Comprehensive Medical Support in Complex Emergencies (CMSCE): pilot course review.

Global threats to health and health security are growing. Fragile and failed states, armed groups, ungoverned spaces, outbreaks and potential unknown "Disease X" threats, antimicrobial resistance (AMR), hybrid and gray zone conflict all exacerbate complex medical emergencies. These growing threats increase preventable morbidity and mortality of the most vulnerable populations. In an effort to promote best practices, standardize responses, and prevent excess death and disability in these contexts, The Kofi Annan International Peacekeeping Training Centre (KAIPTC), with support from multiple international partners and a volunteer facilitator faculty, administered the pilot course for military and civilian health officers involved in U.N. peacekeeping missions entitled, "Comprehensive Medical Support in Complex Emergencies (CMSCE 19)." This brief review paper provides a description of the process in designing and delivering an interdisciplinary course for providers and decision makers responding to complex emergencies. We conclude with best practices and next steps for course evolution.

Socialization During the COVID-19 Pandemic: The Role of Social and Scientific Networks During Social Distancing.

In the COVID-19 era, while we are encouraged to be physically far away from each other, social and scientific networking is needed more than ever. The dire consequences of social distancing can be diminished by social networking. Social media, a quintessential component of social networking, facilitates the dissemination of reliable information and fighting against misinformation by health authorities. Distance learning, telemedicine, and telehealth are among the most prominent applications of networking during this pandemic. Additionally, the COVID-19 pandemic highlights the importance of collaborative scientific efforts. In this chapter, we summarize the advantages of harnessing both social and scientific networking in minimizing the harms of this pandemic. We also discuss the extra collaborative measures we can take in our fight against COVID-19, particularly in the scientific field.

[The tuberculosis situation in the Berlin prison system from 2011-2016-a follow-up study]. / Die Tuberkulosesituation im Berliner Justizvollzug 2011­2016 ­ Eine Folgeerhebung.

Prison inmates are generally considered to be a high-risk group for tuberculosis (TB). When compared to the general population, the incidence and prevalence rates for TB are significantly higher among inmates. This follow-up survey examines the TB situation in Berlin prison facilities from 2011-2016 in comparison to the years 1996-1998 and 2007-2010. It is based on a retrospective case series of all cases with active pulmonary TB documented in the Berlin Prison Hospital from 2011-2016. There, the chest X­ray examination (CXR) according to § 36 (5) IfSG is an essential pillar of active case finding.The migration of the civilian population is accompanied by increases in case finding rates and multi-drug resistant (MDR) TB (16.7%) in the Berlin prison system. For the first time, nine first-infected cases of MDR-TB were recorded among 142 inmates with active lung TB (men: 97.2%, median age: 36.5 years, foreign nationals: 81.7%). Due to short periods of incarceration, treatment success by the time of release decreased to 14.6%.Through professional treatment and adequate monitoring of a vulnerable risk group that is hard to reach in a civilian environment, prison facilities make an important contribution to prevention of infection and TB control in Germany. However, in many cases, short detention periods require the release of inmates from prison while still under therapy. Lack of therapeutic success or incomplete treatments can thus contribute to the transmission of multi-resistant pathogens. Therefore, continuous health reporting, nationwide harmonised healthcare in prison facilities and ensuring the continuation and successful termination of anti-tuberculosis therapy following release, makes the relevance of an ongoing cooperation between the prison system and public health services more important.

Oral Health Status of Healthcare Workers in Ilembula/Tanzania during the COVID-19 Condition.

The challenge of reduced dental treatment and education infrastructure in the Tanzanian highlands affects the oral health situation of both the general population and local healthcare workers. The aim of this study was to investigate the oral health status of healthcare workers at Ilembula Lutheran Hospital (ILH), Tanzania, during the COVID-19 pandemic. In total, 134 healthcare workers (62 women, 72 men; mean age 36.48 ± 9.56 years, range 19-59 years; median age 35.00 years) participated in this cross-sectional study, conducted from 12 February to 27 February. A dental examiner trained in oral health screening performed the oral health data collection. Data collection was performed by probability sampling using the Ilembula Data Collection Form-Oral Health (IDCF-Oral Health) questionnaire distributed in paper form. Ethical approval was obtained from the National Institute for Medical Research/Tanzania. The decayed, missing, and filled teeth (DMF/T) index proposed by the World Health Organization (WHO) was used with the associated caries measurement method and the simplified oral hygiene index (OHI-S). Details regarding edentulism, nutritional habits, and socio-economic factors were collected. Statistical analysis was performed using linear regression (α = 0.05). The average DMF-T index was 3.33 ± 0.82, with age, gender, meal frequency, and soft drink consumption significantly influencing the index. No evidence of dental plaque was detected in 43.3% of the participants. Of the participants, 32.8% required prosthetic treatment (Kennedy Class III), while 16.4% needed it for acute malocclusions. Oral hygiene products were used in 97% of cases. A total of 35.8% of the participants had an OHI-S score of up to 1.0, with (p < 0.001) age and (p < 0.001) sex having a significant influence on the index. The current oral health situation of healthcare workers at ILH shows a moderate need for restorative and prosthetic treatment in rural Tanzania. Despite the COVID-19 pandemic, there was no change in the need for dental treatment, which may be explained by the generally restricted access to dental healthcare in the investigated region. The development of an interdisciplinary oral health prophylaxis system could help to reduce the need for future treatments.

Changing epidemiology of COVID-19: potential future impact on vaccines and vaccination strategies.

INTRODUCTION: COVID-19 was an unprecedented challenge worldwide; however, disease epidemiology has evolved, and COVID-19 no longer constitutes a public health emergency of international concern. Nonetheless, COVID-19 remains a global threat and uncertainties remain, including definition of the end of the pandemic and transition to endemicity, and understanding true rates of SARS-CoV-2 infection/transmission. AREAS COVERED: Six international experts convened (April 2023) to interpret changing COVID-19 epidemiology and public health challenges. We report the panel's recommendations and knowledge gaps in COVID-19 epidemiology, SARS-CoV-2 evolution, and future vaccination strategies, informed by peer-reviewed publications, surveillance data, health authority assessments, and clinical experience. EXPERT OPINION: High population SARS-CoV-2 immunity indicates the likely end to the pandemic's acute phase. Continued emergence of variants/sublineages that can evade the vaccine-induced antibody response are likely, but widespread immunity reduces the risk of disease severity. Continued surveillance is required to capture transition to endemicity, seasonality, and emergence of novel variants/sublineages, to inform future vaccination strategies. COVID-19 vaccination should be integrated into routine vaccination programs throughout life. Co-circulation with other respiratory viruses should be monitored to avoid a combined peak, which could overrun healthcare systems. Effective, combined vaccines and improved education may help overcome vaccine hesitancy/booster fatigue and increase vaccination uptake.

How the corona pandemic affects the global fight against tuberculosis and how to react.

The emergence of the acute pandemic by SARS-CoV-2 is a setback for the fight against chronic pandemics like tuberculosis (TB), malaria, and HIV/AIDS. In fact, after more than a decade of decreasing fatality numbers, 2020 saw a re-increase in the number of people dying from TB. After COVID-19, TB was the infectious disease with the second-highest fatality rate caused by a single pathogen, with 1.6 million deaths in 2021. It is expected by the WHO that the pandemic years to come and even after the pandemic will continue this trend. More efforts are needed to support TB control structures as an integral part of the strengthening measures of the general health care system.

Nocardia farcinica activates human dendritic cells and induces secretion of interleukin-23 (IL-23) rather than IL-12p70.

Studying the interaction of dendritic cells (DCs) with bacteria controlled by T-cell-mediated immune responses may reveal novel adjuvants for the induction of cellular immunity. Murine studies and the observation that nocardias infect predominantly immunosuppressed patients have suggested that these bacteria may possess an adjuvant potential. Moreover, adjuvants on the basis of the nocardial cell wall have been applied in clinical studies. Since the handling of adjuvants by DCs may determine the type of immune responses induced by a vaccine, the present study aimed at investigating the interaction of immature human monocyte-derived DCs with live or inactivated Nocardia farcinica in vitro and determining the cellular phenotypic changes as well as alterations in characteristic functions, such as phagocytosis, induction of T-cell proliferation, and cytokine secretion. Human DCs ingested N. farcinica and eradicated the bacterium intracellularly. DCs exposed to inactivated N. farcinica were activated, i.e., they developed a mature phenotype, downregulated their phagocytic capacity, and stimulated allogeneic T cells in mixed leukocyte reactions. Soluble factors were not involved in this process. To elucidate the potential adjuvant effect of N. farcinica on the induction of T-cell-mediated immune responses, we characterized the cytokines produced by nocardia-exposed DCs and detected substantial amounts of tumor necrosis factor alpha (TNF-α) and interleukin-12 p40 (IL-12p40). However, nocardia-treated DCs secreted only small amounts of IL-12p70, which were significantly smaller than the amounts of IL-23. Thus, N. farcinica activates DCs, but adjuvants based on this bacterium may have only a limited capacity to induce Th1 immune responses.

Perceived challenges to public health in Central and Eastern Europe: a qualitative analysis.

BACKGROUND: There is a major gradient in burden of disease between Central and Eastern Europe compared to Western Europe. Many of the underlying causes and risk factors are amenable to public health interventions. The purpose of the study was to explore perceptions of public health experts from Central and Eastern European countries on public health challenges in their countries. METHODS: We invited 179 public health experts from Central and Eastern European countries to a 2-day workshop in Berlin, Germany. A total of 25 public health experts from 14 countries participated in May 2008. The workshop was structured into 8 sessions of 1.5 hours each, with the topic areas covering coronary heart disease, stroke, prevention, obesity, alcohol, tobacco, tuberculosis, and HIV/AIDS. The workshop was recorded and the proceedings transcribed verbatim. The transcripts were entered into atlas.ti for content analysis and coded according to the session headings. After analysis of the content of each session discussion, a re-coding of the discussions took place based on the themes that emerged from the analysis. RESULTS: Themes discussed recurred across disease entities and sessions. Major themes were the relationship between clinical medicine and public health, the need for public health funding, and the problems of proving the effectiveness of disease prevention. Areas for action identified included the need to engage with the public, to create a better scientific basis for public health interventions, to identify "best practices" of disease prevention, and to implement registries/surveillance instruments. The need for improved data collection was seen throughout all areas discussed, as was the need to harmonize data across countries. CONCLUSIONS: To reduce the burden of disease across Europe, closer collaboration of countries across Europe seems important in order to learn from each other. A more credible scientific basis for effective public health interventions is urgently needed. The monitoring of health trends is crucial to evaluate the impact of public health programmes.

All together to Fight COVID-19.

Novel coronavirus disease (COVID-19), named a pandemic by the WHO, is the current global health crisis. National and international collaboration are indispensable for combating COVID-19 and other similar potential outbreaks. International efforts to tackle this complex problem have led to remarkable scientific advances. Yet, as a global society, we can and must take additional measures to fight this pandemic. Undoubtedly, our approach toward COVID-19 was not perfect, and testing has not been deployed fast enough to arrest the epidemic early on. It is critical that we revise our approaches to be more prepared for pandemics as a united body by promoting global cooperation and commitment.

Safety and immunogenicity of an intramuscular Helicobacter pylori vaccine in noninfected volunteers: a phase I study.

INTRODUCTION: Helicobacter pylori infection is among the most common human infections and the major risk factor for peptic disease and gastric cancer. Immunization with vaccines containing the H pylori vacuolating cytotoxin A (VacA), cytotoxin-associated antigen (CagA), and neutrophil-activating protein (NAP), alone or in combination, have been shown to prevent experimental infection in animals. AIM: We sought to study the safety and immunogenicity of a vaccine consisting of recombinant VacA, CagA, and NAP given intramuscularly with aluminium hydroxide as an adjuvant to noninfected healthy subjects. METHODS: This controlled, single-blind Phase I study randomized 57 H pylori-negative volunteers into 7 study arms exploring 2 dosages (10 and 25 microg) of each antigen and 3 schedules (0, 1, 2 weeks; 0, 1, 2 months; and 0, 1, 4 months) versus alum controls. All participants were followed for 5 months. Thirty-six subjects received a booster vaccination 18-24 months after the completion of the primary vaccination. RESULTS: Local and systemic adverse reactions were mild and similar in placebo and vaccine recipients on the monthly schedules. All subjects responded to 1 or 2 of the antigens and 86% of all vaccines mounted immunoglobulin G antibody responses to all 3 antigens. Vaccinees exhibited an antigen-specific cellular response. Vaccination 18-24 months later elicited anamnestic antibody and cellular responses. CONCLUSIONS: This intramuscular H pylori vaccine demonstrated satisfactory safety and immunogenicity, produced antigen-specific T-cell memory, and, therefore, warrants further clinical study.

Role of acceptability barriers in delayed diagnosis of Tuberculosis: Literature review from high burden countries.

PURPOSE: Direct transmission of mutated tuberculosis (TB) strains is among major contributors to the worldwide epidemic of Drug-Resistant Tuberculosis. Expanding access to TB-services and decreasing diagnostic delays are acknowledged as potential solutions. We aimed to summarize evidence about links between health care acceptability barriers and TB diagnostic delays. Scoping and systematic review approaches were combined to determine the depth/breadth of the literature, identify gaps, and synthesize findings. METHODS: Electronic data-bases, key journals, other relevant electronic sources, and references of relevant articles were selected as potential sources through a preliminary search and experts advice. Titles and abstracts of 4046 initial records and 1796 references were screened against preliminarily developed and post-hoc inclusion/exclusion criteria. Author, year of publication, study location, study aims, overview of methods, study population, intervention type, outcomes measures and results of each included paper were extracted. Methodological quality of studies was assessed. Narrative synthesis of the study results was conducted through the thematic analysis approach. RESULTS: Patients' negative expectations, doubts about quality of services/medications and burden of stigma, as well as providers' discriminative attitudes towards patients' characteristics (age, gender, ethnicity) were reported as major barriers. Scarcity and unequal distribution of the literature and lack of attention to all potential acceptability barriers were found as major gaps in the current research. CONCLUSION: Overall, study findings indicate the significance of acceptability barriers' role in TB diagnostic delays. Emerging character of the field is demonstrated. Recommendations about further research directions are outlined.

Data on the descriptive overview and the quality assessment details of 12 qualitative research papers.

This data article presents the supplementary material for the review paper "Role of acceptability barriers in delayed diagnosis of Tuberculosis: Literature review from high burden countries" (Barnabishvili et al., in press) [1]. General overview of 12 qualitative papers, including the details about authors, years of publication, data source locations, study objectives, overview of methods, study population characteristics, as well as the details of intervention and the outcome parameters of the papers are summarized in the first two tables included to the article. Quality assessment process of the methodological strength of 12 papers and the results of the critical appraisal are further described and summarized in the second part of the article.

Inter-laboratory validation of PCR-based detection of Mycobacterium tuberculosis in formalin-fixed, paraffin-embedded tissues.

The present study is based on the initiative for quality assurance in pathology of the German Society of Pathology and the Professional Association of German Pathologists. Four panel laboratories with experience and expertise in polymerase chain reaction (PCR) detection of Mycobacterium tuberculosis were selected to establish the prerequisites for continuous external laboratory trials, in particular, by providing pre-tested specimens and evaluation criteria for participating institutes. In the first step, the four panel laboratories performed an internal trial to test their own reliability and reproducibility. Paraffin sections and DNA preparations from 34 tissues (25 clinical specimens and 9 controls) totalling to 66 samples were evaluated by each panel institute according to their own protocols. The methodologies differed and are described in detail. Despite these differences, a high degree of inter-laboratory reliability was achieved. In this report, we summarise our results including the correlation with the histology and provide recommendations for applying PCR-based methodology for the detection of mycobacterial DNA in surgical specimens. Supplementary data are available online at http://www.charite.de/ch/patho (rubric "Forschung"). Pre-tested specimens are now available for the external trial and can be ordered from the steering institute via Oligene (http://www.oligene.com/). All molecular pathology laboratories are invited to participate in this quality assurance initiative.

Determination of heat-induced changes in the protein secondary structure of reconstituted livetins (water-soluble proteins from hen's egg yolk) by FTIR.

This study characterized the impact of technological treatments on the protein secondary structure of a newly developed egg yolk livetin formulation and its components α-livetin, which is identical with chicken serum albumin, and γ-livetin, the bioactive antibody immunoglobulin Y. Fourier transform infrared (FTIR) spectroscopy at 25 °C revealed that the largest proportion of conformal elements comprised intramolecular (native) ß-sheets (60-80%) in γ-livetin, and α-helices/random coils (60.59%) in α-livetin. In reconstituted freeze-dried livetins, the main protein conformations were also intramolecular (native) ß-sheets (55.08%) and α-helices/random coils (30.51%), but upon heating from 25 to 95 °C, the former decreased sigmoidally at the onset-of-denaturation temperature (TOD (FTIR)) of 69.5 °C, concomitant with a sigmoidal increase in intermolecular (denatured) ß-sheets at a TOD (FTIR) of 72.4 °C and a sigmoidal decrease in IgY activity at TOD (ELISA) of 67.5 °C. Reconstituted spray-dried livetins showed less native ß-sheets and significantly lower TOD (FTIR) values than freeze-dried livetins.

Mycobacterial persistence and immunity.

Tuberculosis still remains a major threat to global health at the beginning of the 21st century. The extraordinarily high numbers of morbidity and mortality are due to the ability of the pathogen, Mycobacterium tuberculosis, to evade an effective immune response and to persist within the host organism for long periods of time. The following article reviews our knowledge about both pathogen and host mechanisms involved in the immune response to M. tuberculosis.

Barriers to access to antiretroviral treatment for HIV-positive tuberculosis patients in Windhoek, Namibia.

SETTING: Namibia faces a high burden of tuberculosis (TB) and HIV-infection. In 2011, 50% of the TB patients were co-infected with HIV. While all patients co-infected with TB and HIV are eligible for antiretroviral treatment (ART), only 54% were reported to have received ART according to national data. OBJECTIVE: To explore the perspective of healthcare professionals on barriers to access to ART for HIV-positive TB patients. DESIGN: Nine semi-structured qualitative interviews were conducted with healthcare professionals from TB and HIV services in Windhoek in 2012 to investigate access barriers to ART for HIV-positive TB patients in Namibia. RESULTS: Many barriers known from other African countries were also present in Namibia. The barriers rated as most important were: staff shortage (health system level); limited training (healthcare worker level); and fear of stigma and discrimination (patient/community level). Direct treatment costs and limited availability of antiretroviral medication were not observed as barriers. Interference with TB treatment and ART by some Pentecostal churches was revealed as an important barrier that has not yet received sufficient attention. CONCLUSION: The study identified access barriers to ART for HIV-positive TB patients and their relevance in Namibia. The findings provide evidence for tailored interventions to increase ART-uptake among HIV-positive TB patients.