Public Health Response Research Articles

Salmonella Typhi genotypic diversity, cluster identification and antimicrobial resistance determinants in Mukuru settlement, Nairobi Kenya

BackgroundUnderstanding the source of typhoid infections and the genetic relatedness of Salmonella Typhi (S. Typhi) by cluster identification in endemic settings is critical for establishing coordinated public health responses for typhoid fever management. This study investigated the genotypic diversity, antibiotic resistance mechanisms, and clustering of 35 S.Typhi strains isolated from cases and carriers in the Mukuru Informal Settlement.MethodsWe studied 35 S.Typhi isolates, including 32 from cases and 3 from carriers, from study participants in the informal settlement of Mukuru, Nairobi, Kenya. Genomic DNA was extracted, and whole-genome sequencing (WGS) was performed to determine the phylogenetic relatedness of strains and detect antimicrobial resistance determinants (AMR). WGS data were analyzed using bioinformatics tools available at the Center for Genomic Epidemiology and Pathogenwatch platforms.ResultsGenotype 4.3.1.2 EA3 was found to be dominant at 46% (16/35), followed by 4.3.1.2 EA2 at 28% (10/35), and 4.3.1.1 EA1 at 27% (9/35). A comparison of the isolates with global strains from Pathogenwatch identified close clustering with strains from Uganda, Tanzania, Rwanda, and India. Three isolates (9%) distributed in each cluster were isolated from carriers. All genotype 4.3.1.2 EA3 isolates were genotypically multidrug-resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole. Single mutations in the quinolone resistance-determining region were identified in the gyrA (S83Y) and gyrB (S464F) genes. All isolates associated with multidrug resistance showed the presence of the IncQ1 plasmid with the following genes: blaTEM-1B, catA1, sul1, sul2, and dfrA7.ConclusionThe close phylogenetic relatedness between antimicrobial-resistant case isolates and carriage isolates indicates that typhoid carriage is a possible source of infection in the community. Comparative analysis with global isolates revealed that the Kenyan isolates share common lineages with strains from neighboring East African countries and India, suggesting regional dissemination of specific MDR clones. AMR was a major feature of the isolates. Surveillance and testing for antimicrobial susceptibility should inform options for the management of cases.

Resilience during lockdown: a longitudinal study investigating changes in behaviour and attitudes among older females during COVID-19 lockdown in the UK

In order to slow the spread of COVID-19, on March 23, 2020, a strict lockdown was implemented in the UK. This was followed by alternating periods of less restrictive lockdowns until most public health restrictions were lifted in the summer of 2021. While these measures were necessary, they significantly affected people’s daily activities, lifestyles, and mental well-being.This paper presents a longitudinal research study that focused on females aged 55 + in the UK, aiming to understand how COVID-19 and the subsequent 15-month period of lockdowns affected their lifestyles and emotions. The study collected data through online surveys, where respondents reported the frequency and mode of access to activities, and their positive and negative emotional experiences during distinct study phases that encompassed both lockdown and less strict periods.In contrast to previous studies highlighting vulnerabilities for females and the elderly during lockdowns, this research found that the studied group maintained an overall positive outlook throughout the study period and successfully adapted to the lockdowns by increasing their engagement in certain activities, in particular, activities like ‘getting active’. In addition, our findings indicate rapid adaptive behaviour change towards many online activities, such as cultural activities. However, the study also revealed negative emotions and a decrease in some activities during the second lockdown in 2020 and the subsequent lockdowns in 2021, underscoring the challenges inherent in prolonged periods of confinement. In addition, the study found negative affect associated with some activities, including working and studying from home.The findings provide valuable insights into how females aged over 55 coped with stressful circumstances, which can inform the development of resilient and mental health-conscious public health policies and responses in preparation for future pandemics or other hazards.

Big data analytics for epidemic forecasting: Policy Frameworks and technical approaches

This review paper explores the intersection of big data analytics and epidemic forecasting, highlighting both technical approaches and policy frameworks. It delves into data collection methods from IoT, mobile data, and social media. It discusses analytical techniques such as machine learning and predictive modelling. The paper also addresses the regulatory and ethical considerations necessary for effective data use, emphasizing the need for adaptive policy frameworks to support innovation. The importance of international collaboration and global initiatives for data integration and sharing is underscored. By integrating advanced analytics with robust policies, the potential for enhanced epidemic forecasting and proactive public health responses is significant. Keywords: Big Data Analytics, Epidemic Forecasting, Machine Learning, Public Health Policy, Data Privacy.

Revolutionizing infectious disease management in low-resource settings: The impact of rapid diagnostic technologies and portable devices

Revolutionizing infectious disease management in low-resource settings hinges on the integration of rapid diagnostic technologies and portable devices. These innovations offer transformative potential by providing timely, accurate, and cost-effective diagnosis, thereby enhancing patient outcomes and curbing the spread of infectious diseases. Rapid diagnostic technologies, including point-of-care tests and molecular diagnostics, enable swift identification of pathogens, allowing for immediate and appropriate treatment. This is particularly crucial in low-resource settings where laboratory infrastructure is often limited, and delays in diagnosis can lead to increased morbidity and mortality. Portable diagnostic devices, such as handheld PCR machines and mobile phone-based diagnostic tools, further extend the reach of healthcare services to remote and underserved areas. These devices are designed to be user-friendly, requiring minimal training for healthcare workers, and can operate in challenging environments without the need for extensive power supplies or refrigeration. The impact of these technologies is profound. By reducing the time to diagnosis, rapid diagnostic tests can decrease the misuse of antibiotics, helping to combat antibiotic resistance—a major global health threat. Additionally, early and accurate diagnosis facilitates better disease surveillance and outbreak management, enabling quicker public health responses. Cost-effective and scalable, these technologies also offer significant economic benefits, reducing the burden on healthcare systems and improving overall health equity. This review underscores the critical role of rapid diagnostic technologies and portable devices in revolutionizing infectious disease management in low-resource settings. Their implementation not only improves individual patient care but also strengthens public health infrastructure, ultimately contributing to global health security and the fight against infectious diseases. Keywords: Infection Disease, Diagnostic Technologies, Management.

Rapid Online Data Collection and Reporting to Local Health Departments during the Pandemic: The COVID-19 Outbreak Public Evaluation (COPE) Initiative SARS-CoV-2 Case Surveys.

To develop and implement a pilot online data collection tool to help local health departments with their COVID-19 pandemic response efforts and inform health department actions. The COVID-19 Outbreak Public Evaluation (COPE) was an online survey and was distributed by participating sites to individuals who recently tested positive for SARS-CoV-2. Surveys recorded participant demographics and assessed recent infection risk behaviors (eg, mask use, air travel), vaccination status, sleep and exercise habits, social behaviors and beliefs, and physical and mental health. Seven health departments participated in the initiative, which took place during May 1 to September 30, 2022. Identical items were administered to demographically representative samples of adults nationally in the United States within a similar timeframe. A total of 38555 participants completed surveys. Responses from participants with recent SARS-CoV-2 infections were compared with respondents from the national surveys who did not have evidence or awareness of prior SARS-CoV-2 infections. To implement of a process that allows health departments to receive data from local cases and compare this information to national controls during the COVID-19 pandemic. Fifty-four biweekly reports were provided to public health departments between May and September 2022. Information and comparisons within the reports were updated in response to evolving public health priorities for the pandemic response. The initiative helped to guide public health response efforts during the COVID-19 pandemic. Moreover, the receptiveness by local health departments and participants provides evidence to support this data collection and reporting model as a component of the public health response to future emergencies. This project demonstrates the feasibility of a centralized, rapid, and adaptive data collection system for local health departments and provides evidence to advocate for data collection methods to help guide local health departments to respond in a timely and effective manner to future public health emergencies.

The Impact of Air Pollution from Industrial Fires in Urban Settings: Monitoring, Modelling, Health, and Environmental Justice Perspectives

Industrial fires at facilities including waste management sites, warehouses, factories, chemical works, and fuel storage depots are relatively frequent occurrences. Often, these fires occur adjacent to urban communities and result in ground-level airborne pollutant concentrations that are well above guideline values. Land, water, livestock, and crops may also be contaminated by the emissions and by firefighting activities. Moreover, impacted communities tend to have a higher proportion of minority ethnic populations as well as individuals with underlying health vulnerabilities and those of lower socio-economic status. Nevertheless, this is an aspect of air quality that is under-researched, and so this review aims to highlight the public health hazards associated with industrial fires and the need for an effective, coordinated, public health response. We also review the range of monitoring techniques that have been utilised in such fires and highlight the role of dispersion modelling in predicting plume trajectories and in estimating population exposure. We recommend establishing 1 h guideline values for particulate matter to facilitate timely public health interventions, and we highlight the need to review regulatory and technical controls for sites prone to fires, particularly in the waste sector.

Public Health Challenges and Responses to the Growing Ageing Populations

ABSTRACTBackgroundHuman populations are rapidly ageing worldwide due to declining birth rates and rising life expectancies. This profound demographic shift presents complex public health challenges. Synthesizing evidence on key public health issues impacting ageing populations and policy strategies is required to address these needs.MethodsThe study employs narrative literature review based on the PubMed database. Data have been extracted on public health challenges to ageing populations and its recommended policy solutions.ResultsThe key public health challenges identified include rising chronic disease burden, risks for preventable multi‐morbidities and co‐morbidities, disability and dependencies, mental health issues, caregiving gaps, long‐term care system deficiencies, health inequities, healthcare access barriers, end‐of‐life care needs, financial instability, ageism/elder abuse, adverse built environments, climate/disaster threats, and social isolation. Evidence‐based policy responses span interventions in healthcare, social services, urban planning, emergency preparedness, economics, technology, anti‐ageism advocacy and so on.ConclusionsProactively addressing the array of public health challenges faced by rapidly growing ageing populations globally requires implementing collaborative, multisectoral policy solutions focused on promoting healthy, equitable, and socially engaged ageing. Healthcare systems, communities, and policies must be optimized to meet the needs of elderly people and tap into their strengths.

‘Imitate the Motions of Those that are Infected’: Shakespeare’s Love’s Labour’s Lost in Margaret Cavendish’s The Convent of Pleasure

Abstract Despite a Restoration vogue for adapted—or ‘improved’—productions of Shakespeare’s plays, Love’s Labour’s Lost (c.1594) fell out of the theatrical repertoire after 1660. The play’s immediate afterlife exists solely in Margaret Cavendish’s inversion of the play in her closet drama The Convent of Pleasure (1668). This essay argues that both plays respond to the virulent plague outbreaks which immediately preceded them in their depiction of single-sex cloistering, and engage with contemporaneous debates around the efficacy of household quarantine as a public health response. Love’s Labour’s Lost offers a complicated defence of public theatre in the face of quarantine restrictions which saw the playhouses forcibly closed for 11 months. Convent repurposes Shakespeare’s portrayal of infection risk in a public theatre for the closet environment. But transferring a play predicated upon the fear of contagious bodies from the commercial stage to the ‘Stage of Imagination’ has potentially dangerous consequences for its readers. Cavendish’s vitalist materialism renders the recreation of the public stage within the mind an act of potential self-harm. Yet Cavendish’s adaptation of a Shakespearean play preoccupied with plague allows her to think through her own theory of imitation as the driving force behind both contagion and sympathetic inclination.

Factors Associated With Surveillance Testing in Individuals With COVID-19 Symptoms During the Last Leg of the Pandemic: Multivariable Regression Analysis.

Rural underserved areas facing health disparities have unequal access to health resources. By the third and fourth waves of SARS-CoV-2 infections in the United States, COVID-19 testing had reduced, with more reliance on home testing, and those seeking testing were mostly symptomatic. This study identifies factors associated with COVID-19 testing among individuals who were symptomatic versus asymptomatic seen at a Rapid Acceleration of Diagnostics for Underserved Populations phase 2 (RADx-UP2) testing site in West Virginia. Demographic, clinical, and behavioral factors were collected via survey from tested individuals. Logistic regression was used to identify factors associated with the presence of individuals who were symptomatic seen at testing sites. Global tests for spatial autocorrelation were conducted to examine clustering in the proportion of symptomatic to total individuals tested by zip code. Bivariate maps were created to display geographic distributions between higher proportions of tested individuals who were symptomatic and social determinants of health. Among predictors, the presence of a physical (adjusted odds ratio [aOR] 1.85, 95% CI 1.3-2.65) or mental (aOR 1.53, 95% CI 0.96-2.48) comorbid condition, challenges related to a place to stay/live (aOR 307.13, 95% CI 1.46-10,6372), no community socioeconomic distress (aOR 0.99, 95% CI 0.98-1.00), no challenges in getting needed medicine (aOR 0.01, 95% CI 0.00-0.82) or transportation (aOR 0.23, 95% CI 0.05-0.64), an interaction between community socioeconomic distress and not getting needed medicine (aOR 1.06, 95% CI 1.00-1.13), and having no community socioeconomic distress while not facing challenges related to a place to stay/live (aOR 0.93, 95% CI 0.87-0.99) were statistically associated with an individual being symptomatic at the first test visit. This study addresses critical limitations to the current COVID-19 testing literature, which almost exclusively uses population-level disease screening data to inform public health responses.

Migration policies versus public health - the ethics of Covid-19 related movement restrictions for asylum seekers in reception centers in Greece in 2020.

The emergency context of the Covid-19 pandemic necessitated the use of national and international public health measures of unprecedented scale to minimize mortality and morbidity, often in conflict with other principles and rights, such as the autonomy of individuals. Concerns have been voiced that for populations facing precarity, such as migrants, a disproportionate and unfair application of restrictive measures, deficient application of protective measures, and even enforcement of restrictive migration policies under the pretext of the pandemic has occurred. Various principles have been proposed as moral foundations of public health interventions. The author used two public health ethics frameworks to examine the ethical acceptability of movement restrictions on asylum seekers residing in refugee camps in Greece from March 2020 to October 2020. Most of the principles described in the frameworks for the ethical application of movement restrictions were not adhered to. Main concerns include that, measures were prolonged despite lack of evidence about their effectiveness to reduce morbidity and mortality, while posing severe and disproportionate burdens for this population. An ethically acceptable public health response to Covid-19 is incompatible with certain living conditions of refugees, asylum seekers, and migrants. The question of whether and if so the extent to which the discipline of public health inherently has the role of rectifying existing injustices and social inequalities when these can be convincingly related to health outcomes, is central to the design of public health interventions for these populations. The answer can exemplify the need to address moral and political determinants of health. It is essential for public health professionals to be aware of the moral theorizations that underpin their work, so as to ensure that their policies are aligned with those and to contribute to the debate that shapes these determinants.

Physical, mental, and behavioral health after adverse and benevolent childhood experiences: A comparison of two adversity conceptualizations.

Adverse and benevolent childhood experiences (ACEs and BCEs) impact health across the lifespan. No known study has investigated these associations across different health domains using a representative adult sample. This study examined the associations between adult physical, mental, and behavioral health with ACEs and BCEs based on two ACEs conceptualizations. A cross-sectional population-based survey was conducted in Hong Kong. Thirteen ACEs were measured and conceptualized as cumulative ACE scores and ACE patterns. Self-reports of BCEs; 10 physical health problems; current mental health; posttraumatic stress; history of diagnosed mental illness; suicidal thought and suicide attempt; and engagement in three health risk behaviors (smoking, illicit substance misuse, binge drinking) were also included. A series of regression analyses were conducted to examine the association between childhood experiences and health. In a random sample of 1,070 Hong Kong adults (Mage = 41.78 years; 53.93% female; mean ACEs = 1.64), 649 (60.65%) reported at least one ACE. Four ACE patterns were identified (Low ACEs, Household Instability, Household Violence, and High ACEs). Higher ACE scores associated with poorer health in a dose-response fashion. Two ACE patterns shared similar average ACE scores but differentially linked with outcomes across health domains. High BCEs negatively associated with mental and behavioral health problems. Public health responses to ACEs should consider both the accumulation and co-occurrence of ACE exposure. Schools, neighborhoods, and the wider community should take an active role in helping children and families create more positive experiences as a universal prevention strategy to safeguard population health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The San Francisco Health Systems Collaborative: Public Health and Health Care Delivery Systems’ Response to the Covid-19 Pandemic

The Covid-19 pandemic challenged health care delivery systems worldwide. Many acute care hospitals in communities that experienced surges in cases and hospitalizations had to make decisions such as rationing scarce resources. Hospitals serving low-income communities, communities of color, and those in other historically marginalized or vulnerable groups reported the greatest operational impacts of surges. However, cross-institutional collaborations within jurisdictions offer unique opportunities to prevent or mitigate health disparities in resource utilization and access to care. In January 2020, in response to the emerging coronavirus epidemic, the San Francisco Department of Public Health (SFDPH) and local hospital and health systems partners convened to align and coordinate medical surge planning and response. Adopting a governance structure of mutual accountability and transparency, the San Francisco Health Systems Collaborative guided local medical and public health response in the areas of medical surge, vaccination administration, testing, and therapeutics. Four principles guided the collaborative response: (1) shared priorities, (2) clear governance and accountability, (3) data transparency, and (4) operational coordination. High-level priorities established included protecting vulnerable people, protecting health care workers, and maintaining health system capacity. The governance structure consisted of three layers: local hospital and health systems’ CEOs coordinating with SFDPH executives; hospital chief medical and nursing officers coordinating high-level surge capacity assessments and mitigation plans; and local clinical operational managers working with public health response operational leaders to coordinate scarce resource utilization. Fluctuating with the tempo of the disease indicators and medical surge, governance and coordination were maintained through a tiered meeting and reporting system. Data visibility and transparency were key principles facilitating operational decision-making and executive-level coordination of resources, including identifying additional surge bed capacity for use systemwide, as well as ensuring efficient and equitable vaccine distribution through implementation of five mass-vaccination sites with prioritized access for vulnerable communities. Applying these four principles of shared priorities, accountability, transparency, and operational coordination and pragmatism helped the public health and individual hospital systems make contributions to the overall response that were aligned with their unique strengths and resources. Publication here represents the first official public use of the name San Francisco Health Systems Collaborative (which had served as the term used internally to refer to the group) and the first time codifying this structure. Through this coordination, San Francisco achieved one of the lowest Covid-19 death rates and had one of the highest vaccination and booster rates, compared with rates across California or the United States. Similar principles and implementation methods can be adopted by other health jurisdictions for future emergency outbreak response.

‘Life became harder with COVID-19’: exploring the experiences of the COVID-19 pandemic among youth living in eThekwini district, South Africa

BackgroundIn South Africa, pervasive age and gender inequities have been exacerbated by the COVID-19 pandemic and public health response. We aimed to explore experiences of the COVID-19 pandemic among youth in eThekwini district, South Africa.MethodsBetween December 2021-May 2022 we explored experiences of the COVID-19 pandemic on youth aged 16–24 residing in eThekwini, South Africa. We collated responses to the open-ended question “Has the COVID-19 pandemic affected you in any other way you want to tell us about?” in an online survey focused on understanding the pandemic’s multi-levelled health and social effects. We used a thematic analysis to summarise the responses.ResultsOf 2,068 respondents, 256 (12.4%, median age = 22, 60.9% women) completed the open-ended survey question (11% in isiZulu). Results were organized into three main themes encompassing (1) COVID-19-related loss, fear, grief, and exacerbated mental and physical health concerns; (2) COVID-19-related intensified hardships, which contributed to financial, employment, food, education, and relationship insecurities for individuals and households; and (3) positive effects of the pandemic response, including the benefits of government policies and silver linings to government restrictions.ConclusionsWe found that South African youth experienced significant grief and multiple losses (e.g., death, income, job, and educational) during the COVID-19 pandemic. Trauma-aware interventions that provide economic and educational opportunities must be included in post-COVID recovery efforts.

Care for Women's Health

The mechanisms by which Internet use influences rural women's health are explored in this paper using a mixed-methods approach. Findings indicate that internet use has a significant and positive effect on the health of rural women and hold up to endogenous and robustness testing. Additionally, the strength of the effects of internet use on self-rated health, depression, and cognition level decreases with age. Information accessibility and social trust as the important path mechanisms for Internet use to promote self-rated health and cognition level. We also investigated the impact of COVID-19 outbreak on this mechanism to further recognize the critical role of digital technology in global public health emergency preparedness and response efforts. These findings provide some insights for policy formulation by Governments and practical action by organizations to better improve women's health in rural areas and reduce rural health disparities.

Jointly estimating epidemiological dynamics of Covid-19 from case and wastewater data in Aotearoa New Zealand

BackgroundTimely and informed public health responses to infectious diseases such as COVID-19 necessitate reliable information about infection dynamics. The case ascertainment rate (CAR), the proportion of infections that are reported as cases, is typically much less than one and varies with testing practices and behaviours, making reported cases unreliable as the sole source of data. The concentration of viral RNA in wastewater samples provides an alternate measure of infection prevalence that is not affected by clinical testing, healthcare-seeking behaviour or access to care.MethodsWe construct a state-space model with observed data of levels of SARS-CoV-2 in wastewater and reported case incidence and estimate the hidden states of the effective reproduction number, R, and CAR using sequential Monte Carlo methods.ResultsWe analyse data from 1 January 2022 to 31 March 2023 from Aotearoa New Zealand. Our model estimates that R peaks at 2.76 (95% CrI 2.20, 3.83) around 18 February 2022 and the CAR peaks around 12 March 2022. We calculate that New Zealand’s second Omicron wave in July 2022 is similar in size to the first, despite fewer reported cases. We estimate that the CAR in the BA.5 Omicron wave in July 2022 is approximately 50% lower than in the BA.1/BA.2 Omicron wave in March 2022.ConclusionsEstimating R, CAR, and cumulative number of infections provides useful information for planning public health responses and understanding the state of immunity in the population. This model is a useful disease surveillance tool, improving situational awareness of infectious disease dynamics in real-time.

Effectiveness of Harm Reduction Interventions in Chemsex: A Systematic Review.

A systematic review of the scientific literature related to harm and risk reduction strategies and the effectiveness of chemsex interventions. Between January 2024 and May 2024, the articles were retrieved from the electronic databases Pubmed, Web of Science, Scopus, PsycInfo, Cochrane, Dialnet, CUIDEN, and SciELO. The review protocol was registered in the PROSPERO database (registration number CRD42024508953). The inclusion criteria were as follows: (I) original studies published in peer-reviewed journals, (II) studies exploring harm reduction interventions for chemsex, and (III) studies reflecting the efficacy of harm reduction interventions for chemsex. Two reviewers independently selected articles by title, abstract, and full paper review and extracted data. Two authors described the selected studies and assessed their methodological quality. The systematic review comprised six scientific papers that met the selection criteria and were obtained from five countries. Although a limited number of studies were included, it was observed that they presented a medium-high methodological quality. Programs evaluated interventions to reduce harm from chemsex, such as a web-based intervention that improved self-efficacy to refuse risky behaviors and accept HIV testing. The studies suggested that peer-led programs can be effective, especially with facilitators who have experienced chemsex dependence. Harm reduction strategies in chemsex are effective and should be promoted by health professionals. Interventions should be accessible, personalized, and non-judgmental to provide appropriate care and support, ensuring a comprehensive and effective public health response.

Adverse Events of COVID-19 Vaccines in the United States: Temporal and Spatial Analysis.

The COVID-19 pandemic, caused by SARS-CoV-2, has had a profound impact worldwide, leading to widespread morbidity and mortality. Vaccination against COVID-19 is a critical tool in controlling the spread of the virus and reducing the severity of the disease. However, the rapid development and deployment of COVID-19 vaccines have raised concerns about potential adverse events following immunization (AEFIs). Understanding the temporal and spatial patterns of these AEFIs is crucial for an effective public health response and vaccine safety monitoring. This study aimed to analyze the temporal and spatial characteristics of AEFIs associated with COVID-19 vaccines in the United States reported to the Vaccine Adverse Event Reporting System (VAERS), thereby providing insights into the patterns and distributions of the AEFIs, the safety profile of COVID-19 vaccines, and potential risk factors associated with the AEFIs. We conducted a retrospective analysis of administration data from the Centers for Disease Control and Prevention (n=663,822,575) and reports from the surveillance system VAERS (n=900,522) between 2020 and 2022. To gain a broader understanding of postvaccination AEFIs reported, we categorized them into system organ classes (SOCs) according to the Medical Dictionary for Regulatory Activities. Additionally, we performed temporal analysis to examine the trends of AEFIs in all VAERS reports, those related to Pfizer-BioNTech and Moderna, and the top 10 AEFI trends in serious reports. We also compared the similarity of symptoms across various regions within the United States. Our findings revealed that the most frequently reported symptoms following COVID-19 vaccination were headache (n=141,186, 15.68%), pyrexia (n=122,120, 13.56%), and fatigue (n=121,910, 13.54%). The most common symptom combination was chills and pyrexia (n=56,954, 6.32%). Initially, general disorders and administration site conditions (SOC 22) were the most prevalent class reported. Moderna exhibited a higher reporting rate of AEFIs compared to Pfizer-BioNTech. Over time, we observed a decreasing reporting rate of AEFIs associated with COVID-19 vaccines. In addition, the overall rates of AEFIs between the Pfizer-BioNTech and Moderna vaccines were comparable. In terms of spatial analysis, the middle and north regions of the United States displayed a higher reporting rate of AEFIs associated with COVID-19 vaccines, while the southeast and south-central regions showed notable similarity in symptoms reported. This study provides valuable insights into the temporal and spatial patterns of AEFIs associated with COVID-19 vaccines in the United States. The findings underscore the critical need for increasing vaccination coverage, as well as ongoing surveillance and monitoring of AEFIs. Implementing targeted monitoring programs can facilitate the effective and efficient management of AEFIs, enhancing public confidence in future COVID-19 vaccine campaigns.

A Study on Economic Stressors During the COVID-19 Pandemic Among Intimate Partner and Sexual Violence Survivors in the United States.

Systemic racism and racialized poverty are socially produced structural determinants that shape health outcomes during infectious disease outbreaks. Public health emergencies compound vulnerabilities for survivors of intimate partner violence (IPV) and sexual violence (SV) and those who self-identify as people from racial and ethnic minority groups. We describe findings from an online survey designed to collect data on financial conditions faced by survivors of IPV and SV to understand these conditions during the COVID-19 pandemic. Our analyses were limited to a sample of women in the United States (91.4%, n = 523) who reported IPV or SV to whom we refer as survivors. We characterize the differences of economic stressors across White and aggregated categories of self-identified race, i.e., Black and Brown Latinx women and non-Black or non-Brown Latinx women of color, to highlight disparities between White and non-White populations in our sample. Logistic regressions were used to examine the relationships among racial categories, food insecurity, housing insecurity, and economic insecurity during the COVID-19 pandemic. Black and Brown Latinx women survivors were twice as likely as White women to report housing, financial, and economic insecurity during the COVID-19 pandemic. Approximately one-third of all survivors anticipated taking on more debt than they would want to cover their expenses due to COVID-19. The results of this study have implications for public health responses that involve coordinating economic relief measures among populations disparately affected by public health crises and disasters to ensure that the economic needs of the most impacted are addressed.

Genomic characterization of Dengue virus circulation in Ethiopia.

In Ethiopia, dengue virus (DENV) infections have been reported in several regions, however, little is known about the circulating genetic diversity. Here, we conducted clinical surveillance for DENV during the 2023 nationwide outbreak and sequenced DENV whole genomes for the first time in Ethiopia. We enrolled patients at three sentinel hospital sites. Using RT-PCR, we screened serum samples for three arboviruses followed by serotyping and sequencing for DENV-positive samples (10.4% of samples). We detected two DENV serotypes (DENV1 and DENV3). Phylogenetic analysis identified one transmission cluster of DENV1 (genotype III major lineage A), and two clusters of DENV3 (genotype III major lineage B). The first showed close evolutionary relationship to the 2023 Italian outbreak and the second cluster to Indian isolates. Co-circulation of DENV1 and DENV3 in some regions of Ethiopia highlights the potential for severe dengue. Intensified surveillance and coordinated public health response are needed to address the threat of severe dengue outbreaks.

Enhancing Mass Vaccination Programs with Queueing Theory and Spatial Optimization.

Mass vaccination is a cornerstone of public health emergency preparedness and response. However, injudicious placement of vaccination sites can lead to the formation of long waiting lines or queues , which discourages individuals from waiting to be vaccinated and may thus jeopardize the achievement of public health targets. Queueing theory offers a framework for modeling queue formation at vaccination sites and its effect on vaccine uptake. We developed an algorithm that integrates queueing theory within a spatial optimization framework to optimize the placement of mass vaccination sites. The algorithm was built and tested using data from a mass canine rabies vaccination campaign in Arequipa, Peru. We compared expected vaccination coverage and losses from queueing (i.e., attrition) for sites optimized with our queue-conscious algorithm to those obtained from a queue-naive version of the same algorithm. Sites placed by the queue-conscious algorithm resulted in 9-19% less attrition and 1-2% higher vaccination coverage compared to sites placed by the queue-naïve algorithm. Compared to the queue-naïve algorithm, the queue-conscious algorithm favored placing more sites in densely populated areas to offset high arrival volumes, thereby reducing losses due to excessive queueing. These results were not sensitive to misspecification of queueing parameters or relaxation of the constant arrival rate assumption. One should consider losses from queueing to optimally place mass vaccination sites, even when empirically derived queueing parameters are not available. Due to the negative impacts of excessive wait times on participant satisfaction, reducing queueing attrition is also expected to yield downstream benefits and improve vaccination coverage in subsequent mass vaccination campaigns.