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PubMed2005

Ring vaccination versus mass vaccination in event of a smallpox attack.

Since vaccination is critical in responding to smallpox exposure, vaccination strategies must be evaluated during bioterrorism preparedness. Information on historical factors, smallpox characteristics, public health capabilities and hypothetical attack scenarios was used to evaluate major vaccination strategies. In event of a smallpox attack, the optimal strategy is situational, mass vaccination may be best for dense island populations such as Oahu.

Bioterrorism↗
PubMed2006

Update on preparing for the next influenza pandemic.

While previous pandemics have taken the world by surprise, the present situation has given the world advanced warning and a rare opportunity to prepare for the next pandemic. WHO urges all countries to take action now to assess their level of preparedness, identify priority needs, and develop a national influenza preparedness plan. If containing or delaying the spread of a new human influenza strain is possible, it will take rapid, massive coordinated global and national actions. The success of these actions will depend on the preparations that have made in advance by each member of the international community.

Antiviral Agents↗
PubMed1976

[Robert Koch's unpublished and unfinished experiments on sheep-pox (author's transl)].

The archives of the Robert Koch Institute include a casket with preparations and handwritten notes by Robert Koch (Fig. 1). He made these preparations during his time as a rural doctor between October of 1878 and September of 1880. They refer to an outbreak of sheep-pox at Rackwitz, a place near his practice at Wollstein (Fig. 2). This work has not been published; we know of it from one of Robert Koch's private letters (11). To reconstruct his working scheme and reasoning, we consulted particularly his reports on rinderpest experiments which he began in 1896 (6). The preparations from this casket which had been stained with Bismarck brown (according to Weigert) date back to a period when Robert Koch developed the foundations of bacteriology and they are evidence of his preparedness to accept new operational procedures (1, 2, 3). Thus, we have to assume that these preparations were to serve as evidence of a bacteriological etiology of sheep-pox. A wrong conclusion as to associations between the superinfection present and etiology of the disease (7) was ruled out by maintaining his own postulate. Simultaneously with this preparation work, Robert Koch performed animal experiments (11). His experience from these studies was utilized later on in his rinderpest experiments (6). On account of his confrontation with viral disease - which had its starting point in his unpublished work on sheep-pox - Robert Koch stated his postulate to be valid in the same manner as if bacteriological etiology had been demonstrated (4,6). The importance of these preparations is also seen in the interpretation of viral tissue damage, i.e. increase of macrophages and plasma cells with subsequent necrosis (9) characteristic of vira infection (Figs. 3, 4).

Animals↗
PubMed2003

Analysis and reporting of meningococcal meningitis epidemic in north Gondar 2001-2002.

Severe epidemic meningococcal meningitis occurs in countries of the meningitis belt of Sub-Saharan Africa, including Ethiopia. Many epidemics occurred in this country in the past decade, the recent being in 2000 in Addis Ababa unusually during the wet and rainy season. The study was a cross-sectional design. Data were collected with prepared questionnaires and the line listing. CSF (Cerebro Spinal Fluid) culture and antibiotic sensitivities were done for a limited number of patients. The objective of the study was to assess the progress and management outcome of the epidemic. During the out breaks of epidemic meningitis in north Gondar zone of the Amhara regional state in 2001 and 2002 children and young adults were most affected. There were 384 cases and 26 deaths in 2001 and 1235 cases and 128 deaths, in 2002, making a total of 1619 cases and 154 deaths with a case fatality rate of 9.5%. The etiologic agent was sero-group A. The most affected age group was 15-30 years. About 80% of the cases were in the age 30 years and below. Surveillance, epidemic preparedness, interventions and response were found to be inadequate. Selective vaccination was not effective in handling the epidemic. Efficient surveillance, local processing and use of data, regional laboratory support, multisectoral approach and mass vaccination were recommended to appropriately and timely handle such epidemics.

Adolescent↗
PubMed2006

The GP's response to pandemic influenza: a qualitative study.

BACKGROUND: Current pandemic influenza plans to place GPs at the front line of a pandemic influenza response. However, little is known about GPs' perceptions of their role and preparedness in the event of a pandemic occurring. OBJECTIVE: Our aim was to assess general practice preparedness to respond to pandemic influenza and to identify issues that need to be addressed to enhance preparedness for the next pandemic. METHODS: We conducted a series of semi-structured interviews to explore GPs' views regarding their role in responding to pandemic influenza, practice preparedness and planning issues, and the expectations and requirements of GPs for provision of professional services during a pandemic. The subjects were 60 Australian GPs, purposively selected to maximize diversity within the sample. RESULTS: GPs in this study expressed a willingness to provide professional services in a pandemic. The motivation for this was largely altruistic and was in the context of high personal risk of becoming infected. Participants did not have stockpiles of antivirals or personal protective equipment within their practices and felt that government had a duty of care to stockpile on behalf of the general practice workforce. Participants were enthusiastic about receiving further information and training in pandemic preparedness. The most appropriate setting for this was within practices. CONCLUSIONS: GPs were willing to provide clinical services in a pandemic. However, appropriate education, training and supply of equipment were necessary to support them in this role. This information will inform further planning for the public health response to pandemic influenza.

Adult↗
PubMed2006

Current status of surge research.

The dramatic escalation of bioterrorism and public health emergencies in the United States in recent years unfortunately has coincided with an equally dramatic decline in the institutions and services we rely on for emergency preparedness. Hospitals in nearly every metropolitan area in the country have closed; those that remain open have reduced the number of available beds. "Just in time" supplies and health professional shortages have further compromised the nation's overall surge capacity. Emergency departments routinely operate at capacity. These circumstances make evidence-based research on emergency preparedness and surge capacity both more urgently needed and more complex. The Agency for Healthcare Research and Quality and other government and private agencies have been rapidly widening the field of knowledge in this area in recent months and years. This report focuses primarily on the work of the Agency for Healthcare Research and Quality.

Allied Health Personnel↗
PubMedDate not supplied

Foodborne disease control: a transnational challenge.

In the globalized political economy of the late 20th century, increasing social, political, and economic interdependence is occurring as a result of the rapid movement of people, images, values, and financial transactions across national borders. Another consequence of the increase in transnational trade, travel, and migration is the greater risk of cross-border transmission of infectious diseases. As the world becomes more interconnected, diseases spread more rapidly and effectively. With more than one million people crossing international borders every day, and with the globalization of food production, manufacturing, and marketing, the risk of infectious disease transmission is greater. Economic globalization has also increased the need for governmental budget austerity, and consequent national preparedness has been eroded. The emergence of new infectious diseases, as well as the reemergence of old ones, thus represents a crucial transnational policy issue. These problems cannot be resolved by national governments alone; they require international cooperation. This article analyzes the role of foodborne disease surveillance programs, nationally and internationally, in the control of foodborne diseases.

Disease Outbreaks↗
PubMedDate not supplied

Commonwealth pandemic preparedness plans.

This paper describes the work being done by the Australian Government Department of Health and Ageing to prepare for a possible influenza pandemic. It provides an overview of Australian Government initiatives and explains both the purpose and the content of the Australian Health Management Plan for Pandemic Influenza. It summarises efforts to improve regional detection and response capabilities and it explains the role of simulation exercises in Australian pandemic planning.

Animals↗
PubMed2006

A pandemic flu: not if, but when. SARS was the wake-up call we slept through.

If an influenza pandemic struck today, borders might close, the global economy would be severely impacted, international vaccine supplies and health are systems would be overwhelmed, and some people might panic. To limit the fallout, the industrialized world must create a detailed response strategy involving the public and private sectors. Some experts feel we are overdue for a flu pandemic and the SARS pandemic of 2003 could have been the wake up call to begin preparations. Fortunately there is some assistance coming from the federal government. On January 12, U.S. Department of Health & Human Services Secretary Mike Leavitt announced funding to assist in the preparation for a pandemic flu response. $100 million is being provided initially with another $250 million due later this year to assist states in pandemic flu preparedness. Texas' initial allocation is $5,875,044. While some believe that the AI (H5N1) causing illness and deaths in Asia and Turkey will be the pandemic flu strain, there is no guarantee that will occur. Thus, without knowing which strain may lead to a pandemic, development and manufacturing of a vaccine is delayed.

Communicable Disease Control↗
PubMed2000

Interspecies transmission of influenza viruses: H5N1 virus and a Hong Kong SAR perspective.

This account takes stock of events and involvements, particularly on the avian side of the influenza H5N1 'bird flu' incident in Hong Kong SAR in 1997. It highlights the role of the chicken in the many live poultry markets as the source of the virus for humans. The slaughter of chicken and other poultry across the SAR seemingly averted an influenza pandemic. This perspective from Hong Kong SAR marks the coming-of-age of acceptance of the role of avian hosts as a source of pandemic human influenza viruses and offers the prospect of providing a good baseline for influenza pandemic preparedness in the future. Improved surveillance is the key. This is illustrated through the H9N2 virus which appears to have provided the 'replicating' genes for the H5N1 virus and which has since been isolated in the SAR from poultry, pigs and humans highlighting its propensity for interspecies transmission.

Animals↗
PubMed2005

Lessons learned from SARS: the experience of the Health Protection Agency, England.

The United Kingdom was assessed as a low risk country throughout the 2003 global SARS outbreaks. Despite this, 368 reports of potential SARS cases were made to the Health Protection Agency (HPA) between March and July 2003. The public health actions undertaken in response to these reports, the establishment of reporting mechanisms and the development of guidance documents were substantial. Lessons learned from mounting a UK response to SARS included: the importance of international collaboration; formation of a UK-wide, multidisciplinary Task Force; flexible case reporting mechanisms; integration of surveillance and laboratory data; generation of prompt and web-accessible guidance and advice; availability of surge capacity; and contingency planning. Lessons learned are being incorporated into the HPA's preparedness to prevent and control future newly emerging infectious disease threats.

Advisory Committees↗
PubMed2000

Response to bio-terrorism directed against animals.

The Animal and Plant Health Inspection Service (APHIS) has a long history of rapid direction, control, and eradication of devastating diseases. Our immediate response mechanisms to diseases such as avian influenza, Venezuelan equine encephalomyelitis, and Newcastle disease, have long been recognized by the global emergency response community as models of control and eradication. APHIS and the U.S. livestock industries, in partnership with the Animal Agriculture Coalition, re-evaluated the Nation's animal health emergency preparedness and response systems. The group identified areas that negatively impact, biologically and/or economically, the Nation's animal and food production industries. To counter the increased risks including bioterrorism, APHIS plans to establish a world-class "Center of Excellence for Animal Health Emergency Management." APHIS, Intelligence agencies, other Federal departments, State governments, and industries are working together to provide accurate information on the foreign and domestic threats posed to the U.S. agricultural sector by biological weapons. Additionally, the same agencies and organizations are evaluating, updating, and improving the coordination and training mechanisms necessary to respond in the even of a widespread pest or disease outbreak.

Animal Diseases↗
PubMedDate not supplied

The model of response to viral haemorrhagic fevers of the National Institute for Infectious Diseases "Lazzaro Spallanzani".

Viral haemorrhagic fevers (VHF) are severe and life-threatening diseases caused by a range of viruses. However, only four agents of VHF are known to be readily capable of person-to-person spread: Lassa virus, Crimean/Congo haemorrhagic fever virus, Ebola and Marburg viruses. Diseases caused by these viruses are endemic only in few areas in the world, most notably Africa and some rural parts of the Middle East and Eastern Europe. Nonetheless, the increasing volume of international travel presents a greater likelihood for the importation of these infections or of suspected cases in non endemic countries. Four conditions can lead to the importation and to the subsequent recognition of VHF within Europe: 1) patients arriving as a result of a planned medical evacuation; 2) persons who became sick on route to their destination; 3) persons discovered ill when entering a country, for example during routine clinical examination at the airport; 4) persons becoming sick after their arrival. Public health implications and the risk of secondary spread of pathogens in the above reported circumstances are very different. Similarly, preparedness and response should vary. This paper summarizes the present knowledge on the four VHF capable of person-to-person spread, describes the high isolation area constructed at the Italian National Institute for Infectious Diseases Lazzaro Spallanzani in Rome to respond to the occurrence of VHF. A brief overview of procedures and equipment adopted is provided.

Disease Outbreaks↗
PubMed2004

Review of the 2003 National Syndromic Surveillance Conference--lessons learned and questions to be answered.

Syndromic surveillance is a rapidly evolving field within public health practice. Substantial experience has been gained in learning how to conduct syndromic surveillance, informed by a growing body of research and practice, including refinement of surveillance methods, development of new tools for analysis and evaluation, findings from statistical models and applied evaluations, and expansion of syndromic surveillance to uses beyond preparedness for biologic terrorism. Despite these advances, additional evaluation is needed to help health departments determine whether to conduct syndromic surveillance. This paper summarizes the lessons learned from the 2003 National Conference on Syndromic Surveillance, which provided a foundation for defining a research and evaluation agenda and for developing preliminary guidance for public health agencies planning to implement syndromic surveillance.

Bioterrorism↗
PubMedDate not supplied

Preparedness for a bioterrorism event in Alaska. Part 1: Detection and identification of a biologic event.

U.S. military and public health experts are increasingly concerned that the general public is at risk for terrorist attacks. Traditional weapons of mass destruction such as explosive and chemical devices remain the most likely forms of terrorism, however the threat of bioterrorism is also present and may be increasing. An intentional biologic event may be covert and if so, will not become apparent for days or even weeks when many ill people present with an unidentified illness. Health care providers will be the first responders during a biologic attack and will be called upon to diagnose diseases such as anthrax, tularemia or even smallpox. In the first of a two-part article, a hypothetical scenario is presented to illustrate how such an attack might first be discovered and the agent identified. As the scenario unfolds, evidence is collected that suggests the outbreak was intentional. Information about epidemiologic clues, disease syndromes and specific high-risk agents are discussed.

Alaska↗
PubMed2002

H5N1 influenza viruses isolated from geese in Southeastern China: evidence for genetic reassortment and interspecies transmission to ducks.

The H5N1 viruses (H5N1/97) associated with the "bird-flu" incident in the Hong Kong SAR have not been isolated since the slaughter of poultry in December 1997 brought that outbreak to an end. Recent evidence points to this virus as having arisen through a reassortment of a number of precursor avian viruses and a virus related to Goose/Guangdong/1/96 (H5N1) (Gs/Gd/96) was the likely donor of the H5 hemagglutinin. We characterize the Goose/Guangdong/1/96-like viruses isolated from geese and ducks imported into Hong Kong in the year 2000. Antigenically and genetically, these recent H5N1 viruses fall into two groups, one mainly associated with geese, and the other, recently transmitted to ducks. Further, viruses isolated from a goose and a duck in December 2000 have acquired NS, PA, M, and PB2 genes from the aquatic avian influenza gene pool through reassortment. For pandemic preparedness, it is important to monitor whether these reassortant viruses have the capacity for interspecies transmission to terrestrial poultry or mammals.

Animals↗
PubMed1999

Dealing with animal disease emergencies in Africa: prevention and preparedness.

Emergency preparedness planning for animal diseases is a relatively new concept that is only now being applied in Africa. Information can be drawn from numerous recent disease epidemics involving rinderpest, contagious bovine pleuropneumonia (CBPP) and Rift Valley fever. These examples clearly demonstrate the shortcomings and value of effective early warning with ensured early reaction in the control of transboundary animal disease events. In concert, the Food and Agriculture Organization (FAO), through the Emergency Prevention-System for Transboundary Animal and Plant Pests and Diseases (EMPRES), and Organisation of African Unity/Inter-African Bureau for Animal Resources (OAU/IBAR), through the European Commission-funded Pan-African Rinderpest Campaign (PARC), have been actively promoting the concepts and application of emergency preparedness planning and should continue to do so under the proposed successor of PARC, namely: the Pan-African Programme for the Control of Epizootics (PACE). The potential partnership between the normative function of the FAO in developing and promoting emergency preparedness and the implementation of improved national and regional disease surveillance by PACE and other partners could witness the commencement of more progressive control of epidemic diseases in Africa and greater self-reliance by African countries in coping with transboundary animal disease emergencies.

Africa↗
PubMed2002

Influenza pandemic: preparedness planning in Germany.

The following conceptual framework formed the basis for a common decision made by the health ministers of Germany's 16 federal states to set up an influenza pandemic preparedness plan. The worst case scenario was used, on the basis of the data from the pandemic of 'Spanish flu', in 1918-20. The priority groups for vaccination were assessed, as well as the potentially available antiviral treatments. National policies could be highly improved by a common European view.

Disease Outbreaks↗