Infectious Disease Crisis Research Articles

Disaster preparedness to exotic and emerging infections

Exotic and emerging infectious diseases are emerging more frequently, and impacting more profoundly, all of humanity. Disasters risk reduction efforts over the preceding decades, culminating in the Hyogo and Sendai frameworks, have provided a roadmap for all countries to address emerging disaster related risks. Sudden onset or surprise epidemics of exotic or emerging diseases have the potential to exceed the adaptive capacity of countries and international efforts and lead to widespread unmitigated pandemics with severe flow on impacts. In this article pandemic preparedness is viewed through the lens of international disaster risk reduction and preparedness efforts. Preparing for the unknown or unexpected infectious disease crisis requires different approaches than the traditional approaches to disaster related epidemic events. Countries must be able to position themselves optimally through deliberate planning and preparation to a position where future exotic or emerging infections can be managed without overwhelming public health, and other societal resources.

Establishing a theoretical foundation for measuring global health security: a scoping review

BackgroundSince the 2014–2016 West Africa Ebola epidemic, the concept of measuring health security capacity has become increasingly important within the broader context of health systems-strengthening, enhancing responses to public health emergencies, and reducing global catastrophic biological risks. Efforts to regularly and sustainably track the evolution of health security capabilities and capacities over time – while also accounting for political, social, and environmental risks – could help countries progress toward eliminating sources of health insecurity. We sought to aggregate evidence-based principles that capture a country’s baseline public health and healthcare capabilities, its health security system performance before and during infectious disease crises, and its broader social, political, security, and ecological risk environments.MethodsWe conducted a scoping review of English-language scholarly and gray literature to identify evidence- and practice-based indicators and proxies for measuring health security at the country level over time. We then used a qualitative coding framework to identify recurrent themes in the literature and synthesize foundational principles for measuring global health security. Documents reviewed included English-language literature published after 2001 until the end of the research period—September 2017—to ensure relevance to the current global health security landscape; literature examining acute infectious disease threats with potential for transnational spread; and literature addressing global health security efforts at the country level.ResultsWe synthesized four foundational principles for measuring global health security: measurement requires assessment of existing capacities, as well as efforts to build core public health, healthcare, and biosecurity capabilities; assessments of national programs and efforts to mitigate a critical subset of priority threats could inform efforts to generate useful metrics for global health security; there are measurable enabling factors facilitating health security-strengthening efforts; and finally, measurement requires consideration of social, political, and ecological risk environments.ConclusionThe themes identified in this review could inform efforts to systematically assess the impacts and effectiveness of activities undertaken to strengthen global health security.

Appropriate Governance Responses to Infectious Disease Threats: Developing Working Hypotheses

Infectious diseases remain a threat to public health in today's interconnected world. There is an ongoing debate on how responses to threats of infectious diseases can best be coordinated, and the field remains nascent in understanding which specific structural governance arrangement will perform best. The present paper contributes to this discussion by demonstrating that it is possible to develop working hypotheses specifying the relationship between the type of infectious disease crisis and type of response to the crisis. For type of crises and type of response mechanisms there is still a lack of research, but the hypothesis combining these two provide a perspective for a future research and action agenda. It certainly prevents us from choosing between schism or hypes when it comes to crisis response. It provides instruments to realize that no single type of response is the most effective and that not all responses are equally effective in a concrete case.

1818, 1918, 2018: Two Centuries of Pandemics.

2018 marks the centennial of the 1918 influenza pandemic, widely acknowledged as one of the deadliest infectious disease crises in human history. As public health and medical communities of practice reflect on the aftermath of the influenza pandemic and the ways in which it has altered the trajectory of history and informed current practices in health security, it is worth noting that the Spanish flu was preceded by a very different 100-year threat: the first Asiatic cholera pandemic of 1817 to 1824. In this commentary, we offer a historical analysis of the common socioeconomic, political, and environmental factors underlying both pandemics, consider the roles of cholera and Spanish flu in shaping global health norms and modern public health practices, and examine how strategic applications of soft power and broadening the focus of health security to include sustainable development could help the world prepare for pandemics of the future.

Flight Bans and the Ebola Crisis: Policy Recommendations for Future Global Health Epidemics

Commercial airlines are positioned to be the most effective means to address global infectious disease epidemics. However, during the Ebola epidemic in 2014, many countries responded by shutting down borders and banning flights to Sierra Leone, Guinea and Liberia in attempts to “quarantine” the outbreak. Later studies demonstrated that these flight bans were not only ineffective in controlling the spread of disease but, at times, kept vital humanitarian assistance from reaching the epidemic, effectively providing conditions for the outbreak to grow. This paper examines lessons learned from commercial airline and nation-state behaviors during the Ebola outbreak to recommend how airlines can navigate between the constraints of their for-profit model and responses from nations during the next infectious disease crisis. To address these issues, we propose that before the next global epidemic, the WHO establish an Essential Air Corridor Policy (EAC) centered on global recognition of the need to keep commercial airlines running to affected countries. This policy would have the WHO organize an auction for airlines to bid on service to epidemic-affected areas while also providing a system of incentives to staff members and other airlines employees. The policy would also mandate that leaders from the airline join talks by global experts on the disease and establish mechanisms to ensure airlines have the latest safety protocols for cleaning equipment and surveillance and quarantine of passengers according to the nature of the disease.

The importance of the neighborhood in the 2014 Ebola outbreak in the United States: Distress, worry, and functioning.

Ebola media coverage directed public attention to potential disease carriers: residents or travelers from West Africa. We investigated the role of neighborhood population factors (i.e., the concentration of West African foreigners, non-West African foreigners, non-Hispanic Blacks) on individual responses to the Ebola outbreak in the United States. The role of these community-level factors in emotional responses to this public health crisis is poorly understood. Demographic factors, mental health, and stressful event history, collected as part of an ongoing longitudinal study of residents from 2 metropolitan communities (New York City and Boston, total N = 1,346), were combined with neighborhood data from the U.S. Census. Multilevel models estimated the effects of individual and neighborhood factors on individual psychological distress, functional impairment, and Ebola-related worry. Individuals living in neighborhoods with more West African-born foreigners or non-West African foreigners reported more somatization and anxiety symptoms, functioning difficulties, and/or Ebola-related worry than individuals living in neighborhoods with fewer foreign residents (p < .05). Individuals residing in neighborhoods with more non-Hispanic Blacks also reported more somatization symptoms than their residential counterparts (p < .05). Neighborhood demography is important to study during a public health outbreak like Ebola in which media and policy target specific people or regions. Findings suggest research and policies should not only assist at-risk individuals but also at-risk neighborhoods during and after an infectious disease crisis. (PsycINFO Database Record

US Centers for Disease Control and Prevention and Its Partners' Contributions to Global Health Security.

To achieve compliance with the revised World Health Organization International Health Regulations (IHR 2005), countries must be able to rapidly prevent, detect, and respond to public health threats. Most nations, however, remain unprepared to manage and control complex health emergencies, whether due to natural disasters, emerging infectious disease outbreaks, or the inadvertent or intentional release of highly pathogenic organisms. The US Centers for Disease Control and Prevention (CDC) works with countries and partners to build and strengthen global health security preparedness so they can quickly respond to public health crises. This report highlights selected CDC global health protection platform accomplishments that help mitigate global health threats and build core, cross-cutting capacity to identify and contain disease outbreaks at their source. CDC contributions support country efforts to achieve IHR 2005 compliance, contribute to the international framework for countering infectious disease crises, and enhance health security for Americans and populations around the world.

Failing States as Epidemiologic Risk Zones: Implications for Global Health Security.

Failed states commonly experience health and mortality crises that include outbreaks of infectious disease, violent conflict, reductions in life expectancy, and increased infant and maternal mortality. This article draws from recent research in political science, security studies, and international relations to explore how the process of state failure generates health declines and outbreaks of infectious disease. The key innovation of this model is a revised definition of "the state" as a geographically dynamic rather than static political space. This makes it easier to understand how phases of territorial contraction, collapse, and regeneration interrupt public health programs, destabilize the natural environment, reduce human security, and increase risks of epidemic infectious disease and other humanitarian crises. Better understanding of these dynamics will help international health agencies predict and prepare for future health and mortality crises created by failing states.

The role of primary care professionals in preventive activitites during epidemics. Focus group assessment of the management of flu pandemic in 2009/2010

The experiences gained during the H1N1 flu pandemic in 2009/2010 could serve for a better planning and management of later outbreaks. The EU-sponsored TELL ME project aimed to provide evidence and develop models for improved risk communication during infectious disease crisis. Among its objectives was to develop original communication strategies regarding appropriate messages related to preventative behavior and advice based on uncertainties also addressing vaccine-resistant groups. Focus groups involving family physicians (FPs) were called upon for assessing the main issues during the H1N1 pandemic, the possibilities for improving the preventative process and outcomes. The study demonstrated the key-role of family doctors during outbreaks; patients put their trust in their elected FP, he or she representing a personal example of health behavior. The evidence based information about effectiveness and safety of vaccines are needed in communication towards health professionals. Involvement of health care professionals in the communication provides validity, the communication routine of opinion leaders meant to be used for such purpose. The main media message should be: "For prevention go to see your family doctor". Orv. Hetil., 2017, 158(14), 523-532.

Public Health Surveillance via Template Management in Electronic Health Records: Tri-Service Workflow's Rapid Response to an Infectious Disease Crisis.

To describe the use of template-based screening for risk of infectious disease exposure of patients presenting to primary care medical facilities during the 2014 West African Ebola virus outbreak. The Military Health System implemented an Ebola risk-screening tool in primary care settings in order to create early notifications and early responses to potentially infected persons. Three time-sensitive, evidence-based screening questions were developed and posted to Tri-Service Workflow (TSWF) AHLTA templates in conjunction with appropriate training. Data were collected in January 2015, to assess the adoption of the TSWF-based Ebola risk-screening tool. Among encounters documented using TSWF templates, 41% of all encounters showed use of the TSWF-based Ebola risk-screening questions by the fourth day. The screening rate increased over the next 3 weeks, and reached a plateau at approximately 50%. This report demonstrates the MHS capability to deploy a standardized, globally applicable decision support aid that could be seen the same day by all primary care clinics across the military health direct care system, potentially improving rapid compliance with screening directives.

Assessment of economic vulnerability to infectious disease crises

Infectious disease crises have substantial economic impact. Yet mainstream macroeconomic forecasting rarely takes account of the risk of potential pandemics. This oversight contributes to persistent underestimation of infectious disease risk and consequent underinvestment in preparedness and response to infectious disease crises. One reason why economists fail to include economic vulnerability to infectious disease threats in their assessments is the absence of readily available and digestible input data to inform such analysis. In this Viewpoint we suggest an approach by which the global health community can help to generate such inputs, and a framework to use these inputs to assess the economic vulnerability to infectious disease crises of individual countries and regions. We argue that incorporation of these risks in influential macroeconomic analyses such as the reports from the International Monetary Fund's Article IV consultations, rating agencies and risk consultancies would simultaneously improve the quality of economic risk forecasting and reinforce individual government and donor incentives to mitigate infectious disease risks.

REACTing: the French response to infectious disease crises.

In the past decade, scientific and health systems have been challenged by an increase in the emergence of infectious diseases such as Middle East respiratory syndrome coronavirus, chikungunya, Ebola virus disease, and Zika virus.1–4 An effective and global public health response to these crises depends on our ability to anticipate these events and our level of preparedness. However, the development of research programmes in response to a rapidly emerging infectious disease in an emergency context is a challenge.

Ebola Virus Preparedness: Emerging Viruses and Ethics in Laboratory Medicine.

Emerging pathogens have affected, and will continue to affect, the health care system in diverse ways. Clinical laboratories face ethical challenges in responding to emerging pathogens. We use the 2014-2015 outbreak of Ebola virus disease as a model to explore some of the ethical issues in laboratory medicine related to emerging infectious disease. To describe the major ethical concerns raised in the clinical laboratory environment by emerging infections. We assessed current guidelines and practices in the Ebola outbreak in developed-world clinical laboratories, reviewed risk assessment practices and the role of the clinical laboratory in providing care for patients with potential or confirmed Ebola, and reviewed the relevant literature on duty to provide care in the laboratory context. Clinical laboratories in developed countries have to rely more on expert guidelines and theoretical risk assessments than on practice in less-developed areas. Risk minimization for clinical laboratory workers is essential but may conflict with the laboratory's duty to provide standard of care. Patients can be put at risk not only from loss of laboratory services from restriction of testing but also from impairment of laboratory services in cases of spills or accidents. Significant discrepancies in guidelines from professional and governmental sources exacerbate the difficulty and confusion inherent in dealing with a dynamic, emerging infectious disease crisis. The duty to provide care for laboratory workers is ill-defined. Balancing risks to patients and laboratory workers and benefits to patients presents challenges to laboratory professionals at all levels.

A common feature pharmacophore for FDA-approved drugs inhibiting the Ebola virus.

We are currently faced with a global infectious disease crisis which has been anticipated for decades. While many promising biotherapeutics are being tested, the search for a small molecule has yet to deliver an approved drug or therapeutic for the Ebola or similar filoviruses that cause haemorrhagic fever. Two recent high throughput screens published in 2013 did however identify several hits that progressed to animal studies that are FDA approved drugs used for other indications. The current computational analysis uses these molecules from two different structural classes to construct a common features pharmacophore. This ligand-based pharmacophore implicates a possible common target or mechanism that could be further explored. A recent structure based design project yielded nine co-crystal structures of pyrrolidinone inhibitors bound to the viral protein 35 (VP35). When receptor-ligand pharmacophores based on the analogs of these molecules and the protein structures were constructed, the molecular features partially overlapped with the common features of solely ligand-based pharmacophore models based on FDA approved drugs. These previously identified FDA approved drugs with activity against Ebola were therefore docked into this protein. The antimalarials chloroquine and amodiaquine docked favorably in VP35. We propose that these drugs identified to date as inhibitors of the Ebola virus may be targeting VP35. These computational models may provide preliminary insights into the molecular features that are responsible for their activity against Ebola virus in vitro and in vivo and we propose that this hypothesis could be readily tested.

A common feature pharmacophore for FDA-approved drugs inhibiting the Ebola virus

We are currently faced with a global infectious disease crisis which has been anticipated for decades. While many promising biotherapeutics are being tested, the search for a small molecule has yet to deliver an approved drug or therapeutic for the Ebola or similar filoviruses that cause haemorrhagic fever. Two recent high throughput screens published in 2013 did however identify several hits that progressed to animal studies that are FDA approved drugs used for other indications. The current computational analysis uses these molecules from two different structural classes to construct a common features pharmacophore. This ligand-based pharmacophore implicates a possible common target or mechanism that could be further explored. A recent structure based design project yielded nine co-crystal structures of pyrrolidinone inhibitors bound to the viral protein 35 (VP35). When receptor-ligand pharmacophores based on the analogs of these molecules and the protein structures were constructed, the molecular features partially overlapped with the common features of solely ligand-based pharmacophore models based on FDA approved drugs. These previously identified FDA approved drugs with activity against Ebola were therefore docked into this protein. The antimalarials chloroquine and amodiaquine docked favorably in VP35. We propose that these drugs identified to date as inhibitors of the Ebola virus may be targeting VP35. These computational models may provide preliminary insights into the molecular features that are responsible for their activity against Ebola virus in vitro and in vivo and we propose that this hypothesis could be readily tested.

A common feature pharmacophore for FDA-approved drugs inhibiting the Ebola virus

We are currently faced with a global infectious disease crisis which has been anticipated for decades. While many promising biotherapeutics are being tested, the search for a small molecule has yet to deliver an approved drug or therapeutic for the Ebola or similar filoviruses that cause haemorrhagic fever. Two recent high throughput screens published in 2013 did however identify several hits that progressed to animal studies that are FDA approved drugs used for other indications. The current computational analysis uses these molecules from two different structural classes to construct a common features pharmacophore. This ligand-based pharmacophore implicates a possible common target or mechanism that could be further explored. A recent structure based design project yielded nine co-crystal structures of pyrrolidinone inhibitors bound to the viral protein 35 (VP35). When receptor-ligand pharmacophores based on the analogs of these molecules and the protein structures were constructed, the molecular features partially overlapped with the common features of solely ligand-based pharmacophore models based on FDA approved drugs. These previously identified FDA approved drugs with activity against Ebola were therefore docked into this protein. The antimalarials chloroquine and amodiaquine docked favorably in VP35. We propose that these drugs identified to date as inhibitors of the Ebola virus may be targeting VP35. These computational models may provide preliminary insights into the molecular features that are responsible for their activity against Ebola virus in vitro and in vivo and we propose that this hypothesis could be readily tested.

Solving the Emerging Infectious Disease Crisis*

Today I speak to you as a witness from ‘‘ground zero’’ of the biodiversity crisis. I bring an urgent message. The human population grows daily, it’s on the move, and it’s carving a deep technological footprint on this planet. We alter landscapes and perturb ecosystems, inserting ourselves and other species into novel regions of the world, leading to potentially irreversible changes in the biosphere. This is not news. Half a century ago, Charles Elton, a founder of modern ecology, wrote, ‘‘We must make no mistake; we are seeing one of the greatest historical convulsions in the world’s fauna and flora.’’ We are also in the midst of an epidemiological crisis. Climate change alters movements and geographic distributions for myriad species. Transportation of people and goods carries countless pathogens around the globe. This brings isolated species into sudden contact. Pathogens encounter hosts with no resistance and no time to evolve any. This is also not news: Maladies rare or unknown 2 or 3 decades ago, like HIV (human immunodeficiency virus) and Ebola, West Nile virus and avian influenza, have become commonplace. In such a world—this world—events like these are ongoing. Scarcely a week passes without news of some freshly discovered strain of pathogen trading up to a human host...or bald eagles...or crop plants...or sea anemones. This is the crisis of emerging infectious disease (EID). We think of EID as isolated events, and we react only after the fact. We allocate massive resources to pathogens that have already made themselves known, while ignoring the far greater threat posed by those waiting in the wings. The ones we know are just the tip of the iceberg:—80–90% percent of the world’s pathogens haven’t been discovered yet. They’re discovering us easily enough—weekly outbreaks and endlessly mutating strains of recent years are ample evidence of that. This succession of crises is the new status quo. They’re far better at finding us than we have been at finding them. Why? The current EID crisis is a new manifestation of an old and repeating phenomenon. The rules have not changed. Every episode of global climate change and ecological perturbation throughout Earth history has produced new pathogens. More than a million years ago, our African ancestors moved from forest to savannah. Adopting a predatory lifestyle, sharing prey with grassland carnivores, early humans acquired pathogens previously found in hyenas, large cats, and African hunting dogs. They carried those pathogens out of Africa, where they added native hosts in new environments, while native pathogens returned the favor, infecting the newly arrived humans. Agriculture and urbanization brought people and animals into even closer contact, making infection and transmission easier than ever. In the past 100,000 yr, agriculture, domestication, and urbanization have disseminated EID risk on a global scale. If doctors had existed in those times, they would have remarked on a worrisome surge in the number of EIDs, responding to the crisis as best they could, after the fact. In the past 50 yr, exploding human population, rapid transit, and climate change have produced the real-time crisis you see on television daily. The EID crisis is a medical issue in only a superficial sense. It’s more fundamentally an evolutionary and ecological issue, a predictable consequence of separated species brought into close contact. The difference today is that human activity accelerates the rate of introductions, so outbreaks occur more frequently and over a wider geographic range than ever before. The potential for EID is a ‘‘built-in feature’’ of evolution. Research shows that those species best at surviving climate change will be the primary sources of EID. Pathogens are not only good at finding us, they are really good at surviving. There are many, not a few, evolutionary ‘‘accidents waiting to happen’’ out there, requiring only the catalyst of climate change, species introductions, and the intrusion of humans into areas they have never inhabited before. All of these are happening right now. * Speech given in acceptance of the Helminthological Society of Washington’s 2012 Anniversary Award. Comp. Parasitol. 81(2), 2014, pp. 152–154

Should Health Organizations Use Web 2.0 Media in Times of an Infectious Disease Crisis? An In-depth Qualitative Study of Citizens’ Information Behavior During an EHEC Outbreak

BackgroundWeb 2.0 media (eg, Facebook, Wikipedia) are considered very valuable for communicating with citizens in times of crisis. However, in the case of infectious disease outbreaks, their value has not been determined empirically. In order to be able to take full advantage of Web 2.0 media in such a situation, the link between these media, citizens’ information behavior, and citizens’ information needs has to be investigated.ObjectiveThe goal of our study was to assess citizens’ Web 2.0 media use during an infectious disease outbreak and to determine which Web 2.0 medium is used for which goal. With this information, we wanted to formulate recommendations for health organizations that consider using Web 2.0 media as part of their communication strategy during an infectious disease outbreak.MethodsA total of 18 student participants kept an information diary for 4 weeks during the 2011 enterohemorrhagic E. coli (EHEC) outbreak in Germany. Of them, 9 lived at the epicenter of the outbreak and 9 of them at some distance. The diaries were supplemented by a qualitative pre-survey (demographics) and postsurvey (questioning their satisfaction with information provision during the outbreak).ResultsThe Internet appeared to be the most popular medium for passively receiving EHEC-related information, with news websites and websites of newspapers as the most consulted sources. Twitter was used for receiving information to a small degree, while Facebook played virtually no role. Participants indicated that they thought information posted on Twitter or Facebook was not reliable or was out of place. When actively seeking information, online newspapers and wikis were important sources. Several causes for (dis)satisfaction with information provision were uncovered: source credibility, contradicting messages, and a need for closure.ConclusionsDuring an infectious disease outbreak, our small sample of students did not see social media (like Facebook and Twitter) as suitable or reliable sources for communicating information, but primarily viewed them as a tool for communicating with friends. Wikis, however, did fill several information needs, especially when citizens are actively searching for information. For many, source credibility is an important asset of information usefulness. Finally, we provide several general recommendations for communicating with citizens during an infectious disease outbreak.

An authority for crisis coordination and accountability

The demand for better coordination and control is heard during and after every major international disaster. We now have the potential framework to meet this demand and we should respond. The World Health Assembly altered WHO's role in disasters after the outbreak of severe acute respiratory syndrome with the 2005 International Health Regulations (IHR) Treaty.1 WHO changed from a mainly passive responder during short-term infectious disease crises to an unprecedented active authority with a mandate to address long-term prevention, preparedness, and response roles and responsibilities.

Darwin’s Necessary Misfit and the Sloshing Bucket: The Evolutionary Biology of Emerging Infectious Diseases

Evolutionary studies suggest that the potential for rapid emergence of novel host–parasite associations is a “built-in feature” of the complex phenomenon that is Darwinian evolution. The current Emerging Infectious Disease (EID) crisis is thus a new manifestation of an old and repeating phenomenon. There is evidence that previous episodes of global climate change and ecological perturbation, broadly defined, throughout earth history have been associated with environmental disruptions that produce episodic bursts of new host–parasite associations, each of which would have been called an EID at the time of its first appearance. This perspective implies that there are many evolutionary accidents waiting to happen, requiring only the catalyst of climate change, species introductions, and the intrusion of humans into areas they have never inhabited before.