Syndrome Outbreak Research Articles

Comprehensive Microbiological and Metagenomic Analysis of the Guillain–Barré Syndrome Outbreak in Lima, 2019

In 2018/2019, two large Guillain–Barré Syndrome (GBS) outbreaks took place in Peru. Here, we report a comprehensive analysis of biological samples from GBS patients from the 2019 outbreak. We applied metagenomic, microbiologic, and serological analyses to different biological samples collected from GBS patients. Further phenotypic and genomic characterization was conducted on Campylobacter jejuni isolates from GBS samples. Microbiologic and metagenomic analyses revealed several patients with multiple co-infections, yet no common infectious agents were found other than C. jejuni. Four C. jejuni isolates were isolated from rectal swabs. Twenty-one patients had detectable IgG serum antibodies related to C. jejuni, of whom seven had IgM antibodies. Genomic analyses showed that these four strains were clonal (ST2993) and contained the class A lipooligosaccharide biosynthesis locus. These results further support the idea that that C. jejuni is the etiological agent that triggered the GBS outbreak in Peru in 2019 and that the strains are not restricted to Peru, hence could be regarded as a broad public health concern. Furthermore, though we cannot delineate the role played by co-infections in GBS development, results obtained herein highlight metagenomic analysis as a potential new tool for depicting a yet unknown area of research in GBS.

Hantavirus Pulmonary Syndrome Outbreak Anticipation by a Rapid Synchronous Increase in Rodent Abundance in the Northwestern Argentina Endemic Region: Towards an Early Warning System for Disease Based on Climate and Rodent Surveillance Data.

Hantavirus pulmonary syndrome (HPS) is an American emerging disease caused by the rodent-borne virus genus Orthohantavirus (Family: Hantaviridae: Order: Elliovirales Class: Bunyaviricetes). In Argentina, almost half of the HPS infections occur in the northwestern endemic region. In this study, we monitored rodent abundance during 2022 and 2023 in three sites with different sampling methods (removal trapping, live trapping and hunted rodents by domestic cats) to evaluate their relationship with human infections. We found a similar pattern of variation in rodent abundance across time, and particularly a synchronous rise of rodent abundance that anticipated an HPS outbreak in 2023. Our dynamic regression models revealed a positive relationship between HPS cases and rodent abundance with a three-month lag, as well as rainfall with an eight-month lag. Our results provide a framework for the planning and implementation of public health prevention campaigns based on climatology and rodent monitoring. Domestic cats bringing rodents into houses can be an overlooked risk factor, particularly if viral shedding of infected rodents is magnified by stress. HPS is a disease of public health concern due to its high mortality rate, the lack of a specific therapeutic treatment and no vaccine. Thus, prevention of infections is of the utmost importance.

Description of practices adopted in response to porcine reproductive and respiratory syndrome outbreaks among breeding herds in the United States from 2019-2021

Description of practices adopted in response to porcine reproductive and respiratory syndrome outbreaks among breeding herds in the United States from 2019-2021

Assessment of Brazil's vesicular syndrome surveillance system: Profile of notifications and performance of the official veterinary service

Foot-and-mouth disease (FMD) is an ailment that causes serious damage to the productive chain, and its control through vaccination is of utmost importance for its eradication. Brazil initiated the National Foot-and-Mouth Disease Surveillance Program (PNEFA) with the aim of making the country FMD-free by 2026. As part of the program, notifications of vesicular lesions became mandatory for the Official Veterinary Service (OVS), which is responsible for verifying them. Due to its size, border areas with countries that do not have FMD-free status pose a risk to Brazil and require greater attention. This study described the profile of notifications of suspected outbreaks of vesicular syndrome in Brazil and analyzed the performance of the surveillance system. The results showed 7134 registered notifications of suspected vesicular syndrome outbreaks from 2018 to 2022, with 2022 having the highest number (n = 2343 or 32.85 %). The species that generated the most notifications were swine (90.99 %), cattle and buffaloes (7.54 %), goats and sheep (1.44 %), and others (0.03 %). The sources of notification were "Veterinary medicine professionals" (61.82 %), "Owners or employees" (13.66 %), "Third parties" (8.90 %), "OVS" (7.20 %), and "others" (2.66 %). 41.69 % of notifications originated from non-border municipalities, and 58.32 % from border areas. Only the state of Paraná account for 51.73 % of the total notifications. This state also accounted for 66.70 % of the 32.47 % of notifications with a final diagnosis of "absence of clinically compatible signs or susceptible animals", indicating a certain lack of knowledge in the area, leading to unnecessary notifications and system overload. The performance of the OVS was evaluated based on the service response time from notification registration trough Logistic and Negative binomial regressions. A total of 27.83 % of notifications did not meet the Brazilian legally specified time, and the zone related to the state of Parana needs improvements in performance. The presence and peaks of Senecavirus A cases may have influenced an increased number of swine notifications and led to a decrease in OVS response time. The results demonstrate better performance of surveillance in border areas. Given the vast territory of Brazil, it is not expected that 100 % of responses occur within the legal timeframe, however, the performance of the surveillance system proved to be adequate, with 86 % complied to the legislation. The performance indicators could be used as a monitoring tool, along with indicators to demonstrate system overload. Continued education actions are crucial for strengthening PNEFA.

Impact of Functional Limitation on Quality of Life among Covid-19 Survivors

Background: It has been evident that after viral infections (e.g., SARS-1), patients often sustain functional limitations over a long period after discharge from the hospital. Persisting symptoms with subsequent progression to poor functional status have been reported in a substantial proportion of these patients. These patients are susceptible to developing reduced functional status that impact their ability to care for themselves and to perform usual activities of daily living in the months following hospital admission. Previous severe acute respiratory syndrome (SARS) outbreaks showed to affect the survivors lung function, exercise capacity, health-related quality of life (HrQoL), mental health, and lead to increased symptoms of fatigue and dyspnea from 6 months to 2 years after symptom onset. This study aims to assess those recovering from COVID-19 for symptoms of functional limitation and its impact on quality of life, thus identifying a group worthy of further study and early intervention. . Objective: To determine the impact of functional limitation on quality of life among COVID– 19 survivors Methods 87 patients exposed with covid-19 virus was followed up and assessed for functional limitation and quality of life. Participants were asked on a telephone to choose an appropriate option for each question in relation to current situation from the functional status scale and WHOQOL-BREF among COVID 19 survivors. Result: Karl Pearson correlation coefficient was used to determine the impact of functional limitation on quality of life among COVID19 survivors. Impact of functional limitation on four domains of quality of life was statistically significant at p<0.001. There was significantly strong negative correlation found between functional status scale and domain1 (r=-0.823) and functional status scale and domain 3 (r=-0.902) whereas there was significantly moderate negative correlation between functional status scale and domain 2 (r=0.584), functional status scale and domain 4 (r=-0.416). Conclusion: Present study concludes that there is a profound functional limitation after 6 months of post COVID. Hence the functional limitation and its associated symptoms need to be monitored and early intervention needs to be planned in post COVID19 patients.

Toxicology and safety study of L-tryptophan and its impurities for use in swine.

L-tryptophan, an essential amino acid for physiological processes, metabolism, development, and growth of organisms, is widely utilized in animal nutrition and human health as a feed additive and nutritional supplement, respectively. Despite its known benefits, safety concerns have arisen due to an eosinophilia-myalgia syndrome (EMS) outbreak linked to L-tryptophan consumed by humans. Extensive research has established that the EMS outbreak was caused by an L-tryptophan product that contained certain impurities. Therefore, safety validations are imperative to endorse the use of L-tryptophan as a supplement or a feed additive. This study was conducted in tertiary hybrid [(Landrace × Yorkshire) × Duroc] pigs to assess general toxicity and potential risks for EMS-related symptoms associated with L-tryptophan used as a feed additive. Our investigation elucidated the relationship between L-tryptophan and EMS in swine. No mortalities or clinical signs were observed in any animals during the administration period, and the test substance did not induce toxic effects. Hematological analysis and histopathological examination revealed no changes in EMS-related parameters, such as eosinophil counts, lung lesions, skin lesions, or muscle atrophy. Furthermore, no test substance-related changes occurred in other general toxicological parameters. Through analyzing the tissues and organs of swine, most of the L-tryptophan impurities that may cause EMS were not retained. Based on these findings, we concluded that incorporating L-tryptophan and its impurities into the diet does not induce EMS in swine. Consequently, L-tryptophan may be used as a feed additive throughout all growth stages of swine without safety concerns.

Molecular and serological evidence of chikungunya virus infection with high case fatality among pediatric population with acute encephalitis syndrome: first report from Eastern Uttar Pradesh, India.

Acute encephalitis syndrome (AES) outbreaks in children of Eastern Uttar Pradesh (E-UP) region of India have been a longstanding public health issue, with a significant case fatality rate of 20-25%. Since past decade, a rise in chikungunya (CHIK) cases has been occurring, which is a reported etiology of AES. However, the burden of chikungunya virus (CHIKV) among pediatric AES (pAES) is unknown from E-UP. We included 238 hospitalized pAES cases. The presence of IgM antibodies for CHIKV, and Dengue virus (DENV) was tested, and RT-PCR was performed for CHIKV and DENV in serologically confirmed CHIKV and DENV pAES cases. Positive samples were sequenced using Sangers sequencing. Further, to check for co-infection, IgM antibodies for other AES etiologies including Japanese encephalitis virus (JEV), Leptospira and Orientia tsutsugamushi (OT) in serum were also investigated. IgM ELISA demonstrated 5.04% (12) positivity for CHIKV. Among CHIKV IgM positive, 3 (25%, 3/12) pAES patients died. CHIKV genome was detected in 3 pAES specimens. Among which, 2 CHIKV cases were also positive for OT DNA. Partially sequenced CHIKV were genotyped as ECSA. The overall finding indicates evidence of CHIKV infection with high case fatality among pAES patients from E-UP. This study advocates constant serological and molecular surveillance of CHIKV in AES endemic regions of India.

A novel data driven anticipatory framework for the communicable syndrome

Preceding pandemic trends uncovered the weakness of existing healthcare management. As a result, there is an urgent need to build a resilient pandemic-lockdown model to relieve health systems from crashing and equip them with the latest tools and techniques for rapid actions to manage future pandemics efficiently. Therefore, this research work aims at proposing an adaptable framework called the Automated Selection of Streets for Lockdown (ASSLD) to mitigate the exponential progression of the epidemic from the perspective of urban resilience. Intuitive selection of pandemic-affected streets was accomplished by first applying the shortest path algorithm over the respective spatial network and then validating the selection through spatial analysis using space syntax syntactic measures. Medical records for victims of a preceding contagious viral infection were used as a dataset to prepare test beds against which the ASSLD model was regressively validated. Multiple linear regression was used to analyse the impact of space syntax syntactic measures along with socio-economic factors on the number of replicating victims. The findings indicated that space syntax syntactic variables along with certain socioeconomic factors, provided more granular means of measuring the spatial elements (streets) as diffusion hubs for a communicable disease. This paper presents in detail proof of concept with results applied to actual data obtained from a preceding communicable syndrome outbreak.

Socioeconomic impacts of airborne and droplet-borne infectious diseases on industries: a systematic review

BackgroundRecent pandemics have had far-reaching effects on the world’s largest economies and amplified the need to estimate the full extent and range of socioeconomic impacts of infectious diseases outbreaks on multi-sectoral industries. This systematic review aims to evaluate the socioeconomic impacts of airborne and droplet-borne infectious diseases outbreaks on industries.MethodsA structured, systematic review was performed according to the PRISMA guidelines. Databases of PubMed, Scopus, Web of Science, IDEAS/REPEC, OSHLINE, HSELINE, and NIOSHTIC-2 were reviewed. Study quality appraisal was performed using the Table of Evidence Levels from Cincinnati Children’s Hospital Medical Center, Joanna Briggs Institute tools, Mixed Methods Appraisal Tool, and Center of Evidence Based Management case study critical appraisal checklist. Quantitative analysis was not attempted due to the heterogeneity of included studies. A qualitative synthesis of primary studies examining socioeconomic impact of airborne and droplet-borne infectious diseases outbreaks in any industry was performed and a framework based on empirical findings was conceptualized.ResultsA total of 55 studies conducted from 1984 to 2021 were included, reporting on 46,813,038 participants working in multiple industries across the globe. The quality of articles were good. On the whole, direct socioeconomic impacts of Coronavirus Disease 2019, influenza, influenza A (H1N1), Severe Acute Respiratory Syndrome, tuberculosis and norovirus outbreaks include increased morbidity, mortality, and health costs. This had then led to indirect impacts including social impacts such as employment crises and reduced workforce size as well as economic impacts such as demand shock, supply chain disruptions, increased supply and production cost, service and business disruptions, and financial and Gross Domestic Product loss, attributable to productivity losses from illnesses as well as national policy responses to contain the diseases.ConclusionsEvidence suggests that airborne and droplet-borne infectious diseases have inflicted severe socioeconomic costs on regional and global industries. Further research is needed to better understand their long-term socioeconomic impacts to support improved industry preparedness and response capacity for outbreaks. Public and private stakeholders at local, national, and international levels must join forces to ensure informed systems and sector-specific cost-sharing strategies for optimal global health and economic security.

Enhanced enrichment of collected airborne coronavirus and influenza virus samples via a ConA-coated microfluidic chip for PCR detection

The severe acute respiratory syndrome (SARS-CoV-2) outbreak triggered global concern and emphasized the importance of virus monitoring. During a seasonal influenza A outbreak, relatively low concentrations of 103–104 viral genome copies are available per 1 m3 of air, which makes detection and monitoring very challenging because the limit of detection of most polymerase chain reaction (PCR) devices is approximately 103 viral genome copies/mL. In response to the urgent need for the rapid detection of airborne coronaviruses and influenza viruses, an electrostatic aerosol-to-hydrosol (ATH) sampler was combined with a concanavalin A (ConA)-coated high-throughput microfluidic chip. The samples were then used for PCR detection. The results revealed that the enrichment capacity of the ATH sampler was 30,000-fold for both HCoV-229E and H1N1 influenza virus, whereas the enrichment capacities provided by the ConA-coated microfluidic chip were 8-fold and 16-fold for HCoV-229E and H1N1 virus, respectively. Thus, the total enrichment capacities of our combined ATH sampler and ConA-coated microfluidic chip were 2.4 × 105-fold and 4.8 × 105-fold for HCoV-229E and H1N1 virus, respectively. This methodology significantly improves PCR detection by providing a higher concentration of viable samples.

Quantifying Health Policy Uncertainty in China Using Newspapers: Text Mining Study.

From the severe acute respiratory syndrome (SARS) outbreak in 2003 to the COVID-19 pandemic in 2019, a series of health measures and policies have been introduced from the central to the local level in China. However, no study has constructed an uncertainty index that can reflect the volatility, risk, and policy characteristics of the health environment. We used text mining analysis on mainstream newspapers to quantify the volume of reports about health policy and the total number of news articles and to construct a series of indexes that could reflect the uncertainty of health policy in China. Using the Wisenews database, 11 of the most influential newspapers in mainland China were selected to obtain the sample articles. The health policy uncertainty (HPU) index for each month from 2003 to 2022 was constructed by searching articles containing the specified keywords and calculating their frequency. Robustness tests were conducted through correlation analysis. The HPU index was plotted using STATA (version 16.0), and a comparative analysis of the China and US HPU indexes was then performed. We retrieved 6482 sample articles from 7.49 million news articles in 11 newspapers. The China HPU index was constructed, and the robustness test showed a correlation coefficient greater than 0.74, which indicates good robustness. Key health events can cause index fluctuations. At the beginning of COVID-19 (May 2020), the HPU index climbed to 502.0. In December 2022, China's HPU index reached its highest value of 613.8 after the release of the "New Ten Rules" pandemic prevention and control policy. There were significant differences in HPU index fluctuations between China and the United States during SARS and COVID-19, as well as during the Affordable Care Act period. National health policy is a guide for health development, and uncertainty in health policy can affect not only the implementation of policy by managers but also the health-seeking behavior of the people. Here, we conclude that changes in critical health policies, major national or international events, and infectious diseases with widespread impact can create significant uncertainty in China's health policies. The uncertainty of health policies in China and the United States is quite different due to different political systems and news environments. What is the same is that COVID-19 has brought great policy volatility to both countries. To the best of our knowledge, our work is the first systematic text mining study of HPU in China.

28 On-Farm Rapid Test to Assess Immunological Health of Young Pigs

Abstract Immunological competence is important for young pig survivability. A rapid on-farm test of immunological status may be a tool to help with early identification of sick animals. A new immunological test uses gold nanoparticle technology (D2Dx) to detect changes in serum proteins, particularly IgG and was evaluated as a potential on-farm measure of immunological health of pigs born during a farm level Porcine Respiratory Reproductive Syndrome (PRRS) outbreak. Up to three piglets from each litter in 2 farrowing groups (28 days apart) were selected for serial blood sampling and monitoring of body weight. Group 1 (n = 13 sows) experienced the PRRS outbreak approximately 14 days before farrowing and Group 2 (n = 15) approximately 40 days before farrowing. Attempts were made to select one piglet from each of 3 general categories [small (< 1.0 kg), average (1.1 – 1.6 kg), heavy (>1.6 kg)] from each litter. Serum samples were collected at day 2 and 15 of age from each piglet and serum IgG concentration and D2Dx ratio were assessed. Serum immunocrit at day 2 was also completed. Daily animal care of piglets and sows followed standard barn protocols. No creep feed was provided, sows were fed ad libitum, and cross-fostering was limited. Stillborn rate and preweaning death loss was approximately 70% in Group 1 and 35% in Group 2. Birth weight was similar between Group 1 and 2 litters (1.4 ± 0.3 kg). However, body weight gain to day 15 was 1.7 ± 0.95 kg and 2.7 ± 1.1 kg for piglets from Group 1 and 2, respectively, which may be due to timing of the PRRS outbreak. The D2Dx ratio declined from day 2 to 15 (0.029 vs -0.002) in both groups and was significantly reduced in Group 2 pigs (P < 0.001). A lower ratio suggests a stronger type 2 immune response and has been associated with decreased overall immunity in cattle, humans, and rodents. The D2Dx ratio was negatively correlated (r = -0.58) with BW gain in Group 1 pigs and positively correlated (r = 0.36) with gain in Group 2 pigs. Both immunocrit (day 2) and IgG (d15) were greater in Group 1 pigs than Group 2 (P < 0.01). There was a no relationship between birth weight and day 2 serum immunocrit (R2 = 0.06) or day 2 D2Dx (R2 = 0.01). There was no relationship between serum IgG and D2Dx at d15. The PRRS disease activity impacts immunocrit and serum IgG measures in the neonatal pig. The D2Dx ratio was not strongly related to piglet immunological status under disease conditions; however, the stronger type 2 immune response may be reflective of positive changes in piglet immune function and the response to maternal PRRS antibodies in milk.

Prevalence and Molecular Characteristics of FAdV-4 from Indigenous Chicken Breeds in Yunnan Province, Southwestern China.

Fowl adenovirus-induced hepatitis-pericardial effusion syndrome outbreaks have been increasingly reported in China since 2015, resulting in substantial economic losses to the poultry industry. The genetic diversity of indigenous chicken results in different immune traits, affecting the evolution of these viruses. Although the molecular epidemiology of fowl adenovirus serotype 4 (FAdV-4) has been well studied in commercial broiler and layer chickens, the prevalence and genetic characteristics of FAdV-4 in indigenous chickens remain largely unknown. In this study, samples were collected from six indigenous chicken breeds in Yunnan province, China. FAdV-positive samples were identified in five of the six indigenous chicken populations via PCR and 10 isolates were obtained. All FAdVs belonged to serotype FAdV-4 and species FAdV-C. The hexon, fiber, and penton gene sequence comparison analysis demonstrated that the prevalence of FAdV-4 isolates in these chickens might have originated from other provinces that exported chicks and poultry products to Yunnan province. Moreover, several distinct amino acid mutations were firstly identified in the major structural proteins. Our findings highlighted the need to decrease inter-regional movements of live poultry to protect indigenous chicken genetic resources and that the immune traits of these indigenous chickens might result in new mutations of FAdV-4 strains.

Lessons Learned from COVID-19 to better address future threats to global health security: A Critical Analysis of Experts Perspectives

Emerging infectious diseases have had a significant impact on the Asia-Pacific region in recent years, including a severe acute respiratory syndrome outbreak that occurred in 2002-2003, which had a substantial impact on several Asia-Pacific economies, the outbreak of highly pathogenic Asian avian influenza A (H5N1) that followed in 2006, strains of H1N1, and Middle East respiratory syndrome (MERS). There is an increasing frequency and impact of emerging infectious diseases (EID), as demonstrated by the current global outbreak of COVID-19 (coronavirus disease 2019). The Asia-Pacific region is particularly vulnerable to the spread of EID across national borders. In collaboration with the Ministry of Health of the Republic of Indonesia, the Asia Pacific Economic Cooperation (APEC) Health Working Group conducted an International Workshop on Managing Emerging Infectious Diseases (MEID) in Jakarta, Indonesia, on 12–16 September 2022. The workshop focused on a lesson-learning approach and aimed to strengthen global and domestic preparedness for the next pandemic. Four key lessons can be drawn from the APEC region's COVID-19 pandemic. First, zoonotic outbreaks threaten health security, making One Health an urgent necessity. Secondly, collaboration and partnership are essential to combating the pandemic. Thirdly, decisive leadership is essential at all global and local levels. Finally, risk communication builds trust and acknowledges uncertainty during a crisis. These lessons could strengthen the evidence base for regional policy responses and better responses to future threats.

The 29-nucleotide deletion in SARS-CoV: truncated versions of ORF8 are under purifying selection

BackgroundAccessory proteins have diverse roles in coronavirus pathobiology. One of them in SARS-CoV (the causative agent of the severe acute respiratory syndrome outbreak in 2002–2003) is encoded by the open reading frame 8 (ORF8). Among the most dramatic genomic changes observed in SARS-CoV isolated from patients during the peak of the pandemic in 2003 was the acquisition of a characteristic 29-nucleotide deletion in ORF8. This deletion cause splitting of ORF8 into two smaller ORFs, namely ORF8a and ORF8b. Functional consequences of this event are not entirely clear.ResultsHere, we performed evolutionary analyses of ORF8a and ORF8b genes and documented that in both cases the frequency of synonymous mutations was greater than that of nonsynonymous ones. These results suggest that ORF8a and ORF8b are under purifying selection, thus proteins translated from these ORFs are likely to be functionally important. Comparisons with several other SARS-CoV genes revealed that another accessory gene, ORF7a, has a similar ratio of nonsynonymous to synonymous mutations suggesting that ORF8a, ORF8b, and ORF7a are under similar selection pressure.ConclusionsOur results for SARS-CoV echo the known excess of deletions in the ORF7a-ORF7b-ORF8 complex of accessory genes in SARS-CoV-2. A high frequency of deletions in this gene complex might reflect recurrent searches in “functional space” of various accessory protein combinations that may eventually produce more advantageous configurations of accessory proteins similar to the fixed deletion in the SARS-CoV ORF8 gene.

Global Pattern of Epizootic Ulcerative Syndrome Outbreaks in Freshwater Farmed and Wild Fish from 2005 to 2012

Epizootic ulcerative syndrome (EUS) is an infectious disease of freshwater farmed and wild fish caused by a fungus, Aphanomyces invadans. This disease is an important economic disease causing huge socio-economic losses to fish farmers across the world. While this is an important fish disease, its global epidemiology is poorly understood. The objective of this study is understand the global spatiotemporal epidemiology of EUS outbreaks from 2005 to 2022. The data were retrieved from open access database of the World Organization for Animal Health (WOAH). Results showed that there were a total of 277 outbreaks of EUS reported to WOAH from 2005 to 2022 from 15 countries and territories with 76% outbreaks reported from African countries. Democratic Republic of Congo reported the highest number of EUS outbreaks. Higher number of outbreaks were reported during 2014 to 2017. The observed epidemiological pattern might be biased due to the underreporting of the disease. Nevertheless, it offers important insights to understand the latest global pattern of EUS. We suggest to increase country level awareness on EUS so that outbreaks are reported in a timely manner.

THE RED FLAG OF EMERGENCY USE AUTHORIZATION (EUA)

The Emergency Use Authorization (EUA) policy, a representative biodefense policy, was legislated in the United States in 2001 based on lessons learned from Amerithrax, whereas Korea's EUA policy was based on lessons learned from the Middle East Respiratory Syndrome outbreak in 2015. Due to these divergent origins, the U.S. EUA's homeland security objectives were specialized to deal with highly pathogenic biological agents that could be exploited for bioterrorism, whereas the Korean EUA pursues disease containment purposes to strengthen mass‐testing practices. During the early phase of the COVID‐19 pandemic, the U.S. EUA revealed limitations in its integration with public health surveillance, laboratory partnerships, and insurance systems, which hampered the rapid expansion of testing capacities. Thereafter, once the limitations of the EUA were circumvented, the testing capacity of the United States began to catch up with that of South Korea, and later skyrocketed after solving these issues.

Commentary: Blockchain technology and its current importance in toxic anterior segment syndrome outbreak in India.

Commentary: Blockchain technology and its current importance in toxic anterior segment syndrome outbreak in India.

The Impact of a Public Health Emergency on the Demand for Life Insurance – An Empirical Analysis Based on Severe Acute Respiratory Syndrome

AbstractWe examined changes in personal life insurance purchase decisions after a public health event by incorporating perceived health risk and regret into the expected utility function. The model predicts that the epidemic will create incremental insurance demand. Based on the 2003 severe acute respiratory syndrome outbreak in China, we used a panel dataset of 30 provinces from 2000 to 2007 and applied the difference‐in‐differences method to confirm the prediction empirically. The results showed that the epidemic did not significantly impact the demand for life insurance in the short term but played a role in the long term. People increased their health‐care expenditure and premiums for new policies after the severe acute respiratory syndrome event, suggesting that the epidemic changed people's perceived risk and triggered anticipated regret, which increased life insurance demand. Some robustness checks also supported our findings.

Long-term effect of childhood pandemic experience on medical major choice: Evidence from the 2003 severe acute respiratory syndrome outbreak in China.

This study examines the long-term effect of a pandemic on a crucial human capital decision, namely college major choice. Using China's 2008-2016 major-level National College Entrance Examination (Gaokao) entry grades, we find that the 2003 severe acute respiratory syndrome (SARS) had a substantial deterrent effect on the choice of majoring in medicine among high school graduates who experienced the pandemic in their childhood. In provinces with larger intensities of SARS impact, medical majors become less popular as the average Gaokao grades of enrolled students decline. Further evidence from a nationally representative survey shows that the intensity of the SARS impact significantly decreases children's aspirations to pursue medical occupations, but does not affect their parents' expectations for their children to enter the medical profession. Our discussion on the effect mechanism suggests that the adverse influence of SARS on the popularity of medical majors likely originates from students' childhood experiences.