The impact of economic crises on communicable disease transmission and control: a systematic review of the evidence.

There is concern among public health professionals that the current economic downturn, initiated by the financial crisis that started in 2007, could precipitate the transmission of infectious diseases while also limiting capacity for control. Although studies have reviewed the potential effects of economic downturns on overall health, to our knowledge such an analysis has yet to be done focusing on infectious diseases. We performed a systematic literature review of studies examining changes in infectious disease burden subsequent to periods of crisis. The review identified 230 studies of which 37 met our inclusion criteria. Of these, 30 found evidence of worse infectious disease outcomes during recession, often resulting from higher rates of infectious contact under poorer living circumstances, worsened access to therapy, or poorer retention in treatment. The remaining studies found either reductions in infectious disease or no significant effect. Using the paradigm of the "SIR" (susceptible-infected-recovered) model of infectious disease transmission, we examined the implications of these findings for infectious disease transmission and control. Key susceptible groups include infants and the elderly. We identified certain high-risk groups, including migrants, homeless persons, and prison populations, as particularly vulnerable conduits of epidemics during situations of economic duress. We also observed that the long-term impacts of crises on infectious disease are not inevitable: considerable evidence suggests that the magnitude of effect depends critically on budgetary responses by governments. Like other emergencies and natural disasters, preparedness for financial crises should include consideration of consequences for communicable disease control

Visual Analytics of Surveillance Data on Foodborne Vibriosis, United States, 1973–2010

Foodborne illnesses caused by microbial and chemical contaminants in food are a substantial health burden worldwide. In 2007, human vibriosis (non-cholera Vibrio infections) became a notifiable disease in the United States. In addition, Vibrio species are among the 31 major known pathogens transmitted through food in the United States. Diverse surveillance systems for foodborne pathogens also track outbreaks, illnesses, hospitalization and deaths due to non-cholera vibrios. Considering the recognition of vibriosis as a notifiable disease in the United States and the availability of diverse surveillance systems, there is a need for the development of easily deployed visualization and analysis approaches that can combine diverse data sources in an interactive manner. Current efforts to address this need are still limited. Visual analytics is an iterative process conducted via visual interfaces that involves collecting information, data preprocessing, knowledge representation, interaction, and decision making. We have utilized public domain outbreak and surveillance data sources covering 1973 to 2010, as well as visual analytics software to demonstrate integrated and interactive visualizations of data on foodborne outbreaks and surveillance of Vibrio species. Through the data visualization, we were able to identify unique patterns and/or novel relationships within and across datasets regarding (i) causative agent; (ii) foodborne outbreaks and illness per state; (iii) location of infection; (iv) vehicle (food) of infection; (v) anatomical site of isolation of Vibrio species; (vi) patients and complications of vibriosis; (vii) incidence of laboratory-confirmed vibriosis and V. parahaemolyticus outbreaks. The additional use of emerging visual analytics approaches for interaction with data on vibriosis, including non-foodborne related disease, can guide disease control and prevention as well as ongoing outbreak investigations

Biological Terrorism

In the aftermath of the September 11, 2001 attacks and the subsequent mail-borne anthrax attack of October 2001, it has become dear that health care providers may be called upon to respond to victims of terrorism. Biological terrorism (BT), in particular, involves the use of virulent agents with the intent to cause mass casualties and/or induce fear, a scenario that if effected will severely strain the capacity of regional emergency medical services and pose unique management challenges to clinicians confronted with victimized children. Whether practicing as a pediatric emergency medicine specialist working in an urban children's hospital or as a general clinician in private office-based practice, pediatricians may be the first to suspect that a BT agent may have been utilized. Compared to adults, most caregivers have a relatively low threshold for having children and infants evaluated professionally when they become sick. Furthermore, pediatric patients may have a more rapid or severe response to a biological agent, potentially putting pediatricians and child care providers in the critical position of being the first to diagnose an exposure. The clinician's response to such a situation may determine whether the incident is controlled promptly or whether it evolves into a large-scale epidemiologic catastrophe

Who acquires infection from whom and how? Disentangling multi-host and multi-mode transmission dynamics in the 'elimination' era

Multi-host infectious agents challenge our abilities to understand, predict and manage disease dynamics. Within this, many infectious agents are also able to use, simultaneously or sequentially, multiple modes of transmission. Furthermore, the relative importance of different host species and modes can itself be dynamic, with potential for switches and shifts in host range and/ or transmission mode in response to changing selective pressures, such as those imposed by disease control interventions. The epidemiology of such multi-host, multi-mode infectious agents thereby can involve a multi-faceted community of definitive and intermediate/secondary hosts or vectors, often together with infectious stages in the environment, all of which may represent potential targets, as well as specific challenges, particularly where disease elimination is proposed. Here, we explore, focusing on examples fromboth human and animal pathogen systems, why and how we should aim to disentangle and quantify the relative importance of multi-host multi-mode infectious agent transmission dynamics under contrasting conditions, and ultimately, how this can be used to help achieve efficient and effective disease control. This article is part of the themed issue 'Opening the black box: re-examining the ecology and evolution of parasite transmission'

Economic Analysis of Johne's Disease Control Strategies in Dairy Herds

Infectious diseases play a critical role in determining the profitability of individual farms and maintaining the viability of livestock industries, international trade, and trade policies. Thus, it is critical to analyze the economic consequences of infectious diseases, and the effects of producer strategies to control or eliminate diseases in a cost efficient approach. Also, important is the goal to rally support for the development of public disease control programs. This study examined the long-term feasibility and effectiveness of various producer strategies to prevent and control Johne’s disease in dairy herds, an infectious and incurable disease which has significant economic repercussions for the dairy industry. There are few previous studies available on the economic aspects of Johne’s disease and there remains a knowledge gap with regard to the economics of the disease and the economic justification of the disease controls associated with the biological characteristics of the disease. This study contributes to this body of knowledge. We constructed an optimal control model integrating the biology of animals and disease into an economic framework to estimate the best control method in terms of maximizing an individual farm’s profit and minimizing disease elimination periods. Our results show that any Johne’s disease control method yields a higher net present value compared to no control. Implementing a single control strategy can control the disease, but a combination of control strategies in different categories is the most profitable and effective way to reduce the infection rate in a disease-infected herd. The results of the study are directly applicable to managing this disease on US dairy farms and contribute to controlling a high-priority pathogen in an important industry.Animal disease control, dairy herd model, Johne's disease, optimal control model, paratuberculosis, Agribusiness, Farm Management, Livestock Production/Industries, Research and Development/Tech Change/Emerging Technologies,

Spatial targeting of infectious disease control: identifying multiple, unknown sources

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Disease prevention versus data privacy : using landcover maps to inform spatial epidemic models

The availability of epidemiological data in the early stages of an outbreak of an infectious disease is vital for modelers to make accurate predictions regarding the likely spread of disease and preferred intervention strategies. However, in some countries, the necessary demographic data are only available at an aggregate scale. We investigated the ability of models of livestock infectious diseases to predict epidemic spread and obtain optimal control policies in the event of imperfect, aggregated data. Taking a geographic information approach, we used land cover data to predict UK farm locations and investigated the influence of using these synthetic location data sets upon epidemiological predictions in the event of an outbreak of foot-and-mouth disease. When broadly classified land cover data were used to create synthetic farm locations, model predictions deviated significantly from those simulated on true data. However, when more resolved subclass land use data were used, moderate to highly accurate predictions of epidemic size, duration and optimal vaccination and ring culling strategies were obtained. This suggests that a geographic information approach may be useful where individual farm-level data are not available, to allow predictive analyses to be carried out regarding the likely spread of disease. This method can also be used for contingency planning in collaboration with policy makers to determine preferred control strategies in the event of a future outbreak of infectious disease in livestock

Technologies for the marketplace from the Centers for Disease Control

The Centers for Disease Control, a Public Health Service agency, is responsible for the prevention and control of disease and injury. Programs range from surveillance and prevention of chronic and infectious diseases to occupational health and injury control. These programs have produced technologies in a variety of fields, including vaccine development, new methods of disease diagnosis, and new tools to ensure a safer work environment