Notifications of Public Health Events under the International Health Regulations - 5 Year U.S. Experience

The U.S. fully implemented the International Health Regulations and submitted 59 potential Public Health Emergencies of International Concern (PHEIC) to WHO since 2007. The 2009 H1N1influenza pandemic, first notified as required notification of a novel strain of influenza by the U.S., is the only event determined to be a PHEIC by WHO to date. The public health impact of information sharing of PHEICs on a secure IHR website or of direct exchanges between trusted IHR National Focal Points is not known. However, a shared platform and assessment tool has facilitated notifications across national borders

Notifications of Public Health Events under the International Health Regulations - 5 Year U.S. Experience

The U.S. fully implemented the International Health Regulations and submitted 59 potential Public Health Emergencies of International Concern (PHEIC) to WHO since 2007. The 2009 H1N1influenza pandemic, first notified as required notification of a novel strain of influenza by the U.S., is the only event determined to be a PHEIC by WHO to date. The public health impact of information sharing of PHEICs on a secure IHR website or of direct exchanges between trusted IHR National Focal Points is not known. However, a shared platform and assessment tool has facilitated notifications across national borders

Bioterrorism training in U.S. emergency medicine residencies: has it changed since 9/11

OBJECTIVES: To assess the change in prevalence of bioterrorism training among emergency medicine (EM) residencies from 1998 to 2005, to characterize current training, and to identify characteristics of programs that have implemented more intensive training methods. METHODS: This was a national cross sectional survey of the 133 U.S. EM residencies participating in the 2005 National Resident Matching Program; comparison with a baseline survey from 1998 was performed. Types of training provided were assessed, and programs using experiential methods were identified. RESULTS: Of 112 programs (84.2%) responding, 98% reported formal training in bioterrorism, increased from 53% (40/76) responding in 1998. In 2005, most programs with bioterrorism training (65%) used at least three methods of instruction, mostly lectures (95%) and disaster drills (80%). Fewer programs used experiential methods such as field exercises or bioterrorism-specific rotations (35% and 13%, respectively). Compared with other programs, residency programs with more complex, experiential methods were more likely to teach bioterrorism-related topics at least twice a year (83% vs. 59%; p = 0.018), to teach at least three topics (60% vs. 40%; p = 0.02), and to report funding for bioterrorism research and education (74% vs. 45%; p = 0.007). Experiential and nonexperiential programs were similar in program type (university or nonuniversity), length of program, number of residents, geographic location, and urban or rural setting. CONCLUSIONS: Training of EM residents in bioterrorism preparedness has increased markedly since 1998. However, training is often of low intensity, relying mainly on nonexperiential instruction such as lectures. Although current recommendations are that training in bioterrorism include experiential learning experiences, the authors found the rate of these experiences to be low

Nowcasting the Spread of Chikungunya Virus in the Americas

<div><p>Background</p><p>In December 2013, the first locally-acquired chikungunya virus (CHIKV) infections in the Americas were reported in the Caribbean. As of May 16, 55,992 cases had been reported and the outbreak was still spreading. Identification of newly affected locations is paramount to intervention activities, but challenging due to limitations of current data on the outbreak and on CHIKV transmission. We developed models to make probabilistic predictions of spread based on current data considering these limitations.</p><p>Methods and Findings</p><p>Branching process models capturing travel patterns, local infection prevalence, climate dependent transmission factors, and associated uncertainty estimates were developed to predict probable locations for the arrival of CHIKV-infected travelers and for the initiation of local transmission. Many international cities and areas close to where transmission has already occurred were likely to have received infected travelers. Of the ten locations predicted to be the most likely locations for introduced CHIKV transmission in the first four months of the outbreak, eight had reported local cases by the end of April. Eight additional locations were likely to have had introduction leading to local transmission in April, but with substantial uncertainty.</p><p>Conclusions</p><p>Branching process models can characterize the risk of CHIKV introduction and spread during the ongoing outbreak. Local transmission of CHIKV is currently likely in several Caribbean locations and possible, though uncertain, for other locations in the continental United States, Central America, and South America. This modeling framework may also be useful for other outbreaks where the risk of pathogen spread over heterogeneous transportation networks must be rapidly assessed on the basis of limited information.</p></div

Exportations of Symptomatic Cases of MERS-CoV Infection to Countries outside the Middle East

In 2012, an outbreak of infection with Middle East respiratory syndrome coronavirus (MERS-CoV), was detected in the Arabian Peninsula. Modeling can produce estimates of the expected annual number of symptomatic cases of MERS-CoV infection exported and the likelihood of exportation from source countries in the Middle East to countries outside the region

Probability of chikungunya virus importation for select locations, April 2014.

<p>Location-specific mean estimates (points) and 95% percentiles (lines) for the predicted probability of the arrival of at least one chikungunya infected traveler for the 50 locations most likely to have had imported cases in April. USVI: U.S. Virgin Islands.</p