Tiny - wearable patch makes you invisible to mosquito

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ISDS Webinar: Global Public Health Surveillanc, Governance and Viral Sovereignty

Presenters:  

Affan Shaikh, M.P.H, Senior Epidemiologist, Public Health Practice, LLC 

Scott JN McNabb, Ph.D., M.S., Research Professor, Emory University, Rollins School of Public Health | Managing Partner, Public Health Practice, LLC

Qanta Ahmed, M.D., Attending Sleep Disorders Medicine, Winthrop University Hospital | Associate Professor of Medicine, State University of New York (SUNY) at Stony Brook, New York

Ziad Memish, M.D., Deputy Minister of Public Health, Ministry of Health, Kingdom of Saudi Arabia

Date: Wednesday, August 14, 2013

Time: 3:00 PM - 4:00 PM EDT

Description: Microbes carry no national passports; neither do they recognize geo-political boundaries or state sovereignty. Yet claims of viral sovereignty brings up unresolved controversies that challenge ethical public health governance and add unnecessary risk of global pandemics.  Viral sovereignty refers to a sovereign state's ownership rights over pathogens found within their border.  It was first coined to describe tensions rising from the Indonesian government's decision to conditionally withholding samples of H5N1 avian influenza in early 2007.

While the World Health Organization's (WHO) 2005 revised International Health Regulations (IHR [2005]) provide a global framework to prevent, protect against, control, and facilitate a public health response to the international spread of disease, its success firmly rests on mutual trust and transparency among parties.  Claims of viral sovereignty indicate the critical balance between respecting legitimate national sovereignty and complying with responsible global transparency is far from achieved.

This webinar reviews the origins of viral sovereignty as well as the rights of global health security and responsibilities of transparency required by the IHR (2005) for successful global public health surveillance today.  It points out the critical, current issues and weighs the pros and cons of various options to move forward.

https://www2.gotomeeting.com/register/115066554)

Hosted by the ISDS Global Outreach Committee

Source: http://communityforum.syndromic.org/ 

The Remarkable adaptability of syndromic surveillance to meet public health needs

Article accessed on August 8, 013

 

Link: http://www.sciencedirect.com/science/article/pii/S2210600612000676

 

Journal:

 

Journal of Epidemiology and Global Health

 

Volume 3, Issue 1, March 2013, Pages 41–47

Authors

• Beverley J. Paterson
• David N. Durrheim

Abstract

The goal of syndromic surveillance is the earlier detection of epidemics, allowing a timelier public health response than is possible using traditional surveillance methods. Syndromic surveillance application for public health purposes has changed over time and reflects a dynamic evolution from the collection, interpretation of data with dissemination of data to those who need to act, to a more holistic approach that incorporates response as a core component of the surveillance system. Recent infectious disease threats, such as severe acute respiratory syndrome (SARS), avian influenza (H5N1) and pandemic influenza (H1N1), have all highlighted the need for countries to be rapidly aware of the spread of infectious diseases within a region and across the globe. The International Health Regulations (IHR) obligation to report public health emergencies of international concern has raised the importance of early outbreak detection and response. The emphasis in syndromic surveillance is changing from automated, early alert and detection, to situational awareness and response. Published literature on syndromic surveillance reflects the changing nature of public health threats and responses. Syndromic surveillance has demonstrated a remarkable ability to adapt to rapidly shifting public health needs. This adaptability makes it a highly relevant public health tool.

Keywords

• Syndromic surveillance;
• Outbreaks;
• International Health Regulations;
• Infectious diseases;
• Public health

Risk Map of Cholera Infection for Vaccine Deployment: The Eastern Kolkotta Case

Posted on 3 August 2013 by David Curry

Link: http://centerforvaccineethicsandpolicy.net/

PLoS One
[Accessed 3 August 2013]
http://www.plosone.org/

Research Article

Risk Map of Cholera Infection for Vaccine Deployment: The Eastern Kolkata Case
Young Ae You, Mohammad Ali, Suman Kanungo, Binod Sah, Byomkesh Manna, Mahesh Puri, G. Balakrish Nair, Sujit Kumar Bhattacharya, Matteo Convertino, Jacqueline L. Deen, Anna Lena Lopez, Thomas F. Wierzba, John Clemens, Dipika Sur
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0071173

Abstract

Background
Despite advancement of our knowledge, cholera remains a public health concern. During March-April 2010, a large cholera outbreak afflicted the eastern part of Kolkata, India. The quantification of importance of socio-environmental factors in the risk of cholera, and the calculation of the risk is fundamental for deploying vaccination strategies. Here we investigate socio-environmental characteristics between high and low risk areas as well as the potential impact of vaccination on the spatial occurrence of the disease.

Methods and Findings
The study area comprised three wards of Kolkata Municipal Corporation. A mass cholera vaccination campaign was conducted in mid-2006 as the part of a clinical trial. Cholera cases and data of the trial to identify high risk areas for cholera were analyzed. We used a generalized additive model (GAM) to detect risk areas, and to evaluate the importance of socio-environmental characteristics between high and low risk areas. During the one-year pre-vaccination and two-year post-vaccination periods, 95 and 183 cholera cases were detected in 111,882 and 121,827 study participants, respectively. The GAM model predicts that high risk areas in the west part of the study area where the outbreak largely occurred. High risk areas in both periods were characterized by poor people, use of unsafe water, and proximity to canals used as the main drainage for rain and waste water. Cholera vaccine uptake was significantly lower in the high risk areas compared to low risk areas.

Conclusion
The study shows that even a parsimonious model like GAM predicts high risk areas where cholera outbreaks largely occurred. This is useful for indicating where interventions would be effective in controlling the disease risk. Data showed that vaccination decreased the risk of infection. Overall, the GAM-based risk map is useful for policymakers, especially those from countries where cholera remains to be endemic with periodic outbreaks.

Citation: You YA, Ali M, Kanungo S, Sah B, Manna B, et al. (2013) Risk Map of Cholera Infection for Vaccine Deployment: The Eastern Kolkata Case. PLoS ONE 8(8): e71173. doi:10.1371/journal.pone.0071173

Editor: Matteo Convertino, University of Florida, United States of America

Received: April 11, 2013; Accepted: June 25, 2013; Published: August 2, 2013

Funding: This study is supported by the Bill & Melinda Gates Foundation through the Diseases of the Most Impoverished Program and the Cholera Vaccine Initiative. Additional funding is provided by the Swedish International Development Cooperation Agency and the Governments of South Korea, Sweden, and Kuwait. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Measles like illness outbreak in Upper Mustang, Nepal

Science and Technology Conference 2009, Huachiew Chalermprakiet University, Thailand; 10/2009

ABSTRACT

Background: Since 2004, there have been increasing reports of rubella outbreaks in Nepal, through the Vaccine Preventable Diseases (VPDs) surveillance network. This report details an investigation of a suspected “measles-like illness” outbreak in Mustang, a remote and hard to reach Himalayan district in the Western part of Nepal.

Methods: The Mustang District Rapid Response Team (RRT) investigated the outbreak in Chhonup and Lomanthang villages in Mustang, beginning on the 17th of June 2008, following the standard measles outbreak investigation guidelines. Blood samples were collected from seven children within 4 to 28 days of rash onset. All the samples were tested for both measles and rubella IgM antibodies in the National Public Health Laboratory (NPHL) in Kathmandu, Nepal

Results: Forty-eight cases were detected at the time of the investigation. There were two waves in the outbreak. The first occurred at the beginning of April, and the second from mid-May to mid-June. The primary attack rates were 1% and 4% in Lomanthang and Chhonup respectively. The primary attack rates were highest in the 1 – 9 year old population. No deaths in children with measles-like illness were reported from either village during this investigation. All children found with measles-like illness had been immunized against measles. All 7 serum samples were confirmed to be IgM positive for anti-rubella. The remaining 41 cases with measles like illness were considered epidemiologically linked to these laboratory-confirmed cases, and classified as rubella.

Conclusion: Since there is no vaccination against rubella in Nepal, the number of rubella susceptible individuals in the population has increased. Once the virus was introduced into the community, it spread very quickly and affected many susceptible individuals. It is highly recommended that rubella vaccinations be included in the National Immunization Programme (NIP) of Nepal.

Chhonup Village

 

Dengue Outbreak in Honduras

2010

Death =  83
Illness = > 66000

2013

Death    = 16
Illness   = 12000

 

Link:
http://abcnews.go.com/International/wireStory/honduras-declares-emergency-dengue-kills-16-19822037

Revisiting Cholera Outbreak in Jajarkot, Nepal, 2009

In 2009, it took around two months before the health authorities and public knew the acute watery diarrhea (AWD) outbreak in hilly districts of Mid Western region of Nepal as cholera. That year, > 15,000 people were affected and > 200 people lost their life. There were joint Government of Nepal (GON), UNICEF and other organizations for implementation of medical and behavioral control activities. This incident demands acute need for enhanced surveillance, hygiene and sanitation promotion and selective vaccination in a high risk, remote area of the country.
 
Risk factors: In general, illiteracy and poverty are risk factors for cholera, as any other infectious diseases outbreaks in remote areas. We can add, this is further compounded by combination of following reasons:

1.     Poor or difficult access to source of drinking water

2.     Water and food contamination during monsoon due to sanitation runoff and flooding disrupting everyday life exposing community to all possible infectious diseases

3.     Poor hygiene practices like hand washing after cleaning of dirt or waste / working in the field or defecation. This may be due to poor knowledge on disease causation or simply no supplies (e.g. soap)

4.     No latrines / open defaecation – this is general picture in hard to reach areas of the country.

5.     Poor access to health care, which is geographically remote from most people. Even if there is health centre in the vicinity, there can be a situation when there is lack of health personnel and medicines.

Challenges:

1.     Geography - remote with little road access and probably limited or no electricity there. These challenges make it an important to be innovative, but it is not impossible carry out preventive measures provided we have combination of dedicated staffs / leadership with adequate resources. 

2.     Carry out effective as well as put sustainable surveillance system in place throughout country with focus to reach hard to reach areas. This demands trained health staffs and budget, which is greater challenge for low income countries.

A Short Note on Diseases Surveillance in Nepal

In 1996, the Government of Nepal, Ministry of Health (GoN, MoH) first launched Early Warning and Reporting System (in short EWARS) for hospital-based sentinel surveillance of six diseases: three vaccine-preventable diseases or VPDs (polio, measles and neonatal tetanus or NNT) and three vector-borne diseases - malaria, kala-azar (KA), and Japanese Encephalitis (JE). For which the implementing agency is the Epidemiology and Disease Control Division (EDCD) of the MOH. The primary goal as any surveillance system was designed to provide more timely information to the decision makers to facilitate early response. All hospitals that comes under EWARS are expected to report every week on the number of cases and/or deaths (including “zero” reports) of the six priority diseases (1). However, there remain various challenges which hinder the completeness and timeliness of the reports. We can discuss on this further.

 

The major milestone in the history of public health arena in Nepal would be the introduction of acute flaccid paralysis (AFP) for the eradication of poliomyelitis since 1996. As Nepal was signatory in the Global Polio Eradication Initiative (GPEI), Polio Eradication Nepal (PEN) - surveillance and support team was established in June 1998 by the Ministry of Health and Population in collaboration with technical support from World Health Organization, Nepal. PEN was later re-named Program for Immunization Preventable Diseases (IPD) because activities were expanded to include surveillance for other vaccine preventable diseases such as measles, neonatal tetanus, and Japanese Encephalitis(2). Currently, along with these Vaccine Preventable Diseases (VPDs), are added other infectious diseases of public health importance e.g., rubella.
In addition, there also exists system of data collection known as Health Management Information Reporting System (HMIS). In this reporting system, various illnesses as well as utilization of health services are reported from every village to districts and then to the central level on monthly basis.
Having said that there exist disease surveillance structure in place, there are astronomical challenges to be solved and taken it in right course.

• Leadership / Ownership: Unstable political situation, frequent changes in the state government leadership and reshuffling of government key position in parallel, and their changing priority affects public health system as a whole.
• Policy: Though disease surveillance recognized an important component of public health system at policy level, there are weakness in its implementation due to various reasons like
  • Leadership - weakness
  • Advocacy - weakness
  • Too much dependent on external funding, lacking government ownership
  • Lack of trained human resource
  • Poor infrastructure and network to carry out laboratory surveillance
  • Sample transportation problems (esp. a tremendous challenge in Nepal)

References:

1. Pyle DF, Nath LM, Shrestha BL, Sharma A, Koirala S. Assessment of Early Warning and Reporting Systems (EWARS) in NEPAL. 2004; Available from: http://www.ehproject.org/PDF/Activity_Reports/AR-126%20EWARS-ASSESS....
2. Field Guide for Surveillance of Vaccine Preventable Diseases (VPDs). 2010; Available from: http://www.nep.searo.who.int/LinkFiles/Guidelines_VPD_Field_Guide_2....

WHO: Global policy on the prevention and control of viral hepatitis

World Health Organization
Number of pages: 220
Publication date: July 2013
Languages: English
ISBN: 978 92 4 156463 2


The periodic evaluation of implementation of the WHO strategy requires an initial baseline survey of all Member States. In mid-2012, WHO, in collaboration with the World Hepatitis Alliance, conducted such a survey, asking Member States to provide information relating to the four axes of the WHO strategy. In particular, Member States were asked whether key prevention and control activities are being conducted. This report presents the results.

The first chapter provides an introduction to viral hepatitis and to the global response to this group of diseases. The second chapter provides a global overview of the survey findings. Chapters three through eight present findings from the six WHO regions, including summaries of data from all responding countries. Additional survey data, study methodology information and the survey instrument can be found in Annexes A–E.

Link:

http://apps.who.int/iris/bitstream/10665/85397/1/9789241564632_eng.pdf


Source:

http://centerforvaccineethicsandpolicy.net/2013/07/28/who-global-policy-report-on-the-prevention-and-control-of-viral-hepatitis/

Webinar - Syndromic surveillance in animal health: public, animal and food safety

IF anyone is interested to participate in a webinar organized by International Society for Disease Surveillance (ISDS) link: http://www.syndromic.org/

Title: Syndromic surveillance in animal health: public, animal and food safety

Panelists:
Anne Bronner, Anses, Laboratoire de Lyon, Unité Epidémiologie
Céline Dupuy, Anses, Laboratoire de Lyon, Unité Epidémiologie
Jean-Baptiste Perrin, Anses, Laboratoire de Lyon, Unité Epidémiologie
Fernanda Dórea, Swedish Zoonosis Centre, National Veterinary Institute (SVA)

Early detection of diseases in animal populations is key to protecting the health of companion animals and livestock. Safeguarding the health of animals aims at protecting human populations from diseases that are transmissible from animals to humans (zoonotic diseases), guaranteeing the safety of food products, and avoiding economical losses and food supply shortages due to loss of livestock. In this webinar speakers will discuss the current situation of syndromic surveillance in animal health, highlighting the challenges of dealing with animal health data in light of the current development of this field in public health. Examples of successful systems in North America and Europe will be discussed.

Registration:
https://www2.gotomeeting.com/register/341204498

Time and date: (duration - 1 and 1/2 hrs)

Location	Local time	Time zone	UTC offset
New York (U.S.A. - New York)	Tuesday, 30 July 2013, 10:30:00	EDT	UTC-4 hours
Seoul (South Korea)	Tuesday, 30 July 2013, 23:30:00	KST	UTC+9 hours
Bhubaneshwar (India - Orissa)	Tuesday, 30 July 2013, 20:00:00	IST	UTC+5:30 hours
Kathmandu (Nepal)	Tuesday, 30 July 2013, 20:15:00	NPT	UTC+5:45 hours
Bangkok (Thailand)	Tuesday, 30 July 2013, 21:30:00	ICT	UTC+7 hours
Karachi (Pakistan)	Tuesday, 30 July 2013, 19:30:00	PKT	UTC+5 hours
Yangon (Myanmar)	Tuesday, 30 July 2013, 21:00:00	MMT	UTC+6:30 hours

Thinking about being a scientist

One fine day, there was a discussion and somebody out of blue raised a question regarding cross-protection between the infections caused by the two serogroups of V. cholerae. For me, uhmm... my neo cortex started getting alert to understand what it means, so I began to ask myself what is this cross protection in its literal meaning? then another question followed, what does it mean in terms of immunological explanation? While the discussion started with facts, opinions and so on, I was struggling to recall my undergraduate basics and make sure that my understainding on biotype, serogroup and serotype is correct before I blurt out "non sense". At this moment, I vividly remembered somebody saying, " hey, if you claim yourself to be a scientist or have a responsibility to carry out duty as a scientist, remember that basics ( in our cases, on V. cholerae) must be at tip of your tongue."  I agree 100 % with what he said. This few anecdotes that I have come across that I remeber and ever since, I have been haunted with 2 questions :

1. Who are considered a scientist?
2. What are the qualities that need to be in a scientist?

Now, let us try to explore the first question. Before entering in the field of scientific world, I was of the impression that scientists are supposed to be with thick glass, bald and of course, always in the lab or buried in the pages that is filled with equations or looking into deeper sky or ocean. Now, I am questioning the very notion of understanding, who are scientists? Am I being too skeptical. May be "Yes", may be "Not".  So, I googled this "great" word [great because scientists are considered great people in the society, so the word "scientist"also must be great / strong :)] for it straight forward meaning. First thing first, I came to know this word to be a 'noun" and its meaning as, "A person who is studying or has expert knowledge of one or more of the natural or physical sciences." So, I asked myself, "Do I fulfill the quality to be called as a scientist?" Uhmm..the answer lies within me, whether I accepted the meaning or not. But one thing I can assure you that I asserted on working hard to do justice to its meaning.
                                                 
                                                               Serogroup  Serotype   Biotype

##  Serogroup is was characterized by the presence of a capsule and a modified lipopolysaccharide.
## The serogroup O1 V. cholerae is subdivided into two serotypes based on specific antigens in the O antigen: Ogawa and Inaba. V. cholerae O1 is also divided into two biotypes based on biochemical reactions: classical and El Tor.

 

On writing: just a thought

I have always wanted to write a paper and get it published in a renowned journal. Here, I want to talk about one article that got published in an international journal. It is about the spread of Japanese encephalitis in hilly districts of Nepal. While starting to write the paper, I had to struggle for a whole year. I was motivated to write it but I felt the need for a coaching on writing the paper. So, I approached Dr. Jeff for his advices on writing it well. I found him inspirational and guided me providing useful tips and reviewed the paper till it got published. I miss person like him, who can guide and mentor on writing academic paper. Now, it has been about 2 years that I have not been able to publish a good paper in a good journal except poster presentation in conferences and be satisfied with it. There are some major setbacks that I have found within myself which has hindered from writing a paper. I am trying to sort it out. Let me see how it progresses. While trying to understand what can be barrier to writing down your ideas / thoughts, however absurd it may be, some of the reason could be as follows:

1.       1 % inspiration, 99 % perspiration: Somebody said so. It is true. If somebody says that he can't write saying language is a barrier or this and that in order to get excuse for not writing. It is simply complacency for not writing or in other word, procrastination. So, it can be said that complacency is the greatest enemy getting things done so even writing.

2.       Cultural link: Uhmm……….There may be some truth in saying that there is some cultural link. Some may agree, others equally disagree. I am of the opinion that it plays some role in our part of the world. If I am from a family of higher social strata, it is most likely that I am going to be well versed in Sanskrit text or "Slokas" or English (why?..this another area of discourse..) so, there is every likely that I will excel in education. While from a poor or disadvanted family, there is every possibility that s/he may drop out early from school because of various reasons (why?..this also another area of discourse..). Even if you rise up the social ladder, you have to struggle lot so you will have ample time to write and get your work get published. I can give lots of example for this.

• Reading and writing culture: What does it mean is lack of reading and writing culture in developing countries compared to western developed countries can be one reason (exceptions are there). I think many of us believe this arguement though it may sound flimsy for some of you.
 
• Hierarchical culture: If you dissect historical, cultural and religious facts in low income countries like Nepal, I have to say that hierarchical culture is hindrance to the spread of equal opportunity for people.  But, on the contrary, we still observe social practices that is keep certain community of people away from mainstream social benefit like education.
 

3.       Peer groups / academic clubs:  I find influence of social network or academic circle to be an important reason. Let me put this way - If you are in close circle of obese friends, it is said that there is a likelihood that you are also going to be obese over a period of time. So, the same analogy can be applied to writing and publishing paper. If there is a culture of regular discussion at journal club or debate at debate house, then there is every possibility that your mind will get ignited with some idea or concept at some point of time, which compels you to write and share your idea among your colleagues. Who knows, that simple idea could turn to be a landmark paper, if well written.
 

4.       Mentorship / coaching: Another important reason can be lack of formal mentoring to learn through guidance, somewhat like apprenticeship or internship. Although, there used to be a system of teacher and student (Guru and Chela) in Vedic period in Mah Bharat region, it was meant only for people of certain origin, whereas major proportion of population was ignored from this opportunity.  Now, this proportion of people kept away from formal or informal education, may be decreasing, but there are still millions of people, who are unfortunate to get the opportunity of proper education.

These are my general  and personal statement. There may be many counter - guments against what I am saying and I may be wrong, too. These points are based on my personal experiences in the area, where I was brought up and the kind of schooling that I received. To elaborate a bit more on the kind of education that we recieved. ow, I realize, our education was based primarily on memorizing rather than focus on comprehension of the subject. I never felt, there was importance given to improve reading, writing and comprehension skills. I also want to share that there was no proper library till we completed class 12. Because of poor education in government school, many parents were bound to send their children in missionary school or private boarding schools. I have many stories to share on how we learnt English, why was it necessary?  What are the difficulties if English is your 3^rd or 4^th language? How difficult is it to express your ideas, thoughts or concepts in English?  What is linguistic gap? I leave all these entire questions for others to ponder and share their opinion, while I will try to answer in my next post.

Paradox

“As the dew is dried up by the morning sun, / So are mankind’s sins at the sight of Himalaya,” read the Puranas. That was before global travel reached the remotest peaks and before climate change threatened the glaciers. And that was when artists painted Vaishnavi as an idealized form without evidence of muscle or bone.

"Now, HIV-infected sex-trafficked women and girls from Nepal are more likely than those not infected to also have syphilis and hepatitis B. In one of her many manifestations, Vaishnavi protected her devotees from fear and gave them peace. The task now falls on global public health and its multiple hands."

Link:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600303/ 

## I happen to google searching for emerging diseases in Nepal. I came across Emerg Infect Dis. 2008 June; 14(6): 1009–1010. In the front page, there was the picture of Vaishnavi, a Hindu deity. Reading through the page, it writes on a rich historical past of Himalayan kingdom and also, talks about the natural beauty blended with rich artistic Newari culture. Such was Nepal, the birthplace for Budhism, which is philosophy that preach equality and moral ethics that is relevant now more than ever. It was also a melting pot for various religious thoughts like Hinduism and Jainism to co - exist in continious intellectual dialogue and discourse searching for the meaning of life in simplicity

 ## But now, it is sad to read in this prestigious scientific paper, the flight of poor women from village especially of untouchables and other underpriviledged community, who are being sold to sex brothels in cities inside and outside of country. There are many reasons, why this is happening. If I go into that area of discourse, I will be emotional rather than rationale in my writing. So, I will not touch upon that. However, it is now important for Nepalese and Indian government to act tough on human trafficking. Just take, physical health issues apart from  psycho - social effects, it has brought upon our society, this has cost us huge amount of health budget in caring them. Bitter truth is that most of them, who dare to come back home escaping brutality, come with HIV / Hep B or Hep C infection only to die in Nepal rather in sex den, where they are treated not even like a dog. Atleast a dog can bark, when it prefers to and loiter around the city free !!
 

Dengue in India

Link:

http://www.ijmr.org.in/temp/IndianJMedRes1363373-7640544_211325.pdf
 

Key facts: Cholera

Key facts

• Cholera is an acute diarrhoeal disease that can kill within hours if left untreated.
• There are an estimated 3–5 million cholera cases and 100 000–120 000 deaths due to cholera every year.
• Up to 80% of cases can be successfully treated with oral rehydration salts.
• Effective control measures rely on prevention, preparedness and response.
• Provision of safe water and sanitation is critical in reducing the impact of cholera and other waterborne diseases.
• Oral cholera vaccines are considered an additional means to control cholera, but should not replace conventional control measures.

Reference:
http://www.who.int/mediacentre/factsheets/fs107/en/

Cholera vaccine: A brief summary of March 2010 Position paper

Link: http://www.who.int/immunization/Cholera_PP_Accomp_letter__Mar_10_2010.pdf

 

Correlated infections

Farrington CP, Whitaker HJ, Unkel S, Pebody R. Correlated infections: quantifying individual heterogeneity in the spread of infectious diseases. American Journal of Epidemiology. 2013;177(5):474-486.

Abstract: In this paper, we propose new methods for investigating the extent of heterogeneity in effective contact rates relevant to the transmission of infections. These methods exploit the correlations between ages at infection for different infections within individuals. The methods are developed for serological surveys, which provide accessible individual data on several infections, and are applied to a wide range of infections. We find that childhood infections are often highly correlated within individuals in early childhood, with the correlations persisting into adulthood only for infections sharing a transmission route. We discuss 2 applications of the methods: 1) to making inferences about routes of transmission when these are unknown or uncertain and 2) to estimating epidemiologic parameters such as the basic reproduction number and the critical immunization threshold. Two examples of such applications are presented: elucidating the transmission route of polyomaviruses BK and JC and estimating the basic reproduction number and critical immunization coverage of varicella-zoster infection in Belgium, Italy, Poland, and England and Wales. We speculate that childhood correlations stem from confounding of different transmission routes and represent heterogeneity in childhood circumstances, notably nursery-school attendance. In contrast, it is suggested that correlations in adulthood are route-specific.

Regarding Hepatitis of Infectious Origin

Editorial: A brighter future in the fight against hepatitis Article: Current progress in development of hepatitis C virus vaccines

  

Nature Medicine
July 2013, Volume 19 No 7 pp791-945
http://www.nature.com/nm/journal/v19/n7/index.html

Editorial
A brighter future in the fight against hepatitis
doi:10.1038/nm.3269
Public health and research efforts directed at managing and targeting viral hepatitis have borne fruit in recent decades. However, more work is necessary to meet the goals of preventing transmission and treating infection to eliminate the enormous burden of hepatitis worldwide.
In 2012, the World Health Organization (WHO) established a Global Hepatitis Program with the goal of fully preventing and treating viral hepatitis. This month, the WHO hopes to increase public awareness through the official World Hepatitis Day, on 28 July. In this issue, Nature Medicine features a series of Review and Perspective articles that discuss promising research and clinical efforts and continuing challenges in viral hepatitis.
Hepatitis B virus (HBV) and HCV are primarily responsible for the high global prevalence of hepatitis disease and for the morbidity and mortality associated with chronic infection. A key challenge for the management of hepatitis is its silent progression, as acute hepatic failure rarely occurs. Infection is often asymptomatic, causing liver scarring and damage decades later in up to 30% of people infected with HCV, and the proportion is even higher in those infected with HBV at birth or during early childhood. Inadequate recognition of infection and region-specific variation in prevalence and risk groups hinders diagnosis and precludes timely treatment. The lack of sufficiently widespread antibody screening to identify all exposed individuals and of follow up with RNA testing, a technique not yet available for routine medical use, to distinguish people with active virus, results in incorrect estimates of infection and increased transmission. In the case of hepatitis C, recent human studies showed that less than half of the infected people in the United States knew they carried the virus (Hepatology 55, 1652–1661, 2012), a number that may be higher in areas with limited disease-control tools. Moreover, the harsh side effects of pegylated interferon-α and ribavirin force many infected people to opt out of this standard therapy, contributing to viral persistence in the community and prevalence of chronic disease.
The advent of effective antivirals is changing the therapeutic landscape, and the goal for eradicating hepatitis viruses may not be as distant as it seemed five years ago, high treatment costs notwithstanding. Current antiviral therapies do not cure chronic hepatitis B, which affects about 210 million people worldwide. At the 2013 International Liver Congress, new approaches to eliminate the HBV replication template, which persists inside liver cells, by modulating host processes such as epigenetic mechanisms and hepatocyte regeneration showed promise and may offer the potential of a cure in the future. For HCV, which affects about 150 million individuals worldwide, there have been rapid advances in drugs. Two protease inhibitors approved in 2011 greatly improved responses in patients infected with the predominant genotype 1; however, host genetic variability affecting antiviral efficacy, evolving drug resistance and the lack of coverage to inhibit all existing HCV genotypes are major drawbacks. Also, these new drugs must be given with the standard therapy, which exacerbates side effects. Second-generation antivirals with different viral targets are under development, and combination strategies should improve efficacy and may even eradicate the virus. Although these therapies are promising, resistance may still develop, and monitoring the emergence of resistant variants will be necessary for guiding treatment choices.
An interferon-free therapy for hepatitis C may also soon exist. In April, a triple combination of direct-acting antivirals without interferon showed efficacy in treatment-naive individuals and in nonresponders to standard of care. And in May, four clinical trials tested an inhibitor of viral polymerase, sofosbuvir, in patients infected with HCV (N. Engl. J. Med. 368, 1867–1887, 2013). In combination with ribavirin, sofosbuvir showed increased efficacy against genotypes 2 and 3 compared to both standard of care and placebo, and adding pegylated interferon alpha-2a to the combination achieved broad genotype coverage. Patients with unacceptable side effects to standard therapy or who were unresponsive to previous therapies may therefore benefit from these new approaches. Research on host factors required for the HCV life cycle has also yielded targets that may overcome virus-acquired resistance and circumvent side effects. A recent example is the targeting of microRNA-122, which is liver specific and necessary for viral replication (N. Engl. J. Med. 368, 1685–1694, 2013) Although long-term studies are necessary to address their safety and toxicity in the long run, interferon-free strategies may become the future of hepatitis C therapy.
But the holy grail for eradicating and decreasing the burden of any infectious disease is a prophylactic vaccine. Prevention of infection with the effective HBV vaccines and with improved medical and lifestyle practices has reached impressive levels in developed countries, and continuing efforts to improve testing and implement mass vaccination programs in low-income countries should achieve similar results in these regions. A working vaccine for HCV, however, still remains elusive, in part because of the lack of experimental systems to study the virus and the lack of animal models to test vaccine candidates. Moreover, because this virus has developed mechanisms of persistence and has an enormous genetic diversity, vaccines will need to induce both neutralizing antibodies and T cell–mediated responses to achieve broad, lasting cross-protection. Unraveling how the host immune response clears the virus during the course of natural infection and prevents persistence will help us understand what constitutes protective immunity and provide a rationale to develop an effective pan-genotype vaccine.
The goals of preventing infection, slowing disease progression and curing chronic hepatitis will undoubtedly require continuing research and clinical efforts. Pharmaceutical companies should be encouraged to keep investigating future compounds to overcome the existing therapeutic barriers, and public awareness efforts should be intensified to underscore to funding and public health agencies that, although we are closer, we are still far from achieving the goals proposed to tackle these silent elusive killers.
http://www.nature.com/nm/journal/v19/n7/full/nm.3269.html

Vaccine Preventable Diseases Outbreaks in South Asian countries

Mapping of Vaccine Preventable Diseases (VPDs) outbreaks in Asian region. The map shows many measles outbreaks . This means that measles is still a public health problem. So, various questions can be raised relatedwith the quality of immunization program in those affected areas. If you want details each country of your interest, please refer to the link. Also, questions / thoughts are welcomed. For every reason, there is also another reason.

http://www.cfr.org/interactives/GH_Vaccine_Map/index.html?goback=%2Egde_1868035_member_251194921#map

NyayaHealth, Achham - a center of dedicated staffs

I would like to share this blog that tells the story of NyayaHealth, Achham. I am of the opinion, this hospital has done justice to its name.

Nyaya = justice, which is a rare privilage for people living in hard to areas of any country and in particular, peolpe away from DHQ in these ruaral district of far western developmental region of Nepal in particular suffers a lot from inequalities and lack of access to basic health services. This district also has the highest under 5 children and maternal mortality as any other district with poor developmental index.

http://www.nyayahealth.org/blog/

Application of WHONET for Surveillance of Uropathogens: A First User Experience from Nepal

J Clin Diagn Res. 2013 May;7(5):845-8. doi: 10.7860/JCDR/2013/5193.2955. Epub 2013 May 1.

Application of WHONET in the Antimicrobial Resistance Surveillance of Uropathogens: A First User Experience from Nepal.

Ghosh AN, Bhatta DR, Ansari MT, Tiwari HK, Mathuria JP, Gaur A, Supram HS, Gokhale S.

Source

Department of Microbiology, Gujarat Adani Institute of Medical Sciences (GAIMS), G K General Hospital , Bhuj, Kutch, Gujarat, India - 370001 .

Abstract

Introduction: WHONET is a freely downloadable, Windows-based database software which is used for the management and analysis of microbiology data, with a special focus on the analysis of antimicrobial susceptibility test results. Urinary Tract Infections (UTI) are a common medical problem and they are responsible for notable morbidity among young and sexually active women. Objectives: The major objective of this study was the utilization and application of the WHONET program for the Antimicrobial Resistance (AMR) surveillance of uropathogens. Methods: A total of 3209 urine samples were collected from patients who visited Manipal Teaching Hospital with a clinical suspicion of UTI, during December 2010 to July 2011. The isolation and characterization of the isolates were done by conventional methods. Antimicrobial Susceptibility Testing (AST) was performed by Kirby Bauer's disc diffusion method. The data entry and analysis were done by using the WHONET 5.6 software. Results: Out of the 3209 specimens, 497 bacterial isolates were obtained and they were subjected to AST. Escherichia coli (66.2%) was the commonest bacterial isolate, followed by Enterococcus species (9.3%), Staphylococcus aureus (5.0%), and Klebsiella pneumoniae (4.2%). Among the gram-negative enteric bacilli, a high prevalence of resistance was observed against ampicillin and ciprofloxacin. The gram negative nonfermenters exhibited a high degree of resistance to ceftazidime. Staphylococcus species. showed a moderately high resistance to co-trimoxazole. One isolate was Vancomycin Resistant Enterococci (VRE). Conclusion: This study, a first of its kind which was done in Nepal, was carried out by using the WHONET software to monitor, analyze and share the antimicrobial susceptibility data at various levels. This study was also aimed at building a surveillance network in Nepal, with the National Public Health Laboratory, Nepal, acting as a nodal centre. This would help in the formulation of antibiotic policies and in identifying hospital and community outbreaks at the nodal centre, as well as in sharing information with the clinicians at the local level.