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1.
Annals of the Academy of Medicine, Singapore ; : 477-481, 2008.
Article in English | WPRIM | ID: wpr-358787

ABSTRACT

Global public health security is both a collective aspiration and a mutual responsibility that demands cooperative action at all levels. The expansion of the current H5N1 avian influenza enzootic and its incursion into human health presents a real and significant threat of an influenza pandemic. The world has for the first time an unprecedented opportunity for pandemic preparation. Current global efforts to tackle the H5N1 pandemic threat are centred around the framework of the International Health Regulations (2005) that requires countries to openly share disease intelligence including clinical samples, viruses and epidemiological information. Present international initiatives also seek to establish more equitable allocation and sharing mechanisms for developing countries, of therapeutic resources, public health interventions and other broad-based support in the event of a pandemic. To be sustainable, country preparatory efforts need to be integrated within wider national emergency preparedness frameworks and emphasise the strengthening of basic capacities in disease surveillance, outbreak response and health systems that can respond to a range of public health emergencies. Such capacity building represents permanent investments in health that will have enduring benefits beyond a pandemic. Preparations must also go beyond the health sector; greater promotion of intersectoral cooperation and an adoption of a whole-of-society approach to preparation is recommended. Broad collaboration is vital in addressing the complex challenge posed by influenza to our collective security.


Subject(s)
Animals , Humans , Birds , Communicable Disease Control , Methods , Global Health , Health Planning , Influenza A Virus, H5N1 Subtype , Influenza in Birds , Epidemiology , Virology , Public Health
2.
Annals of the Academy of Medicine, Singapore ; : 783-789, 2006.
Article in English | WPRIM | ID: wpr-275265

ABSTRACT

<p><b>INTRODUCTION</b>Dengue is a major public health problem in Singapore. Age-specific dengue morbidity rates are highest in the young adult population, unlike in many other Southeast Asian countries where dengue is mainly a paediatric disease. Hence, the World Health Organization (WHO) guidelines on dengue diagnosis and management which were developed using the paediatric experiences, may not be suitable for the management of adult dengue infections.</p><p><b>MATERIALS AND METHODS</b>The Early DENgue (EDEN) infection and outcome study is a collaborative longitudinal study to investigate epidemiological, clinical, viral and host-specific features of early dengue-infected adults, in an effort to identify new early markers for prognostication. Patients presenting with early undifferentiated fever were included in the study. We carried out an interim analysis to look for early indicators of severe disease.</p><p><b>RESULTS</b>During the period of this interim study analysis, 455 febrile patients were recruited. Of these, 133 were confirmed as acute dengue cases based on dengue-specific polymerase chain reaction (PCR) results. There were significant clinical and epidemiological differences between dengue and febrile non-dengue cases. Nine per cent of the dengue cases experienced persistent tiredness, drowsiness and loss of appetite beyond 3 weeks of illness. Quantitation of viral loads using the crossover (Ct) value of real-time RT-PCR correlated with the duration of symptoms. More than half of both primary and secondary dengue cases were hospitalised. There was no dengue-related mortality in this study.</p><p><b>CONCLUSION</b>The duration of illness and prolonged symptom duration in 9% of the subjects indicate that the burden of dengue illness is substantially different from other non-dengue febrile illness in our study cohort. Our study also highlights the paucity of early prognostic markers for dengue fever in adults.</p>


Subject(s)
Adult , Female , Humans , Male , Antibodies, Viral , Dengue , Diagnosis , Epidemiology , Virology , Dengue Virus , Genetics , Allergy and Immunology , Enzyme-Linked Immunosorbent Assay , Follow-Up Studies , Morbidity , Prognosis , RNA, Viral , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction , Singapore , Epidemiology
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