Driving improvements in emerging disease surveillance through locally-relevant capacity strengthening

Emerging infectious diseases (EIDs) threaten the health of people, animals, and crops globally, but our ability to predict their occurrence is limited. Current public health capacity and ability to detect and respond to EIDs is typically weakest in low- and middle-income countries (LMICs). Many known drivers of EID emergence also converge in LMICs. Strengthening capacity for surveillance of diseases of relevance to local populations can provide a mechanism for building the cross-cutting and flexible capacities needed to tackle both the burden of existing diseases and EID threats. A focus on locally relevant diseases in LMICs and the economic, social, and cultural contexts of surveillance can help address existing inequalities in health systems, improve the capacity to detect and contain EIDs, and contribute to broader global goals for development

The Global Risks Report 2016, 11th Edition

Now in its 11th edition, The Global Risks Report 2016 draws attention to ways that global risks could evolve and interact in the next decade. The year 2016 marks a forceful departure from past findings, as the risks about which the Report has been warning over the past decade are starting to manifest themselves in new, sometimes unexpected ways and harm people, institutions and economies. Warming climate is likely to raise this year's temperature to 1° Celsius above the pre-industrial era, 60 million people, equivalent to the world's 24th largest country and largest number in recent history, are forcibly displaced, and crimes in cyberspace cost the global economy an estimated US$445 billion, higher than many economies' national incomes. In this context, the Reportcalls for action to build resilience – the "resilience imperative" – and identifies practical examples of how it could be done.The Report also steps back and explores how emerging global risks and major trends, such as climate change, the rise of cyber dependence and income and wealth disparity are impacting already-strained societies by highlighting three clusters of risks as Risks in Focus. As resilience building is helped by the ability to analyse global risks from the perspective of specific stakeholders, the Report also analyses the significance of global risks to the business community at a regional and country-level

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'

Clinical metagenomics.

Clinical metagenomic next-generation sequencing (mNGS), the comprehensive analysis of microbial and host genetic material (DNA and RNA) in samples from patients, is rapidly moving from research to clinical laboratories. This emerging approach is changing how physicians diagnose and treat infectious disease, with applications spanning a wide range of areas, including antimicrobial resistance, the microbiome, human host gene expression (transcriptomics) and oncology. Here, we focus on the challenges of implementing mNGS in the clinical laboratory and address potential solutions for maximizing its impact on patient care and public health

Hazard Analysis of Critical Control Points Assessment as a Tool to Respond to Emerging Infectious Disease Outbreaks

Highly pathogenic avian influenza virus (HPAI) strain H5N1 has had direct and indirect economic impacts arising from direct mortality and control programmes in over 50 countries reporting poultry outbreaks. HPAI H5N1 is now reported as the most widespread and expensive zoonotic disease recorded and continues to pose a global health threat. The aim of this research was to assess the potential of utilising Hazard Analysis of Critical Control Points (HACCP) assessments in providing a framework for a rapid response to emerging infectious disease outbreaks. This novel approach applies a scientific process, widely used in food production systems, to assess risks related to a specific emerging health threat within a known zoonotic disease hotspot. We conducted a HACCP assessment for HPAI viruses within Vietnam’s domestic poultry trade and relate our findings to the existing literature. Our HACCP assessment identified poultry flock isolation, transportation, slaughter, preparation and consumption as critical control points for Vietnam’s domestic poultry trade. Introduction of the preventative measures highlighted through this HACCP evaluation would reduce the risks posed by HPAI viruses and pressure on the national economy. We conclude that this HACCP assessment provides compelling evidence for the future potential that HACCP analyses could play in initiating a rapid response to emerging infectious diseases

Comparison of the initial Ebola virus disease symptoms and subsequent sequelae of 10 survivors in the Koinadugu district of Sierra Leone during the 2014-2015 outbreak (a pilot study)

A epidemia pelo vírus Ébola que devastou a África Ocidental em 2014-2015 foi a maior que o Mundo testemunhou até hoje. Começou em Dezembro de 2013 e permaneuceu indetectável durante 3 meses, permitindo que o vírus se continuasse a espalhar de forma descontrolada e para a epidemia escalar até ao ponto em que foi declarada uma emergencia internacional em Agosto de 2014. Consequências a curto e longo prazo têm sido documentadas em sobreviventes, variando desde físicas, a psicológicas e sociais. Além disso, a permanência do vírus em determinados compartimentos biológicos de sobreviventes (ex: sémen) colocam os países em alto risco do vírus voltar a ser introduzido em comunidades onde este já foi eliminado. Este estudo procurou identificar os sintomas de 10 sobreviventes da doença pelo vírus Ébola, escolhidos de forma não aleatória, tanto no momento em que estavam com a doença na sua fase activa como nos meses de convalescença, e verificar se haveria alguma relação entre os dois. Os sintomas mais comuns durante a fase activa da doença foram perda de peso, artralgia e febre; e nos meses de convalescença foram cefaleias, fadiga, astenia e lombalgias. Sessenta por cento dos sobreviventes apresentavam na fase de convalescença, um ou mais dos sintomas que tinham durante a fase activa da doença, sendo as cefaleias o sintoma mais comum a persistir, seguido de astenia. No entanto, todos os sobreviventes apresentavam no mínimo um sintoma meses após a fase activa da doença, independentemente dos sintomas que haviam desenvolvido na fase activa. Os eventos biológicos e patogénicos que estão envolvidos no desenvolvimento do síndrome pós-Ébola ainda não são claros e mais estudos são necessários nesta área. No entanto, e tendo em consideração uma abordagem sindromática, este estudo em particular conclui que a gravidade da doença pelo vírus Ébola na sua fase aguda não parece estar associada com a gravidade das sequelas apresentadas, também conhecidas como síndrome pós-Ébola.The 2014-2015 West Africa Ebola Outbreak was the largest the World has ever seen. It started in December 2013 and was left unnoticed for 3 months, allowing for the virus to keep spreading uncontrollably and for the outbreak to keep escalating until it was declared an International emergency in August 2014. Both short and long term complications have been reported on EVD survivors, ranging from physical to psychological and social and, in addition, the persistence of EVD in selected body compartments of the survivors (i.e.: semen) poses a great risk of reintroduction of the virus in areas where transmission has previously been eliminated. This study aimed to identify the symptoms presented by 10 non-randomized EVD survivors both during the acute stage of the disease and months after recovery and understand if there was any relation between these two stages. The most common symptoms recorded during the active stage of EVD were weight loss, joint pain and fever; and months after were headache, fatigue, weakness and back pain. Sixty per cent of survivors presented months after recovery with one or more of the symptoms they had during the acute stage of the disease, being headache the most common symptom to persist, followed by weakness. However, all survivors presented with one or more symptom months after recovery, regardless of the symptoms existing during the acute stage of the disease. The pathogenic and biological events that lead to the development of PEVDS are still unclear and more studies still need to be done on that subject. However, taking in consideration a symptomatic approach, this particular study concludes that the severity of the disease in its acute stage doesn‟t seem to be associated with the severity of the sequelae, also known as post-EVD syndrome

Efficacy in Emergency Legal Preparedness Underlying the 2014 Ebola Outbreak

From its relative obscurity over the past three decades, Ebola viral disease (“EVD”) emerged as a substantial global biothreat in 2014 and 2015. The current outbreak of varied strains of Ebola, beginning in March 2014 in Guinea, is projected to impact hundreds of thousands of people over months, years, or even indefinitely. As of October 31, 2014, the spread of EVD was concentrated in several Af- rican countries (e.g., Sierra Leone, Liberia, Guinea, and an unrelated outbreak in Democratic Republic of Congo), with limited additional cases in Nigeria, Senegal, and Mali. Over 2,700 people are known to have died from Ebola in fewer than eight months in Liberia alone; the actual death toll may be far higher. At one point, the U.S. Centers for Disease Control and Prevention (“CDC”) estimated a worst-case scenario of 1.4 million new cases arising largely in already affected countries by early 2015. Reported cases in the affected regions are considerably less than these estimates, but with a fatality rate hovering near 50%, thousands more West Africans may perish before the end of this current outbreak

Macaque models of human infectious disease.

Macaques have served as models for more than 70 human infectious diseases of diverse etiologies, including a multitude of agents-bacteria, viruses, fungi, parasites, prions. The remarkable diversity of human infectious diseases that have been modeled in the macaque includes global, childhood, and tropical diseases as well as newly emergent, sexually transmitted, oncogenic, degenerative neurologic, potential bioterrorism, and miscellaneous other diseases. Historically, macaques played a major role in establishing the etiology of yellow fever, polio, and prion diseases. With rare exceptions (Chagas disease, bartonellosis), all of the infectious diseases in this review are of Old World origin. Perhaps most surprising is the large number of tropical (16), newly emergent (7), and bioterrorism diseases (9) that have been modeled in macaques. Many of these human diseases (e.g., AIDS, hepatitis E, bartonellosis) are a consequence of zoonotic infection. However, infectious agents of certain diseases, including measles and tuberculosis, can sometimes go both ways, and thus several human pathogens are threats to nonhuman primates including macaques. Through experimental studies in macaques, researchers have gained insight into pathogenic mechanisms and novel treatment and vaccine approaches for many human infectious diseases, most notably acquired immunodeficiency syndrome (AIDS), which is caused by infection with human immunodeficiency virus (HIV). Other infectious agents for which macaques have been a uniquely valuable resource for biomedical research, and particularly vaccinology, include influenza virus, paramyxoviruses, flaviviruses, arenaviruses, hepatitis E virus, papillomavirus, smallpox virus, Mycobacteria, Bacillus anthracis, Helicobacter pylori, Yersinia pestis, and Plasmodium species. This review summarizes the extensive past and present research on macaque models of human infectious disease