Illness Surveillance Research Articles

Health challenges and facilitators of arbaeen pilgrimage: a scoping review

BackgroundThe Arbaeen Pilgrimage, a momentous religious journey drawing millions of participants annually, presents a profound spiritual experience. However, amidst its significance lie various health challenges that pilgrims encounter along the way. Addressing these challenges is vital to ensure the well-being of participants and the success of this extraordinary event. In light of this, the aim of this study is to examine the health challenges of the Arbaeen Pilgrimage, identify facilitators for solving these challenges, and propose effective solutions to enhance the overall pilgrimage experience for all involved.MethodsThe scoping review was performed by searching databases such as Web of Science, PubMed, Scopus, and Google Scholar search engine with a focus on the keywords “Arbaeen”, “Arbaeen walk” and “Arbaeen pilgrimage”. The search was not constrained by a specific time limitation in the databases. Data from studies were extracted using a data extraction form consisting of 9 fields. The selection of articles and data extraction were carried out by two researchers, adhering to predefined inclusion and exclusion criteria. Any disagreements were resolved through consultation with a third researcher. The study was reported following the PRISMA checklist.ResultsOut of 1619 retrieved articles, 9 were finally included in this study. All these studies were published since 2017 and conducted in Iraq and Iran. In total, 101 health challenges and facilitators were identified, comprising 61 challenges and 40 facilitators. The challenges with the highest frequency included “infectious disease outbreaks” (n = 7), “Poor management of Iraq’s health system in waste collection and disposal” (n = 4), “Rising incidence of walking injuries among pilgrims (e.g., burns, fractures, lacerations, wounds, and blisters)” (n = 4), and “Insufficient knowledge about personal and public health“(n = 4). The most important facilitators to solving the challenges were: “Customized pilgrim training and addressing their issues, with a focus on vital practices” (n = 6), “Coordinating mass gathering stakeholders, including health ministries and organizations” (n = 4), and “Implementing an agile syndromic system for rapid surveillance and identification of contagious illnesses” (n = 4).ConclusionThe article discusses health challenges faced during the Arbaeen Pilgrimage and proposes facilitative measures for participants’ well-being. It emphasizes the significance of addressing health risks in large gatherings and suggests incorporating measures for a safer and enjoyable pilgrimage experience. Overall, understanding and managing these health factors can lead to a successful execution of the Arbaeen Pilgrimage, benefiting the physical and spiritual well-being of all involved.

What is the Injury Incidence and Profile in Professional Male Ice Hockey? A Systematic Review.

Professional male ice hockey is characterized by a congested in-season match schedule and by different scenarios where the whole body is exposed to great internal and external forces. Consequently, injuries occur from head to toe. However, there is a lack of data synthesis regarding the injury incidence and profile in this population. The aim of this study was to conduct a systematic review to quantify the injury incidence rates in professional male ice hockey. Systematic Review. The electronic databases PubMed, CINAHL, Web of Science, ProQuest-Sport medicine & Education Index, and Pro-Quest Dissertation and Thesis were searched utilizing terms related to ice hockey and injuries. Studies were included if they provided the incidence of injury in professional male hockey players and reported injuries in terms of time lost. The modified Newcastle Ottawa Scale for cohort studies and the Strengthening the Reporting of Observational Studies in Epidemiology - Sports Injury and Illness Surveillance Statement were used to assess the methodological quality of the studies. Eleven studies were included in the review. Match injury incidence ranged from 38 to 88.6 injuries/1000 hours of exposure, whereas training injury incidence varied from 0.4 to 2.6 injuries/1000 hours of exposure. Injuries of traumatic origin accounted for 76% to 96.6% of all injuries, with contusions and lacerations being the most common. Severe injuries accounted for 7.8% - 20% of all injuries. The lower extremities were the most susceptible to injury, comprising 27% to 53.7% of all reported injuries. Professional male ice hockey players are exposed to a substantial risk of injury during competitions, with lower extremities being the most commonly affected body part. The majority of injuries are traumatic and severe injuries account for a notable portion of overall injury cases.

Editorial

From Editor’s Desk… Fungal diseases remain a major medical concern, posing a global hazard to human health and affecting about one billion people. The second wave of COVID-19 has hit particularly hard, drastically increasing the incidence of invasive fungal infections in countries like India. Fungal infections linked to COVID-19, primarily caused by Aspergillus and Candida species, as well as fungus belonging to the order Mucorales, have been documented in multiple countries as posing a serious threat to the healthcare system. Individuals with COVID-19 who are hospitalized are more likely to have fungal co-infections, which can worsen their prognosis by misdiagnosing the illness, which frequently leads to treatment failure and a high death rate. Elderly, critically ill, and immunocompromised patients are more prone to opportunistic fungal diseases. Other rare but increasingly common fungal infections include those caused by Pneumocystis jirovecii, Histoplasma sp., Cryptococcus sp., and others. Fungal-related hospitalizations rose by 8.5% annually in the US between 2019 and 2021, per data that was released. Compared to patients with non-COVID-19 associated fungal infections (12.3%), hospitalized patients with COVID-19 linked fungal infections had greater in-hospital mortality rates (48.5%). More surveillance for fungal diseases is required, especially during pandemics of respiratory viruses. Given the enormous worldwide devastation caused by the COVID-19 pandemic, it is imperative that we get more ready for infectious disease outbreaks in the future and conduct thorough public health surveillance for fungal illnesses in order to characterize disease epidemiology and direct efforts to prevent illness and death. Healthcare professionals should be more informed and ready, particularly when it comes to high-risk patients. More research, improved treatment techniques, and quicker diagnosis are required to manage these fungal infections. Dr. Khalid Mohammed Alabdulwahhab Editor in Chief

Identifying immunological markers for bowel cancer

The role of immunological processes in the pathophysiology of colorectal cancer has received a lot of attention lately and has been extensively researched. Immune processes are significantly regulated by cytokines and antimicrobial peptides (AMP). Numerous studies have demonstrated the significance of cytokines in the prognosis and surveillance of malignant oncological illnesses. In group II, the blood serum concentration of Calprotectin was found to be greater in 13 patients (92.0%) and lower in 1 patient (8.0%) compared to control limits (χ=24.27, p<0.001). The obtained results show that, in comparison to the control group, the concentration of Calprotectin rises statistically consistently by 3.5 times, with a coefficient of integrity of p<0.001. According to the data, there is a statistically significant rise in Calprotectin concentration (3.5 times higher than in the control group) with a p-value of less than 0.001. The average mathematical density of this indicator is 3.42±0.48 pg/ml, the minimum density is 0.7 pg/ml, and the maximum thickness is 6.1 pg/ml.

Decreased Seasonal Influenza Rates Detected in a Crowdsourced Influenza-Like Illness Surveillance System During the COVID-19 Pandemic: Prospective Cohort Study.

Seasonal respiratory viruses had lower incidence during their 2019-2020 and 2020-2021 seasons, which overlapped with the COVID-19 pandemic. The widespread implementation of precautionary measures to prevent transmission of SARS-CoV-2 has been seen to also mitigate transmission of seasonal influenza. The COVID-19 pandemic also led to changes in care seeking and access. Participatory surveillance systems have historically captured mild illnesses that are often missed by surveillance systems that rely on encounters with a health care provider for detection. This study aimed to assess if a crowdsourced syndromic surveillance system capable of detecting mild influenza-like illness (ILI) also captured the globally observed decrease in ILI in the 2019-2020 and 2020-2021 influenza seasons, concurrent with the COVID-19 pandemic. Flu Near You (FNY) is a web-based participatory syndromic surveillance system that allows participants in the United States to report their health information using a brief weekly survey. Reminder emails are sent to registered FNY participants to report on their symptoms and the symptoms of household members. Guest participants may also report. ILI was defined as fever and sore throat or fever and cough. ILI rates were determined as the number of ILI reports over the total number of reports and assessed for the 2016-2017, 2017-2018, 2018-2019, 2019-2020, and 2020-2021 influenza seasons. Baseline season (2016-2017, 2017-2018, and 2018-2019) rates were compared to the 2019-2020 and 2020-2021 influenza seasons. Self-reported influenza diagnosis and vaccination status were captured and assessed as the total number of reported events over the total number of reports submitted. CIs for all proportions were calculated via a 1-sample test of proportions. ILI was detected in 3.8% (32,239/848,878) of participants in the baseline seasons (2016-2019), 2.58% (7418/287,909) in the 2019-2020 season, and 0.27% (546/201,079) in the 2020-2021 season. Both influenza seasons that overlapped with the COVID-19 pandemic had lower ILI rates than the baseline seasons. ILI decline was observed during the months with widespread implementation of COVID-19 precautions, starting in February 2020. Self-reported influenza diagnoses decreased from early 2020 through the influenza season. Self-reported influenza positivity among ILI cases varied over the observed time period. Self-reported influenza vaccination rates in FNY were high across all observed seasons. A decrease in ILI was detected in the crowdsourced FNY surveillance system during the 2019-2020 and 2020-2021 influenza seasons, mirroring trends observed in other influenza surveillance systems. Specifically, the months within seasons that overlapped with widespread pandemic precautions showed decreases in ILI and confirmed influenza. Concerns persist regarding respiratory pathogens re-emerging with changes to COVID-19 guidelines. Traditional surveillance is subject to changes in health care behaviors. Systems like FNY are uniquely situated to detect disease across disease severity and care seeking, providing key insights during public health emergencies.

Influenza activity and regional mortality for non-small cell lung cancer

Lung cancer is the leading cause of cancer deaths in the United States and worldwide. While influenza illness is known to be particularly dangerous for frail and elderly patients, the relationship between influenza illness and outcomes in patients with cancer remains largely unknown. The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with non-small cell lung cancer (NSCLC) diagnosed between 2009 and 2015. Influenza-like illness (ILI) activity, provided by the Outpatient Influenza-like Illness Surveillance Network of the Center of Disease for Control and Prevention, was merged with the SEER dataset on the state-month level. Regional monthly mortality rates were compared during low versus high flu months in this ecological cohort study. 202,485 patients with NSCLC from 13 SEER-reporting states were included in the analysis. 53 of 1049 state-months (5.1%) had high flu activity. Monthly mortality rates during low and high flu months were 0.041 (95% CI 0.041–0.042) and 0.051 (95% CI 0.050–0.053), respectively (RR 1.24 [95% CI 1.21–1.27]). The association between ILI activity and mortality was observed at the individual state level and in all clinical and regional subgroups. Increased regional influenza activity is associated with higher mortality rates for patients with NSCLC. Vaccine-directed initiatives and increased awareness amongst providers will be necessary to address the growing but potentially preventable burden of influenza-related lung cancer deaths in the U.S.

Persistent predominance of the Victoria lineage of influenza B virus during COVID-19 epidemic in Nanchang, China.

The sentinel hospital-based influenza-like illness (ILI) surveillance network was established in China since the 2009 H1N1 pandemic. This network plays important roles in monitoring influenza virus variation and identifying novel respiratory pathogens. In this study, we characterized the pathogen spectrum pattern (PSP) of ILI based on three sentinel hospitals and analyzed the significant change of PSP during the COVID-19 epidemic. The notable change of influenza virus spectrum was observed since the beginning of COVID-19 outbreak, and we found persistent domination of Victoria lineage of influenza B virus and "extinction" of A/H1N1, A/H3N2, and B/Yamagata during the dynamic Zero-COVID-19 pandemic in Nanchang, China. However, these strains intermittently co-circulated before the COVID-19.

900. The Epidemiology of Viral Coinfections within Households with Children

Abstract Background Improvements in virus detection using molecular assays, such as multiplex polymerase chain reaction, has led to more common identification of viral coinfections. The incidence of viral coinfections may depend on population factors, such as age structure, distribution of chronic respiratory conditions, geographic location, and setting of the study population (e.g., community, in-patient admission), which has new relevance given observations of coinfections involving SARS-CoV-2. Household-level data on mild to moderate illnesses offer an important complement to other coinfection data that are largely measured in clinical settings. Methods The Household Influenza Vaccine Evaluation (HIVE) study is an ongoing prospective cohort study of households with children in Southeast Michigan that began in 2010. Active acute respiratory illness (ARI) surveillance is conducted, and participants with eligible ARI’s are tested for a range of respiratory pathogens. Descriptive statistics were used to characterize viral coinfections within this cohort for a period prior to the COVID-19 pandemic (2010-2020) and will be performed for a period during the pandemic (2020-2022). The consequences of these coinfections in terms of symptoms and household transmission are under evaluation. Results There were 6,245 virus-positive ARI’s in the cohort from 2010-2020, with multiple viruses detected in 896 (14.3%) ARI’s. Of the coinfections, rhinovirus/enterovirus most frequently appeared (58.15%), followed by common CoV (38.84%), and AdV (24%) (See Figure 1). The most common virus combination was a coronavirus (229E, OC43, NL63, or HKU1) along with rhinovirus/enterovirus, making up 12.05% (n=108) of coinfections. Eight infections were made up of four or more viruses. Similar analyses will be conducted for pandemic-period data. Conclusion While awareness of viral coinfections has grown since the start of the COVID-19 pandemic, coinfections within the HIVE cohort were not uncommon prior to the pandemic. Coronaviruses were the second leading viruses identified in coinfections, which aligns with observations noted during the pandemic. These results contribute important information about coinfections and expand the understanding of respiratory virus dynamics within households. Disclosures Emily T. Martin, PhD, MPH, Merck: Grant/Research Support Arnold Monto, MD, Roche: Advisor/Consultant|Roche: Honoraria

1384. Verbal Autopsy as a Tool to Identify Probable Cause of Death in People with Acute Febrile Illness in Zambia — January 2020-December 2022

Abstract Background Acute febrile illness (AFI) surveillance improves a country’s understanding of what diseases are circulating. However, fever as an entry point for patient identification casts a wide net that will likely capture non-infectious causes of AFI. We used mortality surveillance data to examine probable causes of death (CoD) potentially associated with AFI to expand our understanding of febrile illness in Zambia. Methods The Zambian Ministry of Health provided verbal autopsy (VA) data from 27 (of 117) districts representing ∼50% of Zambia’s population. The World Health Organization’s standardized tool for VA was used by hospital staff to interview relatives or close associates of deceased persons of all ages on clinical presentation and circumstances prior to death. The InterVA-5 validated computer algorithm provided a CoD. Using questionnaire data, we applied an AFI case definition based on common global AFI surveillance criteria: a febrile person with a fever duration of < 1-14 days and a mild, moderate, or severe fever classification (in lieu of a temperature cutoff). We analyzed the CoDs and SARS-CoV-2 infections among those that met our AFI case definition in R. Results From January 2020 to December 2022, 51,751 VAs were conducted on people over 28 days old–14,503 (28%) reported fever prior to death, of which 12,071 (23%) met our AFI case definition. Broadly, we found that 64% of those that met our AFI case definition had an infectious CoD, 32% had a non-communicable CoD, and 4% had other CoDs. Specifically, the most reported CoDs were acute respiratory infection (14%), diarrheal disease (11%), and HIV/AIDS (10%). A positive SARS-CoV-2 test was reported in 965 (8%) persons with AFI versus 1,876 (5%) without AFI (p< 0.001). Conclusion AFI-associated deaths were primarily attributable to infectious disease, as identified through VA. AFI is one approach for multi-pathogen surveillance that provides valuable insight into circulating diseases, including SARS-CoV-2, but findings are limited by which pathogens are targeted for testing. Mortality surveillance is a valuable supplementary data source when attempting to understand inconclusive findings in AFI surveillance and aids in a country’s understanding of common causes of febrile illness not captured through AFI surveillance diagnostics. Disclosures All Authors: No reported disclosures

Responding to avian influenza A H5N1 detection on a hospital property in Maine-An interdisciplinary approach.

The risk of infection with avian influenza A viruses currently circulating in wild and domestic birds in the Americas is considered low for the general public; however, detections in humans have been reported and warning signs of increased zoonotic potential have been identified. In December 2022, two Canada geese residing on the grounds of an urban hospital in Maine tested positive for influenza A H5N1 clade 2.3.4.4b. Given the opportunity for exposure to staff and hospital visitors through potentially infected faeces on the property, public health authorities determined mitigation efforts were needed to prevent the spread of disease. The ensuing response relied on collaboration between the public health and animal health agencies to guide the hospital through efforts in preventing possible zoonotic transmission to humans. Mitigation efforts included staff communication and education, environmental cleaning and disinfection, enhanced illness surveillance among staff and patients, and exposure and source reduction. No human H5N1 cases were identified, and no additional detections in birds on the property occurred. Hospital staff identified barriers to preparedness resulting from a lack of understanding of avian influenza A viruses and transmission prevention methods, including avian influenza risk in resident wild bird populations and proper wildlife management methods. As this virus continues to circulate at the animal-human interface, this event and resulting response highlights the need for influenza A H5N1 risk awareness and guidance for facilities and groups not traditionally involved in avian influenza responses.

Safety and Injury of US-Certified Organic Crop Producers in the Southwest Region

ABSTRACT Objectives Literature on occupational risks among organic farmers is scarce. This study explored safety practices and non-fatal injuries among organic producers, and the role of sociodemographic, work, and farm characteristics on safety and injury. Methods Cross sectional survey of certified organic crop producers in the Southwest (SW) region of the United States (US). The Organic Integrity Database was used for recruitment. Data were collected through an electronic and paper survey. Results Analyses were conducted on 115 cases; response rate was estimated at 25%. A high majority of respondents owned their operation and were younger than 65 years, male, educated beyond high-school, and non-Hispanic whites. Less than half had more than 10 years of experience in organic farming; one-third worked off the farm year-round. Safety practices were very basic despite the widespread use of equipment and machinery, and limited to wearing normal clothing and apparel such hats and glasses. About half of respondents (52.6%) reported non-fatal injuries in the past year; and one-third (32.7%) time lost due to injuries. The overall cumulative incidence rate was estimated at 5.3 injuries per 10 workers within the last year. The injury rate decreased with hours worked. Significant differences were found on gender and education level and safety practices, with female respondents and the more educated being more proactive in practicing safety. Those working less than 40 h/week, in farms smaller than 50 acres, using light machinery or compact utility tractors, and tractors without roll-over protection reported significantly higher injury frequency compared to their counterparts. Conclusion This study contributes unique data on an essential workforce not captured by current occupational injury and illness surveillance systems. It identifies important personal and contextual factors that may contribute to safety and injury in this population. The findings indicate the need to promote safety and prevent injuries that result in work time lost. This study may also inform future occupational safety and health research and practice, including surveillance, injury prevention programs that target certain workers and production practices, and policies that support and protect the organic farmer.

Burden of diarrhea and antibiotic use among children in low-resource settings preventable by Shigella vaccination: A simulation study.

Shigella is a leading cause of diarrhea and dysentery in children in low-resource settings, which is frequently treated with antibiotics. The primary goal of a Shigella vaccine would be to reduce mortality and morbidity associated with Shigella diarrhea. However, ancillary benefits could include reducing antibiotic use and antibiotic exposures for bystander pathogens carried at the time of treatment, specifically for fluoroquinolones and macrolides (F/M), which are the recommended drug classes to treat dysentery. The aim of the study was to quantify the reduction in Shigella attributable diarrhea, all diarrhea, and antibiotic use in the first 2 years of life that could be prevented by a Shigella vaccine. We used data from the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study, a birth cohort study that followed 1,715 children with twice weekly surveillance for enteric infections, illnesses, and antibiotic use for the first 2 years of life from November 2009 to February 2014 at 8 sites. We estimated the impact of 2 one-dose (6 or 9 months) and 3 two-dose (6 and 9 months, 9 and 12 months, and 12 and 15 months) Shigella vaccines on diarrheal episodes, overall antibiotic use, and F/M use. Further, we considered additional protection through indirect and boosting effects. We used Monte Carlo simulations to estimate the absolute and relative reductions in the incidence of diarrhea and antibiotic use comparing each vaccination scenario to no vaccination. We analyzed 9,392 diarrhea episodes and 15,697 antibiotic courses among 1,715 children in the MAL-ED birth cohort study. There were 273.8 diarrhea episodes, 30.6 shigellosis episodes, and 457.6 antibiotic courses per 100 child-years. A Shigella vaccine with a mean vaccine efficacy of 60% against severe disease given at 9 and 12 months prevented 10.6 (95% CI [9.5, 11.5]) Shigella diarrhea episodes of any severity per 100 child-years (relative 34.5% reduction), 3.0 (95% CI [2.5, 3.5]) F/M courses for Shigella treatment per 100 child-years (relative 35.8% reduction), and 5.6 (95% CI [5.0, 6.3]) antibiotic courses of any drug class for Shigella treatment per 100 child-years (relative 34.5% reduction). This translated to a relative 3.8% reduction in all diarrhea, a relative 2.8% reduction in all F/M courses, a relative 3.1% reduction in F/M exposures to bystander pathogens, and a relative 0.9% reduction in all antibiotic courses. These results reflect Shigella incidence and antibiotic use patterns at the 8 MAL-ED sites and may not be generalizable to all low-resource settings. Our simulation results suggest that a Shigella vaccine meeting WHO targets for efficacy could prevent about a third of Shigella diarrhea episodes, antibiotic use to treat shigellosis, and bystander exposures due to shigellosis treatment. However, the reductions in overall diarrhea episodes and antibiotic use are expected to be modest (<5%).

SA Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP): The Currie Cup Premiership Competition Injury Surveillance Report, 2022.

The content of the report is based on data collected by the SA Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP) steering group.

Pan-India influenza-like illness (ILI) and Severe acute respiratory infection (SARI) surveillance: epidemiological, clinical and genomic analysis.

Over time, COVID-19 testing has significantly declined across the world. However, it is critical to monitor the virus through surveillance. In late 2020, WHO released interim guidance advising the use of the existing Global Influenza Surveillance and Response System (GISRS) for the integrated surveillance of influenza and SARS-CoV-2. In July 2021, we initiated a pan-India integrated surveillance for influenza and SARS-CoV-2 through the geographically representative network of Virus Research and Diagnostic Laboratories (VRDLs) across 26 hospital and laboratory sites and 70 community sites. A total of 34,260 cases of influenza-like illness (ILI) and Severe acute respiratory infection (SARI) were enrolled from 4 July 2021 to 31 October 2022. Influenza A(H3) and B/Victoria dominated during 2021 monsoon season while A(H1N1)pdm09 dominated during 2022 monsoon season. The SARS-CoV-2 "variants of concern" (VoC) Delta and Omicron predominated in 2021 and 2022, respectively. Increased proportion of SARI was seen in extremes of age: 90% cases in < 1 year; 68% in 1 to 5 years and 61% in ≥ 8 years age group. Approximately 40.7% of enrolled cases only partially fulfilled WHO ILI and SARI case definitions. Influenza- and SARS-CoV-2-infected comorbid patients had higher risks of hospitalization, ICU admission, and oxygen requirement. The results depicted the varying strains and transmission dynamics of influenza and SARS-CoV-2 viruses over time, thus emphasizing the need to continue and expand surveillance across countries for improved decision making. The study also describes important information related to clinical outcomes of ILI and SARI patients and highlights the need to review existing WHO ILI and SARI case definitions.

Database derived from an electronic medical record-based surveillance network of US emergency department patients with acute respiratory illness

BackgroundFor surveillance of episodic illness, the emergency department (ED) represents one of the largest interfaces for generalizable data about segments of the US public experiencing a need for unscheduled care. This protocol manuscript describes the development and operation of a national network linking symptom, clinical, laboratory and disposition data that provides a public database dedicated to the surveillance of acute respiratory infections (ARIs) in EDs.MethodsThe Respiratory Virus Laboratory Emergency Department Network Surveillance (RESP-LENS) network includes 26 academic investigators, from 24 sites, with 91 hospitals, and the Centers for Disease Control and Prevention (CDC) to survey viral infections. All data originate from electronic medical records (EMRs) accessed by structured query language (SQL) coding. Each Tuesday, data are imported into the standard data form for ARI visits that occurred the prior week (termed the index file); outcomes at 30 days and ED volume are also recorded. Up to 325 data fields can be populated for each case. Data are transferred from sites into an encrypted Google Cloud Platform, then programmatically checked for compliance, parsed, and aggregated into a central database housed on a second cloud platform prior to transfer to CDC.ResultsAs of August, 2023, the network has reported data on over 870,000 ARI cases selected from approximately 5.2 million ED encounters. Post-contracting challenges to network execution have included local shifts in testing policies and platforms, delays in ICD-10 coding to detect ARI cases, and site-level personnel turnover. The network is addressing these challenges and is poised to begin streaming weekly data for dissemination.ConclusionsThe RESP-LENS network provides a weekly updated database that is a public health resource to survey the epidemiology, viral causes, and outcomes of ED patients with acute respiratory infections.

Comparison of Influenza-Like Illness (ILI) incidence data from the novel LeCellPHIA participatory surveillance system with COVID-19 case count data, Lesotho, July 2020 – July 2021

BackgroundWhile laboratory testing for infectious diseases such as COVID-19 is the surveillance gold standard, it is not always feasible, particularly in settings where resources are scarce. In the small country of Lesotho, located in sub-Saharan Africa, COVID-19 testing has been limited, thus surveillance data available to local authorities are limited. The goal of this study was to compare a participatory influenza-like illness (ILI) surveillance system in Lesotho with COVID-19 case count data, and ultimately to determine whether the participatory surveillance system adequately estimates the case count data.MethodsA nationally-representative sample was called on their mobile phones weekly to create an estimate of incidence of ILI between July 2020 and July 2021. Case counts from the website Our World in Data (OWID) were used as the gold standard to which our participatory surveillance data were compared. We calculated Spearman’s and Pearson’s correlation coefficients to compare the weekly incidence of ILI reports to COVID-19 case count data.ResultsOver course of the study period, an ILI symptom was reported 1,085 times via participatory surveillance for an average annual cumulative incidence of 45.7 per 100 people (95% Confidence Interval [CI]: 40.7 – 51.4). The cumulative incidence of reports of ILI symptoms was similar among males (46.5, 95% CI: 39.6 – 54.4) and females (45.1, 95% CI: 39.8 – 51.1). There was a slightly higher annual cumulative incidence of ILI among persons living in peri-urban (49.5, 95% CI: 31.7 – 77.3) and urban settings compared to rural areas. The January peak of the participatory surveillance system ILI estimates correlated significantly with the January peak of the COVID-19 case count data (Spearman’s correlation coefficient = 0.49; P < 0.001) (Pearson’s correlation coefficient = 0.67; P < 0.0001).ConclusionsThe ILI trends captured by the participatory surveillance system in Lesotho mirrored trends of the COVID-19 case count data from Our World in Data. Public health practitioners in geographies that lack the resources to conduct direct surveillance of infectious diseases may be able to use cell phone-based data collection to monitor trends.

Diversity of Non-Influenza Respiratory Viruses Associated with Influenza-Like Illness during 2009 pre and pandemic periods in Sao Paulo, Brazil, a Historical Overview

Background and objective: During the 2009 influenza A (H1N1) pandemic, 60% of the respiratory specimens collected from patients under surveillance for influenza-like illness (ILI) in São Paulo, Brazil, tested negative for influenza A and B by Real-Time RT-PCR (RT-qPCR) assays. In this retrospective study, we identified the diversity of other respiratory viruses associated with ILI during the pandemic period and added the benefit of RT-qPCR for their detection. Methods: Five-hundred and forty-two influenza RT-qPCR negative respiratory specimens from ILI patients collected from Jan - Dec 2009, that also tested negative by a commercial Indirect Immuno Fluorescence (IIF) assay for the Respiratory Syncytial Virus (RSV), Parainfluenza (PIV) PIV1, PIV2, PIV 3 and Adenovirus (AdV) were retested by a panel of RT-qPCR assays for the other respiratory viruses, including RSV, Human Metapneumovirus (HMPV), PIV 1-4, AdV, Human Coronaviruses (HCoV) OC43, 229E, NL63 and HKU1, Rhinovirus (RV), Enterovirus (EV) and Human Bocavirus (HBoV). Results: Of the 542 negative specimens, 428 (78%) were positive by RT-qPCR for another respiratory virus: In descending order: RV (149, 27%); RSV (41, 8%); AdV (32, 6%); HMPV (29, 5%); PIV3 (19, 4%); PIV1 (3, 1%); HCoV-OC43 (9, 2%); HBoV (9, 2%); PIV4 (6, 1%); HCoV-HKU1 (6, 1%); EV (5, 1%); HCoV-229E 4 (4, 1%); HCoV-NL63 (3, 1%). Co-detections of two viruses (98, 18%) and three viruses (12, 2%) were common. Conclusion: This retrospective study revealed a high prevalence of respiratory viruses other than influenza associated with ILI during the pandemic period and highlights the superiority of RT-qPCR over IIF for ILI surveillance.

Expanding the role of village malaria workers in Cambodia: Implementation and evaluation of four health education packages.

Early access to correct diagnosis and appropriate treatment is essential for malaria elimination, and in Cambodia this relies on village malaria workers (VMWs). Decreasing malaria transmission leave VMWs with diminished roles. Activities related to the control of other health conditions could keep these community health workers relevant. During 2022, 120 VMWs attended training at local health centres on four health education packages: 1. hygiene and sanitation; 2. disease surveillance; 3. management of mild illness; 4. vaccination and antenatal care. All training and evaluation sessions were documented through meeting minutes, and 19 focus group discussions (FGDs) were conducted among VMWs and health centre personnel. Audio-records of FGDs were transcribed and translated in English and underwent thematic analysis. VMWs reported strong interest in the training and welcomed the expansion of their roles thus assuring their continued relevance. VMWs prioritized disease surveillance and management of mild illness among the available training packages because these topics were seen as most relevant. While training was considered comprehensible and important, the low literacy among VMWs was an impediment suggesting training materials need to be delivered visually. Since VMWs have limited resources, incentives could ensure that VMWs are motivated to undertake additional roles and responsibilities. The transformation of VMWs into community health workers with roles beyond malaria is a promising approach for sustaining health care provision in remote areas. Training needs to consider the low scientific literacy, time constraints and limited resources of VMWs.

Methods on COVID-19 Epidemic Curve Estimation During Emergency Based on Baidu Search Engine and ILI Traditional Surveillance in Beijing, China

Surveillance is an essential work on infectious diseases prevention and control. When the pandemic occurred, the inadequacy of traditional surveillance was exposed, but it also provided a valuable opportunity to explore new surveillance methods. This study aimed to estimate the transmission dynamics and epidemic curve of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron BF.7 in Beijing under the emergent situation using Baidu index and influenza-like illness (ILI) surveillance. A novel hybrid model (multiattention bidirectional gated recurrent unit (MABG)–susceptible–exposed–infected–removed (SEIR)) was developed, which leveraged a deep learning algorithm (MABG) to scrutinize the past records of ILI occurrences and the Baidu index of diverse symptoms such as fever, pyrexia, cough, sore throat, anti-fever medicine, and runny nose. By considering the current Baidu index and the correlation between ILI cases and coronavirus disease 2019 (COVID-19) cases, a transmission dynamics model (SEIR) was formulated to estimate the transmission dynamics and epidemic curve of SARS-CoV-2. During the COVID-19 pandemic, when conventional surveillance measures have been suspended temporarily, cases of ILI can serve as a useful indicator for estimating the epidemiological trends of COVID-19. In the specific case of Beijing, it has been ascertained that cumulative infection attack rate surpass 80.25% (95% confidence interval (95% CI): 77.51%–82.99%) since December 17, 2022, with the apex of the outbreak projected to transpire on December 12. The culmination of existing patients is expected to occur three days subsequent to this peak. Effective reproduction number (Rt) represents the average number of secondary infections generated from a single infected individual at a specific point in time during an epidemic, remained below 1 since December 17, 2022. The traditional disease surveillance systems should be complemented with information from modern surveillance data such as online data sources with advanced technical support. Modern surveillance channels should be used primarily in emerging infectious and disease outbreaks. Syndrome surveillance on COVID-19 should be established to following on the epidemic, clinical severity, and medical resource demand.

Surveillance of respiratory viruses at health facilities from across Kenya, 2014

Background: Acute respiratory illnesses (ARI) are a major cause of morbidity and mortality globally. With (re)emergence of novel viruses and increased access to childhood bacterial vaccines, viruses have assumed greater importance in the aetiology of ARI. There are now promising candidate vaccines against some of the most common endemic respiratory viruses. Optimal delivery strategies for these vaccines, and the need for interventions against other respiratory viruses, requires geographically diverse data capturing temporal variations in virus circulation. Methods: We leveraged three health facility-based respiratory illness surveillance platforms operating in 11 sites across Kenya. Nasopharyngeal (NP) and/or oropharyngeal (OP) specimens, patient demographic, and clinical characteristics were collected in 2014 from individuals of various ages presenting with respiratory symptoms at the surveillance facilities. Real time multiplex polymerase chain reaction was used to detect rhinoviruses, respiratory syncytial virus (RSV), influenza virus, human coronaviruses (hCoV), and adenoviruses. Results: From 11 sites, 5451 NP/OP specimens were collected and tested from patients. Of these, 40.2% were positive for at least one of the targeted respiratory viruses. The most frequently detected were rhinoviruses (17.0%) and RSV A/B (10.5%), followed by influenza A (6.2%), adenovirus (6.0%) and hCoV (4.2%). RSV was most prevalent among infants aged &lt;12 months old (18.9%), adenovirus among children aged 12–23 months old (11.0%), influenza A among children aged 24–59 months (9.3%), and rhinovirus across all age groups (range, 12.7–19.0%). The overall percent virus positivity varied by surveillance site, health facility type and case definition used in surveillance. Conclusions: We identify rhinoviruses, RSV, and influenza A as the most prevalent respiratory viruses. Higher RSV positivity in inpatient settings compared to outpatient clinics strengthen the case for RSV vaccination. To inform the design and delivery of public health interventions, long-term surveillance is required to establish regional heterogeneities in respiratory virus circulation and seasonality.