Future Attacks Research Articles

Analysis of Challenges in Modern Network Forensic Framework

Network forensics can be an expansion associated with network security design which typically emphasizes avoidance and detection of community assaults. It covers the necessity for dedicated investigative abilities. When you look at the design, this indeed currently allows investigating harmful behavior in communities. It will help organizations to examine external and community this is undoubtedly around. It is also important for police force investigations. Network forensic techniques can be used to identify the source of the intrusion and the intruder’s location. Forensics can resolve many cybercrime cases using the methods of network forensics. These methods can extract intruder’s information, the nature of the intrusion, and how it can be prevented in the future. These techniques can also be used to avoid attacks in near future. Modern network forensic techniques face several challenges that must be resolved to improve the forensic methods. Some of the key challenges include high storage speed, the requirement of ample storage space, data integrity, data privacy, access to IP address, and location of data extraction. The details concerning these challenges are provided with potential solutions to these challenges. In general, the network forensic tools and techniques cannot be improved without addressing these challenges of the forensic network. This paper proposed a thematic taxonomy of classifications of network forensic techniques based on extensive. The classification has been carried out based on the target datasets and implementation techniques while performing forensic investigations. For this purpose, qualitative methods have been used to develop thematic taxonomy. The distinct objectives of this study include accessibility to the network infrastructure and artifacts and collection of evidence against the intruder using network forensic techniques to communicate the information related to network attacks with minimum false-negative results. It will help organizations to investigate external and internal causes of network security attacks.

Continuous updating of individual headache forecasting models using Bayesian methods.

To illustrate the benefits of deploying individual headache forecasting models using continuous updating with Bayesian methods. The ability to reliably forecast headache attacks within an individual over time would enhance the study of attacks and allow preemptive treatment. However, deploying a suitable forecasting model in a clinical setting will likely involve several unique challenges related to heterogeneity in the predictor weights, limited or sparse data, and the need for a quick "warm-up." The use of Bayesian methods offers solutions to each of these specific challenges. This was a post hoc analysis of a cohort study of individuals with episodic migraine attacks. Individuals completed daily diaries that allowed the estimation of several forecasting models, each using different types of ancillary information incorporated into formal prior probability distributions. An in silico analysis was conducted that mimicked the deployment of these models in a clinical-like setting where the parameters of the models were continuously updated and evaluated each day using root mean square error (RMSE). Individuals (N=95) were followed for 50days and contributed 3359days of nonmissing diary data. During the observation period, there were 1293/3359 (38.5%) days with a headache attack. Self-reported baseline headache frequency was associated with the corresponding predicted probability of future attacks, r=0.15-0.39. At Day 25, the correlation between baseline information and predicted attack likelihood was r=0.29 (95% CI: 0.09-0.47). Additionally, the use of prior probability distributions for model parameters improved the model fit, especially early in the deployment of the models (e.g., Day 5 RMSE 0.45 vs. 0.43). Models using informative prior probability distributions outperformed the models estimated without this information during the first 42days of observation, although performance became more similar as more data were collected. This analysis demonstrates the value of Bayesian methods in using additional available information to improve forecasting model performance, especially early in the deployment of a forecasting model. To obtain the full value of such models or to apply any model in clinical settings, a model with adequate discrimination and calibration will be needed.

The Degree of Carotid Artery Stenosis Affects the Perioperative Stroke Rate in Symptomatic Patients Undergoing Carotid Intervention

In patients with carotid stenosis, both the severity of the stenosis as well as the plaque morphology influence the likelihood of future transient ischemic attack or stroke. In general, severely stenotic lesions are presumed to have a higher embolic potential than moderately stenotic lesions. Carotid intervention is indicated in patients with both moderate and severe stenosis with related cerebrovascular symptoms. However, the effect of the degree of carotid stenosis in symptomatic patients upon the outcome of carotid intervention has not been extensively studied.

Deployment of a Mobile Laboratory for the Control and Monitoring of High-Consequence Infectious Diseases: An Illustration With the Ebola Virus, the Biowarfare Agents, and the COVID-19

The novel coronavirus (COVID-19) pandemic has caused societal issues, economic and political tensions worldwide. This shows, once more, that dissemination of correct information based on scientific evidence together with a quick and concerted action is the key to build a sound capability for the management of biological emergencies. Here, we summarize the lessons learned from our preparedness and intervention during (i) our deployment during the 2014-2016 Ebola outbreak in West Africa; (ii) our large-scale exercises from Horizon 2020 Security program where the focus is on handling intentional dispersion of infectious agents; and (iii) our fight against COVID-19: by the deployment of Biological Light Fieldable Laboratory for Emergencies (B￾LiFE mobile laboratory) in Turin and Novara, Piedmont Region, Italy. At the latter deployment, the ultimate goal was a large screening for COVID-19 prevalence in primo intervention individuals. It cannot be ignored that the COVID-19 pandemic is an ideal situation to whet our preparedness, coordination of response and risks monitoring in case of future biological threats or attacks.

Stop Drill, Make a Change: An In Vivo Study.

BackgroundThe chemomechanical method of caries removal is a modality that is non-invasive, cost-effective, and if some caries preventive measures could be added to them, then it might render the remaining dentin more resistant to future caries attacks also. Thereby, this study is conducted to evaluate the in vivo aspect of newly developed “one man army material—Apacaries gel”.Aim and objectiveTo evaluate and compare the antimicrobial efficacy, efficiency, and pain perception of a chemomechanical caries removal agent (Apacaries gel) with a conventional method.DesignTwenty children (aged 6–12 years) with bilateral occlusal caries making a sample size of 40 were included in the study. Group I: caries removal using rotary instruments and Group II: caries removal using Apacaries gel (n = 20 each). Caries removal time and pain perception were measured using a stopwatch and Wong–Baker Pain Scale. Dentin samples of both groups were taken before and after caries removal for microbiological analysis.Statistical analysis usedThe data were statistically analyzed using the Student's t-test to compare the two groups.ResultsThere was a non-significant difference in bacterial count while a significant difference was seen in time consumption and pain perception in both methods of caries removal.ConclusionChemomechanical caries removal (Apacaries gel) can be an effective clinical alternative treatment for caries removal in children.Key messagesIt is the only in vivo study on “Apacaries gel—a one man army” which eliciting the unique property of prevention of dental caries.How to cite this articleDogra M, Gupta MP, Sheikh T, et al. Stop Drill, Make a Change: An In Vivo Study. Int J Clin Pediatr Dent 2021;14(2):258–262.

Acoustic and visual stimuli combined promote stronger responses to aerial predation in fish.

Bird predation poses a strong selection pressure on fish. Since birds must enter the water to catch fish, a combination of visual and mechano-acoustic cues (multimodal) characterize an immediate attack, while single cues (unimodal) may represent less dangerous disturbances. We investigated whether fish could use this information to distinguish between non-threatening and dangerous events and adjust their antipredator response to the perceived level of risk. To do so, we investigated the antipredator behavior of the sulphur molly (Poecilia sulphuraria), a small freshwater fish which is almost exclusively preyed on by piscivorous birds in its endemic sulfide spring habitat. In a field survey, we confirmed that these fish frequently have to distinguish between disturbances stemming from attacking birds (multimodal) and those which pose no (immediate) threat such as bird overflights (unimodal). In a laboratory experiment, we then exposed fish to artificial visual and/or acoustic stimuli presented separately or combined. Sensitivity was high regardless of stimulus type and number (more than 96% of fish initiated diving), but fish dove deeper, faster, and for longer when both stimuli were available simultaneously. Based on the system’s high rates of bird activity, we argue that such an unselective dive initiation with subsequent fine-tuning of diving parameters in accordance to cue modality represents an optimal strategy for these fish to save energy necessary to respond to future attacks. Ultimately, our study shows that fish anticipate the imminent risk posed by disturbances linked to bird predation through integrating information from both visual and acoustic cues.

PROSPER THE IMMUNITY THROUGH DIET – A MUST IN UNEASE SITUATIONS

As the world watches COVID -19, a disease caused by a novel corona virus, SARS – CoV-2, the focus has shifted to immunology. The immune response is critical for controlling and eliminating CoV infections. Hopefully, the profound understanding gained between the hosts innate immune system and corona viruses would lessen the lung inflammation induced by CoVs, which was identified by careful investigation of the immune system. The immune system's duty is to protect the host from viruses, germs, and other diseases. The immune system produces different cells to deal with infections caused by these pathogens, not only to destroy the current dwelling harmful agents, but also to guard the host from future attacks of the same kind. The immune system is always active, but when a person becomes infected, it becomes even more active.A number of vitamins, as well as other sources of vitamins and trace elements, have been shown to have an important role in strengthening the immune system and reducing infection risk. This review article discusses the numerous nutrients that can be used in antiviral and antibacterial defence. Dietary practices for acquiring a healthy microbiota can also benefit the immune system.

A new approach of classical Hill Cipher in public key cryptography

Secure message transformation promote the creation of various cryptography systems to enable re???ceivers to interpret the transformed information. In the present age of information technology, the secure transfer of information is the main study of most agencies. In this study, a particular symmetric cryptography system, Hill Cipher method, is enhanced with the help of encryption and decryption algorithms of the asymmetric RSA cryptography system to avoid certain problems. Previous results show that the original Hill algorithms are still insufficient because of their weakness to known plaintext attack, and a modification of the Hill Cipher cryptography system is therefore presented to increase its invulnerability. The enhancement focuses on implementing the RSA algorithms over the Hill Cipher to increase its security efficiency. The suggested method relies on the security of the RSA and Hill Cipher cryptosystems to find the private decryption keys, and thus is much more secure and powerful than both methods applied separately. Also secure and dynamic generation of the Hill Cipher matrix instead of using static matrix are proposed. This new approach is composed of a public key cryptosystem that has a shared secret key (between participants only), public key (announced to all), and two private keys (for each person). Therefore, this new modification can increase the invulnerability of the Hill Cipher against future attacks during transmission of information between agencies in this age of information technology

The Familiarity Paradox: Why Has Digital Sourcing Not Democratized the News?

This article presents for the first time longitudinal evidence according to which the role of digital news sources has grown dramatically since 2006. The study includes reconstructions of 1,594 news items, authored by a representative sample of Israeli news reporters, and details regarding each item’s sources (n = 5,647). We found that digital sourcing did not open the gates for alternative voices. Moreover, digital sources are verified less than non-digital ones and are mentioned less often in final publications. However, the lower epistemic standards in treating digital sources were explained in a series of follow-up interviews, not due to their elevated trust, but rather due to the traceable footprints of digital sources that can protect journalists against future attacks, thus making these sources reliable. In addition, reporters continue to adhere to elite sources due to the familiarity paradox we found: while in principle reporters understand the ethical value of alternative sources, in practice they dismiss them, as they consider them riskier and less reliable due to their unfamiliarity. This may suggest that until the familiarity paradox is resolved, one cannot expect new technology to democratize the mix of news sources.

Deterrence in the Cyber Realm: Public versus Private Cyber Capacity

Abstract Can cyber deterrence work? Existing scholarly works argue that deterrence by punishment using cyberattacks is ineffective because the difficulty of attributing the origin of cyberattacks makes the threat of future attacks less credible. However, these works have told us relatively little about the deterrence ability of public cyberinstitutions (PCIs), defined as publicly observable proactive efforts aimed at signaling a country’s level of cyber offensive and defensive capability. This research shows that middle powers (that have scarce cyber arsenals) can use PCIs to deter cyber attacks that cause significant damage to their economy and prosperity; however, this deterrent capability is rather limited. Using an incomplete-information model, we demonstrate that PCIs only deter adversaries that are susceptible to the costs created by these institutions. Despite this limited deterrence ability, middle powers tend to over-invest resources in these cyberinstitutions: Weak cyber states tend to over-invest to convince strong cyber adversaries that they are strong, whereas strong cyber states over-invest so that adversaries do not believe that they are weak states pretending to be strong. By doing so, states reduce their overall cybercapacity. We establish the empirical plausibility of these results using election interference campaigns as examples of strategic attacks. Our focus on the strategic use of PCIs as a deterrent represents a departure from existing literature—which has focused only on cyberoperations—and has important policy implications.

Analysing terrorist networks – An entropy‐driven method

AbstractTerrorism is a scourge of humanity. Thousands of people were killed by terrorists in the last years. To understand the structure, information flow and leadership in terrorist cells is a must for all societies to prevent future attacks. Network theory can help to model such cells and to identify leading members therein. This contribution uses the graph theoretical approach as a basis and enriches it by an entropy‐driven knowledge processing. After presenting the theoretical concept two terrorist cells, the one of the Bali attack and the one of the 9/11 attack, are analysed. The results are compared to those of other methods. A preview on the application of weighted networks and multi‐nets complements the new findings.

Risk factors for asthma attacks and poor control in children: a prospective observational study in UK primary care

ObjectiveTo identify risk factors for asthma attacks and poor asthma control in children aged 5–16 years.MethodsProspective observational cohort study of 460 children with asthma or suspected asthma from 10 UK...

ASSESSING CONGREGANTS PERCEPTION OF VULNERABILITY OF CHURCH BUILDINGS TO SECURITY THREATS IN NAIROBI COUNTY, KENYA

This paper uses data collected for an MA Thesis on Assessing Congregants’ perception of Vulnerability of Church Buildings to security threats in Nairobi County, Kenya. The study has been necessitated by increased cases of targeted criminal attacks on congregants and church buildings in addition to increased perceptions of congregants as soft targets of insecurity, more pertinently in Nairobi County. The study will be guided by the following objectives; to investigate the nature of perceived vulnerability against church buildings; to explore congregant’s perceptions of what constitutes church buildings security and safety; to establish congregant’s perceptions of their level of preparedness in case of a criminal attack while in church buildings service; and to determine the congregant’s perceptions of what they think should be done to secure church buildings in Nairobi County Kenya. This study was grounded by two theories; Defensive Space Concept and Crime Prevention through Environmental Design (CPTED). This study adopted a cross-sectional survey design while Stratified random sampling technique was used to pick all the main respondents. Questionnaires were used to collect data from 182 members of each church (main respondents). In addition, Key Informants (K.I) guide was used to collect qualitative data from 8 K.I who include 4 Priests (1 from each church), and 4 security guards (one from each church). Data was analyzed with the aid of Statistical Package for Social Sciences (SPSS) and results presented using tables, bar and pie charts. The study results revealed that violent attacks against the churches in Nairobi county are on the increase (72%) and that the violent attacks against the churches in Nairobi county have inspired fear among church attendants (68.1%). Further, results showed the gun attacks were the most prevalent in church buildings (29.7%) closely followed by knife attacks (29.1%), explosive attacks (20.3%), suicide bombs (13.2%). Further, the results have revealed that some churches had employed various measures to counter violent attacks that included amongst other measures employed full time trained security staff to manage such incidents. Congregant’s perceptions on violent attacks against churches include; Knife and explosive attacks during services, but which have prompted fears of future gun or other terror attacks as is the case in other countries. According to the study; main measure of church security and safety included the Perimeter Walls, use of Surveillance cameras, use of Metal Detectors in church entrances, and heavy barriers in church entrance amongst other measures. As a policy measure, the study recommended formulation of standard security and safety measures applicable to all places of worship in Kenya that include; permanent security staff and armed security in all places of worship.

Smartphone application-supported validation of three automatic devices for self-measurement of blood pressure according to the European Society of Hypertension International Protocol revision 2010: the Omron HEM-7120, Yuwell YE680A and Cofoe KF-65B.

BackgroundAccurate measurement of blood pressure (BP) is crucial to hypertension control and prevention of future stroke and heart attack. All BP measuring devices must be validated independently in the clinical setting.ObjectiveTo validate the accuracy of three automatic upper arm devices (Omron HEM-7120, Yuwell YE680A and Cofoe KF-65B) for self-measurement of BP in Chinese adults with arm size of 22–32 cm.MethodsThe validation was conducted independently for each of the three devices according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP revision 2010), with the facilitation of a designated smartphone application. Subjects were recruited from those attending Beijing Anzhen Hospital for routine physical examination and clinic visits. For each device, BP was measured sequentially in 33 adults using a mercury sphygmomanometer (two observers) and the test device (one supervisor) with seven measurements alternating between observers and the device, which generated a total of 99 before/after paired values for SBP and DBP separately. The judgments were made based on the distribution of the paired difference among the 99 measurements (Part 1) and among the 33 subjects (Part 2). To pass, a device must achieve all the minimum Pass requirements in Part 1 and Part 2 for both SBP and DBP (Part 3).ResultsOnly HEM-7120 achieved the part 1 and part 2 targets for both SBP and DBP. KF-65B achieved the DBP targets of part 1 and part 2 but failed for SBP. YE680A only achieved the DBP targets of part 2 but failed for all others. The findings also indicated that the devices had higher SBP readings (1.3 mmHg, 1.0 mmHg and 4.1 mmHg higher for HEM-7120, YE680A and KF-65B, respectively) and lower DBP readings (2.0 mmHg, 1.1 mmHg and 3.3 mmHg lower, respectively) when compared to the mercury sphygmomanometer.ConclusionsThe Omron HEM-7120 passed the requirements of the ESH-IP 2010 revision, while the Yuwell YE680A and Cofoe KF-65B failed (part 3).

A Generic Review of Web Technology: DJango and Flask

The research is discussing the relevance of web technology based on its history, current development, future working process, threats, or attacks that are common in web technology, and its solutions to encounter the threats. Nowadays, web services have become one of the most vital components in peoples' daily lifestyle. People are talking how the advancement in the technology leads the world now. The evolution of network has triggered the demands especially in internet connection as everyone around the world are depending on the connection to do their activities especially for communication. It is required to have high speed internet and bandwidth to prevent poor connection. Besides that, due to advance development in computing products and network, people enables to catch up with the current trends which spark the existence of web development that are used to gather information.

A Generic Review of Web Technology: DJango and Flask

The research is discussing the relevance of web technology based on its history, current development, future working process, threats, or attacks that are common in web technology, and its solutions to encounter the threats. Nowadays, web services have become one of the most vital components in peoples' daily lifestyle. People are talking how the advancement in the technology leads the world now. The evolution of network has triggered the demands especially in internet connection as everyone around the world are depending on the connection to do their activities especially for communication. It is required to have high speed internet and bandwidth to prevent poor connection. Besides that, due to advance development in computing products and network, people enables to catch up with the current trends which spark the existence of web development that are used to gather information.

The Direct and Indirect Costs of Treating the Victims of the 2016 Nice Terror Attacks in a Single Pediatric Hospital.

To analyze the cost of the terror attack in Nice in a single pediatric institution. We carried out descriptive analyses of the data coming from the Lenval University Children's Hospital of Nice database after the July 14, 2016 terror attack. The medical cost for each patient was estimated from the invoice that the hospital sent to public insurance. The indirect costs were calculated from the hospital's accounting, as the items that were previously absent or the difference between costs in 2016 versus the previous year. The costs total 1.56 million USD, corresponding to 2% of Lenval Hospital's 2016 annual budget. Direct medical costs represented 9% of the total cost. The indirect costs were related to human resources (overtime, sick leave), revenue shortfall, and security and psychiatric reinforcement. Indirect costs had a greater impact than did direct medical costs. Examining the level and variety of direct and indirect costs will lead to a better understanding of the consequences of terror acts and to improved preparation for future attacks.

Proteome impact on maize silks under the priming state induced by Trichoderma root colonization.

Trichoderma activates plant proteins to counteract Fusarium infection. Comparison between proteomic and transcriptomic data suggests differential response regulation. Proteins from the phenylpropanoid pathway are activated to quickly respond to pathogen attack. Trichoderma species can stimulate local and distant immune responses in colonized plant tissues to prevent future pathogenic attacks. Priming of plant defenses is characterized by changes in transcriptional, metabolic, and epigenetic states after stimulus perception. We have previously investigated transcriptional reprogramming in silk tissues from maize plants inoculated with Trichoderma atroviride and challenged with Fusarium verticillioides (Agostini et al., Mol Plant-Microbe In 32:95-106, 2019). To better understand the molecular changes induced by T. atroviride in maize, a proteomic approach was conducted in this instance. Several proteins belonging to different metabolic categories were detected as priming-involved proteins. However, we detected a very low correlation with those priming-modulated transcripts suggesting the importance of regulatory events a posteriori of the transcriptional process to accomplish the final goal of blocking pathogen entry. Specifically, we focused on the phenylpropanoid pathway, since we detected several proteins that are upregulated in the priming state and might explain cell wall reinforcement as well as the increase in flavonoid and lignin content in maize silks after activation of induced systemic resistance.

Serum GFAP and NfL as disease severity and prognostic biomarkers in patients with aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) is a frequently disabling neuroinflammatory syndrome with a relapsing course. Blood-based disease severity and prognostic biomarkers for NMOSD are a yet unmet clinical need. Here, we evaluated serum glial fibrillary acidic protein (sGFAP) and neurofilament light (sNfL) as disease severity and prognostic biomarkers in patients with aquaporin-4 immunoglobulin (Ig)G positive (AQP4-IgG+) NMOSD.MethodssGFAP and sNfL were determined by single-molecule array technology in a prospective cohort of 33 AQP4-IgG+ patients with NMOSD, 32 of which were in clinical remission at study baseline. Sixteen myelin oligodendrocyte glycoprotein IgG-positive (MOG-IgG+) patients and 38 healthy persons were included as controls. Attacks were recorded in all AQP4-IgG+ patients over a median observation period of 4.25 years.ResultsIn patients with AQP4-IgG+ NMOSD, median sGFAP (109.2 pg/ml) was non-significantly higher than in MOG-IgG+ patients (81.1 pg/ml; p = 0.83) and healthy controls (67.7 pg/ml; p = 0.07); sNfL did not substantially differ between groups. Yet, in AQP4-IgG+, but not MOG-IgG+ patients, higher sGFAP was associated with worse clinical disability scores, including the Expanded Disability Status Scale (EDSS, standardized effect size = 1.30, p = 0.007) and Multiple Sclerosis Functional Composite (MSFC, standardized effect size = − 1.28, p = 0.01). While in AQP4-IgG+, but not MOG-IgG+ patients, baseline sGFAP and sNfL were positively associated (standardized effect size = 2.24, p = 0.001), higher sNfL was only non-significantly associated with worse EDSS (standardized effect size = 1.09, p = 0.15) and MSFC (standardized effect size = − 1.75, p = 0.06) in patients with AQP4-IgG+ NMOSD. Patients with AQP4-IgG+ NMOSD with sGFAP > 90 pg/ml at baseline had a shorter time to a future attack than those with sGFAP ≤ 90 pg/ml (adjusted hazard ratio [95% confidence interval] = 11.6 [1.3–105.6], p = 0.03). In contrast, baseline sNfL levels above the 75th age adjusted percentile were not associated with a shorter time to a future attack in patients with AQP4-IgG+ NMOSD.ConclusionThese findings suggest a potential role for sGFAP as biomarker for disease severity and future disease activity in patients with AQP4-IgG+ NMOSD in phases of clinical remission.

Simulated Identification of Silent COVID-19 Infections Among Children and Estimated Future Infection Rates With Vaccination

A significant proportion of COVID-19 transmission occurs silently during the presymptomatic and asymptomatic stages of infection. Children, although important drivers of silent transmission, are not included in the current COVID-19 vaccination campaigns. To estimate the benefits of identifying silent infections among children as a proxy for their vaccination. This study used an age-structured disease transmission model, parameterized with census data and estimates from published literature, to simulate the estimated synergistic effect of interventions in reducing attack rates during the course of 1 year among a synthetic population representative of the US demographic composition. The population included 6 age groups of 0 to 4, 5 to 10, 11 to 18, 19 to 49, 50 to 64, and 65 years or older based on US census data. Data were analyzed from December 12, 2020, to February 26, 2021. In addition to the isolation of symptomatic cases within 24 hours of symptom onset, vaccination of adults was implemented to reach a 40% to 60% coverage during 1 year with an efficacy of 95% against symptomatic and severe COVID-19. The combinations of proportion and speed for detecting silent infections among children that would suppress future attack rates to less than 5%. In the base-case scenarios with an effective reproduction number Re = 1.2, a targeted approach that identifies 11% of silent infections among children within 2 days and 14% within 3 days after infection would bring attack rates to less than 5% with 40% vaccination coverage of adults. If silent infections among children remained undetected, achieving the same attack rates would require an unrealistically high vaccination coverage (≥81%) of this age group, in addition to 40% vaccination coverage of adults. The estimated effect of identifying silent infections was robust in sensitivity analyses with respect to vaccine efficacy against infection and reduced susceptibility of children to infection. In this simulation modeling study of a synthetic US population, in the absence of vaccine availability for children, a targeted approach to rapidly identify silent COVID-19 infections in this age group was estimated to significantly mitigate disease burden. These findings suggest that without measures to interrupt transmission chains from silent infections, vaccination of adults is unlikely to contain the outbreaks in the near term.