Research of Epidemic Big Data Based on Improved Deep Convolutional Neural Network.

In recent years, with the acceleration of the aging process and the aggravation of life pressure, the proportion of chronic epidemics has gradually increased. A large amount of medical data will be generated during the hospitalization of diabetics. It will have important practical significance and social value to discover potential medical laws and valuable information among medical data. In view of this, an improved deep convolutional neural network ("CNN+" for short) algorithm was proposed to predict the changes of diabetes. Firstly, the bagging integrated classification algorithm was used instead of the output layer function of the deep CNN, which can help the improved deep CNN algorithm constructed for the data set of diabetic patients and improve the accuracy of classification. In this way, the "CNN+" algorithm can take the advantages of both the deep CNN and the bagging algorithm. On the one hand, it can extract the potential features of the data set by using the powerful feature extraction ability of deep CNN. On the other hand, the bagging integrated classification algorithm can be used for feature classification, so as to improve the classification accuracy and obtain better disease prediction effect to assist doctors in diagnosis and treatment. Experimental results show that compared with the traditional convolutional neural network and other classification algorithm, the "CNN+" model can get more reliable prediction results.

Detecting critical slowing down in high-dimensional epidemiological systems.

Despite medical advances, the emergence and re-emergence of infectious diseases continue to pose a public health threat. Low-dimensional epidemiological models predict that epidemic transitions are preceded by the phenomenon of critical slowing down (CSD). This has raised the possibility of anticipating disease (re-)emergence using CSD-based early-warning signals (EWS), which are statistical moments estimated from time series data. For EWS to be useful at detecting future (re-)emergence, CSD needs to be a generic (model-independent) feature of epidemiological dynamics irrespective of system complexity. Currently, it is unclear whether the predictions of CSD-derived from simple, low-dimensional systems-pertain to real systems, which are high-dimensional. To assess the generality of CSD, we carried out a simulation study of a hierarchy of models, with increasing structural complexity and dimensionality, for a measles-like infectious disease. Our five models included: i) a nonseasonal homogeneous Susceptible-Exposed-Infectious-Recovered (SEIR) model, ii) a homogeneous SEIR model with seasonality in transmission, iii) an age-structured SEIR model, iv) a multiplex network-based model (Mplex) and v) an agent-based simulator (FRED). All models were parameterised to have a herd-immunity immunization threshold of around 90% coverage, and underwent a linear decrease in vaccine uptake, from 92% to 70% over 15 years. We found evidence of CSD prior to disease re-emergence in all models. We also evaluated the performance of seven EWS: the autocorrelation, coefficient of variation, index of dispersion, kurtosis, mean, skewness, variance. Performance was scored using the Area Under the ROC Curve (AUC) statistic. The best performing EWS were the mean and variance, with AUC > 0.75 one year before the estimated transition time. These two, along with the autocorrelation and index of dispersion, are promising candidate EWS for detecting disease emergence.

Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread.

Public health interventions to control the current epidemic of carbapenem-resistant Klebsiella pneumoniae rely on a comprehensive understanding of its emergence and spread over a wide range of geographical scales. We analysed the genome sequences and epidemiological data of >1,700 K. pneumoniae samples isolated from patients in 244 hospitals in 32 countries during the European Survey of Carbapenemase-Producing Enterobacteriaceae. We demonstrate that carbapenemase acquisition is the main cause of carbapenem resistance and that it occurred across diverse phylogenetic backgrounds. However, 477 of 682 (69.9%) carbapenemase-positive isolates are concentrated in four clonal lineages, sequence types 11, 15, 101, 258/512 and their derivatives. Combined analysis of the genetic and geographic distances between isolates with different ß-lactam resistance determinants suggests that the propensity of K. pneumoniae to spread in hospital environments correlates with the degree of resistance and that carbapenemase-positive isolates have the highest transmissibility. Indeed, we found that over half of the hospitals that contributed carbapenemase-positive isolates probably experienced within-hospital transmission, and interhospital spread is far more frequent within, rather than between, countries. Finally, we propose a value of 21 for the number of single nucleotide polymorphisms that optimizes the discrimination of hospital clusters and detail the international spread of the successful epidemic lineage, ST258/512.

Estimating severity of influenza epidemics from severe acute respiratory infections (SARI) in intensive care units.

BACKGROUND: While influenza-like-illness (ILI) surveillance is well-organized at primary care level in Europe, few data are available on more severe cases. With retrospective data from intensive care units (ICU) we aim to fill this current knowledge gap. Using multiple parameters proposed by the World Health Organization we estimate the burden of severe acute respiratory infections (SARI) in the ICU and how this varies between influenza epidemics. METHODS: We analyzed weekly ICU admissions in the Netherlands (2007-2016) from the National Intensive Care Evaluation (NICE) quality registry (100% coverage of adult ICUs in 2016; population size 14 million) to calculate SARI incidence, SARI peak levels, ICU SARI mortality, SARI mean Acute Physiology and Chronic Health Evaluation (APACHE) IV score, and the ICU SARI/ILI ratio. These parameters were calculated both yearly and per separate influenza epidemic (defined epidemic weeks). A SARI syndrome was defined as admission diagnosis being any of six pneumonia or pulmonary sepsis codes in the APACHE IV prognostic model. Influenza epidemic periods were retrieved from primary care sentinel influenza surveillance data. RESULTS: Annually, an average of 13% of medical admissions to adult ICUs were for a SARI but varied widely between weeks (minimum 5% to maximum 25% per week). Admissions for bacterial pneumonia (59%) and pulmonary sepsis (25%) contributed most to ICU SARI. Between the eight different influenza epidemics under study, the value of each of the severity parameters varied. Per parameter the minimum and maximum of those eight values were as follows: ICU SARI incidence 558-2400 cumulated admissions nationwide, rate 0.40-1.71/10,000 inhabitants; average APACHE score 71-78; ICU SARI mortality 13-20%; ICU SARI/ILI ratio 8-17 cases per 1000 expected medically attended ILI in primary care); peak-incidence 101-188 ICU SARI admissions in highest-incidence week, rate 0.07-0.13/10,000 population). CONCLUSIONS: In the ICU there is great variation between the yearly influenza epidemic periods in terms of different influenza severity parameters. The parameters also complement each other by reflecting different aspects of severity. Prospective syndromic ICU SARI surveillance, as proposed by the World Health Organization, thereby would provide insight into the severity of ongoing influenza epidemics, which differ from season to season.

Naming and the Public Health Roles of Physicians.

Resources from the American Medical Association (AMA) Archives facilitate historical consideration of how physicians' authority has been exercised in naming diseases, epidemics, and other health-related issues of national importance. Selected images emphasize physicians' roles in motivating public health initiatives through public service posters, advertisements, and minutes of the AMA House of Delegates meetings.

Dengue epidemic typology and risk factors for extensive epidemic in Amazonas state, Brazil, 2010-2011.

BACKGROUND: Dengue is the most prevalent arboviral disease affecting humans. The frequency and magnitude of dengue epidemic have significantly increased over recent decades. This study aimed to identify dengue epidemic types and risk factors for the extensive epidemics that occurred in 2010-2011, across the municipalities of Amazonas state, Brazil. METHODS: Using an ecological approach, secondary data were obtained from the dengue fever surveillance system. Epidemic waves were classified according to three indices: duration, intensity, and coverage. A hierarchical model of multiple logistic regression was used for the identification of risk factors, with the occurrence of extensive dengue epidemic. RESULTS: During the study period, dengue virus affected 49 of the 62 Amazonas municipalities. In 22 of these, the epidemics were of high intensity, wide range, and long time span, and therefore categorized as "extensive epidemics". The final multivariable model revealed a significant association between extensive dengue epidemics occurrence and the average number of days with precipitation (adjusted OR = 1.40, 95% CI: 1.01-1.94) and the number of years with infestation (adjusted OR = 1.53, 95% CI: 1.18-1.98). CONCLUSIONS: Our results indicate that it is crucial to integrate vector control, case management, epidemiological investigation, and health education, in order to respond to the growing threat of multiple mosquito-borne diseases, such as dengue, Zika and chikungunya, which are highly prevalent in the South America region.

Enfermedades venéreas: un problema sanitario internacional en 1900 / Venereal diseases: an international health problem in 1900

Durante la segunda mitad del siglo XIX surgió un poderoso movimiento sanitario internacional como expresión de la importancia política y económica del binomio salud-enfermedad. Desde los años 1850 una larga serie de conferencias sanitarias internacionales sobre epidemias, higiene, beneficencia, tuberculosis, salud materno-infantil y sanidad rural reunieron a médicos, diplomáticos y gobernantes de muchos países para buscar soluciones políticas al impacto social de las enfermedades. Surgía así una diplomacia sanitaria internacional como vía de debate y solución de los principales problemas de salud. Según las estadísticas oficiales, la elevada prevalencia de enfermos sifilíticos al iniciarse el siglo XX disparó las alarmas ante los problemas de prevención y tratamiento de la enfermedad. Se convocaron dos conferencias internacionales sobre la sífilis. Este artículo analiza las contribuciones y debates entre los expertos internacionales, los argumentos médico sanitarios, morales y sociales, y las reacciones políticas, las regulaciones nacionales de la prostitución, así como las iniciativas y recomendaciones internacionales. Las principales fuentes utilizadas son las reglamentaciones nacionales, y las ponencias, informes y debates que tuvieron lugar durante las dos Conferencias internacionales sobre la sífilis, celebradas en París y Bruselas, entre 1898 y 1902 (AU)

During the second half of the XIX century a powerful international health movement appeared as the expression of the political and economic importance of the health-disease relationship. From 1850 a long series of international health conferences on epidemics, hygiene, charity, tuberculosis, mother-baby health and rural health brought together doctors, diplomats and governors from many countries to look for political solutions to the social impact of disease. An international health diplomacy arose from this as a channel for debate and solution to the main health problems. According to official statistics, the elevated prevalence of syphilitics at the beginning of the XX century set off the alarm regarding the problems of preventing and treating the disease. Two international conferences on syphilis were convened. This article analyses the contributions and debates among the international experts, the medico-sanitary, moral and social arguments, and the political reactions, national regulations for prostitution as well as international initiatives and recommendations. The main sources used are national regulations, and the lectures, reports and debates that occurred during the two international Conferences on Syphilis, held in Paris and Brussels between 1898 and 1902 (AU)

Epidemic Reconstruction in a Phylogenetics Framework: Transmission Trees as Partitions of the Node Set.

The use of genetic data to reconstruct the transmission tree of infectious disease epidemics and outbreaks has been the subject of an increasing number of studies, but previous approaches have usually either made assumptions that are not fully compatible with phylogenetic inference, or, where they have based inference on a phylogeny, have employed a procedure that requires this tree to be fixed. At the same time, the coalescent-based models of the pathogen population that are employed in the methods usually used for time-resolved phylogeny reconstruction are a considerable simplification of epidemic process, as they assume that pathogen lineages mix freely. Here, we contribute a new method that is simultaneously a phylogeny reconstruction method for isolates taken from an epidemic, and a procedure for transmission tree reconstruction. We observe that, if one or more samples is taken from each host in an epidemic or outbreak and these are used to build a phylogeny, a transmission tree is equivalent to a partition of the set of nodes of this phylogeny, such that each partition element is a set of nodes that is connected in the full tree and contains all the tips corresponding to samples taken from one and only one host. We then implement a Monte Carlo Markov Chain (MCMC) procedure for simultaneous sampling from the spaces of both trees, utilising a newly-designed set of phylogenetic tree proposals that also respect node partitions. We calculate the posterior probability of these partitioned trees based on a model that acknowledges the population structure of an epidemic by employing an individual-based disease transmission model and a coalescent process taking place within each host. We demonstrate our method, first using simulated data, and then with sequences taken from the H7N7 avian influenza outbreak that occurred in the Netherlands in 2003. We show that it is superior to established coalescent methods for reconstructing the topology and node heights of the phylogeny and performs well for transmission tree reconstruction when the phylogeny is well-resolved by the genetic data, but caution that this will often not be the case in practice and that existing genetic and epidemiological data should be used to configure such analyses whenever possible. This method is available for use by the research community as part of BEAST, one of the most widely-used packages for reconstruction of dated phylogenies.

Causes of type 2 diabetes in China.

The prevalence of diabetes in China has increased substantially over recent decades, with more than 100 million people estimated to be affected by the disease presently. During this period there has been an increase in the rates of obesity and a reduction in physical activity. Many of the changes in lifestyle and diet are a result of increased economic development and urbanisation. In addition to an increasingly westernised diet, the traditional Chinese diet also plays a part, with the quantity and quality of rice intake linked to the risk of type 2 diabetes. Familial factors including inherited genetic variants are important, although differences in the genetic architecture suggest a different combination of genetic variants could be most relevant in Chinese when compared with Europeans. Recent advances have also emphasised the role of early life factors in the epidemic of diabetes and non-communicable diseases: maternal undernutrition, maternal obesity, and gestational diabetes are all linked to increased risk of diabetes in offspring. A mismatch between developmentally programmed biology and the modern environment is relevant for countries like China where there has been rapid economic transformation. Multisectoral efforts to address the risks will be needed at different stages throughout the lifecourse to reduce the burden of diabetes.

¿Es gripe todo lo que clínicamente parece gripe? / Is flu all that which clinically appears as flu?

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Determination of French influenza outbreaks periods between 1985 and 2011 through a web-based Delphi method.

BACKGROUND: Assessing the accuracy of influenza epidemic periods determined by statistical models is important to improve the performance of algorithms used in real-time syndromic surveillance systems. This is a difficult problem to address in the absence of a reliable gold standard. The objective of this study is to establish an expert-based determination of the start and the end of influenza epidemics in France. METHODS: A three-round international web-based Delphi survey was proposed to 288 eligible influenza experts. Fifty-seven (20%) experts completed the three-rounds of the study. The experts were invited to indicate the starting and the ending week of influenza epidemics, on 32 time-series graphs of influenza seasons drawn using data from the French Sentinelles Network (Influenza-like illness incidence rates) and virological data from the WHO-FluNet. Twenty-six of 32 time-series graphs proposed corresponded to each of the French influenza seasons observed between 1985 and 2011. Six influenza seasons were proposed twice at each round to measure variation among expert responses. RESULTS: We obtained consensual results for 88% (23/26) of the epidemic periods. In two or three rounds (depending on the season) answers gathered around modes, and the internal control demonstrated a good reproducibility of the answers. Virological data did not appear to have a significant impact on the answers or the level of consensus, except for a season with a major mismatch between virological and incidence data timings. CONCLUSIONS: Thanks to this international web-based Delphi survey, we obtained reproducible, stable and consensual results for the majority of the French influenza epidemic curves analysed. The detailed curves together with the estimates from the Delphi study could be a helpful tool for assessing the performance of statistical outbreak detection methods, in order to optimize them.

Inquérito integrado biológico e comportamental entre mulheres trabalhadoras de sexo, moçambique 2011­2012: relatorio final / Integrated Biological and Behavior among Women Sex Workers, Mozambique 2011­2012

O Plano Estratégico Nacional de HIV e SIDA de Moçambique (PEN III) considera as Mulheres Trabalhadoras de Sexo (MTS) um grupo prioritário para intervenções para prevenir o HIV, pela sua elevada vulnerabilidade à infecção pelo HIV. O Inquérito Integrado Biológico e comportamental entre Mulheres Trabalhadoras de Sexo, Moçambique (IBBS-MTS) é o primeiro a ser realizado no país e pretendia determinar a prevalência da infecção pelo HIV nas áreas urbanas de Maputo, Beira e Nampula, e da infecção por sífilis em Maputo, junto com os seus factores comportamentais de risco. Pretendia também estimar o tamanho e distribuição da população das MTS nas três áreas urbanas. Por outro lado, permitiu avaliar o uso e acesso aos programas de cuidados de saúde para essa população e, finalmente, avaliar a possibilidade de inclusão da testagem de sífilis em outros locais fora de Maputo em futuras rondas de IBBS-MTS…

Unusual epidemic events: a new method of early orientation and differentiation between natural and deliberate epidemics.

OBJECTIVE: To develop a model for quick and accurate evaluation of unusual epidemic events (UEE), based on the original model of bioterrorism risk assessment. METHODS: A new scoring system was developed for quick differentiation between a biological attack and other epidemics, using eight qualitative and six quantitative indicators. RESULTS: A new scoring system was applied to three UEEs: (1) a spontaneous outbreak of a new or re-emerging disease ('swine flu'); (2) a spontaneous outbreak following accidental release of a pathogen (Sverdlovsk anthrax); and (3) a spontaneous natural outbreak of a known endemic disease that may mimic bioterrorism or biowarfare (Kosovo tularaemia). The disease agent was found to be the most important and the most informative UEE component of the scoring system. CONCLUSIONS: This new scoring system may be useful for public health institutions and federal civil and military officials responsible for bio-attack investigations.