Rumor Surveillance and Avian Influenza H5N1

We describe the enhanced rumor surveillance during the avian influenza H5N1 outbreak in 2004. The World Health Organization’s Western Pacific Regional Office identified 40 rumors; 9 were verified to be true. Rumor surveillance informed immediate public health action and prevented unnecessary and costly responses

Study protocol: building an evidence base for epidemiology emergency response, a mixed-methods study

Introduction: Determinants and drivers for emergencies, such as political instability, weak health systems, climate change and forcibly displaced populations, are increasing the severity, complexity and frequency of public health emergencies. As emergencies become more complex, it is increasingly important that the required skillset of the emergency response workforce is clearly defined. To enable essential epidemiological activities to be implemented and managed during an emergency, a workforce is required with the right mix of skills, knowledge, experience and local context awareness. This study aims to provide local and international responders with an opportunity to actively contribute to the development of new thinking around emergency response roles and required competencies. In this study, we will develop recommendations using a broad range of evidence to address identified lessons and challenges so that future major emergency responses are culturally and contextually appropriate, and less reliant on long-term international deployments. Method and analysis: We will conduct a mixed-methods study using an exploratory sequential study design. The integration of four data sources, including key informant interviews, a scoping literature review, survey and semistructured interviews will allow the research questions to be examined in a flexible, semistructured way, from a range of perspectives. The study is unequally weighted, with a qualitative emphasis. We will analyse all activities as individual components, and then together in an integrated analysis. Thematic analysis will be conducted in NVivo V.11 and quantitative analysis will be conducted in Stata V.15. Ethics and dissemination: All activities have been approved by the Science and Medical Delegated Ethics Review Committee at the Australian National University (protocol numbers 2018-521, 2018-641, 2019-068). Findings will be disseminated through international and local deployment partners, peer-reviewed publication, presentation at international conferences and through social media such as Twitter and Facebook.AEP receives Commonwealth and ANU science merit scholarships, along with funding from the Australian National Health and Medical Research Council (NHMRC) Integrated Systems for Epidemic Response (APP1107393). MDK is supported by an NHMRC fellowship (APP1145997) and receives funding from the NHMRC for Integrated Systems for Epidemic Response

A Geographically-Restricted but Prevalent Mycobacterium tuberculosis Strain Identified in the West Midlands Region of the UK between 1995 and 2008

Background: We describe the identification of, and risk factors for, the single most prevalent Mycobacterium tuberculosis strain in the West Midlands region of the UK.Methodology/Principal Findings: Prospective 15-locus MIRU-VNTR genotyping of all M. tuberculosis isolates in the West Midlands between 2004 and 2008 was undertaken. Two retrospective epidemiological investigations were also undertaken using univariable and multivariable logistic regression analysis. The first study of all TB patients in the West Midlands between 2004 and 2008 identified a single prevalent strain in each of the study years (total 155/3,056 (5%) isolates). This prevalent MIRU-VNTR profile (32333 2432515314 434443183) remained clustered after typing with an additional 9-loci MIRU-VNTR and spoligotyping. The majority of these patients (122/155, 79%) resided in three major cities located within a 40 km radius. From the apparent geographical restriction, we have named this the "Mercian" strain. A multivariate analysis of all TB patients in the West Midlands identified that infection with a Mercian strain was significantly associated with being UK-born (OR = 9.03, 95% CI = 4.56-17.87, p 65 years old (OR = 0.25, 95% CI = 0.09-0.67, p < 0.01). A second more detailed investigation analyzed a cohort of 82 patients resident in Wolverhampton between 2003 and 2006. A significant association with being born in the UK remained after a multivariate analysis (OR = 9.68, 95% CI = 2.00-46.78, p < 0.01) and excess alcohol intake and cannabis use (OR = 6.26, 95% CI = 1.45-27.02, p = .01) were observed as social risk factors for infection.Conclusions/Significance: The continued consistent presence of the Mercian strain suggests ongoing community transmission. Whilst significant associations have been found, there may be other common risk factors yet to be identified. Future investigations should focus on targeting the relevant risk groups and elucidating the biological factors that mediate continued transmission of this strain

Body Temperature Monitoring and SARS Fever Hotline, Taiwan

In Taiwan, a temperature-monitoring campaign and hotline for severe acute respiratory syndrome (SARS) fever were implemented in June 2003. Among 1,966 calls, fever was recorded in 19% (n = 378); 18 persons at high risk for SARS were identified. In a cross-sectional telephone survey, 95% (n = 1,060) of households knew about the campaign and 7 households reported fever

The impact of Hib conjugate vaccine on the epidemiology of invasive Haemophilus influenzae disease in the West Midlands and the effect of deprivation and other environmental risk factors : an ecological study, 1990-1994

Objective: To describe the epidemiology of invasive Haemophilus influenzae (HI) disease, and to explore the relationship between socioeconomic disadvantage and invasive HI disease in the two years immediately before (October 1990 to September 1992), and following (October 1992 to September 1994) the introduction of HI type b (Hib) conjugate vaccine. Design: Multiple sources of case ascertainment were used to identify children with invasive HI disease in the West Midlands Health Region (WMHR) and compile a case register. An ecological study examined socioeconomic disadvantage using selected socioeconomic census data for enumeration districts, and the Townsend index of material deprivation. Setting: WMHR, England from October 1990 to September 1994. Subjects: Children under 5 years of age with invasive HI present on the West Midlands invasive HI case register (HICARE). Results : The incidence of invasive HI disease in the WMHR fell from 28.3/105 (95% CI=24.5 to 32.6) children <5 years of age in the pre-conjugate vaccine period to 5.4/105 (3.8 to 7.4) after the vaccine had been introduced. Nine vaccine failures were identified. Those aged 6-11 months were most at risk in the pre-conjugate vaccine period (OR=2.69,95% CI=1.14 to 6.55). In the post-conjugate vaccine period those aged 24-35 months were at most risk (OR=2.64,1.16 to 5.94). More cases of meningitis were identified in girls than boys but the difference was not statistically significant. Significantly more cases of invasive HI seen in children of South Asian origin aged less than 12 months than in non-South Asian children (OR=2.88,1.07 to 7.86). Children from affluent areas were at significantly reduced risk of disease compared to children from the more deprived areas (OR=0.73,0.54 to 0.99). In the second period of the study a number of significant risk factors were identified. Children living in areas containing predominantly rented accommodation (p=0.0025), mobile populations (p=0.013) and a low density of children aged <5 years per km2 (p=0.039) were at increased risk of invasive HI disease. Following meningitis, children from deprived areas were more likely to suffer sensorineural hearing loss (p=0.035). Case fatality was higher in the second period of the study, although not significantly so (OR=3.64,0.88 to 15.05). Conclusion: This four year study provides the first detailed account of the relationship between deprivation, , socioeconomic risk factors, ethnic group, and invasive HI disease in Britain. The incidence of the disease fell dramatically in the post-conjugate vaccine period. A number of socioeconomic risk factors were identified in the second period of the study. The data suggest that although Hib conjugate vaccine has greatly reduced the incidence of disease, children from deprived areas remain at greater risk than children in more affluent areas. They also indicate that the disease is still responsible for considerable sequelae and mortality

School closures and influenza: systematic review of epidemiological studies.

OBJECTIVE: To review the effects of school closures on pandemic and seasonal influenza outbreaks. DESIGN: Systematic review. DATA SOURCES: MEDLINE and EMBASE, reference lists of identified articles, hand searches of key journals and additional papers from the authors' collections. STUDY SELECTION: Studies were included if they reported on a seasonal or pandemic influenza outbreak coinciding with a planned or unplanned school closure. RESULTS: Of 2579 papers identified through MEDLINE and EMBASE, 65 were eligible for inclusion in the review along with 14 identified from other sources. Influenza incidence frequently declined after school closure. The effect was sometimes reversed when schools reopened, supporting a causal role for school closure in reducing incidence. Any benefits associated with school closure appeared to be greatest among school-aged children. However, as schools often closed late in the outbreak or other interventions were used concurrently, it was sometimes unclear how much school closure contributed to the reductions in incidence. CONCLUSIONS: School closures appear to have the potential to reduce influenza transmission, but the heterogeneity in the data available means that the optimum strategy (eg, the ideal length and timing of closure) remains unclear