Large-scale Disease Outbreaks Research Articles

Determinants of intention to leave among nurses and physicians in a hospital setting during the COVID-19 pandemic: A systematic review and meta-analysis.

The global outbreak of COVID-19 has brought to light the profound impact that large-scale disease outbreaks can have on healthcare systems and the dedicated professionals who serve within them. It becomes increasingly important to explore strategies for retaining nurses and physicians within hospital settings during such challenging times. This paper aims to investigate the determinants of retention among nurses and physicians during the COVID-19 pandemic. A systematic review of other potential determinants impacting retention rates during the pandemic was carried out. Secondly, a meta-analysis on the prevalence of intention to leave for nurses and physicians during the COVID-19 pandemic. A comprehensive search was performed within four electronic databases on March 17 2023. Fifty-five papers were included in the systematic review, whereas thirty-three papers fulfilled the eligibility criteria for the meta-analysis. The systematic review resulted in six themes of determinants impacting intention to leave: personal characteristics, job demands, employment services, working conditions, work relationships, and organisational culture. The main determinants impacting the intention to leave are the fear of COVID-19, age, experience, burnout symptoms and support. Meta-analysis showed a prevalence of intent to leave the current job of 38% for nurses (95% CI: 26%-51%) and 29% for physicians (95% CI: 21%-39%), whereas intention to leave the profession for nurses 28% (95% CI: 21%-34%) and 24% for physicians (95% CI: 23%-25%). The findings of this paper showed the critical need for hospital managers to address the concerning increase in nurses' and physicians' intentions to leave during the COVID-19 pandemic. This intention to leave is affected by a complex conjunction of multiple determinants, including the fear of COVID-19 and the confidence in and availability of personal protective equipment. Moreover, individual factors like age, experience, burnout symptoms, and support are maintained in this review. Understanding the influence of determinants on retention during the COVID-19 pandemic offers an opportunity to formulate prospective strategies for retaining nurses and physicians within hospital settings.

Understanding the spread of infectious diseases in edge areas of hotspots: dengue epidemics in tropical metropolitan regions

Identifying clusters or hotspots from disease maps is critical in research and practice. Hotspots have been shown to have a higher potential for transmission risk and may be the source of infections, making them a priority for controlling epidemics. However, the role of edge areas of hotspots in disease transmission remains unclear. This study aims to investigate the role of edge areas in disease transmission by examining whether disease incidence rate growth is higher in the edges of disease hotspots during outbreaks. Our data is based on the three most severe dengue epidemic years in Kaohsiung city, Taiwan, from 1998 to 2020. We employed conditional autoregressive (CAR) models and Bayesian areal Wombling methods to identify significant edge areas of hotspots based on the extent of risk difference between adjacent areas. The difference-in-difference (DID) estimator in spatial panel models measures the growth rate of risk by comparing the incidence rate between two groups (hotspots and edge areas) over two time periods. Our results show that in years characterized by exceptionally large-scale outbreaks, the edge areas of hotspots have a more significant increase in disease risk than hotspots, leading to a higher risk of disease transmission and potential disease foci. This finding explains the geographic diffusion mechanism of epidemics, a pattern mixed with expansion and relocation, indicating that the edge areas play an essential role. The study highlights the importance of considering edge areas of hotspots in disease transmission. Furthermore, it provides valuable insights for policymakers and health authorities in designing effective interventions to control large-scale disease outbreaks.

Identifying Barriers to Basic Needs, Academic Success, and the Vaccination Pattern among College Students during the COVID-19 Pandemic.

College students face significant challenges during large-scale disease outbreaks that potentially compromise their basic needs, vaccine confidence, and academic success. Using a cross-sectional design and convenience sampling, we examined the impact of COVID-19 among college students (N = 828). The survey was administered using the Qualtrics survey platform to collect data on multiple demographic and health behaviors of students in the summer semester (2021). Our study demonstrated that the most common financial shock experienced by the study participants was job loss, with less remarkable changes in food and housing insecurities. Academically, students had the most difficulty learning online compared to other modalities (face-to-face, Hyflex, etc.) and struggled with staying motivated. They also struggled with group work and finding appropriate learning spaces. However, many did not use university support systems such as career and tutoring services. Exploring the COVID-19 vaccination attitudes, we found that only age, ethnicity, classification, and health insurance status were associated with getting vaccinated (p < 0.05). When the learning environment was assessed for various modalities, only college attendance was significantly associated (p < 0.05) with the accessible platforms (online, Hyflex, face-to-face, and others); however, nearly 40% of students reported difficulty learning on an online learning platform compared other categories that had much lower proportions. Our findings underscore an immediate need for universities to take measures to improve their preparedness and response strategies to mitigate the negative effects of future large-scale public health emergencies among students.

Dietary supplementation of Patchouli oil increases the resistance against Streptococcus agalactiae infection in GIFT tilapia as revealed by transcriptome and 16s amplicon profiling

Large-scale disease outbreaks that caused by Streptococcus agalactiae (SA) infection have dramatically affected tilapia production worldwide. Patchouli oil (PO) is a traditional Chinese herbal medicine in treating gastrointestinal symptoms and is considered to be a safe and efficient candidate to treat SA infection in tilapia. In this study, we first investigated the changes of intestinal microbiota and host responses in GIFT tilapia after a 28-day dietary supplementation of different concentrations of PO (basic diet, 5 μL PO/g diet, or 15 μL PO/g diet) and followed by SA infection using an integrative analysis of transcriptome and 16 S amplicon profiling. We observed that dietary supplementation of 5 μL PO/g diet improved food intake and growth in tilapia. Histopathological observation confirmed there were increased surface area of intestinal villi and generally decreased ROS as revealed by the MAD, GSH-PX, and T-SOD activities in the tilapia intestines in response to dietary PO supplementation. The intestinal microbial diversities and community structures were significantly affected, and the colonization of probiotics (e.g., Cetobacterium and clostridium_ sensu_stricto_1) in the mucosa was improved in the dietary PO groups. The relative abundance of Streptococcus (0.033%) in the 15 μL PO/g dietary group was much lower than that in the control group (basic diet; 0.86%). A large number of DEGs were enriched in the immune-related pathways, e.g., lysosomal lumen, MHC protein complex, and toll-like receptor 2 signaling pathway. Our findings suggested that dietary supplementation of PO enhanced intestinal physical barriers, increased the colonization of probiotic bacteria and improved intestinal immunity in tilapia. This provides novel knowledge on PO as a dietary supplement to improve intestinal health against SA invasion in tilapia.

Analysis of the Readiness of Primary Health Center Nurses in Encountering Community Stigma during the COVID-19 Pandemic

The COVID-19 outbreak has resulted in public fear of transmitting infection. Nurses in dealing with the COVID-19 outbreak also obtained stigmatized due to discrimination received by COVID-19 sufferers. The objective of the study is to identify the dominant factor to determine the occurrence of stigma experienced by nurses when caring for COVID-19 patients. The research design was qualitative and quantitative, with a sample of 121 Primary Health Center nurses who were performed by convenience sampling. Data analysis with Multiple Linear Regression presented that overall, there was a significant correlation between knowledge in preventing COVID-19, Personal Ability and Organizational Ability to stigma from society experienced by nurses with ANOVA or F test results (229.427) with p = 0.000. Morever, there is a strong and significant relationship between knowledge, self-efficacy and organizational ability to community stigma (R Square = 0.964). The dominant factor that affects stigma as seen from the t-test is self-ability = 14,828 (p=0.001) followed by organizational ability= -8,790 (0.001) and knowledge = 5.050 (p=0.001). It was concluded that the limitations of human resources and special infrastructure for people with COVID-19 were the trigger for the occurrence of stigma. It is hoped that the maintenance of well-being among health workers is at the forefront by beginning at the policy-making level to offer enhanced support for health workers who play a critical role during large-scale disease outbreaks. The psychological implications are mostly negative and urgently need greater attention to be mitigated, potentially through the involvement of psychologists, given better awareness and education. It is expected that further researchers can explore the phenomenon of the experience of nurses who suffer from COVID-19 in dealing with the stigma that occurs to them.

Rapid Workforce Development to Combat the COVID-19 Pandemic: Experience From a Tertiary Health Care Centre in North India.

IntroductionDuring a large-scale disease outbreak, one needs to respond to the situation quickly towards capacity building, by identifying areas that require training and planning a workable strategy and implementing it. There are limited studies focused on fast-track workforce creation under challenging circumstances that demand mandatory social distancing and discouragement of gatherings. This study was conducted to analyze the planning process and implementation of fast-track training during the Coronavirus disease (COVID-19) pandemic, and evaluate its effectiveness in building a rapid, skilled, and massive workforce.MethodsA cross-sectional study was conducted to evaluate rapid preparedness training delivered from March to June 2020, based on documents and data regarding the process, planning, and implementation for large-scale capacity building. Pre-test and post-test scores were compared to assess the effectiveness of training. The number of personnel trained was evaluated to determine the efficiency of the training program. Data on COVID-19 among health care workers (HCWs) were analyzed.ResultsThe Advanced Center of Continuous Professional Development acted as the central facility, quickly responding to the situation. A total of 327 training sessions were conducted, including 76 online sessions with 153 instructors. The capacity-building of 2,706 individuals (913 clinicians and 1,793 nurses, paramedics, and non-medical staff) was achieved through multiple parallel sessions on general precautionary measures and specialized skills within four months. The rate of hospital staff infected with COVID-19 was found to be 0.01% over five months.ConclusionsA fast-track, efficient, large-scale workforce can be created through a central facility even under challenging circumstances which restrict gatherings and require physical distancing. A training action plan for disease outbreaks would be a useful resource to tackle such medical emergencies affecting substantial populations in future.

Understanding misinformation infodemic during public health emergencies due to large-scale disease outbreaks: a rapid review.

AimThe coronavirus disease 2019 (COVID-19) has caused hundreds of thousands of deaths, impacted the flow of life and resulted in an immeasurable amount of socio-economic damage. However, not all of this damage is attributable to the disease itself; much of it has occurred due to the prevailing misinformation around COVID-19. This rapid integrative review will draw on knowledge from the literature about misinformation during previous abrupt large-scale infectious disease outbreaks to enable policymakers, governments and health institutions to proactively mitigate the spread and effect of misinformation.Subject and methodsFor this rapid integrative review, we systematically searched MEDLINE and Google Scholar and extracted the literature on misinformation during abrupt large-scale infectious disease outbreaks since 2000. We screened articles using predetermined inclusion criteria. We followed an updated methodology for integrated reviews and adjusted it for our rapid review approach.ResultsWe found widespread misinformation in all aspects of large-scale infectious disease outbreaks since 2000, including prevention, treatment, risk factor, transmission mode, complications and vaccines. Conspiracy theories also prevailed, particularly involving vaccines. Misinformation most frequently has been reported regarding Ebola, and women and youth are particularly vulnerable to misinformation. A lack of scientific knowledge by individuals and a lack of trust in the government increased the consumption of misinformation, which is disseminated quickly by the unregulated media, particularly social media.ConclusionThis review identified the nature and pattern of misinformation during large-scale infectious disease outbreaks, which could potentially be used to address misinformation during the ongoing COVID-19 or any future pandemic.

Assessing Mental Health of Women Living in Karachi During the Covid-19 Pandemic.

Introduction: Women are more susceptible to mental health disorders and have been reported to experience higher levels of depression and anxiety during previous large-scale disease outbreaks. Stressful events like the COVID-19 pandemic can add extra burdens to women's already multifaceted lives. Keeping the gender implications of COVID-19 in mind can assist health care workers to offer more effective management. In our study, we aimed to assess the impact of COVID-19 on the mental health of women in Karachi, Pakistan and investigate the possible risk factors.Methods: An online questionnaire was distributed to women on social media platforms in the month of June 2020. The questionnaire had two self-assessment scales, Patient Health Questionnaire (PHQ-9) scale which measures the symptoms of depression and General Anxiety Disorder (GAD-7) scale which measures anxiety.Results: Three hundred and ninety three individuals completed the questionnaire with the mean age calculated to be 27.6 ± 11.7 years. Age, education, marital status, number of children, financial issues, employment status, smoking, comorbidities and mental illnesses were significantly associated with participants' mean anxiety and depression scores. The depression scores were generally higher compared to anxiety scores in each category. As the age increased, their scores decreased, with women aged 18–30 having a significantly higher mean depression and anxiety scores compared to women who were above 50. Severe anxiety was identified in 21.9% women and severe depression was noted in 17.8% women. A frightening number of 148 (37.7%) was found of women who had self-destructive thoughts at one time or another. Out of these women, surprisingly 97 (65.5%) individuals were not previously diagnosed with any mental illnesses.Discussion: This study supports the existing literature regarding the disturbed psychological state of women close to the peak of the covid-19 pandemic. We noted increased percentage of depressive women as compared to studies conducted before the covid-19 era. This raises concern especially with our thought provoking finding of self-harm or suicidal thoughts among women. Most of our female population is also seen to be anxious. This study highlights the importance for help and support groups of mental health to effectively reach women during this period of social isolation.

FINANCIAL AND ECONOMIC SYSTEM OF YEMEN: IS RECOVERY POSSIBLE?

The regional war in Yemen (the Republic of Yemen) began on the 26th March 2015 in the result of the military intervention of the Arabic coalition headed by Saudi Arabia. Nearly all the northern part of the the country is under control of the alliance with the participation of the former ruling party “Yemeni General People's Congress” and Houthi rebellions from the Shiite movement Ansar Allah. In August 2019 the southern part of the country loyal to the coalition was threatened by disintegration as a result of expulsion of the structures of internationally recognized President A.M. Hadi, living in Riyadh since the beginning of the conflict, from the temporary capital Aden by forces of the pro-Emirates group headed by the Southern Transition Council.&#x0D; The war did not solve any domestic problems of Yemen caused by a massive peaceful protest in all parts of the country split by the crisis in 2011, disrupted the international plan of the peaceful solution to the crisis under United Nations auspices, which started in November 2011, and de facto worsened the split of Yemen, which appeared on the map of Arabia only in 1990 in the result of merging two previously existing sovereign republics – the Yemen Arab Republic and People's Democratic Republic of Yemen.&#x0D; According to the announcements of the UN, currently the country goes through the hardest humanitarian crisis in the world. The military actions devastated the economy of the country, almost entirely ruined the infrastructure and lead to the absence of food security. The UN estimated that in 2019 nearly 24.1 million people (80% of the population) were exposed to the risk of famine and diseases. In the result of the absence of sanitary conditions and vaccination of the population, the country faces large-scale disease outbreaks, such as cholera, diphtheria, measles and fever.&#x0D; In addition, analysts estimate that more than 40% of Yemeni families lost their main source of income, consequently, it is quite difficult for them to by goods included in the minimum consumer basket. Poverty is getting worse: before the crisis it affected nearly half of the population, and currently it affects about 80% of Yemenis.&#x0D; In the result of the inflation, the value of the national currency threefold dropped. Besides, the humanitarian crisis worsened, and failure in the operation of the facilities of the national infrastructure and financial institutions significantly influenced the activity of business society, especially small and medium-sized businesses.&#x0D; The military conflict in Yemen disrupted the social and economic activity both of individual institutions and of the state as a whole. In the hard situation is found the revenue part of the budget, whose main source of income was export of hydrocarbons. Financial losses from oil revenues resulted in severe shortage of the national currency and plummeting of state revenue. The aforementioned factors in combination with the fragmentation of the public institutions, including the Central Bank of Yemen, resulted in stopping flow of foreign currency for essential imports and payment of salaries in the public sector, which led to the growth of inflation and worsening humanitarian crisis.

Human activities and climate change in the emergence of vector-borne diseases

Because of human population expansion and activities, arthropod-borne viruses (arboviruses) have increased in importance during these last decades. Arboviruses are maintained by alternate replication in both vertebrate hosts and arthropod vectors. Successful transmission relies on a complex life cycle in the vector, which starts when a competent arthropod ingests an infectious blood meal from a viremic vertebrate host. Following an extrinsic incubation time during which the virus replicates in the vector midgut, followed by systemic viral dissemination to the salivary glands, the vector can transmit the virus to a new naïve host. Whereas they typically cause self-limiting, acute infections in their vertebrate hosts, arboviruses establish persistent infections in their vectors. Arboviruses are typically maintained within an enzootic cycle between wild animals and vectors. As human populations encroach on regions where these diseases are endemic, spillover transmission to humans and domestic animals can lead to large-scale disease outbreaks affecting millions of people. Dengue, chikungunya, Zika, and yellow fever mainly use humans as amplification hosts. Extensive urbanization combined with increased commerce and travel give rise to the mosquitoes Aedes aegypti and Aedes albopictus , both highly adapted to the human environment. The high densities of these human-biting mosquitoes that proliferate in highly populated cities made the bed to explosive outbreaks of arboviral diseases. As insects are ectothermic organisms, climate change may affect the geographical distribution of vectors, with consequences on the transmission of arboviruses. Yellow fever (YF) is a good example of an emerging arbovirus, as it illustrates three main steps in the emergence: (i) introduction of a new pathogen in a new environment causing urban outbreaks, (ii) spillback of this pathogen into the wild initiating an enzootic cycle, and (iii) the spillover of this pathogen from an enzootic cycle to initiate an urban cycle ( Fig. 1 ). YF (YFV, Flavivirus , Flaviviridae) is a disease endemic to tropical regions of Africa and South America. There are seven lineages: five in Africa and two in America. Each year, 200,000 cases and 30,000 deaths were reported. In 2016, YFV emerged in Angola and imported cases were detected outside Africa, posing the threat of emergence of this virus outside Africa and Americas (Amraoui et al. Euro Surveill 2016). YFV was introduced into the New World during the slave trade, causing devastating outbreaks in several American countries, including cities like New York City and Boston. Once Carlos Finlay and Walter Reed had demonstrated that the YFV was transmitted by a mosquito, Ae. aegypti , eradication campaigns of the vector were initiated, leading to the control of YF. In Brazil, Ae. aegypti was eradicated in 1954. YF disappeared from cities and only persisted in a sylvatic cycle where YFV circulated between zoophilic mosquitoes ( Hemagogus and Sabethes ) and non-human primates. Using experimental infections, we showed that the zoophilic mosquitoes ( Hemagogus leucocelaenus and Sabethes albiprivus ) were able to transmit YFV at very high rates (Couto-Lima et al. Sci Rep 2017). With the relaxation of control measures in Brazil, Ae. aegypti was reintroduced in 1967 and Ae. albopictus in 1986. We showed that Ae. aegypti and Ae. albopictus were highly susceptible to YFV. We also demonstrated that using a protocol of experimental selection, we were able to select a YFV well adapted to a transmission by Ae. albopictus (Amraoui et al. Sci Rep 2018). This result should alert about the potential of YFV to initiate an urban cycle in Brazil, like in the past.

The pig transport network in Switzerland: Structure, patterns, and implications for the transmission of infectious diseases between animal holdings.

The topology of animal transport networks contributes substantially to how fast and to what extent a disease can transmit between animal holdings. Therefore, public authorities in many countries mandate livestock holdings to report all movements of animals. However, the reported data often does not contain information about the exact sequence of transports, making it impossible to assess the effect of truck sharing and truck contamination on disease transmission. The aim of this study was to analyze the topology of the Swiss pig transport network by means of social network analysis and to assess the implications for disease transmission between animal holdings. In particular, we studied how additional information about transport sequences changes the topology of the contact network. The study is based on the official animal movement database in Switzerland and a sample of transport data from one transport company. The results show that the Swiss pig transport network is highly fragmented, which mitigates the risk of a large-scale disease outbreak. By considering the time sequence of transports, we found that even in the worst case, only 0.34% of all farm-pairs were connected within one month. However, both network connectivity and individual connectedness of farms increased if truck sharing and especially truck contamination were considered. Therefore, the extent to which a disease may be transmitted between animal holdings may be underestimated if we only consider data from the official animal movement database. Our results highlight the need for a comprehensive analysis of contacts between farms that includes indirect contacts due to truck sharing and contamination. As the nature of animal transport networks is inherently temporal, we strongly suggest the use of temporal network measures in order to evaluate individual and overall risk of disease transmission through animal transportation.

Low salt exposure results in inactivation of Toxoplasma gondii bradyzoites during formulation of dry cured ready-to-eat pork sausage

The production of safe and healthy food products represents one of the main objectives of the food industry. The presence of microorganisms in meat and products containing meat can result in a range of human health problems, as well as economic losses to producers of these products. However, contaminated meat products continue to initiate serious and large-scale outbreaks of disease in consumers. In addition to outbreaks of diseases caused by bacteria and viruses, parasitic organisms, such as Toxoplasma gondii, are responsible for foodborne infections worldwide, and in the case of T. gondii, is considered the 2nd leading cause of death from foodborne illness in the U.S. Transmission of Toxoplasma gondii has historically been linked to the consumption of raw or undercooked meat products, including pork. Specific concerns with respect to pork products are ready-to-eat (RTE) pork meals. These are pork or products containing pork that are prepared by curing or drying, and are not intended to be cooked before being consumed.Previous studies have demonstrated that T. gondii is inactivated during dry cured sausage preparation, apparently in the batter during fermentation. In this study, we have analyzed timing of inactivation of T. gondii in freshly prepared pepperoni batter to confirm our previous findings, to determine how quickly inactivation occurs during fermentation, and to confirm what parameters of the sausage preparation are involved in inactivation of the parasite. Results from the current and previous study indicate that rapid inactivation of T. gondii bradyzoites occurs in low salt batter for dry cured sausage within 4 h of initiation of fermentation.

Bat Coronaviruses in China.

During the past two decades, three zoonotic coronaviruses have been identified as the cause of large-scale disease outbreaks–Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and Swine Acute Diarrhea Syndrome (SADS). SARS and MERS emerged in 2003 and 2012, respectively, and caused a worldwide pandemic that claimed thousands of human lives, while SADS struck the swine industry in 2017. They have common characteristics, such as they are all highly pathogenic to humans or livestock, their agents originated from bats, and two of them originated in China. Thus, it is highly likely that future SARS- or MERS-like coronavirus outbreaks will originate from bats, and there is an increased probability that this will occur in China. Therefore, the investigation of bat coronaviruses becomes an urgent issue for the detection of early warning signs, which in turn minimizes the impact of such future outbreaks in China. The purpose of the review is to summarize the current knowledge on viral diversity, reservoir hosts, and the geographical distributions of bat coronaviruses in China, and eventually we aim to predict virus hotspots and their cross-species transmission potential.

Public Health Surveillance in a Large Evacuation Shelter Post Hurricane Harvey

Objective1) Describe HCPH’s disease surveillance and prevention activities within the NRG Center mega-shelter; 2) Present surveillance findings with an emphasis on sharing tools that were developed and may be utilized for future disaster response efforts; 3) Discuss successes achieved, challenges encountered, and lessons learned from this emergency response.IntroductionHurricane Harvey made landfall along the Texas coast on August 25th, 2017 as a Category 4 storm. It is estimated that the ensuing rainfall caused record flooding of at least 18 inches in 70% of Harris County. Over 30,000 residents were displaced and 50 deaths occurred due to the devastation. At least 53 temporary refuge shelters opened in various parts of Harris County to accommodate displaced residents. On the evening of August 29th, Harris County and community partners set up a 10,000 bed mega-shelter at NRG Center, in efforts to centralize refuge efforts. Harris County Public Health (HCPH) was responsible for round-the-clock surveillance to monitor resident health status and prevent communicable disease outbreaks within the mega-shelter. This was accomplished through direct and indirect resident health assessments, along with coordinated prevention and disease control efforts. Despite HCPH’s 20-day active response, and identification of two relatively small but potentially worrisome communicable disease outbreaks, no large-scale disease outbreaks occurred within the NRG Center mega-shelter.MethodsActive surveillance was conducted in the NRG shelter to rapidly detect communicable and high-consequence illness and to prevent disease transmission. An online survey tool and novel epidemiology consulting method were developed to aid in this surveillance. Surveillance included daily review of onsite medical, mental health, pharmacy, and vaccination activities, as well as nightly cot-to-cot resident health surveys. Symptoms of infectious disease, exacerbation of chronic disease, and mental health issues among evacuees were closely monitored. Rapid epidemiology consultations were performed for shelter residents displaying symptoms consistent with communicable illness or other signs of distress during nightly cot surveys. Onsite rapid assay tests and public health laboratory testing were used to confirm disease diagnoses. When indicated, disease control measures were implemented and residents referred for further evaluation. Frequencies and percentages were used in the descriptive analysis.ResultsHarris County’s NRG Center mega-shelter housed 3,365 evacuees at its peak. 3,606 household health surveys were completed during 20 days of active surveillance, representing 7,152 individual resident evaluations, and 395 epidemiology consultations. Multifaceted surveillance uncovered influenza-like illness and gastrointestinal (GI) complaints, revealing an Influenza A outbreak of 20 cases, 3 isolated cases of strep throat, and a Norovirus cluster of 5 cases. Disease control activities included creation of respiratory and GI isolation rooms, provision of over 771 influenza vaccinations, generous distribution of hand sanitizer throughout the shelter, placement of hygiene signage, and frequent bilingual public health public service announcements in the dormitory areas. No widespread outbreaks of communicable disease occurred. Additionally, a number of shelter residents were referred to the clinic after reporting exacerbation of chronical conditions or mental health concerns, including one individual with suicidal ideations.ConclusionsEffective public health surveillance and implementation of disease control measures in disaster shelters are critical to detecting and preventing communicable illness. HCPH’s rigorous surveillance and response system in the NRG Center mega-shelter, including online survey tool and novel consultation method, resulted in timely identification and isolation of patients with gastrointestinal and influenza-like illness. These were likely key factors in the successful prevention of widespread disease transmission. Additional success factors included successful partnerships with onsite clinical and pharmacy teams, cooperative and engaged shelter leadership, synergistic internal surveillance team dynamics, availability of student volunteers, sufficient quantities of influenza vaccine, and access to mobile survey technology. Challenges, mostly related to scope and magnitude of response, included lack of pre-designed survey tools, relatively new staff without significant disaster experience, and simultaneous management of multiple surveillance activities within the community. Personal hurricane-related losses experienced by HCPH staff also impacted response efforts. HCPH’s rich disaster response experiences at the NRG mega-shelter and developed surveillance tools can serve as a planning guide for future public health emergencies in Harris County and other jurisdictions.

Development of an early warning algorithm to detect sick broilers

The frequent occurrence of poultry diseases, such as bird flu, not only causes huge economic losses to farmers but also seriously threatens the health of human beings. Providing early warnings of new poultry disease outbreaks is essential in poultry breeding. With the rise of digital image processing technology and machine learning algorithms, real-time monitoring of poultry health status through cameras is an effective way to prevent large-scale outbreaks of disease. To analyze the postures of healthy and sick broilers, bird flu virus was inoculated intranasally into healthy broilers manually. The broilers were then placed in isolator cages for comparative experiments. The methods of observing the posture changes of broilers and extracting the key features are used to realize the automatic classification of healthy and sick broilers. In this research, broiler images are obtained, and two kinds of segmentation algorithms are proposed to separate the broilers from the background to obtain the outlines and skeleton information of the broilers. According to the preset feature extraction algorithm, the posture features of healthy and sick chickens are extracted, the eigenvectors are established, the postures of the broilers are analyzed by machine learning algorithms, and the diseased broilers are predicted. A series of experiments have been done. Data for each feature acquired by the algorithms are analyzed, and the effect of each feature on the recognition accuracy is obtained. Using some of the features proposed in this research, accuracy rates of 84.248%, 60.531% and 91.504% are obtained, but using all the features can yield an accuracy rate of 99.469%. Then, the recognition effects of several commonly used machine learning algorithms are compared. The Support Vector Machine (SVM) model obtains an accuracy rate of 99.469% on the test samples, which is superior to those of the other machine learning algorithms. The experimental results show that the algorithms proposed in this research can effectively separate broilers from the background, extract the posture information of broilers, and accurately and quickly identify the health status of broilers by means of SVM. The algorithms for digital image processing and machine learning are evaluated in the diagnosis of broiler health status and show high accuracy, good stability and good generalization performance, and can give early warning signals. This research can provide a reference for the intelligent identification of broiler health status in the future.

Animal Health Surveillance in Scotland in 2030: Using Scenario Planning to Develop Strategies in the Context of "Brexit".

Animal health surveillance is necessary to protect human and animal health, rural economies, and the environment from the consequences of large-scale disease outbreaks. In Scotland, since the Kinnaird review in 2011, efforts have been made to engage with stakeholders to ensure that the strategic goals of surveillance are better aligned with the needs of the end-users and other beneficiaries. The aims of this study were to engage with Scottish surveillance stakeholders and multidisciplinary experts to inform the future long-term strategy for animal health surveillance in Scotland. In this paper, we describe the use of scenario planning as an effective tool for the creation and exploration of five plausible long-term futures; we describe prioritization of critical drivers of change (i.e., international trade policy, data-sharing philosophies, and public versus private resourcing of surveillance capacity) that will unpredictably influence the future implementation of animal health surveillance activities. We present 10 participant-developed strategies to support 3 long-term visions to improve future resilience of animal health surveillance and contingency planning for animal and zoonotic disease outbreaks in Scotland. In the absence of any certainty about the nature of post-Brexit trade agreements for agriculture, participants considered the best investments for long-term resilience to include data collection strategies to improve animal health benchmarking, user-benefit strategies to improve digital literacy in farming communities, and investment strategies to increase veterinary and scientific research capacity in rural areas. This is the first scenario planning study to explore stakeholder beliefs and perceptions about important environmental, technological, societal, political, and legal drivers (in addition to epidemiological “risk factors”) and effective strategies to manage future uncertainties for both the Scottish livestock industry and animal health surveillance after Brexit. This insight from stakeholders is important to improve uptake and implementation of animal heath surveillance activities and the future resilience of the livestock industry. The conclusions drawn from this study are applicable not only to Scotland but to other countries and international organizations involved in global animal health surveillance activities.

Identification of the key pathogens responsible for production losses at grouper nurseries in Aceh Indonesia

Identification of the key pathogens responsible for production losses at grouper nurseries in Aceh Indonesia

Cyclic avian mass mortality in the northeastern United States is associated with a novel orthomyxovirus.

Since 1998, cyclic mortality events in common eiders (Somateria mollissima), numbering in the hundreds to thousands of dead birds, have been documented along the coast of Cape Cod, MA, USA. Although longitudinal disease investigations have uncovered potential contributing factors responsible for these outbreaks, detecting a primary etiological agent has proven enigmatic. Here, we identify a novel orthomyxovirus, tentatively named Wellfleet Bay virus (WFBV), as a potential causative agent of these outbreaks. Genomic analysis of WFBV revealed that it is most closely related to members of the Quaranjavirus genus within the family Orthomyxoviridae. Similar to other members of the genus, WFBV contains an alphabaculovirus gp64-like glycoprotein that was demonstrated to have fusion activity; this also tentatively suggests that ticks (and/or insects) may vector the virus in nature. However, in addition to the six RNA segments encoding the prototypical structural proteins identified in other quaranjaviruses, a previously unknown RNA segment (segment 7) encoding a novel protein designated VP7 was discovered in WFBV. Although WFBV shows low to moderate levels of sequence similarity to Quaranfil virus and Johnston Atoll virus, the original members of the Quaranjavirus genus, additional antigenic and genetic analyses demonstrated that it is closely related to the recently identified Cygnet River virus (CyRV) from South Australia, suggesting that WFBV and CyRV may be geographic variants of the same virus. Although the identification of WFBV in part may resolve the enigma of these mass mortality events, the details of the ecology and epidemiology of the virus remain to be determined. The emergence or reemergence of viral pathogens resulting in large-scale outbreaks of disease in humans and/or animals is one of the most important challenges facing biomedicine. For example, understanding how orthomyxoviruses such as novel influenza A virus reassortants and/or mutants emerge to cause epidemic or pandemic disease is at the forefront of current global health concerns. Here, we describe the emergence of a novel orthomyxovirus, Wellfleet Bay virus (WFBV), which has been associated with cyclic large-scale bird die-offs in the northeastern United States. This initial characterization study provides a foundation for further research into the evolution, epidemiology, and ecology of newly emerging orthomyxoviruses, such as WFBV, and their potential impacts on animal and/or human health.

Practising Uncertainty in the Face of Large-Scale Disease Outbreaks

In contrast to calculable risks, uncertainty—understood here as the unexpected and non-calculable—is under-researched despite its societal and organizational relevance and omnipresence. Against this backdrop, the present study investigates how organizations practise uncertainty in the face of the numerous large-scale outbreaks of disease in Germany between 2000 and 2012. I position this study in the body of knowledge on disasters and crises, normal accident theory, and high-reliability organizations, and propose a practising uncertainty perspective that focuses on how to deal with unexpected external events and/or their latent dangers. I identify two overarching forms of practice, namely, reducing (i.e., coping with unforeseen incidents) and inducing (i.e., championing an overarching cause) uncertainty. I show that actors use both these forms of practice, which constitute the basis of the framework introduced herein, intentionally or unintentionally depending on the differing and sometimes conflicting objectives of the organizations involved.

From biodefence to biosecurity: the Obama administration's strategy for countering biological threats

The Seventh Review Conference of the Biological Weapons Convention (BWC), the first international treaty to outlaw an entire class of weapons, was held in Geneva in December 2011. On 7 December, Secretary of State Hillary Clinton became the highest-ranking US government official to address a BWC meeting. Secretary Clinton told the assembled delegation that ‘we view the risk of bioweapons attack as both a serious national security challenge and a foreign policy priority’. At the same time, she warned that a large-scale disease outbreak ‘could cripple an already fragile global economy’. Secretary Clinton's speech reflected a new understanding that the range of biological threats to international security has expanded from state-sponsored biological warfare programmes to include biological terrorism, dual-use research and naturally occurring infectious diseases such as pandemics. Recognizing these changes, President Barack Obama released a new national strategy for countering biological threats in 2009. This strategy represents a shift in thinking away from the George W. Bush administration's focus on biodefence, which emphasized preparing for and responding to biological weapon attacks, to the concept of biosecurity, which includes measures to prevent, prepare for and respond to naturally occurring and man-made biological threats. The Obama administration's biosecurity strategy seeks to reduce the global risk of naturally occurring and deliberate disease outbreaks through prevention, international cooperation, and maximizing synergies between health and security. The biosecurity strategy is closely aligned with the Obama administration's broader approach to foreign policy, which emphasizes the pragmatic use of smart power, multilateralism and engagement to further the national interest. This article describes the Obama administration's biosecurity strategy; highlights elements of continuity and change from the policies of the Bush administration; discusses how it fits into Obama's broader foreign policy agenda; and analyses critical issues that will have to be addressed in order to implement the strategy successfully.