Local Public Health Institutions Research Articles

Building Quality Control for Molecular Assays in the Global Measles and Rubella Laboratory Network.

More than 100 laboratories in the World Health Organization Global Measles and Rubella Laboratory Network (GMRLN) perform nucleic acid-based methods for case confirmation of measles or rubella infections and/or strain surveillance (genotyping). The quality of laboratory data is critical to ensure that diagnostic results and country reports to regional verification committees are based on accurate data. A molecular External Quality Assurance (mEQA) program was initiated by the US-CDC in 2014 to evaluate the performance of laboratories in the network. The inclusion of testing for measles and rubella viruses, with a focus on detection and genotyping, plus the diversity of assays and platforms employed required a flexible and comprehensive proficiency testing program. A stepwise introduction of new evaluation criteria gradually increased the stringency of the proficiency testing program, while giving laboratories time to implement the required changes. The mEQA program plays an important role in many processes in the GMRLN, including informing plans for the training of laboratory staff, access to reagents, and the submission of sequence data to global databases. The EQA program for Local Public Health Institutes in Japan is described as an example for national mEQA programs. As more laboratories initiate molecular testing, the mEQA will need to continue to expand and to adapt to the changing landscape for molecular testing.

Trust in Institutions, Not in Political Leaders, Determines Compliance in COVID-19 Prevention Measures within Societies across the Globe.

A core assumption often heard in public health discourse is that increasing trust in national political leaders is essential for securing public health compliance during crises such as the COVID-19 pandemic (2019–ongoing). However, studies of national government trust are typically too coarse-grained to differentiate between trust in institutions versus more interpersonal trust in political leaders. Here, we present multiscale trust measurements for twelve countries and territories across the West, Oceania and East Asia. These trust results were used to identify which specific domains of government and social trust were most crucial for securing public health compliance (frequency of mask wearing and social distancing) and understanding the reasons for following health measures (belief in effectiveness of public health measures). Through the use of linear regression and structural equation modeling, our cross-cultural survey-based analysis (N = 3369 subjects) revealed that higher trust in national and local public health institutions was a universally consistent predictor of public health compliance, while trust in national political leaders was not predictive of compliance across cultures and geographical regions. Institutional trust was mediated by multiple types of transparency, including providing rationale, securing public feedback, and honestly expressing uncertainty. These results highlight the importance of distinguishing between components of government trust, to better understand which entities the public gives the most attention to during crises.

Early signs of geographic spread of COVID-19: lessons learnt from outbreaks in Wuhan 2020 and Nanjing 2021.

Knowing the spatiotemporal pattern of the early geographic spread of coronavirus disease 2019 (COVID-19) would inform the preparedness for a possible recurrence of COVID-19. We ascertained the number of confirmed cases during the early spread of COVID-19 during the Wuhan outbreak in 2020 and the Nanjing outbreak in 2021. We observed a speeding-up pattern of geographic spread, in particular to cities of no particular orientation then outflowing to commercial cities during the first month of both the Wuhan and Nanjing outbreaks. Re-emergence of COVID-19 indicates it is becoming endemic, with new outbreaks and a risk of increased transmission remaining a challenge to local public health institutions. Social distancing and lockdowns should continue in response to any potential widespread and focal outbreaks.

The International Family Study of Nonsyndromic Orofacial Clefts: Design and Methods

The majority of research to understand the risk factors of nonsyndromic orofacial clefts (NSOFCs) has been conducted in high-income populations. Although patients with NSOFCs in low- and middle-income countries (LMICs) are at the highest risk of not receiving care, global health infrastructure allows innovative partnerships to explore the etiologic mechanisms of cleft and targets for prevention unique to these populations. The International Family Study (IFS) is an ongoing case-control study with supplemental parental trio data designed to examine genetic, environmental, lifestyle, and sociodemographic risk factors for NSOFCs in 8 LMICs (through August 2020). Interview and biological samples are collected for each family. The interview includes demographics, family history of cleft, diet and water sources, maternal pregnancy history, and other lifestyle and environmental factors. Seven of 8 countries are currently summarized (2012-2017) for a total of 2955 case and 2774 control families with 11 946 unique biological samples from Vietnam, Philippines, Honduras, Madagascar, Morocco, Democratic Republic of the Congo, and Nicaragua. The phenotype distribution was 1641 (55.5%) cases with cleft lip and palate, 782 (26.5%) with cleft lip (CL), and 432 (14.6%) with cleft palate (CP). The International Family Study is the largest case set of NSOFCs with an associated biobank in LMICs currently assembled. The biobank, family, and case-control study now include samples from 8 LMICs where local health care infrastructure cannot address the surgical burden of cleft or investigate causal mechanisms. The International Family Study can be a source of information and may collaborate with local public health institutions regarding education and interventions to potentially prevent NSOFCs.

Cost of Public Health Response and Outbreak Control With a Third Dose of Measles-Mumps-Rubella Vaccine During a University Mumps Outbreak-Iowa, 2015-2016.

The United States is experiencing mumps outbreaks in settings with high 2-dose measles-mumps-rubella (MMR) vaccine coverage, mainly universities. The economic impact of mumps outbreaks on public health systems is largely unknown. During a 2015-2016 mumps outbreak at the University of Iowa, we estimated the cost of public health response that included a third dose of MMR vaccine. Data on activities performed, personnel hours spent, MMR vaccine doses administered, miles traveled, hourly earnings, and unitary costs were collected using a customized data tool. These data were then used to calculate associated costs. Approximately 6300 hours of personnel time were required from state and local public health institutions and the university, including for vaccination and laboratory work. Among activities demanding time were case/contact investigation (36%), response planning/coordination (20%), and specimen testing and report preparation (13% each). A total of 4736 MMR doses were administered and 1920 miles traveled. The total cost was >$649 000, roughly equally distributed between standard outbreak control activities and third-dose MMR vaccination (55% and 45%, respectively). Public health response to the mumps outbreak at the University of Iowa required important amounts of personnel time and other resources. Associated costs were sizable enough to affect other public health activities.

The Influence of a Legal Revision on Infectious Agent Surveillance in Local Public Health Institutes

目的：感染症の予防及び感染症の患者に対する医療に関する法律（感染症法）の改正により，2016 年4 月から病原体サーベイランスの情報収集体制が強化された．そこで，5 類定点把握対象のウイルス性疾患について，その影響を検討した．

A cost-benefit analysis of occupational disease reporting in China

Objective: To perform a cost-benefit analysis of the occupational disease reporting system in China, and to provide a basis for effective resource allocation. Methods: The data on the cost of occupational diseases were collected from China Health Statistics Yearbook 2013, the estimated benefit data were collected from published articles in China and foreign countries, and the probability data were collected from the occupational diseasereports published by health and family planning administrative departments. Adecision-making tree was used for the cost-benefit analysis. Results: The estimated cost of occupational disease reporting was about 102.47 million yuan/year, consisting of a cost of reporting in national medical institutions of 1.25 million yuan/year, a management cost of 30.35 million yuan/year, a management cost in local public health institutions of 69.80 million yuan/year, a management cost in national public health institutions of 370 thousand yuan/year, and a cost of construction and maintenance of reporting system of 700 thousand yuan/year. The results of the decision tree analysis showed that when an occupational disease monitoring system was established, the incremental input for occupational disease monitoring and prevention/control was 2.1 billion yuan/year, the output was 6.5 billion yuan/year, and the benefit of occupational disease reporting system was 4.4 billion yuan/year. Conclusion: The benefit of occupational disease reporting system depends on the cost-benefit of occupational disease prevention and control measures, and proper prevention and control measures are extremely important for improving the benefit of occupational disease reporting system.

Partnerships between the faith-based and medical sectors: Implications for preventive medicine and public health.

Interconnections between the faith-based and medical sectors are multifaceted and have existed for centuries, including partnerships that have evolved over the past several decades in the U.S. This paper outlines ten points of intersection that have engaged medical and healthcare professionals and institutions across specialties, focusing especially on primary care, global health, and community-based outreach to underserved populations. In a time of healthcare resource scarcity, such partnerships—involving religious congregations, denominations, and communal and philanthropic agencies—are useful complements to the work of private-sector medical care providers and of federal, state, and local public health institutions in their efforts to protect and maintain the health of the population. At the same time, challenges and obstacles remain, mostly related to negotiating the complex and contentious relations between these two sectors. This paper identifies pressing legal/constitutional, political/policy, professional/jurisdictional, ethical, and research and evaluation issues that need to be better addressed before this work can realize its full potential.

Laboratory Diagnosis of Human Adenovirus for Surveillance in Japan in 2014

This study sought to clarify how laboratory testing of human mastadenovirus (adenovirus) is conducted in local public health institutes (LPHI) as part of Japanese adenovirus surveillance. Questionnaires on adenovirus surveillance were distributed to LPHIs (n=77) between February and May, 2014. The participation response rate was 100%. During this period, adenoviral cultures were conducted at 65 institutes (84%) while 49 (64%) used neutralization testing. PCR diagnoses were conducted at 58 institutes (75%). The national adenovirus diagnosis manual (http://www.nih.go.jp/niid/ja/labo-manual.html), which includes methods of viral culture and PCR for penton, hexon, and fiber-coding regions, was used in 68% of the LPHIs. Ocular samples were diagnosed at 36 (47%) LPHIs. Most LPHIs conduct adenovirus surveillance in accordance with the national diagnosis manual. Both PCR and viral cultures were used for adenovirus surveillance in the majority of LPHIs during the surveyed period.

The application of China Infectious Diseases Automated-alert and Response System in Zhejiang province, 2012

To analyze and evaluate the application of China Infectious Diseases Automated-alert and Response System(CIDARS)in Zhejiang province. Data through the monitoring program in 2012 was analyzed descriptively and compared with the incidence data in the same period as well information related to public health emergency events. A total of 14 292 signals were generated on 28 kinds of infectious diseases in the system, in Zhejiang province. 100% of the signals had been responded and the median time to response was 0.81 hours. 123 signals (0.86%)were preliminarily verified as suspected outbreaks and 33 outbreaks were finally confirmed by further field investigation, with a positive ratio of 0.23% . Information related to regional distribution showed significant differences which reflecting a positive correlation between the numbers of diseases and the time of early-warning(r = 0. 97, P < 0.01). Distribution of information related to different types of diseases was also significantly different, showing a positive correlation between the prevalent strength of the disease and the amount of information in a specific area(r = 0.80, P < 0.01). CIDARS had a good performance which could be used to assist the local public health institutions on early detection of possible outbreaks at the early stage. However, the effectiveness was different for different regions and diseases.

Storage and transport of isolated M. tuberculosis at public and private health institutions in Japan

To obtain basic data about the present practices on storage and transport of isolated M. tuberculosis at public and private health institutions in Japan. Survey forms regarding the practices on storage and transport of isolated M. tuberculosis were distributed and collected by post-mail in January 2007 to 76 local public health institutions, 145 public health centres, and 150 public or private hospitals. The questionnaire was adopted from the guidelines proposed by the Ministry of Health, Labour, and Welfare in 2006 on storage and transport of isolated M. tuberculosis. The respondents of the survey were as follows: 96.1% (73/76) from local public health institutions, 93.8% (136/145) from public health centres, and 73.3% (110/150) from hospitals. In general, local public health institutions conformed well to the proposed standards, however public health centres and hospitals were not compliant to some standards. Based on the survey conducted on the practice of storage and transport of isolated M. tuberculosis, certain discrepancy was found among public health centres and hospitals.

Dengue virus infection in travellers returning from Benin to France, July – August, 2010

In 2010, our laboratory confirmed a case of DENV-3 infection in a traveller returning from Benin [2]. Isolation of DENV-3 in both east and west Africa suggests that the serotype has emerged or re-emerged in various parts of Africa [3]. As indicated by Gautret et al., further studies are needed to understand the extent of DENV-3 outbreak in Africa, and to reinforce disease surveillance. Laboratory investigation of all suspected cases of DENV infection is conducted in Japan as a part of surveillance for imported cases of DENV infection. As of 19 September 2010, 163 imported cases of DENV infection have been reported, as required by the Japanese Infectious Diseases Control Law. All were confirmed by laboratory tests in the Japanese National Institute of Infectious Diseases or in local public health institutes. Due to the complexity of identifying DENV in the laboratory, virus isolation or a four-fold rise in acute and convalescent serum antibody titre is required for confirmatory diagnosis. In our laboratory, all suspected cases of DENV infection are tested for the virus using reverse transcription-polymerase chain reaction (RT-PCR), commercial anti-DENV IgM and IgG enzymelinked immunosorbent assay (ELISA), virus isolation and nonstructural protein 1 (NS1) antigen ELISA. Our laboratory data and current data on evaluation of commercial kits for the detection of NS1 antigen by other investigators demonstrated that NS1 could be detected in patients with DENV infections up to 14 days after onset of symptoms [4]. It is probable that in combination with IgM and IgG assay results, as acknowledged by Gautret et al., NS1 antigen ELISA may increase the confidence of the diagnosis of DENV infection in travellers [1]. As discussed by Gautret et al., it is highly probable that the French travellers returning from Benin were infected with DENV-3. It is therefore important to examine if these patients develop high neutralizing antibody titres to DENV-3. Taken together, our findings and those of Gautret et al. suggest local DENV transmission in Benin. With the increase in the number of cases of DENV infection reported annually worldwide and the identification of local DENV infection in non-endemic areas, including France [5], more attention needs to be paid to identification of epidemics, disease management and enhanced surveillance of travellers returning from endemic areas.

Seroprevalence of Blood-borne Infections and Population Sizes Estimates in a Population of Injecting Drug Users in Croatia

Similar to some other Central European countries, Croatia has low HIV prevalence among injecting drug users (IDUs) but high hepatitis C (HCV) prevalence. This may indicate different patterns of risk behaviour in this region than in other parts of Europe. The main objectives of this study were to assess the seroprevalence of HIV and hepatitis B and C and related risk factors among IDUs in the three largest Croatian cities (Zagreb, Split, Rijeka) and within the national prison system, as well as to apply a multiplier-method population size estimation of IDUs in Zagreb, Split and Rijeka. Recruitment sites were selected in collaboration with the local public health institutes, NGOs, Centers for treatment municipalities and the judiciary system. Participants were recruited during September and October 2007. Trained peer-recruiters were used to recruit IDU participants at treatment and harm reduction centres as well as pre-identified social, commercial and street based venues. Participants completed the study questionnaire and provided venous blood samples for HIV, hepatitis B and hepatitis C testing. The study included 601 participants, of whom 121 were recruited in Split, 130 in Zagreb, 150 in Rijeka and 200 in the prison system. The prevalence of positive anti-HCV tests was 65% in Split, 51% in Zagreb, 29% in Rijeka and 44% in the prisons. The prevalence of anti-HBcAg was 31% in Split, 13% in Zagreb, 9% in Rijeka and 24% in prison. No case of HIV infection was found. The estimated IDUs population sizes were 2,805 for Zagreb area, 3,347 for Split and 1,370 for Rijeka area, however confidence intervals were very large, indicating the need for larger samples. A high frequency of positive markers on hepatitis B virus and C virus in the population of injecting drug users in Croatia has been confirmed with this research, as well as a low prevalence of HIV infection. This may be related to relatively low levels of injecting risk behaviour and injecting frequency although it is not possible to make strong conclusions on risk behaviour, as participants were mostly recruited in harm reduction programmes. This research should be followed by targeted activities for reducing risks of infectious diseases among injecting drug users in the Republic of Croatia and future research at the national level.

Requirements Analysis of Information Services for Patients on a General Practitioner's Website

To elicit and analyze information needs of patients and primary care physicians (GPs) regarding the information services (static and functional) that a GP's practice website should provide. To find candidate information services, we conducted a literature search and examined primary care physicians' websites, especially Dutch websites. Semi-structured depth interviews with the stakeholders, Dutch patients and GPs, were done to arrive at a final checklist. We then conducted a survey to elicit the level of importance associated with each service on the checklist. The data underwent statistical analysis and relevant requirements were formulated. The requirements were then validated by interviews. General website quality and usability aspects were elicited from the literature. The research resulted in a checklist of 38 selected information services including their priority ratings for patients and GPs; a discrepancy list between GP and patient priorities; and a requirements document containing information services (14 static and 6 functional), and general quality and usability aspects (8 and 5). The following items occurred in the top 10 of both user groups: general practice information, information of local public health institutions, self-help information, repeat prescription, links to health web sites. At the bottom on both priority lists were: links to journals, tests and forums. Dutch GPs are much more selective in terms of which information services to provide on-line. Discrepancy between the two groups concerns on-line services that seem to require a change to the GP's workflow, or those services that are not recognized for reimbursing the GP. Although the Dutch patients' requirements seem to generalize to other patients, the conflict list might depend on the primary care system.

Epidemic of influenza in Kyushu-Okinawa District (April 1994-March 1995)

The prevalence of influenza in Kyushu-Okinawa District in April 1994- March 1995 was studied as the prevalence of influenza virus, to determine the sero-type of influenza viruses isolated in Kyushu- Okinawa District prefectures and cities. As a result, three sero-types of influenza viruses, i.e. type A/H1N1, type H3N2 and type B, were isolated in Kyushu-Okinawa District in this season, but most of the isolates were type A/H3N2 and type B. Weekly changes of reported influenza patients and period of virus isolation at local public health institutes revealed that influenza epidemics of the earlier part in this season was caused by type A/H3N2 and the latter part due to type B. Type A/H3N2 spread all over Kyushu-Okinawa District in a shorter period (about 2 weeks) through the westside of Kyushu and down south, and type B stayed about one month in northern Kyushu and took about 7 weeks to spread all over Kyushu-Okinawa District. Based on these results, the spread of influenza virus in Kyushu-Okinawa District was visualized on the isopleth maps.