platform and health authorities, desire to avoid stigmatization, and privacy needs. These factors are best accommodated by a platform that adapts to users' preferences and needs. ePN presents an opportunity to link partners at risk for gonorrhea or chlamydia to clinical care that is complementary to the more labor-intensive FE role.

The role of the Field Epidemiology Training Program in the public health emergency response: Sudan armed conflict 2023.

On April 15, 2023, the armed conflict between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) started in Khartoum state, Sudan. This conflict was complicated by the preexisting complicated epidemiological situation and fragile health system in Sudan. This study endeavors to illuminate the pivotal role essayed by the Sudan FETP (SFETP) in enhancing the nation's public health response, particularly amidst the tumultuous backdrop of armed conflicts that have left their indelible mark on the region. Employing a blend of quantitative and qualitative methodologies, we investigated the SFETP's contributions to the public health response during the initial 4 months of the conflict (April-July 2023). Sixty-four SFETP residents and graduates were invited to participate, and data were gathered through semi-structured questionnaires. A total of 44 (69%) SFETP residents and graduates were included in this study. Out of 38 SFETPs present in the states, 32 have considerably contributed to the crisis response at state and locality levels. Three-quarters of them have played key leadership, planning, and management roles. In essence, 38% (n = 12) of them have contributed to public health surveillance, particularly in data management, reports, Early Warning Alert and Response System (EWAR) establishment, and epidemic investigation. SFETPs have made special contributions to crisis response at the community level. The involved SFETPs supported WASH interventions (n = 4), and almost one-third of them strengthened risk communication and community engagement (n = 9). Despite their physical presence at the subnational level, 27% of graduates were not deployed to the crisis emergency response. Notably, throughout this time, half of the total SFETPs were formally retained during this response. The study highlighted the importance of FETP engagement and support during public health crises. SFETP residents and graduates played diverse roles in the various levels of public health emergency response to the crisis. However. Strategies to improve the deployment and retention of FETP residents are necessary to ensure their availability during crises. Overall, FETP has proven to be an asset in public health crisis management in Sudan.

Capacity and needs assessment of veterinary services in Vietnam in biosecurity, biosafety and One Health.

The Asia-Pacific region is recognised as an epicentre of emerging infectious diseases (EIDs), of which 75% are zoonotic in nature. Vietnam is recognised as a potential hotspot for zoonotic EIDs. There is a growing recognition that progress towards global health security requires greater focus on collaboration between the human health and animal health sectors to control diseases at their animal source and prevent against human health impacts. Assessment of veterinary epidemiology capacity in Vietnam is paramount to strengthening the health security of Asia-Pacific. This study aims to evaluate the national capacity and needs of veterinary services in Vietnam in biosecurity, biosafety and One Health. A cross-sectional, convergent mixed-methods study was conducted between November 2020 and April 2021. An online questionnaire was administered to government-employed field veterinarians. Descriptive analyses and logistic regression models were performed using survey responses to understand capacity in the field. Semi-structured interviews were also conducted with stakeholders in veterinary services including government, academia, research institutes, non-profit and international organisations. Coding and thematic analysis using a deductive approach was used for data collected from interviews to contextualise findings from the survey and understand institutional capacity. In total, 178 field veterinarians completed the online survey and 25 stakeholders were interviewed. The majority of participants had reported receiving training in biosecurity and biosafety, including use of personal protective equipment. Most respondents reported practicing good biosecurity measures (92%) and good biosafety measures (88%). Physical and socioeconomic barriers to practicing biosecurity were reported to be prevalent for smallholder farmers, which may suggest a gap in the capacity of veterinary services to provide cost-effective and practical biosecurity strategies. Seventy five percent of participants had never or rarely participated in One Health approaches in the field in the last 12 months and 69% reported further training as a high priority. There was a knowledge gap reported amongst district and commune-level veterinary staff about the need for, and awareness of multisectoral collaboration. Respondents that completed postgraduate qualifications in epidemiology or Field Epidemiology Training Programs (adjusted OR: 3.06; 95% CI: 1.01, 9.23, p = 0.046) and had longer job tenure between 10-12 years (OR: 10.38; 95% CI: 3.06, 35.15, p = <0.001) were more likely to have higher levels of experience in One Health. This study identified gaps in knowledge, attitudes and adoption of practices related to biosecurity, biosafety and One Health specifically in lower-level or less experienced veterinary staff without further training opportunities in epidemiology. These findings enable prioritisation of training, policy, and planning activities to further enhance the national capacity of veterinary services in Vietnam.

Case study: adult learning and public health—a foundational training programme in field epidemiology with lessons and opportunities for collaboration

ABSTRACT This article explores the first field epidemiology training programme (FETP) through a case study to understand its approach to learning and education. Field epidemiologists deploy to outbreaks to investigate, control, and prevent future epidemics and pandemics. Since the 1950s, they have learned their trade through FETP. FETP arose at a paradigmatic crossroads, has endured for seventy years, and is now delivered in over ninety countries. COVID-19 has highlighted the urgency for re-thinking learning in the health sector, hence the analysis of this case can inform FETP, public health, and the adult education field. Inductive content analysis of this case using published accounts from the programme designer-leader and participants suggests the programme’s approach to learning reflected Knowles’s andragogical assumptions, Kolb’s experiential learning cycle, and Lave and Wenger’s legitimate peripheral participation in communities of practice. Alignment with such influential contributors to the field of adult learning clarifies the programme’s paradigm and explains its endurance. Now, given the lessons of COVID-19, critical learning approaches are needed to enable field epidemiologists to engage issues of culture and power as they investigate epidemics. Recent adult learning theories offer opportunities for adult educators to collaborate with public health programmes. COVID-19 urges that we do not hesitate.

Evaluation of field epidemiology training programs: a scoping review.

Field Epidemiology Training Programs (FETPs) are competency-based training programs that play a critical role in strengthening global health security and enhancing the epidemiological capabilities of public health professionals. This scoping review examined available published literature on the evaluations of FETPs globally. A literature review was conducted to evaluate FETPs globally. Keywords specific to the evaluation of FETPs were utilized to search the PubMed, Scopus, and Web Science databases. After applying the inclusion and exclusion criteria, 12 relevant studies from an initial pool of 60 were included in this study. Data extraction included key details, and a qualitative synthesis organized diverse findings using a narrative approach to draw appropriate conclusions and generate recommendations. The review covered findings from 12 studies covering all three FETP modalities and spanning countries in various regions. Evaluations explored gained skills, engagement in FETP activities, and improvements in field epidemiological functions. Gained skills and knowledge, engagement in FETP activities, and improvements in field epidemiological functions were evident, with specific expectations for each FETP tier. Positive outcomes were consistent across studies, revealing improvements in surveillance activities, outbreak response, data management, and other system functions. This review confirmed the positive impact of FETPs on trainees and graduates, which emphasized competency enhancements across different modalities. Various strategies are recommended to improve the evaluation of FETPs. For effective evaluation, it is necessary to develop robust evaluation tools and establish standardized metrics to compare FETPs across regions or countries.

How do field epidemiologists learn? A protocol for a qualitative inquiry into learning in field epidemiology training programmes

IntroductionCOVID-19 underscored the importance of field epidemiology training programmes (FETPs) as countries struggled with overwhelming demands. Experts are calling for more field epidemiologists with better training. Since 1951, FETPs have...

Investigating the barriers and enablers to outbreak reporting in the Asia-Pacific region: A mixed-methods study protocol.

The COVID-19 pandemic has raised concerns about the global capacity for timely outbreak reporting. However, gaps remain in our understanding of barriers and enablers to outbreak reporting, particularly at the local level. Field epidemiology training program (FETP) fellows often participate in the outbreak reporting process as part of both their training and the public health roles they assume after graduating; they therefore represent a potentially valuable source of information for better understanding these barriers and enablers. This study will investigate the barriers and enablers to outbreak reporting through a mixed methods approach that will encompass a review of the existing literature as well as surveying and interviewing FETP trainees and graduates from the Asia-Pacific region. This study will begin with a scoping review of the literature to identify existing evidence of barriers and enablers to outbreak reporting. Based on our findings from the scoping review, we will administer a survey to FETP trainees and graduates from the World Health Organization Western Pacific and South-East Asian Regions and conduct interviews with a subset of survey respondents to investigate the survey findings in more detail. We will summarise and compare the survey results according to various country-level economic and political indicators, and we will employ thematic analysis to evaluate the interview responses. Based on the findings from the scoping review, survey, and interviews, we will construct a model to comprehensively describe the various barriers and enablers to outbreak reporting. This study will contribute to our understanding of the determinants of outbreak reporting across several geographic, political, and economic contexts by eliciting the viewpoints and experiences of persons involved with outbreak reporting, particularly at the local level. This information will help improve the outbreak reporting process, allowing for more timely reporting and helping prevent future outbreaks from becoming pandemics.

Investigating the workforce capacity and needs for animal disease surveillance and outbreak investigation: a mixed-methods study of veterinary services in Vietnam.

The need for strengthening national capacities for disease prevention, preparedness, and response is increasingly becoming urgent. Central to this is strengthening existing systems and workforce capacity for disease surveillance and disease outbreak response. This study aimed to evaluate the national capacity and needs of veterinary services in Vietnam in animal disease surveillance and outbreak investigation skills. A cross-sectional, convergent, mixed-methods study was conducted between November 2020 and April 2021. An online questionnaire was administered to government field veterinarians, followed by descriptive and multivariable analyses to understand field capacity, specifically levels of experience in outbreak investigation and animal health surveillance. Semi-structured interviews were conducted with various stakeholders in veterinary services and interview transcripts were coded and thematically analyzed. Qualitative results were used to contextualize quantitative findings from the survey. Overall, 178 field veterinary staff completed the online survey, and 25 stakeholders were interviewed. Eighty percent of respondents reported a high priority for further training in both animal disease surveillance and outbreak investigation. Training and competence were more limited at the district and commune levels, highlighting a gap in capacity at the subnational level. Reasons included a lack of in-depth training opportunities, limited access to resources and high staff turnover. Respondents who completed postgraduate qualifications in epidemiology or Field Epidemiology Training Programs were more likely to have higher levels of experience in animal health surveillance and outbreak investigation. This study identified gaps in knowledge and adoption of practices most often related to local-level or less experienced veterinary staff with limited training opportunities in epidemiology. Findings inform the prioritization of training and planning activities to further enhance the national capacity of veterinary services in Vietnam. Underlying explanations for existing gaps in capacity include inequities in skill development and training opportunities across levels of veterinary staff, gaps in the chain of command and unequal funding across provinces.

GOARN training: supporting field epidemiology trainees to upskill for public health emergency response.

GOARN training: supporting field epidemiology trainees to upskill for public health emergency response.

Rising Antimicrobial Resistance In Pakistan: A Call For An Urgent Action.

Madam, Antibiotic resistance is a growing global concern. Pakistan is a developing nation in South Asia with a high rate of antibiotic resistance, posing a serious concern on a global and regional scale1 In Pakistan in recent years, both extensively drug-resistant (XDR) and multi-drug-resistant. (MDR) microorganisms have been found2.From January 2017 to June 2021, a total of 14,360. XDR-TF cases were reported in Karachi, according to the National Institute of Health (NIH) Islamabad's Weekly Field Epidemiological Report2.Only three antimicrobials: azithromycin, carbapenems, and tigecycline(parenteral) are effective against the XDR strains3. However, after Covid-19, the misuse of Azithromycin has increased manifold, which is worrisome. Pakistani public’s lack of awareness about the harms of antibiotic self-prescription and the widespread presence of quacks in the society has posed a great threat to rational use of antimicrobials4. According to a cross-sectional survey of pharmacy staff’s opinion ,approximately 81.5% of participants declared that dispensing non-prescribed antibiotics is a common practice in community pharmacies, and 51.1% considered themselves to be authorized to dispense these drugs5. The chicken industry of Pakistan is excessively using important antimicrobials in their bird feed6. According to a surveillance survey done in 2019 in Pakistan; among the antimicrobials used for therapeutic or prophylactic purposes in animals; colistin, tylosin, enrofloxacin, and doxycycline were the most frequently used6.This calls for an urgent action in Pakistan to prevent a public health crisis. It is a dire need of the hour to implement the National Drug Policy (NDP) of Pakistan. There should be a national action plan on how to curb this menace of the misuse of therapeutically important antimicrobials in Pakistan. Special units should be devised by Drug regulatory Authority of Pakistan (DRAP) and The Ministry of Health (MoH) to rein back those chemist stores involved in selling of prescription only antimicrobials without the advice of a medical doctor. These teams should catch quacks working in all provinces of Pakistan. Quackery should be made illegal. The sale of large flocks of antimicrobials to animal keepers and broiler industry people should be immediately stopped and the involved people should be fined and their licenses cancelled. Talks and sessions should be held in schools, colleges and public places about the correct use of antibiotics. A medical doctor’s stamp with a registration number should be mentioned on each prescription of an antimicrobial. ---Continue