WorldWideScience

Sample records for prevent future outbreaks

  1. A two-dose heterologous prime-boost vaccine regimen eliciting sustained immune responses to Ebola Zaire could support a preventive strategy for future outbreaks.

    Science.gov (United States)

    Shukarev, Georgi; Callendret, Benoit; Luhn, Kerstin; Douoguih, Macaya

    2017-02-01

    The consequences of the 2013-16 Ebola Zaire virus disease epidemic in West Africa were grave. The economies, healthcare systems and communities of Guinea, Sierra Leone and Liberia were devastated by over 18 months of active Ebola virus transmission, followed by sporadic resurgences potentially related to sexual transmission by survivors with viral persistence in body fluids following recovery. The need to develop and implement strategies to prevent and mitigate future outbreaks is now beyond dispute. The potential for unpredictable outbreaks of indeterminate duration, and control challenges posed by the possibility of sporadic re-emergence, mean that implementation of an effective vaccination program for outbreak containment necessitates a vaccine providing durable immunity. Heterologous prime-boost vaccine regimens deliver the same or similar antigens through different vaccine types, the first to prime and the second to boost the immune system. Ad26.ZEBOV/MVA-BN-Filo is an investigational Ebola Zaire vaccine regimen that uses this heterologous prime-boost approach. Preliminary Phase 1 data suggest that Ad26.ZEBOV/MVA-BN-Filo confers durable immunity for at least 240 d and is well-tolerated with a good safety profile. This regimen may therefore be suitable for prophylactic use in a regional or targeted population vaccination strategy, and could potentially aid prevention and control of future Ebola outbreaks.

  2. E. Coli: Preventing Outbreaks at Camp.

    Science.gov (United States)

    McKinney, Mary D.

    1996-01-01

    One strain of E. coli is not usually found in foods, but has been related to consumption of undercooked ground beef. Symptoms are stomach cramps and diarrhea, and 2-7% of infections lead to hemolytic uremic syndrome, which is life threatening. Camps can prevent outbreaks by avoiding uncooked meat on overnight campouts and requiring appropriate…

  3. Crisis prevention and management during SARS outbreak, Singapore.

    Science.gov (United States)

    Quah, Stella R; Hin-Peng, Lee

    2004-02-01

    We discuss crisis prevention and management during the first 3 months of the severe acute respiratory syndrome (SARS) outbreak in Singapore. Four public health issues were considered: prevention measures, self-health evaluation, SARS knowledge, and appraisal of crisis management. We conducted telephone interviews with a representative sample of 1,201 adults, > or = 21 years of age. We found that sex, age, and attitude (anxiety and perception of open communication with authorities) were associated with practicing preventive measures. Analysis of Singapore's outbreak improves our understanding of the social dimensions of infectious disease outbreaks.

  4. Model-specification uncertainty in future forest pest outbreak.

    Science.gov (United States)

    Boulanger, Yan; Gray, David R; Cooke, Barry J; De Grandpré, Louis

    2016-04-01

    Climate change will modify forest pest outbreak characteristics, although there are disagreements regarding the specifics of these changes. A large part of this variability may be attributed to model specifications. As a case study, we developed a consensus model predicting spruce budworm (SBW, Choristoneura fumiferana [Clem.]) outbreak duration using two different predictor data sets and six different correlative methods. The model was used to project outbreak duration and the uncertainty associated with using different data sets and correlative methods (=model-specification uncertainty) for 2011-2040, 2041-2070 and 2071-2100, according to three forcing scenarios (RCP 2.6, RCP 4.5 and RCP 8.5). The consensus model showed very high explanatory power and low bias. The model projected a more important northward shift and decrease in outbreak duration under the RCP 8.5 scenario. However, variation in single-model projections increases with time, making future projections highly uncertain. Notably, the magnitude of the shifts in northward expansion, overall outbreak duration and the patterns of outbreaks duration at the southern edge were highly variable according to the predictor data set and correlative method used. We also demonstrated that variation in forcing scenarios contributed only slightly to the uncertainty of model projections compared with the two sources of model-specification uncertainty. Our approach helped to quantify model-specification uncertainty in future forest pest outbreak characteristics. It may contribute to sounder decision-making by acknowledging the limits of the projections and help to identify areas where model-specification uncertainty is high. As such, we further stress that this uncertainty should be strongly considered when making forest management plans, notably by adopting adaptive management strategies so as to reduce future risks. © 2015 Her Majesty the Queen in Right of Canada Global Change Biology © 2015 Published by John

  5. Large Outbreak Caused by Methicillin Resistant Staphylococcus pseudintermedius ST71 in a Finnish Veterinary Teaching Hospital – From Outbreak Control to Outbreak Prevention

    Science.gov (United States)

    Grönthal, Thomas; Moodley, Arshnee; Nykäsenoja, Suvi; Junnila, Jouni; Guardabassi, Luca; Thomson, Katariina; Rantala, Merja

    2014-01-01

    Introduction The purpose of this study was to describe a nosocomial outbreak caused by methicillin resistant Staphylococcus pseudintermedius (MRSP) ST71 SCCmec II-III in dogs and cats at the Veterinary Teaching Hospital of the University of Helsinki in November 2010 – January 2012, and to determine the risk factors for acquiring MRSP. In addition, measures to control the outbreak and current policy for MRSP prevention are presented. Methods Data of patients were collected from the hospital patient record software. MRSP surveillance data were acquired from the laboratory information system. Risk factors for MRSP acquisition were analyzed from 55 cases and 213 controls using multivariable logistic regression in a case-control study design. Forty-seven MRSP isolates were analyzed by pulsed field gel electrophoresis and three were further analyzed with multi-locus sequence and SCCmec typing. Results Sixty-three MRSP cases were identified, including 27 infections. MRSPs from the cases shared a specific multi-drug resistant antibiogram and PFGE-pattern indicated clonal spread. Four risk factors were identified; skin lesion (OR = 6.2; CI95% 2.3–17.0, P = 0.0003), antimicrobial treatment (OR = 3.8, CI95% 1.0–13.9, P = 0.0442), cumulative number of days in the intensive care unit (OR = 1.3, CI95% 1.1–1.6, P = 0.0007) or in the surgery ward (OR = 1.1, CI95% 1.0–1.3, P = 0.0401). Tracing and screening of contact patients, enhanced hand hygiene, cohorting and barrier nursing, as well as cleaning and disinfection were used to control the outbreak. To avoid future outbreaks and spread of MRSP a search-and-isolate policy was implemented. Currently nearly all new MRSP findings are detected in screening targeted to risk patients on admission. Conclusion Multidrug resistant MRSP is capable of causing a large outbreak difficult to control. Skin lesions, antimicrobial treatment and prolonged hospital stay increase the probability of acquiring

  6. Large outbreak caused by methicillin resistant Staphylococcus pseudintermedius ST71 in a Finnish Veterinary Teaching Hospital--from outbreak control to outbreak prevention.

    Directory of Open Access Journals (Sweden)

    Thomas Grönthal

    Full Text Available INTRODUCTION: The purpose of this study was to describe a nosocomial outbreak caused by methicillin resistant Staphylococcus pseudintermedius (MRSP ST71 SCCmec II-III in dogs and cats at the Veterinary Teaching Hospital of the University of Helsinki in November 2010 - January 2012, and to determine the risk factors for acquiring MRSP. In addition, measures to control the outbreak and current policy for MRSP prevention are presented. METHODS: Data of patients were collected from the hospital patient record software. MRSP surveillance data were acquired from the laboratory information system. Risk factors for MRSP acquisition were analyzed from 55 cases and 213 controls using multivariable logistic regression in a case-control study design. Forty-seven MRSP isolates were analyzed by pulsed field gel electrophoresis and three were further analyzed with multi-locus sequence and SCCmec typing. RESULTS: Sixty-three MRSP cases were identified, including 27 infections. MRSPs from the cases shared a specific multi-drug resistant antibiogram and PFGE-pattern indicated clonal spread. Four risk factors were identified; skin lesion (OR = 6.2; CI95% 2.3-17.0, P = 0.0003, antimicrobial treatment (OR = 3.8, CI95% 1.0-13.9, P = 0.0442, cumulative number of days in the intensive care unit (OR = 1.3, CI95% 1.1-1.6, P = 0.0007 or in the surgery ward (OR = 1.1, CI95% 1.0-1.3, P = 0.0401. Tracing and screening of contact patients, enhanced hand hygiene, cohorting and barrier nursing, as well as cleaning and disinfection were used to control the outbreak. To avoid future outbreaks and spread of MRSP a search-and-isolate policy was implemented. Currently nearly all new MRSP findings are detected in screening targeted to risk patients on admission. CONCLUSION: Multidrug resistant MRSP is capable of causing a large outbreak difficult to control. Skin lesions, antimicrobial treatment and prolonged hospital stay increase the probability of acquiring MRSP. Rigorous control

  7. Positive impact of infection prevention on the management of nosocomial outbreaks at an academic hospital.

    Science.gov (United States)

    Dik, Jan-Willem H; Sinha, Bhanu; Lokate, Mariëtte; Lo-Ten-Foe, Jerome R; Dinkelacker, Ariane G; Postma, Maarten J; Friedrich, Alexander W

    2016-10-01

    Infection prevention (IP) measures are vital to prevent (nosocomial) outbreaks. Financial evaluations of these are scarce. An incremental cost analysis for an academic IP unit was performed. On a yearly basis, we evaluated: IP measures; costs thereof; numbers of patients at risk for causing nosocomial outbreaks; predicted outbreak patients; and actual outbreak patients. IP costs rose on average yearly with €150,000; however, more IP actions were undertaken. Numbers of patients colonized with high-risk microorganisms increased. The trend of actual outbreak patients remained stable. Predicted prevented outbreak patients saved costs, leading to a positive return on investment of 1.94. This study shows that investments in IP can prevent outbreak cases, thereby saving enough money to earn back these investments.

  8. Perceptions of vulnerability to a future outbreak: a study of horse managers affected by the first Australian equine influenza outbreak

    Science.gov (United States)

    2013-01-01

    Background A growing body of work shows the benefits of applying social cognitive behavioural theory to investigate infection control and biosecurity practices. Protection motivation theory has been used to predict protective health behaviours. The theory outlines that a perception of a lack of vulnerability to a disease contributes to a reduced threat appraisal, which results in poorer motivation, and is linked to poorer compliance with advised health protective behaviours. This study, conducted following the first-ever outbreak of equine influenza in Australia in 2007, identified factors associated with horse managers’ perceived vulnerability to a future equine influenza outbreak. Results Of the 200 respondents, 31.9% perceived themselves to be very vulnerable, 36.6% vulnerable and 31.4% not vulnerable to a future outbreak of equine influenza. Multivariable logistic regression modelling revealed that managers involved in horse racing and those on rural horse premises perceived themselves to have low levels of vulnerability. Managers of horse premises that experienced infection in their horses in 2007 and those seeking infection control information from specific sources reported increased levels of perceived vulnerability to a future outbreak. Conclusion Different groups across the horse industry perceived differing levels of vulnerability to a future outbreak. Increased vulnerability contributes to favourable infection control behaviour and hence these findings are important for understanding uptake of recommended infection control measures. Future biosecurity communication strategies should be delivered through information sources suitable for the horse racing and rural sectors. PMID:23902718

  9. Perceptions of vulnerability to a future outbreak: a study of horse managers affected by the first Australian equine influenza outbreak.

    Science.gov (United States)

    Schemann, Kathrin; Firestone, Simon M; Taylor, Melanie R; Toribio, Jenny-Ann L M L; Ward, Michael P; Dhand, Navneet K

    2013-07-31

    A growing body of work shows the benefits of applying social cognitive behavioural theory to investigate infection control and biosecurity practices. Protection motivation theory has been used to predict protective health behaviours. The theory outlines that a perception of a lack of vulnerability to a disease contributes to a reduced threat appraisal, which results in poorer motivation, and is linked to poorer compliance with advised health protective behaviours. This study, conducted following the first-ever outbreak of equine influenza in Australia in 2007, identified factors associated with horse managers' perceived vulnerability to a future equine influenza outbreak. Of the 200 respondents, 31.9% perceived themselves to be very vulnerable, 36.6% vulnerable and 31.4% not vulnerable to a future outbreak of equine influenza. Multivariable logistic regression modelling revealed that managers involved in horse racing and those on rural horse premises perceived themselves to have low levels of vulnerability. Managers of horse premises that experienced infection in their horses in 2007 and those seeking infection control information from specific sources reported increased levels of perceived vulnerability to a future outbreak. Different groups across the horse industry perceived differing levels of vulnerability to a future outbreak. Increased vulnerability contributes to favourable infection control behaviour and hence these findings are important for understanding uptake of recommended infection control measures. Future biosecurity communication strategies should be delivered through information sources suitable for the horse racing and rural sectors.

  10. Prevention of Tetanus Outbreak Following Natural Disaster in Indonesia: Lessons Learned from Previous Disasters.

    Science.gov (United States)

    Pascapurnama, Dyshelly Nurkartika; Murakami, Aya; Chagan-Yasutan, Haorile; Hattori, Toshio; Sasaki, Hiroyuki; Egawa, Shinichi

    2016-03-01

    In Indonesia, the Aceh earthquake and tsunami in 2004 killed 127,000 people and caused half a million injuries, while the Yogyakarta earthquake in 2006 caused 5,700 deaths and 37,000 injuries. Because disaster-affected areas are vulnerable to epidemic-prone diseases and tetanus is one such disease that is preventable, we systematically reviewed the literature related to tetanus outbreaks following previous two natural disasters in Indonesia. Based on our findings, recommendations for proper vaccination and education can be made for future countermeasures. Using specified keywords related to tetanus and disasters, relevant documents were screened from PubMed, the WHO website, and books. Reports offering limited data and those released before 2004 were excluded. In all, 16 publications were reviewed systematically. Results show that 106 cases of tetanus occurred in Aceh, with a case fatality ratio (CFR) of 18.9%; 71 cases occurred in Yogyakarta, with CFR of 36.6%. For both outbreaks, most patients had been wounded during scavenging or evacuation after the disaster occurred. Poor access to health care because of limited transportation or hospital facilities, and low vaccination coverage and lack of awareness of tetanus risk contributed to delayed treatment and case severity. Tetanus outbreaks after disasters are preventable by increasing vaccination coverage, improving wound care treatment, and establishing a regular surveillance system, in addition to good practices of disaster management and supportive care following national guidelines. Furthermore, health education for communities should be provided to raise awareness of tetanus risk reduction.

  11. Infection prevention and control of the Ebola outbreak in Liberia, 2014-2015: key challenges and successes.

    Science.gov (United States)

    Cooper, Catherine; Fisher, Dale; Gupta, Neil; MaCauley, Rose; Pessoa-Silva, Carmem L

    2016-01-05

    Prior to the 2014-2015 Ebola outbreak, infection prevention and control (IPC) activities in Liberian healthcare facilities were basic. There was no national IPC guidance, nor dedicated staff at any level of government or healthcare facility (HCF) to ensure the implementation of best practices. Efforts to improve IPC early in the outbreak were ad hoc and messaging was inconsistent. In September 2014, at the height of the outbreak, the national IPC Task Force was established with a Ministry of Health (MoH) mandate to coordinate IPC response activities. A steering group of the Task Force, including representatives of the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC), supported MoH leadership in implementing standardized messaging and IPC training for the health workforce. This structure, and the activities implemented under this structure, played a crucial role in the implementation of IPC practices and successful containment of the outbreak. Moving forward, a nationwide culture of IPC needs to be maintained through this governance structure in Liberia's health system to prevent and respond to future outbreaks.

  12. Management of Animal Botulism Outbreaks: From Clinical Suspicion to Practical Countermeasures to Prevent or Minimize Outbreaks

    DEFF Research Database (Denmark)

    Anniballi, Fabrizio; Fiore, Alfonsina; Löfström, Charlotta

    2013-01-01

    and economic concern because of its high mortality rate. Moreover, meat or other products from affected animals entering the food chain may result in a public health problem. To this end, early diagnosis is crucial to define and apply appropriate veterinary public health measures. Clinical diagnosis is based...... outbreaks. In this article we outline all phases of management of animal botulism outbreaks occurring in wet wild birds, poultry, cattle, horses, and fur farm animals....

  13. Natural Disasters and Cholera Outbreaks: Current Understanding and Future Outlook.

    Science.gov (United States)

    Jutla, Antarpreet; Khan, Rakibul; Colwell, Rita

    2017-03-01

    Diarrheal diseases remain a serious global public health threat, especially for those populations lacking access to safe water and sanitation infrastructure. Although association of several diarrheal diseases, e.g., cholera, shigellosis, etc., with climatic processes has been documented, the global human population remains at heightened risk of outbreak of diseases after natural disasters, such as earthquakes, floods, or droughts. In this review, cholera was selected as a signature diarrheal disease and the role of natural disasters in triggering and transmitting cholera was analyzed. Key observations include identification of an inherent feedback loop that includes societal structure, prevailing climatic processes, and spatio-temporal seasonal variability of natural disasters. Data obtained from satellite-based remote sensing are concluded to have application, although limited, in predicting risks of a cholera outbreak(s). We argue that with the advent of new high spectral and spatial resolution data, earth observation systems should be seamlessly integrated in a decision support mechanism to be mobilize resources when a region suffers a natural disaster. A framework is proposed that can be used to assess the impact of natural disasters with response to outbreak of cholera, providing assessment of short- and long-term influence of climatic processes on disease outbreaks.

  14. Detection and forecasting of oyster norovirus outbreaks: recent advances and future perspectives.

    Science.gov (United States)

    Wang, Jiao; Deng, Zhiqiang

    2012-09-01

    Norovirus is a highly infectious pathogen that is commonly found in oysters growing in fecally contaminated waters. Norovirus outbreaks can cause the closure of oyster harvesting waters and acute gastroenteritis in humans associated with consumption of contaminated raw oysters. Extensive efforts and progresses have been made in detection and forecasting of oyster norovirus outbreaks over the past decades. The main objective of this paper is to provide a literature review of methods and techniques for detecting and forecasting oyster norovirus outbreaks and thereby to identify the future directions for improving the detection and forecasting of norovirus outbreaks. It is found that (1) norovirus outbreaks display strong seasonality with the outbreak peak occurring commonly in December-March in the U.S. and April-May in the Europe; (2) norovirus outbreaks are affected by multiple environmental factors, including but not limited to precipitation, temperature, solar radiation, wind, and salinity; (3) various modeling approaches may be employed to forecast norovirus outbreaks, including Bayesian models, regression models, Artificial Neural Networks, and process-based models; and (4) diverse techniques are available for near real-time detection of norovirus outbreaks, including multiplex PCR, seminested PCR, real-time PCR, quantitative PCR, and satellite remote sensing. The findings are important to the management of oyster growing waters and to future investigations into norovirus outbreaks. It is recommended that a combined approach of sensor-assisted real time monitoring and modeling-based forecasting should be utilized for an efficient and effective detection and forecasting of norovirus outbreaks caused by consumption of contaminated oysters. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Addressing Therapeutic Options for Ebola Virus Infection in Current and Future Outbreaks.

    Science.gov (United States)

    Haque, Azizul; Hober, Didier; Blondiaux, Joel

    2015-10-01

    Ebola virus can cause severe hemorrhagic disease with high fatality rates. Currently, no specific therapeutic agent or vaccine has been approved for treatment and prevention of Ebola virus infection of humans. Although the number of Ebola cases has fallen in the last few weeks, multiple outbreaks of Ebola virus infection and the likelihood of future exposure highlight the need for development and rapid evaluation of pre- and postexposure treatments. Here, we briefly review the existing and future options for anti-Ebola therapy, based on the data coming from rare clinical reports, studies on animals, and results from in vitro models. We also project the mechanistic hypotheses of several potential drugs against Ebola virus, including small-molecule-based drugs, which are under development and being tested in animal models or in vitro using various cell types. Our paper discusses strategies toward identifying and testing anti-Ebola virus properties of known and medically approved drugs, especially those that can limit the pathological inflammatory response in Ebola patients and thereby provide protection from mortality. We underline the importance of developing combinational therapy for better treatment outcomes for Ebola patients. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  16. Contact Tracing during an Outbreak of Ebola Virus Disease in the Western Area Districts of Sierra Leone: Lessons for Future Ebola Outbreak Response.

    Science.gov (United States)

    Olu, Olushayo Oluseun; Lamunu, Margaret; Nanyunja, Miriam; Dafae, Foday; Samba, Thomas; Sempiira, Noah; Kuti-George, Fredson; Abebe, Fikru Zeleke; Sensasi, Benjamin; Chimbaru, Alexander; Ganda, Louisa; Gausi, Khoti; Gilroy, Sonia; Mugume, James

    2016-01-01

    Contact tracing is a critical strategy required for timely prevention and control of Ebola virus disease (EVD) outbreaks. Available evidence suggests that poor contact tracing was a driver of the EVD outbreak in West Africa, including Sierra Leone. In this article, we answered the question as to whether EVD contact tracing, as practiced in Western Area (WA) districts of Sierra Leone from 2014 to 2015, was effective. The goal is to describe contact tracing and identify obstacles to its effective implementation. Mixed methods comprising secondary data analysis of the EVD case and contact tracing data sets collected from WA during the period from 2014 to 2015, key informant interviews of contact tracers and their supervisors, and a review of available reports on contact tracing were implemented to obtain data for this study. During the study period, 3,838 confirmed cases and 32,706 contacts were listed in the viral hemorrhagic fever and contact databases for the district (mean 8.5 contacts per case). Only 22.1% (852) of the confirmed cases in the study area were listed as contacts at the onset of their illness, which indicates incomplete identification and tracing of contacts. Challenges associated with effective contact tracing included lack of community trust, concealing of exposure information, political interference with recruitment of tracers, inadequate training of contact tracers, and incomplete EVD case and contact database. While the tracers noted the usefulness of community quarantine in facilitating their work, they also reported delayed or irregular supply of basic needs, such as food and water, which created resistance from the communities. Multiple gaps in contact tracing attributed to a variety of factors associated with implementers, and communities were identified as obstacles that impeded timely control of the EVD outbreak in the WA of Sierra Leone. In future outbreaks, early community engagement and participation in contact tracing, establishment of

  17. How can health systems be strengthened to control and prevent an Ebola outbreak? A narrative review

    Directory of Open Access Journals (Sweden)

    Krishna Regmi

    2015-11-01

    Full Text Available The emergence and re-emergence of infectious diseases are now more than ever considered threats to public health systems. There have been over 20 outbreaks of Ebola in the past 40 years. Only recently, the World Health Organization has declared a public health emergency of international concern (PHEIC in West Africa, with a projected estimate of 1.2 million deaths expected in the next 6 months. Ebola virus is a highly virulent pathogen, often fatal in humans and non-human primates. Ebola is now a great priority for global health security and often becomes fatal if left untreated. This study employed a narrative review. Three major databases – MEDLINE, EMBASE, and Global Health – were searched using both ‘text-words’ and ‘thesaurus terms’. Evidence shows that low- and middle-income countries (LMICs are not coping well with the current challenges of Ebola, not only because they have poor and fragile systems but also because there are poor infectious disease surveillance and response systems in place. The identification of potential cases is problematic, particularly in the aspects of contact tracing, infection control, and prevention, prior to the diagnosis of the case. This review therefore aims to examine whether LMICs’ health systems would be able to control and manage Ebola in future and identifies two key elements of health systems strengthening that are needed to ensure the robustness of the health system to respond effectively.

  18. Preventative Vaccines for Zika Virus Outbreak: Preliminary Evaluation

    Directory of Open Access Journals (Sweden)

    Eun Kim

    2016-11-01

    Full Text Available Since it emerged in Brazil in May 2015, the mosquito-borne Zika virus (ZIKV has raised global concern due to its association with a significant rise in the number of infants born with microcephaly and neurological disorders such as Guillain-Barré syndrome. We developed prototype subunit and adenoviral-based Zika vaccines encoding the extracellular portion of the ZIKV envelope gene (E fused to the T4 fibritin foldon trimerization domain (Efl. The subunit vaccine was delivered intradermally through carboxymethyl cellulose microneedle array (MNA. The immunogenicity of these two vaccines, named Ad5.ZIKV-Efl and ZIKV-rEfl, was tested in C57BL/6 mice. Prime/boost immunization regimen was associated with induction of a ZIKV-specific antibody response, which provided neutralizing immunity. Moreover, protection was evaluated in seven-day-old pups after virulent ZIKV intraperitoneal challenge. Pups born to mice immunized with Ad5.ZIKV-Efl were all protected against lethal challenge infection without weight loss or neurological signs, while pups born to dams immunized with MNA-ZIKV-rEfl were partially protected (50%. No protection was seen in pups born to phosphate buffered saline-immunized mice. This study illustrates the preliminary efficacy of the E ZIKV antigen vaccination in controlling ZIKV infectivity, providing a promising candidate vaccine and antigen format for the prevention of Zika virus disease.

  19. Preventative Vaccines for Zika Virus Outbreak: Preliminary Evaluation.

    Science.gov (United States)

    Kim, Eun; Erdos, Geza; Huang, Shaohua; Kenniston, Thomas; Falo, Louis D; Gambotto, Andrea

    2016-11-01

    Since it emerged in Brazil in May 2015, the mosquito-borne Zika virus (ZIKV) has raised global concern due to its association with a significant rise in the number of infants born with microcephaly and neurological disorders such as Guillain-Barré syndrome. We developed prototype subunit and adenoviral-based Zika vaccines encoding the extracellular portion of the ZIKV envelope gene (E) fused to the T4 fibritin foldon trimerization domain (Efl). The subunit vaccine was delivered intradermally through carboxymethyl cellulose microneedle array (MNA). The immunogenicity of these two vaccines, named Ad5.ZIKV-Efl and ZIKV-rEfl, was tested in C57BL/6 mice. Prime/boost immunization regimen was associated with induction of a ZIKV-specific antibody response, which provided neutralizing immunity. Moreover, protection was evaluated in seven-day-old pups after virulent ZIKV intraperitoneal challenge. Pups born to mice immunized with Ad5.ZIKV-Efl were all protected against lethal challenge infection without weight loss or neurological signs, while pups born to dams immunized with MNA-ZIKV-rEfl were partially protected (50%). No protection was seen in pups born to phosphate buffered saline-immunized mice. This study illustrates the preliminary efficacy of the E ZIKV antigen vaccination in controlling ZIKV infectivity, providing a promising candidate vaccine and antigen format for the prevention of Zika virus disease. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  20. Efficacies of prevention and control measures applied during an outbreak in Southwest Madrid, Spain.

    Directory of Open Access Journals (Sweden)

    Anaiá da Paixão Sevá

    Full Text Available Leishmaniasis is a vector-borne disease of worldwide distribution, currently present in 98 countries. Since late 2010, an unusual increase of human visceral and cutaneous leishmaniasis cases has been observed in the south-western Madrid region, totaling more than 600 cases until 2015. Some hosts, such as human, domestic dog and cat, rabbit (Oryctolagus cuniculus, and hare (Lepus granatensis, were found infected by the parasite of this disease in the area. Hares were described as the most important reservoir due to their higher prevalence, capacity to infect the vector, and presence of the same strains as in humans. Various measures were adopted to prevent and control the disease, and since 2013 there was a slight decline in the human sickness. We used a mathematical model to evaluate the efficacy of each measure in reducing the number of infected hosts. We identified in the present model that culling both hares and rabbits, without immediate reposition of the animals, was the best measure adopted, decreasing the proportion of all infected hosts. Particularly, culling hares was more efficacious than culling rabbits to reduce the proportion of infected individuals of all hosts. Likewise, lowering vector contact with hares highly influenced the reduction of the proportion of infected hosts. The reduction of the vector density per host in the park decreased the leishmaniasis incidence of hosts in the park and the urban areas. On the other hand, the reduction of the vector density per host of the urban area (humans, dogs and cats decreased only their affected population, albeit at a higher proportion. The use of insecticide-impregnated collar and vaccination in dogs affected only the infected dogs' population. The parameters related to the vector contact with dog, cat or human do not present a high impact on the other hosts infected by Leishmania. In conclusion, the efficacy of each control strategy was determined, in order to direct future actions

  1. Learning from Ebola Virus: How to Prevent Future Epidemics

    Directory of Open Access Journals (Sweden)

    Alexander S. Kekulé

    2015-07-01

    Full Text Available The recent Ebola virus disease (EVD epidemic in Guinea, Liberia and Sierra Leone demonstrated that the World Health Organization (WHO is incapable to control outbreaks of infectious diseases in less developed regions of the world. This essay analyses the causes for the failure of the international response and proposes four measures to improve resilience, early detection and response to future outbreaks of infectious diseases.

  2. The 2012 Madeira dengue outbreak: epidemiological determinants and future epidemic potential.

    Directory of Open Access Journals (Sweden)

    José Lourenço

    2014-08-01

    Full Text Available Dengue, a vector-borne viral disease of increasing global importance, is classically associated with tropical and sub-tropical regions around the world. Urbanisation, globalisation and climate trends, however, are facilitating the geographic spread of its mosquito vectors, thereby increasing the risk of the virus establishing itself in previously unaffected areas and causing large-scale epidemics. On 3 October 2012, two autochthonous dengue infections were reported within the Autonomous Region of Madeira, Portugal. During the following seven months, this first 'European' dengue outbreak caused more than 2000 local cases and 81 exported cases to mainland Europe. Here, using an ento-epidemiological mathematical framework, we estimate that the introduction of dengue to Madeira occurred around a month before the first official cases, during the period of maximum influx of airline travel, and that the naturally declining temperatures of autumn were the determining factor for the outbreak's demise in early December 2012. Using key estimates, together with local climate data, we further propose that there is little support for dengue endemicity on this island, but a high potential for future epidemic outbreaks when seeded between May and August-a period when detection of imported cases is crucial for Madeira's public health planning.

  3. The 2012 Madeira dengue outbreak: epidemiological determinants and future epidemic potential.

    Science.gov (United States)

    Lourenço, José; Recker, Mario

    2014-08-01

    Dengue, a vector-borne viral disease of increasing global importance, is classically associated with tropical and sub-tropical regions around the world. Urbanisation, globalisation and climate trends, however, are facilitating the geographic spread of its mosquito vectors, thereby increasing the risk of the virus establishing itself in previously unaffected areas and causing large-scale epidemics. On 3 October 2012, two autochthonous dengue infections were reported within the Autonomous Region of Madeira, Portugal. During the following seven months, this first 'European' dengue outbreak caused more than 2000 local cases and 81 exported cases to mainland Europe. Here, using an ento-epidemiological mathematical framework, we estimate that the introduction of dengue to Madeira occurred around a month before the first official cases, during the period of maximum influx of airline travel, and that the naturally declining temperatures of autumn were the determining factor for the outbreak's demise in early December 2012. Using key estimates, together with local climate data, we further propose that there is little support for dengue endemicity on this island, but a high potential for future epidemic outbreaks when seeded between May and August-a period when detection of imported cases is crucial for Madeira's public health planning.

  4. Enhancing preparation for large Nipah outbreaks beyond Bangladesh: Preventing a tragedy like Ebola in West Africa

    Directory of Open Access Journals (Sweden)

    Halsie Donaldson

    2018-07-01

    Full Text Available The Nipah virus has been transmitted from person-to-person via close contact in non-urban parts of India (including Kerala May 2018, Bangladesh, and the Philippines. It can cause encephalitis and pneumonia, and has a high case fatality rate. Nipah is a One Health zoonotic infectious disease linked to fruit bats, and sometimes pigs or horses. We advocate anticipating and preparing for urban and larger rural outbreaks of Nipah. Immediate enhanced preparations would include standardized guidance on infection prevention and control, and personal protective equipment, from the World Health Organization (WHO on their OpenWHO website and 2018 “Managing Epidemics” handbook, along with adding best clinical practices by experts in countries with multiple outbreaks such as Bangladesh and India. Longer-term enhanced preparations include accelerating development of field diagnostics, antiviral drugs, immune-based therapies, and vaccines. WHO-coordinated multi-partner protocols to test investigational treatments, diagnostics, and vaccines are needed, by analogy to such protocols for Ebola during the unanticipated pan-epidemic in Guinea, Liberia, and Sierra Leone. Anticipating and preparing now for urban and rural Nipah outbreaks in nations with no experience with Nipah will help avoid the potential for what the United Nations 2016 report on Ebola in West Africa called a “preventable tragedy”. Keywords: Nipah epidemics beyond Bangladesh, Nipah countermeasures, Nipah, One Health

  5. Strategies to Prevent Cholera Introduction during International Personnel Deployments: A Computational Modeling Analysis Based on the 2010 Haiti Outbreak

    Science.gov (United States)

    Lewnard, Joseph A.; Antillón, Marina; Gonsalves, Gregg; Miller, Alice M.; Ko, Albert I.; Pitzer, Virginia E.

    2016-01-01

    Background Introduction of Vibrio cholerae to Haiti during the deployment of United Nations (UN) peacekeepers in 2010 resulted in one of the largest cholera epidemics of the modern era. Following the outbreak, a UN-commissioned independent panel recommended three pre-deployment intervention strategies to minimize the risk of cholera introduction in future peacekeeping operations: screening for V. cholerae carriage, administering prophylactic antimicrobial chemotherapies, or immunizing with oral cholera vaccines. However, uncertainty regarding the effectiveness of these approaches has forestalled their implementation by the UN. We assessed how the interventions would have impacted the likelihood of the Haiti cholera epidemic. Methods and Findings We developed a stochastic model for cholera importation and transmission, fitted to reported cases during the first weeks of the 2010 outbreak in Haiti. Using this model, we estimated that diagnostic screening reduces the probability of cases occurring by 82% (95% credible interval: 75%, 85%); however, false-positive test outcomes may hamper this approach. Antimicrobial chemoprophylaxis at time of departure and oral cholera vaccination reduce the probability of cases by 50% (41%, 57%) and by up to 61% (58%, 63%), respectively. Chemoprophylaxis beginning 1 wk before departure confers a 91% (78%, 96%) reduction independently, and up to a 98% reduction (94%, 99%) if coupled with vaccination. These results are not sensitive to assumptions about the background cholera incidence rate in the endemic troop-sending country. Further research is needed to (1) validate the sensitivity and specificity of rapid test approaches for detecting asymptomatic carriage, (2) compare prophylactic efficacy across antimicrobial regimens, and (3) quantify the impact of oral cholera vaccine on transmission from asymptomatic carriers. Conclusions Screening, chemoprophylaxis, and vaccination are all effective strategies to prevent cholera introduction

  6. A State-by-State Assessment of Food Service Regulations for Prevention of Norovirus Outbreaks.

    Science.gov (United States)

    Kambhampati, Anita; Shioda, Kayoko; Gould, L Hannah; Sharp, Donald; Brown, Laura G; Parashar, Umesh D; Hall, Aron J

    2016-09-01

    Noroviruses are the leading cause of foodborne disease in the United States. Foodborne transmission of norovirus is often associated with contamination of food during preparation by an infected food worker. The U.S. Food and Drug Administration's Food Code provides model food safety regulations for preventing transmission of foodborne disease in restaurants; however, adoption of specific provisions is at the discretion of state and local governments. We analyzed the food service regulations of all 50 states and the District of Columbia (i.e., 51 states) to describe differences in adoption of norovirus-related Food Code provisions into state food service regulations. We then assessed potential correlations between adoption of these regulations and characteristics of foodborne norovirus outbreaks reported to the National Outbreak Reporting System from 2009 through 2014. Of the 51 states assessed, all (100%) required food workers to wash their hands, and 39 (76%) prohibited bare-hand contact with ready-to-eat food. Thirty states (59%) required exclusion of staff with vomiting and diarrhea until 24 h after cessation of symptoms. Provisions requiring a certified food protection manager (CFPM) and a response plan for contamination events (i.e., vomiting) were least commonly adopted; 26 states (51%) required a CFPM, and 8 (16%) required a response plan. Although not statistically significant, states that adopted the provisions prohibiting bare-hand contact (0.45 versus 0.74, P =0.07), requiring a CFPM (0.38 versus 0.75, P =0.09), and excluding ill staff for ≥24 h after symptom resolution (0.44 versus 0.73, P =0.24) each reported fewer foodborne norovirus outbreaks per million person-years than did those states without these provisions. Adoption and compliance with federal recommended food service regulations may decrease the incidence of foodborne norovirus outbreaks.

  7. Implementing systems thinking for infection prevention: The cessation of repeated scabies outbreaks in a respiratory care ward.

    Science.gov (United States)

    Chuang, Sheuwen; Howley, Peter P; Lin, Shih-Hua

    2015-05-01

    Root cause analysis (RCA) is often adopted to complement epidemiologic investigation for outbreaks and infection-related adverse events in hospitals; however, RCA has been argued to have limited effectiveness in preventing such events. We describe how an innovative systems analysis approach halted repeated scabies outbreaks, and highlight the importance of systems thinking for outbreaks analysis and sustaining effective infection prevention and control. Following RCA for a third successive outbreak of scabies over a 17-month period in a 60-bed respiratory care ward of a Taiwan hospital, a systems-oriented event analysis (SOEA) model was used to reanalyze the outbreak. Both approaches and the recommendations were compared. No nosocomial scabies have been reported for more than 1975 days since implementation of the SOEA. Previous intervals between seeming eradication and repeat outbreaks following RCA were 270 days and 180 days. Achieving a sustainable positive resolution relied on applying systems thinking and the holistic analysis of the system, not merely looking for root causes of events. To improve the effectiveness of outbreaks analysis and infection control, an emphasis on systems thinking is critical, along with a practical approach to ensure its effective implementation. The SOEA model provides the necessary framework and is a viable complementary approach, or alternative, to RCA. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  8. Prevention of child injuries during tornadoes: cases from the 2011 tornado outbreak in Alabama.

    Science.gov (United States)

    Campbell, Christine M; Baker, Mark D; Monroe, Kathy W

    2012-12-01

    Tornadoes and violent weather pose a hazard to children, yet little is known about the use of personal protective devices during storms. An outbreak of tornadoes on April 27, 2011, resulted in the deaths of 23 children in Alabama. Records from 60 patients seen in a pediatric emergency department for tornado-related injuries were reviewed to identify the use of injury prevention devices. Three children directly exposed to a violent tornado (Enhanced Fujita Scale 4) were using safety equipment, specifically, a helmet and infant car seats. These 3 children sustained only minor injuries. Personal protective devices may have played a role in preventing child injuries from tornadoes. To our knowledge, this is the first report in the medical literature on helmet and infant car seat use as child protective devices during tornadoes.

  9. Impact of a dengue outbreak experience in the preventive perceptions of the community from a temperate region: Madeira Island, Portugal.

    Directory of Open Access Journals (Sweden)

    Teresa Nazareth

    2015-03-01

    Full Text Available The ability to effectively modify behaviours is increasingly relevant to attain and maintain a good health status. Current behaviour-change models and theories present two main approaches for (healthier decision-making: one analytical/logical, and one experiential/emotional/intuitive. Therefore, to achieve an integral and dynamic understanding of the public perceptions both approaches should be considered: community surveys should measure cognitive understanding of health-risk contexts, and also explore how past experiences affect this understanding. In 2011, community perceptions regarding domestic source reduction were assessed in Madeira Island͘. After Madeira's first dengue outbreak (2012 a unique opportunity to compare perceptions before and after the outbreak-experience occurred. This was the aim of this study, which constituted the first report on the effect of an outbreak experience on community perceptions regarding a specific vector-borne disease. A cross-sectional survey was performed within female residents at the most aegypti-infested areas. Perceptions regarding domestic source reduction were assessed according to the Essential Perception (EP-analysis tool. A matching process paired individuals from studies performed before and after the outbreak, ensuring homogeneity in six determinant variables. After the outbreak, there were more female residents who assimilated the concepts considered to be essential to understand the proposed behaviour. Nevertheless, no significant difference was observed in the number of female residents who achieved the defined 'minimal understanding''. Moreover, most of the population (95.5% still believed at least in one of the identified myths. After the outbreak some myths disappeared and others appeared. The present study quantified and explored how the experience of an outbreak influenced the perception regarding a dengue-preventive behaviour. The outbreak experience surprisingly led to the appearance

  10. Impact of a Dengue Outbreak Experience in the Preventive Perceptions of the Community from a Temperate Region: Madeira Island, Portugal

    Science.gov (United States)

    Nazareth, Teresa; Sousa, Carla Alexandra; Porto, Graça; Gonçalves, Luzia; Seixas, Gonçalo; Antunes, Luís; Silva, Ana Clara; Teodósio, Rosa

    2015-01-01

    The ability to effectively modify behaviours is increasingly relevant to attain and maintain a good health status. Current behaviour-change models and theories present two main approaches for (healthier) decision-making: one analytical/logical, and one experiential/emotional/intuitive. Therefore, to achieve an integral and dynamic understanding of the public perceptions both approaches should be considered: community surveys should measure cognitive understanding of health-risk contexts, and also explore how past experiences affect this understanding. In 2011, community perceptions regarding domestic source reduction were assessed in Madeira Island. After Madeira’s first dengue outbreak (2012) a unique opportunity to compare perceptions before and after the outbreak-experience occurred. This was the aim of this study, which constituted the first report on the effect of an outbreak experience on community perceptions regarding a specific vector-borne disease. A cross-sectional survey was performed within female residents at the most aegypti-infested areas. Perceptions regarding domestic source reduction were assessed according to the Essential Perception (EP)-analysis tool. A matching process paired individuals from studies performed before and after the outbreak, ensuring homogeneity in six determinant variables. After the outbreak, there were more female residents who assimilated the concepts considered to be essential to understand the proposed behaviour. Nevertheless, no significant difference was observed in the number of female residents who achieved the defined ‘minimal understanding’’. Moreover, most of the population (95.5%) still believed at least in one of the identified myths. After the outbreak some myths disappeared and others appeared. The present study quantified and explored how the experience of an outbreak influenced the perception regarding a dengue-preventive behaviour. The outbreak experience surprisingly led to the appearance of new

  11. Impact of a dengue outbreak experience in the preventive perceptions of the community from a temperate region: Madeira Island, Portugal.

    Science.gov (United States)

    Nazareth, Teresa; Sousa, Carla Alexandra; Porto, Graça; Gonçalves, Luzia; Seixas, Gonçalo; Antunes, Luís; Silva, Ana Clara; Teodósio, Rosa

    2015-03-01

    The ability to effectively modify behaviours is increasingly relevant to attain and maintain a good health status. Current behaviour-change models and theories present two main approaches for (healthier) decision-making: one analytical/logical, and one experiential/emotional/intuitive. Therefore, to achieve an integral and dynamic understanding of the public perceptions both approaches should be considered: community surveys should measure cognitive understanding of health-risk contexts, and also explore how past experiences affect this understanding. In 2011, community perceptions regarding domestic source reduction were assessed in Madeira Island͘. After Madeira's first dengue outbreak (2012) a unique opportunity to compare perceptions before and after the outbreak-experience occurred. This was the aim of this study, which constituted the first report on the effect of an outbreak experience on community perceptions regarding a specific vector-borne disease. A cross-sectional survey was performed within female residents at the most aegypti-infested areas. Perceptions regarding domestic source reduction were assessed according to the Essential Perception (EP)-analysis tool. A matching process paired individuals from studies performed before and after the outbreak, ensuring homogeneity in six determinant variables. After the outbreak, there were more female residents who assimilated the concepts considered to be essential to understand the proposed behaviour. Nevertheless, no significant difference was observed in the number of female residents who achieved the defined 'minimal understanding''. Moreover, most of the population (95.5%) still believed at least in one of the identified myths. After the outbreak some myths disappeared and others appeared. The present study quantified and explored how the experience of an outbreak influenced the perception regarding a dengue-preventive behaviour. The outbreak experience surprisingly led to the appearance of new myths

  12. Asymmetric competition prevents the outbreak of an opportunistic species after coral reef degradation.

    Science.gov (United States)

    González-Rivero, Manuel; Bozec, Yves-Marie; Chollett, Iliana; Ferrari, Renata; Schönberg, Christine H L; Mumby, Peter J

    2016-05-01

    Disturbance releases space and allows the growth of opportunistic species, excluded by the old stands, with a potential to alter community dynamics. In coral reefs, abundances of fast-growing, and disturbance-tolerant sponges are expected to increase and dominate as space becomes available following acute coral mortality events. Yet, an increase in abundance of these opportunistic species has been reported in only a few studies, suggesting certain mechanisms may be acting to regulate sponge populations. To gain insights into mechanisms of population control, we simulated the dynamics of the common reef-excavating sponge Cliona tenuis in the Caribbean using an individual-based model. An orthogonal hypothesis testing approach was used, where four candidate mechanisms-algal competition, stock-recruitment limitation, whole and partial mortality-were incorporated sequentially into the model and the results were tested against independent field observations taken over a decade in Belize, Central America. We found that releasing space after coral mortality can promote C. tenuis outbreaks, but such outbreaks can be curtailed by macroalgal competition. The asymmetrical competitive superiority of macroalgae, given by their capacity to pre-empt space and outcompete with the sponge in a size-dependant fashion, supports their capacity to steal the opportunity from other opportunists. While multiple system stages can be expected in coral reefs following intense perturbation macroalgae may prevent the growth of other space-occupiers, such as bioeroding sponges, under low grazing pressure.

  13. Characteristics of wild polio virus outbreak investigation and response in Ethiopia in 2013-2014: implications for prevention of outbreaks due to importations.

    Science.gov (United States)

    Tegegne, Ayesheshem Ademe; Braka, Fiona; Shebeshi, Meseret Eshetu; Aregay, Aron Kassahun; Beyene, Berhane; Mersha, Amare Mengistu; Ademe, Mohammed; Muhyadin, Abdulahi; Jima, Dadi; Wyessa, Abyot Bekele

    2018-01-05

    Ethiopia joined the Global Polio Eradication Initiative (GPEI) in 1996, and by the end of December 2001 circulation of indigenous Wild Polio Virus (WPV) had been interrupted. Nonetheless, the country experienced multiple importations during 2004-2008, and in 2013. We characterize the 2013 outbreak investigations and response activities, and document lessons learned. The data were pulled from different field investigation reports and from the national surveillance database for Acute Flaccid Paralysis (AFP). In 2013, a WPV1 outbreak was confirmed following importation in Dollo zone of the Somali region, which affected three Woredas (Warder, Geladi and Bokh). Between July 10, 2013, and January 5, 2014, there were 10 children paralyzed due to WPV1 infection. The majorities (7 of 10) were male and below 5 years of age, and 7 of 10 cases was not vaccinated, and 72% (92/129) of < 5 years of old children living in close proximity with WPV cases had zero doses of oral polio vaccine (OPV). The travel history of the cases showed that seven of the 10 cases had contact with someone who had traveled or had a travel history prior to the onset of paralysis. Underserved and inaccessibility of routine immunization service, suboptimal surveillance sensitivity, poor quality and inadequate supplemental immunization were the most crucial gaps identified during the outbreak investigations. Prior to the 2013 outbreak, Ethiopia experienced multiple imported polio outbreaks following the interruption of indigenous WPV in December 2001. The 2013 outbreak erupted due to massive population movement and was fueled by low population immunity as a result of low routine immunization and supplemental Immunization coverage and quality. In order to avert future outbreaks, it is critical that surveillance sensitivity be improved by establishing community-based surveillance systems and by assigning surveillance focal points at all level particularly in border areas. In addition, it is vital to set

  14. Direct costs associated with a nosocomial outbreak of Salmonella infection: an ounce of prevention is worth a pound of cure.

    Science.gov (United States)

    Spearing, N M; Jensen, A; McCall, B J; Neill, A S; McCormack, J G

    2000-02-01

    Nosocomial outbreaks of Salmonella infections in Australia are an infrequent but significant source of morbidity and mortality. Such an outbreak results in direct, measurable expenses for acute care management, as well as numerous indirect (and less quantifiable) costs to those affected, the hospital, and the wider community. This article describes the significant direct costs incurred as a result of a nosocomial outbreak of Salmonella infection involving patients and staff. Information on costs incurred by the hospital was gathered from a number of sources. The data were grouped into 4 sections (medical costs, investigative costs, lost productivity costs, and miscellaneous) with use of an existing tool for calculating the economic impact of foodborne illness. The outbreak cost the hospital more than AU $120, 000. (US $95,000). This amount is independent of more substantial indirect costs. Salmonella infections are preventable. Measures to aid the prevention of costly outbreaks of nosocomial salmonellosis, although available, require an investment of both time and money. We suggest that dedication of limited resources toward such preventive strategies as education is a practical and cost-effective option for health care facilities.

  15. Probiotic Saccharomyces boulardii CNCM I-745 prevents outbreak-associated Clostridium difficile-associated cecal inflammation in hamsters.

    Science.gov (United States)

    Koon, Hon Wai; Su, Bowei; Xu, Chunlan; Mussatto, Caroline C; Tran, Diana Hoang-Ngoc; Lee, Elaine C; Ortiz, Christina; Wang, Jiani; Lee, Jung Eun; Ho, Samantha; Chen, Xinhua; Kelly, Ciaran P; Pothoulakis, Charalabos

    2016-10-01

    C. difficile infection (CDI) is a common debilitating nosocomial infection associated with high mortality. Several CDI outbreaks have been attributed to ribotypes 027, 017, and 078. Clinical and experimental evidence indicates that the nonpathogenic yeast Saccharomyces boulardii CNCM I-745 (S.b) is effective for the prevention of CDI. However, there is no current evidence suggesting this probiotic can protect from CDI caused by outbreak-associated strains. We used established hamster models infected with outbreak-associated C. difficile strains to determine whether oral administration of live or heat-inactivated S.b can prevent cecal tissue damage and inflammation. Hamsters infected with C. difficile strain VPI10463 (ribotype 087) and outbreak-associated strains ribotype 017, 027, and 078 developed severe cecal inflammation with mucosal damage, neutrophil infiltration, edema, increased NF-κB phosphorylation, and increased proinflammatory cytokine TNFα protein expression. Oral gavage of live, but not heated, S.b starting 5 days before C. difficile infection significantly reduced cecal tissue damage, NF-κB phosphorylation, and TNFα protein expression caused by infection with all strains. Moreover, S.b-conditioned medium reduced cell rounding caused by filtered supernatants from all C. difficile strains. S.b-conditioned medium also inhibited toxin A- and B-mediated actin cytoskeleton disruption. S.b is effective in preventing C. difficile infection by outbreak-associated via inhibition of the cytotoxic effects of C. difficile toxins. Copyright © 2016 the American Physiological Society.

  16. Probiotic Saccharomyces boulardii CNCM I-745 prevents outbreak-associated Clostridium difficile-associated cecal inflammation in hamsters

    Science.gov (United States)

    Koon, Hon Wai; Su, Bowei; Xu, Chunlan; Mussatto, Caroline C.; Tran, Diana Hoang-Ngoc; Lee, Elaine C.; Ortiz, Christina; Wang, Jiani; Lee, Jung Eun; Ho, Samantha; Chen, Xinhua; Kelly, Ciaran P.

    2016-01-01

    C. difficile infection (CDI) is a common debilitating nosocomial infection associated with high mortality. Several CDI outbreaks have been attributed to ribotypes 027, 017, and 078. Clinical and experimental evidence indicates that the nonpathogenic yeast Saccharomyces boulardii CNCM I-745 (S.b) is effective for the prevention of CDI. However, there is no current evidence suggesting this probiotic can protect from CDI caused by outbreak-associated strains. We used established hamster models infected with outbreak-associated C. difficile strains to determine whether oral administration of live or heat-inactivated S.b can prevent cecal tissue damage and inflammation. Hamsters infected with C. difficile strain VPI10463 (ribotype 087) and outbreak-associated strains ribotype 017, 027, and 078 developed severe cecal inflammation with mucosal damage, neutrophil infiltration, edema, increased NF-κB phosphorylation, and increased proinflammatory cytokine TNFα protein expression. Oral gavage of live, but not heated, S.b starting 5 days before C. difficile infection significantly reduced cecal tissue damage, NF-κB phosphorylation, and TNFα protein expression caused by infection with all strains. Moreover, S.b-conditioned medium reduced cell rounding caused by filtered supernatants from all C. difficile strains. S.b-conditioned medium also inhibited toxin A- and B-mediated actin cytoskeleton disruption. S.b is effective in preventing C. difficile infection by outbreak-associated via inhibition of the cytotoxic effects of C. difficile toxins. PMID:27514478

  17. A statistical model of the international spread of wild poliovirus in Africa used to predict and prevent outbreaks.

    Directory of Open Access Journals (Sweden)

    Kathleen M O'Reilly

    2011-10-01

    Full Text Available Outbreaks of poliomyelitis in African countries that were previously free of wild-type poliovirus cost the Global Polio Eradication Initiative US$850 million during 2003-2009, and have limited the ability of the program to focus on endemic countries. A quantitative understanding of the factors that predict the distribution and timing of outbreaks will enable their prevention and facilitate the completion of global eradication.Children with poliomyelitis in Africa from 1 January 2003 to 31 December 2010 were identified through routine surveillance of cases of acute flaccid paralysis, and separate outbreaks associated with importation of wild-type poliovirus were defined using the genetic relatedness of these viruses in the VP1/2A region. Potential explanatory variables were examined for their association with the number, size, and duration of poliomyelitis outbreaks in 6-mo periods using multivariable regression analysis. The predictive ability of 6-mo-ahead forecasts of poliomyelitis outbreaks in each country based on the regression model was assessed. A total of 142 genetically distinct outbreaks of poliomyelitis were recorded in 25 African countries, resulting in 1-228 cases (median of two cases. The estimated number of people arriving from infected countries and <5-y childhood mortality were independently associated with the number of outbreaks. Immunisation coverage based on the reported vaccination history of children with non-polio acute flaccid paralysis was associated with the duration and size of each outbreak, as well as the number of outbreaks. Six-month-ahead forecasts of the number of outbreaks in a country or region changed over time and had a predictive ability of 82%.Outbreaks of poliomyelitis resulted primarily from continued transmission in Nigeria and the poor immunisation status of populations in neighbouring countries. From 1 January 2010 to 30 June 2011, reduced transmission in Nigeria and increased incidence in reinfected

  18. Molecular Cancer Prevention: Current Status & Future Directions

    Science.gov (United States)

    Maresso, Karen Colbert; Tsai, Kenneth Y.; Brown, Powel H.; Szabo, Eva; Lippman, Scott; Hawk, Ernest

    2016-01-01

    The heterogeneity and complexity of advanced cancers strongly supports the rationale for an enhanced focus on molecular prevention as a priority strategy to reduce the burden of cancer. Molecular prevention encompasses traditional chemopreventive agents as well as vaccinations and therapeutic approaches to cancer-predisposing conditions. Despite challenges to the field, we now have refined insights into cancer etiology and early pathogenesis; successful risk assessment and new risk models; agents with broad preventive efficacy (e.g., aspirin) in common chronic diseases, including cancer; and a successful track record of more than 10 agents approved by the FDA for the treatment of precancerous lesions or cancer risk reduction. The development of molecular preventive agents does not differ significantly from the development of therapies for advanced cancers, yet has unique challenges and special considerations given that it most often involves healthy or asymptomatic individuals. Agents, biomarkers, cohorts, overall design, and endpoints are key determinants of molecular preventive trials, as with therapeutic trials, although distinctions exist for each within the preventive setting. Progress in the development and evolution of molecular preventive agents has been steadier in some organ systems, such as breast and skin, than in others. In order for molecular prevention to be fully realized as an effective strategy, a number of challenges to the field must be addressed. Here we provide a brief overview of the context for and special considerations of molecular prevention along with a discussion of the results of major randomized controlled trials. PMID:26284997

  19. An intelligent and secure system for predicting and preventing Zika virus outbreak using Fog computing

    Science.gov (United States)

    Sareen, Sanjay; Gupta, Sunil Kumar; Sood, Sandeep K.

    2017-10-01

    Zika virus is a mosquito-borne disease that spreads very quickly in different parts of the world. In this article, we proposed a system to prevent and control the spread of Zika virus disease using integration of Fog computing, cloud computing, mobile phones and the Internet of things (IoT)-based sensor devices. Fog computing is used as an intermediary layer between the cloud and end users to reduce the latency time and extra communication cost that is usually found high in cloud-based systems. A fuzzy k-nearest neighbour is used to diagnose the possibly infected users, and Google map web service is used to provide the geographic positioning system (GPS)-based risk assessment to prevent the outbreak. It is used to represent each Zika virus (ZikaV)-infected user, mosquito-dense sites and breeding sites on the Google map that help the government healthcare authorities to control such risk-prone areas effectively and efficiently. The proposed system is deployed on Amazon EC2 cloud to evaluate its performance and accuracy using data set for 2 million users. Our system provides high accuracy of 94.5% for initial diagnosis of different users according to their symptoms and appropriate GPS-based risk assessment.

  20. Disneyland Measles Outbreak

    OpenAIRE

    Palladino, Erica

    2015-01-01

    This media information sheet analyzes print and online coverage of the 2015 Disneyland measles outbreak. The frameworks that the media used to report on the outbreak presented vaccination as the only viable option from preventing the spread of measles. Reporting also failed to mention that the 2015 Disneyland measles outbreak was smaller than U.S. measles outbreaks in 2013 and 2014.

  1. Learning from history, predicting the future: the UK Dutch elm disease outbreak in relation to contemporary tree disease threats

    Science.gov (United States)

    Potter, Clive; Harwood, Tom; Knight, Jon; Tomlinson, Isobel

    2011-01-01

    Expanding international trade and increased transportation are heavily implicated in the growing threat posed by invasive pathogens to biodiversity and landscapes. With trees and woodland in the UK now facing threats from a number of disease systems, this paper looks to historical experience with the Dutch elm disease (DED) epidemic of the 1970s to see what can be learned about an outbreak and attempts to prevent, manage and control it. The paper draws on an interdisciplinary investigation into the history, biology and policy of the epidemic. It presents a reconstruction based on a spatial modelling exercise underpinned by archival research and interviews with individuals involved in the attempted management of the epidemic at the time. The paper explores what, if anything, might have been done to contain the outbreak and discusses the wider lessons for plant protection. Reading across to present-day biosecurity concerns, the paper looks at the current outbreak of ramorum blight in the UK and presents an analysis of the unfolding epidemiology and policy of this more recent, and potentially very serious, disease outbreak. The paper concludes by reflecting on the continuing contemporary relevance of the DED experience at an important juncture in the evolution of plant protection policy. PMID:21624917

  2. Future Directions in Preventing Child Abuse.

    Science.gov (United States)

    Krugman, Richard D.

    1995-01-01

    Efforts to prevent the abuse and neglect of children requires: professionals and citizens who care to make a difference; development of multidisciplinary units, teams, or organizations to deal with specific parts of the problem; a clear statement of child protection policy; programs that work; commitment to research and program evaluation; and a…

  3. Role of healthcare workers in early epidemic spread of Ebola: policy implications of prophylactic compared to reactive vaccination policy in outbreak prevention and control.

    Science.gov (United States)

    Coltart, Cordelia E M; Johnson, Anne M; Whitty, Christopher J M

    2015-10-19

    mitigation of future epidemics than reactive strategies and, in some cases, might prevent them. However, in a confirmed outbreak, reactive vaccination would be an essential humanitarian priority. The value of HCW Ebola vaccination is often only seen in terms of personal protection of the HCW workforce. A prophylactic vaccination strategy is likely to bring substantial additional benefit by preventing early transmission and might abort some epidemics. This has implications both for policy and for the optimum product profile for vaccines currently in development.

  4. Known Predators of Crown-of-Thorns Starfish (Acanthaster spp. and Their Role in Mitigating, If Not Preventing, Population Outbreaks

    Directory of Open Access Journals (Sweden)

    Zara-Louise Cowan

    2017-01-01

    Full Text Available Predatory release has long been considered a potential contributor to population outbreaks of crown-of-thorns starfish (CoTS; Acanthaster spp.. This has initiated extensive searches for potentially important predators that can consume large numbers of CoTS at high rates, which are also vulnerable to over-fishing or reef degradation. Herein, we review reported predators of CoTS and assess the potential for these organisms to exert significant mortality, and thereby prevent and/or moderate CoTS outbreaks. In all, 80 species of coral reef organisms (including fishes, and motile and sessile invertebrates are reported to predate on CoTS gametes (three species, larvae (17 species, juveniles (15 species, adults (18 species and/or opportunistically feed on injured (10 species or moribund (42 species individuals within reef habitats. It is clear however, that predation on early life-history stages has been understudied, and there are likely to be many more species of reef fishes and/or sessile invertebrates that readily consume CoTS gametes and/or larvae. Given the number and diversity of coral reef species that consume Acanthaster spp., most of which (e.g., Arothron pufferfishes are not explicitly targeted by reef-based fisheries, links between overfishing and CoTS outbreaks remain equivocal. There is also no single species that appears to have a disproportionate role in regulating CoTS populations. Rather, the collective consumption of CoTS by multiple different species and at different life-history stages is likely to suppress the local abundance of CoTS, and thereby mediate the severity of outbreaks. It is possible therefore, that general degradation of reef ecosystems and corresponding declines in biodiversity and productivity, may contribute to increasing incidence or severity of outbreaks of Acanthaster spp. However, it seems unlikely that predatory release in and of itself could account for initial onset of CoTS outbreaks. In conclusion, reducing

  5. [Prevention of an outbreak of Acinetobacter baumannii in intensive care units: study of the efficacy of different mathematical methods].

    Science.gov (United States)

    Fresnadillo-Martínez, María José; García-Merino, Enrique; García-Sánchez, Enrique; Martín-del Rey, Ángel; Rodríguez-Encinas, Ángel; Rodríguez-Sánchez, Gerardo; García-Sánchez, José Elías

    2015-02-01

    Although in past decades, Acinetobacter baumanni infections have been sporadically identified in hospitals, nowadays the nosocomial infections due to this pathogen have notably increased. Its importance is due to its multidrug- resistance, morbidity and mortatility in healthcare settings. Consequently, it is important to predict the evolution of these outbreaks in order to stablish the most efficient control measures. There are several experimental studies shown that the compliance with hand and environmental hygiene and the efficient management of the healthcare work help to control the evolution of these outbreaks. The goal of this work is to formally proof these experimental results by means of the analysis of the results provided by the model. A stochastic mathematical model based on cellular automata was developed. The variables and parameters involved in it have been identified from the knowledge of the epidemiology and main characteristics of Acinetobacter infections. The model provides several simulations from different initial conditions. The analysis of these results proofs in a formal way that the compliance with hand and environmental hygiene and an efficient plannification of the work of healtcare workers yield a decrease in the colonized patients. Moreover, this is the unique model proposed studying the dynamics of an outbreak of A. baumanni. The computational implementation of the model provides us an efficient tool in the management of outbreaks due to A. baumanni. The analysis of the simulations obtained allows us to obtain a formal proof of the behaviour of the measures for control and prevention.

  6. Characterizing recent and projecting future potential patterns of mountain pine beetle outbreaks in the Southern Rocky Mountains

    Science.gov (United States)

    Liang, Lu; Hawbaker, Todd J.; Chen, Yanlei; Zhu, Zhi-Liang; Gong, Peng

    2014-01-01

    The recent widespread mountain pine beetle (MPB) outbreak in the Southern Rocky Mountains presents an opportunity to investigate the relative influence of anthropogenic, biologic, and physical drivers that have shaped the spatiotemporal patterns of the outbreak. The aim of this study was to quantify the landscape-level drivers that explained the dynamic patterns of MPB mortality, and simulate areas with future potential MPB mortality under projected climate-change scenarios in Grand County, Colorado, USA. The outbreak patterns of MPB were characterized by analysis of a decade-long Landsat time-series stack, aided by automatic attribution of change detected by the Landsat-based Detection of Trends in Disturbance and Recovery algorithm (LandTrendr). The annual area of new MPB mortality was then related to a suite of anthropogenic, biologic, and physical predictor variables under a general linear model (GLM) framework. Data from years 2001–2005 were used to train the model and data from years 2006–2011 were retained for validation. After stepwise removal of non-significant predictors, the remaining predictors in the GLM indicated that neighborhood mortality, winter mean temperature anomaly, and residential housing density were positively associated with MPB mortality, whereas summer precipitation was negatively related. The final model had an average area under the curve (AUC) of a receiver operating characteristic plot value of 0.72 in predicting the annual area of new mortality for the independent validation years, and the mean deviation from the base maps in the MPB mortality areal estimates was around 5%. The extent of MPB mortality will likely expand under two climate-change scenarios (RCP 4.5 and 8.5) in Grand County, which implies that the impacts of MPB outbreaks on vegetation composition and structure, and ecosystem functioning are likely to increase in the future.

  7. Outbreak of resistant Acinetobacter baumannii- measures and proposal for prevention and control.

    Science.gov (United States)

    Romanelli, Roberta Maia de Castro; Jesus, Lenize Adriana de; Clemente, Wanessa Trindade; Lima, Stella Sala Soares; Rezende, Edna Maria; Coutinho, Rosane Luiza; Moreira, Ricardo Luiz Fontes; Neves, Francelli Aparecida Cordeiro; Brás, Nelma de Jesus

    2009-10-01

    Acinetobacter baumannii colonization and infection, frequent in Intensive Care Unit (ICU) patients, is commonly associated with high morbimortality. Several outbreaks due to multidrug-resistant (MDR) A. baumanii have been reported but few of them in Brazil. This study aimed to identify risk factors associated with colonization and infection by MDR and carbapenem-resistant A. baumannii strains isolated from patients admitted to the adult ICU at HC/UFMG. A case-control study was performed from January 2007 to June 2008. Cases were defined as patients colonized or infected by MDR/carbapenem-resistant A. baumannii, and controls were patients without MDR/carbapenem-resistant A. baumannii isolation, in a 1:2 proportion. For statistical analysis, due to changes in infection control guidelines, infection criteria and the notification process, this study was divided into two periods. During the first period analyzed, from January to December 2007, colonization or infection by MDR/carbapenem-resistant A. baumannii was associated with prior infection, invasive device utilization, prior carbapenem use and clinical severity. In the multivariate analysis, prior infection and mechanical ventilation proved to be statistically significant risk factors. Carbapenem use showed a tendency towards a statistical association. During the second study period, from January to June 2008, variables with a significant association with MDR/carbapenem-resistant A. baumannii colonization/infection were catheter utilization, carbapenem and third-generation cephalosporin use, hepatic transplantation, and clinical severity. In the multivariate analysis, only CVC use showed a statistical difference. Carbapenem and third-generation cephalosporin use displayed a tendency to be risk factors. Risk factors must be focused on infection control and prevention measures considering A. baumanni dissemination.

  8. Outbreak of resistant Acinetobacter baumannii: measures and proposal for prevention and control

    Directory of Open Access Journals (Sweden)

    Roberta Maia de Castro Romanelli

    Full Text Available Acinetobacter baumannii colonization and infection, frequent in Intensive Care Unit (ICU patients, is commonly associated with high morbimortality. Several outbreaks due to multidrug-resistant (MDR A. baumanii have been reported but few of them in Brazil. This study aimed to identify risk factors associated with colonization and infection by MDR and carbapenem-resistant A. baumannii strains isolated from patients admitted to the adult ICU at HC/UFMG. A case-control study was performed from January 2007 to June 2008. Cases were defined as patients colonized or infected by MDR/carbapenem-resistant A. baumannii, and controls were patients without MDR/carbapenem-resistant A. baumannii isolation, in a 1:2 proportion. For statistical analysis, due to changes in infection control guidelines, infection criteria and the notification process, this study was divided into two periods. During the first period analyzed, from January to December 2007, colonization or infection by MDR/carbapenem-resistant A. baumannii was associated with prior infection, invasive device utilization, prior carbapenem use and clinical severity. In the multivariate analysis, prior infection and mechanical ventilation proved to be statistically significant risk factors. Carbapenem use showed a tendency towards a statistical association. During the second study period, from January to June 2008, variables with a significant association with MDR/carbapenem-resistant A. baumannii colonization/infection were catheter utilization, carbapenem and third-generation cephalosporin use, hepatic transplantation, and clinical severity. In the multivariate analysis, only CVC use showed a statistical difference. Carbapenem and third-generation cephalosporin use displayed a tendency to be risk factors. Risk factors must be focused on infection control and prevention measures considering A. baumanni dissemination.

  9. Future of obesity prevention and treatment.

    Science.gov (United States)

    Ness-Abramof, Rosane; Apovian, Caroline M

    2009-01-01

    The prevalence of obesity has risen sharply during the last 4 decades imposing a serious health burden to modern society. Obesity is known to cause and exacerbate many chronic diseases such as diabetes, hypertension, dyslipidemia, coronary heart disease, stroke, obstructive sleep apnea and certain cancers, among many others. The rise in obesity prevalence is mainly caused by overconsumption of energy, coupled to a sedentary life in susceptible individuals. Weight homeostasis is paramount for survival and its control is coordinated by neural and endocrine signals emanating from the fat tissue, digestive system and brain. During thousands of years humans were challenged by nutrient deprivation, developing an efficient mechanism to store energy. It explains the difficulty in losing weight, making obesity prevention the main effective health approach to halt the obesity epidemic.

  10. Phocine distemper virus (PDV) seroprevalence as predictor for future outbreaks in harbour seals.

    Science.gov (United States)

    Ludes-Wehrmeister, Eva; Dupke, Claudia; Harder, Timm C; Baumgärtner, Wolfgang; Haas, Ludwig; Teilmann, Jonas; Dietz, Rune; Jensen, Lasse F; Siebert, Ursula

    2016-02-01

    Phocine distemper virus (PDV) infections caused the two most pronounced mass mortalities in marine mammals documented in the past century. During the two outbreaks, 23,000 and 30,000 harbour seals (Phoca vitulina), died in 1988/1989 and 2002 across populations in the Wadden Sea and adjacent waters, respectively. To follow the mechanism and development of disease spreading, the dynamics of Morbillivirus-specific antibodies in harbour seal populations in German and Danish waters were examined. 522 serum samples of free-ranging harbour seals of different ages were sampled between 1990 and 2014. By standard neutralisation assays, Morbillivirus-specific antibodies were detected, using either the PDV isolate 2558/Han 88 or the related canine distemper virus (CDV) strain Onderstepoort. A total of 159 (30.5%) of the harbour seals were seropositive. Annual seroprevalence rates showed an undulating course: Peaks were seen in the post-epidemic years 1990/1991 and 2002/2003. Following each PDV outbreak, seroprevalence decreased and six to eight years after the epidemics samples were tested seronegative, indicating that the populations are now again susceptible to new PDV outbreak. After the last outbreak in 2002, the populations grew steadily to an estimated maximum (since 1975) of about 39,100 individuals in the Wadden Sea in 2014 and about 23,540 harbour seals in the Kattegat area in 2013. A re-appearence of PDV would presumably result in another epizootic with high mortality rates as encountered in the previous outbreaks. The current high population density renders harbour seals vulnerable to rapid spread of infectious agents including PDV and the recently detected influenza A virus. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Impact of infection prevention and control training on health facilities during the Ebola virus disease outbreak in Guinea.

    Science.gov (United States)

    Keïta, Mory; Camara, Ansoumane Yassima; Traoré, Falaye; Camara, Mohamed ElMady; Kpanamou, André; Camara, Sékou; Tolno, Aminata; Houndjo, Bienvenu; Diallo, Fatimatou; Conté, Fatoumata; Subissi, Lorenzo

    2018-04-24

    In 2014-2016, West Africa faced the most deadly Ebola Virus Disease (EVD) outbreak in history. A key strategy to overcome this outbreak was continual staff training in Infection Prevention and Control (IPC), with a focus on Ebola. This research aimed to evaluate the impact of IPC training and the quality of IPC performance in health care facilities of one municipality of Conakry, Guinea. This study was conducted in February 2016. All health facilities within Ratoma municipality, Conakry, Guinea, were evaluated based on IPC performance standards developed by the Guinean Ministry of Health. The IPC performance of healthcare facilities was categorised into high or low IPC scores based on the median IPC score of the sample. The Mantel-Haenzsel method and logistic regression were used for statistical analysis. Twenty-five percent of health centres had one IPC-trained worker, 53% had at least two IPC-trained workers, and 22% of health centres had no IPC-trained workers. An IPC score above median was positively associated with the number of trained staff; health centres with two or more IPC-trained workers were eight times as likely to have an IPC score above median, while those with one IPC-trained worker were four times as likely, compared to centres with no trained workers. Health centres that implemented IPC cascade training to untrained medical staff were five times as likely to have an IPC score above median. This research highlights the importance of training healthcare staff in IPC and organising regular cascade trainings. IPC strategies implemented during the outbreak should continue to be reinforced for the better health of patients and medical staff, and be considered a key factor in any outbreak response.

  12. Role of cancer awareness in prevention of its outbreak: current scenario in Pakistan

    International Nuclear Information System (INIS)

    Saif, R.; Yousaf, M.Z.

    2011-01-01

    Cancer is one of the major threats to mankind after heart diseases. In developing countries, malnutrition and parasitic infections are more serious but cancer has a unique significance because roughly one in the five persons on the face of earth expires due to this ailment. It is traditionally thought to be a disease that has a strong bond with industrial revolution, modem world and chemicals exposed life style on the planet. Excluding the other cancers, solely breast cancer contributes 45% of its cases and 55% deaths occur in low and middle income countries like Pakistan who are in the queue of that transition stage of modernism once faced by the nations. In this review, we discuss the epidemiology, causes, challenges, screening and managerial issues along with a bird's eye view of cancer status in Pakistan that might be helpful in devising preventive and treatment strategies in the future. (author)

  13. Technology-based suicide prevention: current applications and future directions.

    Science.gov (United States)

    Luxton, David D; June, Jennifer D; Kinn, Julie T

    2011-01-01

    This review reports on current and emerging technologies for suicide prevention. Technology-based programs discussed include interactive educational and social networking Web sites, e-mail outreach, and programs that use mobile devices and texting. We describe innovative applications such as virtual worlds, gaming, and text analysis that are currently being developed and applied to suicide prevention and outreach programs. We also discuss the benefits and limitations of technology-based applications and discuss future directions for their use.

  14. Developing new approaches for detecting and preventing Aedes aegypti population outbreaks: basis for surveillance, alert and control system

    Directory of Open Access Journals (Sweden)

    Lêda Regis

    2008-02-01

    Full Text Available A new approach to dengue vector surveillance based on permanent egg-collection using a modified ovitrap and Bacillus thuringiensis israelensis(Bti was evaluated in different urban landscapes in Recife, Northeast Brazil. From April 2004 to April 2005, 13 egg-collection cycles of four weeks were carried out. Geo-referenced ovitraps containing grass infusion, Bti and three paddles were placed at fixed sampling stations distributed over five selected sites. Continuous egg-collections yielded more than four million eggs laid into 464 sentinel-ovitraps over one year. The overall positive ovitrap index was 98.5% (over 5,616 trap observations. The egg density index ranged from 100 to 2,500 eggs per trap-cycle, indicating a wide spread and high density of Aedes aegypti (Diptera: Culicidae breeding populations in all sites. Fluctuations in population density over time were observed, particularly a marked increase from January on, or later, according to site. Massive egg-collection carried out at one of the sites prevented such a population outbreak. At intra-site level, egg counts made it possible to identify spots where the vector population is consistently concentrated over the time, pinpointing areas that should be considered high priority for control activities. The results indicate that these could be promising strategies for detecting and preventing Ae. aegypti population outbreaks.

  15. Improved laboratory capacity is required to respond better to future cholera outbreaks in Papua New Guinea

    Directory of Open Access Journals (Sweden)

    Paul Horwood

    2012-05-01

    Full Text Available Cholera was first detected in Papua New Guinea in July 2009, caused by Vibrio cholerae O1 El Tor serotype Ogawa. By late 2011, 15 500 cases had been reported throughout lowland Papua New Guinea with a case fatality rate of 3.2%. The epidemic has since slowed, with only sporadic cases reported in Western Province and the Autonomous Region of Bougainville (ARB. Accurate and timely diagnosis is a critical element of the public health response to cholera, yet in low-income countries where the burden of cholera is the greatest, diagnostic services are often limited. Here we report on the diagnostic challenges and the logistical factors that impacted on diagnosis during the first reported outbreak of cholera in Papua New Guinea.

  16. Environmental scan of infection prevention and control practices for containment of hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada.

    Science.gov (United States)

    Ocampo, Wrechelle; Geransar, Rose; Clayden, Nancy; Jones, Jessica; de Grood, Jill; Joffe, Mark; Taylor, Geoffrey; Missaghi, Bayan; Pearce, Craig; Ghali, William; Conly, John

    2017-10-01

    Ward closure is a method of controlling hospital-acquired infectious diseases outbreaks and is often coupled with other practices. However, the value and efficacy of ward closures remains uncertain. To understand the current practices and perceptions with respect to ward closure for hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada. A Web-based environmental scan survey was developed by a team of infection prevention and control (IPC) experts and distributed to 235 IPC professionals at acute care sites across Canada. Data were analyzed using a mixed-methods approach of descriptive statistics and thematic analysis. A total of 110 completed responses showed that 70% of sites reported at least 1 outbreak during 2013, 44% of these sites reported the use of ward closure. Ward closure was considered an "appropriate," "sometimes appropriate," or "not appropriate" strategy to control outbreaks by 50%, 45%, and 5% of participants, respectively. System capacity issues and overall risk assessment were main factors influencing the decision to close hospital wards following an outbreak. Results suggest the use of ward closure for containment of hospital-acquired infectious disease outbreaks in Canadian acute care health settings is mixed, with outbreak control methods varying. The successful implementation of ward closure was dependent on overall support for the IPC team within hospital administration. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  17. Economic appraisal of the public control and prevention strategy against the 2010 West Nile Virus outbreak in Central Macedonia, Greece.

    Science.gov (United States)

    Kolimenakis, A; Bithas, K; Richardson, C; Latinopoulos, D; Baka, A; Vakali, A; Hadjichristodoulou, C; Mourelatos, S; Kalaitzopoulou, S; Gewehr, S; Michaelakis, A; Koliopoulos, G

    2016-02-01

    The aim of the present paper is to evaluate the economic efficiency of the public control and prevention strategies to tackle the 2010 West Nile Virus (WNV) outbreak in the Region of Central Macedonia, Greece. Efficiency is examined on the basis of the public prevention costs incurred and their potential in justifying the costs arising from health and nuisance impacts in the succeeding years. Economic appraisal of public health management interventions. Prevention and control cost categories including control programmes, contingency planning and blood safety testing, are analyzed based on market prices. A separate cost of illness approach is conducted for the estimation of medical costs and productivity losses from 2010 to 2013 and for the calculation of averted health impacts. The averted mosquito nuisance costs to households are estimated on the basis of a contingent valuation study. Based on these findings, a limited cost-benefit analysis is employed in order to evaluate the economic efficiency of these strategies in 2010-2013. Results indicate that cost of illness and prevention costs fell significantly in the years following the 2010 outbreak, also as a result of the epidemic coming under control. According to the contingent valuation survey, the annual average willingness to pay to eliminate the mosquito problem in the study area ranged between 22 and 27 € per household. Cost-benefit analysis indicates that the aggregate benefit of implementing the previous 3-year strategy creates a net socio-economic benefit in 2013. However the spread of the WNV epidemic and the overall socio-economic consequences, had the various costs not been employed, remain unpredictable and extremely difficult to calculate. The application of a post epidemic strategy appears to be of utmost importance for public health safety. An updated well designed survey is needed for a more precise definition of the optimum prevention policies and levels and for the establishment of the various

  18. Strategies for preventing invasive plant outbreaks after prescribed fire in ponderosa pine forest

    Science.gov (United States)

    Symstad, Amy J.; Newton, Wesley E.; Swanson, Daniel J.

    2014-01-01

    Land managers use prescribed fire to return a vital process to fire-adapted ecosystems, restore forest structure from a state altered by long-term fire suppression, and reduce wildfire intensity. However, fire often produces favorable conditions for invasive plant species, particularly if it is intense enough to reveal bare mineral soil and open previously closed canopies. Understanding the environmental or fire characteristics that explain post-fire invasive plant abundance would aid managers in efficiently finding and quickly responding to fire-caused infestations. To that end, we used an information-theoretic model-selection approach to assess the relative importance of abiotic environmental characteristics (topoedaphic position, distance from roads), pre-and post-fire biotic environmental characteristics (forest structure, understory vegetation, fuel load), and prescribed fire severity (measured in four different ways) in explaining invasive plant cover in ponderosa pine forest in South Dakota’s Black Hills. Environmental characteristics (distance from roads and post-fire forest structure) alone provided the most explanation of variation (26%) in post-fire cover of Verbascum thapsus (common mullein), but a combination of surface fire severity and environmental characteristics (pre-fire forest structure and distance from roads) explained 36–39% of the variation in post-fire cover of Cirsium arvense (Canada thistle) and all invasives together. For four species and all invasives together, their pre-fire cover explained more variation (26–82%) in post-fire cover than environmental and fire characteristics did, suggesting one strategy for reducing post-fire invasive outbreaks may be to find and control invasives before the fire. Finding them may be difficult, however, since pre-fire environmental characteristics explained only 20% of variation in pre-fire total invasive cover, and less for individual species. Thus, moderating fire intensity or targeting areas

  19. Importance of Internet surveillance in public health emergency control and prevention: evidence from a digital epidemiologic study during avian influenza A H7N9 outbreaks.

    Science.gov (United States)

    Gu, Hua; Chen, Bin; Zhu, Honghong; Jiang, Tao; Wang, Xinyi; Chen, Lei; Jiang, Zhenggang; Zheng, Dawei; Jiang, Jianmin

    2014-01-17

    Outbreaks of human infection with a new avian influenza A H7N9 virus occurred in China in the spring of 2013. Control and prevention of a new human infectious disease outbreak can be strongly affected by public reaction and social impact through the Internet and social media. This study aimed to investigate the potential roles of Internet surveillance in control and prevention of the human H7N9 outbreaks. Official data for the human H7N9 outbreaks were collected via the China National Health and Family Planning Committee website from March 31 to April 24, 2013. We obtained daily posted and forwarded number of blogs for the keyword "H7N9" from Sina microblog website and a daily Baidu Attention Index (BAI) from Baidu website, which reflected public attention to the outbreak. Rumors identified and confirmed by the authorities were collected from Baidu search engine. Both daily posted and forwarded number and BAI for keyword H7N9 increased quickly during the first 3 days of the outbreaks and remained at a high level for 5 days. The total daily posted and forwarded number for H7N9 on Sina microblog peaked at 850,000 on April 3, from zero blogs before March 31, increasing to 97,726 on April 1 and to 370,607 on April 2, and remaining above 500,000 from April 5-8 before declining to 208,524 on April 12. The total daily BAI showed a similar pattern of change to the total daily posted and forwarded number over time from March 31 to April 12. When the outbreak locations spread, especially into other areas of the same province/city and the capital, Beijing, daily posted and forwarded number and BAI increased again to a peak at 368,500 and 116,911, respectively. The median daily BAI during the studied 25 days was significantly higher among the 7 provinces/cities with reported human H7N9 cases than the 2 provinces without any cases (Psocial media. The first 3 days of an epidemic is a critical period for the authorities to take appropriate action through Internet surveillance to

  20. Prevention, detection, and response to anthrax outbreak in Northern Tanzania using one health approach: A case study of Selela ward in Monduli district

    Directory of Open Access Journals (Sweden)

    Elibariki R. Mwakapeje

    2017-11-01

    Full Text Available Background: Anthrax is an infectious fatal zoonotic disease caused by Bacillus anthracis. Anthrax outbreak was confirmed in samples of wild animals following rumors of the outbreak in wild animals, livestock, and humans in Selela ward, Monduli district of Northern Tanzania. Therefore, a multi-sectorial team was deployed for outbreak response in the affected areas. Objectives: The aim of the response was to manage the outbreak in a One Health approach and specifically: (i To determine the magnitude of anthrax outbreak in humans, livestock, and wild animals in Selela ward, (ii to assess the outbreak local response capacity, (iii to establish mechanisms for safe disposal of animal carcasses in the affected areas, and (iv to mount effective control and preventive strategies using One Health approach in the affected areas. Materials and Methods: This was a cross-sectional field survey using: (i Active searching of suspected human cases at health facilities and community level, (ii physical counting and disposal of wild animal carcasses in the affected area, (iii collection of specimens from suspected human cases and animal carcasses for laboratory analysis, and (iv meetings with local animal and human health staff, political, and traditional leaders at local levels. We analyzed data by STATA software, and a map was created using Quantum GIS software. Results: A total of 21 humans were suspected, and most of them (62% being from Selela ward. The outbreak caused deaths of 10 cattle, 26 goats, and three sheep, and 131 wild animal carcasses were discarded the majority of them being wildebeest (83%. Based on laboratory results, three blood smears tested positive for anthrax using Giemsa staining while two wildebeest samples tested positive and five human blood samples tested negative for anthrax using quantitative polymerase chain reaction techniques. Clinical forms of anthrax were also observed in humans and livestock which suggest that wild animals may

  1. Prevention of Rheumatic Diseases: Strategies, Caveats and Future Directions

    Science.gov (United States)

    Finckh, Axel

    2014-01-01

    Rheumatic diseases affect a significant portion of the population and lead to increased health care costs, disability and even premature mortality; as such, effective preventive measures for these diseases could lead to substantial improvements in public health. Importantly, established and emerging data from natural history studies show that for most rheumatic diseases there is a period of ‘preclinical’ disease development during which abnormal biomarkers or other processes can be detected. These changes are useful to understand mechanisms of disease pathogenesis; in addition, they may be applied to estimate a personal risk of future disease, while individuals are still relatively asymptomatic. Based on this, a hope is to implement effective screening and preventive approaches for some rheumatic diseases, perhaps in the near future. However, a key part of such approaches is a deep understanding of the mechanisms of disease development as well as evidence-based and effective screening and preventive interventions that incorporate disease biology as well as ethical and public health concerns. PMID:25437291

  2. Cyberbullying Prevention and Intervention Efforts: Current Knowledge and Future Directions

    Science.gov (United States)

    Hong, Jun Sung

    2016-01-01

    Bullying is a serious public health concern that is associated with significant negative mental, social, and physical outcomes. Technological advances have increased adolescents’ use of social media, and online communication platforms have exposed adolescents to another mode of bullying—cyberbullying. Prevention and intervention materials, from websites and tip sheets to classroom curriculum, have been developed to help youth, parents, and teachers address cyberbullying. While youth and parents are willing to disclose their experiences with bullying to their health care providers, these disclosures need to be taken seriously and handled in a caring manner. Health care providers need to include questions about bullying on intake forms to encourage these disclosures. The aim of this article is to examine the current status of cyberbullying prevention and intervention. Research support for several school-based intervention programs is summarised. Recommendations for future research are provided. PMID:28562094

  3. Cyberbullying Prevention and Intervention Efforts: Current Knowledge and Future Directions.

    Science.gov (United States)

    Espelage, Dorothy L; Hong, Jun Sung

    2017-06-01

    Bullying is a serious public health concern that is associated with significant negative mental, social, and physical outcomes. Technological advances have increased adolescents' use of social media, and online communication platforms have exposed adolescents to another mode of bullying- cyberbullying. Prevention and intervention materials, from websites and tip sheets to classroom curriculum, have been developed to help youth, parents, and teachers address cyberbullying. While youth and parents are willing to disclose their experiences with bullying to their health care providers, these disclosures need to be taken seriously and handled in a caring manner. Health care providers need to include questions about bullying on intake forms to encourage these disclosures. The aim of this article is to examine the current status of cyberbullying prevention and intervention. Research support for several school-based intervention programs is summarised. Recommendations for future research are provided.

  4. It’s not only what you say, it’s also how you say it: communicating Nipah virus prevention messages during an outbreak in Bangladesh

    Directory of Open Access Journals (Sweden)

    Shahana Parveen

    2016-08-01

    Full Text Available Abstract Background During a fatal Nipah virus (NiV outbreak in Bangladesh, residents rejected biomedical explanations of NiV transmission and treatment and lost trust in the public healthcare system. Field anthropologists developed and communicated a prevention strategy to bridge the gap between the biomedical and local explanation of the outbreak. Methods We explored residents’ beliefs and perceptions about the illness and care-seeking practices and explained prevention messages following an interactive strategy with the aid of photos showed the types of contact that can lead to NiV transmission from bats to humans by drinking raw date palm sap and from person-to-person. Results The residents initially believed that the outbreak was caused by supernatural forces and continued drinking raw date palm sap despite messages from local health authorities to stop. Participants in community meetings stated that the initial messages did not explain that bats were the source of this virus. After our intervention, participants responded that they now understood how NiV could be transmitted and would abstain from raw sap consumption and maintain safer behaviours while caring for patients. Conclusions During outbreaks, one-way behaviour change communication without meaningful causal explanations is unlikely to be effective. Based on the cultural context, interactive communication strategies in lay language with supporting evidence can make biomedical prevention messages credible in affected communities, even among those who initially invoke supernatural causal explanations.

  5. It's not only what you say, it's also how you say it: communicating nipah virus prevention messages during an outbreak in Bangladesh.

    Science.gov (United States)

    Parveen, Shahana; Islam, M Saiful; Begum, Momtaz; Alam, Mahbub-Ul; Sazzad, Hossain M S; Sultana, Rebeca; Rahman, Mahmudur; Gurley, Emily S; Hossain, M Jahangir; Luby, Stephen P

    2016-08-05

    During a fatal Nipah virus (NiV) outbreak in Bangladesh, residents rejected biomedical explanations of NiV transmission and treatment and lost trust in the public healthcare system. Field anthropologists developed and communicated a prevention strategy to bridge the gap between the biomedical and local explanation of the outbreak. We explored residents' beliefs and perceptions about the illness and care-seeking practices and explained prevention messages following an interactive strategy with the aid of photos showed the types of contact that can lead to NiV transmission from bats to humans by drinking raw date palm sap and from person-to-person. The residents initially believed that the outbreak was caused by supernatural forces and continued drinking raw date palm sap despite messages from local health authorities to stop. Participants in community meetings stated that the initial messages did not explain that bats were the source of this virus. After our intervention, participants responded that they now understood how NiV could be transmitted and would abstain from raw sap consumption and maintain safer behaviours while caring for patients. During outbreaks, one-way behaviour change communication without meaningful causal explanations is unlikely to be effective. Based on the cultural context, interactive communication strategies in lay language with supporting evidence can make biomedical prevention messages credible in affected communities, even among those who initially invoke supernatural causal explanations.

  6. Impact of infectious disease epidemics on tuberculosis diagnostic, management, and prevention services: experiences and lessons from the 2014–2015 Ebola virus disease outbreak in West Africa

    Directory of Open Access Journals (Sweden)

    Rashid Ansumana

    2017-03-01

    Full Text Available The World Health Organization (WHO Global Tuberculosis Report 2015 states that 28% of the world's 9.6 million new tuberculosis (TB cases are in the WHO Africa Region. The Mano River Union (MRU countries of West Africa–Guinea, Sierra Leone, and Liberia–have made incremental sustained investments into TB control programmes over the past two decades. The devastating Ebola virus disease (EVD outbreak of 2014–2015 in West Africa impacted significantly on all sectors of the healthcare systems in the MRU countries, including the TB prevention and control programmes. The EVD outbreak also had an adverse impact on the healthcare workforce and healthcare service delivery. At the height of the EVD outbreak, numerous staff members in all MRU countries contracted EBV at the Ebola treatment units and died. Many healthcare workers were also infected in healthcare facilities that were not Ebola treatment units but were national hospitals and peripheral health units that were unprepared for receiving patients with EVD. In all three MRU countries, the disruption to TB services due to the EVD epidemic will no doubt have increased Mycobacterium tuberculosis transmission, TB morbidity and mortality, and decreased patient adherence to TB treatment, and the likely impact will not be known for several years to come. In this viewpoint, the impact that the EVD outbreak had on TB diagnostic, management, and prevention services is described. Vaccination against TB with BCG in children under 5 years of age was affected adversely by the EVD epidemic. The EVD outbreak was a result of global failure and represents yet another ‘wake-up call’ to the international community, and particularly to African governments, to reach a consensus on new ways of thinking at the national, regional, and global levels for building healthcare systems that can sustain their function during outbreaks. This is necessary so that other disease control programmes (like those for TB, malaria

  7. Oral antiviral therapy for prevention of genital herpes outbreaks in immunocompetent and nonpregnant patients.

    Science.gov (United States)

    Le Cleach, Laurence; Trinquart, Ludovic; Do, Giao; Maruani, Annabel; Lebrun-Vignes, Benedicte; Ravaud, Philippe; Chosidow, Olivier

    2014-08-03

    Genital herpes is caused by herpes simplex virus 1 (HSV-1) or 2 (HSV-2). Some infected people experience outbreaks of genital herpes, typically, characterized by vesicular and erosive localized painful genital lesions. To compare the effectiveness and safety of three oral antiviral drugs (acyclovir, famciclovir and valacyclovir) prescribed to suppress genital herpes outbreaks in non-pregnant patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the search portal of the World Health Organization International Clinical Trials Registry Platform and pharmaceutical company databases up to February 2014. We also searched US Food and Drug Administration databases and proceedings of seven congresses to a maximum of 10 years. We contacted trial authors and pharmaceutical companies. We selected parallel-group and cross-over randomized controlled trials including patients with recurrent genital herpes caused by HSV, whatever the type (HSV-1, HSV-2, or undetermined), with at least four recurrences per year (trials concerning human immunodeficiency virus (HIV)-positive patients or pregnant women were not eligible) and comparing suppressive oral antiviral treatment with oral acyclovir, famciclovir, and valacyclovir versus placebo or another suppressive oral antiviral treatment. Two review authors independently selected eligible trials and extracted data. The Risk of bias tool was used to assess risk of bias. Treatment effect was measured by the risk ratio (RR) of having at least one genital herpes recurrence. Pooled RRs were derived by conventional pairwise meta-analyses. A network meta-analysis allowed for estimation of all possible two-by-two comparisons between antiviral drugs. A total of 26 trials (among which six had a cross-over design) were included. Among the 6950 randomly assigned participants, 54% (range 0 to 100%) were female, mean age was 35 years (range 26 to 45.1), and the mean number of recurrences per year was 11

  8. Epidemiological investigation of an outbreak of hepatitis A in rural China

    Directory of Open Access Journals (Sweden)

    Ping Yu

    2015-04-01

    Conclusion: The pattern of transmission in this outbreak was person-to-person, and the transmission route was indicated to be fecal–oral. In addition to close contact, insufficient hand-washing was a risk factor. Strengthening the management of the rural environmental sanitation services and enhancing awareness in the household are key to preventing outbreaks of hepatitis A in the future.

  9. Effects of a five-year citywide intervention program to control Aedes aegypti and prevent dengue outbreaks in northern Argentina.

    Directory of Open Access Journals (Sweden)

    Ricardo E Gürtler

    Full Text Available Dengue has propagated widely through the Americas. Most countries have not been able to maintain permanent larval mosquito control programs, and the long-term effects of control actions have rarely been documented.The study design was based on a before-and-after citywide assessment of Aedes aegypti larval indices and the reported incidence of dengue in Clorinda, northeastern Argentina, over 2003-2007. Interventions were mainly based on focal treatment with larvicides of every mosquito developmental site every four months (14 cycles, combined with limited source reduction efforts and ultra-low-volume insecticide spraying during emergency operations. The program conducted 120,000 house searches for mosquito developmental sites and 37,000 larvicide applications.Random-effects regression models showed that Breteau indices declined significantly in nearly all focal cycles compared to pre-intervention indices clustered by neighborhood, after allowing for lagged effects of temperature and rainfall, baseline Breteau index, and surveillance coverage. Significant heterogeneity between neighborhoods was revealed. Larval indices seldom fell to 0 shortly after interventions at the same blocks. Large water-storage containers were the most abundant and likely to be infested. The reported incidence of dengue cases declined from 10.4 per 10,000 in 2000 (by DEN-1 to 0 from 2001 to 2006, and then rose to 4.5 cases per 10,000 in 2007 (by DEN-3. In neighboring Paraguay, the reported incidence of dengue in 2007 was 30.6 times higher than that in Clorinda.Control interventions exerted significant impacts on larval indices but failed to keep them below target levels during every summer, achieved sustained community acceptance, most likely prevented new dengue outbreaks over 2003-2006, and limited to a large degree the 2007 outbreak. For further improvement, a shift is needed towards a multifaceted program with intensified coverage and source reduction efforts, lids or

  10. Primary prevention of diabetes mellitus: current strategies and future trends

    Directory of Open Access Journals (Sweden)

    Prasanta K. Bhattacharya

    2016-04-01

    Full Text Available Aim of this paper is to find evidence for primary prevention of type-2 diabetes mellitus (T2DM from epidemiological studies and clinical trials, and the feasibility of applying these interventions in resource limited countries. T2DM, which accounts for more than nine-tenths of all diabetics, results from inadequate insulin secretion or underlying insulin resistance. The prevalence of diabetes, mainly T2DM, has increased rapidly during the last few decades worldwide. Since the genetic background is unlikely to change during this short time period, the growing epidemic of T2DM is more likely due to changes in environmental or lifestyle risk factors including obesity, physical inactivity, smoking, alcohol and stress. The scope and feasibility for primary prevention of T2DM is based on elimination of these risk factors. This evidence that T2DM is preventable comes from epidemiologic studies and clinical trials of effect of lifestyle changes and drugs in development of T2DM. The positive effects are more profound and safer with lifestyle modifications (LSM compared to medications. This is shown to be effective globally, across various ethnicities and races and sustainable on long-term follow-up. However, there is a major challenge in translating this evidence into economically viable and sustained community programs, as these LSM interventions are expensive, even from western standards point of view. Future plan should focus on health education of the public, improving the national capacity to detect and manage the environmental risks including strategies to reduce stress, and development of innovative, cost effective, and scalable methodologies.

  11. Societal impact of dengue outbreaks: Stakeholder perceptions and related implications. A qualitative study in Brazil, 2015.

    Science.gov (United States)

    Ladner, Joël; Rodrigues, Mariana; Davis, Ben; Besson, Marie-Hélène; Audureau, Etienne; Saba, Joseph

    2017-03-01

    The growing burden of dengue in many countries worldwide and the difficulty of preventing outbreaks have increased the urgency to identify alternative public health management strategies and effective approaches to control and prevent dengue outbreaks. The objectives of this study were to understand the impact of dengue outbreak on different stakeholders in Brazil, to explore their perceptions of approaches used by governmental authorities to control and prevent dengue outbreaks and to define the challenges and implications of preventing future outbreaks. In 2015, a qualitative study was conducted in two urban states in Brazil: São Paulo, which was experiencing an outbreak in 2015, and Rio de Janeiro, which experienced outbreaks in 2011 and 2012. Face-to-face interviews using a semi-structured questionnaire were conducted with nine different categories of stakeholders: health workers (physicians, nurses), hospital administrators, municipal government representatives, community members and leaders, school administrators, business leaders and vector control managers. Interviews were focused on the following areas: impact of the dengue outbreak, perceptions of control measures implemented by governmental authorities during outbreaks and challenges in preventing future dengue outbreaks. A total of 40 stakeholders were included in the study. Health workers and community members reported longer waiting times at hospitals due to the increased number of patients receiving care for dengue-related symptoms. Health workers and hospital administrators reported that there were no major interruptions in access to care. Overall financial impact of dengue outbreaks on households was greatest for low-income families. Despite prevention and control campaigns implemented between outbreak periods, various stakeholders reported that dengue prevention and control efforts performed by municipal authorities remained insufficient, suggesting that efforts should be reinforced and better

  12. Field note from Pakistan floods: Preventing future flood disasters

    Directory of Open Access Journals (Sweden)

    Marcus Oxley

    2011-04-01

    Full Text Available Unusually heavy monsoon rains in Northern Pakistan have caused disproportionate levels of extreme flooding and unprecedented flood losses across the entire Indus River basin. Extensive land use changes and environmental degradation in the uplands and lowlands of the river basin together with the construction of a “built environment” out of balance with the functioning, capacities, scale and limits of the local ecosystems have exposed millions of people to an increased risk of extreme #ooding. The catastrophic nature of the August #ooding provides a unique opportunity to fundamentally change Pakistan’s current socio-economic development path by incorporating disaster risk reduction and climate change measures into the post-disaster recovery process to rebuild a safer, more resilient nation. In January 2005 one hundred and sixty-eight nations adopted the Hyogo Framework for Action (HFA2005-2015 to bring about a “substantial reduction in disaster losses” by 2015. Despite this global initiative a series of major disasters, including the recent flooding in Pakistan, all indicate that we are not on track to achieve the substantial reduction of disaster losses. The following fieldnote considers what can be done to accelerate progress towards implementation of the Hyogo Framework, drawing on insights and lessons learnt from the August flooding to understand how Pakistan and neighbouring countries can prevent a repeat of such catastrophic disasters in future years.

  13. [Waterborne diseases outbreaks in the Czech Republic, 1995-2005].

    Science.gov (United States)

    Kozísek, F; Jeligová, H; Dvoráková, A

    2009-08-01

    should be taken into account that only the diagnosed and reported outbreak cases are covered, while the actual number of cases is likely to be underreported. Although no evidence is available that any vast and serious waterborne diseases outbreaks escaped reporting, some small and less serious outbreaks may have occurred unnoticed. In the future, the diagnosis, investigation and evaluation of waterborne diseases outbreaks should be improved, among others by implementing an evidence-based classification system and issuing regular surveys of outbreaks and their causes which would be helpful in preventing failures in other similar water sources.

  14. The Prevention of Blindness-Past, Present and Future

    Institute of Scientific and Technical Information of China (English)

    Akira; Nakajima

    1992-01-01

    Prevention of blindness is the most important aim of ophthalmology. Prevention of blindness is related to many factors. It is related to many factors, such as science and technology, economy and social behavior. There are worldwide activities by WHO, NGOs and other functions to promote the prevention of blindness in the world. More than 90% of blind population lives in developing world. Cataract is the top causes of blindness which is curable. Onchocerciasis is an endemic disease in west Africa and cent...

  15. The use of typing methods and infection prevention measures to control a bullous impetigo outbreak on a neonatal ward.

    Science.gov (United States)

    Koningstein, Maike; Groen, Leon; Geraats-Peters, Kathelijn; Lutgens, Suzanne; Rietveld, Ariene; Jira, Petr; Kluytmans, Jan; de Greeff, Sabine C; Hermans, Mirjam; Schneeberger, Peter M

    2012-11-20

    We describe an outbreak of Bullous Impetigo (BI), caused by a (methicillin susceptible, fusidic acid resistant) Staphylococcus aureus (SA) strain, spa-type t408, at the neonatal and gynaecology ward of the Jeroen Bosch hospital in the Netherlands, from March-November 2011. We performed an outbreak investigation with revision of the hygienic protocols, MSSA colonization surveillance and environmental sampling for MSSA including detailed typing of SA isolates. Spa typing was performed to discriminate between the SA isolates. In addition, Raman-typing was performed on all t408 isolates. Nineteen cases of BI were confirmed by SA positive cultures. A cluster of nine neonates and three health care workers (HCW) with SA t408 was detected. These strains were MecA-, PVL-, Exfoliative Toxin (ET)A-, ETB+, ETAD-, fusidic acid-resistant and methicillin susceptible. Eight out of nine neonates and two out of three HCW t408 strains yielded a similar Raman type. Positive t408 HCW were treated and infection control procedures were reinforced. These measures stopped the outbreak. We conclude that treatment of patients and HCW carrying a predominant SA t408, and re-implementing and emphasising hygienic measures were effective to control the outbreak of SA t408 among neonates.

  16. The use of typing methods and infection prevention measures to control a bullous impetigo outbreak on a neonatal ward

    Directory of Open Access Journals (Sweden)

    Koningstein Maike

    2012-11-01

    Full Text Available Abstract Background We describe an outbreak of Bullous Impetigo (BI, caused by a (methicillin susceptible, fusidic acid resistant Staphylococcus aureus (SA strain, spa-type t408, at the neonatal and gynaecology ward of the Jeroen Bosch hospital in the Netherlands, from March-November 2011. Methods We performed an outbreak investigation with revision of the hygienic protocols, MSSA colonization surveillance and environmental sampling for MSSA including detailed typing of SA isolates. Spa typing was performed to discriminate between the SA isolates. In addition, Raman-typing was performed on all t408 isolates. Results Nineteen cases of BI were confirmed by SA positive cultures. A cluster of nine neonates and three health care workers (HCW with SA t408 was detected. These strains were MecA-, PVL-, Exfoliative Toxin (ETA-, ETB+, ETAD-, fusidic acid-resistant and methicillin susceptible. Eight out of nine neonates and two out of three HCW t408 strains yielded a similar Raman type. Positive t408 HCW were treated and infection control procedures were reinforced. These measures stopped the outbreak. Conclusions We conclude that treatment of patients and HCW carrying a predominant SA t408, and re-implementing and emphasising hygienic measures were effective to control the outbreak of SA t408 among neonates.

  17. Structural Factors of the Middle East Respiratory Syndrome Coronavirus Outbreak as a Public Health Crisis in Korea and Future Response Strategies

    Directory of Open Access Journals (Sweden)

    Dong-Hyun Kim

    2015-11-01

    Full Text Available The recent Middle East respiratory syndrome coronavirus (MERS-CoV outbreak has originated from a failure in the national quarantine system in the Republic of Korea as most basic role of protecting the safety and lives of its citizens. Furthermore, a number of the Korean healthcare system’s weaknesses seem to have been completely exposed. The MERS-CoV outbreak can be considered a typical public health crisis in that the public was not only greatly terrorized by the actual fear of the disease, but also experienced a great impact to their daily lives, all in a short period of time. Preparedness for and an appropriate response to a public health crisis require comprehensive systematic public healthcare measures to address risks comprehensively with an all-hazards approach. Consequently, discussion regarding establishment of post-MERS-CoV improvement measures must focus on the total reform of the national quarantine system and strengthening of the public health infrastructure. In addition, the Korea Centers for Disease Control and Prevention must implement specific strategies of action including taking on the role of “control tower” in a public health emergency, training of Field Epidemic Intelligence Service officers, establishment of collaborative governance between central and local governments for infection prevention and control, strengthening the roles and capabilities of community-based public hospitals, and development of nationwide crisis communication methods.

  18. Infection prevention and control interventions in the first outbreak of methicillin-resistant Staphylococcus aureus infections in an equine hospital in Sweden.

    Science.gov (United States)

    Bergström, Karin; Nyman, Görel; Widgren, Stefan; Johnston, Christopher; Grönlund-Andersson, Ulrika; Ransjö, Ulrika

    2012-03-08

    The first outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in horses in Sweden occurred in 2008 at the University Animal Hospital and highlighted the need for improved infection prevention and control. The present study describes interventions and infection prevention control in an equine hospital setting July 2008 - April 2010. This descriptive study of interventions is based on examination of policy documents, medical records, notes from meetings and cost estimates. MRSA cases were identified through clinical sampling and telephone enquiries about horses post-surgery. Prospective sampling in the hospital environment with culture for MRSA and genotyping of isolates by spa-typing and pulsed-field gel electrophoresis (PFGE) were performed. Interventions focused on interruption of indirect contact spread of MRSA between horses via staff and equipment and included: Temporary suspension of elective surgery; and identification and isolation of MRSA-infected horses; collaboration was initiated between authorities in animal and human public health, human medicine infection control and the veterinary hospital; extensive cleaning and disinfection was performed; basic hygiene and cleaning policies, staff training, equipment modification and interior renovation were implemented over seven months.Ten (11%) of 92 surfaces sampled between July 2008 and April 2010 tested positive for MRSA spa-type 011, seven of which were from the first of nine sampling occasions. PFGE typing showed the isolates to be the outbreak strain (9 of 10) or a closely related strain. Two new cases of MRSA infection occurred 14 and 19 months later, but had no proven connections to the outbreak cases. Collaboration between relevant authorities and the veterinary hospital and formation of an infection control committee with an executive working group were required to move the intervention process forward. Support from hospital management and the dedication of staff were essential for

  19. A decrease in the number of cases of necrotizing enterocolitis associated with the enhancement of infection prevention and control measures during a Staphylococcus aureus outbreak in a neonatal intensive care unit.

    Science.gov (United States)

    Lemyre, Brigitte; Xiu, Wenlong; Bouali, Nicole Rouvinez; Brintnell, Janet; Janigan, Jo-Anne; Suh, Kathryn N; Barrowman, Nicholas

    2012-01-01

    Most cases of necrotizing enterocolitis (NEC) are sporadic, but outbreaks in hospital settings suggest an infectious cause. Our neonatal intensive care unit (NICU) experienced an outbreak of methicillin-sensitive Staphylococcus aureus (MSSA). We aimed to assess whether the enhancement of infection prevention and control measures would be associated with a reduction in the number of cases of NEC. Retrospective chart review. A 24-bed, university-affiliated, inborn level 3 NICU. Infants of less than 30 weeks gestation or birth weight ≤ 1,500 g admitted to the NICU between January 2007 and December 2008 were considered at risk of NEC. All cases of NEC were reviewed. Infection prevention and control measures, including hand hygiene education, were enhanced during the outbreak. Avoidance of overcapacity in the NICU was reinforced, environmental services (ES) measures were enhanced, and ES hours were increased. Two hundred eighty-two at-risk infants were admitted during the study. Their gestational age and birth weight (mean ± SD) were 28.2 ± 2.7 weeks and 1,031 ± 290 g, respectively. The proportion of NEC was 18/110 (16.4%) before the outbreak, 1/54 (1.8%) during the outbreak, and 4/118 (3.4%) after the outbreak. After adjustment for gestational age, birth weight, gender, and singleton versus multiple births, the proportion was lower in the postoutbreak period than in the preoutbreak period (P control measures to manage an MSSA outbreak.

  20. Once Is Enough: A Guide to Preventing Future Fractures

    Science.gov (United States)

    ... you should choose calcium supplements that are known brand names with proven reliability. Also, you will absorb ... mission of NIH ORBD~NRC is to expand awareness and enhance knowledge and understanding of the prevention, ...

  1. Future Research Opportunities in Peri-Prosthetic Joint Infection Prevention.

    Science.gov (United States)

    Berbari, Elie; Segreti, John; Parvizi, Javad; Berríos-Torres, Sandra I

    Peri-prosthetic joint infection (PJI) is a serious complication of prosthetic joint arthroplasty. A better understanding and reversal of modifiable risk factors may lead to a reduction in the incidence of incisional (superficial and deep) and organ/space (e.g., PJI) surgical site infections (SSI). Recently, the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) published the Guideline for Prevention of Surgical Site Infection. This targeted update applies evidence-based methodology in drafting recommendations for potential strategies to reduce the risk of SSI both across surgical procedures and specifically in prosthetic joint arthroplasty. A panel of PJI content experts identified nine PJI prevention research opportunities based on both evidence gaps identified through the guideline development process (transfusion, immunosuppressive therapy, anticoagulation, orthopedic space suit, and biofilm) and expert opinion (anesthesia, operative room environment, glycemic control, and Staphylococcus aureus nasal screening and decolonization. This article offers a road map for PJI prevention research.

  2. Human Papilloma Virus Vaccine: Future of Cervical Cancer Prevention

    Directory of Open Access Journals (Sweden)

    Jannatul Fardows

    2016-09-01

    Full Text Available Cervical cancer is a deadly cancer that clutches lives of the women in most of the cases due to lack of consciousness about the disease in the developing countries. It remains a threat which is second only to breast cancer in overall disease burden for women throughout the world. Cervical cancer is almost a preventable disease by prophylactic vaccine and routine screening. Both Cervarix and Gardasil vaccines have been effective in preventing persistent infection with targeted HPV types and in preventing cervical intraepithelial lesions. It is safe and nearly 100% effective if given before onset of sexual activity. This review article is aimed to explore different aspects of this vaccine as well as to develop awareness among health professionals of different disciplines.

  3. Creating Safe and Healthy Futures: Michigan Youth Violence Prevention Center

    Science.gov (United States)

    Morrel-Samuels, Susan; Zimmerman, Marc A.; Reischl, Thomas M.

    2013-01-01

    Youth are in the cross-fire of gun violence, and the highest rate in the nation is in Flint, Michigan. This article highlights six innovative strategies that prepare youth to solve problems at home and in their communities in peaceful ways. The Michigan Youth Violence Prevention Center (MI-YVPC) works with community groups to strengthen…

  4. Gastroenteritis outbreaks on cruise ships

    DEFF Research Database (Denmark)

    Mouchtouri, Varvara A; Verykouki, Eleni; Zamfir, Dumitru

    2017-01-01

    When an increased number of acute gastroenteritis (AG) cases is detected among tourists staying at the same accommodation, outbreak management plans must be activated in a timely manner to prevent large outbreaks. Syndromic surveillance data collected between 1 January 2010 and 31 December 2013...

  5. Moderating effect of age on the association between future time perspective and preventive coping.

    Science.gov (United States)

    Chen, Tao; Liu, Lu-Lu; Cui, Ji-Fang; Chen, Xing-Jie; Shi, Hai-Song; Neumann, David L; Shum, David H K; Wang, Ya; Chan, Raymond C K

    2017-09-01

    The present study aimed to investigate the moderating effect of age on the relationship between future time perspective (FTP) and future-oriented coping. A total of 1,915 participants aged 9-84 years completed measures of FTP and future-oriented coping. Moderation analyses were conducted to examine whether age played a role in the association between FTP and future-oriented coping (proactive and preventive). Results showed that proactive and preventive coping were negatively correlated with age, and age moderated the association between FTP and preventive coping but not proactive coping. Furthermore, the strength of the positive association between FTP and preventive coping was strongest among the older participants, moderate among the middle-aged participants, and weakest among the younger participants. These results suggest that the association between FTP and preventive coping varies across the lifespan. © 2017 The Institute of Psychology, Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.

  6. Future trends in environmental mercury concentrations: implications for prevention strategies

    Directory of Open Access Journals (Sweden)

    Sunderland Elsie M

    2013-01-01

    Full Text Available Abstract In their new paper, Bellanger and coauthors show substantial economic impacts to the EU from neurocognitive impairment associated with methylmercury (MeHg exposures. The main source of MeHg exposure is seafood consumption, including many marine species harvested from the global oceans. Fish, birds and other wildlife are also susceptible to the impacts of MeHg and already exceed toxicological thresholds in vulnerable regions like the Arctic. Most future emissions scenarios project a growth or stabilization of anthropogenic mercury releases relative to present-day levels. At these emissions levels, inputs of mercury to ecosystems are expected to increase substantially in the future, in part due to growth in the legacy reservoirs of mercury in oceanic and terrestrial ecosystems. Seawater mercury concentration trajectories in areas such as the North Pacific Ocean that supply large quantities of marine fish to the global seafood market are projected to increase by more than 50% by 2050. Fish mercury levels and subsequent human and biological exposures are likely to also increase because production of MeHg in ocean ecosystems is driven by the supply of available inorganic mercury, among other factors. Analyses that only consider changes in primary anthropogenic emissions are likely to underestimate the severity of future deposition and concentration increases associated with growth in mercury reservoirs in the land and ocean. We therefore recommend that future policy analyses consider the fully coupled interactions among short and long-lived reservoirs of mercury in the atmosphere, ocean, and terrestrial ecosystems. Aggressive anthropogenic emission reductions are needed to reduce MeHg exposures and associated health impacts on humans and wildlife and protect the integrity of one of the last wild-food sources globally. In the near-term, public health advice on safe fish consumption choices such as smaller species, younger fish, and harvests

  7. The Future of Preschool Prevention, Assessment, and Intervention.

    Science.gov (United States)

    Hudziak, Jim; Archangeli, Christopher

    2017-07-01

    Preschoolers are in the most rapid period of brain development. Environment shapes the structure and function of the developing brain. Promoting brain health requires cultivation of healthy environments at home, school, and in the community. This improves the emotional-behavioral and physical health of all children, can prevent problems in children at risk, and can alter the trajectory of children already suffering. For clinicians, this starts with assessing and treating the entire family, equipping parents with the principles of parent management training, and incorporating wellness prescriptions for nutrition, physical activity, music, and mindfulness. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. The future of digital games for HIV prevention and care.

    Science.gov (United States)

    Hightow-Weidman, Lisa B; Muessig, Kathryn E; Bauermeister, José A; LeGrand, Sara; Fiellin, Lynn E

    2017-09-01

    Although there has been a significant increase in mHealth interventions addressing the HIV prevention and care continuum, interventions using game mechanics have been less explored. Digital games are rapidly becoming an important tool for improving health behaviors and supporting the delivery of care and education. The purpose of this review is to provide a historical context for the use of gamification and videogames (including those using virtual reality) used in technology-based HIV interventions and to review new research in the field. A review of recently published (1 January 2016-31 March 2017) or presented abstracts (2016) identified a paucity of technology-based interventions that included gamification elements or any terms associated with videogames or gameplay. A larger portfolio of digital gaming interventions is in the pipeline. Use of digital games that include elements of gamification or consist of standalone videogames or virtual-reality-based games, represent a promising intervention strategy to address the HIV prevention and care continuum, especially among youth. Our review demonstrates that there is significant room for growth in this area in designing, developing, testing and most importantly, implementation and dissemination these novel interventions.

  9. Vancomycin-resistant enterococcus outbreak in a pediatric intensive care unit: report of successful interventions for control and prevention

    Directory of Open Access Journals (Sweden)

    F. Carmona

    2012-02-01

    Full Text Available The objective of this study is to retrospectively report the results of interventions for controlling a vancomycin-resistant enterococcus (VRE outbreak in a tertiary-care pediatric intensive care unit (PICU of a University Hospital. After identification of the outbreak, interventions were made at the following levels: patient care, microbiological surveillance, and medical and nursing staff training. Data were collected from computer-based databases and from the electronic prescription system. Vancomycin use progressively increased after March 2008, peaking in August 2009. Five cases of VRE infection were identified, with 3 deaths. After the interventions, we noted a significant reduction in vancomycin prescription and use (75% reduction, and the last case of VRE infection was identified 4 months later. The survivors remained colonized until hospital discharge. After interventions there was a transient increase in PICU length-of-stay and mortality. Since then, the use of vancomycin has remained relatively constant and strict, no other cases of VRE infection or colonization have been identified and length-of-stay and mortality returned to baseline. In conclusion, we showed that a bundle intervention aiming at a strict control of vancomycin use and full compliance with the Hospital Infection Control Practices Advisory Committee guidelines, along with contact precautions and hand-hygiene promotion, can be effective in reducing vancomycin use and the emergence and spread of vancomycin-resistant bacteria in a tertiary-care PICU.

  10. Future threats to biodiversity and pathways to their prevention.

    Science.gov (United States)

    Tilman, David; Clark, Michael; Williams, David R; Kimmel, Kaitlin; Polasky, Stephen; Packer, Craig

    2017-05-31

    Tens of thousands of species are threatened with extinction as a result of human activities. Here we explore how the extinction risks of terrestrial mammals and birds might change in the next 50 years. Future population growth and economic development are forecasted to impose unprecedented levels of extinction risk on many more species worldwide, especially the large mammals of tropical Africa, Asia and South America. Yet these threats are not inevitable. Proactive international efforts to increase crop yields, minimize land clearing and habitat fragmentation, and protect natural lands could increase food security in developing nations and preserve much of Earth's remaining biodiversity.

  11. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 8. Gloves as barriers to prevent contamination of food by workers.

    Science.gov (United States)

    Todd, Ewen C D; Michaels, Barry S; Greig, Judy D; Smith, Debra; Bartleson, Charles A

    2010-09-01

    The role played by food workers and other individuals in the contamination of food has been identified as an important contributing factor leading to foodborne outbreaks. To prevent direct bare hand contact with food and food surfaces, many jurisdictions have made glove use compulsory for food production and preparation. When properly used, gloves can substantially reduce opportunities for food contamination. However, gloves have limitations and may become a source of contamination if they are punctured or improperly used. Experiments conducted in clinical and dental settings have revealed pinhole leaks in gloves. Although such loss of glove integrity can lead to contamination of foods and surfaces, in the food industry improper use of gloves is more likely than leakage to lead to food contamination and outbreaks. Wearing jewelry (e.g., rings) and artificial nails is discouraged because these items can puncture gloves and allow accumulation of microbial populations under them. Occlusion of the skin during long-term glove use in food operations creates the warm, moist conditions necessary for microbial proliferation and can increase pathogen transfer onto foods through leaks or exposed skin or during glove removal. The most important issue is that glove use can create a false sense of security, resulting in more high-risk behaviors that can lead to cross-contamination when employees are not adequately trained.

  12. An Assessment of Household and Individual-Level Mosquito Prevention Methods during the Chikungunya Virus Outbreak in the United States Virgin Islands, 2014-2015.

    Science.gov (United States)

    Feldstein, Leora R; Rowhani-Rahbar, Ali; Staples, J Erin; Halloran, M Elizabeth; Ellis, Esther M

    2018-03-01

    Recent large-scale chikungunya virus (CHIKV) and Zika virus epidemics in the Americas pose a growing public health threat. Given that mosquito bite prevention and vector control are the main prevention methods available to reduce transmission of these viruses, we assessed adherence to these methods in the United States Virgin Islands (USVI). We interviewed 334 USVI residents between December 2014 and February 2015 to measure differences in mosquito prevention practices by gender, income, presence of CHIKV symptoms, and age. Only 27% (91/334) of participants reported having an air conditioner, and of the 91 with air-conditioners, 18 (20%) reported never using it. Annual household income > $50,000 was associated with owning and using an air conditioner (41%; 95% confidence interval [CI]: 28-53% compared with annual household income ≤ $50,000: 17%; 95% CI: 12-22%). The majority of participants reported the presence of vegetation in their yard or near their home (79%; 265) and a cistern on their property (78%; 259). Only 52 (16%) participants reported wearing mosquito repellent more than once per week. Although the majority (80%; 268) of participants reported having screens on all of their windows and doors, most (82%; 273) of those interviewed still reported seeing mosquitoes in their homes. Given the uniformly low adherence to individual- and household-level mosquito bite prevention measures in the USVI, these findings emphasize the need for improved public health messaging and investment in therapeutic and vaccine research to mitigate vector-borne disease outbreaks.

  13. A Systematic Review of Waterborne Disease Outbreaks Associated with Small Non-Community Drinking Water Systems in Canada and the United States.

    Directory of Open Access Journals (Sweden)

    Wendy Pons

    Full Text Available Reports of outbreaks in Canada and the United States (U.S. indicate that approximately 50% of all waterborne diseases occur in small non-community drinking water systems (SDWSs. Summarizing these investigations to identify the factors and conditions contributing to outbreaks is needed in order to help prevent future outbreaks.The objectives of this study were to: 1 identify published reports of waterborne disease outbreaks involving SDWSs in Canada and the U.S. since 1970; 2 summarize reported factors contributing to outbreaks, including water system characteristics and events surrounding the outbreaks; and 3 identify terminology used to describe SDWSs in outbreak reports.Three electronic databases and grey literature sources were searched for outbreak reports involving SDWSs throughout Canada and the U.S. from 1970 to 2014. Two reviewers independently screened and extracted data related to water system characteristics and outbreak events. The data were analyzed descriptively with 'outbreak' as the unit of analysis.From a total of 1,995 citations, we identified 50 relevant articles reporting 293 unique outbreaks. Failure of an existing water treatment system (22.7% and lack of water treatment (20.2% were the leading causes of waterborne outbreaks in SDWSs. A seasonal trend was observed with 51% of outbreaks occurring in summer months (p<0.001. There was large variation in terminology used to describe SDWSs, and a large number of variables were not reported, including water source and whether water treatment was used (missing in 31% and 66% of reports, respectively.More consistent reporting and descriptions of SDWSs in future outbreak reports are needed to understand the epidemiology of these outbreaks and to inform the development of targeted interventions for SDWSs. Additional monitoring of water systems that are used on a seasonal or infrequent basis would be worthwhile to inform future protection efforts.

  14. A Systematic Review of Waterborne Disease Outbreaks Associated with Small Non-Community Drinking Water Systems in Canada and the United States.

    Science.gov (United States)

    Pons, Wendy; Young, Ian; Truong, Jenifer; Jones-Bitton, Andria; McEwen, Scott; Pintar, Katarina; Papadopoulos, Andrew

    2015-01-01

    Reports of outbreaks in Canada and the United States (U.S.) indicate that approximately 50% of all waterborne diseases occur in small non-community drinking water systems (SDWSs). Summarizing these investigations to identify the factors and conditions contributing to outbreaks is needed in order to help prevent future outbreaks. The objectives of this study were to: 1) identify published reports of waterborne disease outbreaks involving SDWSs in Canada and the U.S. since 1970; 2) summarize reported factors contributing to outbreaks, including water system characteristics and events surrounding the outbreaks; and 3) identify terminology used to describe SDWSs in outbreak reports. Three electronic databases and grey literature sources were searched for outbreak reports involving SDWSs throughout Canada and the U.S. from 1970 to 2014. Two reviewers independently screened and extracted data related to water system characteristics and outbreak events. The data were analyzed descriptively with 'outbreak' as the unit of analysis. From a total of 1,995 citations, we identified 50 relevant articles reporting 293 unique outbreaks. Failure of an existing water treatment system (22.7%) and lack of water treatment (20.2%) were the leading causes of waterborne outbreaks in SDWSs. A seasonal trend was observed with 51% of outbreaks occurring in summer months (pwater source and whether water treatment was used (missing in 31% and 66% of reports, respectively). More consistent reporting and descriptions of SDWSs in future outbreak reports are needed to understand the epidemiology of these outbreaks and to inform the development of targeted interventions for SDWSs. Additional monitoring of water systems that are used on a seasonal or infrequent basis would be worthwhile to inform future protection efforts.

  15. Predicting and preventing the future: actively managing multiple sclerosis.

    LENUS (Irish Health Repository)

    Hutchinson, Michael

    2012-02-01

    Relapsing-remitting multiple sclerosis (MS) has a highly variable clinical course but a number of demographic, clinical and MRI features can guide the clinician in the assessment of disease activity and likely disability outcome. It is also clear that the inflammatory activity in the first five years of relapsing-remitting MS results in the neurodegenerative changes seen in secondary progressive MS 10-15 years later. While conventional first-line disease modifying therapy has an effect on relapses, about one third of patients have a suboptimal response to treatment. With the advent of highly active second-line therapies with their evident marked suppression of inflammation, the clinician now has the tools to manage the course of relapsing-remitting MS more effectively. The development of treatment optimisation recommendations based on the clinical response to first-line therapies can guide the neurologist in more active management of the early course of relapsing-remitting MS, with the aim of preventing both acute inflammatory axonal injury and the neurodegenerative process which leads to secondary progressive MS.

  16. Waterborne norovirus outbreak in a municipal drinking-water supply in Sweden.

    Science.gov (United States)

    Riera-Montes, M; Brus Sjölander, K; Allestam, G; Hallin, E; Hedlund, K-O; Löfdahl, M

    2011-12-01

    During Easter 2009, almost 200 people resident in a small Swedish village fell ill with gastrointestinal symptoms. We conducted a retrospective cohort study and a molecular investigation in order to identify the source of the outbreak. Residents living in households connected to the public water network were at an increased risk of developing disease (relative risk 4·80, 95% confidence interval 1·68-13·73) compared to those with no connection to the public network. Norovirus genotype GI.3 was identified in stool samples from six patients and in a sample from the public water network. Contamination of one of the wells supplying the public water network was thought to be the source of the outbreak. This is a description of a norovirus outbreak linked to a municipal drinking-water supply in Sweden. Information from epidemiological and molecular investigations is of utmost importance to guide outbreak control measures and to prevent future outbreaks.

  17. Future Forests Webinar Series, Webinar Proceedings and Summary: Ongoing Research and Management Responses to the Mountain Pine Beetle Outbreak

    Science.gov (United States)

    M. Matonis; R. Hubbard; K. Gebert; B. Hahn; C. Regan

    2014-01-01

    The Future Forest Webinar Series facilitated dialogue between scientists and managers about the challenges and opportunities created by the mountain pine beetle (MPB) epidemic. The series consisted of six webinar facilitated by the USFS Rocky Mountain Research Station, the Northern and Rocky Mountain Regions, and the Colorado Forest Restoration Institute. The series...

  18. A review of outbreaks of waterborne disease associated with ships: evidence for risk management.

    Science.gov (United States)

    Rooney, Roisin M; Bartram, Jamie K; Cramer, Elaine H; Mantha, Stacey; Nichols, Gordon; Suraj, Rohini; Todd, Ewen C D

    2004-01-01

    The organization of water supply to and on ships differs considerably from that of water supply on land. Risks of contamination can arise from source water at the port or during loading, storage, or distribution on the ship. The purpose of this article is to review documented outbreaks of waterborne diseases associated with passenger, cargo, fishing, and naval ships to identify contributing factors so that similar outbreaks can be prevented in the future. The authors reviewed 21 reported outbreaks of waterborne diseases associated with ships. For each outbreak, data on pathogens/toxins, type of ship, factors contributing to outbreaks, mortality and morbidity, and remedial action are presented. The findings of this review show that the majority of reported outbreaks were associated with passenger ships and that more than 6,400 people were affected. Waterborne outbreaks due to Enterotoxigenic Escherichia coli, noroviruses, Salmonella spp, Shigella sp, Cryptosporidium sp, and Giardia lamblia occurred on ships. Enterotoxigenic E. coli was the pathogen most frequently associated with outbreaks. One outbreak of chemical water poisoning also occurred on a ship. Risk factors included contaminated port water, inadequate treatment, improper loading techniques, poor design and maintenance of storage tanks, ingress of contamination during repair and maintenance, cross-connections, back siphonage, and insufficient residual disinfectant. Waterborne disease outbreaks on ships can be prevented. The factors contributing to outbreaks emphasize the need for hygienic handling of water along the supply chain from source to consumption. A comprehensive approach to water safety on ships is essential. This may be achieved by the adoption of Water Safety Plans that cover design, construction, operation, and routine inspection and maintenance.

  19. Mediational effects of self-efficacy dimensions in the relationship between knowledge of dengue and dengue preventive behaviour with respect to control of dengue outbreaks: a structural equation model of a cross-sectional survey.

    Directory of Open Access Journals (Sweden)

    Affendi Isa

    Full Text Available Dengue fever is endemic in Malaysia, with frequent major outbreaks in urban areas. The major control strategy relies on health promotional campaigns aimed at encouraging people to reduce mosquito breeding sites close to people's homes. However, such campaigns have not always been 100% effective. The concept of self-efficacy is an area of increasing research interest in understanding how health promotion can be most effective. This paper reports on a study of the impact of self-efficacy on dengue knowledge and dengue preventive behaviour.We recruited 280 adults from 27 post-outbreak villages in the state of Terengganu, east coast of Malaysia. Measures of health promotion and educational intervention activities and types of communication during outbreak, level of dengue knowledge, level and strength of self-efficacy and dengue preventive behaviour were obtained via face-to-face interviews and questionnaires. A structural equation model was tested and fitted the data well (χ(2 = 71.659, df = 40, p = 0.002, RMSEA = 0.053, CFI = 0.973, TLI = 0.963. Mass media, local contact and direct information-giving sessions significantly predicted level of knowledge of dengue. Level and strength of self-efficacy fully mediated the relationship between knowledge of dengue and dengue preventive behaviours. Strength of self-efficacy acted as partial mediator in the relationship between knowledge of dengue and dengue preventive behaviours.To control and prevent dengue outbreaks by behavioural measures, health promotion and educational interventions during outbreaks should now focus on those approaches that are most likely to increase the level and strength of self-efficacy.

  20. Mediational Effects of Self-Efficacy Dimensions in the Relationship between Knowledge of Dengue and Dengue Preventive Behaviour with Respect to Control of Dengue Outbreaks: A Structural Equation Model of a Cross-Sectional Survey

    Science.gov (United States)

    Isa, Affendi; Loke, Yoon K.; Smith, Jane R.; Papageorgiou, Alexia; Hunter, Paul R.

    2013-01-01

    Background Dengue fever is endemic in Malaysia, with frequent major outbreaks in urban areas. The major control strategy relies on health promotional campaigns aimed at encouraging people to reduce mosquito breeding sites close to people's homes. However, such campaigns have not always been 100% effective. The concept of self-efficacy is an area of increasing research interest in understanding how health promotion can be most effective. This paper reports on a study of the impact of self-efficacy on dengue knowledge and dengue preventive behaviour. Methods and Findings We recruited 280 adults from 27 post-outbreak villages in the state of Terengganu, east coast of Malaysia. Measures of health promotion and educational intervention activities and types of communication during outbreak, level of dengue knowledge, level and strength of self-efficacy and dengue preventive behaviour were obtained via face-to-face interviews and questionnaires. A structural equation model was tested and fitted the data well (χ2 = 71.659, df = 40, p = 0.002, RMSEA = 0.053, CFI = 0.973, TLI = 0.963). Mass media, local contact and direct information-giving sessions significantly predicted level of knowledge of dengue. Level and strength of self-efficacy fully mediated the relationship between knowledge of dengue and dengue preventive behaviours. Strength of self-efficacy acted as partial mediator in the relationship between knowledge of dengue and dengue preventive behaviours. Conclusions To control and prevent dengue outbreaks by behavioural measures, health promotion and educational interventions during outbreaks should now focus on those approaches that are most likely to increase the level and strength of self-efficacy. PMID:24086777

  1. Outbreak of caliciviruses in the Singapore military, 2015.

    Science.gov (United States)

    Neo, Freddy Jun Xian; Loh, Jimmy Jin Phang; Ting, Peijun; Yeo, Wei Xin; Gao, Christine Qiu Han; Lee, Vernon Jian Ming; Tan, Boon Huan; Ng, Ching Ging

    2017-11-14

    From 31 August to 9 September 2015, a total of 150 military personnel at a military institution in Singapore were infected with acute gastroenteritis (AGE) with an attack rate of approximately 3%. This study aimed to determine the epidemiology of the outbreak, investigate its origins, and discuss measures to prevent future occurrences. After the AGE outbreak was declared on 31 August 2015, symptom surveys, hygiene inspections, and the testing of water, food, and stool samples were initiated. We collected 86 stool samples from AGE cases and 58 samples from food-handlers during the course of the outbreak and these stool samples were tested for 8 bacterial pathogens and 2 viral pathogens (i.e., norovirus and sapovirus). We detected Sapovirus (SaV), group I Norovirus (NoV GI) and group II Norovirus (NoV GII) from the stool samples of AGE cases. Further sequence analyses showed that the AGE outbreak in August was caused mainly by three rarely reported calicivirus novel genotypes: NoV GI.7, NoV GII.17 and SaV GII.3. Control measures implemented focused on the escalation of personal and environmental hygiene, which included the separation of affected and unaffected soldiers, enforcement of rigorous hand-washing and hygiene, raising awareness of food and water safety, and disinfection of communal areas with bleach. This study identified both NoV and SaV as the causative agents for an AGE outbreak at a Singapore military camp in August 2015. This study is also the first to report SaV as one of the main causative agents, highlighting the importance of caliciviruses as causative agents of AGE outbreaks in the Singapore military. As there are no commercially available vaccines against caliciviruses, strict personal hygiene and proper disinfection of environmental surfaces remain crucial to prevent calicivirus outbreak and transmission.

  2. Future Integrated Systems Concept for Preventing Aircraft Loss-of-Control Accidents

    Science.gov (United States)

    Belcastro, Christine M.; Jacobson, Steven r.

    2010-01-01

    Loss of control remains one of the largest contributors to aircraft fatal accidents worldwide. Aircraft loss-of-control accidents are highly complex in that they can result from numerous causal and contributing factors acting alone or (more often) in combination. Hence, there is no single intervention strategy to prevent these accidents. This paper presents future system concepts and research directions for preventing aircraft loss-of-control accidents.

  3. Pacemaker pocket infection due to environmental mycobacteria: Successful management of an outbreak and steps for prevention in future

    Directory of Open Access Journals (Sweden)

    Vijaya Bharat

    2016-01-01

    Interpretation: Water is a potential reservoir for EMB. Use of the term ‘environmental mycobacteria’ instead of ‘atypical mycobacteria’ will generate awareness about contamination as the cause of SSI.

  4. Future Directions in Etiologic, Prevention, and Treatment Research for Eating Disorders

    Science.gov (United States)

    Stice, Eric; South, Kelsey; Shaw, Heather

    2012-01-01

    Significant advances have occurred regarding the understanding of etiologic processes that give rise to eating disorders and the design and evaluation of efficacious prevention programs and treatment interventions. Herein we offer suggestions regarding potentially fruitful directions for future research in these areas. We suggest it would be…

  5. Analysis of epidemiological data of foodborne outbreak reported in Iran

    Directory of Open Access Journals (Sweden)

    Mohammad Mehdi Soltan Dallal

    2015-02-01

    Conclusion: The knowledge of bacterial agent of foodborne diseases and determination of antimicrobial resistance pattern are helpful to reduce the rate of foodborne outbreaks, the cost of treatment. The prevention control of outbreaks is also very important.

  6. Injury and violence prevention policy: celebrating our successes, protecting our future.

    Science.gov (United States)

    Koné, Rebecca Greco; Zurick, Elizabeth; Patterson, Sara; Peeples, Amy

    2012-09-01

    Policy strategies for injury and violence prevention influence systems development, organizational change, social norms, and individual behavior to improve the health and safety of a population. Injury and violence prevention professionals should consider how their issues resonate with various audiences, including policy makers, the public, and other decision makers. As the cost of healthcare continues to rise and greater demands are placed on the healthcare system, the use of public health policy becomes increasingly critical to protect the public's health and prevent injury and violence and its related morbidities and disabilities (Degutis, 2011). This article highlights some impactful policy successes from the field, allows us to reflect on the Injury Center's 20th anniversary, and describes steps to address injuries and violence into the future. The purpose of this paper is to discuss policy as a public health strategy and the critical role it plays in injury and violence prevention. Published by Elsevier Ltd.

  7. Investigating the Effects of Mass Media Exposure on the Uptake of Preventive Measures by Hong Kong Residents during the 2015 MERS Outbreak: The Mediating Role of Interpersonal Communication and the Perception of Concern.

    Science.gov (United States)

    Ludolph, Ramona; Schulz, Peter J; Chen, Ling

    2018-01-01

    In 2015, South Korea experienced the largest outbreak to date of the Middle East Respiratory Syndrome (MERS-CoV) outside the Middle East. Fears related to a potential spread of the disease led to an increased alert level as well as heightened media coverage in the neighboring Hong Kong. A cross-sectional survey (N = 533) among residents of Hong Kong was conducted to assess the relationships between the effects of outbreak-related mass media coverage, interpersonal communication, the perceived level of concern in one's close environment, and the uptake of preventive measures. A serial multiple mediator model finds that interpersonal communication and higher perceived concern indirectly influence the effects of media coverage on the engagement in preventive actions. These results expand previous research on the mediating role of interpersonal communication and support assumptions about a modified two-step flow of communication in the context of a public health emergency.

  8. Perspectives on West Africa Ebola Virus Disease Outbreak, 2013-2016.

    Science.gov (United States)

    Spengler, Jessica R; Ervin, Elizabeth D; Towner, Jonathan S; Rollin, Pierre E; Nichol, Stuart T

    2016-06-01

    The variety of factors that contributed to the initial undetected spread of Ebola virus disease in West Africa during 2013-2016 and the difficulty controlling the outbreak once the etiology was identified highlight priorities for disease prevention, detection, and response. These factors include occurrence in a region recovering from civil instability and lacking experience with Ebola response; inadequate surveillance, recognition of suspected cases, and Ebola diagnosis; mobile populations and extensive urban transmission; and the community's insufficient general understanding about the disease. The magnitude of the outbreak was not attributable to a substantial change of the virus. Continued efforts during the outbreak and in preparation for future outbreak response should involve identifying the reservoir, improving in-country detection and response capacity, conducting survivor studies and supporting survivors, engaging in culturally appropriate public education and risk communication, building productive interagency relationships, and continuing support for basic research.

  9. Viewpoint: methanol poisoning outbreak in Libya: a need for policy reforms.

    Science.gov (United States)

    Taleb, Ziyad Ben; Bahelah, Raed

    2014-11-01

    We address the controversies surrounding a 2013 outbreak of methanol poisoning in Tripoli, Libya. We critically examine and systematically analyze the outbreak to highlight the lessons learned from this disaster and how to act properly to prevent similar outbreaks in future. Many health problems have been directly attributed to drinking alcohol; the type and quality of alcohol determines the detrimental effects. An unregulated and flourishing black market in alcohol is among the factors behind the Libyan tragedy, where approximately 90 deaths and about 1000 hospital admissions were reported. We reviewed gaps in local and regional alcohol policy, and highlighted the issue of illegally produced and home-made alcohol. Collaboration between countries in the region plus critical health and policy reforms in Libya, with emphasis on public health preparedness, can dramatically decrease morbidity and mortality associated with such outbreaks.

  10. Considering treatment of male genital schistosomiasis as a tool for future HIV prevention

    DEFF Research Database (Denmark)

    Stecher, Chalotte Willemann; Kallestrup, Per; Kjetland, Eyrun Floerecke

    2015-01-01

    OBJECTIVES: Male genital schistosomiasis (MGS) is a neglected manifestation of Schistosoma haematobium infection with ignored implications on reproductive health and a differential diagnosis to sexually transmitted infections in endemic regions. MGS may have associations with HIV transmission...... and acquisition, and treatment could be a neglected chance of HIV prevention. This review summarizes current knowledge on epidemiology, clinical manifestations, diagnosis and treatment of MGS as a hypothesized risk factor for HIV transmission. Future research areas of global interest are suggested. METHODS: Pub...... association between MGS and HIV are urgently needed. Furthermore, field diagnostic tools should be developed and future mass treatment programs should include adults to reduce morbidity and prevent HIV acquisition. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42015016252....

  11. Fall Prediction and Prevention Systems: Recent Trends, Challenges, and Future Research Directions

    Directory of Open Access Journals (Sweden)

    Ramesh Rajagopalan

    2017-11-01

    Full Text Available Fall prediction is a multifaceted problem that involves complex interactions between physiological, behavioral, and environmental factors. Existing fall detection and prediction systems mainly focus on physiological factors such as gait, vision, and cognition, and do not address the multifactorial nature of falls. In addition, these systems lack efficient user interfaces and feedback for preventing future falls. Recent advances in internet of things (IoT and mobile technologies offer ample opportunities for integrating contextual information about patient behavior and environment along with physiological health data for predicting falls. This article reviews the state-of-the-art in fall detection and prediction systems. It also describes the challenges, limitations, and future directions in the design and implementation of effective fall prediction and prevention systems.

  12. Fall Prediction and Prevention Systems: Recent Trends, Challenges, and Future Research Directions.

    Science.gov (United States)

    Rajagopalan, Ramesh; Litvan, Irene; Jung, Tzyy-Ping

    2017-11-01

    Fall prediction is a multifaceted problem that involves complex interactions between physiological, behavioral, and environmental factors. Existing fall detection and prediction systems mainly focus on physiological factors such as gait, vision, and cognition, and do not address the multifactorial nature of falls. In addition, these systems lack efficient user interfaces and feedback for preventing future falls. Recent advances in internet of things (IoT) and mobile technologies offer ample opportunities for integrating contextual information about patient behavior and environment along with physiological health data for predicting falls. This article reviews the state-of-the-art in fall detection and prediction systems. It also describes the challenges, limitations, and future directions in the design and implementation of effective fall prediction and prevention systems.

  13. The future workforce in cancer prevention: advancing discovery, research, and technology.

    Science.gov (United States)

    Newhauser, Wayne D; Scheurer, Michael E; Faupel-Badger, Jessica M; Clague, Jessica; Weitzel, Jeffrey; Woods, Kendra V

    2012-05-01

    As part of a 2-day conference on October 15 and 16, 2009, a nine-member task force composed of scientists, clinicians, educators, administrators, and students from across the USA was formed to discuss research, discovery, and technology obstacles to progress in cancer prevention and control, specifically those related to the cancer prevention workforce. This article summarizes the task force's findings on the current state of the cancer prevention workforce in this area and its needs for the future. The task force identified two types of barriers impeding the current cancer prevention workforce in research, discovery, and technology from reaching its fullest potential: (1) limited cross-disciplinary research opportunities with underutilization of some disciplines is hampering discovery and research in cancer prevention, and (2) new research avenues are not being investigated because technology development and implementation are lagging. Examples of impediments and desired outcomes are provided in each of these areas. Recommended solutions to these problems are based on the goals of enhancing the current cancer prevention workforce and accelerating the pace of discovery and clinical translation.

  14. Outbreak Column 16: Cognitive errors in outbreak decision making.

    Science.gov (United States)

    Curran, Evonne T

    2015-01-01

    During outbreaks, decisions must be made without all the required information. People, including infection prevention and control teams (IPCTs), who have to make decisions during uncertainty use heuristics to fill the missing data gaps. Heuristics are mental model short cuts that by-and-large enable us to make good decisions quickly. However, these heuristics contain biases and effects that at times lead to cognitive (thinking) errors. These cognitive errors are not made to deliberately misrepresent any given situation; we are subject to heuristic biases when we are trying to perform optimally. The science of decision making is large; there are over 100 different biases recognised and described. Outbreak Column 16 discusses and relates these heuristics and biases to decision making during outbreak prevention, preparedness and management. Insights as to how we might recognise and avoid them are offered.

  15. A Waterborne Gastroenteritis Outbreak Caused by Norovirus GII.17 in a Hotel, Hebei, China, December 2014.

    Science.gov (United States)

    Qin, Meng; Dong, Xiao-Gen; Jing, Yan-Yan; Wei, Xiu-Xia; Wang, Zhao-E; Feng, Hui-Ru; Yu, Hong; Li, Jin-Song; Li, Jie

    2016-09-01

    Norovirus (NoV) is responsible for an estimated 90 % of all epidemic nonbacterial outbreaks of gastroenteritis worldwide. Waterborne outbreaks of NoV are commonly reported. A novel GII.17 NoV strain emerged as a major cause of gastroenteritis outbreaks in China during the winter of 2014/2015. During this time, an outbreak of gastroenteritis occurred at a hotel in a ski park in Hebei Province, China. Epidemiological investigations indicated that one water well, which had only recently been in use, was the probable source. GII.17 NoV was detected by real-time reverse-transcription polymerase chain reaction from samples taken from cases, from concentrated water samples from water well, and from the nearby sewage settling tank. Nucleotide sequences of NoV extracted from clinical and water specimens were genetically identical and had 99 % homology with Beijing/CHN/2015. All epidemiological data indicated that GII.17 NoV was responsible for this outbreak. This is the first reported laboratory-confirmed waterborne outbreak caused by GII.17 NoV genotype in China. Strengthening management of well drinking water and systematica monitoring of NoV is essential for preventing future outbreaks.

  16. Gene–Environment Interactions in Preventive Medicine: Current Status and Expectations for the Future

    Directory of Open Access Journals (Sweden)

    Hiroto Narimatsu

    2017-01-01

    Full Text Available The progression of many common disorders involves a complex interplay of multiple factors, including numerous different genes and environmental factors. Gene–environmental cohort studies focus on the identification of risk factors that cannot be discovered by conventional epidemiological methodologies. Such epidemiological methodologies preclude precise predictions, because the exact risk factors can be revealed only after detailed analyses of the interactions among multiple factors, that is, between genes and environmental factors. To date, these cohort studies have reported some promising results. However, the findings do not yet have sufficient clinical significance for the development of precise, personalized preventive medicine. Especially, some promising preliminary studies have been conducted in terms of the prevention of obesity. Large-scale validation studies of those preliminary studies, using a prospective cohort design and long follow-ups, will produce useful and practical evidence for the development of preventive medicine in the future.

  17. Disease Outbreak News

    Science.gov (United States)

    ... MERS-CoV) Pandemic (H1N1) 2009 Influenza at the Human-Animal Interface (HAI) Related documents WHO outbreak communication guide 2008 WHO outbreak communications guidelines Outbreak communication: ...

  18. Preventing Norovirus Outbreaks PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    2014-06-03

    This 60 second public service announcement is based on the June 2014 CDC Vital Signs report. Norovirus infects about 20 million Americans each year. Learn how to protect yourself and your family from this very contagious, potentially serious illness.  Created: 6/3/2014 by National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 6/3/2014.

  19. Preventing Norovirus Outbreaks PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    This 60 second public service announcement is based on the June 2014 CDC Vital Signs report. Norovirus infects about 20 million Americans each year. Learn how to protect yourself and your family from this very contagious, potentially serious illness.

  20. Outbreaks of Acute Gastroenteritis Transmitted by Person-to-Person Contact, Environmental Contamination, and Unknown Modes of Transmission--United States, 2009-2013.

    Science.gov (United States)

    Wikswo, Mary E; Kambhampati, Anita; Shioda, Kayoko; Walsh, Kelly A; Bowen, Anna; Hall, Aron J

    2015-12-11

    -term-care facilities (n = 4,894). In contrast, 59% (n = 143) of shigellosis outbreaks, 36% (n = 30) of salmonellosis outbreaks, and 32% (n = 84) of other or multiple etiology outbreaks were identified in child care facilities. NORS is the first U.S. surveillance system that provides national data on AGE outbreaks spread through person-to-person contact, environmental contamination, and unknown modes of transmission. The increase in reporting rates during 2009-2013 indicates that reporting to NORS improved notably in the 5 years since its inception. Norovirus is the most commonly reported cause of these outbreaks and, on the basis of epidemiologic data, might account for a substantial proportion of outbreaks without a reported etiology. During 2009-2013, norovirus accounted for most deaths and health care visits in AGE outbreaks spread through person-to-person contact, environmental contamination, and unknown modes of transmission. Recommendations for prevention and control of AGE outbreaks transmitted through person-to-person contact, environmental contamination, and unknown modes of transmission depend primarily on appropriate hand hygiene, environmental disinfection, and isolation of ill persons. NORS surveillance data can help identify priority targets for the development of future control strategies, including hygiene interventions and vaccines, and help monitor the frequency and severity of AGE outbreaks in the United States. Ongoing study of these AGE outbreaks can provide a better understanding of certain pathogens and their modes of transmission. For example, certain reported outbreak etiologies (e.g., Salmonella) are considered primarily foodborne pathogens but can be transmitted through multiple routes. Similarly, further examination of outbreaks of unknown etiology could help identify barriers to making an etiologic determination, to analyze clinical and epidemiologic clues suggestive of a probable etiology, and to discover new and emerging etiologic agents. Outbreak

  1. Mitigating Infectious Disease Outbreaks

    Science.gov (United States)

    Davey, Victoria

    The emergence of new, transmissible infections poses a significant threat to human populations. As the 2009 novel influenza A/H1N1 pandemic and the 2014-2015 Ebola epidemic demonstrate, we have observed the effects of rapid spread of illness in non-immune populations and experienced disturbing uncertainty about future potential for human suffering and societal disruption. Clinical and epidemiologic characteristics of a newly emerged infectious organism are usually gathered in retrospect as the outbreak evolves and affects populations. Knowledge of potential effects of outbreaks and epidemics and most importantly, mitigation at community, regional, national and global levels is needed to inform policy that will prepare and protect people. Study of possible outcomes of evolving epidemics and application of mitigation strategies is not possible in observational or experimental research designs, but computational modeling allows conduct of `virtual' experiments. Results of well-designed computer simulations can aid in the selection and implementation of strategies that limit illness and death, and maintain systems of healthcare and other critical resources that are vital to public protection. Mitigating Infectious Disease Outbreaks.

  2. Establishing a milkborne disease outbreak profile: potential food defense implications.

    Science.gov (United States)

    Newkirk, Ryan; Hedberg, Craig; Bender, Jeff

    2011-03-01

    The main objectives of this study were to establish baseline characteristics for milkborne outbreaks, establish an expected milkborne outbreak profile, and identify potential indicators of food terrorism. This study used 1990-2006 data from the Centers for Disease Control and Prevention Annual Listings of Disease Outbreaks and the Foodborne Outbreak Database (FOOD) to establish epidemiologic baseline characteristics for disease outbreaks associated with fluid milk. FOOD data from 2007 were used to qualitatively validate the potential of the baseline characteristics and the expected outbreak profile. Eighty-three fluid milkborne outbreaks were reported between 1990 and 2006, resulting in 3621 illnesses. The mean number of illnesses per outbreak was 43.6 (illness range: 2-1644). Consumption of unpasteurized milk was associated with 55.4% of reported outbreaks. Campylobacter spp., Escherichia coli, and Salmonella spp. caused 51.2%, 10.8%, and 9.6% of reported outbreaks, respectively. Private homes accounted for 41.0% of outbreak locations. Number ill, outbreak location, and etiology were the primary characteristics which could signal a potential intentional contamination event. In 2007, one pasteurized milk outbreak caused by Listeria was flagged as aberrative compared with the expected outbreak profile. The creation and dissemination of expected outbreak profiles and epidemiologic baseline characteristics allow public health and Homeland Security officials to quickly assess the potential of intentional food contamination. A faster public health and medical system response can result in decreased morbidity and mortality.

  3. Putting the Barker Theory into the Future: Time to Act on Preventing Pediatric Obesity.

    Science.gov (United States)

    Pietrobelli, Angelo; Agosti, Massimo; Zuccotti, Gianvincenzo

    2016-11-17

    Growth and development are key characteristics of childhood and sensitive markers of health and adequate nutrition. The first 1000 days of life-conception through 24 months of age-represent a fundamental period for development and thus the prevention of childhood obesity and its adverse consequences is mandatory. There are many growth drivers during this complex phase of life, such as nutrition, genetic and epigenetic factors, and hormonal regulation. The challenge thus involves maximizing the potential for normal growth without increasing the risk of associated disorders. The Mediterranean Nutrition Group (MeNu Group), a group of researchers of the Mediterranean Region, in this Special Issue titled "Prevent Obesity in the First 1000 Days", presented results that advanced the science of obesity risk factors in early life, coming both from animal model studies and studies in humans. In the future, early-life intervention designs for the prevention of pediatric obesity will need to look at different strategies, and the MeNu Group is available for guidance regarding an appropriate conceptual framework to accomplish either prevention or treatment strategies to tackle pediatric obesity.

  4. Putting the Barker Theory into the Future: Time to Act on Preventing Pediatric Obesity

    Directory of Open Access Journals (Sweden)

    Angelo Pietrobelli

    2016-11-01

    Full Text Available Growth and development are key characteristics of childhood and sensitive markers of health and adequate nutrition. The first 1000 days of life—conception through 24 months of age—represent a fundamental period for development and thus the prevention of childhood obesity and its adverse consequences is mandatory. There are many growth drivers during this complex phase of life, such as nutrition, genetic and epigenetic factors, and hormonal regulation. The challenge thus involves maximizing the potential for normal growth without increasing the risk of associated disorders. The Mediterranean Nutrition Group (MeNu Group, a group of researchers of the Mediterranean Region, in this Special Issue titled “Prevent Obesity in the First 1000 Days”, presented results that advanced the science of obesity risk factors in early life, coming both from animal model studies and studies in humans. In the future, early-life intervention designs for the prevention of pediatric obesity will need to look at different strategies, and the MeNu Group is available for guidance regarding an appropriate conceptual framework to accomplish either prevention or treatment strategies to tackle pediatric obesity.

  5. The role of infant nutrition in the prevention of future disease

    Directory of Open Access Journals (Sweden)

    Ron eShaoul

    2014-07-01

    Full Text Available There is growing evidence that nutrition is part of the environmental factors affecting the incidence of various diseases. The effect starts in the prenatal life and affects fetal growth and continues in early life and throughout childhood. The effect has been shown on various disease states such as allergic diseases, hyperlipidemia and cardiovascular diseases, obesity, type II diabetes and metabolic syndrome and immunologic diseases such as celiac disease and type 1 diabetes mellitus. It seems that the recommendations of exclusive breastfeeding until the age of 4 months and subsequently exposure to various solid foods has beneficial effect in terms of allergic, immune and cardiovascular diseases prevention. Will these recommendations change the natural course of these diseases is unknown yet, but there is an accumulating evidence that indeed this is the case. In this review we review the evidence of early nutritional intervention and future disease prevention.

  6. [Institutional changes for the future of Hygiene and Preventive Medicine in Italy].

    Science.gov (United States)

    Faggioli, Antonio

    2011-01-01

    Following a brief overview of the initiatives undertaken since 2005 by the Italian Society of Hygiene (SitI) regarding he future of Hygiene and Public Health in Italy, the authors examine the latest proposals for renewing the organizational structure of the departments of Prevention, as well as for training programs and function of public health physicians. These changes, however, may be insufficient for a real renewal of public health, in the absence of institutional changes which would allocate administrative management of healthcare functions to local government, with community participation in health promotion. The planned establishment of "metropolitan cities" in 2012 is an opportunity for the SItI to show that the management of health administrative functions by the new local government organs is compatible with the institutional framework, is useful for achieving the objectives of health promotion and disease prevention, and facilitates health policy in local governments.

  7. Ebola virus outbreak, updates on current therapeutic strategies.

    Science.gov (United States)

    Elshabrawy, Hatem A; Erickson, Timothy B; Prabhakar, Bellur S

    2015-07-01

    Filoviruses are enveloped negative-sense single-stranded RNA viruses, which include Ebola and Marburg viruses, known to cause hemorrhagic fever in humans with a case fatality of up to 90%. There have been several Ebola virus outbreaks since the first outbreak in the Democratic Republic of Congo in 1976 of which, the recent 2013-2015 epidemic in Guinea, Liberia, and Sierra Leone is the largest in recorded history. Within a few months of the start of the outbreak in December 2013, thousands of infected cases were reported with a significant number of deaths. As of March 2015, according to the Centers for Disease Control and Prevention, there have been nearly 25,000 suspected cases, with 15,000 confirmed by laboratory testing, and over 10,000 deaths. The large number of cases and the high mortality rate, combined with the lack of effective Food and Drug Administration-approved treatments, necessitate the development of potent and safe therapeutic measures to combat the current and future outbreaks. Since the beginning of the outbreak, there have been considerable efforts to develop and characterize protective measures including vaccines and antiviral small molecules, and some have proven effective in vitro and in animal models. Most recently, a cocktail of monoclonal antibodies has been shown to be highly effective in protecting non-human primates from Ebola virus infection. In this review, we will discuss what is known about the nature of the virus, phylogenetic classification, genomic organization and replication, disease transmission, and viral entry and highlight the current approaches and efforts, in the development of therapeutics, to control the outbreak. Copyright © 2015 John Wiley & Sons, Ltd.

  8. How prepared are we? : The organizational network responses in two infectious disease outbreak scenarios in the Netherlands

    NARCIS (Netherlands)

    Kenis, P.N.; Raab, J.; Kraaij – Dirkzwager, Marleen; Timen, A.

    2017-01-01

    The paper will report results of a research project on the organizational network response to prevent or contain an outbreak of an infectious disease in the Netherlands. The paper is one of the first to present an attempt to conduct an ex ante evaluation of a response network in a likely future

  9. Male circumcision and HIV prevention: current knowledge and future research directions.

    Science.gov (United States)

    Bailey, R C; Plummer, F A; Moses, S

    2001-11-01

    Over the past decade, numerous epidemiological studies have reported a significant association between lack of male circumcision and risk for HIV infection, leading to recommendations for male circumcision to be added to the armamentarium of effective HIV prevention strategies. We review the epidemiological data from studies that have investigated this association, including ecological, cross-sectional/case-control, and prospective studies. We discuss problematic issues in interpreting the epidemiological data, including the presence of other sexually transmitted infections, age of circumcision, and potential confounders such as religion, cultural practices, and genital hygiene. In addition, we review studies of biological mechanisms by which the presence of the foreskin may increase HIV susceptibility, data on risks associated with the circumcision procedure, and available data on the acceptability and feasibility of introducing male circumcision in societies where it is traditionally not practised. Although the evidence in support of male circumcision as an effective HIV prevention measure is compelling, residual confounding in observational studies cannot be excluded. Taken together with concerns over the potential disinhibiting effect of male circumcision on risk behaviour, and safety of the circumcision procedure, randomised trials of male circumcision to prevent HIV infection are recommended. An individual's choice to undergo male circumcision or a community's decision to promote the practice should be made in the light of the best available scientific evidence. More knowledge is required to assist individuals and communities in making those decisions. We conclude with recommendations for future research.

  10. How far can we prevent further physical soil degradation in the future?

    Science.gov (United States)

    Horn, Rainer

    2017-04-01

    .g. fodder production and harvesting, adequate animal grazing), - wind is furthermore minimized by adequate hedgerow plantations, continuous cover crop growth, optimized particle bindings by water, infiltrating organic acids, appropriate grazing intensity. Agroforestry can be considered as an additional positive measure to reduce soil erosion risks generally and to ameliorate degraded sites. C) -plant cover on slopes remains untouched, overgrazing and consecutive soil homogenization especially under moist climatic conditions must be prevented but adjusted to the actual structure stability of the hillsides. The communication of these findings followed by application of such measures can help farmers and foresters as well as landowners to prevent (further) physical soil degradation in the future.

  11. Coccidioidomycosis Outbreaks, United States and Worldwide, 1940-2015.

    Science.gov (United States)

    Freedman, Michael; Jackson, Brendan R; McCotter, Orion; Benedict, Kaitlin

    2018-03-01

    Coccidioidomycosis causes substantial illness and death in the United States each year. Although most cases are sporadic, outbreaks provide insight into the clinical and environmental features of coccidioidomycosis, high-risk activities, and the geographic range of Coccidioides fungi. We identified reports published in English of 47 coccidioidomycosis outbreaks worldwide that resulted in 1,464 cases during 1940-2015. Most (85%) outbreaks were associated with environmental exposures; the 2 largest outbreaks resulted from an earthquake and a large dust storm. More than one third of outbreaks occurred in areas where the fungus was not previously known to be endemic, and more than half of outbreaks involved occupational exposures. Coccidioidomycosis outbreaks can be difficult to detect and challenging to prevent given the unknown effectiveness of environmental control methods and personal protective equipment; therefore, increased awareness of coccidioidomycosis outbreaks is needed among public health professionals, healthcare providers, and the public.

  12. Multistate outbreak of Listeriosis linked to turkey deli meat and subsequent changes in US regulatory policy.

    Science.gov (United States)

    Gottlieb, Sami L; Newbern, E Claire; Griffin, Patricia M; Graves, Lewis M; Hoekstra, R Michael; Baker, Nicole L; Hunter, Susan B; Holt, Kristin G; Ramsey, Fred; Head, Marcus; Levine, Priscilla; Johnson, Geraldine; Schoonmaker-Bopp, Dianna; Reddy, Vasudha; Kornstein, Laura; Gerwel, Michal; Nsubuga, Johnson; Edwards, Leslie; Stonecipher, Shelley; Hurd, Sharon; Austin, Deri; Jefferson, Michelle A; Young, Suzanne D; Hise, Kelley; Chernak, Esther D; Sobel, Jeremy

    2006-01-01

    Listeriosis, a life-threatening foodborne illness caused by Listeria monocytogenes, affects approximately 2500 Americans annually. Between July and October 2002, an uncommon strain of L. monocytogenes caused an outbreak of listeriosis in 9 states. We conducted case finding, a case-control study, and traceback and microbiological investigations to determine the extent and source of the outbreak and to propose control measures. Case patients were infected with the outbreak strain of L. monocytogenes between July and November 2002 in 9 states, and control patients were infected with different L. monocytogenes strains. Outcome measures included food exposure associated with outbreak strain infection and source of the implicated food. Fifty-four case patients were identified; 8 died, and 3 pregnant women had fetal deaths. The case-control study included 38 case patients and 53 control patients. Case patients consumed turkey deli meat much more frequently than did control patients (P = .008, by Wilcoxon rank-sum test). In the 4 weeks before illness, 55% of case patients had eaten deli turkey breast more than 1-2 times, compared with 28% of control patients (odds ratio, 4.5; 95% confidence interval, 1.3-17.1). Investigation of turkey deli meat eaten by case patients led to several turkey processing plants. The outbreak strain was found in the environment of 1 processing plant and in turkey products from a second. Together, the processing plants recalled > 30 million pounds of products. Following the outbreak, the US Department of Agriculture's Food Safety and Inspection Service issued new regulations outlining a L. monocytogenes control and testing program for ready-to-eat meat and poultry processing plants. Turkey deli meat was the source of a large multistate outbreak of listeriosis. Investigation of this outbreak helped guide policy changes designed to prevent future L. monocytogenes contamination of ready-to-eat meat and poultry products.

  13. Bogoch Replikins Pandemic Prevention: Increase of Strain-Specific Influenza Genomic Replikin Counts, Having Predicted Outbreaks and their Location Seven Times Consecutively, Up to Two Years in Advance, Provides Time for Prevention of Pandemics

    OpenAIRE

    Samuel Bogoch; Elenore S. Bogoch

    2012-01-01

    Earlier studies have shown that the increased concentration of a new class of virus genomic peptides, Replikins, precedes and predicts virus outbreaks. We now find that the area in the genome of the highest concentration of Replikins, and the country in which this peak exists in scout viruses, have permitted in the past five years seven consecutive accurate predictions of the geographic localization of coming outbreaks, including those now realized in Mexico for H1N1, and in Cambodia for H5N1...

  14. Diarrhoeal disease outbreak in a rural area of Karnataka

    Directory of Open Access Journals (Sweden)

    Bhavana R Hiremath

    2015-12-01

    Full Text Available Background: Acute diarrhoea is the passage of 3 or more loose or watery stools in the past 24 hours with or without dehydration. Owing to WASH strategy (Water, Sanitation and Hygiene the burden of diarrheal diseases has seen a tremendous decline over the past 2 decades. Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio Cholerae. Objectives: 1. To document the factors responsible for the outbreak. 2. To provide recommendations for prevention and control of such outbreaks in future. Methods: After receiving verbal information from district office regarding outbreak of diarrhoeal disease (cholera in a town of Bijapur district, we independently conducted a cross sectional study in the affected area and collected information regarding no. of people affected since the outbreak, their age and sex distribution. A total of 3802 people were interviewed using a predesigned questionnaire on 28th and 29th July, 2012. We also conducted environmental investigation regarding the source of contamination and collected 2 water samples from drinking water source. Results: All the cases were clustered in the five streets, which were consuming water from contaminated two water tanks. A total of 121 cases of diarrhoea were identified affecting 3.18% of the population. Attack rate of cholera was highest (4.5% in 25-34 years age group followed by 4.22% in 15-24 years age group. Attack rates was higher among females (3.4% compared to males (2.9%. Laboratory report stated that water samples were unfit for drinking purpose. V. Cholera (Ogawa serotype was isolated from water sample. Conclusion: Consumption of contaminated water from a newly dug bore-well had led to the diarrhea outbreak. Lack of sanitation and hygiene had worsened the situation.

  15. Diarrhoeal disease outbreak in a rural area of Karnataka

    Directory of Open Access Journals (Sweden)

    Bhavana R Hiremath

    2015-12-01

    Full Text Available Background: Acute diarrhoea is the passage of 3 or more loose or watery stools in the past 24 hours with or without dehydration. Owing to WASH strategy (Water, Sanitation and Hygiene the burden of diarrheal diseases has seen a tremendous decline over the past 2 decades. Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio Cholerae. Objectives: 1. To document the factors responsible for the outbreak. 2. To provide recommendations for prevention and control of such outbreaks in future. Methods: After receiving verbal information from district office regarding outbreak of diarrhoeal disease (cholera in a town of Bijapur district, we independently conducted a cross sectional study in the affected area and collected information regarding no. of people affected since the outbreak, their age and sex distribution. A total of 3802 people were interviewed using a predesigned questionnaire on 28th and 29th July, 2012. We also conducted environmental investigation regarding the source of contamination and collected 2 water samples from drinking water source. Results: All the cases were clustered in the five streets, which were consuming water from contaminated two water tanks. A total of 121 cases of diarrhoea were identified affecting 3.18% of the population. Attack rate of cholera was highest (4.5% in 25-34 years age group followed by 4.22% in 15-24 years age group. Attack rates was higher among females (3.4% compared to males (2.9%. Laboratory report stated that water samples were unfit for drinking purpose. V. Cholera (Ogawa serotype was isolated from water sample. Conclusion: Consumption of contaminated water from a newly dug bore-well had led to the diarrhea outbreak. Lack of sanitation and hygiene had worsened the situation.

  16. Failure of Quality Control Measures To Prevent Reporting of False Resistance to Imipenem, Resulting in a Pseudo-Outbreak of Imipenem-Resistant Pseudomonas aeruginosa

    Science.gov (United States)

    Carmeli, Yehuda; Eichelberger, Karen; Soja, Don; Dakos, Joanna; Venkataraman, Lata; DeGirolami, Paola; Samore, Matthew

    1998-01-01

    False results showing an outbreak of Pseudomonas aeruginosa with resistance to imipenem were traced to a defective lot of microdilution MIC testing panels. These panels contained two- to threefold lower concentrations of imipenem than expected and resulted in artifactual two- to fourfold increases in MICs of imipenem. The quality-control MIC results for Pseudomonas aeruginosa ATCC 27853 were 4 μg/ml, the highest value within the range recommended by the National Committee for Clinical Laboratory Standards. We recommend that this value be considered out of the quality-control range. PMID:9466787

  17. Acceptance of vaccinations in pandemic outbreaks: a discrete choice experiment.

    Science.gov (United States)

    Determann, Domino; Korfage, Ida J; Lambooij, Mattijs S; Bliemer, Michiel; Richardus, Jan Hendrik; Steyerberg, Ewout W; de Bekker-Grob, Esther W

    2014-01-01

    Preventive measures are essential to limit the spread of new viruses; their uptake is key to their success. However, the vaccination uptake in pandemic outbreaks is often low. We aim to elicit how disease and vaccination characteristics determine preferences of the general public for new pandemic vaccinations. In an internet-based discrete choice experiment (DCE) a representative sample of 536 participants (49% participation rate) from the Dutch population was asked for their preference for vaccination programs in hypothetical communicable disease outbreaks. We used scenarios based on two disease characteristics (susceptibility to and severity of the disease) and five vaccination program characteristics (effectiveness, safety, advice regarding vaccination, media attention, and out-of-pocket costs). The DCE design was based on a literature review, expert interviews and focus group discussions. A panel latent class logit model was used to estimate which trade-offs individuals were willing to make. All above mentioned characteristics proved to influence respondents' preferences for vaccination. Preference heterogeneity was substantial. Females who stated that they were never in favor of vaccination made different trade-offs than males who stated that they were (possibly) willing to get vaccinated. As expected, respondents preferred and were willing to pay more for more effective vaccines, especially if the outbreak was more serious (€6-€39 for a 10% more effective vaccine). Changes in effectiveness, out-of-pocket costs and in the body that advises the vaccine all substantially influenced the predicted uptake. We conclude that various disease and vaccination program characteristics influence respondents' preferences for pandemic vaccination programs. Agencies responsible for preventive measures during pandemics can use the knowledge that out-of-pocket costs and the way advice is given affect vaccination uptake to improve their plans for future pandemic outbreaks

  18. Acceptance of vaccinations in pandemic outbreaks: a discrete choice experiment.

    Directory of Open Access Journals (Sweden)

    Domino Determann

    Full Text Available Preventive measures are essential to limit the spread of new viruses; their uptake is key to their success. However, the vaccination uptake in pandemic outbreaks is often low. We aim to elicit how disease and vaccination characteristics determine preferences of the general public for new pandemic vaccinations.In an internet-based discrete choice experiment (DCE a representative sample of 536 participants (49% participation rate from the Dutch population was asked for their preference for vaccination programs in hypothetical communicable disease outbreaks. We used scenarios based on two disease characteristics (susceptibility to and severity of the disease and five vaccination program characteristics (effectiveness, safety, advice regarding vaccination, media attention, and out-of-pocket costs. The DCE design was based on a literature review, expert interviews and focus group discussions. A panel latent class logit model was used to estimate which trade-offs individuals were willing to make.All above mentioned characteristics proved to influence respondents' preferences for vaccination. Preference heterogeneity was substantial. Females who stated that they were never in favor of vaccination made different trade-offs than males who stated that they were (possibly willing to get vaccinated. As expected, respondents preferred and were willing to pay more for more effective vaccines, especially if the outbreak was more serious (€6-€39 for a 10% more effective vaccine. Changes in effectiveness, out-of-pocket costs and in the body that advises the vaccine all substantially influenced the predicted uptake.We conclude that various disease and vaccination program characteristics influence respondents' preferences for pandemic vaccination programs. Agencies responsible for preventive measures during pandemics can use the knowledge that out-of-pocket costs and the way advice is given affect vaccination uptake to improve their plans for future pandemic

  19. Epidemiology of restaurant-associated foodborne disease outbreaks, United States, 1998-2013.

    Science.gov (United States)

    Angelo, K M; Nisler, A L; Hall, A J; Brown, L G; Gould, L H

    2017-02-01

    Although contamination of food can occur at any point from farm to table, restaurant food workers are a common source of foodborne illness. We describe the characteristics of restaurant-associated foodborne disease outbreaks and explore the role of food workers by analysing outbreaks associated with restaurants from 1998 to 2013 reported to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System. We identified 9788 restaurant-associated outbreaks. The median annual number of outbreaks was 620 (interquartile range 618-629). In 3072 outbreaks with a single confirmed aetiology reported, norovirus caused the largest number of outbreaks (1425, 46%). Of outbreaks with a single food reported and a confirmed aetiology, fish (254 outbreaks, 34%) was most commonly implicated, and these outbreaks were commonly caused by scombroid toxin (219 outbreaks, 86% of fish outbreaks). Most outbreaks (79%) occurred at sit-down establishments. The most commonly reported contributing factors were those related to food handling and preparation practices in the restaurant (2955 outbreaks, 61%). Food workers contributed to 2415 (25%) outbreaks. Knowledge of the foods, aetiologies, and contributing factors that result in foodborne disease restaurant outbreaks can help guide efforts to prevent foodborne illness.

  20. Adolescent Cellphone Use While Driving: An Overview of the Literature and Promising Future Directions for Prevention

    Directory of Open Access Journals (Sweden)

    M. Kit Delgado

    2016-06-01

    Full Text Available Motor vehicle crashes are the leading cause of death in adolescents, and drivers aged 16–19 are the most likely to die in distracted driving crashes. This paper provides an overview of the literature on adolescent cellphone use while driving, focusing on the crash risk, incidence, risk factors for engagement, and the effectiveness of current mitigation strategies. We conclude by discussing promising future approaches to prevent crashes related to cellphone use in adolescents. Handheld manipulation of the phone while driving has been shown to have a 3 to 4-fold increased risk of a near crash or crash, and eye glance duration greater than 2 seconds increases crash risk exponentially. Nearly half of U.S. high school students admit to texting while driving in the last month, but the frequency of use according to vehicle speed and high-risk situations remains unknown. Several risk factors are associated with cell phone use while driving including: parental cellphone use while driving, social norms for quick responses to text messages, and higher levels of temporal discounting. Given the limited effectiveness of current mitigation strategies such as educational campaigns and legal bans, a multi-pronged behavioral and technological approach addressing the above risk factors will be necessary to reduce this dangerous behavior in adolescents.

  1. Adolescent Cellphone Use While Driving: An Overview of the Literature and Promising Future Directions for Prevention

    Science.gov (United States)

    Delgado, M. Kit; Wanner, Kathryn J.; McDonald, Catherine

    2016-01-01

    Motor vehicle crashes are the leading cause of death in adolescents, and drivers aged 16–19 are the most likely to die in distracted driving crashes. This paper provides an overview of the literature on adolescent cellphone use while driving, focusing on the crash risk, incidence, risk factors for engagement, and the effectiveness of current mitigation strategies. We conclude by discussing promising future approaches to prevent crashes related to cellphone use in adolescents. Handheld manipulation of the phone while driving has been shown to have a 3 to 4-fold increased risk of a near crash or crash, and eye glance duration greater than 2 seconds increases crash risk exponentially. Nearly half of U.S. high school students admit to texting while driving in the last month, but the frequency of use according to vehicle speed and high-risk situations remains unknown. Several risk factors are associated with cell phone use while driving including: parental cellphone use while driving, social norms for quick responses to text messages, and higher levels of temporal discounting. Given the limited effectiveness of current mitigation strategies such as educational campaigns and legal bans, a multi-pronged behavioral and technological approach addressing the above risk factors will be necessary to reduce this dangerous behavior in adolescents. PMID:27695663

  2. Role of oral pre-exposure prophylaxis (PrEP) in current and future HIV prevention strategies.

    Science.gov (United States)

    Burns, David N; Grossman, Cynthia; Turpin, Jim; Elharrar, Vanessa; Veronese, Fulvia

    2014-12-01

    Treatment as prevention is expected to have a major role in reducing HIV incidence, but other prevention interventions will also be required to bring the epidemic under control, particularly among key populations. One or more forms of pre-exposure prophylaxis (PrEP) will likely play a critical role. Oral PrEP with emtricitabine-tenofovir (Truvada®) is currently available in the US and some other countries, but uptake has been slow. We review the concerns that have contributed to this slow uptake and discuss current and future research in this critical area of HIV prevention research.

  3. NCIPC's contribution to global injury and violence prevention: past, present, and future.

    Science.gov (United States)

    Mahendra, Reshma R; Roehler, Douglas R; Degutis, Linda C

    2012-09-01

    Injuries and violence impact millions across the globe each year. For the past 20 years, the National Center for Injury Prevention and Control (NCIPC) at the Centers for Disease Control and Prevention (CDC) has assembled the largest cadre of injury and violence prevention experts in the world to reduce the burden of injuries and violence domestically and to inform global injury and violence prevention efforts. This article focuses on NCIPC's global injury and violence prevention work that involves: increasing awareness of the preventability of injury and violence, partnerships to promote injury research and best practices; establishing standards and guidance for data collection; building capacity through training and mentoring; and supporting evidence-based strategies. To decrease the global burden, the authors propose priority setting to maximize the development and sustainability of financial and human resources for injury and violence prevention. The authors call for increased capacity and resources for global injury and violence prevention. Published by Elsevier Ltd.

  4. Control of simultaneous outbreaks of carbapenemase-producing enterobacteriaceae and extensively drug-resistant Acinetobacter baumannii infection in an intensive care unit using interventions promoted in the Centers for Disease Control and Prevention 2012 carbapenemase-resistant Enterobacteriaceae Toolkit.

    Science.gov (United States)

    Enfield, Kyle B; Huq, Nujhat N; Gosseling, Megan F; Low, Darla J; Hazen, Kevin C; Toney, Denise M; Slitt, Gavin; Zapata, Heidi J; Cox, Heather L; Lewis, Jessica D; Kundzins, John R; Mathers, Amy J; Sifri, Costi D

    2014-07-01

    We describe the efficacy of enhanced infection control measures, including those recommended in the Centers for Disease Control and Prevention's 2012 carbapenem-resistant Enterobacteriaceae (CRE) toolkit, to control concurrent outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) and extensively drug-resistant Acinetobacter baumannii (XDR-AB). Before-after intervention study. Fifteen-bed surgical trauma intensive care unit (ICU). We investigated the impact of enhanced infection control measures in response to clusters of CPE and XDR-AB infections in an ICU from April 2009 to March 2010. Polymerase chain reaction was used to detect the presence of blaKPC and resistance plasmids in CRE. Pulsed-field gel electrophoresis was performed to assess XDR-AB clonality. Enhanced infection-control measures were implemented in response to ongoing transmission of CPE and a new outbreak of XDR-AB. Efficacy was evaluated by comparing the incidence rate (IR) of CPE and XDR-AB before and after the implementation of these measures. The IR of CPE for the 12 months before the implementation of enhanced measures was 7.77 cases per 1,000 patient-days, whereas the IR of XDR-AB for the 3 months before implementation was 6.79 cases per 1,000 patient-days. All examined CPE shared endemic blaKPC resistance plasmids, and 6 of the 7 XDR-AB isolates were clonal. Following institution of enhanced infection control measures, the CPE IR decreased to 1.22 cases per 1,000 patient-days (P = .001), and no more cases of XDR-AB were identified. Use of infection control measures described in the Centers for Disease Control and Prevention's 2012 CRE toolkit was associated with a reduction in the IR of CPE and an interruption in XDR-AB transmission.

  5. Outbreak of Salmonella Oslo Infections Linked to Persian Cucumbers - United States, 2016.

    Science.gov (United States)

    Bottichio, Lyndsay; Medus, Carlota; Sorenson, Alida; Donovan, Danielle; Sharma, Reeti; Dowell, Natasha; Williams, Ian; Wellman, Allison; Jackson, Alikeh; Tolar, Beth; Griswold, Taylor; Basler, Colin

    2016-12-30

    In April 2016, PulseNet, the national molecular subtyping network for foodborne disease surveillance, detected a multistate cluster of Salmonella enterica serotype Oslo infections with an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern (XbaI PFGE pattern OSLX01.0090).* This PFGE pattern was new in the database; no previous infections or outbreaks have been identified. CDC, state and local health and agriculture departments and laboratories, and the Food and Drug Administration (FDA) conducted epidemiologic, traceback, and laboratory investigations to identify the source of this outbreak. A total of 14 patients in eight states were identified, with illness onsets occurring during March 21-April 9, 2016. Whole genome sequencing, a highly discriminating subtyping method, was used to further characterize PFGE pattern OSLX01.0090 isolates. Epidemiologic evidence indicates Persian cucumbers as the source of Salmonella Oslo infections in this outbreak. This is the fourth identified multistate outbreak of salmonellosis associated with cucumbers since 2013. Further research is needed to understand the mechanism and factors that contribute to contamination of cucumbers during growth, harvesting, and processing to prevent future outbreaks.

  6. Food poisoning outbreak in a training establishment: A retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Maramraj Kiran Kumar

    2017-01-01

    Full Text Available Background: An outbreak of food poisoning occurred among recruits in a training establishment. Investigation of outbreak was undertaken with active preventive interventions concurrently to arrest the current outbreak as well as to avoid such incidents in future. Materials and Methods: A retrospective cohort study was undertaken among all recruits, regardless of presence or absence of symptoms. The risk ratios (relative risks and attributable risks were calculated for each food item of the suspected meal to assess the association between consumption of individual food items and subsequent illness. An environmental survey was undertaken to investigate into the course of food processing and storage facilities at trainees' galley (cookhouse and other relevant eating establishments. Results: A total of 494 recruits reported with symptoms of gastroenteritis in a span of 3 days. Of those affected, only 9 were admitted and rest recovered with treatment on OPD basis. The overall attack rate was 22.9%. No deaths were reported. It was a classical point source, single exposure gastroenteritis outbreak. When food histories and sickness histories were analyzed, the attributable risk (24.17 and relative risk (5.11 were highest for the “Flavoured milk,” which was an outsourced item. The statistical findings were substantiated with environmental and epidemiological evidence. Conclusion: Epidemiological investigation incriminated dinner of the previous day as the meal responsible for the outbreak with flavored milk as the most attributable food item.

  7. Determination of future prevention strategies in elite track and field: analysis of Daegu 2011 IAAF Championships injuries and illnesses surveillance

    OpenAIRE

    Alonso, Juan-Manuel; Edouard, Pascal; Fischetto, Giuseppe; Adams, Bob; Depiesse, Frédéric; Mountjoy, Margo

    2012-01-01

    Objective To determine the incidence and characteristics of newly incurred injuries and illnesses during international Athletics Championships, by improving the medical surveillance coverage, in order to determine future prevention strategies. Design Prospective recording of newly occurred injuries and illnesses. Setting 13th International Association of Athletics Federations World Championships in Athletics 2011 in Daegu, Korea. Participants National team and Local Organising Committee physi...

  8. Gynecologic Cancer Prevention and Control in the National Comprehensive Cancer Control Program: Progress, Current Activities, and Future Directions

    OpenAIRE

    Stewart, Sherri L.; Lakhani, Naheed; Brown, Phaeydra M.; Larkin, O. Ann; Moore, Angela R.; Hayes, Nikki S.

    2013-01-01

    Gynecologic cancer confers a large burden among women in the United States. Several evidence-based interventions are available to reduce the incidence, morbidity, and mortality from these cancers. The National Comprehensive Cancer Control Program (NCCCP) is uniquely positioned to implement these interventions in the US population. This review discusses progress and future directions for the NCCCP in preventing and controlling gynecologic cancer.

  9. Gynecologic cancer prevention and control in the National Comprehensive Cancer Control Program: progress, current activities, and future directions.

    Science.gov (United States)

    Stewart, Sherri L; Lakhani, Naheed; Brown, Phaeydra M; Larkin, O Ann; Moore, Angela R; Hayes, Nikki S

    2013-08-01

    Gynecologic cancer confers a large burden among women in the United States. Several evidence-based interventions are available to reduce the incidence, morbidity, and mortality from these cancers. The National Comprehensive Cancer Control Program (NCCCP) is uniquely positioned to implement these interventions in the US population. This review discusses progress and future directions for the NCCCP in preventing and controlling gynecologic cancer.

  10. Anesthetic gases and global warming: Potentials, prevention and future of anesthesia.

    Science.gov (United States)

    Gadani, Hina; Vyas, Arun

    2011-01-01

    Global warming refers to an average increase in the earth's temperature, which in turn causes changes in climate. A warmer earth may lead to changes in rainfall patterns, a rise in sea level, and a wide range of impacts on plants, wildlife, and humans. Greenhouse gases make the earth warmer by trapping energy inside the atmosphere. Greenhouse gases are any gas that absorbs infrared radiation in the atmosphere and include: water vapor, carbon dioxide (CO2), methane (CH4), nitrous oxide (N2O), halogenated fluorocarbons (HCFCs), ozone (O3), perfluorinated carbons (PFCs), and hydrofluorocarbons (HFCs). Hazardous chemicals enter the air we breathe as a result of dozens of activities carried out during a typical day at a healthcare facility like processing lab samples, burning fossil fuels etc. We sometimes forget that anesthetic agents are also greenhouse gases (GHGs). Anesthetic agents used today are volatile halogenated ethers and the common carrier gas nitrous oxide known to be aggressive GHGs. With less than 5% of the total delivered halogenated anesthetic being metabolized by the patient, the vast majority of the anesthetic is routinely vented to the atmosphere through the operating room scavenging system. The global warming potential (GWP) of a halogenated anesthetic is up to 2,000 times greater than CO2. Global warming potentials are used to compare the strength of different GHGs to trap heat in the atmosphere relative to that of CO2. Here we discuss about the GWP of anesthetic gases, preventive measures to decrease the global warming effects of anesthetic gases and Xenon, a newer anesthetic gas for the future of anesthesia.

  11. Varicella outbreak among Afghan National Civil Order Police recruits-Herat Regional Military Training Center, Herat, Afghanistan, 2010.

    Science.gov (United States)

    Cowan, James B; Davis, Theodore S

    2012-08-01

    In December 2010, an outbreak of varicella was reported among student recruits enrolled at the Afghan National Civil Order Police Herat Regional Military Training Center. The outbreak had an overall attack rate of 9.8% (31 of 316 recruits) with primary, secondary, and tertiary attack rates of 6.3% (20 of 316), 3.4% (10 of 296), and 0.35% (1 of 286). Fortunately, the outbreak did not lead to any deaths or serious complications. However, it significantly interfered with Afghan National Civil Order Police training by causing a loss of 378 person-days of training. Medical personnel from the Afghan National Police, DynCorp International, Government of the Islamic Republic of Afghanistan Ministry of Public Health, and NATO Training Mission-Afghanistan Herat Joint Medical Operation Cell joined together to control and characterize the outbreak and prepare and disseminate recommendations for preventing future outbreaks. Control measures were quickly implemented, but less than ideal. Varicella vaccine was not available in Afghanistan to immunize exposed recruits. The outbreak was reported to medical authorities through a slow and convoluted process. And the majority of varicella cases did not self-report for care. Rather, medical personnel diagnosed most cases only after recruits were directed to report for a physical examination.

  12. Motivational Antecedents of Preventive Proactivity in Late Life: Linking Future Orientation and Exercise1

    OpenAIRE

    Kahana, Eva; Kahana, Boaz; Zhang, Jianping

    2005-01-01

    Future orientation is considered as a motivational antecedent of late-life proactivity. In a panel study of 453 old-old adults, we linked future orientation to exercise, a key component of late-life proactivity. Findings based on hierarchical linear modeling reveal that future orientation at baseline predicts changes in exercise during the subsequent four years. Whereas exercise behavior generally declined over time, future orientation and female gender were associated with smaller decline. T...

  13. Outbreak of Occupational Brucellosis at a Pharmaceutical Factory in Southeast China.

    Science.gov (United States)

    Zhan, B D; Wang, S Q; Lai, S M; Lu, Y; Shi, X G; Cao, G P; Hu, X L; Zheng, C J; Yu, Z Y; Zhang, J M; Fang, C F; Gong, Z Y

    2017-09-01

    Brucellosis is an occupational disease affecting workers in butcher shops, the milking and dairy product industry, causing more than 500 000 new cases around the world. As a national statutory B infectious disease in China, morbidity of brucellosis is rapidly increasing in recent years. We report an occupational outbreak of brucellosis infection in a pharmaceutical factory. Exposure was a result of manual operation in the process line, close contact with sheep placentas, insufficient disinfection and repeated using of protective suits and infected by aerosol dissemination. Improved preventive methods, appropriate public health measures and spread of health education would be helpful to prevent the occupational outbreak of brucellosis in future. © 2016 Blackwell Verlag GmbH.

  14. Two consecutive large outbreaks of Salmonella Muenchen linked to pig farming in Germany, 2013 to 2014: Is something missing in our regulatory framework?

    Science.gov (United States)

    Schielke, Anika; Rabsch, Wolfgang; Prager, Rita; Simon, Sandra; Fruth, Angelika; Helling, Rüdiger; Schnabel, Martin; Siffczyk, Claudia; Wieczorek, Sina; Schroeder, Sabine; Ahrens, Beate; Oppermann, Hanna; Pfeiffer, Stefan; Merbecks, Sophie Susann; Rosner, Bettina; Frank, Christina; Weiser, Armin A; Luber, Petra; Gilsdorf, Andreas; Stark, Klaus; Werber, Dirk

    2017-05-04

    In 2013, raw pork was the suspected vehicle of a large outbreak (n = 203 cases) of Salmonella Muenchen in the German federal state of Saxony. In 2014, we investigated an outbreak (n = 247 cases) caused by the same serovar affecting Saxony and three further federal states in the eastern part of Germany. Evidence from epidemiological, microbiological and trace-back investigations strongly implicated different raw pork products as outbreak vehicles. Trace-back analysis of S. Muenchen-contaminated raw pork sausages narrowed the possible source down to 54 pig farms, and S. Muenchen was detected in three of them, which traded animals with each other. One of these farms had already been the suspected source of the 2013 outbreak. S. Muenchen isolates from stool of patients in 2013 and 2014 as well as from food and environmental surface swabs of the three pig farms shared indistinguishable pulsed-field gel electrophoresis patterns. Our results indicate a common source of both outbreaks in the primary production of pigs. Current European regulations do not make provisions for Salmonella control measures on pig farms that have been involved in human disease outbreaks. In order to prevent future outbreaks, legislators should consider tightening regulations for Salmonella control in causative primary production settings. This article is copyright of The Authors, 2017.

  15. Measles Cases during Ebola Outbreak, West Africa, 2013-2106.

    Science.gov (United States)

    Colavita, Francesca; Biava, Mirella; Castilletti, Concetta; Quartu, Serena; Vairo, Francesco; Caglioti, Claudia; Agrati, Chiara; Lalle, Eleonora; Bordi, Licia; Lanini, Simone; Guanti, Michela Delli; Miccio, Rossella; Ippolito, Giuseppe; Capobianchi, Maria R; Di Caro, Antonino

    2017-06-01

    The recent Ebola outbreak in West Africa caused breakdowns in public health systems, which might have caused outbreaks of vaccine-preventable diseases. We tested 80 patients admitted to an Ebola treatment center in Freetown, Sierra Leone, for measles. These patients were negative for Ebola virus. Measles virus IgM was detected in 13 (16%) of the patients.

  16. Prevention of Mental Health Disorders Using Internet- and Mobile-Based Interventions: A Narrative Review and Recommendations for Future Research

    Directory of Open Access Journals (Sweden)

    David Daniel Ebert

    2017-08-01

    Full Text Available Although psychological interventions might have a tremendous potential for the prevention of mental health disorders (MHD, their current impact on the reduction of disease burden is questionable. Possible reasons include that it is not practical to deliver those interventions to the community en masse due to limited health care resources and the limited availability of evidence-based interventions and clinicians in routine practice, especially in rural areas. Therefore, new approaches are needed to maximize the impact of psychological preventive interventions. Limitations of traditional prevention programs could potentially be overcome by providing Internet- and mobile-based interventions (IMIs. This relatively new medium for promoting mental health and preventing MHD introduces a fresh array of possibilities, including the provision of evidence-based psychological interventions that are free from the restraints of travel and time and allow reaching participants for whom traditional opportunities are not an option. This article provides an introduction to the subject and narratively reviews the available evidence for the effectiveness of IMIs with regard to the prevention of MHD onsets. The number of randomized controlled trials that have been conducted to date is very limited and so far it is not possible to draw definite conclusions about the potential of IMIs for the prevention of MHD for specific disorders. Only for the indicated prevention of depression there is consistent evidence across four different randomized trial trials. The only trial on the prevention of general anxiety did not result in positive findings in terms of eating disorders (EDs, effects were only found in post hoc subgroup analyses, indicating that it might be possible to prevent ED onset for subpopulations of people at risk of developing EDs. Future studies need to identify those subpopulations likely to profit from preventive. Disorders not examined so far include

  17. Prevention of Mental Health Disorders Using Internet- and Mobile-Based Interventions: A Narrative Review and Recommendations for Future Research.

    Science.gov (United States)

    Ebert, David Daniel; Cuijpers, Pim; Muñoz, Ricardo F; Baumeister, Harald

    2017-01-01

    Although psychological interventions might have a tremendous potential for the prevention of mental health disorders (MHD), their current impact on the reduction of disease burden is questionable. Possible reasons include that it is not practical to deliver those interventions to the community en masse due to limited health care resources and the limited availability of evidence-based interventions and clinicians in routine practice, especially in rural areas. Therefore, new approaches are needed to maximize the impact of psychological preventive interventions. Limitations of traditional prevention programs could potentially be overcome by providing Internet- and mobile-based interventions (IMIs). This relatively new medium for promoting mental health and preventing MHD introduces a fresh array of possibilities, including the provision of evidence-based psychological interventions that are free from the restraints of travel and time and allow reaching participants for whom traditional opportunities are not an option. This article provides an introduction to the subject and narratively reviews the available evidence for the effectiveness of IMIs with regard to the prevention of MHD onsets. The number of randomized controlled trials that have been conducted to date is very limited and so far it is not possible to draw definite conclusions about the potential of IMIs for the prevention of MHD for specific disorders. Only for the indicated prevention of depression there is consistent evidence across four different randomized trial trials. The only trial on the prevention of general anxiety did not result in positive findings in terms of eating disorders (EDs), effects were only found in post hoc subgroup analyses, indicating that it might be possible to prevent ED onset for subpopulations of people at risk of developing EDs. Future studies need to identify those subpopulations likely to profit from preventive. Disorders not examined so far include substance use

  18. 寨卡病毒暴发流行与孕产妇预防控制措施研究进展%Prevalence of Zika virus outbreak and the prevention and control measures against infection in pregnant women

    Institute of Scientific and Technical Information of China (English)

    吕志华

    2017-01-01

    孕产妇感染寨卡病毒可增加小头症和格林-巴利综合征发病率.目前尚无有效的寨卡病毒疫苗及特异性治疗药物,做好孕产妇预防控制工作具有重要意义.本文就寨卡病毒的暴发流行与孕产妇预防控制措施的研究进展作一综述.%Zika virus infection in pregnant women may increase the incidence of microcephaly in newborns and GuillainBarré syndrome in children.There is no vaccine or specific drug for Zika virus,therefore the effective prevention and control measures are critical,especially for pregnant women.This paper reviews the prevalence of Zika virus outbreak and the prevention and control measures against the infection in pregnant women.

  19. Cross-Border Cholera Outbreaks in Sub-Saharan Africa, the Mystery behind the Silent Illness: What Needs to Be Done?

    Science.gov (United States)

    Bwire, Godfrey; Mwesawina, Maurice; Baluku, Yosia; Kanyanda, Setiala S E; Orach, Christopher Garimoi

    2016-01-01

    Cross-border cholera outbreaks are a major public health problem in Sub-Saharan Africa contributing to the high annual reported cholera cases and deaths. These outbreaks affect all categories of people and are challenging to prevent and control. This article describes lessons learnt during the cross-border cholera outbreak control in Eastern and Southern Africa sub-regions using the case of Uganda-DRC and Malawi-Mozambique borders and makes recommendations for future outbreak prevention and control. We reviewed weekly surveillance data, outbreak response reports and documented experiences on the management of the most recent cross-border cholera outbreaks in Eastern and Southern Africa sub-regions, namely in Uganda and Malawi respectively. Uganda-Democratic Republic of Congo and Malawi-Mozambique borders were selected because the countries sharing these borders reported high cholera disease burden to WHO. A total of 603 cross-border cholera cases with 5 deaths were recorded in Malawi and Uganda in 2015. Uganda recorded 118 cases with 2 deaths and CFR of 1.7%. The under-fives and school going children were the most affected age groups contributing 24.2% and 36.4% of all patients seen along Malawi-Mozambique and Uganda-DRC borders, respectively. These outbreaks lasted for over 3 months and spread to new areas leading to 60 cases with 3 deaths, CRF of 5%, and 102 cases 0 deaths in Malawi and Uganda, respectively. Factors contributing to these outbreaks were: poor sanitation and hygiene, use of contaminated water, floods and rampant cross-border movements. The outbreak control efforts mainly involved unilateral measures implemented by only one of the affected countries. Cross-border cholera outbreaks contribute to the high annual reported cholera burden in Sub-Saharan Africa yet they remain silent, marginalized and poorly identified by cholera actors (governments and international agencies). The under-fives and the school going children were the most affected age

  20. Cross-Border Cholera Outbreaks in Sub-Saharan Africa, the Mystery behind the Silent Illness: What Needs to Be Done?

    Directory of Open Access Journals (Sweden)

    Godfrey Bwire

    Full Text Available Cross-border cholera outbreaks are a major public health problem in Sub-Saharan Africa contributing to the high annual reported cholera cases and deaths. These outbreaks affect all categories of people and are challenging to prevent and control. This article describes lessons learnt during the cross-border cholera outbreak control in Eastern and Southern Africa sub-regions using the case of Uganda-DRC and Malawi-Mozambique borders and makes recommendations for future outbreak prevention and control.We reviewed weekly surveillance data, outbreak response reports and documented experiences on the management of the most recent cross-border cholera outbreaks in Eastern and Southern Africa sub-regions, namely in Uganda and Malawi respectively. Uganda-Democratic Republic of Congo and Malawi-Mozambique borders were selected because the countries sharing these borders reported high cholera disease burden to WHO.A total of 603 cross-border cholera cases with 5 deaths were recorded in Malawi and Uganda in 2015. Uganda recorded 118 cases with 2 deaths and CFR of 1.7%. The under-fives and school going children were the most affected age groups contributing 24.2% and 36.4% of all patients seen along Malawi-Mozambique and Uganda-DRC borders, respectively. These outbreaks lasted for over 3 months and spread to new areas leading to 60 cases with 3 deaths, CRF of 5%, and 102 cases 0 deaths in Malawi and Uganda, respectively. Factors contributing to these outbreaks were: poor sanitation and hygiene, use of contaminated water, floods and rampant cross-border movements. The outbreak control efforts mainly involved unilateral measures implemented by only one of the affected countries.Cross-border cholera outbreaks contribute to the high annual reported cholera burden in Sub-Saharan Africa yet they remain silent, marginalized and poorly identified by cholera actors (governments and international agencies. The under-fives and the school going children were the most

  1. Knowledge sharing in infection prevention in routine and outbreak situations: a survey of the Society for Healthcare Epidemiology of America Research Network

    Directory of Open Access Journals (Sweden)

    Rami Sommerstein

    2017-08-01

    Full Text Available Abstract In this cross-sectional Society for Healthcare Epidemiology of America Research Network survey on knowledge sharing in infection prevention we identified a rudimentary understanding of how to communicate and share knowledge within healthcare institutions. Our data support the need of further research in this important field.

  2. The health profile of professional soccer players: future opportunities for injury prevention.

    Science.gov (United States)

    Volpi, Piero; Taioli, Emanuela

    2012-12-01

    Injuries are a major adverse event during a soccer player's career; they require medical and surgical treatment and rehabilitation and thus may interrupt the player's activity, often with severe physical and psychological sequel. Specialists have tried to identify the risk factors for injuries, in an attempt to discover predictors that could be prevented and or eliminated before the injury occurs, but the results are scarce. This article reviews the epidemiology of the frequency and occurrence of injuries in Italian soccer players, reports a list of preventable risk factors that are associated with injuries, and identifies preventable risk factors. We have identified personal factors (age, previous traumatic events, physical and biological characteristics of the player, life style habits such as smoking, alcohol, and diet, changes in physical-athletic aspects of the players, such as increased muscle strength, and use of medications) as possible risk factors for injuries. However, environmental factors such as changes in training techniques, field composition, and shoes structure may also have a major influence. This summary indicates that appropriate preventive measures can be undertaken to prevent injuries in professional soccer players. Professionals who are in close contacts with the players should be informed of the predictors of injuries and should be trained to intervene and plan appropriate preventive measures.

  3. Stroke prevention in atrial fibrillation: Past, present and future. Comparing the guidelines and practical decision-making.

    Science.gov (United States)

    Lip, Gregory; Freedman, Ben; De Caterina, Raffaele; Potpara, Tatjana S

    2017-06-28

    Concepts and our approaches to stroke prevention in atrial fibrillation (AF) have changed markedly over the last decade. There has been an evolution over the approach to stroke and bleeding risk assessment, as well as new treatment options. An increasing awareness of AF has led to calls to improve the detection of and population screening for AF. Stroke and bleeding risk assessment continues to evolve, and the ongoing debate on balance between simplicity and practicality, against precision medicine will continue. In this review article, we provide an overview of past, present and the (likely) future concepts and approaches to stroke prevention in AF. We propose three simple steps (the Birmingham '3-step') that offers a practical management pathway to help streamline and simplify decision-making for stroke prevention in patients with AF.

  4. Simple visit behavior unifies complex Zika outbreaks

    Directory of Open Access Journals (Sweden)

    P.D. Manrique

    2017-12-01

    Full Text Available New outbreaks of Zika in the U.S. are imminent. Human nature dictates that many individuals will continue to revisit affected ‘Ground Zero’ patches, whether out of choice, work or family reasons − yet this feature is missing from traditional epidemiological analyses. Here we show that this missing visit-revisit mechanism is by itself capable of explaining quantitatively the 2016 human Zika outbreaks in all three Ground Zero patches. Our findings reveal counterintuitive ways in which this human flow can be managed to tailor any future outbreak’s duration, severity and time-to-peak. Effective public health planning can leverage these results to impact the evolution of future outbreaks via soft control of the overall human flow, as well as to suggest best-practice visitation behavior for local residents.

  5. Futures

    DEFF Research Database (Denmark)

    Pedersen, Michael Haldrup

    2017-01-01

    Currently both design thinking and critical social science experience an increased interest in speculating in alternative future scenarios. This interest is not least related to the challenges issues of global sustainability present for politics, ethics and design. This paper explores the potenti......Currently both design thinking and critical social science experience an increased interest in speculating in alternative future scenarios. This interest is not least related to the challenges issues of global sustainability present for politics, ethics and design. This paper explores...... the potentials of speculative thinking in relation to design and social and cultural studies, arguing that both offer valuable insights for creating a speculative space for new emergent criticalities challenging current assumptions of the relations between power and design. It does so by tracing out discussions...... of ‘futurity’ and ‘futuring’ in design as well as social and cultural studies. Firstly, by discussing futurist and speculative approaches in design thinking; secondly by engaging with ideas of scenario thinking and utopianism in current social and cultural studies; and thirdly by showing how the articulation...

  6. Trials in the prevention of type 1 diabetes: current and future.

    Science.gov (United States)

    Wherrett, Diane K

    2014-08-01

    A major thrust in type 1 diabetes research is stopping the destruction of beta cells that leads to type 1 diabetes. Research over the past 30 years has defined genetic factors and evidence of autoimmunity that have led to the development of robust prediction models in those at high risk for type 1 diabetes. The ability to identify those at risk and the development of new agents and of collaborative research networks has led to multiple trials aimed at preventing beta cell loss. Trials at all stages of beta cell loss have been conducted: primary prevention (prior to the development of autoimmunity); secondary prevention (after autoantibodies are found) and tertiary prevention (intervening after diagnosis to maintain remaining beta cells). Studies have shown mixed results; evidence of maintained insulin secretion after the time of diagnosis has been described in a number of studies, and primary and secondary prevention is proving to be elusive. Much has been learned from the increasing number of studies in the field in terms of network creation, study design and choice of intervention that will facilitate new avenues of investigation. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  7. Late-life suicide prevention strategies: current status and future directions.

    Science.gov (United States)

    Van Orden, Kim; Deming, Charlene

    2017-09-08

    Late life suicide prevention differs from suicide prevention for other age groups: first, the number of older adults worldwide is on the rise; second, late-life suicide receives much less attention in all societal spheres, from the media, to federal funding agencies, to healthcare initiatives. Recent findings indicate an association between internalized ageist stereotypes and reduced will to live. Recent research also addresses the role of cognitive control as a contributor to risk and as an intervention target (e.g., through psychotherapies such as problem solving therapy) as well as firearm safety as a promising, though a politicized and challenging strategy to implement. Another strategy that may prove feasible is an approach on upstream prevention strategies in healthcare. One strategy we believe holds great promise is the promotion of high quality geriatric medicine. Geriatricians are trained to work with patients to prioritize the promotion of physical and cognitive functioning (rather than solely absence of disease) and to focus on well-being as a goal. Thus, geriatricians routinely target numerous late-life suicide risk factors-physical illness, functioning, pain, and (dis)satisfaction with life. However, efficacious strategies will not prevent suicide deaths if they are not implemented-addressing ageism as a universal prevention strategy is essential. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Identification of Elizabethkingia meningoseptica from American bullfrog (Rana catesbeiana farmed in Sabah, Malaysia using PCR method and future management of outbreak

    Directory of Open Access Journals (Sweden)

    Zainuri, N.

    2013-01-01

    Full Text Available Aims: High demand for frog meat in Malaysia especially the American bullfrog (Rana catesbeiana has promoted intensive farming of the animal. However, the farming of American bullfrog is restricted by the occurrence of diseases. This study reports the first isolation of Elizabethkingia meningoseptica from specimens of American bullfrog that suffer from cataract and ‘red-leg’ syndrome.Methodology and Result: The pathogen was isolated from eyes and internal organs (liver, kidney and spleen of thediseased bullfrog specimens. All the bacterial isolates were subjected to phenotypic characterization and antibiotic susceptibility assay, and further identified by using the 16S rDNA sequencing analysis. We designed two pair of specific PCR primers (22-25 mers which are complimentary to the β-lactamase gene in the reference strain ofE. meningoseptica ATCC49470. The result showed all the bacterial isolates shared similar phenotypic characters and antibiotic susceptibility. BLAST analysis of the 16S rDNA sequences indicated that the bacterial isolates had very high sequence homology (100% with E. meningospetica ATCC49470 and E. meningoseptica isolates from mosquito. The two PCR primers were very specific to E. meningoseptica isolates of this study. Conclusion, significance and impact of study: This is the first isolation and characterization of bacterial pathogen, E. meningoseptica in cultured American bullfrog (Rana catesbeina that suffered from eye cataract and ‘red-leg’syndrome in Sabah, Malaysia. It is suspected that one of the possible transmission routes of the bacterial pathogen could be via mosquito bites. The findings suggest that there is urgent requirement for standard guideline of good farming practice to be adopted in frog farms throughout the country. Such a guideline can help in minimizing economic losses, preventing transmission of the zoonotic bacterial pathogen to farm workers, and sustaining the industry in Malaysia andupgrading

  9. Yellow Fever Outbreak - Kongo Central Province, Democratic Republic of the Congo, August 2016.

    Science.gov (United States)

    Otshudiema, John O; Ndakala, Nestor G; Mawanda, Elande-Taty K; Tshapenda, Gaston P; Kimfuta, Jacques M; Nsibu, Loupy-Régence N; Gueye, Abdou S; Dee, Jacob; Philen, Rossanne M; Giese, Coralie; Murrill, Christopher S; Arthur, Ray R; Kebela, Benoit I

    2017-03-31

    On April 23, 2016, the Democratic Republic of the Congo's (DRC's) Ministry of Health declared a yellow fever outbreak. As of May 24, 2016, approximately 90% of suspected yellow fever cases (n = 459) and deaths (45) were reported in a single province, Kongo Central Province, that borders Angola, where a large yellow fever outbreak had begun in December 2015. Two yellow fever mass vaccination campaigns were conducted in Kongo Central Province during May 25-June 7, 2016 and August 17-28, 2016. In June 2016, the DRC Ministry of Health requested assistance from CDC to control the outbreak. As of August 18, 2016, a total of 410 suspected yellow fever cases and 42 deaths were reported in Kongo Central Province. Thirty seven of the 393 specimens tested in the laboratory were confirmed as positive for yellow fever virus (local outbreak threshold is one laboratory-confirmed case of yellow fever). Although not well-documented for this outbreak, malaria, viral hepatitis, and typhoid fever are common differential diagnoses among suspected yellow fever cases in this region. Other possible diagnoses include Zika, West Nile, or dengue viruses; however, no laboratory-confirmed cases of these viruses were reported. Thirty five of the 37 cases of yellow fever were imported from Angola. Two-thirds of confirmed cases occurred in persons who crossed the DRC-Angola border at one market city on the DRC side, where ≤40,000 travelers cross the border each week on market day. Strategies to improve coordination between health surveillance and cross-border trade activities at land borders and to enhance laboratory and case-based surveillance and health border screening capacity are needed to prevent and control future yellow fever outbreaks.

  10. The future of metabolic syndrome and cardiovascular disease prevention: polyhype or polyhope?: tales from the polyera

    NARCIS (Netherlands)

    Franco, O.; Karnik, K.; Bonneux, L.G.A.

    2007-01-01

    Recently society has been witnessing the rise of a new era in the prevention and treatment of the metabolic syndrome and cardiovascular disease: the Polyera. This new era started when a promising concept – the Polypill – was introduced by Wald et al. in 2003. The Polypill is a theoretical

  11. Outbreaks and Investigations

    Science.gov (United States)

    ... Who Gets Fungal Infections? People living with HIV/AIDS Organ Transplant Patients Cancer Patients Hospitalized Patients Stem Cell Transplant Patients Medications that Weaken Your Immune System Outbreaks Rhizopus Investigation CDC at Work Global Fungal Diseases Cryptococcal Meningitis ...

  12. Investigating Listeria Outbreaks

    Centers for Disease Control (CDC) Podcasts

    Dr. Emily Cartwright, Infectious Disease fellow at Emory University and former EIS Officer with CDC’s Division of Foodborne, Waterborne, and Environmental Diseases discusses foodborne Listeria outbreaks.

  13. National Outbreak Reporting System

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Outbreak Reporting System (NORS) is a web-based platform designed to support reporting to CDC by local, state, and territorial health departments in the...

  14. A waterborne outbreak of multiple diarrhoeagenic Escherichia coli infections associated with drinking water at a school camp

    Directory of Open Access Journals (Sweden)

    Jungsun Park

    2018-01-01

    Conclusions: This outbreak points to the importance of drinking water quality management in group facilities where underground water is used and emphasizes the need for periodic sanitation and inspection to prevent possible waterborne outbreaks.

  15. Implementing falls prevention research into policy and practice in Australia: past, present and future.

    Science.gov (United States)

    Lord, Stephen R; Sherrington, Catherine; Cameron, Ian D; Close, Jacqueline C T

    2011-12-01

    Falls in older Australians are a significant public health issue with one in three older people falling one or more times each year. Many fall prevention randomized controlled trials have been conducted in Australia as well as across the world. The findings of these studies now constitute a substantial evidence base that can provide direction for health and lifestyle interventions for preventing falls in older people. This research evidence has contributed to health policy in Australia to some extent, but is yet to be widely implemented into practice. This opinion piece overviews previous policy initiatives and describes a new Partnership research program funded by the Australian National Health and Medical Research Council (NHMRC), which seeks to further influence health policy and address the ongoing research-practice gap. Copyright © 2011. Published by Elsevier Ltd.

  16. Prevention of Mother-to-Child HIV Transmission: Predictors of Utilization & Future Policy Implication

    OpenAIRE

    Martz, Tyler Elizabeth

    2015-01-01

    Despite the availability of highly efficacious antiretroviral drug regimens for the prevention of mother-to-child HIV transmission (PMTCT), transmission rates remain higher than those achieved in clinical trials. Access to these efficacious drug regimens continues to expand rapidly in countries most affected by HIV. Such expansion is an important first step in dramatically reducing mother-to-child HIV transmission rates. However, beyond access to drug regimens, programs must also identify and...

  17. Using commercial video games for falls prevention in older adults: the way for the future?

    Science.gov (United States)

    Pietrzak, Eva; Cotea, Cristina; Pullman, Stephen

    2014-01-01

    Falls in older adults are an increasingly costly public health issue. There are many fall prevention strategies that are effective. However, with an increasing population of older people and ever-decreasing availability of health practitioners and health funding, novel modes of intervention are being developed, including those relying on computer technologies.The aim of this article was to review the literature on the use of exergaming to prevent falls in older adult persons living in the community. The Cochrane, Medline, and Embase databases were searched using prespecified search terms. To be included, studies had to investigate the effect of using commercially available consoles and video games on outcome measures such as a decrease in falls, improvements in balance control or gait parameters, decreased fear of falling, and attitude to exercise in older adult persons living in the community. All study designs with the exception of single-person case studies were included. Articles had to be published in peer-reviewed journals in the English language. Nineteen studies fulfilled the inclusion criteria. The following outcomes were observed: (1) using computer-based virtual reality gaming for balance training in older adults was feasible; (2) the majority of studies showed a positive effect of exergaming on balance control; (3) some studies showed a positive effect on balance confidence and gait parameters; (4) the effect was seen across the age and sex spectrum of older adults, including those with and without balance impairment. There is as yet no evidence that using virtual reality games will prevent falls, but there is an indication that their use in balance training may improve balance control, which in turn may lead to falls prevention.

  18. Health Prevention Programs in Social Marketing: Recent Trends and Future Prospects

    Directory of Open Access Journals (Sweden)

    Corina Serban

    2011-02-01

    Full Text Available Social marketing methods are nowadays frequently used in the development of healthprevention programs. The main Objectives of this paper are: to identify the role of skin protectionprograms in society, to evaluate sun protection behavior among consumers and to propose futuredirections of research in skin cancer prevention. Prior Work in skin protection focused on the risksassociated with long periods of sun exposure while offering advice regarding responsible behavior. InEurope, the main center of skin cancer research is European Cancer Observatory and, in Romania,Romanian Society of Dermatology (SRD. These institutions develop specialized programs annualy.The Approach used in this article is the survey. The paper analysis consumers’ perceptions regardingskin protection behavior in Romania by using a structured online questionnaire. A total number of 86respondents participated in the study. Results show that 53% of respondents don’t have a sunprotection behavior. Implications of the study are: health practitioners can use these findings infurther research and nonprofit organizations can increase their prevention programs in certain groups.The Value of this paper consists of direct analysis regarding skin cancer issue in Romania whileemphasizing the importance of health prevention programs for social marketing domain.

  19. Hospital-acquired influenza: a synthesis using the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) statement.

    Science.gov (United States)

    Voirin, N; Barret, B; Metzger, M-H; Vanhems, P

    2009-01-01

    Nosocomial influenza outbreaks occur in almost all types of hospital wards, and their consequences for patients and hospitals in terms of morbidity, mortality and costs are considerable. The source of infection is often unknown, since any patient, healthcare worker (HCW) or visitor is capable of transmitting it to susceptible persons within hospitals. Nosocomial influenza outbreak investigations should help to identify the source of infection, prevent additional cases, and increase our knowledge of disease control to face future outbreaks. However, such outbreaks are probably underdetected and underreported, making routes of transmission difficult to track and describe with precision. In addition, the absence of standardised information in the literature limits comparison between studies and better understanding of disease dynamics. In this study, reports of nosocomial influenza outbreaks are synthesised according to the ORION guidelines to highlight existing knowledge in relation to the detection of influenza cases, evidence of transmission between patients and HCWs and measures of disease incidence. Although a body of evidence has confirmed that influenza spreads within hospitals, we should improve clinical and virological confirmation and initiate active surveillance and quantitative studies to determine incidence rates in order to assess the risk to patients.

  20. Epidemiological Characteristics and Space-Time Analysis of the 2015 Dengue Outbreak in the Metropolitan Region of Tainan City, Taiwan.

    Science.gov (United States)

    Chuang, Ting-Wu; Ng, Ka-Chon; Nguyen, Thi Luong; Chaves, Luis Fernando

    2018-02-26

    The metropolitan region of Tainan City in southern Taiwan experienced a dengue outbreak in 2015. This manuscript describes basic epidemiological features of this outbreak and uses spatial and temporal analysis tools to understand the spread of dengue during the outbreak. The analysis found that, independently of gender, dengue incidence rate increased with age, and proportionally affected more males below the age of 40 years but females above the age of 40 years. A spatial scan statistic was applied to detect clusters of disease transmission. The scan statistic found that dengue spread in a north-south diffusion direction, which is across the North, West-Central and South districts of Tainan City. Spatial regression models were used to quantify factors associated with transmission. This analysis indicated that neighborhoods with high proportions of residential area (or low wetland cover) were associated with dengue transmission. However, these association patterns were non-linear. The findings presented here can help Taiwanese public health agencies to understand the fundamental epidemiological characteristics and diffusion patterns of the 2015 dengue outbreak in Tainan City. This type of information is fundamental for policy making to prevent future uncontrolled dengue outbreaks, given that results from this study suggest that control interventions should be emphasized in the North and West-Central districts of Tainan city, in areas with a moderate percentage of residential land cover.

  1. Outbreak of acute gastroenteritis of unknown etiology caused by contaminated drinking water in a rural village in Austria, August 2006.

    Science.gov (United States)

    Meusburger, Stefan; Reichart, Sandra; Kapfer, Sabine; Schableger, Karl; Fretz, Rainer; Allerberger, Franz

    2007-01-01

    In August 2006 a physician from a rural village reported an outbreak of acute gastroenteritis. An investigation was undertaken in order to determine the magnitude of the outbreak, the source of infection and to prevent further disease. This is the first published outbreak of acute gastroenteritis caused by contaminated drinking water in Austria. For descriptive epidemiology, the investigators had to rely on voluntary cooperation from physicians and patients, data collected by a police officer and data on sick leave reported by physicians to the health insurance system. Microbiological testing of water samples indicated that this cluster was caused by fecal contamination of untreated drinking water. Age and sex distributions were available for 146 of 160 cases: ages ranged from 5 to 91 years (median 45) and 81 cases (55.5%) were female. Stool samples from 14 patients were sent for microbiological analysis: all tested negative for Salmonella, Campylobacter, Shigella and Yersinia enterocolitica. Specimens were not tested for viruses, parasites or enteropathogenic Escherichia coli. In this outbreak no identification was made of pathogenic microorganisms in stool samples from affected patients, despite the occurrence of fecal indicator organisms in samples of drinking water. In outbreaks of gastroenteritis, medical practitioners should encourage microbiological testing beyond the limited routine program. Public health officers must be made aware that the spectrum of routine laboratory tests on stool specimens does not cover the wide array of pathogens capable of causing waterborne outbreaks. The springs serving the affected village originate in a mountainous area of karst formations, and heavy falls of rain that occurred at the beginning of the outbreak may explain introduction of fecal bacteria. In view of the unsolved problem of possible future contamination of springs in karst areas, the water department of this district authority has issued an order requesting

  2. Health Services Vulnerability During the Ebola Outbreak: A Qualitative Report

    Directory of Open Access Journals (Sweden)

    Nasir Amanat

    2017-07-01

    Full Text Available Ebola is an infectious disease, which is caused by a virus belonging to the Filoviridae group. The outbreak of the disease in the African countries in 2015 caused massive death and contamination of the healthcare personnel those who were engaged in treating the infected patients and caused irreparable damage to the healthcare system. In this study, the vulnerability of the team of health service providers during the Ebola outbreak in Liberia, Guinea and Sierra Leone is studied. The article also proposes solutions that can be learned as a lesson, help in increasing their resilience in similar biological hazards and planning management strategies for similar events in the future. Long before the outbreak took place, West African countries were already facing acute problems in terms of access to health services and health infrastructure. The most important shortcomings for the same were identified as insufficient number of health personnel and capacity shortage that prevented the people from being ready to deal with such uncalled events viz. accidents and epidemic disease outbreak. The Ebola epidemic exacerbated the persisting problems caused due to a shortage of personnel in these countries and caused the death of a large number of common people as well as healthcare personnel. Generally, the vulnerability of the health team working during the Ebola outbreak could be divided into five general dimensions: 1. Management weakness; 2. Lack of engineering and environmental control; 3. Obstacles in the use of personal protective equipment; 4. Not having enough skills and practice exercises; and 5. Ignoring the social factors and satisfaction of the healthcare personnel. The main theme of the study was failure to understand the risk of personnel in accidents and disasters. Findings revealed building capacity and reducing vulnerability of the healthcare personnel against disasters and epidemics depends upon the perceived risk, which is a decisive factor

  3. FLU AS PROBLEM COMMON TO ALL MANKIND. FUTURE DIRECTIONS FOR PREVENTION AND TREATMENT OF INFLUENZA

    Directory of Open Access Journals (Sweden)

    Korovaeva I.V

    2014-06-01

    Full Text Available This article discusses the flu, as one of the most common infectious diseases affecting humanity throughout its history. The data on the structure of A influenza virus and its variability is given historical background for most famous of the pandemics, which inflicted irreparable damage to the population of the Earth, are shown the basic stages of the study for influenza virus. Are considered the types of variability of the A virus influenza, its ability to overcome interspecies barriers that form the basis of pathogen escape from the immune response. The article shows the promising areas of modern prevention and treatment of this disease

  4. Modeling the 2016-2017 Yemen Cholera Outbreak with the Impact of Limited Medical Resources.

    Science.gov (United States)

    He, Daihai; Wang, Xueying; Gao, Daozhou; Wang, Jin

    2018-05-01

    We present a mathematical model to investigate the transmission dynamics of the 2016-2017 Yemen Cholera Outbreak. Our model describes the interaction between the human hosts and the pathogenic bacteria, under the impact of limited medical resources. We fit our model to Yemen epidemic data published by the World Health Organization, at both the country and regional levels. We find that the Yemen cholera outbreak is shaped by the interplay of environmental, socioeconomic, and climatic factors. Our results suggest that improvement of the public health system and strategic implementation of control measures with respect to time and location are key to future cholera prevention and intervention in Yemen. Copyright © 2018. Published by Elsevier Ltd.

  5. Aripiprazole for relapse prevention and craving in alcohol use disorder: current evidence and future perspectives.

    Science.gov (United States)

    Martinotti, Giovanni; Orsolini, Laura; Fornaro, Michele; Vecchiotti, Roberta; De Berardis, Domenico; Iasevoli, Felice; Torrens, Marta; Di Giannantonio, Massimo

    2016-06-01

    Among other approaches, the modulation of the dopaminergic pathway has been advocated in the therapeutic management of Alcohol Use Disorders (AUD). A potential avenue toward the modulation of the dopaminergic pathway across varying substance disorders seems to be provided by aripiprazole, a second-generation antipsychotic characterized by a peculiar pharmacodynamics signature. In this review, the authors provided a qualitative synthesis and a critical perspective on the efficacy of aripiprazole in relapse prevention and craving in AUD. A systematic search was carried out through MEDLINE/Embase/PsycINFO/Cochrane Library from inception until September 2015, combining free terms and MESH headings for the topics of AUD and aripiprazole as following: (((Alcohol use Disorder) OR (Alcohol use)) AND aripiprazole). Based both on a qualitative synthesis and a critical interpretation of the evidence, the authors submit that aripiprazole would promote alcohol abstinence and reduce the alcohol seeking behaviour possibly via dopaminergic and serotoninergic modulations at the fronto-subcortical circuits underpinning alcohol reward and craving, impulsive behaviour as well as reduce alcohol-related anxiety/low mood and anhedonia. However, due to the lack of published studies, a conclusive statement about any direct effect of aripiprazole in the prevention of craving and/or alcohol consumption is not possible.

  6. Current strategies and future directions for the prevention of transfusion-transmitted cytomegalovirus

    Directory of Open Access Journals (Sweden)

    Harmon CM

    2017-04-01

    Full Text Available Charles M Harmon, Laura L Cooling Department of Pathology, University of Michigan, Ann Arbor, MI, USA Abstract: Cytomegalovirus (CMV is a pervasive DNA virus that infects a significant portion of individuals worldwide, and may be transmitted through the transfusion of blood products. Although CMV infection is of little consequence in immunocompetent individuals, patients with an impaired immune system are at risk of significant morbidity and mortality. Unlike other blood-borne infectious agents, it is impractical to defer all CMV-positive individuals from blood donation as this would exclude a substantial number of otherwise eligible donors. Other methods such as transfusion of CMV-seronegative and leukoreduced blood products must be employed to prevent the transmission of CMV to at-risk patients. In this study, the widespread use of current strategies for the prevention of transfusion-transmitted CMV (TT-CMV infection and the evidence to support these methods in various at-risk groups were reviewed. In addition, emerging pathogen inactivation technologies that have the potential to eliminate TT-CMV were also discussed. Keywords: blood transfusion, cytomegalovirus, leukoreduction, pathogen inactivation, hematopoietic stem cell transplantation, very low birth weight infants

  7. A reading of the crisis of prevention activities: current paradoxes and future challenges

    Directory of Open Access Journals (Sweden)

    Rodolfo Andrade de Gouveia Vilela

    2017-12-01

    Full Text Available Introduction: The activity of occupational health and safety professionals is in a paradoxical situation considering, among other aspects, the productivity context, which gives low priority to safety and health, the limitation imposed by the hegemonic conceptual references in the field, the limitation of these professionals’ power to act and the highly conflicting and complex character of the occupational world. Objective: In essay form, the article, in dialog with the literature of the field, proposes to reflect on the impasses and challenges of the prevention field. Method: The reflections are based on the experience of the authors both in the practical area as also in research, teaching and extension activities in the field of health surveillance and workers’ safety. Results: Even though this field of activity has been recognized as a specialized and legal area for more than 40 years in the country, the magnitude of the data concerning occupational and industrial accidents reveals the limitations and difficulties that these professionals face, and justifies the importance of the analysis of current practices in order to understand the contradictions that lie at the root of the difficulties to achieve prevention. Conclusion: Citizens could pressure corporations to improve their safety practices and concepts. State can also be pressured to create new safety policies.

  8. Present and future of desertification in Spain: Implementation of a surveillance system to prevent land degradation.

    Science.gov (United States)

    Martínez-Valderrama, Jaime; Ibáñez, Javier; Del Barrio, Gabriel; Sanjuán, Maria E; Alcalá, Francisco J; Martínez-Vicente, Silvio; Ruiz, Alberto; Puigdefábregas, Juan

    2016-09-01

    Mitigation strategies are crucial for desertification given that once degradation starts, other solutions are extremely expensive or unworkable. Prevention is key to handle this problem and solutions should be based on spotting and deactivating the stressors of the system. Following this topic, the Spanish Plan of Action to Combat Desertification (SPACD) created the basis for implementing two innovative approaches to evaluate the threat of land degradation in the country. This paper presents tools for preventing desertification in the form of a geomatic approach to enable the periodic assessments of the status and trends of land condition. Also System Dynamics modelling has been used to integrate bio-physical and socio-economic aspects of desertification to explain and analyse degradation in the main hot spots detected in Spain. The 2dRUE procedure was implemented to map the land-condition status by comparing potential land productivity according to water availability, the limiting factor in arid lands, with plant-biomass data. This assessment showed that 20% of the territory is degraded and an additional 1% is actively degrading. System Dynamics modelling was applied to study the five desertification landscapes identified by the SPACD. The risk analysis, implemented on these models, concluded that 'Herbaceous crops affected by soil erosion' is the landscape most at risk, while the Plackett-Burman sensitivity analysis used to rank the factors highlighted the supremacy of climatic factors above socioeconomic drivers. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. Is prophylactic fixation a cost-effective method to prevent a future contralateral fragility hip fracture?

    Science.gov (United States)

    Faucett, Scott C; Genuario, James W; Tosteson, Anna N A; Koval, Kenneth J

    2010-02-01

    : A previous hip fracture more than doubles the risk of a contralateral hip fracture. Pharmacologic and environmental interventions to prevent hip fracture have documented poor compliance. The purpose of this study was to examine the cost-effectiveness of prophylactic fixation of the uninjured hip to prevent contralateral hip fracture. : A Markov state-transition model was used to evaluate the cost and quality-adjusted life-years (QALYs) for unilateral fixation of hip fracture alone (including internal fixation or arthroplasty) compared with unilateral fixation and contralateral prophylactic hip fixation performed at the time of hip fracture or unilateral fixation and bilateral hip pad protection. Prophylactic fixation involved placement of a cephalomedullary nail in the uninjured hip and was initially assumed to have a relative risk of a contralateral fracture of 1%. Health states included good health, surgery-related complications requiring a second operation (infection, osteonecrosis, nonunion, and malunion), fracture of the uninjured hip, and death. The primary outcome measure was the incremental cost-effectiveness ratio estimated as cost per QALY gained in 2006 US dollars with incremental cost-effectiveness ratios below $50,000 per QALY gained considered cost-effective. Sensitivity analyses evaluated the impact of patient age, annual mortality and complication rates, intervention effectiveness, utilities, and costs on the value of prophylactic fixation. : In the baseline analysis, in a 79-year-old woman, prophylactic fixation was not found to be cost-effective (incremental cost-effectiveness ratio = $142,795/QALY). However, prophylactic fixation was found to be a cost-effective method to prevent contralateral hip fracture in: 1) women 71 to 75 years old who had 30% greater relative risk for a contralateral fracture; and 2) women younger than age 70 years. Cost-effectiveness was greater when the additional costs of prophylaxis were less than $6000. However, for

  10. Stakeholders' opinions on a future in-vehicle alcohol detection system for prevention of drunk driving.

    Science.gov (United States)

    Anund, Anna; Antonson, Hans; Ihlström, Jonas

    2015-01-01

    There is a common understanding that driving under the influence of alcohol is associated with higher risk of being involved in crashes with injuries and possible fatalities as the outcome. Various countermeasures have therefore from time to time been taken by the authorities to prevent drunk driving. One of them has been the alcohol interlock. Up to now, interlocks have mainly been used by previously convicted drunk drivers and in the commercial road transport sector, but not in private cars. New technology has today reached a level where broader implementation might be possible. To our knowledge, however, little is known about different stakeholders' opinions of a broader implementation of such systems. In order to increase that knowledge, we conducted a focus group study to collect in-depth thoughts from different stakeholders on this topic. Eight focus groups representing a broad societal span were recruited and conducted for the purpose. The results show that most stakeholders thought that an integrated system for alcohol detection in vehicles might be beneficial in lowering the number of drunk driving crashes. They said that the system would probably mainly prevent driving by people who unintentionally and unknowingly drive under the influence of alcohol. The groups did, however, not regard the system as a final solution to the drunk driving problem, and believed that certain groups, such as criminals and alcoholics, would most likely find a way around the system. Concerns were raised about the risk of increased sleepy driving and driving just under the legal blood alcohol concentration (BAC) limit. The results also indicate that stakeholders preferred a system that provides information on the BAC up to the legal limit, but not for levels above the limit; for those, the system should simply prevent the car from starting. Acceptance of the system depended on the reliability of the system, on its ability to perform fast sampling, and on the analytical process

  11. Introduction to proceedings of healthy futures: engaging the oral health community in childhood obesity prevention national conference.

    Science.gov (United States)

    Tinanoff, Norman; Holt, Katrina

    2017-06-01

    The Robert Wood Johnson Foundation (RWJF) has worked to ensure that all children have healthy weights. To promote this goal, the RWJF has supported the Healthy Futures: Engaging the Oral Health Community in Childhood Obesity Prevention National Conference, held on November 3-4, 2016, and the proceeding of this conference. The goals of the conference were to increase understanding of the science focusing on oral health and childhood obesity, increase understanding of how to prevent childhood obesity, and provide opportunities to network and plan activities to prevent childhood obesity. The papers prepared for the conference identified through systematic reviews or scoping reviews the state of the science related to preventing childhood obesity and reducing children's consumption of sugar-sweetened beverages and strategies that oral health professionals and organizations can employ prevent childhood obesity. Causes of childhood obesity are multifactorial and include genetic components, environmental and lifestyle variables, and nutritional factors. Dental caries also is caused by a combination of factors, including cariogenic diet, inadequate fluoride exposure, a susceptible host, and the presence of caries-causing bacteria in the oral cavity. One key risk factors for both obesity and caries is excessive sugar consumption. To reduce the risk of obesity and dental caries in children, health professionals and parents need to be aware of the sugar content of processed foods and beverages as well as of current daily sugar-consumption recommendations. Additionally, oral health professionals must become more engaged in identifying children who are at risk for obesity and dental caries; and provide education, screening and referral to reduce these risks. © 2017 American Association of Public Health Dentistry.

  12. Youth violence prevention comes of age: research, training and future directions.

    Science.gov (United States)

    Williams, Kara; Rivera, Lourdes; Neighbours, Robert; Reznik, Vivian

    2007-01-01

    Youth violence is recognized as a major public health problem in the United States and the world. Over the past ten years, progress has been made in documenting the factors that contribute to violent behavior. Emerging research is deepening our understanding of the individual and societal influences that contribute to and protect against youth violence. However, much work still remains to be done in this field, both in examining potential causes and in designing effective intervention strategies. This chapter highlights specific dimensions of youth violence prevention selected by the authors because these dimensions are the focus of public attention, are emerging as critical issues in the study of youth violence, or have a unique place in the current political and social context. We focus on the developmental pathways to violence, factors that mediate and moderate youth violence, the role of culture and media in youth violence, school-based violence such as school shootings and bullying, and the training of health care professionals.

  13. Prevention of inhibitor development in hemophilia A in 2016. A glimpse into the future?

    Science.gov (United States)

    Franchini, Massimo; Lippi, Giuseppe

    2016-12-01

    Thanks to considerable progresses made over the last 30years, hemophilia benefits from the most efficacious and safe treatment among the many monogenic inherited disorders. The most challenging complication of replacement therapy in hemophilia A is the occurrence of alloantibodies against infused factor VIII (FVIII), thus predisposing the patients to increased morbidity and disability. Extensive research in this field has definitively unraveled that development of inhibitors in hemophilia A is a complex and multifactorial process, in which inherited and environmental factors dynamically interact. This narrative review, after providing a concise overview about the main genetic and non-genetic risk factors, is aimed to focus on prediction risk models and preventive strategies for minimizing the risk of developing inhibitors in hemophilia A patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. The future of HIV prevention: prospects for an effective anti-HIV microbicide.

    Science.gov (United States)

    Nuttall, Jeremy; Romano, Joseph; Douville, Karen; Galbreath, Caroline; Nel, Annaléne; Heyward, William; Mitchnick, Mark; Walker, Saul; Rosenberg, Zeda

    2007-03-01

    Topical microbicides are self-administered products for prevention of HIV transmission, and they present one of the most promising strategies for combating the HIV-AIDS epidemic. The development of microbicides is a long and complicated process, with many hurdles that are unique to this class of product, including challenges in product design, in the conduct and design of clinical trials, and in obtaining licensure of a new class of products intended for use almost exclusively in developing countries. Once they have been registered, there are additional challenges to the marketing and distribution of microbicides. An overview of the types of microbicide currently in development, and a summary of the issues and the approaches being taken to address them, are provided.

  15. Nanotechnology and the Future of Condoms in the Prevention of Sexually Transmitted Infections

    Science.gov (United States)

    Yah, Clarence S.; Simate, Geoffrey S.; Hlangothi, Percy; Somai, Benesh M.

    2018-01-01

    Objective: The human immunodeficiency virus (HIV) is among the utmost destructive viruses humankind has ever faced in almost four decades. It carries with it profound socioeconomic and public health implications. Unfortunately, there is, currently, no effective cure for HIV infections. This review discusses the various types of condoms, microbicides, and the potential use of nanoparticle-coated condoms as a means of diminishing the risk of HIV transmission and sexually transmitted infections (STIs) during sexual intercourse. Methods: We identified 153 articles from 1989 to 2015 indexed in various journal platforms, reports, and magazines. Using the PRISMA guidelines as proxy in performing the research review process, only 53 articles were selected. Ideally, articles that failed to describe the nature and types of condoms, condom failures, nanoparticle-coated condoms, microbicides, and HIV prevention were excluded. Results and Discussion: In general, it has been shown that antiretroviral therapy (ART) currently available can only limit transmission and acquisition of HIV strains. Apart from ART treatment, the use of condoms has been identified globally as a cost-effective intervention for reducing the spread of HIV and other STIs. However, while condoms are supposed to be effective, reliable, and easy to use, research has shown that they are attributable to 20% failures including breakages. Nevertheless, other studies have shown that coating condoms with nanoparticles is an important and effective method for reducing condom breakage and HIV/STI transmission during sexual intercourse. Conclusions: A review of literature cited in this paper has shown that nanotechnology-based condom systems have the potential to prevent the spread of HIV and STIs. Furthermore, the antimicrobial nature of some nanoparticles could provide a safe and efficient way to disrupt and/or inactivate different STIs – including viral, bacterial, and fungal diseases. PMID:29536957

  16. Microbicides in the prevention of HIV infection: current status and future directions.

    Science.gov (United States)

    Nuttall, Jeremy

    2010-07-09

    More than 28 years since the first cases of HIV/AIDS, there is still no cure or vaccine. The worst affected region is sub-Saharan Africa and, increasingly, it is young women who are bearing the brunt of the epidemic. Consequently, there is an urgent need for HIV prevention options for women in developing countries. Microbicides are topical products that can be used vaginally by women to impede sexual transmission of HIV and thus represent one of the most promising prevention strategies. Efficacy trials with early nonspecific microbicide gels have so far been unsuccessful, but the field has now switched its focus to products containing highly potent and highly specific antiretroviral drugs that are easier to use, and can be formulated in a variety of dosage forms to suit individual and regional preferences. However, these products have their own challenges, with a greater likelihood of absorption, and the potential for systemic toxicities or the development of resistance in infected individuals who are unaware of their HIV status. The conduct of clinical trials is complex for all microbicides, with limited availability of trial sites, difficulties in dose selection and safety monitoring, and a lack of a truly objective measure of adherence. Once a microbicide has been shown to be safe and effective, there will need to be a clear pathway to regulatory approval, and the successful launch of a product will depend on having in place appropriate methods for distribution to the women who need it, along with a strategy for ensuring that they use it correctly. This will require substantial effort in terms of education and community engagement, and these activities need to be initiated well in advance of microbicide rollout.

  17. HIV Treatment as Prevention: Modelling the Cost of Antiretroviral Treatment—State of the Art and Future Directions

    Science.gov (United States)

    Meyer-Rath, Gesine; Over, Mead

    2012-01-01

    Policy discussions about the feasibility of massively scaling up antiretroviral therapy (ART) to reduce HIV transmission and incidence hinge on accurately projecting the cost of such scale-up in comparison to the benefits from reduced HIV incidence and mortality. We review the available literature on modelled estimates of the cost of providing ART to different populations around the world, and suggest alternative methods of characterising cost when modelling several decades into the future. In past economic analyses of ART provision, costs were often assumed to vary by disease stage and treatment regimen, but for treatment as prevention, in particular, most analyses assume a uniform cost per patient. This approach disregards variables that can affect unit cost, such as differences in factor prices (i.e., the prices of supplies and services) and the scale and scope of operations (i.e., the sizes and types of facilities providing ART). We discuss several of these variables, and then present a worked example of a flexible cost function used to determine the effect of scale on the cost of a proposed scale-up of treatment as prevention in South Africa. Adjusting previously estimated costs of universal testing and treatment in South Africa for diseconomies of small scale, i.e., more patients being treated in smaller facilities, adds 42% to the expected future cost of the intervention. PMID:22802731

  18. [First ciguatera outbreak in Germany in 2012].

    Science.gov (United States)

    Friedemann, Miriam

    2016-12-01

    In November 2012, 23 cases of ciguatera with typical combinations of gastrointestinal and neurological symptoms occurred in Germany after consumption of imported tropical fish (Lutjanus spp.). A questionnaire was used to gather information on the disease course and fish consumption. All patients suffered from pathognomonic cold allodynia. Aside from two severe courses of illness, all other cases showed symptoms of moderate intensity. During a three-year follow-up, seven patients reported prolonged paresthesia for more than one year. Two of them reported further neuropathies over almost three years. This is the first time that long-term persistence of symptoms has been documented in detail. Outbreak cases were allocated to eight clusters in seven German cities. A further cluster was prevented by the successful recall of ciguatoxic fish. Three clusters were confirmed by the detection of ciguatoxin in samples of suspicious and recalled fish. An extrapolation on the basis of ciguatoxic samples revealed twenty prevented cases of ciguatera. Further officially unknown cases should be assumed. During the outbreak investigations, inadvertently falsely labelled fish species and fishing capture areas on import and retail level documents were observed. The ascertainment of cases and the outbreak investigations proved to be difficult due to inconsistent case reports to poisons centers, local health and veterinary authorities. In Germany, many physicians are unaware of the disease pattern of ciguatera and the risks caused by tropical fish. The occurrence of further outbreaks during the following years emphasizes the increasing significance of ciguatera in Germany.

  19. Prevent recurrence of nuclear disaster (4). Future tasks in the field of structure and components

    International Nuclear Information System (INIS)

    Okamoto, Koji; Takagi, Toshiyuki; Ueda, Susumu

    2012-01-01

    Structure and components subcommittee under the special committee of seismic safety of nuclear power stations of the Atomic Energy Society of Japan discussed future activities related with technical problems of seismic design of structures, components and piping system and evaluation of seismic effects in collaboration with the Japan Society of Mechanical Engineers. These problems were arranged by 'logic of seismic safety' and tabulated just enough, and then their roadmap was prepared. This article described selected relevant problems and discussed safety margins of seismic design and their related problems, referring to state of countermeasures and evaluated results of nuclear power stations after Great East Japan Earthquake occurred in March 11, 2011. Main problems were related with seismic safety margins of structure and components, consideration of ground motion index, rationalization and upgrade of seismic design, application of new technology, integrity evaluation of structure and components after or at earthquake, and upgrade of seismic probabilistic risk assessment methodology. (T. Tanaka)

  20. Prevention

    DEFF Research Database (Denmark)

    Halken, S; Høst, A

    2001-01-01

    , breastfeeding should be encouraged for 4-6 months. In high-risk infants a documented extensively hydrolysed formula is recommended if exclusive breastfeeding is not possible for the first 4 months of life. There is no evidence for preventive dietary intervention neither during pregnancy nor lactation...... populations. These theories remain to be documented in proper, controlled and prospective studies. Breastfeeding and the late introduction of solid foods (>4 months) is associated with a reduced risk of food allergy, atopic dermatitis, and recurrent wheezing and asthma in early childhood. In all infants....... Preventive dietary restrictions after the age of 4-6 months are not scientifically documented....

  1. The future of metabolic syndrome and cardiovascular disease prevention: polyhype or polyhope? Tales from the polyera.

    Science.gov (United States)

    Franco, O H; Karnik, K; Bonneux, L

    2007-09-01

    Recently society has been witnessing the rise of a new era in the prevention and treatment of the metabolic syndrome and cardiovascular disease: the Polyera. This new era started when a promising concept - the Polypill - was introduced by Wald et al. in 2003. The Polypill is a theoretical combination of six pharmacological compounds (a statin, three different antihypertensives, aspirin, and folic acid) that in combination could reduce cardiovascular disease by more than 80%. Although the Polypill could theoretically be a highly effective intervention, it is not yet available in the market and its effectiveness remains unproven. In the population at large, cheap prizes may come at prohibitive costs. With frail elderly and population prevalences of co-morbidity far higher than in drug trials, rare adverse effects may be frequent. In December 2004, a more natural, safer, and probably tastier alternative to the Polypill - the Polymeal - was introduced. Contrary to the Polypill, the Polymeal combined 6 different foods (fruits and vegetables, almonds, chocolate, wine, fish, and garlic) that taken together in a regular basis could cut cardiovascular disease risk by over 75%. Polyproducts from the polyera in true populations might hide unexpected polyinteractions. In the polyera, polytrials will need to establish benefits, harms, and costs.

  2. Planning for smallpox outbreaks

    Science.gov (United States)

    Ferguson, Neil M.; Keeling, Matt J.; John Edmunds, W.; Gani, Raymond; Grenfell, Bryan T.; Anderson, Roy M.; Leach, Steve

    2003-10-01

    Mathematical models of viral transmission and control are important tools for assessing the threat posed by deliberate release of the smallpox virus and the best means of containing an outbreak. Models must balance biological realism against limitations of knowledge, and uncertainties need to be accurately communicated to policy-makers. Smallpox poses the particular challenge that key biological, social and spatial factors affecting disease spread in contemporary populations must be elucidated largely from historical studies undertaken before disease eradication in 1979. We review the use of models in smallpox planning within the broader epidemiological context set by recent outbreaks of both novel and re-emerging pathogens.

  3. Knitting the Future Story of Indian Women: Preventing Violence, Fostering Development, and Accelerating Empowerment

    Directory of Open Access Journals (Sweden)

    Prerna S Ramteke

    2017-07-01

    Full Text Available A number of cases of women’s exploitation in India reflects serious problem in viewing and treating women. This article highlights the issues of women in India that are aimed to describe the violence against women in India that degrades their dignity as a human being, to analyze both conceptual and practical aspects of women, particularly with regards to their role in development and also to discuss the need for accelerating the empowerment of women in India. Some concepts such as the three classical approaches on the relationship between women and development are discussed in this writing. Besides this it also analyzes the present situation faced by Indian women that can potentially become obstacles for their development. In addition, this paper looks at some legal instruments and cases that relates to the legal protection of women in India. It is as a research in the field of Sociology that will be enriched by legal, cultural and economic approaches. It will also highlight about the dreams on the better situation for women in India that are expected to become true and will also encourage women in India to involve in any efforts to knit their future story.

  4. Morbidity management and disability prevention for lymphatic filariasis in Sri Lanka: Current status and future prospects.

    Science.gov (United States)

    Chandrasena, Nilmini; Premaratna, Ranjan; Gunaratna, Indeewarie E; de Silva, Nilanthi R

    2018-05-01

    Sri Lanka was acknowledged to have eliminated lymphatic filariasis (LF) as a public health problem in 2016, largely due to its success in Mass Drug Administration (MDA) to interrupt disease transmission. Analysis of the Strengths, Weaknesses, Opportunities and Threats (SWOT) of the national Morbidity Management and Disability Prevention (MMDP) program, the other pillar of the LF control program, was carried out with the objective of evaluating it and providing recommendations to optimize the use of available resources. A situation analysis of the MMDP activities provided by the state health sector was carried out using published records, in-depth interviews with key informants of the Anti Filariasis Campaign, site-visits to filariasis clinics with informal discussions with clinic workforce and personal communications to identify strengths and weaknesses; and opportunities to overcome weaknesses and perceived threats to the program were explored. The principal strength of the MMDP program was the filariasis clinics operational in most endemic districts of Sri Lanka, providing free health care and health education to clinic attendees. The weaknesses identified were the low accessibility of clinics, incomplete coverage of the endemic region and lack of facilities for rehabilitation. The perceived threats were diversion of staff and resources for control of other vector-borne infections, under-utilization of clinics and non-compliance with recommended treatment. Enhanced high level commitment for MMDP, wider publicity and referral systems, integration of MMDP with other disease management services and collaboration with welfare organizations and research groups were identified as opportunities to overcome weaknesses and challenges. The recommended basic package of MMDP was functional in most of the LF-endemic region. The highlighted weaknesses and challenges, unless addressed, may threaten program sustainability. The identified opportunities for improvement of the

  5. Hepatitis A outbreaks in the vaccination era in Catalonia, Spain.

    Science.gov (United States)

    Martínez, Ana; Broner, Sonia; Torner, Nuria; Godoy, Pere; Batalla, Joan; Alvarez, Josep; Barrabeig, Irene; Camps, Neus; Carmona, Gloria; Minguell, Sofía; Sala, Rosa; Caylà, Joan; Domínguez, Angela

    2011-01-01

    Hepatitis A outbreaks have a major impact on public health services and involve case investigation and intervention measures to susceptible contacts. At the end of 1998 a universal vaccination program with a combined hepatitis A+B vaccine was started in Catalonia (Spain) in 12-years-old preadolescents. The objective of this study was to compare the characteristics of hepatitis A outbreaks in the periods before and after the introduction of the preadolescent vaccination program and to estimate the preventable fraction of cases associated to outbreaks. The incidence rates of outbreaks, cases and hospitalization associated with each outbreak were calculated. Two periods were considered: before (1991-1998) and after (2000-2007) the introduction of mass vaccination. The preventable fraction and 95% confidence intervals (CI) of cases associated with outbreaks was calculated. The rate of associated cases with outbreaks was higher in the period before the vaccination program than in the post vaccination period (1.53 per 100,000 person-year vs 1.12 ; pcases associated to outbreaks was 19.6%(95%CI 6.7-32.5) in the 0-4 years group and 16.7% (95% CI 6.0-27.5) in the 5-14 years group, but the highest figure (38.6%; 95%CI 21.3-55.9) was observed in the 15-24 years age group. The estimated proportion of cases associated with outbreaks that would theoretically have been prevented with the vaccination program suggests that substantial benefits have been obtained in Catalonia in people aged less than 25 years.

  6. What caused the 2012 dengue outbreak in Pucallpa, Peru? A socio-ecological autopsy.

    Science.gov (United States)

    Charette, Margot; Berrang-Ford, Lea; Llanos-Cuentas, Elmer Alejandro; Cárcamo, César; Kulkarni, Manisha

    2017-02-01

    Dengue is highly endemic in Peru, with increases in transmission particularly since vector re-infestation of the country in the 1980s. Pucallpa, the second largest city in the Peruvian Amazon, experienced a large outbreak in 2012 that caused more than 10,000 cases and 13 deaths. To date, there has been limited research on dengue in the Peruvian Amazon outside of Iquitos, and no published review or critical analysis of the 2012 Pucallpa dengue outbreak. This study describes the incidence, surveillance, and control of dengue in Ucayali to understand the factors that contributed to the 2012 Pucallpa outbreak. We employed a socio-ecological autopsy approach to consider distal and proximal contributing factors, drawing on existing literature and interviews with key personnel involved in dengue control, surveillance and treatment in Ucayali. Spatio-temporal analysis showed that relative risk of dengue was higher in the northern districts of Calleria (RR = 2.18), Manantay (RR = 1.49) and Yarinacocha (RR = 1.25) compared to all other districts between 2004 and 2014. The seasonal occurrence of the 2012 outbreak is consistent with typical seasonal patterns for dengue incidence in the region. Our assessment suggests that the outbreak was proximally triggered by the introduction of a new virus serotype (DENV-2 Asian/America) to the region. Increased travel, rapid urbanization, and inadequate water management facilitated the potential for virus spread and transmission, both within Pucallpa and regionally. These triggers occurred within the context of failures in surveillance and control programming, including underfunded and ad hoc vector control. These findings have implications for future prevention and control of dengue in Ucayali as new diseases such as chikungunya and Zika threaten the region. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Shigellosis Outbreak in Al Batinah South Governorate, Oman; Case-control study

    Directory of Open Access Journals (Sweden)

    Idris Abaidani

    2015-08-01

    Full Text Available Objectives: An outbreak of acute gastroenteritis due to Shigella flexneri occurred in August 2012 in the catchment area of the Wadi Sahtan Health Center in Rustaq, Al Batinah South Governorate, Oman. The aim of this study was to discover possible causes of this outbreak in the villages of Fassa, Rogh and Amk and to measure the risk of exposure among cases and controls. Methods: A case-control study was conducted in September 2012 in Fassa, Rogh and Amk. All households in the three villages were interviewed. Case and control households were compared to determine possible exposure avenues, including place of residence, source of drinking water, hand hygiene levels and practices related to drinking water, food preparation and environmental sanitation. Results: Residing in Fassa (P <0.0001; odds ratio [OR] = 4.86, 95% confidence interval [CI] = 2.22–10.63 and average hand hygiene practices (P = 0.008; OR = 13.97, 95% CI = 1.58–123.36 were associated with an increased risk of contracting shigellosis. No significant differences were found with regards to the other exposure avenues. Conclusion: This was the first study conducted in Oman regarding an outbreak of shigellosis in a community setting. The only variables that significantly impacted the risk of acute gastroenteritis were residing in Fassa and average hand hygiene practices. The source of the outbreak could not be identified. However, septic tank sanitation and water and food consumption practices were not satisfactory in the studied villages. These need to be addressed to prevent similar outbreaks of acute gastroenteritis in this region in the future.

  8. Responding to Outbreaks

    Centers for Disease Control (CDC) Podcasts

    2009-04-27

    In this podcast, a team of CDC specialists travels to Uganda and tracks the source of an Ebola outbreak where CDC scientists are studying bats for clues to the Ebola mystery.  Created: 4/27/2009 by National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED).   Date Released: 4/27/2009.

  9. Investigating Listeria Outbreaks

    Centers for Disease Control (CDC) Podcasts

    2013-01-04

    Dr. Emily Cartwright, Infectious Disease fellow at Emory University and former EIS Officer with CDC’s Division of Foodborne, Waterborne, and Environmental Diseases discusses foodborne Listeria outbreaks.  Created: 1/4/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 1/8/2013.

  10. Foodborne Norovirus Outbreaks

    Centers for Disease Control (CDC) Podcasts

    2012-09-17

    Dr. Aron Hall, a CDC epidemiologist specializing in noroviruses, discusses foodborne norovirus outbreaks.  Created: 9/17/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID); National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 9/17/2012.

  11. Vital Signs-Preventing Norovirus Outbreaks

    Centers for Disease Control (CDC) Podcasts

    2014-06-03

    This podcast is based on the June 2014 CDC Vital Signs report. Norovirus infects about 20 million Americans each year. Learn how to protect yourself and your family from this very contagious, potentially serious illness.  Created: 6/3/2014 by National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 6/3/2014.

  12. Vital Signs-Preventing Norovirus Outbreaks

    Centers for Disease Control (CDC) Podcasts

    This podcast is based on the June 2014 CDC Vital Signs report. Norovirus infects about 20 million Americans each year. Learn how to protect yourself and your family from this very contagious, potentially serious illness.

  13. CDC Vital Signs: Preventing Norovirus Outbreaks

    Science.gov (United States)

    ... the restroom. Use utensils and single-use disposable gloves to avoid touching ready-to-eat foods with ... Visit www.FoodSafety.gov for the latest information. Top of Page Science Behind the Issue MMWR Science ...

  14. Epidemiology of bacterial toxin-mediated foodborne gastroenteritis outbreaks in Australia, 2001 to 2013.

    Science.gov (United States)

    May, Fiona J; Polkinghorne, Benjamin G; Fearnley, Emily J

    2016-12-24

    Bacterial toxin-mediated foodborne outbreaks, such as those caused by Clostridium perfringens, Staphylococcus aureus and Bacillus cereus, are an important and preventable cause of morbidity and mortality. Due to the short incubation period and duration of illness, these outbreaks are often under-reported. This is the first study to describe the epidemiology of bacterial toxin-mediated outbreaks in Australia. Using data collected between 2001 and 2013, we identify high risk groups and risk factors to inform prevention measures. Descriptive analyses of confirmed bacterial toxin-mediated outbreaks between 2001 and 2013 were undertaken using data extracted from the OzFoodNet Outbreak Register, a database of all outbreaks of gastrointestinal disease investigated by public health authorities in Australia. A total of 107 laboratory confirmed bacterial toxin-mediated outbreaks were reported between 2001 and 2013, affecting 2,219 people, including 47 hospitalisations and 13 deaths. Twelve deaths occurred in residents of aged care facilities. Clostridium perfringens was the most commonly reported aetiological agent (81 outbreaks, 76%). The most commonly reported food preparation settings were commercial food preparation services (51 outbreaks, 48%) and aged care facilities (42 outbreaks, 39%). Bacterial toxin outbreaks were rarely associated with food preparation in the home (2 outbreaks, 2%). In all outbreaks, the primary factor contributing to the outbreak was inadequate temperature control of the food. Public health efforts aimed at improving storage and handling practices for pre-cooked and re-heated foods, especially in commercial food preparation services and aged care facilities, could help to reduce the magnitude of bacterial toxin outbreaks.

  15. Historical development of vaginal microbicides to prevent sexual transmission of HIV in women: from past failures to future hopes.

    Science.gov (United States)

    Notario-Pérez, Fernando; Ruiz-Caro, Roberto; Veiga-Ochoa, María-Dolores

    2017-01-01

    Infection with human immunodeficiency virus (HIV) remains a global public health concern and is particularly serious in low- and middle-income countries. Widespread sexual violence and poverty, among other factors, increase the risk of infection in women, while currently available prevention methods are outside the control of most. This has driven the study of vaginal microbicides to prevent sexual transmission of HIV from men to women in recent decades. The first microbicides evaluated were formulated as gels for daily use and contained different substances such as surfactants, acidifiers and monoclonal antibodies, which failed to demonstrate efficacy in clinical trials. A gel containing the reverse transcriptase inhibitor tenofovir showed protective efficacy in women. However, the lack of adherence by patients led to the search for dosage forms capable of releasing the active principle for longer periods, and hence to the emergence of the vaginal ring loaded with dapivirine, which requires a monthly application and is able to reduce the sexual transmission of HIV. The future of vaginal microbicides will feature the use of alternative dosage forms, nanosystems for drug release and probiotics, which have emerged as potential microbicides but are still in the early stages of development. Protecting women with vaginal microbicide formulations would, therefore, be a valuable tool for avoiding sexual transmission of HIV.

  16. Historical development of vaginal microbicides to prevent sexual transmission of HIV in women: from past failures to future hopes

    Directory of Open Access Journals (Sweden)

    Notario-Pérez F

    2017-06-01

    Full Text Available Fernando Notario-Pérez, Roberto Ruiz-Caro, María-Dolores Veiga-Ochoa Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, Universidad Complutense de Madrid, Madrid, Spain Abstract: Infection with human immunodeficiency virus (HIV remains a global public health concern and is particularly serious in low- and middle-income countries. Widespread sexual violence and poverty, among other factors, increase the risk of infection in women, while currently available prevention methods are outside the control of most. This has driven the study of vaginal microbicides to prevent sexual transmission of HIV from men to women in recent decades. The first microbicides evaluated were formulated as gels for daily use and contained different substances such as surfactants, acidifiers and monoclonal antibodies, which failed to demonstrate efficacy in clinical trials. A gel containing the reverse transcriptase inhibitor tenofovir showed protective efficacy in women. However, the lack of adherence by patients led to the search for dosage forms capable of releasing the active principle for longer periods, and hence to the emergence of the vaginal ring loaded with dapivirine, which requires a monthly application and is able to reduce the sexual transmission of HIV. The future of vaginal microbicides will feature the use of alternative dosage forms, nanosystems for drug release and probiotics, which have emerged as potential microbicides but are still in the early stages of development. Protecting women with vaginal microbicide formulations would, therefore, be a valuable tool for avoiding sexual transmission of HIV. Keywords: vaginal formulations, microbicides, prevention, sexual transmission, acquired immunodeficiency syndrome (AIDS, human immunodeficiency virus (HIV

  17. Infection prevention behaviour and infectious disease modelling: a review of the literature and recommendations for the future.

    Science.gov (United States)

    Weston, Dale; Hauck, Katharina; Amlôt, Richard

    2018-03-09

    Given the importance of person to person transmission in the spread of infectious diseases, it is critically important to ensure that human behaviour with respect to infection prevention is appropriately represented within infectious disease models. This paper presents a large scale scoping review regarding the incorporation of infection prevention behaviour in infectious disease models. The outcomes of this review are contextualised within the psychological literature concerning health behaviour and behaviour change, resulting in a series of key recommendations for the incorporation of human behaviour in future infectious disease models. The search strategy focused on terms relating to behaviour, infectious disease and mathematical modelling. The selection criteria were developed iteratively to focus on original research articles that present an infectious disease model with human-human spread, in which individuals' self-protective health behaviour varied endogenously within the model. Data extracted included: the behaviour that is modelled; how this behaviour is modelled; any theoretical background for the modelling of behaviour, and; any behavioural data used to parameterise the models. Forty-two papers from an initial total of 2987 were retained for inclusion in the final review. All of these papers were published between 2002 and 2015. Many of the included papers employed a multiple, linked models to incorporate infection prevention behaviour. Both cognitive constructs (e.g., perceived risk) and, to a lesser extent, social constructs (e.g., social norms) were identified in the included papers. However, only five papers made explicit reference to psychological health behaviour change theories. Finally, just under half of the included papers incorporated behavioural data in their modelling. By contextualising the review outcomes within the psychological literature on health behaviour and behaviour change, three key recommendations for future behavioural

  18. Estimated Cost to a Restaurant of a Foodborne Illness Outbreak.

    Science.gov (United States)

    Bartsch, Sarah M; Asti, Lindsey; Nyathi, Sindiso; Spiker, Marie L; Lee, Bruce Y

    Although outbreaks of restaurant-associated foodborne illness occur periodically and make the news, a restaurant may not be aware of the cost of an outbreak. We estimated this cost under varying circumstances. We developed a computational simulation model; scenarios varied outbreak size (5 to 250 people affected), pathogen (n = 15), type of dining establishment (fast food, fast casual, casual dining, and fine dining), lost revenue (ie, meals lost per illness), cost of lawsuits and legal fees, fines, and insurance premium increases. We estimated that the cost of a single foodborne illness outbreak ranged from $3968 to $1.9 million for a fast-food restaurant, $6330 to $2.1 million for a fast-casual restaurant, $8030 to $2.2 million for a casual-dining restaurant, and $8273 to $2.6 million for a fine-dining restaurant, varying from a 5-person outbreak, with no lost revenue, lawsuits, legal fees, or fines, to a 250-person outbreak, with high lost revenue (100 meals lost per illness), and a high amount of lawsuits and legal fees ($1 656 569) and fines ($100 000). This cost amounts to 10% to 5790% of a restaurant's annual marketing costs and 0.3% to 101% of annual profits and revenue. The biggest cost drivers were lawsuits and legal fees, outbreak size, and lost revenue. Pathogen type affected the cost by a maximum of $337 000, the difference between a Bacillus cereus outbreak (least costly) and a listeria outbreak (most costly). The cost of a single foodborne illness outbreak to a restaurant can be substantial and outweigh the typical costs of prevention and control measures. Our study can help decision makers determine investment and motivate research for infection-control measures in restaurant settings.

  19. Can tail damage outbreaks in the pig be predicted by behavioural change?

    DEFF Research Database (Denmark)

    Larsen, Mona Lilian Vestbjerg; Andersen, Heidi Mai-Lis; Pedersen, Lene Juul

    2016-01-01

    preventive methods. One strategy is the surveillance of the pigs' behaviour for known preceding indicators of tail damage, which makes it possible to predict a tail damage outbreak and prevent it in proper time. This review discusses the existing literature on behavioural changes observed prior to a tail...... damage outbreak. Behaviours found to change prior to an outbreak include increased activity level, increased performance of enrichment object manipulation, and a changed proportion of tail posture with more tails between the legs. Monitoring these types of behaviours is also discussed for the purpose......, starting with the description of the temporal development of the predictive behaviour in relation to tail damage outbreaks...

  20. Contextualizing willingness to participate: recommendations for engagement, recruitment & enrolment of Kenyan MSM in future HIV prevention trials

    Directory of Open Access Journals (Sweden)

    Monika Doshi

    2017-05-01

    Full Text Available Abstract Background The HIV epidemic among men who have sex with men (MSM continues to expand globally. The addition of an efficacious, prophylactic vaccine to combination prevention offers immense hope, particularly in low- and middle- income countries which bear the greatest global impact. However, in these settings, there is a paucity of vaccine preparedness studies that specifically pertain to MSM. Our study is the first vaccine preparedness study among MSM and female sex workers (FSWs in Kenya. In this paper, we explore willingness of Kenyan MSM to participate in HIV vaccine efficacy trials. In addition to individual and socio-cultural motivators and barriers that influence willingness to participate (WTP, we explore the associations or linkages that participants draw between their experiences with or knowledge of medical research both generally and within the context of HIV/AIDS, their perceptions of a future HIV vaccine and their willingness to participate in HIV vaccine trials. Methods Using a social network-based approach, we employed snowball sampling to recruit MSM into the study from Kisumu, Mombasa, and Nairobi. A field team consisting of seven community researchers conducted in-depth interviews with a total of 70 study participants. A coding scheme for transcribed and translated data was developed and the data was then analysed thematically. Results Most participants felt that an HIV vaccine would bring a number of benefits to self, as well as to MSM communities, including quelling personal fears related to HIV acquisition and reducing/eliminating stigma and discrimination shouldered by their community. Willingness to participate in HIV vaccine efficacy trials was highly motivated by various forms of altruism. Specific researcher responsibilities centred on safe-guarding the rights and well-being of participants were also found to govern WTP, as were reflections on the acceptability of a future preventive HIV vaccine. Conclusion

  1. An outbreak of hepatitis A associated with a contaminated well in a middle school, Guangxi, China

    Directory of Open Access Journals (Sweden)

    Luo Hui-min

    2012-12-01

    Full Text Available Background: In May 2012, an outbreak of viral hepatitis A was reported to the Guangxi Center for Disease Control and Prevention from a middle school in Liujiang County. An investigation was conducted to identify the cause and mode of transmission and to recommend control and prevention measures.Methods: A case was defined as any person from the middle school with onset of fatigue, anorexia, abdominal pain, diarrhoea or jaundice from 20 February to 20 May 2012. We compared attack rates (AR between boys and girls, assuming that only boys used well water and girls used pipeline water. We then selected 133 students from three classes in each of the three grades to compare AR by reported water source and drinking history.Results: There were 22 cases, an AR of 3.8% (21/553 for students and 1.5% for teachers (1/65. Those who used well water were 8.7 (95% confidence interval [CI] = 2.1–37.2 times more likely to be ill than those using pipeline water. The cohort study showed that students who reported using well water daily were 5.2 (95% CI = 0.7–41.8 times more likely to be ill than those that reported using the pipeline water daily. Eighteen cases were confirmed as hepatitis A.Conclusion: This hepatitis A outbreak was potentially caused by a contaminated school well. We recommended that the school discontinue using the well and that the students should drink boiled water. As there is a vaccine for hepatitis A, we recommended that several doses of the vaccine be stored for controlling outbreaks and for immunizing susceptible populations in future outbreaks.

  2. An outbreak of hepatitis A associated with a contaminated well in a middle school, Guangxi, China.

    Science.gov (United States)

    Ye-Qing, Xu; Fu-Qing, Cui; Jia-Tong, Zhuo; Guo-Ming, Zhang; Jin-Fa, Du; Qu-Yun, Den; Hui-Min, Luo

    2012-10-01

    In May 2012, an outbreak of viral hepatitis A was reported to the Guangxi Center for Disease Control and Prevention from a middle school in Liujiang County. An investigation was conducted to identify the cause and mode of transmission and to recommend control and prevention measures. A case was defined as any person from the middle school with onset of fatigue, anorexia, abdominal pain, diarrhoea or jaundice from 20 February to 20 May 2012. We compared attack rates (AR) between boys and girls, assuming that only boys used well water and girls used pipeline water. We then selected 133 students from three classes in each of the three grades to compare AR by reported water source and drinking history. There were 22 cases, an AR of 3.8% (21/553) for students and 1.5% for teachers (1/65). Those who used well water were 8.7 (95% confidence interval [CI] = 2.1-37.2) times more likely to be ill than those using pipeline water. The cohort study showed that students who reported using well water daily were 5.2 (95% CI = 0.7-41.8) times more likely to be ill than those that reported using the pipeline water daily. Eighteen cases were confirmed as hepatitis A. This hepatitis A outbreak was potentially caused by a contaminated school well. We recommended that the school discontinue using the well and that the students should drink boiled water. As there is a vaccine for hepatitis A, we recommended that several doses of the vaccine be stored for controlling outbreaks and for immunizing susceptible populations in future outbreaks.

  3. A scoping review of epidemiologic risk factors for pediatric obesity: Implications for future childhood obesity and dental caries prevention research.

    Science.gov (United States)

    Chi, Donald L; Luu, Monique; Chu, Frances

    2017-06-01

    important implications for future oral health research aimed at preventing childhood obesity and dental caries. Epidemiologic knowledge gleaned from the literature can be used to develop rigorous interventions and programs aimed at preventing these highly prevalent diseases and improving health outcomes for children. © 2017 American Association of Public Health Dentistry.

  4. The Methanol Poisoning Outbreaks in Libya 2013 and Kenya 2014.

    Science.gov (United States)

    Rostrup, Morten; Edwards, Jeffrey K; Abukalish, Mohamed; Ezzabi, Masoud; Some, David; Ritter, Helga; Menge, Tom; Abdelrahman, Ahmed; Rootwelt, Rebecca; Janssens, Bart; Lind, Kyrre; Paasma, Raido; Hovda, Knut Erik

    2016-01-01

    Outbreaks of methanol poisoning occur frequently on a global basis, affecting poor and vulnerable populations. Knowledge regarding methanol is limited, likely many cases and even outbreaks go unnoticed, with patients dying unnecessarily. We describe findings from the first three large outbreaks of methanol poisoning where Médecins Sans Frontières (MSF) responded, and evaluate the benefits of a possible future collaboration between local health authorities, a Non-Governmental Organisation and international expertise. Retrospective study of three major methanol outbreaks in Libya (2013) and Kenya (May and July 2014). Data were collected from MSF field personnel, local health personnel, hospital files, and media reports. In Tripoli, Libya, over 1,000 patients were poisoned with a reported case fatality rate of 10% (101/1,066). In Kenya, two outbreaks resulted in approximately 341 and 126 patients, with case fatality rates of 29% (100/341) and 21% (26/126), respectively. MSF launched an emergency team with international experts, medications and equipment, however, the outbreaks were resolving by the time of arrival. Recognition of an outbreak of methanol poisoning and diagnosis seem to be the most challenging tasks, with significant delay from time of first presentations to public health warnings being issued. In spite of the rapid response from an emergency team, the outbreaks were nearly concluded by the time of arrival. A major impact on the outcome was not seen, but large educational trainings were conducted to increase awareness and knowledge about methanol poisoning. Based on this training, MSF was able to send a local emergency team during the second outbreak, supporting that such an approach could improve outcomes. Basic training, simplified treatment protocols, point-of-care diagnostic tools, and early support when needed, are likely the most important components to impact the consequences of methanol poisoning outbreaks in these challenging contexts.

  5. Cost of a measles outbreak in a remote island economy: 2014 Federated States of Micronesia measles outbreak.

    Science.gov (United States)

    Pike, Jamison; Tippins, Ashley; Nyaku, Mawuli; Eckert, Maribeth; Helgenberger, Louisa; Underwood, J Michael

    2017-10-13

    After 20years with no reported measles cases, on May 15, 2014 the Centers for Disease Control and Prevention (CDC) was notified of two cases testing positive for measles-specific immunoglobulin M (IgM) antibodies in the Federated States of Micronesia (FSM). Under the Compact of Free Association, FSM receives immunization funding and technical support from the United States (US) domestic vaccination program managed by the Centers for Disease Control and Prevention (CDC). In a collaborative effort, public health officials and volunteers from FSM and the US government worked to respond and contain the measles outbreak through an emergency mass vaccination campaign, contact tracing, and other outbreak investigation activities. Contributions were also made by United Nations Children's Emergency Fund (UNICEF) and World Health Organization (WHO). Total costs incurred as a result of the outbreak were nearly $4,000,000; approximately $10,000 per case. Direct medical costs (≈$141,000) were incurred in the treatment of those individuals infected, as well as lost productivity of the infected and informal caregivers (≈$250,000) and costs to contain the outbreak (≈$3.5 million). We assessed the economic burden of the 2014 measles outbreak to FSM, as well as the economic responsibilities of the US. Although the US paid the majority of total costs of the outbreak (≈67%), examining each country's costs relative to their respective economy illustrates a far greater burden to FSM. We demonstrate that while FSM was heavily assisted by the US in responding to the 2014 Measles Outbreak, the outbreak significantly impacted their economy. FSM's economic burden from the outbreak is approximately equivalent to their entire 2016 Fiscal Year budget dedicated to education. Published by Elsevier Ltd.

  6. Cost of dengue outbreaks: literature review and country case studies.

    Science.gov (United States)

    Stahl, Hans-Christian; Butenschoen, Vicki Marie; Tran, Hien Tinh; Gozzer, Ernesto; Skewes, Ronald; Mahendradhata, Yodi; Runge-Ranzinger, Silvia; Kroeger, Axel; Farlow, Andrew

    2013-11-06

    Dengue disease surveillance and vector surveillance are presumed to detect dengue outbreaks at an early stage and to save--through early response activities--resources, and reduce the social and economic impact of outbreaks on individuals, health systems and economies. The aim of this study is to unveil evidence on the cost of dengue outbreaks. Economic evidence on dengue outbreaks was gathered by conducting a literature review and collecting information on the costs of recent dengue outbreaks in 4 countries: Peru, Dominican Republic, Vietnam, and Indonesia. The literature review distinguished between costs of dengue illness including cost of dengue outbreaks, cost of interventions and cost-effectiveness of interventions. Seventeen publications on cost of dengue showed a large range of costs from 0.2 Million US$ in Venezuela to 135.2 Million US$ in Brazil. However, these figures were not standardized to make them comparable. Furthermore, dengue outbreak costs are calculated differently across the publications, and cost of dengue illness is used interchangeably with cost of dengue outbreaks. Only one paper from Australia analysed the resources saved through active dengue surveillance. Costs of vector control interventions have been reported in 4 studies, indicating that the costs of such interventions are lower than those of actual outbreaks. Nine papers focussed on the cost-effectiveness of dengue vaccines or dengue vector control; they do not provide any direct information on cost of dengue outbreaks, but their modelling methodologies could guide future research on cost-effectiveness of national surveillance systems.The country case studies--conducted in very different geographic and health system settings - unveiled rough estimates for 2011 outbreak costs of: 12 million US$ in Vietnam, 6.75 million US$ in Indonesia, 4.5 million US$ in Peru and 2.8 million US$ in Dominican Republic (all in 2012 US$). The proportions of the different cost components (vector control

  7. Cost of dengue outbreaks: literature review and country case studies

    Science.gov (United States)

    2013-01-01

    Background Dengue disease surveillance and vector surveillance are presumed to detect dengue outbreaks at an early stage and to save – through early response activities – resources, and reduce the social and economic impact of outbreaks on individuals, health systems and economies. The aim of this study is to unveil evidence on the cost of dengue outbreaks. Methods Economic evidence on dengue outbreaks was gathered by conducting a literature review and collecting information on the costs of recent dengue outbreaks in 4 countries: Peru, Dominican Republic, Vietnam, and Indonesia. The literature review distinguished between costs of dengue illness including cost of dengue outbreaks, cost of interventions and cost-effectiveness of interventions. Results Seventeen publications on cost of dengue showed a large range of costs from 0.2 Million US$ in Venezuela to 135.2 Million US$ in Brazil. However, these figures were not standardized to make them comparable. Furthermore, dengue outbreak costs are calculated differently across the publications, and cost of dengue illness is used interchangeably with cost of dengue outbreaks. Only one paper from Australia analysed the resources saved through active dengue surveillance. Costs of vector control interventions have been reported in 4 studies, indicating that the costs of such interventions are lower than those of actual outbreaks. Nine papers focussed on the cost-effectiveness of dengue vaccines or dengue vector control; they do not provide any direct information on cost of dengue outbreaks, but their modelling methodologies could guide future research on cost-effectiveness of national surveillance systems. The country case studies – conducted in very different geographic and health system settings - unveiled rough estimates for 2011 outbreak costs of: 12 million US$ in Vietnam, 6.75 million US$ in Indonesia, 4.5 million US$ in Peru and 2.8 million US$ in Dominican Republic (all in 2012 US$). The proportions of the

  8. Diphtheria outbreak in Thailand, 2012; seroprevalence of diphtheria antibodies among Thai adults and its implications for immunization programs.

    Science.gov (United States)

    Wanlapakorn, Nasamon; Yoocharoen, Pornsak; Tharmaphornpilas, Piyanit; Theamboonlers, Apiradee; Poovorawan, Yong

    2014-09-01

    An age distribution shift in diphtheria cases during a 2012 outbreak in northeastern of Thailand suggests adults are increasingly at risk for infection in Thailand. Data regarding immunity against diphtheria among the adult Thai population is limited. We review a 2012 diphtheria outbreak in Thailand and conducted a nationwide seroepidemiological survey to determine the prevalence of diphtheria antibodies among Thai adults in order to inform immunization programs. A total of 41 confirmed cases, 6 probable cases and 101 carriers of diphtheria were reported from northeastern and upper southern Thailand. The diphtheria outbreak in northeastern Thailand occurred among adults aged > or =15 years; sporadic cases occurred among children from upper southern Thailand. We conducted a seroepidemiological survey of 890 Thai adults from 4 age groups (20-29, 30-39, 40-49 and 50-59 years) in 7 different geographical areas of Thailand (Chiang Mai, Ratchaburi, Chon Buri, Nakhon Si Thammarat, Phitsanulok, Khon Kaen and Songkhla). Diptheria toxin antibody levels were measured with a commercially available ELISA test. The seroprotection rate ranged from 83% to 99%, with the highest in eastern Thailand (Chon Buri, 99%) and the lowest in northern Thailand (Chiang Mai, 83%). Diphtheria antibodies declined with increasing age. We recommend one doseof diphtheria-tetanus toxoid (dT) vaccine once after 20 years of age in order to boost the antibody and revaccinations every 10 years to prevent future outbreaks.

  9. The importance of waterborne disease outbreak surveillance in the United States

    Directory of Open Access Journals (Sweden)

    Gunther Franz Craun

    2012-12-01

    Full Text Available Analyses of the causes of disease outbreaks associated with contaminated drinking water in the United States have helped inform prevention efforts at the national, state, and local levels. This article describes the changing nature of disease outbreaks in public water systems during 1971-2008 and discusses the importance of a collaborative waterborne outbreak surveillance system established in 1971. Increasing reports of outbreaks throughout the early 1980s emphasized that microbial contaminants remained a health-risk challenge for suppliers of drinking water. Outbreak investigations identified the responsible etiologic agents and deficiencies in the treatment and distribution of drinking water, especially the high risk associated with unfiltered surface water systems. Surveillance information was important in establishing an effective research program that guided government regulations and industry actions to improve drinking water quality. Recent surveillance statistics suggest that prevention efforts based on these research findings have been effective in reducing outbreak risks especially for surface water systems.

  10. outbreak of hepatitis 'E' in risalpur garrison

    International Nuclear Information System (INIS)

    Sharif, T.B.; Tariq, W.U.Z.

    2007-01-01

    Hepatitis E virus is an RNA virus. It results in epidemics/outbreaks in geographical areas lacking clean water and sanitation. It is excreted in stools and is enterically transmitted (faeco-oral route). The clinical picture resembles other acute hepatitis and diagnosis is clinched by detecting anti-HEV IgM in infected individuals. It is a self-limiting disease and does not progress to chronicity. There is no vaccine available so far, to confer immunity against HEV infection. HEV is endemic in many parts of the world and has resulted in many epidemics / outbreaks worldwide. It is also endemic in Pakistan and epidemics / outbreaks have generally been under reported. To establish the cause of outbreak Blood samples of the patients (n=195), admitted in isolation ward were collected aseptically for routine baseline investigations and hepatitis screening. Separate blood samples were sent to Armed Forces Institute of pathology (AFIP), Rawalpindi for detection of antibodies to hepatitis E virus (Anti HEV IgM). Water samples collected during the outbreak were tested by multiple tube technique. MPN (Most Probable Number) method was used to determine faecal coliform bacteria per 100 ml of water sample. All the patients (n=195) on admission had raised ALT (Alanine Aminotransferase) levels along with hyperbilirubinemia, 37% had raised TLC with polymorphonuclear response. None had HBsAg (Hepatitis B surface antign) or anti-HCV (antibodies to hepatitis C virus), 23% had prolonged PT (Prothrombin Time). Samples despatched to AFIP Rawalpindi confirmed the presence of anti-HEV IgM. Follow up analysis revealed many fold increase in ALT levels. Average stay in the Hospital was 23.6 days per patient. All the water samples were declared unfit for drinking due to high coliform count. At present, no vaccine is available to protect against HEV infection. Mainstay for prevention and occurrence is to formulate cost-effective strategies for improvement of self/environmental hygiene and

  11. Determination of future prevention strategies in elite track and field: analysis of Daegu 2011 IAAF Championships injuries and illnesses surveillance

    Science.gov (United States)

    Alonso, Juan-Manuel; Edouard, Pascal; Fischetto, Giuseppe; Adams, Bob; Depiesse, Frédéric; Mountjoy, Margo

    2012-01-01

    Objective To determine the incidence and characteristics of newly incurred injuries and illnesses during international Athletics Championships, by improving the medical surveillance coverage, in order to determine future prevention strategies. Design Prospective recording of newly occurred injuries and illnesses. Setting 13th International Association of Athletics Federations World Championships in Athletics 2011 in Daegu, Korea. Participants National team and Local Organising Committee physicians; and 1851 registered athletes. Main outcome measures Incidence and characteristics of newly incurred injuries and illnesses. Results 82% of athletes were covered by medical teams participating with a response rate of 94%. A total of 249 injuries were reported, representing an incidence of 134.5 injuries per 1000 registered athletes, and 119 (48%) resulted in time loss from sport. A total of 185 injuries affected the lower limb (74%). Hamstring strain was the main diagnosis and 67% resulted in absence from sport. Overuse (n=148; 59%) was the predominant cause. A total of 126 illnesses were reported, signifying an incidence of 68.1 per 1000 registered athletes. Upper respiratory tract infection was the most common reported diagnosis (18%), followed by exercise-induced dehydration (12%), and gastroenteritis/diarrhoea (10%). The highest incidences of injuries were found in combined events and middle and long-distance events, and of illness in race walking events. Conclusion During elite Athletics World Championships, 135 injuries, 60 time-loss injuries and 68 illnesses per 1000 registered athletes were reported. Higher risks of injuries were found in combined events and long-distance runs. Preventive interventions should focus on overuse injuries and hamstring strains, decreasing the risk of transmission of infectious diseases, appropriate event scheduling and heat acclimatisation. PMID:22522588

  12. Fitting outbreak models to data from many small norovirus outbreaks

    Directory of Open Access Journals (Sweden)

    Eamon B. O’Dea

    2014-03-01

    Full Text Available Infectious disease often occurs in small, independent outbreaks in populations with varying characteristics. Each outbreak by itself may provide too little information for accurate estimation of epidemic model parameters. Here we show that using standard stochastic epidemic models for each outbreak and allowing parameters to vary between outbreaks according to a linear predictor leads to a generalized linear model that accurately estimates parameters from many small and diverse outbreaks. By estimating initial growth rates in addition to transmission rates, we are able to characterize variation in numbers of initially susceptible individuals or contact patterns between outbreaks. With simulation, we find that the estimates are fairly robust to the data being collected at discrete intervals and imputation of about half of all infectious periods. We apply the method by fitting data from 75 norovirus outbreaks in health-care settings. Our baseline regression estimates are 0.0037 transmissions per infective-susceptible day, an initial growth rate of 0.27 transmissions per infective day, and a symptomatic period of 3.35 days. Outbreaks in long-term-care facilities had significantly higher transmission and initial growth rates than outbreaks in hospitals.

  13. Human angiostrongyliasis outbreak in Dali, China.

    Directory of Open Access Journals (Sweden)

    Shan Lv

    campaigns could limit the risk, and a hospital-based surveillance system should be established in order to detect future outbreaks.

  14. Human angiostrongyliasis outbreak in Dali, China.

    Science.gov (United States)

    Lv, Shan; Zhang, Yi; Chen, Shao-Rong; Wang, Li-Bo; Fang, Wen; Chen, Feng; Jiang, Jin-Yong; Li, Yuan-Lin; Du, Zun-Wei; Zhou, Xiao-Nong

    2009-09-22

    established in order to detect future outbreaks.

  15. Mitigating measles outbreaks in West Africa post-Ebola.

    Science.gov (United States)

    Truelove, Shaun A; Moss, William J; Lessler, Justin

    2015-01-01

    The Ebola outbreak in 2014-2015 devastated the populations, economies and healthcare systems of Guinea, Liberia and Sierra Leone. With this devastation comes the impending threat of outbreaks of other infectious diseases like measles. Strategies for mitigating these risks must include both prevention, through vaccination, and case detection and management, focused on surveillance, diagnosis and appropriate clinical care and case management. With the high transmissibility of measles virus, small-scale reactive vaccinations will be essential to extinguish focal outbreaks, while national vaccination campaigns are needed to guarantee vaccination coverage targets are reached in the long term. Rapid and multifaceted strategies should carefully navigate challenges present in the wake of Ebola, while also taking advantage of current Ebola-related activities and international attention. Above all, resources and focus currently aimed at these countries must be utilized to build up the deficit in infrastructure and healthcare systems that contributed to the extent of the Ebola outbreak.

  16. Operation of a low-level waste disposal facility and how to prevent problems in future facilities

    International Nuclear Information System (INIS)

    Di Sibio, R.

    1985-01-01

    Operation of a low-level waste facility is an ever increasing problem nationally, and specifically one that could grow to crisis proportion in Pennsylvania. There have been, nevertheless, a variety of changes over the years in the management of low level radioactive waste, particularly with regard to disposal facilities that can avert a crisis condition. A number of companies have been organized thru possible a broad range of services to the nuclear industry, including those that emphasize solidification of waste materials, engineering services, waste management, and transportation to disposal sites across the United States. This paper addresses one particular site and the problems which evolved at that site from an environmental perspective. It is important that it is clearly understood that, although these problems are resolvable, the lessons learned here are critical for the prevention of problems at future facilities. The focus of this paper is on the Maxey Flats, Kentucky disposal facility which was closed in 1977. It must be understood that the regulations for siting, management, burial techniques, waste classification, and the overall management of disposal sites were limited when this facility was in operation

  17. Forecasting rodent outbreaks in Africa

    DEFF Research Database (Denmark)

    Leirs, Herwig; Verhagen, Ron; Verheyen, Walter

    1996-01-01

    1. Rainfall data were collated for years preceding historical outbreaks of Mastomys rats in East Africa in order to test the hypothesis that such outbreaks occur after long dry periods. 2. Rodent outbreaks were generally not preceded by long dry periods. 3. Population dynamics of Mastomys...... natalensis rats in Tanzania are significantly affected by the distribution of rainfall during the rainy season. 4. All previous rodent outbreaks in Tanzania were preceded by abundant rainfall early in the rainy season, i.e, towards the end of the year. 5. A flow chart is constructed to assess the likelihood...

  18. Incentives for reporting disease outbreaks.

    Directory of Open Access Journals (Sweden)

    Ramanan Laxminarayan

    Full Text Available BACKGROUND: Countries face conflicting incentives to report infectious disease outbreaks. Reports of outbreaks can prompt other countries to impose trade and travel restrictions, which has the potential to discourage reporting. However, reports can also bring medical assistance to contain the outbreak, including access to vaccines. METHODS: We compiled data on reports of meningococcal meningitis to the World Health Organization (WHO from 54 African countries between 1966 and 2002, a period is marked by two events: first, a large outbreak reported from many countries in 1987 associated with the Hajj that resulted in more stringent requirements for meningitis vaccination among pilgrims; and second, another large outbreak in Sub-Saharan Africa in 1996 that led to a new international mechanism to supply vaccines to countries reporting a meningitis outbreak. We used fixed-effects regression modeling to statistically estimate the effect of external forcing events on the number of countries reporting cases of meningitis to WHO. FINDINGS: We find that the Hajj vaccination requirements started in 1988 were associated with reduced reporting, especially among countries with relatively fewer cases reported between 1966 and 1979. After the vaccine provision mechanism was in place in 1996, reporting among countries that had previously not reported meningitis outbreaks increased. INTERPRETATION: These results indicate that countries may respond to changing incentives to report outbreaks when they can do so. In the long term, these incentives are likely to be more important than surveillance assistance in prompt reporting of outbreaks.

  19. An Outbreak of Sheep Pox in Zabajkalskij kray of Russia.

    Science.gov (United States)

    Maksyutov, R A; Gavrilova, E V; Agafonov, A P; Taranov, O S; Glotov, A G; Miheev, V N; Shchelkunov, S N; Sergeev, A N

    2015-08-01

    In this study, we investigated recent sheep pox outbreaks that occurred in Ononsky and Borzunsky regions of Zabajkalskij kray of Russia. The outbreaks involved in 2756 animals of which 112 were infected and 3 were slaughtered. Samples of injured skin of infected sheep were analysed by electron microscopy and CaPV-specific P32 gene amplification. Following sequence analysis of entire P32 gene showed that both specimens were identical to the sequence of several sheep poxvirus isolates from China and India. The close location of China to the last decade's Russian outbreaks suggest that possible future outbreaks in Russia could occur along the border regions with countries where sheep and goat pox are not controlled. © 2013 Blackwell Verlag GmbH.

  20. Pre-outbreak forest conditions mediate the effects of spruce beetle outbreaks on fuels in subalpine forests of Colorado.

    Science.gov (United States)

    Mietkiewicz, Nathan; Kulakowski, Dominik; Veblen, Thomas T

    2018-03-01

    Over the past 30 years, forest disturbances have increased in size, intensity, and frequency globally, and are predicted to continue increasing due to climate change, potentially relaxing the constraints of vegetation properties on disturbance regimes. However, the consequences of the potentially declining importance of vegetation in determining future disturbance regimes are not well understood. Historically, bark beetles preferentially attack older trees and stands in later stages of development. However, as climate warming intensifies outbreaks by promoting growth of beetle populations and compromising tree defenses, smaller diameter trees and stands in early stages of development now are being affected by outbreaks. To date, no study has considered how stand age and other pre-outbreak forest conditions mediate the effects of outbreaks on surface and aerial fuel arrangements. We collected fuels data across a chronosequence of post-outbreak sites affected by spruce beetle (SB) between the 1940s and the 2010s, stratified by young (130 yr) post-fire stands. Canopy and surface fuel loads were calculated for each tree and stand, and available crown fuel load, crown bulk density, and canopy bulk densities were estimated. Canopy bulk density and density of live canopy individuals were reduced in all stands affected by SB, though foliage loss was proportionally greater in old stands as compared to young stands. Fine surface fuel loads in young stands were three times greater shortly (fuels decreased to below endemic (i.e., non-outbreak) levels. In both young and old stands, the net effect of SB outbreaks during the 20th and 21st centuries reduced total canopy fuels and increased stand-scale spatial heterogeneity of canopy fuels following outbreak. Importantly, the decrease in canopy fuels following outbreaks was greater in young post-fire stands than in older stands, suggesting that SB outbreaks may more substantially reduce risk of active crown fire when they affect

  1. Impact of ethylene oxide gas sterilization of duodenoscopes after a carbapenem-resistant Enterobacteriaceae outbreak.

    Science.gov (United States)

    Naryzhny, Igor; Silas, Dean; Chi, Kenneth

    2016-08-01

    Carbapenem-resistant Enterobacteriaceae (CRE) outbreaks have been implicated at several medical institutions involving gastroenterology laboratories and, specifically, duodenoscopes. Currently, there are no specific guidelines to eradicate or prevent the outbreak of this bacteria. We describe ethylene oxide (ETO) gas sterilizations of duodenoscopes to address this issue. A complete investigation of the gastroenterology laboratory and an evaluation by the Centers for Disease Control and Prevention concluded that no lapses were found in the reprocessing of the equipment. With no deficiencies to address, we began a novel cleaning process using surgical ETO gas sterilizers in addition to standard endoscope reprocessing recommendations and guidelines, all while trying to eradicate the CRE contamination and prevent future recurrences. We also instituted a surveillance system for recurrence of CRE contamination via monthly cultures of the duodenoscopes. Between October 2013 and April 2014, 589 ERCPs were performed with 645 ETO gas sterilizations of 6 duodenoscopes. Given the extra 16 hours needed to sterilize the duodenoscopes, our institution incurred costs resulting from purchasing additional equipment and surveillance cultures. Four duodenoscopes sustained damage during this period; however, this could not be directly attributed to the sterilization process. Furthermore, after an 18-month success period we encountered a positive CRE culture after sterilization, albeit of a different strain than originally detected during the outbreak. The duodenoscope underwent additional ETO gas sterilization, with a negative repeated culture; all potentially exposed individuals screened negative for CRE. Proper use of high-level disinfection alone may not eliminate multidrug-resistant organisms from duodenoscopes. In this single-center study, the addition of ETO sterilization and frequent monitoring with cultures reduced duodenoscope contamination and eliminated clinical infections

  2. The Transmission Chain Analysis of 2014–2015 Ebola Virus Disease Outbreak in Koinadugu District, Sierra Leone: An Observational Study

    Directory of Open Access Journals (Sweden)

    Ifeanyi-Stanley Muoghalu

    2017-07-01

    Full Text Available IntroductionSierra Leone experienced an unprecedented Ebola virus disease (EVD outbreak in all its districts. Koinadugu District was the last to report an EVD case. Several outbreak response strategies were implemented. As part of lessons learnt, we conducted an observational study to describe the transmission chain in the district and the impact of the control measures implemented to contain the outbreak.MethodsWe reconstructed the transmission chain, positioning both confirmed and probable cases, described the distribution of the EVD confirmed cases in the context of the routes of transmission (Community, Funeral or Health facility setting and assessed the impact of control measures using the surveillance data collected during the outbreak.ResultsAll 142 confirmed and probable EVD cases registered were fully resolved in the transmission chain. 72.5% of all the EVD cases in the district were exposed in the community, 26.1% exposed during funerals, and 1.4% exposed in the health facility setting. Health-care workers contributed little to the EVD outbreak. 71.1% of EVD transmission occurred among family members. Female EVD cases generated more secondary cases than their male counterparts (P = 0.03. With removal of EVD cases from the community and admission to the community care center (CCC, the EVD transmission in the community decreased to substantially lower rates. In addition, transmission due to exposure in health facilities was further reduced with the implementation of full infection and prevention controls.ConclusionThis study details the transmission chain of EVD in a rural district setting and the public health interventions implemented to successfully limit the outbreak to just one of 11 chiefdoms. Heightened community-based surveillance for early case detection, swift isolation of suspect cases, efficient contact tracing and monitoring, and good infection prevention and control measures in health facilities were highly effective in

  3. Outbreaks Associated with Treated Recreational Water - United States, 2000-2014.

    Science.gov (United States)

    Hlavsa, Michele C; Cikesh, Bryanna L; Roberts, Virginia A; Kahler, Amy M; Vigar, Marissa; Hilborn, Elizabeth D; Wade, Timothy J; Roellig, Dawn M; Murphy, Jennifer L; Xiao, Lihua; Yates, Kirsten M; Kunz, Jasen M; Arduino, Matthew J; Reddy, Sujan C; Fullerton, Kathleen E; Cooley, Laura A; Beach, Michael J; Hill, Vincent R; Yoder, Jonathan S

    2018-05-18

    Outbreaks associated with exposure to treated recreational water can be caused by pathogens or chemicals in venues such as pools, hot tubs/spas, and interactive water play venues (i.e., water playgrounds). During 2000-2014, public health officials from 46 states and Puerto Rico reported 493 outbreaks associated with treated recreational water. These outbreaks resulted in at least 27,219 cases and eight deaths. Among the 363 outbreaks with a confirmed infectious etiology, 212 (58%) were caused by Cryptosporidium (which causes predominantly gastrointestinal illness), 57 (16%) by Legionella (which causes Legionnaires' disease, a severe pneumonia, and Pontiac fever, a milder illness with flu-like symptoms), and 47 (13%) by Pseudomonas (which causes folliculitis ["hot tub rash"] and otitis externa ["swimmers' ear"]). Investigations of the 363 outbreaks identified 24,453 cases; 21,766 (89%) were caused by Cryptosporidium, 920 (4%) by Pseudomonas, and 624 (3%) by Legionella. At least six of the eight reported deaths occurred in persons affected by outbreaks caused by Legionella. Hotels were the leading setting, associated with 157 (32%) of the 493 outbreaks. Overall, the outbreaks had a bimodal temporal distribution: 275 (56%) outbreaks started during June-August and 46 (9%) in March. Assessment of trends in the annual counts of outbreaks caused by Cryptosporidium, Legionella, or Pseudomonas indicate mixed progress in preventing transmission. Pathogens able to evade chlorine inactivation have become leading outbreak etiologies. The consequent outbreak and case counts and mortality underscore the utility of CDC's Model Aquatic Health Code (https://www.cdc.gov/mahc) to prevent outbreaks associated with treated recreational water.

  4. Addiction research centres and the nurturing of creativity: The Swiss Institute for the Prevention of Alcohol and Drug Problems. Past, present and future

    NARCIS (Netherlands)

    Kuntsche, E.N.; Maffli, E.; Kuntsche, S.; Delgrande Jordan, M.

    2009-01-01

    The aim of this paper is to offer an account of the history, the current status and the future of substance use research at the Swiss Institute for the Prevention of Alcohol and Drug Problems (SIPA). Although founded originally by the temperance movement in 1901, its policy has shifted over time

  5. Post-Ebola Measles Outbreak in Lola, Guinea, January-June 2015(1).

    Science.gov (United States)

    Suk, Jonathan E; Paez Jimenez, Adela; Kourouma, Mamadou; Derrough, Tarik; Baldé, Mamadou; Honomou, Patric; Kolie, Nestor; Mamadi, Oularé; Tamba, Kaduono; Lamah, Kalaya; Loua, Angelo; Mollet, Thomas; Lamah, Molou; Camara, Amara Nana; Prikazsky, Vladimir

    2016-06-01

    During public health crises such as the recent outbreaks of Ebola virus disease in West Africa, breakdowns in public health systems can lead to epidemics of vaccine-preventable diseases. We report here on an outbreak of measles in the prefecture of Lola, Guinea, which started in January 2015.

  6. Lessons from worldwide measles out-breaks in 2011-2012 and ...

    African Journals Online (AJOL)

    Measles is a leading cause of under-five mortality among vaccine preventable diseases in today's developing world. In fact, Tanzania has been experiencing measles out-breaks almost every year. Since last year, the world has experienced several out-breaks in several areas including many developed countries with high ...

  7. An outbreak of Bacillus cereus implicating a part-time banquet caterer.

    Science.gov (United States)

    Gaulin, Colette; Viger, Yv Bonnier; Fillion, Lise

    2002-01-01

    In the aftermath of a party, 70% (25 of 36) of attendees had gastroenteritis. The objectives of this study were to identify a risk factor associated with the food during the banquet and to identify measures of control for avoiding this kind of outbreak in the future. A retrospective cohort study was used. We tried to reach by telephone all guests who had attended this banquet. A standardized questionnaire was used to provide information about identification of a risk factor, especially in relation to food. The cohort study has shown that potato salad served at the party was significantly associated with the disease. The mayonnaise used to prepare the salad was analyzed and Bacillus cereus was isolated (10(3) bacteria per gram). Bacillus microorganisms are usually found in decaying organic matter, dust, soil, vegetables and water. The bacteria has a remarkable ability to survive strong environmental stresses. There are strains of B. cereus that can cause food poisoning episodes with infective doses as low as 10(3) to 10(4) bacteria per gram. B. cereus is an infrequently reported cause of foodborne illnesses in Quebec and in North America but this may be due to underreporting of episodes. In this outbreak, bacterial multiplication was facilitated at several points in the interval between the preparation of the meal and the consumption of the banquet by the guests. Because the spores are ubiquitous and resistant to inactivation with most food grade disinfectants, temperature control should be the main focus of B. cereus outbreak prevention. The meal was prepared by a restaurateur who was inexperienced in catering services and temperature control in particular when food is served outside the restaurant. This outbreak underscores the importance of maintaining meticulous hygienic procedures in food processing. Restaurateurs who offer catering services should be familiar with the constraints that are specific to this sector of the food industry.

  8. Trends of major disease outbreaks in the African region, 2003-2007.

    Science.gov (United States)

    Kebede, Senait; Duales, Sambe; Yokouide, Allarangar; Alemu, Wondimagegnehu

    2010-03-01

    Communicable disease outbreaks cause millions of deaths throughout Sub-Saharan Africa each year. Most of the diseases causing epidemics in the region have been nearly eradicated or brought under control in other parts of the world. In recent years, considerable effort has been directed toward public health initiatives and strategies with a potential for significant impact in the fight against infectious diseases. In 1998, the World Health Organization African Regional Office (WHO/AFRO) launched the Integrated Disease Surveillance and Response (IDSR) strategy aimed at mitigating the impact of communicable diseases, including epidemic-prone diseases, through improving surveillance, laboratory confirmation and appropriate and timely public health interventions. Over the past decade, WHO and its partners have been providing technical and financial resources to African countries to strengthen epidemic preparedness and response (EPR) activities. This review examined the major epidemics reported to WHO/AFRO from 2003 to 2007. we conduct a review of documents and reports obtained from WHO/AFRO, WHO inter-country team, and partners and held meeting and discussions with key stakeholders to elicit the experiences of local, regional and international efforts against these epidemics to evaluate the lessons learned and to stimulate discussion on the future course for enhancing EPR. The most commonly reported epidemic outbreaks in Africa include: cholera, dysentery, malaria and hemorrhagic fevers (e.g. Ebola, Rift Valley fever, Crimean-Congo fever and yellow fever). The cyclic meningococcal meningitis outbreak that affects countries along the "meningitis belt" (spanning Sub-Saharan Africa from Senegal and The Gambia to Kenya and Ethiopia) accounts for other major epidemics in the region. The reporting of disease outbreaks to WHO/AFRO has improved since the launch of the IDSR strategy in 1998. Although the epidemic trends for cholera showed a decline in case fatality rate (CFR

  9. Measles outbreak investigation in Guji zone of Oromia Region, Ethiopia.

    Science.gov (United States)

    Belda, Ketema; Tegegne, Ayesheshem Ademe; Mersha, Amare Mengistu; Bayenessagne, Mekonnen Getahun; Hussein, Ibrahim; Bezabeh, Belay

    2017-01-01

    Despite the increase of immunization coverage (administrative) of measles in the country, there are widespread outbreaks of measles. In this respect, we investigated one of the outbreaks that occurred in hard to reach kebeles of Guji Zone, Oromia region, to identify the contributing factors that lead to the protracted outbreak of measles. We used a cross-sectional study design to investigate a measles outbreak in Guji zone, Oromia region. Data entry and analysis was performed using EPI-Info version 7.1.0.6 and MS-Microsoft Excel. In three months' time a total of 1059 suspected cases and two deaths were reported from 9 woredas affected by a measles outbreak in Guji zone. The cumulative attack rate of 81/100,000 population and case fatality ratio of 0.2% was recorded. Of these, 821 (77.5%) cases were measles vaccine. Although, all age groups were affected under five years old were more affected 495 (48%) than any other age groups. In response to the outbreak, an outbreak response immunization was organized at the 11th week of the epidemic, when the epidemic curve started to decline. 6 months to14 years old were targeted for outbreak response immunization and the overall coverage was 97 % (range: 90-103%). Case management with vitamin A supplementation, active case search, and health education was some of the activities carried out to curb the outbreak. We conclude that low routine immunization coverage in conjunction with low access to routine immunization in hard to reach areas, low community awareness in utilization of immunization service, inadequate cold chain management and delivery of a potent vaccine in hard to reach woredas/kebeles were likely contributed to the outbreak that's triggered a broad spread epidemic affecting mostly children without any vaccination. We also figured that the case-based surveillance lacks sensitivity and timely confirmation of the outbreak, which as a result outbreak response immunization were delayed. We recommend establishing

  10. Outbreaks of virulent diarrheagenic Escherichia coli - are we in control?

    Directory of Open Access Journals (Sweden)

    Werber Dirk

    2012-02-01

    Full Text Available Abstract Shiga toxin-producing Escherichia coli (STEC are the most virulent diarrheagenic E. coli known to date. They can be spread with alarming ease via food as exemplified by a large sprout-borne outbreak of STEC O104:H4 in 2011 that was centered in northern Germany and affected several countries. Effective control of such outbreaks is an important public health task and necessitates early outbreak detection, fast identification of the outbreak vehicle and immediate removal of the suspected food from the market, flanked by consumer advice and measures to prevent secondary spread. In our view, opportunities to improve control of STEC outbreaks lie in early clinical suspicion for STEC infection, timely diagnosis of all STEC at the serotype-level and integrating molecular subtyping information into surveillance systems. Furthermore, conducting analytical studies that supplement patients' imperfect food history recall and performing, as an investigative element, product tracebacks, are pivotal but underutilized tools for successful epidemiologic identification of the suspected vehicle in foodborne outbreaks. As a corollary, these tools are amenable to tailor microbiological testing of suspected food. Please see related article: http://www.biomedcentral.com/1741-7015/10/12

  11. Surveillance for foodborne disease outbreaks - United States, 1998-2008.

    Science.gov (United States)

    Gould, L Hannah; Walsh, Kelly A; Vieira, Antonio R; Herman, Karen; Williams, Ian T; Hall, Aron J; Cole, Dana

    2013-06-28

    to assess changes in the food commodities associated most frequently with outbreaks that might occur following improvements in food safety or changes in consumption patterns or food preparation practices. Prevention of foodborne disease depends on targeted interventions at appropriate points from food production to food preparation. Efforts to reduce foodborne illness should focus on the pathogens and food commodities causing the most outbreaks and outbreak-associated illnesses, including beef, poultry, fish, and produce.

  12. Is the absence or intermittent YF vaccination the major contributor to its persistent outbreaks in eastern Africa?

    Science.gov (United States)

    Baba, Marycelin Mandu; Ikusemoran, Mayomi

    2017-10-28

    vaccination, promoting environmental sanitation/hygienic practices, driving behavioral change and community-based vector control are significant to preventing future epidemics. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Ebola virus disease outbreak; the role of field epidemiology training programme in the fight against the epidemic, Liberia, 2014.

    Science.gov (United States)

    Lubogo, Mutaawe; Donewell, Bangure; Godbless, Lucas; Shabani, Sasita; Maeda, Justin; Temba, Herilinda; Malibiche, Theophil C; Berhanu, Naod

    2015-01-01

    The African Field Epidemiology Network (AFENET) is a public health network established in 2005 as a non-profit networking alliance of Field Epidemiology and Laboratory Training Programs (FELTPs) and Field Epidemiology Training Programs (FETPs) in Africa. AFENET is dedicated to supporting Ministries of Health in Africa build strong, effective and sustainable programs and capacity to improve public health systems by partnering with global public health experts. The Network's goal is to strengthen field epidemiology and public health laboratory capacity to contribute effectively to addressing epidemics and other major public health problems in Africa. The goal for the establishment of FETP and FELTP was and still is to produce highly competent multi-disciplinary public health professionals who would assume influential posts in the public health structures and tackle emerging and re-emerging communicable and non-communicable diseases. AFENET currently networks 12 FELTPs and FETPs in sub-Saharan Africa with operations in 20 countries. During the Ebola Virus Disease (EVD) outbreak in West Africa, African Union Support for the Ebola Outbreak in West Africa (ASEOWA) supported FETP graduates from Uganda, Zimbabwe, Ethiopia and Tanzania for the investigation and control of the EVD outbreak in Liberia. The graduates were posted in different counties in Liberia where they lead teams of other experts conduct EVD outbreak investigations, Infection Control and Prevention trainings among health workers and communities, Strengthening integrated disease surveillance, developing Standard Operating Procedures for infection control and case notification in the Liberian setting as well as building capacity of local surveillance officers' conduct outbreak investigation and contact tracing. The team was also responsible for EVD data management at the different Counties in Liberia. The FETP graduates have been instrumental in the earlier successes registered in various counties in Liberia

  14. Factors determining dengue outbreak in Malaysia.

    Science.gov (United States)

    Ahmad, Rohani; Suzilah, Ismail; Wan Najdah, Wan Mohamad Ali; Topek, Omar; Mustafakamal, Ibrahim; Lee, Han Lim

    2018-01-01

    that preventive interventions can be taken early to avert the outbreaks.

  15. A Hospital-wide Outbreak of Serratia marcescens, and Ishikawa's “Fishbone” Analysis to Support Outbreak Control

    Science.gov (United States)

    Vetter, Luzia; Schuepfer, Guido; Kuster, Stefan P.

    2016-01-01

    A nosocomial outbreak of Serratia marcescens in respiratory samples predominantly from patients in a surgical intensive care unit is reported. Most of these patients were cardiac surgical patients. Initially, a vigorous but inconclusive investigation was implemented on the basis of standardized (according the US Centers for Disease Control and Prevention) steps of outbreak investigation. Then, a systemic quality management approach with “fishbone” analysis was added. As a consequence, plausible causes for the outbreak were identified: (i) S marcescens was found on the transesophageal echocardiography probe used during cardiac surgery; and (ii) the quality of the surface disinfection was insufficient due to multiple reasons and was completely reengineered. In conclusion, in addition to the standardized steps of outbreak investigation, the complementary use of quality management tools such as the Ishikawa “fishbone” analysis is helpful for outbreak control. The complete reengineering of the disinfectant procurement and logistics is assumed to have been the most effective measure to control the described outbreak. PMID:26783861

  16. Outbreak of Diarrhetic Shellfish Poisoning Associated with Mussels, British Columbia, Canada

    Science.gov (United States)

    Taylor, Marsha; McIntyre, Lorraine; Ritson, Mark; Stone, Jason; Bronson, Roni; Bitzikos, Olga; Rourke, Wade; Galanis, Eleni

    2013-01-01

    In 2011, a Diarrhetic Shellfish Poisoning (DSP) outbreak occurred in British Columbia (BC), Canada that was associated with cooked mussel consumption. This is the first reported DSP outbreak in BC. Investigation of ill individuals, traceback of product and laboratory testing for toxins were used in this investigation. Sixty-two illnesses were reported. Public health and food safety investigation identified a common food source and harvest area. Public health and regulatory agencies took actions to recall product and notify the public. Shellfish monitoring program changes were implemented after the outbreak. Improved response and understanding of toxin production will improve management of future DSP outbreaks. PMID:23697950

  17. Outbreaks of forest defoliating insects in Japan, 1950-2000.

    Science.gov (United States)

    Kamata, N; Kamata, N

    2002-04-01

    In Japan, several forest-defoliating insects reach outbreak levels and cause serious defoliation. Stand mortality sometimes occurs after severe defoliation. However, in general, tree mortality caused by insect defoliation is low because of the prevailing moist climate in Japan. Evergreen conifers are more susceptible to tree mortality as a result of insect defoliation whereas deciduous broad-leaved trees are seldom killed. Insect defoliation occurs more frequently in man-made environments such as among shade trees, orchards, and plantations than in natural habitats. Outbreaks of some defoliators tend to occur in stands of a particular age: e.g. outbreaks of the pine caterpillar, Dendrolimus spectabilis Butler (Lepidoptera: Lasiocampidae) occur more frequently in young pine plantations. In contrast, defoliation caused by outbreaks of lepidopterous and hymenopterous pests in larch plantations is more frequent with stand maturation. There is a relationship between outbreaks of some defoliators and altitude above sea level. Most outbreaks of forest defoliators were terminated by insect pathogens that operated in a density-dependent fashion. Since the 1970s, Japan has been prosperous and can afford to buy timber from abroad. More recently, there has been an increasing demand for timber in Japan, that coincides with a huge demand internationally, so that the country will need to produce more timber locally in the future. The increasing pressure on the forestry industry to meet this demand will require more sophisticated methods of pest control coupled with more sustainable methods of silviculture.

  18. Acceptance of vaccinations in pandemic outbreaks: A discrete choice experiment

    NARCIS (Netherlands)

    D. Determann (Domino); I.J. Korfage (Ida); A.C. Lambooij (Antoinette); M.C.J. Bliemer (Michiel); J.H. Richardus (Jan Hendrik); E.W. Steyerberg (Ewout); E.W. de Bekker-Grob (Esther)

    2014-01-01

    textabstractBackground: Preventive measures are essential to limit the spread of new viruses; their uptake is key to their success. However, the vaccination uptake in pandemic outbreaks is often low. We aim to elicit how disease and vaccination characteristics determine preferences of the general

  19. Outbreaks of Rickettsia felis in Kenya and Senegal, 2010

    Centers for Disease Control (CDC) Podcasts

    This podcast describes the outbreak of Rickettsia felis in Kenya between August 2006 and June 2008, and in rural Senegal from November 2008 through July 2009. CDC infectious disease pathologist Dr. Chris Paddock discusses what researchers learned about this flea-borne disease and how to prevent infection.

  20. Measles outbreak in a poorly vaccinated region in Cameroon: a ...

    African Journals Online (AJOL)

    preventable deaths in Africa; especially in unvaccinated populations. We reviewed the medical reports of the measles outbreak that occurred in Misaje, in the North west region of Cameroon from 11/03/2015 to 14/05/2015. Six measles cases ...

  1. Outbreak of a New Strain of Flu at a Fair

    Centers for Disease Control (CDC) Podcasts

    2013-02-28

    Dr. Karen Wong, an EIS officer with the Centers for Disease Control and Prevention, discusses her study about flu outbreaks at agricultural fairs.  Created: 2/28/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 3/4/2013.

  2. The past, present and future use of epidemiological intelligence to plan malaria vector control and parasite prevention in Uganda.

    Science.gov (United States)

    Talisuna, Ambrose O; Noor, Abdisalan M; Okui, Albert P; Snow, Robert W

    2015-04-15

    An important prelude to developing strategies to control infectious diseases is a detailed epidemiological evidence platform to target cost-effective interventions and define resource needs. A review of published and un-published reports of malaria vector control and parasite prevention in Uganda was conducted for the period 1900-2013. The objective was to provide a perspective as to how epidemiological intelligence was used to design malaria control before and during the global malaria eradication programme (GMEP) and to contrast this with the evidence generated in support of the Roll Back Malaria (RBM) initiative from 1998 to date. During the GMEP era, comprehensive investigations were undertaken on the effectiveness of vector and parasite control such as indoor residual house-spraying (IRS) and mass drug administration (MDA) at different sites in Uganda. Nationwide malariometric surveys were undertaken between 1964 and 1967 to provide a profile of risk, epidemiology and seasonality leading to an evidence-based national cartography of risk to characterize the diversity of malaria transmission in Uganda. At the launch of the RBM initiative in the late 1990s, an equivalent level of evidence was lacking. There was no contemporary national evidence-base for the likely impact of insecticide-treated nets (ITN), no new malariometric data, no new national cartography of malaria risk or any evidence of tailored intervention delivery based on variations in the ecology of malaria risk in Uganda. Despite millions of dollars of overseas development assistance over the last ten years in ITN, and more recently the resurrection of the use of IRS, the epidemiological impact of vector control remains uncertain due to an absence of nationwide basic parasite and vector-based field studies. Readily available epidemiological data should become the future business model to maximize malaria funding from 2015. Over the next five to ten years, accountability, impact analysis, financial

  3. Novel Influenza A (H1N1) Outbreak at the U.S. Air Force Academy: Epidemiology and Viral Shedding Duration (American Journal of Preventive Medicine, Volume 20, Number 10, 2009)

    Science.gov (United States)

    2009-01-01

    virus : zoonotic potential and vaccina- tion strategies for the control of avian and swine influenzas . J Infect Dis 2008;197(1S):S19–24. ber x www.ajpm-online.net ...nsubtypeable influenza A virus from patient samples. he viral specimens were transported to the CDC nfluenza laboratory, where both viral samples were...etermined to be a novel influenza A virus of swine rigin (nH1N1), consistent with virus isolated from atients in a Mexico influenza outbreak that began

  4. Outbreak of Serratia marcescens bloodstream infections in patients receiving parenteral nutrition prepared by a compounding pharmacy.

    Science.gov (United States)

    Gupta, Neil; Hocevar, Susan N; Moulton-Meissner, Heather A; Stevens, Kelly M; McIntyre, Mary G; Jensen, Bette; Kuhar, David T; Noble-Wang, Judith A; Schnatz, Rick G; Becker, Shawn C; Kastango, Eric S; Shehab, Nadine; Kallen, Alexander J

    2014-07-01

    Compounding pharmacies often prepare parenteral nutrition (PN) and must adhere to rigorous standards to avoid contamination of the sterile preparation. In March 2011, Serratia marcescens bloodstream infections (BSIs) were identified in 5 patients receiving PN from a single compounding pharmacy. An investigation was conducted to identify potential sources of contamination and prevent further infections. Cases were defined as S. marcescens BSIs in patients receiving PN from the pharmacy between January and March 2011. We reviewed case patients' clinical records, evaluated pharmacy compounding practices, and obtained epidemiologically directed environmental cultures. Molecular relatedness of available Serratia isolates was determined by pulsed-field gel electrophoresis (PFGE). Nineteen case patients were identified; 9 died. The attack rate for patients receiving PN in March was 35%. No case patients were younger than 18 years. In October 2010, the pharmacy began compounding and filter-sterilizing amino acid solution for adult PN using nonsterile amino acids due to a national manufacturer shortage. Review of this process identified breaches in mixing, filtration, and sterility testing practices. S. marcescens was identified from a pharmacy water faucet, mixing container, and opened amino acid powder. These isolates were indistinguishable from the outbreak strain by PFGE. Compounding of nonsterile amino acid components of PN was initiated due to a manufacturer shortage. Failure to follow recommended compounding standards contributed to an outbreak of S. marcescens BSIs. Improved adherence to sterile compounding standards, critical examination of standards for sterile compounding from nonsterile ingredients, and more rigorous oversight of compounding pharmacies is needed to prevent future outbreaks. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public

  5. The use of a mobile laboratory unit in support of patient management and epidemiological surveillance during the 2005 Marburg Outbreak in Angola.

    Directory of Open Access Journals (Sweden)

    Allen Grolla

    2011-05-01

    Full Text Available BACKGROUND: Marburg virus (MARV, a zoonotic pathogen causing severe hemorrhagic fever in man, has emerged in Angola resulting in the largest outbreak of Marburg hemorrhagic fever (MHF with the highest case fatality rate to date. METHODOLOGY/PRINCIPAL FINDINGS: A mobile laboratory unit (MLU was deployed as part of the World Health Organization outbreak response. Utilizing quantitative real-time PCR assays, this laboratory provided specific MARV diagnostics in Uige, the epicentre of the outbreak. The MLU operated over a period of 88 days and tested 620 specimens from 388 individuals. Specimens included mainly oral swabs and EDTA blood. Following establishing on site, the MLU operation allowed a diagnostic response in <4 hours from sample receiving. Most cases were found among females in the child-bearing age and in children less than five years of age. The outbreak had a high number of paediatric cases and breastfeeding may have been a factor in MARV transmission as indicated by the epidemiology and MARV positive breast milk specimens. Oral swabs were a useful alternative specimen source to whole blood/serum allowing testing of patients in circumstances of resistance to invasive procedures but limited diagnostic testing to molecular approaches. There was a high concordance in test results between the MLU and the reference laboratory in Luanda operated by the US Centers for Disease Control and Prevention. CONCLUSIONS/SIGNIFICANCE: The MLU was an important outbreak response asset providing support in patient management and epidemiological surveillance. Field laboratory capacity should be expanded and made an essential part of any future outbreak investigation.

  6. Public health action and mass chemoprophylaxis in response to a small meningococcal infection outbreak at a nursery in the West Midlands, England.

    Science.gov (United States)

    Stewart, Antony; Coetzee, Nic; Knapper, Elizabeth; Rajanaidu, Subhadra; Iqbal, Zafar; Duggal, Harsh

    2013-03-01

    Meningococcal infection is fatal in 10% of cases, and age-specific attack rates are highest in infancy. A nursery outbreak was declared just before a bank holiday weekend in August 2010, when two children attending the same nursery were confirmed to have meningococcal infection. Although such outbreaks are rare, they generate considerable public alarm and are challenging to manage and control. This report describes the investigation and public health response to the outbreak. Both cases had relatively mild disease and were confirmed as having serogroup B infection. Chemoprophylaxis and advice were given to most of the 146 children and 30 staff at the nursery. Within 28 hours of declaring the outbreak, over 95% of parents received information, advice and prescriptions for their children. GPs were also given information and the after-hours service provided continuity over the weekend. No further cases were identified and the outbreak was closed four weeks after being declared. Considerable logistical challenges were involved in providing timely advice and chemoprophylaxis to the entire nursery and staff one day before a bank holiday weekend. The speed of the public health response and implementation of preventive measures was crucial in providing assurance to parents and staff, and reducing their anxiety. The decision to provide on-site prescribing at the nursery (coupled with information sessions and individual counselling) proved to be a key implementation-success factor. Effective coordination and management by the outbreak control team was able to rapidly provide leadership, delegate tasks, identify gaps, allocate resources and ensure a proactive media response. A number of useful lessons were learnt and recommendations were made for future local practice.

  7. “A time of fear”: local, national, and international responses to a large Ebola outbreak in Uganda

    Directory of Open Access Journals (Sweden)

    Kinsman John

    2012-06-01

    experience of 2000/2001 demonstrates that responses to an Ebola outbreak can be very dramatic, but perhaps disproportionate to the actual danger presented. An important objective for any future outbreak control strategy must be to prevent excessive fear, which, it is expected, would reduce stigma and other negative outcomes. To this end, the value of openness in the provision of public information, and critically, of being seen to be open, cannot be overstated.

  8. Assessment of water, sanitation and hygiene interventions in response to an outbreak of typhoid fever in Neno District, Malawi.

    Science.gov (United States)

    Bennett, Sarah D; Lowther, Sara A; Chingoli, Felix; Chilima, Benson; Kabuluzi, Storn; Ayers, Tracy L; Warne, Thomas A; Mintz, Eric

    2018-01-01

    On May 2, 2009 an outbreak of typhoid fever began in rural villages along the Malawi-Mozambique border resulting in 748 illnesses and 44 deaths by September 2010. Despite numerous interventions, including distribution of WaterGuard (WG) for in-home water treatment and education on its use, cases of typhoid fever continued. To inform response activities during the ongoing Typhoid outbreak information on knowledge, attitudes, and practices surrounding typhoid fever, safe water, and hygiene were necessary to plan future outbreak interventions. In September 2010, a survey was administered to female heads in randomly selected households in 17 villages in Neno District, Malawi. Stored household drinking water was tested for free chlorine residual (FCR) levels using the N,N diethyl-p-phenylene diamine colorimetric method (HACH Company, Loveland, CO, USA). Attendance at community-wide educational meetings was reported by 56% of household respondents. Respondents reported that typhoid fever is caused by poor hygiene (77%), drinking unsafe water (49%), and consuming unsafe food (25%), and that treating drinking water can prevent it (68%). WaterGuard, a chlorination solution for drinking water treatment, was observed in 112 (56%) households, among which 34% reported treating drinking water. FCR levels were adequate (FCR ≥ 0.2 mg/L) in 29 (76%) of the 38 households who reported treatment of stored water and had stored water available for testing and an observed bottle of WaterGuard in the home. Soap was observed in 154 (77%) households, among which 51% reported using soap for hand washing. Educational interventions did not reach almost one-half of target households and knowledge remains low. Despite distribution and promotion of WaterGuard and soap during the outbreak response, usage was low. Future interventions should focus on improving water, sanitation and hygiene knowledge, practices, and infrastructure. Typhoid vaccination should be considered.

  9. Fears and Misperceptions of the Ebola Response System during the 2014-2015 Outbreak in Sierra Leone.

    Directory of Open Access Journals (Sweden)

    Thespina Yamanis

    2016-10-01

    Full Text Available Future infectious disease epidemics are likely to disproportionately affect countries with weak health systems, exacerbating global vulnerability. To decrease the severity of epidemics in these settings, lessons can be drawn from the Ebola outbreak in West Africa. There is a dearth of literature on public perceptions of the public health response system that required citizens to report and treat Ebola cases. Epidemiological reports suggested that there were delays in diagnosis and treatment. The purpose of our study was to explore the barriers preventing Sierra Leoneans from trusting and using the Ebola response system during the height of the outbreak.Using an experienced ethnographer, we conducted 30 semi-structured in-depth interviews in public spaces in Ebola-affected areas. Participants were at least age 18, spoke Krio, and reported no contact in the recent 21 days with an Ebola-infected person. We used inductive coding and noted emergent themes.Most participants feared that calling the national hotline for someone they believed had Ebola would result in that person's death. Many stated that if they developed a fever they would assume it was not Ebola and self-medicate. Some thought the chlorine sprayed by ambulance workers was toxic. Although most knew there was a laboratory test for Ebola, some erroneously assumed the ubiquitous thermometers were the test and most did not understand the need to re-test in the presence of Ebola symptoms.Fears and misperceptions, related to lack of trust in the response system, may have delayed care-seeking during the Ebola outbreak in Sierra Leone. Protocols for future outbreak responses should incorporate dynamic, qualitative research to understand and address people's perceptions. Strategies that enhance trust in the response system, such as community mobilization, may be particularly effective.

  10. Women Veterans? Experience With a Web-Based Diabetes Prevention Program: A Qualitative Study to Inform Future Practice

    OpenAIRE

    Moin, Tannaz; Ertl, Kristyn; Schneider, Jessica; Vasti, Elena; Makki, Fatima; Richardson, Caroline; Havens, Kathryn; Damschroder, Laura

    2015-01-01

    Background Diabetes prevention is a national goal and particularly important in the Veterans Health Administration (VHA) where 1 in 4 veterans has diabetes. There is growing evidence to support the use of Web-based diabetes prevention program (DPP) interventions, shown to be as effective and often more feasible than in-person interventions. Objective Our primary objective was to qualitatively explore women veterans? early experiences with a Web-based DPP intervention. Our secondary objective ...

  11. Ariadne´s house (Pompeii, Italy) wall paintings: A multidisciplinary study of its present state focused on a future restoration and preventive conservation

    OpenAIRE

    Pérez, M.C.; García-Diego, F. J.; Merello, P.; D’Antoni, P.; Fernández-Navajas, A.; Ribera i Lacomba, A.; Ferrazza, L.; Pérez-Miralles, J.; Baró, José-Luis; Merce, P.; D’Antoni, H.; Curiel-Esparza, J.

    2013-01-01

    This paper deals with the development of a multidisciplinary study on the current state of conservation of Ariadne's house (Pompeii, Italy), a domus of great archaeological value. The aim of this study is to undertake the preventive conservation actions required and increase the knowledge about its conservation and to generate discussions and points of view for a future restoration. Environmental studies, electromagnetic radiation measurements, study of materials and a photographical study we...

  12. Neonatal staphylococcal scalded skin syndrome: clinical and outbreak containment review.

    LENUS (Irish Health Repository)

    Neylon, Orla

    2012-01-31

    Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated exfoliating skin condition predominated by desquamation and blistering. Neonatal outbreaks have already been reported; however, our outbreak highlights the potential for SSSS following neonatal health promotion measures such as intra-muscular vitamin K administration and metabolic screening (heel prick) as well as effective case containment measures and the value of staff screening. Between February and June 2007, five confirmed cases of neonatal SSSS were identified in full-term neonates born in an Irish regional maternity hospital. All infants were treated successfully. Analysis of contact and environmental screening was undertaken, including family members and healthcare workers. Molecular typing on isolates was carried out. An outbreak control team (OCT) was assembled and took successful prospective steps to prevent further cases. All five Staphylococcus aureus isolates tested positive for exfoliative toxin A, of which two distinct strains were identified on pulsed-field gel electrophoresis analysis. Two cases followed staphylococcal inoculation during preventive measures such as intra-muscular vitamin K administration and metabolic screening (heel prick). None of the neonatal isolates were methicillin resistant. Of 259 hospital staff (70% of staff) screened, 30% were colonised with S. aureus, and 6% were positive for MRSA carriage. This is the first reported outbreak of neonatal SSSS in Ireland. Effective case containment measures and clinical value of OCT is demonstrated. Results of staff screening underlines the need for vigilance and compliance in hand disinfection strategies in maternity hospitals especially during neonatal screening and preventive procedures.

  13. Averting HIV infections in New York City: a modeling approach estimating the future impact of additional behavioral and biomedical HIV prevention strategies.

    Science.gov (United States)

    Kessler, Jason; Myers, Julie E; Nucifora, Kimberly A; Mensah, Nana; Kowalski, Alexis; Sweeney, Monica; Toohey, Christopher; Khademi, Amin; Shepard, Colin; Cutler, Blayne; Braithwaite, R Scott

    2013-01-01

    New York City (NYC) remains an epicenter of the HIV epidemic in the United States. Given the variety of evidence-based HIV prevention strategies available and the significant resources required to implement each of them, comparative studies are needed to identify how to maximize the number of HIV cases prevented most economically. A new model of HIV disease transmission was developed integrating information from a previously validated micro-simulation HIV disease progression model. Specification and parameterization of the model and its inputs, including the intervention portfolio, intervention effects and costs were conducted through a collaborative process between the academic modeling team and the NYC Department of Health and Mental Hygiene. The model projects the impact of different prevention strategies, or portfolios of prevention strategies, on the HIV epidemic in NYC. Ten unique interventions were able to provide a prevention benefit at an annual program cost of less than $360,000, the threshold for consideration as a cost-saving intervention (because of offsets by future HIV treatment costs averted). An optimized portfolio of these specific interventions could result in up to a 34% reduction in new HIV infections over the next 20 years. The cost-per-infection averted of the portfolio was estimated to be $106,378; the total cost was in excess of $2 billion (over the 20 year period, or approximately $100 million per year, on average). The cost-savings of prevented infections was estimated at more than $5 billion (or approximately $250 million per year, on average). Optimal implementation of a portfolio of evidence-based interventions can have a substantial, favorable impact on the ongoing HIV epidemic in NYC and provide future cost-saving despite significant initial costs.

  14. Causes of Outbreaks Associated with Drinking Water in the United States from 1971 to 2006

    Science.gov (United States)

    Craun, Gunther F.; Brunkard, Joan M.; Yoder, Jonathan S.; Roberts, Virginia A.; Carpenter, Joe; Wade, Tim; Calderon, Rebecca L.; Roberts, Jacquelin M.; Beach, Michael J.; Roy, Sharon L.

    2010-01-01

    Summary: Since 1971, the CDC, EPA, and Council of State and Territorial Epidemiologists (CSTE) have maintained the collaborative national Waterborne Disease and Outbreak Surveillance System (WBDOSS) to document waterborne disease outbreaks (WBDOs) reported by local, state, and territorial health departments. WBDOs were recently reclassified to better characterize water system deficiencies and risk factors; data were analyzed for trends in outbreak occurrence, etiologies, and deficiencies during 1971 to 2006. A total of 833 WBDOs, 577,991 cases of illness, and 106 deaths were reported during 1971 to 2006. Trends of public health significance include (i) a decrease in the number of reported outbreaks over time and in the annual proportion of outbreaks reported in public water systems, (ii) an increase in the annual proportion of outbreaks reported in individual water systems and in the proportion of outbreaks associated with premise plumbing deficiencies in public water systems, (iii) no change in the annual proportion of outbreaks associated with distribution system deficiencies or the use of untreated and improperly treated groundwater in public water systems, and (iv) the increasing importance of Legionella since its inclusion in WBDOSS in 2001. Data from WBDOSS have helped inform public health and regulatory responses. Additional resources for waterborne disease surveillance and outbreak detection are essential to improve our ability to monitor, detect, and prevent waterborne disease in the United States. PMID:20610821

  15. Prevalence of avian influenza virus in wild birds before and after the HPAI H5N8 outbreak in 2014 in South Korea.

    Science.gov (United States)

    Shin, Jeong-Hwa; Woo, Chanjin; Wang, Seung-Jun; Jeong, Jipseol; An, In-Jung; Hwang, Jong-Kyung; Jo, Seong-Deok; Yu, Seung Do; Choi, Kyunghee; Chung, Hyen-Mi; Suh, Jae-Hwa; Kim, Seol-Hee

    2015-07-01

    Since 2003, highly pathogenic avian influenza (HPAI) virus outbreaks have occurred five times in Korea, with four HPAI H5N1 outbreaks and one HPAI H5N8 outbreak. Migratory birds have been suggested to be the first source of HPAI in Korea. Here, we surveyed migratory wild birds for the presence of AI and compared regional AI prevalence in wild birds from September 2012 to April 2014 for birds having migratory pathways in South Korea. Finally, we investigated the prevalence of AI in migratory birds before and after HPAI H5N8 outbreaks. Overall, we captured 1617 migratory wild birds, while 18,817 feces samples and 74 dead birds were collected from major wild bird habitats. A total of 21 HPAI viruses were isolated from dead birds, and 86 low pathogenic AI (LPAI) viruses were isolated from captured birds and from feces samples. Spatiotemporal distribution analysis revealed that AI viruses were spread southward until December, but tended to shift north after January, consistent with the movement of migratory birds in South Korea. Furthermore, we found that LPAI virus prevalences within wild birds were notably higher in 2013-2014 than the previous prevalence during the northward migration season. The data from our study demonstrate the importance of the surveillance of AI in wild birds. Future studies including in-depth genetic analysis in combination with evaluation of the movement and ecology of migratory birds might help us to bridge the gaps in our knowledge and better explain, predict, and ultimately prevent future HPAI outbreaks.

  16. Severe canine distemper outbreak in unvaccinated dogs in Mozambique

    Directory of Open Access Journals (Sweden)

    Julieta Zacarias

    2016-07-01

    Full Text Available Although significant animal suffering caused by preventable diseases is frequently seen in developing countries, reports of this are scarce. This report describes avoidable animal suffering owing to a suspected canine distemper (CD outbreak in unvaccinated dogs owned by low-income families in Mozambique that killed approximately 200 animals. Affected dogs exhibited clinical signs, and gross and microscopic lesions compatible with CD. Immunohistochemical staining confirmed the presence of canine distemper virus (CDV in the kidney of one dog from the cohort. This brief communication again illustrates that large outbreaks of CDV in unvaccinated dogs occur and that large-scale avoidable suffering and threats to the health of dogs and wild canines continue. Mass vaccination supported by government and non-government organisations is recommended. Keywords: Canine distemper; dogs; outbreak; animal welfare; Mozambique

  17. EFSA (European Food Safety Authority) and ECDC (European Centre for Disease Prevention and Control), 2014. The European Union Summary Report on Trends and Sources of Zoonoses, Zoonotic Agents and Food-borne Outbreaks in 2012

    DEFF Research Database (Denmark)

    Korsgaard, Helle; Helwigh, Birgitte; Sørensen, Anna Irene Vedel

    the same as in 2011. The number of brucellosis-positive cattle, and sheep and goat herds continued to decrease, although marginally compared with 2011. Trichinella caused 301 confirmed human cases in the European Union. Although the number of cases was slightly higher in 2012 than in 2011, human...... trichinellosis cases remained at a low level in the European Union compared with 2009 and previous years. In 2012, the prevalence of Trichinella in pigs was similar to that observed in 2011. The parasite was more prevalent in wildlife than in farmed animals. However, seven out of the nine strong......-evidence outbreaks reported were due to consumption of pig meat. Toxoplasma was reported by the Member States from pigs, sheep, goats, hunted wild boar and hunted deer, in 2011 and 2012. In addition, positive findings were detected in cats (the natural hosts), cattle and dogs as well as several other animal species...

  18. Filoviruses in Bats: Current Knowledge and Future Directions

    Science.gov (United States)

    Olival, Kevin J.; Hayman, David T. S.

    2014-01-01

    Filoviruses, including Ebolavirus and Marburgvirus, pose significant threats to public health and species conservation by causing hemorrhagic fever outbreaks with high mortality rates. Since the first outbreak in 1967, their origins, natural history, and ecology remained elusive until recent studies linked them through molecular, serological, and virological studies to bats. We review the ecology, epidemiology, and natural history of these systems, drawing on examples from other bat-borne zoonoses, and highlight key areas for future research. We compare and contrast results from ecological and virological studies of bats and filoviruses with those of other systems. We also highlight how advanced methods, such as more recent serological assays, can be interlinked with flexible statistical methods and experimental studies to inform the field studies necessary to understand filovirus persistence in wildlife populations and cross-species transmission leading to outbreaks. We highlight the need for a more unified, global surveillance strategy for filoviruses in wildlife, and advocate for more integrated, multi-disciplinary approaches to understand dynamics in bat populations to ultimately mitigate or prevent potentially devastating disease outbreaks. PMID:24747773

  19. The Future of Research on Evidence-based Developmental Violence Prevention in Europe – Introduction to the Focus Section

    Directory of Open Access Journals (Sweden)

    Manuel Eisner

    2012-12-01

    Full Text Available Across Europe, there is an increasing demand for good evidence that can inform policies aimed at reducing violence against and among children and adolescents. However, there is still a paucity of high-quality research on effective prevention of bullying and violence, and researchers from different parts of Europe rarely discuss their findings. The focus section of this issue of the International Journal of Conflict and Violence brings together work by prominent preventionscholars from across Europe, who show that significant progress is being made. The introduction presents nine recommendations about how prevention research could be further strengthened in Europe.

  20. Mortality from a tornado outbreak, Alabama, April 27, 2011.

    Science.gov (United States)

    Chiu, Cindy H; Schnall, Amy H; Mertzlufft, Caitlin E; Noe, Rebecca S; Wolkin, Amy F; Spears, Jeanne; Casey-Lockyer, Mary; Vagi, Sara J

    2013-08-01

    We describe the demographics of the decedents from the tornado outbreak in Alabama on April 27, 2011; examine the circumstances of death surrounding these fatalities; and identify measures to prevent future tornado-related fatalities. We collected information about the decedents from death certificates, disaster-related mortality surveillance, and interview data collected by American Red Cross volunteers from the decedent's families. We describe demographic characteristics, circumstances and causes of death, and sheltering behaviors before death. Of the 247 fatalities, females and older adults were at highest risk for tornado-related deaths. Most deaths were directly related to the tornadoes, on scene, and trauma-related. The majority of the deceased were indoors in single-family homes. Word of mouth was the most common warning mechanism. This tornado event was the third deadliest in recent US history. Our findings support the need for local community shelters, enhanced messaging to inform the public of shelter locations, and encouragement of word-of-mouth warnings and personal and family preparedness planning, with a special focus on assisting vulnerable individuals in taking shelter.

  1. HIV Prevention Service Utilization in the Los Angeles House and Ball Communities: Past Experiences and Recommendations for the Future

    Science.gov (United States)

    Holloway, Ian W.; Traube, Dorian E.; Kubicek, Katrina; Supan, Jocelyn; Weiss, George; Kipke, Michele D.

    2012-01-01

    African-American young men who have sex with men and transgender persons are at elevated risk for HIV infection. House and Ball communities, networks of mostly African-American gay, bisexual, and transgender individuals who compete in modeling and dance, represent a prime venue for HIV prevention with these difficult-to-reach populations; however,…

  2. Prevention of Mental Health Disorders using Internet and mobile-based Interventions: a narrative review and recommendations for future research.

    NARCIS (Netherlands)

    Ebert, David Daniel; Cuijpers, Pim; Muñoz, Ricardo F.; Baumeister, Harald

    2017-01-01

    Although psychological interventions might have a tremendous potential for the prevention of mental health disorders (MHD), their current impact on the reduction of disease burden is questionable. Possible reasons include that it is not practical to deliver those interventions to the community en

  3. Prevention of mental health disorders using internet- and mobile-based interventions : A narrative review and recommendations for future research

    NARCIS (Netherlands)

    Ebert, David Daniel; Cuijpers, Pim; Muñoz, Ricardo F.; Baumeister, Harald

    2017-01-01

    Although psychological interventions might have a tremendous potential for the prevention of mental health disorders (MHD), their current impact on the reduction of disease burden is questionable. Possible reasons include that it is not practical to deliver those interventions to the community en

  4. Participation in ball sports may represent a prehabilitation strategy to prevent future stress fractures and promote bone health in young athletes.

    Science.gov (United States)

    Tenforde, Adam Sebastian; Sainani, Kristin Lynn; Carter Sayres, Lauren; Milgrom, Charles; Fredericson, Michael

    2015-02-01

    Sports participation has many benefits for the young athlete, including improved bone health. However, a subset of athletes may attain suboptimal bone health and be at increased risk for stress fractures. This risk is greater for female than for male athletes. In healthy children, high-impact physical activity has been shown to improve bone health during growth and development. We offer our perspective on the importance of promoting high-impact, multidirectional loading activities, including ball sports, as a method of enhancing bone quality and fracture prevention based on collective research. Ball sports have been associated with greater bone mineral density and enhanced bone geometric properties compared with participation in repetitive, low-impact sports such as distance running or nonimpact sports such as swimming. Runners and infantry who participated in ball sports during childhood were at decreased risk of future stress fractures. Gender-specific differences, including the coexistence of female athlete triad, may negate the benefits of previous ball sports on fracture prevention. Ball sports involve multidirectional loading with high ground reaction forces that may result in stiffer and more fracture-resistant bones. Encouraging young athletes to participate in ball sports may optimize bone health in the setting of adequate nutrition and in female athletes, eumenorrhea. Future research to determine timing, frequency, and type of loading activity could result in a primary prevention program for stress fracture injuries and improved life-long bone health. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  5. The 2011 outbreak of African horse sickness in the African horse sickness controlled area in South Africa

    Directory of Open Access Journals (Sweden)

    John D. Grewar

    2013-11-01

    Full Text Available African horse sickness (AHS is a controlled animal disease in South Africa, and as a result of the high mortality rates experienced, outbreaks in the AHS controlled area in the Western Cape Province have a significant impact on affected properties as well as on the exportation of live horses from the AHS free zone in metropolitan Cape Town. An outbreak of AHS serotype 1 occurred in the surveillance zone of the AHS controlled area of the Western Cape during the summer of 2011. The epicentre of the outbreak was the town of Mamre in the magisterial district of Malmesbury and the outbreak was confined to a defined containment zone within this area by movement control of all equids and a blanket vaccination campaign. A total of 73 cases of AHS were confirmed during this outbreak, which included four confirmed subclinical cases. The morbidity rate for the outbreak was 16%with a mortality rate of 14%and a case fatality rate of 88%. Outbreak disease surveillance relied on agent identification using polymerase chain reaction (PCR-based assays, which is novel for an AHS outbreak in South Africa. The source of this outbreak was never confirmed although it is believed to be associated with the illegal movement of an infected animal into the Mamre area. This detailed description of the outbreak provides a sound scientific basis to assist decision making in future AHS outbreaks in the AHS controlled area of South Africa and in countries where AHS is an exotic or emerging disease.

  6. Epidemiology, Evolution, and Recent Outbreaks of Avian Influenza Virus in China.

    Science.gov (United States)

    Su, Shuo; Bi, Yuhai; Wong, Gary; Gray, Gregory C; Gao, George F; Li, Shoujun

    2015-09-01

    Novel reassortants of H7N9, H10N8, and H5N6 avian influenza viruses (AIVs) are currently circulating in China's poultry flocks, occasionally infecting humans and other mammals. Combined with the sometimes enzootic H5N1 and H9N2 strains, this cauldron of genetically diverse AIVs pose significant risks to public health. Here, we review the epidemiology, evolution, and recent outbreaks of AIVs in China, discuss reasons behind the recent increase in the emergence of novel AIVs, and identify warning signs which may point to the emergence of a potentially virulent and highly transmissible AIV to humans. This review will be useful to authorities who consider options for the detection and control of AIV transmission in animals and humans, with the goal of preventing future epidemics and pandemics. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  7. Measles outbreak in the Republic of the Marshall Islands, 2003.

    Science.gov (United States)

    Hyde, Terri B; Dayan, Gustavo H; Langidrik, Justina R; Nandy, Robin; Edwards, Russell; Briand, Kennar; Konelios, Mailynn; Marin, Mona; Nguyen, Huong Q; Khalifah, Anthony P; O'leary, Michael J; Williams, Nobia J; Bellini, William J; Bi, Daoling; Brown, Cedric J; Seward, Jane F; Papania, Mark J

    2006-04-01

    Measles is a highly contagious viral infection. Measles transmission can be prevented through high population immunity (>or=95%) achieved by measles vaccination. In the Republic of the Marshall Islands (RMI), no measles cases were reported during 1989-2002; however, a large measles outbreak occurred in 2003. Reported 1-dose measles vaccine coverage among children aged 12-23 months varied widely (52-94%) between 1990 and 2000. RMI is a Pacific island nation (1999 population: 50,840). A measles case was defined as fever, rash, and cough, or coryza, or conjunctivitis, in an RMI resident between July 13 and November 7, 2003. A vaccination campaign was used for outbreak control. Of the 826 reported measles cases, 766 (92%) occurred in the capital (Majuro). There were 186 (23%) cases in infants aged or=15 years. The attack rate was highest among infants (Majuro atoll: 213 cases/1,000 infants). Among cases aged 1-14 years, 281 (59%) reported no measles vaccination before July 2003. There were 100 hospitalizations and 3 deaths. The measles H1 genotype was identified. The vaccination campaign resulted in 93% coverage among persons aged 6 months to 40 years. Interpretation Populations without endemic measles transmission can accumulate substantial susceptibility and be at risk for large outbreaks when measles virus is imported. 'Islands' of measles susceptibility may develop in infants, adults, and any groups with low vaccine coverage. To prevent outbreaks, high population immunity must be sustained by maintaining and documenting high vaccine coverage.

  8. The Use of Chemoprophylaxis after Floods to Reduce the Occurrence and Impact of Leptospirosis Outbreaks.

    Science.gov (United States)

    Schneider, Maria Cristina; Velasco-Hernandez, Jorge; Min, Kyung-Duk; Leonel, Deise Galan; Baca-Carrasco, David; Gompper, Matthew E; Hartskeerl, Rudy; Munoz-Zanzi, Claudia

    2017-06-03

    Record-breaking and devastating rainfall events have occurred in the past decade. Rain and floods are considered the main risk factors for leptospirosis and several outbreaks have been reported following extreme weather events. In such situations, one possible intervention to prevent leptospirosis cases in high-risk groups is the use of chemoprophylaxis. However, not enough evidence of its effect is available. The objectives of this study were to review the literature on the current practices of chemoprophylaxis for leptospirosis and to explore, using a mathematical model, how various chemoprophylaxis scenarios may affect the progression of a leptospirosis outbreak. Twenty-six peer-reviewed publications were selected (10 quantitative studies, two systematic reviews and 14 articles of other types). Oral doxycycline was the most used antibiotic for chemoprophylaxis of leptospirosis. Post-exposure prophylaxis was assessed in four studies following a natural disaster. Although evidence of the effectiveness of post-exposure prophylaxis is inconsistent, the direction of association supported a protective effect for morbidity and mortality. The theoretical model showed how the assumed benefit of chemoprophylaxis was influenced by the time and rate of administration. Future models should consider the heterogeneity of affected communities, improved estimates of the effect of chemoprophylaxis on leptospirosis infection and disease, as well as potential detrimental impacts. Additional research is critical to provide clear evidence-based recommendations for leptospirosis control during an outbreak. The results of this study suggest that chemoprophylaxis may provide some protection in reducing the number of leptospirosis cases after a high-risk exposure; however, the effective benefit may depend on a variety of factors such as the timing and coverage of prophylaxis. The information summarized can be used to support decision-making during a high-risk event.

  9. The Use of Chemoprophylaxis after Floods to Reduce the Occurrence and Impact of Leptospirosis Outbreaks

    Directory of Open Access Journals (Sweden)

    Maria Cristina Schneider

    2017-06-01

    Full Text Available Record-breaking and devastating rainfall events have occurred in the past decade. Rain and floods are considered the main risk factors for leptospirosis and several outbreaks have been reported following extreme weather events. In such situations, one possible intervention to prevent leptospirosis cases in high-risk groups is the use of chemoprophylaxis. However, not enough evidence of its effect is available. The objectives of this study were to review the literature on the current practices of chemoprophylaxis for leptospirosis and to explore, using a mathematical model, how various chemoprophylaxis scenarios may affect the progression of a leptospirosis outbreak. Twenty-six peer-reviewed publications were selected (10 quantitative studies, two systematic reviews and 14 articles of other types. Oral doxycycline was the most used antibiotic for chemoprophylaxis of leptospirosis. Post-exposure prophylaxis was assessed in four studies following a natural disaster. Although evidence of the effectiveness of post-exposure prophylaxis is inconsistent, the direction of association supported a protective effect for morbidity and mortality. The theoretical model showed how the assumed benefit of chemoprophylaxis was influenced by the time and rate of administration. Future models should consider the heterogeneity of affected communities, improved estimates of the effect of chemoprophylaxis on leptospirosis infection and disease, as well as potential detrimental impacts. Additional research is critical to provide clear evidence-based recommendations for leptospirosis control during an outbreak. The results of this study suggest that chemoprophylaxis may provide some protection in reducing the number of leptospirosis cases after a high-risk exposure; however, the effective benefit may depend on a variety of factors such as the timing and coverage of prophylaxis. The information summarized can be used to support decision-making during a high-risk event.

  10. National outbreak of Salmonella Give linked to a local food manufacturer in Malta, October 2016.

    Science.gov (United States)

    Donachie, A; Melillo, T; Bubba, L; Hartman, H; Borg, M-L

    2018-06-26

    Salmonella Give is a rare serotype across Europe. In October 2016, a national outbreak of S. Give occurred in Malta. We describe the epidemiological, environmental, microbiological and veterinary investigations. Whole-genome sequencing (WGS) was performed on human, food, environmental and veterinary isolates. Thirty-six human cases were reported between October and November 2016, 10 (28%) of whom required hospitalisation. Twenty-six (72%) cases were linked to four restaurants. S. Give was isolated from ready-to-eat antipasti served by three restaurants which were all supplied by the same local food manufacturer. Food-trace-back investigations identified S. Give in packaged bean dips, ham, pork and an asymptomatic food handler at the manufacturer; inspections found inadequate separation between raw and ready-to-eat food during processing. WGS indicated two genetically distinguishable strains of S. Give with two distinct clusters identified; one cluster linked to the local food manufacturer and a second linked to veterinary samples. Epidemiological, environmental and WGS evidence pointed towards cross-contamination of raw and ready-to-eat foods at the local manufacturer as the likely source of one cluster. Severity of illness indicates a high virulence of this specific serotype. To prevent future cases and outbreaks, adherence to food safety practices at manufacturing level need to be reinforced.

  11. Epidemiology of the Zika Virus Outbreak in the Cabo Verde Islands, West Africa.

    Science.gov (United States)

    Lourenço, José; de Lourdes Monteiro, Maria; Valdez, Tomás; Monteiro Rodrigues, Júlio; Pybus, Oliver; Rodrigues Faria, Nuno

    2018-03-15

    The Zika virus (ZIKV) outbreak in the island nation of Cabo Verde was of unprecedented magnitude in Africa and the first to be associated with microcephaly in the continent. Using a simple mathematical framework we present a first epidemiological assessment of attack and observation rates from 7,580 ZIKV notified cases and 18 microcephaly reports between July 2015 and May 2016. In line with observations from the Americas and elsewhere, the single-wave Cabo Verdean ZIKV epidemic was characterized by a basic reproductive number of 1.85 (95% CI, 1.5 - 2.2), with overall the attack rate of 51.1% (range 42.1 - 61.1) and observation rate of 2.7% (range 2.29 - 3.33). Current herd-immunity may not be sufficient to prevent future small-to-medium epidemics in Cabo Verde. Together with a small observation rate, these results highlight the need for rapid and integrated epidemiological, molecular and genomic surveillance to tackle forthcoming outbreaks of ZIKV and other arboviruses.

  12. Information Needs and Seeking Behavior During the H1N1 Virus Outbreak

    Directory of Open Access Journals (Sweden)

    Majid, Shaheen

    2013-03-01

    Full Text Available Timely access to quality healthcare information during an outbreak plays an important role in curtailing its spread. The aim of this study was to investigate the information needs and seeking behavior of the general public in Singapore during the H1N1 pandemic. A pre-tested questionnaire was used for data collection. The convenience snowball sampling method was used and 260 working adults and tertiary-level students participated in this study. The most crucial information needs of a majority of the participants were: symptoms of H1N1, causes of the infection, preventive measures, and possible treatments. Data analysis also revealed that mass media such as television, newspapers, and radio were most frequently used for seeking the needed information. The use of human information sources was also quite high while only a small number of the respondents accessed online news and healthcare websites. About three-quarters of the participants indicated that the gathered information helped them to stay vigilant and take necessary precautionary measures. A major problem identified by the participants in using H1N1 information was the lack of understanding of certain terms used in public communications. This paper suggests certain measures for strengthening health information communication during future outbreaks.

  13. A Mumps Outbreak in Vojvodina, Serbia, in 2012 Underlines the Need for Additional Vaccination Opportunities for Young Adults.

    Directory of Open Access Journals (Sweden)

    Jasminka Nedeljković

    Full Text Available In 2012, mumps was introduced from Bosnia and Herzegovina to Vojvodina, causing an outbreak with 335 reported cases. The present manuscript analyses the epidemiological and laboratory characteristics of this outbreak, identifies its main causes and suggests potential future preventive measures. Sera of 133 patients were tested for mumps-specific antibodies by ELISA and 15 nose/throat swabs were investigated for mumps virus RNA by RT-PCR. IgG antibodies were found in 127 patients (95.5%. Mumps infection was laboratory-confirmed in 53 patients, including 44 IgM and 9 PCR positive cases. All other 282 cases were classified as epidemiologically-confirmed. More than half of the patients (n = 181, 54% were 20-29 years old, followed by the 15-19 age bracket (n = 95, 28.4%. Twice as many males as females were affected (67% versus 33%. Disease complications were reported in 13 cases (3.9%, including 9 patients with orchitis and 4 with pancreatitis. According to medical records or anamnestic data, 190 patients (56.7% were immunized with two doses and 35 (10.4% with one dose of mumps-containing vaccine. The Serbian sequences corresponded to a minor genotype G variant detected during the 2011/2012 mumps outbreak in Bosnia and Herzegovina. Vaccine failures, the initial one-dose immunization policy and a vaccine shortage between 1999 and 2002 contributed to the outbreak. Additional vaccination opportunities should be offered to young adults during transition periods in their life trajectories.

  14. August, 2002 - floods events, affected areas revitalisation and prevention for the future in the central Bohemian region, Czech Republic

    Science.gov (United States)

    Bina, L.; Vacha, F.; Vodova, J.

    2003-04-01

    Central Bohemian Region is located in a shape of a ring surrounding the capitol of Prague. Its total territorial area is 11.014 sq.km and population of 1 130.000 inhabitants. According to EU nomenclature of regional statistical units, the Central Bohemian Region is classified as an independent NUTS II. Bohemia's biggest rivers, Vltava and Labe form the region's backbone dividing it along a north-south line, besides that there are Sazava and Berounka, the two big headwaters of Vltava, which flow through the region and there also are some cascade man made lakes and 2 important big dams - Orlik and Slapy on the Vltava River in the area of the region. Overflowing of these rivers and their feeders including cracking of high-water dams during the floods in August 2002 caused total or partial destruction or damage of more than 200 towns and villages and total losses to the extend of 450 mil. EUR. The worst impact was on damaged or destroyed human dwellings, social infrastructure (schools, kindergartens, humanitarian facilities) and technical infrastructure (roads, waterworks, power distribution). Also businesses were considerably damaged including transport terminals in the area of river ports. Flowage of Spolana Neratovice chemical works caused critical environmental havoc. Regional crisis staff with regional Governor in the lead worked continuously during the floods and a regional integrated rescue system was subordinated to it. Due to the huge extent of the floods the crisis staff coordinated its work with central bodies of state including the Government and single "power" resorts (army, interior, transport). Immediately after floods a regional - controlled management was set up including an executive body for regional revitalisation which is connected to state coordinating resort - Ministry for Local Development, EU sources and humanitarian aid. In addition to a program of regional revitalisation additional preventive flood control programs are being developed

  15. The Ebola Spatial Care Path™: Accelerating point-of-care diagnosis, decision making, and community resilience in outbreaks.

    Science.gov (United States)

    Kost, Gerald J; Ferguson, William J; Hoe, Jackie; Truong, Anh-Thu; Banpavichit, Arirat; Kongpila, Surin

    2015-01-01

    To present a vision where point-of-care testing (POCT) accelerates an Ebola Spatial Care Path™ (SCP) and future molecular diagnostics enable facilitated-access self-testing (FAST POC); to design an alternate care facility (ACF) for the SCP; to innovate an Ebola diagnostic center (DC); and to propel rapid POCT to the frontline to create resilience that stops future outbreaks. PubMed, literature, and web searches. Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), Medicine Without Frontiers, and World Health Organization (WHO) document analyses. Investigations in China, the Philippines, Thailand, and the United States. Review of SE Asia, US, and West Africa isolation-treatment centers. Innovation of a SCP, ACF, and DC suitable for American and other communities. The authors designed an ACF and DC to integrate SCP principles for urgent Ebola care. FDA emergency use authorizations for Ebola molecular diagnostics were discovered, but no portable, handheld, or self-contained molecular POC instruments are yet available, although feasible. The WHO initiated design criteria and an acceptance protocol for testing. Financial investment in POCT will downsize Ebola outbreaks. POCT is facilitating global health. Now, global health problems are elevating POCT to new levels of importance for accelerating diagnosis and evidence-based decision making during disease outbreaks. Authorities concur that rapid diagnosis has potential to stop disease spread. With embedded POCT, strategic SCPs planned by communities fulfill CDC recommendations. POC devices should consolidate multiplex test clusters supporting patients with Ebola in isolation. The ultimate future solution is FAST POC. New technologies offer minimally significant risks. Diagnostic centers in ACFs and transportable formats also will optimize Ebola SCPs.

  16. A large rubella outbreak with spread from the workplace to the community.

    Science.gov (United States)

    Danovaro-Holliday, M C; LeBaron, C W; Allensworth, C; Raymond, R; Borden, T G; Murray, A B; Icenogle, J P; Reef, S E

    2000-12-06

    Childhood vaccination has reduced rubella disease to low levels in the United States, but outbreaks continue to occur. The largest outbreak in the past 5 years occurred in Nebraska in 1999. To examine risk factors for disease, susceptibility of the risk population, role of vaccine failure, and the need for new vaccination strategies in response to the Nebraska rubella outbreak. Investigation of 83 confirmed rubella cases occurring in Douglas County, Nebraska, between March 23 and August 24, 1999; serosurvey of 413 pregnant women in the outbreak locale between October 1998 and March 1999 (prior to outbreak) and April and November 1999 (during and after outbreak). Case characteristics, compared with that of the general county population; area childhood rubella vaccination rates; and susceptibility among pregnant women before vs during and after the outbreak. All 83 rubella cases were unvaccinated or had unknown vaccination status and fell into 3 groups: (1) 52 (63%) were young adults (median age, 26 years), 83% of whom were born in Latin American countries where rubella vaccination was not routine. They were either employed in meatpacking plants or were their household contacts. Attack rates in the plants were high (14.4 per 1000 vs 0. 19 per 1000 for general county population); (2) 16 (19%), including 14 children (9 of whom were aged pregnant women, susceptibility rates were 13% before the outbreak and 11% during and after the outbreak. Six (25%) of 24 susceptible women tested were seropositive for rubella IgM. Rubella vaccination rates were 90.2% for preschool children and 99.8% for school-aged children. A large rubella outbreak occurred among unvaccinated persons in a community with high immunity levels. Crowded working and living conditions facilitated transmission, but vaccine failure did not. Workplace vaccination could be considered to prevent similar outbreaks. JAMA. 2000;284:2733-2739.

  17. Nanoparticle Delivery of Natural Products in the Prevention and Treatment of Cancers: Current Status and Future Prospects

    International Nuclear Information System (INIS)

    Bharali, Dhruba J.; Siddiqui, Imtiaz A.; Adhami, Vaqar M.; Chamcheu, Jean Christopher; Aldahmash, Abdullah M.; Mukhtar, Hasan; Mousa, Shaker A.

    2011-01-01

    The advent of nanotechnology has had a revolutionary impact on many aspects of 21 st century life. Nanotechnology has provided an opportunity to explore new avenues that conventional technologies have been unable to make an impact on for diagnosis, prevention, and therapy of different diseases, and of cancer in particular. Entities in nanometer sizes are excellent platforms to incorporate various drugs or active materials that can be delivered effectively to the desired action site without compromising the activity of the incorporated drug or material. In particular, nanotechnology entities can be used to deliver conventional natural products that have poor solubility or a short half life. Conventional natural products used with entities in nanometer sizes enable us to solve many of the inherent problems (stability, solubility, toxicity) associated with natural products, and also provide a platform for targeted delivery to tumor sites. We recently introduced the novel concept of using nanotechnology for enhancing the outcome of chemoprevention, which we called ‘nanochemoprevention’. This idea was subsequently exploited by several laboratories worldwide and has now become an advancing field in chemoprevention research. This review examines some of the applications of nanotechnology for cancer prevention and therapy using natural products

  18. Nanoparticle Delivery of Natural Products in the Prevention and Treatment of Cancers: Current Status and Future Prospects

    Directory of Open Access Journals (Sweden)

    Hasan Mukhtar

    2011-10-01

    Full Text Available The advent of nanotechnology has had a revolutionary impact on many aspects of 21st century life. Nanotechnology has provided an opportunity to explore new avenues that conventional technologies have been unable to make an impact on for diagnosis, prevention, and therapy of different diseases, and of cancer in particular. Entities in nanometer sizes are excellent platforms to incorporate various drugs or active materials that can be delivered effectively to the desired action site without compromising the activity of the incorporated drug or material. In particular, nanotechnology entities can be used to deliver conventional natural products that have poor solubility or a short half life. Conventional natural products used with entities in nanometer sizes enable us to solve many of the inherent problems (stability, solubility, toxicity associated with natural products, and also provide a platform for targeted delivery to tumor sites. We recently introduced the novel concept of using nanotechnology for enhancing the outcome of chemoprevention, which we called ‘nanochemoprevention’. This idea was subsequently exploited by several laboratories worldwide and has now become an advancing field in chemoprevention research. This review examines some of the applications of nanotechnology for cancer prevention and therapy using natural products.

  19. Nanoparticle Delivery of Natural Products in the Prevention and Treatment of Cancers: Current Status and Future Prospects

    Energy Technology Data Exchange (ETDEWEB)

    Bharali, Dhruba J. [The Pharmaceutical Research Institute at Albany College of Pharmacy and Health Sciences, 1 Discovery Drive, Rensselaer, NY 12144 (United States); Siddiqui, Imtiaz A.; Adhami, Vaqar M.; Chamcheu, Jean Christopher [Department of Dermatology, University of Wisconsin, Madison, WI 53706 (United States); Aldahmash, Abdullah M. [Stem Cell Unit, College of Medicine, King Saud University, Riyadh, 11461 (Saudi Arabia); University Hospital of Odense & Medical Biotechnology Center, Winslowsparken 25, DK-5000, Odense (Denmark); Mukhtar, Hasan [Department of Dermatology, University of Wisconsin, Madison, WI 53706 (United States); Mousa, Shaker A., E-mail: shaker.mousa@acphs.edu [The Pharmaceutical Research Institute at Albany College of Pharmacy and Health Sciences, 1 Discovery Drive, Rensselaer, NY 12144 (United States); Stem Cell Unit, College of Medicine, King Saud University, Riyadh, 11461 (Saudi Arabia)

    2011-10-26

    The advent of nanotechnology has had a revolutionary impact on many aspects of 21{sup st} century life. Nanotechnology has provided an opportunity to explore new avenues that conventional technologies have been unable to make an impact on for diagnosis, prevention, and therapy of different diseases, and of cancer in particular. Entities in nanometer sizes are excellent platforms to incorporate various drugs or active materials that can be delivered effectively to the desired action site without compromising the activity of the incorporated drug or material. In particular, nanotechnology entities can be used to deliver conventional natural products that have poor solubility or a short half life. Conventional natural products used with entities in nanometer sizes enable us to solve many of the inherent problems (stability, solubility, toxicity) associated with natural products, and also provide a platform for targeted delivery to tumor sites. We recently introduced the novel concept of using nanotechnology for enhancing the outcome of chemoprevention, which we called ‘nanochemoprevention’. This idea was subsequently exploited by several laboratories worldwide and has now become an advancing field in chemoprevention research. This review examines some of the applications of nanotechnology for cancer prevention and therapy using natural products.

  20. Prevention and treatment of demineralisation during fixed appliance therapy: a review of current methods and future applications.

    Science.gov (United States)

    Chambers, C; Stewart, S; Su, B; Sandy, J; Ireland, A

    2013-11-01

    Orthodontic treatment, like all aspects of dentistry, exposes the clinician to the risk of malpractice and litigation. Demineralisation of tooth enamel is still one of the main complications of orthodontic treatment and it is essential patients are made aware of this risk during the consent process. There are a variety of fluoride delivery systems (mouthrinse, varnish, bonding system, and elastics), which can be used to prevent white spot lesion (WSL) formation. Glass-ionomer bonding cements (GIC) have also been shown to reduce WSL formation and have the benefit of not relying on patient compliance. However, these materials have not found widespread acceptance, possibly due to handling characteristics. A number of new technologies, principally fillers and coatings, have recently become available with potential antimicrobial and antibiofilm properties. Coatings can be applied to brackets and wires, which prevent bacterial adhesion. However, the longevity of these coatings is questionable. There are a number of methods available aimed at reducing the incidence of WSL, but they all have limitations. Capitalising on technological advances will enable the production of tailor made orthodontic brackets and adhesive systems, which provide long-term protection against WSL without relying on patient compliance.

  1. Selection tool for foodborne norovirus outbreaks.

    Science.gov (United States)

    Verhoef, Linda P B; Kroneman, Annelies; van Duynhoven, Yvonne; Boshuizen, Hendriek; van Pelt, Wilfrid; Koopmans, Marion

    2009-01-01

    Detection of pathogens in the food chain is limited mainly to bacteria, and the globalization of the food industry enables international viral foodborne outbreaks to occur. Outbreaks from 2002 through 2006 recorded in a European norovirus surveillance database were investigated for virologic and epidemiologic indicators of food relatedness. The resulting validated multivariate logistic regression model comparing foodborne (n = 224) and person-to-person (n = 654) outbreaks was used to create a practical web-based tool that can be limited to epidemiologic parameters for nongenotyping countries. Non-genogroup-II.4 outbreaks, higher numbers of cases, and outbreaks in restaurants or households characterized (sensitivity = 0.80, specificity = 0.86) foodborne outbreaks and reduced the percentage of outbreaks requiring source-tracing to 31%. The selection tool enabled prospectively focused follow-up. Use of this tool is likely to improve data quality and strain typing in current surveillance systems, which is necessary for identification of potential international foodborne outbreaks.

  2. Norovirus: U.S. Trends and Outbreaks

    Science.gov (United States)

    ... harvested from contaminated water and raspberries irrigated with contaminated water have caused norovirus outbreaks. Norovirus on Cruise Ships Over 90% of diarrheal disease outbreaks on cruise ships are caused by norovirus ( ...

  3. Reporting and Surveillance for Norovirus Outbreaks

    Science.gov (United States)

    ... Vaccine Surveillance Network (NVSN) Foodborne Diseases Active Surveillance Network (FoodNet) National Outbreak Reporting System (NORS) Estimates of Foodborne Illness in the United States CDC's Vessel Sanitation Program CDC Feature: Surveillance for Norovirus Outbreaks Top ...

  4. Tularaemia outbreaks in Sakarya, Turkey: case-control and environmental studies.

    Science.gov (United States)

    Meric, M; Sayan, M; Dundar, D; Willke, A

    2010-08-01

    Tularaemia is an important zoonotic disease that leads to outbreaks. This study aimed to compare the epidemiological characteristics of two tularaemia outbreaks that occurred in the Sakarya region of Turkey, analyse the risk factors for the development of outbreaks and identify Francisella (F.) tularensis in the water samples. Two tularaemia outbreaks occurred in the Kocadongel village in 2005 and 2006. A field investigation and a case-control study with 47 cases and 47 healthy households were performed during the second outbreak. Clinical samples from the patients and filtrated water samples were analysed for F. tularensis via real-time polymerase chain reaction. From the two outbreaks, a total of 58 patients were diagnosed with oropharyngeal tularaemia based on their clinical and serological results. Both outbreaks occurred between the months of January and April, and the number of patients peaked in February. Logistic regression analysis revealed that the consumption of natural spring water was the only significant risk factor for tularaemia infection (odds ratio 3.5, confidence interval 1.23-10.07). F. tularensis was detected in eight clinical samples and in the filtrated natural spring water. This study is the first report of tularaemia from this region. The results show that both tularaemia outbreaks were related to the consumption of untreated natural spring water. To prevent waterborne tularaemia, community water supplies should be treated and checked periodically.

  5. Internet and free press are associated with reduced lags in global outbreak reporting.

    Science.gov (United States)

    McAlarnen, Lindsey; Smith, Katherine; Brownstein, John S; Jerde, Christopher

    2014-10-30

    Global outbreak detection and reporting have generally improved for a variety of infectious diseases and geographic regions in recent decades. Nevertheless, lags in outbreak reporting remain a threat to the global human health and economy. In the time between first occurrence of a novel disease incident and public notification of an outbreak, infected individuals have a greater possibility of traveling and spreading the pathogen to other nations. Shortening outbreak reporting lags has the potential to improve global health by preventing local outbreaks from escalating into global epidemics. Reporting lags between the first record and the first public report of an event were calculated for 318 outbreaks occurring 1996-2009. The influence of freedom of the press, Internet usage, per capita health expenditure, and cell phone subscriptions, on the timeliness of outbreak reporting was evaluated. Freer presses and increasing Internet usage correlate with reduced time between the first record of an outbreak and the public report. Increasing Internet usage reduced the expected reporting lag from more than one month in nations without Internet users to one day in those where 75 of 100 people use the Internet. Advances in technology and the emergence of more open and free governments are associated with to improved global infectious disease surveillance.

  6. Potential exposure to Australian bat lyssavirus is unlikely to prevent future bat handling among adults in South East Queensland.

    Science.gov (United States)

    Young, M K; Banu, S; McCall, B J; Vlack, S; Carroll, H; Bennett, S; Davison, R; Francis, D

    2018-02-01

    Despite ongoing public health messages about the risks associated with bat contact, the number of potential exposures to Australian bat lyssavirus (ABLV) due to intentional handling by members of the general public in Queensland has remained high. We sought to better understand the reasons for intentional handling among these members of the public who reported their potential exposure to inform future public health messages. We interviewed adults who resided in a defined geographic area in South East Queensland and notified potential exposure to ABLV due to intentional handling of bats by telephone between 1 January 2012 and 31 December 2013. The participation rate was 54%. Adults who reported they had intentionally handled bats in South East Queensland indicated high levels of knowledge and perception of a moderately high risk associated with bats with overall low intentions to handle bats in the future. However, substantial proportions of people would attempt to handle bats again in some circumstances, particularly to protect their children or pets. Fifty-two percent indicated that they would handle a bat if a child was about to pick up or touch a live bat, and 49% would intervene if a pet was interacting with a bat. Future public health communications should recognize the situations in which even people with highrisk perceptions of bats will attempt to handle them. Public health messages currently focus on avoidance of bats in all circumstances and recommend calling in a trained vaccinated handler, but messaging directed at adults for circumstances where children or pets may be potentially exposed should provide safe immediate management options. © 2017 Blackwell Verlag GmbH.

  7. The Economic Burden of Intimate Partner Violence in Ecuador: Setting the Agenda for Future Research and Violence Prevention Policies

    Directory of Open Access Journals (Sweden)

    Phaedra Corso

    2013-08-01

    Full Text Available Introduction: Intimate partner violence (IPV is a widespread social structural problem that affects a great proportion of Ecuadorian women. IPV is a sexually, psychologically, or physically coercive act against an adult or adolescent woman by a current or former intimate partner. Not-for-profit groups in Ecuador report that 70% of women experience 1 of the forms of IPV sometime during their lifetime, but population-based surveys suggest that 41% of Ecuadorian women are exposed to emotional violence, 31% physical violence, and 12% sexual violence by their spouse or partner over their lifetime. Despite the high prevalence, the response of the Ecuadorian government has been insufficient to reduce the number of victims and to provide adequate legal and health services for the prevention and treatment of IPV. Given the power of economic data to influence policy making, the goal of this study is to produce the first estimate of the economic impact of IPV in Ecuador and to identify the policy paths in which these estimates would have the greatest impact for Ecuador.Methods: Using a bottom-up method for estimating the economic burden of IPV and a national prevalence of IPV based on a population-based survey in the 2003–2004 year, the total economic burden is estimated at approximately $109 million adjusted to the 2012 United States (U.S. currency rate. Results: Based on a prevalence of 255,267 women who were victims of IPV in the 2003–2004 year, the total economic burden is estimated at approximately $109 million adjusted to the 2012 the U.S. currency rate. The largest cost category contributing to the economic burden was the costs of healthcare services to treat injuries associated with IPV events.Conclusion: The asymmetry between the economic burden of IPV and the amount of government resources devoted to IPV prevention efforts suggests the need for a greater role to be played by the government and other factors in society in the area of IPV

  8. TOWARDS MODELING DISEASE OUTBREAK NOTIFICATION SYSTEMS

    OpenAIRE

    Farag Azzedin; Jaweed Yazdani,; Salahadin Adam; Mustafa Ghaleb

    2014-01-01

    Disease outbreak detection, monitoring and notification systems play an important role in assessing threats to public health since disease outbreaks are becoming increasingly common world-wide. There are several systems in use around the world, with coverage of national, international and global disease outbreaks. These systems use different taxonomies and classifications for the detection and prioritization of potential disease outbreaks. In this paper, we study and analyze th...

  9. Protective measures and human antibody response during an avian influenza H7N3 outbreak in poultry in British Columbia, Canada.

    Science.gov (United States)

    Skowronski, Danuta M; Li, Yan; Tweed, S Aleina; Tam, Theresa W S; Petric, Martin; David, Samara T; Marra, Fawziah; Bastien, Nathalie; Lee, Sandra W; Krajden, Mel; Brunham, Robert C

    2007-01-02

    In 2004 an outbreak of avian influenza of the H7N3 subtype occurred among poultry in British Columbia, Canada. We report compliance with recommended protective measures and associated human infections during this outbreak. We sought voluntary participation by anyone (cullers, farmers and their families) involved in efforts to control the poultry outbreak. Recruitment was by advertisements at the worker deployment site, in local media and through newsletters sent directly to farmers. Sera were tested for antibody to H7N3 by microneutralization assay. A subset of 16 sera (including convalescent sera from 2 unprotected workers with conjunctivitis from whom virus had been isolated) was further tested by Western blot and routine and modified hemagglutination inhibition assays. A total of 167 people (20% to 25% of all workers) participated between May 7 and July 26, 2004. Of these, 19 had experienced influenza-like illness and 21 had experienced red or watery eyes. There was no significant association between illness reports and exposure to infected birds. Among 65 people who entered barns with infected birds, 55 (85%) had received influenza vaccine, 48 (74%) had received oseltamivir, and 55 (85%), 54 (83%) and 36 (55%) reported always wearing gloves, mask or goggles, respectively. Antibody to the H7 subtype was not detected in any sera. During the BC outbreak, compliance with recommended protective measures, especially goggles, was incomplete. Multiple back-up precautions, including oseltamivir prophylaxis, may prevent human infections and should be readily accessible and consistently used by those involved in the control of future outbreaks of avian influenza in poultry. Localized human avian influenza infections may not result in serologic response despite confirmed viral detection and culture.

  10. Measles (Rubeola) Cases and Outbreaks

    Science.gov (United States)

    ... Address What’s this? Submit What's this? Submit Button Measles Cases and Outbreaks Language: English (US) Español (Spanish) ... Español: Casos y brotes de sarampión Number of measles cases by year since 2010 Measles cases per ...

  11. Outbreak of Sporotrichosis, Western Australia

    Science.gov (United States)

    Feeney, Kynan T.; Whittle, Amanda J.; Altman, Shelley A.; Speers, David J.

    2007-01-01

    A cluster of sporotrichosis cases occurred in the Busselton-Margaret River region of Western Australia from 2000 to 2003. Epidemiologic investigation and mycologic culture for Sporothrix schenckii implicated hay initially distributed through a commercial hay supplier as the source of the outbreak. Declining infection rates have occurred after various community measures were instigated. PMID:17953099

  12. Larval outbreaks in West Greenland

    DEFF Research Database (Denmark)

    Lund, Magnus; Raundrup, Katrine; Westergaard-Nielsen, Andreas

    2017-01-01

    effects of a larval outbreak in 2011 on vegetation productivity and CO2 exchange. We estimate a decreased carbon (C) sink strength in the order of 118–143 g C m−2, corresponding to 1210–1470 tonnes C at the Kobbefjord catchment scale. The decreased C sink was, however, counteracted the following years...

  13. Pharmacokinetics and pharmacodynamics in HIV prevention; current status and future directions: a summary of the DAIDS and BMGF sponsored think tank on pharmacokinetics (PK)/pharmacodynamics (PD) in HIV prevention.

    Science.gov (United States)

    Romano, Joseph; Kashuba, Angela; Becker, Stephen; Cummins, James; Turpin, Jim; Veronese, Fulvia

    2013-11-01

    Thirty years after its beginning, the HIV/AIDS epidemic is still raging around the world. According to UNAIDS, in 2011 alone 1.7M deaths were attributable to AIDS, and 2.5M people were newly infected by the virus. Despite the success in treating HIV-infected people with potent antiretroviral drugs, preventing HIV infection is the key to ending the epidemic. Recently, the efficacy of topical and systemic antiviral chemoprophylaxis (i.e., preexposure prophylaxis or "PrEP"), using the same drugs used for HIV treatment, has been demonstrated in a number of clinical trials. However, results from other trials have been inconsistent, especially those evaluating PrEP in women. These inconsistencies may result from our incomplete understanding of pharmacokinetics (PK)/pharmacodynamics (PD) at the mucosal sites of sexual transmission: the male and female gastrointestinal and reproductive tracts. The drug concentrations used in these trials were derived from those used for treatment; however, we still do not know the relationship between the therapeutic and the preventive dose. This article presents the first comprehensive review of the available data in the HIV pharmacology field from animal models to human studies, and outlines gaps, challenges, and future directions. Addressing these pharmacological gaps and challenges will be critical in selecting and advancing future PrEP candidates and strategies with the greatest impact on the HIV epidemic.

  14. The challenges of detecting and responding to a Lassa fever outbreak in an Ebola-affected setting

    Directory of Open Access Journals (Sweden)

    E.L. Hamblion

    2018-01-01

    Conclusions: The delay in response to this outbreak could have been related to a number of challenges in this EVD-affected setting: a need to strengthen the IDSR system, develop preparedness plans, train rapid response teams, and build laboratory capacity. Prioritizing these actions will aid in the timely response to future outbreaks.

  15. Outbreaks of Rickettsia felis in Kenya and Senegal, 2010

    Centers for Disease Control (CDC) Podcasts

    2010-06-09

    This podcast describes the outbreak of Rickettsia felis in Kenya between August 2006 and June 2008, and in rural Senegal from November 2008 through July 2009. CDC infectious disease pathologist Dr. Chris Paddock discusses what researchers learned about this flea-borne disease and how to prevent infection.  Created: 6/9/2010 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 6/24/2010.

  16. Emergency nurses’ perceptions of emergency department preparedness for an ebola outbreak: a qualitative descriptive study

    OpenAIRE

    Pincha Baduge, Mihirika Surangi De Silva

    2017-01-01

    Introduction: Ebola Virus Disease (EVD) is a highly contagious disease with a high mortality rate. The 2014 outbreak in West Africa grew uncontrollably, and on the 8th August 2014, the World Health Organization (WHO) declared the outbreak as a public health emergency of international concern. Emergency Departments (ED) in Australian health services commenced preparation and vigilance for people presenting with EVD like symptoms, so that any spread of the disease could be prevented. Researc...

  17. Consumer Adoption of Future MyData-Based Preventive eHealth Services: An Acceptance Model and Survey Study.

    Science.gov (United States)

    Koivumäki, Timo; Pekkarinen, Saara; Lappi, Minna; Väisänen, Jere; Juntunen, Jouni; Pikkarainen, Minna

    2017-12-22

    Constantly increasing health care costs have led countries and health care providers to the point where health care systems must be reinvented. Consequently, electronic health (eHealth) has recently received a great deal of attention in social sciences in the domain of Internet studies. However, only a fraction of these studies focuses on the acceptability of eHealth, making consumers' subjective evaluation an understudied field. This study will address this gap by focusing on the acceptance of MyData-based preventive eHealth services from the consumer point of view. We are adopting the term "MyData", which according to a White Paper of the Finnish Ministry of Transport and Communication refers to "1) a new approach, a paradigm shift in personal data management and processing that seeks to transform the current organization centric system to a human centric system, 2) to personal data as a resource that the individual can access and control." The aim of this study was to investigate what factors influence consumers' intentions to use a MyData-based preventive eHealth service before use. We applied a new adoption model combining Venkatesh's unified theory of acceptance and use of technology 2 (UTAUT2) in a consumer context and three constructs from health behavior theories, namely threat appraisals, self-efficacy, and perceived barriers. To test the research model, we applied structural equation modeling (SEM) with Mplus software, version 7.4. A Web-based survey was administered. We collected 855 responses. We first applied traditional SEM for the research model, which was not statistically significant. We then tested for possible heterogeneity in the data by running a mixture analysis. We found that heterogeneity was not the cause for the poor performance of the research model. Thus, we moved on to model-generating SEM and ended up with a statistically significant empirical model (root mean square error of approximation [RMSEA] 0.051, Tucker-Lewis index [TLI] 0

  18. Diet, Gut Microbiota, and Colorectal Cancer Prevention: A Review of Potential Mechanisms and Promising Targets for Future Research.

    Science.gov (United States)

    Song, Mingyang; Chan, Andrew T

    2017-12-01

    Diet plays an important role in the development of colorectal cancer. Emerging data have implicated the gut microbiota in colorectal cancer. Diet is a major determinant for the gut microbial structure and function. Therefore, it has been hypothesized that alterations in gut microbes and their metabolites may contribute to the influence of diet on the development of colorectal cancer. We review several major dietary factors that have been linked to gut microbiota and colorectal cancer, including major dietary patterns, fiber, red meat and sulfur, and obesity. Most of the epidemiologic evidence derives from cross-sectional or short-term, highly controlled feeding studies that are limited in size. Therefore, high-quality large-scale prospective studies with dietary data collected over the life course and comprehensive gut microbial composition and function assessed well prior to neoplastic occurrence are critically needed to identify microbiome-based interventions that may complement or optimize current diet-based strategies for colorectal cancer prevention and management.

  19. Nickel Allergy and Our Children's Health: A Review of Indexed Cases and a View of Future Prevention.

    Science.gov (United States)

    Jacob, Sharon E; Goldenberg, Alina; Pelletier, Janice L; Fonacier, Luz S; Usatine, Richard; Silverberg, Nanette

    2015-01-01

    Nickel is the leading cause of allergic contact dermatitis (ACD) from early childhood through adolescence. Studies have shown that skin piercings and other nickel-laden exposures can trigger the onset of nickel ACD in those who are susceptible. Nickel ACD causes a vast amount of cutaneous disease in children. Cases of nickel ACD in children have been reported in peer-reviewed literature from 28 states. Common items that contain inciting nickel include jewelry, coins, zippers, belts, tools, toys, chair studs, cases for cell phones and tablets, and dental appliances. The diagnosis of nickel ACD has been routinely confirmed by patch testing in children older than 6 months suspected of ACD from nickel. Unlike in Europe, there are no mandatory restrictions legislated for nickel exposure in the United States. Denmark has demonstrated that regulation of the nickel content in metals can lower the risk of ACD and the associated health care-related costs that arise from excess nickel exposure. To further awareness, this article reviews the prominent role of nickel in pediatric skin disease in the United States. It discusses the need for a campaign by caretakers to reduce nickel-related morbidity. Lastly, it promotes the model of European legislation as a successful intervention in the prevention of nickel ACD. © 2015 Wiley Periodicals, Inc.

  20. Can tail damage outbreaks in the pig be predicted by behavioural change?

    Science.gov (United States)

    Larsen, Mona Lilian Vestbjerg; Andersen, Heidi Mai-Lis; Pedersen, Lene Juul

    2016-03-01

    Tail biting, resulting in outbreaks of tail damage in pigs, is a multifactorial welfare and economic problem which is usually partly prevented through tail docking. According to European Union legislation, tail docking is not allowed on a routine basis; thus there is a need for alternative preventive methods. One strategy is the surveillance of the pigs' behaviour for known preceding indicators of tail damage, which makes it possible to predict a tail damage outbreak and prevent it in proper time. This review discusses the existing literature on behavioural changes observed prior to a tail damage outbreak. Behaviours found to change prior to an outbreak include increased activity level, increased performance of enrichment object manipulation, and a changed proportion of tail posture with more tails between the legs. Monitoring these types of behaviours is also discussed for the purpose of developing an automatic warning system for tail damage outbreaks, with activity level showing promising results for being monitored automatically. Encouraging results have been found so far for the development of an automatic warning system; however, there is a need for further investigation and development, starting with the description of the temporal development of the predictive behaviour in relation to tail damage outbreaks. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Epidemiology and Management of the 2013-16 West African Ebola Outbreak.

    Science.gov (United States)

    Boisen, M L; Hartnett, J N; Goba, A; Vandi, M A; Grant, D S; Schieffelin, J S; Garry, R F; Branco, L M

    2016-09-29

    The 2013-16 West African Ebola outbreak is the largest, most geographically dispersed, and deadliest on record, with 28,616 suspected cases and 11,310 deaths recorded to date in Guinea, Liberia, and Sierra Leone. We provide a review of the epidemiology and management of the 2013-16 Ebola outbreak in West Africa aimed at stimulating reflection on lessons learned that may improve the response to the next international health crisis caused by a pathogen that emerges in a region of the world with a severely limited health care infrastructure. Surveillance efforts employing rapid and effective point-of-care diagnostics designed for environments that lack advanced laboratory infrastructure will greatly aid in early detection and containment efforts during future outbreaks. Introduction of effective therapeutics and vaccines against Ebola into the public health system and the biodefense armamentarium is of the highest priority if future outbreaks are to be adequately managed and contained in a timely manner.

  2. Hepatitis A outbreak on a floating restaurant in Florida, 1986.

    Science.gov (United States)

    Lowry, P W; Levine, R; Stroup, D F; Gunn, R A; Wilder, M H; Konigsberg, C

    1989-01-01

    In April and May 1986, the largest reported foodborne outbreak of hepatitis A in Florida state history occurred among patrons and employees of a floating restaurant. A total of 103 cases (97 patrons and six employees) were identified. The exposure period lasted 31 days (March 20-April 19), making this the most prolonged hepatitis A outbreak to occur in a restaurant that to date has been reported to the Centers for Disease Control. The exposure period was divided into time intervals (peak, early, late, and total) for calculation of food-specific attack rates. The authors showed that green salad was an important vehicle of transmission for each phase of the exposure period, with the highest adjusted odds ratio for the three-day peak exposure interval (March 28-30), 6.8 (p = 0.001). Non-salad pantry items and mixed bar drinks were also identified as vehicles of transmission; both were more important during the early interval of the exposure period than during the late interval. Two of six infected employees worked in the pantry and may have sequentially infected patrons. Though rare, this outbreak suggests that hepatitis A infection among employees may allow for transmission to patrons for prolonged periods of time. Prevention of such outbreaks requires prompt reporting of ill patrons with rapid identification of infected employees and correction of food handling practices.

  3. Tracking the evolution of HIV/AIDS in China from 1989-2009 to inform future prevention and control efforts.

    Directory of Open Access Journals (Sweden)

    Zhongwei Jia

    Full Text Available BACKGROUND: To determine policy implications, this analysis tracks the evolution of HIV/AIDS infection across China to understand current trends and potential risk factors. METHODS AND PRINCIPAL FINDINGS: A retrospective study with spatial analytical model and multilevel spatial models was conducted among 326,157 HIV/AIDS cases reported from 1989-2009. The results indicate that the distribution of HIV/AIDS was clustered at the county level with different directional distributions across China from 2003 to 2009. Compared to 2003, by 2009 there was a 122% increase in HIV cases among rural residents, 294% increase among urban residents, 211% increase among migrants, and 237% increase among permanent residents. The overall proportion of HIV by different routes of transmission showed dramatic changes with a 504% increase in sexual transmission of HIV, 90% decrease in blood/plasma transmission, and 35% decrease in injecting drug user transmission. Sexual transmission was the major transmission route among women (44% and the elderly (59% in men, 44% in women as well as among permanent (36% and urban residents (33%. Among those <65 years old, women increased more than men, but among those ≥ 65 years, men increased more than women. Migrants contributed to the variance of HIV infection between counties but not within counties. The length of highway and urbanization combined with illiteracy were risk factors for HIV/AIDS. CONCLUSIONS/SIGNIFICANCE: Rates of HIV/AIDS among permanent urban residents, particularly women and elderly men, have increased significantly in recent years. To prevent HIV from spreading further among the general population, additional attention should be paid to these populations as well as to migrants.

  4. Surveillance for waterborne disease outbreaks associated with drinking water---United States, 2007--2008.

    Science.gov (United States)

    Brunkard, Joan M; Ailes, Elizabeth; Roberts, Virginia A; Hill, Vincent; Hilborn, Elizabeth D; Craun, Gunther F; Rajasingham, Anu; Kahler, Amy; Garrison, Laurel; Hicks, Lauri; Carpenter, Joe; Wade, Timothy J; Beach, Michael J; Yoder Msw, Jonathan S

    2011-09-23

    or inadequately treated ground water, indicating that contamination of ground water remains a public health problem. The majority of these outbreaks occurred in public water systems that are subject to EPA's new Ground Water Rule (GWR), which requires the majority of community water systems to complete initial sanitary surveys by 2012. The GWR focuses on identification of deficiencies, protection of wells and springs from contamination, and providing disinfection when necessary to protect against bacterial and viral agents. In addition, several drinking water--associated outbreaks that were related to contaminated ground water appeared to occur in systems that were potentially under the influence of surface water. Future efforts to collect data systematically on contributing factors associated with drinking water outbreaks and deficiencies, including identification of ground water under the direct influence of surface water and the criteria used for their classification, would be useful to better assess risks associated with ground water. During 2007--2008, Legionella was the most frequently reported etiology among drinking water--associated outbreaks, following the pattern observed since it was first included in WBDOSS in 2001. However, six (50%) of the 12 drinking water--associated Legionella outbreaks were reported from one state, highlighting the substantial variance in outbreak detection and reporting across states and territories. The addition of published and CDC-investigated legionellosis outbreaks to the WBDOSS database clarifies that Legionella is not a new public health issue. During 2009, Legionella was added to EPA's Contaminant Candidate List for the first time. CDC and EPA use WBDOSS surveillance data to identify the types of etiologic agents, deficiencies, water systems, and sources associated with waterborne disease outbreaks and to evaluate the adequacy of current technologies and practices for providing safe drinking water. Surveillance data also

  5. What's new with the flu? Reflections regarding the management and prevention of influenza from the 2nd New Zealand Influenza Symposium, November 2015.

    Science.gov (United States)

    Charania, Nadia A; Mansoor, Osman D; Murfitt, Diana; Turner, Nikki M

    2016-09-09

    Influenza is a common respiratory viral infection. Seasonal outbreaks of influenza cause substantial morbidity and mortality that burdens healthcare services every year. The influenza virus constantly evolves by antigenic drift and occasionally by antigenic shift, making this disease particularly challenging to manage and prevent. As influenza viruses cause seasonal outbreaks and also have the ability to cause pandemics leading to widespread social and economic losses, focused discussions on improving management and prevention efforts is warranted. The Immunisation Advisory Centre (IMAC) hosted the 2nd New Zealand Influenza Symposium (NZiS) in November 2015. International and national participants discussed current issues in influenza management and prevention. Experts in the field presented data from recent studies and discussed the ecology of influenza viruses, epidemiology of influenza, methods of prevention and minimisation, and experiences from the 2015 seasonal influenza immunisation campaign. The symposium concluded that although much progress in this field has been made, many areas for future research remain.

  6. EFSA (European Food Safety Authority) and ECDC (European Centre for Disease Prevention and Control), 2015. The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2014

    DEFF Research Database (Denmark)

    Helwigh, Birgitte; Porsbo, Lone Jannok; Boysen, Louise

    This report of the European Food Safety Authority and the European Centre for Disease Prevention and Control presents the results of the zoonoses monitoring activities carried out in 2014 in 32 European countries (28 Member States (MS) and four non-MS). Campylobacteriosis was the most commonly re......, molluscs and products thereof’. The report further summarises trends and sources along the food chain of tuberculosis due to Mycobacterium bovis, Brucella, Trichinella, Echinococcus, Toxoplasma, rabies, Coxiella burnetii (Q fever), West Nile virus and tularaemia....

  7. EFSA and ECDC (European Food Safety Authority and European Centre for Disease Prevention and Control), 2015. The European Union Summary Report on Trends and Sources of Zoonoses, Zoonotic Agents and Food-borne Outbreaks in 2013

    DEFF Research Database (Denmark)

    Helwigh, Birgitte

    This report of the European Food Safety Authority and the European Centre for Disease Prevention and Control presents the results of the zoonoses monitoring activities carried out in 2013 in 32 European countries (28 Member States and four non-Member States). Campylobacter iosis was the most comm...... chain of tuberculosis due to Mycobacterium bovis, Brucella, Trichinella, Echinococcus, Toxoplasma , rabies, Coxiella burnetii (Q fever), West Nile Virus and tularaemia....

  8. EFSA and ECDC (European Food Safety Authority and European Centre for Disease Prevention and Control), 2015. The European Union Summary Report on Trends and Sources of Zoonoses, Zoonotic Agents and Food-borne Outbreaks in 2013

    OpenAIRE

    Helwigh, Birgitte

    2015-01-01

    This report of the European Food Safety Authority and the European Centre for Disease Prevention and Control presents the results of the zoonoses monitoring activities carried out in 2013 in 32 European countries (28 Member States and four non-Member States). Campylobacter iosis was the most commonly reported zoonosis. After several years of an increasing European Union (EU) trend, the human Campylobacter iosis notification rate has stabilised. In food and animals no EU trends were observed a...

  9. EFSA (European Food Safety Authority) and ECDC (European Centre for Disease Prevention and Control), 2014. The European Union Summary Report on Trends and Sources of Zoonoses, Zoonotic Agents and Food-borne Outbreaks in 2012

    OpenAIRE

    Korsgaard, Helle; Helwigh, Birgitte; Sørensen, Anna Irene Vedel; Skiby, Jeffrey Edward; Borck Høg, Birgitte

    2014-01-01

    Zoonoses are infections and diseases that are naturally transmissible, directly or indirectly, for example via contaminated foodstuffs, between animals and humans. The severity of these diseases in humans varies from subclinical infection or mild symptoms to life-threatening conditions. In order to prevent zoonoses from occurring, it is important to identify which animals and foodstuffs are the main sources of infection. For this purpose information aimed at protecting human health is collect...

  10. EFSA (European Food Safety Authority) and ECDC (European Centre for Disease Prevention and Control), 2015. The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2014

    OpenAIRE

    Helwigh, Birgitte; Porsbo, Lone Jannok; Boysen, Louise; Bager, Flemming

    2015-01-01

    This report of the European Food Safety Authority and the European Centre for Disease Prevention and Control presents the results of the zoonoses monitoring activities carried out in 2014 in 32 European countries (28 Member States (MS) and four non-MS). Campylobacteriosis was the most commonly reported zoonosis with an increase in confirmed human cases in the European Union (EU) since 2008. In food the occurrence of Campylobacter remained high in broiler meat. The decreasing EU trend for conf...

  11. Role of Omega-3 Fatty Acids in the Etiology, Treatment, and Prevention of Depression: Current Status and Future Directions

    Science.gov (United States)

    McNamara, Robert K.

    2016-01-01

    Over the past three decades a body of translational evidence has implicated dietary deficiency in long-chain omega-3 (LCn-3) fatty acids, including eicosapenaenoic acid (EPA) and docosahexaenoic acid (DHA), in the pathophysiology and etiology of major depressive disorder (MDD). Cross-national and cross-sectional data suggest that greater habitual intake of preformed EPA+DHA is associated with reduced risk for developing depressive symptoms and syndromal MDD. Erythrocyte EPA and DHA composition is highly correlated with habitual fish or fish oil intake, and case-control studies have consistently observed lower erythrocyte EPA and/or DHA levels in patients with MDD. Low erythrocyte EPA+DHA composition may also be associated with increased risk for suicide and cardiovascular disease, two primary causes of excess premature mortality in MDD. While controversial, dietary EPA+DHA supplementation may have antidepressant properties and may augment the therapeutic efficacy of antidepressant medications. Neuroimaging and rodent neurodevelopmental studies further suggest that low LCn-3 fatty acid intake or biostatus can recapitulate central pathophysiological features associated with MDD. Prospective findings suggest that low LCn-3 fatty acid biostatus increases risk for depressive symptoms in part by augmenting pro-inflammatory responsivity. When taken collectively, these translational findings provide a strong empirical foundation in support of dietary LCn-3 fatty acid deficiency as a modifiable risk factor for MDD. This review provides an overview of this translational evidence and then discusses future directions including strategies to translate this evidence into routine clinical screening and treatment algorithms. PMID:27766299

  12. Ebola hemorrhagic fever outbreaks: strategies for effective epidemic management, containment and control

    Directory of Open Access Journals (Sweden)

    Gerald Amandu Matua

    2015-05-01

    The current epidemic management approaches are largely “reactive”, with containment efforts aimed at halting spread of existing outbreaks. We recommend that for better outcomes, in addition to “reactive” interventions, “pre-emptive” strategies also need to be instituted. We conclude that emphasizing both “reactive” and “pre-emptive” strategies is more likely to lead to better epidemic preparedness and response at individual, community, institutional, and government levels, resulting in timely containment of future Ebola outbreaks.

  13. Cholera outbreak in a village in south India – Timely action saved lives

    Directory of Open Access Journals (Sweden)

    R. Deepthi

    2013-02-01

    Full Text Available Summary: Cholera remains a public health concern in developing countries because of its high morbidity and mortality. This study was designed to assess the magnitude of and factors responsible for an outbreak in a South Indian village and to implement measures for containing and preventing the recurrence of such outbreaks. Data was obtained by surveying households in the village to identify cases and assess factors responsible for the outbreak. A sanitary survey of the water supply system was performed to identify the cause of the outbreak. Preventive measures were implemented by setting up a rapid response team to manage cases and provide safe drinking water and health education regarding the prevention of such outbreaks. A total of 73 cases were reported during the outbreak, an attack rate of 17.5%. Attack rates were similar among males and females, and the highest rates were observed among the elderly (33.3%, while the lowest rates were observed among adults (14.7%. There were no deaths reported due to cholera in the village. Most households (81% surveyed did not use any method of water purification, 79.7% practiced open field defecation and 58.2% practiced inadequate hand washing, indicating poor sanitary practices. Cases were most commonly observed in houses which did not practice any method of water purification (p < 0.001 and among people living below the poverty line (p = 0.02. Despite the high attack rate, no deaths were reported, largely thanks to timely medical and preventive interventions. Keywords: Outbreak investigation, Cholera, Sanitary practices, Prevention

  14. Key data for outbreak evaluation: building on the Ebola experience.

    Science.gov (United States)

    Cori, Anne; Donnelly, Christl A; Dorigatti, Ilaria; Ferguson, Neil M; Fraser, Christophe; Garske, Tini; Jombart, Thibaut; Nedjati-Gilani, Gemma; Nouvellet, Pierre; Riley, Steven; Van Kerkhove, Maria D; Mills, Harriet L; Blake, Isobel M

    2017-05-26

    Following the detection of an infectious disease outbreak, rapid epidemiological assessment is critical for guiding an effective public health response. To understand the transmission dynamics and potential impact of an outbreak, several types of data are necessary. Here we build on experience gained in the West African Ebola epidemic and prior emerging infectious disease outbreaks to set out a checklist of data needed to: (1) quantify severity and transmissibility; (2) characterize heterogeneities in transmission and their determinants; and (3) assess the effectiveness of different interventions. We differentiate data needs into individual-level data (e.g. a detailed list of reported cases), exposure data (e.g. identifying where/how cases may have been infected) and population-level data (e.g. size/demographics of the population(s) affected and when/where interventions were implemented). A remarkable amount of individual-level and exposure data was collected during the West African Ebola epidemic, which allowed the assessment of (1) and (2). However, gaps in population-level data (particularly around which interventions were applied when and where) posed challenges to the assessment of (3). Here we highlight recurrent data issues, give practical suggestions for addressing these issues and discuss priorities for improvements in data collection in future outbreaks.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'. © 2017 The Authors.

  15. Ethics for pandemics beyond influenza: Ebola, drug-resistant tuberculosis, and anticipating future ethical challenges in pandemic preparedness and response.

    Science.gov (United States)

    Smith, Maxwell J; Silva, Diego S

    2015-01-01

    The unprecedented outbreak of Ebola virus disease (EVD) in West Africa has raised several novel ethical issues for global outbreak preparedness. It has also illustrated that familiar ethical issues in infectious disease management endure despite considerable efforts to understand and mitigate such issues in the wake of past outbreaks. To improve future global outbreak preparedness and response, we must examine these shortcomings and reflect upon the current state of ethical preparedness. To this end, we focus our efforts in this article on the examination of one substantial area: ethical guidance in pandemic plans. We argue that, due in part to their focus on considerations arising specifically in relation to pandemics of influenza origin, pandemic plans and their existing ethical guidance are ill-equipped to anticipate and facilitate the navigation of unique ethical challenges that may arise in other infectious disease pandemics. We proceed by outlining three reasons why this is so, and situate our analysis in the context of the EVD outbreak and the threat posed by drug-resistant tuberculosis: (1) different infectious diseases have distinct characteristics that challenge anticipated or existing modes of pandemic prevention, preparedness, response, and recovery, (2) clear, transparent, context-specific ethical reasoning and justification within current influenza pandemic plans are lacking, and (3) current plans neglect the context of how other significant pandemics may manifest. We conclude the article with several options for reflecting upon and ultimately addressing ethical issues that may emerge with different infectious disease pandemics.

  16. Ecological consequences of mountain pine beetle outbreaks for wildlife in western North American forests

    Science.gov (United States)

    Saab, Victoria A.; Latif, Quresh S.; Rowland, Mary M.; Johnson, Tracey N.; Chalfoun, Anna D.; Buskirk, Steven W.; Heyward, Joslin E.; Dresser, Matthew A.

    2014-01-01

    Mountain pine beetle (Dendroctonus ponderosae) (MPB) outbreaks are increasingly prevalent in western North America, causing considerable ecological change in pine (Pinus spp.) forests with important implications for wildlife. We reviewed studies examining wildlife responses to MPB outbreaks and postoutbreak salvage logging to inform forest management and guide future research. Our review included 16 studies describing MPB outbreak relationships with 89 bird species and 6 studies describing relationships with 11 mammalian species, but no studies of reptiles or amphibians. We included studies that compared wildlife response metrics temporally (before versus after the outbreak) and spatially (across sites that varied in severity of outbreak) in relation to beetle outbreaks. Outbreaks ranged in size from 20,600 to ≥107 ha and studies occurred 1‐30 years after the peak MPB outbreak, but most studies were conducted over the short-term (i.e., ≤6 years after the peak of MPB-induced tree mortality). Birds were the only taxa studied frequently; however, high variability existed among those studies to allow many inferences, although some patterns were evident. Avian studies concluded that cavity-nesting species responded more favorably to beetle-killed forests than species with open-cup nests, and species nesting in the shrub layer favored outbreak forests compared with ground and open-cup canopy nesters that generally showed mixed relationships. Bark-drilling species as a group clearly demonstrated a positive short-term association with MPB epidemics compared with that of other foraging assemblages. Cavity-nesting birds that do not consume bark beetles (i.e., secondary cavity-nesting species and nonbark-drilling woodpeckers) also exhibited some positive responses to MPB outbreaks, although not as pronounced or consistent as those of bark-drilling woodpeckers. Mammalian responses to MPB outbreaks were mixed. Studies consistently reported negative effects of MPB

  17. Intensified colonisation screening according to the recommendations of the German Commission for Hospital Hygiene and Infectious Diseases Prevention (KRINKO): identification and containment of a Serratia marcescens outbreak in the neonatal intensive care unit, Jena, Germany, 2013-2014.

    Science.gov (United States)

    Dawczynski, Kristin; Proquitté, Hans; Roedel, Jürgen; Edel, Brigit; Pfeifer, Yvonne; Hoyer, Heike; Dobermann, Helke; Hagel, Stefan; Pletz, Mathias W

    2016-12-01

    In 2013, the German Commission for Hospital Hygiene and Infectious Disease Prevention (KRINKO) stated that extending weekly colonisation screening from very low birth weight (VLBW) infants (Serratia marcescens. Strains were typed by Pulsed Field Gel Electrophoresis (PFGE). Over 6 months, 19 out of 159 infants acquired S. marcescens. Twelve of the nineteen patients with S. marcescens were non-VLBW infants, and they were colonised significantly earlier than were VLBW infants (median 17 vs. 28 days; p marcescens.

  18. Swine flu - A pandemic outbreak

    Directory of Open Access Journals (Sweden)

    Jini George

    Full Text Available Hippocrates had described influenza like outbreak in 412 B.C. and since then repeated influenza like epidemics and pandemics have been recorded in recent times. One of the greatest killers of all time was the pandemic of swine flu (Spanish flu of 1918-1919, when 230 million people died. Annual influenza epidemics are estimated to affect 5–15% of the global population, resulting in severe illness in 3–5 million patients causing 250,000–500,000 deaths worldwide. Severe illness and deaths occur mainly in the high-risk populations of infants, the elderly and chronically ill patients. The 2009 outbreak of swine flu is thought to be a mutation more specifically a reassortment of four known strains of influenza A virus subtype H1N1; one endemic in humans, one endemic in birds, and two endemic in pigs. WHO officially declared the outbreak to be a pandemic on June 11, 2009, but stressed that the new designation was a result of the global "spread of the virus," not its severity. [Vet World 2009; 2(12.000: 472-474

  19. Listeriosis Outbreaks in British Columbia, Canada, Caused by Soft Ripened Cheese Contaminated from Environmental Sources

    Science.gov (United States)

    Wilcott, Lynn; Naus, Monika

    2015-01-01

    Soft ripened cheese (SRC) caused over 130 foodborne illnesses in British Columbia (BC), Canada, during two separate listeriosis outbreaks. Multiple agencies investigated the events that lead to cheese contamination with Listeria monocytogenes (L.m.), an environmentally ubiquitous foodborne pathogen. In both outbreaks pasteurized milk and the pasteurization process were ruled out as sources of contamination. In outbreak A, environmental transmission of L.m. likely occurred from farm animals to personnel to culture solutions used during cheese production. In outbreak B, birds were identified as likely contaminating the dairy plant's water supply and cheese during the curd-washing step. Issues noted during outbreak A included the risks of operating a dairy plant in a farm environment, potential for transfer of L.m. from the farm environment to the plant via shared toilet facilities, failure to clean and sanitize culture spray bottles, and cross-contamination during cheese aging. L.m. contamination in outbreak B was traced to wild swallows defecating in the plant's open cistern water reservoir and a multibarrier failure in the water disinfection system. These outbreaks led to enhanced inspection and surveillance of cheese plants, test and release programs for all SRC manufactured in BC, improvements in plant design and prevention programs, and reduced listeriosis incidence. PMID:25918702

  20. Listeriosis Outbreaks in British Columbia, Canada, Caused by Soft Ripened Cheese Contaminated from Environmental Sources

    Directory of Open Access Journals (Sweden)

    Lorraine McIntyre

    2015-01-01

    Full Text Available Soft ripened cheese (SRC caused over 130 foodborne illnesses in British Columbia (BC, Canada, during two separate listeriosis outbreaks. Multiple agencies investigated the events that lead to cheese contamination with Listeria monocytogenes (L.m., an environmentally ubiquitous foodborne pathogen. In both outbreaks pasteurized milk and the pasteurization process were ruled out as sources of contamination. In outbreak A, environmental transmission of L.m. likely occurred from farm animals to personnel to culture solutions used during cheese production. In outbreak B, birds were identified as likely contaminating the dairy plant’s water supply and cheese during the curd-washing step. Issues noted during outbreak A included the risks of operating a dairy plant in a farm environment, potential for transfer of L.m. from the farm environment to the plant via shared toilet facilities, failure to clean and sanitize culture spray bottles, and cross-contamination during cheese aging. L.m. contamination in outbreak B was traced to wild swallows defecating in the plant’s open cistern water reservoir and a multibarrier failure in the water disinfection system. These outbreaks led to enhanced inspection and surveillance of cheese plants, test and release programs for all SRC manufactured in BC, improvements in plant design and prevention programs, and reduced listeriosis incidence.

  1. Dengue disease outbreak definitions are implicitly variable

    Directory of Open Access Journals (Sweden)

    Oliver J. Brady

    2015-06-01

    Full Text Available Infectious diseases rarely exhibit simple dynamics. Outbreaks (defined as excess cases beyond response capabilities have the potential to cause a disproportionately high burden due to overwhelming health care systems. The recommendations of international policy guidelines and research agendas are based on a perceived standardised definition of an outbreak characterised by a prolonged, high-caseload, extra-seasonal surge. In this analysis we apply multiple candidate outbreak definitions to reported dengue case data from Brazil to test this assumption. The methods identify highly heterogeneous outbreak characteristics in terms of frequency, duration and case burden. All definitions identify outbreaks with characteristics that vary over time and space. Further, definitions differ in their timeliness of outbreak onset, and thus may be more or less suitable for early intervention. This raises concerns about the application of current outbreak guidelines for early warning/identification systems. It is clear that quantitatively defining the characteristics of an outbreak is an essential prerequisite for effective reactive response. More work is needed so that definitions of disease outbreaks can take into account the baseline capacities of treatment, surveillance and control. This is essential if outbreak guidelines are to be effective and generalisable across a range of epidemiologically different settings.

  2. The Tablets, Ring, Injections as Options (TRIO) study: what young African women chose and used for future HIV and pregnancy prevention.

    Science.gov (United States)

    van der Straten, Ariane; Agot, Kawango; Ahmed, Khatija; Weinrib, Rachel; Browne, Erica N; Manenzhe, Kgahlisho; Owino, Fredrick; Schwartz, Jill; Minnis, Alexandra

    2018-03-01

    Preventing HIV and unintended pregnancies are key global health priorities. To inform product rollout and to understand attributes of future multipurpose prevention technologies (MPT) associated with preference and use, we evaluated three placebo delivery forms: daily oral tablets, a monthly vaginal ring, and two monthly intramuscular injections in TRIO, a five-month study among young Kenyan and South African women. HIV-negative, sexually active, non-pregnant women aged 18 to 30 were enrolled and randomized to use each placebo delivery form for one month (stage 1). Then, participants chose one product to use for two additional months (stage 2). We assessed safety, product ranking, choice, and use. We examined demographic and behavioural correlates of choice and, reciprocally, unwillingness to use in the future with logistic regression models. 277 women enrolled, 249 completed stage 1 and 246 completed stage 2. Median age was 23 years, 49% were Kenyan and 51% were South African. Three participants became pregnant during the study and one participant HIV-seroconverted. There were 18 product-related adverse events, six tablets-related, 11 ring-related, and one injection-related. After trying each product, 85% preferred a TRIO product over condoms. Injections were chosen most (64%, 95% confidence interval (CI) 58%, 70%; p < 0.001), and by more South Africans than Kenyans (odds ratio (OR) 2.01, 95% CI: 1.17, 3.43; p = 0.01). There was no significant difference in choosing tablets versus ring (21%, 95% CI: 16%, 26% vs. 15%, 95% CI: 11%, 20%; p = 0.11). Tablet and ring adherence, based on direct observations and self-reports, improved over time. However, participants' self-reported use of tablets did not match objective data from the electronic dose monitoring device. Participants were fully compliant with injections. In this population at risk for HIV and pregnancy, all participants agreed to choose and use a placebo MPT delivery form. A majority of participants

  3. Norovirus outbreak associated with a hotel in the west of Ireland, 2006.

    Science.gov (United States)

    Michel, A; Fitzgerald, R; Whyte, D; Fitzgerald, A; Beggan, E; O'Connell, N; Greally, T

    2007-07-01

    An outbreak of gastrointestinal disease (nausea, vomiting or diarrhoea) occurred among a party of wedding guests, staff and other guests in a hotel in the west of Ireland, in October 2006. Upon notification, a multi-disciplinary outbreak control team was convened to investigate and control the outbreak. In all, 98 people were ascertained ill. The median duration of illness was 48 hours. The attack rate ranged between 48 and 85%. The hotel voluntarily notified health authorities and co-operated fully with investigation and control measures. Strict prevention and control measures were instituted promptly, including air ventilation, enhanced hand hygiene, isolation of cases, temporary "cooked food only", temporary alternative accommodation and specialised cleaning. Three cases of norovirus infection were laboratory-confirmed. There was no evidence of food- or water-borne transmission. Clinical and epidemiological findings indicated person-to-person transmission of norovirus. This report highlights the potential for large social gatherings to facilitate the spread of viral gastroenteritis by person-to-person transmission and via contaminated environment. Effective community management of this outbreak appears to have prevented its having an impact on local acute hospital services. The authors conclude that in addition to the existing national guidelines on the management of outbreaks of norovirus in healthcare settings, agreed guidelines for the management of norovirus outbreaks in the hotel and tourism industry are needed in Ireland.

  4. Measles outbreak response decision-making under uncertainty: a retrospective analysis.

    Science.gov (United States)

    Fonnesbeck, Christopher J; Shea, Katriona; Carran, Spencer; Cassio de Moraes, Jose; Gregory, Christopher; Goodson, James L; Ferrari, Matthew J

    2018-03-01

    Resurgent outbreaks of vaccine-preventable diseases that have previously been controlled or eliminated have been observed in many settings. Reactive vaccination campaigns may successfully control outbreaks but must necessarily be implemented in the face of considerable uncertainty. Real-time surveillance may provide critical information about at-risk population and optimal vaccination targets, but may itself be limited by the specificity of disease confirmation. We propose an integrated modelling approach that synthesizes historical demographic and vaccination data with real-time outbreak surveillance via a dynamic transmission model and an age-specific disease confirmation model. We apply this framework to data from the 1996-1997 measles outbreak in São Paulo, Brazil. To simulate the information available to decision-makers, we truncated the surveillance data to what would have been available at 1 or 2 months prior to the realized interventions. We use the model, fitted to real-time observations, to evaluate the likelihood that candidate age-targeted interventions could control the outbreak. Using only data available prior to the interventions, we estimate that a significant excess of susceptible adults would prevent child-targeted campaigns from controlling the outbreak and that failing to account for age-specific confirmation rates would underestimate the importance of adult-targeted vaccination. © 2018 The Author(s).

  5. The effect of school dismissal on rates of influenza-like illness in New York City schools during the spring 2009 novel H1N1 outbreak.

    Science.gov (United States)

    Egger, Joseph R; Konty, Kevin J; Wilson, Elisha; Karpati, Adam; Matte, Thomas; Weiss, Don; Barbot, Oxiris

    2012-03-01

    The effects of individual school dismissal on influenza transmission have not been well studied. During the spring 2009 novel H1N1 outbreak, New York City implemented an individual school dismissal policy intended to limit influenza transmission at schools with high rates of influenza-like illness (ILI). Active disease surveillance data collected by the New York City Health Department on rates of ILI in schools were used to evaluate the impact. Sixty-four schools that met the Health Department's criteria for considering dismissal were included in the analysis. Twenty-four schools that met criteria subsequently dismissed all classes for approximately 1 school week. A regression model was fit to these data, estimating the effect of school dismissal on rates of in-school ILI following reconvening, adjusting for potential confounders. The model estimated that, on average, school dismissal reduced the rate of ILI by 7.1% over the entire average outbreak period. However, a large proportion of in-school ILI occurred before dismissal criteria were met. A separate model estimated that school absenteeism rates were not significantly affected by dismissal. Results suggest that individual school dismissal could be considered in situations where schools have a disproportionate number of high-risk students or may be unable to implement recommended preventive or infection control measures. Future work should focus on developing more sensitive indicators of early outbreak detection in schools and evaluating the impact of school dismissal on community transmission. © 2012, American School Health Association.

  6. Shigellosis outbreak at Addis Ababa University: March-April 2010.

    Science.gov (United States)

    Aragaw, Mer'awi; Tafese, Tilahun; Beyene, Zayeda; Hailemariam, Zegeye; Azaze, Aklilu; Luce, Richard; Addissie, Adamu

    2011-10-01

    Between 2006 and 2008, there have been various reports of diarrhea with blood in Ethiopia and also reports of Shigelloses outbreaks in some parts of the country. In March 2010, Addis Ababa University (AAU) Technology Campus reported occurrence of an outbreak of diarrheal illness among students. The study was conducted to identify the causative agent and the possible source of the diarrhea outbreak that occurred at Technology Campus. Active case finding and review of medical records were undertaken to characterize the outbreak. The investigation consisted of a case-control study with laboratory testing and environmental assessment. A structured questionnaire was used to collect data. Data were analyzed using Epi-info (v3.3.2). A total of 104 suspected cases were identified, based on the case definition, with an attack rate of 6.8%. Stool culture confirmed Shigella flexneri species in 5/11 (45%) of specimens tested. Risk factors associated with illness included eating specific foods at specific meal times. Food items served on Friday March 26, at lunch time (OR: 3.59, CI: 1.0- 12.7, p = 0.04) and on Saturday March 27, during dinner (OR: 2.89 CI: 1.0- 8.2, p = 0.04) were significantly associated with increased odds of illness. Water stored in a tank in the cafeteria had evidence of fecal contamination (fecal coliform count > 161 Mpn /100ml) and the hygiene and sanitary conditions in the cafeteria, kitchen, living area were unsatisfactory. Food-borne transmission and water contamination were suspected as the sources of infection. Regular supervision and inspection of the campus' food handling facilities and practices were recommended to improve food hygiene and sanitation. Improved water storage, correcting periodic water shortages in the latrine facility and promotion of hand washing could reduce potential future outbreaks.

  7. Severe canine distemper outbreak in unvaccinated dogs in Mozambique.

    Science.gov (United States)

    Zacarias, Julieta; Dimande, Alberto; Achá, Sara; Dias, Paula T; Leonel, Elisa M; Messa, Aurora; Macucule, Baltazar; Júnior, José L; Bila, Custódio G

    2016-07-15

    Although significant animal suffering caused by preventable diseases is frequently seen in developing countries, reports of this are scarce. This report describes avoidable animal suffering owing to a suspected canine distemper (CD) outbreak in unvaccinated dogs owned by low-income families in Mozambique that killed approximately 200 animals. Affected dogs exhibited clinical signs, and gross and microscopic lesions compatible with CD. Immunohistochemical staining confirmed the presence of canine distemper virus (CDV) in the kidney of one dog from the cohort. This brief communication again illustrates that large outbreaks of CDV in unvaccinated dogs occur and that large-scale avoidable suffering and threats to the health of dogs and wild canines continue. Mass vaccination supported by government and non-government organisations is recommended.

  8. A large foodborne outbreak on a small Pacific island.

    Science.gov (United States)

    Thein, C C; Trinidad, R M; Pavlin, B I

    2010-04-01

    On March 25, 2009, the Ebeye Leroj Kitlang Memorial Health Center on the island of Ebeye in the Republic of the Marshall Islands was overwhelmed with over 100 patients presenting for vomiting and diarrhea. Epidemiologic investigation revealed that there were 174 cases among 187 attendees at a local funeral earlier in the day. Most cases had eaten served sandwiches containing egg products that had undergone severe time-temperature abuse. While no causal agents were identified, the epidemiology and clinical presentation is compatible with foodborne toxins, most likely enterotoxins of either Staphylococcus aureus or Bacillus cereus. Mitigation measures undertaken by public health centered on education of food preparers and the general public regarding safe food preparation practices. This large outbreak serves to remind us that, while there are simple and highly effective measures to prevent such foodborne disease outbreaks, we in the public health sector have a duty to improve the community's knowledge and understanding of these measures.

  9. International employees' concerns during serious disease outbreaks and the potential impact on business continuity: Lessons identified from the 2014-15 West African Ebola outbreak.

    Science.gov (United States)

    Cole, Jennifer; Watkins, Chris

    This paper presents the findings of research carried out into the information-seeking behaviour, and information requirements of a small sample of international workers stationed in West Africa during the Zaire Ebola virus outbreak of 2014-15. The research study under which these results were obtained was part of exploratory research for a PhD focused on the use, and potential uses, of social media platforms during serious disease outbreaks that might be used to inform policy planning for public health and emergency response interventions. Thus, the findings from this study may provide valuable insights to business continuity managers and emergency planners in making future decisions about information exchange and crisis decision-making during future serious disease outbreaks.

  10. Outbreak of ocular toxoplasmosis in Coimbatore, India

    Directory of Open Access Journals (Sweden)

    Palanisamy Manikandan

    2006-01-01

    Full Text Available Toxoplasma gondii is a protozoan parasite that infects up to a third of the world′s population. Infection is mainly acquired by ingestion of food that is contaminated with oocysts. We report an outbreak of ocular toxoplasmosis, which is an acute acquired type rather than reactivation of congenital toxoplasmosis. Our preliminary investigation points to municipal water contamination. This outbreak only proves the need of an effective public health system and health education in curtailing any outbreak.

  11. Measles outbreak in adults: A changing epidemiological pattern

    Directory of Open Access Journals (Sweden)

    Swati Bajaj

    2017-01-01

    Full Text Available Background: Thirty-one cases of fever with rash were reported among students of a college in Pune, India, from March to May 2014. The clinical profile was similar to that of measles and 7 of them tested positive for measles-specific immunoglobulin M (IgM. An outbreak of measles was declared, and epidemiological investigation was carried out to assess the situation and suggest preventive measures. Methods: An epidemiological case sheet filled for each case to identify the source and likely contacts. Medical and administrative authorities were sensitized about the increase in incidence and clustering of cases. A surveillance system was set up for detection of new cases and follow-up of contacts. Throat swabs and blood samples from 12 cases were tested by ELISA method for commonly occurring viral exanthematous fevers to confirm the diagnosis and 7 were positive for measles-specific IgM antibody. Preventive measures were advised to control the outbreak. Results: A total of 31 cases of fever with rashes were reported among students of a college in Pune, India, during the months of March–May 2014. Most of the students were in the age group of 18–24 years. Samples from 12 cases were sent for testing and 7 tested positive for measles-specific IgM antibodies. Seven cases were epidemiologically linked to a lab-confirmed case. All cases had fever, maculopapular rash, and sore throat and gave a history of vaccination for measles in childhood. Conclusion: An epidemiological investigation was carried out for outbreak of measles in a young adult population of college students from Pune. It is reported that, with increase in overall coverage of vaccination, there is a rise in incidence of measles in vaccinated individuals. The age profile also shifts to higher age groups. Investigation of such outbreaks provides an opportunity to identify high-risk groups, changes in measles epidemiology and weaknesses in the routine immunization programs.

  12. Diphtheria outbreak in Lao People's Democratic Republic, 2012-2013.

    Science.gov (United States)

    Sein, Carolyn; Tiwari, Tejpratap; Macneil, Adam; Wannemuehler, Kathleen; Soulaphy, Chanthavy; Souliphone, Phouthone; Reyburn, Rita; Ramirez Gonzalez, Alejandro; Watkins, Margaret; Goodson, James L

    2016-08-05

    Diphtheria is a vaccine-preventable disease. When vaccination coverage and population immunity are low, outbreaks can occur. We investigated a diphtheria outbreak in Lao People's Democratic Republic that occurred during 2012-2013 and highlighted challenges in immunization services delivery to children in the country. We reviewed diphtheria surveillance data from April 1, 2012-May 31, 2013. A diphtheria case was defined as a respiratory illness consisting of pharyngitis, tonsillitis, or laryngitis, and an adherent tonsillar or nasopharyngeal pseudomembrane. To identify potential risk factors for diphtheria, we conducted a retrospective case-control study with two aged-matched neighborhood controls per case-patient in Houaphan Province, using bivariate analysis to calculate matched odds ratio (mOR) with 95% confidence intervals (CI). Reasons for non-vaccination among unvaccinated persons were assessed. Sixty-two clinical cases of diphtheria and 12 diphtheria-related deaths were reported in seven of 17 provinces. Among case-patients, 43 (69%) were diphtheria case-patients from Houaphan province and 79 matched-controls were enrolled. Five (12%) case-patients and 20 (25%) controls had received DTP3 (mOR=0.4, CI=0.1-1.7). No diphtheria toxoid-containing vaccine was received by 20 (48%) case-patients and 38 (46%) controls. Among case-patients and controls with no DTP dose, 43% of case-patients and 40% of controls lacked access to routine immunization services. Suboptimal DTP3 coverage likely caused the outbreak. To prevent continued outbreaks, access to routine immunization services should be strengthened, outreach visits need to be increased, and missed opportunities need to be minimized. In the short term, to rapidly increase population immunity, three rounds of DTP immunization campaign should be completed, targeting children aged 0-14years in affected provinces. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Cost-Analysis of Seven Nosocomial Outbreaks in an Academic Hospital.

    Science.gov (United States)

    Dik, Jan-Willem H; Dinkelacker, Ariane G; Vemer, Pepijn; Lo-Ten-Foe, Jerome R; Lokate, Mariëtte; Sinha, Bhanu; Friedrich, Alex W; Postma, Maarten J

    2016-01-01

    Nosocomial outbreaks, especially with (multi-)resistant microorganisms, are a major problem for health care institutions. They can cause morbidity and mortality for patients and controlling these costs substantial amounts of funds and resources. However, how much is unclear. This study sets out to provide a comparable overview of the costs of multiple outbreaks in a single academic hospital in the Netherlands. Based on interviews with the involved staff, multiple databases and stored records from the Infection Prevention Division all actions undertaken, extra staff employment, use of resources, bed-occupancy rates, and other miscellaneous cost drivers during different outbreaks were scored and quantified into Euros. This led to total costs per outbreak and an estimated average cost per positive patient per outbreak day. Seven outbreaks that occurred between 2012 and 2014 in the hospital were evaluated. Total costs for the hospital ranged between €10,778 and €356,754. Costs per positive patient per outbreak day, ranged between €10 and €1,369 (95% CI: €49-€1,042), with a mean of €546 and a median of €519. Majority of the costs (50%) were made because of closed beds. This analysis is the first to give a comparable overview of various outbreaks, caused by different microorganisms, in the same hospital and all analyzed with the same method. It shows a large variation within the average costs due to different factors (e.g. closure of wards, type of ward). All outbreaks however cost considerable amounts of efforts and money (up to €356,754), including missed revenue and control measures.

  14. Cost-Analysis of Seven Nosocomial Outbreaks in an Academic Hospital.

    Directory of Open Access Journals (Sweden)

    Jan-Willem H Dik

    Full Text Available Nosocomial outbreaks, especially with (multi-resistant microorganisms, are a major problem for health care institutions. They can cause morbidity and mortality for patients and controlling these costs substantial amounts of funds and resources. However, how much is unclear. This study sets out to provide a comparable overview of the costs of multiple outbreaks in a single academic hospital in the Netherlands.Based on interviews with the involved staff, multiple databases and stored records from the Infection Prevention Division all actions undertaken, extra staff employment, use of resources, bed-occupancy rates, and other miscellaneous cost drivers during different outbreaks were scored and quantified into Euros. This led to total costs per outbreak and an estimated average cost per positive patient per outbreak day.Seven outbreaks that occurred between 2012 and 2014 in the hospital were evaluated. Total costs for the hospital ranged between €10,778 and €356,754. Costs per positive patient per outbreak day, ranged between €10 and €1,369 (95% CI: €49-€1,042, with a mean of €546 and a median of €519. Majority of the costs (50% were made because of closed beds.This analysis is the first to give a comparable overview of various outbreaks, caused by different microorganisms, in the same hospital and all analyzed with the same method. It shows a large variation within the average costs due to different factors (e.g. closure of wards, type of ward. All outbreaks however cost considerable amounts of efforts and money (up to €356,754, including missed revenue and control measures.

  15. The gut microbiome as a target for prevention and treatment of hyperglycaemia in type 2 diabetes: from current human evidence to future possibilities.

    Science.gov (United States)

    Brunkwall, Louise; Orho-Melander, Marju

    2017-06-01

    The totality of microbial genomes in the gut exceeds the size of the human genome, having around 500-fold more genes that importantly complement our coding potential. Microbial genes are essential for key metabolic processes, such as the breakdown of indigestible dietary fibres to short-chain fatty acids, biosynthesis of amino acids and vitamins, and production of neurotransmitters and hormones. During the last decade, evidence has accumulated to support a role for gut microbiota (analysed from faecal samples) in glycaemic control and type 2 diabetes. Mechanistic studies in mice support a causal role for gut microbiota in metabolic diseases, although human data favouring causality is insufficient. As it may be challenging to sort the human evidence from the large number of animal studies in the field, there is a need to provide a review of human studies. Thus, the aim of this review is to cover the current and future possibilities and challenges of using the gut microbiota, with its capacity to be modified, in the development of preventive and treatment strategies for hyperglycaemia and type 2 diabetes in humans. We discuss what is known about the composition and functionality of human gut microbiota in type 2 diabetes and summarise recent evidence of current treatment strategies that involve, or are based on, modification of gut microbiota (diet, probiotics, metformin and bariatric surgery). We go on to review some potential future gut-based glucose-lowering approaches involving microbiota, including the development of personalised nutrition and probiotic approaches, identification of therapeutic components of probiotics, targeted delivery of propionate in the proximal colon, targeted delivery of metformin in the lower gut, faecal microbiota transplantation, and the incorporation of genetically modified bacteria that express therapeutic factors into microbiota. Finally, future avenues and challenges for understanding the interplay between human nutrition, genetics

  16. Tactics and Strategies for Managing Ebola Outbreaks and the Salience of Immunization

    Directory of Open Access Journals (Sweden)

    Wayne M. Getz

    2015-01-01

    Full Text Available We present a stochastic transmission chain simulation model for Ebola viral disease (EVD in West Africa, with the salutary result that the virus may be more controllable than previously suspected. The ongoing tactics to detect cases as rapidly as possible and isolate individuals as safely as practicable is essential to saving lives in the current outbreaks in Guinea, Liberia, and Sierra Leone. Equally important are educational campaigns that reduce contact rates between susceptible and infectious individuals in the community once an outbreak occurs. However, due to the relatively low R0 of Ebola (around 1.5 to 2.5 next generation cases are produced per current generation case in naïve populations, rapid isolation of infectious individuals proves to be highly efficacious in containing outbreaks in new areas, while vaccination programs, even with low efficacy vaccines, can be decisive in curbing future outbreaks in areas where the Ebola virus is maintained in reservoir populations.

  17. Tactics and strategies for managing Ebola outbreaks and the salience of immunization.

    Science.gov (United States)

    Getz, Wayne M; Gonzalez, Jean-Paul; Salter, Richard; Bangura, James; Carlson, Colin; Coomber, Moinya; Dougherty, Eric; Kargbo, David; Wolfe, Nathan D; Wauquier, Nadia

    2015-01-01

    We present a stochastic transmission chain simulation model for Ebola viral disease (EVD) in West Africa, with the salutary result that the virus may be more controllable than previously suspected. The ongoing tactics to detect cases as rapidly as possible and isolate individuals as safely as practicable is essential to saving lives in the current outbreaks in Guinea, Liberia, and Sierra Leone. Equally important are educational campaigns that reduce contact rates between susceptible and infectious individuals in the community once an outbreak occurs. However, due to the relatively low R 0 of Ebola (around 1.5 to 2.5 next generation cases are produced per current generation case in naïve populations), rapid isolation of infectious individuals proves to be highly efficacious in containing outbreaks in new areas, while vaccination programs, even with low efficacy vaccines, can be decisive in curbing future outbreaks in areas where the Ebola virus is maintained in reservoir populations.

  18. Progression of Ebola Therapeutics During the 2014-2015 Outbreak.

    Science.gov (United States)

    Mendoza, Emelissa J; Qiu, Xiangguo; Kobinger, Gary P

    2016-02-01

    The recent Ebola virus (EBOV) outbreak in West Africa was the deadliest EBOV epidemic in history, highlighting the need for a safe and efficacious treatment against EBOV disease (EVD). In the absence of an approved treatment, experimental drugs were utilized under compassionate grounds hoping to diminish EVD-associated morbidity and mortality. As more data were collected from safety studies, Phase II/III clinical trials were introduced in Guinea, Sierra Leone, and Liberia to test promising candidates, including small-molecule drugs, RNA-based treatments, and antibody-based therapies. In this review, we summarize the use of, and preliminary observations from, current clinical trials with EVD therapeutics, shedding light on experimental drug selection, emergency clinical evaluation, and the impact these factors may have on future infectious disease outbreaks. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  19. A Comment on “Management for Mountain Pine Beetle Outbreak Suppression: Does Relevant Science Support Current Policy?”

    Directory of Open Access Journals (Sweden)

    Christopher J. Fettig

    2014-04-01

    Full Text Available There are two general approaches for reducing the negative impacts of mountain pine beetle, Dendroctonus ponderosae Hopkins, on forests. Direct control involves short-term tactics designed to address current infestations by manipulating mountain pine beetle populations, and includes the use of fire, insecticides, semiochemicals, sanitation harvests, or a combination of these treatments. Indirect control is preventive, and designed to reduce the probability and severity of future infestations within treated areas by manipulating stand, forest and/or landscape conditions by reducing the number of susceptible host trees through thinning, prescribed burning, and/or alterations of age classes and species composition. We emphasize that “outbreak suppression” is not the intent or objective of management strategies implemented for mountain pine beetle in the western United States, and that the use of clear, descriptive language is important when assessing the merits of various treatment strategies.

  20. Ebola hemorrhagic fever outbreaks: strategies for effective epidemic management, containment and control.

    Science.gov (United States)

    Matua, Gerald Amandu; Van der Wal, Dirk Mostert; Locsin, Rozzano C

    2015-01-01

    Ebola hemorrhagic fever, caused by the highly virulent RNA virus of the filoviridae family, has become one of the world's most feared pathogens. The virus induces acute fever and death, often associated with hemorrhagic symptoms in up to 90% of infected patients. The known sub-types of the virus are Zaire, Sudan, Taï Forest, Bundibugyo and Reston Ebola viruses. In the past, outbreaks were limited to the East and Central African tropical belt with the exception of Ebola Reston outbreaks that occurred in animal facilities in the Philippines, USA and Italy. The on-going outbreak in West Africa that is causing numerous deaths and severe socio-economic challenges has resulted in widespread anxiety globally. This panic may be attributed to the intense media interest, the rapid spread of the virus to other countries like United States and Spain, and moreover, to the absence of an approved treatment or vaccine. Informed by this widespread fear and anxiety, we analyzed the commonly used strategies to manage and control Ebola outbreaks and proposed new approaches that could improve epidemic management and control during future outbreaks. We based our recommendations on epidemic management practices employed during recent outbreaks in East, Central and West Africa, and synthesis of peer-reviewed publications as well as published "field" information from individuals and organizations recently involved in the management of Ebola epidemics. The current epidemic management approaches are largely "reactive", with containment efforts aimed at halting spread of existing outbreaks. We recommend that for better outcomes, in addition to "reactive" interventions, "pre-emptive" strategies also need to be instituted. We conclude that emphasizing both "reactive" and "pre-emptive" strategies is more likely to lead to better epidemic preparedness and response at individual, community, institutional, and government levels, resulting in timely containment of future Ebola outbreaks. Copyright

  1. Outbreaks of infections associated with drug diversion by US health care personnel.

    Science.gov (United States)

    Schaefer, Melissa K; Perz, Joseph F

    2014-07-01

    To summarize available information about outbreaks of infections stemming from drug diversion in US health care settings and describe recommended protocols and public health actions. We reviewed records at the Centers for Disease Control and Prevention related to outbreaks of infections from drug diversion by health care personnel in US health care settings from January 1, 2000, through December 31, 2013. Searches of the medical literature published during the same period were also conducted using PubMed. Information compiled included health care setting(s), infection type(s), specialty of the implicated health care professional, implicated medication(s), mechanism(s) of diversion, number of infected patients, number of patients with potential exposure to blood-borne pathogens, and resolution of the investigation. We identified 6 outbreaks over a 10-year period beginning in 2004; all occurred in hospital settings. Implicated health care professionals included 3 technicians and 3 nurses, one of whom was a nurse anesthetist. The mechanism by which infections were spread was tampering with injectable controlled substances. Two outbreaks involved tampering with opioids administered via patient-controlled analgesia pumps and resulted in gram-negative bacteremia in 34 patients. The remaining 4 outbreaks involved tampering with syringes or vials containing fentanyl; hepatitis C virus infection was transmitted to 84 patients. In each of these outbreaks, the implicated health care professional was infected with hepatitis C virus and served as the source; nearly 30,000 patients were potentially exposed to blood-borne pathogens and targeted for notification advising testing. These outbreaks revealed gaps in prevention, detection, and response to drug diversion in US health care facilities. Drug diversion is best prevented by health care facilities having strong narcotics security measures and active monitoring systems. Appropriate response includes assessment of harm to

  2. A local outbreak of dengue caused by an imported case in Dongguan China

    Directory of Open Access Journals (Sweden)

    Peng Hong-Juan

    2012-01-01

    Full Text Available Abstract Background Dengue, a mosquito-borne febrile viral disease, is found in tropical and sub-tropical regions around the world. Since the first occurrence of dengue was confirmed in Guangdong, China in 1978, dengue outbreaks have been reported sequentially in different provinces in South China transmitted by.peridomestic Ae. albopictus mosquitoes, diplaying Ae. aegypti, a fully domestic vector that transmits dengue worldwide. Rapid and uncontrolled urbanization is a characteristic change in developing countries, which impacts greatly on vector habitat, human lifestyle and transmission dynamics on dengue epidemics. In September 2010, an outbreak of dengue was detected in Dongguan, a city in Guangdong province characterized by its fast urbanization. An investigation was initiated to identify the cause, to describe the epidemical characteristics of the outbreak, and to implement control measures to stop the outbreak. This is the first report of dengue outbreak in Dongguan, even though dengue cases were documented before in this city. Methods Epidemiological data were obtained from local Center of Disease Control and prevention (CDC. Laboratory tests such as real-time Reverse Transcription Polymerase Chain Reaction (RT-PCR, the virus cDNA sequencing, and Enzyme-Linked immunosorbent assay (ELISA were employed to identify the virus infection and molecular phylogenetic analysis was performed with MEGA5. The febrile cases were reported every day by the fever surveillance system. Vector control measures including insecticidal fogging and elimination of habitats of Ae. albopictus were used to control the dengue outbreak. Results The epidemiological studies results showed that this dengue outbreak was initiated by an imported case from Southeast Asia. The outbreak was characterized by 31 cases reported with an attack rate of 50.63 out of a population of 100,000. Ae. albopictus was the only vector species responsible for the outbreak. The virus c

  3. Assessment of the response to cholera outbreaks in two districts in Ghana.

    Science.gov (United States)

    Ohene, Sally-Ann; Klenyuie, Wisdom; Sarpeh, Mark

    2016-11-02

    community knowledge about cholera preventive measures. The assessment of the cholera outbreak response in the two districts highlighted strengths in the epidemic control activities. There was however need to strengthen preparedness especially in the area of improving community surveillance and awareness about cholera prevention and the importance of seeking prompt treatment in health facilities in the event of an outbreak.

  4. Yellow Fever in Africa: Estimating the Burden of Disease and Impact of Mass Vaccination from Outbreak and Serological Data

    Science.gov (United States)

    Garske, Tini; Van Kerkhove, Maria D.; Yactayo, Sergio; Ronveaux, Olivier; Lewis, Rosamund F.; Staples, J. Erin; Perea, William; Ferguson, Neil M.

    2014-01-01

    Background Yellow fever is a vector-borne disease affecting humans and non-human primates in tropical areas of Africa and South America. While eradication is not feasible due to the wildlife reservoir, large scale vaccination activities in Africa during the 1940s to 1960s reduced yellow fever incidence for several decades. However, after a period of low vaccination coverage, yellow fever has resurged in the continent. Since 2006 there has been substantial funding for large preventive mass vaccination campaigns in the most affected countries in Africa to curb the rising burden of disease and control future outbreaks. Contemporary estimates of the yellow fever disease burden are lacking, and the present study aimed to update the previous estimates on the basis of more recent yellow fever occurrence data and improved estimation methods. Methods and Findings Generalised linear regression models were fitted to a dataset of the locations of yellow fever outbreaks within the last 25 years to estimate the probability of outbreak reports across the endemic zone. Environmental variables and indicators for the surveillance quality in the affected countries were used as covariates. By comparing probabilities of outbreak reports estimated in the regression with the force of infection estimated for a limited set of locations for which serological surveys were available, the detection probability per case and the force of infection were estimated across the endemic zone. The yellow fever burden in Africa was estimated for the year 2013 as 130,000 (95% CI 51,000–380,000) cases with fever and jaundice or haemorrhage including 78,000 (95% CI 19,000–180,000) deaths, taking into account the current level of vaccination coverage. The impact of the recent mass vaccination campaigns was assessed by evaluating the difference between the estimates obtained for the current vaccination coverage and for a hypothetical scenario excluding these vaccination campaigns. Vaccination campaigns

  5. Yellow Fever in Africa: estimating the burden of disease and impact of mass vaccination from outbreak and serological data.

    Science.gov (United States)

    Garske, Tini; Van Kerkhove, Maria D; Yactayo, Sergio; Ronveaux, Olivier; Lewis, Rosamund F; Staples, J Erin; Perea, William; Ferguson, Neil M

    2014-05-01

    Yellow fever is a vector-borne disease affecting humans and non-human primates in tropical areas of Africa and South America. While eradication is not feasible due to the wildlife reservoir, large scale vaccination activities in Africa during the 1940s to 1960s reduced yellow fever incidence for several decades. However, after a period of low vaccination coverage, yellow fever has resurged in the continent. Since 2006 there has been substantial funding for large preventive mass vaccination campaigns in the most affected countries in Africa to curb the rising burden of disease and control future outbreaks. Contemporary estimates of the yellow fever disease burden are lacking, and the present study aimed to update the previous estimates on the basis of more recent yellow fever occurrence data and improved estimation methods. Generalised linear regression models were fitted to a dataset of the locations of yellow fever outbreaks within the last 25 years to estimate the probability of outbreak reports across the endemic zone. Environmental variables and indicators for the surveillance quality in the affected countries were used as covariates. By comparing probabilities of outbreak reports estimated in the regression with the force of infection estimated for a limited set of locations for which serological surveys were available, the detection probability per case and the force of infection were estimated across the endemic zone. The yellow fever burden in Africa was estimated for the year 2013 as 130,000 (95% CI 51,000-380,000) cases with fever and jaundice or haemorrhage including 78,000 (95% CI 19,000-180,000) deaths, taking into account the current level of vaccination coverage. The impact of the recent mass vaccination campaigns was assessed by evaluating the difference between the estimates obtained for the current vaccination coverage and for a hypothetical scenario excluding these vaccination campaigns. Vaccination campaigns were estimated to have reduced the

  6. Outbreak-related mumps vaccine effectiveness among a cohort of children and of young adults in Germany 2011.

    Science.gov (United States)

    Takla, Anja; Böhmer, Merle M; Klinc, Christina; Kurz, Norbert; Schaffer, Alice; Stich, Heribert; Stöcker, Petra; Wichmann, Ole; Koch, Judith

    2014-01-01

    Mumps outbreaks in populations with high 2-dose vaccination coverage and among young adults are increasingly reported. However, data on the duration of vaccine-induced protection conferred by mumps vaccines are scarce. As part of a supra-regional outbreak in Germany 2010/11, we conducted two retrospective cohort studies in a primary school and among adult ice hockey teams to determine mumps vaccine effectiveness (VE). Via questionnaires we collected information on demography, clinical manifestations, and reviewed vaccination cards. We estimated VE as 1-RR, RR being the rate ratio of disease among two-times or one-time mumps-vaccinated compared with unvaccinated persons. The response rate was 92.6% (100/108--children cohort) and 91.7% (44/48--adult cohort). Fourteen cases were identified in the children and 6 in the adult cohort. In the children cohort (mean age: 9 y), 2-dose VE was 91.9% (95% CI 81.0-96.5%). In the adult cohort (mean age: 26 y), no cases occurred among the 13 2-times vaccinated, while 1-dose VE was 50.0% (95% CI -9.4-87.1%). Average time since last vaccination showed no significant difference for cases and non-cases, but cases were younger at age of last mumps vaccination (children cohort: 2 vs. 3 y, P=0.04; adult cohort: 1 vs. 4 y, P=0.03). We did not observe signs of waning immunity in the children cohort. Due to the small sample size VE in the adult cohort should be interpreted with caution. Given the estimated VE, very high 2-dose vaccination coverage is required to prevent future outbreaks. Intervention efforts to increase coverage must especially target young adults who received<2 vaccinations during childhood.

  7. Hazard analysis of critical control points assessment as a tool to respond to emerging infectious disease outbreaks.

    Directory of Open Access Journals (Sweden)

    Kelly L Edmunds

    Full Text Available Highly pathogenic avian influenza virus (HPAI strain H5N1 has had direct and indirect economic impacts arising from direct mortality and control programmes in over 50 countries reporting poultry outbreaks. HPAI H5N1 is now reported as the most widespread and expensive zoonotic disease recorded and continues to pose a global health threat. The aim of this research was to assess the potential of utilising Hazard Analysis of Critical Control Points (HACCP assessments in providing a framework for a rapid response to emerging infectious disease outbreaks. This novel approach applies a scientific process, widely used in food production systems, to assess risks related to a specific emerging health threat within a known zoonotic disease hotspot. We conducted a HACCP assessment for HPAI viruses within Vietnam's domestic poultry trade and relate our findings to the existing literature. Our HACCP assessment identified poultry flock isolation, transportation, slaughter, preparation and consumption as critical control points for Vietnam's domestic poultry trade. Introduction of the preventative measures highlighted through this HACCP evaluation would reduce the risks posed by HPAI viruses and pressure on the national economy. We conclude that this HACCP assessment provides compelling evidence for the future potential that HACCP analyses could play in initiating a rapid response to emerging infectious diseases.

  8. Outbreak of syphilis in men who have sex with men living in rural North Wales (UK) associated with the use of social media.

    Science.gov (United States)

    Thomas, Daniel Rh; Williams, Christopher J; Andrady, Ushan; Anderson, Valerie; Humphreys, Sioned; Midgley, Claire M; Fina, Laia; Craine, Noel; Porter-Jones, Gary; Wilde, Alison; Whiteside, Chris

    2016-08-01

    To describe an outbreak of infectious syphilis in rural North Wales and the control measures implemented. Following reports of an increase of syphilis in North Wales, a multidisciplinary Outbreak Control Team (OCT) was established. A multilevel prevention and control response was initiated, including: active case surveillance, partner notification and treatment, sexual network analysis, awareness raising with professionals and affected communities, point-of-care syphilis testing at a sauna and a health promotion campaign targeting users of men who have sex with men (MSM) social network mobile phone applications (apps). Four cases of infectious syphilis were diagnosed in clinics in North Wales per 100 000 population in 2013 compared with a mean of one case per 100 000 in the preceding decade. Diagnosed cases peaked in January 2014, declining in the first half of 2014. Initial cases were clustered in the westerly rural counties of North Wales and were predominantly white men, self-reporting as MSM (median age: 34 years, range: 17-61). Point-of-care testing at a sauna did not identity further new infections, suggesting that the cluster was relatively focused and had probably been detected early. The use of apps to find sexual partners was a feature of the network affected. A health promotion campaign, initiated by the OCT, targeting men using MSM apps reached 92% of the 755 men messaged. The outbreak was successfully controlled. However, it is difficult to determine which of the interventions implemented were most effective. Future outbreaks should be used as an opportunity to evaluate interventions using apps. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  9. An outbreak investigation of congenital rubella syndrome in Solomon Islands, 2013

    Directory of Open Access Journals (Sweden)

    Kara N Durski

    2016-02-01

    Full Text Available Introduction: During May 2012, a rubella outbreak was declared in Solomon Islands. A suspected case of congenital rubella syndrome (CRS was reported from one hospital 11 months later in 2013. This report describes the subsequent CRS investigation, findings and measures implemented. Methods: Prospective CRS surveillance was conducted at the newborn nursery, paediatric and post-natal wards, and the paediatric cardiology and ophthalmology clinics of the study hospital from April to July 2013. Retrospective case finding by reviewing medical records was also undertaken to identify additional cases born between January and March 2013 for the same wards and clinics. Cases were identified using established World Health Organization case definitions for CRS. Results: A total of 13 CRS cases were identified, including two laboratory-confirmed, four clinically confirmed and seven suspected cases. Five CRS cases were retrospectively identified, including four suspected and one clinically confirmed case. There was no geospatial clustering of residences. The mothers of the cases were aged between 20 and 36 years. Three of the six mothers available for interview recalled an acute illness with rash during the first trimester of pregnancy. Discussion: Additional CRS cases not captured in this investigation are likely. Caring for CRS cases is a challenge in resource-poor settings. Rubella vaccination is safe and effective and can prevent the serious consequences of CRS. Well-planned and funded vaccination activities can prevent future CRS cases.

  10. Measles Outbreak among Unvaccinated Children in Bajura

    Directory of Open Access Journals (Sweden)

    S Sitaula

    2010-12-01

    CFR of this outbreak is higher than the national CFR. Vaccine efficacy of 50% points towards the need for investigation of vaccine logistics and cold chain system. Moreover, this laboratory test confirmed an outbreak showing that the measles virus could be imported from an endemic region and rapidly spread through a susceptible population who were previously not immunized.

  11. Molecular Diagnostic Analysis of Outbreak Scenarios

    Science.gov (United States)

    Morsink, M. C.; Dekter, H. E.; Dirks-Mulder, A.; van Leeuwen, W. B.

    2012-01-01

    In the current laboratory assignment, technical aspects of the polymerase chain reaction (PCR) are integrated in the context of six different bacterial outbreak scenarios. The "Enterobacterial Repetitive Intergenic Consensus Sequence" (ERIC) PCR was used to analyze different outbreak scenarios. First, groups of 2-4 students determined optimal…

  12. MRSA outbreak at a transplantation unit

    Directory of Open Access Journals (Sweden)

    RMC Romanelli

    Full Text Available Methicillin-resistant Staphylococcus aureus (MRSA infections frequently complicate the post-operative course of transplant recipients, and despite nasal carriage and endemic colonization, MRSA outbreaks are not commonly described. This study reports a case of MRSA outbreak and discusses infection control measures and recommendations for this situation.

  13. The biennial cycle of respiratory syncytial virus outbreaks in Croatia

    Directory of Open Access Journals (Sweden)

    Drazenovic Vladimir

    2008-01-01

    Full Text Available Abstract The paper analyses the epidemic pattern of respiratory syncytial virus (RSV outbreaks in children in Croatia. Over a period of 11 consecutive winter seasons (1994–2005 3,435 inpatients from Zagreb County aged from infancy to 10 years who were hospitalised with acute respiratory tract infections were tested for RSV-infection. RSV was identified in nasopharyngeal secretions of patients by virus isolation in cell culture and by detection of viral antigen with monoclonal antibodies. In the Zagreb area, RSV outbreaks were proven to vary in a two-year cycle, which was repeated every 23–25 months. This biennial cycle comprised one larger and one smaller season. Climate factors correlated significantly with the number of RSV cases identified only in the large seasons, which suggests that the biennial cycle is likely to continue regardless of meteorological conditions. Knowledge of this biennial pattern should be useful in predicting the onset of RSV outbreaks in Croatia, and would facilitate planning for the prevention and control of RSV infections in the region.

  14. Strengthening epidemiologic investigation of infectious diseases in Korea: lessons from the Middle East Respiratory Syndrome outbreak

    Directory of Open Access Journals (Sweden)

    Changhwan Lee

    2015-09-01

    Full Text Available The recent outbreak of Middle East Respiratory Syndrome (MERS coronavirus infection in Korea resulted in large socioeconomic losses. This provoked the Korean government and the general public to recognize the importance of having a well-established system against infectious diseases. Although epidemiologic investigation is one of the most important aspects of prevention, it has been pointed out that much needs to be improved in Korea. We review here the current status of the Korean epidemiologic service and suggest possible supplementation measures. We examine the current national preventive infrastructure, including human resources such as Epidemic Intelligence Service officers, its governmental management, and related policies. In addition, we describe the practical application of these resources to the recent MERS outbreak and the progress in preventive measures. The spread of MERS demonstrated that the general readiness for emerging infectious diseases in Korea is considerably low. We believe that it is essential to increase society’s investment in disease prevention. Fostering public health personnel, legislating management policies, and establishing research centers for emerging infectious diseases are potential solutions. Evaluating international preventive systems, developing cooperative measures, and initiating improvements are necessary. We evaluated the Korean epidemiologic investigation system and the public preventive measures against infectious diseases in light of the recent MERS outbreak. We suggest that governmental authorities in Korea enforce preventive policies, foster the development of highly qualified personnel, and increase investment in the public health domain of infectious disease prevention.

  15. Salmonella outbreak among railway and airline passengers.

    Science.gov (United States)

    Hatakka, M

    1992-01-01

    A widespread outbreak by Salmonella infantis, infecting a total of 226 people, occurred in Finland at the beginning of August 1986. Of those infected, 107 were railway passengers, 91 were airline passengers and 28 were employed in a food processing establishment. The outbreak among the railway passengers was caused by egg sandwiches, the airline passengers were infected by a meal served on board and the catering employees by the breakfast served in the establishment. The outbreak was caused by food prepared in the establishment's kitchen. The employees' breakfasts had probably been contaminated by an employee who was a symptom-free Salmonella infantis carrier, and a number of the employees subsequently became infected, leading to widespread contamination of the food prepared in the establishment. The spread of the outbreak was further influenced by a heatwave at the time and by shortcomings in the cold storage facilities. The kitchen's hygiene supervision and the quality control of its output were reorganized after the outbreak.

  16. Lungworm outbreaks in adult dairy cows: estimating economic losses and lessons to be learned.

    Science.gov (United States)

    Holzhauer, M; van Schaik, G; Saatkamp, H W; Ploeger, H W

    2011-11-05

    Two lungworm outbreaks in dairy herds were investigated in order to estimate the resulting economic costs. On the two farms, with 110 and 95 cows, total costs were estimated at €159 and €167 per cow, respectively. Overall, milk production reduced by 15 to 20 per cent during the outbreaks. Five cows died on one farm, while on the other farm seven cows died as a result of the lungworm outbreak. On one farm, 51.7 per cent of the total costs was due to reduced milk production and 33.1 per cent was due to disposal of dead animals. On the other farm, it was 36.3 and 50.9 per cent, respectively. The remaining 13 to 15 per cent of the total costs were due to extra inseminations, laboratory diagnosis and treatments. The history and development of the outbreaks are described. One lesson from these outbreaks is that recognising that potentially lungworm-naïve animals are to be introduced into the adult herd allows for timely measures (for example, vaccination) to prevent a lungworm outbreak.

  17. Large multistate outbreak of norovirus gastroenteritis associated with frozen strawberries, Germany, 2012.

    Science.gov (United States)

    Bernard, H; Faber, M; Wilking, H; Haller, S; Höhle, M; Schielke, A; Ducomble, T; Siffczyk, C; Merbecks, S S; Fricke, G; Hamouda, O; Stark, K; Werber, D

    2014-02-27

    From 20 September through 5 October 2012, the largest recorded food-borne outbreak in Germany occurred. Norovirus was identified as the causative agent. We conducted four analytical epidemiological studies, two case–control studies and two surveys (in total 150 cases) in secondary schools in three different federal states. Overall, 390 institutions in five federal states reported nearly 11,000 cases of gastroenteritis. They were predominantly schools and childcare facilities and were supplied almost exclusively by one large catering company. The analytical epidemiological studies consistently identified dishes containing strawberries as the most likely vehicle, with estimated odds ratios ranging from 2.6 to 45.4. The dishes had been prepared in different regional kitchens of the catering company and were served in the schools two days before the peaks of the respective outbreaks. All affected institutions had received strawberries of one lot, imported frozen from China. The outbreak vehicle was identified within a week, which led to a timely recall and prevented more than half of the lot from reaching the consumer. This outbreak exemplifies the risk of large outbreaks in the era of global food trade. It underlines the importance of timely surveillance and epidemiological outbreak investigations for food safety.

  18. Using typing techniques in a specific outbreak: the ethical reflection of public health professionals.

    Science.gov (United States)

    Rump, B; Cornelis, C; Woonink, F; VAN Steenbergen, J; Verweij, M; Hulscher, M

    2017-05-01

    Typing techniques are laboratory methods used in outbreak management to investigate the degree to which microbes found within an outbreak are related. Knowledge about relational patterns between microbes benefits outbreak management, but inevitably also tells us something about the relational patterns of the people hosting them. Since the technique is often used without explicit consent of all individuals involved, this may raise ethical questions. The aim of this study was to unravel the complex ethical deliberation of professionals over the use of such techniques. We organised group discussions (n = 3) with Dutch outbreak managers (n = 23). The topic list was based on previously identified ethical issues and discussions were analysed for recurrent themes. We found that outbreak managers first and foremost reflect on the balance of individual harm with public health benefit. This key question was approached by way of discussing four more specific ethical themes: (1) justification of governmental intervention, (2) responsibility to prevent infections, (3) scientific uncertainty and (4) legal consequences. The themes found in this study, rephrased into accessible questions, represent the shared ethical understanding of professionals and can help to articulate the ethical dimensions of using molecular science in response to infectious disease outbreaks.

  19. Management of animal botulism outbreaks: from clinical suspicion to practical countermeasures to prevent or minimize outbreaks

    NARCIS (Netherlands)

    Anniballi, F.; Fiore, A.; Löfström, Ch.; Skarin, H.; Auricchio, B.; Woudstra, C.; Bano, L.; Segerman, B.; Koene, M.G.J.

    2013-01-01

    Botulism is a severe neuroparalytic disease that affects humans, all warm-blooded animals, and some fishes. The disease is caused by exposure to toxins produced by Clostridium botulinum and other botulinum toxin–producing clostridia. Botulism in animals represents a severe environmental and economic

  20. Assessing the environmental health relevance of cooling towers--a systematic review of legionellosis outbreaks.

    Science.gov (United States)

    Walser, Sandra M; Gerstner, Doris G; Brenner, Bernhard; Höller, Christiane; Liebl, Bernhard; Herr, Caroline E W

    2014-03-01

    Bioaerosols from cooling towers are often suspected to cause community-acquired legionellosis outbreaks. Although Legionella infections can mostly be assigned to the emission sources, uncertainty exists about the release and distribution into the air, the occurrence of the respirable virulent form and the level of the infective concentration. Our study aimed to evaluate studies on legionellosis outbreaks attributed to cooling towers published within the last 11 years by means of a systematic review of the literature. 19 legionellosis outbreaks were identified affecting 12 countries. Recurring events were observed in Spain and Great Britain. In total, 1609 confirmed cases of legionellosis and a case-fatality rate of approximately 6% were reported. Duration of outbreaks was 65 days on average. For diagnosis the urinary antigen test was mainly used. Age, smoking, male sex and underlying diseases (diabetes, immunodeficiency) could be confirmed as risk factors. Smoking and underlying diseases were the most frequent risk factors associated with legionellosis in 11 and 10 of the 19 studies, respectively. The meteorological conditions varied strongly. Several studies reported a temporal association of outbreaks with inadequate maintenance of the cooling systems. A match of clinical and environmental isolates by serotyping and/or molecular subtyping could be confirmed in 84% of outbreaks. Legionella-contaminated cooling towers as environmental trigger, in particular in the neighbourhood of susceptible individuals, can cause severe health problems and even death. To prevent and control Legionella contamination of cooling towers, maintenance actions should focus on low-emission cleaning procedures of cooling towers combined with control measurements of water and air samples. Procedures allowing rapid detection and risk assessment in the case of outbreaks are essential for adequate public health measures. Systematic registration of cooling towers will facilitate the

  1. A comprehensive database of the geographic spread of past human Ebola outbreaks

    Science.gov (United States)

    Mylne, Adrian; Brady, Oliver J.; Huang, Zhi; Pigott, David M.; Golding, Nick; Kraemer, Moritz U.G.; Hay, Simon I.

    2014-01-01

    Ebola is a zoonotic filovirus that has the potential to cause outbreaks of variable magnitude in human populations. This database collates our existing knowledge of all known human outbreaks of Ebola for the first time by extracting details of their suspected zoonotic origin and subsequent human-to-human spread from a range of published and non-published sources. In total, 22 unique Ebola outbreaks were identified, composed of 117 unique geographic transmission clusters. Details of the index case and geographic spread of secondary and imported cases were recorded as well as summaries of patient numbers and case fatality rates. A brief text summary describing suspected routes and means of spread for each outbreak was also included. While we cannot yet include the ongoing Guinea and DRC outbreaks until they are over, these data and compiled maps can be used to gain an improved understanding of the initial spread of past Ebola outbreaks and help evaluate surveillance and control guidelines for limiting the spread of future epidemics. PMID:25984346

  2. A comprehensive database of the geographic spread of past human Ebola outbreaks.

    Science.gov (United States)

    Mylne, Adrian; Brady, Oliver J; Huang, Zhi; Pigott, David M; Golding, Nick; Kraemer, Moritz U G; Hay, Simon I

    2014-01-01

    Ebola is a zoonotic filovirus that has the potential to cause outbreaks of variable magnitude in human populations. This database collates our existing knowledge of all known human outbreaks of Ebola for the first time by extracting details of their suspected zoonotic origin and subsequent human-to-human spread from a range of published and non-published sources. In total, 22 unique Ebola outbreaks were identified, composed of 117 unique geographic transmission clusters. Details of the index case and geographic spread of secondary and imported cases were recorded as well as summaries of patient numbers and case fatality rates. A brief text summary describing suspected routes and means of spread for each outbreak was also included. While we cannot yet include the ongoing Guinea and DRC outbreaks until they are over, these data and compiled maps can be used to gain an improved understanding of the initial spread of past Ebola outbreaks and help evaluate surveillance and control guidelines for limiting the spread of future epidemics.

  3. Ebolavirus diagnosis made simple, comparable and faster than molecular detection methods: preparing for the future.

    Science.gov (United States)

    James, Ameh S; Todd, Shawn; Pollak, Nina M; Marsh, Glenn A; Macdonald, Joanne

    2018-04-23

    The 2014/2015 Ebolavirus outbreak resulted in more than 28,000 cases and 11,323 reported deaths, as of March 2016. Domestic transmission of the Guinea strain associated with the outbreak occurred mainly in six African countries, and international transmission was reported in four countries. Outbreak management was limited by the inability to rapidly diagnose infected cases. A further fifteen countries in Africa are predicted to be at risk of Ebolavirus outbreaks in the future as a consequence of climate change and urbanization. Early detection of cases and reduction of transmission rates is critical to prevent and manage future severe outbreaks. We designed a rapid assay for detection of Ebolavirus using recombinase polymerase amplification, a rapid isothermal amplification technology that can be combined with portable lateral flow detection technology. The developed rapid assay operates in 30 min and was comparable with real-time TaqMan™ PCR. Designed, screened, selected and optimized oligonucleotides using the NP coding region from Ebola Zaire virus (Guinea strain). We determined the analytical sensitivity of our Ebola rapid molecular test by testing selected primers and probe with tenfold serial dilutions (1.34 × 10 10-  1.34 × 10 1 copies/μL) of cloned NP gene from Mayinga strain of Zaire ebolavirus in pCAGGS vector, and serially diluted cultured Ebolavirus as established by real-time TaqMan™ PCR that was performed using ABI7500 in Fast Mode. We tested extracted and reverse transcribed RNA from cultured Zaire ebolavirus strains - Mayinga, Gueckedou C05, Gueckedou C07, Makona, Kissidougou and Kiwit. We determined the analytical specificity of our assay with related viruses: Marburg, Ebola Reston and Ebola Sudan. We further tested for Dengue virus 1-4, Plasmodium falciparum and West Nile Virus (Kunjin strain). The assay had a detection limit of 134 copies per μL of plasmid containing the NP gene of Ebolavirus Mayinga, and cultured Ebolavirus

  4. Legionnaires' Disease Outbreak Caused by Endemic Strain of Legionella pneumophila, New York, New York, USA, 2015.

    Science.gov (United States)

    Lapierre, Pascal; Nazarian, Elizabeth; Zhu, Yan; Wroblewski, Danielle; Saylors, Amy; Passaretti, Teresa; Hughes, Scott; Tran, Anthony; Lin, Ying; Kornblum, John; Morrison, Shatavia S; Mercante, Jeffrey W; Fitzhenry, Robert; Weiss, Don; Raphael, Brian H; Varma, Jay K; Zucker, Howard A; Rakeman, Jennifer L; Musser, Kimberlee A

    2017-11-01

    During the summer of 2015, New York, New York, USA, had one of the largest and deadliest outbreaks of Legionnaires' disease in the history of the United States. A total of 138 cases and 16 deaths were linked to a single cooling tower in the South Bronx. Analysis of environmental samples and clinical isolates showed that sporadic cases of legionellosis before, during, and after the outbreak could be traced to a slowly evolving, single-ancestor strain. Detection of an ostensibly virulent Legionella strain endemic to the Bronx community suggests potential risk for future cases of legionellosis in the area. The genetic homogeneity of the Legionella population in this area might complicate investigations and interpretations of future outbreaks of Legionnaires' disease.

  5. After the flood is before the next flood - post event review of the Central European Floods of June 2013. Insights, recommendations and next steps for future flood prevention

    Science.gov (United States)

    Szoenyi, Michael; Mechler, Reinhard; McCallum, Ian

    2015-04-01

    In early June 2013, severe flooding hit Central and Eastern Europe, causing extensive damage, in particular along the Danube and Elbe main watersheds. The situation was particularly severe in Eastern Germany, Austria, Hungary and the Czech Republic. Based on the Post Event Review Capability (PERC) approach, developed by Zurich Insurance's Flood Resilience Program to provide independent review of large flood events, we examine what has worked well (best practice) and opportunities for further improvement. The PERC overall aims to thoroughly examine aspects of flood resilience, flood risk management and catastrophe intervention in order to help build back better after events and learn for future events. As our research from post event analyses shows a lot of losses are in fact avoidable by taking the right measures pre-event and these measures are economically - efficient with a return of 4 Euro on losses saved for every Euro invested in prevention on average (Wharton/IIASA flood resilience alliance paper on cost benefit analysis, Mechler et al. 2014) and up to 10 Euros for certain countries. For the 2013 flood events we provide analysis on the following aspects and in general identify a number of factors that worked in terms of reducing the loss and risk burden. 1. Understanding risk factors of the Central European Floods 2013 We review the precursors leading up to the floods in June, with an extremely wet May 2013 and an atypical V-b weather pattern that brought immense precipitation in a very short period to the watersheds of Elbe, Donau and partially the Rhine in the D-A-CH countries and researched what happened during the flood and why. Key questions we asked revolve around which protection and risk reduction approaches worked well and which did not, and why. 2. Insights and recommendations from the post event review The PERC identified a number of risk factors, which need attention if risk is to be reduced over time. • Yet another "100-year flood" - risk

  6. Polio infrastructure strengthened disease outbreak preparedness and response in the WHO African Region.

    Science.gov (United States)

    Kouadio, Koffi; Okeibunor, Joseph; Nsubuga, Peter; Mihigo, Richard; Mkanda, Pascal

    2016-10-10

    The continuous deployments of polio resources, infrastructures and systems for responding to other disease outbreaks in many African countries has led to a number of lessons considered as best practice that need to be documented for strengthening preparedness and response activities in future outbreaks. We reviewed and documented the influence of polio best practices in outbreak preparedness and response in Angola, Nigeria and Ethiopia. Data from relevant programmes of the WHO African Region were also analyzed to demonstrate clearly the relative contributions of PEI resources and infrastructure to effective disease outbreak preparedness and response. Polio resources including, human, financial, and logistic, tool and strategies have tremendously contributed to responding to diseases outbreaks across the African region. In Angola, Nigeria and Ethiopia, many disease epidemics including Marburg Hemorrhagic fever, Dengue fever, Ebola Virus Diseases (EVD), Measles, Anthrax and Shigella have been controlled using existing polio Eradication Initiatives resources. Polio staffs are usually deployed in occasions to supports outbreak response activities (coordination, surveillance, contact tracing, case investigation, finance, data management, etc.). Polio logistics such vehicles, laboratories were also used in the response activities to other infectious diseases. Many polio tools including micro planning, dashboard, guidelines, SOPs on preparedness and response have also benefited to other epidemic-prone diseases. The Countries' preparedness and response plan to WPV importation as well as the Polio Emergency Operation Center models were successfully used to develop, strengthen and respond to many other diseases outbreak with the implication of partners and the strong leadership and ownership of governments. This review has important implications for WHO/AFRO initiative to strengthening and improving disease outbreak preparedness and responses in the African Region in respect

  7. A cholera outbreak in Alborz Province, Iran: a matched case-control study.

    Science.gov (United States)

    Moradi, Ghobad; Rasouli, Mohammad Aziz; Mohammadi, Parvin; Elahi, Elham; Barati, Hojatollah

    2016-01-01

    A total of 229 confirmed cholera cases were reported in Alborz Province during an outbreak that lasted from June 2011 to August 2011. This study aimed to identify potential sources of transmission in order to determine suitable interventions in similar outbreaks. In other words, the lessons learned from this retrospective study can be utilized to manage future similar outbreaks. An age-matched and sex-matched case-control study was conducted during the outbreak. For each case, two control subjects were selected from the neighborhood. A case of cholera was defined as a bacteriologically confirmed case with signs and symptoms of cholera. This study was conducted from June 14, 2011 through August 23, 2011. The data were analyzed by calculating odds ratios (ORs) using the logistic regression method. In this outbreak, 229 confirmed cholera cases were diagnosed. The following risk factors were found to be associated with cholera: consumption of unrefrigerated leftover food (OR, 3.05; 95% confidence interval [CI], 1.72 to 5.41), consumption of vegetables and fruits in the previous three days (OR, 2.75; 95% CI, 1.95 to 3.89), and a history of traveling in the previous five days (OR, 5.31; 95% CI, 2.21 to 9.72). Consumption of vegetables and fruits has remained an unresolved risk factor in cholera outbreaks in Iran in recent years. In order to reduce the risk of cholera, sanitary standards for fruits and vegetables should be observed at all points from production to consumption, the population should be educated regarding hygienic food storage during outbreaks, and sanitary standards should be maintained when traveling during cholera outbreaks.

  8. A cholera outbreak in Alborz Province, Iran: a matched case-control study

    Directory of Open Access Journals (Sweden)

    Ghobad Moradi

    2016-05-01

    Full Text Available OBJECTIVES: A total of 229 confirmed cholera cases were reported in Alborz Province during an outbreak that lasted from June 2011 to August 2011. This study aimed to identify potential sources of transmission in order to determine suitable interventions in similar outbreaks. In other words, the lessons learned from this retrospective study can be utilized to manage future similar outbreaks. METHODS: An age-matched and sex-matched case-control study was conducted during the outbreak. For each case, two control subjects were selected from the neighborhood. A case of cholera was defined as a bacteriologically confirmed case with signs and symptoms of cholera. This study was conducted from June 14, 2011 through August 23, 2011. The data were analyzed by calculating odds ratios (ORs using the logistic regression method. RESULTS: In this outbreak, 229 confirmed cholera cases were diagnosed. The following risk factors were found to be associated with cholera: consumption of unrefrigerated leftover food (OR, 3.05; 95% confidence interval [CI], 1.72 to 5.41, consumption of vegetables and fruits in the previous three days (OR, 2.75; 95% CI, 1.95 to 3.89, and a history of traveling in the previous five days (OR, 5.31; 95% CI, 2.21 to 9.72. CONCLUSIONS: Consumption of vegetables and fruits has remained an unresolved risk factor in cholera outbreaks in Iran in recent years. In order to reduce the risk of cholera, sanitary standards for fruits and vegetables should be observed at all points from production to consumption, the population should be educated regarding hygienic food storage during outbreaks, and sanitary standards should be maintained when traveling during cholera outbreaks.

  9. The Ebola Outbreak: Catalyzing a "Shift" in Global Health Governance?

    Science.gov (United States)

    Mackey, Tim K

    2016-11-24

    As the 2014 Ebola virus disease outbreak (EVD) transitions to its post-endemic phase, its impact on the future of global public health, particularly the World Health Organization (WHO), is the subject of continued debate. Criticism of WHO's performance grew louder in the outbreak's wake, placing this international health UN-specialized agency in the difficult position of navigating a complex series of reform recommendations put forth by different stakeholders. Decisions on WHO governance reform and the broader role of the United Nations could very well shape the future landscape of 21st century global health and how the international community responds to health emergencies. In order to better understand the implications of the EVD outbreak on global health and infectious disease governance, this debate article critically examines a series of reports issued by four high-level commissions/panels convened to specifically assess WHO's performance post-Ebola. Collectively, these recommendations add increasing complexity to the urgent need for WHO reform, a process that the agency must carry out in order to maintain its legitimacy. Proposals that garnered strong support included the formation of an independent WHO Centre for Emergency Preparedness and Response, the urgent need to increase WHO infectious disease funding and capacity, and establishing better operational and policy coordination between WHO, UN agencies, and other global health partners. The recommendations also raise more fundamental questions about restructuring the global health architecture, and whether the UN should play a more active role in global health governance. Despite the need for a fully modernized WHO, reform proposals recently announced by WHO fail to achieve the "evolution" in global health governance needed in order to ensure that global society is adequately protected against the multifaceted and increasingly complex nature of modern public health emergencies. Instead, the lasting

  10. Primary and secondary cases in Escherichia coli O157 outbreaks: a statistical analysis.

    LENUS (Irish Health Repository)

    Snedeker, Kate G

    2009-01-01

    category. CONCLUSION: Our analyses indicated that ~20% of E. coli O157 outbreak cases were the result of secondary spread, and that this spread is significantly influenced by age and modes of primary and secondary transmission, but not country. In particular, the results provide further data emphasising the importance of simple but effective preventive strategies, such as handwashing, that can reduce the risk of secondary spread, particularly amongst young children in nurseries.

  11. Epidemiology of pediatric burns and future prevention strategies-a study of 475 patients from a high-volume burn center in North India.

    Science.gov (United States)

    Dhopte, Amol; Tiwari, V K; Patel, Pankaj; Bamal, Rahul

    2017-01-01

    Pediatric burns have a long-term social impact. This is more apparent in a developing country such as India, where their incidence and morbidity are high. The aim of this study was to provide recent prospective epidemiological data on pediatric burns in India and to suggest future preventive strategies. Children up to 18 years old admitted to the Department of Burns, Plastic & Maxillofacial Surgery, VMMC & Safdarjung Hospital, New Delhi, between January and December 2014 were included in the study. Data regarding age, sex, etiology, total body surface area (TBSA), circumstances of injury, and clinical assessment were collected. The Mann-Whitney test or Kruskal-Wallis test or ANOVA was used to compare involved TBSA among various cohort groups accordingly. Univariate and multivariate linear regression analyses were used to determine the predictors of TBSA. There were a total of 475 patients involved in the study, including seven suicidal burns, all of whom were females with a mean age greater than the cohort average. Age, type of burns, mode of injury, presence or absence of inhalation injury, gender, and time of year (quarter) for admission were found to independently affect the TBSA involved. Electrical burns also formed an important number of presenting burn patients, mainly involving teenagers. Several societal issues have come forth, e.g., child marriage, child labor, and likely psychological problems among female children as suggested by a high incidence of suicidal burns. This study also highlights several issues such as overcrowding, lack of awareness, dangerous cooking practices, and improper use of kerosene oil. There is an emergent need to recognize the problems, formulate strategies, spread awareness, and ban or replace hazardous substances responsible for most burn accidents.

  12. Surveillance for waterborne disease and outbreaks associated with recreational water--United States, 2003-2004.

    Science.gov (United States)

    Dziuban, Eric J; Liang, Jennifer L; Craun, Gunther F; Hill, Vincent; Yu, Patricia A; Painter, John; Moore, Matthew R; Calderon, Rebecca L; Roy, Sharon L; Beach, Michael J

    2006-12-22

    .1%) of 2,698 illnesses. Forty-three (69.4%) WBDOs occurred at treated water venues, resulting in 2,446 (90.7%) cases of illness. The etiologic agent was confirmed in 44 (71.0%) of the 62 WBDOs, suspected in 15 (24.2%), and unidentified in three (4.8%). Twenty (32.3%) WBDOs had a bacterial etiology; 15 (24.2%), parasitic; six (9.7%), viral; and three (4.8%), chemical or toxin. Among the 30 gastroenteritis outbreaks, Cryptosporidium was confirmed as the causal agent in 11 (36.7%), and all except one of these outbreaks occurred in treated water venues where Cryptosporidium caused 55.6% (10/18) of the gastroenteritis outbreaks. In this report, 142 Vibrio illnesses (reported to the Cholera and Other Vibrio Illness Surveillance System) that were associated with recreational water exposure were analyzed separately. The most commonly reported species were Vibrio vulnificus, V. alginolyticus, and V. parahaemolyticus. V. vulnificus illnesses associated with recreational water exposure had the highest Vibrio illness hospitalization (87.2%) and mortality (12.8%) rates. The number of WBDOs summarized in this report and the trends in recreational water-associated disease and outbreaks are consistent with previous years. Outbreaks, especially the largest ones, are most likely to be associated with summer months, treated water venues, and gastrointestinal illness. Approximately 60% of illnesses reported for 2003-2004 were associated with the seven largest outbreaks (>100 cases). Deficiencies leading to WBDOs included problems with water quality, venue design, usage, and maintenance. CDC uses WBDO surveillance data to 1) identify the etiologic agents, types of aquatic venues, water-treatment systems, and deficiencies associated with outbreaks; 2) evaluate the adequacy of efforts (i.e., regulations and public awareness activities) to provide safe recreational water; and 3) establish public health prevention priorities that might lead to improved regulations and prevention measures at the

  13. Rift Valley fever: current challenges and future prospects

    Directory of Open Access Journals (Sweden)

    Himeidan YE

    2016-03-01

    Full Text Available Yousif E Himeidan Vector Control Unit, Africa Technical Research Centre, Vector Health International, Arusha, Tanzania Abstract: Rift Valley fever (RVF is a zoonotic, mosquito-borne viral disease that affects human health and causes significant losses in the livestock industry. Recent outbreaks have led to severe human infections with high mortality rates. There are many challenges to applying effective preventive and control measures, including weak infrastructure of health facilities, lack of capacity and support systems for field logistics and communication, access to global expert organizations, and insufficient information on the epidemiological and reservoir status of the RVF virus. The health systems in East African countries are underdeveloped, with gaps in adaptability to new, more accurate and rapid techniques, and well-trained staff that affect their capacity to monitor and evaluate the disease. Surveillance and response systems are inadequate in providing accurate information in a timely manner for decision making to deal with the scope of interrupting the disease transmission by applying mass animal vaccination, and other preventive measures at the early stage of an outbreak. The historical vaccines are unsuitable for use in newborn and gestating livestock, and the recent ones require a booster and annual revaccination. Future live-attenuated RVF vaccines should possess lower safety concerns regardless of the physiologic state of the animal, and provide rapid and long-term immunity after a single dose of vaccination. In the absence of an effective vaccination program, prevention and control measures must be immediately undertaken after an alert is generated. These measures include enforcing and adapting standard protocols for animal trade and movement, extensive vector control, safe disposal of infected animals, and modification of human–animal contact behavior. Directing control efforts on farmers and workers who deal with

  14. Biodiversity can help prevent malaria outbreaks in tropical forests.

    Directory of Open Access Journals (Sweden)

    Gabriel Zorello Laporta

    Full Text Available BACKGROUND: Plasmodium vivax is a widely distributed, neglected parasite that can cause malaria and death in tropical areas. It is associated with an estimated 80-300 million cases of malaria worldwide. Brazilian tropical rain forests encompass host- and vector-rich communities, in which two hypothetical mechanisms could play a role in the dynamics of malaria transmission. The first mechanism is the dilution effect caused by presence of wild warm-blooded animals, which can act as dead-end hosts to Plasmodium parasites. The second is diffuse mosquito vector competition, in which vector and non-vector mosquito species compete for blood feeding upon a defensive host. Considering that the World Health Organization Malaria Eradication Research Agenda calls for novel strategies to eliminate malaria transmission locally, we used mathematical modeling to assess those two mechanisms in a pristine tropical rain forest, where the primary vector is present but malaria is absent. METHODOLOGY/PRINCIPAL FINDINGS: The Ross-Macdonald model and a biodiversity-oriented model were parameterized using newly collected data and data from the literature. The basic reproduction number ([Formula: see text] estimated employing Ross-Macdonald model indicated that malaria cases occur in the study location. However, no malaria cases have been reported since 1980. In contrast, the biodiversity-oriented model corroborated the absence of malaria transmission. In addition, the diffuse competition mechanism was negatively correlated with the risk of malaria transmission, which suggests a protective effect provided by the forest ecosystem. There is a non-linear, unimodal correlation between the mechanism of dead-end transmission of parasites and the risk of malaria transmission, suggesting a protective effect only under certain circumstances (e.g., a high abundance of wild warm-blooded animals. CONCLUSIONS/SIGNIFICANCE: To achieve biological conservation and to eliminate Plasmodium parasites in human populations, the World Health Organization Malaria Eradication Research Agenda should take biodiversity issues into consideration.

  15. Mobile technology detects, prevents disease outbreaks in Sri Lanka ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The findings also moved the national government to expand the role of their veterinarians into areas such as antibiotic resistance and farm practices. Both of these outcomes will have positive implications for disease monitoring and for improving human health. Researchers from the University of Calgary collaborated with ...

  16. Mobile technology detects, prevents disease outbreaks in Sri Lanka ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-05-02

    May 2, 2016 ... Researchers used innovative ways to reduce the spread of ... the role of their veterinarians into areas such as antibiotic resistance and farm practices. ... with Sri Lanka's Ministry of Livestock and Rural Development and the ...

  17. Three outbreaks of foodborne botulism caused by unsafe home canning of vegetables--Ohio and Washington, 2008 and 2009.

    Science.gov (United States)

    Date, Kashmira; Fagan, Ryan; Crossland, Sandra; Maceachern, Dorothy; Pyper, Brian; Bokanyi, Rick; Houze, Yolanda; Andress, Elizabeth; Tauxe, Robert

    2011-12-01

    Foodborne botulism is a potentially fatal paralytic illness caused by ingestion of neurotoxin produced by the spore-forming bacterium Clostridium botulinum. Historically, home-canned vegetables have been the most common cause of botulism outbreaks in the United States. During 2008 and 2009, the Centers for Disease Control and Prevention (CDC) and state and local health departments in Ohio and Washington State investigated three outbreaks caused by unsafe home canning of vegetables. We analyzed CDC surveillance data for background on food vehicles that caused botulism outbreaks from 1999 to 2008. For the three outbreaks described, patients and their family members were interviewed and foods were collected. Laboratory testing of clinical and food samples was done at the respective state public health laboratories. From 1999 to 2008, 116 outbreaks of foodborne botulism were reported. Of the 48 outbreaks caused by home-prepared foods from the contiguous United States, 38% (18) were from home-canned vegetables. Three outbreaks of Type A botulism occurred in Ohio and Washington in September 2008, January 2009, and June 2009. Home-canned vegetables (green beans, green bean and carrot blend, and asparagus) served at family meals were confirmed as the source of each outbreak. In each instance, home canners did not follow canning instructions, did not use pressure cookers, ignored signs of food spoilage, and were unaware of the risk of botulism from consuming improperly preserved vegetables. Home-canned vegetables remain a leading cause of foodborne botulism. These outbreaks illustrate critical areas of concern in current home canning and food preparation knowledge and practices. Similar gaps were identified in a 2005 national survey of U.S. adults. Botulism prevention efforts should include targeted educational outreach to home canners.

  18. A Rational Approach to Estimating the Surgical Demand Elasticity Needed to Guide Manpower Reallocation during Contagious Outbreaks

    OpenAIRE

    Tsao, Hsiao-Mei; Sun, Ying-Chou; Liou, Der-Ming

    2015-01-01

    Background Emerging infectious diseases continue to pose serious threats to global public health. So far, however, few published study has addressed the need for manpower reallocation needed in hospitals when such a serious contagious outbreak occurs. Aim To quantify the demand elasticity of the major surgery types in order to guide future manpower reallocation during contagious outbreaks. Materials and Methods Based on a nationwide research database in Taiwan, we extracted the monthly volume...

  19. Evaluation of fixed and variable hospital costs due to Clostridium difficile infection: institutional incentives and directions for future research.

    Science.gov (United States)

    Ryan, P; Skally, M; Duffy, F; Farrelly, M; Gaughan, L; Flood, P; McFadden, E; Fitzpatrick, F

    2017-04-01

    Economic analysis of Clostridium difficile infection (CDI) should consider the incentives facing institutional decision-makers. To avoid overstating the financial benefits of infection prevention, fixed and variable costs should be distinguished. To quantify CDI fixed and variable costs in a tertiary referral hospital during August 2015. A micro-costing analysis estimated CDI costs per patient, including the additional costs of a CDI outbreak. Resource use was quantified after review of patient charts, pharmacy data, administrative resource input, and records of salary and cleaning/decontamination expenditure. The incremental cost of CDI was €75,680 (mean: €5,820 per patient) with key cost drivers being cleaning, pharmaceuticals, and length of stay (LOS). Additional LOS ranged from 1.75 to 22.55 days. For seven patients involved in a CDI outbreak, excluding the value of the 58 lost bed-days (€34,585); costs were 30% higher (€7,589 per patient). Therefore, total spending on CDI was €88,062 (mean: €6,773 across all patients). Potential savings from variable costs were €1,026 (17%) or €1,768 (26%) if outbreak costs were included. Investment in an antimicrobial pharmacist would require 47 CDI cases to be prevented annually. Prevention of 5%, 10% and 20% CDI would reduce attributable costs by €4,403, €8,806 and €17,612. Increasing the incremental LOS attributable to CDI to seven days per patient would have increased costs to €7,478 or €8,431 (if outbreak costs were included). As much CDI costs are fixed, potential savings from infection prevention are limited. Future analysis must consider more effectively this distinction and its impact on institutional decision-making. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  20. EPIDEMIOLOGY OF CHOLERA OUTBREAK IN KAMPALA ...

    African Journals Online (AJOL)

    hi-tech

    77 No. 7 July 2000. EPIDEMIOLOGY OF CHOLERA OUTBREAK IN KAMPALA, UGANDA ... spread much (106 cases in 1995), resulting in a low level of immunity ... An intensive social ... development of a network of community health workers,.

  1. Infection control during filoviral hemorrhagic fever outbreaks

    Directory of Open Access Journals (Sweden)

    N Raabe Vanessa

    2012-01-01

    Full Text Available Breaking the human-to-human transmission cycle remains the cornerstone of infection control during filoviral (Ebola and Marburg hemorrhagic fever outbreaks. This requires effective identification and isolation of cases, timely contact tracing and monitoring, proper usage of barrier personal protection gear by health workers, and safely conducted burials. Solely implementing these measures is insufficient for infection control; control efforts must be culturally sensitive and conducted in a transparent manner to promote the necessary trust between the community and infection control team in order to succeed. This article provides a review of the literature on infection control during filoviral hemorrhagic fever outbreaks focusing on outbreaks in a developing setting and lessons learned from previous outbreaks. The primary search database used to review the literature was PUBMED, the National Library of Medicine website.

  2. Carcass Management During Avian Influenza Outbreaks

    Science.gov (United States)

    This page on Avian Influenza (AI) describes carcass management during Avian Flu outbreaks, including who oversees carcass management, how they're managed, environmental concerns from carcass management, and disinfection. The page also describes what AI is.

  3. An outbreak of leptospirosis among Peruvian military recruits.

    Science.gov (United States)

    Russell, Kevin L; Montiel Gonzalez, Marco A; Watts, Douglas M; Lagos-Figueroa, Roberto C; Chauca, Gloria; Ore, Marianela; Gonzalez, Jose E; Moron, Cecilia; Tesh, Robert B; Vinetz, Joseph M

    2003-07-01

    Acute undifferentiated febrile illnesses are common in tropical developing countries but are difficult to diagnose on clinical grounds alone. Leptospirosis is rarely diagnosed, despite evidence that sporadic cases and epidemics continue to occur worldwide. The purpose of this study was to diagnose an outbreak of acute undifferentiated febrile illness among Peruvian military recruits that developed after a training exercise in the high jungle rainforest of Peru. Of 193 military recruits, 78 developed an acute febrile illness with varied manifestations. Of these, 72 were found to have acute leptospirosis by a microscopic agglutination test (MAT). An enzyme-linked immunosorbent assay using Leptospira biflexa antigen was insensitive for the detection of anti-leptospiral IgM antibodies compared with the MAT (20 of 72, 28%). This outbreak of acute undifferentiated febrile illness among Peruvian military recruits was due to leptospirosis. High clinical suspicion, initiation of preventative measures, and performance of appropriate diagnostic testing is warranted in similar settings to identify, treat, and prevent leptospirosis.

  4. Current pathogenic Escherichia coli foodborne outbreak cases and therapy development.

    Science.gov (United States)

    Yang, Shih-Chun; Lin, Chih-Hung; Aljuffali, Ibrahim A; Fang, Jia-You

    2017-08-01

    Food contamination by pathogenic microorganisms has been a serious public health problem and a cause of huge economic losses worldwide. Foodborne pathogenic Escherichia coli (E. coli) contamination, such as that with E. coli O157 and O104, is very common, even in developed countries. Bacterial contamination may occur during any of the steps in the farm-to-table continuum from environmental, animal, or human sources and cause foodborne illness. To understand the causes of the foodborne outbreaks by E. coli and food-contamination prevention measures, we collected and investigated the past 10 years' worldwide reports of foodborne E. coli contamination cases. In the first half of this review article, we introduce the infection and symptoms of five major foodborne diarrheagenic E. coli pathotypes: enteropathogenic E. coli (EPEC), Shiga toxin-producing E. coli/enterohemorrhagic E. coli (STEC/EHEC), Shigella/enteroinvasive E. coli (EIEC), enteroaggregative E. coli (EAEC), and enterotoxigenic E. coli (ETEC). In the second half of this review article, we introduce the foodborne outbreak cases caused by E. coli in natural foods and food products. Finally, we discuss current developments that can be applied to control and prevent bacterial food contamination.

  5. Epidemiology of two large measles virus outbreaks in Catalonia

    Science.gov (United States)

    Torner, Núria; Anton, Andres; Barrabeig, Irene; Lafuente, Sara; Parron, Ignasi; Arias, César; Camps, Neus; Costa, Josep; Martínez, Ana; Torra, Roser; Godoy, Pere; Minguell, Sofia; Ferrús, Glòria; Cabezas, Carmen; Domínguez, Ángela; Elimination Program Surveillance Network of Spain, the Measles

    2013-01-01

    Measles cases in the European Region have been increasing in the last decade; this illustrates the challenge of what we are now encountering in the form of pediatric preventable diseases. In Catalonia, autochthonous measles was declared eliminated in the year 2000 as the result of high measles-mumps-rubella vaccine (MMR) coverage for first and second dose (15 mo and 4 y) since the mid-1990s. From then on, sporadic imported cases and small outbreaks appeared, until in 2006–2007 a large measles outbreak affecting mostly unvaccinated toddlers hit the Barcelona Health Region. Consequently, in January 2008, first dose administration of MMR was lowered from 15 to 12 mo of age. A new honeymoon period went by until the end of 2010, when several importations of cases triggered new sustained transmission of different wild measles virus genotypes, but this time striking young adults. The aim of this study is to show the effect of a change in MMR vaccination schedule policy, and the difference in age incidence and hospitalization rates of affected individuals between both outbreaks. Epidemiologic data were obtained by case interviews and review of medical records. Samples for virological confirmation and genotyping of cases were collected as established in the Measles Elimination plan guidelines. Incidence rate (IR), rate ratio (RR) and their 95% CI and hospitalization rate (HR) by age group were determined. Statistic z was used for comparing proportions. Total number of confirmed cases was 305 in the 2010 outbreak and 381 in the 2006–2007 outbreak; mean age 20 y (SD 14.8 y; 3 mo to 51 y) vs. 15 mo (SD 13.1 y; 1 mo to 50 y). Highest proportion of cases was set in ≥ 25 y (47%) vs. 24.2% in 2006 (p < 0.001). Differences in IR for ≤ 15 mo (49/100,000 vs. 278.2/100,000; RR: 3,9; 95%CI 2,9–5.4) and in overall HR 29.8% vs. 15.7% were all statistically significant (p < 0.001). The change of the month of age for the administration of the first MMR dose proved successful to

  6. Giardiasis in Bergen. Outbreak and clinical consequences.

    OpenAIRE

    Wensaas, Knut-Arne

    2011-01-01

    Background Giardia lamblia is a common cause of waterborne disease. It is endemic in many parts of the world, especially where sanitation is poor, but in Europe and North America it is most often encountered in outbreaks following contamination of drinking water. The first registered outbreak of giardiasis affecting a large community in Norway happened in Bergen in the autumn of 2004. The reservoir “Svartediket” was the source, and the water probably held Giardia cysts for s...

  7. Ariadne´s house (Pompeii, Italy wall paintings: A multidisciplinary study of its present state focused on a future restoration and preventive conservation

    Directory of Open Access Journals (Sweden)

    Pérez, M.C.

    2013-09-01

    Full Text Available This paper deals with the development of a multidisciplinary study on the current state of conservation of Ariadne's house (Pompeii, Italy, a domus of great archaeological value. The aim of this study is to undertake the preventive conservation actions required and increase the knowledge about its conservation and to generate discussions and points of view for a future restoration. Environmental studies, electromagnetic radiation measurements, study of materials and a photographical study were carried out. Those studies revealed that the rooftops covering the analyzed rooms resulting in adverse weather conditions causing grave damage to the conservation of the wall paintings. Thus, between 2009-2010 the rooftops were changed and new environmental studies were conducted. Studies of materials showed that the paintings match in execution and composition with those reported by other authors. The salts from modern mortars from previous restorations were affecting frescoes, also it is described a thin grayish surface layer from environmental contaminants.Este trabajo desarrolla un estudio multidisciplinar sobre el actual estado de conservación de la casa de Ariadna (Pompeya, Italia, domus de gran valor arqueológico. El objetivo es aumentar el conocimiento del estado actual de conservación de la casa para la discusión de una futura restauración. Para ello se realizaron estudios ambientales, mediciones de radiación electromagnética, estudio de materiales y un estudio fotográfico. Los estudios revelaron que los tejados que cubrían las salas analizadas estaban originando unas condiciones climatológicas adversas que se traducían en un grave daño para la conservación de las pinturas murales. Entre 2009-2010 se cambiaron las cubiertas y los estudios ambientales fueron repetidos. Los estudios de materiales demostraron que las pinturas coinciden en ejecución y composición con las señaladas por otros autores. Las sales procedentes de morteros

  8. Cost analysis of an outbreak of Clostridium difficile infection ribotype 027 in a Dutch tertiary care centre.

    Science.gov (United States)

    van Beurden, Y H; Bomers, M K; van der Werff, S D; Pompe, E A P M; Spiering, S; Vandenbroucke-Grauls, C M J E; Mulder, C J J

    2017-04-01

    The economic impact of Clostridium difficile infection (CDI) on the healthcare system is significant. From May 2013 to May 2014, an outbreak of C. difficile ribotype 027 occurred in a Dutch tertiary care hospital, involving 72 patients. The primary aim of this study was to provide insight into the financial burden that this CDI outbreak brought upon this hospital. A retrospective analysis was performed to estimate the costs of a one-year-long C. difficile ribotype 027 outbreak. Medical charts were reviewed for patient data. In addition, all costs associated with the outbreak control measures were collected. The attributable costs of the whole outbreak were estimated to be €1,222,376. The main contributing factor was missed revenue due to increased length of stay of CDI patients and closure of beds to enable contact isolation of CDI patients (36%). A second important cost component was extra surveillance and activities of the Department of Medical Microbiology and Infection Control (25%). To the authors' knowledge, this is the first study to provide insight into the attributable costs of CDI in an outbreak setting, and to delineate the major cost items. It is clear that the economic consequences of CDI are significant. The high costs associated with a CDI outbreak should help to justify the use of additional resources for CDI prevention and control. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  9. The national web-based outbreak rapid alert system in Norway: eight years of experience, 2006-2013.

    Science.gov (United States)

    Guzman-Herrador, B; Vold, L; Berg, T; Berglund, T M; Heier, B; Kapperud, G; Lange, H; Nygård, K

    2016-01-01

    In 2005, the Norwegian Institute of Public Health established a web-based outbreak rapid alert system called Vesuv. The system is used for mandatory outbreak alerts from municipal medical officers, healthcare institutions, and food safety authorities. As of 2013, 1426 outbreaks have been reported, involving 32913 cases. More than half of the outbreaks occurred in healthcare institutions (759 outbreaks, 53·2%). A total of 474 (33·2%) outbreaks were associated with food or drinking water. The web-based rapid alert system has proved to be a helpful tool by enhancing reporting and enabling rapid and efficient information sharing between different authorities at both the local and national levels. It is also an important tool for event-based reporting, as required by the International Health Regulations (IHR) 2005. Collecting information from all the outbreak alerts and reports in a national database is also useful for analysing trends, such as occurrence of certain microorganisms, places or sources of infection, or route of transmission. This can facilitate the identification of specific areas where more general preventive measures are needed.

  10. Protracted outbreak of S. Enteritidis PT 21c in a large Hamburg nursing home

    Directory of Open Access Journals (Sweden)

    Domke Paul-Gerhard

    2007-09-01

    Full Text Available Abstract Background During August 2006, a protracted outbreak of Salmonella (S. Enteritidis infections in a large Hamburg nursing home was investigated. Methods A site visit of the home was conducted and food suppliers' premises tested for Salmonella. Among nursing home residents a cohort study was carried out focusing on foods consumed in the three days before the first part of the outbreak. Instead of relying on residents' memory, data from the home's patient food ordering system was used as exposure data. S. Enteritidis isolates from patients and suspected food vehicles were phage typed and compared. Results Within a population of 822 nursing home residents, 94 case patients among residents (1 fatality and 17 among staff members were counted 6 through 29 August. The outbreak peaked 7 through 9 August, two days after a spell of very warm summer weather. S. Enteritidis was consistently recovered from patients' stools throughout the outbreak. Among the food items served during 5 through 7 August, the cohort study pointed to afternoon cake on all three days as potential risk factors for disease. Investigation of the bakery supplying the cake yielded S. Enteritidis from cakes sampled 31 August. Comparison of the isolates by phage typing demonstrated both isolates from patients and the cake to be the exceedingly rare phage type 21c. Conclusion Cake (various types served on various days contaminated with S. Enteritidis were the likely vehicle of the outbreak in the nursing home. While the cakes were probably contaminated with low pathogen dose throughout the outbreak period, high ambient summer temperatures and failure to keep the cake refrigerated led to high pathogen dose in cake on some days and in some of the housing units. This would explain the initial peak of cases, but also the drawn out nature of the outbreak with cases until the end of August. Suggestions are made to nursing homes, aiding in outbreak prevention. Early outbreak detection is

  11. Two aircraft carriers’ perspectives: a comparative of control measures in shipboard H1N1 outbreaks.

    Science.gov (United States)

    Harwood, Jared L; LaVan, Joseph T; Brand, George J

    2013-02-01

    The USS George Washington (GW) and the USS Ronald Reagan (RR), 2 US Navy aircraft carriers, experienced almost simultaneous outbreaks of novel H1N1 influenza A in the summer of 2009. We compared the respective epidemic control measures taken and subsequent lessons learned. Data were collated from both outbreaks to assess various elements including attack rate, isolation/quarantine protocols, and treatment methods. The respective duration of each outbreak was compared with survival curve analysis. The number of personnel affected in each outbreak was compared using χ2 analysis. Differences were found in the protocols used on the 2 ships. The GW treated about two-thirds of the patients with oseltamivir through day 14 and quarantined all patients meeting case definition throughout the outbreak. Face masks were used throughout. The RR used oseltamivir and quarantined many fewer patients (through days 5 and 3, respectively). No face masks were used after day 5. The outbreaks were similar in duration (GW = 25 days, RR = 27 days, P = .38), but the RR had significantly more cases (n = 253 vs 142, P < .0001). A portion of each group had samples that were confirmed H1N1 by polymerase chain reaction. GW's protocol, including aggressive oseltamivir treatment of two-thirds of the cases and quarantine throughout the duration decreased the overall number of personnel affected, likely reducing the overall control reproduction number. Both outbreaks were similar in duration. Even though the GW expended significantly more resources than the RR, if the 2009 pandemic H1N1 strain had been as clinically severe as the 1918 pandemic, a more stringent treatment protocol may have been the only way to prevent significant operational impact.

  12. The impact of work-related risk on nurses during the SARS outbreak in Hong Kong.

    Science.gov (United States)

    Chan, Sophia S C; Leung, Gabriel M; Tiwari, Agnes F Y; Salili, Farideh; Leung, Sharron S K; Wong, David C N; Wong, Alan S F; Lai, Adela S F; Lam, Tai Hing

    2005-01-01

    Severe acute respiratory syndrome (SARS) is a highly infectious disease, with high potential for transmission to close contacts, particularly among healthcare workers. This is the first systematic study investigating hospital nurses' physical and psychological health status and the kinds of healthcare used-stratified by the level of contact with SARS patients-during the 2003 outbreak in Hong Kong. Nurses in moderate-risk areas appeared to have more stress symptoms than those working in high-risk areas. It is essential to design hospital support systems and occupational health policy to promote the psychological well-being of nurses during future outbreaks of emerging infections.

  13. The determinants of spread of Ebola virus disease - an evidence from the past outbreak experiences.

    Science.gov (United States)

    Gałas, Aleksander

    2014-01-01

    The paper summarizes available evidence regarding the determinants of spread of Ebola virus disease, including health care and community related risk factors. It was observed that the level of uncertainty for the estimations is relatively high which may hinder to make some predictions for the future evolution of EVD outbreak. The natural history of EVD has shown that the disease may pose a problem to developed countries and may present a thread to individuals. Although observed modes of transmission mainly include direct contact and contaminated staff, high case fatality ratio and frequent contacts among individuals in developed countries are among determinants which may lead to the development of the EVD outbreak.

  14. Predicting and Evaluating the Epidemic Trend of Ebola Virus Disease in the 2014-2015 Outbreak and the Effects of Intervention Measures.

    Directory of Open Access Journals (Sweden)

    Zuiyuan Guo

    Full Text Available We constructed dynamic Ebola virus disease (EVD transmission models to predict epidemic trends and evaluate intervention measure efficacy following the 2014 EVD epidemic in West Africa. We estimated the effective vaccination rate for the population, with basic reproduction number (R0 as the intermediate variable. Periodic EVD fluctuation was analyzed by solving a Jacobian matrix of differential equations based on a SIR (susceptible, infective, and removed model. A comprehensive compartment model was constructed to fit and predict EVD transmission patterns, and to evaluate the effects of control and prevention measures. Effective EVD vaccination rates were estimated to be 42% (31-50%, 45% (42-48%, and 51% (44-56% among susceptible individuals in Guinea, Liberia and Sierra Leone, respectively. In the absence of control measures, there would be rapid mortality in these three countries, and an EVD epidemic would be likely recur in 2035, and then again 8~9 years later. Oscillation intervals would shorten and outbreak severity would decrease until the periodicity reached ~5.3 years. Measures that reduced the spread of EVD included: early diagnosis, treatment in isolation, isolating/monitoring close contacts, timely corpse removal, post-recovery condom use, and preventing or quarantining imported cases. EVD may re-emerge within two decades without control and prevention measures. Mass vaccination campaigns and control and prevention measures should be instituted to prevent future EVD epidemics.

  15. Clinical and epidemiologic characteristics of an outbreak of novel H1N1 (swine origin) influenza A virus among United States military beneficiaries.

    Science.gov (United States)

    Crum-Cianflone, Nancy F; Blair, Patrick J; Faix, Dennis; Arnold, John; Echols, Sara; Sherman, Sterling S; Tueller, John E; Warkentien, Tyler; Sanguineti, Gabriela; Bavaro, Mary; Hale, Braden R

    2009-12-15

    A novel swine-origin influenza A (H1N1) virus was identified in March 2009 and subsequently caused worldwide outbreaks. The San Diego region was an early focal point of the emerging pandemic. We describe the clinical and epidemiologic characteristics of this novel strain in a military population to assist in future outbreak prevention and control efforts. We performed an epidemiologic evaluation of novel H1N1 virus infections diagnosed in San Diego County among 96,258 local US military beneficiaries. The structured military medical system afforded the ability to obtain precise epidemiologic information on the impact on H1N1 virus infection in a population. The novel H1N1 virus was confirmed using real-time reverse transcriptase polymerase chain reaction (rRT-PCR). From 21 April through 8 May 2009, 761 patients presented with influenza-like illness and underwent rRT-PCR testing. Of these patients, 97 had confirmed novel H1N1 virus infection, with an incidence rate of 101 cases per 100,000 persons. The median age of H1N1 patients with H1N1 virus infection was 21 years (interquartile range, 15-25 years). Fever was a universal symptom in patients with H1N1 virus infection; other symptoms included cough (present in 96% of patients), myalgia or arthralgia (57%), and sore throat (51%). Sixty-eight (70%) of our patients had an identifiable epidemiologic link to another confirmed patient. The largest cluster of cases of H1N1 virus infection occurred on a Navy ship and involved 32 (8%) of 402 crew members; the secondary attack rate was 6%-14%. The rapid influenza testing that was used during this outbreak had a sensitivity of 51% and specificity of 98%, compared with rRT-PCR. Only 1 patient was hospitalized, and there were no deaths. A novel H1N1 influenza A virus caused a significant outbreak among military beneficiaries in San Diego County, including a significant cluster of cases onboard a Navy ship. The outbreak described here primarily affected adolescents and young

  16. Investigating an outbreak of acute fever in Chuuk, Federated States of Micronesia

    Directory of Open Access Journals (Sweden)

    Damian Hoy

    2014-11-01

    Full Text Available Objective: In September 2012, there was an unexpected increase of acute febrile illness (AFI in Chuuk State of the Federated States of Micronesia. At the same time, dengue outbreaks were occurring in two of the Federated States of Micronesia’s other three states. The cause of AFI was suspected to be dengue; however, by the end of October, only one of 39 samples was positive for dengue. The objective of the investigation was to establish the cause of the outbreak. Methods: A line list was created and data analysed by time, place, person and clinical features. Reported symptoms were compared with the published symptoms of several diagnoses and laboratory testing undertaken. Results: Of the 168 suspected cases, 62% were less than 20 years of age and 60% were male. The clinical features of the cases were not typical for dengue but suggestive of respiratory illness. Nasopharyngeal swabs were subsequently collected and found to be positive for influenza. Public health measures were undertaken and the AFI returned to expected levels. Discussion: Clinical diagnosis of acute febrile illness (AFI can often be difficult and misleading. This can mean that opportunities for preventive measures early on in an outbreak are missed. In any outbreak, descriptive epidemiological analyses are valuable in helping to ascertain the cause of the outbreak.

  17. Economic effects of foot and mouth disease outbreaks along the cattle marketing chain in Uganda.

    Science.gov (United States)

    Baluka, Sylvia Angubua

    2016-06-01

    Disease outbreaks increase the cost of animal production; reduce milk and beef yield, cattle sales, farmers' incomes, and enterprise profitability. The study assessed the economic effects of foot and mouth disease (FMD) outbreaks along the cattle marketing chain in selected study districts in Uganda. The study combined qualitative and quantitative study designs. Respondents were selected proportionally using simple random sampling from the sampling frame comprising of 224, 173, 291, and 185 farmers for Nakasongola, Nakaseke, Isingiro, and Rakai, respectively. Key informants were selected purposively. Data analysis combined descriptive, modeling, and regression analysis. Data on the socio-economic characteristics and how they influenced FMD outbreaks, cattle markets revenue losses, and the economic cost of the outbreaks were analyzed using descriptive measures including percentages, means, and frequencies. Farmers with small and medium herds incurred higher control costs, whereas large herds experienced the highest milk losses. Total income earned by the actors per month at the processing level reduced by 23%. In Isingiro, bulls and cows were salvage sold at 83% and 88% less market value, i.e., a loss of $196.1 and $1,552.9 in small and medium herds, respectively. All actors along the cattle marketing chain incur losses during FMD outbreaks, but smallholder farmers are most affected. Control and prevention of FMD should remain the responsibility of the government if Uganda is to achieve a disease-free status that is a prerequisite for free movement and operation of cattle markets throughout the year which will boost cattle marketing.

  18. Health department inspection criteria more likely to be associated with outbreak restaurants in Minnesota.

    Science.gov (United States)

    Petran, Ruth L; White, Bruce W; Hedberg, Craig W

    2012-11-01

    Millions of routine restaurant inspections are performed each year in the United States, and the Centers for Disease Control and Prevention has reported that a majority of foodborne illness outbreaks occur in restaurant settings. In an attempt to relate the data collected during inspections in Minnesota to illness likelihood, data from routine inspections conducted at outbreak restaurants were compared with data from routine inspections conducted at nonoutbreak restaurants. The goal was to identify differences in recorded violations. Significantly more violations were recorded at restaurants that had outbreaks. The majority of these violations were related to contamination in the facility and environment and to food handling procedures. Relative risks also were calculated for violations significantly more likely to occur at locations that had outbreaks of norovirus infection, Clostridium perfringens infection or toxin-type illness, and Salmonella infection. These three pathogens are estimated to cause the majority of foodborne illnesses in the United States. Meta-analysis of composited data for the three pathogens revealed 11 violations significantly more likely (α restaurants than during inspections at nonoutbreak restaurants. Application of this information permits assessment of health department inspection data in a consistent fashion. This approach can help identify criteria more likely to be associated with outbreak locations and allow operators to focus on interventions that will have the most significant impact in higher risk establishments.

  19. Risk factors for porcine reproductive and respiratory syndrome outbreaks in Vietnamese small stock farms.

    Science.gov (United States)

    Truong, V M; Gummow, B

    2014-07-01

    To examine risk factors that could have played a role in the 2010 porcine reproductive and respiratory syndrome (PRRS) outbreak in Yenhung district, Quangninh province, North-Vietnam, with the purpose of establishing why existing control measures implemented after previous outbreaks had failed to prevent further outbreaks. A case-control study was carried out in Yenhung district. Data were obtained by an interview-based questionnaire survey. The sampling unit was households, which equated to small-scale pig farms. A total of 150 case and 150 control households were selected at communes affected by the 2010 PRRS epidemic during April to June. Risk factors were analysed using binary logistic regression and unconditional multiple logistic regression. Households infected with PRRS were significantly associated with multiple variables belonging to three main groups: (1) location of the farms: i.e. farms positioned risk factor most strongly associated with infected households in the 2010 outbreak (OR=22; 95% CI=12-42). The results show that the epidemiology of PRRS in Quangninh province was linked to sociological and cultural practices, and that effective PRRS control needs an integrated approach coupled with behavioural changes in the pig raising practices of the general public. Failure to recognise this could explain why further outbreaks have occurred.

  20. A "high severity" spruce beetle outbreak in Wyoming causes moderate-severity carbon cycle perturbations

    Science.gov (United States)

    Berryman, E.; Frank, J. M.; Speckman, H. N.; Bradford, J. B.; Ryan, M. G.; Massman, W. J.; Hawbaker, T. J.

    2017-12-01

    Bark beetle outbreaks in Western North American forests are often considered a high-severity disturbance from a carbon (C) cycling perspective, but field measurements that quantify impacts on C dynamics are very limited. Often, factors out of the researcher's control complicate the separation of beetle impacts from other drivers of C cycling variability and restrict statistical inference. Fortuitously, we had four years of pre-spruce beetle outbreak C cycle measurements in a subalpine forest in southeastern Wyoming (Glacier Lakes Ecosystem Experiments Site, or GLEES) and sustained intermittent monitoring for nearly a decade after the outbreak. Here, we synthesize published and unpublished pre- and post-outbreak measurements of key C cycle stocks and fluxes at GLEES. Multiple lines of evidence, including chamber measurements, eddy covariance measurements, and tracking of soil and forest floor C pools over time, point to the GLEES outbreak as a moderate-severity disturbance for C loss to the atmosphere, despite 70% to 80% of overstory tree death. Reductions in NEE were short-lived and the forest quickly returned to a carbon-neutral state, likely driven by an uptick in understory growth. Effect of mortality on the C cycle was asymmetrical, with a 50% reduction in net carbon uptake (NEE) two years into the outbreak, yet no measureable change in either ecosystem or growing season soil respiration. A small pulse in soil respiration occurred but was only detectable during the winter and amounted to < 10% of NEE. Possible reasons for the lack of measureable respiration response are discussed with emphasis on lessons learned for monitoring and modeling future outbreaks. We suggest a comprehensive assessment and definition of "moderate-severity" disturbances for Western forests and suggest that all tree mortality events may not be high-severity when it comes to C fluxes.

  1. Measles & rubella outbreaks in Maharashtra State, India

    Science.gov (United States)

    Vaidya, Sunil R.; Kamble, Madhukar B.; Chowdhury, Deepika T.; Kumbhar, Neelakshi S.

    2016-01-01

    Background & objectives: Under the outbreak-based measles surveillance in Maharashtra State the National Institute of Virology at Pune receives 3-5 serum samples from each outbreak and samples from the local hospitals in Pune for laboratory diagnosis. This report describes one year data on the measles and rubella serology, virus isolation and genotyping. Methods: Maharashtra State Health Agencies investigated 98 suspected outbreaks between January-December 2013 in the 20 districts. Altogether, 491 serum samples were received from 20 districts and 126 suspected cases from local hospitals. Samples were tested for the measles and rubella IgM antibodies by commercial enzyme immunoassay (EIA). To understand the diagnostic utility, a subset of serum samples (n=53) was tested by measles focus reduction neutralization test (FRNT). Further, 37 throat swabs and 32 urine specimens were tested by measles reverse transcription (RT)-PCR and positive products were sequenced. Virus isolation was performed in Vero hSLAM cells. Results: Of the 98 suspected measles outbreaks, 61 were confirmed as measles, 12 as rubella and 21 confirmed as the mixed outbreaks. Four outbreaks remained unconfirmed. Of the 126 cases from the local hospitals, 91 were confirmed for measles and three for rubella. Overall, 93.6 per cent (383/409) confirmed measles cases were in the age group of 0-15 yr. Measles virus was detected in 18 of 38 specimens obtained from the suspected cases. Sequencing of PCR products revealed circulation of D4 (n=9) and D8 (n=9) strains. Four measles viruses (three D4 & one D8) were isolated. Interpretation & conclusions: Altogether, 94 measles and rubella outbreaks were confirmed in 2013 in the State of Maharasthra indicating the necessity to increase measles vaccine coverage in the State. PMID:27121521

  2. Guidelines on suicide prevention measures for South Korea and Japan based on recent suicide trends: the need to utilize this approach to devise future suicide prevention measures for the rest of asia and the rest of the world

    OpenAIRE

    INOUE K.; CHAIZHUNUSOVA N.; HOSHI M.; NOSO Y.; TAKEICHI N.; OSPANOVA N.; MOLDAGALIEV T.; SARSEMBINA ZH.; KALIEVA A.; JAMEDINOVA U.; CHEGEDEKOVA SH.; SHARAPIYEVA A.; BITEBAYEVA D.; RAKHYPBEKOV T.K.

    2016-01-01

    Introduction: Devising and implementing effective suicide prevention measures is an urgent matter for countries around the world. South Korea and Japan have some of the world’s highest suicide rates, so the current study examined more effective suicide prevention measures for those countries with a focus on recent suicide rates by age group. Materials and Methods: This study examined the suicide rate for each sex by age group in South Korea and Japan in 2009 and 2012, and this study then calc...

  3. Biomedical HIV Prevention Including Pre-exposure Prophylaxis and Opiate Agonist Therapy for Women Who Inject Drugs: State of Research and Future Directions.

    Science.gov (United States)

    Page, Kimberly; Tsui, Judith; Maher, Lisa; Choopanya, Kachit; Vanichseni, Suphak; Mock, Philip A; Celum, Connie; Martin, Michael

    2015-06-01

    Women who inject drugs (WWID) are at higher risk of HIV compared with their male counterparts as a result of multiple factors, including biological, behavioral, and sociostructural factors, yet comparatively little effort has been invested in testing and delivering prevention methods that directly target this group. In this article, we discuss the need for expanded prevention interventions for WWID, focusing on 2 safe, effective, and approved, yet underutilized biomedical prevention methods: opiate agonist therapy (OAT) and oral pre-exposure prophylaxis (PrEP). Although both interventions are well researched, they have not been well examined in the context of gender. We discuss the drivers of women injectors' higher HIV risk, review the effectiveness of OAT and PrEP interventions among women, and explain why these new HIV prevention tools should be prioritized for WWID. There is substantial potential for impact of OAT and PrEP programs for WWID in the context of broader gender-responsive HIV prevention initiatives. Although awaiting efficacy data on other biomedical approaches in the HIV prevention research "pipeline," we propose that the scale-up and implementation of these proven, safe, and effective interventions are needed now.

  4. Infectious respiratory disease outbreaks and pregnancy: occupational health and safety concerns of Canadian nurses.

    Science.gov (United States)

    Phillips, Karen P; O'Sullivan, Tracey L; Dow, Darcie; Amaratunga, Carol A

    2011-04-01

    This paper is a report of a qualitative study of emergency and critical care nurses' perceptions of occupational response and preparedness during infectious respiratory disease outbreaks including severe acute respiratory syndrome (SARS) and influenza. Healthcare workers, predominantly female, face occupational and personal challenges in their roles as first responders/first receivers. Exposure to SARS or other respiratory pathogens during pregnancy represents additional occupational risk for healthcare workers. Perceptions of occupational reproductive risk during response to infectious respiratory disease outbreaks were assessed qualitatively by five focus groups comprised of 100 Canadian nurses conducted between 2005 and 2006. Occupational health and safety issues anticipated by Canadian nurses for future infectious respiratory disease outbreaks were grouped into four major themes: (1) apprehension about occupational risks to pregnant nurses; (2) unknown pregnancy risks of anti-infective therapy/prophylaxis; (3) occupational risk communication for pregnant nurses; and (4) human resource strategies required for pregnant nurses during outbreaks. The reproductive risk perceptions voiced by Canadian nurses generally were consistent with reported case reports of pregnant women infected with SARS or emerging influenza strains. Nurses' fears of fertility risks posed by exposure to infectious agents or anti-infective therapy and prophylaxis are not well supported by the literature, with the former not biologically plausible and the latter lacking sufficient data. Reproductive risk assessments should be performed for each infectious respiratory disease outbreak to provide female healthcare workers and in particular pregnant women with guidelines regarding infection control and use of anti-infective therapy and prophylaxis.

  5. Investigation of a measles outbreak in Cordillera, northern Philippines, 2013

    Directory of Open Access Journals (Sweden)

    Paola Katrina Ching

    2016-07-01

    Full Text Available Introduction: Measles is a highly infectious viral illness that remains one of the leading causes of death among children worldwide. In the Philippines, decreasing routine vaccination coverage from 2007 to 2011 led to local measles outbreaks. A team investigated a measles outbreak reported in Cordillera of the Philippines in May 2013. Methods: Measles case data with symptom onset from 2 February to 27 May 2013 were obtained from official sources and verified on site. Data included age, sex, residential address, signs and symptoms and vaccination status. Active case-findings were also conducted for contacts of these cases. The living environments of the cases were investigated. A survey was conducted with the cases and caregivers to understand their knowledge and attitudes about measles. Results: There were 50 measles cases identified with an age range from six months to 32 years (median: 16 years. Thirty-two were male (64%. Twenty (40% were hospitalized with one death. Thirty-two (64% cases were laboratory confirmed, and 36 (72% received a single dose of measles vaccine. Overcrowded living environments were observed among many cases. The majority of respondents (46/48, 96% knew about measles, but there were misconceptions about the cause of measles and how it can be prevented and managed. Conclusion: This measles outbreak occurred in an area with low immunization coverage. Achieving 95% measles immunization coverage and strengthening routine immunization strategies to address high-risk populations are recommended. Also, we recommend health education campaigns to include components that address misconceptions about measles.

  6. Rapid response to syphilis outbreak among female sex workers

    Directory of Open Access Journals (Sweden)

    Shaily B Surti

    2017-01-01

    Full Text Available Background: Outbreak of syphilis, i.e., 16 cases of rapid plasma reagin (RPR reactive cases of syphilis was reported in Community Based Organization (CBO Sahyog of Surat, India, from April to August 2014. The aim of the study was to find risk factors and take immediate actions to prevent spread. Materials and Methods: Outbreak investigation of 16 Female Sex Workers of CBO Sahyog in Surat who were found Rapid Plasma Reagin (RPR and Treponema Pallidum Hemagglutination Assay (TPHA positive from April to August 2014; was carried out. Clinico-epidemiological and laboratory-based evidence for different sexually transmitted infections (STIs conducted at Government Medical College, New Civil Hospital, Surat. Root cause analysis (RCA of index case was carried out. Results: Desk review for the past 3 years data of STI revealed total STI cases as 88 (2011, 95 (2012, and 130 (2013, of which 4, 2, and 2 found RPR reactive, respectively. Data from April to August 2014 revealed 16 RPR reactive cases and confirmed by TPHA. On examination, one had ulcerative cervical lesion, rest did not have any symptoms of syphilis. Eleven had vaginal/cervical discharge, 11 had lower abdominal pain. A total of 11 had unprotected sex, 7 encountered condom tear in the past 6 months, and 5 reported sexual violence. Seven had sexual activity under influence of alcohol. Laboratory investigation revealed two as HIV-positive. RPR reactivity reported highest (9 out of 16 from same area of hotspot. RCA of probable index case revealed factors responsible as violence and nonuse of condoms. Conclusions: Outbreak investigation revealed one probable index case. All 16 treated with injection Penidure. Violence or condom tear is responsible for the spread. Crisis management team should be strengthened.

  7. [Hospital hygiene - outbreak management of nosocomial infections].

    Science.gov (United States)

    Kerwat, Klaus; Wulf, Hinnerk

    2012-04-01

    According to §6, section 3 of the German Protection against Infections Act [Infektionsschutzgesetz (IfSG)] an outbreak is defined as the occurrence in large numbers of nosocomial infections for which an epidemiological relationship is probable or can be assumed. About 2-10% of nosocomial infections in hospitals (about 5% in intensive care wards) occur within the framework of an outbreak. The heaped occurrence of nosocomial infections can be declared according to the prescribed surveillance of nosocomial infections (§23 IfSG) when, in the course of this assessment, a statistically significant increase in the rate of infections becomes apparent. On the other hand, the occurrence of an outbreak can also be recognized through the vigilance of all involved personnel and a general sensibilization towards this subject. The names of patients involved in outbreaks need not be reported to the responsible health authorities. As a consequence of the report the health authorities become involved in the investigation to determine the cause and its elimination, and to provide support and advice. The outbreak management should be oriented on the respective recommendations of the Robert Koch Institute. © Georg Thieme Verlag Stuttgart · New York.

  8. Economic impact of a nationwide outbreak of salmonellosis: cost-benefit of early intervention.

    Science.gov (United States)

    Roberts, J A; Sockett, P N; Gill, O N

    1989-05-06

    The recognition and investigation of an outbreak of food poisoning in 1982 due to chocolate contaminated with Salmonella napoli enabled the food that carried the salmonella to be identified and four fifths of the implicated consignment of chocolate to be withdrawn. The economic benefits of prompt intervention in the outbreak have been assessed. The cost of the outbreak was over 0.5 pounds m. It is estimated that five deaths were prevented by the intervention and that 185 admissions to hospital and 29,000 cases of S napoli enteritis were avoided. This successful investigation yielded a 3.5-fold rate of return to the public sector and a 23.3-fold return to society on an investment in public health surveillance. A methodology is described that can be used to estimate the benefits of early intervention in outbreaks of foodborne illness and topics for further research are suggested. It is concluded that public health authorities and industry have much to gain by collaborating in the research into the design of cost effective programmes to prevent foodborne infections.

  9. Ebola outbreak in West Africa: a neglected tropical disease

    Directory of Open Access Journals (Sweden)

    Alcides Troncoso

    2015-04-01

    Full Text Available Neglected tropical diseases (NTDs are remediable injustices of our times. Poverty is the starting point, and the ultimate outcome, of NTD. Ebola is just one of many NTDs that badly need attention. Ebola exacerbates West Africa's poverty crisis. The virus spreading in Guinea, Liberia and Sierra Leone has led to food shortages and neglect of other devastating tropical illnesses. A health crisis that was ignored for months until it was out of control is now beginning to get the attention required, if not the resources. So far, the world´s nations have contributed far less than the $ 1 billion. The U.N. estimates would need to control the epidemic before it becomes endemic. Past outbreaks of Ebola have flared up in remote, forested communities, disconnected from much of the outside world. But the outbreak in West Africa has not slowed yet, and it worsens there the chances of it spreading to other countries. Ebola draws attention to NTD. Ebola is not only a health emergency, but also it´s a poverty crisis. The current Global Ebola crisis presents a multitude of challenges in terms of our capacity to respond; the future is even less predictable. Ebola outbreak represents inequity in health as the occurrence of health differences considered unnecessary, avoidable, unfair, and unjust, thus adding a moral and ethical dimension to health inequalities. Health equity does not refer only to the fairness in the distribution of health or the provision of health care; rather, it is linked with the larger issues of fairness and justice in social arrangements.

  10. Changes in the epidemiology of hepatitis A outbreaks 13 years after the introduction of a mass vaccination program

    Science.gov (United States)

    Martínez, Ana; Broner, Sonia; Sala, M Rosa; Manzanares-Laya, Sandra; Godoy, Pere; Planas, Caritat; Minguell, Sofia; Torner, Nuria; Jané, Mireia; Domínguez, Angela; for the Study of the Immune Status in Health Care, the Working Group; Hepatitis A in Catalonia, for the Study of

    2014-01-01

    A hepatitis A+B vaccine vaccination program of 12-year-olds was introduced in Catalonia in 1998. The aim of this study was to investigate the evolution of hepatitis A outbreaks in Catalonia and estimate the preventable fraction of cases associated with outbreaks as a measure of the impact of the vaccination program. Hepatitis A outbreaks reported to the Health Department between 1991 and 2012 were analyzed. The incidence rates of outbreaks, outbreak-associated cases and hospitalizations were calculated. The preventable fraction (PF) and 95% confidence intervals (CI) were estimated for the whole study period (pre-vaccination and post-vaccination) and the post-vaccination period. One-hundred-eight (108) outbreaks (rate of 2.21 per 106 persons-year) were reported in the pre-vaccination period and 258 outbreaks (rate of 2.82 per 106 persons-year) in the post-vaccination period. The rate of cases associated with outbreaks was 1.52 per 105 persons-year in the pre-vaccination period and 1.28 per 105 persons-year in the post-vaccination period. Hospitalization rates were 0.08 and 0.75 per 106 persons-year, respectively. The number of person-to-person outbreaks whose index case was a school contact decreased in the post-vaccination period (aOR 2.72; 95%CI 1.35–5.48), but outbreaks whose index case was a man who has sex with men (MSM) or an immigrant increased. The PF of all outbreak-associated cases was 6.46% (95%CI 3.11–9.82) and the highest PF was in the 15–24 years age group (42.53%; 95%CI 29.30–55.75). In the 0–4 years age group, the PF was 18.35% (95%CI 9.59–27.11), suggesting a protective herd effect in unvaccinated subjects. Vaccination of immigrants traveling to endemic countries and MSM should be reinforced. PMID:25483535

  11. Landscape Epidemiology of Tularemia Outbreaks in Sweden

    Science.gov (United States)

    Svensson, Kerstin; Bäck, Erik; Eliasson, Henrik; Berglund, Lennart; Granberg, Malin; Karlsson, Linda; Larsson, Pär; Forsman, Mats

    2009-01-01

    Summer outbreaks of tularemia that occurred from 1995 through 2005 in 2 locations in Sweden affected 441 persons. We performed an epidemiologic investigation of these outbreaks using a novel strategy, involving high-resolution genotyping of Francisella tularensis isolates obtained from 136 patients (using 18 genetic markers developed from 6 F. tularensis genome sequences) and interviews with the patients. Strong spatial associations were found between F. tularensis subpopulations and the places of disease transmission; infection by some subpopulations occurred within areas as small as 2 km2, indicating unidentified environmental point sources of tularemia. In both locations, disease clusters were associated with recreational areas beside water, and genetic subpopulations were present throughout the tularemia season and persisted over years. High-resolution genotyping in combination with patients’ statements about geographic places of disease transmission provided valuable indications of likely sources of infection and the causal genotypes during these tularemia outbreaks. PMID:19961673

  12. An Outbreak of Foodborne Botulism in Ontario

    Directory of Open Access Journals (Sweden)

    Mona R Loutfy

    2003-01-01

    Full Text Available Botulism is a rare paralytic illness resulting from a potent neurotoxin produced by Clostridium botulinum. Botulism in Canada is predominately due to C botulinum type E and affects mainly the First Nations and Inuit populations. The most recent outbreak of botulism in Ontario was in Ottawa in 1991 and was caused by C botulinum type A. We report an outbreak of foodborne type B botulism in Ontario, which implicated home-canned tomatoes. The outbreak was characterized by mild symptoms in two cases and moderately severe illness in one case. The investigation shows the importance of considering the diagnosis of botulism in patients presenting with cranial nerve and autonomic dysfunction, especially when combined with gastrointestinal complaints; it also highlights the importance of proper home canning technique.

  13. Hub nodes inhibit the outbreak of epidemic under voluntary vaccination

    Energy Technology Data Exchange (ETDEWEB)

    Zhang Haifeng; Wang Binghong [Department of Modern Physics, University of Science and Technology of China, Hefei 230026 (China)], E-mail: bhwang@ustc.edu.cn; Zhang Jie; Small, Michael [Department of Electronic and Information Engineering, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (China)], E-mail: ensmall@polyu.edu.hk; Zhou Changsong [Department of Physics, Centre for Nonlinear Studies, and Beijing-Hong Kong-Singapore Joint Centre for Nonlinear and Complex Systems (Hong Kong), Hong Kong Baptist University, Kowloon Tong, Hong Kong (China)

    2010-02-15

    It is commonly believed that epidemic spreading on scale-free networks is difficult to control and that the disease can spread even with a low infection rate, lacking an epidemic threshold. In this paper, we study epidemic spreading on complex networks under the framework of game theory, in which a voluntary vaccination strategy is incorporated. In particular, individuals face the 'dilemma' of vaccination: they have to decide whether or not to vaccinate according to the trade-off between the risk and the side effects or cost of vaccination. Remarkably and quite excitingly, we find that disease outbreak can be more effectively inhibited on scale-free networks than on random networks. This is because the hub nodes of scale-free networks are more inclined to take self-vaccination after balancing the pros and cons. This result is encouraging as it indicates that real-world networks, which are often claimed to be scale free, can be favorably and easily controlled under voluntary vaccination. Our work provides a way of understanding how to prevent the outbreak of diseases under voluntary vaccination, and is expected to provide valuable information on effective disease control and appropriate decision-making.

  14. Listeria monocytogenes in Fresh Produce: Outbreaks, Prevalence and Contamination Levels

    Directory of Open Access Journals (Sweden)

    Qi Zhu

    2017-03-01

    Full Text Available Listeria monocytogenes, a member of the genus Listeria, is widely distributed in agricultural environments, such as soil, manure and water. This organism is a recognized foodborne pathogenic bacterium that causes many diseases, from mild gastroenteritis to severe blood and/or central nervous system infections, as well as abortion in pregnant women. Generally, processed ready-to-eat and cold-stored meat and dairy products are considered high-risk foods for L. monocytogenes infections that cause human illness (listeriosis. However, recently, several listeriosis outbreaks have been linked to fresh produce contamination around the world. Additionally, many studies have detected L. monocytogenes in fresh produce samples and even in some minimally processed vegetables. Thus L. monocytogenes may contaminate fresh produce if present in the growing environment (soil and water. Prevention of biofilm formation is an important control measure to reduce the prevalence and survival of L. monocytogenes in growing environments and on fresh produce. This article specifically focuses on fresh produce–associated listeriosis outbreaks, prevalence in growing environments, contamination levels of fresh produce, and associated fresh produce safety challenges.

  15. Regional outbreak of staphylococcal scalded skin syndrome in healthy children

    Directory of Open Access Journals (Sweden)

    Hyun Jeong Do

    2010-01-01

    Full Text Available Purpose : Staphylococcal scalded skin syndrome (SSSS is a relatively uncommon superficial blistering skin disease that is due to Staphylococcus aureus. We had experienced a regional outbreak of SSSS over 3 years in healthy children. Methods : We retrospectively reviewed the medical records of those patients diagnosed as SSSS. Most of neonatal cases were nosocomial infections and excluded from the analysis. The clinical features, laboratory findings, the isolation and antibiotic resistance of S. aureus, the antibiotic management and other supportive treatments were analyzed. Results : Fifty-five patients with SSSS were admitted to our hospital from October 2001 to September 2004. The median age of patients was 3.0 years. Of the 55 patients, 9 were the generalized type, 13 were the intermediate type and 33 were the scarletiniform rash. All the patients were living in neighborhood of the Jinju area. S. aureus were isolated from 9 of the patients and all of the isolated S. aureus were methicillin resistant. All the patients except two were treated with intravenous flocloxacillin or nafcillin and/or cefotaxime. All the patients recovered during the follow-up period of 2 to 3 weeks. Conclusion : We experienced a regional outbreak of SSSS in previous healthy children. Further study for finding the carriers of S. aureus caused SSSS and preventing the spread of this disease is needed. Additionally, guidelines for treating SSSS due to methicillin resistant S. aureus should be established.

  16. Sporothrix brasiliensis outbreaks and the rapid emergence of feline sporotrichosis.

    Science.gov (United States)

    Sanchotene, Karine Ortiz; Madrid, Isabel Martins; Klafke, Gabriel Baracy; Bergamashi, Mariana; Della Terra, Paula Portella; Rodrigues, Anderson Messias; de Camargo, Zoilo Pires; Xavier, Melissa Orzechowski

    2015-11-01

    Sporotrichosis is the main subcutaneous mycosis in Brazil, and is caused by Sporothrix schenckii and allied species. Sporothrix propagules present on soil and plant debris may be traumatically inoculated into the cutaneous/ subcutaneous tissues of the warm-blooded host. An alternative route involves direct animal-animal and animal-human transmissions through deep scratches and bites of diseased cats. Sporotrichosis is much more common than previously appreciated with several cases emerging over the years especially in South and Southeast Brazil. We conducted an epidemiological surveillance in endemic areas of feline sporotrichosis in the southern region of Rio Grande do Sul state, Brazil. Over the last 5-year period the number of feline sporotrichosis in Rio Grande increased from 0.75 new cases per month in 2010 to 3.33 cases per month in 2014. The wide geographic distribution of diagnosed cases highlights the dynamics of Sporothrix transmission across urban areas with high population density. Molecular identification down to species level by PCR-RFLP of cat-transmitted Sporothrix revealed the emergence of the clonal offshoot S. brasiliensis during feline outbreaks; this scenario is similar to the epidemics taking place in the metropolitan areas of Rio de Janeiro and São Paulo. Controlling and preventing sporotrichosis outbreaks are essential steps to managing the disease among humans and animals. © 2015 Blackwell Verlag GmbH.

  17. Foodborne outbreak of hepatitis A, November 2007-January 2008, Austria.

    Science.gov (United States)

    Schmid, D; Fretz, R; Buchner, G; König, C; Perner, H; Sollak, R; Tratter, A; Hell, M; Maass, M; Strasser, M; Allerberger, F

    2009-04-01

    An outbreak of hepatitis A affecting 21 residents of an Austrian city occurred from the end of November 2007 until mid-January 2008. A case series investigation suggested the consumption of food purchased from supermarket X as the common link. A food handler employed in the delicatessen department of that supermarket had been serologically diagnosed with hepatitis A on 28th November 2007. During the infectious period of approximately 3 weeks, he worked on 11 days. Interviews with the other cluster cases revealed that the hepatitis A virus (HAV)-infected food handler did not practice appropriate hand hygiene. The investigation revealed no other possible source of infection. We hypothesize that the food of the delicatessen department contaminated by the HAV-infected food handler during his infectious period was the source of the outbreak. The district public health authority recommended the reinforcement of hygiene precautions, i.e., access to viricidal hand disinfectant and the use of disposable gloves and single-use paper towels, in the involved supermarket. The federal ministry of health recommended HAV vaccination for all food handlers in food production and gastronomy companies; this recommendation was included in the Austrian national vaccination plan 2008, even though the vaccination of food handlers is costly and its cost-effectiveness is not proven. Appropriate and regular hand hygiene, particularly after toilet visits, is the most effective measure for preventing HAV transmission.

  18. Hub nodes inhibit the outbreak of epidemic under voluntary vaccination

    International Nuclear Information System (INIS)

    Zhang Haifeng; Wang Binghong; Zhang Jie; Small, Michael; Zhou Changsong

    2010-01-01

    It is commonly believed that epidemic spreading on scale-free networks is difficult to control and that the disease can spread even with a low infection rate, lacking an epidemic threshold. In this paper, we study epidemic spreading on complex networks under the framework of game theory, in which a voluntary vaccination strategy is incorporated. In particular, individuals face the 'dilemma' of vaccination: they have to decide whether or not to vaccinate according to the trade-off between the risk and the side effects or cost of vaccination. Remarkably and quite excitingly, we find that disease outbreak can be more effectively inhibited on scale-free networks than on random networks. This is because the hub nodes of scale-free networks are more inclined to take self-vaccination after balancing the pros and cons. This result is encouraging as it indicates that real-world networks, which are often claimed to be scale free, can be favorably and easily controlled under voluntary vaccination. Our work provides a way of understanding how to prevent the outbreak of diseases under voluntary vaccination, and is expected to provide valuable information on effective disease control and appropriate decision-making.

  19. Detecting and Responding to a Dengue Outbreak: Evaluation of Existing Strategies in Country Outbreak Response Planning

    Directory of Open Access Journals (Sweden)

    Julia Harrington

    2013-01-01

    Full Text Available Background. Dengue outbreaks are occurring with increasing frequency and intensity. Evidence-based epidemic preparedness and effective response are now a matter of urgency. Therefore, we have analysed national and municipal dengue outbreak response plans. Methods. Thirteen country plans from Asia, Latin America and Australia, and one international plan were obtained from the World Health Organization. The information was transferred to a data analysis matrix where information was extracted according to predefined and emerging themes and analysed for scope, inconsistencies, omissions, and usefulness. Findings. Outbreak response planning currently has a considerable number of flaws. Outbreak governance was weak with a lack of clarity of stakeholder roles. Late timing of responses due to poor surveillance, a lack of combining routine data with additional alerts, and lack of triggers for initiating the response weakened the functionality of plans. Frequently an outbreak was not defined, and early response mechanisms based on alert signals were neglected. There was a distinct lack of consideration of contextual influences which can affect how an outbreak detection and response is managed. Conclusion. A model contingency plan for dengue outbreak prediction, detection, and response may help national disease control authorities to develop their own more detailed and functional context specific plans.

  20. Salmonellosis outbreak due to chicken contact leading to a foodborne outbreak associated with infected delicatessen workers.

    Science.gov (United States)

    Hedican, Erin; Miller, Ben; Ziemer, Brian; LeMaster, Pam; Jawahir, Selina; Leano, Fe; Smith, Kirk

    2010-08-01

    Salmonella is the most common bacterial cause of foodborne outbreaks in the United States. Starting in June 2007, investigation of a cluster of Salmonella Montevideo cases with indistinguishable pulsed-field gel electrophoresis (PFGE) patterns resulted in the identification of an outbreak associated with contact with chickens purchased from a single hatchery. Nine Minnesota cases from May through August 2007 were part of this outbreak. Cases with the outbreak PFGE pattern of Salmonella Montevideo continued to occur in Minnesota after August, but none of these cases reported chicken contact. The majority of these cases resided in the same town in rural Minnesota. Routine interviews revealed that all cases from these counties purchased groceries from the same local grocery store, with two specifically reporting consuming items from the grocery store delicatessen in the week before illness. As a result, an investigation into the delicatessen was initiated. Illness histories and stool samples were collected from all delicatessen employees, and food and environmental samples were collected. None of the employees reported experiencing recent gastrointestinal symptoms, but the outbreak PFGE subtype of Salmonella Montevideo was identified from stool from two food workers. Food and environmental samples collected tested negative for Salmonella. One of the positive employees reported having chickens at home, but the animals did not test positive for Salmonella. The positive food workers were excluded from work until they had two consecutive negative stool cultures for Salmonella. There was no evidence of ongoing transmission thereafter. This was an outbreak of Salmonella Montevideo infections that began as an animal-contact-associated outbreak which subsequently resulted in a foodborne outbreak associated with infected food workers. These outbreaks illustrate the complex epidemiology of salmonellosis.

  1. Hydrogen outbreak of Zirconium Molybdate Hihydrate

    International Nuclear Information System (INIS)

    Miura, Yasuhiko; Fukuda, Kazuhiro; Ochi, Eiji

    2008-01-01

    JNFL is planning to construct a facility for enclosing the hull and end pieces produced due to reprocessing of spent fuel into stainless canisters after compressing, while those hull and end pieces enclosed into the stainless canisters are called 'compressed hulls'. Since the compressed hulls contain moisture absorbent Zirconium Molybdate Hihydrate accompanying hull and end pieces, there is a risk of outbreak of radiolysisradiolysis gas such as hydrogen, etc. by radiolysisradiolysis. This report intends to state the result of radiation irradiation experiment with the purpose of examining the volume of hydrogen outbreak from Zirconium Molybdate Hihydrate of the compressed hulls. (author)

  2. Lessons from the Ebola Outbreak: Action Items for Emerging Infectious Disease Preparedness and Response.

    Science.gov (United States)

    Jacobsen, Kathryn H; Aguirre, A Alonso; Bailey, Charles L; Baranova, Ancha V; Crooks, Andrew T; Croitoru, Arie; Delamater, Paul L; Gupta, Jhumka; Kehn-Hall, Kylene; Narayanan, Aarthi; Pierobon, Mariaelena; Rowan, Katherine E; Schwebach, J Reid; Seshaiyer, Padmanabhan; Sklarew, Dann M; Stefanidis, Anthony; Agouris, Peggy

    2016-03-01

    As the Ebola outbreak in West Africa wanes, it is time for the international scientific community to reflect on how to improve the detection of and coordinated response to future epidemics. Our interdisciplinary team identified key lessons learned from the Ebola outbreak that can be clustered into three areas: environmental conditions related to early warning systems, host characteristics related to public health, and agent issues that can be addressed through the laboratory sciences. In particular, we need to increase zoonotic surveillance activities, implement more effective ecological health interventions, expand prediction modeling, support medical and public health systems in order to improve local and international responses to epidemics, improve risk communication, better understand the role of social media in outbreak awareness and response, produce better diagnostic tools, create better therapeutic medications, and design better vaccines. This list highlights research priorities and policy actions the global community can take now to be better prepared for future emerging infectious disease outbreaks that threaten global public health and security.

  3. Animal disease outbreak control: the use of crisis management tools.

    Science.gov (United States)

    Kroschewski, K; Kramer, M; Micklich, A; Staubach, C; Carmanns, R; Conraths, F J

    2006-04-01

    In this era of globalisation the effective control of animal disease outbreaks requires powerful crisis management tools. In the 1990s software packages for different sectors of the government and agricultural industry began to be developed. In 2004, as a special application for tracking the movement of animals and animal products, the European Union developed the Trade Control and Expert System (TRACES) on the basis of its predecessor, the ANImal MOvement (ANIMO) project. The nationwide use of the ANIMO system by the veterinary authorities in Germany marked the beginning of the development in 1993 of a computerised national animal disease reporting system--the TierSeuchenNachrichten (TSN)--using the ANIMO hardware and software components. In addition to TRACES and TSN the third pillar for the management of animal disease outbreaks and crises in Germany is the national cattle and swine database--called Herkunftssicherungs- und Informationssystem für Tiere. A high degree of standardisation is necessary when integrating the different solutions at all levels of government and with the private sector. In this paper, the authors describe the use of these tools on the basis of their experience and in relation to what we can do now and what we should opt for in the future.

  4. Healthcare Workers Emotions, Perceived Stressors and Coping Strategies During a MERS-CoV Outbreak.

    Science.gov (United States)

    Khalid, Imran; Khalid, Tabindeh J; Qabajah, Mohammed R; Barnard, Aletta G; Qushmaq, Ismael A

    2016-03-01

    Healthcare workers (HCWs) are at high risk of contracting Middle East respiratory syndrome coronavirus (MERS-CoV) during an epidemic. We explored the emotions, perceived stressors, and coping strategies of healthcare workers who worked during a MERS-CoV outbreak in our hospital. A cross-sectional descriptive survey design. A tertiary care hospital. HCWs (150) who worked in high risk areas during the April-May 2014 MERS-CoV outbreak that occurred in Jeddah, Saudi Arabia. We developed and administered a "MERS-CoV staff questionnaire" to study participants. The questionnaire consisted of 5 sections with 72 questions. The sections evaluated hospital staffs emotions, perceived stressors, factors that reduced their stress, coping strategies, and motivators to work during future outbreaks. Responses were scored on a scale from 0-3. The varying levels of stress or effectiveness of measures were reported as mean and standard deviation, as appropriate. Completed questionnaires were returned by 117 (78%) of the participants. The results had many unique elements. HCWs ethical obligation to their profession pushed them to continue with their jobs. The main sentiments centered upon fear of personal safety and well-being of colleagues and family. Positive attitudes in the workplace, clinical improvement of infected colleagues, and stoppage of disease transmission among HCWs after adopting strict protective measures alleviated their fear and drove them through the epidemic. They appreciated recognition of their efforts by hospital management and expected similar acknowledgment, infection control guidance, and equipment would entice them to work during future epidemics. The MERS-CoV outbreak was a distressing time for our staff. Hospitals can enhance HCWs experiences during any future MERS-CoV outbreak by focusing on the above mentioned aspects. © 2016 Marshfield Clinic.

  5. Utility of Whole-Genome Sequencing in Characterizing Acinetobacter Epidemiology and Analyzing Hospital Outbreaks

    Science.gov (United States)

    Fitzpatrick, Margaret A.; Hauser, Alan R.

    2015-01-01

    Acinetobacter baumannii frequently causes nosocomial infections and outbreaks. Whole-genome sequencing (WGS) is a promising technique for strain typing and outbreak investigations. We compared the performance of conventional methods with WGS for strain typing clinical Acinetobacter isolates and analyzing a carbapenem-resistant A. baumannii (CRAB) outbreak. We performed two band-based typing techniques (pulsed-field gel electrophoresis and repetitive extragenic palindromic-PCR), multilocus sequence type (MLST) analysis, and WGS on 148 Acinetobacter calcoaceticus-A. baumannii complex bloodstream isolates collected from a single hospital from 2005 to 2012. Phylogenetic trees inferred from core-genome single nucleotide polymorphisms (SNPs) confirmed three Acinetobacter species within this collection. Four major A. baumannii clonal lineages (as defined by MLST) circulated during the study, three of which are globally distributed and one of which is novel. WGS indicated that a threshold of 2,500 core SNPs accurately distinguished A. baumannii isolates from different clonal lineages. The band-based techniques performed poorly in assigning isolates to clonal lineages and exhibited little agreement with sequence-based techniques. After applying WGS to a CRAB outbreak that occurred during the study, we identified a threshold of 2.5 core SNPs that distinguished nonoutbreak from outbreak strains. WGS was more discriminatory than the band-based techniques and was used to construct a more accurate transmission map that resolved many of the plausible transmission routes suggested by epidemiologic links. Our study demonstrates that WGS is superior to conventional techniques for A. baumannii strain typing and outbreak analysis. These findings support the incorporation of WGS into health care infection prevention efforts. PMID:26699703

  6. [Surveillance Plan on Recent Outbreak of Measles and Rubella in Catalonia, Spain].

    Science.gov (United States)

    Jané, Mireia; Torner, Nuria; Vidal, Ma José

    2015-01-01

    Measles and rubella are two immuno-preventive illnesses. In Catalonia, since 1988 all children are given two doses of measles and rubella vaccine with high levels of vaccination coverage. The measles elimination programme has been carried out since 1990 in Catalonia. This programme includes achieving and keeping high immunization levels among population with high vaccination coverage, intense epidemiological surveillance and an immediate response to the appearance of a case or outbreak. In 2014, the measles incidence rate was 1.9 cases/ 100,000 inhabitants. There were 4 recent outbreaks in 2006, 2011, 2013 and 2014 that affected 381, 289, 31 and 124 people respectively. All outbreaks were triggered by an imported case. In 2011 and 2014 measles outbreaks, 6% and 5.5% of affected people were health care workers. All outbreaks presented a great variety of measles genotypes. Concerning rubella elimination programme, since 2002, 68 cases of postnatal rubella and 5 cases of congenital rubella were confirmed. Regarding measles and rubella surveillance and control, in addition to strengthen vaccination coverage, it is essential immediate notification, within the first 24 hours since suspicion and laboratory confirmation. In addition there is a need to enforce vaccination among health care workers as well as in other susceptible and unvaccinated people. It is recommended to vaccinate all people who were born after 1966 and who have not been vaccinated with two doses of trivalent measles-mumps-rubella vaccine. Furthermore, we have to emphasize that the progress concerning genotypes study allows identifying various imported cases from other European countries with active outbreaks, aspect that makes easier the surveillance of these illnesses.

  7. Extensively drug-resistant Acinetobacter baumannii outbreak cross-transmitted in an intensive care unit and respiratory intensive care unit.

    Science.gov (United States)

    Lei, Jin'e; Han, Shaoshan; Wu, Wenjing; Wang, Xue; Xu, Jiru; Han, Lei

    2016-11-01

    Extensively drug-resistant Acinetobacter baumannii (XDRAB) is a great threat in intensive care units (ICUs). The aim of this study was to describe an XDRAB outbreak which was cross-transmitted in the ICU and respiratory intensive care unit (RICU) in a tertiary care hospital from January-March 2013. Patient and environmental surveillances were performed. Isolates were tested for antimicrobial susceptibility. Genotypes were analyzed by multilocus sequence typing (MLST). A series of enhanced strategies were implemented to control the outbreak. A total of 11 patients were infected by XDRAB strains during this outbreak. Three patients in the ICU were found positive for XDRAB at the onset of the outbreak. Thereafter, infections were detected in 6 patients in the RICU, followed by reappearance of this strain in the ICU in 2 patients. All A baumannii strains isolated from patients and the environment were extensively drug resistant. MLST revealed them as ST368. After 3 rounds of environmental screening and cleaning, the laminar flow system connecting the ICU and RICU was found as the source of transmission. Successful control of this outbreak was achieved through multifaceted intervention measures. This study suggested the importance of thorough surveillance and disinfection of the environment, including concealed devices, in preventing the transmission of an outbreak. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  8. Outbreak of imipenem-resistant Acinetobacter baumannii in different wards at a regional hospital related to untrained bedside caregivers.

    Science.gov (United States)

    Wang, Ching-Hsun; Li, Jin-Feng; Huang, Li-Yueh; Lin, Fu-Mei; Yang, Ya-Sung; Siu, L Kristopher; Chang, Feng-Yee; Lin, Jung-Chung

    2017-10-01

    This study describes an outbreak caused by imipenem-resistant Acinetobacter baumannii (IRAB) involving 2 general wards at the Penghu branch of Tri-Service General Hospital. Clinical data obtained from the patients with IRAB during an outbreak from May 2014-October 2014 were reviewed. Microbiologic sampling from the environment and the hands of health care workers (HCWs) was performed. Clinical isolates from case patients were genotyped using pulsed-field gel electrophoresis (PFGE). During the outbreak period, 12 patients were colonized or infected with IRAB. The hospital room environments of the case patients were contaminated with IRAB. Hands of nurses and physicians were not colonized with IRAB, but the hands of 2 bedside caregivers of case patients were colonized with IRAB. The PFGE analysis revealed that at least 2 major genetically distinct strains disseminated between 2 different wards. After implementation of infection control measures with a cohort of nursing patients, hand hygiene education for caregivers who had not received instructions before the outbreak, and a critical value alert system to notify case patients, the outbreak was controlled successfully. This outbreak study highlights the importance of adherence to hand hygiene by all HCWs to prevent the dissemination of multidrug-resistant organisms. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  9. An outbreak of Salmonella gastroenteritis in an urban jail.

    Science.gov (United States)

    Alcabes, P; O'Sullivan, B; Nadal, E; Mouzon, M

    1988-12-01

    An outbreak of gastroenteritis in New York City's largest jail involved 145 cases over a two-month period. The outbreak was unusual in that two Salmonella strains (serogroups B and D) were involved. Management of the outbreak involved screening kitchen workers by culture of stool samples, and education regarding personal hygiene. Obstacles to investigation and management of the outbreak arose out of the special nature of the jail environment; these included jurisdictional problems and high turnover of the inmate population.

  10. Leprosy New Case Detection Trends and the Future Effect of Preventive Interventions in Pará State, Brazil: A Modelling Study

    NARCIS (Netherlands)

    H.J. de Matos (Haroldo José); D.J. Blok (David); S.J. de Vlas (Sake); J.H. Richardus (Jan Hendrik)

    2016-01-01

    textabstractBackground: Leprosy remains a public health problem in Brazil. Although the overall number of new cases is declining, there are still areas with a high disease burden, such as Pará State in the north of the country. We aim to predict future trends in new case detection rate (NCDR) and

  11. Chikungunya virus outbreak expansion and microevolutionary events affecting epidemiology and epidemic potential

    Directory of Open Access Journals (Sweden)

    Powers AM

    2015-03-01

    Full Text Available Ann M PowersArboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USAAbstract: Chikungunya virus (CHIKV is a mosquito-borne virus that is associated with severe and prolonged arthralgia. Starting in 2004, CHIKV reemerged in a series of outbreaks along the east coast of Africa and on several islands of the Indian Ocean. Over the subsequent 10 years, the virus spread throughout the globe and caused over three million cases. Molecular characterization of the genomes over time revealed changes that were associated with changes in epidemiology and transmission patterns. Monitoring and exploitation of these changes may lead to better understanding of viral movement and potential options for prevention and control.Keywords: chikungunya, alphaviral evolution, molecular epidemiology, transmission, outbreaks

  12. Nanopore Sequencing as a Rapidly Deployable Ebola Outbreak Tool.

    Science.gov (United States)

    Hoenen, Thomas; Groseth, Allison; Rosenke, Kyle; Fischer, Robert J; Hoenen, Andreas; Judson, Seth D; Martellaro, Cynthia; Falzarano, Darryl; Marzi, Andrea; Squires, R Burke; Wollenberg, Kurt R; de Wit, Emmie; Prescott, Joseph; Safronetz, David; van Doremalen, Neeltje; Bushmaker, Trenton; Feldmann, Friederike; McNally, Kristin; Bolay, Fatorma K; Fields, Barry; Sealy, Tara; Rayfield, Mark; Nichol, Stuart T; Zoon, Kathryn C; Massaquoi, Moses; Munster, Vincent J; Feldmann, Heinz

    2016-02-01

    Rapid sequencing of RNA/DNA from pathogen samples obtained during disease outbreaks provides critical scientific and public health information. However, challenges exist for exporting samples to laboratories or establishing conventional sequencers in remote outbreak regions. We successfully used a novel, pocket-sized nanopore sequencer at a field diagnostic laboratory in Liberia during the current Ebola virus outbreak.

  13. Cholera outbreak in districts around Lake Chilwa, Malawi: Lessons ...

    African Journals Online (AJOL)

    Cholera is endemic in Malawi with seasonal outbreaks during the wet season. People living around Lake Chilwa rely on the lake for their water supply. From May 2009 to May 2010, a cholera outbreak occurred in fishing communities around Lake Chilwa. This paper describes the outbreak response and lessons learned for ...

  14. Grasshopper species composition shifts following a severe rangeland grasshopper outbreak

    Science.gov (United States)

    Little is known about how grasshopper species abundances shift during and following severe outbreaks, as sampling efforts usually end when outbreaks subside. Grasshopper densities, species composition and vegetation have infrequently been sampled during and after a severe outbreak in the western U.S...

  15. Management of Nosocomial Scabies, an Outbreak of Occupational Disease

    NARCIS (Netherlands)

    Jungbauer, Frank H. W.; Veenstra-Kyuchukova, Yanka K.; Koeze, Jacqueline; KruijtSpanjer, Martijn R.; Kardaun, Sylvia H.

    Background The optimal approach to managing institutional scabies outbreaks has yet to be defined. We report on outbreak managements are needed. Methods We report on a large outbreak of scabies in three acute care wards in a tertiary university teaching hospital in the Netherlands. Results The

  16. Chikungunya virus outbreak in Sint Maarten, 2013–2014

    Directory of Open Access Journals (Sweden)

    Maria Henry

    2017-08-01

    Full Text Available ABSTRACT This report describes the outbreak of chikungunya virus (CHIKV in Sint Maarten, a constituent country of Kingdom of the Netherlands comprising the southern part of the Caribbean island of Saint Martin, from 22 December 2013 (first reported case through 5 December 2014. The outbreak was first reported by the French overseas collectivity of Saint-Martin in the northern part of the island—the first site in the Americas to report autochthonous transmission of CHIKV. By 5 December 2014, Sint Maarten had reported a total of 658 cases—an overall attack rate of 1.76%. Actual prevalence may have been higher, as some cases may have been misdiagnosed as dengue. Fever and arthralgia affected 71% and 69% of reported cases respectively. Of the 390 laboratory-confirmed cases, 61% were female and the majority were 20–59 years old (mean: 42; range: 4–92. The spread of CHIKV to Sint Maarten was inevitable given the ease of movement of people, and the vector, island-wide. Continuing their history of collaboration, the French and Dutch parts of the island coordinated efforts for prevention and control of the disease. These included a formal agreement to exchange epidemiological information on a regular basis and provide alerts in a timely manner; collaboration among personnel through joint island-wide planning of mosquito control activities, especially along borders; notification of all island visitors, upon their arrival at airports and seaports, of preventative measures to avoid being bitten by mosquitoes; dissemination of educational materials to the public; and island-wide public awareness campaigns, particularly in densely populated areas, for both residents and visitors. The information provided in this report could help increase understanding of the epidemiological characteristics of CHIKV and guide other countries dealing with vector-borne epidemics.

  17. Fish and Shellfish Associated Disease Outbreaks.

    Science.gov (United States)

    Levin, M.

    1978-01-01

    Presents a literature review of disease outbreaks related to fish and shellfish, covering publications of 1976-77. This review covers the chemical, bacterial, and viral diseases that are transmitted by fish and shellfish. A list of 50 references is also presented. (HM)

  18. Canine distemper outbreak in rhesus monkeys, China.

    Science.gov (United States)

    Qiu, Wei; Zheng, Ying; Zhang, Shoufeng; Fan, Quanshui; Liu, Hua; Zhang, Fuqiang; Wang, Wei; Liao, Guoyang; Hu, Rongliang

    2011-08-01

    Since 2006, canine distemper outbreaks have occurred in rhesus monkeys at a breeding farm in Guangxi, People's Republic of China. Approximately 10,000 animals were infected (25%-60% disease incidence); 5%-30% of infected animals died. The epidemic was controlled by vaccination. Amino acid sequence analysis of the virus indicated a unique strain.

  19. Pneumonia outbreaks in calves and finishers.

    Science.gov (United States)

    2016-03-19

    Pneumonia in calves and finishers. Ovarian tumour in a calf . Abortion associated with bovine herpesvirus 1 in a suckler herd. Parasitic gastroenteritis causing illthrift and death in sheep. Outbreaks of acute fasciolosis in sheep. These are among matters discussed in the disease surveillance report for December 2015 from SAC Consulting: Veterinary Services (SAC C VS). British Veterinary Association.

  20. How Will Climate Change Impact Cholera Outbreaks?

    Science.gov (United States)

    Nasr Azadani, F.; Jutla, A.; Rahimikolu, J.; Akanda, A. S.; Huq, A.; Colwell, R. R.

    2014-12-01

    Environmental parameters associated with cholera are well documented. However, cholera continues to be a global public health threat. Uncertainty in defining environmental processes affecting growth and multiplication of the cholera bacteria can be affected significantly by changing climate at different temporal and spatial scales, either through amplification of the hydroclimatic cycle or by enhanced variability of large scale geophysical processes. Endemic cholera in the Bengal Delta region of South Asia has a unique pattern of two seasonal peaks and there are associated with asymmetric and episodic variability in river discharge. The first cholera outbreak in spring is related with intrusion of bacteria laden coastal seawater during low river discharge. Cholera occurring during the fall season is hypothesized to be associated with high river discharge related to a cross-contamination of water resources and, therefore, a second wave of disease, a phenomenon characteristic primarily in the inland regions. Because of difficulties in establishing linkage between coarse resolutions of the Global Climate Model (GCM) output and localized disease outbreaks, the impact of climate change on diarrheal disease has not been explored. Here using the downscaling method of Support Vector Machines from HADCM3 and ECHAM models, we show how cholera outbreak patterns are changing in the Bengal Delta. Our preliminary results indicate statistically significant changes in both seasonality and magnitude in the occurrence of cholera over the next century. Endemic cholera is likely to transform into epidemic forms and new geographical areas will be at risk for cholera outbreaks.

  1. Nosocomial outbreak of cryptosporidiosis in AIDS patients

    DEFF Research Database (Denmark)

    Ravn, Pernille; Lundgren, Jens Dilling; Kjaeldgaard, P

    1991-01-01

    admitted as inpatients during the transmission period of the outbreak (20 June-14 August), of whom 18 (17 with AIDS, one with AIDS related complex), developed cryptosporidiosis. Two further HIV negative subjects (one departmental secretary, one visiting relative) developed cryptosporidiosis. MAIN OUTCOME...

  2. October 2012 Multistate Fungal Meningitis Outbreak

    Centers for Disease Control (CDC) Podcasts

    2012-10-17

    This podcast gives an overview of the October 2012 multistate fungal meningitis outbreak, including symptoms to watch for and a website for up-to-date information.  Created: 10/17/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 10/17/2012.

  3. Preparing for a Pandemic Flu Outbreak

    Science.gov (United States)

    Dittbenner, Richard

    2009-01-01

    This article discusses the things college leaders should know and do in case of a pandemic influenza outbreak. The author talks about four principles that will guide college leaders in developing a pandemic influenza plan and presents the 10 elements of an effective college pandemic planning process.

  4. Canine Distemper Outbreak in Rhesus Monkeys, China

    Science.gov (United States)

    Qiu, Wei; Zheng, Ying; Zhang, Shoufeng; Fan, Quanshui; Liu, Hua; Zhang, Fuqiang; Wang, Wei; Liao, Guoyang

    2011-01-01

    Since 2006, canine distemper outbreaks have occurred in rhesus monkeys at a breeding farm in Guangxi, People’s Republic of China. Approximately 10,000 animals were infected (25%–60% disease incidence); 5%–30% of infected animals died. The epidemic was controlled by vaccination. Amino acid sequence analysis of the virus indicated a unique strain. PMID:21801646

  5. Quantifying reporting timeliness to improve outbreak control

    NARCIS (Netherlands)

    Bonačić Marinović, Axel; Swaan, Corien; van Steenbergen, Jim; Kretzschmar, MEE

    The extent to which reporting delays should be reduced to gain substantial improvement in outbreak control is unclear. We developed a model to quantitatively assess reporting timeliness. Using reporting speed data for 6 infectious diseases in the notification system in the Netherlands, we calculated

  6. Outbreak of Mysterious Illness Among Hospital Staff

    DEFF Research Database (Denmark)

    Jacobsen, Peter; Ebbehøj, Niels Erik

    2016-01-01

    BACKGROUND: Hospitals are rarely reported as settings for mass psychogenic illness (MPI). The present report scrutinizes an outbreak of probable MPI among hospital staff, with medical intervention reinforcing the course of the illness. CASE REPORT: Four of seven staff members in an emergency...

  7. Lessons in Outbreak a Consumer perspective

    NARCIS (Netherlands)

    Fischer, A.R.H.

    2008-01-01

    Lessons in Outbreak a Consumer perspective. Arnout Fischer Consumer risk perceptions is not necessarily the same as an economic weighing of risks and benefits. Consumers tend to be risk averse, tend to estimate catastrophic, unnatural or involuntary risks as larger, while personal lifestyle risks

  8. Evaluation of a theory-driven e-learning intervention for future oral healthcare providers on secondary prevention of disordered eating behaviors.

    Science.gov (United States)

    DeBate, Rita D; Severson, Herbert H; Cragun, Deborah L; Gau, Jeff M; Merrell, Laura K; Bleck, Jennifer R; Christiansen, Steve; Koerber, Anne; Tomar, Scott L; McCormack Brown, Kelli R; Tedesco, Lisa A; Hendricson, William

    2013-06-01

    Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills. The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation framework, a longitudinal group-randomized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes, knowledge, self-efficacy and skills related to the secondary prevention of disordered eating behaviors. Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group (effect sizes: 0.51-0.83) on all six outcomes of interest. Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors. Implications and value of using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework are discussed.

  9. The future of pain research, education, and treatment: a summary of the IOM report "Relieving pain in America: a blueprint for transforming prevention, care, education, and research".

    Science.gov (United States)

    Steglitz, Jeremy; Buscemi, Joanna; Ferguson, Molly Jean

    2012-03-01

    The fifth column on Evidence-Based Behavioral Medicine is focused on the Institute of Medicine's (IOM) report entitled "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research." The IOM has reported that chronic pain affects 116 million American adults, which is greater than the total of heart disease, cancer, and diabetes combined. It is recommended that data collection takes place at regular intervals using standardized questions, survey protocols, and electronic medical records with the aim of the identifying the following: subpopulations at risk; characteristics of acute and chronic pain; health consequences of pain, including death, disease, and disability; and longitudinal trends of pain. In addition, health education programs should be redesigned to include information about self-management, actions to prevent injuries at the individual and community level, advocacy for pain treatment, and support for improved prevention and control policies. Through teamwork between various professions, from physicians, nurses, and psychologists to physical therapists, pharmacists, and policy makers, advancements in pain awareness, education, research, and treatment should begin to materialize.

  10. Ascertaining the impact of catastrophic events on dengue outbreak: The 2014 gas explosions in Kaohsiung, Taiwan

    Science.gov (United States)

    2017-01-01

    Infectious disease outbreaks often occur in the aftermath of catastrophic events, either natural or man-made. While natural disasters such as typhoons/hurricanes, flooding and earthquakes have been known to increase the risk of infectious disease outbreak, the impact of anthropogenic disasters is less well-understood. Kaohsiung City is located in southern Taiwan, where most dengue outbreaks had occurred in the past two decades. It is also the center of petrochemical industry in Taiwan with pipelines running underneath city streets. Multiple underground gas explosions occurred in Kaohsiung in the evening of July 31, 2014 due to chemical leaks in the pipelines. The explosions caused 32 deaths, including five firefighters and two volunteer firefighters, and injured 321 persons. Historically, dengue outbreaks in southern Taiwan occurred mostly in small numbers of around 2000 cases or less, except in 2002 with over 5000 cases. However, in the months after the gas explosions, the city reported 14528 lab-confirmed dengue cases from August to December. To investigate the possible impact, if any, of the gas explosions on this record-breaking dengue outbreak, a simple mathematical model, the Richards model, is utilized to study the temporal patterns of the spread of dengue in the districts of Kaohsiung in the proximity of the explosion sites and to pinpoint the waves of infections that had occurred in each district in the aftermath of the gas explosions. The reproduction number of each wave in each district is also computed. In the aftermath of the gas explosions, early waves occurred 4–5 days (which coincides with the minimum of human intrinsic incubation period for dengue) later in districts with multiple waves. The gas explosions likely impacted the timing of the waves, but their impact on the magnitude of the 2014 outbreak remains unclear. The modeling suggests the need for public health surveillance and preparedness in the aftermath of future disasters. PMID:28520740

  11. Factors Influencing Emergency Nurses' Burnout During an Outbreak of Middle East Respiratory Syndrome Coronavirus in Korea

    OpenAIRE

    Kim, Ji Soo; Choi, Jeong Sil

    2016-01-01

    Purpose: Emergency department (ED) nurses suffer from persistent stress after experiencing the traumatic event of exposure to Middle East respiratory syndrome coronavirus (MERS-CoV), which can subsequently lead to burnout. This study aimed to assess ED nurses' burnout level during an outbreak of MERS-CoV and to identify influencing factors in order to provide basic information for lowering and preventing the level of burnout. Methods: Study participants were ED nurses working in eight hosp...

  12. A Growing Global Network’s Role in Outbreak Response: AFHSC-GEIS 2008-2009

    Science.gov (United States)

    2011-01-01

    John Snow’s investigation of cholera and the Broad Street pump in 19th century London [1], effective outbreak response continues to be challenging... Mexico border [in colla- boration with the U.S. Centers for Disease Control and Prevention (CDC) and the County of San Diego Health Department]. The U.S...IHR (2005). The most common diseases investigated were influenza (47), cholera (four), dengue fever (four) and hepatitis (three). Human disease was

  13. Measles outbreak linked to European B3 outbreaks, Wales, United Kingdom, 2017.

    Science.gov (United States)

    Currie, Jonny; Davies, Llion; McCarthy, Joanne; Perry, Malorie; Moore, Catherine; Cottrell, Simon; Bowley, Mererid; Williams, Chris; Shankar, Ananda Giri; Stiff, Rhianwen

    2017-10-01

    The United Kingdom achieved interrupted endemic measles transmission for 36 months in 2016. Despite this, ongoing challenges from sporadic measles cases typically imported from abroad remain. We summarise a B3 measles genotype outbreak in south-east Wales occurring between May and September 2017, linked with other European outbreaks, and lessons learnt. Seventeen confirmed cases and one probable case occurred principally in education and healthcare-settings. Six confirmed cases attended healthcare settings when infectious, without being isolated.

  14. Detection of Severe Respiratory Disease Epidemic Outbreaks by CUSUM-Based Overcrowd-Severe-Respiratory-Disease-Index Model

    Directory of Open Access Journals (Sweden)

    Carlos Polanco

    2013-01-01

    Full Text Available A severe respiratory disease epidemic outbreak correlates with a high demand of specific supplies and specialized personnel to hold it back in a wide region or set of regions; these supplies would be beds, storage areas, hemodynamic monitors, and mechanical ventilators, as well as physicians, respiratory technicians, and specialized nurses. We describe an online cumulative sum based model named Overcrowd-Severe-Respiratory-Disease-Index based on the Modified Overcrowd Index that simultaneously monitors and informs the demand of those supplies and personnel in a healthcare network generating early warnings of severe respiratory disease epidemic outbreaks through the interpretation of such variables. A post hoc historical archive is generated, helping physicians in charge to improve the transit and future allocation of supplies in the entire hospital network during the outbreak. The model was thoroughly verified in a virtual scenario, generating multiple epidemic outbreaks in a 6-year span for a 13-hospital network. When it was superimposed over the H1N1 influenza outbreak census (2008–2010 taken by the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, it showed that it is an effective algorithm to notify early warnings of severe respiratory disease epidemic outbreaks with a minimal rate of false alerts.

  15. Detection of Severe Respiratory Disease Epidemic Outbreaks by CUSUM-Based Overcrowd-Severe-Respiratory-Disease-Index Model

    Science.gov (United States)

    Castañón-González, Jorge Alberto; Macías, Alejandro E.; Samaniego, José Lino; Buhse, Thomas; Villanueva-Martínez, Sebastián

    2013-01-01

    A severe respiratory disease epidemic outbreak correlates with a high demand of specific supplies and specialized personnel to hold it back in a wide region or set of regions; these supplies would be beds, storage areas, hemodynamic monitors, and mechanical ventilators, as well as physicians, respiratory technicians, and specialized nurses. We describe an online cumulative sum based model named Overcrowd-Severe-Respiratory-Disease-Index based on the Modified Overcrowd Index that simultaneously monitors and informs the demand of those supplies and personnel in a healthcare network generating early warnings of severe respiratory disease epidemic outbreaks through the interpretation of such variables. A post hoc historical archive is generated, helping physicians in charge to improve the transit and future allocation of supplies in the entire hospital network during the outbreak. The model was thoroughly verified in a virtual scenario, generating multiple epidemic outbreaks in a 6-year span for a 13-hospital network. When it was superimposed over the H1N1 influenza outbreak census (2008–2010) taken by the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, it showed that it is an effective algorithm to notify early warnings of severe respiratory disease epidemic outbreaks with a minimal rate of false alerts. PMID:24069063

  16. An Adjusted Likelihood Ratio Approach Analysing Distribution of Food Products to Assist the Investigation of Foodborne Outbreaks

    Science.gov (United States)

    Norström, Madelaine; Kristoffersen, Anja Bråthen; Görlach, Franziska Sophie; Nygård, Karin; Hopp, Petter

    2015-01-01

    In order to facilitate foodborne outbreak investigations there is a need to improve the methods for identifying the food products that should be sampled for laboratory analysis. The aim of this study was to examine the applicability of a likelihood ratio approach previously developed on simulated data, to real outbreak data. We used human case and food product distribution data from the Norwegian enterohaemorrhagic Escherichia coli outbreak in 2006. The approach was adjusted to include time, space smoothing and to handle missing or misclassified information. The performance of the adjusted likelihood ratio approach on the data originating from the HUS outbreak and control data indicates that the adjusted approach is promising and indicates that the adjusted approach could be a useful tool to assist and facilitate the investigation of food borne outbreaks in the future if good traceability are available and implemented in the distribution chain. However, the approach needs to be further validated on other outbreak data and also including other food products than meat products in order to make a more general conclusion of the applicability of the developed approach. PMID:26237468

  17. Comparison of ARIMA and Random Forest time series models for prediction of avian influenza H5N1 outbreaks.

    Science.gov (United States)

    Kane, Michael J; Price, Natalie; Scotch, Matthew; Rabinowitz, Peter

    2014-08-13

    Time series models can play an important role in disease prediction. Incidence data can be used to predict the future occurrence of disease events. Developments in modeling approaches provide an opportunity to compare different time series models for predictive power. We applied ARIMA and Random Forest time series models to incidence data of outbreaks of highly pathogenic avian influenza (H5N1) in Egypt, available through the online EMPRES-I system. We found that the Random Forest model outperformed the ARIMA model in predictive ability. Furthermore, we found that the Random Forest model is effective for predicting outbreaks of H5N1 in Egypt. Random Forest time series modeling provides enhanced predictive ability over existing time series models for the prediction of infectious disease outbreaks. This result, along with those showing the concordance between bird and human outbreaks (Rabinowitz et al. 2012), provides a new approach to predicting these dangerous outbreaks in bird populations based on existing, freely available data. Our analysis uncovers the time-series structure of outbreak severity for highly pathogenic avain influenza (H5N1) in Egypt.

  18. Cholera Outbreaks in Urban Bangladesh In 2011.

    Science.gov (United States)

    Haque, Farhana; Hossain, M Jahangir; Kundu, Subodh Kumar; Naser, Abu Mohd; Rahman, Mahmudur; Luby, Stephen P

    In 2011, a multidisciplinary team investigated two diarrhoea outbreaks affecting urban Bangladeshi communities from the districts of Bogra and Kishorganj to identify etiology, pathways of transmission, and factors contributing to these outbreaks. We defined case-patients with severe diarrhoea as residents from affected communities admitted with ≥3 loose stools per day. We listed case-patients, interviewed and examined them, and collected rectal swabs. We visited the affected communities to explore the water and sanitation infrastructure. We tested the microbial load of water samples from selected case household taps, tube wells, and pump stations. We conducted anthropological investigations to understand community perceptions regarding the outbreaks. We identified 21 case-patients from Bogra and 84 from Kishorganj. The median age in Bogra was 23 years, and 21 years in Kishorganj. There were no reported deaths. We isolated Vibrio in 29% (5/17) of rectal swabs from Bogra and in 40% (8/20) from Kishorganj. We found Vibrio in 1/8 tap water samples from Bogra and in both of the samples from Kishorganj. We did not find Vibrio in water samples from pumps or tube wells in either outbreak. Ground water extracted through deep tube wells was supplied intermittently through interconnected pipes without treatment in both areas. We found leakages in the water pipes in Bogra, and in Kishorganj water pipes passed through open sewers. The rapid onset of severe diarrhoea predominantly affecting adults and the isolation of cholera in rectal swabs confirmed that these outbreaks were caused by Vibrio cholerae . The detection of Vibrio in water samples organisms from taps but not from pumps or tube wells, suggested contamination within the pipes. Safe water provision is difficult in municipalities where supply is intermittent, and where pipes commonly leak. Research to develop and evaluate water purification strategies could identify appropriate approaches for ensuring safe drinking

  19. How does increasing immunity change spread kernel parameters in subsequent outbreaks? – A simulation study on Bluetongue Virus

    DEFF Research Database (Denmark)

    Græsbøll, Kaare; Bødker, Rene; Enøe, Claes

    Modelling the spatial spread of vector borne diseases, one may choose methods ranging from statistic to process oriented. One often used statistic tool is the empirical spread kernel. An empiric spread kernel fitted to outbreak data provides hints on the spread mechanisms, and may provide a good...... estimate on how future epidemics could proceed under similar conditions. However, a number of variables influence the spread of vector borne diseases. If one of these changes significantly after an outbreak, it needs to be incorporated into the model to improve the prediction on future outbreaks. Examples...... of such changes are: vaccinations, acquired immunity, vector density and control, meteorological variations, wind pattern, and so on. Including more and more variables leads to a more process oriented model. A full process oriented approach simulates the movement of virus between vectors and host, describing...

  20. Yellow Fever outbreak in Darfur, Sudan in October 2012; the initial outbreak investigation report

    Directory of Open Access Journals (Sweden)

    Mohammed A. Soghaier

    2013-10-01

    Full Text Available Summary: Introduction: Sudan is subject to repeated outbreaks, including Viral Hemorrhagic Fever (VHF, which is considered to be a very serious illness. Yellow Fever (YF outbreaks in Sudan have been reported from the 1940s through 2005. In 2012, a new outbreak of YF occurred in the Darfur region. Objective: To identify the potential for an outbreak, to diagnose the disease and to be able to recognize its cause among the initial reported cases. Methodology: >This is a descriptive and investigative field study that applies standard communicable disease outbreak investigation steps. The study involved clinical, serological, entomological and environmental surveys. Results: The field investigation confirmed the outbreak and identified its cause to be YF. Conclusion: National surveillance systems should be strong enough to detect VHFs in a timely manner. Local health facilities should be prepared to promptly treat the initial cases because the case fatality ratios (CFRs are usually very high among the index cases. Keywords: Yellow Fever, Sudan, Darfur, VHFs, Soghaier

  1. Yellow Fever outbreak in Darfur, Sudan in October 2012; the initial outbreak investigation report.

    Science.gov (United States)

    Soghaier, Mohammed A; Hagar, Ahmed; Abbas, Mohammed A; Elmangory, Mutasim M; Eltahir, Khalid M; Sall, Amadou A

    2013-10-01

    Sudan is subject to repeated outbreaks, including Viral Hemorrhagic Fever (VHF), which is considered to be a very serious illness. Yellow Fever (YF) outbreaks in Sudan have been reported from the 1940s through 2005. In 2012, a new outbreak of YF occurred in the Darfur region. To identify the potential for an outbreak, to diagnose the disease and to be able to recognize its cause among the initial reported cases. >This is a descriptive and investigative field study that applies standard communicable disease outbreak investigation steps. The study involved clinical, serological, entomological and environmental surveys. The field investigation confirmed the outbreak and identified its cause to be YF. National surveillance systems should be strong enough to detect VHFs in a timely manner. Local health facilities should be prepared to promptly treat the initial cases because the case fatality ratios (CFRs) are usually very high among the index cases. Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  2. Pertussis outbreak in Papua New Guinea: the challenges of response in a remote geo-topographical setting

    Directory of Open Access Journals (Sweden)

    William Lagani

    2012-10-01

    Full Text Available Introduction: A large outbreak of pertussis was detected during March 2011 in Goilala, a remote district of the Central Province in Papua New Guinea, characterized by rugged topography with no road access from the provincial headquarters. This outbreak investigation highlights the difficulties in reporting and responding to outbreaks in these settings.Method: The suspected pertussis cases, reported by health workers from the Ononge health centre area, were investigated and confirmed for the presence of Bordetella pertussis DNA using the polymerase chain reaction (PCR method.Results: There were 205 suspected pertussis cases, with a case-fatality rate (CFR of 3%. All cases were unvaccinated. The Central Province conducted a response vaccination programme providing 65% of children less than five years of age with diphtheria–pertussis-tetanus-HepB-Hib vaccine at a cost of US$ 12.62 per child.Discussion: The incurred cost of vaccination in response to this outbreak was much higher than the US$ 3.80 per child for routine outreach patrol. To prevent further outbreaks of vaccine-preventable diseases in these areas, local health centres must ensure routine vaccination is strengthened through the “Reaching Every District” initiative of the National Department of Health.

  3. Assessing the Knowledge Level, Attitudes, Risky Behaviors and Preventive Practices on Sexually Transmitted Diseases among University Students as Future Healthcare Providers in the Central Zone of Malaysia: A Cross-Sectional Study