Emerg Infect Dis

PMC4550154611

Particulate delivery systems for vaccination against bioterrorism agents and emerging infectious pathogens

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135287/1/wnan1403.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135287/2/wnan1403_am.pd

Emerging infectious diseases

Emerging Infectious Diseases is providing access to these abstracts on behalf of the ICEID 2008 program committee, which performed peer review. Emerging Infectious Diseases has not edited or proofread these materials and is not responsible for inaccuracies or omissions. All information is subject to change.Comments and corrections should be brought to the attention of the authors.Slide Sessions -- Foodborne & waterborne diseases I -- Influenza I -- Surveillance: International -- Zoonotic & animal diseases I -- Methicillin-resistant stapylococcal infections -- Vectorborne diseases -- Foodborne & waterborne diseases II -- Influenza II -- Surveillance: Domestic -- Zoonotic & animal diseases II -- Noscomial infections -- Respiratory diseases -- Health communications -- Blood, organ, & tissue safety -- Tropical diseases -- New rapid diagnostics -- Mobile populations & infectious diseases -- Vaccine-preventable diseases -- Tuberculosis -- Sexually transmitted diseases -- -- Poster Abstracts -- Vaccines & vaccine-preventable diseases -- Antimicrobial resistance -- Climate changes -- Foodborne & waterborne infections -- Health communication -- Infectious causes of chronic diseases -- Influenza -- New or rapid diagnostics -- Nosocomial infections -- Outbreak investigation: Lab & epi response -- Sexually transmitted diseases -- Surveillance: International & new strategies -- Travelers' health & disease importation -- Tropical infections & parasitic diseases -- Vector-borne diseases -- Women, gender, sexual minorities & infectious diseases -- Zoonotic & animal diseases -- Vaccines & vaccine-preventable diseases -- Antimicrobial resistance -- Emerging aspects of HIV -- Foodborne & waterborne infections -- Health communication -- Molecular epidemiology -- Outbreak investigation: Lab & epi response -- Poverty & infectious diseases -- Surveillance: International & new strategies -- Tropical infections & parasitic diseases -- Vector-borne diseases -- Zoonotic & animal diseases -- Vaccines & vaccine-preventable diseases -- Antimicrobial resistance -- Blood, organ, & other tissue safety -- Foodborne & waterborne infections -- Host & microbial genetics -- Influenza -- Molecular epidemiology -- New or rapid diagnostics -- Outbreak investigation: Lab & epi response -- Prevention effectiveness, cost effectiveness, & cost studies -- Surveillance: International & new strategies -- Vector-borne diseases -- Zoonotic & animal diseases -- Vaccines & vaccine-preventable diseases -- Antimicrobial resistance -- Bioterrorism preparedness -- Emerging opportunistic infections -- Foodborne & waterborne infections -- Healthcare worker safety -- Influenza -- Laboratory proficiency testing/quality assurance -- Modeling -- Nosocomial infections -- Outbreak investigation: Lab & epi response -- Vector-borne diseases -- Viral hepatitis -- Zoonotic & animal diseases -- Vaccines & vaccine-preventable diseases -- Antimicrobial resistance -- Emerging opportunistic infections -- Foodborne & waterborne infections -- Influenza -- New or rapid diagnostics -- Nosocomial infections -- Outbreak investigation: Lab & epi response -- Social determinants of infectious disease disparities -- Surveillance: International & new strategies -- Tuberculosis -- Vector-borne diseases -- Zoonotic & animal diseases -- -- Additional Poster Abstracts.Abstracts published in advance of the conference

Salmonella Typhi – a Quiet Bacteria with a Loud Message: an ICU Case Report

Typhoid fever, caused by Salmonella enterica, serovar Typhi, is restricted to humans as its host and evades the human immune system with ease. This quality has been one of the many reasons why it is commonly found as an endemic bacterium in emerging economies. Also, due to a remarkably low yield from blood cultures (median of 1 CFU/mL of blood), Salmonella septicemia is uncommon. New evidence gathered together with clinical investigations have provided insight into the mechanisms that underlie the pathogenesis of typhoid, host restriction as well as antibiotic and vaccine susceptibility. However, very little has been done to curb the persistence of disease and emergence of resistant strains. We discuss a case of Salmonella Septic Shock in the Intensive Care Unit (ICU) that takes us through various aspects in diagnosis, the treatment potential and the problems surrounding prevention

Challenges in developing methods for quantifying the effects of weather and climate on water-associated diseases: A systematic review

Infectious diseases attributable to unsafe water supply, sanitation and hygiene (e.g. Cholera, Leptospirosis, Giardiasis) remain an important cause of morbidity and mortality, especially in low-income countries. Climate and weather factors are known to affect the transmission and distribution of infectious diseases and statistical and mathematical modelling are continuously developing to investigate the impact of weather and climate on water-associated diseases. There have been little critical analyses of the methodological approaches. Our objective is to review and summarize statistical and modelling methods used to investigate the effects of weather and climate on infectious diseases associated with water, in order to identify limitations and knowledge gaps in developing of new methods. We conducted a systematic review of English-language papers published from 2000 to 2015. Search terms included concepts related to water-associated diseases, weather and climate, statistical, epidemiological and modelling methods. We found 102 full text papers that met our criteria and were included in the analysis. The most commonly used methods were grouped in two clusters: process-based models (PBM) and time series and spatial epidemiology (TS-SE). In general, PBM methods were employed when the bio-physical mechanism of the pathogen under study was relatively well known (e.g. Vibrio cholerae); TS-SE tended to be used when the specific environmental mechanisms were unclear (e.g. Campylobacter). Important data and methodological challenges emerged, with implications for surveillance and control of water-associated infections. The most common limitations comprised: non-inclusion of key factors (e.g. biological mechanism, demographic heterogeneity, human behavior), reporting bias, poor data quality, and collinearity in exposures. Furthermore, the methods often did not distinguish among the multiple sources of time-lags (e.g. patient physiology, reporting bias, healthcare access) between environmental drivers/exposures and disease detection. Key areas of future research include: disentangling the complex effects of weather/climate on each exposure-health outcome pathway (e.g. person-to-person vs environment-to-person), and linking weather data to individual cases longitudinally

Climate change and childhood diarrhoea in Kathmandu, Nepal: a health risk assessment and exploration of surveillance capacity

There is substantial evidence that the onset and transmission of infectious diseases, particularly vector-borne diseases and diarrheal diseases, are influenced by many factors including climate change. Improving the understanding of the impacts of climate change on infectious diseases is important to inform policy decision making on disease control and prevention, as well as predicting the trends in the infectious diseases burden. Epidemiological analysis of long-term surveillance data on infectious diseases and meteorological factors are instrumental in establishing the association between infectious disease incidence and climate change. Advanced epidemiological techniques are now available to precisely estimate the nature of association (linear, non-linear) as well as the delayed effect: this means that it is possible to plan and design climate-based early warning systems to predict conditions that are likely to be favourable for an outbreak of climate-sensitive infectious disease. However, the association between infectious diseases and climate change varies, depending upon the pathogens responsible for infection. Similarly, the ability of infectious disease surveillance systems or disease control divisions to generate this evidence and utilise the knowledge to cope or adapt to the impacts of climate change is contingent upon the social, economic, political and other contextual problems. In the Nepalese context, the impacts of climate change on infectious diseases, in particular diarrheal disease, remains unknown: similarly, there has been no exploration of the contextual factors associated with the integration of climate change-related risk in Nepalese infectious diseases surveillance systems. Given this background, the first aim of this PhD thesis is to characterize the association between diarrhoea among children below five years of age and climate variables in Kathmandu, Nepal and then project the future burden of diarrhoea due to climate change. The second aim is to understand the association between rotavirus infection among children below five years of age and temperature variability in Kathmandu and compute the fraction of rotavirus infection that is attributable to temperature. The third aim is to explore the extant research on climate change and infectious diseases in Nepal and to identify the reasons behind sparse evidence on the topic. The final aim is to explore social, economic and cultural factors associated with infectious diseases surveillance in Nepal in the context of climate change. A mixed method study design was employed to achieve the goals of this project. There are four analytical chapters in this thesis: two quantitative studies; a study that reviews evidence of the impacts of climate change on infectious disease and policy documents related to infectious disease control and prevention in Nepal; and a qualitative study. Two quantitative studies were carried out to estimate the association between climate variability and childhood diarrhoea, and childhood rotavirus infection in Kathmandu. Study 1 and study 2 utilised time series design involving Poisson regression equations fitted with distributed lag models to characterise exposure-response and possible lagged association between climate variables and diarrhoea, and rotavirus infection. A qualitative research study was undertaken to explore the social, economic, cultural and political factors associated with infectious diseases surveillance in the context of climate change in Nepal. In study 4, semi-structured interviews were conducted with key informants and stakeholders from the Department of Health Services Nepal, World Health Organization Nepal, the Department of Hydrology and Meteorology Nepal and infectious disease experts working in both public and private sectors in Nepal. The interviews and subsequent thematic analysis of data were conducted from a critical realist perspective. Study 1 established a significant positive association between childhood diarrhoea and temperature, and rainfall. A 1°C increase in maximum temperature above the monthly average was found to be associated with 8.1% (RR: 1.081; 95% CI: 1.02-1.14) increase in the monthly count of diarrhoea among children below five years of age living in Kathmandu, Nepal. Similarly, a 10mm increase in monthly cumulative rainfall above the mean value was associated with 0.09% (RR: 1.009; 95% CI: 1.004-1.015) increase in childhood diarrhoea. It was further projected that 1357 (UI: 410–2274) additional cases of childhood diarrhoea could be experienced by 2050 given the projected change in climate under low-risk scenario (0.9°C increase in maximum temperature). Study 2 established a nonlinear negative association between temperature (maximum, mean and minimum) and weekly rotavirus infection cases among children below five years of age in Kathmandu. Compared to the median value of mean temperature, an increased risk (RR: 1.52; 95% CI: 1.08–2.15) of rotavirus infection was detected at the lower quantile (10th percentile) and a decreased risk (RR: 0.64; 95% CI: 0.43–0.95) was detected at the higher quantile (75th percentile). Similarly, an increased risk [(RR: 1.93; 95% CI: 1.40–2.65) and (RR: 1.42; 95% CI: 1.04–1.95)] of infection was detected for both maximum and minimum temperature at their lower quantile (10th percentile). It was further estimated that 47.01% of the rotavirus infection cases reported between 2013 and 2016 in Kathmandu could be attributed to minimum temperature. Study 3 identified that there was little evidence describing the impacts of climate change on infectious diseases and no evidence describing the projected burden under climate change scenarios. I explored the reasons behind paucity in the evidence and challenges faced by epidemiologists in Nepal. The challenges identified included poor quality infectious disease datasets, shortage of trained human resources, inadequate funding and political instability. As such, it was recommended that an integrated digital network of interdisciplinary experts be established and increased collaboration among different stakeholders be promoted to advance the evidence base on the impacts of climate change on infectious diseases in Nepal. The fourth and final study outlined that climate change and its impacts on infectious disease surveillance is treated as a less serious issue than other more ‘salient’ public health risks in the context of Nepal. The study further illustrates how climate change is variably constructed as a contingent risk for infectious diseases transmission and public health systems. The analysis exposes a weaker alliance among different stakeholders, particularly policymakers and evidence generators that leads to the continuation of traditional practices of infectious diseases surveillance without consideration of the impacts of climate change. In summary, this thesis brings to prominence important progress in understanding the link between climate change and infectious diseases, in particular childhood diarrhoea, in a subtropical highland climate from a low and middle income South Asian country. So far, we have not found any other study that explores the contextual factors (social, economic, cultural and political) that impede the integration of climate change-related risk in the disease surveillance systems. Therefore, this thesis illustrates a novel facet of infectious disease surveillance and climate change. This thesis makes an important contribution to address the gap on information related to climate change and infectious diseases in Nepal and can have significant implications towards building a climate-resilient public health system in Nepal.Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 202

Toward the Year 2000

Cover title.1990833

Global burden of norovirus and prospects for vaccine development

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, or the US Department of Health and Human Services.This work was funded in part by a grant from the Bill & Melinda Gates Foundation to the CDC Foundation.global-burden-report.pdf201

Reliability of case definitions for public health surveillance assessed by Round-Robin test methodology

BACKGROUND: Case definitions have been recognized to be important elements of public health surveillance systems. They are to assure comparability and consistency of surveillance data and have crucial impact on the sensitivity and the positive predictive value of a surveillance system. The reliability of case definitions has rarely been investigated systematically. METHODS: We conducted a Round-Robin test by asking all 425 local health departments (LHD) and the 16 state health departments (SHD) in Germany to classify a selection of 68 case examples using case definitions. By multivariate analysis we investigated factors linked to classification agreement with a gold standard, which was defined by an expert panel. RESULTS: A total of 7870 classifications were done by 396 LHD (93%) and all SHD. Reporting sensitivity was 90.0%, positive predictive value 76.6%. Polio case examples had the lowest reporting precision, salmonellosis case examples the highest (OR = 0.008; CI: 0.005–0.013). Case definitions with a check-list format of clinical criteria resulted in higher reporting precision than case definitions with a narrative description (OR = 3.08; CI: 2.47–3.83). Reporting precision was higher among SHD compared to LHD (OR = 1.52; CI: 1.14–2.02). CONCLUSION: Our findings led to a systematic revision of the German case definitions and build the basis for general recommendations for the creation of case definitions. These include, among others, that testable yes/no criteria in a check-list format is likely to improve reliability, and that software used for data transmission should be designed in strict accordance with the case definitions. The findings of this study are largely applicable to case definitions in many other countries or international networks as they share the same structural and editorial characteristics of the case definitions evaluated in this study before their revision