Global Outbreak Research Articles

Clinical characteristics and outcomes of patients with mpox during the 2022 mpox outbreak compared with those before the outbreak: A systematic review and meta-analysis.

On 23 July 2022, the World Health Organization declared the global mpox outbreak as a public health emergency of international significance. The mpox virus (MPXV) that caused the outbreak was classified as clade IIb, which belongs to the West African clade. However, the relationship between MPXV clades and symptoms, as well as the severity of mpox outcomes, is not fully understood. Thus, we aimed to investigate the global mpox prevalence and the differences in clinical manifestations and outcomes among patients with mpox between pre-outbreak (2003-2021) and the current mpox outbreak. In this systematic review and meta-analysis, PubMed/MEDLINE, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar were searched using the keyword "monkeypox" and "mpox" up to 13 October 2022. A random effects model was used to obtain the pooled prevalence and 95% confidence intervals. This study included 27 articles, and 5698 patients with mpox with 19 distinctive features from 19 countries across five continents were assessed. Patients with mpox during the 2022 mpox outbreak showed mild clinical manifestations and outcomes compared with those before the 2022 mpox outbreak: mild rash (relative ratio [RR]: 5.09, 95% confidence interval [CI]: 1.52-17.08), fever (0.68, 0.49-0.94), pruritus (0.25, 0.19-0.32), myalgia (0.50, 0.31-0.81), headache (0.56, 0.35-0.88), skin ulcer (0.32, 0.17-0.59), abdominal symptom (0.29, 0.20-0.42), pharyngitis (0.32, 0.18-0.58), nausea or vomiting (0.15, 0.02-0.93), conjunctivitis (0.11, 0.03-0.38), concomitant infection with HIV (1.70, 0.95-3 0.04), and death (0.02, 0.001-0.31). MPXV clade IIb exhibited higher infectivity but may cause mild disease symptoms and low mortality rate. It is important to consider MPXV infection in patients with mpox-related features and/or a history of sexual transmission to prevent the spread of the disease and recognise the current pandemic threat.

AN INVISIBLE TERROR OUTSIDE: THE ANXIETY OF UNCERTAINTY, PANIC AND ISOLATION IN RUMAAN ALAM’S LEAVE THE WORLD BEHIND

Today humanity is going through a period of great upheavals and rapid changes in every sphere of life, including the environment, that inevitably lead to general destabilisation and disruptions. In the latest novel by Rumaan Alam, apocalyptic Leave the World Behind (2020), a crisis appears to reshape our closest bonds and forge new ones. This story of an invisible terror deals with cataclysmic but mysterious events that shut down the communication networks we over-rely on, and sees an almost overwhelming sense of uncertainty, panic and increasing anxiety. Isolated in the remote holiday house with the Vermont stone kitchen tops and night-lit swimming pool, a couple of New Yorkers and their teenage children are looking forward to taking a rest from the routines of city life when catastrophe strikes. In addition to the major theme of the threat of human extinction, Leave the World Behind explores the relationship between class and race and the complexities of parenthood and solitude during an unspecified disaster. Those issues are included in the context of the global problem of anthropogenic impacts on the environment. At the same time, Alam demonstrates how habituation to the ongoing crises in the modern world, including social-ecological transformations, affects the understanding of a severe situation people are facing and ways to prevent it: they have increasing tolerance for the absurd. The suspenseful, provocative and prescient book, Leave the World Behind, captures the generalised panic of 2020, the year of a global outbreak of coronavirus. As a kind of end-of-the-world fiction, the novel is full of moments of exquisite recognition and reappraising of our attitudes the article discusses.

Epidemiological and molecular surveillance of norovirus in the Brazilian Amazon: description of recombinant genotypes and improvement of evolutionary analysis.

Noroviruses are highly infectious, genetically diverse viruses. Global outbreaks occur frequently, making molecular surveillance important for infection monitoring. This cross-sectional descriptive study aimed to monitor cases of norovirus gastroenteritis in the Brazilian Amazon. Fecal samples were tested by immunoenzymatic assay, RT-PCR and genetic sequencing for the ORF1/ORF2 and protease regions. Bayesian inference with a molecular clock was employed to construct the phylogeny. The norovirus prevalence was 25.8%, with a higher positivity rate among children aged 0-24 months. Genogroup GII accounted for 98.1% of the sequenced samples, while GI accounted for 1.9% of them. The GII.P16/GII.4 genotype was the most prevalent, with an evolution rate of 2.87x10-3 and TMRCA estimated in 2012. This study demonstrates that norovirus is a primary causative agent of gastroenteritis and provides data on viral genetic diversity that may facilitate infection surveillance and vaccine development.

Clinical characteristics of Mpox at a single center in Saudi Arabia: a retrospective study

Objectives: Mpox (formerly known as monkeypox) is a viral infection that has been linked to a global outbreak as recent as in the year 2022. Mpox outbreaks have been increasingly reported in non-endemic regions since 2017 with over 23,000 cases reported in 80 countries as of August 1, 2022. Objective of study was describe the clinical characteristics, treatment and outcomes of Mpox disease as experienced in a tertiary care center in Riyadh, Saudi Arabia from May 2022 till the study date. Methodology: This retrospective chart review study was conducted in a large academic tertiary care hospital in Riyadh, Saudi Arabia. Data were obtained from administrative and electronic medical records and analyzed. Results: Of 33 patients suspected to have Mpox since May 2022, 16 tested positive. In total, 18.8% of patients with Mpox (3/16) had a personal history of recent travel, and 62.5% (10/16) reported some form of recent sexual contact. All the patients presented with rash, and most of them (93.8%) had anogenital rash. The mean number of skin lesions was 6.69, and no one reported coexisting sexually transmitted diseases. In addition, 31.25% (5/16) received antivirals, and no mortality was recorded. Conclusions: Mpox infection demonstrated a variety of signs and symptoms, with all patients presenting with dermatological manifestations. The spread of this disease in our region exhibited some dissimilarities in the clinical presentation and coexisting infections. This highlights the importance of maintaining a high index of suspicion and a low threshold for testing in order to halt further spread.

One response: Global Outbreak Alert and Response Network supporting the COVID-19 response, Kiribati.

In January 2022, Kiribati experienced widespread community transmission of COVID-19, leading to high rates of infection among health-care workers (HCWs), which reduced essential HCWs during a period of increased hospital admissions. Kiribati, a Pacific island country made up of a remote group of 33 low-lying atolls in the Pacific Ocean, experienced its first surge of COVID-19 cases beginning on 24 January 2022. Reports of increasing numbers of COVID-19 cases in South Tarawa prompted the Kiribati Ministry of Health and Medical Services to request assistance from the international community, including the World Health Organization's Global Outbreak Alert and Response Network (GOARN), to support national COVID-19 response operations. Specialists in infection prevention and control (IPC) were deployed to Kiribati in February 2022 to assist the Ministry's National COVID-19 Taskforce in collaboration with national partners. These specialists helped review and strengthen IPC capacities to accommodate a potential patient surge and consequent demands for medical consumables in health-care facilities in South Tarawa. Strengthened knowledge about and processes for IPC among HCWs prevented health care-associated infections and reduced community disease transmission during the first surge of COVID-19 cases in Kiribati. GOARN has the capacity and ability to rapidly deploy experts to support requests for assistance. Outbreak response activities can be enhanced and sustained by using GOARN's resources and collaborating with all partners, as necessary.

The Impacts of COVID-19 Lockdown on Human–Primate Coexistence: Insights and Recommendations

The global outbreak of the COVID-19 pandemic has led to a series of human lockdowns. Studying human–animal linkages during these periods is essential in conserving global biodiversity, maintaining ecosystem integrity, and preventing zoonotic diseases. This especially applies to the matters between human and nonhuman primates—their coexistence. In this study, we used community interviews and camera traps to analyze behavioral responses and changes in human–monkey relationships regarding a semi-wild group of macaques ( Macaca mulatta ) in a tourism area during the lockdown. The results indicate that food provision for macaques from tourists substantially declined. As a result, macaques moved to communities for food, causing increased human–monkey conflicts; consequently, local communities’ attitudes toward macaques prominently changed: those who have experienced severe conflicts are far less tolerant of the macaques than those without experience. Thus, to maintain a cordial coexistence between humans, primates, and other animals in ecotourism areas, we suggest (a) establishing long-term monitoring to maintain a sustainable balance between animal population size and available food resources provided by humans and the environment; (b) improving emergency management policies for controlling monkey populations to prevent the unwanted conflicts between macaques and communities, responding to exceptional circumstances such as the COVID-19 lockdown; (c) strengthening the establishment of conduct code for tourists to avoid conflicts between tourists and primates and the spread of pathogens; and (d) upgrading compensation policies for the damages caused by human–wildlife conflicts and strengthening the cooperation between the community and tourist management; an amicable relationship between communities, economic development, and animal conservation is highly demanded.

A111: Relationship Between Physical Activity and Mental Toughness

Purpose: Physical activity has favorable impacts on exercisers' stress levels, psychological distress and anxiety, emotional regulation, and mental wellness. In recent years, the global outbreak of COVID-19 has subtly altered college students' lifestyles. Studies have shown that the physical and mental health of students has deteriorated dramatically, which is alarming. Mental toughness refers to the ability to adapt well in the face of major pressures, setbacks, and adversity in life. The purpose of the present study was to examine variations in mental toughness depending on the intensity, length, and frequency of physical activity. Methods: A total of 3,120 Chinese college students participated in this study. In the spring semester of 2022, participants were given the demographic questionnaire, the Physical Activity Rating Scale (PARS-3), and the Chinese version of the Mental Resilience Scale (CD-RISC). 3049 students completed the survey. Independent sample t test, one-way analysis of variance (ANOVA), correlation analysis, and regression analysis were performed using SPSS 25.0 statistical software. Results: The physical activity level differed significantly across sex (t = 14.37, p < 0.001), grade (F=3.72, p < 0.05), and monthly living expenses (F = 5.70, p < 0.001). The mental toughness had significant differences across sex (t = 4.55, p < 0.001), grade (F = 3.35, p < 0.05), and monthly living expenses (F = 5.41, p < 0.001). There were significant differences in mental toughness across different levels of physical activity intensity (F = 39.28, p < 0.001), different length of physical activity (F = 33.35, p < 0.001), different frequency of physical activity (F = 30.14, p < 0.001), and different levels of physical activity (F = 91.55, p < 0.001). Physical activity was significantly and positively correlated with mental toughness (r = 0.26, p < 0.01). Conclusion: Male students exhibited significantly higher levels of physical activity than their female counterparts, and freshmen demonstrated greater physical activity than students in other grades. Additionally, the amount of physical activity among college students was influenced by their monthly living expenses. The mental toughness score of male students was notably higher than that of female students, with freshmen scoring significantly higher than students in other grades. In comparison to other levels of physical activity, engaging in a high quantity of exercise, high-intensity short-duration exercise, more than 60 minutes of activity time, and a daily activity frequency had the most pronounced impact on enhancing mental toughness. Moreover, there was a positive correlation between physical activity and mental toughness.

Pandemic and Superstitions: Anantha Murthy’s Samskara as a Testimony to Fragile Society

With the global outbreak of the Covid-19 pandemic, there has been a heightened interest in pandemic literature and epidemic narratives, as the everyday lives of individuals undergo significant transformations in response to the arrival of such a pandemic, reflecting a growing curiosity about how literature explores and elucidates these challenging experiences. It is widely acknowledged that there has been no shortage of pandemic literature and related material in world literature, including Indian vernacular literature, available in both its original languages and translated forms, underscoring the richness and diversity of perspectives on pandemics across different literary traditions. What is particularly intriguing is that socially conscious and perceptive writers often use epidemics or pandemics as a lens through which to critically examine and delve into the intricate layers of India’s caste-based hierarchical social structure, offering a unique perspective to dissect and reflect upon the dynamics of this deeply entrenched societal framework. In this paper, an attempt has been made to examine Anantha Murthy’s Samskara: A Rite for a Dead Man as a pandemic narrative that brilliantly captures the vignettes of the reality of superstition-ridden society at times of crisis and emergency. The paper also endeavours to investigate how literature seeks to provide solace during moments of necessity and hardship by offering an insightful account of various events that occur during pandemics, illustrating how the portrayal of pandemics in literature often serves as a source of inspiration for humanity, highlighting the capacity of literature to offer guidance and motivation in challenging times.

Exploring the dynamics of monkeypox transmission with data-driven methods and a deterministic model.

Mpox (formerly monkeypox) is an infectious disease that spreads mostly through direct contact with infected animals or people's blood, bodily fluids, or cutaneous or mucosal lesions. In light of the global outbreak that occurred in 2022-2023, in this paper, we analyzed global Mpox univariate time series data and provided a comprehensive analysis of disease outbreaks across the world, including the USA with Brazil and three continents: North America, South America, and Europe. The novelty of this study is that it delved into the Mpox time series data by implementing the data-driven methods and a mathematical model concurrently-an aspect not typically addressed in the existing literature. The study is also important because implementing these models concurrently improved our predictions' reliability for infectious diseases. We proposed a traditional compartmental model and also implemented deep learning models (1D- convolutional neural network (CNN), long-short term memory (LSTM), bidirectional LSTM (BiLSTM), hybrid CNN-LSTM, and CNN-BiLSTM) as well as statistical time series models: autoregressive integrated moving average (ARIMA) and exponential smoothing on the Mpox data. We also employed the least squares method fitting to estimate the essential epidemiological parameters in the proposed deterministic model. The primary finding of the deterministic model is that vaccination rates can flatten the curve of infected dynamics and influence the basic reproduction number. Through the numerical simulations, we determined that increased vaccination among the susceptible human population is crucial to control disease transmission. Moreover, in case of an outbreak, our model showed the potential for epidemic control by adjusting the key epidemiological parameters, namely the baseline contact rate and the proportion of contacts within the human population. Next, we analyzed data-driven models that contribute to a comprehensive understanding of disease dynamics in different locations. Additionally, we trained models to provide short-term (eight-week) predictions across various geographical locations, and all eight models produced reliable results. This study utilized a comprehensive framework to investigate univariate time series data to understand the dynamics of Mpox transmission. The prediction showed that Mpox is in its die-out situation as of July 29, 2023. Moreover, the deterministic model showed the importance of the Mpox vaccination in mitigating the Mpox transmission and highlighted the significance of effectively adjusting key epidemiological parameters during outbreaks, particularly the contact rate in high-risk groups.

Outbreak response capacity of the Global Outbreak Alert and Response Network across WHO's South-East Asia and Western Pacific regions.

The COVID-19 pandemic challenged the Global Outbreak Alert and Response Network's (GOARN) mechanism used to rapidly deploy technical support for international responses and highlighted areas that require strengthened capacity within the Network. GOARN's partners in the World Health Organization's (WHO) South-East Asia and Western Pacific regions were engaged to explore their levels of preparedness, readiness and ability to respond to international public health emergencies. Consultative discussions were held and a survey was conducted with GOARN's partners from the two WHO regions. Discussion topics included partners' capacity to support and participate in a GOARN deployment, training, research and collaboration. Descriptive and content analyses were conducted. Barriers to engaging in GOARN's international outbreak response efforts included limited numbers of personnel trained to respond to outbreaks; institutional, financial and administrative hurdles; and limited collaboration opportunities. Partners identified innovative solutions that could strengthen their engagement with deployment, such as financial subsidies, mentorship for less experienced staff, and the ability to provide remote support. GOARN plays an important role in enabling WHO to fulfil its international alert and response duties during disease outbreaks and humanitarian crises that have the potential to spark disease outbreaks. Yet without systematic improvement to strengthen national outbreak capacity and regional connectedness, support for international outbreak responses may remain limited. Thus, it is necessary to integrate novel approaches to support international deployments, as identified in this study.

Traffic Data-Empowered XGBoost-LSTM Framework for Infectious Disease Prediction

Large-scale infectious diseases pose a tremendous risk to humans, with global outbreaks of COVID-19 causing millions of deaths and trillions of dollars in economic losses. To minimize the damage caused by large-scale infectious diseases, it is necessary to develop infectious disease prediction models to provide assistance for prevention. In this paper, we propose an XGBoost-LSTM mixed framework that predicts the spread of infectious diseases in multiple cities and regions. According to big traffic data, it was found that population flow is closely related to the spread of infectious diseases. Clustering and dividing cities according to population flow can significantly improve prediction accuracy. Meanwhile, an XGBoost is used to predict the transmission trend based on the key features of infection. An LSTM is used to predict the transmission fluctuation based on infection-related multiple time series features. The mixed model combines transmission trends and fluctuations to predict infections accurately. The proposed method is evaluated on a dataset of highly pathogenic infectious disease transmission published by Baidu and compared with other advanced methods. The results show that the model has an excellent predictive effect and practical value for large-scale infectious disease prediction.

Risk Management for Whole-Process Safe Disposal of Medical Waste: Progress and Challenges.

Over the past decade, the global outbreaks of SARS, influenza A (H1N1), COVID-19, and other major infectious diseases have exposed the insufficient capacity for emergency disposal of medical waste in numerous countries and regions. Particularly during epidemics of major infectious diseases, medical waste exhibits new characteristics such as accelerated growth rate, heightened risk level, and more stringent disposal requirements. Consequently, there is an urgent need for advanced theoretical approaches that can perceive, predict, evaluate, and control risks associated with safe disposal throughout the entire process in a timely, accurate, efficient, and comprehensive manner. This article provides a systematic review of relevant research on collection, storage, transportation, and disposal of medical waste throughout its entirety to illustrate the current state of safe disposal practices. Building upon this foundation and leveraging emerging information technologies like Internet of Things (IoT), cloud computing, big data analytics, and artificial intelligence (AI), we deeply contemplate future research directions with an aim to minimize risks across all stages of medical waste disposal while offering valuable references and decision support to further advance safe disposal practices.

Detection of monkeypox virus based on a convenient and sensitive single-step RPA-CRISPR/Cas12a strategy.

The global outbreak of monkeypox virus (MPXV) has highlighted the need for rapid molecular diagnostics techniques. In this study, a single-step recombinase polymerase amplification (RPA)-CRISPR/Cas12a system was developed for rapid and sensitive detection of MPXV. The limit of detection of this assay was 1 copy per μL of extracted nucleic acids. A heating lysis method was integrated to further simplify the sample processing workflow and shorten the assay time to 40 min from sample to result. The reaction mixture can be lyophilized to improve its accessibility in resource-limited settings. The analysis results of the proposed single-step RPA-CRISPR/Cas12a assay for clinical MPXV positive and negative samples were 100% consistent with standard PCR assay. These results demonstrate the feasibility and efficiency of this method for rapid and accurate MPXV detection in real-world settings, showcasing its potential utility in urgent and practical settings.

Global Outbreak Alert and Response Network deployments during the COVID-19 pandemic, WHO Western Pacific Region.

The Global Outbreak Alert and Response Network (GOARN) has responded to more than 100 outbreaks during the past 23 years. The coronavirus disease (COVID-19) pandemic presented unprecedented operational constraints that challenged GOARN's core mission to rapidly deploy technical experts from its partners to support national in-country responses to public health emergencies. This paper describes the type and duration of GOARN deployments to and within the World Health Organization's (WHO's) Western Pacific Region during the COVID-19 pandemic. Despite strict border closures and ever-changing vaccination and quarantine requirements, GOARN continued to deploy international technical assistance to strengthen COVID-19 response operations within the Region, as requested. Data were analysed from the GOARN Knowledge Platform about deployments to and within the Region for responses to the COVID-19 pandemic between 1 January 2020 and 5 May 2023. Data were available about deployment duration, technical role requested, country or area, partner organization and deployed expert's demographics. Feedback from postdeployment briefings with the experts was collected and thematically analysed to determine ongoing needs and gaps to help improve deployment operations. There were 72 experts deployed on 89 missions through GOARN to 12 countries and areas in the Region, for a total of 4558 field days, to support the response to the COVID-19 pandemic. The volume of requests for assistance from countries and areas in the Region to respond to the COVID-19 pandemic uncovered a deficit in human resources available for domestic response to outbreaks and the reliance on international assistance. Strengthening the in-country capacity of ready-to-respond public health emergency staff is critical to meet the needs for outbreak response. The ongoing demand for technical experts to support national responses means that these lessons may have immediate implications.

The history of the Japanese Society for Neuro-infectious Diseases: Foundation, objectives, and legacy.

The Japanese Research Group for Neuro-infectious Diseases was founded in August 1996, and by 2004 it had evolved into the Japanese Society for Neuro-infectious Diseases. The Society focuses on neuroinfectious conditions (e.g., encephalitis/encephalopathy, myelitis, and meningitis), providing a venue for academic presentations and exchanges. Clinical guidelines for major neurological infectious diseases are also published by the Society, in order to meet the social demands of each era. Although the threat of herpes simplex encephalitis has declined due to acyclovir's introduction, the frequency of encephalitis or peripheral neuropathy caused by varicella-zoster virus is increasing. In Japan, prion disease, human T-cell leukemia virus-1 (HTLV-1)-associated myelopathy (HAM), subacute sclerosing panencephalitis (SSPE), and progressive multifocal leukoencephalopathy (PML) are designated as intractable diseases. The incidence of prion disease is 1.8/1,000,000 individuals, with the sporadic type accounting for 80%. Prion disease is fatal, and effective medications are awaited. HAM's prevalence is ~3/100,000 individuals, with a male-to-female ratio of 1:2-3. HAM is common in western Japan, including Kyushu and Okinawa. The prevalence of PML is rising with the spread of both immunosuppressive therapy for transplantation and treatment for multiple sclerosis. From late 2019 through 2020, the world faced a global outbreak of coronavirus disease 2019 (COVID-19) due to virus mutations, and the threat of new mutations persists. Close attention should be paid to the emergence of new neurological infections that could arise from abnormal weather patterns and/or a decline in immune function due to aging.

Beyond deployments: Australia's strategic contributions to the Global Outbreak Alert and Response Network.

Beyond deployments: Australia's strategic contributions to the Global Outbreak Alert and Response Network.

Inaugural meeting of Global Outbreak Alert and Response Network partners from Australia.

Inaugural meeting of Global Outbreak Alert and Response Network partners from Australia.

Analysis of the COVID-19 model with self-protection and isolation measures affected by the environment.

Since the global outbreak of COVID-19, the virus has continuously mutated and can survive in the air for long periods of time. This paper establishes and analyzes a model of COVID-19 with self-protection and quarantine measures affected by viruses in the environment to investigate the influence of viruses in the environment on the spread of the outbreak, as well as to develop a rational prevention and control measure to control the spread of the outbreak. The basic reproduction number was calculated and Lyapunov functions were constructed to discuss the stability of the model equilibrium points. The disease-free equilibrium point was proven to be globally asymptotically stable when $ R_0 < 1 $, and the endemic equilibrium point was globally asymptotically stable when $ R_0 > 1 $. The model was fitted using data from COVID-19 cases in Chongqing between November 1 to November 25, 2022. Based on the numerical analysis, the following conclusion was obtained: clearing the virus in the environment and strengthening the isolation measures for infected people can control the epidemic to a certain extent, but enhancing the self-protection of individuals can be more effective in reducing the risk of being infected and controlling the transmission of the epidemic, which is more conducive to the practical application.

Editorial How Technology Can Build Resilience to Achieve a Sustainable World: Overcoming Challenges for Humanity to Fight Global Outbreaks

Editorial How Technology Can Build Resilience to Achieve a Sustainable World: Overcoming Challenges for Humanity to Fight Global Outbreaks

Global Outbreak Alert and Response Network (GOARN) focal point engagement meeting with partners in Japan.

Global Outbreak Alert and Response Network (GOARN) focal point engagement meeting with partners in Japan.