The effectiveness of policies to control a human influenza pandemic : a literature review

The studies reviewed in this paper indicate that with adequate preparedness planning and execution it is possible to contain pandemic influenza outbreaks where they occur, for viral strains of moderate infectiousness. For viral strains of higher infectiousness, containment may be difficult, but it may be possible to mitigate the effects of the spread of pandemic influenza within a country and/or internationally with a combination of policies suited to the origins and nature of the initial outbreak. These results indicate the likelihood of containment success in'frontline risk'countries, given specific resource availability and level of infectiousness; as well as mitigation success in'secondary'risk countries, given the assumption of inevitable international transmission through air travel networks. However, from the analysis of the modeling results on interventions in the U.S. and U.K. after a global pandemic starts, there is a basis for arguing that the emphasis in the secondary risk countries could shift from mitigation towards containment. This follows since a mitigation-focused strategy in such developed countries presupposes that initial outbreak containment in these countries will necessarily fail. This is paradoxical if containment success at similar infectiousness of the virus is likely in developing countries with lower public health resources, based on results using similar modeling methodologies. Such a shift in emphasis could have major implications for global risk management for diseases of international concern such as pandemic influenza or a SARS-like disease.Avian Flu,Disease Control&Prevention,Health Monitoring&Evaluation,Population Policies,HIV AIDS

Impact of infectious disease epidemics on xenophobia: A systematic review

Background Globally, xenophobia towards out-groups is frequently increased in times of economic and political instability, such as in infectious disease outbreaks. This systematic review aims to: (1) assess the xenophobic attitudes and behaviors towards migrants during disease outbreaks; and (2) identify adverse health outcomes linked to xenophobia. Methods We searched nine scientific databases to identify studies measuring xenophobic tendencies towards international migrants during disease outbreaks and evaluated the resulting adverse health effects. Results Eighteen articles were included in the review. The findings were grouped into: (1) xenophobia-related outcomes, including social exclusion, out-group avoidance, support for exclusionary health policies, othering, and germ aversion; and (2) mental health problems, such as anxiety and fear. Depending on the disease outbreak, different migrant populations were negatively affected, particularly Asians, Africans, and Latino people. Factors such as perceived vulnerability to disease, disgust sensitivity, medical mistrust individualism, collectivism, disease salience, social representation of disease and beliefs in different origins of disease were associated with xenophobia. Conclusions Overall, migrants can be a vulnerable population frequently blamed for spreading disease, promoting irrational fear, worry and stigma in various forms, thus leading to health inequities worldwide. It is urgent that societies adopt effective support strategies to combat xenophobia and structural forms of discrimination against migrants

The Economic Implications of Epidemics Old and New

The outbreak of Severe Acute Respiratory Syndrome (SARS) in the winter of 2002–03 raised the specter of a new, unknown and uncontrollable infectious disease that spreads quickly and is often fatal. Certain branches of economic activity, notably tourism, felt its impact almost at once, and investor expectations of a safe and controlled investment climate were brought into question. Part of the shock of SARS was the abrupt reversal of a mounting legacy of disease control that had altered societies’ expectations from coping with waves of epidemics of smallpox, cholera, and measles, among other diseases, to complacency with the virtual elimination of disease epidemics. This paper analyzes the economic implications of the Great Plague in the fourteenth century, the 1918–19 influenza epidemic, HIV/AIDS and SARS to demonstrate the short- and long-term effects of different kinds of epidemics.severe acute respiratory syndrome (SARS), infectious disease, epidemics

Intellectual Property Management Strategies to Accelerate the Development and Access of Vaccines and Diagnostics: Case Studies on Pandemic Influenza, Malaria and SARS

Achieving global access to vaccines, diagnostics, and pharmaceuticals remains a challenge. Throughout the developing world, intellectual property (IP) constraints complicate access to critically essential medical technologies and products. Vaccines for malaria and pandemic strains of influenza, as well as diagnostic and vaccine technologies for SARS, are not only relevant to global public health but are particularly critical to the needs of developing countries. A global access solution is urgently needed. This article offers a timely case‐by‐case analysis of preliminary patent landscape surveys and formulates options via patent pools and other forms of creative IP management to accelerate development and access. The analysis of the feasibility of patent pools reveals several impediments to patent pools: these include antitrust considerations, bargaining difficulties caused by asymmetric interests and asymmetric rights among IP holders (e.g. improvement vs. foundational patents), and the difficulties of securing financial support given the significant transaction costs associated with pools. Because of the above conceptual and operational hurdles, patent pools do not appear to be a feasible way to accelerate development. Other mechanisms, however, can ameliorate IP constraints. For example, a key IP constraint related to pandemic influenza vaccines R&D appears to have been resolved when Medimmune secured the assembly of all relevant reverse genetics IP and pledged broad access. Clearly, the landscape is complex and multidimensional. Licensing systems are not the only issue. Measures must also be taken to limit regulatory hurdles and enable the swift, legal production of pandemic influenza vaccines to meet the needs of developing countries. This is why a comprehensive analysis is so necessary. From a strictly legal perspective, IP systems work through the power to exclude. However, as this study’s exploration and formulation of creative licensing strategies reveals, it is also true that IP can be structured and managed to work through the “power to include.

Airborne

Airborne diseases are spread when droplets containing pathogens, viruses and/or bacteria, are expelled into the air due to coughing, sneezing or talking. These droplets, or aerosols, can remain suspended in the air for quite some time in contained environments. Diseases are also transmitted by close physical contact and by rubbing eyes, mouth and nose after touching a contaminated surface. Radically increased mobility among humans, our treatment of animals and climate changes have increased the frequency of epidemics and the probability that a novel or mutated virus can spread rapidly. With the help of WHO and a high level of international collaboration and transparency, more alarms of pandemic alerts will be heard. The research of this topic begun with news articles about current viral events and the bigger picture; pandemics. This was accompanied by a deeper dive into the world of viruses and airborne diseases by the help of scientific articles. Interviews with experts in the field; a Surgeon, Infectious Disease Specialist, Infection Control Practitioner and a Health Care Hygiene Specialist lead to an understanding of why today’s respiratory masks are not efficient enough and why we are not relying on physical barriers today. The specialists could provide with more scientific articles on the topic of constraints and threats with respirators and also when and where the risks of transmission occurs. Microorganisms can penetrate through respirator filters, sealing surfaces or other parts of the respirator. Wearing disposable and reusable respirators causes difficulties in breathing and communicating. The chosen strategy was to avoid a health threat rather than curing a symptom. The intended target group is individuals whom due to their profession are exposed to many others while being in a confined space. These people could be a danger to others should they become infectious themselves. The conceptual respirator was developed firstly by sketching and by making rough prototypes for testing. The final concept can be reused for weeks with disposable filters and a full face piece respirator and it prevents the three ways of transmission. The respirator consists of a lightweight plastic visor which is combined with adhesive and stretchy silicone. The soft and gentle adhesive edges makes the respirator more effective and safe than disposable ones by completely sealing the edges to the face. Adhesive silicone is reattachable and reusable. This also prohibits casual and easy donning and doffing, which is linked to a higher risk of user error and contracting diseases. This new user scenario instead is in need of a mirror and sink and the donning and doffing therefor encourages a ritual of adequate hygiene of both hands and respirator. The impact of air travel on the spread of infectious diseases has given rise to considerable concern however limited research. During the early phases of a pandemic, strategies that rely on physical barriers will be more prominent and respiratory protection has been largely overlooked. A generally neglected possible portal of entry for viruses is the conjunctiva. Modern research on nanofibrous filtering material is welcomed news, as well as the aim to provide adequate information to the public in time

To Pandemic or Not? Reconfiguring Global Responses to Influenza

ESR

Cumulative Risk and a Call for Action in Environmental Justice Communities

Health disparities, social inequalities, and environmental injustice cumulatively affect individual and community vulnerability and overall health; yet health researchers, social scientists and environmental scientists generally study them separately. Cumulative risk assessment in poor, racially segregated, economically isolated and medically underserved communities needs to account for their multiple layers of vulnerability, including greater susceptibility, greater exposure, less preparedness to cope, and less ability to recover in the face of exposure. Recommendations for evidence-based action in environmental justice communities include: reducing pollution in communities of highest burden; building on community resources; redressing inequality when doing community-based research; and creating a screening framework to identify communities of greatest risk

Role of Influenza among Adult Respiratory Hospitalizations: a Systemic Review

With the threat of avian influenza, influenza laboratory testing and surveillance capacity has increased globally. Data from global surveillance activities have been used to identify circulating influenza strains for vaccine policy decisions, and have provided evidence of influenza disease among various populations. A recent meta-analysis, which includes findings from these surveillance efforts, has shown that influenza contributes to 10% of pediatric respiratory hospitalizations. Although statistical models indicate a high burden of influenza-associated morbidity among older adults and pandemic studies reveal an increase in hospitalizations among young adults, the global burden of seasonal influenza among adults remains unknown. In order to estimate the global burden of seasonal influenza among adult respiratory hospitalizations, we conducted a systematic review of the published literature, and identified 48 eligible articles published between January 1996 and June 2012 that met our inclusion criteria. We combined these published datasets with 29 eligible, unique datasets from year-round, influenza hospital-based surveillance. These combined data covered 50 countries with varying income and vaccine policies. Extracting numbers tested and positive for influenza, we calculated crude median positive proportions and evaluated potential differences in crude proportions among variables using Kruskal-Wallis non-parametric tests. We observed differences by data source and country development status when we included the 2009 pandemic year. With the exclusion of the 2009 pandemic year, we then generated adjusted pooled estimates using the log binomial model. We found 11% of cases from adult respiratory hospitalizations worldwide were laboratory-confirmed for influenza. This pooled estimate was independent of age but increased as country development or income level decreased. Our findings suggest that influenza is an important contributor to severe acute respiratory illness among both young and older adult populations. For countries without reliable influenza data, we provide an estimate that they may use in planning and allocating resources for the control and prevention of influenza