World Health Organization Emergency Research Articles

Novel Oral Poliovirus Vaccine 2 Safety Evaluation during Nationwide Supplemental Immunization Activity, Uganda, 2022.

Given its enhanced genetic stability, novel oral poliovirus vaccine type 2 was deployed for type 2 poliovirus outbreak responses under World Health Organization Emergency Use Listing. We evaluated the safety profile of this vaccine. No safety signals were identified using a multipronged approach of passive and active surveillance.

5 Stepped-Wedge Trial to Assess Reduction of Mortality of Sentential Conditions After World Health Organization Emergency Care System Toolkit Implementation

5 Stepped-Wedge Trial to Assess Reduction of Mortality of Sentential Conditions After World Health Organization Emergency Care System Toolkit Implementation

Disaster Response and Management: The Integral Role of Rehabilitation.

With the increasing frequency of disasters and the significant upsurge of survivors with severe impairments and long-term disabling conditions, there is a greater focus on the importance of rehabilitation in disaster management. During disasters, rehabilitation services confront a greater load due to the influx of victims, management of persons with pre-existing disabilities and chronic conditions, and longer-term care continuum. Despite robust consensus amongst the international disaster response and management community for the rehabilitation-inclusive disaster management process, rehabilitation is still less prioritised. Evidence supports the early involvement of rehabilitation professionals in disaster response and management for minimising mortality and disability, and improving clinical outcomes and participation in disaster survivors. In the last two decades, there have been substantial developments in disaster response/management processes including the World Health Organization Emergency Medical Team (EMT) initiative, which provides a standardized structured plan to provide effective and coordinated care during disasters. However, rehabilitation-inclusive disaster management plans are yet to be developed and/or implemented in many disaster-prone countries. Strong leadership and effective action from national and international bodies are required to strengthen national rehabilitation capacity (services and skilled workforce) and empower international and local EMTs and health services for comprehensive disaster management in future calamities. This narrative review highlights the role of rehabilitation and current developments in disaster rehabilitation; challenges and key future perspectives in this area.

Comprehensive Review of the Initial 11 WHO Emergency Use Listed COVID-19 Vaccine Candidates: Mechanisms, Efficacy, and Comparative Attributes for Safety and Well-Being

Since December 2019, the world has witnessed a massive outbreak of a novel coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which prompted cross-national collaboration to establish essential diagnostics, effective treatment protocols, and most importantly the design and development of suitable COVID-19 vaccine candidates. This effort has been fueled by collaborations among academic researchers, funding agencies, companies, and regulatory authorities. As a result, more than 242 vaccine candidates are currently under clinical trial, and nearly 50 vaccines have been approved in different countries. In this study, we conduct a comprehensive review of 11 vaccine candidates that have been granted Emergency Use Listing (EUL) by the World Health Organization (WHO). Our review summarizes the mode of synthesis, mechanism of action, approval authority, target age group, efficacy, merits, and gaps of these vaccine candidates. Additionally, we provide comparative attributes of these vaccine candidates to enhance understanding of safety and well-being.

The role of a genetically stable, novel oral type 2 poliovirus vaccine in the poliomyelitis endgame.

Poliovirus infection causes paralysis in up to 1 in 200 infected persons. The use of safe and effective inactivated poliovirus vaccines and live attenuated oral poliovirus vaccines (OPVs) means that only two pockets of wild-type poliovirus type 1 remain, in Afghanistan and Pakistan. However, OPVs can revert to virulence, causing outbreaks of circulating vaccine-derived poliovirus (cVDPV). During 2020-2022, cVDPV type 2 (cVDPV2) was responsible for 97-99% of poliomyelitis cases, mainly in Africa. Between January and August 2022, cVDPV2 was detected in sewage samples in Israel, the United Kingdom and the United States of America, where a case of acute flaccid paralysis caused by cVDPV2 also occurred. The Pan American Health Organization has warned that Brazil, the Dominican Republic, Haiti and Peru are at very high risk for the reintroduction of poliovirus and an additional eight countries in Latin America are at high risk, following dropping vaccination rates (average 80% coverage in 2022). Sabin type 2 monovalent OPV has been used to control VDPV2 outbreaks, but its use could also lead to outbreaks. To address this issue, a more genetically stable, novel OPV2 (nOPV2) was developed against cVDPV2 and in 2020 was granted World Health Organization Emergency Use Listing. Rolling out a novel vaccine under the Emergency Use Listing in mass settings to contain outbreaks requires unique local regulatory and operational preparedness.

Early Stages of Global Neurosurgery

The year 2015 was pivotal for the growth of global neurosurgery. In January, the United Nations (UN) adopted the Sustainable Development Goals (SDGs), replacing the expiring Millennial Development Goals. The SDGs were more comprehensive, having 17 Goals with 169 associated targets; a significant number of these included the necessity for surgical care to achieve the targets. 1
 In early Spring 2015, publication of Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development - The Lancet Commission on Global Surgery created a paradigm shift in the understanding of surgical needs worldwide, particularly in access to safe, timely and affordable surgical care for billions of individuals and large gaps in global surgical health workforce.2 At around the same time, Disease Control Priorities 3rd Edition, Volume 1, Essential Surgery laid out the economic case for surgical care, particularly in low resource settings.3 In May, the 68th World Health Assembly unanimously approved WHA resolution 68.15 on strengthening emergency and essential surgical care as a component of universal health coverage.4 
 The adoption of SDGs and WHA 68.15 provided the political impetus toward making surgical care a global priority, DCP3 created the health economic basis for global surgical care, and the Lancet Commission developed the factual needs basis for greatly enlarging global surgical service delivery.
 The World Health Organization (WHO) is the health technical arm of the UN. The WHA is composed of the health ministers of all UN Member States (countries) and is the governing body of WHO, setting the global health agenda and steering WHO’s work. The WHO Emergency and Essential Surgical Care (EESC) Programme5 was given the mandate to implement WHA resolution 68.15; a task that could only be achieved through extensive worldwide partnerships, such as the World Federation of Neurosurgical Societies (WFNS), which has official working relations as a non-state actor with WHO.6
 September 9-12, 2015, the 15th Interim Meeting of the World Federation of Neurosurgical Societies (WFNS) met in Rome, Italy.7 For the first time, a neurosurgeon was Lead of WHO EESC, creating a unique opportunity for optimally augmenting this WHO/WFNS partnership going forward. The Foundation for International Education in Neurosurgery (FIENS) held a session during this meeting, further highlighting future prospects.

Medical officers as the key stakeholders in district level hospitals in Kenya

Background: A core component of the World Health Organization (WHO) infection prevention and control (IPC) recommends that staffing levels be adequate for the patient workload. The lack of health-care workers in low- and middle-income countries (LMICs), particularly in sub-Saharan Africa is well documented; one way to alleviate the burden of surgical infections without a large commitment of resources is to better train and educate existing facility staff. The study aimed to understand the current allocation of the surgical workload in district level hospitals in Kenya to create targeted task-shifting and education programs. Methods: We developed a cross-sectional survey on IPC practices, adapted from the WHO Guideline on Core Components for IPC and the WHO Emergency and Essential Surgical Care Situational Analysis Tool, for use in district level facilities in LMICs. The survey components included IPC guidelines, surveillance, workload and environment, hospital characteristics, clinical workforce, obstetrical outcomes, and perioperative care practices. In a pilot feasibility trial of the survey tool, data were collected from 27 district level hospitals in Kenya from March to May 2019. These facilities were selected in part based on their capacity to provide comprehensive maternal and obstetric care, including cesarean operations, as cesareans make up the majority of surgeries in the regions and are associated with high surgical site infection rates. Results: The facilities included in the survey pilot serve an estimated population of 3,615,166. The average number of annual admissions was 7801 (Range: 1190–25,783). Thirteen of the 27 total facilities (48.1%) had no certified surgeons, six facilities had one certified surgeon (22.2%), and eight facilities employed two or more certified surgeons. In contrast, almost all facilities (n = 25; range: 2–15) employed medical officers who performed cesarean operations. The number of nurses in surgical and obstetricians and gynecologists wards ranged from 4 to 101, with an average of 27 years. Conclusion: Dedicating specialized training and education to medical officers and engaging them as key stakeholders is the key to creating practical and sustainable change when it comes to safe surgical provision of surgical and obstetric care within Kenya.

Cost-effectiveness analysis of the multi-strategy WHO emergency care toolkit in regional referral hospitals in Uganda.

Low- and middle-income countries bear a disproportionate amount of the global burden of disease from emergency conditions. To improve the provision of emergency care in low-resource settings, a multifaceted World Health Organization (WHO) intervention introduced a toolkit including Basic Emergency Care training, resuscitation area guidelines, a trauma registry, a trauma checklist, and triage tool in two public hospital sites in Uganda. While introduction of the toolkit revealed a large reduction in the case fatality rate of patients, little is known about the cost-effectiveness and affordability. We analysed the cost-effectiveness of the toolkit and conducted a budget analysis to estimate the impact of scale up to all regional referral hospitals for the national level. A decision tree model was constructed to assess pre- and post-intervention groups from a societal perspective. Data regarding mortality were drawn from WHO quality improvement reports captured at two public hospitals in Uganda from 2016-2017. Cost data were drawn from project budgets and included direct costs of the implementation of the intervention, and direct costs of clinical care for patients with disability. Development costs were not included. Parameter uncertainty was assessed using both deterministic and probabilistic sensitivity analyses. Our model estimated the incremental cost-effectiveness of implementing the WHO emergency care toolkit measuring all costs and outcomes as disability-adjusted life-years (DALYs) over a lifetime, discounting both costs and outcomes at 3.5%. Implementation of the WHO Toolkit averted 1,498 DALYs when compared to standard care over a one-year time horizon. The initial investment of $5,873 saved 34 lives (637 life years) and avoided $1,670,689 in downstream societal costs, resulted in a negative incremental cost-effectiveness ratio, dominating the comparator scenario of no intervention. This would increase to saving 884 lives and 25,236 DALYs annually with national scale up. If scaled to a national level the total intervention cost over period of five years would be $4,562,588 or a 0.09% increase of the total health budget for Uganda. The economic gains are estimated to be $29,880,949 USD, the equivalent of a 655% return on investment. The model was most sensitive to average annual cash income, discount rate and frequency survivor is a road-traffic incident survivor, but was robust for all other parameters. Improving emergency care using the WHO Toolkit produces a cost-savings in a low-resource setting such as Uganda. In alignment with the growing body of literature highlighting the value of systematizing emergency care, our findings suggest the toolkit could be an efficient approach to strengthening emergency care systems.

KNOWLEDGE, CHARACTERISTICS, WORK SITES OF HEALTH PRACTITIONERS FOR CHEST PHYSIOTHERAPY IN PATIENTS WITH COVID-19, IN KHARTOUM, SUDAN

Background and objective: COVID-19 was first identified in December 2019. The outbreak of coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization Emergency Committee and originated in the Hubei Province of the People's Republic of China, and on March 11, 2020. This study aims to describe the characteristics and work locations of health practitioners who apply chest physiotherapy for coronavirus patients and the extent and types of complications for coronavirus patients in Jabra and universal isolation centers in Khartoum. Methods: A total of 109 participants from Jabra and universal isolation centers in Khartoum completed a questionnaire based survey on the Knowledge and practices and outcome of Physiotherapy for COVID-19 patients. The questionnaire was self-administrated and distributed by personal contact. Convenient sampling method was used for data collection and the distributions of responses were presented as frequencies and percentages. Results: Total 109 individuals participated in this study; females (56%) were more than males. 28.4 % worked in isolation center for 3 -6 months while 23.9 % were worked for 6-9 months. 33 % from physiotherapists received patients aged 40-50 years old, while 23.95 received patients aged more than 60 years old. The intensive care unit was the most common site for chest physiotherapy (41.3%). Complications to isolation center patients occur as stated by 59.6% and the most common complications mentioned were shortness of breath (37.6%), followed by repeated chest infections (22.9%). Chest physiotherapy is very important for COVID-19 patients in isolation center as stated by (53.2%). Conclusion: As overall, COVID-19 presents challenges to inpatient care and participants know that physiotherapists play a fundamental role throughout help patients to prevent very serious complications and patient hospitalization. Physiotherapist in hospitals must be well-oriented regarding specific care to both provide the best patient care and reduce infection risk and Peer Review History: Received: 3 September 2022; Revised: 14 October; Accepted: 4 November, Available online: 15 November 2022 Academic Editor: Dr. Ali Abdullah Al-yahawi, Al-Razi university, Department of Pharmacy, Yemen, alyahawipharm@yahoo.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Dr. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.ye Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com Similar Articles: KNOWLEDGE ATTITUDE AND PERCEPTION OF HYPERTENSION AMONG STAFF OF A TERTIARY INSTITUTION IN NIGERIA THE PRACTICE AND PERCEPTION OF HOSPITAL PHARMACISTS TOWARDS ERRORS IN DISPENSING MEDICINES AND THEIR POSSIBLE CAUSES IN OMDURMAN MILITARY HOSPITAL, SUDAN

First Activation of the WHO Emergency Medical Team Minimum Data Set in the 2019 Response to Tropical Cyclone Idai in Mozambique.

During a disaster, comprehensive, accurate, timely, and standardized health data collection is needed to improve patient care and support effective responses. In 2017, the World Health Organization (WHO) developed the Emergency Medical Team (EMT) Minimum Data Set (MDS) as an international standard for data collection in the context of disasters and public health emergencies. The EMT MDS was formally activated for the first time in 2019 during the response to Cyclone Idai in Mozambique. The aim of this study was to analyze data collected through the EMT MDS during Cyclone Idai of 2019 and to identify the benefits of and opportunities for its future use. The EMT MDS was used for data collection. All 13 international EMTs deployed from March 27 through July 12 reported data in accordance with the EMT MDS form. The collected data were analyzed descriptively. A total of 18,468 consultations, including delivery of 94 live births, were recorded. For children under-five and those five-years and older, the top five reasons for consultation were minor injuries (4.5% and 10.8%, respectively), acute respiratory infections ([ARI] 12.6% and 4.8%, respectively), acute watery diarrhea (18.7% and 7.7%, respectively), malaria (9.2% and 6.1%, respectively), and skin diseases (5.1% and 3.1%, respectively). Non-disaster-related health events accounted for 84.7% of the total health problems recorded. Obstetric care was among the core services provided by EMTs during the response. Despite of challenges, the EMT MDS reporting system was found to support the responses and coordination of EMTs. The role of the Mozambican Ministry of Health (MOH), its cooperation with EMTs, and the dedicated technical support of international organizations enabled its successful implementation.

Role of population and test characteristics in antigen-based SARS-CoV-2 diagnosis, Czechia, August to November 2021.

BackgroundAnalyses of diagnostic performance of SARS-CoV-2 antigen rapid diagnostic tests (AG-RDTs) based on long-term data, population subgroups and many AG-RDT types are scarce.AimWe aimed to analyse sensitivity and specificity of AG-RDTs for subgroups based on age, incidence, sample type, reason for test, symptoms, vaccination status and the AG-RDT’s presence on approved lists.MethodsWe included AG-RDT results registered in Czechia’s Information System for Infectious Diseases between August and November 2021. Subpopulations were analysed based on 346,000 test results for which a confirmatory PCR test was recorded ≤ 3 days after the AG-RDT; 38 AG-RDTs with more than 100 PCR-positive and 300 PCR-negative samples were individually evaluated.ResultsAverage sensitivity and specificity were 72.4% and 96.7%, respectively. We recorded lower sensitivity for age groups 0–12 (65.5%) and 13–18 years (65.3%). The sensitivity level rose with increasing SARS-CoV-2 incidence from 66.0% to 76.7%. Nasopharyngeal samples had the highest sensitivity and saliva the lowest. Sensitivity for preventive reasons was 63.6% vs 86.1% when testing for suspected infection. Sensitivity was 84.8% when one or more symptoms were reported compared with 57.1% for no symptoms. Vaccination was associated with a 4.2% higher sensitivity. Significantly higher sensitivity levels pertained to AG-RDTs on the World Health Organization Emergency Use List (WHO EUL), European Union Common List and the list of the United Kingdom’s Department of Health and Social Care.ConclusionAG-RDTs from approved lists should be considered, especially in situations associated with lower viral load. Results are limited to SARS-CoV-2 delta variant.

Development of the India COVID-19 vaccine tracker.

COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Since then, efforts were initiated to develop safe and effective vaccines. Till date, 11 vaccines have been included in the WHO's emergency use list. The emergence and spread of variant strains of SARS-CoV-2 has altered the disease transmission dynamics, thus creating a need for continuously monitoring the real-world effectiveness of various vaccines and assessing their overall impact on disease control. To achieve this goal, the Indian Council of Medical Research (ICMR) along with the Ministry of Health and Family Welfare, Government of India, took the lead to develop the India COVID-19 Vaccination Tracker by synergizing three different public health databases: National COVID-19 testing database, CoWIN vaccination database and the COVID-19 India portal. A Vaccine Data Analytics Committee (VDAC) was constituted to advise on various modalities of the proposed tracker. The VDAC reviewed the data related to COVID-19 testing, vaccination and patient outcomes available in the three databases and selected relevant data points for inclusion in the tracker, following which databases were integrated, using common identifiers, wherever feasible. Multiple data filters were applied to retrieve information of all individuals ≥18 yr who died after the acquisition of COVID-19 infection with or without vaccination, irrespective of the time between vaccination and test positivity. Vaccine effectiveness (VE) against the reduction of mortality and hospitalizations was initially assessed. As compared to the hospitalization data, mortality reporting was found to be much better in terms of correctness and completeness. Therefore, hospitalization data were not considered for analysis and presentation in the vaccine tracker. The vaccine tracker thus depicts VE against mortality, calculated by a cohort approach using person-time analysis. Incidence of COVID-19 deaths among one- and two-dose vaccine recipients was compared with that among unvaccinated groups, to estimate the rate ratios (RRs). VE was estimated as 96.6 and 97.5 per cent, with one and two doses of the vaccines, respectively, during the period of reporting. The India COVID-19 Vaccination Tracker was officially launched on September 9, 2021. The high VE against mortality, as demonstrated by the tracker, has helped aid in allaying vaccine hesitancy, augmenting and maintaining the momentum of India's COVID-19 vaccination drive.

Situation reports and impacts on public health during the war in Ukraine, 24 February to 21 June 2022: World Health Organization Emergency Reports

Due to the Russian illegal invasion of Ukraine on February 24, 2022, evident and dramatic increases were found in the numbers of war-affected populations, the refugees, individuals relocated in Ukraine, and civilian injuries and deaths as the war is escalated. The war has delivered great pressures and demands for the Ukrainian health division. Food shortages are of great concern due to substantial damage to agricultural framework and destruction of food supply chains. The health shock caused by this war seems to have had effect beyond the borders of Ukraine. Over 5.3 million refugees from Ukraine have left their country seeking refuge in neighboring countries in Europe; therefore, the crisis has begun to apply excessive pressure on human and technical resources and health systems in these neighboring countries.

Mandatory Vaccination Against COVID-19: Twitter Poll Analysis on Public Health Opinion.

BackgroundOn January 30, 2020, the World Health Organization Emergency Committee declared the rapid worldwide spread of COVID-19 a global health emergency. By December 2020, the safety and efficacy of the first COVID-19 vaccines had been demonstrated. However, international vaccination coverage rates have remained below expectations (in Europe at the time of manuscript submission). Controversial mandatory vaccination is currently being discussed and has already been introduced in some countries (Austria, Greece, and Italy). We used the Twitter survey system as a viable method to quickly and comprehensively gather international public health insights on mandatory vaccination against COVID-19.ObjectiveThe purpose of this study was to better understand the public’s perception of mandatory COVID-19 vaccination in real time using Twitter polls.MethodsTwo Twitter polls were developed (in the English language) to seek the public’s opinion on the possibility of mandatory vaccination. The polls were pinned to the Digital Health and Patient Safety Platform’s (based in Vienna, Austria) Twitter timeline for 1 week in mid-November 2021, 3 days after the official public announcement of mandatory COVID-19 vaccination in Austria. Twitter users were asked to participate and retweet the polls to reach the largest possible audience.ResultsOur Twitter polls revealed two extremes on the topic of mandatory vaccination against COVID-19. Almost half of the 2545 respondents (n=1246, 49%) favor mandatory vaccination, at least in certain areas. This attitude contrasts with the 45.7% (n=1162) who categorically reject mandatory vaccination. Over one-quarter (n=621, 26.3%) of participating Twitter users said they would never get vaccinated, as reflected by the current Western European and North American vaccination coverage rate. Concatenating interpretation of these two polls should be done cautiously as participating populations might substantially differ.ConclusionsMandatory vaccination against COVID-19 (in at least certain areas) is favored by less than 50%, whereas it is opposed by almost half of the surveyed Twitter users. Since (social) media strongly influences public perceptions and views, and social media discussions and surveys are specifically susceptible to the “echo chamber effect,” the results should be interpreted as a momentary snapshot. Therefore, the results of this study need to be complemented by long-term surveys to maintain their validity.

A Systematic Review of Coronavirus Disease 2019 Vaccine Efficacy and Effectiveness Against Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Disease.

Billions of doses of coronavirus disease 2019 (COVID-19) vaccines have been administered globally, dramatically reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) incidence and severity in some settings. Many studies suggest vaccines provide a high degree of protection against infection and disease, but precise estimates vary and studies differ in design, outcomes measured, dosing regime, location, and circulating virus strains. In this study, we conduct a systematic review of COVID-19 vaccines through February 2022. We included efficacy data from Phase 3 clinical trials for 15 vaccines undergoing World Health Organization Emergency Use Listing evaluation and real-world effectiveness for 8 vaccines with observational studies meeting inclusion criteria. Vaccine metrics collected include protection against asymptomatic infection, any infection, symptomatic COVID-19, and severe outcomes including hospitalization and death, for partial or complete vaccination, and against variants of concern Alpha, Beta, Gamma, Delta, and Omicron. We additionally review the epidemiological principles behind the design and interpretation of vaccine efficacy and effectiveness studies, including important sources of heterogeneity.

Development and Validation of Two RT-qPCR Diagnostic Assays for Detecting Severe Acute Respiratory Syndrome Coronavirus 2 Genomic Targets across Two Specimen Types

Following the outbreak and subsequent pandemic of coronavirus disease 2019 (COVID-19), clinical diagnostic laboratories worldwide sought accurate and reliable testing methodologies. However, many laboratories were and still are hindered by a number of factors, including an unprecedented demand for testing, reagent and laboratory supply shortages and availability of qualified staff. To respond to these concerns, two separate laboratory-developed tests were validated for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using two different specimen types. In addition, these assays target different genomic regions of SARS-CoV-2, allowing for viral detection and mitigating genetic variation. Lower limit of detection and clinical evaluation studies showed detection of SARS-CoV-2 at 500 cp/mL with nasopharyngeal and saliva samples. These multiplexed RT-qPCR assays, although based on modified CDC, New York State Department of Health, and World Health Organization Emergency Use Authorization tests, allow for higher throughput and rapid turnaround time, benefiting patients, clinicians, and communities as a whole. These cost-effective tests also use readily obtainable reagents, circumventing commercial assay supply chain issues. The laboratory-developed tests described here have improved patient care and are highly adaptable should the need arise at other clinical diagnostic laboratories. Furthermore, the foundation and design of these assays may be modified in the future for detection of COVID-19 variants or other RNA-based viral detection tests.

Safety and Immunogenicity of Two Novel Type 2 Oral Poliovirus Vaccine Candidates Compared With Monovalent Type 2 Oral Poliovirus Vaccine in Children and Infants: Two Clinical Trials

There is an increasing incidence of paralytic poliomyelitis cases because of circulating vaccine-derived polioviruses over the past 3 years. The person-to-person transmission of circulating vaccine-derived polioviruses that are neurovirulent are primarily responsible for this emergence of these outbreaks; the World Health Organization has designated type 2 circulating vaccine-derived polioviruses as a Public Health Emergency of International Concern.Two novel oral poliovirus vaccines (OPVs), OPV2-c1 and OPV2-c2, were tested for safety and immunogenicity in infants and children. These 2 novel poliovirus vaccines had genetic modifications introduced to enhance the stability of the Sabin attenuations and reduce the risk of reversion to neurovirulence. A previous study in healthy adults was conducted.This study was a phase 2 study with low and high doses of 2 novel OPV2 candidates in Panama through a multicenter, partly masked randomized study. In the phase 2 study, children received 2 high doses of novel OPV2-c1 or novel OPV2-c2 28 days apart. Infants (at 18–22 weeks of age) received 1 low dose or high dose of novel OPV2-c1 or novel OPV2-c2; randomly selected subsets (n = 50) of each group received a second dose 28 days later. Parents monitored and reported adverse events postvaccination. Type 2 poliovirus neutralizing antibodies were measured at days 0, 7, 28, and 56, and stool viral shedding was assessed up to 28 days postvaccination. The primary objective was the safety in all participants and noninferiority of the novel OPV2 day 28 seroprotection versus monovalent OPV2 in infants.In the novel OPV2 study, 47 children received the OPV2-c1 vaccine, and 53 received the OPV2-c2 vaccine as their first dose. A total of 97 of 100 children received a second dose; 45 children obtained the OPV2-c1 vaccine, and 52 received the novel OPV2-c2 vaccine. A total of 574 infants received the first dose of the novel OPV2 vaccine. A total of 36% of children (17 of 47) after the OPV2-c1vaccine and 26% of children (14 of 53) after the OPV2-c2 vaccine reported adverse events, consisting of loss of appetite, crying, fever, and irritability. There were 9 serious adverse events after OPV2-c1 and 13 after OPV2-c2 noted postvaccination (mostly pneumonia or bronchiolitis; 1 death from severe pneumonia), but none were believed to be causally associated with the vaccine. Infants also experienced crying, irritability, fever, and vomiting. The authors reported no consistent pattern of laboratory abnormalities or changes in laboratory assessments in both infants and children. Evaluable seroconversion rates were 94% to 100% after 1 to 2 doses in the novel OPV2 groups. The low-dose and high dose OPV2-c1 and the high dose OPV2-c2 met noninferiority criterion. Almost all infants who received either high dose OPV2-c1 or OPV2-c2 had shedding of type 2 virus in stools at day 7.The novel OPV 2 candidates appeared to be safe and immunogenic in children and infants in Panama. These candidates may represent a mechanism to decrease transmission of circulating neurovirulent type 2 vaccine-derived polioviruses.In the study, the authors report both results with the novel OPV2 vaccine candidates and a baseline study with monovalent Sabin OPV2 before cessation of administration. Most doses were administered to infants who experienced mostly transient and mild adverse effects. Noninferiority criterion was met with the high dose and low-dose OPV2-c1 and high dose OPV2-c2 vaccines. These novel candidates potentially represent a mechanism for immunity against type 2 polioviruses and the OPV2-c1 vaccine was listed under the World Health Organization Emergency Use for use against type 2 circulating vaccine-derived poliovirus outbreaks. With further larger studies, researchers will shed further light on safety, tolerability, and immunogenicity.

A review of COVID-19 vaccination and the reported cardiac manifestations.

In Singapore, 9.03 million doses of the mRNA COVID-19 vaccines by Pfizer-BioNTech and Moderna have been administered, and 4.46 million people are fully vaccinated. An additional 87,000 people have been vaccinated with vaccines in World Health Organization's Emergency Use Listing. The aim of this review is to explore the reported cardiac adverse events associated with different types of COVID-19 vaccines. A total of 42 studies that reported cardiac side effects after COVID-19 vaccination were included in this study. Reported COVID-19 vaccine-associated cardiac adverse events were mainly myocarditis and pericarditis, most commonly seen in adolescent and young adult male individuals after mRNA vaccination. Reports of other events such as acute myocardial infarction, arrhythmia and stress cardiomyopathy were rare. Outcomes of post-vaccine myocarditis and pericarditis were good. Given the good vaccine efficacy and the high number of cases of infection, hospitalisation and death that could potentially be prevented, COVID-19 vaccine remains of overall benefit, based on the current available data.

Referral Pathway for the Patients with Maxillofacial Trauma in Emergency Health Response

Healthcare and logistical needs in emergencies have been acknowledged. The professionalism and standards of care for disaster-affected are improved by the World Health Organization Emergency Medical Team (EMT), The International Committee of the Red Cross, Médecins sans Frontiers, and other initiatives. Mass casualty incidents resulting in maxillofacial injuries establish unique challenges. Maxillofacial management benefits from specialist knowledge, expert skills, and timely Availability of X-Ray resources. The need to strengthen craniofacial care capability is evident. Despite Russian Federation having well-established disaster management plans, including specific maxillofacial surgery implementation, many medical, supply, and logistic points stay unestablished in places where mass casualty events occur. Progressing globally relevant recommendations is the main part of addressing this deficit and Reinforcing preparedness to face such disasters.

Establishment of disaster medical assistance team standards and evaluation of the teams’ disaster preparedness: An experience from Taiwan

Taiwan set up disaster medical assistance teams (DMATs) after the Chi-Chi earthquake, but these teams lack unified standards. This study was divided into two phases. Phase I was a Delphi study conducted in 2019 with 26 experts who were invited to establish Taiwan's DMAT standards by modifying the World Health Organization Emergency Medical Team (WHO EMT) type I fixed standards. Phase II was a cross-sectional study conducted in 2020. A questionnaire was used to evaluate the disaster preparedness of DMATs by standards set in phase I. In phase I, Taiwan's DMAT standards were established after three rounds of Delphi consensus, with a response rate of 88.5%. The major departures from the WHO EMT standards were the exclusion of obstetric care, mental health, rehabilitation, and laboratory and blood transfusion standards and the addition of an ultrasound standard. During phase II, a total of 32 teams were invited, and the response rate was 96.9%. The overall standard achievement rate was 56.9%, and the three lowest achievement rates corresponded to sanitation (22.6%), medical malpractice insurance (25.8%), and pharmacy and drug supply (25.8%). The national DMATs, official DMATs, DMATs funded by government, and DMATs with ≥10 years of experience had significantly higher achievement rates for partial or overall standards. Using localized standards to evaluate the disaster preparedness of each team, DMATs were found to have many shortcomings mainly due to the lack of unified government announcement standards, legal protection, and adequate financial support.