Global trend and epidemiological profiles of climate-related disasters from 2000 to 2021.

OBJECTIVE: The objective of this study is to analyse the epidemiological profile of global climate-related disasters in terms of morbidity and mortality, as well as to examine their temporal trends. METHOD: This cross-sectional study analysed climate-related global disasters from 2000 to 2021, utilising definitions and criteria from the United Nations Strategy for Disaster Reduction and the Centre for Research on the Epidemiology of Disasters. Data were sourced from the EM-DAT database. The study assessed trends over the entire period and compared them with previous years (1978-2000). RESULTS: A total of 7398 climate-related disasters were recorded, with hydrological disasters being the most frequent, followed by meteorological and climatological disasters. Statistically significant differences were noted in the average rates of affected individuals and injuries per million inhabitants. No significant trends were found in mortality rates, but the frequency trends for the entire period (1978-2021) and the subperiod (1978-2000) were increasing and statistically significant. However, the trend from 2000 onwards showed a non-significant decrease, potentially reflecting better disaster preparedness and response strategies under the Hyogo and Sendai Framework. CONCLUSION: The study highlights hydrological disasters as the most frequent and deadliest climate-related events, with climatological disasters affecting and injuring the most people. The lack of standardised criteria for disaster inclusion in databases presents a significant challenge in comparing results and analysing trends. Establishing uniform inclusion criteria is crucial for effective data analysis and disaster management.

The epidemiological profile of incidence and mortality from epidemics in complex humanitarian emergencies from 1990 to 2022 - A scoping review.

AIM: This study aimed to investigate the impact of communicable diseases with epidemic potential in complex emergency (CE) situations, focusing on the epidemiological profile of incidence and mortality and exploring underlying factors contributing to increased epidemic risks. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines, we conducted a scoping review of articles published between 1990 and 2022. The search included terms related to complex emergencies, communicable diseases, outbreaks, and epidemics. We identified 92 epidemics related to CE occurring in 32 different countries. RESULTS: Communicable diseases like Shigellosis, Cholera, Measles, Meningococcal meningitis, Yellow Fever, and Malaria caused significant morbidity and mortality. Diarrhoeal diseases, particularly Cholera and Shigellosis, had the highest incidence rates. Shigella specifically had an incidence of 241.0 per 1000 (people at risk), with a mortality rate of 11.7 per 1000, while Cholera's incidence was 13.0 per 1000, with a mortality rate of 0.22 per 1000. Measles followed, with an incidence of 25.0 per 1000 and a mortality rate of 0.76 per 1000. Meningococcal Meningitis had an incidence rate of 1.3 per 1000 and a mortality rate of 0.13 per 1000. Despite their lower incidences, yellow fever at 0.8 per 1000 and malaria at 0.4 per 1000, their high case fatality rates of 20.1% and 0.4% remained concerning in CE. The qualitative synthesis reveals that factors such as water, sanitation, and hygiene, shelter and settlements, food and nutrition, and public health and healthcare in complex emergencies affect the risk of epidemics. CONCLUSION: Epidemics during complex emergencies could potentially lead to a public health crisis. Between 1990 and 2022, there have been no statistically significant changes in the trend of incidence, mortality, or fatality rates of epidemic diseases in CE. It is crucial to understand that all epidemics identified in CE are fundamentally preventable.

Potential role of Emergency Medical System call centres in epidemiological surveillance of seasonal influenza.

OBJECTIVES: Seasonal influenza causes high morbidity worldwide and high mortality in developing countries. As a result, the development of systems for seasonal influenza surveillance has been of great interest. The aim of this study is to explore the potential role of an Emergency Medical System (EMS) call centre to complement traditional surveillance systems of seasonal influenza. METHODS: Retrospective observational study in which data on influenza from the system of Notifiable Diseases List (Spanish acronym EDO) and Sentinel Physicians Network (Spanish acronym RMC) were compared with information on calls made to the Principality of Asturias EMS call centre that covers all the region population (1,027,659 inhabitants) based on a set of specific criteria to determine differences and explore this emergency call system as a complementary epidemiological surveillance system. Cases registered by different systems have been compared to the same 68 weeks period, from week 45 of 2011 to week 8 of 2013. RESULTS: RMC reported a total of 2,354 cases of influenza, EDO 43,071 cases and EMS call centre 4,360 "case calls" out of 180,720 total emergency calls. Case series of EDO and EMS call centre have shown a positive correlation (R = 0.42, p = 0.003). Case series from EMS call centre and RMC were correlated (R = 0.38, p = 0.007). Case series from EDO and RMC have shown a strong positive correlation (R = 0.91, p < 0.001). Correlation analysis of the cases reported by the three systems have shown a significant positive correlation between them (p < 0.001). The spike of EMS calls related to the studied influenza syndrome occurs one week in advance compared to traditional epidemiological surveillance systems. CONCLUSIONS: EMS call centre data on influenza could be potentially used as a complementary surveillance system to the traditional epidemiological surveillance systems for influenza.

Difficulties of Spanish Primary Health Care nurses to assist emergencies: A cross-sectional study.

BACKGROUND: The competence of a Primary Health Care nurse to handle emergency situations depends largely on prior acquisition of theoretical knowledge to make appropriate decisions, combined with the corresponding practical skills to carry out swift and effective interventions. METHODS: Cross-sectional study conducted in through a survey auto-administered to a simple random sample of 269 nurses (n) with replacement of Asturias, Spain from the total nursing staff of 730 members (N) in Asturias. RESULTS: In rural areas, the most frequently mentioned reasons were the lack of practical skills (18.9%) and the absence of adequate material (14.4 %). In the semi-urban area, the most common reasons were the lack of practical skills (13.2 %) and the lack of theoretical knowledge (10.3 %). Finally, in the urban area, the main reasons were the lack of practical skills (14.4 %) and the absence of adequate material (7.2 %). The differences were significant (p = 0.025). CONCLUSIONS: Despite the requirement that they acquire the necessary theoretical and practical skills, not all PHC nurses perceive themselves to be sufficiently prepared. The degree of self-perceived acquisition of this knowledge and skills, which is so important and necessary, is heterogeneous, with clear differences according to the respective field of work.

A Review of Mpox Outbreak and Public Health Response in Spain.

Objective: In May 2022, an unprecedented Mpox outbreak was reported in several non-endemic countries with unknown epidemiological links. Since May 2022, more than 20,000 cases have been reported in Europe. Spain has been the most affected country in Europe. We aim to describe the Mpox epidemiological profile in Spain, identify its outbreak risks, and describe public health interventions implemented by the Spanish authorities. Methods: A literature review was conducted, using specific selection criteria to obtain relevant publications describing Mpox clinical presentation and risk factors and the public health response in Spain to the ongoing outbreak. Results: 63.1% of the cases presented an anogenital rash, considered a specific and early symptom in this outbreak. Low case fatality rate is observed, mainly in risk groups, such as the immunocompromised population. Patients evolution was generally favorable, although 3-8% required hospitalization and two deaths occurred; 40% of patients were previously diagnosed with HIV infection. Most of the cases were seen among young population and concentrated in men who had sex with other men, mainly with multiple sexual partners, who did not practice safe sex such as using condoms, and those attending mass event parties. Conclusion: To date, the Mpox outbreak is not considered a public health emergency of international concern. The epidemiological trend of the virus in Spain shows that public health response interventions (health education, contact tracing, vaccination, etc.) have adequately controlled the epidemic curve in high-risk populations and avoided spreading the virus to other groups within the community.

Total worker health® based Helicobacter pylori public health prevention strategy.

Purpose of review: This review aims to explore the public health approach for Helicobacter pylori Infection Prevention within the Total Worker Health (TWH) framework strategy. Recent findings: The review identifies certain occupations considered high-risk groups for H. pylori infection. It underscores primary, secondary, and tertiary public health preventive measures align with the TWH approach. Within this framework, the role of raising awareness, emphasizing infection control, worker hygiene, risk assessment, and ensuring healthcare accessibility is emphasized. The importance of early detection, treatment, eradication, and a TWH approach emerges as a central theme. The TWH approach offers a holistic perspective, intertwining occupation-related health risks with overall health and well being. Summary: Adopting the TWH approach, coupled with household-based infection control and eradication strategies, can significantly reduce H. pylori prevalence, fostering a healthier workforce and diminishing long-term healthcare costs. The review underscores the importance of recognizing H. pylori as an occupational disease. It calls for further research into the "one-health" perspective on H. pylori transmission dynamics.

Exploring Cascading Disaster Risk During Complex Emergencies: Chemical Industry Disaster Risk Assessment in the Aftermath of the Kakhovka Dam Bombing in Ukraine.

OBJECTIVE: This risk assessment aims to investigate the analysis of cascading disaster risks from the perspective of the chemical industry and public health subsequent to the Kakhovka dam bombing in Ukraine. METHOD: The study utilized a modified observational cross-sectional risk assessment method to assess disaster risk. The method involved identifying the location of chemical factories, determining flooded or at-risk factories, analyzing the type and frequency of chemical hazards, assessing population exposure, and plotting a disaster risk metric. Data on chemical industries and flood extent were collected from open-source secondary data. RESULTS: The destruction of the Kakhovka dam in June 2023 led to severe flooding, placing 42 000 individuals at risk. The analysis identified four chemical factories, with 1 affected by flooding and 3 at risk. The overall risk assessment indicated a high likelihood and severe consequences, including loss of life, environmental contamination, and property damage. CONCLUSION: The combination of complex emergencies and high-risk chemical facilities in Kherson Oblast poses a significant risk of a chemical industry disaster. The interplay between compound and cascading risks during complex emergencies amid the current war further exacerbates the situation, leading to the devastation and destruction of the environment to the detriment of life, and aligns with the characterization of ecocide.

Development, validation, and accuracy of ORCHESTRA emotional exhaustion screening questionnaire among healthcare workers during COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has posed unprecedented challenges, particularly for healthcare workers (HCWs). The prolonged struggles exposed the HCWs to a variety of stressors, potentially leading to burnout. Emotional exhaustion is widely recognized as the core component of burnout. This research aims to conceptualize and develop an emotional exhaustion screening questionnaire through literature review, validation, and accuracy testing. METHOD: A literature review of questionnaires and extraction of items on emotional exhaustion were performed in June 2022. We proceed with the face validity of the items by experts. The items with good content validity ratio and index were selected and reworded to suit the context of HCWs working during the COVID-19 pandemic. A pilot test of the questionnaire was done in the Central University Hospital of Asturias (HUCA) from October to December 2022 with a sample of 148 HCWs from the ORCHESTRA cohort to determine its reliability, convergent validity, and accuracy. RESULTS: Our literature review identified 15 validated questionnaires. After exclusion, 32 items were sent for content validation by experts, yielding five final items that proceeded with the pilot test. Resulting in a Cronbach's alpha-coefficient of .83 for the scale and .78 for dichotomous responses, demonstrating good internal consistency and convergent validity. The result of our accuracy test yielded sensitivity (90.6%) and specificity (91.6%) for the OEEQ scale; and sensitivity (88.7%) and specificity (89.5%) for OEEQ dichotomous responses. CONCLUSION: This study developed and validated the ORCHESTRA Emotional Exhaustion Questionnaire, demonstrating the questionnaire's clarity, relevance, and comprehensibility in screening emotional exhaustion among HCWs.

Magnitude and determinants of excess total, age-specific and sex-specific all-cause mortality in 24 countries worldwide during 2020 and 2021: results on the impact of the COVID-19 pandemic from the C-MOR project.

INTRODUCTION: To examine the impact of the COVID-19 pandemic on mortality, we estimated excess all-cause mortality in 24 countries for 2020 and 2021, overall and stratified by sex and age. METHODS: Total, age-specific and sex-specific weekly all-cause mortality was collected for 2015-2021 and excess mortality for 2020 and 2021 was calculated by comparing weekly 2020 and 2021 age-standardised mortality rates against expected mortality, estimated based on historical data (2015-2019), accounting for seasonality, and long-term and short-term trends. Age-specific weekly excess mortality was similarly calculated using crude mortality rates. The association of country and pandemic-related variables with excess mortality was investigated using simple and multilevel regression models. RESULTS: Excess cumulative mortality for both 2020 and 2021 was found in Austria, Brazil, Belgium, Cyprus, England and Wales, Estonia, France, Georgia, Greece, Israel, Italy, Kazakhstan, Mauritius, Northern Ireland, Norway, Peru, Poland, Slovenia, Spain, Sweden, Ukraine, and the USA. Australia and Denmark experienced excess mortality only in 2021. Mauritius demonstrated a statistically significant decrease in all-cause mortality during both years. Weekly incidence of COVID-19 was significantly positively associated with excess mortality for both years, but the positive association was attenuated in 2021 as percentage of the population fully vaccinated increased. Stringency index of control measures was positively and negatively associated with excess mortality in 2020 and 2021, respectively. CONCLUSION: This study provides evidence of substantial excess mortality in most countries investigated during the first 2 years of the pandemic and suggests that COVID-19 incidence, stringency of control measures and vaccination rates interacted in determining the magnitude of excess mortality.

[Impact of disasters on the mental health]. / Impacto de los desastres sobre la salud mental.

The study on the impact of disasters on the mental health is a relatively recent research field. Despite this, there are a significant number of studies showing the epidemiological data of the psychiatric pathology present in survivors and those affected by disasters This review attempts to summarize current knowledge and give an integrated vision of the effects of the disasters on the mental health, either natural or manmade disasters, as well as identify the effects prevalence and differences in each type of disaster. Post-traumatic stress disorder, depression, anxiety disorders, suicidal ideation or suicide attempts are some of the pathologies observed in people affected by disasters and with an ineffective adaptation, jointly with an increase in the consumption of toxic substances, generating an additional public health problem within another problem. The consequences will be different depending on the type of population and its cultural pattern, sex and gender of the affected people and type of disasters.

Hospital Disasters Preparedness for Mass-Casualty Incidents at Emergency Units in Northwest of Ethiopia: A Cross-Sectional Study.

BACKGROUND: Ethiopian policy and strategy aim to make health care systems capable of dealing with emergencies. However, Ethiopian health care still lacks a comprehensive "all-hazard" approach and a disaster preparedness program. Thus, this study aimed to assess the level of disaster preparedness in selected public hospitals for mass-casualty incidents (MCIs) in Amhara Regional State, Northwest Ethiopia. METHODS: A descriptive cross-sectional study was conducted at general and comprehensive specialized hospitals (CSHs) in Amhara Regional State, Ethiopia using a World Health Organization (WHO) hospital emergency response checklist that included a domain on mass-casualty management (MCM) adapted from a literature review. RESULTS: Seventeen (17) hospitals were evaluated (response rate: 81%). Five (29.4%) were teaching hospitals (tertiary health care) and 12 (70.5%) were non-teaching (secondary health care) hospitals. With an average mean of 97.3 (SD = 33.68; range 31-160), most hospitals under WHO required an Acceptable level of preparedness. Two were at an Unacceptable (0-67) level of preparedness, 12 (70.5%) hospitals were at an Insufficient (68-134) state, while the other three had an Acceptable (135-192) level of preparedness. CONCLUSION: The preparedness level of hospitals is Insufficient for potential MCIs in this region and needs prior attention in implementing existing strategic guidelines to develop and activate hospital disaster plans if and when needed.

Outbreaks Following Natural Disasters: A Review of the Literature.

Understanding the relationship between infectious disease outbreaks and natural disasters is important in developing response and disaster risk reduction strategies. The aim of this study was to identify outbreaks associated with natural disasters during the past 20 y, and outline risk factors and mechanisms for postdisaster outbreaks. Review of the international disaster database (EM-DAT) and systematic review of the literature were conducted. The records of disaster events in EM-DAT during the past 20 y were screened. A literature search was carried out in the databases PubMed and Embase. Articles in English language published between 2000 and 2020 were searched. Data were extracted from articles and Narrative synthesis was used to summarize the findings. We found 108 events associated with epidemics, the majority being floods. We found 36 articles, most of them focused on outbreaks after floods. Risk factors and mechanisms that contributed to the outbreaks were mainly related to the consequences of disaster and its impact on the environment and living conditions of population. Infrastructure readiness and postdisaster measures play important roles in controlling the spread of epidemics after natural disasters. More evidence and research are required for better understanding of the association between natural disasters and infectious diseases outbreaks.

Disasters in Spain from 1950 - 2020: Impact on Public Health.

OBJECTIVE: The aim of this study was to establish the frequency and profile of disasters and to analyze trends in disasters and their impact on Spanish public health. METHODS: Retrospective observational study of disasters that occurred in Spain from 1950 through 2020 was conducted. The variables studied for each episode were number of people affected, number of injured/sick, and number of deaths. Absolute and relative frequencies, population rates, mean, median, standard error of the mean (SEM), and 95% confidence intervals (CI) were used, and trend analysis was performed using exponential smoothing and linear regression. RESULTS: A total of 491 disasters were identified in Spain. Of these, 255 (51.9%) were natural disasters, 224 (45.7%) technological disasters, and 12 (2.4%) man-made disasters. The average number of disasters per year was 7.01 (95% CI, 5.99-9.34). These disasters affected a total of 820,489 people, with an average of 3,491 people (SEM = 2.18) per episode. There was a significant increase (P <.001) in the total frequency of disasters in Spain during the period studied. CONCLUSIONS: Spain has a disaster profile of mixed type, combining natural with technological disasters. From 1950 through 2020, there was a significant increase in the number of disasters, with an overall profile similar to that of Europe, with climatological disasters being the most frequent type.

Novel Google Maps and Google Earth application for chemical industry disaster risk assessment during complex emergencies in Eastern Ukraine.

The war in Ukraine has led to complex emergencies, humanitarian crises, and other severe consequences, such as chemical industry disasters. The chemical industry is one of the principal sectors of Ukraine's economy. In 2019, Ukraine had a total volume of hazardous chemical accumulation of more than a 5.1billion tons. Therefore, an attack on chemical industrial facilities will lead to catastrophic consequences such as chemical disasters. This paper aims to study the disaster risk of chemical industrial facilities and its effects on public health and the environment during complex emergencies in Eastern Ukraine. Observational cross-sectional risk assessment method was utilized to assess hazard, vulnerability, and exposure of the chemical industry in Eastern Ukraine in Donetsk Oblast and Luhansk Oblast. Data on chemical factories in Eastern Ukraine was collected on Google Maps and Google Earth on May 2022. Lastly, the semi-quantitative risk assessment method was utilized to describe the risk from the perspective of consequences for life and health, the environment, property, and speed of development. Our disaster risk assessment found more than 1 million people (1,187,240 people) in Donetsk Oblast and more than 350 thousand people (353,716 people) in Luhansk Oblast are exposed to potential hazards from the chemical facilities clusters. The aggregation risk of bombardment of chemical facilities cluster in Eastern Ukraine is also high due to ongoing war. Therefore, the chemical industry disaster risks for Eastern Ukraine during complex emergencies in Donetsk Oblast and Luhansk Oblast are high in terms of likelihood and consequences to life and health, environment, property, and speed of development.

Disaster Preparedness and Hospital Safety in State Hospitals in Lima (Peru).

INTRODUCTION: Peru's health infrastructures, particularly hospitals, are exposed to disaster threats of different natures. Traditionally, earthquakes have been the main disaster in terms of physical and structural vulnerability, but the coronavirus disease 2019 (COVID-19) pandemic has also shown their functional vulnerability. Public hospitals in Lima are very different in terms of year constructed, type of construction, and number of floors, making them highly vulnerable to earthquakes. In addition, they are subject to a high demand for care daily. Therefore, if a major earthquake were to occur in Lima, the hospitals would not have the capacity to respond to the high demand. OBJECTIVE: The aim of this study was to analyze the Hospital Safety Index (HSI) in hospitals in Lima (Peru). MATERIALS AND METHODS: This was a cross-sectional observational study of 18 state-run hospitals that met the inclusion criteria; open access data were collected for the indicators proposed by the Pan American Health Organization (PAHO) Version 1. Associations between variables were calculated using the chi-square test, considering a confidence level of 95%. A P value less than .05 was considered to determine statistical significance. RESULTS: The average bed occupancy rate was 90%, the average age was 70 years, on average had one bed per 25,126 inhabitants, and HSI average score was 0.36 with a vulnerability of 0.63. No association was found between HSI and hospital characteristics. CONCLUSION: Most of the hospitals were considered Category C in earthquake and disaster safety, and only one hospital was Category A. The hospital situation needs to be clarified, and the specific deficiencies of each institution need to be identified and addressed according to their own characteristics and context.

Point-of-care ultrasonography in diagnosing necrotizing fasciitis-a literature review.

INTRODUCTION: Necrotizing fasciitis (NF) is a rapidly progressive necrosis of the fascial layer with a high mortality rate. It is a life-threatening medical emergency that requires urgent treatment. Lack of skin finding in NF made diagnosis difficult and required a high clinical index of suspicion. The use of ultrasound may guide clinicians in improving diagnostic speed and accuracy, thus leading to improved management decisions and patient outcomes. This literature search aims to review the use of point-of-care ultrasonography in diagnosing necrotizing fasciitis. METHOD: We searched relevant electronic databases, including PUBMED, MEDLINE, and SCOPUS, and performed a systematic review. Keywords used were "necrotizing fasciitis" or "necrotising fasciitis" or "necrotizing soft tissue infections" and "point-of-care ultrasonography" "ultrasonography" or "ultrasound". No temporal limitation was set. An additional search was performed via google scholar, and the top 100 entry was screened. RESULTS: Among 540 papers screened, only 21 were related to diagnosing necrotizing fasciitis using ultrasonography. The outcome includes three observational studies, 16 case reports, and two case series, covering the period from 1976 to 2022. CONCLUSION: Although the use of ultrasonography in diagnosing NF was published in several papers with promising results, more studies are required to investigate its diagnostic accuracy and potential to reduce time delay before surgical intervention, morbidity, and mortality.

The Epidemiological Profile of Multiple Casualty Incidents in Northern Spain: 2014-2020.

OBJECTIVE: To describe the epidemiological profile of multiple casualty incidents (MCI) and contribute to the better understanding of their impacts in Northern Spain. METHOD: Retrospective, population-based observational study of MCI between 2014 and 2020 in 5 autonomous communities (Aragón, Castilla y León, Galicia, the Basque Country and Principado de Asturias) that participated in the MCI Database of Northern Spain. Inclusion criteria was any incident with 4 or more patients needing ambulance mobilization. A total of 54 variables were collected. This study presents the most relevant results. RESULTS: There were 253 MCI. Of these, 79.8% were road traffic accidents, 12.3% fires or explosions, 2.0% poisonings and 5.9% defined as others. Monthly average was 2.9 (SD = 0.35; EEM = 15.90), average of victims by MCI was 6.8 (CI95% 6.16 - 7.60). There were significantly (P < 0.05) more victims in 3 types of MCI (fires, poisonings, and others). We saw 37.7% of MCI involved 4 victims, 18.8% 5 victims, and 37.9% more than 5. Mean response time was 30.8 minutes (95% CI 28.6 - 33.1), longer in maritime incidents. A total of 67% (95% CI 64.5 - 69.5) of victims were mild. CONCLUSIONS: Road traffic accidents are the most frequent MCI and minor injuries predominate. More than 50% of the MCI have 5 or fewer patients. Fires had significantly more mild patients and significantly more resources deployed. Maritime incidents had a significantly longer response time.

Conceptualization of the Transmission Dynamic of Faecal-Orally Transmitted Diseases in Urban Exposome of Sub-Saharan Africa.

In sub-Saharan Africa, many urban dwellers are at risk of faecal-orally transmitted diseases due to unplanned and growing urbanization with inadequate sanitation. Making it essential to understand the urban transmission of these diseases and the associated responses. This perspective paper discussed an approach to design a diagram of transmission dynamic from a combination of an urban exposome framework and transmission of faecal-oral diseases. The result is an exposome diagram displaying the interconnection of exposure components and potential barriers to stop the transmission of faecal-oral diseases in the urban area subdivided into public, domestic and individual. As an exposome diagram, it helps to follow the dynamics of exposure over time and to plan targeted surveillance and intervention.

The Impact of COVID-19 Pandemic Lockdown on Routine Immunization in the Province of Laghman, Afghanistan.

Background: The COVID-19 pandemic, declared by the World Health Organization as a public health international emergency concern in March 2020, has caused serious impacts on individuals, families, communities, and societies across the globe. The COVID-19 pandemic not only disrupted the health systems and the economy, but also significantly impacted routine immunization programs. Aim: To study the impact of the COVID-19 pandemic lockdown on the routine immunization coverage program in the province of Laghman, Afghanistan. Methods: A comparative cross-sectional quantitative study was conducted to understand the impact of COVID-19 on routine childhood immunization during the study period. Secondary data was used from the Ministry of Health from April to July 2020 and compared with the historical data of the same period in 2019. Student t-test was used to test the association between the mean changes in the daily immunization coverage. A p-value<0.05 was considered as statistically significant with 95% confidence interval. Results: There was a 21.4% significant (p<0.01) decline in the total immunization coverage during April-July 2020 compared to April-July 2019. This reduction was diverse across all districts and all vaccine antigens. The most affected district was Alingar, and the most affected vaccines were measles and OPV4, with 28% declines, followed by PCV3 at 26%, and DPT3, IPV, OPV3, PCV2 and rotavirus at 23%. The outreach vaccination coverage declined by 56.1% compared to the fixed, at 13.4%. Conclusion: The COVID-19 pandemic seriously affected the routine immunization in Afghanistan. On average, 325 children per day missed out on a lifesaving vaccine in Laghman province which put them at risk of getting preventable diseases. To provide access to routine immunization during pandemics, the study suggests a set of customized interventions to strengthen and sustain routine immunization.

Management of the COVID-19 Pandemic: Analysis of the Perception of Professionals of Emergency Medical Systems in Spain after the First Wave.

OBJECTIVE: The objective of this study was to identify the perceived problems by medical and nursing professionals that have arisen in the Spanish Emergency Medical Services (EMS) as a consequence of the first wave of the severe acute respiratory syndrome-coronavirus-2/SARS-CoV-2 pandemic, as well as the measures or solutions adopted to manage those problems and improve response. METHOD: This was a cross-sectional study of quantitative and qualitative methodology ("mixed methods") using a self-administered questionnaire in 23 key informants of EMS of Spain selected by purposeful sampling, followed by the statistical analysis of both types of variables and an integration of the results in the discussion. RESULTS: Common problems had been identified in many EMS, as well as similar solutions in some of them. Among the former, the following had been found: lack of leadership and support from managers, initial shortage of personal protective equipment (PPE), lack of participation in decision making, initial lack of clinical protocols, and slowness and/or lack of adaptability of the system, among others. Among the solutions adopted: reinforcement of emergency call centers, development of specific coronavirus disease 2019 (COVID-19) telephone lines and new resources, personal effort of professionals, new functions of EMS, support to other structures, and reinforcement of the role of nursing. CONCLUSION: The general perception among the respondents was that there was a lack of support and communication with health care managers and that the staff expertise was not used by policy makers to make decisions adapted to reality, also expressing the need to improve the capacity for analysis of the EMS response. Few respondents reported good overall satisfaction with their EMS response. The EMS adopted different types of measures to adapt to the COVID-19 pandemic.