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PubMedDate not supplied

Human influenza virus A/HongKong/156/97 (H5N1) infection.

Introduction of influenza viruses with gene segments of avian origin into the human population may result in the emergence of new pathogenic human influenza viruses. The recent infection of a 3-year-old boy with an influenza A (H5N1) virus of avian origin can be considered as an example of such an event. However, this virus, influenza A/Hong Kong/156/97 (H5N1) and the 17 additional H5N1 viruses isolated from humans by the end of 1997 lack the ability to spread efficiently amongst humans and therefore have limited pandemic potential. However, the possibility of reassortment of these viruses with currently circulating human viruses illustrates the need for pandemic preparedness.

Animals↗
PubMed2003

Are we ready for pandemic influenza?

During the past year, the public has become keenly aware of the threat of emerging infectious diseases with the global spread of severe acute respiratory syndrome (SARS), the continuing threat of bioterrorism, the proliferation of West Nile virus, and the discovery of human cases of monkeypox in the United States. At the same time, an old foe has again raised its head, reminding us that our worst nightmare may not be a new one. In 2003, highly pathogenic strains of avian influenza virus, including the H5N1 and H7N7 subtypes, again crossed from birds to humans and caused fatal disease. Direct avian-to-human influenza transmission was unknown before 1997. Have we responded to these threats by better preparing for emerging disease agents, or are we continuing to act only as crises arise? Here we consider progress to date in preparedness for an influenza pandemic and review what remains to be done. We conclude by prioritizing the remaining needs and exploring the reasons for our current lack of preparedness for an influenza pandemic.

Animals↗
PubMed2005

Dispelling disaster myths about dead bodies and disease: the role of scientific evidence and the media.

For decades, after nearly every natural disaster, fear of disease has encouraged communities, local authorities, and governments to rapidly dispose of the bodies of the victims without first identifying them. In May 2004 this journal published the first-ever review article to comprehensively assess the scientific evidence on the infectious disease risks of dead bodies following natural disasters, along with an editorial commenting on the persistence of myths concerning the dangers allegedly posed by dead bodies. This paper assesses the impact that the review article and the editorial have had on the way that health risks from dead bodies have been reported by the media over the following year, especially focusing on the South Asian tsunami disaster of December 2004. While some media outlets have reported erroneous information, hundreds of other news stories have accurately reported that dead bodies pose no public health risk, and have explained the priority for properly identifying the deceased. Nevertheless, publication of scientific evidence alone is insufficient to bring about public health action. International agencies need to continue their work on producing standards, guidelines, and practical guidance on managing dead bodies. There needs to be a community-centered approach to informing communities about the management of the dead following disasters and the rights of individuals to be treated respectfully after death. Nongovernmental organizations should be encouraged to provide expertise and technical support in identifying and burying large numbers of dead. There also needs to be ongoing assessment of the technical processes involved in the recovery, identification, and disposal of dead bodies, as well as the effectiveness of disaster preparedness plans and communication with the affected population.

Attitude to Death↗
PubMed2004

SARS in healthcare facilities, Toronto and Taiwan.

The healthcare setting was important in the early spread of severe acute respiratory syndrome (SARS) in both Toronto and Taiwan. Healthcare workers, patients, and visitors were at increased risk for infection. Nonetheless, the ability of individual SARS patients to transmit disease was quite variable. Unrecognized SARS case-patients were a primary source of transmission, and early detection and intervention were important to limit spread. Strict adherence to infection control precautions was essential in containing outbreaks. In addition, grouping patients into cohorts and limiting access to SARS patients minimized exposure opportunities. Given the difficulty in implementing several of these measures, control measures were frequently adapted to the acuity of SARS care and level of transmission within facilities. Although these conclusions are based only on a retrospective analysis of events, applying the experiences of Toronto and Taiwan to SARS preparedness planning efforts will likely minimize future transmission within healthcare facilities.

Canada↗
PubMed2006

Antiviral drug discovery against SARS-CoV.

Severe Acute Respiratory Syndrome (SARS) is a life-threatening infectious disease caused by SARS-CoV. In the 2003 outbreak, it infected more than 8,000 people worldwide and claimed the lives of more than 900 victims. The high mortality rate resulted, at least in part, from the absence of definitive treatment protocols or therapeutic agents. Although the virus spreading has been contained, due preparedness and planning, including the successful development of antiviral drugs against SARS-CoV, is necessary for possible reappearance of SARS. In this review, we have discussed currently available strategies for antiviral drug discovery and how these technologies have been utilized to identify potential antiviral agents for the inhibition of SARS-CoV replication. Moreover, progress in the drug development based on different molecular targets is also summarized, including 1) Compounds that block the S protein-ACE2-mediated viral entry; 2) Compounds targeting SARS-CoV M(pro); 3) Compounds targeting papain-like protease 2 (PLP2); 4) Compounds targeting SARS-CoV RdRp; 5) Compounds targeting SARS-CoV helicase; 6) Active compounds with unspecified targets; and 7) Research on siRNA. This review aims to provide a comprehensive account of drug discovery on SARS. The experiences with the SARS outbreak and drug discovery would certainly be an important lesson for the drug development for any new viral outbreaks that may emerge in the future.

Animals↗
PubMed1999

Trends in infectious disease mortality in the United States during the 20th century.

CONTEXT: Recent increases in infectious disease mortality and concern about emerging infections warrant an examination of longer-term trends. OBJECTIVE: To describe trends in infectious disease mortality in the United States during the 20th century. DESIGN AND SETTING: Descriptive study of infectious disease mortality in the United States. Deaths due to infectious diseases from 1900 to 1996 were tallied by using mortality tables. Trends in age-specific infectious disease mortality were examined by using age-specific death rates for 9 common infectious causes of death. SUBJECTS: Persons who died in the United States between 1900 and 1996. MAIN OUTCOME MEASURES: Crude and age-adjusted mortality rates. RESULTS: Infectious disease mortality declined during the first 8 decades of the 20th century from 797 deaths per 100000 in 1900 to 36 deaths per 100000 in 1980. From 1981 to 1995, the mortality rate increased to a peak of 63 deaths per 100000 in 1995 and declined to 59 deaths per 100000 in 1996. The decline was interrupted by a sharp spike in mortality caused by the 1918 influenza epidemic. From 1938 to 1952, the decline was particularly rapid, with mortality decreasing 8.2% per year. Pneumonia and influenza were responsible for the largest number of infectious disease deaths throughout the century. Tuberculosis caused almost as many deaths as pneumonia and influenza early in the century, but tuberculosis mortality dropped off sharply after 1945. Infectious disease mortality increased in the 1980s and early 1990s in persons aged 25 years and older and was mainly due to the emergence of the acquired immunodeficiency syndrome (AIDS) in 25- to 64-year-olds and, to a lesser degree, to increases in pneumonia and influenza deaths among persons aged 65 years and older. There was considerable year-to-year variability in infectious disease mortality, especially for the youngest and oldest age groups. CONCLUSIONS: Although most of the 20th century has been marked by declining infectious disease mortality, substantial year-to-year variation as well as recent increases emphasize the dynamic nature of infectious diseases and the need for preparedness to address them.

Adolescent↗
PubMedDate not supplied

New paradigm for protection: the emergency ambulance services in the time of severe acute respiratory syndrome.

Severe acute respiratory syndrome (SARS) is a newly emerging and highly infectious form of atypical pneumonia with a high rate of transmission, especially among health care workers. With SARS, certain policies had to be implemented rapidly by the emergency ambulance services and the Ministry of Health to support and protect all personnel adequately. The authors discuss the changes in policies and personnel behavior, the training and education that had to be disseminated widely, and certain alternatives in policies such as transportation. The authors hope to share their experience in the implementation of these strategies by the Singapore Civil Defence Force and stress the importance of the psychological preparedness of the paramedics and prehospital care providers worldwide in this era of SARS.

Ambulances↗
PubMed2004

Improving epidemic malaria planning, preparedness and response in Southern Africa. Report on the 1st Southern African Regional Epidemic Outlook Forum, Harare, Zimbabwe, 26-29 September, 2004.

Malaria is a major public health problem for countries in the Southern Africa Development Community (SADC). While the endemicity of malaria varies enormously across this region, many of the countries have districts that are prone to periodic epidemics, which can be regional in their extent, and to resurgent outbreaks that are much more localized. These epidemics are frequently triggered by climate anomalies and often follow periods of drought. Many parts of Southern Africa have suffered rainfall deficit over the past three years and countries expect to see increased levels of malaria when the rains return to more 'normal' levels. Problems with drug and insecticide resistance are documented widely and the region contains countries with the highest rates of HIV prevalence to be found anywhere in the world. Consequently, many communities are vulnerable to severe disease outcomes should epidemics occur. The SADC countries have adopted the Abuja targets for Roll Back Malaria in Africa, which include improved epidemic detection and response, i.e., that 60% of epidemics will be detected within two weeks of onset, and 60% of epidemics will be responded to within two weeks of detection. The SADC countries recognize that to achieve these targets they need improved information on where and when to look for epidemics. The WHO integrated framework for improved early warning and early detection of malaria epidemics has been recognized as a potentially useful tool for epidemic preparedness and response planning. Following evidence of successful adoption and implementation of this approach in Botswana, the SADC countries, the WHO Southern Africa Inter-Country Programme on Malaria Control, and the SADC Drought Monitoring Centre decided to organize a regional meeting where countries could gather to assess their current control status and community vulnerability, consider changes in epidemic risk, and develop a detailed plan of action for the forthcoming 2004-2005 season. The following is a report on the 1st Southern African Regional Epidemic Outlook Forum, which was held in Harare, Zimbabwe, 26th-29th September, 2004.

Africa, Southern↗
PubMedDate not supplied

Embracing computer modeling to address pandemic influenza in the 21st century.

Reacting to a pandemic influenza outbreak will require the mass distribution of vaccine, when available, which will require county health departments to set up and operate one or more mass vaccination clinics, also known as points of dispensing (PODs). Carefully planning these PODs before an event occurs is a difficult but important job. First, this article describes a tool--the Clinic Planning Model Generator computer program--designed to help public health agencies evaluate and make adjustments to their POD plans. The Clinic Planning Model Generator was built on data from a smallpox exercise and other biological agent POD exercises. Second, this article demonstrates the application of the Clinic Planning Model Generator through an example pandemic influenza scenario. This work is the result of an ongoing collaboration between Montgomery County, Maryland's Advanced Practice Center for Public Health Emergency Preparedness and Response, and the Institute for Systems Research at the University of Maryland.

Computer Simulation↗
PubMed2005

Pandemic influenza preparedness in Maryland: improving readiness through a tabletop exercise.

In February 1999, the Maryland Department of Health and Mental Hygiene initiated pandemic influenza planning for the state of Maryland. This process involved several major steps, including the development of the Maryland Pandemic Influenza Preparedness Plan, and culminated in a high-level tabletop exercise to test the plan in April 2004. During the tabletop exercise, participants were presented with nine different fictitious scripts encompassing a single scenario. They were asked to respond to the information presented in each script, discuss organization-specific questions posed by the exercise facilitator, and make decisions regarding action steps that their organization would take in response to the various issues raised. The exercise identified a number of important gaps that need to be addressed, including (1) additional surge capacity specific to a pandemic, (2) greater understanding of the realities and implications of pandemic influenza among elected officials and decision-makers, (3) coordination of pandemic influenza planning with the existing emergency response infrastructure coupled with additional training in incident command, (4) further steps to operationalize several aspects of the Maryland Pandemic Influenza Preparedness Plan, and (5) additional federal guidance.

Disease Outbreaks↗
PubMed2002

Defending against viruses in biowarfare. How to respond to smallpox, encephalitides, hemorrhagic fevers.

The threat of bioterrorism with use of viruses is increasing. Smallpox, encephalitis, and hemorrhagic fevers are the most likely diseases to result from viral deployment. It is critical that all healthcare professionals become familiar with the clinical presentation, diagnosis, management, and prevention of these diseases. Awareness and preparedness are instrumental in reducing viral transmission and improving survival of the victims.

Biological Warfare↗
PubMed2005

Influenza: the next pandemic?: A review.

OBJECTIVES: To examine existing information on the recent influenza outbreaks in order to create awareness of a possible influenza pandemic and to suggest future research areas in developing control strategies in Kenya. DATA SOURCES: Review of literature via Internet, articles, journals and un-refereed features from the media and personal communications. DATA SELECTION: Most published data from 1979 to March 2005 found to reveal cases of influenza outbreaks were included in the review. Also, selected articles on the recent outbreaks and professional guidance on influenza infections were critically examined and analyzed. DATA EXTRACTION: Abstracts and articles identified were accessed, read to establish relevance to this review. DATA SYNTHESIS: Important points were prioritised and then included as subtitles; below each subtitle, published works were included. Finally, a table of influenza outbreaks and the strains of the viruses involved were drawn as summary. CONCLUSION: Influenza is a highly contagious, acute respiratory disease that may spread rapidly and pervasively through a population. Due to the diversity of susceptible reservoirs of influenza viruses and the interspecies transmission recently reported, a mutated strain of the virus to which people have no immunity could cause an influenza pandemic once the virus gains efficient and sustained human-to-human transmission. The fear that avian influenza could be a precursor to the next pandemic is real and inevitable, given the extremely high case-fatality ratio among confirmed cases and that genetic sequencing of influenza A (H5N1) viruses from human cases in Thailand and Vietnam show resistance to the antiviral medication amantadine and rimantadine. This calls for a high level of preparedness to avoid a public health emergency. Nowhere is this paradigm more real than in Africa.

Animals↗
PubMed2004

[Role of the European Scientific Work Group on Influenza in the battle against influenza].

The European Scientific Working group on Influenza (ESWI) was established in 1992. Its main task is to reduce impact of influenza in Europe by increase of awareness about influenza, dangers, methods of its prevention among physicians and in the society, stimulation of scientific studies, organizing of conferences, including those on the preparedness plans for the next pandemic. Infections, and in some cases also deaths, caused in humans by avian influenza viruses A(H5N1) in 1997 and 2003, A(H9N2) in 1999 and A(H7N7) in 2003 show that the outbreak of the next pandemic is a matter of time. Considering the above facts ESWI prepared a pilot study to introduce in Poland, Germany and Sweden. The main aim of this project is to achieve a better and more effective control of influenza by an increase of knowledge about influenza, promoting of vaccinations and new antiinfluenza drugs--neuraminidase inhibitors. In Poland project is coordinated by the National Influenza Center located at the National Institute of Hygiene, Warsaw. This is only one center in Poland and one of 112 similar centers in 83 countries of the world participating in the international program of influenza surveillance in cooperation with WHO, ESWI and European Influenza Surveillance Scheme.

Europe↗
PubMed1996

Profile of epidemic emergencies in India during 1991-95.

Epidemic emergencies have shown increasing trend in India and most parts of the country appear to be vulnerable to these emergencies. In this paper we present a profile of epidemic emergencies attended by the National Institute of Communicable Diseases in the last five years, to delineate aspects that will promote better preparedness and management. Water borne and water related disease epidemics constituted more than 70% of the epidemic emergencies in India. Non 01 cholera epidemics constituted one fourth of total cholera epidemics during 1991-95. Most of the hepatitis outbreaks were attributed to Non A Non B. The source of infection in majority of the cholera and jaundice epidemics was contaminated water. Dengue and resistant typhoid fever were among other emergencies reported during last five years. Some of these epidemic were reported to local health authorities as mysterious diseases due to lack of public health laboratory facilities. Encephalitis and encephalitis like epidemics in the form of Liquor poisoning and chronic Heat syndrome encephalopathy were also observed. The re-emerging disease epidemics like plague in Beed, Pneumonic plague in Surat and malaria in Rajasthan were also investigated during 1994. These observations indicate the weakness in the epidemiological and laboratory surveillance besides inadequacy in water management practices and other socio environmental reasons.

Disaster Planning↗
PubMed2005

Leveraging bioterrorism preparedness for non-bioterrorism events: a public health example.

When a local health department in Virginia learned that a deceased hospital-based nurse had worked for several months with undiagnosed and untreated active tuberculosis, it mounted an extraordinary effort to find, screen, test, and potentially treat numerous contacts. In responding to this challenge, it adapted plans, concepts, and equipment that had been recently developed or acquired for responding to acts of bioterrorism. The improved coordination and integration with community partners and participating agencies, fostered through bioterrorism preparedness planning, were keys to success. Using procedures developed and exercised to distribute prophylactic medication in the Strategic National Stockpile, the health department shifted philosophically from a program-specific response to a more integrated approach. Implementation of this mass tuberculosis-screening program was based on the principles of the Incident Command System (ICS). Owing to the efficiency of the operation, more than 2,500 people were quickly screened, and the rate of return for skin test readings was 91.6%, ranking it extremely high compared to the benchmarks. Overall, 5.9% of those tested were found to be infected with tuberculosis, and no cases of active tuberculosis were identified. This outcome demonstrated public health's improved ability to react, as a result of bioterrorism preparedness activities, to "traditional" public health mass events and non-bioterrorism emergencies.

Bioterrorism↗
PubMed2005

Simulating public health response to a severe acute respiratory syndrome (SARS) event: a comprehensive and systematic approach to designing, implementing, and evaluating a tabletop exercise.

In response to recent public health threats and disasters, greater emphasis has been placed on the use of exercises and drills to improve individual performance and enhance capacity of the public health workforce. However, despite the increased application of these exercises, rigorous research regarding their appropriate development and relative effectiveness in improving public health preparedness is limited. The present study attempted to fill this void by presenting a detailed account of a comprehensive and integrated approach to developing, implementing, and evaluating a tabletop exercise designed to enhance emergency preparedness and response of public health workers. Following a comprehensive training systems model, a tabletop exercise was developed to simulate worker recognition and response to a Severe Acute Respiratory Syndrome event among public health workers in Arkansas. Forty-nine individuals participated in the tabletop exercise, including public health workers and their external partners. Results demonstrated the effectiveness of this tabletop exercise in increasing participants' competency-related knowledge and skills. The flexibility afforded by creating a standardized competency-based process can extend to other state and local health departments and provides evidence of the reciprocal relationship between research and practice needed to advance the areas of emergency preparedness training and workforce development initiatives in public health.

Competency-Based Education↗
PubMed2004

Psychological impact of the animal-human bond in disaster preparedness and response.

The authors present an overview of the impact of the animal-human bond on disaster management and highlight the need to further examine the relationship of animals and humans in disaster response. The human connection to animals influences compliance with individual and community evacuation plans. Search and rescue teams with canine units confront physical and emotional demands that affect both handler and animal. The culling of animal populations on a scale such as occurred during the recent foot-and-mouth epidemic in the United Kingdom affects every member of rural society. Livestock farmers and their families endure enormous emotional losses, and veterinarians and government officials who must implement these programs suffer as well. A familiarity with and understanding of these issues is important for psychiatrists and other mental health professionals who are involved in disaster preparedness and response.

Animal Welfare↗
PubMed2005

Are we ready for pandemic influenza H5N1?

Influenza is an important annual respiratory pathogen with the potential to cause infrequent pandemics with devastating consequences. The establishment of highly pathogenic avian influenza H5N1 as an endemic virus within duck and poultry populations in Asia increases the possibility of adaptation to humans and the threat of an emerging pandemic. Vaccines are the mainstay of prophylaxis against influenza, but there are technical and safety issues that must be overcome in the development of vaccines in order to combat avian influenza. Pandemic preparedness plans have been developed by national and international authorities but may be compromised by a lack of readily available interventions.

Animals↗