Global Mortality Estimates for the 2009 Influenza Pandemic from the GLaMOR Project: A Modeling Study

Background: Assessing the mortality impact of the 2009 influenza A H1N1 virus (H1N1pdm09) is essential for optimizing public health responses to future pandemics. The World Health Organization reported 18,631 laboratory-confirmed pandemic deaths, but the total pandemic mortality burden was substantially higher. We estimated the 2009 pandemic mortality burden through statistical modeling of mortality data from multiple countries. Methods and Findings: We obtained weekly virology and underlying cause-of-death mortality time series for 2005–2009 for 20 countries covering ~35% of the world population. We applied a multivariate linear regression model to estimate pandemic respiratory mortality in each collaborating country. We then used these results plus ten country indicators in a multiple imputation model to project the mortality burden in all world countries. Between 123,000 and 203,000 pandemic respiratory deaths were estimated globally for the last 9 mo of 2009. The majority (62%–85%) were attributed to persons under 65 y of age. We observed a striking regional heterogeneity, with almost 20-fold higher mortality in some countries in the Americas than in Europe. The model attributed 148,000–249,000 respiratory deaths to influenza in an average pre-pandemic season, with only 19% in person

Should there be a standardised approach to the diagnostic workup of suspected adult encephalitis? a case series from Australia

<p>Abstract</p> <p>Background</p> <p>The clinical diagnosis of encephalitis is often difficult and identification of a causative organism is infrequent. The encephalitis syndrome may herald the emergence of novel pathogens with outbreak potential. Individual treatment and an effective public health response rely on identifying a specific pathogen. In Australia there have been no studies to try to improve the identification rate of encephalitis pathogens. This study aims to review the diagnostic assessment of adult suspected encephalitis cases.</p> <p>Methods</p> <p>A retrospective clinical audit was performed, of all adult encephalitis presentations between July 1998 and December 2007 to the three hospitals with adult neurological services in the Hunter New England area, northern New South Wales, Australia. Case notes were examined for evidence of relevant history taking, clinical features, physical examination, laboratory and neuroradiology investigations, and outcomes.</p> <p>Results</p> <p>A total of 74 cases were included in the case series. Amongst suspected encephalitis cases, presenting symptoms and signs included fever (77.0%), headache (62.1%), altered consciousness (63.5%), lethargy (32.4%), seizures (25.7%), focal neurological deficits (31.1%) and photophobia (17.6%). The most common diagnostic laboratory test performed was cerebrospinal fluid (CSF) analysis (n = 67, 91%). Herpes virus polymerase chain reaction (n = 53, 71.6%) and cryptococcal antigen (n = 46, 62.2%) were the antigenic tests most regularly performed on CSF. Neuroradiological procedures employed were computerized tomographic brain scanning (n = 68, 91.9%) and magnetic resonance imaging of the brain (n = 35, 47.3%). Thirty-five patients (47.3%) had electroencephalograms. The treating clinicians suspected a specific causative organism in 14/74 cases (18.9%), of which nine (12.1%) were confirmed by laboratory testing.</p> <p>Conclusions</p> <p>The diagnostic assessment of patients with suspected encephalitis was not standardised. Appropriate assessment is necessary to exclude treatable agents and identify pathogens warranting public health interventions, such as those transmitted by mosquitoes and those that are vaccine preventable. An algorithm and guidelines for the diagnostic workup of encephalitis cases would assist in optimising laboratory testing so that clinical management can be best tailored to the pathogen, and appropriate public health measures implemented.</p

The Neoarchaean Limpopo Orogeny: exhumation and regional-scale gravitational crustal overturn driven by a granulite diapir

Integrated geological, geochronological and geophysical data from the Neoarchaean Limpopo Complex (LC) and adjacent granite-greenstone terrane of the Northern Kaapvaal Craton (NKVC) demonstrates the following three key features. (1) The LC-NKVC tectonic boundary defined by the Hout River Shear Zone (HRSZ) played a fundamental role in establishing high-grade metamorphic domains in the Southern Marginal Zone (SMZ) of the LC. These domains are characterized by their specific retrograde P-T evolution, (2) Near-isobaric southward thrusting of a hot allochthonous SMZ nappe with imbedded steeply plunging folds and steep shear zones against and over the NKVC along the HRSZ before ca. 2.68 Ga occurred as a consequence of steep exhumation within the Central Zone (CZ) at 2.72–2.62 Ga. (3) Initial exhumation of the CZ to mid-crustal levels before ca. 2.68 Ga was associated with isoclinal folding and melt-weakened domes and directed the southwards channelling of the hot nappe. Final exhumation of the CZ to the upper crust at 2.65–2.62 Ga was driven by granitic diapirism and the 32 formation of shear-related, mega-scale closed structures. These features favour an intracrustal Neoarchaean Limpopo orogeny as the result of a granulite diapir triggered by mantle heat-fluid flow underneath the CZ at 2.72–2.62 Ga. The data is neither compatible with continent collisional models nor with an Archean accretionary orogen along the northern edge of the Kaapvaal Craton that is linked to the collision of the Pietersburg Block with the C