Syndemic health crises-The growing role of National Public Health Institutes in shaping a coordinated response.

Countries across the world are experiencing syndemic health crises where infectious pathogens including COVID-19 interact with epidemics of communicable and non-communicable diseases. Combined with war, environmental instability and the effects of soaring inflation, a public health crisis has emerged requiring an integrated response. Increasingly, national public health institutes (NPHIs) are at the forefront of leading this, as demonstrated at the 2022 Annual Meeting of the International Association of National Public Health Institutes (IANPHI). These effects are particularly evident where conflict is exacerbating health crises in Ukraine and Somalia. In Ukraine, medical and public health workers have been killed and infrastructure destroyed, which require major efforts to rebuild to international standards. In Somalia, these crises are magnified by the effects of climate change, leading to greater food insecurity, heat-related deaths and famine. National public health institutes are crucial in these contexts and many others to support integrated political responses where health challenges span local, national and international levels and involve multiple stakeholders. This can be seen in strengthening of Integrated Disease Surveillance and work towards the Sustainable Development Goals. National public health institutes also provide integration through the international system, working jointly to build national capacities to deliver essential public health functions. In this context, the 2022 IANPHI Annual meeting agreed the Stockholm Statement, highlighting the role that NPHIs play in tackling the causes and effects of interconnected global and local challenges to public health. This represents an important step in addressing complex health crises and syndemics which require whole-of-society responses, with NPHIs uniquely placed to work across sectors and provide system leadership in response.

Ebola virus disease in West Africa--the first 9 months of the epidemic and forward projections.

BACKGROUND: On March 23, 2014, the World Health Organization (WHO) was notified of an outbreak of Ebola virus disease (EVD) in Guinea. On August 8, the WHO declared the epidemic to be a "public health emergency of international concern." METHODS: By September 14, 2014, a total of 4507 probable and confirmed cases, including 2296 deaths from EVD (Zaire species) had been reported from five countries in West Africa--Guinea, Liberia, Nigeria, Senegal, and Sierra Leone. We analyzed a detailed subset of data on 3343 confirmed and 667 probable Ebola cases collected in Guinea, Liberia, Nigeria, and Sierra Leone as of September 14. RESULTS: The majority of patients are 15 to 44 years of age (49.9% male), and we estimate that the case fatality rate is 70.8% (95% confidence interval [CI], 69 to 73) among persons with known clinical outcome of infection. The course of infection, including signs and symptoms, incubation period (11.4 days), and serial interval (15.3 days), is similar to that reported in previous outbreaks of EVD. On the basis of the initial periods of exponential growth, the estimated basic reproduction numbers (R0 ) are 1.71 (95% CI, 1.44 to 2.01) for Guinea, 1.83 (95% CI, 1.72 to 1.94) for Liberia, and 2.02 (95% CI, 1.79 to 2.26) for Sierra Leone. The estimated current reproduction numbers (R) are 1.81 (95% CI, 1.60 to 2.03) for Guinea, 1.51 (95% CI, 1.41 to 1.60) for Liberia, and 1.38 (95% CI, 1.27 to 1.51) for Sierra Leone; the corresponding doubling times are 15.7 days (95% CI, 12.9 to 20.3) for Guinea, 23.6 days (95% CI, 20.2 to 28.2) for Liberia, and 30.2 days (95% CI, 23.6 to 42.3) for Sierra Leone. Assuming no change in the control measures for this epidemic, by November 2, 2014, the cumulative reported numbers of confirmed and probable cases are predicted to be 5740 in Guinea, 9890 in Liberia, and 5000 in Sierra Leone, exceeding 20,000 in total. CONCLUSIONS: These data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from EVD are expected to continue increasing from hundreds to thousands per week in the coming months.

Switching to brolucizumab: injection intervals and visual, anatomical and safety outcomes at 12 and 18 months in real-world eyes with neovascular age-related macular degeneration.

BACKGROUND: The anti-vascular endothelial growth factor (anti-VEGF) injection interval influences treatment burden and compliance in neovascular age-related macular degeneration (nAMD). This real-world study investigates visual acuity (VA), injection-interval extension, central macular thickness (CMT) and safety in nAMD eyes switched to the anti-VEGF agent brolucizumab and followed for up to 18 months. METHODS: This retrospective study included patients with nAMD who were switched from other anti-VEGF agents to brolucizumab only. Patient eyes were grouped into three nested cohorts with the overall cohort receiving ≥ 1 brolucizumab injection, the second receiving ≥ 3 brolucizumab injections with a follow-up period of ≥ 12 months and the third cohort receiving ≥ 3 brolucizumab injections with a follow-up period of ≥ 18 months. Study endpoints included changes from baseline at 12 or 18 months in VA, injection intervals, and CMT. Sub-group analyses were conducted using baseline injection interval length or baseline VA as qualifiers. RESULTS: Overall, 482 eyes received ≥ 1 brolucizumab injection; 174 eyes received ≥ 3 brolucizumab injections with ≥ 12 months of follow-up, and 95 eyes received ≥ 3 brolucizumab injections with ≥ 18 months of follow-up. VA (mean [95% confidence intervals]) remained stable relative to baseline after 12 months (- 1.1 [- 3.7, 1.6] letters; p = 0.42) and 18 months (0.0 [- 3.1, 3.1] letters; p = 0.98) of brolucizumab treatment, respectively, and pre-switch injection intervals or baseline VA had no notable effect. Following the switch to brolucizumab, injection intervals were extended from baseline to month 12 by 26.9 (19.7, 34.0) days (p < 0.0001), and eyes with pre-switch injection intervals < 8 weeks were able to have their injection intervals extended by 23.6 days longer than eyes with pre-switch injection intervals ≥ 8 weeks. At 18 months, injection intervals were extended by 36.3 (25.6, 46.9) days (p < 0.0001) compared to baseline. Following switch to brolucizumab, CMT was reduced at both 12 and 18 months (12 months: - 35.2 (- 51.7, - 18.8) µm, p < 0.0001; 18 months: - 38.9 (- 54.3, - 22.0) µm, p < 0.0001). Intraocular inflammation-related adverse events were reported in 4.6% of brolucizumab-treated eyes. CONCLUSIONS: This real-world study demonstrates that injection intervals may be significantly extended with maintained vision and reduced CMT in nAMD eyes switching to brolucizumab therapy from other anti-VEGFs.

One-Year and 18-Month Outcomes in nAMD Patient Eyes Switched to Brolucizumab Alone versus to Brolucizumab Alternating with Other Anti-VEGF Agents.

Objective: Retrospective, real-world study to evaluate visual acuity (VA), anti-vascular endothelial growth factor (anti-VEGF) injection intervals, and central macular thickness (CMT) in neovascular age-related macular degeneration (nAMD) eyes switched to brolucizumab only or to brolucizumab alternating with another anti-VEGF. Methods: The overall study population comprised eyes that were given ≥1 brolucizumab injection between 1 October 2019 and 30 November 2021. The brolucizumab-only (BRO) cohort consisted of prior anti-VEGF-treated eyes treated exclusively with ≥3 brolucizumab injections over ≥12 or ≥18 months; the alternating brolucizumab (ALT) cohort comprised prior anti-VEGF-treated eyes treated with ≥2 brolucizumab injections and ≥1 other anti-VEGF over ≥12 or ≥18 months. Results: A total of 482 eyes received ≥1 brolucizumab injection during the study period. Mean VA changes from baseline were -1.1±15.1 letters (BRO cohort; n = 174) and 1.3±13.0 letters (ALT cohort; n = 47) at Month 12, and 0.0±13.5 letters (BRO cohort; n = 95) and -7.3±17.2 letters (ALT cohort; n = 29) at Month 18. Mean changes in injection intervals were +26.9±48.1 days (BRO cohort) and +11.1±17.3 days (ALT cohort) at Month 12 and +36.3±52.3 days (BRO cohort) and +14.0±19.9 days (ALT cohort) at Month 18. Mean changes in CMT were -35.2±108.1 µm (BRO cohort) and -31.5±91.2 µm (ALT cohort) at Month 12 and -38.9±75.0 µm (BRO cohort) and -9.0±59.9 µm (ALT cohort) at Month 18. Intraocular inflammation-related adverse events were recorded in 22/482 (4.6%) eyes. Conclusion: Treatment with either brolucizumab alone or brolucizumab alternating with another anti-VEGF can preserve vision, reduce CMT, and extend anti-VEGF injection intervals in patients with nAMD.

The effects of scleral buckling on young rabbit eyes.

OBJECTIVE: To evaluate the effects of scleral buckling surgery on the developing eye in an animal model. METHODS: Eleven young rabbits underwent scleral buckling surgery in one eye. In 6 rabbits, a 2.5 x 0.6-mm solid silicone encircling band (240 style) with a Watzke sleeve was used, and in 5 rabbits, a 2.0-mm silicone encircling sponge (502 style) with its ends abutting, but not connected, was used. After 3 months, both eyes of each animal were enucleated. Six eyes of an additional 3 rabbits served as baseline controls for determining initial globe volumes. RESULTS: Of the eyes buckled with a 240 band, 4 of 6 developed glaucoma compared with 0 of 5 eyes buckled with a 502 sponge (P =.06). Migration of the element occurred in all eyes with a 240 band (3 anterior, 3 posterior), while none of the 502 sponges migrated. There was no significant difference in the mean final corneal diameter between eyes with a 240 band (P =.94) and untreated fellow eyes or between eyes with a 502 sponge and untreated fellow eyes (P =.25). The mean axial length of eyes with a 240 band and untreated fellow eyes was 19.57 mm and 16.83 mm, respectively (P =.009). The mean axial length of eyes with a 502 sponge and untreated fellow eyes was 16.67 mm and 16.50 mm, respectively (P =.67). When comparing eyes with a 240 band with eyes with a 502 sponge, a significant difference was observed in the mean axial length (P =.006) and mean volume (P =.006) between the 2 scleral buckle groups. CONCLUSIONS: The use of a noninterrupted solid silicone encircling band appeared to have significant effects on the growth of young rabbit eyes. The use of an interrupted silicone sponge produced a buckling effect similar to the solid silicone band and did not migrate, adversely affect eye growth, or result in glaucoma. CLINICAL RELEVANCE: Noncontinuous encircling elements may prove to be as beneficial as continuous encircling elements in the treatment of tractional and rhegmatogenous retinal detachment in infant eyes without the potentially deleterious effects associated with a nondivided encircling band or the need for a second surgery to divide the encircling element.