Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.783
Filtrar
2.
N Engl J Med ; 384(13): 1240-1247, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33789012

RESUMO

During the 2018-2020 Ebola virus disease (EVD) outbreak in North Kivu province in the Democratic Republic of Congo, EVD was diagnosed in a patient who had received the recombinant vesicular stomatitis virus-based vaccine expressing a ZEBOV glycoprotein (rVSV-ZEBOV) (Merck). His treatment included an Ebola virus (EBOV)-specific monoclonal antibody (mAb114), and he recovered within 14 days. However, 6 months later, he presented again with severe EVD-like illness and EBOV viremia, and he died. We initiated epidemiologic and genomic investigations that showed that the patient had had a relapse of acute EVD that led to a transmission chain resulting in 91 cases across six health zones over 4 months. (Funded by the Bill and Melinda Gates Foundation and others.).


Assuntos
Ebolavirus/genética , Doença pelo Vírus Ebola/transmissão , Adulto , Teorema de Bayes , República Democrática do Congo/epidemiologia , Vacinas contra Ebola/imunologia , Ebolavirus/isolamento & purificação , Evolução Fatal , Genoma Viral , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/terapia , Humanos , Masculino , Mutação , Filogenia , RNA Viral/sangue , Recidiva
3.
BMC Med Res Methodol ; 21(1): 34, 2021 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-33583405

RESUMO

BACKGROUND: Ensemble modeling aims to boost the forecasting performance by systematically integrating the predictive accuracy across individual models. Here we introduce a simple-yet-powerful ensemble methodology for forecasting the trajectory of dynamic growth processes that are defined by a system of non-linear differential equations with applications to infectious disease spread. METHODS: We propose and assess the performance of two ensemble modeling schemes with different parametric bootstrapping procedures for trajectory forecasting and uncertainty quantification. Specifically, we conduct sequential probabilistic forecasts to evaluate their forecasting performance using simple dynamical growth models with good track records including the Richards model, the generalized-logistic growth model, and the Gompertz model. We first test and verify the functionality of the method using simulated data from phenomenological models and a mechanistic transmission model. Next, the performance of the method is demonstrated using a diversity of epidemic datasets including scenario outbreak data of the Ebola Forecasting Challenge and real-world epidemic data outbreaks of including influenza, plague, Zika, and COVID-19. RESULTS: We found that the ensemble method that randomly selects a model from the set of individual models for each time point of the trajectory of the epidemic frequently outcompeted the individual models as well as an alternative ensemble method based on the weighted combination of the individual models and yields broader and more realistic uncertainty bounds for the trajectory envelope, achieving not only better coverage rate of the 95% prediction interval but also improved mean interval scores across a diversity of epidemic datasets. CONCLUSION: Our new methodology for ensemble forecasting outcompete component models and an alternative ensemble model that differ in how the variance is evaluated for the generation of the prediction intervals of the forecasts.


Assuntos
Surtos de Doenças , Previsões/métodos , Modelos Estatísticos , /epidemiologia , Doença pelo Vírus Ebola/epidemiologia , Humanos , Influenza Humana/epidemiologia , Infecção por Zika virus/epidemiologia
4.
Drugs Today (Barc) ; 57(1): 27-45, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33594388

RESUMO

Ebola virus (EBOV) causes outbreaks of lethal febrile illness in Africa, the largest of which resulted in over 11,000 deaths and represented a global public health threat. A new biomedical countermeasure, the recombinant vesicular stomatitis virus expressing EBOV glycoprotein (rVSV-EBOV) has been licensed (Ervebo; Merck & Co.). rVSV-EBOV is a replicative viral vaccine engineered to express EBOV antigen. Following rapid development stimulated by the large West African epidemic, an open-label, cluster-randomized ring vaccination trial called Ebola Ça Suffit! in Guinea and Sierra Leone demonstrated strong efficacy. The vaccine has a good safety profile, but is associated with self-limited arthritis and rash in a minority of recipients. rVSV-EBOV is highly immunogenic after a single intramuscular dose with antibody titers persisting for at least 2 years. In the recent outbreak in the Democratic Republic of the Congo, rVSV-EBOV was administered to more than 300,000 individuals and may have contributed, at least in part, to controlling the epidemic.


Assuntos
Vacinas contra Ebola , Ebolavirus , Doença pelo Vírus Ebola , Estomatite Vesicular , Animais , Glicoproteínas , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , Humanos
6.
PLoS One ; 16(2): e0246515, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33544772

RESUMO

BACKGROUND: During health disaster events such as the current devastating havoc being inflicted on countries globally by the SARS-CoV-19 pandemic, mental health problems among survivors and frontline workers are likely concerns. However, during such health disaster events, stakeholders tend to give more precedence to the socio-economic and biomedical health consequences at the expense of mental health. Meanwhile, studies show that regardless of the kind of disaster/antecedent, all traumatic events trigger similar post-traumatic stress symptoms among survivors, families, and frontline workers. Thus, our study investigated the prevalence of anxiety, depression and insomnia symptoms among survivors of the 2014-2016 Ebola virus disease that plagued the West African sub-region. METHODS: We systematically retrieved peer-reviewed articles published between 1970 and 2019 from seven electronic databases, including Google Scholar, MEDLINE, PsychInfo, PubMed, Scopus, Springer Link, Web of Science on Ebola and post-traumatic stress disorder symptoms. A comprehensive hand search complemented this literature search. Of the 87 articles retrieved, only 13 met the inclusion criteria for this meta-analysis. RESULTS: After heterogeneity, influence, and publication bias analysis, our meta-analysis pooled proportion effects estimates showed a moderate to a high prevalence of anxiety (14%; 99% CI: 0.05-0.30), depression (15%; 99% CI: 0.11-0.21), and insomnia (22%; 99% CI: 0.13-0.36). Effect estimates ranging from (0.13; 99% CI: 0.05, 0.28) through to (0.11; 99% CI: 0.05-0.22), (0.15; 99% CI: 0.09-0.25) through to (0.13; 99% CI: 0.08-0.21) and (0.23; 99% CI: 0.11-0.41) to (0.23; 99% CI: 0.11-0.41) were respectively reported for anxiety, depression and insomnia symptoms. These findings suggest a significant amount of EVD survivors are struggling with anxiety, depression and insomnia symptoms. CONCLUSION: Our study provided the first-ever meta-analysis evidence of anxiety, depression, and insomnia symptoms among EVD survivors, and suggest that the predominant biomedical health response to regional and global health disasters should be complemented with trauma-related mental health services.


Assuntos
Ansiedade/complicações , Depressão/complicações , Doença pelo Vírus Ebola/complicações , Distúrbios do Início e da Manutenção do Sono/complicações , África Ocidental/epidemiologia , Ansiedade/epidemiologia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/epidemiologia , Depressão/epidemiologia , Transtorno Depressivo/complicações , Transtorno Depressivo/epidemiologia , Ebolavirus/isolamento & purificação , Doença pelo Vírus Ebola/epidemiologia , Humanos , Prevalência , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Sobreviventes
7.
Public Health Rep ; 136(2): 148-153, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33541219

RESUMO

Force health protection (FHP) is defined as "the prevention of disease and injury in order to protect the strength and capabilities" of any service population. FHP was the foundational principal of the US Public Health Service (USPHS). President John Adams' signing of An Act for Sick and Disabled Seamen on July 16, 1798, marked the first dedication of US federal resources to ensuring the well-being of US civilian sailors and Naval service members. On January 4, 1889, President Cleveland enacted the USPHS Commissioned Corps, creating the world's first (and still only) uniformed service dedicated to promoting, protecting, and advancing the health and safety of the United States and the world. Building on the lessons of the 2014-2015 response to the Ebola virus pandemic, the Corps Care program was formalized in 2017 to establish and implement a uniform and comprehensive strategy to meet the behavioral health, medical, and spiritual needs of all Commissioned Corps officers. Its role was expanded in response to the coronavirus disease 2019 (COVID-19) pandemic, which has placed unprecedented demands on health care workers and spotlighted the need for FHP strategies. We describe the FHP roles of the Corps Care program for the resiliency of Commission Corps officers in general and the Corps' impact during the response to the COVID-19 pandemic. Qualitative analysis of FHP discussions with deployed officers highlights the unique challenges to FHP presented by the pandemic response.


Assuntos
/epidemiologia , Pessoal de Saúde/psicologia , Doença pelo Vírus Ebola/epidemiologia , Resiliência Psicológica , United States Public Health Service , /terapia , Doença pelo Vírus Ebola/terapia , Estados Unidos
8.
Math Biosci ; 334: 108558, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33571534

RESUMO

Phenomenological growth models (PGMs) provide a framework for characterizing epidemic trajectories, estimating key transmission parameters, gaining insight into the contribution of various transmission pathways, and providing long-term and short-term forecasts. Such models only require a small number of parameters to describe epidemic growth patterns. They can be expressed by an ordinary differential equation (ODE) of the type C'(t)=f(t,C;Θ) for t>0, C(0)=C0, where t is time, C(t) is the total size of the epidemic (the cumulative number of cases) at time t, C0 is the initial number of cases, f is a model-specific incidence function, and Θ is a vector of parameters. The current COVID-19 pandemic is a scenario for which such models are of obvious importance. In Bürger et al. (2019) it is demonstrated that some PGMs are better at fitting data of specific epidemic outbreaks than others even when the models have the same number of parameters. This situation motivates the need to measure differences in the dynamics that two different models are capable of generating. The present work contributes to a systematic study of differences between PGMs and how these may explain the ability of certain models to provide a better fit to data than others. To this end a so-called empirical directed distance (EDD) is defined to describe the differences in the dynamics between different dynamic models. The EDD of one PGM from another one quantifies how well the former fits data generated by the latter. The concept of EDD is, however, not symmetric in the usual sense of metric spaces. The procedure of calculating EDDs is applied to synthetic data and real data from influenza, Ebola, and COVID-19 outbreaks.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Métodos Epidemiológicos , Modelos Teóricos , /epidemiologia , Doença pelo Vírus Ebola/epidemiologia , Humanos , Influenza Humana/epidemiologia , Modelos Estatísticos
9.
Nat Commun ; 12(1): 1153, 2021 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-33608536

RESUMO

Zaire ebolavirus (EBOV) is a highly pathogenic filovirus which can result in Ebola virus disease (EVD); a serious medical condition that presents as flu like symptoms but then often leads to more serious or fatal outcomes. The 2013-16 West Africa epidemic saw an unparalleled number of cases. Here we show characterisation and identification of T cell epitopes in surviving patients from Guinea to the EBOV glycoprotein. We perform interferon gamma (IFNγ) ELISpot using a glycoprotein peptide library to identify T cell epitopes and determine the CD4+ or CD8+ T cell component response. Additionally, we generate data on the T cell phenotype and measure polyfunctional cytokine secretion by these antigen specific cells. We show candidate peptides able to elicit a T cell response in EBOV survivors and provide inferred human leukocyte antigen (HLA) allele restriction. This data informs on the long-term T cell response to Ebola virus disease and highlights potentially important immunodominant peptides.


Assuntos
Ebolavirus/imunologia , Epitopos de Linfócito T/imunologia , Glicoproteínas/imunologia , Doença pelo Vírus Ebola/imunologia , Linfócitos T/imunologia , África Ocidental/epidemiologia , Linfócitos T CD4-Positivos , Linfócitos T CD8-Positivos , Ebolavirus/genética , ELISPOT , Epidemias , Glicoproteínas/genética , Doença pelo Vírus Ebola/epidemiologia , Humanos , Imunidade Celular , Interferon gama , Sobreviventes
10.
J Infect Public Health ; 14(3): 293-305, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33610938

RESUMO

BACKGROUND: Ebola virus (EBOV); a public health emergency of international concern,is known to pose threat of global outbreaks. EBOV has spread in African continent and due to unchecked international travel, importation of cases has been reported in different countries. In this alarming scenario, developing countries need to evaluate and upgrade their preparedness plan to contain the spread of EBOV. The present review lays down the updated preparedness plan for developing countries to contain future EBOV outbreaks. METHODS: The literature on EBOV outbreaks and preparedness strategies reported were searched on Pubmed and Google Scholar using the MeSH terms such as "Ebola virus disease, Epidemic, Outbreak, Imported case, Preparedness, Public health interventions" combined with Boolean operator (OR) for the period of 2011-2020. Additionally, World Health organization (WHO) and Centers for Disease Control & Prevention (CDC) websites were searched for the guidelines, reports, containment strategies, containment plan of countries, actions taken by countries and international partners, etc. RESULTS: The present review analyzed the EBOV outbreaks between 2011-2020 and containment strategies used by the affected countries. Based on the lessons learned from EBOV outbreaks and personal experience in infectious disease management, we have recommended a preparedness and response plan for EBOV containment in developing countries. CONCLUSION: Developing countries are particularly vulnerable to major outbreaks of EBOV due to increased international travel and unchecked transmission. The recommended preparedness plan will help developing counties to contain EBOV outbreaks in future.


Assuntos
Surtos de Doenças/prevenção & controle , Ebolavirus , Epidemias/prevenção & controle , Doença pelo Vírus Ebola/prevenção & controle , Vigilância em Saúde Pública/métodos , Defesa Civil , Busca de Comunicante , Países em Desenvolvimento , Doença pelo Vírus Ebola/epidemiologia , Humanos , Testes Imediatos
11.
BMC Public Health ; 21(1): 105, 2021 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-33422049

RESUMO

BACKGROUND: When a new or re-emergent pathogen, such as SARS-CoV-2, causes a major outbreak, rapid access to pertinent research findings is crucial for planning strategies and decision making. We researched whether the speed of sharing research results in the COVID-19 epidemic was higher than the SARS and Ebola epidemics. We also researched whether there is any difference in the most frequent topics investigated before and after the COVID-19, SARS, and Ebola epidemics started. METHODS: We used PubMed database search tools to determine the time-period it took for the number of articles to rise after the epidemics started and the most frequent topics assigned to the articles. RESULTS: The main results were, first, the rise in the number of articles occurred 6 weeks after the COVID-19 epidemic started whereas, this rise occurred 4 months after the SARS and 7 months after the Ebola epidemics started. Second, etiology, statistics & numerical data, and epidemiology were the three most frequent topics investigated in the COVID-19 epidemic. However, etiology, microbiology, and genetics in the SARS epidemic, and statistics & numerical data, epidemiology, and prevention & control in the Ebola epidemic were more frequently studied compared with other topics. Third, some topics were studied more frequently after the epidemics started. CONCLUSIONS: The speed of sharing results in the COVID-19 epidemic was much higher than the SARS and Ebola epidemics, and that there is a difference in the most frequent articles' topics investigated in these three epidemics. Due to the value of time in controlling epidemics spread, the study highlights the necessity of defining more solutions for rapidly providing pertinent research findings in fighting against the next public health emergency.


Assuntos
/epidemiologia , Epidemias , Disseminação de Informação , Pesquisa , Doença pelo Vírus Ebola/epidemiologia , Humanos , Síndrome Respiratória Aguda Grave/epidemiologia
13.
MMWR Recomm Rep ; 70(1): 1-12, 2021 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-33417593

RESUMO

This report summarizes the recommendations of the Advisory Committee on Immunization Practices (ACIP) for use of the rVSVΔG-ZEBOV-GP Ebola vaccine (Ervebo) in the United States. The vaccine contains rice-derived recombinant human serum albumin and live attenuated recombinant vesicular stomatitis virus (VSV) in which the gene encoding the glycoprotein of VSV was replaced with the gene encoding the glycoprotein of Ebola virus species Zaire ebolavirus. Persons with a history of severe allergic reaction (e.g., anaphylaxis) to rice protein should not receive Ervebo. This is the first and only vaccine currently licensed by the Food and Drug Administration for the prevention of Ebola virus disease (EVD). These guidelines will be updated based on availability of new data or as new vaccines are licensed to protect against EVD.ACIP recommends preexposure vaccination with Ervebo for adults aged ≥18 years in the U.S. population who are at highest risk for potential occupational exposure to Ebola virus species Zaire ebolavirus because they are responding to an outbreak of EVD, work as health care personnel at federally designated Ebola treatment centers in the United States, or work as laboratorians or other staff at biosafety level 4 facilities in the United States. Recommendations for use of Ervebo in additional populations at risk for exposure and other settings will be considered and discussed by ACIP in the future.


Assuntos
Vacinas contra Ebola/administração & dosagem , Doença pelo Vírus Ebola/prevenção & controle , Adulto , Comitês Consultivos , Doença pelo Vírus Ebola/epidemiologia , Humanos , Estados Unidos/epidemiologia , United States Food and Drug Administration
14.
Nature ; 590(7846): 468-472, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33505020

RESUMO

Neutralizing antibody function provides a foundation for the efficacy of vaccines and therapies1-3. Here, using a robust in vitro Ebola virus (EBOV) pseudo-particle infection assay and a well-defined set of solid-phase assays, we describe a wide spectrum of antibody responses in a cohort of healthy survivors of the Sierra Leone EBOV outbreak of 2013-2016. Pseudo-particle virus-neutralizing antibodies correlated with total anti-EBOV reactivity and neutralizing antibodies against live EBOV. Variant EBOV glycoproteins (1995 and 2014 strains) were similarly neutralized. During longitudinal follow-up, antibody responses fluctuated in a 'decay-stimulation-decay' pattern that suggests de novo restimulation by EBOV antigens after recovery. A pharmacodynamic model of antibody reactivity identified a decay half-life of 77-100 days and a doubling time of 46-86 days in a high proportion of survivors. The highest antibody reactivity was observed around 200 days after an individual had recovered. The model suggests that EBOV antibody reactivity declines over 0.5-2 years after recovery. In a high proportion of healthy survivors, antibody responses undergo rapid restimulation. Vigilant follow-up of survivors and possible elective de novo antigenic stimulation by vaccine immunization should be considered in order to prevent EBOV viral recrudescence in recovering individuals and thereby to mitigate the potential risk of reseeding an outbreak.


Assuntos
Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Convalescença , Ebolavirus/imunologia , Doença pelo Vírus Ebola/imunologia , Sobreviventes , Adolescente , Adulto , África Ocidental/epidemiologia , Anticorpos Neutralizantes/sangue , Anticorpos Neutralizantes/imunologia , Estudos de Coortes , Feminino , Meia-Vida , Doença pelo Vírus Ebola/sangue , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Neutralização , Fatores de Tempo , Viremia/sangue , Viremia/imunologia , Adulto Jovem
16.
Epidemiol Infect ; 149: e6, 2020 12 28.
Artigo em Inglês | MEDLINE | ID: mdl-33357248

RESUMO

Using monthly data from the Ebola-outbreak 2013-2016 in West Africa, we compared two calibrations for data fitting, least-squares (SSE) and weighted least-squares (SWSE) with weights reciprocal to the number of new infections. To compare (in hindsight) forecasts for the final disease size (the actual value was observed at month 28 of the outbreak) we fitted Bertalanffy-Pütter growth models to truncated initial data (first 11, 12, …, 28 months). The growth curves identified the epidemic peak at month 10 and the relative errors of the forecasts (asymptotic limits) were below 10%, if 16 or more month were used; for SWSE the relative errors were smaller than for SSE. However, the calibrations differed insofar as for SWSE there were good fitting models that forecasted reasonable upper and lower bounds, while SSE was biased, as the forecasts of good fitting models systematically underestimated the final disease size. Furthermore, for SSE the normal distribution hypothesis of the fit residuals was refuted, while the similar hypothesis for SWSE was not refuted. We therefore recommend considering SWSE for epidemic forecasts.


Assuntos
Surtos de Doenças , Doença pelo Vírus Ebola/epidemiologia , Modelos Biológicos , Modelos Estatísticos , África Ocidental/epidemiologia , Previsões , Humanos
17.
BMC Infect Dis ; 20(1): 838, 2020 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-33183252

RESUMO

BACKGROUND: A functioning Viral Haemorrhagic Fever (VHF) surveillance system in countries at risk for outbreaks can reduce early transmission in case of an outbreak. Surveillance performance depends on the application of suspect case definitions in daily clinical practice. Recommended suspect case criteria during outbreaks are designed for high sensitivity and include general symptoms, pyrexia, haemorrhage, epidemiological link and unexplained death in patients. Non-outbreak criteria are narrower, relying on the persistence of fever and the presence of haemorrhagic signs. METHODS: This study ascertains VHF suspect case prevalence based on outbreak and non-outbreak criteria in a Guinean regional hospital for a period of three months. The study further describes clinical trajectories of patients who meet non-outbreak VHF suspect case criteria in order to discuss challenges in their identification. We used cross-sectional data collection at triage and emergency room to record demographic and clinical data of all admitted patients during the study period. For the follow-up study with description of diagnostic trajectories of VHF suspect cases, we used retrospective chart review. RESULTS: The most common symptoms of all patients upon admission were fever, tiredness/weakness and abdominal pain. 686 patients met EVD outbreak criteria, ten adult patients and two paediatric patients met study-specific non-outbreak VHF suspect case criteria. None of the suspect cases was treated as VHF suspect case and none tested positive for malaria upon admission. Their most frequent discharge diagnosis was unspecific gastrointestinal infection. The most common diagnostic measures were haemoglobin level and glycaemia for both adults and for children; of the requested examinations for hospitalized suspect cases, 36% were not executed or obtained. Half of those patients self-discharged against medical advice. CONCLUSIONS: Our study shows that the number of VHF suspect cases may vary greatly depending on which suspect case criteria are applied. Identification of VHF suspect cases seems challenging in clinical practice. We suggest that this may be due to the low use of laboratory diagnostics to support certain diagnoses and the non-application of VHF suspect case definitions in clinical practice. Future VHF suspect case management should aim to tackle such challenges in comparable hospital settings.


Assuntos
Surtos de Doenças , Ebolavirus/genética , Serviço Hospitalar de Emergência , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/epidemiologia , Centros de Atenção Terciária , Triagem/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Febre/diagnóstico , Febre/epidemiologia , Seguimentos , Guiné/epidemiologia , Doença pelo Vírus Ebola/virologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Adulto Jovem
18.
Cochrane Database Syst Rev ; 11: CD013779, 2020 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-33150970

RESUMO

BACKGROUND: Evidence from disease epidemics shows that healthcare workers are at risk of developing short- and long-term mental health problems. The World Health Organization (WHO) has warned about the potential negative impact of the COVID-19 crisis on the mental well-being of health and social care professionals. Symptoms of mental health problems commonly include depression, anxiety, stress, and additional cognitive and social problems; these can impact on function in the workplace. The mental health and resilience (ability to cope with the negative effects of stress) of frontline health and social care professionals ('frontline workers' in this review) could be supported during disease epidemics by workplace interventions, interventions to support basic daily needs, psychological support interventions, pharmacological interventions, or a combination of any or all of these. OBJECTIVES: Objective 1: to assess the effects of interventions aimed at supporting the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic. Objective 2: to identify barriers and facilitators that may impact on the implementation of interventions aimed at supporting the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic. SEARCH METHODS: On 28 May 2020 we searched the Cochrane Database of Systematic Reviews, CENTRAL, MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, Global Index Medicus databases and WHO Institutional Repository for Information Sharing. We also searched ongoing trials registers and Google Scholar. We ran all searches from the year 2002 onwards, with no language restrictions. SELECTION CRITERIA: We included studies in which participants were health and social care professionals working at the front line during infectious disease outbreaks, categorised as epidemics or pandemics by WHO, from 2002 onwards. For objective 1 we included quantitative evidence from randomised trials, non-randomised trials, controlled before-after studies and interrupted time series studies, which investigated the effect of any intervention to support mental health or resilience, compared to no intervention, standard care, placebo or attention control intervention, or other active interventions. For objective 2 we included qualitative evidence from studies that described barriers and facilitators to the implementation of interventions. Outcomes critical to this review were general mental health and resilience. Additional outcomes included psychological symptoms of anxiety, depression or stress; burnout; other mental health disorders; workplace staffing; and adverse events arising from interventions. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently applied selection criteria to abstracts and full papers, with disagreements resolved through discussion. One review author systematically extracted data, cross-checked by a second review author. For objective 1, we assessed risk of bias of studies of effectiveness using the Cochrane 'Risk of bias' tool. For objective 2, we assessed methodological limitations using either the CASP (Critical Appraisal Skills Programme) qualitative study tool, for qualitative studies, or WEIRD (Ways of Evaluating Important and Relevant Data) tool, for descriptive studies. We planned meta-analyses of pairwise comparisons for outcomes if direct evidence were available. Two review authors extracted evidence relating to barriers and facilitators to implementation, organised these around the domains of the Consolidated Framework of Implementation Research, and used the GRADE-CERQual approach to assess confidence in each finding. We planned to produce an overarching synthesis, bringing quantitative and qualitative findings together. MAIN RESULTS: We included 16 studies that reported implementation of an intervention aimed at supporting the resilience or mental health of frontline workers during disease outbreaks (severe acute respiratory syndrome (SARS): 2; Ebola: 9; Middle East respiratory syndrome (MERS): 1; COVID-19: 4). Interventions studied included workplace interventions, such as training, structure and communication (6 studies); psychological support interventions, such as counselling and psychology services (8 studies); and multifaceted interventions (2 studies). Objective 1: a mixed-methods study that incorporated a cluster-randomised trial, investigating the effect of a work-based intervention, provided very low-certainty evidence about the effect of training frontline healthcare workers to deliver psychological first aid on a measure of burnout. Objective 2: we included all 16 studies in our qualitative evidence synthesis; we classified seven as qualitative and nine as descriptive studies. We identified 17 key findings from multiple barriers and facilitators reported in studies. We did not have high confidence in any of the findings; we had moderate confidence in six findings and low to very low confidence in 11 findings. We are moderately confident that the following two factors were barriers to intervention implementation: frontline workers, or the organisations in which they worked, not being fully aware of what they needed to support their mental well-being; and a lack of equipment, staff time or skills needed for an intervention. We are moderately confident that the following three factors were facilitators of intervention implementation: interventions that could be adapted for local needs; having effective communication, both formally and socially; and having positive, safe and supportive learning environments for frontline workers. We are moderately confident that the knowledge or beliefs, or both, that people have about an intervention can act as either barriers or facilitators to implementation of the intervention. AUTHORS' CONCLUSIONS: There is a lack of both quantitative and qualitative evidence from studies carried out during or after disease epidemics and pandemics that can inform the selection of interventions that are beneficial to the resilience and mental health of frontline workers. Alternative sources of evidence (e.g. from other healthcare crises, and general evidence about interventions that support mental well-being) could therefore be used to inform decision making. When selecting interventions aimed at supporting frontline workers' mental health, organisational, social, personal, and psychological factors may all be important. Research to determine the effectiveness of interventions is a high priority. The COVID-19 pandemic provides unique opportunities for robust evaluation of interventions. Future studies must be developed with appropriately rigorous planning, including development, peer review and transparent reporting of research protocols, following guidance and standards for best practice, and with appropriate length of follow-up. Factors that may act as barriers and facilitators to implementation of interventions should be considered during the planning of future research and when selecting interventions to deliver within local settings.


Assuntos
Surtos de Doenças , Pessoal de Saúde/psicologia , Saúde Mental , Saúde do Trabalhador , Resiliência Psicológica , Assistentes Sociais/psicologia , Betacoronavirus , Viés , Esgotamento Profissional/psicologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Epidemias , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/terapia , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Sistemas de Apoio Psicossocial , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/terapia , Local de Trabalho
19.
Yale J Biol Med ; 93(4): 579-585, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33005122

RESUMO

Not only do epidemics such as HIV/AIDS, Ebola Virus Disease (EVD), and the current Coronavirus Disease (COVID-19) cause the loss of millions of lives, but they also cost the global economy billions of dollars. Consequently, there is an urgent need to formulate interventions that will help control their spread and impact when they emerge. The education of young girls and women is one such historical approach. They are usually the vulnerable targets of disease outbreaks - they are most likely to be vehicles for the spread of epidemics due to their assigned traditional roles in resource-limited countries. Based on our work and the work of others on educational interventions, we propose six critical components of a cost-effective and sustainable response to promote girl-child education in resource-limited settings.


Assuntos
Doenças Transmissíveis Emergentes , Infecções por Coronavirus , Identidade de Gênero , Saúde Global , Educação em Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , Criança , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Países em Desenvolvimento , Feminino , Saúde Global/economia , Saúde Global/educação , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Educação em Saúde/métodos , Educação em Saúde/organização & administração , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
20.
Rev Sci Tech ; 39(2): 579-590, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33046918

RESUMO

All-hazards preparedness and response planning requires ongoing individual, organisational and multi-jurisdictional learning. Disaster after-action reviews are an established emergency management practice to acquire knowledge through a process of analysing what happened and why, to improve the emergency response before the next crisis. After-action reviews help individuals and organisations learn, and are an essential step in the preparedness cycle. Human and animal health authorities have begun to employ after-action reviews for disaster preparedness and response among public health and Veterinary Services. The World Organisation for Animal Health (OIE) encourages Members to establish after-action reviews and share best practice. The adoption of afteraction review is an essential step for all provincial, national and multinational emergency management authorities to mitigate the impact of disasters on human and animal health. Emerging and re-emerging infectious diseases with pandemic potential pose unique preparedness challenges, requiring high-level policy attention to close long-standing gaps. A review of after-action reports from the 2001 anthrax bioterror attacks and of naturally occurring infectious disease crises, from the 2003 outbreak of severe acute respiratory syndrome (SARS) to the 2014 Ebola epidemic, reveal a similar pattern of repeated weakness and failures. These phenomena are described as 'lessons observed but not lessons learned'. Most infectious disease outbreaks with pandemic potential are zoonotic and require a One Health approach to prevent, prepare for and respond to global health security crises. After-action reviews in a One Health security context are essential to improve the pandemic preparedness of public health and Veterinary Services. After-action reviews can also provide the evidence-based 'feedback loop' needed to galvanise public policy and political will to translate lessons observed into sustained and applied lessons learned.


Assuntos
Desastres , Doença pelo Vírus Ebola , Animais , Surtos de Doenças/prevenção & controle , Surtos de Doenças/veterinária , Saúde Global , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/veterinária , Humanos , Saúde Pública
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...