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PubMed2006

Applied medical & care compunetics to public health disease surveillance and management: Leveraging external data sources--a key to public health preparedness.

In today's global community the ability to prepare for a disease outbreak in order to mitigate the public health, social, and economic impacts on a community depends upon data to support the decision and response process. Data can come from a variety of sources. These sources not only include the medical and health care community, but also geographic, demographic, and socio-economic data. The ability to capture and utilize the data effectively from these types of data sources can mean the difference between a manageable disease outbreak that represents little or no threat to a community and one that causes a significant social and economic impact. As the health profession expands the applied use of information technology within the medical and health care communities, opportunities are created to expand the use of new data sources to support information based decisions. Information that can be used to provide early warning for disease outbreaks both naturally occurring or through a bioterrorist event; information that can be used to plan, analyze and respond to a disease event; information that can support a community's preparedness activities in order to minimize a public health event. This chapter illustrates how applied compunetics can be used to support health care as the public health professional responds to, and manages, naturally occurring diseases as well as emerging new disease threats. An electronic health environment (EHE) vision is presented that capitalizes on the use of a variety of environmental, medical, and health care data to support disease early warning, reporting, case and outbreak management and community preparedness.

Community Health Planning↗
PubMed2005

Hospital preparedness and management of patients affected by viral haemorrhagic fever or smallpox at the Lazzaro Spallanzani Institute, Italy.

The US cases of anthrax in 2001 and the recent severe acute respiratory syndrome outbreak have heightened the need for preparedness and response to naturally emerging and re-emerging infections or deliberately released biological agents. This report describes the response model of the Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (INMI), Rome, Italy for managing patients suspected of or affected by smallpox or viral haemorrhagic fever (VHF) either in the context of an intentional release or natural occurrence. The INMI is Italy's leading hospital in its preparedness and response plan to bioterrorism-related infectious agents. All single and double rooms of INMI are equipped with negative air pressure, sealed doors, high efficiency particulate air (HEPA) filters and a fully-equipped anteroom; moreover, a dedicated high isolation unit with a laboratory next door for the initial diagnostic assays is available for admission of sporadic patients requiring high isolation. For patient transportation, two fully equipped ambulances and two stretcher isolators with a negative pressure section are available. Biomolecular and traditional diagnostic assays are currently performed in the biosafety level 3/4 (BSL 3/4) laboratories. Continuing education and training of hospital staff, consistent application of infection control practices, and availability of adequate personnel protective equipment are additional resources implemented for the care of highly infectious patients and to maintain the readiness of an appropriately trained workforce to handle large scale outbreaks.

Disease Management↗
PubMed2003

Reverse genetics for the control of avian influenza.

Avian influenza viruses are major contributors to viral disease in poultry as well as humans. Outbreaks of high-pathogenicity avian influenza viruses cause high mortality in poultry, resulting in significant economic losses. The potential of avian influenza viruses to reassort with human stains resulted in global pandemics in 1957 and 1968, while the introduction of an entirely avian virus into humans claimed several lives in Hong Kong in 1997. Despite considerable research, the mechanisms that determine the pathogenic potential of a virus or its ability to cross the species barrier are poorly understood. Reverse genetics methods, i.e., methods that allow the generation of an influenza virus entirely from cloned cDNAs, have provided us with one means to address these issues. In addition, reverse genetics is an excellent tool for vaccine production and development. This technology should increase our preparedness for future influenza virus outbreaks.

Animals↗
PubMed2025

Using homologous network to identify reassortment risk in H5Nx avian influenza viruses.

The resurgence of H5Nx reassortment has caused multiple epidemics resulting in severe disease even death in wild birds and poultry. Assessing H5Nx reassortment risk is crucial for designing targeted interventions and enhancing preparedness efforts to manage H5Nx outbreaks effectively. However, the complexity in H5Nx reassortment, driven by the diversity of influenza A viruses (IAVs) and wide range of hosts, has hindered the effective quantification of reassortment risk. In this study, we utilized a network approach to explore the reassortment history using a large-scale dataset. By inferring genomic homogeneity among IAVs, we constructed an IAVs homologous network with reassortment history embedded within it. We estimated the communities within the IAVs homologous network to represent the reassortment risk of various viruses, revealing diverse reassortment risks across different H5Nx viruses. Our analysis also identified the primary hosts contributing to reassortment: domestic poultry in China, and wild birds in North America and Europe. These primary hosts are critical targets for future H5Nx reassortment interventions. Our study provides a framework for quantifying and ranking H5Nx reassortment risk, contributing to enhanced preparedness and prevention efforts.

Animals↗
PubMed2006

Preparedness for influenza pandemic in Hong Kong nursing units.

BACKGROUND: To present preparedness planning for an influenza pandemic for two nursing subunits: nursing services in hospitals and schools of nursing in universities. DISCUSSION: The preparedness plan is modeled on a modified Haddon matrix, a logical approach to identify measures appropriate for the pre-event, event, and postevent phases of an influenza pandemic. For the pre-event phase, the objective is to ensure preparedness for the potential pandemic outbreak through training, communication, surveillance, infection control, and vaccination. Once the pandemic outbreak is declared, the aim is to implement effective measures to ensure a rapid and appropriate response. For the postevent phase, the plan is focused on the restoration of core functions, vigilance for a second or possibly more waves of the pandemic, and psychosocial support to staff and students. CONCLUSION: Measures required to prepare for, respond to, and manage the consequences of influenza pandemic are identified. This planning indicates the need to balance a logical approach with contextual perspectives and the importance for nursing leaders to develop plans for subunits of larger entities.

Communication↗
PubMed2002

The economics of foot and mouth disease.

The economic effects of foot and mouth disease (FMD) are summarised. Losses arise from the direct effects of the disease on production, costs of disease control and restriction of trade. Direct effects are of greatest importance in dairy and pig production systems. Costs of disease control, whether by stamping-out or vaccination are high. Even countries that are free of the disease incur prevention and emergency preparedness costs. The published studies indicate that where FMD eradication is feasible, this is the least-cost policy option, even allowing for the costs of prevention, emergency preparedness and the risk of outbreaks. Where eradication is not feasible, it is economically beneficial to protect high-producing livestock by vaccination. Vaccination of lower-producing animals may also be justified, especially where these animals produce milk or traction power, or where this would serve to protect high-producing livestock from disease challenge.

Animals↗
PubMed2003

Epidemic hand, foot and mouth disease caused by human enterovirus 71, Singapore.

Singapore experienced a large epidemic of hand, foot and mouth disease (HFMD) in 2000. After reviewing HFMD notifications from doctors and child-care centers, we found that the incidence of HFMD rose in September and declined at the end of October. During this period, 3,790 cases were reported. We performed enteroviral cultures on 311 and 157 specimens from 175 HFMD patients and 107 non-HFMD patients, respectively; human enterovirus 71 (HEV71) was the most frequently isolated virus from both groups. Most of the HFMD patients were </=4 years of age. Three HFMD and two non-HFMD patients died. Specimens from two HFMD and both non-HFMD patients were culture positive for HEV71; a third patient was possibly associated with the virus. Autopsies performed on all three HFMD and one of the non-HFMD case-patients showed encephalitis, interstitial pneumonitis, and myocarditis. A preparedness plan for severe HFMD outbreaks provided for the prompt, coordinated actions needed to control the epidemic.

Age Distribution↗
PubMed2004

SARS preparedness. Revisiting the procedures to protect staff and help prevent or contain an outbreak.

Last year, more than 8,000 people worldwide contracted severe acute respiratory syndrome (SARS), leading to 774 deaths. Although transmission of the disease was quickly controlled, with the outbreak declared over by July, there is concern that SARS could in fact be a seasonal disease and that another outbreak could occur in 2004. In early January, Chinese health officials confirmed the first non-laboratory-related SARS case since the initial outbreak was contained. The threat of another outbreak underscores the importance of having a response plan in place to safeguard the health of your community and your staff. In this article, we discuss the latest information on the risks of acquiring SARS, review recent recommendations from the U.S. Centers for Disease Control and Prevention (CDC), discuss the role of hospital facility and clinical engineers in SARS preparations, and update ECRI's recommendations for infection control procedures during equipment servicing. (ECRI first addressed this issue in two June 2003 Health Devices Guidance Articles.) In two appendixes to the current article, we present CDC guidance on patient isolation in an airborne infection isolation room and offer a navigational guide to CDC's SARS Web site.

Cross Infection↗
PubMed2005

Emergency preparedness volunteer training program.

The Vermont Department of Health (VDH) does not have sufficient personnel to fully staff a mass prophylaxis or vaccination clinic in response to a natural or man-made disease outbreak. Therefore, the VDH developed an emergency preparedness volunteer training program with three primary goals: to include both background information about public health and emergency preparedness and a hands-on training for clinic volunteers; to be adaptable for both community and healthcare professional volunteers; and to examine local emergencies and the VDH public health response to these events. Major components of the training program include basic public health goals and capacities; an introduction to emergency preparedness; a role-playing exercise using Job Action Sheets to simulate "just-in-time" training; and guidance for personal and family preparedness. The VDH has experienced difficulty finding and recruiting volunteers. To increase the potential volunteer pool, it will be implementing a multifaceted training program (on-line, through the mail, in person) to most effectively engage volunteers with varying interests and learning styles. The VDH must also develop a system to maintain regular contact with volunteers and clarify regulations regarding their scope of practice and liability.

Disaster Planning↗
PubMed2026

Advancing One Health genomics in Africa: opportunities and challenges for outbreak and antimicrobial resistance control.

SUMMARYAfrica's ongoing struggles with emerging epidemics and antimicrobial resistance (AMR) underscore the urgency of integrating pathogen genomics and surveillance systems into the continent's One Health strategy, particularly given the existing limitations in preparedness and technological resources. This review brings together current evidence on the growth of sequencing infrastructure, the development of regional genomic hubs, and the establishment of governance frameworks, while identifying critical challenges in data integration, bioinformatics capacity, and sustainable financing. Special focus is placed on the lack of African-based genomic data, with our analysis showing that only 1.82% of the global total is available. Case studies illustrate the immense potential and importance of pathogen genomics, giving policymakers a tangible sense of its impact. These examples demonstrate how genomic technologies integrated with artificial intelligence (AI) are transforming outbreak response, AMR surveillance, and stewardship programs by enabling early detection of zoonotic threats, mapping transmission pathways, and guiding vaccine development. However, to fully realize this scientific intel, it is essential to embed One Health pathogen surveillance within strong policy and system frameworks to ensure the translation of technical progress into lasting institutional capacity and sustainable impact. Long-term implementation depends on coordinated investment and advocacy across four interdependent pillars: data architecture, governance and sovereignty, human capital, and technical capacity.

Humans↗
PubMed2006

Pandemic influenza preparedness in the Asia-Pacific region.

Concerns are mounting that the threat of another influenza pandemic will become a reality and that the epicentre of the outbreak could be the Asia-Pacific region. We assessed the documents that some Asia-Pacific countries have published as part of preparedness planning for an outbreak of influenza in people. Regional approaches were polarised. Thailand, China, and Vietnam had set out a strategic vision to strengthen future capacity in preparedness planning. By contrast, Hong Kong, Australia, and New Zealand took a strategic approach aimed mainly at harnessing available resources or preparing for the deployment of resources such as stockpiled antiviral agents and vaccines. The plans of Hong Kong, Australia, and New Zealand compared favourably with the best European plans. The plans of resource-poor countries addressed some issues that were largely neglected by most European plans. Other countries (including those that do not yet have plans) could benefit from analysis of the strengths and weaknesses of the plans drawn up by countries in the region and in Europe.

Asia, Southeastern↗
PubMed2007

Tracking avian flu on the Web.

To some the term avian flu or H5N1 has become synonymous with the pandemic flu of 1918. Like the former pandemic, this current threat has the potential to cause up to 7.4 million deaths worldwide. Yet as of mid-2006, the viability of this threat is still unclear. There is no doubt that birds, especially poultry, have been the primary target of this particular strain of influenza. Human illnesses and deaths have resulted from direct contact with birds; farmers and food handlers are most at risk. Fortunately there has not been a shift to human-to-human transmission. However, it is imperative for public heath officers, health professionals, and other appropriate officials to keep current on the progress of this virus within the bird population, and its spread around the world. Preventative measures including worst case scenarios have been widely discussed and even resulted in a made-for-TV movie. The need for up-to-date information is essential in order to track the extent of transmission, location of current outbreaks, and most importantly steps for preparedness that could be vital for prevention and containment. This article explores and identifies major Web sites along with basic Internet search techniques to find informative and credible Webbased resources. doi:10.1300/J115v26n01_06.

Animals↗
PubMed2006

SARS: how to manage future outbreaks?

Severe acute respiratory syndrome (SARS) was an unknown disease barely 3 years ago. After the World Health Organization declared the world SARS-free on 5 July 2003, there were episodic recurrences of SARS between September 2003 and May 2004, including 4 cases of laboratory-acquired SARS. SARS posed a mammoth challenge because of the impact of nosocomial transmission on healthcare manpower and facilities, and the resources needed for controlling and preventing further spread. Through worldwide scientific collaboration, the medical community has made much progress in unraveling its enigma, though much more needs to be discovered. This paper highlights how we can apply our knowledge of its epidemiology, mode of transmission, clinical course, ICU admission, complications, predictors of poor outcome, treatment and infection control to help us avert a catastrophic outbreak, and to manage our resources and patients. SARS preparedness and response planning must be flexible and dynamic so that appropriate measures can be implemented as an outbreak progresses. Even if SARS does not reemerge, the experience gained from such planning is valuable in preparing for threats of bioterrorism or a global avian influenza A (H5N1) virus pandemic.

Cross Infection↗
PubMed2005

Terrorism and emergency preparedness in state and territorial public health departments--United States, 2004.

After the events of September 11, 2001, federal funding for state public health preparedness programs increased from $67 million in fiscal year (FY) 2001 to approximately $1 billion in FY 2002. These funds were intended to support preparedness for and response to terrorism, infectious disease outbreaks, and other public health threats and emergencies. The Council of State and Territorial Epidemiologists (CSTE) assessed the impact of funding on epidemiologic capacity, including terrorism preparedness and response, in state health departments in November 2001 and again in May 2004, after distribution of an additional $1 billion in FY 2003. This report describes the results of those assessments, which indicated that increased funding for terrorism preparedness and emergency response has rapidly increased the number of epidemiologists and increased capacity for preparedness at the state level. However, despite the increase in epidemiologists, state public health officials estimate that 192 additional epidemiologists, an increase of 45.3%, are needed nationwide to fully staff terrorism preparedness programs.

Disaster Planning↗
PubMedDate not supplied

Meningitis outbreaks and vaccination strategy.

Three outbreaks of meningitis caused by Neisseria meningitidis serogroup A (subgroup III) are described: Niger (1991), Burundi (1992), and Guinea (1993). These outbreaks showed unusual characteristics: a shorter inter-epidemic interval (Niger), unusual geographical location outside the meningitis belt (Burundi and Guinea), and high age-specific attack rates in all age groups (Burundi and Guinea). Mass immunization campaigns mobilized considerable human and financial means (US $322,000 and 3000 person-days of work for health personnel to immunize 629,000 people in Guinea). The vaccination coverage was over 80% in densely populated areas (Burundi and urban Guinea), but below 50% in less populated areas (24/27 and 26/30 sub-districts in Niger and Guinea, respectively). The preventive fraction (proportion of cases prevented by vaccination) was substantial in Guinea (35% for a vaccine efficacy of 85%) and was higher where the campaign was initiated earlier. An 'alert' threshold indicating the onset of an epidemic of 15/100,000 cases in one week showed good sensitivity (94%), specificity (98%) and positive predictive value (89%) in Burundi, permitting quick decision making outside the meningitis belt. These 3 meningococcal meningitis outbreaks show the need for epidemic emergency preparedness and for vigilance on the whole African continent.

Adolescent↗
PubMed2006

Potential benefits and limitations of various strategies to mitigate the impact of an influenza pandemic.

The recent avian influenza outbreaks underscore the importance of improving our preparedness for an impending influenza pandemic. Various strategies, including pharmaceutical interventions (such as vaccines and antivirals) and nonpharmaceutical interventions (such as quarantine, isolation, and social distancing) may be implemented to mitigate the impact of a pandemic. It is necessary to understand the potential benefits and limitations of each strategy to determine the most appropriate strategies to be implemented. In this article, each strategy is reviewed to define its potential benefits and limitations during a pandemic. Vaccines are probably the most effective measure to reduce morbidity and mortality. However, vaccines are not likely to be available at an early stage of a pandemic. The supply of vaccines is most likely to be insufficient due to limited worldwide production capacity. Antivirals, particularly neuraminidase inhibitors, are expected to be effective against a pandemic influenza strain and are the only available pharmaceutical intervention until enough vaccines are produced. Shortage of supply and high cost is still a major limiting factor in amassing large stockpiles of neuraminidase inhibitors. The possible emergence of resistant strains should also be considered. Nonpharmaceutical interventions can be effective in preventing the spread of the virus under certain conditions. The effectiveness of nonpharmaceutical interventions depends on how influenza viruses are transmitted. There are still significant gaps in the scientific evidence of the way in which influenza viruses are transmitted. Further studies should be conducted to define the basic transmission patterns of influenza viruses.

Antiviral Agents↗