Monitoring Temporal Changes in SARS-CoV-2 Spike Antibody Levels and Variant-Specific Risk for Infection, Dominican Republic, March 2021-August 2022

To assess changes in SARS-CoV-2 spike binding antibody prevalence in the Dominican Republic and implications for immunologic protection against variants of concern, we prospectively enrolled 2,300 patients with undifferentiated febrile illnesses in a study during March 2021-August 2022. We tested serum samples for spike antibodies and tested nasopharyngeal samples for acute SARS-CoV-2 infection using a reverse transcription PCR nucleic acid amplification test. Geometric mean spike antibody titers increased from 6.6 (95% CI 5.1-8.7) binding antibody units (BAU)/mL during March-June 2021 to 1,332 (95% CI 1,055-1,682) BAU/mL during May-August 2022. Multivariable binomial odds ratios for acute infection were 0.55 (95% CI 0.40-0.74), 0.38 (95% CI 0.27-0.55), and 0.27 (95% CI 0.18-0.40) for the second, third, and fourth versus the first anti-spike quartile; findings were similar by viral strain. Combining serologic and virologic screening might enable monitoring of discrete population immunologic markers and their implications for emergent variant transmission

Increasing Health System Resilience During Times of Crisis: Application of Systems Thinking & Creative Problem-Solving Methodologies

University of Minnesota Ph.D. dissertation. December 2020. Major: Environmental Health. Advisor: Michael Osterholm. 1 computer file (PDF); vi, 82 pages.Disease outbreaks and health emergencies cause substantial human suffering, death and economic loss and often test the responsiveness and resilience of health systems. It is therefore necessary to shift the current paradigm of managing outbreaks to include health system strengthening as a critical component of the response. Yet, this is not systematically being done as there is limited evidence on how to do so effectively. Using methodologies that allow for the acute challenges in outbreak response to be addressed while identifying and supporting the strengthening of components of health systems and enabling optimization of resources (both human and financial) is critical. My research aims to lay the foundation for future work in this area through the piloting of systems thinking (process mapping) and creative problem-solving methodologies (design thinking). Process mapping and design thinking are particularly useful methodologies as they can be applied to any country that has an outbreak during any timepoint. These approaches were chosen as they have proven success in other industries, have documented use-cases in healthcare and public health, have a low-cost of implementation, have a low barrier to entry requiring minimal training, and are collaborative methodologies. By using these methods in three settings with three different emerging pathogen outbreaks I was able to show that despite the chaos and complexities associated with them, process mapping can address immediate response priorities while simultaneously strengthening components of a health system. Further, the design thinking principles were used to develop a data collection and reporting system which contains all laboratory data from one of the most complicated multi-country outbreaks to date demonstrating both short and long-term benefits to the response and information management systems Process mapping and design thinking are effective methods to strengthen components of a health system while responding to disease outbreaks. Testing and piloting additional systems thinking and critical problem-solving methodologies is recommended. It is through trying novel approaches, working together and remaining in a growth mind-set that we will be able to address acute and long-term challenges that impact the health of our populations

A Global, Multi-Disciplinary, Multi-Sectorial Initiative to Combat Leptospirosis: Global Leptospirosis Environmental Action Network (GLEAN)

Leptospirosis has emerged as a major public health problem in both animals and humans. The true burden of this epidemic and endemic disease is likely to be grossly under-estimated due to the non-specific clinical presentations of the disease and the difficulty of laboratory confirmation. The complexity that surrounds the transmission dynamics, particularly in epidemic situations, requires a coordinated, multi-disciplinary effort. Therefore, the Global Leptospirosis Environmental Action Network (GLEAN) was developed to improve global and local strategies of how to predict, prevent, detect, and intervene in leptospirosis outbreaks in order to prevent and control leptospirosis in high-risk populations

Rapid tests for diagnosis of leptospirosis: current tools and emerging technologies

Leptospirosis is an emerging zoonosis with a worldwide distribution but is more commonly found in impoverished populations in developing countries and tropical regions with frequent flooding. The rapid detection of leptospirosis is a critical step to effectively manage the disease and to control outbreaks in both human and animal populations. Therefore, there is a need for accurate and rapid diagnostic tests and appropriate surveillance and alert systems to identify outbreaks. This review describes current in-house methods and commercialized tests for the rapid diagnosis of acute leptospirosis. It focuses on diagnostic tests that can be performed with minimal training and limited equipment in less-developed and newly industrialized countries, particularly in resource-limited settings and with results in minutes to less than 4 hours. We also describe recent technological advances in the field of diagnostic tests that could allow for the development of innovative rapid tests in the near future.JRC.H.6-Digital Earth and Reference Dat

Rapid tests for diagnosis of leptospirosis: Current tools and emerging technologies

Leptospirosis is an emerging zoonosis with a worldwide distribution but is more commonly found in impoverished populations in developing countries and tropical regions with frequent flooding. The rapid detection of leptospirosis is a critical step to effectively manage the disease and to control outbreaks in both human and animal populations. Therefore, there is a need for accurate and rapid diagnostic tests and appropriate surveillance and alert systems to identify outbreaks. This review describes current in-house methods and commercialized tests for the rapid diagnosis of acute leptospirosis. It focuses on diagnostic tests that can be performed with minimal training and limited equipment in less-developed and newly industrialized countries, particularly in resource-limited settings and with results in minutes to less than 4 hours. We also describe recent technological advances in the field of diagnostic tests that could allow for the development of innovative rapid tests in the near futur

Shifting the paradigm: using disease outbreaks to build resilient health systems

Disease outbreaks and health emergencies can push health systems to a breaking point, especially fragile systems. Building resilient and responsive health systems is an imperative for the global health community and there is an important opportunity to address health systems strengthening activities during outbreak response. The resources dedicated to outbreaks create organisational infrastructure, capacity and networks that can be leveraged to simultaneously strengthen health systems. It is necessary to shift the current paradigm of managing outbreaks to include health system strengthening as a critical component of the response. We identify 10 activities that could be implemented during health emergencies to achieve this goal

An outbreak investigation of congenital rubella syndrome in Solomon Islands, 2013

Introduction: During May 2012, a rubella outbreak was declared in Solomon Islands. A suspected case of congenital rubella syndrome (CRS) was reported from one hospital 11 months later in 2013. This report describes the subsequent CRS investigation, findings and measures implemented. Methods: Prospective CRS surveillance was conducted at the newborn nursery, paediatric and post-natal wards, and the paediatric cardiology and ophthalmology clinics of the study hospital from April to July 2013. Retrospective case finding by reviewing medical records was also undertaken to identify additional cases born between January and March 2013 for the same wards and clinics. Cases were identified using established World Health Organization case definitions for CRS. Results: A total of 13 CRS cases were identified, including two laboratory-confirmed, four clinically confirmed and seven suspected cases. Five CRS cases were retrospectively identified, including four suspected and one clinically confirmed case. There was no geospatial clustering of residences. The mothers of the cases were aged between 20 and 36 years. Three of the six mothers available for interview recalled an acute illness with rash during the first trimester of pregnancy. Discussion: Additional CRS cases not captured in this investigation are likely. Caring for CRS cases is a challenge in resource-poor settings. Rubella vaccination is safe and effective and can prevent the serious consequences of CRS. Well-planned and funded vaccination activities can prevent future CRS cases

Leptospirosis: A Silent Epidemic Disease

Made available in DSpace on 2015-09-21T17:25:07Z (GMT). No. of bitstreams: 2 license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) daniel_buss_etal_IOC_2013.pdf: 141335 bytes, checksum: 25db814dbb30dc7261007143cf76f3c3 (MD5) Previous issue date: 2013Pan American Health Organization. Washington, DC, USA.Health and Climate Foundation. Washington, DC, USA.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.Pan American Health Organization. Washington, DC, USA.World Health Organization. Geneva, Switzerland.Pan American Health Organization. Washington, DC, USA.Pan American Health Organization. Washington, DC, USA.World Health Organization. Geneva, Switzerland.Pan American Health Organization. Washington, DC, USA

Leptospirosis and Extensive Urbanization in West Africa: A Neglected and Underestimated Threat?

International audienceLeptospirosis affects 1 million and kills 60,000 people annually, but it remains poorly documented in Africa. We aim to describe the large West African Conurbation Corridor where the omnipresence of slums, water and close animal/human interactions may result in high leptospiral risk. Though scarce, data from this region point towards the wide circulation of pathogenic leptospires in the urban environment as well as in humans. However, because of the absence of reliable surveillance systems together with lack of awareness, the absence of reference laboratory and/or a high number of infected people showing only mild manifestations, it is likely that the burden is much higher. We believe raising awareness of leptospirosis may have a positive impact on many vulnerable African city dwellers, as the disease is a preventable and treatable