Future Outbreaks Research Articles

Four Models of Wastewater-Based Monitoring for SARS-CoV-2 Complementing Individual Screening in Jail Settings.

Objectives. To describe 4 unique models of operationalizing wastewater-based surveillance (WBS) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in jails of graduated sizes and different architectural designs. Methods. We summarize how jails of Cook County, Illinois (average daily population [ADP] 6000); Fulton County, Georgia (ADP 3000); Middlesex County, Massachusetts (ADP 875); and Washington, DC (ADP 1600) initiated WBS between 2020 and 2023. Results. Positive signals for SARS-CoV-2 via WBS can herald a new onset of infections in previously uninfected jail housing units. Challenges implementing WBS included political will and realized value, funding, understanding the building architecture, and the need for details in the findings. Conclusions. WBS has been effective for detecting outbreaks of SARS-CoV-2 in different sized jails, those with both dorm- and cell-based architectural design. Public Health Implications. Given its effectiveness in monitoring SARS-CoV-2, WBS provides a model for population-based surveillance in carceral facilities for future infectious disease outbreaks. (Am J Public Health. 2024;114(11):1232-1241. https://doi.org/10.2105/AJPH.2024.307785).

Development of the cognitive-behavioral communication (CBC) framework: A novel approach for mass communication in contact tracing during infectious disease outbreaks

The Cognitive-Behavioral Communication (CBC) Framework was developed to improve public compliance with contact tracing during infectious disease outbreaks, addressing the gaps exposed by the COVID-19 pandemic in the United States. These gaps, including public distrust, misinformation, and privacy concerns, hindered traditional contact tracing efforts. The CBC Framework integrates mass communication theories, cognitive-behavioral strategies, and AI-driven message personalization to enhance public engagement. The framework was tested through comparative field trials, with one group receiving personalized communication via the CBC model and another receiving standard public health messages. Results showed that the CBC group achieved a significantly higher compliance rate (85.6% vs. 66.4%) and a 33% reduction in privacy concerns. AI-driven messages also increased relevance over time, with 86.2% of participants reporting improved message relevance. Public trust was significantly higher in the CBC group, with positive sentiment at 67.5% compared to 45.2% in the control group. These findings have particular relevance to the U.S., where challenges like distrust and privacy concerns have impeded the effectiveness of contact tracing. The CBC Framework presents a scalable solution to improve compliance, trust, and overall public health outcomes during future outbreaks.

A case study of the 2023 highly pathogenic avian influenza (HPAI) outbreak in tern (Sternidae) colonies on the east coast of the Republic of Ireland

ABSTRACT Capsule:HPAI H5N1 had a significant impact on breeding Common Terns Sterna hirundo, Arctic Terns Sterna paradisaea and Roseate Terns Sterna dougallii on the east coast of the Republic of Ireland (ROI) in 2023, with a lesser impact on Sandwich Terns Thalasseus sandvicensis and only two cases among Little Terns Sternula albifrons. Aims: To document the outbreak of HPAI H5N1 in the tern colonies on the east coast of ROI during the 2023 breeding season. Methods:Precautions were taken from the start of the breeding season, including personal protective equipment (PPE) and safe operating procedures. Regular meetings were held between BirdWatch Ireland and the National Parks and Wildlife Service (NPWS) to respond to the emerging situation. Once HPAI was confirmed in a colony, all ringing and nest visits were stopped. Carcass removal was carried out at all affected colonies and most carcasses were incinerated. Results: Common Terns suffered the highest mortality across all colonies in 2023, with smaller but notable numbers of dead Roseate Terns and Arctic Terns, but very few Sandwich Terns and only two Little Tern deaths were attributed to HPAI. Conclusion: Regular meetings between relevant organizations were invaluable in preparing for outbreaks and ensuring an adaptive approach as the situation changed over time and between colonies. There was no way of knowing if the actions taken were effective, as the pattern of virus spread between species and sites remains poorly understood. Future clarity over the role of various state agencies and other relevant bodies in responding to HPAI in wild birds, greater sharing of real-time information, and pre-arranged agreements to ensure rapid testing and disposal of carcasses, would be useful to ensure an effective response to future outbreaks.

A single-center analysis of clonal transmission of carbapenem-resistant Acinetobacter baumannii among intensive care unit patients during the COVID-19 pandemic

Carbapenem-Resistant Acinetobacter baumannii (CRAB) outbreak in intensive care units (ICUs) is a significant problem for healthcare facilities. In this study, we aimed to investigate the occurrence of CRAB isolates among ICU-admitted patients during the three waves of the COVID-19 pandemic in Iran using Multiple-Locus Variable Number Tandem-Repeat Analysis (MLVA). We obtained 50 (A) baumannii isolates from tracheal aspirate and blood culture samples. In the disc diffusion method, all isolates were cefotaxime, ceftriaxone, and cefepime-resistant, while 98% (49/50) of isolates were resistant to piperacillin, piperacillin-tazobactam, ceftazidime, and ciprofloxacin. Levofloxacin and tobramycin resistance was found in 76% (38/50) of isolates. In the microbroth dilution test all isolates were resistant to imipenem, 98% (49/50) to meropenem, 68% (34/50) to colistin, and 20% (10/50) to polymyxin (B) Based on the PCR findings, all isolates harbored blaOXA−40, ISAba-1, and int-2 genes. There were no isolates found that have the blaOXA−58, blaOXA−143, blaVEB−1, blaVIM, and int-3 genes. Among Extended-spectrum beta-lactamases (ESBL) genes, blaCTX−M, blaTEM, blaSHV, blaGES, and blaPER−1 have a prevalence of 42% (21/50), 84% (42/50), 58% (29/50), 78% (39/50), and 54% (27/50), respectively. 74% (37/50) of the isolates had the blaOXA−23 gene, while all of the isolates carried the blaOXA−40 gene. Among MBL genes, blaIPM, blaGIM, blaSIM, and blaNDM−1 have a prevalence of 20% (10/50), 8% (4/50), 22% (11/50), and 60% (30/50), respectively. The prevalence of int-1 was documented as 74% (37/50). Accordingly, all isolates were identified as CRAB. The co-existence of blaOXA−23/int-2 and blaOXA−23/isaba-1 was 74% (37/50). The co-existence of blaNDM−1/ISAba-1 was observed in 30 (60%) isolates. Using an 80% similarity threshold on the dendrogram constructed through MLVA typing, all isolates were grouped into two clusters: cluster A with 9 isolates from wave 3, and cluster B with 41 isolates from waves 3, 4, and 5. Our study confirms a clonal transmission of CRAB during the study period and suggests using molecular typing methods like MLVA in healthcare settings to identify dominant clones, antibiotic resistance patterns, and transmission routes. This will help to better manage the emergence and spread of antibiotic-resistant strains in future outbreaks.

Determinants of crimean-congo hemorrhagic fever (cchf) outbreaks: a retrospective analysis

Abstract Introduction Crimean-Congo Hemorrhagic Fever (CCHF), a viral tick-borne zoonotic disease with high mortality rates, poses a particular threat in Pakistan during religious event of Eid-ul-Azha as increased livestock contact. This study aims to analyze CCHF cases from three outbreaks, to identify transmission and disease patterns. Understanding these patterns can inform targeted interventions for future outbreaks. Methods A retrospective cross-sectional study was conducted to examine three CCHF outbreak investigations between July 2nd and August 12th, 2023 in Khyber Pakhtunkhwa, Pakistan. Multisectoral teams, including human and animal health departments, investigated these outbreaks. Data was collected through semi-structured case investigation tools. The healthcare providers, patients and family were subjects. During active case surveillance, 41 probable contacts were traced. Results Among positive cases, male predominance (71.4%) was observed. The highest proportion of cases occurred in the 15-29 year age group (42.9%, n = 6). Individuals involved in animal handling professions had the highest prevalence (50%, n = 7), followed by students (21.4%, n = 3). Common clinical manifestations included high-grade fever (100%), muscle pain (92.9%), and bleeding symptoms (85.7%), with 64.3% of cases reporting vomiting blood. The average recovery time was 7.1 days, while fatal cases had an average of 6.8 days from symptom onset to death. Recovery was observed in 64.3% of cases, with a mortality rate of 35.7%. Chi-square analysis showed significant associations between gender, occupation, and disease outcome (p < 0.05). Conclusions This study identified a higher risk of CCHF in males, young adults, and individuals involved in animal handling during outbreaks. Public health interventions targeting occupations, demographics, particularly education and protective measures for animal handlers during Eid-ul-Azha days, are crucial to mitigate future outbreaks Key messages • Young male adults, and individuals involved in animal handling are on greater risk of higher risk of CCHF infections in Khyber Pakhtunkhwa, Pakistan. • One Health community can leverage these findings to develop better prevention and control strategies through collaboration between human and animal health sectors.

Strengthening Global Health Security: The Role of the International Health Regulations in Monitoring and Controlling Vector-Borne Diseases

Abstract Vector-borne diseases pose a significant global threat, with approximately 500 million reported cases annually, affecting previously unaffected regions due to climate change and increased international travel. This presentation brings insights from two scoping reviews examining the implementation and operationalization of the International Health Regulations (IHR) in preventing the spread of vector-borne diseases. The first review analysed strategies and policies adopted at continental and national levels and identified four major categories of measures: surveillance and epidemic intelligence, Declaration of Public Health Emergency of International Concern, measures in Points of Entry, and vaccination status. Surveillance systems vary widely across countries, with severe asymmetries in their implementation. The COVID-19 pandemic facilitated the adoption of screening measures and collaboration with airlines and travel agencies, highlighting the importance of early detection and response. An additional review focused on the contribution of IHR to public health action in monitoring and controlling vector-borne diseases. It emphasised the prioritisation of preventive measures related to travel and borders, including vector surveillance. Environmental changes, particularly socio-ecological and climate factors, influence the recurrence of outbreaks, creating the need for enhanced epidemic intelligence. Both reviews underscored the importance of cooperation between institutions and countries in effectively monitoring and controlling vector-borne diseases. Assessing core capacities under the IHR enables readiness levels in outbreak response to be measured, promoting concerted action tailored to each epidemiological context. As the world faces ongoing health challenges, it is imperative for State Parties to refine their core capacities in alignment with the lessons learned from the COVID-19 pandemic, ensuring a robust global response to future infectious disease outbreaks.

Autochthonous dengue outbreak in Lombardy, Italy: enhanced surveillance and vector control measures

Abstract Description of the problem On 18 August 2023, the first autochthonous case of dengue was registered in Lombardy, in a person living in a village in Lodi province. The case, a man with no history of travels prior to symptoms onset, developed flu-like symptoms on 3 August. After initial suspicion of WNV infection, he was confirmed to have a DENV-1 infection. Following the notification, measures to control the spread of the disease were activated, including alert of healthcare professionals, vector control activities, entomological monitoring and active case finding among household contacts and people living close to the case. Moreover, a serological screening was proposed to population of the entire municipality, along with a survey collecting data about travels abroad and symptoms. Results Forty-one confirmed and six probable autochthonous cases were identified. The last case developed symptoms on 20 October. Among confirmed cases, 24 were identified after admission to Emergency Department, 16 through community screening and one at the time of blood donation. 38/41 confirmed cases were symptomatic, with fever, rash and retro-orbital pain being the most common symptoms. Mean age was 55,5 years (3-88), while male: female ratio was 2:1. Hospitalisation was required for 7/41 cases. Community screening was offered from 25 August to 8 October and 416 individuals participated. Among them 10 tested positive for DENV IgG and 27 for DENV IgM (16 were subsequently confirmed as DENV cases, 6 remained probable and 5 were ruled out as non-cases). The primary case of the outbreak was not identified. Vector control activities and entomological monitoring were conducted on 21 August within 200-m radius area around the residence and places visited by index case. Subsequent interventions were conducted in all public areas and sensitive sites of the municipality. Lessons Enhancement of surveillance through community screening allowed identification of several additional autochthonous cases. Key messages • Strengthening of surveillance, vector control activities and entomological monitoring is crucial to prevent and control future outbreaks in non-endemic areas with stable presence of Aedes mosquitoes. • To minimize the risk of introduction and spread of dengue virus in non-endemic areas, it is essential to raise awareness among travellers and general population about preventive and control measures.

3.I. Scientific session: Increasing EU preparedness and improving European Vaccination Beyond COVID-19: the EUVABECO approach

Abstract This workshop provides a platform for delegates to enhance their understanding of the interdisciplinary approach developed in the European Vaccination Beyond COVID-19 (EUVABECO) project, funded under the European Commission’s EU4Health programme. The project is to build and validate implementation plans for EU Member States (MS) to equip them with operational and technical tools to enhance vaccination practices both in routine vaccination and in case of future outbreaks. Validation will be based on innovative practices that emerged in the context of the COVID-19 pandemic. Ultimately, EUVABECO will provide MS with robust implementation plans for common tools to support said innovative vaccination practices, thus, enhancing preparedness and increasing resilience against future health threats in Europe and globally. Guided by two chairs, the workshop is structured around five brief interactive presentations to deliver the conceptualisation, methodologies, and early results and vision for vaccination beyond COVID-19. It is designed to highlight how project activities strengthen resilience and increase preparedness against communicable diseases across the EU and beyond its borders, whilst brokering dialogue on related public health priorities. The presentations will focus on: 1. Preparing for future public health crises by fostering a conducive environment. 2. Enhancing preparedness by developing robust implementation plans. 3. An interdisciplinary approach: Exploring the five dimensions (medical/clinical, social, industrial, modelling and forecasting, and digital) of the tools deployed by EUVABECO. 4. The vital role of stakeholders and of the National Immunization Technical Advisory Groups (NITAGs). 5. Future actions and a call for ongoing support and collaboration in a structured manner. The session will also give the opportunity to formally present EUVABECO’s multistakeholder approach and to formally launch the EU Vaccination Stakeholder Forum, where early access will be granted to EU MS for the various resources generate. This will allow the audience to give input about the needs of the broader public health community involved in vaccination across the EU, for the Stakeholder Forum to effectively promote and support: • The scaling up of existing implementation plans within MS; • The development of new implementation plans for additional tools; • Integration between public health and primary care; • Inform the targeted interaction with EU and MS bodies involved in related policies and decision-making. The presentations will be augmented by real-time polling to maximize participant engagement. This approach will maximize interaction whilst eliciting critical insights into stakeholders’ knowledge, attitudes, and practices concerning EUVABECO’s tools and strategies. This type of engagement will ensure effective knowledge transfer and a comprehensive understanding of the project’s objectives and implementation strategies. Key messages • Enhancing vaccination preparedness requires an evidence-based and harmonized set of tools to be deployed across EU MS. EUVABECO will deliver validated implementation plans to achieve this. • An interdisciplinary approach and multistakeholder engagement are critical for evidence-informed decision-making and harmonization to successfully deploy vaccination initiatives across the EU.

Influenza A as a True Zoonotic Pathogen: Transmission through Reservoir Hosts

Influenza A virus (IAV) represents a considerable global health threat due to its rapid mutation rates and broad host range, facilitating cross-species transmission and enabling the virus to evade immune defenses. This review explores the molecular mechanisms underlying IAV's pathogenicity, focusing on its zoonotic potential through reservoir hosts, such as wild birds and swine. The virus's ability to undergo antigenic shift and drift allows it to continually adapt to new hosts and environments, posing challenges for control and treatment. Current antiviral therapies are limited by the emergence of resistant strains, underscoring the necessity for innovative vaccine development and treatment strategies. By examining IAV's molecular evolution, immune evasion tactics, and transmission dynamics, this review highlights the critical need for enhanced surveillance, improved therapeutic options, and international cooperation to mitigate future outbreaks. A deeper understanding of these processes is essential to inform public health efforts and combat the persistent threat of IAV.

Rational Design of Macrocyclic Noncovalent Inhibitors of SARS-CoV-2 Mpro from a DNA-Encoded Chemical Library Screening Hit That Demonstrate Potent Inhibition against Pan-Coronavirus Homologues and Nirmatrelvir-Resistant Variants.

The recent global COVID-19 pandemic has highlighted treatments for coronavirus infection as an unmet medical need. The main protease (Mpro) has been an important target for the development of SARS-CoV-2 direct-acting antivirals. Nirmatrelvir as a covalent Mpro inhibitor was the first such approved therapy. Although Mpro inhibitors of various chemical classes have been reported, they are generally less active against nirmatrelvir-resistant variants and have limited pan-coronavirus potential, presenting a significant human health risk upon future outbreaks. We here present a novel approach and utilized DNA-encoded chemical library screening to identify the noncovalent Mpro inhibitor 5, which demonstrated a distinct binding mode to nirmatrelvir. A macrocyclization strategy designed to lock the active conformation resulted in lactone 12 with significantly improved antiviral activity. Further optimization led to the potent lactam 26, which demonstrated exceptional potency against nirmatrelvir-resistant variants as well as against a panel of viral main proteases from other coronaviruses.

Relationships Among COVID-19-Related Service Uptake, HIV Status, Drug Use, and COVID-19 Antibody Status Among HIV Testing Intervention Participants in KwaZulu-Natal, South Africa

People living with HIV (PLWH) and people who use drugs are vulnerable populations who may face barriers to accessing health services and may have irregularities in immune function. People with undiagnosed HIV infection may be particularly likely to have compromised immune function. However, research about whether/how HIV status is related to COVID-19-related health outcomes has been equivocal, and research on the predictors of COVID-19-related health service access/uptake has been limited in Sub-Saharan African settings. Among 470 participants of a peer-recruitment-based HIV-testing intervention in KwaZulu-Natal, we examined whether HIV status and/or hard drug use were associated with uptake of COVID-19 testing and vaccination, and whether they moderated the relationship between COVID-19 vaccination status and COVID-19 IgG antibody status. Women were significantly more likely than men to report testing for COVID-19 (OR = 1.84; p = 0.002) and being vaccinated (OR = 1.79; p = 0.002). Neither HIV status nor drug use was associated with likelihood of getting tested or vaccinated. Vaccinated participants (90% of whom obtained vaccines more than 6 months before the study) were significantly more likely to test positive for COVID-19 IgG antibodies (OR = 6.86; p < 0.0005). This relationship held true for subgroups of PLWH and participants with previously undiagnosed/uncontrolled HIV infection, and was not moderated by HIV status or hard drug use. These findings may suggest that both people who use drugs and PLWH were served as well as other people by KwaZulu-Natal’s COVID-19 response. However, gender-based disparities in COVID-19 service uptake suggest that special care should be taken during future COVID-19 outbreaks or other new epidemics to improve access to related healthcare services among men in this region.

Vaccine Hesitancy and COVID-19 Risk Behaviors Associated with Social Media Use in Japan

ABSTRACT We examined the associations between the use of different types of media and COVID-19 vaccine hesitancy, as well as risk behaviors of COVID-19 infection, in Japan in late 2021. Cross-sectional surveys were conducted using rapid online surveys of residents in Iwate Prefecture from February 5 to 7, 2021, and from October 1 to 3, 2021. Each individual’s risk of acquiring SARS-CoV-2 infection was calculated using a quantitative assessment tool (the microCOVID). Intention to get vaccinated for COVID-19 was assessed by self-report. Usage of five types of media for obtaining COVID-related information was assessed: (1) newspapers, (2) television or radio, (3) internet or news apps, (4) social network services (SNS) (excluding LINE, a popular messaging app), and (5) other. Reliance on SNS did not show significant associations with either intention to get vaccinated or engaging in risky behavior for acquiring COVID-19. Although users of the internet or news apps were marginally significantly less likely to engage in high-risk behavior, significant associations between vaccine hesitancy and the usage of the internet or news apps were found in the middle age and elderly groups (OR [95% confidence interval (CI)] in middle age: 1.55 [1.07–2.23]; in elderly; 9.24 [3.28–26.02]). The differential associations between different types of media use and COVID-19 prevention behaviors may assist in preparing for future pandemic outbreaks. One implication for public health risk communication is audience segmentation, such as emphasizing vaccine safety and effectiveness for older audiences.

A Scoping Review of the Respiratory Effects of Red Tide in Humans.

Algal blooms of Karenia brevis produce brevetoxins that lead to the natural phenomenon of red tide. Beyond monitoring the red tide concentration and forecasting future outbreaks, uncertainty exists in the field when examining these toxins in relation to physiologic aspect of humans. Contaminated air that results from outbreaks of K. brevis leads to inhalation of aerosolized brevetoxins, which directly impact the human respiratory system. This scoping review focused on the respiratory effects of red tide and was conducted by using a comparative method between 2 researchers. Relevant abstracts were collected, and full-text articles were reviewed by using PubMed, Science Direct, CINAHL Complete, and BioMed Central databases. Thirty articles were included in the final analysis and categorized by study design, location, and number and age of participants, and were also divided into assessment by respiratory effects, exposure, measurements of K. brevis, and asthma. The research indicates that respiratory health issues exist and can be compounded with exposure to red tide, specifically upper respiratory symptoms. Both symptomatic issues and pulmonary function tests were of concern when individuals were subjected to brevetoxin exposure. Even low levels of K. brevis resulted in negative respiratory health effects. Red tide is common in many areas of the world. The toxins released can cause adverse respiratory effects in humans. This article provides a comprehensive summary of the scholarly literature focused on the respiratory system and red tide produced by K. brevis.

Leveraging Digital Health Data to Transform the United Nations Systems for Palestine Refugees for the Post Pandemic Time

ABSTRACT The COVID-19 pandemic presented a grave threat to the continuity of health services that UNRWA provides to 5.9 million Palestine Refugees in the Near East. UNRWA runs 140 primary health care clinics, providing approximately nine million medical consultations a year. During the pandemic, UNRWA’s e-Health system (and other digital health tools) were crucial in maintaining health services. The e-Health system enabled the identification of at-risk patients and transformed UNRWA’s services for sustainability and efficiency. Innovations like telemedicine and two smartphone applications (e-NCD and e-MCH) enhanced service delivery and staff management. To evaluate the effectiveness of digital health integration in UNRWA’s services during and after the pandemic, the team analyzed reports, events, and e-Health data from 2019–2022. Results show that digital tools, like e-NCD and e-MCH applications, helped reduce COVID-19 among Palestine Refugees, enabling remote care and continuous access to essential health services. Digital health has now become essential in UNRWA’s post-pandemic operations. This paper offers a paradigm for future outbreak responses. By harnessing the power of digital health, UNRWA’s e-Health system served as a beacon of hope, demonstrating how innovative approaches can empower patients, enhance health care outcomes, and ensure equitable access to health care services during crisis situations and beyond.

Mechanical ventilation, hospitalization time, deaths and disability according to the variants of Guillain-Barré syndrome: systematic review and meta-analysis.

Motivation for the study. It is unclear which variant of Guillain-Barré syndrome is mostly associated with adverse outcomes. Main findings. Variants had longer time in MV (7.42 days longer), and hospitalization (3.11 days longer). By subgroups, we found that children with the axonal variant had a greater use of MV; whereas, the demyelinating variant was more frequent among adults in MV. Implications. Our results could be used for the implementation of new public health policies, allowing health personnel to have a better knowledge of the prognosis of each variant and the necessary resources to face future outbreaks. To determine the requirement and time to mechanical ventilation and Intensive Care Unit (ICU), hospitalization and hospitalization time, death and disability of the axonal variants of Guillain-Barré Syndrome (GBS) in comparison with the acute demyelinating variant in patients of all the ages. The systematic review that included patients with GBS. The exposure variable was the axonal variants and the comparator was acute inflammatory demyelinating polyneuropathy (AIDP). The outcomes were the requirement and time on mechanical ventilation (MV), requirement and time in the ICU, hospitalization time, disability and death. The NewCasttle-Ottawa Scale (NOS) was used to assess risk of bias. A meta-analysis was conducted to calculate mean differences and relative risks (RR) with their 95% confidence intervals (CI) using inverse variances and random effects models. Of the 3116 articles found, 46 met the selection criteria. The time on MV was 7.42 days (95% CI: 0.36 to 1.48) and the hospitalization time was 3.11 (95% CI: 0.73 to 5.49) days for the axonal variants. The axonal variants had a RR of 0.47 (95% CI: 0.24 to 0.92) for the requirement of MV in adults, but it was 1.68 (95% CI: 1.25 to 2.25) in children. There was a high statistical heterogeneity. Axonal variants showed, on average, longer MV and hospitalization time, overall and by subgroups. A high MV requirement was found for axonal variants in children; it was lower for adults.

Yellow fever in Ghana: Predicting emergence and ecology from historical outbreaks.

Understanding the epidemiology and ecology of yellow fever in endemic regions is critical for preventing future outbreaks. Ghana is a high-risk country for yellow fever. In this study we estimate the disease burden, ecological cycles, and areas at risk for yellow fever in Ghana based on historical outbreaks. We identify 2387 cases and 888 deaths (case fatality rate 37.7%) from yellow fever reported in Ghana from 1910 to 2022. During the approximately 30-year periods before and after implementation of routine childhood vaccination in 1992, the reported mean annual number of cases decreased by 80%. The geographic distribution of yellow fever cases has also changed over the past century. While there have been multiple large historical outbreaks of yellow fever in regions throughout Ghana, recent outbreaks have originated in northern regions. Comparing the locations where yellow fever outbreaks have emerged, we find patterns with seasons and different ecological transmission cycles. Using an ecological niche modeling framework, we predict areas in Ghana that are similar to where prior yellow fever outbreaks have originated based on temperature, precipitation, vegetation, and human population density. We find that these predictions differ depending on the ecological cycles of outbreaks. Ultimately, these findings and methods could be used to inform further subnational risk assessments for yellow fever in Ghana and other high-risk countries.

A Novel Data Analytics Methodology for Discovering Behavioral Risk Profiles: The Case of Diners During a Pandemic

Understanding tourist profiles and behaviors during health pandemics is key to better preparedness for unforeseen future outbreaks, particularly for tourism and hospitality businesses. This study develops and applies a novel data analytics methodology to gain insights into the health risk reduction behavior of restaurant diners/patrons during their dining out experiences in a pandemic. The methodology builds on data relating to four constructs (question categories) and measurements (questions and attributes), with the constructs being worry, health risk prevention behavior, health risk reduction behavior, and demographic characteristics. As a unique contribution, the methodology generates a behavioral typology by identifying risk profiles, which are expressed as one- and two-level decision rules. For example, the results highlighted the significance of restaurants’ adherence to cautionary measures and diners’ perception of seclusion. These and other factors enable a multifaceted analysis, typology, and understanding of diners’ risk profiles, offering valuable guidance for developing managerial strategies and skill development programs to promote safer dining experiences during pandemics. Besides yielding novel types of insights through rules, another practical contribution of the research is the development of a public web-based analytics dashboard for interactive insight discovery and decision support.

Evaluation of a multiplexed immunoassay for assessing long-term humoral immunity Orthopoxviruses

BackgroundThe 2022 Monkeypox virus (MPXV) global outbreak boosted development of multiple serological assays to aid understanding of Mpox immunology. ObjectivesThe study aimed to assess a multiplexed solid-phase electrochemiluminescence immunoassay (Meso Scale Discovery (MSD)) for simultaneous detection of antibodies against MPXV, including A35, E8 and M1 antigens, along with corresponding Vaccina Virus (VACV) homologues and demonstrate its accuracy in assessing antibody titres post-vaccination and infection. MethodsAssay performance was assessed for simultaneous detection of antibodies against MPXV and corresponding VACV antigens. Sensitivity and specificity were evaluated with paediatric negatives (n = 215), pre- and post-IMVANEX vaccinated (n = 80), and MPXV (Clade IIb, n = 39) infected serum samples. ResultsThe assay demonstrated high specificity (75.68 % (CI: 69.01–81.29) - 95.98 % (CI:92.54–97.87)) and sensitivity (62.11 % (CI:52.06–71.21) - 98.59 % (CI:92.44 %–99.93 %)) depending on the Orthopoxvirus antigen. Preferential binding was observed between MPXV-infected individuals and MPXV antigens, while vaccinated individuals exhibited increased binding to VACV antigens. These results highlight differential binding patterns between antigen homologues in related viruses. ConclusionOverall, this assay demonstrates high sensitivities in detecting antibodies for multiple relevant MPXV and VACV antigens post-infection and post-vaccination, indicating its utility in understanding immune responses to Orthopoxviruses in current and future outbreaks and evaluating the immunogenicity of new-generation Mpox-specific vaccinations.

Understanding Viral Haemorrhagic Fevers: Virus Diversity, Vector Ecology, and Public Health Strategies.

Viral haemorrhagic fevers encompass a diverse group of severe, often life-threatening illnesses caused by viruses from multiple families, including Arenaviridae, Filoviridae, Flaviviridae, Hantaviridae, Nairoviridae, Peribunyaviridae, and Phenuiviridae. Characterised by fever and haemorrhagic symptoms, these diseases challenge public health systems by overwhelming healthcare facilities, complicating diagnostic processes, and requiring extensive resources for containment and treatment, especially in resource-limited settings. This discussion explores the intricate relationships between VHFs and their transmission vectors-both animal and arthropod-and examines the impact of ecological and geographic factors on disease spread. The primary transmission of VHFs typically occurs through direct contact with infected animals or via bites from haematophagous arthropods, facilitating zoonotic and, at times, human-to-human transmission. With an emphasis on the role of diverse wildlife, domesticated animals, and vectors such as mosquitoes and ticks in the epidemiology of VHFs, there is a recognised need for robust surveillance and strategic public health responses to manage outbreaks. This review discusses the necessity of interdisciplinary approaches that integrate virology, ecology, and public health to enhance diagnostic capabilities, develop vaccines and antivirals, and improve outbreak interventions. Exploring the ecological and biological dynamics of VHFs will help bolster a deeper understanding of these emerging viruses and underpin preparation for future outbreaks. The importance of enhanced global cooperation, continuous research, and collaboration to mitigate the public health threats posed by these complex infections is a central theme, serving as a foundational strategy to reinforce worldwide preparedness and response efforts. Future directions include addressing gaps in vaccine development and tailoring public health strategies to the unique challenges of managing VHFs, such as the rapid mutation rates of viruses, the need for cold chain logistics for vaccine distribution, and socio-economic barriers to healthcare access, in order to ensure readiness for and effective response to emerging threats worldwide.

ESTUDO EPIDEMIOLÓGICO DE CASOS NOTIFICADOS POR CHIKUNGUNYA ENTRE OS ANOS DE 2019 A 2023 EM UM MUNICÍPIO DO TOCANTINS

INTRODUCTION: The Chikungunya virus is transmitted by Aedes aegypti and Aedes albopictus, causing fever and joint pain, with potential serious complications. This study aimed to analyze the incidence and epidemiological profile of Chikungunya cases in Porto Nacional, Tocantins, between 2019 and 2023. METHODOLOGY: A quantitative approach was used, based on retrospective data found in the Notifiable Diseases Information System (SINAN). The variables tested included sex, age group, education and disease progression. The incidence calculation was carried out based on population estimates provided by IBGE. RESULTS: The results indicated a significant increase in cases in 2022, representing 58% of the total, followed by a drop in 2023. The majority of cases affected women (65%) and people between 20 and 39 years old. Laboratory classification was the main diagnostic method, responsible for 60% of confirmed cases. DISCUSSION: The discussion of the results highlights the need for more effective public policies to control the spread of the virus, especially in vulnerable regions. FINAL CONSIDERATIONS: Therefore, although there was a reduction in cases in 2023, it is crucial to maintain continuous epidemiological surveillance and vector control actions to prevent future outbreaks and mitigate the impacts of Chikungunya on the population.