Public Health Response Research Articles

Relation between the Pandemic COVID-19 and the outbreak of Crimean-Congo Hemorrhagic Fever in Iraq, 2023

Objective: This review examines the link between the COVID-19 pandemic and the outbreak of Crimean-Congo Hemorrhagic Fever (CCHF) in Iraq. Methods: We reviewed literature and data to explore potential associations between the two diseases. Results: No direct causative link between COVID-19 and increased CCHF cases in Iraq was found. However, changes in healthcare,agriculture, and human-animal interactions during the pandemic may have indirectly affected CCHF transmission. Conclusion: This review highlights the need for further research to confirm any connections between the COVID-19 pandemic and CCHFoutbreaks in Iraq. Understanding these links is crucial for effective public health responses to emerging infectious diseases.

Assessment of Primary Laboratory Facilities for Rural Health Care Preparedness in Osmanabad District, India

Government of India has provided Indian Public Health Standards to improve rural health care services and health status, but still rural laboratory is a cause of concern. This study is performed to understand the laboratory facility-level gaps that need to be addressed to improve the public primary health centres (PHCs) present in rural areas. The laboratory assessment is performed for governance, financing, resources and services, and results are validated with the PHC laboratory performance. The current assessment shows critical gaps in the facilities regarding governance, services, resources and financing required for the laboratory services at the rural primary health care level. Governance and services need to be strengthened the most, followed with sustained availability of resources and financing. Poor health status in rural areas necessitates public health response based on health systems. Therefore, health system preparedness in the form of laboratory services is essential in primary health care facilities.

Using Family Needs Assessments to Guide Place‐Based Services for Vulnerable Families: Lessons From the COVID‐19 Pandemic

ABSTRACTThe COVID‐19 pandemic created significant health, social and economic impacts, disproportionately affecting minority, immigrant and low‐income communities. Agencies were challenged to rapidly address emerging needs, yet most operated on anecdotal information. This paper describes a community‐informed family needs assessment in Miami, Florida, during November 2020–March 2021. It was conducted by a nonprofit agency collaborating with a university. The aims were to capture socio‐economic, educational and health needs experienced during the early pandemic to inform place‐based services. Eighty‐one participants, mostly Hispanic, foreign‐born parents, completed an anonymous online survey of pandemic experiences, with 15 parents participating in additional, in‐depth focus group discussions. Utilizing a mixed methods approach, results show that perceived economic, educational and psychosocial needs often exceeded and complicated health impacts, with basic needs including food/housing assistance, occupational programmes and online support groups. By coordinating the response around identified needs, this community–academic partnership strengthened and targeted their place‐based public health response, an approach that can serve to guide other communities.

Exploring the impacts of COVID-19 on Alberta correctional workers

COVID-19 and the subsequent public health responses disrupted the routines and lives of people globally. The impact was felt by correctional workers who navigated rapidly changing public health policies and many disruptions to operations within both institutional and community correctional services. In the current study, we unpack qualitative findings emerging from an online mental health and well-being survey, during COVID-19, of 571 correctional workers employed in the Canadian province of Alberta. Results emphasize how correctional work was strained by the on-set of the COVID-19 pandemic, creating other risks and vulnerabilities for both staff and incarcerated people. Respondents highlighted impacts to their workload, routine, personal and institutional security, relationships with colleagues and incarcerated people, and their competing perspectives on the enforcement and ethics of ensuing public health measures intended to contain the spread of the virus. We discuss the empirical implications of these findings and areas for future research post pandemic.

Real-time genomic surveillance for enhanced control of infectious diseases and antimicrobial resistance

This article advocates for mobilizing pathogen genomic surveillance to contain and mitigate health threats from infectious diseases and antimicrobial resistance (AMR), building upon successes achieved by large-scale genome sequencing analysis of SARS-CoV-2 variants in guiding COVID-19 monitoring and public health responses and adopting a One Health approach. Capabilities of laboratory-based surveillance and epidemic alert systems should be enhanced by fostering (i) universal access to real-time whole genome sequence (WGS) data of pathogens to inform clinical practice, infection control, public health policies, and vaccine and antimicrobial drug research and development; (ii) integration of diagnostic microbiology data, data from testing asymptomatic individuals, pathogen sequence data, clinical data, and epidemiological data into surveillance programs; (iii) stronger cross-sectorial collaborations between healthcare, public health, animal health, and environmental surveillance and research using One Health approaches, toward understanding the ecology and transmission pathways of pathogens and AMR across ecosystems; (iv) international collaboration and interconnection of surveillance networks, harmonization of laboratory methods, and standardization of surveillance methods for global reporting, including on pathogen genomic variant or strain nomenclature; (v) responsible data sharing between surveillance networks, databases, and platforms according to FAIR (findability, accessibility, interoperability, and reusability) principles; and (vi) research on genomic surveillance system implementation and its cost-effectiveness for different pathogens and AMR threats across different settings. Regional and global One Health policies and governance initiatives should foster the concerted development and efficient utilization of pathogen genomic surveillance to protect the health of humans, animals, and the environment.

Trends in Suspected Opioid Drug Overdose Events in Emergency Medical Service Encounters in South Carolina, 2019-2022.

The number of drug overdoses and drug-related deaths has increased across the United States in recent years. Reports of suspected opioid drug overdoses identified through emergency medical services (EMS) are valuable sources of information for shaping the public health response to drug overdoses. The objective of this study was to describe trends in the number of EMS-reported suspected opioid drug overdose events in South Carolina from 2019 through 2022. We included reports of suspected opioid drug overdoses if they met the definition of nonfatal opioid overdose syndrome in our analysis. We analyzed statewide data reported from EMS agencies to biospatial, Inc, from January 2019 through December 2022 to understand demographic trends for a statewide overdose and response program in South Carolina. In 2022, a total of 11 078 suspected opioid drug overdose events, or 216.4 per 100 000 South Carolina residents, were reported by EMS. During the 4-year study period, the number of EMS-reported suspected opioid drug overdoses increased by 82%, with African American people experiencing a 133% increase and White people experiencing a 68% increase. The number of opioid overdoses increased among all age groups during the study period. Approximately 84% of opioid overdoses were reported in urban counties, but rural counties had a higher number of opioid overdose reports per capita than urban counties. Monitoring trends in suspected opioid drug overdoses allows decision makers to adjust resources and programs for overdose response and is essential for local coordinated response. Continued monitoring of trends is needed for an equitable response to prevent opioid drug overdoses.

Exploring factors influencing attitudes towards COVID-19 prevention measures and compliance with behavioral guidelines

This study provides a comprehensive analysis of how individual traits, political ideologies, and media perceptions influence attitudes and behaviors toward COVID-19 prevention measures. It highlights the significant positive impact of individual-level collectivism and uncertainty avoidance on adherence to these measures, emphasizing the effectiveness of public health communications that resonate with collectivist values and offer clear, structured guidance. The research also reveals a negative correlation between conservative political ideology and compliance with COVID-19 prevention, suggesting that political affiliations significantly shape public health responses. Additionally, the study examines the role of media, showing that favorable views towards traditional media correlate with better compliance. These findings underline the importance of tailored health communication strategies that consider psychological, social, and political factors. This study also points to the necessity for further research to explore these dynamics more deeply across different cultural contexts, enhancing the efficacy of global public health initiatives.

Communities organizing to promote equity: engaging local communities in public health responses to health inequities exacerbated by COVID-19-protocol paper.

The COVID-19 pandemic has disproportionately impacted rural and under-resourced urban communities in Kansas. The state's response to COVID-19 has relied on a highly decentralized and underfunded public health system, with 100 local health departments in the state, few of which had prior experience engaging local community coalitions in a coordinated response to a public health crisis. To improve the capacity for local community-driven responses to COVID-19 and other public health needs, the University of Kansas Medical Center, in partnership with the Kansas Department of Health and Environment, will launch Communities Organizing to Promote Equity (COPE) in 20 counties across Kansas. COPE will establish Local Health Equity Action Teams (LHEATs), coalitions comprised of community members and service providers, who work with COPE-hired community health workers (CHWs) recruited to represent the diversity of the communities they serve. CHWs in each county are tasked with addressing unmet social needs of residents and supporting their county's LHEAT. LHEATs are charged with implementing strategies to improve social determinants of health in their county. Monthly, LHEATs and CHWs from all 20 counties will come together as part of a learning collaborative to share strategies, foster innovation, and engage in peer problem-solving. These efforts will be supported by a multilevel communications strategy that will increase awareness of COPE activities and resources at the local level and successes across the state. Our mixed methods evaluation design will assess the processes and impact of COPE activities as well as barriers and facilitators to implementation using aspects of both the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) models. This protocol is designed to expand community capacity to strategically partner with local public health and social service partners to prioritize and implement health equity efforts. COPE intentionally engages historically resilient communities and those living in underserved rural areas to inform pragmatic strategies to improve health equity.

Social impact: Trusting open science for future pandemic resilience

In response to the pressing need to improve epidemic preparedness, this paper presents the development and application of EPISOS, a project designed to improve the timeliness, completeness, and accessibility of epidemiological data. Through EPISOS, we have created a dynamic, cross-sectoral collaborative framework that supports the detection, monitoring, and risk assessment of emerging and re-emerging infectious diseases across Europe. This initiative not only addresses the challenges of standardizing data quality and resource availability, but also promotes equity in data access and use. The paper critically analyzes the difficulties encountered in these areas and outlines effective strategies for leveraging open science to strengthen public health responses. Integrating real-world examples, we illustrate the practical impact and potential of EPISOS in promoting scientific collaboration and transparency during health crises.

Impact of the COVID-19 Pandemic on HIV Test Uptake Among People Who Inject Drugs in the Context of an HIV Outbreak

Glasgow, Scotland’s largest city, has been experiencing an HIV outbreak among people who inject drugs (PWID) since 2015. A key focus of the public health response has been to increase HIV testing among those at risk of infection. Our aim was to assess the impact of COVID-19 on HIV testing among PWID in Glasgow. HIV test uptake in the last 12 months was quantified among: (1) PWID recruited in six Needle Exchange Surveillance Initiative (NESI) surveys (n = 6110); linked laboratory data for (2) people prescribed opioid agonist therapy (OAT) (n = 14,527) and (3) people hospitalised for an injecting-related hospital admission (IRHA) (n = 12,621) across four time periods: pre-outbreak (2010–2014); early-outbreak (2015–2016); ongoing-outbreak (2017–2019); and COVID-19 (2020–June 21). From the pre to ongoing period, HIV testing increased: the highest among people recruited in NESI (from 28% to 56%) and on OAT (from 17% to 54%) while the lowest was among people with an IRHA (from 15% to 42%). From the ongoing to the COVID-19 period, HIV testing decreased markedly among people prescribed OAT, from 54% to 37% (aOR 0.50, 95% CI 0.48–0.53), but increased marginally among people with an IRHA from 42% to 47% (aOR 1.19, 95% CI 1.08–1.31). In conclusion, progress in increasing testing in response to the HIV outbreak has been eroded by COVID-19. Adoption of a linked data approach could be warranted in other settings to inform efforts to eliminate HIV transmission.

Genomic characterization of human respiratory syncytial virus circulating in Islamabad, Pakistan, during an outbreak in 2022-2023.

In this study, conducted at the National Institute of Health, Islamabad, during an outbreak of human respiratory syncytial virus (hRSV) from December 2022 to January 2023, the first whole-genome sequences of hRSV isolates from Islamabad, Pakistan, were determined. Out of 10 positive samples, five were sequenced, revealing the presence of two genotypes: RSV-A (GA2.3.5, ON1 strain) and RSV-B (GB5.0.5.a, BA-10 strain). A rare non-synonymous substitution (E232G) in G the protein and N276S in the F protein were found in RSV-A. In RSV-B, the unique mutations K191R, Q209R, and I206M were found in the F protein. These mutations could potentially influence vaccine efficacy and viral pathogenicity. This research underscores the importance of genomic surveillance for understanding RSV diversity and guiding public health responses in Pakistan.

Legal Difficulties Associated With the Use of Big Data in Healthcare: Civil Law and Cyberlaw Review

Current trends suggest a future in which big data can be used to predict individual health risks and outcomes with exceptional accuracy. By analyzing large datasets that include various health indicators, algorithms can predict the onset of disease, allowing for early intervention and personalized treatment plans. However, the legal and ethical implications of predictive health analytics, such as potential misuse of predictive information or unfair discrimination based on health risks, require careful consideration. In terms of global health surveillance, the COVID-19 pandemic has highlighted the potential of big data to track the spread of disease and inform public health responses.

Drug Use Stigma and Public Preferences for Public Health Versus Legal System Responses

This study explored what perceptions and beliefs about substances and substance users, personal experiences, and network experiences with substance use were related to people’s preferences for public health and legal system responses to substance use. Social context was also considered, including location of residence, political ideology, and a sense of insecurity. Data were from the Nebraska Annual Social Indicators Survey, a cross-sectional omnibus mail survey of public attitudes in Nebraska, conducted in fall 2021. Approximately 1700 adults completed the survey. Controlling for demographic characteristics, the study found stigmatized attitudes about substance use, limited or no personal history with substance use, rural residence, and political conservatism were associated with more support for legal system responses. In contrast, less stigmatized attitudes about substance use, personal history of marijuana use, urban residence, political liberalism, and a sense of security were all associated with more support for public health responses.

Genomic Analysis and Surveillance of Respiratory Syncytial Virus Using Wastewater-Based Epidemiology.

Respiratory syncytial virus (RSV) causes severe infections in infants, immunocompromised or elderly individuals resulting in annual epidemics of respiratory disease. Currently, limited clinical surveillance and the lack of predictable seasonal dynamics limit the public health response. Wastewater-based epidemiology (WBE) has recently been used globally as a key metric in determining prevalence of severe acute respiratory syndrome coronavirus 2 in the community, but its application to other respiratory viruses is limited. In this study, we present an integrated genomic WBE approach, applying reverse-transcription quantitative polymerase chain reaction and partial G-gene sequencing to track RSV levels and variants in the community. We report increasing detection of RSV in wastewater concomitant with increasing numbers of positive clinical cases. Analysis of wastewater-derived RSV sequences permitted identification of distinct circulating lineages within and between seasons. Altogether, our genomic WBE platform has the potential to complement ongoing global surveillance and aid the management of RSV by informing the timely deployment of pharmaceutical and nonpharmaceutical interventions.

When do we need multiple infectious disease models? Agreement between projection rank and magnitude in a multi-model setting

Mathematical models are useful for public health planning and response to infectious disease threats. However, different models can provide differing results, which can hamper decision making if not synthesized appropriately. To address this challenge, multi-model hubs convene independent modeling groups to generate ensembles, known to provide more accurate predictions of future outcomes. Yet, these hubs are resource intensive, and how many models are sufficient in a hub is not known. Here, we compare the benefit of predictions from multiple models in different contexts: (1) decision settings that depend on predictions of quantitative outcomes (e.g., hospital capacity planning), where assessments of the benefits of multi-model ensembles have largely focused; and (2) decisions settings that require the ranking of alternative epidemic scenarios (e.g., comparing outcomes under multiple possible interventions and biological uncertainties). We develop a mathematical framework to mimic a multi-model prediction setting, and use this framework to quantify how frequently predictions from different models agree. We further explore multi-model agreement using real-world, empirical data from 14 rounds of U.S. COVID-19 Scenario Modeling Hub projections. Our results suggest that the value of multiple models could be different in different decision contexts, and if only a few models are available, focusing on the rank of alternative epidemic scenarios could be more robust than focusing on quantitative outcomes. Although additional exploration of the sufficient number of models for different contexts is still needed, our results indicate that it may be possible to identify decision contexts where it is robust to rely on fewer models, a finding that can inform the use of modeling resources during future public health crises.

JN.1 variant in enduring COVID-19 pandemic: is it a variety of interest (VoI) or variety of concern (VoC)?

The emergence of the SARS-CoV-2 Omicron variant, classified as a Variant of Concern (VoC) in November 2021, marked a significant shift in the COVID-19 landscape. This study investigates the subsequent development of a novel Omicron sublineage, JN.1, which displays distinctive mutations in the spike protein. The study delves into the phylogenetic differences between these variants and their potential implications. A comprehensive analysis of the genomic profiles and mutation patterns of JN.1 and BA.2.86 was conducted, utilizing SARS-CoV-2 database. The study explores the unique mutations, such as S:L455S in JN.1, associated with increased transmissibility and immune escape. Furthermore, a comparison with prevalent strains like XBB.1.5 and HV.1 highlights the substantial genetic divergence of JN.1. JN.1, first detected in August 2023, exhibits a notable spike protein mutation profile, including the reappearance of earlier variants' mutations (E484K and P681R). The variant's increased transmissibility and immune evasion potential are attributed to specific spike protein mutations like R21T, S50L, V127F, R158G, and others. The study also explores the distribution and prevalence of JN.1 globally, with a focus on the rising cases in India. JN.1 poses aunique challenge as one of the most immune-evading variants, with potential implications for COVID-19 transmission. The study emphasizes the importance of monitoring and understanding emerging variants, especially those with distinct spike protein mutations. The observed cases in India highlight the need for vigilance and prompt public health responses. As JN.1 continues to evolve, ongoing surveillance, vaccination strategies, and adherence to preventive measures are crucial to mitigating its potential impact on global public health.

Genomic surveillance and sequencing of SARS-CoV-2 in Malaysia

This manuscript offers an in-depth review of the genomic surveillance of SARS-CoV-2 variants in Malaysia, emphasizing the integral role of this surveillance in understanding the virus's evolution and informing public health responses. Leveraging platforms like GISAID, Nextstrain, and the Pangolin classification system, researchers in Malaysia and their global counterparts share genome sequences and clinical data of SARS-CoV-2. These tools, particularly Nextstrain for real-time tracking and visualization of viral evolution, and Pangolin for lineage classification have advanced understanding of significant mutations, such as D614G and N501Y, and their impact on virus transmissibility and pathogenicity. The study of the virus's emergence in Malaysia offers vital insights into its evolutionary trajectories, aiding in effective pandemic management. Malaysia's Genomic Surveillance Program, aligned with national immunization efforts, plays a key role in identifying and controlling COVID-19 spread. This program integrates molecular, epidemiological, and clinical data that helps the health authorities in making a decision that leads to public health intervention and policymaking. This review details the significance of genomic surveillance in Malaysia, emphasizing its impact on understanding viral evolution, monitoring variants, informing public health strategies and responses, and preparing for future infectious disease challenges effectively.

Advocating for population health: The role of public health practitioners in the age of artificial intelligence.

Over the past decade, artificial intelligence (AI) has begun to transform Canadian organizations, driven by the promise of improved efficiency, better decision-making, and enhanced client experience. While AI holds great opportunities, there are also near-term impacts on the determinants of health and population health equity that are already emerging. If adoption is unregulated, there is a substantial risk that health inequities could be exacerbated through intended or unintended biases embedded in AI systems. New economic opportunities could be disproportionately leveraged by already privileged workers and owners of AI systems, reinforcing prevailing power dynamics. AI could also detrimentally affect population well-being by replacing human interactions rather than fostering social connectedness. Furthermore, AI-powered health misinformation could undermine effective public health communication. To respond to these challenges, public health must assess and report on the health equity impacts of AI, inform implementation to reduce health inequities, and facilitate intersectoral partnerships to foster development of policies and regulatory frameworks to mitigate risks. This commentary highlights AI's near-term risks for population health to inform a public health response.

Public Health Responses to CBRN Terrorism in the Middle East and North Africa.

Escalating global challenges (such as disasters, conflict, and climate change) underline the importance of addressing Chemical, Biological, Radiological, and Nuclear (CBRN) terrorism for sustainable public health strategies. This study aims to provide a comprehensive epidemiological analysis of CBRN incidents in the Middle East and North Africa (MENA) region, emphasizing the necessity of sustainable responses to safeguard healthcare infrastructures. Utilizing a retrospective approach, this research analyzes data from the Global Terrorism Database (GTD) covering the period from 2003 to 2020. The study focuses on examining the frequency, characteristics, and consequences of CBRN incidents in the MENA region to identify patterns and trends that pose significant challenges to public health systems. The analysis revealed a significant clustering of CBRN incidents in Iraq and Syria, with a predominant involvement of chemical agents. These findings indicate the extensive impact of CBRN terrorism on healthcare infrastructures, highlighting the challenges in providing immediate health responses and the necessity for long-term recovery strategies. The study underscores the need for improved healthcare preparedness, robust emergency response systems, and the development of sustainable public health policies. Advocating for international collaboration, the research contributes to the strategic adaptation of healthcare systems to mitigate the impacts of CBRN terrorism, ensuring preparedness for future incidents in the MENA region and beyond.

Regional workshop on the implementation of the global plan on public health response to dementia (2017–2025)*

Regional workshop on the implementation of the global plan on public health response to dementia (2017–2025)*