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1.
MMWR Morb Mortal Wkly Rep ; 69(5): 140-146, 2020 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-32027631

RESUMEN

On December 31, 2019, Chinese health officials reported a cluster of cases of acute respiratory illness in persons associated with the Hunan seafood and animal market in the city of Wuhan, Hubei Province, in central China. On January 7, 2020, Chinese health officials confirmed that a novel coronavirus (2019-nCoV) was associated with this initial cluster (1). As of February 4, 2020, a total of 20,471 confirmed cases, including 2,788 (13.6%) with severe illness,* and 425 deaths (2.1%) had been reported by the National Health Commission of China (2). Cases have also been reported in 26 locations outside of mainland China, including documentation of some person-to-person transmission and one death (2). As of February 4, 11 cases had been reported in the United States. On January 30, the World Health Organization (WHO) Director-General declared that the 2019-nCoV outbreak constitutes a Public Health Emergency of International Concern.† On January 31, the U.S. Department of Health and Human Services (HHS) Secretary declared a U.S. public health emergency to respond to 2019-nCoV.§ Also on January 31, the president of the United States signed a "Proclamation on Suspension of Entry as Immigrants and Nonimmigrants of Persons who Pose a Risk of Transmitting 2019 Novel Coronavirus," which limits entry into the United States of persons who traveled to mainland China to U.S. citizens and lawful permanent residents and their families (3). CDC, multiple other federal agencies, state and local health departments, and other partners are implementing aggressive measures to slow transmission of 2019-nCoV in the United States (4,5). These measures require the identification of cases and their contacts in the United States and the appropriate assessment and care of travelers arriving from mainland China to the United States. These measures are being implemented in anticipation of additional 2019-nCoV cases in the United States. Although these measures might not prevent the eventual establishment of ongoing, widespread transmission of the virus in the United States, they are being implemented to 1) slow the spread of illness; 2) provide time to better prepare health care systems and the general public to be ready if widespread transmission with substantial associated illness occurs; and 3) better characterize 2019-nCoV infection to guide public health recommendations and the development of medical countermeasures including diagnostics, therapeutics, and vaccines. Public health authorities are monitoring the situation closely. As more is learned about this novel virus and this outbreak, CDC will rapidly incorporate new knowledge into guidance for action by CDC and state and local health departments.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Brotes de Enfermedades/prevención & control , Adulto , Anciano , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Control de Infecciones , Laboratorios , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Práctica de Salud Pública , Estados Unidos/epidemiología
2.
MMWR Morb Mortal Wkly Rep ; 69(1): 10-13, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31917781

RESUMEN

Tailoring communicable disease preparedness and response strategies to unique population movement patterns between an outbreak area and neighboring countries can help limit the international spread of disease. Global recognition of the value of addressing community connectivity in preparedness and response, through field work and visualizing the identified movement patterns, is reflected in the World Health Organization's declaration on July 17, 2019, that the 10th Ebola virus disease (Ebola) outbreak in the Democratic Republic of the Congo (DRC) was a Public Health Emergency of International Concern (1). In March 2019, the Infectious Diseases Institute (IDI), Uganda, in collaboration with the Ministry of Health (MOH) Uganda and CDC, had previously identified areas at increased risk for Ebola importation by facilitating community engagement with participatory mapping to characterize cross-border population connectivity patterns. Multisectoral participants identified 31 locations and associated movement pathways with high levels of connectivity to the Ebola outbreak areas. They described a major shift in the movement pattern between Goma (DRC) and Kisoro (Uganda), mainly through Rwanda, when Rwanda closed the Cyanika ground crossing with Uganda. This closure led some travelers to use a potentially less secure route within DRC. District and national leadership used these results to bolster preparedness at identified points of entry and health care facilities and prioritized locations at high risk further into Uganda, especially markets and transportation hubs, for enhanced preparedness. Strategies to forecast, identify, and rapidly respond to the international spread of disease require adapting to complex, dynamic, multisectoral cross-border population movement, which can be influenced by border control and public health measures of neighboring countries.


Asunto(s)
Brotes de Enfermedades , Fiebre Hemorrágica Ebola/epidemiología , Migración Humana/estadística & datos numéricos , Participación de la Comunidad , República Democrática del Congo/epidemiología , Brotes de Enfermedades/prevención & control , Fiebre Hemorrágica Ebola/prevención & control , Humanos , Rwanda/epidemiología , Uganda/epidemiología
3.
Food Microbiol ; 85: 103279, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31500702

RESUMEN

Cereulide, a potent toxin produced by Bacillus cereus, is a small, highly heat- and acid-resistant depsipeptide toxin, which confronts food industry with several challenges. Due to the ubiquitous presence of B. cereus in the environment, this opportunistic pathogen can enter food production and processing at almost any stage. Although the bacteria itself might be removed during food processing, the cereulide toxin will most likely not be destroyed or inactivated by these processes. Because of the high toxicity of cereulide and the high incidence rates often observed in connection with foodborne outbreaks, the understanding of the mechanisms of toxin production as well as accurate data on contamination sources and factors promoting toxin formation are urgently needed to prevent contamination and toxin production in food production processes. Over the last decade, considerable progress had been made on the understanding of cereulide toxin biosynthesis in emetic B. cereus, but an overview of current knowledge on this toxin with regards to food industry perspective is lacking. Thus, we aim in this work to summarize data available on extrinsic parameters acting on cereulide toxin synthesis in emetic B. cereus and to discuss the food industry specific challenges related to this toxin. Furthermore, we emphasize how identification of the cardinals in food production processes can lead to novel effective strategies for prevention of toxin formation in the food processing chain and could contribute to the improvement of existing HACCP studies.


Asunto(s)
Bacillus cereus/metabolismo , Depsipéptidos/biosíntesis , Contaminación de Alimentos/análisis , Microbiología de Alimentos , Enfermedades Transmitidas por los Alimentos/prevención & control , Toxinas Bacterianas/biosíntesis , Brotes de Enfermedades/prevención & control , Contaminación de Alimentos/prevención & control , Manipulación de Alimentos , Industria de Alimentos/métodos , Industria de Alimentos/normas
4.
Presse Med ; 48(12): 1536-1550, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31784255

RESUMEN

Africa along side with south-east Asia are the epicentres of emerging and epidemic prone-infectious diseases and megacity biosecurity threat scenarios. Massive mobility and reluctance in the populations exposed to epidemic and emerging prone-infectious diseases coupled by a weak health system made disease alert and control measures difficult to implement. The investigation of virus detection and persistence in semen across a range of emerging viruses is useful for clinical and public health reasons, in particular for viruses that lead to high mortality or morbidity rates or to epidemics. Innovating built facility to safely treat patients with highly pathogenic infectious diseases is urgently need, not only to prevent the spread of infection from patients to healthcare workers but also to offer provision of relatively invasive organ support, whenever considered appropriate, without posing additional risk to staff. Despite multiple challenges, the need to conduct research during epidemics is inevitable, and candidate products must continue undergoing rigorous trials. Preparedness including management of complex humanitarian crises with community distrust is a cornerstone in response to high consequence emerging infectious disease outbreaks and imposes strengthening of the public health response infrastructure and emergency outbreak systems in high-risk regions.


Asunto(s)
Enfermedades Transmisibles Emergentes/epidemiología , Epidemias , Control de Infecciones , Enfermedades Transmisibles Emergentes/prevención & control , Brotes de Enfermedades/prevención & control , Epidemias/prevención & control , Epidemias/estadística & datos numéricos , Salud Global/normas , Salud Global/tendencias , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Control de Infecciones/tendencias , Salud Pública/normas , Salud Pública/tendencias , Administración en Salud Pública/métodos , Administración en Salud Pública/tendencias
5.
MMWR Morb Mortal Wkly Rep ; 68(48): 1112-1116, 2019 Dec 06.
Artículo en Inglés | MEDLINE | ID: mdl-31805034

RESUMEN

In 2005, the World Health Organization (WHO) Western Pacific Region countries, including China, resolved to eliminate measles by 2012 or as soon as feasible thereafter (1). As of 2018, nine* of the 37 Western Pacific Region countries or areas† had eliminated§ measles. China's Measles Elimination Action Plan 2006-2012 included strengthening routine immunization; conducting measles risk assessments, followed by supplementary immunization activities (SIAs) with measles-containing vaccine (MCV) at national and subnational levels; strengthening surveillance and laboratory capacity; and investigating and responding to measles outbreaks. Most recently, progress toward measles elimination in China was described in a 2014 report documenting measles elimination efforts in China during 2008-2012 and a resurgence in 2013 (2). This report describes progress toward measles elimination in China during January 2013-June 2019.¶ Measles incidence per million persons decreased from 20.4 in 2013 to 2.8 in 2018; reported measles-related deaths decreased from 32 in 2015 to one in 2018 and no deaths in 2019 through June. Measles elimination in China can be achieved through strengthening the immunization program's existing strategy by ensuring sufficient vaccine supply; continuing to improve laboratory-supported surveillance, outbreak investigation and response; strengthening school entry vaccination record checks; vaccinating students who do not have documentation of receipt of 2 doses of measles-rubella vaccine; and vaccinating health care professionals and other adults at risk for measles.


Asunto(s)
Erradicación de la Enfermedad , Brotes de Enfermedades/prevención & control , Sarampión/prevención & control , Vigilancia de la Población , Adolescente , Niño , Preescolar , China/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , Femenino , Humanos , Programas de Inmunización , Incidencia , Lactante , Masculino , Sarampión/epidemiología , Sarampión/mortalidad , Vacuna Antisarampión/administración & dosificación
6.
Mayo Clin Proc ; 94(12): 2572-2586, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31806107

RESUMEN

Zika virus outbreaks have been explosive and unpredictable and have led to significant adverse health effects-as well as considerable public anxiety. Significant scientific work has resulted in multiple candidate vaccines that are now undergoing further clinical development, with several vaccines now in phase 2 clinical trials. In this review, we survey current vaccine efforts, preclinical and clinical results, and ethical and other concerns that directly bear on vaccine development. It is clear that the world needs safe and effective vaccines to protect against Zika virus infection. Whether such vaccines can be developed through to licensure and public availability absent significant financial investment by countries, and other barriers discussed within this article, remains uncertain.


Asunto(s)
Brotes de Enfermedades/prevención & control , Desarrollo de Medicamentos , Vacunas Virales , Infección por el Virus Zika/prevención & control , Humanos , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/epidemiología
7.
Artículo en Ruso | MEDLINE | ID: mdl-31884773

RESUMEN

The Hepatitis E (HE) is a viral liver disease that is common on all continents at different rates and very frequently is not symptomatically distinguishable from other viral hepatitis, such as hepatitis A, B and C, as well as from other infectious diseases referred to as "acute jaundice syndrome". The GE-anthroponosis (in the case of infection caused by genotypes 1 or 2 of hepatitis E virus) or anthropozoonosis (in the case of infection caused by 3 or 4 viruses) is predominantly propagated through fecal-oral transmission. The article presents the general characteristics of VGE, human risk factors and means of prevention. The particular attention is paid to the development of complex of anti-epidemic, hygienic and veterinary sanitary measures in the Belgorod Oblast.


Asunto(s)
Brotes de Enfermedades/prevención & control , Hepatitis E/epidemiología , Monitoreo Epidemiológico , Humanos , Higiene , Factores de Riesgo , Federación de Rusia/epidemiología , Saneamiento
8.
MMWR Morb Mortal Wkly Rep ; 68(50): 1162-1165, 2019 Dec 20.
Artículo en Inglés | MEDLINE | ID: mdl-31856146

RESUMEN

On August 1, 2018, the Democratic Republic of the Congo Ministry of Health (DRC MoH) declared the tenth outbreak of Ebola virus disease (Ebola) in DRC, in the North Kivu province in eastern DRC on the border with Uganda, 8 days after another Ebola outbreak was declared over in northwest Équateur province. During mid- to late-July 2018, a cluster of 26 cases of acute hemorrhagic fever, including 20 deaths, was reported in North Kivu province.* Blood specimens from six patients hospitalized in the Mabalako health zone and sent to the Institut National de Recherche Biomédicale (National Biomedical Research Institute) in Kinshasa tested positive for Ebola virus. Genetic sequencing confirmed that the outbreaks in North Kivu and Équateur provinces were unrelated. From North Kivu province, the outbreak spread north to Ituri province, and south to South Kivu province (1). On July 17, 2019, the World Health Organization designated the North Kivu and Ituri outbreak a public health emergency of international concern, based on the geographic spread of the disease to Goma, the capital of North Kivu province, and to Uganda and the challenges to implementing prevention and control measures specific to this region (2). This report describes the outbreak in the North Kivu and Ituri provinces. As of November 17, 2019, a total of 3,296 Ebola cases and 2,196 (67%) deaths were reported, making this the second largest documented outbreak after the 2014-2016 epidemic in West Africa, which resulted in 28,600 cases and 11,325 deaths.† Since August 2018, DRC MoH has been collaborating with partners, including the World Health Organization, the United Nations Children's Fund, the United Nations Office for the Coordination of Humanitarian Affairs, the International Organization of Migration, The Alliance for International Medical Action (ALIMA), Médecins Sans Frontières, DRC Red Cross National Society, and CDC, to control the outbreak. Enhanced communication and effective community engagement, timing of interventions during periods of relative stability, and intensive training of local residents to manage response activities with periodic supervision by national and international personnel are needed to end the outbreak.


Asunto(s)
Brotes de Enfermedades , Fiebre Hemorrágica Ebola/epidemiología , República Democrática del Congo/epidemiología , Brotes de Enfermedades/prevención & control , Ebolavirus/aislamiento & purificación , Femenino , Fiebre Hemorrágica Ebola/prevención & control , Humanos , Laboratorios , Masculino , Práctica de Salud Pública
9.
Rev Med Chil ; 147(6): 776-786, 2019 Jun.
Artículo en Español | MEDLINE | ID: mdl-31859831

RESUMEN

Invasive meningococcal disease is challenging for public health, mainly when it manifests with sudden changes in incidence, serogroups and hypervirulent clones that spread in the population, causing great alarm due to its sequelae and often fatal course, a situation that occurred in Chile, starting at week 26 of the year 2012. To face this scenario, an organization of multidisciplinary teams was required, called W-135 Action Plan in Chile, which included sanitary alerts, education, reinforcement of the epidemiological surveillance of suspicious cases, immediate diagnosis through state-of-the-art techniques, blocking of contacts, communication plans, and, from the 42nd week, ON the vaccination campaign was started for children aged from 9-months-old to less than 5 years of age. The vaccination strategy had a great impact on the decrease in incidence (1.3 to 0.1/100,000) and case fatality rate in the vaccinated population (23% to 0%), with a high safety profile, leading to its subsequent inclusion in the national immunization program. The ability to develop molecular, clinical and epidemiological studies allowed us to better understand the situation, supporting public health policy decisions for its control. The W-135 Action Plan implemented by the Ministry of Health in Chile, to manage the outbreak of meningococcal disease by Neisseria meningitidis serogroup W, demonstrated that the coordination of these efforts, through an organized Action Plan, allows the implementation of campaigns at the national level achieving high coverage of risk populations in short periods of time, generating a positive impact on the health of the population.


Asunto(s)
Implementación de Plan de Salud/métodos , Vacunación Masiva/métodos , Infecciones Meningocócicas/epidemiología , Infecciones Meningocócicas/prevención & control , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Chile/epidemiología , Brotes de Enfermedades/prevención & control , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Neisseria meningitidis Serogrupo W-135 , Estaciones del Año , Cobertura de Vacunación , Adulto Joven
10.
BMC Infect Dis ; 19(1): 1075, 2019 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-31864298

RESUMEN

BACKGROUND: Cholera is a major public health concern in displaced-person camps, which often contend with overcrowding and scarcity of resources. Maela, the largest and longest-standing refugee camp in Thailand, located along the Thai-Burmese border, experienced four cholera outbreaks between 2005 and 2010. In 2013, a cholera vaccine campaign was implemented in the camp. To assist in the evaluation of the campaign and planning for subsequent campaigns, we developed a mathematical model of cholera in Maela. METHODS: We formulated a Susceptible-Infectious-Water-Recovered-based transmission model and estimated parameters using incidence data from 2010. We next evaluated the reduction in cases conferred by several immunization strategies, varying timing, effectiveness, and resources (i.e., vaccine availability). After the vaccine campaign, we generated case forecasts for the next year, to inform on-the-ground decision-making regarding whether a booster campaign was needed. RESULTS: We found that preexposure vaccination can substantially reduce the risk of cholera even when <50% of the population is given the full two-dose series. Additionally, the preferred number of doses per person should be considered in the context of one vs. two dose effectiveness and vaccine availability. For reactive vaccination, a trade-off between timing and effectiveness was revealed, indicating that it may be beneficial to give one dose to more people rather than two doses to fewer people, given that a two-dose schedule would incur a delay in administration of the second dose. Forecasting using realistic coverage levels predicted that there was no need for a booster campaign in 2014 (consistent with our predictions, there was not a cholera epidemic in 2014). CONCLUSIONS: Our analyses suggest that vaccination in conjunction with ongoing water sanitation and hygiene efforts provides an effective strategy for controlling cholera outbreaks in refugee camps. Effective preexposure vaccination depends on timing and effectiveness. If a camp is facing an outbreak, delayed distribution of vaccines can substantially alter the effectiveness of reactive vaccination, suggesting that quick distribution of vaccines may be more important than ensuring every individual receives both vaccine doses. Overall, this analysis illustrates how mathematical models can be applied in public health practice, to assist in evaluating alternative intervention strategies and inform decision-making.


Asunto(s)
Vacunas contra el Cólera/administración & dosificación , Cólera/prevención & control , Modelos Teóricos , Salud Pública/métodos , Campos de Refugiados , Vacunación/métodos , Cólera/epidemiología , Cólera/transmisión , Vacunas contra el Cólera/provisión & distribución , Brotes de Enfermedades/prevención & control , Humanos , Saneamiento , Tailandia/epidemiología
11.
Presse Med ; 48(12): 1528-1535, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31767249

RESUMEN

The emergence of a viral disease most often results from an imbalance in the interaction between the infectious agent, the host and the environment. After the introduction phase of a viral disease in a territory or a given population and once the first chains of transmission occur, the spread of the disease or its sustainability are possible if the control measures are not implemented or are not sufficiently effective. If it is difficult to anticipate the occurrence and introduction of an emerging viral disease, the following three key elements must be strengthened to limit its impact: (1) anticipation and preparation; (2) research and (3) monitoring and surveillance. Finally, to guarantee that the measures taken are relevant and acceptable to the population, a multidisciplinary approach must be systematically relied upon and re-evaluated on a prospective basis.


Asunto(s)
Enfermedades Transmisibles Emergentes/epidemiología , Brotes de Enfermedades , Predicción , Virosis/epidemiología , Enfermedades Transmisibles Emergentes/prevención & control , Brotes de Enfermedades/prevención & control , Ambiente , Diseño de Investigaciones Epidemiológicas , Monitoreo Epidemiológico , Predicción/métodos , Humanos , Control de Infecciones/organización & administración , Control de Infecciones/normas , Control de Infecciones/tendencias , Prevención Primaria/métodos , Prevención Primaria/organización & administración , Virosis/prevención & control
12.
Curr Top Microbiol Immunol ; 424: 121-128, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31667598

RESUMEN

By definition, Global Catastrophic Biological Risks (GCBRs) are "beyond the collective capability of national and international governments and the private sector to control". Implicit in this definition is that no single country, sector, or entity can effectively mitigate risk and impact of GCBRs and that doing so requires public-private cooperation. This short commentary offers five trends suggesting that conditions for cooperation are favorable, along with three gaps to be addressed, and five high-level recommendations to strengthen public-private cooperation to mitigate risk and impact of GCBRs.


Asunto(s)
Desastres/prevención & control , Brotes de Enfermedades/prevención & control , Brotes de Enfermedades/estadística & datos numéricos , Asociación entre el Sector Público-Privado , Gestión de Riesgos , Desastres/estadística & datos numéricos , Humanos , Sector Privado
13.
Epidemiol Health ; 41: e2019038, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31715685

RESUMEN

The 2019 hepatitis A outbreak has become increasingly prevalent among adults in Korea and is the largest outbreak since that in 2009-2010. The incidence in the current outbreak is highest among adults aged 35-44 years, corresponding to the peak incidence among those aged 25-34 years 10 years ago. This may indicate a cohort effect in the corresponding age group. Causes of these repeated outbreaks of hepatitis A in Korea are low level of immunity among adults, Korean food culture that consumes raw seafood such as salted clam and inadequate public health system. Among countermeasures, along with general infectious disease control measures including control of the infectious agent, infection spread, and host, urgent actions are needed to review the vaccination policy and establish an adequate public health system.


Asunto(s)
Brotes de Enfermedades , Hepatitis A/epidemiología , Hepatitis A/prevención & control , Adulto , Brotes de Enfermedades/prevención & control , Política de Salud , Vacunas contra la Hepatitis A/administración & dosificación , Humanos , Salud Pública , República de Corea/epidemiología , Factores de Riesgo
14.
Nat Commun ; 10(1): 4531, 2019 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615986

RESUMEN

Recent outbreaks of animal-borne emerging infectious diseases have likely been precipitated by a complex interplay of changing ecological, epidemiological and socio-economic factors. Here, we develop modelling methods that capture elements of each of these factors, to predict the risk of Ebola virus disease (EVD) across time and space. Our modelling results match previously-observed outbreak patterns with high accuracy, and suggest further outbreaks could occur across most of West and Central Africa. Trends in the underlying drivers of EVD risk suggest a 1.75 to 3.2-fold increase in the endemic rate of animal-human viral spill-overs in Africa by 2070, given current modes of healthcare intervention. Future global change scenarios with higher human population growth and lower rates of socio-economic development yield a fourfold higher likelihood of epidemics occurring as a result of spill-over events. Our modelling framework can be used to target interventions designed to reduce epidemic risk for many zoonotic diseases.


Asunto(s)
Enfermedades Transmisibles Emergentes/virología , Ebolavirus/fisiología , Ambiente , Fiebre Hemorrágica Ebola/virología , Factores Socioeconómicos , Zoonosis/virología , África/epidemiología , Animales , Enfermedades Transmisibles Emergentes/epidemiología , Brotes de Enfermedades/prevención & control , Epidemias/prevención & control , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Factores de Riesgo , Zoonosis/epidemiología
15.
Global Health ; 15(1): 58, 2019 10 10.
Artículo en Inglés | MEDLINE | ID: mdl-31601233

RESUMEN

BACKGROUND: After Action Reviews (AARs) provide a means to observe how well preparedness systems perform in real world conditions and can help to identify - and address - gaps in national and global public health emergency preparedness (PHEP) systems. WHO has recently published guidance for voluntary AARs. This analysis builds on this guidance by reviewing evidence on the effectiveness of AARs as tools for system improvement and by summarizing some key lessons about ensuring that AARs result in meaningful learning from experience. RESULTS: Empirical evidence from a variety of fields suggests that AARs hold considerable promise as tools of system improvement for PHEP. Our review of the literature and practical experience demonstrates that AARs are most likely to result in meaningful learning if they focus on incidents that are selected for their learning value, involve an appropriately broad range of perspectives, are conducted with appropriate time for reflection, employ systems frameworks and rigorous tools such as facilitated lookbacks and root cause analysis, and strike a balance between attention to incident specifics vs. generalizable capacities and capabilities. CONCLUSIONS: Employing these practices requires a PHEP system that facilitates the preparation of insightful AARs, and more generally rewards learning. The barriers to AARs fall into two categories: concerns about the cultural sensitivity and context, liability, the political response, and national security; and constraints on staff time and the lack of experience and the requisite analytical skills. Ensuring that AARs fulfill their promise as tools of system improvement will require ongoing investment and a change in mindset. The first step should be to clarify that the goal of AARs is organizational learning, not placing blame or punishing poor performance. Based on experience in other fields, the buy-in of agency and political leadership is critical in this regard. National public health systems also need support in the form of toolkits, guides, and training, as well as research on AAR methods. An AAR registry could support organizational improvement through careful post-event analysis of systems' own events, facilitate identification and sharing of best practices across jurisdictions, and enable cross-case analyses.


Asunto(s)
Planificación en Desastres/organización & administración , Brotes de Enfermedades/prevención & control , Salud Global , Salud Pública , Humanos
16.
Epidemiol Health ; 41: e2019044, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31623421

RESUMEN

OBJECTIVES: The aim of this study was to estimate the medical surge capacity required for mass prophylaxis based on a hypothetical outbreak of smallpox. METHODS: We performed a simulation using the Bioterrorism and Epidemic Outbreak Response Model and varied some important parameters, such as the number of core medical personnel and the number of dispensing clinics. RESULTS: Gaps were identified in the medical surge capacity of the Korean government, especially in the number of medical personnel who could respond to the need for mass prophylaxis against smallpox. CONCLUSIONS: The Korean government will need to train 1,000 or more medical personnel for such an event, and will need to prepare many more dispensing centers than are currently available.


Asunto(s)
Brotes de Enfermedades/prevención & control , Vacunación Masiva/organización & administración , Vacuna contra Viruela/administración & dosificación , Viruela/prevención & control , Competencia Clínica , Simulación por Computador , Instituciones de Salud/provisión & distribución , Fuerza Laboral en Salud/estadística & datos numéricos , Humanos , República de Corea/epidemiología , Viruela/epidemiología
17.
BMC Public Health ; 19(1): 1310, 2019 Oct 17.
Artículo en Inglés | MEDLINE | ID: mdl-31623594

RESUMEN

BACKGROUND: The 2014-2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency. METHODS: We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization's Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations. RESULTS: We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings. CONCLUSIONS: An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Brotes de Enfermedades/prevención & control , Desastres Naturales/prevención & control , Humanos
18.
MMWR Morb Mortal Wkly Rep ; 68(39): 851-854, 2019 Oct 04.
Artículo en Inglés | MEDLINE | ID: mdl-31581162

RESUMEN

Infection prevention and control (IPC) in health care facilities is essential to protecting patients, visitors, and health care personnel from the spread of infectious diseases, including Ebola virus disease (Ebola). Patients with suspected Ebola are typically referred to specialized Ebola treatment units (ETUs), which have strict isolation and IPC protocols, for testing and treatment (1,2). However, in settings where contact tracing is inadequate, Ebola patients might first seek care at general health care facilities, which often have insufficient IPC capacity (3-6). Before 2014-2016, most Ebola outbreaks occurred in rural or nonurban communities, and the role of health care facilities as amplification points, while recognized, was limited (7,8). In contrast to these earlier outbreaks, the 2014-2016 West Africa Ebola outbreak occurred in densely populated urban areas where access to health care facilities was better, but contact tracing was generally inadequate (8). Patients with unrecognized Ebola who sought care at health care facilities with inadequate IPC initiated multiple chains of transmission, which amplified the epidemic to an extent not seen in previous Ebola outbreaks (3-5,7). Implementation of robust IPC practices in general health care facilities was critical to ending health care-associated transmission (8). In August 2018, when an Ebola outbreak was recognized in the Democratic Republic of the Congo (DRC), neighboring countries began preparing for possible introduction of Ebola, with a focus on IPC. Baseline IPC assessments conducted in frontline health care facilities in high-risk districts in Uganda found IPC gaps in screening, isolation, and notification. Based on findings, additional funds were provided for IPC, a training curriculum was developed, and other corrective actions were taken. Ebola preparedness efforts should include activities to ensure that frontline health care facilities have the IPC capacity to rapidly identify suspected Ebola cases and refer such patients for treatment to protect patients, staff members, and visitors.


Asunto(s)
Infección Hospitalaria/prevención & control , Brotes de Enfermedades/prevención & control , Administración de Instituciones de Salud , Fiebre Hemorrágica Ebola/prevención & control , Control de Infecciones/organización & administración , República Democrática del Congo/epidemiología , Investigación sobre Servicios de Salud , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Medición de Riesgo , Uganda
19.
BMC Health Serv Res ; 19(1): 689, 2019 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-31606053

RESUMEN

BACKGROUND: Antimicrobial resistance is an increasing problem in hospitals world-wide. Following other countries, English hospitals experienced outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), a bacterial infection commonly resistant to last resort antibiotics. One way to improve CPE prevention, management and control is the production of guidelines, such as the CPE toolkit published by Public Health England in December 2013. The aim of this research was to investigate the implementation of the CPE toolkit and to identify barriers and facilitators to inform future policies. METHODS: Acute hospital trusts (N = 12) were purposively sampled based on their self-assessed CPE colonisation rates and time point of introducing local CPE action plans. Following maximum variation sampling, 44 interviews with hospital staff were conducted between April and August 2017 using a semi-structured topic guide based on the Capability, Opportunity, Motivation and Behaviour Model and the Theoretical Domains Framework, covering areas of influences on behaviour. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: The national CPE toolkit was widely disseminated within infection prevention and control teams (IPCT), but awareness was rare among other hospital staff. Local plans, developed by IPCTs referring to the CPE toolkit while considering local circumstances, were in place in all hospitals. Implementation barriers included: shortage of isolation facilities for CPE patients, time pressures, and competing demands. Facilitators were within hospital and across-hospital collaborations and knowledge sharing, availability of dedicated IPCTs, leadership support and prioritisation of CPE as an important concern. Participants using the CPE toolkit had mixed views, appreciating its readability and clarity about patient management, but voicing concerns about the lack of transparency on the level of evidence and the practicality of implementation. They recommended regular updates, additional clarifications, tailored information and implementation guidance. CONCLUSIONS: There were problems with the awareness and implementation of the CPE toolkit and frontline staff saw room for improvement, identifying implementation barriers and facilitators. An updated CPE toolkit version should provide comprehensive and instructive guidance on evidence-based CPE prevention, management and control procedures and their implementation in a modular format with sections tailored to hospitals' CPE status and to different staff groups.


Asunto(s)
Enterobacteriaceae Resistentes a los Carbapenémicos , Infección Hospitalaria/prevención & control , Brotes de Enfermedades/prevención & control , Infecciones por Enterobacteriaceae/prevención & control , Control de Infecciones/métodos , Adulto , Anciano , Antibacterianos/uso terapéutico , Inglaterra , Femenino , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Adulto Joven
20.
Rev Sci Tech ; 38(1): 303-314, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31564720

RESUMEN

Under the International Health Regulations (IHR, 2005), a legally binding document adopted by 196 States Parties, countries are required to develop their capacity to rapidly detect, assess, notify and respond to unusual health events of potential international concern. To support countries in monitoring and enhancing their capacities and complying with the IHR (2005), the World Health Organization (WHO) developed the IHR Monitoring and Evaluation Framework (IHR MEF). This framework comprises four complementary components: the State Party Annual Report, the Joint External Evaluation, after-action reviews and simulation exercises. The first two are used to review capacities and the second two to help to explore their functionality. The contribution of different disciplines, sectors, and areas of work, joining forces through a One Health approach, is essential for the implementation of the IHR (2005). Therefore, WHO, in partnership with the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), and other international and national partners, has actively worked on facilitating the inclusion of the relevant sectors, in particular the animal health sector, in each of the four components of the IHR MEF. Other tools complement the IHR MEF, such as the WHO/OIE IHR-PVS [Performance of Veterinary Services] National Bridging Workshops, which facilitate the optimal use of the results of the IHR MEF and the OIE Performance of Veterinary Services Pathway and create an opportunity for stakeholders from animal health and human health services to work on the coordination of their efforts. The results of these various tools are used in countries' planning processes and are incorporated in their National Action Plan for Health Security to accelerate the implementation of IHR core capacities. The present article describes how One Health is incorporated in all components of the IHR MEF.


Asunto(s)
Reglamento Sanitario Internacional , Salud Única , Animales , Brotes de Enfermedades/prevención & control , Salud Global , Humanos , Cooperación Internacional , Salud Única/normas , Organización Mundial de la Salud
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