16 July 2015

NACDD Now Accepting Applications for the 2015-2016 Epidemiology Mentoring Program

Applications are now being accepted for the Centers for Disease Control and Prevention and National Association of Chronic Disease Directors 2015-2016 National Mentorship Program in Applied Chronic Disease Epidemiology cohort. 
The goals of the Mentorship Program are to:
·    enlarge the pool of trained chronic disease epidemiologists at public health agencies,
·    improve the practice of chronic disease epidemiology; and
·    increase the epidemiological science in chronic disease programs and policies.
NACDD will select up to nine newly-hired (less than one year) and junior-level epidemiologists from state, tribal, local and territorial health departments.  Interested applicants must select a project that will serve as the focus of their mentorship.  
NACDD is also accepting resumes or curricula vitae from senior chronic disease epidemiologists and senior-level epidemiologists with substantial experience in applied chronic disease epidemiology.  Mentors will receive a $5,000 stipend and travel support to complete a mentor site visit.  Anyone interested in serving as a mentor must be able to enter into a contractual agreement with NACDD to receive the stipend. 
The mentoring program will begin in August 2015 and continue until June 30, 2016.  Program participants will receive travel support to attend the 16th annual Council of State and Territorial Epidemiologists Conference, June 19-23, 2016, in Anchorage, Alaska.    To Apply:
Mentee: Send completed mentee application, letters of support and required documents to nmccoy@chronicdisease.org
Mentor: Send cover letter and most recent resume or curriculum vitae to nmccoy@chronicdisease.org.   Address all letters to John Robitscher, MPH, Chief Executive Officer, National Association of Chronic Disease Directors, ATTN: Epidemiology Mentoring Program, 2200 Century Parkway, Suite 250, Atlanta, GA, 30345.  
NACDD must receive all applications and resumes by midnight, local time, on Friday, August 14, 2015.
Application and supporting documents attached.  Information on the CDC-NACDD National Mentorship in Applied Chronic Disease Epidemiology can be accessed online at http://www.chronicdisease.org/members/group_content_view.asp?group=128220&id=321462. 

Access official application announcement online at http://www.chronicdisease.org/forums/Posts.aspx?topic=1127936&page=1#post_1127936. 



The CDC and NACDD National Mentorship Program in Applied Chronic Disease Epidemiology serves to enhance state and local capacity through networking and professional development opportunities.  This program is supported by a cooperative agreement from the Centers for Disease Control and Prevention's Division of Population Health.
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15 July 2015

Research Committee Selected Articles of the Week, July 13, 2015

Articles from July_06_2015

Research Committee Selected Articles for the Week of July_06_2015


  • Jiang L., Lee V.J., Lim W.Y., Chen M.I., Chen Y., Tan L., Lin R.T., Leo Y.S., Barr I., Cook A.R. Performance of case definitions for influenza surveillance
  • Hlavinkova L., Kristufkova Z., Mikas J. Risk factors for severe outcome of cases with pandemic influenza A(H1N1)pdm09
  • Barde P.V., Shukla M.K., Kori B.K., Chand G., Jain L., Varun B.M., Dutta D., Baruah K., Singh N. Emergence of dengue in tribal villages of Mandla district, Madhya Pradesh, India
  • Davila-Torres J., Chowell G., Borja-Aburto V.H., Viboud C., Grajalez-Muniz C., Miller M.A. Intense seasonal A/H1N1 influenza in Mexico, winter 2013-2014 ★
  • Boggild A.K., Esposito D.H., Kozarsky P.E., Ansdell V., Beeching N.J., Campion D., Castelli F., Caum Differential diagnosis of illness in travelers arriving from sierra Leone, Liberia, or guinea: A cross-sectional study from the Geosentinel surveillance network
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    The movement pattern of horses around race meetings in New Zealand


    In order to describe the implications of racehorse movement on the potential spread and control of infectious disease in New Zealand, the movement of horses due to regular racing activities needed to be quantified. Race meeting, trainer and starter data we re collected in 2009 from the governing bodies for the two racing codes in New Zealand; Harness Racing New Zealand and New Zealand Thoroughbred Racing. During 2009, 507 Thoroughbred and 506 Standardbred race meetings were held. A random selection of 42 Sta ndardbred and 39 Thoroughbred race meetings were taken from all race meetings held in 2009 and the distances travelled by trainers to these race meetings were determined. The trainers attending selected race meetings represented 50% (1135/2287) of all regi stered trainers in 2009. There was no seasonal pattern of when race meetings were held between racing codes (P ? 0.18) or by race type (P ? 0.83). There were significant differences in the distance travelled by trainers to race meetings, by racing code (P < 0.001). Thoroughbred trainers travelled a median of 91 km (IQR 40-203 km), while Standardbred trainers travelled a median of 45 km (IQR 24-113 km) (P < 0.001). Within each racing code, trainers travelled further to attend premier races than other types o f race meetings (P < 0.001). These data demonstrate there is higher potential for more widespread disease dissemination from premier race meetings compared with other types of race meetings. Additionally, lack of a seasonal pattern indicates that a widespr ead outbreak could occur at any time of the year. Widespread disease dissemination would increase the logistic effort required for effective infectious disease control and has the potential to increase the time required to achieve control. © CSIRO 2015.
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    Performance of case definitions for influenza surveillance


    Influenza-like illness (ILI) case definitions, such as those from the European Centre for Disease Control and Prevention, World Health Organization (WHO) and United States Centers for Disease Control and Prevention, are commonly used for influenza surveill ance. We assessed how various case definitions performed during the initial wave of influenza A(H1N1 pdm09 infections in Singapore on a cohort of 727 patients with two to three blood samples and whose symptoms were reviewed fortnightly from June to October 2009. Using seroconversion (? 4-fold rise) to A/California/7/2009 (H1N1), we identified 36 presumptive influenza A(H1N1)pdm09 episodes and 664 episodes unrelated to influenza A(H1N1)pdm09. Cough, fever and headache occurred more commonly in presumptive in fluenza A(H1N1)pdm09. Although the sensitivity was low (36%), the recently revised WHO ILI case definition gave a higher positive predictive value (42%) and positive likelihood ratio (13.3) than the other case definitions. Results including only episodes w ith primary care consultations were similar. Individuals who worked or had episodes with fever, cough or sore throat were more likely to consult a physician, while episodes with Saturday onset were less likely, with some consultations skipped or postponed. Our analysis supports the use of the revised WHO ILI case definition,which includes only cough in the presence of fever defined as body temperature ?38 °C for influenza surveillance. © 2015 European Centre for Disease Prevention and Control (ECDC). All ri ghts reserved.
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    Risk factors for severe outcome of cases with pandemic influenza A(H1N1)pdm09


    OBJECTIVES: The aim of this study is to describe demographic, clinical and epidemiological characteristics of cases with laboratory-confirmed pandemic influenza virus A(H1N1)pdm09 reported in Slovakia from May 28, 2009 to December 30, 2009 and analyse the association between risk factors and severe outcome of these cases. BACKGROUND: In the spring of 2009, an outbreak of a pandemic influenza virus A(H1N1)pdm09, emerged in Mexico and spread globally. Until December 2009, 1,014 cases were notified in Slovakia . METHODS: The data were collected within national influenza surveillance system. Odds ratios (95% CI) were calculated. Associations were found to be significantly associated with the worse outcome (p < 0.05) in the univariate analysis and were adjusted fo r possible effects of age and sex by using a logistic regression model. RESULTS: Out of the total number of 1,014 cases, 131 (12.9 %) cases were hospitalized, and 43 (4.2 %) of those were admitted to intensive care units. During the reporting period, 38 de aths were reported, representing a case fatality rate of 3.75 %. The median age of severe cases (35 years, IQR = 29 y) was significantly higher than the median age of mild cases (24 years, IQR = 19 y; p < 0.001). By using a logistic regression, we found ou t that chronic obstructive pulmonary disease (COPD) (aOR = 9.2; 95%CI: 1.42-59.98), cardiovascular diseases (aOR = 14.97; 95%CI: 5.49-40.79), malignity (aOR = 7.6; 95%CI: 1.95-29.37) and gravidity (aOR = 55.21; 95% CI: 14.40-211.58) were significantly asso ciated with severe outcomes of the cases. CONCLUSION: The fact, that 35% of severely ill patients did not report any risk factor suggests the importance of vaccination as a prevention of influenza.
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    Emergence of dengue in tribal villages of Mandla district, Madhya Pradesh, India


    Background & objectives: Dengue (DEN) is a rapidly spreading arboviral disease transmitted by Aedes mosquitoes. Although it is endemic in India, dengue virus (DENV) infection has not been reported from tribal areas of Madhya Pradesh. Investigations were co nducted to establish the aetiology of sudden upsurge of cases with febrile illness in June 2013 from tribal villages of Mandla district of Madhya Pradesh, India. Methods: The rapid response team of the National Institute for Research in Tribal Health, Jaba lpur, conducted clinical investigations and field surveys to collect the samples from suspected cases. Samples were tested using molecular and serological tools. Collected mosquitoes were identified and tested for the presence of virus using semi nested re verse transcriptase-polymerase chain reaction (nRT-PCR). The sequences were analysed to identify serotype and genotype of the virus. Results: of the 648 samples collected from 18 villages of Mandla, 321 (49.53%) were found to be positive for dengue. The nR T-PCR and sequencing confirmed the aetiology as dengue virus type 2. Eighteen per cent of patients needed hospitalization and five deaths were attributed to dengue. The virus was also detected from Aedes aegypti mosquito, which was incriminated as a vector . Phylogenetic analysis revealed that the dengue virus 2 detected belonged to cosmopolitan genotype of the virus. Interpretation & conclusions: Dengue virus serotype 2 was detected as the aetiological agent in the outbreak in tribal villages of Mandla dist rict of Madhya Pradesh. Conducive man-made environment favouring mosquitogenic conditions and seeding of virus could be the probable reasons for this outbreak. Urgent attention is needed to control this new threat to tribal population, which is already ove rburdened with other vector borne diseases. © 2015, Indian Council of Medical Research. All rights reserved.
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    Intense seasonal A/H1N1 influenza in Mexico, winter 2013-2014


    Background and Aims: A recrudescent wave of pandemic influenza A/H1N1 affected Mexico during the winter of 2013-2014 following a mild 2012-2013 A/H3N2 influenza season. Methods: We compared the demographic and geographic characteristics of hospitalizations and inpatient deaths for severe acute respiratory infection (SARI) and laboratory-confirmed influenza during the 2013-2014 influenza season compared to previous influenza seasons, based on a large prospective surveillance system maintained by the Mexican Social Security health care system. Results: A total of 14,236 SARI hospitalizations and 1,163 inpatient deaths (8.2%) were reported between October 1, 2013 and March 31, 2014. Rates of laboratory-confirmed A/H1N1 hospitalizations and deaths were significa ntly higher among individuals aged 30-59years and lower among younger age groups for the 2013-2014 A/H1N1 season compared to the previous A/H1N1 season in 2011-2012 (?2 test, p<0 data-blogger-escaped-.001="" data-blogger-escaped-1.3-1.4="" data-blogger-escaped-2011-2012="" data-blogger-escaped-2013-2014="" data-blogger-escaped-2013-march="" data-blogger-escaped-2014="" data-blogger-escaped-2015="" data-blogger-escaped-a="" data-blogger-escaped-absence="" data-blogger-escaped-activity="" data-blogger-escaped-adults="" data-blogger-escaped-age="" data-blogger-escaped-among="" data-blogger-escaped-and="" data-blogger-escaped-antigenic="" data-blogger-escaped-at="" data-blogger-escaped-build-up="" data-blogger-escaped-but="" data-blogger-escaped-c="" data-blogger-escaped-ce="" data-blogger-escaped-change="" data-blogger-escaped-clear="" data-blogger-escaped-conclusions:="" data-blogger-escaped-deaths="" data-blogger-escaped-disease="" data-blogger-escaped-distribution="" data-blogger-escaped-documented="" data-blogger-escaped-drift="" data-blogger-escaped-during="" data-blogger-escaped-estimated="" data-blogger-escaped-for="" data-blogger-escaped-from="" data-blogger-escaped-globally="" data-blogger-escaped-gradual="" data-blogger-escaped-hospitalizations="" data-blogger-escaped-immunity="" data-blogger-escaped-imss.="" data-blogger-escaped-in2009.="" data-blogger-escaped-in="" data-blogger-escaped-increase="" data-blogger-escaped-infections="" data-blogger-escaped-influenza="" data-blogger-escaped-initial="" data-blogger-escaped-irculating="" data-blogger-escaped-line="" data-blogger-escaped-lower="" data-blogger-escaped-mexico="" data-blogger-escaped-middle-aged="" data-blogger-escaped-ntral="" data-blogger-escaped-number="" data-blogger-escaped-observed="" data-blogger-escaped-october="" data-blogger-escaped-of="" data-blogger-escaped-pandemic="" data-blogger-escaped-pandemics.="" data-blogger-escaped-past="" data-blogger-escaped-period="" data-blogger-escaped-populations="" data-blogger-escaped-post-2009="" data-blogger-escaped-preceding="" data-blogger-escaped-profile="" data-blogger-escaped-proportionate="" data-blogger-escaped-related="" data-blogger-escaped-relative="" data-blogger-escaped-reminiscent="" data-blogger-escaped-reported="" data-blogger-escaped-reproduction="" data-blogger-escaped-season.="" data-blogger-escaped-season="" data-blogger-escaped-severe="" data-blogger-escaped-shift="" data-blogger-escaped-slow="" data-blogger-escaped-substantial="" data-blogger-escaped-suggests="" data-blogger-escaped-than="" data-blogger-escaped-that="" data-blogger-escaped-the="" data-blogger-escaped-to="" data-blogger-escaped-viruses="" data-blogger-escaped-was="" data-blogger-escaped-waves="" data-blogger-escaped-we="" data-blogger-escaped-winter="" data-blogger-escaped-with="" data-blogger-escaped-younger="">
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    Differential diagnosis of illness in travelers arriving from sierra Leone, Liberia, or guinea: A cross-sectional study from the Geosentinel surveillance network


    Background: The largest-ever outbreak of Ebola virus disease (EVD), ongoing in West Africa since late 2013, has led to export of cases to Europe and North America. Clinicians encountering ill travelers arriving from countries with widespread Ebola virus tr ansmission must be aware of alternate diagnoses associated with fever and other nonspecific symptoms. Objective: To define the spectrum of illness observed in persons returning from areas of West Africa where EVD transmission has been widespread. Design: D escriptive, using GeoSentinel records. Setting: 57 travel or tropical medicine clinics in 25 countries. Patients: 805 ill returned travelers and new immigrants from Sierra Leone, Liberia, or Guinea seen between September 2009 and August 2014. Measurements: Frequencies of demographic and travelrelated characteristics and illnesses reported. Results: The most common specific diagnosis among 770 nonimmigrant travelers was malaria (n = 310 [40.3%]), with Plasmodium falciparum or severe malaria in 267 (86%) and non-P. falciparum malaria in 43 (14%). Acute diarrhea was the second most common diagnosis among nonimmigrant travelers (n= 95 [12.3%]). Such common diagnoses as upper respiratory tract infection, urinary tract infection, and influenza-like illness occurre d in only 26, 9, and 7 returning travelers, respectively. Few instances of typhoid fever (n = 8), acute HIV infection (n = 5), and dengue (n = 2) were encountered.
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    Research Committee Articles of the Week, 06 Jul, 2015

    Articles from July_06_2015

    Research Committee Selected Articles for the Week of July_06_2015

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    Major emerging vector-borne zoonotic diseases of public health importance in Canada

    In Canada, the emergence of vector-borne diseases may occur via international movement and subsequent establishment of vectors and pathogens, or via northward spread from endemic areas in the USA. Re-emergence of endemic vector-borne diseases may occur due to climate-driven changes to their geographic range and ecology. Lyme disease, West Nile virus (WNV), and other vector-borne diseases were identified as priority emerging non-enteric zoonoses in Canada in a prioritization exercise conducted by public heal th stakeholders in 2013. We review and present the state of knowledge on the public health importance of these high priority emerging vector-borne diseases in Canada. Lyme disease is emerging in Canada due to range expansion of the tick vector, which also signals concern for the emergence of human granulocytic anaplasmosis, babesiosis, and Powassan virus. WNV has been established in Canada since 2001, with epidemics of varying intensity in following years linked to climatic drivers. Eastern equine encephali tis virus, Jamestown Canyon virus, snowshoe hare virus, and Cache Valley virus are other mosquito-borne viruses endemic to Canada with the potential for human health impact. Increased surveillance for emerging pathogens and vectors and coordinated efforts among sectors and jurisdictions will aid in early detection and timely public health response. © 2015 SSCC. All rights reserved.

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    Global spatio-temporal patterns of influenza in the post-pandemic era

    We study the global spatio-temporal patterns of influenza dynamics. This is achieved by analysing and modelling weekly laboratory confirmed cases of influenza A and B from 138 countries between January 2006 and January 2015. The data were obtained from Flu Net, the surveillance network compiled by the the World Health Organization. We report a pattern of skip-and-resurgence behavior between the years 2011 and 2013 for influenza H1N1pdm, the strain responsible for the 2009 pandemic, in Europe and Eastern Asia . In particular, the expected H1N1pdm epidemic outbreak in 2011/12 failed to occur (or "skipped") in many countries across the globe, although an outbreak occurred in the following year. We also report a pattern of well-synchronized wave of H1N1pdm in earl y 2011 in the Northern Hemisphere countries, and a pattern of replacement of strain H1N1pre by H1N1pdm between the 2009 and 2012 influenza seasons. Using both a statistical and a mechanistic mathematical model, and through fitting the data of 108 countries , we discuss the mechanisms that are likely to generate these events taking into account the role of multi-strain dynamics. A basic understanding of these patterns has important public health implications and scientific significance.

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    Rodent reservoirs of future zoonotic diseases

    The increasing frequency of zoonotic disease events underscores a need to develop forecasting tools toward a more preemptive approach to outbreak investigation. We apply machine learning to data describing the traits and zoonotic pathogen diversity of the most speciose group of mammals, the rodents, which also comprise a disproportionate number of zoonotic disease reservoirs. Our models predict reservoir status in this group with over 90% accuracy, identifying species with high probabilities of harboring un discovered zoonotic pathogens based on trait profiles that may serve as rules of thumb to distinguish reservoirs from nonreservoir species. Key predictors of zoonotic reservoirs include biogeographical properties, such as range size, as well as intrinsic h ost traits associated with lifetime reproductive output. Predicted hotspots of novel rodent reservoir diversity occur in the Middle East and Central Asia and the Midwestern United States. © 2015, National Academy of Sciences. All rights reserved.

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    Distribution and diversity of the vectors of Rift Valley fever along the livestock movement routes in the northeastern and coastal regions of Kenya

    Background: Knowledge of vector ecology is important in understanding the transmission dynamics of vector borne disease. In this study, we determined the distribution and diversity of mosquitoes along the major nomadic livestock movement routes (LMR) in th e traditional pastoral ecozone of northeastern Kenya. We focused on the vectors of Rift Valley fever virus (RVFv) with the aim of understanding their ecology and how they can potentially influence the circulation of RVFv. Methods: Mosquito surveys were con ducted during the short and long rainy seasons from November 2012 to August 2014 using CO2-baited CDC light traps at seven sites selected for their proximity to stopover points that provide pasture, water and night bomas (where animals spend nig hts). We compared mosquito abundance and diversity across the sites, which were located in three ecological zones (IV, V and VI), based on the classification system of agro-ecological zones in Kenya. Results: Over 31,000 mosquitoes were trapped comprising 21 species belonging to 6 genera. Overall mosquito abundance varied significantly by ecological zones and sites. Mansonia species (Ma. uniformis and Ma. africana) were predominant (n?=?12,181, 38.3 %). This was followed by the primary RVF vectors, Ae. ochr aceus and Ae. mcintoshi comprising 17.9 and 14.98 %, respectively, of the total captures and represented across all sites and ecological zones. The Shannon diversity index ranged from 0.8 to 2.4 with significant zone, site and seasonal variations. There wa s also significant species richness of RVF vector across ecological zones. Conclusion: Our findings highlight differential occurrence of RVFv vectors across ecological zones and sampling sites, which may be important in determining areas at risk of emergen ce and circulation of RVFv. Moreover, the vector distribution map along LMR generated in this study will guide potential interventions for control of the disease, including strategic vaccination for livestock

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    Estimating risks of heat strain by age and sex: A population-level simulation model

    Individuals living in hot climates face health risks from hyperthermia due to excessive heat. Heat strain is influenced by weather exposure and by individual characteristics such as age, sex, body size, and occupation. To explore the population-level drive rs of heat strain, we developed a simulation model that scales up individual risks of heat storage (estimated using Myrup and Morgan’s man model “MANMO”) to a large population. Using Australian weather data, we identify high-risk weather conditions togethe r with individual characteristics that increase the risk of heat stress under these conditions. The model identifies elevated risks in children and the elderly, with females aged 75 and older those most likely to experience heat strain. Risk of heat strain in males does not increase as rapidly with age, but is greatest on hot days with high solar radiation. Although cloudy days are less dangerous for the wider population, older women still have an elevated risk of heat strain on hot cloudy days or when indo ors during high temperatures. Simulation models provide a valuable method for exploring population level risks of heat strain, and a tool for evaluating public health and other government policy interventions. © 2015 by the authors; licensee MDPI, Basel, S witzerland.

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    EigenEvent: An algorithm for event detection from complex data streams in syndromic surveillance

    Syndromic surveillance systems continuously monitor multiple pre-diagnostic daily streams of indicators from different regions with the aim of early detection of disease outbreaks. The main objective of these systems is to detect outbreaks hours or days be fore the clinical and laboratory confirmation. The type of data that is being generated via these systems is usually multivariate and seasonal with spatial and temporal dimensions. The algorithm What's Strange About Recent Events (WSARE) is the state-of-th e-art method for such problems. It exhaustively searches for contrast sets in the multivariate data and signals an alarm when find statistically significant rules. This bottom-up approach presents a much lower detection delay comparing the existing top-dow n approaches. However, WSARE is very sensitive to the small-scale changes and subsequently comes with a relatively high rate of false alarms. We propose a new approach called EigenEvent that is neither fully top-down nor bottom-up. In this method, we inste ad of top-down or bottom-up search, track changes in data correlation structure via eigenspace techniques. This new methodology enables us to detect both overall changes (via eigenvalue) and dimension-level changes (via eigenvectors). Experimental results on hundred sets of benchmark data reveals that EigenEvent presents a better overall performance comparing state-of-the-art, in particular in terms of the false alarm rate. © 2015 - IOS Press and the authors. All rights reserved.

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    What can we learn about the Ebola outbreak from tweets?

    Background Twitter can address the challenges of the current Ebola outbreak surveillance. The aims of this study are to demonstrate the use of Twitter as a real-time method of Ebola outbreak surveillance to monitor information spread, capture early epidemi c detection, and examine content of public knowledge and attitudes. Methods We collected tweets mentioning Ebola in English during the early stage of the current Ebola outbreak from July 24-August 1, 2014. Our analysis for this observational study includes time series analysis with geologic visualization to observe information dissemination and content analysis using natural language processing to examine public knowledge and attitudes. Results A total of 42,236 tweets (16,499 unique and 25,737 retweets) me ntioning Ebola were posted and disseminated to 9,362,267,048 people, 63 times higher than the initial number. Tweets started to rise in Nigeria 3-7 days prior to the official announcement of the first probable Ebola case. The topics discussed in tweets inc lude risk factors, prevention education, disease trends, and compassion. Conclusion Because of the analysis of a unique Twitter dataset captured in the early stage of the current Ebola outbreak, our results provide insight into the intersection of social m edia and public health outbreak surveillance. Findings demonstrate the usefulness of Twitter mining to inform public health education. © 2015 Association for Professionals in Infection Control and Epidemiology, Inc.

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    Tracking the distribution and impacts of diseases with biological records and distribution modelling

    Species distribution modelling is widely used in epidemiology for mapping spatial patterns and the risk of introduction of diseases and vectors and also for predicting how exposure may alter given future environmental change, motivated by the high societal impact and the multiple environmental drivers of disease outbreaks. Although pathogens and vectors have historically been sparsely recorded, monitoring systems and media sources are generating novel, online data sources on occurrence. Moreover, increasing ecological realism is being incorporated into distribution modelling techniques, focussing on dispersal, biotic interactions and evolutionary constraints that shape species distributions alongside abiotic factors and biases in recording effort, common to pathogens and vectors and wildlife species. Considering pathogens and arthropod vector systems with high impact on plant, animal and human health, the present review describes how biological records for vectors and pathogens arise, introduces the concepts behind distribution models and illustrates the potential for ecologically realistic distribution models to yield insight into the establishment and spread of pathogens. Because distribution modellers aim to provide policy makers with evidence and maps for planning and evaluation of disease mitigation measures, we highlight factors that currently constrain direct translation of models to policy. Disease distributions will be better understood and mapped in the future given improved occurrence data access and integration and combined (correlative and mechanistic) modelling approaches that are developed iteratively in concert with stakeholders. © 2015 The Linnean Society of London.

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    Severe pediatric adenovirus 7 disease in singapore linked to recent outbreaks across asia

    During November 2012–July 2013, a marked increase of adenovirus type 7 (Ad7) infections associated with severe disease was documented among pediatric patients in Sin­gapore. Phylogenetic analysis revealed close genetic links with severe Ad7 outbreaks in Ch ina, Taiwan, and other parts of Asia. © 2015, Centers for Disease Control and Prevention (CDC). All rights reserved.

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    Cholera outbreak linked with lack of safe water supply following a tropical cyclone in Pondicherry, India, 2012

    In the aftermath of a severe cyclonic storm on 7 January 2012, a cluster of acute diarrhoea cases was reported from two localities in Pondicherry, Southern India. We investigated the outbreak to identify causes and recommend control measures. We defined a case as occurrence of diarrhoea of more than three loose stools per day with or without vomiting in a resident of affected areas during 6-18 January 2012. We used active (door-to-door survey) and stimulated passive (healthy facility-based) surveillance to identify cases. We described the outbreak by time, place, and person. We compared the case-patients with up to three controls without any apparent signs and symptoms of diarrhoea and matched for age, gender, and neighbourhood. We calculated matched odds ra tio (MOR), 95% confidence intervals (CI), and population attributable fractions (PAF). We collected rectal swabs and water samples for laboratory diagnosis and tested water samples for microbiological quality. We identified 921 cases and one death among 8, 367 residents (attack rate: 11%, case-fatality: 0.1%). The attack rate was the highest among persons of 50 years and above (14%) and females (12%). The outbreak started on 6 January and peaked on the 9th and lasted till 14 January. Cases were clustered aro und two major leakages in water supply system. Nine of the 16 stool samples yielded V. cholerae O1 Ogawa. We identified that consumption of water from the public distribution system (MOR=37, 95% CI 4.9-285, PAF: 97%), drinking unboiled water (MOR=35, 95% C I 4.5-269, PAF: 97%), and a common latrine used by two or more households (MOR=2.7, 95% CI 1.3-5.6) were independently associated with cholera. Epidemiological evidence suggested that this outbreak was due to ingestion of water contaminated by drainage fol lowing rains during cyclone. We recommended repair of the water supply lines, cleaning-up of the drains, handwashing, and drinking of boiled water. © International Centre For Diarrhoeal Disease Research, Bang

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    Spatiotemporal dynamics of Puumala hantavirus associated with its rodent host, Myodes glareolus

    Many viruses significantly impact human and animal health. Understanding the population dynamics of these viruses and their hosts can provide important insights for epidemiology and virus evolution. Puumala virus (PUUV) is a European hantavirus that may ca use regional outbreaks of hemorrhagic fever with renal syndrome in humans. Here, we analyzed the spatiotemporal dynamics of PUUV circulating in local populations of its rodent reservoir host, the bank vole (Myodes glareolus) during eight years. Phylogeneti c and population genetic analyses of all three genome segments of PUUV showed strong geographical structuring at a very local scale. There was a high temporal turnover of virus strains in the local bank vole populations, but several virus strains persisted through multiple years. Phylodynamic analyses showed no significant changes in the local effective population sizes of PUUV, although vole numbers and virus prevalence fluctuated widely. Microsatellite data demonstrated also a temporally persisting subdiv ision between local vole populations, but these groups did not correspond to the subdivision in the virus strains. We conclude that restricted transmission between vole populations and genetic drift play important roles in shaping the genetic structure and temporal dynamics of PUUV in its natural host which has several implications for zoonotic risks of the human population. © 2015 The Authors.

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    Spread of infectious microbes during emergency medical response

    Background To our knowledge, no studies to date demonstrate potential spread of microbes during actual emergency medical service (EMS) activities. Our study introduces a novel approach to identification of contributors to EMS environment contamination and development of infection control strategies, using a bacteriophage surrogate for pathogenic organisms. Methods Bacteriophage ?X174 was used to trace cross-contamination and evaluate current disinfection practices and a hydrogen peroxide (H2O2) wipe intervention within emergency response vehicles. Prior to EMS calls, 2 surfaces were seeded with ?X174. On call completion, EMS vehicle and equipment surfaces were sampled before decontamination, after decontamination per current practices, and after implementation of the intervention. Results Current decontamination practices did not significantly reduce viral loads on surfaces (P =.3113), but H2O2 wipe intervention did (P =.0065). Bacteriophage spread to 56% (27/48) of sites and was reduced to 54% (26/48) and 40% (19/48) with current decontamination practices and intervention practices, respectively. Conclusion Results suggest firefighters' hands were the main vehicles of microbial transfer. Current practices were not c onsistently applied or standardized and minimally reduced prevalence and quantity of microbial contamination on EMS surfaces. Although use of a consistent protocol of H2O2 wipes significantly reduced percent prevalence and concentrati on of viruses, training and promotion of surface disinfection should be provided. © 2015 Association for Professionals in Infection Control and Epidemiology, Inc.

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    Public Health Impact and Cost-Effectiveness of Hepatitis A Vaccination in the United States: A Disease Transmission Dynamic Modeling Approach

    Abstract Objective To assess the population-level impact and cost-effectiveness of hepatitis A vaccination programs in the United States. Methods We developed an age-structured population model of hepatitis A transmission dynamics to evaluate two policies of administering a two-dose hepatitis A vaccine to children aged 12 to 18 months: 1) universal routine vaccination as recommended by the Advisory Committee on Immunization Practices in 2006 and 2) Advisory Committee on Immunization Practices's previous reg ional policy of routine vaccination of children living in states with high hepatitis A incidence. Inputs were obtained from the published literature, public sources, and clinical trial data. The model was fitted to hepatitis A seroprevalence (National Heal th and Nutrition Examination Survey II and III) and reported incidence from the National Notifiable Diseases Surveillance System (1980-1995). We used a societal perspective and projected costs (in 2013 US $), quality-adjusted life-years, incremental cost-e ffectiveness ratio, and other outcomes over the period 2006 to 2106. Results On average, universal routine hepatitis A vaccination prevented 259,776 additional infections, 167,094 outpatient visits, 4781 hospitalizations, and 228 deaths annually. Compared with the regional vaccination policy, universal routine hepatitis A vaccination was cost saving. In scenario analysis, universal vaccination prevented 94,957 infections, 46,179 outpatient visits, 1286 hospitalizations, and 15 deaths annually and had an inc remental cost-effectiveness ratio of $21,223/quality-adjusted life-year when herd protection was ignored. Conclusions Our model predicted that universal childhood hepatitis A vaccination led to significant reductions in hepatitis A mortality and morbidity. Consequently, universal vaccination was cost saving compared with a regional vaccination policy. Herd protection effects of hepatitis A vaccination programs had a significant impact on hepatitis A mortality,

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    Drinking water quality and the geospatial distribution of notified gastro-intestinal infections

    Introduction. Even brief episodes of fecal contamination of drinking water can lead directly to illness in the consumers. In water-borne outbreaks, the connection between poor microbial water quality and disease can be quickly identified. The impact of non -compliant drinking water samples due to E. coli taken for regular monitoring on the incidence of notified acute gastrointestinal infections has not yet been studied. Methods. The objective of this study was to analyse the geographical distribution of noti fied acute gastrointestinal infections (AGI) in Slovenia in 2010, with hotspot identification. The second aim of the study was to correlate the fecal contamination of water supply system on the settlement level with the distribution of notified AGI cases. Spatial analysis using geo-information technology and other methods were used. Results. Hot spots with the highest proportion of notified AGI cases were mainly identified in areas with small supply zones. The risk for getting AGI was drinking water contami nated with E. coli from supply zones with 50-1000 users: RR was 1.25 and significantly greater than one (p-value less than 0.001). Conclusion. This study showed the correlation between the frequency of notified AGI cases and noncompliant results in drinkin g water monitoring. © Slovenian Journal of Public Health 2015.

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    The utility of Google Trends data to examine interest in cancer screening

    Objectives: We examined the utility of January 2004 to April 2014 Google Trends data from information searches for cancer screenings and preparations as a complement to population screening data, which are traditionally estimated through costly population- level surveys. Setting: State-level data across the USA. Participants: Persons who searched for terms related to cancer screening using Google, and persons who participated in the Behavioral Risk Factor Surveillance System (BRFSS). Primary and secondary ou tcome measures: (1) State-level Google Trends data, providing relative search volume (RSV) data scaled to the highest search proportion per week (RSV100) for search terms over time since 2004 and across different geographical locations. (2) RSV of new scre ening tests, free/low-cost screening for breast and colorectal cancer, and new preparations for colonoscopy (Prepopik). (3) State-level breast, cervical, colorectal and prostate cancer screening rates. Results: Correlations between Google Trends and BRFSS data ranged from 0.55 for ever having had a colonoscopy to 0.14 for having a Pap smear within the past 3 years. Free/low-cost mammography and colonoscopy showed higher RSV during their respective cancer awareness months. RSV for Miralax remained stable, wh ile interest in Prepopik increased over time. RSV for lung cancer screening, virtual colonoscopy and three-dimensional mammography was low. Conclusions: Google Trends data provides enormous scientific possibilities, but are not a suitable substitute for, b ut may complement, traditional data collection and analysis about cancer screening and related interests. © BMJ Open 2015.

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    A mathematical model for understanding the spread of nipah fever epidemic in Bangladesh

    In this paper, a mathematical model for the nipah virus (NiV) infections, commonly known as 'nipah fever' in Bangladesh is proposed. The host-pathogen interaction of NiV infection in terms of nonlinear ordinary differential equations (ODEs) is studied. The aim is to investigate the disease propagation and control strategy of NiV infections. The behavior of the dynamics of NiV infections as well as the optimal control strategy has been studied in vein of optimal control theory and the results are presented w ith an illustration by the numerical simulations. © 2015 IEEE.

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    Emergence in Taiwan of novel norovirus GII.4 variants causing acute gastroenteritis and intestinal haemorrhage in children

    Norovirus is the leading cause of viral gastroenteritis globally. Norovirus genotype GII.4 is responsible for the majority of outbreaks, but new variants are continuously emerging. The objective of the study was to delineate the clinical manifestations and complications associated with these new norovirus GII.4 variants in children. We investigated norovirus infections from the community outbreak in October 2011–September 2012 and an earlier outbreak in 2006–2007, in northern Taiwan. Norovirus genotypes and their variants were validated using molecular methods. A norovirus outbreak started in mid-2011 and continued through 2012 in northern Taiwan. Hospitalized children infected by norovirus in 2012 showed a significantly higher incidence of intestinal haemor rhage, as indicated by grossly bloody faeces (P50.012) and occult blood in faeces (P=0.001), and also presented with more high fever>39 °C (P<0.001), fever.38.5 °C (P<0.001) and fever of any temperature.38 °C (P<0.001), compared with children hospitalized in 2006–2007. Analysis of 20 near-full-length genome sequences indicated an emergence of GII.4 2012 variants in 2011–2012. Circulating noroviruses can be divided into two clusters: GII.4 2012a, which is identical to the newly reported strain GII.4 Sydney 2 012, and GII.4 2012b, which is close to GII.4 2006b, the earlier predominant strain. The emerging new variants of norovirus GII.4 caused a distinct clinical syndrome of acute gastroenteritis with severe fever and a high rate of intestinal haemorrhage in ch ildren. The genetic diversity associated with changing clinical manifestations poses major obstacles to norovirus control. © 2015 The Authors.

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    The impacts of mosquito density and meteorological factors on dengue fever epidemics in Guangzhou, China, 2006-2014: A time-series analysis

    Objective To explore the associations between the monthly number of dengue fever(DF) cases and possible risk factors in Guangzhou, a subtropical city of China.1 Methods The monthly number of DF cases, Breteau Index (BI), and meteorological measures during 2006-2014 recorded in Guangzhou, China, were assessed. A negative binomial regression model was used to evaluate the relationships between BI, meteorological factors, and the monthly number of DF cases. Results A total of 39,697 DF cases were detected in G uangzhou during the study period. DF incidence presented an obvious seasonal pattern, with most cases occurring from June to November. The current month's BI, average temperature (Tave), previous month's minimum temperature (Tmin), an d Tave were positively associated with DF incidence. A threshold of 18.25 °C was found in the relationship between the current month's Tmin and DF incidence. Conclusion Mosquito density, Tave, and Tmin play a cri tical role in DF transmission in Guangzhou. These findings could be useful in the development of a DF early warning system and assist in effective control and prevention strategies in the DF epidemic. © 2015 The Editorial Board of Biomedical and Environmen tal Sciences.

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    Geographical and temporal correlations in the incidence of lyme disease, RMSF, ehrlichiosis, and coccidioidomycosis with search data

    [No abstract available]

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    Armies of pestilence: CNS infections as potential weapons of mass destruction

    Infectious agents have been investigated, developed, and used by both governments and terrorist groups as weapons of mass destruction. CNS infections, though traditionally considered less often than respiratory diseases in this scenario, may be very import ant. Viruses responsible for encephalitides can be highly infectious in aerosol form. CNS involvement in anthrax is ominous but should change treatment. Brucellosis, plague, Q fever, and other bacteria can uncommonly manifest with meningoencephalitis and o ther findings. Emerging diseases may also pose threats. We review infectious agents of particular concern for purposes of biowarfare with respect to CNS manifestations and imaging features.

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    Numerical identification of epidemic thresholds for susceptible-infectedrecovered model on finite-size networks

    Epidemic threshold has always been a very hot topic for studying epidemic dynamics on complex networks. The previous studies have provided different theoretical predictions of the epidemic threshold for the susceptible-infected-recovered (SIR) model, but t he numerical verification of these theoretical predictions is still lacking. Considering that the large fluctuation of the outbreak size occurs near the epidemic threshold, we propose a novel numerical identification method of SIR epidemic threshold by ana lyzing the peak of the epidemic variability. Extensive experiments on synthetic and real-world networks demonstrate that the variability measure can successfully give the numerical threshold for the SIR model. The heterogeneous mean-field prediction agrees very well with the numerical threshold, except the case that the networks are disassortative, in which the quenched mean-field prediction is relatively close to the numerical threshold. Moreover, the numerical method presented is also suitable for the sus ceptible-infected-susceptible model. This work helps to verify the theoretical analysis of epidemic threshold and would promote further studies on the phase transition of epidemic dynamics. © 2015 AIP Publishing LLC.

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    A proposed approach to systematically identify and monitor the corporate political activity of the food industry with respect to public health using publicly available informatio

    Unhealthy diets represent one of the major risk factors for non-communicable diseases. There is currently a risk that the political influence of the food industry results in public health policies that do not adequately balance public and commercial intere sts. This paper aims to develop a framework for categorizing the corporate political activity of the food industry with respect to public health and proposes an approach to systematically identify and monitor it. The proposed framework includes six strateg ies used by the food industry to influence public health policies and outcomes: information and messaging; financial incentive; constituency building; legal; policy substitution; opposition fragmentation and destabilization. The corporate political activit y of the food industry could be identified and monitored through publicly available data sourced from the industry itself, governments, the media and other sources. Steps for country-level monitoring include identification of key food industry actors and r elated sources of information, followed by systematic data collection and analysis of relevant documents, using the proposed framework as a basis for classification of results. The proposed monitoring approach should be pilot tested in different countries as part of efforts to increase the transparency and accountability of the food industry. This approach has the potential to help redress any imbalance of interests and thereby contribute to the prevention and control of non-communicable diseases. © 2015 Wo rld Obesity.

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    Surveillance of adverse events following vaccination in the French armed forces, 2011-2012

    Objectives: French military personnel are subject to a compulsory vaccination schedule. The aim of this study was to present the results of surveillance of vaccine adverse events (VAEs) reported from 2011 to 2012 in the French armed forces. Study design: V AEs were surveyed among all French armed forces from 2011 to 2012 by the epidemiological departments of the military health service. For each case, a notification form providing patient and clinical information was provided. Methods: Case definitions were derived from the French drug safety guidelines. Three types of VAE were considered: non-serious, serious and unexpected. Incidence rates were calculated by relating VAEs to the number of vaccine doses delivered. Results: In total, 161 VAE cases were report ed. The overall VAE reporting rate was 24.6 VAEs per 100,000 doses, and the serious VAE rate was 1.3 per 100,000 doses (nine cases). The serious VAEs included two cases of Guillain-Barré syndrome, one case of optic neuritis, one case of a meningeal-like sy ndrome, one case of rheumatoid purpura, one case of acute asthma and three cases of fainting. The highest rates of VAE were observed with the Bacille Calmette-Guérin vaccine (BCG) (482.3 per 100,000 doses), inactivated diphtheria-tetanus-poliovirus with ac ellular pertussis vaccine (dTap-IPV) (106.1 per 100,000 doses) and meningococcal quadrivalent glycoconjugate vaccine (MenACWY-CRM) (39.3 per 100,000 doses). Conclusions: The global rates of VAE observed in 2011 and 2012 confirm the increase that has been o bserved since 2009 in the French armed forces, which could reflect improved practitioner awareness about VAEs and the use of certain vaccines added to the vaccination schedule recently (dTap-IPV in 2008 and MenACWY-CRM in 2010). VAEs appear to be relativel y rare, particularly serious VAEs, which indicates acceptable tolerance of vaccines. © 2015 The Royal Society for Public Health.

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    Lack of transmission among close contacts of patient with case of middle east respiratory syndrome imported into the United States, 2014

    In May 2014, a traveler from the Kingdom of Saudi Arabia was the first person identified with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States. To evaluate transmission risk, we determined the type, duration, and frequ ency of patient contact among health care personnel (HCP), household, and community contacts by using standard questionnaires and, for HCP, global positioning system (GPS) tracer tag logs. Respiratory and serum samples from all contacts were tested for MER S-CoV. Of 61 identified contacts, 56 were interviewed. HCP exposures occurred most frequently in the emergency department (69%) and among nurses (47%); some HCP had contact with respiratory secretions. Household and community contacts had brief contact (e. g., hugging). All laboratory test results were negative for MERS-CoV. This contact investigation found no secondary cases, despite case-patient contact by 61 persons, and provides useful information about MERS-CoV transmission risk. Compared with GPS trace r tag recordings, self-reported contact may not be as accurate © 2015, Centers for Disease Control and Prevention (CDC). All rights reserved.

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    Prognostics and health management: A review on data driven approaches

    Prognostics and health management (PHM) is a framework that offers comprehensive yet individualized solutions for managing system health. In recent years, PHM has emerged as an essential approach for achieving competitive advantages in the global market by improving reliability, maintainability, safety, and affordability. Concepts and components in PHM have been developed separately in many areas such as mechanical engineering, electrical engineering, and statistical science, under varied names. In this pap er, we provide a concise review of mainstream methods in major aspects of the PHM framework, including the updated research from both statistical science and engineering, with a focus on data-driven approaches. Real world examples have been provided to ill ustrate the implementation of PHM in practice. © 2015 Kwok L. Tsui et al.

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    Interim influenza vaccine effectiveness: A good proxy for final estimates in Spain in the seasons 2010-2014

    Introduction: The agreement between interim and final influenza vaccine effectiveness (VE) estimates would support the use of interim assessments as a proxy for final VE results to guide health authorities in influenza prevention. We aimed to compare inter im/final VE estimates in Spain. Methods: We used a test-negative case-control study (cycEVA) for 2010/11-2013/14 seasons. Sensitivity analyses were carried out by type/subtype of influenza virus and by target groups for vaccination. Results: In general, in terim estimates were higher compared to end-season estimates. Interim and final VE differences were higher for the target groups compared to all population. Subtype-specific interim/final VE estimates showed greater concordance (3-13%) than for any virus ( 7-24%). Conclusion: In Spain, interim influenza VE estimates over 2010-2014 were a good proxy of the final protection of the vaccine. Interim and final estimates showed greater concordance for all population and if performed subtype-specific. © 2015 Elsevi er Ltd.

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    06 July 2015

    Register for the CSTE BRFSS Small Area Estimation Webinar!

    CSTE will be hosting a BRFSS small areas estimation webinar on Thursday, July 16th at 1pm ET. This training will be focused on the concept of small area estimation, its uses and limitations, and will illustrate how survey data are used to produce estimates for areas that do not have a sufficient sample size for direct estimation. Please refer to the attached one pager for a full summary of the webinar.

    Please use the link below to register for this webinar. To maximize the number of attendees, we encourage those of you in one office to have one person register and share the viewing space with other colleagues.

    Topic: CSTE BRFSS Small Area Estimation Webinar
    Host: Nidal Kram
    Date: Thursday, July 16, 2015
    Time: 1:00 pm, Eastern Daylight Time (New York, GMT-04:00)
    Session number: Not Available
    Registration password: This session does not require a registration password.

    -------------------------------------------------------
    To register for this session
    -------------------------------------------------------
    Go to https://cste.webex.com/cste/k2/j.php?MTID=t89168b19a3a9cd11fcfebb18a24d649a and register.

    Once the host approves your registration, you will receive a confirmation email with instructions for joining the session.

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    29 June 2015

    NAHDO Webinar: SAS tool to support ICD-9/10 Transition


    SAS tool to support ICD-9/10 Transition
    Join us for a webinar on Jul 15, 2015 at 12:00 PM MDT.

    Register now!

    The adoption of ICD-10-CM/PCS is effective October 1, 2015 for medical claims. Public health programs that obtain data from multiple data sources may receive data in overlapping time periods without clear indication of which coding scheme (ICD-9 or ICD-10) was used. 

    Some data reporting entities are not covered by HIPAA and may not switch to ICD-10-CM on 10/1/2015 and some data reporting entities may choose to implement ICD-10-CM before 10/1/2015, given no prohibition against doing so. 

    To help programs and data users identify which coding scheme is used, the University of California at Davis (UCD) developed a SAS program.

    Conversion Tool to the ICD-9 CM to ICD-10 CM Transition is made possible through funding from the Center for Surveillance, Epidemiology and Laboratory Services (CSELS) within the Office of Public Health Scientific Services (OPHSS) at the Centers for Disease Control and Prevention (CDC).
    After registering, you will receive a confirmation email containing information about joining the webinar.

    View System Requirements

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    22 June 2015

    Research Committee Articles of the week, Jun 22, 2015

    Articles from June_22_2015

    Research Committee Selected Articles for the Week of June_22_2015

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    A spatial-temporal transmission model and early intervention policies of 2009 A/H1N1 influenza in South Korea

    We developed a spatial-temporal model of the 2009 A/H1N1 influenza pandemic in the Seoul metropolitan area (SMA), which is located in the north-west of South Korea and is the second-most complex metropolitan area worldwide. This multi-patch influenza model consists of a SEIAR influenza transmission model and flow model between two districts. This model is based on the daily confirmed cases of A/H1N1 influenza collected by the Korea Center for Disease Control and Prevention from April 27 to September 15, 200 9 and the daily commuting data from 33 districts of SMA reported in the 2010 Population and Housing Census (PHC). We analyzed the spread patterns of 2009 influenza in the SMA by the reproductive numbers and geographic information systems. During the early period of novel influenza pandemics, when pharmaceutical interventions are lacking, non-pharmaceutical public health interventions will be the most critical strategies for impeding the spread of influenza and delaying an epidemic. Using the spatial-tempora l model developed herein, we also investigated the impact of non-pharmaceutical public health interventions, isolation and/or commuting restrictions, on the incidence reduction in various scenarios. Our model provides scientific evidence for predicting the spread of disease and preparedness for a future pandemic. © 2015 Elsevier Ltd.

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    A dynamic allocation model for medical resources in the control of influenza diffusion

    In this paper, we develop a unique time-varying forecasting model for dynamic demand of medical resources based on a susceptible-exposed-infected-recovered (SEIR) influenza diffusion model. In this forecasting mechanism, medical resources allocated in the early period will take effect in subduing the spread of influenza and thus impact the demand in the later period. We adopt a discrete time-space network to describe the medical resources allocation process following a hypothetical influenza outbreak in a r egion. The entire medical resources allocation process is constructed as a multi-stage integer programming problem. At each stage, we solve a cost minimization sub-problem subject to the time-varying demand. The corresponding optimal allocation result is t hen used as an input to the control process of influenza spread, which in turn determines the demand for the next stage. In addition, we present a comparison between the proposed model and an empirical model. Our results could help decision makers prepare for a pandemic, including how to allocate limited resources dynamically. © 2015 Systems Engineering Society of China and Springer-Verlag Berlin Heidelberg

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    Optimizing agent-based transmission models for infectious diseases

    Background: Infectious disease modeling and computational power have evolved such that large-scale agent-based models (ABMs) have become feasible. However, the increasing hardware complexity requires adapted software designs to achieve the full potential o f current high-performance workstations. Results: We have found large performance differences with a discrete-time ABM for close-contact disease transmission due to data locality. Sorting the population according to the social contact clusters reduced simu lation time by a factor of two. Data locality and model performance can also be improved by storing person attributes separately instead of using person objects. Next, decreasing the number of operations by sorting people by health status before processing disease transmission has also a large impact on model performance. Depending of the clinical attack rate, target population and computer hardware, the introduction of the sort phase decreased the run time from 26 % up to more than 70 %. We have investigat ed the application of parallel programming techniques and found that the speedup is significant but it drops quickly with the number of cores. We observed that the effect of scheduling and workload chunk size is model specific and can make a large differen ce. Conclusions: Investment in performance optimization of ABM simulator code can lead to significant run time reductions. The key steps are straightforward: the data structure for the population and sorting people on health status before effecting disease propagation. We believe these conclusions to be valid for a wide range of infectious disease ABMs. We recommend that future studies evaluate the impact of data management, algorithmic procedures and parallelization on model performance. © 2015 Willem et a l.; licensee BioMed Central.

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    Detection of equine herpesvirus-4 and physiological stress patterns in young Thoroughbreds consigned to a South African auction sale

    Background: The prevalence of equine herpesvirus types-1 and -4 (EHV-1 and -4) in South African Thoroughbreds at auction sales is currently undefined. Commingling of young Thoroughbreds from various populations together with physiological stress related to their transport and confinement at a sales complex, may be associated with shedding and transmission of EHV-1 and -4. This prospective cohort study sampled 90 young Thoroughbreds consigned from eight farms, originating from three provinces representative of the South African Thoroughbred breeding demographic to a sales complex. Nasal swabs for quantitative real-time polymerase chain reaction (qPCR) assay to detect EHV-1 and -4 nucleic acid and blood samples for enzyme-linked immunosorbent assay for EHV-1 a nd -4 antibodies were collected from all horses on arrival and departure. Additional nasal swabs for qPCR were obtained serially from those displaying pyrexia and, or nasal discharge. Daily faecal samples were used for determination of faecal glucocorticoi d metabolite (FGM) concentrations as a measurement of physiological stress and these values were modelled to determine the factors best explaining FGM variability. Results: EHV-4 nucleic acid was detected in 14.4 % and EHV-1 from none of the animals in the study population. Most (93.3 %) and very few (1.1 %) of this population showed antibodies indicating prior exposure to EHV-4 and EHV-1 respectively. Pyrexia and nasal discharge were poor predictors for detecting EHV-4 nucleic acid. The horses' FGM concent rations increased following arrival before decreasing for most of the remaining study period including the auction process. Model averaging showed that variation in FGM concentrations was best explained by days post-arrival and transport duration. Conclusi ons: In this study population, sales consignment was associated with limited detection of EHV-4 nucleic acid in nasal secretions, with most showing prior exposure to EHV-4 and very few to EHV-1. The physiolog

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    Harnessing Case Isolation and Ring Vaccination to Control Ebola

    As a devastating Ebola outbreak in West Africa continues, non-pharmaceutical control measures including contact tracing, quarantine, and case isolation are being implemented. In addition, public health agencies are scaling up efforts to test and deploy can didate vaccines. Given the experimental nature and limited initial supplies of vaccines, a mass vaccination campaign might not be feasible. However, ring vaccination of likely case contacts could provide an effective alternative in distributing the vaccine . To evaluate ring vaccination as a strategy for eliminating Ebola, we developed a pair approximation model of Ebola transmission, parameterized by confirmed incidence data from June 2014 to January 2015 in Liberia and Sierra Leone. Our results suggest tha t if a combined intervention of case isolation and ring vaccination had been initiated in the early fall of 2014, up to an additional 126 cases in Liberia and 560 cases in Sierra Leone could have been averted beyond case isolation alone. The marginal benef it of ring vaccination is predicted to be greatest in settings where there are more contacts per individual, greater clustering among individuals, when contact tracing has low efficacy or vaccination confers post-exposure protection. In such settings, ring vaccination can avert up to an additional 8% of Ebola cases. Accordingly, ring vaccination is predicted to offer a moderately beneficial supplement to ongoing non-pharmaceutical Ebola control efforts. © 2015 Wells et al.

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    Predicting Unprecedented Dengue Outbreak Using Imported Cases and Climatic Factors in Guangzhou, 2014

    Dengue is endemic in more than 100 countries, mainly in tropical and subtropical regions, and the incidence has increased 30-fold in the past 50 years. The situation of dengue in China has become more and more severe, with an unprecedented dengue outbreak hitting south China in 2014. Building a dengue early warning system is therefore urgent and necessary for timely and effective response. In the study we developed a time series Poisson multivariate regression model using imported dengue cases, local minimu m temperature and accumulative precipitation to predict the dengue occurrence in four districts of Guangzhou, China. The time series data were decomposed into seasonal, trend and remainder components using a seasonal-trend decomposition procedure based on loess (STL). The time lag of climatic factors included in the model was chosen based on Spearman correlation analysis. Autocorrelation, seasonality and long-term trend were controlled in the model. A best model was selected and validated using Generalized Cross Validation (GCV) score and residual test. The data from March 2006 to December 2012 were used to develop the model while the data from January 2013 to September 2014 were employed to validate the model. Time series Poisson model showed that imported cases in the previous month, minimum temperature in the previous month and accumulative precipitation with three month lags could project the dengue outbreaks occurred in 2013 and 2014 after controlling the autocorrelation, seasonality and long-term trend. Together with the sole transmission vector Aedes albopictus, imported cases, monthly minimum temperature and monthly accumulative precipitation may be used to develop a low-cost effective early warning system. © 2015 Sang et al.

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    Surveillance for Neisseria meningitidis disease activity and transmission using information technology

    Background: While formal reporting, surveillance, and response structures remain essential to protecting public health, a new generation of freely accessible, online, and real-time informatics tools for disease tracking are expanding the ability to raise e arlier public awareness of emerging disease threats. The rationale for this study is to test the hypothesis that the HealthMap informatics tools can complement epidemiological data captured by traditional surveillance monitoring systems for meningitis due to Neisseria meningitides (N. meningitides) by highlighting severe transmissible disease activity and outbreaks in the United States. Methods: Annual analyses of N. meningitides disease alerts captured by HealthMap were compared to epidemiological data cap tured by the Centers for Disease Control's Active Bacterial Core surveillance (ABCs) for N. meningitides. Morbidity and mortality case reports were measured annually from 2010 to 2013 (HealthMap) and 2005 to 2012 (ABCs). Findings: HealthMap N. meningitides monitoring captured 80-90% of alerts as diagnosed N. meningitides, 5-20% of alerts as suspected cases, and 5-10% of alerts as related news articles. HealthMap disease alert activity for emerging disease threats related to N. meningitides were in agreement with patterns identified historically using traditional surveillance systems. HealthMap's strength lies in its ability to provide a cumulative "snapshot" of weak signals that allows for rapid dissemination of knowledge and earlier public awareness of pote ntial outbreak status while formal testing and confirmation for specific serotypes is ongoing by public health authorities. Conclusions: The underreporting of disease cases in internet-based data streaming makes inadequate any comparison to epidemiological trends illustrated by the more comprehensive ABCs network published by the Centers for Disease Control. However, the expected delays in compiling confirmatory reports by traditional surveillance systems (at

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    Morbidity rate prediction of dengue hemorrhagic fever (DHF) using the support vector machine and the Aedes aegypti infection rate in similar climates and geographical areas

    Background: In the past few decades, several researchers have proposed highly accurate prediction models that have typically relied on climate parameters. However, climate factors can be unreliable and can lower the effectiveness of prediction when they ar e applied in locations where climate factors do not differ significantly. The purpose of this study was to improve a dengue surveillance system in areas with similar climate by exploiting the infection rate in the Aedes aegypti mosquito and using the suppo rt vector machine (SVM) technique for forecasting the dengue morbidity rate. Methods and Findings: Areas with high incidence of dengue outbreaks in central Thailand were studied. The proposed framework consisted of the following three major parts: 1) data integration, 2) model construction, and 3) model evaluation. We discovered that the Ae. aegypti female and larvae mosquito infection rates were significantly positively associated with the morbidity rate. Thus, the increasing infection rate of female mosqu itoes and larvae led to a higher number of dengue cases, and the prediction performance increased when those predictors were integrated into a predictive model. In this research, we applied the SVM with the radial basis function (RBF) kernel to forecast th e high morbidity rate and take precautions to prevent the development of pervasive dengue epidemics. The experimental results showed that the introduced parameters significantly increased the prediction accuracy to 88.37% when used on the test set data, an d these parameters led to the highest performance compared to state-of-the-art forecasting models. Conclusions: The infection rates of the Ae. aegypti female mosquitoes and larvae improved the morbidity rate forecasting efficiency better than the climate p arameters used in classical frameworks. We demonstrated that the SVM-R-based model has high generalization performance and obtained the highest prediction performance compared to classical models as measured

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    Modelling the spatial distribution of the nuisance mosquito species Anopheles plumbeus (Diptera: Culicidae) in the Netherlands Mathematical models for parasites and vectors

    Background: Landscape modifications, urbanization or changes of use of rural-agricultural areas can create more favourable conditions for certain mosquito species and therefore indirectly cause nuisance problems for humans. This could potentially result in mosquito-borne disease outbreaks when the nuisance is caused by mosquito species that can transmit pathogens. Anopheles plumbeus is a nuisance mosquito species and a potential malaria vector. It is one of the most frequently observed species in the Nether lands. Information on the distribution of this species is essential for risk assessments. The purpose of the study was to investigate the potential spatial distribution of An. plumbeus in the Netherlands. Methods: Random forest models were used to link the occurrence and the abundance of An. plumbeus with environmental features and to produce distribution maps in the Netherlands. Mosquito data were collected using a cross-sectional study design in the Netherlands, from April to October 2010-2013. The enviro nmental data were obtained from satellite imagery and weather stations. Statistical measures (accuracy for the occurrence model and mean squared error for the abundance model) were used to evaluate the models performance. The models were externally validat ed. Results: The maps show that forested areas (centre of the Netherlands) and the east of the country were predicted as suitable for An. plumbeus. In particular high suitability and high abundance was predicted in the south-eastern provinces Limburg and N orth Brabant. Elevation, precipitation, day and night temperature and vegetation indices were important predictors for calculating the probability of occurrence for An. plumbeus. The probability of occurrence, vegetation indices and precipitation were impo rtant for predicting its abundance. The AUC value was 0.73 and the error in the validation was 0.29; the mean squared error value was 0.12. Conclusions: The areas identified by the model as suitable and with

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    Systematic review of surveillance systems and methods for early detection of exotic, new and re-emerging diseases in animal populations

    In this globalized world, the spread of new, exotic and re-emerging diseases has become one of the most important threats to animal production and public health. This systematic review analyses conventional and novel early detection methods applied to surv eillance. In all, 125 scientific documents were considered for this study. Exotic (n = 49) and re-emerging (n = 27) diseases constituted the most frequently represented health threats. In addition, the majority of studies were related to zoonoses (n = 66). The approaches found in the review could be divided in surveillance modalities, both active (n = 23) and passive (n = 5); and tools and methodologies that support surveillance activities (n = 57). Combinations of surveillance modalities and tools (n = 40) were also found. Risk-based approaches were very common (n = 60), especially in the papers describing tools and methodologies (n = 50). The main applications, benefits and limitations of each approach were extracted from the papers. This information will be very useful for informing the development of tools to facilitate the design of cost-effective surveillance strategies. Thus, the current literature review provides key information about the advantages, disadvantages, limitations and potential applicatio n of methodologies for the early detection of new, exotic and re-emerging diseases. © 2014 Cambridge University Press.

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    Forecasting the 2013–2014 Influenza Season Using Wikipedia

    Infectious diseases are one of the leading causes of morbidity and mortality around the world; thus, forecasting their impact is crucial for planning an effective response strategy. According to the Centers for Disease Control and Prevention (CDC), seasona l influenza affects 5% to 20% of the U.S. population and causes major economic impacts resulting from hospitalization and absenteeism. Understanding influenza dynamics and forecasting its impact is fundamental for developing prevention and mitigation strat egies. We combine modern data assimilation methods with Wikipedia access logs and CDC influenza-like illness (ILI) reports to create a weekly forecast for seasonal influenza. The methods are applied to the 2013-2014 influenza season but are sufficiently ge neral to forecast any disease outbreak, given incidence or case count data. We adjust the initialization and parametrization of a disease model and show that this allows us to determine systematic model bias. In addition, we provide a way to determine wher e the model diverges from observation and evaluate forecast accuracy. Wikipedia article access logs are shown to be highly correlated with historical ILI records and allow for accurate prediction of ILI data several weeks before it becomes available. The r esults show that prior to the peak of the flu season, our forecasting method produced 50% and 95% credible intervals for the 2013-2014 ILI observations that contained the actual observations for most weeks in the forecast. However, since our model does not account for re-infection or multiple strains of influenza, the tail of the epidemic is not predicted well after the peak of flu season has passed.

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    The state of population health surveillance using electronic health records: A narrative review

    Electronic health records (EHRs) are transforming the practice of clinical medicine, but the extent to which they are being harnessed to advance public health goals remains uncertain. Data extracted from integrated EHR networks offer the potential for almo st real-time determination of the health status of populations in care, for targeting interventions to vulnerable populations, and for monitoring the impact of such initiatives over time. This is especially true in ambulatory care settings, which are uniqu ely suited for monitoring population health indicators including risk factors and disease management indicators associated with chronic diseases. As efforts gather steam to integrate health data across delivery systems, large networks of electronic patient information are increasingly emerging. Few of the national population health surveillance systems that rely on EHR data have progressed beyond laying groundwork to launch and maintain EHR-based surveillance, but a limited number of more focused or local e fforts have demonstrated innovation in population health surveillance. Common challenges include incompleteness of population coverage, lack of interoperability across data systems, and variable data quality. This review defines progress, opportunities, an d challenges in using EHR data for population health surveillance. © Copyright 2015, Mary Ann Liebert, Inc.

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    Preparedness for emerging infectious diseases: Pathways from anticipation to action

    Emerging and re-emerging infectious disease (EID) events can have devastating human, animal and environmental health impacts. The emergence of EIDs has been associated with interconnected economic, social and environmental changes. Understanding these chan ges is crucial for EID preparedness and subsequent prevention and control of EID events. The aim of this review is to describe tools currently available for identification, prioritization and investigation of EIDs impacting human and animal health, and how these might be integrated into a systematic approach for directing EID preparedness. Environmental scanning, foresight programmes, horizon scanning and surveillance are used to collect and assess information for rapidly responding to EIDs and to anticipat e drivers of emergence for mitigating future EID impacts. Prioritization of EIDs-using transparent and repeatable methods-based on disease impacts and the importance of those impacts to decision-makers can then be used for more efficient resource allocatio n for prevention and control. Risk assessment and simulation modelling methods assess the likelihood of EIDs occurring, define impact and identify mitigation strategies. Each of these tools has a role to play individually; however, we propose integration o f these tools into a framework that enhances the development of tactical and strategic plans for emerging risk preparedness. © 2014 Cambridge University Press.

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    Emerging infections and old friends: remaining prepared in South Dakota

    Recent reports of serious infection outbreaks internationally remind us of the importance of accurate information and continual vigilance. The Ebola outbreak in West Africa has captured headlines as the most severe outbreak in the history of this disease. West Nile disease, measles, pertussis and tuberculosis infect South Dakota patients on a yearly basis. A significant rise in syphilis cases has prompted recommendations for increased prenatal screening. The more unusual viral diseases, Ebola, Middle East r espiratory syndrome (MERS) and Chikungunha virus, receive media attention but present minimal risk to the state, while the annual influenza epidemic continues to plague us all. We review these infections, both old and emerging, and describe national and lo cal preparedness practices.

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    Detection of varying influenza circulation within England in 2012/13: Informing antiviral prescription and public health response

    Background Subnational variation of 2009 pandemic influenza activity in England has been reported; however, little work has been published on this topic for seasonal influenza. If variation is present, this knowledge may assist with both identifying the on set of influenza epidemics, informing community antiviral prescription and local health planning. Methods An end-of-season analysis of influenza surveillance systems (acute respiratory outbreaks, primary care consultations, virological testing, influenza-c onfirmed secondary care admissions and excess all-cause mortality) was undertaken at national and subnational levels for 2012/13 when influenza B and A(H3N2) dominated. Results National community antiviral prescription was recommended in Week 51 following national threshold exceedance. However, this was preceded up to 2 weeks by subnational influenza activity in 2/9 regions in England. Regional variation in circulation of influenza subtypes was observed and severe influenza surveillance data sources were ab le to monitor the subnational impact. Conclusions Evidence of virological activity in two or more regions above a threshold indicated the onset of the 2012/13 season. Subnational thresholds should be determined and evaluated in order to improve timeliness of the national antiviral alert. During the season, outputs should be reported at levels that can inform local public health responses and variation considered when retrospectively evaluating the impact of interventions. © 2014 The Author 2014. Published b y Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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    'One Health' investigation: Outbreak of human Salmonella Braenderup infections traced to a mail-order hatchery-United States, 2012-2013

    Human salmonellosis linked to contact with live poultry is an increasing public health concern. In 2012, eight unrelated outbreaks of human salmonellosis linked to live poultry contact resulted in 517 illnesses. In July 2012, PulseNet, a national molecular surveillance network, reported a multistate cluster of a rare strain of Salmonella Braenderup infections which we investigated. We defined a case as infection with the outbreak strain, determined by pulsed-field gel electrophoresis, with illness onset fro m 25 July 2012-27 February 2013. Ill persons and mail-order hatchery (MOH) owners were interviewed using standardized questionnaires. Traceback and environmental investigations were conducted. We identified 48 cases in 24 states. Twenty-six (81%) of 32 ill persons reported live poultry contact in the week before illness; case-patients named 12 different MOHs from eight states. The investigation identified hatchery D as the ultimate poultry source. Sampling at hatchery D yielded the outbreak strain. Hatchery D improved sanitation procedures and pest control; subsequent sampling failed to yield Salmonella. This outbreak highlights the interconnectedness of humans, animals, and the environment and the importance of industry knowledge and involvement in solving complex outbreaks. Preventing these infections requires a 'One Health' approach that leverages expertise in human, animal, and environmental health. © 2015 Cambridge University Press.

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    Evaluation of containment and mitigation strategies for an influenza A pandemic in China

    The world is still in heightened awareness of the potential threat of another influenza pandemic, although it has been 5 years since the 2009 influenza A (H1N1) pandemic. Evaluation of the adopted intervention strategies for handling the 2009 H1N1 pandemic is helpful for dealing with future outbreaks. In this paper we developed a hybrid model combining meta-population and agent-based models to evaluate the containment and mitigation strategies (e.g., contact tracing and quarantine of contacts at assembly si tes in the early phase, more medical institutions to detect cases and treat serious patients in the developing phase, and rapid vaccines delivered to students first) for an H1N1 pandemic that were adopted in China. We find that the presented model can retr ospectively fit relatively well to the spreading progress through comparison of the simulation results with actual infections data, and it can be used for practical application in evaluating the containment and mitigation strategies for an influenza pandem ic if model validation and parameter estimation can be conducted by using actual data. The results will contribute to understanding the spread of viruses and the control of infectious diseases, and to helping government officials create policies on handlin g an influenza pandemic, especially beneficial to a large and diverse country such as the People's Republic of China. © 2015 The Author(s).

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    Mathematical modelling, simulation, and optimal control of the 2014 ebola outbreak in West Africa

    The Ebola virus is currently one of the most virulent pathogens for humans. The latest major outbreak occurred in Guinea, Sierra Leone, and Liberia in 2014. With the aim of understanding the spread of infection in the affected countries, it is crucial to m odelize the virus and simulate it. In this paper, we begin by studying a simple mathematical model that describes the 2014 Ebola outbreak in Liberia. Then, we use numerical simulations and available data provided by the World Health Organization to validat e the obtained mathematical model. Moreover, we develop a new mathematical model including vaccination of individuals. We discuss different cases of vaccination in order to predict the effect of vaccination on the infected individuals over time. Finally, w e apply optimal control to study the impact of vaccination on the spread of the Ebola virus. The optimal control problem is solved numerically by using a direct multiple shooting method. © 2015 Amira Rachah and Delfim F. M. Torres.

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    Influenza surveillance in animals: What is our capacity to detect emerging influenza viruses with zoonotic potential?

    A survey of national animal influenza surveillance programmes was conducted to assess the current capacity to detect influenza viruses with zoonotic potential in animals (i.e. those influenza viruses that can be naturally transmitted between animals and hu mans) at regional and global levels. Information on 587 animal influenza surveillance system components was collected for 99 countries from Chief Veterinary Officers (CVOs) (n = 94) and published literature. Less than 1% (n = 4) of these components were sp ecifically aimed at detecting influenza viruses with pandemic potential in animals (i.e. those influenza viruses that are capable of causing epidemic spread in human populations over large geographical regions or worldwide), which would have zoonotic poten tial as a prerequisite. Those countries that sought to detect influenza viruses with pandemic potential searched for such viruses exclusively in domestic pigs. This work shows the global need for increasing surveillance that targets potentially zoonotic in fluenza viruses in relevant animal species. © 2014 Food and Agriculture Organization of the United Nations.

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    Estimating the secondary attack rate and serial interval of influenza-like illnesses using social media

    Objectives: Knowledge of the secondary attack rate (SAR) and serial interval (SI) of influenza is important for assessing the severity of seasonal epidemics of the virus. To date, such estimates have required extensive surveys of target populations. Here, we propose a method for estimating the intrafamily SAR and SI from postings on the Twitter social network. This estimate is derived from a large number of people reporting ILI symptoms in them and\or their immediate family members. Design: We analyze data from the 2012-2013 and the 2013-2014 influenza seasons in England and find that increases in the estimated SAR precede increases in ILI rates reported by physicians. Results: We hypothesize that observed variations in the peak value of SAR are related to t he appearance of specific strains of the virus and demonstrate this by comparing the changes in SAR values over time in relation to known virology. In addition, we estimate SI (the average time between cases) as 2·41 days for 2012 and 2·48 days for 2013. C onclusions: The proposed method can assist health authorities by providing near-real-time estimation of SAR and SI, and especially in alerting to sudden increases thereof. © 2015 The Authors.

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    The spatiotemporal trajectory of a dengue epidemic in a medium-sized city

    Understanding the transmission dynamics of infectious diseases is important to allow for improvements of control measures. To investigate the spatiotemporal pattern of an epidemic dengue occurred at a medium-sized city in the Northeast Region of Brazil in 2009, we conducted an ecological study of the notified dengue cases georeferenced according to epidemiological week (EW) and home address. Kernel density estimation and space-time interaction were analysed using the Knox method. The evolution of the epidem ic was analysed using an animated projection technique. The dengue incidence was 6.918.7/100,000 inhabitants; the peak of the epidemic occurred from 8 February-1 March, EWs 6-9 (828.7/100,000 inhabitants). There were cases throughout the city and was ident ified space-time interaction. Three epicenters were responsible for spreading the disease in an expansion and relocation diffusion pattern. If the health services could detect in real time the epicenters and apply nimbly control measures, may possibly redu ce the magnitude of dengue epidemics. © 2015 Fundacao Oswaldo Cruz. All rights reserved.

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    A review of typhoid fever transmission dynamic models and economic evaluations of vaccination

    Despite a recommendation by the World Health Organization (WHO) that typhoid vaccines be considered for the control of endemic disease and outbreaks, programmatic use remains limited. Transmission models and economic evaluation may be informative in decisi on making about vaccine programme introductions and their role alongside other control measures. A literature search found few typhoid transmission models or economic evaluations relative to analyses of other infectious diseases of similar or lower health burden.Modelling suggests vaccines alone are unlikely to eliminate endemic disease in the short to medium term without measures to reduce transmission from asymptomatic carriage. The single identified data-fitted transmission model of typhoid vaccination s uggests vaccines can reduce disease burden substantially when introduced programmatically but that indirect protection depends on the relative contribution of carriage to transmission in a given setting. This is an important source of epidemiological uncer tainty, alongside the extent and nature of natural immunity.Economic evaluations suggest that typhoid vaccination can be cost-saving to health services if incidence is extremely high and cost-effective in other high-incidence situations, when compared to W HO norms. Targeting vaccination to the highest incidence age-groups is likely to improve cost-effectiveness substantially. Economic perspective and vaccine costs substantially affect estimates, with disease incidence, case-fatality rates, and vaccine effic acy over time also important determinants of cost-effectiveness and sources of uncertainty. Static economic models may under-estimate benefits of typhoid vaccination by omitting indirect protection.Typhoid fever transmission models currently require per-se tting epidemiological parameterisation to inform their use in economic evaluation, which may limit their generalisability. We found no economic evaluation based on transmission dynamic modelling, and no econo

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    Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance

    The 2009 influenza A(H1N1)pdm09 pandemic highlighted the need for improved scientific knowledge to support better pandemic preparedness and seasonal influenza control. The Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance (S HIVERS) project, a 5-year (2012-2016) multiagency and multidisciplinary collaboration, aimed to measure disease burden, epidemiology, aetiology, risk factors, immunology, effectiveness of vaccination and other prevention strategies for influenza and other respiratory infectious diseases of public health importance. Two active, prospective, population-based surveillance systems were established for monitoring influenza and other respiratory pathogens among those hospitalized patients with acute respiratory i llness and those enrolled patients seeking consultations at sentinel general practices. In 2015, a sero-epidemiological study will use a sample of patients from the same practices. These data will provide a full picture of the disease burden and risk facto rs from asymptomatic infections to severe hospitalized disease and deaths and related economic burden. The results during the first 2 years (2012-2013) provided scientific evidence to (a) support a change to NZ's vaccination policy for young children due t o high influenza hospitalizations in these children; (b) contribute to the revision of the World Health Organization's case definition for severe acute respiratory illness for global influenza surveillance; and (c) contribute in part to vaccine strain sele ction using vaccine effectiveness assessment in the prevention of influenza-related consultations and hospitalizations. In summary, SHIVERS provides valuable international platforms for supporting seasonal influenza control and pandemic preparedness, and r esponding to other emerging/endemic respiratory-related infections. © 2015 The Authors.

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    Methanol mass poisoning in Iran: Role of case finding in outbreak management

    Background There are no guidelines addressing the public health aspects of methanol poisoning during larger outbreaks. The current study was done to discuss the role of active case finding and a national guideline that organizes all available resources acc ording to a triage strategy in the successful management of a methanol mass poisoning in Rafsanjan, Iran, in May 2013. Methods A retrospective cross-sectional study was performed reviewing the outbreak Emergency Operation Center files. The objectives were to describe the characteristics, management and outcome of a methanol outbreak using Active Case Finding to trace the victims. Results A total of 694 patients presented to emergency departments in Rafsanjan after public announcement of the outbreak between 29th May and 3rd June 2013. The announcement was mainly performed via short message service (SMS) and local radio broadcasting. A total of 361 cases were observed and managed in Rafsanjan and 333 were transferred to other cities. Seventy-five and 100 pati ents underwent hemodialysis (HD), retrospectively. The main indication for HD was refractory metabolic acidosis. Eight patients expired due to the intoxication. Except for the deceased cases, no serum methanol level was available. Conclusion In developing countries, where diagnostic resources are limited, use of active case finding and developing national guidelines can help in the management of large outbreaks of methanol poisonings. © 2014 The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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    Epidemiological study of influenza B in Shanghai during the 2009-2014 seasons: Implications for influenza vaccination strategy

    A new quadrivalent influenza vaccine has been available for influenza B, which can pose a significant global health burden. Shanghai has the highest GDP and largest metropolitan population in China. To understand the impact of influenza B in Shanghai in te rms of age-related incidence and relative prevalence compared with other subtypes, we conducted this retrospective epidemiological study of influenza B in the 2009-2014 seasons. A total of 71 354 outpatients with influenza-like illness were included, and b oth lineages of influenza B and subtypes of influenza A were identified using real-time RT-PCR. The antigenic characteristics of influenza B isolates were analysed by sequencing and reciprocal haemagglutinin inhibition assay. On average, 33.45% of influenz a strains were influenza B, and 40.20% of strains isolated from children were influenza B. The incidence of influenza B was highest (12.52 per 100 people with influenza-like illness) in children ages 6-17 years and usually peaked in this age group at the e arly stage of an influenza B epidemic. Overall, both matched and mismatched influenza B strains co-circulated in Shanghai annually, and 44.57% of the circulating influenza B belonged to the opposite lineage of the vaccine strains. We concluded that influen za B has caused a substantial impact in Shanghai and that school-aged children play a key role in the transmission of influenza B. Hence, it may be beneficial to prioritize influenza vaccination for school-aged children to mitigate the outbreaks of influen za B. © 2015 The Authors.

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    Clinical diagnosis of influenza in the ED

    Background Timely and accurate diagnosis of influenza remains a challenge but is critical for patients who may benefit from antiviral therapy. This study determined the test characteristics of provider diagnosis of influenza, final ED electronic medical re cord (EMR) diagnosis of influenza, and influenza-like illness (ILI) in patients recommended to receive antiviral treatment according to Centers for Disease Control and Prevention (CDC) guidelines. In addition, we evaluated the compliance with CDC antiviral guidelines. Methods A prospective cohort of adults presenting to a tertiary care ED with an acute respiratory illness who met CDC criteria for recommended antiviral treatment were enrolled and tested for influenza. A clinical diagnosis of influenza was as sessed by asking the clinician: "Do you think this patient has influenza?" Influenza-like illness was defined according to current CDC criteria. Results In this cohort of 270 subjects, 42 (16%; 95% confidence interval [CI], 11%-20%) had influenza. Clinicia n diagnosis had a sensitivity of 36% (95% CI, 22%-52%) and specificity of 78% (95% CI, 72%-83%); EMR final ED diagnosis had a sensitivity of 26% (95% CI, 14%-42%) and specificity of 97% (95% CI, 94%-99%); ILI had a sensitivity of 31% (95% CI, 18%-47%) and specificity of 88% (95% CI, 83%-92%). Only 15 influenza-positive patients (36%) received antiviral treatment. Conclusion Clinician diagnosis, final ED EMR diagnosis, and ILI have low sensitivity for diagnosing influenza, and there is overall poor complianc e with CDC antiviral treatment recommendations. Improved methods of influenza diagnosis are needed to help guide management in the clinical setting. © 2015 Elsevier Inc.

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    Tdap vaccine effectiveness in adolescents during the 2012 Washington State pertussis epidemic

    BACKGROUND: Acellular pertussis vaccines replaced whole-cell vaccines for the 5-dose childhood vaccination series in 1997. A sixth dose of pertussis-containing vaccine, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed (Tdap), wa s recommended in 2005 for adolescents and adults. Studies examining Tdap vaccine effectiveness (VE) among adolescents who have received all acellular vaccines are limited. METHODS: To assess Tdap VE and duration of protection, we conducted a matched case-c ontrol study during the 2012 pertussis epidemic in Washington among adolescents born during 1993-2000. All pertussis cases reported from January 1 through June 30, 2012, in 7 counties were included; 3 controls were matched by primary provider clinic and bi rth year to each case. Vaccination histories were obtained through medical records, the state immunization registry, and parent interviews. Participants were classified by type of pertussis vaccine received on the basis of birth year: a mix of whole-cell a nd acellular vaccines (1993-1997) or all acellular vaccines (1998-2000). We used conditional logistic regression to calculate odds ratios comparing Tdap receipt between cases and controls. RESULTS: Among adolescents who received all acellular vaccines (450 cases, 1246 controls), overall Tdap VE was 63.9% (95% confidence interval [CI]: 50% to 74%). VE within 1 year of vaccination was 73% (95% CI: 60% to 82%). At 2 to 4 years postvaccination, VE declined to 34% (95% CI: -0.03% to 58%). CONCLUSIONS: Tdap prote ction wanes within 2 to 4 years. Lack of long-term protection after vaccination is likely contributing to increases in pertussis among adolescents. Copyright © 2015 by the American Academy of Pediatrics.

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    Estimates of pertussis vaccine effectiveness in United States air force pediatric dependents

    Background: Pertussis vaccination compliance is critical for reduction in the prevalence of disease; however, the current acellular pertussis vaccine may not provide sufficient protection from infection. This study examined acellular pertussis vaccine effe ctiveness (VE) for Air Force dependents less than 12 years of age. Methods: We conducted a case-control study among Air Force pediatric dependents from 2011 to 2013, comparing cases with positive pertussis test results to controls who received the same lab tests with a negative result. Our study population was categorized by age group and vaccination status based on the Centers for Disease Control and Prevention recommended pertussis vaccination schedule. VE was calculated with respect to vaccination status and pertussis lab results. Results: We compared 27 pertussis laboratory positive cases with 974 pertussis laboratory negative controls, 2 months to <12 years old. Comparing completely vaccinated to non-vaccinated patients, the overall VE was 78.3% (95% co nfidence interval (CI): 48.6, 90.8; p<. 0.001). VE was highest among those 15 months to <6 years old: 97.6% (95% CI: 78.5, 99.7; p<. 0.001). Children 6 to <12 years old had the lowest VE: 48.5% (95% CI: -74.0, 84.7; p= 0.28). Comparing partially vaccinated patients to nonvaccinated patients yielded 64.2% (95% CI: -7.2, 88.1; p= 0.06) overall VE. Conclusions: Acellular pertussis vaccination was effective at preventing laboratory confirmed pertussis among our Air Force pediatric dependent population, with hig hest protection among completely vaccinated, young children. Older children received the lowest amount of protection. Partial vaccination had near significant protection. Our overall calculated pertussis VE corroborates other pertussis VE studies looking a t similar age groups. © 2015 Elsevier Ltd.

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    Multidrug-resistant tuberculosis in New South Wales, Australia, 1999-2010: A case series report

    SETTING : The emergence of multidrug-resistant tuberculosis (MDR-TB) threatens the ongoing control of tuberculosis (TB). The Australian state of New South Wales (NSW) has low TB and MDR-TB incidence. OBJ ECT IVE : To examine the epidemiology and the clinic al and public health management of MDR-TB in NSW. DESIGN : A retrospective case-series analysis of MDRTB diagnosed in NSW between 1999 and 2010 was undertaken. A standardised questionnaire was used to collect information from the public health surveillance system, medical records and the State Mycobacterium Reference Laboratory about clinical features, drug susceptibility, treatment regimens, hospitalisation, risk factors for tuberculous infection, contact tracing and patient outcomes. RESULTS : Fifty-five cases of culture-confirmed MDRTB, including two cases of extensively drug-resistant TB, were diagnosed. All cases were reviewed by an expert management panel. Fifty cases (91%) were foreign-born, and 50 cases (91%) had fully supervised treatment. Of the 55 cases, 46 (84%) successfully completed treatment, 3 (5%) died of TB and 3 (5%) required surgery. No MDR-TB cases were reported among contacts. CONCLUSION: Using a multidisciplinary, expert guided, case-management approach, the NSW TB Control Program achie ved excellent MDR-TB outcomes. The impact of global increases in MDR-TB requires sustained commitment to TB in all settings. © 2015 The Union.

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