Background: Annual seasonal influenza infection is unpredictable, and varies from season to season. Australia experienced a severe season in 2017, followed by a mild season in 2018. In 2019, it featured unusually high inter-seasonal activity followed by a severe H3N2 season, proclaimed by the media as “the worst ever”. Following a severe season in 2017, enhanced vaccines were introduced in 2018 for people aged >65 years. Aim: To compare the seasonal severity of the 2017 and 2019 influenza season. Methods: Data were collated from the National Notifiable Diseases Surveillance System (NNDSS) report. Epidemiological trends of seasonal influenza infection were compared between the two years 2017 and 2019. Reported hospitalisations, ICU admissions and deaths were obtained from published sources and compared. Results: A(H3N2) dominated in both years. There was an early start to influenza circulation in 2019 with an unusually high number of cases seen during summer. There was no significant difference in the number of influenza hospitalisations or deaths reported in 2019 and 2017, but the proportion of hospitalisations that were admitted to ICU was significantly lower in 2019 (6.4% vs 8.9%, p<0.001). In both years, while large numbers of cases were reported, the severity of those cases was summarised as moderate. In 2019, 1108 influenza diagnoses per 100,000 population were notified to NNDSS up to October nationally, compared to 1021 per 100,000 for the same time period in 2017. There was variation in influenza activity by state in 2019, with Western Australia recording the highest activity and increased incidence compared to 2017. Most other states did not differ between 2019 and 2017. The 2017 epidemic affected the extremes of age more severely, as did 2019, but there was high activity in the young adult age group in 2019. Available data on the reported number of tests conducted in New South Wales and Western Australia were higher in 2019 than 2017. Vaccine effectiveness (VE) was reported initially as 40-60% for 2019 vs 33% (17-46%) in 2017. Conclusion: Both 2017 and 2019 were H3N2 seasons with large numbers of infections. Higher numbers of notifications to NNDSS were observed in 2019, probably due to an unusually high level of summer activity and increased testing. Clinical severity was estimated as similar to or less in 2019 compared to 2017. Estimated VE was higher in 2019 compared to 2017, and suggests a benefit of enhanced vaccines.
Introduction: Pertussis is a highly infectious disease that remains endemic despite a rising vaccination coverage rates globally. Due to the lack of global surveillance data for pertussis, the unconventional use of open-source data gives a glimpse into global outbreaks, compensating for the lack of national reporting systems in some countries. The objective of the study is to describe global reporting of pertussis through open source data. Methods: An open-source database, EpiWATCH was used to analyse global outbreaks of pertussis. Data was retrieved on pertussis and analysed on multiple epidemiological factors from 2016 to 2019. In addition, prevalence rates were calculated for each country and compared to the World Health Organization (WHO) public domain data on global reported cases. Results: A total of 96 reports were collected globally between the years 2016 to 2019. Of those reports, 95.8% (92/96) were from high-income countries. Data from the United States comprised 59.3% (57/96) of the total reports. . In addition, prevalence rates were calculated for each country and compared to the World Health Organization (WHO) public domain data on global reported cases. An outbreak report was identified in Papua New Guinea, which was not reported in WHO surveillance. Discussion: Open-source data gives insight and analysis on pertussis outbreaks globally, given there is no formal global surveillance system for pertussis. There is a bias toward reports from high income countries in open source data. However, the timeliness of reporting coupled with assisting countries with lacking national reporting systems are benefits of open source data.
DOI : 10.31646/gbio.65
ISSN: 2652-0036 Cilt: 1 Sayı: 4
Disease outbreaks can adversely impact the health and economic status of the affected populations. The notification of disease outbreaks to public health authorities can take months, delaying efficient response to those outbreaks. However, disease outbreak data gathered from informal sources such as media reports prove to be a good, resource-light source of real-time data. This provides a faster option to conduct epidemiologic analyses on disease outbreaks globally. At the time this report was prepared, there was no epidemiological analysis of unknown disease outbreaks globally; outbreaks whose causes are not immediately known. EpiWATCH data is used to analyse the epidemiology of unknown disease outbreaks globally from 2016 to 2019. Descriptive analysis of EpiWATCH data was conducted. One hundred and nine reports of unknown outbreaks were found for analysis. Ninety-three reports were on human cases and 17 were on non-human populations (one report also included human cases). Unknown disease outbreaks resulted in 6714 human cases. India and USA were responsible for the greatest number of outbreak reports. The year 2017 saw the greatest number of reports on unknown diseases published. August, across all four years, produced the greatest number of reports. Fever and vomiting were the most common symptoms reported by human cases. Measles, Nipah virus, norovirus and influenza were the most common causes of unknown disease outbreaks. Seventy-six percent of unknown disease outbreaks remain undiagnosed.
DOI : 10.31646/gbio.62 Anahtar Kelimeler :
unknown diseases, disease outbreaks, global outbreaks, descriptive analysis, epiwatch data
ISSN: 2652-0036 Cilt: 1 Sayı: 4
The 21st Commonwealth Games (the Games) was hosted on the Gold Coast, Australia in April 2018. With a large number of international travellers congregating at the mass gathering, it was important to monitor international communicable disease outbreaks with potential to be imported into Australia. The Australian Government Department of Health (DoH) conducted and reported enhanced international communicable disease surveillance during and surrounding the Games period. Surveillance focused on diseases with higher than normal incidence in Commonwealth countries with potential to be imported through travellers and ability to continue transmission in Australia. Over four months, 27 disease events were identified, monitored and reported to local, state and federal public health authorities, as well as general practitioners and pathologists throughout Queensland. Surveillance provided situational awareness for decision making and risk assessment during the Games. It complemented and informed surveillance of local disease activity during the Games and allowed frontline health professionals to contextualise disease presentations.
DOI : 10.31646/gbio.6 Anahtar Kelimeler :
Surveillance, Mass gatherings, Communicable disease, Public Health, Preparedness
ISSN: 2652-0036 Cilt: 1 Sayı: 1 Sayfa: 123 - 125
Background: Salmonella is one of the leading causes of foodborne outbreaks globally, with chicken and eggs the most common food vehicles associated. Fruit and vegetables have increasingly been reported as vehicles for salmonella. Aims: We aimed to determine the trends in salmonella outbreaks associated with cucumbers, as well as other fruit and vegetables from 2009-2017. Methods: Data from the published and grey literature were searched to investigate outbreaks of Salmonella globally caused by fruit and vegetables and specifically cucumbers. An open-source epidemic database, Epi-Watch, was also searched for salmonella outbreaks. Results: We identified and described 39 Salmonella outbreaks due to fruit and vegetables between 2009 and 2017 from Northern America, Europe, and Australia, including 6 multi-state and 1 state-based outbreaks due to cucumbers, the first being documented in 2013. The proportion of Salmonella outbreaks cause by fruit and vegetables has been increasing, as observed in both the United States of America (USA) and Australia. Conclusions: There has been a shift in the epidemiology of foodborne Salmonella outbreaks, with a higher number and proportion now associated with fruit and vegetables. This includes novel vehicles such as cucumbers, only reported as a vehicle for Salmonella since 2013. Emergence of less common serotypes has been observed in outbreaks from 2017-2019. Prevention at the production stage is important with limited options for consumers to reduce their risk of vegetable-associated Salmonella. Globalisation, changes in farming practices and importation of produce remains a challenge in monitoring and ensuring safety in the food supply chain.
Background: The epidemic of novel coronavirus disease (COVID-19) started in Wuhan, China, in December 2019, has been progressed to a pandemic level with high morbidity and mortality affecting many countries globally. Due to varied clinical characteristics of the disease, diagnosis can be missed easily among the affected population. The epidemiological data and early signals of COVID-19 infection are crucial for the disease investigation. Aim: To assess the presence of early signals of COVID-19 in India before official reporting of cases in the country and to compare epidemiological characters using different surveillance sources in the study. Methods: This study uses Epiwatch outbreaks surveillance data from November 2019 to March 2020 was used to determine the trend of pneumonia of unknown causes in India in order to assess if the COVID-19 could have been detected before the first case was reported.The search was carried out using the search terms defined in the study to identify the early signals of COVID-19.The COVID-19 line list extracted from the crowdsourced database (https://www.covid19india.org/) was additionally used to determine the demographic characteristics of cases. A descriptive analysis was conducted. Results: A total of 379 reports was extracted from Epiwatch. In 2019, there were only six reports of pneumonia of unknown causes in India, and the majority of the reports were focused on swine flu or undetected influenza cases. In 2020, there were 312 news reports of unknown pneumonia and COVID-19. The early signals of COVID-19 in India were observed from 24th January 2020 as the trend of pneumonia news had moderately increased. The trend of pneumonia reporting was low before the first confirmed case was reported in India. The study findings also suggested that there was under-reporting of COVID-19 cases in India by the World Health Organization (WHO) and the Ministry of Health, India when compared to data reported by Epiwatch and the line list. Conclusion: The study findings suggested that there were early signals of COVID-19 in India around 24th January when there was a slight increase in the trend of pneumonia reports in the country. The number of COVID-19 cases in India is under-reported by the Ministry of Health and the WHO. The use of online media surveillance reports such as Epiwatch and the line list could provide real-time assessment and timely investigation of emerging diseases globally.
DOI : 10.31646/gbio.72 Anahtar Kelimeler :
covid-19, pneumonia of unknown cause, india, epiwatch, pandemic
ISSN: 2652-0036 Cilt: 1 Sayı: 4
A national outbreak of listeriosis is linked to the consumption of rockmelon (cantaloupe) originating from New South Wales and has affected other states of Australia, including Victoria, Queensland and Tasmania.The outbreak began after 10 elderly people were diagnosed with Listeriosis after consuming cantaloupe and became ill between 17 January and 9 February, 2018 .
Increasingly COVID-19 is being recognised as a multisystem disease, with viral replication within the gastrointestinal tract now being well accepted. This article collates evidence pointing to possible gastrointestinal transmission as well as outlining possible mechanisms for intra-institutional or cruise ship spread, and explores the possible impact of gastrointestinal replication on disease course.
The prefecture of Koubia in the Labé region of Guinea suffers from permanent threats due to anthrax outbreaks. However, investigations have never benefited from laboratory diagnostic testing of suspicious samples. In this work, we performed laboratory diagnostic testing on samples from the most recent anthrax outbreaks that occurred in February and May of 2019. We report the first evidence of laboratory confirmation of anthrax in Guinea. This work highlights the importance for conducting study to understand the dynamic of anthrax at the human, animal, and environment interface in the prefecture of Koubia.
A new virus, classified as a variant of the coronavirus that causes severe acute respiratory syndrome (SARS), is severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2. The virus can be inactivated by heating at 56 ºC for 30 minutes and by using lipid solvents such as ethanol (> 75%), isopropanol (> 70%), formaldehyde (> 0.7%), povidone iodine (> 0, 23%), sodium hypochlorite (> 0.21%), or hydrogen peroxide (> 0.5%), but not chlorhexidine. Another approach is to use a footbath at the entrance of a house. The use of irradiation with ultraviolet light for 60 minutes resulted in the inactivation of several coronaviruses.
This commentary reviews the implications of the gas explosion at the Russian State Research Centre of Virology and Biotechnology building (Vector) on September 16th 2019. Public health and engineering perspectives are provided on the implications of the explosion causing a physical breach of the building, and the potential for dispersion of pathogens in the surrounding area. A global public health and risk analysis perspective is taken in discussing preparedness planning around this event.
'Introduction:' Lassa fever (LF) is a communicable viral haemorrhagic disease. Person-to-person spread occurs by inhalation or direct contact with the bodily fluids of an infected patient. Infection Prevention and Control (IPC) is essential in healthcare facilities for the wellbeing and safety of patients, staff and visitors. Federal Teaching Hospital, Abakaliki is the designated treatment center for LF in Ebonyi State. We assessed IPC practices in this facility during the 2018 outbreak of LF involving healthcare workers. 'Methods:' We conducted a cross-sectional study on 135 healthcare workers selected by systematic sampling. Information on their knowledge and practice of IPC was collected using a pre-tested, semi-structured questionnaire. We classified knowledge into “good”, “fair” and “poor” based on the total correct response. Those that scored ≥75% of the maximum score were classified as good, 50-74% as fair and <50% as poor. We calculated prevalence odds ratio and 95% confidence intervals of the odds ratio to determine the factors associated with good knowledge scores. We purposively sampled key units involved in the management of suspected Lassa fever cases and assessed the availability of basic IPC requirements. 'Results:' The mean age of the respondents was 37.6 ± 7.6 years and 75 (55.6%) were females. Fifty-seven (42.5%), 29 (21.6%) and 13 (9.9%) respondents claimed always to have gloves, running water and hand washing soaps, respectively, in their units. The proportion of respondents with good knowledge of IPC measures was 71.8%, while 58.5% and 37.8% had good knowledge of LF epidemiology and LF clinical features, respectively. Being a core health worker (OR: 3.39 95%CI: 1.38-8.32) was significantly associated with good knowledge of LF epidemiology. Being male (OR: 1.55 95%CI: 0.72-3.34) and having spent >15years in the facility (OR: 1.16 95%CI: 0.39 - 3.44) were associated with good knowledge of IPC precautionary measures. However, these associations were not statistically significant. 'Conclusions:' The majority of the staff had good knowledge of IPC. However, knowledge of LF epidemiology was greater among those whose roles were related to management of LF cases. We recommended more awareness on LF, IPC practices and improved supply of IPC commodities.
Aims: This study aimed to achieve a better understanding of factors contributing to effective training in outbreak investigation, including characteristics of effective trainees, supervisors, and training activities. Methods: We designed a semi-structured interview aimed at exploring factors in Tynjala’s 3P model related to Presage (which we defined as qualities of a good FETP trainee), Process (activities that support trainees in attaining competence as outbreak investigators, including effective supervision) and Product (qualities of a good outbreak investigation and investigator). These topics were explored principally within the context of the Australian MAE Program. Deductive content analysis was conducted on interview transcripts to construct qualitative themes relating to these topics based on interview data. Results: The principal themes identified as the key components in training a competent outbreak investigator related to: personal qualities and interpersonal skills, alongside prior qualifications; elements of effective supervision including technical and soft skills, flexibility, and personal compatibility with the trainee; and activities to best support trainee development including classroom teaching in preparation for practical experience, and the ideal approach and quantity of practical exercises. Conclusions: This study identified that effective outbreak investigators possess a broad range of skills and knowledge. These span from proficiency at epidemiological tasks to interpersonal communication, underpinned by personal attributes such as perseverance and curiosity. Similarly, supervisors should ideally demonstrate passion for teaching and investment in the holistic performance and wellbeing of trainees, providing flexibility to adapt to the needs and learning styles of each trainee. Training activities should support trainees to learn theoretical content that complements practical experience, and develop mastery and confidence by having incrementally increased responsibility and independence across successive practical scenarios. These findings will be important considerations when reviewing procedures and curriculum materials for Field Epidemiology Training Programs.
DOI : 10.31646/gbio.53 Anahtar Kelimeler :
outbreak investigation training, field epidemiology training, workplace learning, supervision, training, field epidemiology, outbreak investigation
ISSN: 2652-0036 Cilt: 1 Sayı: 4
Dr Dionisio Herrera Guibert, who passed away on 4-12-2018, was a key figure in the development of the epidemiology training, both in Spain and internationally. This commentary is in his memory and recognises his achievements in field epidemiology.
'Background': Early detection of disease outbreaks, using appropriate surveillance methods, is a basic principle for effective control of epidemics. Indicator-based surveillance methods, such as comprehensive surveillance, sentinel surveillance and syndromic surveillance, have been routinely utilized for early epidemic detection to minimize mortality and morbidity related to emerging infectious disease threats. In addition, event-based surveillance uses unstructured data sources to detect and monitor outbreaks such as media reports, social media and websites. The use of mobile phone technology is growing in many low and middle-income countries, which has made mHealth an efficient means of health communication in such countries for epidemic surveillance, mitigation and response. Mobile Apps may draw data from validated health sources or unvalidated public sources and convey information to responders. The aim of this study was to review mobile Apps used for epidemic surveillance and response. 'Methods': A review of Google Play and the App Store was conducted from June 2018 to August 2018 for Apps containing the words “epidemic”, “outbreak”, “pandemic”, “public health”, “infectious diseases”, “infection”, “bioterrorism” or “CBRNE”, “surveillance”. Available Apps were analysed by the intended user, purpose, platform, functions and number of downloads. 'Results': We found a total of 106 Apps in an initial search, and of those 80 Apps did not meet the selection criteria and were excluded. Finally, 26 relevant surveillance Apps, including 21 free of charge and 5 paid Apps, were included in this review. Of these, 17 Apps are for single disease surveillance, 7 Apps for multiple disease surveillance and 2 Apps provides information on possible bioterrorism agents. The intended user varied from the general public (18 Apps) to health practitioners (4 Apps) and remaining 4 Apps intended for both general public and health practitioners. The Apps included real-time tracking in an interactive map (10 Apps), daily notification alerts (3 Apps), user function to report diseases/ outbreaks (4 Apps) and multiple disease tracking options (7 Apps). The most downloaded Apps were Sickweather with 100,000+ downloads and HealthMap with 10,000+ downloads. Only 4 Apps were available on both Android and iOS platforms. 'Conclusion': There are at least 26 mobile Apps for surveillance of epidemics, mostly free of charge and mostly for laypeople. Among them, HealthMap is the most comprehensive, but by far the greatest number of downloads was for a consumer App, Sickweather. Some Apps can provide real-time tracking and interactive maps. However, limitations included unavailability of Apps suitable for general public or surveillance of potential bioterrorism incidents, limited geographic or disease relevance, and high cost for some Apps. There is great potential to utilize existing Apps and develop new ones, especially which meet the needs of health professionals and public health authorities for real-time disease surveillance.
DOI : 10.31646/gbio.39 Anahtar Kelimeler :
mobile applications, epidemic surveillance, mHealth Apps, diseases or outbreaks monitoring, epidemic, outbreak, pandemic, public health, infectious diseases, bio-terrorism events App, surveillance
ISSN: 2652-0036 Cilt: 1 Sayı: 2 Sayfa: 37 - 49
Background: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; named 2019 novel coronavirus or 2019-nCoV) disease in China at the end of 2019 has led to pandemic. A robust surveillance system is required for true estimation of burden of the disease. This study was conducted to identify the strengths and weaknesses of laboratory-based COVID-19 surveillance system in Pakistan and to propose some doable actions for improvement. Method: An evaluative study was conducted from February to March, 2020 at National Institute of Health (NIH) Islamabad, Pakistan. CDC’s “Updated Guidelines for Evaluation Public Health Surveillance System-2001” were used to evaluate the COVID-19 disease surveillance system. Information was gathered and analyzed on different system attributes using qualitative and quantitative methods. Results: System found simple, stable and readily acceptable at all public and private sectors with flexibility to incorporate other respiratory pathogens detection. Reporting was timely, typically within 24-48 hours of sample reception, using electronic as well as paper based management system. All stakeholders contributed in this health emergency. With evolving cases definition and unknown prevalence till first week of April, sensitivity and predictive value positive was found 1.25% and 4.50% respectively. Representativeness was good since it is a reference lab with few sentinel sites for COVID-19 specific testing. Conclusion: Based on the findings of this study, system meets the initial objectives of the surveillance but rapid expansion of sentinel sites along with continuous provision of logistics, supplies and trained human resources is needed to meet the increasing need of detection in wake of rapidly spreading pandemic.
DOI : 10.31646/gbio.73 Anahtar Kelimeler :
surveillance, covid-19, system attributes, evaluation, pakistan.
ISSN: 2652-0036 Cilt: 1 Sayı: 4
The number of cases of coronavirus disease (COVID-19) is increasing rapidly and case fatality ratio (CFR) is estimated to be around 2 to 3%. However, the epidemic is still ongoing and the outcome of many sick cases of COVID-19, particularly the outcome of severe cases, is not yet available, which may lead to underestimation of CFR. This was observed during the initial phase of severe acute respiratory syndrome coronavirus (SARS-CoV) outbreak as well, where CFR increased with the passage of time. We estimated the CFR of COVID-19 by extrapolating the data using SARS as an analogy. According to our estimates, the actual CFR of COVID-19 may be around 4.4 to 4.8%. However, these results should be interpreted with cautions as we did not adjust for many confounding factors. Various epidemiological and modelling techniques can be used to estimate CFR of COVID-19 during the epidemic. Precise estimates of CFR will be available after the end of the epidemic when the outcome of all cases will be available.
DOI : 10.31646/gbio.56 Anahtar Kelimeler :
coronavirus, covid-19, cfr, case fatality ratio, sars-cov, sars-cov2
ISSN: 2652-0036 Cilt: 1 Sayı: 3
Volunteers are an integral component of any medium to large scale multi-agency response and, like the comic book “The Invisibles”, have emergency management “superpowers” that could be utilised by the health sector to strengthen Australia’s response to human health threats such as epidemics, pandemics and bioterrorism.
Antimicrobial resistance (AMR) has been recognized by global leadership as the biggest - and the harshest challenge to the economic development of the humanity and the global health security. Factors responsible for burgeoning AMR are well known. Possible avenues for rapid containment of this scourge have also been articulated. Huge resources -both financial and technical are needed by the developing countries. In the absence of these, innovative cost-effective approaches are needed. Universal health coverage, and One Health approach that brings together human health, animal health and environmental impact to benefit health should be considered by resource-limited countries to implement in their countries with appropriate modifications that provide them with the best outcomes for their populations by preserving efficacy of currently available and affordable antimicrobial agents against infectious diseases.
DOI : 10.31646/gbio.4 Anahtar Kelimeler :
antimicrobial resistance, universal health coverage, One Health, Asian countries
ISSN: 2652-0036 Cilt: 1 Sayı: 2
The highly contagious SARS-CoV-2 (COVID-19) pandemic has affected 213 countries and territories and six continents as of 1st June 2020. The World Health Organization (WHO) has identified this highly pathogenic outbreak as posing a severe health threat to the global population. The disease is particularly concerning for approximately one million Rohingya refugees living in the world’s largest refugee camp in the Cox’s Bazar district of Bangladesh because of existing poor health determinants. As of 15th May 2020, Bangladesh and UN officials confirmed that ‘two refugees tested positive at the refugee camps in Cox's Bazar, Bangladesh where 1,900 other refugees — who may have been in contact with them — are being isolated for tests. Although the incidence rate is low at this stage, epidemiological modelling estimates a mortality rate of 1,500 Rohingya refugees per day. This high rates of mortality warrants to undertake rapid and comprehensive preventative measures to control the COVID-19 outbreak and subsequently reduce aggravating existing humanitarian crisis in the refugee camp. This paper highlights epidemiological insights into the need for a rapid response to COVID-19 in the refugee camps. Subsequently, it offers community, health, and political level-recommendations to help control the spread of COVID-19 among the extremely vulnerable Rohingya refugees. This paper draws upon secondary sources of data, grey literature, published studies as well as personal communication with field officers to offer translational strategies to control and prevent the spread of COVID 19 in the camps.
It is a politically controversial but by no means scientifically contentious hypothesis that many of the root causes of contemporary climate change emerge from the profit-seeking activities of multinational corporations – for instance in the oil, coal, deforestation and livestock industries. Contemporary corporatogenic warming of the climate is recognised scientifically as not only having tragic environmental consequences, but also creating significant biosecurity risks. Using the 2008 Dengue Fever outbreak in Northern Queensland as a critical focal point, this article explores the implications of corporatogenic climate change to Australian biosecurity in the context both of Australia’s new federal biosecurity legislation ('Biosecurity Act 2015 (Cth)') and the investor-State dispute settlement provisions of the 'Comprehensive and Progressive Trans-Pacific Partnership' (CPTPP) particularly as they may impact the health and international human rights of Australia’s northerly indigenous populations.
Background: Crimean Congo Haemorrhagic Fever (CCHF) is an acute viral zoonotic disease that is endemic in Pakistan. Poverty, limited awareness and lack of biosafety practices make it a potential occupational health risk. A poor surveillance system makes it more difficult to monitor the disease burden. ' ' Purpose: An evaluation was carried out to identify the strengths and weaknesses of the event-based CCHF surveillance system in Balochistan, Pakistan, and to propose recommendations for improvement. Methods: A descriptive evaluation study was conducted at an isolation ward of a public hospital from November 2017 to February 2018 in Balochistan Province. Event-based CCHF surveillance system was evaluated by using updated CDC guidelines for Evaluating Public Health Surveillance Systems. Data were collected through review of records and interaction with stakeholders. Using a semi-structured questionnaire, surveillance system attributes were assessed according to the guidelines in the study tool. Findings: The system was simple, but had no standardised case definition. It was found to be flexible as new health-related events could be easily incorporated. Data quality was moderate; 80% (75/94) of the reports were completely filled. The system had good timeliness but lacked involvement of the private sector. Acceptability was good with involvement of different government stakeholders. Sensitivity was poor while positive predictive value was 27.5%. Conclusion: Event based surveillance for CCHF can be improved by involvement of private practitioners and laboratories in the surveillance system to improve representativeness. The timeliness could be improved by adopting an online reporting mechanism. Feedback, support and supervision should be ensured for data quality assurance. Periodic refresher trainings of the staff could be organized.
Current momentum in military research efforts has opened the possibility for both the enhancement but also augmentation of military personnel for the purpose of achieving advantage over rivals. Rapid technological advances, currently breaking ground well ahead of prudent commentary and consideration of impacts on human society, ethics, geopolitics and military operations. This has potentially allowed friend and foe alike to exploit opportunities to develop completely novel countermeasures and defences, but also develop new threats in Chemical, Biological, Radiological and Nuclear (CBRN) military operations. In this editorial two recent technological developments driving medical countermeasure research are highlighted as examples. How such developments impact on capability competitions – in other words driving new arms races – in near-peer rivals is discussed. The profound potential impacts of these new technologies on the fundamentals of human existence as we understand it today are highlighted.
Background: In a global political climate increasingly concerned about terrorism, bioterrorism agents such as smallpox would undoubtedly be catastrophic. Since WHO announced the eradication of smallpox in 1980, consequently discontinuing the worldwide vaccination campaign, today’s population is either immunologically naïve or has waning levels of protection. Further, up to 25% of today’s population are contraindicated for smallpox vaccination due to various immunodeficiency conditions. The aim of this study was to evaluate the efficacy of the anti-DNA antivirals cidofovir (CDV), brincidofovir (BCV), and tecovirimat. As of July 2018, FDA approved tecovirimat as the first treatment for smallpox. Methods: A systematic review was conducted to identify relevant literature describing the efficacy and safety of CDV, BCV and tecovirimat 'in vitro, in vivo 'animal studies, human safety trials and human case reports of orthopoxvirus infection. Results: 158 studies met the inclusion criteria. CDV, BCV and tecovirimat are highly effective 'in vitro 'and 'in vivo 'animal studies when used therapeutically and prophylactically. They are partially protective in moderate, but not severe, immunodeficiency models. Clinical trials consistently report BCV and tecovirimat to be safe and well tolerated in humans. In human case reports, CDV, BCV and tecovirimat contributed to recovery from orthopoxvirus infection. BCV and tecovirimat demonstrate strong synergistic effect, and may reduce risk of antiviral-resistant strains. Conclusion: BCV and tecovirimat are particularly promising as anti-smallpox agents. Gaps in the literature indicate that further research should focus on developing more robust immunodeficiency and antiviral-resistance models.