Potential Public Health Emergencies Research Articles

Is primary care ready for a potential new public health emergency in the wake of the COVID-19 pandemic, now subsided?

The lingering burden of the COVID-19 pandemic on primary care clinicians and practices poses a public health emergency for the United States. This study uses clinician-reported data to examine changes in primary care demand and capacity. From March 2020 to March 2022, 36 electronic surveys were fielded among primary care clinicians responding to survey invitations as posted on listservs and identified through social media and crowd sourcing. Quantitative and qualitative analyses were performed on both closed- and open-ended survey questions. An average of 937 respondents per survey represented family medicine, pediatrics, internal medicine, geriatrics, and other specialties. Responses reported increases in patient health burden, including worsening chronic care management and increasing volume and complexity. A higher frequency of dental- and eyesight-related issues was noted by respondents, as was a substantial increase in mental or emotional health needs. Respondents also noted increased demand, "record high" wait times, and struggles to keep up with patient needs and the higher volume of patient questions. Frequent qualitative statements highlighted the mismatch of patient needs with practice capacity. Staffing shortages and the inability to fill open clinical positions impaired clinicians' ability to meet patient needs and a substantial proportion of respondents indicated an intention to leave the profession or knew someone who had. These data signal an urgent need to take action to support the ability of primary care to meet ongoing patient and population health care needs.

Long-acting injectable antipsychotics as maintenance therapy for schizophrenia during the COVID-19 pandemic: A micro-narrative review.

The coronavirus disease pandemic has presented healthcare systems with unprecedented challenges globally and substantially impacted the management of chronic diseases such as schizophrenia. This narrative review highlights the usefulness of long-acting injectable antipsychotics (LAIs) as maintenance therapy for patients with schizophrenia during the pandemic. The analysis of relevant literature and psychiatric survey data revealed diverse trends in LAIs prescription and patient adherence with oral antipsychotics. Although some studies have reported a decrease in LAIs prescriptions owing to pandemic-related disruptions, others have suggested stable patient adherence with oral antipsychotics. Approximately 70% of Japanese psychiatrists reported an increase in schizophrenia relapse rates in a survey, underscoring the critical role of LAIs in maintaining therapeutic stability. The potential benefits of LAIs with extended dosing intervals have been highlighted, including improving oral medication adherence and reducing the frequency of hospital visits. In conclusion, this review emphasizes the continued need for uninterrupted LAIs therapy in conjunction with community and home-based care despite the disruptions caused by the coronavirus disease pandemic. Further development of LAIs maintenance therapy strategies considering the ongoing pandemic and potential future public health emergencies are required.

The relationship between self-control and mental health problems among Chinese university students.

Mental health issues are often associated with poor self-control. Therefore, effective interventions against mental health problems should include self-control training. However, it is unclear whether the effect of self-control varies across different types of mental health problems. A cross-sectional survey was conducted using the convenience sampling method at five universities in Chongqing, China, where 1,409 students reported their demographic information, level of self-control, and symptoms of irritability, depression, and anxiety. Descriptive statistical methods and a network analysis approach were employed to explore the relationship between self-control and symptoms of irritability, depression, and anxiety among 1,409 students. The bridging links between self-control and the three mental health problems were analyzed. The findings revealed a negative correlation between self-control and symptoms of irritability, depression, and anxiety among university students. Impulse control was found to be the bridge between self-control and irritability or anxiety symptoms, while resistance to temptation was the bridge between self-control and depressive symptoms. These results demonstrate the different relationship between self-control with irritability, anxiety, and depressive symptoms. The findings of this study may shed light on future mental health interventions for university students during potential public health emergencies, such as prior knowledge of the main types of psychological problems among university students, which may allow for the development of precise self-control intervention strategies, such as targeting impulsivity or resistance to temptation.

Assessment of the supply/demand balance of medical resources in Beijing from the perspective of hierarchical diagnosis and treatment.

Considering the United Nations' Sustainable Development Goals (SDGs) and the need for a balanced spatial distribution of urban medical resources capable of perspective of hierarchical diagnosis and treatment, i.e. providing continuous and accessible medical services during potential public health emergencies, we assessed accessibility and service capacity of the three hospital levels in Beijing. Using geographical information systems (GIS) and the two-step floating catchment area method with the street as research unit, we found that there is an over-supply of medical resources in the centre of the city with weaker support in the peripheral areas as manifested by less supply in relation to popular demand of medical services. The spatial distribution of hospitals at all levels and their resources was found to be uneven: 82.4% of the residents can reach a tertiary hospital (a hospital offering advanced specialized medical and health services to multiple regions) within a 15-minute drive; 50.6% can reach a secondary hospital (a hospital offering comprehensive medical and health services to various communities) within a 10-minute drive; and 77.6% can reach a primary hospital (a hospital directly delivering prevention, medical treatment, healthcare, and rehabilitation services to the community of a certain population) within a 15- minute walk. It was noted that the supply/demand balance of medical resources in the tertiary hospitals decreases from the centre to the periphery, while the secondary hospitals show a dual-centre pattern and the primary hospitals a more uneven distribution, with oversupply in the East and the opposite in the Centre. The results of the study provide supplementary decision support for improving the hierarchical diagnosis and treatment system and accelerate the overall deployment of medical resources.

Individual preferences, government policy, and COVID-19: A game-theoretic epidemiological analysis

PurposeThe ongoing COVID-19 pandemic imposes serious short-term and long-term health costs on populations. Restrictive government policy measures decrease the risks of infection, but produce similarly serious social, mental health, and economic problems. Citizens have varying preferences about the desirability of restrictive policies, and governments are thus forced to navigate this tension in making pandemic policy. This paper analyses the situation facing government using a game-theoretic epidemiological model. MethodologyWe classify individuals into health-centered individuals and freedom-centered individuals to capture the heterogeneous preferences of citizens. We first use the extended Susceptible-Exposed-Asymptomatic-Infectious-Recovered (SEAIR) model (adding individual preferences) and the signaling game model (adding government) to analyze the strategic situation against the backdrop of a realistic model of COVID-19 infection. FindingsWe find the following: 1. There exists two pooling equilibria. When health-centered and freedom-centered individuals send anti-epidemic signals, the government will adopt strict restrictive policies under budget surplus or balance. When health-centered and freedom-centered individuals send freedom signals, the government chooses not to implement restrictive policies. 2. When governments choose not to impose restrictions, the extinction of an epidemic depends on whether it has a high infection transmission rate; when the government chooses to implement non-pharmacological interventions (NPIs), whether an epidemic will disappear depends on how strict the government's restrictions are. Originality/valueBased on the existing literature, we add individual preferences and put the government into the game as a player. Our research extends the current form of combining epidemiology and game theory. By using both we get a more realistic understanding of the spread of the virus and combine that with a richer understanding of the strategic social dynamics enabled by game theoretic analysis. Our findings have important implications for public management and government decision-making in the context of COVID-19 and for potential future public health emergencies.

Parental perspectives on emergency health service use during the first wave of the COVID-19 pandemic in the United Kingdom: A qualitative study.

UK 'Lockdown' measures introduced in March 2020 aimed to mitigate the spread of COVID-19. Although seeking healthcare was still permitted within restrictions, paediatric emergency department attendances reduced dramatically and led to concern over risks caused by delayed presentation. Our aim was to gain insight into healthcare decisions faced by parents during the first wave of the COVID-19 pandemic and to understand if use of urgent healthcare, self-care, and information needs differed during lockdown as well as how parents perceived risks of COVID-19. We undertook qualitative telephone interviews with a purposive sample of parents living in the North East of England recruited through online advertising. We used a semi-structured interview schedule to explore past and current healthcare use, perceptions of risk and the impact of the pandemic on healthcare decisions. Interviews were transcribed and analysed using Thematic Analysis. Three major themes were identified which concerned (i) how parents made sense of risks posed to, and by their children, (ii) understanding information regarding health services and (iii) attempting to make the right decision. These themes contribute to the understanding of the initial impact of COVID-19 and associated restrictions on parental decisions about urgent healthcare for children. These findings are important to consider when planning for potential future public health emergencies but also in the wider context of encouraging appropriate use of urgent healthcare.

The Need to Establish and Sustain Public Health Emergency Operation Centers for Managing Infectious Disease Outbreaks: Lesson From Response to Louse-Borne Relapsing Fever Outbreak in Jimma, Ethiopia.

The coronavirus disease 2019 (COVID-19) pandemic has provided a great lesson for the globe about the necessity and significance of pandemics-related preparedness in all settings. Public health emergency operation centers play critical roles in preparing for and responding to public health events and emergencies by coordinating and pooling resources. In this article, we aimed to share lessons learnt from the public health response to the louse-borne relapsing fever (LBRF) outbreak coordinated by the emergency operation center established to respond to the COVID-19 pandemic in Jimma, Ethiopia.After the major waves of COVID-19 outbreaks in Ethiopia were over, Jimma University Medical Center (JUMC) reported clusters of louse-borne relapsing fever cases from Jimma Main Prison. Accordingly, Jimma Emergency Operation Center (JEOC) established for the COVID-19 pandemic was immediately alerted and effectively coordinated the overall response.As a result, the outbreak was contained within the prison without spreading to the community and the outbreak ended within a shorter period compared to previous LBRF outbreaks in Ethiopia. This indicates the necessity of establishing and sustaining public health emergency operation centers to prepare for and combat potential future public health emergencies.

Anti-malarial activity of HCl salt of SKM13 (SKM13-2HCl)

Malaria is among the most devastating and widespread tropical parasitic diseases in developing countries. To prevent a potential public health emergency, there is an urgent need for new antimalarial drugs, with single-dose cures, broad therapeutic potential, and novel mechanism of action. We synthesized HCl salt of SKM13 (SKM13-2HCl) based on the modification of SKM13 to improve solubility in water. The anti-malarial activity of the synthesized drug was evaluated in both in vitro and in vivo models. The selective index indicated that SKM13-2HCl showed the same effectiveness with SKM13 in Plasmodium falciparum in in-vitro. Even though, in vivo mouse study demonstrated that SKM13 (20 mg/kg) at single dose could not completely inhibit P. berghei growth in blood. The survival rate increased from 33 to 90% at 15 days after infection. However, SKM13-2HCl (20 mg/kg) at a single dose increased the survival rate up to 100% at the same duration. Ultra-High-Performance Liquid Chromatography (UHPLC) showed that solubility in water of SKM13 and SKM13-2HCL was 0.389 mg/mL and 417 mg/mL, respectively. Pharmacokinetics (PK) analysis corresponded to the increased solubility of SKM13-2HCl over SKM13. Haematological parameters [red blood cell (RBC) count, haemoglobin level, and haematocrit level] supported the comparable efficacy of SKM13 and SKM13-2HCl in a 4-day suppression test. One mode of these drugs was found to be activating phosphorylation of eIF2α, hallmark of ER-stress, to kill parasite. Novel salt derivative of SKM13 (SKM13-2HCl) have enhanced anti-malarial activity against P. falciparum with endoplasmic reticulum (ER)-stress and salt form of SKM13 is an excellent direction to develop anti-malarial drug candidate in mice model.

The monkeypox outbreak: risks to children and pregnant women

As of July 21, 2022, WHO has reported 15 734 laboratory-confirmed monkeypox infections, including children, in 75 countries across five continents.1 The unprecedented widespread geographical distribution of this poxvirus shows the risk for a potential public health emergency of international concern. These laboratory-confirmed monkeypox infections are more than double the total number of cases than in the previous situation report published 2 weeks earlier on July 9, 2022, emphasising the sustained transmission of the monkeypox virus.

Design, molecular docking, and antimicrobial assessment of newly synthesized phytochemical thymol Mannich base derivatives

• Synthesized and structural elucidation of Mannich based thymol congeners. • Antibacterial and antifungal activities were carried out against UTI bacteria and T. rubrum, C. tropicalis . • Compound 4-((dimethylamine)methyl)−2-isopropyl-5-methylphenol 4 g had shown potent antifungal action with MIC against 3.12 μg/mL T. rubrum . • Molecular docking and PreADMET was performed against viz ., bacterial DHPS enzyme and fungal lanosterol C14α-Demethylase. Antibacterial resistance has been brewing for decades and has now surfaced into potential public health emergency, everywhere. Thus, newer potent drug candidates are needed urgently that would help overcoming antibiotic resistances in bacteria and fungi. A series of thymol-bearing amino methylated sulfonamide congeners, 4a-4l were designed and synthesized by the Mannich condensation reaction of the respective cyclic amines 3a-3 g , and N -heteroaryl- 4-amino benzenesulfonamide 3h-3l , with thymol and formaldehyde in an acidic medium . The synthesized compounds were structurally confirmed by spectroscopic studies; 1 H/ 13 C NMR, FTIR, ESI-HRMS, and elemental analysis. The powder characterization of the synthesized compounds was performed by XRD analysis. The obtained products were screened for antibacterial assay against uropathogenic bacteria, Staphylococcus aureus, Streptococcus pyogenes and Escherichia coli ; and for antifungal assay with Candida tropicalis and Trichophyton rubrum. The results of antimicrobial activities of all compounds had exhibited moderate to excellent bacterial inhibition; whereas the compound 2-isopropyl-5-methyl-4-(pyrrolidin-1-ylmethyl)phenol , 4f had exhibited significant inhibition of E.coli and S. aureus with MIC 3.12 μg/ml, 12.5 μg/ml, respectively. The compound 4-((dimethylamino)methyl)-2-isopropyl-5-methylphenol , 4 g had a good inhibition against E. coli and S. aureus at MIC 6.25 μg/ml; and for T. rubrum at 3.12 μg/ml. The synthesized compounds 4 g and 4 h had the highest inhibition against the fungus, T. rubrum at inhibition with 27 and 28 mm, respectively. Thus, the synthesized compounds with methylated dimethylamino in thymol could be the potential lead candidates for antibacterial and antifungal actions. The binding affinity of the compounds had been evaluated by molecular docking with both bacterial and fungal target proteins and their physiological and ADME properties were assessed.

Design, molecular docking and antimicrobial assessment of newly synthesized p-cuminal-sulfonamide Schiff base derivatives

Antibiotic resistance of bacteria and fungi has been brewing for decades and has now surfaced as a potential public health emergency, globally. Thus, newer potent drug candidates are needed urgently to overcome antibiotic-resistant episodes. As an attempt to overcome the antimicrobial multi-drug resistance problems, a new series of p-cuminal sulfonamide Schiff base congeners 3a-3h were designed, synthesized, and their structures confirmed by several spectral studies. The antimicrobial activities assessment of obtained products was carried out against pathogenic bacteria Staphylococcus aureus, Streptococcus pyogenes, Methicillin-resistant Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and against pathogenic fungi Candida tropicalis and Trichophyton rubrum. Among them, 3b exhibited significant inhibition of all the strains of bacteria with MIC as 3.12μg/mL and the compound 3e exhibited the most promising control against both C. tropicalis and T. rubrum (MIC 6.25μg/mL) in comparison to Ketoconazole as well as good inhibition against both S. aureus and MRSA at MIC 6.25 μg/mL The presence of sulfamoyl and azomethine groups and some of heteroaryl rings in individual molecules could have increased the antibacterial actions, while the antifungal action could be attributed to the presence of guanyl and acetyl groups in the molecular structure. Furthermore, in silico investigation and drug-likeness have been ascertained with biological targets.

Resource Allocation During the COVID-19 Pandemic: Contributions to an Ethical Approach.

The COVID-19 pandemic has brought dramatic worldwide consequences affecting social, economic and healthcare systems. Considering that the number of infected patients requiring admission to intensive care units far exceeded the available resources, healthcareprofessionals have had to face challenging decisions concerning who should benefit from the limited resources and who should not. In this context, after a careful ethical reflection, we propose some principles to be adopted when dealing with allocation resource decisions, based on core ethical values. Ideally, these strategies should be established and integrated into institutional policies before a crisis scenario, in order to anticipate a potential new public health emergency and prevent possible tragic consequences.

Mind the gap: an analysis of core capacities of the international health regulations (2005) to respond to outbreaks in Yemen

BackgroundYemen that has been devastated by war is facing various challenges to respond to the recent potential outbreaks and other public health emergencies due to lack of proper strategies and regulations, which are essential to public health security. The aim of this study is to assess the implementation of the International Health Regulations (IHR 2005) core capacities under the current ongoing conflict in Yemen.MethodsThe study simulated the World Health Organization (WHO) Joint External Evaluation (JEE) tool to assess the IHR core capacities in Yemen. Qualitative research methods were used, including desk reviews, in-depth interviews with key informants and analysis of the pooled data.ResultBased on the assessment of the three main functions of the IHR framework (prevention, detection, and response), Yemen showed a demonstrated or developed capacity to detect outbreaks, but nevertheless limited or no capacity to prevent and respond to outbreaks.ConclusionThis study shows that there has been poor implementation of IHR in Yemen. Therefore, urgent interventions are needed to strengthen the implementation of the IHR core capacities in Yemen. The study recommends 1) raising awareness among national and international health staff on the importance of IHR; 2) improving alignment of INGO programs with government health programs and aligning both towards better implementation of the IHR; 3) improving programmatic coordination, planning and implementation among health stakeholders; 4) increasing funding of the global health security agenda at country level; 5) using innovative approaches to analyze and address gaps in the disrupted health system, and; 6) addressing the root cause of the collapse of the health services and overall health system in Yemen by ending the protracted conflict situation.

Response to reviews of Containing Contagion by Sara E. Davies

It was always known that implementing the IHR was going to be a long and difficult journey for many countries in the region, one pursued alongside other equally important health goals such as universal health care and vaccination coverage The COVID-19 pandemic has clearly demonstrated the cost of failing to incorporate a human rights framework as one of the essential core capacity requirements for meeting the IHR The Asia Pacific Strategy for Emerging Infectious Diseases (APSED) was developed to assist the two regional offices member states come to grips with the capacities required under the revised IHR I found that though there were profound differences between them, overall, ASEAN states had responded positively to the concept of shared infectious disease surveillance and the reporting of infectious disease outbreaks, both endemic and emerging diseases, to neighbouring states [Extracted from the article] Copyright of Singapore Journal of Tropical Geography is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

A stepped wedge cluster randomized control trial to evaluate the implementation and effectiveness of optimized initiatives in improving quality of care for ST segment elevation myocardial infarction in response to the COVID-19 outbreak

BackgroundThe National Chest Pain Center Accreditation Program (CHANGE) is the first hospital-based, multifaceted, nationwide quality improvement (QI) initiative, to monitor and improve the quality of the ST segment elevation myocardial infarction (STEMI) care in China. The QI initiatives, as implementation strategies, include a bundle of evidence-based interventions adapted for implementation in China. During the pandemic of coronavirus disease 2019 (COVID-19), fear of infection with severe acute respiratory syndrome coronavirus 2, national lockdowns, and altered health care priorities have highlighted the program’s importance in improving STEMI care quality. This study aims to minimize the adverse impact of the COVID-19 pandemic on the quality of STEMI care, by developing interventions that optimize the QI initiatives, implementing and evaluating the optimized QI initiatives, and developing scale-up activities of the optimized QI initiatives in response to COVID-19 and other public health emergencies.MethodsA stepped wedge cluster randomized control trial will be conducted in three selected cities of China: Wuhan, Suzhou, and Shenzhen. Two districts have been randomly selected in each city, yielding a total of 24 registered hospitals. This study will conduct a rollout in these hospitals every 3 months. The 24 hospitals will be randomly assigned to four clusters, and each cluster will commence the intervention (optimized QI initiatives) at one of the four steps. We will conduct hospital-based assessments, questionnaire surveys among health care providers, community-based household surveys, and key informant interviews during the trial. All outcome measures will be organized using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, including implementation outcomes, service outcomes (e.g., treatment time), and patient outcomes (e.g., in-hospital mortality and 1-year complication). The Consolidated Framework for Implementation Research framework will be used to identify factors that influence implementation of the optimized QI interventions.DiscussionThe study findings could be translated into a systematic solution to implementing QI initiatives in response to COVID-19 and future potential major public health emergencies. Such actionable knowledge is critical for implementors of scale-up activities in low- and middle-income settings.Trial registrationChiCTR 2100043319. Registered on 10 February 2021

IMPACT OF PUBLIC HEALTH EMERGENCIES ON THE COMPREHENSIVE EDUCATION OF MEDICAL STUDENTS IN COLLEGES AND UNIVERSITIES FROM THE PERSPECTIVE OF NARRATIVE MEDICINE

ABSTRACT The impact of traditional public health emergencies on the comprehensive education of medical students in colleges and universities is mainly reflected in the test of comprehensive literacy. Based on this, this paper studies the construction of a public health emergency impact analysis platform from a medical perspective and cloud computing. From the platform’s database construction, event collection methods, impact evaluation rules and other aspects to achieve accurate analysis of the impact of emergencies, using the cloud computing method for comprehensive analysis and evaluation, the algorithm can analyze and intelligently classify information data on the Internet in the process of multiple input, and respond to potential public health emergencies according to cloud computing technology, in order to analyze the impact on the comprehensive quality of medical students. The experimental results show that the public health emergency analysis platform has the advantages of high feasibility and high data utilization, and can effectively improve the impact of public health emergencies on the comprehensive literacy of medical students.

Recent Progress in the Development of New Antimalarial Drugs with Novel Targets.

Malaria is a major global health problem that causes significant mortality and morbidity annually. The therapeutic options are scarce and massively challenged by the emergence of resistant parasite strains, which causes a major obstacle to malaria control. To prevent a potential public health emergency, there is an urgent need for new antimalarial drugs, with single-dose cures, broad therapeutic potential, and novel mechanism of action. Antimalarial drug development can follow several approaches ranging from modifications of existing agents to the design of novel agents that act against novel targets. Modern advancement in the biology of the parasite and the availability of the different genomic techniques provide a wide range of novel targets in the development of new therapy. Several promising targets for drug intervention have been revealed in recent years. Therefore, this review focuses on the progress made on the latest scientific and technological advances in the discovery and development of novel antimalarial agents. Among the most interesting antimalarial target proteins currently studied are proteases, protein kinases, Plasmodium sugar transporter inhibitor, aquaporin-3 inhibitor, choline transport inhibitor, dihydroorotate dehydrogenase inhibitor, isoprenoid biosynthesis inhibitor, farnesyltransferase inhibitor and enzymes are involved in lipid metabolism and DNA replication. This review summarizes the novel molecular targets and their inhibitors for antimalarial drug development approaches.

Spatial and temporal distribution of infectious disease epidemics, disasters and other potential public health emergencies in the World Health Organisation Africa region, 2016\u20132018

BackgroundEmerging and re-emerging diseases with pandemic potential continue to challenge fragile health systems in Africa, creating enormous human and economic toll. To provide evidence for the investment case for public health emergency preparedness, we analysed the spatial and temporal distribution of epidemics, disasters and other potential public health emergencies in the WHO African region between 2016 and 2018.MethodsWe abstracted data from several sources, including: the WHO African Region’s weekly bulletins on epidemics and emergencies, the WHO-Disease Outbreak News (DON) and the Emergency Events Database (EM-DAT) of the Centre for Research on the Epidemiology of Disasters (CRED). Other sources were: the Program for Monitoring Emerging Diseases (ProMED) and the Global Infectious Disease and Epidemiology Network (GIDEON). We included information on the time and location of the event, the number of cases and deaths and counter-checked the different data sources.Data analysisWe used bubble plots for temporal analysis and generated graphs and maps showing the frequency and distribution of each event. Based on the frequency of events, we categorised countries into three: Tier 1, 10 or more events, Tier 2, 5–9 events, and Tier 3, less than 5 or no event. Finally, we compared the event frequencies to a summary International Health Regulations (IHR) index generated from the IHR technical area scores of the 2018 annual reports.ResultsOver 260 events were identified between 2016 and 2018. Forty-one countries (87%) had at least one epidemic between 2016 and 2018, and 21 of them (45%) had at least one epidemic annually. Twenty-two countries (47%) had disasters/humanitarian crises. Seven countries (the epicentres) experienced over 10 events and all of them had limited or developing IHR capacities. The top five causes of epidemics were: Cholera, Measles, Viral Haemorrhagic Diseases, Malaria and Meningitis.ConclusionsThe frequent and widespread occurrence of epidemics and disasters in Africa is a clarion call for investing in preparedness. While strengthening preparedness should be guided by global frameworks, it is the responsibility of each government to finance country specific needs. We call upon all African countries to establish governance and predictable financing mechanisms for IHR implementation and to build resilient health systems everywhere.

Establishment of a Sentinel Laboratory-Based Antimicrobial Resistance Surveillance Network in Ethiopia.

In 2014, as part of the Global Health Security Agenda, Ethiopia was provided the technical and financial resources needed to prioritize antimicrobial resistance (AMR) in the national public health sphere. Under the direction of a multi-stakeholder working group, AMR surveillance was launched in July 2017 at 4 sentinel sites across the country. The AMR surveillance initiative in Ethiopia represents one of the first systematic efforts to prospectively collect, analyze, and report national-level microbiology results from a network of hospitals and public health laboratories in the country. Baseline readiness assessments were conducted to identify potential challenges to implementation to be addressed through capacity-building efforts. As part of these efforts, the working group leveraged existing resources, initiated laboratory capacity building through mentorship, and established infrastructure and systems for quality assurance, data management, and improved coordination. As a result, AMR surveillance data are being reported and analyzed for use; data from more than 1,700 patients were collected between July 2017 and March 2018. The critical challenges and effective solutions identified through surveillance planning and implementation have provided lessons to help guide successful AMR surveillance in other settings. Ultimately, the surveillance infrastructure, laboratory expertise, and communication frameworks built specifically for AMR surveillance in Ethiopia can be extended for use with other infectious diseases and potential public health emergencies. Thus, building AMR surveillance in Ethiopia has illustrated how laying the foundation for a specific public health initiative can develop capacity for core public health functions with potential benefit.

688. Impact of Expanded Influenza Post-exposure Prophylaxis on Healthcare Worker Absenteeism at a Tertiary Care Center During the 2017–2018 Season

BackgroundA severe 2017–2018 influenza season was expected for the United States. We hypothesized that a surge in influenza cases paired with decreased vaccine effectiveness could increase healthcare worker (HCW) absenteeism. Because of a potential public health emergency during the 2017–2018 season, we offered oseltamivir post-exposure prophylaxis (PEP) to exposed HCWs regardless of vaccination status. We describe PEP uptake, cost, and impact on absenteeism at the University of Iowa Hospital and Clinics (UIHC).MethodsUIHC serves as a referral and safety net health system for Eastern Iowa. Influenza seasons were defined as the period between Week 40 from 1 year to Week 13 of the following year. During the 2016–2017 season, PEP (75 mg/day for 7 days) was offered free of charge to unvaccinated exposed HCWs. Exposure was defined as proximity within 3 ft of a confirmed influenza-infected person for ≥10 minutes without mask protection, or direct contact with respiratory secretions. During the 2017–2018 season, PEP was expanded to all exposed HCWs regardless of vaccination status. We reviewed surveillance, employee health, pharmacy, and human resources records for the 2016–2017 and 2017–2018 seasons. We defined PEP uptake as prescriptions picked up/all referrals and absenteeism rate as sick-leave requests/scheduled hours.ResultsDuring the 2016–2017 and 2017–2018 seasons, we detected 373 and 427 confirmed influenza cases among patients at UIHC. HCW vaccination rates were similar: 89.7% and 90.9%. PEP was recommended in 49 exposures during 2016–2017 and 280 exposures during 2017–2018. A total of 22 (44.9%) and 133 (47.5%) HCWs picked up oseltamivir from the pharmacy during the 2016–2017 and 2017–2018 seasons. The estimated cost of oseltamivir was $1,791 and $10,828, respectively. Overall, 6,187 sick-leave requests (median = 12 hours, absenteeism rate = 3.2%), and 6,174 sick-leave requests (median = 12 hours, absenteeism rate = 3.4%) were reported during the 2016–2017 and 2017–2018 seasons.ConclusionInfluenza case counts mildly increased from the 2016–2017 to the 2017–2018 season. Expanding PEP to all exposed HCWs, regardless of vaccination status, had moderate uptake and was costly. Absenteeism rates remained similar during both seasons.Disclosures All authors: No reported disclosures.