Comparative Evaluation of Tears and Nasopharyngeal Swab for SARS-CoV-2 in COVID-19 Dedicated Intensive Care Unit Patients.

Purpose: To compare the cycle threshold (Ct) values of tears and nasopharyngeal (NP) swab in severe COVID-19 ICU patients with positive NP swabs.Procedure: A cross-sectional study for the detection of SARS-CoV-2 by real-time RT-PCR on simultaneously collected NP swabs and tears was performed. Detailed demographic profile, including comorbidities, ocular, and systemic features were analyzed.Results: In the 78 cases, the mean tear positivity was 26.92% (21/78), 2 tear samples being positive despite a negative NP swab. The mean Ct value of tears and NP were 28.17 ± 4.76 and 23.71 ± 6.19, respectively (p= .003). None of the cases had ocular findings or relationship between tear positivity and comorbidity.Conclusions: The viral load of tears is less than the NP secretions with the possibility of prolonged shedding in tears. Tears act as an additional source of contact transmission in ICU that can possibly be decreased by frequent hand hygiene by the patient.Abbreviations: SARS-CoV-2: Severe acute respiratory syndrome coronavirus; RT-PCR: Real-time Reverse transcriptase-polymerase chain reaction; COVID-19: Corona virus disease 2019; ICU: Intensive care unit; RdRp: RNA-dependent RNA polymerase; ORF 1b: Open reading frame 1b; AIIR: Airborne infection isolation room; HCW: Health care workers; VTM: viral transport media; NP: Nasopharyngeal swab; PPE: Personal protective equipment.

One Health operational framework for action for the Eastern Mediterranean Region, focusing on zoonotic diseases.

Human health is intrinsically linked to the health of animals and to the environment, and efforts by just one sector alone cannot prevent or adequately address the complex problems at the human-animal-environment interface. Countries of the World Health Organization Eastern Mediterranean Region, as any other region, face the threat of emerging and remerging zoonoses. However, the challenges in this Region are high given the lack of resources, poor health systems, and political factors. Hence, adopting the One Health approach becomes urgent to assist those countries. Subsequently, based on analysis of One Health capacities in the Region and in close consultation with representatives and subject matter experts from countries in the Region, a framework for action towards effectively implementing the One Health approach was developed. The framework capitalizes on current opportunities in the region and provide countries with a list of practical key activities towards optimal use of their resources and strengthening their capabilities to tackle concurrent and future health challenges at the interface. Strong governance structures and building on existing mechanisms are crucial for achieving effective disease surveillance and response. Additionally, using intersectoral approaches for risk assessment and risk mitigation for health issues at the human-animal-environment interface can improve efficiency and result in more successful outcomes.

Enhancing surveillance for early detection of Zika virus infection: strategies for the countries of Eastern Mediterranean Region.

BACKGROUND: Zika virus infection (ZIKV) has caused major outbreaks in tropic and sub-tropic areas. No case from ZIKV has yet been reported in the countries of the Eastern Mediterranean Region (EMR) despite the presence of competent vector Aedes mosquitoes in many of these countries. AIMS: This study addresses appropriate surveillance strategies for early detection of ZIKV infection, which is important for EMR countries with established Aedes populations, but with no known or documented autochthonous transmission of ZIKV. METHODS: The WHO Regional Office for the Eastern Mediterranean developed a strategic framework for enhancing surveillance for ZIKV infection in EMR countries with established Aedes populations through a consultative process and review of available evidence. RESULTS: The framework calls for enhancing surveillance for early detection of ZIKV infection using a combination of both syndromic and event-based surveillance approaches. CONCLUSIONS: Enhancing surveillance for ZIKAV would require no shift in the existing system. A number of considerations would be required to integrate this syndromic and event-based surveillance approaches within the existing system.

Gap in measles vaccination coverage among children aged 9 months to 10 years in Ho Chi Minh City, Viet Nam, 2014.

INTRODUCTION: When Viet Nam launched the Expanded Programme on Immunization in 1981, it covered six vaccines, including measles. Subsequently, Viet Nam experienced a marked reduction in measles infections. A nationwide measles epidemic occurred in April 2014 and an investigation found that 86% of affected children aged 9 months to 10 years were not fully vaccinated; therefore, understanding the reasons for not vaccinating could improve vaccination coverage. METHOD: We performed a cross-sectional study to determine vaccination coverage and reasons for non-vaccination among children aged 9 months to 10 years in six districts in Ho Chi Minh City with the highest number of measles cases in 2014. Measles vaccination status of the youngest child in each household was determined and reasons for non-vaccination were investigated. A χ2 test and multiple logistic regression were used to identify independent predictors of full vaccination. RESULTS: In total, 207 children were enrolled during the study period in 2014. Full measles vaccination coverage was 55% in these households, and 73% of parents were aware of the importance of measles vaccination to protect their children. We found that the father's education level (under high school versus high school and above) and the site where the survey was conducted were significantly associated with vaccination status. CONCLUSION: The vaccination coverage was lower than the coverage reported by district preventive medicine centres of the seven study wards. Lack of the second vaccination was a key obstacle to eliminating the vaccination gap. A catch-up mass vaccination campaign or health promotion of measles vaccination directed towards parents should be considered to improve vaccination coverage.

Epidemiological and clinical characteristics of patients who died from Influenza A(H1N1)pdm09 in Viet Nam.

We describe the epidemiological and clinical characteristics of patients who died from influenza A(H1N1)pdm09 in hospitals in Viet Nam between August 2009 and March 2010. Of 58 fatal cases, 32 (55%) were below 30 years of age and 14 (24%) were pregnant females. Forty-five (78%) patients had at least one underlying medical condition including chronic heart, kidney or lung diseases or pregnancy. Twelve (21%) cases sought medical attention on the day of symptom onset. Only 13 (36%) of 36 cases for whom treatment data were available had been given antiviral drugs within the recommended two days of symptom onset. The clinical and epidemiologic characteristics of the patients who died from influenza A(H1N1)pdm09 are similar to those reported from other countries. To improve preparedness and response to future pandemics, Viet Nam needs to strengthen the surveillance of influenza; increase laboratory capacity to test for influenza viruses; and develop strategies for promoting the timely attendance of at-risk individuals at health facilities and the early administration of antiviral drugs, particularly for persons with underlying medical conditions and pregnant females.

A community-wide outbreak of legionnaires disease linked to industrial cooling towers--how far can contaminated aerosols spread?

A community-wide outbreak of legionnaires disease occurred in Pas-de-Calais, France, in November 2003-January 2004. Eighteen (21%) of 86 laboratory-confirmed cases were fatal. A case-control study identified smoking, silicosis, and spending >100 min outdoors daily as risk factors for acquiring the disease. Legionella pneumophila strain Lens was isolated from cooling towers, wastewater, and air samples from plant A. This unique strain matched all 23 clinical isolates, as assessed by pulsed-field gel electrophoresis subtyping. Modeling of atmospheric dispersion of aerosols emitted from plant A cooling towers showed good coverage of the communes where patients lived and showed that the dispersion extended over a distance of at least 6 km from plant A. No other aerosol-producing installation was identified as a plausible source, and no common source of indoor exposure was found. These findings implicate plant A as the most likely outbreak source and suggest that the distance of airborne transmission of L. pneumophila may be greater than previously reported.