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Assessment of epidemiological situation in the Middle East, in the Mediterranean Sea basin, based on the status of the Syrian health service and diseases occurring among society of this country within the space of the last tens of years is presented in this article. Knowledge of morbidity and morbidness of Syrians, representatives of Arab-Muslim community is relatively low. First of all, it is related to isolation of Syria in the international arena, poor status of education and health service, lack of current epidemiological data on health condition of the country population. Knowledge of issues mentioned above has essential importance for people working or serving in Syria (military and civilian UN personnel), as well as for tourists travelling in the Middle East.
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This special supplement of Nature Medicine, directed at the topic of emerging infectious diseases, is very timely. Recent high-profile outbreaks have highlighted the global risk that infectious agents, both new and old, represent for society. The experience of severe acute respiratory syndrome (SARS) shows the risk posed by emerging infectious diseases, but also the power of strongly coordinated global surveillance and public health measures, coupled with scientific research, to keep infection under control. Diseases such as drug-resistant malaria continue to be threats. There is a need to enhance global resources to investigate, detect and respond to emerging infections, and to appropriately coordinate and direct research efforts to meet the challenges presented by these diseases.
Modern medicine has led to dramatic changes in infectious diseases practice. Vaccination and antibiotic therapy have benefited millions of persons. However, constrained resources now threaten our ability to adequately manage threats of infectious diseases by placing clinical microbiology services and expertise distant from the patient and their infectious diseases physician. Continuing in such a direction threatens quality of laboratory results, timeliness of diagnosis, appropriateness of treatment, effective communication, reduction of health care-associated infections, advances in infectious diseases practice, and training of future practitioners. Microbiology laboratories are the first lines of defense for detection of new antibiotic resistance, outbreaks of foodborne infection, and a possible bioterrorism event. Maintaining high-quality clinical microbiology laboratories on the site of the institution that they serve is the current best approach for managing today's problems of emerging infectious diseases and antimicrobial agent resistance by providing good patient care outcomes that actually save money.
OBJECTIVE: To implement simplified infectious disease surveillance and epidemic disease control during the relocation of Bhutanese refugees to Nepal. DESIGN: Longitudinal observation study of mortality and morbidity. SETTING: Refugee health units in six refugee camps housing 73,500 Bhutanese refugees in the eastern tropical lowland between Nepal and India. INTERVENTIONS: Infectious disease surveillance and community-based programs to promote vitamin A supplementation, measles vaccination, oral rehydration therapy, and early use of antibiotics to treat acute respiratory infection. MAIN OUTCOME MEASURES: Crude mortality rate, mortality rate for children younger than 5 years, and cause-specific mortality. RESULTS: Crude mortality rates up to 1.15 deaths per 10,000 persons per day were reported during the first 6 months of surveillance. The leading causes of death were measles, diarrhea, and acute respiratory infections. Surveillance data were used to institute changes in public health management including measles vaccination, vitamin A supplementation, and control programs for diarrhea and acute respiratory infections and to ensure rapid responses to cholera, Shigella dysentery, and meningoencephalitis. Within 4 months of establishing disease control interventions, crude mortality rates were reduced by 75% and were below emergency levels. CONCLUSIONS: Simple, sustainable disease surveillance in refugee populations is essential during emergency relief efforts. Data can be used to direct community-based public health interventions to control common infectious diseases and reduce high mortality rates among refugees while placing a minimal burden on health workers.
BACKGROUND & OBJECTIVES: A disease surveillance model developed in the North Arcot district, Tamil Nadu, was found to be practical, efficient, inexpensive and useful for public health action to monitor the success of ongoing interventions and to detect and intercept outbreaks. It was centred in the private (voluntary) sector with full co-operation and participation by the government sector. As Kerala state wanted to replicate this model in all districts, one district was chosen to pilot test it centred within the existing district public health system, soliciting participation from the private sector. A two-year (1999-2001) performance of this model is presented. METHODS: After elaborate preparations including the selection of 14 diseases to be reported and training of doctors in the private sector health care institutions and doctors and paramedical staff in all government health centres and hospitals, printed post cards were widely distributed. The business reply system was used so as to avoid handling postage stamps. Cards were received by the nodal officer in the district public health office and checked on a daily basis to detect disease prevalence and evidence of clustering in time and space. Swift action was taken on detecting case clustering. A monthly bulletin containing disease summaries and other useful information was freely distributed to all reporting centres. RESULTS: On an average, just over 100 disease reports were received every month. The most frequently reported diseases were, in the descending order, leptospirosis, acute dysentery, typhoid fever and acute hepatitis. Among vaccine-preventable childhood diseases, only measles was reported, but no diphtheria, tetanus or whooping cough. Several outbreaks were detected early and interventions applied to intercept them. The most striking example was that of cholera, the occurrence of which was detected swiftly for instituting highly successful control measures. INTERPRETATION & CONCLUSION: The district level disease surveillance system centred in the government public health system has been highly successful. Disease surveillance was responsible for the government to obtain information on the prevalence of leptospirosis in the district. The reports enabled the public health officers to detect disease-clustering as the early signals of outbreaks and to take quick remedial measures.
Since the launch of Landsat-1 28 years ago, remotely sensed data have been used to map features on the earth's surface. An increasing number of health studies have used remotely sensed data for monitoring, surveillance, or risk mapping, particularly of vector-borne diseases. Nearly all studies used data from Landsat, the French Système Pour l'Observation de la Terre, and the National Oceanic and Atmospheric Administration's Advanced Very High Resolution Radiometer. New sensor systems are in orbit, or soon to be launched, whose data may prove useful for characterizing and monitoring the spatial and temporal patterns of infectious diseases. Increased computing power and spatial modeling capabilities of geographic information systems could extend the use of remote sensing beyond the research community into operational disease surveillance and control. This article illustrates how remotely sensed data have been used in health applications and assesses earth-observing satellites that could detect and map environmental variables related to the distribution of vector-borne and other diseases.
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We propose a new threshold quantity for the analysis of the epidemiology of infectious diseases. The quantity is similar in concept to the familiar basic reproduction ratio, R0, but it singles out particular host types instead of providing a criterion that is uniform for all host types. Using this methodology we are able to identify the long-term effects of disease-control strategies for particular subgroups of the population, to estimate the level of control necessary when targeting control effort at a subset of host types, and to identify host types that constitute a reservoir of infection. These insights cannot be obtained by using R0 alone.
Globally, aquaculture is steadily expanding both in terms of total production and the range of species farmed. At an overall annual growth rate of about 10%, it is by far the fastest growing sector of food animal production in the world and is providing an increasing proportion of the total production of fish and shellfish for human consumption. However, diseases continue to cause significant economic losses in international aquaculture production and to have a detrimental effect on valuable export trade for some countries. Financial losses have been drastic in some cases and the national economies of some developing countries have been adversely affected. Even just at the local level, disease can have a serious impact on the livelihoods and food security of many individual small farmers and their families, particularly in poorer countries. Despite all the problems caused, diseases continue to be spread internationally even where import health safeguards are in place. Recent examples of such spread are presented and some reasons for the appearance of a disease in a country for the first time are given. It is an unfortunate fact that despite many years of damaging economic and social impact of disease in different sectors of aquaculture, and large sums being spent on research around the world, there are relatively few effective and officially approved products available to control or prevent them. Despite the potential market, there are as yet no commercial vaccines available to prevent the damaging effects of many of the most serious diseases. Without such vaccines, it is likely that the serious impact of diseases in international aquaculture will continue for many years to come.
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The control of infectious diseases in the main food-producing animals is considered and the main factors involved in the epizootiology of disease are presented. The properties of infectious agents and their natural history together with factors that influence the spread and development of disease are summarized. The factors in intensive animal husbandry that affect the occurrence of infectious disease and its control are considered. These include population density, population movement, management, hygiene and genetic constitution of the host. They encourage the appearance of new diseases, changes in the character of established diseases and the development of pathogenicity in infectious agents that were previously of no importance. Intensive animal husbandry has also increased the importance of multifactorial disease, which includes diseases that require more than one infectious agent or one or more infectious agents plus other factors for their cause. The methods of control of infectious disease currently available are described and the success and difficulties of their control on a global, national and local (farm or enterprise) basis are considered. Examples of diseases of global importance where national and world programmes of control and eradication have been of varying success are described. Examples of diseases that are enzootic throughout the world and the procedures used for their control are also described. The technological opportunities for the improvement of the control of infectious disease in the future are discussed. It is considered that developments in molecular biology and immunology will provide improvements in diagnostic tools and will revolutionize the development of animal resistance to disease and the production and use of vaccines.
The events of the autumn of 2001 in the United States made it clear that the spectre of the use of microorganisms to intentionally harm humans is a reality. The current strategy to control disease outbreaks caused by the intentional release of bacteria is to use antimicrobial agents, both therapeutically and prophylactically. However, multidrug-resistant strains of bacterial bioterrorism agents occur naturally or have been bio-engineered, indicating how vulnerable this strategy is.
The Australian economy is vitally dependent on agriculture, livestock health and freedom from major exotic animal diseases. Future exotic animal disease pressures on Australian livestock industries will increase. High category risks include vesicular diseases, arthropod-borne virus diseases and Newcastle disease. Tighter quarantine control and surveillance alone cannot neutralise the increasing risks. Increasing preparedness to deal promptly with introduced disease demands a national approach and continuing liaison between veterinary authorities, the livestock industries and the many organisations that would be called on to assist in a major eradication effort.
The European Union of Medical Specialists (UEMS) core curricula for training in infectious diseases and medical microbiology are adequate with the exception of one deficiency which is the absence of training in epidemiology, public health and infection control. Infectious disease curricula should include training in HIV, tuberculosis, hepatitis and sexually transmitted diseases. There is a need for a core curriculum in infection control. Infection control should have a basis in both medical microbiology and infectious diseases, and should become a specialty dealing with healthcare hygiene in hospitals, in outpatient clinics and also in institutions for the elderly. In the UK, a specialty training in infection is offered and includes internal medicine, clinical infectious diseases and medical microbiology for a total of 9 years. The UEMS should be contacted about the creation of a single specialty of infection, allowing for various degrees of sub-specialisation in infectious diseases or medical microbiology. It is unlikely that a European board examination validating the training of specialists will become a reality soon. Meanwhile, national systems should be created, documenting the content of the training and evaluating the quality of the training institutions. A medical specialist has a constant need for further education. This is generally a national matter, with requirements varying throughout Europe. It should be possible to accumulate continuing medical education/continuing professional development merits on a European level as well as on a national one. With the expansion of the European Union, it is important that the quality and content of specialist training can be verified and training curricula be harmonised. The UEMS should assist in this, in collaboration with scientific societies such as the ESCMID.
Infertility is the diminished or absent capacity to produce viable offspring. Infections that reduce ovulation rates, fertilization rates, embryonic survival rates, fetal survival rates or perinatal survival rates result in observed infertility in beef cows. Reproductive pathogens include Leptospira, Campylobacter, Hemophilus, Brucella, bovine herpesvirus-1, bovine viral diarrhea virus, Tritrichomonas foetus, and Neospora caninum. Infectious infertility can be prevented or controlled with appropriate surveillance, biosecurity, and/or vaccination. The objective of this review is to briefly summarize current scientific information to assist with adoption of surveillance methods, implementation of biosecurity and selection of appropriate commercially available vaccines.
In the paper the methods of prevention and control of social diseases (tuberculosis, trachoma, increased infantile and maternal mortality, alcoholism) in Poland of interwar period were presented. A considerable prevalence of these diseases was connected with social and economic conditions, in which broad classes of society had to live. The most effective methods in reducing the incidence of the diseases were prophylaxis and organization of free health care.