Health Security Threats Research Articles

Enabling multiple health security threats detection using mobile edge computing

The purposeful acts of bioterrorism and the emergence of new pathogens call for developing efficient biosurveillance systems that are capable of detecting health security threats and localizing their origins. For this sake, several biosurveillance systems have been developed and deployed in different regions around the world. The objectives of these systems are to efficiently detect threats and effectively manage responses. Although modern biosurveillance systems start to leverage recent advances in internet-of-things and communication technologies to detect natural biological outbreaks, it is not evident whether these systems can be generalized to detect threats related to purposeful biological attacks. As opposed to natural disease outbreaks, biological attacks can be triggered concurrently at different locations and in vital areas that are traversed by a large number of humans. In this paper, we propose an efficient framework to detect multiple concurrent threats and localize their origins based on real-time information and mobile-edge computing support. The proposed framework is organized into a hierarchical architecture. At the micro-level, monitored humans are equipped with wearable sensors that periodically capture the monitored human vital signs. To process the captured information efficiently, the monitored environment is partitioned into cells. Each cell is assigned a mobile-edge computing (MEC) component that is responsible for processing the monitoring information within its cell. The MEC components then send the processed information to a super component for final processing and to detect possible threats. The experimental results show that the proposed framework accurately detects multiple concurrent health security threats and localize their origins.

Takeshi Kasai: the health security thinker from Japan

Takeshi Kasai: the health security thinker from Japan

Clinical Profile of MDR-TB patients with special reference to kanamycin induced ototoxicity in a tertiary care hospital of eastern India

Introduction: MDR-TB is defined as resistance to isoniazid and rifampicin, with or without resistance to other anti-TB drugs. Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. Kanamycin, is an aminoglycoside antibiotic used to treat multi-drug resistant TB in the intensive phase. Objective: To analyze the patients of MDR-TB with respect to age, sex and presence of comorbidities like diabetes mellitus. Also to study the incidence of hearing impairments among patients of MDR-TB receiving injectable Kanamycin. Methods: 40 patients of MDR-TB diagnosed by sputum culture and drug susceptibility testing (DST) have been classified on the basis of age, sex and presence of diabetes mellitus. All have received injectable Kanamycin for 6months in their intensive phase (IP). Patients giving history of auditory impairments underwent pure tone audiometry (PTA) for detection of sensory neural hearing loss, if any. Result: Out of 40 patients of MDR-TB, 30 were males and the rest 10 were females. Age ranges from 12 to 70 years among which maximum patients fell in the age group of 21-30 years (12 patients). 16 patients were diabetic. After getting Kanamycin, 8 patients gave the history of auditory disturbances and only 1 patient found to have severe sensory neural hearing loss confirmed by pure tone audiometry. Conclusion: Prevalence of MDR-TB has been found more among males and in younger age group. Diabetes Mellitus play a major role here. Kanamycin induced hearing loss is not a very serious concern in our study.

Evolving Threat of Community Acquired Methicillin Resistant Staphylococcus aureus Upper Extremity Infections in the South Pacific: 2011-2015.

Background: Community Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) rates have been increasing worldwide and contribute to a growing "global health security threat" as reported by the WHO. Our group previously reported an overall rate of 7% in CA-MRSA upper extremity infections between 2004-2009 at the Auckland Regional Hand Unit. This fell below the Center for Disease Control (CDC) recommendation for empiric antimicrobial cover once local rates exceed 10-15%. We examined prevalence and characteristics of CA-MRSA upper extremity infections in our region over a subsequent 5-year period. Methods: One thousand two hundred and fifty-two patients with upper extremity infections requiring operative management between 2011 and 2015 inclusive were included in this study. Associated clinical characteristics were recorded including ethnicity, cultured organisms, antibiotic sensitivities, infection rate, and treatment practice. Results: One hundred and fifty (12%) of patients had culture positive CA-MRSA upper extremity infections. There was an increasing annual trend. Of note, rates of CA-MRSA in the Maori and Pacific Island ethnic subpopulations exceeded 15% in 2014 and 2015. Susceptibilities, associated factors and patient demographics are reported. Conclusions: Our unit enjoys significantly lower rates of CA-MRSA upper extremity infections than has been reported internationally. However, trends are increasing relative to our prior 6-year report, and the threshold for empiric treatment has been met within the Maori and Pacific Island ethnic subpopulations. This evolving threat is also highlighted by increasing cases of multi-drug resistant CA-MRSA. Evolving regional guidelines for empiric coverage of CA-MRSA among high-risk ethnic subpopulations identified by this study are underway.

The Importance of Wildlife Disease Monitoring as Part of Global Surveillance for Zoonotic Diseases: The Role of Australia.

Australia has a comprehensive system of capabilities and functions to prepare, detect and respond to health security threats. Strong cooperative links and coordination mechanisms exist between the human (public health) and animal arms of the health system in Australia. Wildlife is included in this system. Recent reviews of both the animal and human health sectors have highlighted Australia’s relative strengths in the detection and management of emerging zoonotic diseases. However, the risks to Australia posed by diseases with wildlife as part of their epidemiology will almost certainly become greater with changing land use and climate change and as societal attitudes bring wildlife, livestock and people into closer contact. These risks are not isolated to Australia but are global. A greater emphasis on wildlife disease surveillance to assist in the detection of emerging infectious diseases and integration of wildlife health into One Health policy will be critical in better preparing Australia and other countries in their efforts to recognize and manage the adverse impacts of zoonotic diseases on human health. Animal and human health practitioners are encouraged to consider wildlife in their day to day activities and to learn more about Australia’s system and how they can become more involved by visiting www.wildlifeheathaustralia.com.au.

Post-Ebola Awakening: Urgent Call for Investing in Maintaining Effective Preparedness Capacities at the National and Regional Levels in Sub-Saharan Africa.

Background:The 2014 Ebola outbreak reminded us of the importance of preparedness for addressing health security threats. Learning from this experience, we aim to (1) enhance the understanding of preparedness by policy and decision makers, (2) discuss opportunities for Africa to invest in the prevention of health security threats, (3) highlight the value of investing in preventing health security threats, and (4) propose innovations to enhance investments for the prevention or containment of health security threats at the source.Methods:We used observations of governments' attitudes towards investing in preparedness for health security prevention or containment at the source. We conducted a literature review through PubMed, the World Wide Web, and Mendeley using the keywords: “health emergency financing”, “investing in health threats prevention”, and “stopping outbreaks at the source”.Results:Countries in sub-Saharan Africa invest inadequately towards building and maintaining critical capacities for preventing, detecting, and containing outbreaks at the source. Global health security emergency funding schemes target responses to outbreaks but neglect their prevention. Governments are not absorbing and maintaining adequately capacity built through GHS, World Bank, and development aid projects – a lost opportunity for building and retaining outbreak prevention capacity.Recommendations:Governments should (1) allocate adequate national budgets for health honouring the Abuja and related commitments; (2) own and maintain capacities developed through International Development Aids, OH networks, research consortia and projects; (3) establish a regional health security threats prevention fund. The global community and scientists should (1) consider broadening existing health emergency funds to finance the prevention and containment outbreaks at the source and (2) Strengthen economic analyses and case studies as incentives for governments' budget allocations to prevent health security threats.

Recognizing noncommunicable diseases as a global health security threat.

Recognizing noncommunicable diseases as a global health security threat.

100 years on: the Spanish Flu, pandemics and keeping nurses safe.

100 years on: the Spanish Flu, pandemics and keeping nurses safe.

Managing emerging transnational public health security threats: lessons learned from the 2014 West African Ebola outbreak

BackgroundPandemics pose significant security/stability risks to nations with fragile infrastructures. We evaluated characteristics of the 2014 West African Ebola outbreak to elucidate lessons learned for managing transnational public health security threats.MethodsWe used publically available data to compare demographic and outbreak-specific data for Guinea, Sierra Leone, and Liberia, including key indicator data by the World Health Organization. Pearson correlation statistics were calculated to compare country-level infrastructure characteristics with outbreak size and duration.ResultsHospital bed density was inversely correlated with longer EVD outbreak duration (r = − 0.99). Country-specific funding amount allocations were more likely associated with number of incident cases than the population at-risk or infrastructure needs. Key indicators demonstrating challenges for Guinea included: number of unsafe burials, percent of EVD-positive samples, and days between symptom onset and case hospitalization. Sierra Leone’s primary key indicator was the number of districts with ≥1 security incident. Liberia controlled their outbreak before much of the key-indicator data were collected.ConclusionMany of the country-level factors, particularly the WHO key indicators were associated with controlling the epidemic. The infrastructure of countries affected by communicable diseases should be assessed by international political and public health leaders.

Nervous System Infections and the Global Traveler.

Neurological complications of infectious diseases are associated with high rates of morbidity and mortality. It is imperative that neurologists be up-to-date on current developments including typical and atypical presentations of neurological infections in travelers, diagnostic and treatment recommendations, and emerging pathogen resistance patterns to avoid fatal outcomes and long-term sequelae. This article will address concepts of emerging and reemerging infectious diseases, and will provide updates on the neurological manifestations of select emerging and reemerging infections, including Ebola virus, bacterial meningitis, enterovirus 71, Zika virus, cerebral malaria, and Japanese encephalitis. Emerging and reemerging neurotropic infectious diseases, including Zika virus, have recently been major global health threats. Factors contributing to the emergence of infectious diseases include closer contact with zoonoses, population growth in cities, globalization, environmental changes, and the rise in antibiotic resistance. Serotype replacement of bacterial meningitis, the possibility of viral persistence in the central nervous system in Ebola virus, antibiotic resistance of malaria, and the evolution of neurovirulent strains of Zika virus display some of the developing challenges that accompany various neurotropic infectious diseases. Neurologists should be aware of the factors contributing to the emergence and reemergence of neurotropic infectious diseases. As emerging and reemerging neurotropic infectious continue to be a major global health security threat, clinicians should be aware of the risks to travelers and current guidelines on prevention and management.

Capacity Development through the US President's Malaria Initiative-Supported Antimalarial Resistance Monitoring in Africa Network.

Antimalarial drug resistance is an evolving global health security threat to malaria control. Early detection of Plasmodium falciparum resistance through therapeutic efficacy studies and associated genetic analyses may facilitate timely implementation of intervention strategies. The US President’s Malaria Initiative–supported Antimalarial Resistance Monitoring in Africa Network has assisted numerous laboratories in partner countries in acquiring the knowledge and capability to independently monitor for molecular markers of antimalarial drug resistance.

Health Security in Hawaii by 2050: The Physical Effects of Climate Change

Abstract The World Health Organization defined climate change as the most important issue for the 21st century. In 2014, the State of Hawaii called climate change “a matter of security” that directly threatens “economic systems – food, water, energy, biodiversity and health” and has called for “actionable information for local decision making.” According to the Intergovernmental Panel on Climate Change, the burden of human morbidity attributable to climate change is relatively small although not well quantified. Nevertheless, generic climate change impacts are often used to justify actions without adequate supporting local evidence. This paper analyzes Hawaii’s health risks in relation to air pollution, heat extremes, ultraviolet radiation, and weather extremes and finds that Hawaii’s natural geography, robust water, and sanitation infrastructure render the islands less vulnerable to many of the often-mentioned climate change threats. It concludes that the health security threat posed by climate change effects on Hawaii’s physical environment over the next 35 years is slight in most areas and moderate with regard to ecosystem health. Because all global communities tend to be both discrete and unique in their vulnerability, it recommends the collection of grassroots, community-based resilience data to reveal local vulnerabilities that can inform strategic statewide planning.

Challenges in achieving the sustainable development goal on good health and well-being: Global governance as an issue for the means of implementation

To formulate health development policy and strategies aimed at the Sustainable Development Goal 3, which seeks to ensuring health and well-being for all, it is indispensable to revisit the issue of global health governance in the wake of the Ebola virus disease outbreak in West Africa. The issue of global health governance is also relevant in the Asia-Pacific region, where Severe Acute Respiratory Syndrome (SARS), influenza A (H1N1) and the Middle East respiratory syndrome coronavirus (MERS-CoV) were health security threats. The failure to respond timely and effectively to the health crisis was derived from a few factors that are relevant to the means of implementation necessary to achieve the Sustainable Development Goals. During ordinary times, efforts to enhance health systems should include building the core capacities of the International Health Regulations (IHR), which should be supported not only by the World Health Organization (WHO), but also through coordination among diverse multilateral and bilateral organizations as part of their health development cooperation programmes associated with achieving the Sustainable Development Goals. To enhance preparedness for handling health crises, the organizational capacities of WHO and its regional offices need to be strengthened. In addition, coordination among WHO and other actors should be facilitated in accordance with the situational categories based on the combination of (a) the capacity of the country where an outbreak of an infectious disease is occurring and (b) the severity and magnitude of that infectious disease.

Protecting the Nation from Health Security Threats.

Protecting the Nation from Health Security Threats.

Applying a Capability Maturity Model (CMM) to evaluate global health security-related research programmes in under-resourced areas

Organisations in under-resourced areas that achieve long-term research sustainability by successfully competing for research funding will not only build their reputation for conducting quality science but also develop their human resources in a manner that reduces the risk of becoming a future security threat. Major challenges to these organisations include identifying and prioritising funding opportunities, securing and administering external grant awards and publishing both the outcomes of research and relevant surveillance data. Lack of a standardised evaluation technique to assess institutional research capabilities poses challenges for identifying and targeting specific, repeatable processes that lead to organisational improvements. Short- and long-term goals, which are challenged by research quality, funding and human resources, need to be established in order to achieve complex missions such as reducing global health security threats. Once baseline capabilities are established, a consistent evaluation technique provides an objective view to complement other steps that enhance capabilities. The capability maturity model, which is often used in business and technology sectors for establishing life cycle and planning sustainment, is a technique that enhances performance by defining three levels of capability (initial, managed and optimised). An organisation can assess its current state of capability (‘as is’) and develop an actionable strategy for its next progression (‘to be’). In addition, application of a CMM aids creation of a strategy for realising a more repeatable and optimised process. Research programmes frequently rely on basic metrics such as the number of peer-reviewed publications and grant funding awards to measure their quality. Our analysis suggests an approach that includes references and tools, especially those that are risk-based, which can be used to establish initial best practices, define metrics, measure outputs and rates of success in a stepwise manner. In addition, we provide a pilot example from a survey of research institutes in under-resourced areas.

Practical recommendations for strengthening national and regional laboratory networks in Africa in the Global Health Security era.

The role of national health laboratories in support of public health response has expanded beyond laboratory testing to include a number of other core functions such as emergency response, training and outreach, communications, laboratory-based surveillance and data management. These functions can only be accomplished by an efficient and resilient national laboratory network that includes public health, reference, clinical and other laboratories. It is a primary responsibility of the national health laboratory in the Ministry of Health to develop and maintain the national laboratory network in the country. In this article, we present practical recommendations based on 17 years of network development experience for the development of effective national laboratory networks. These recommendations and examples of current laboratory networks, are provided to facilitate laboratory network development in other states. The development of resilient, integrated laboratory networks will enhance each state’s public health system and is critical to the development of a robust national laboratory response network to meet global health security threats.

Strengthening Surveillance for Health Security Threats: The Time Is Now.

Strengthening Surveillance for Health Security Threats: The Time Is Now.

Managing Emerging Health Security Threats Since 9/11: The Role of Intelligence

The health and broader biosecurity environment has evolved dramatically since 11 September 2001 (9/11). Less clear is the role intelligence should play in understanding emerging bio-threats. Unders...

Radicalized Health Care Workers and the Risk of Ebola as a Bioterror Weapon

A biological attack employing the deliberate spread of Ebola virus by radicalized health care workers is a significant public health and national security threat. The chain of custody for medical materials contaminated with Ebola can be vast, and opportunities for health care workers to self-infect themselves with Ebola exist. As demonstrated in recent years, Westerners will support Islamic terror organizations by carrying out attacks on domestic soil. This paper addresses scenarios by which Ebola virus could be disseminated into unsuspecting populations by health care workers. Also elucidated are risk mitigation methods.

The Emergence of Zika Virus as a Global Health Security Threat: A Review and a Consensus Statement of the INDUSEM Joint working Group (JWG).

The Zika virus (ZIKV), first discovered in 1947, has emerged as a global public health threat over the last decade, with the accelerated geographic spread of the virus noted during the last 5 years. The World Health Organization (WHO) predicts that millions of cases of ZIKV are likely to occur in the Americas during the next 12 months. These projections, in conjunction with suspected Zika-associated increase in newborn microcephaly cases, prompted WHO to declare public health emergency of international concern. ZIKV-associated illness is characterized by an incubation period of 3-12 days. Most patients remain asymptomatic (i.e., ~80%) after contracting the virus. When symptomatic, clinical presentation is usually mild and consists of a self-limiting febrile illness that lasts approximately 2-7 days. Among common clinical manifestations are fever, arthralgia, conjunctivitis, myalgia, headache, and maculopapular rash. Hospitalization and complication rates are low, with fatalities being extremely rare. Newborn microcephaly, the most devastating and insidious complication associated with the ZIKV, has been described in the offspring of women who became infected while pregnant. Much remains to be elucidated about the timing of ZIKV infection in the context of the temporal progression of pregnancy, the corresponding in utero fetal development stage(s), and the risk of microcephaly. Without further knowledge of the pathophysiology involved, the true risk of ZIKV to the unborn remains difficult to quantify and remediate. Accurate, portable, and inexpensive point-of-care testing is required to better identify cases and manage the current and future outbreaks of ZIKV, including optimization of preventive approaches and the identification of more effective risk reduction strategies. In addition, much more work needs to be done to produce an effective vaccine. Given the rapid geographic spread of ZIKV in recent years, a coordinated local, regional, and global effort is needed to generate sufficient resources and political traction to effectively halt and contain further expansion of the current outbreak.