Monkeypox Virus and Other Emerging Outbreaks: An Overview and Future Perspective.

Monkeypox (MPX) is a zoonotic disease caused by the MPX virus from the poxviridae family of orthopoxviruses. Typically, endemic in central and west Africa, it has now become a matter of concern since cases have been reported in non-endemic countries around mid-June 2022, especially in the European region, with the transmission not related to travel. The diagnosis is made by PCR testing of the skin lesions. Even though treatment is symptomatic, antiretrovirals, such as tecovirimat, are used in severe cases. Vaccination with second and third generation vaccines is approved for prophylaxis in high risk individuals. Unfortunately, these options of treatment and prevention are only available in high income countries at the moment. This review, through a thorough literature search of articles from 2017 onward, focuses on epidemiology, clinical manifestations, challenges, treatment, prevention and control of MPX virus and how they can be corelated with other viral outbreaks including COVID-19, Acute Hepatitis of unknown origin, Measles and Dengue, to better predict and therefore prevent its transmission. The previous COVID-19 pandemic increased the disease burden on healthcare infrastructure of low-middle income countries, therefore, this recent MPX outbreak calls for a joint effort from healthcare authorities, political figures, and NGOs to combat the disease and prevent its further spread not only in high income but also in middle- and low-income countries.

COVID-19 vaccine hesitancy in conflict zones: A review of current literature.

Background: Vaccine hesitancy (VH) is prevalent in conflict zones due to a lack of essential resources and knowledge, thereby escalating the coronavirus disease of 2019 (COVID-19) cases in these territories. This has resulted in a higher incidence of cases from exposure to a single COVID-19 positive case and further burdens the health care system of conflict zones which are already on the brink of collapsing. Aim: This narrative review aims to determine VH to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in five conflict zones that include Somalia, Yemen, Palestine, Syria, and Afghanistan. Methodology: A Boolean search was carried out in MEDLINE-PubMed from inception till 6 June 2022. The search was performed by using the following keywords: "(SARS-CoV-2 OR covid OR covid 19) AND (vaccine hesitancy OR covid vaccine acceptance OR intention to vaccinate) AND (Syria OR Yemen OR Palestine OR Afghanistan OR Somalia"). The full text of all relevant articles in English along with their supplementary material was extracted. Results: All the included studies reported at least 30% or more increase in vaccine hesitancy among conflict settings. VH was mostly due to a lack of available resources, lack of appropriate knowledge, and believing misleading rumors about the vaccine. Discussion: Considering the massive amount of reluctance among people residing in conflict zones, the need to take effective measures against VH is undoubtedly apparent. This can be accomplished by carrying out mass vaccinations by the governments and proper health education through raising the public awareness regarding vaccines, thereby eliminating rumors that exacerbate the fear of adverse effects. Conclusion: The approach described in this article to combat VH can be implemented to increase vaccination rates and significantly alleviate R0 across the globe.

What has been learned about COVID-19 vaccine hesitancy in Pakistan: Insights from a narrative review.

Background: Vaccine hesitancy is not a new phenomenon to Pakistan. This is evidenced through the slow progress of previous vaccination campaigns and programs against MMR, BCG, and especially polio. This issue continues to persist and is therefore becoming the cause of low COVID-19 vaccination rates in Pakistan. Aim: To provide insights about COVID-19 vaccine hesitancy among Pakistanis, and its potential harm on public health. Moreover, we aim provide recommendations to counter the factors limiting the COVID-19 vaccination in Pakistan. Methodology: A Boolean search was conducted to find the literature in MEDLINE-PubMed, Google Scholar, and Clinicaltrials.gov databases up till March 16, 2022. Specific keywords were used which comprised of "SARS-CoV-2," "COVID-19," "vaccine hesitancy," "vaccine acceptance," "intention to vaccinate," and "Pakistan," with use of "OR" and "AND." Only free full-text original studies in English language were used to compare and contrast. Results: As proven by various studies, COVID-19 vaccination rates are influenced by multiple factors, including inaccurate beliefs about COVID-19, hesitancy amongst healthcare workers, uncertainty regarding vaccine's efficacy and fear of side effects. Various conspiracy theories and lower testing rates among others also add up to impose a negative impact on the vaccination rates and public health of Pakistan. This may lead to newer strains of potentially harmful COVID-19, mental health deterioration, and prolonged lockdowns. Conclusion: Vaccine hesitancy is a global public health threat, and its impacts are pronounced in Pakistan. This is reflected in the COVID-19 pandemic; low vaccination rates in Pakistan may lead to future outbreaks of new, potentially harmful, strains of COVID-19 which can prolong lockdowns in the country and affect mental health of the population. To improve the current situations, it is imperative for the government, educational institutes, and healthcare systems to develop trust and continually use dialogue, communication, and education to address misconceptions to improve COVID-19 vaccination in Pakistan.

The impact of violence on healthcare workers' mental health in conflict based settings amidst COVID-19 pandemic, and potential interventions: A narrative review.

Healthcare workers (HCWs) have faced an increased amount of mental health struggles amidst the COVID-19 pandemic. However, those in conflict-based settings with fragile healthcare systems meet additional challenges. This study reviews violence, conflict and mental health among HCWs in five countries: Syria, Palestine, Yemen, Afghanistan and Lebanon. Our study reports that HCWs are targeted by violence, bombings, mistreatment and different forms of abuse, including verbal and physical. With the additional burdens of the pandemic including prolonged working hours, limited resources and insufficient humanitarian aid, the healthcare workers fall victim to increased levels of burnout and mental illnesses. The situation leads to dire consequences on their personal lives and professional development, compelling them to quit their job or country all together. Although healthcare workers remain resilient in these conflict-based settings, immediate interventions are required to prevent violence against them and cater to their rapidly declining mental health.

COVID-19 vaccine hesitancy: A narrative review of four South Asian countries

Objectives Vaccine hesitancy remains a global issue, especially within poverty-stricken countries where there's an interplay of financial and non-financial barriers. This narrative review aims to understand attitudes and behaviors toward COVID-19 vaccination in four South Asian countries and make context-specific recommendations to vaccine program drivers and decision-makers. Methods A search was conducted using PubMed and Science Direct, and CINHAL from January 2020 up to May 2022 restricted to the English language for terms: “Afghanistan” OR “Pakistan” OR “India” OR “Bangladesh” in combination with “COVID-19 vaccine” and other related terms. All articles were initially included, and those with relevance were included in the synthesis of this paper. Results A narrative review was performed for this study. Our narrative review included a total of eighteen studies with a sample size (n = 223–5,237) averaging about 1,325 participants per study conducted. The studies included revealed public hesitancy to receive the COVID-19 vaccine ranging from 6.3 to 56.2% with an average of 31.63% across all eighteen studies. Several reasons were linked to this observation in these four South Asian countries, and the predominant ones included: Insufficient information provided to the general public about the side effects of the vaccines, concerns regarding vaccine safety, and skepticism of vaccine efficacy. Conclusion Vaccine hesitancy is a global problem within the context of COVID-19, and issues regarding equity, misinformation, and poverty in South Asian countries makes it difficult to meet goals for herd immunity. Policymakers and governments should aim toward financial and non-financial incentives to drive the public toward vaccination.

Burnout in health care workers during the fourth wave of COVID-19: A cross sectional study from Pakistan.

Objective: To assess the burnout among the healthcare workers during the fourth wave of COVID-19. Methods: In this cross-sectional study, burn out was measured in health care professionals using the MBI scale inventory during the fourth wave of COVID-19. Age, gender, marital status, having children, hospital, job type, experience, and workload, as well as the severity of burnout in each subscale, were all measured. We used the chi-square test to detect the difference between the level of burnout and other demographic variables, and a multiple logistic regression test was used to define the predicted correlation between the high level of burnout and the risk factors. Odds ratios and corresponding 95% confidence intervals (CI) were reported. A p-value of less than 0.05 indicated a statistically significant outcome. Results: Out of 776 healthcare workers who participated in our study, 468 (63.2%), 161 (21.7%) and 112 (15.1%) participants experienced low, moderate and high levels of emotional exhaustion, respectively. For the depersonalization subscale, 358 (48.3%), 188 (25.4%) and 195 (26.3%) people suffered from low, moderate, and high levels of depersonalization, respectively while 649 (87.6%), 40 (5.4%) and 52 (7.0%) respondents had low, moderate and high levels in the personal accomplishment subscale, respectively. Conclusion: During the fourth wave of COVID-19, the healthcare workers reported increased level of burnout overall possibly due to the long term physical and mental impacts that the pandemic has had over the time. Moreover, healthcare workers in Pakistan were more prone to burnout as compared to other countries.

Unraveling the Jeopardy: Child health in Afghanistan.

A humanitarian crisis started in Afghanistan after the United States and international Allies withdrew in August 2021, causing numerous challenges and have especially impacted children. Children in Afghanistan have been affected by a long history of suffering from violence, war, and poverty. The US withdraw and COVID-19 pandemic have caused an economic crisis causing high rates of child malnutrition and prevented them from receiving healthcare and education. In the long run, the impacts of the current situation will significantly affect the child growth, education, and psychological health. There is a need for international organizations to intervene now to ensure children do not further suffer and have the option for a bright future. In turn, ensuring a brighter future for Afghanistan.

Obstacles and Policy Measures Toward COVID-19 Vaccination: Creating a Sustainable Road Map for Malawi.

The Coronavirus Disease 2019 (COVID-19) pandemic is a public health threat for Malawi which is facing several challenges concurrently including disease burden; inadequate finances; illiteracy; and public mistrust in government. In this pandemic, vaccines are the most reliable and cost-effective public health intervention, and the Malawian government has instituted an action plan which includes prioritizing the vaccination of traditional and religious leaders, increased vaccination sites to include workplaces and shopping malls, and health promotion. However, there is still considerable hesitancy around the use of the available vaccines in Malawi. In this paper, we explore the multiple interrelated factors driving COVID-19 vaccine hesitancy in Malawi. It is therefore recommended that the Malawian government embrace multicomponent and wide-ranging strategies to address COVID-19 vaccine hesitancy in the country. This includes reviving trust in national health authorities by offering population-specific, target-driven, and effective, transparent, and timely communication to its citizens and relevant stakeholders about the safety and efficacy of the COVID-19 vaccine.

Typhoid in Pakistan: Challenges, Efforts, and Recommendations.

Typhoid, and its extra drug resistant form which is highly prevalent Pakistan, is increasing the burden on healthcare through multiple factors. These range from lack of sanitation, the collapsing economy, and poor access to clean drinking water which have made it arduous for the government and various other organizations in containing it. With the COVID-19 pandemic, treatment of typhoid became a challenge as focus was driven towards limiting the COVID-19 spread, and hence preferential use of antibiotics such as azithromycin may limit future empirical antibiotic therapy for typhoid. Socioeconomic disparities and geographical as well as demographic barriers further limit access to appropriate typhoid management. Lastly, illiteracy and self-medication with antibiotics may predispose Pakistan to another outbreak of typhoid. These concerns, although largely unaddressed effectively, need immediate action. Previously, the government and international organizations have made efforts to control the spread through the introduction of TCV as a part of EPI and awareness, additional improvements are needed. These include: improving access to telemedicine in rural areas, extensive vaccination programs, and routine awareness programs especially in schools.

Food Insecurity during COVID-19 in Yemen.

The United Nations has declared Yemen as the world's worst humanitarian crisis with 21 million people in need of humanitarian assistance. Due to the convergence of severe economic instability exacerbated by the COVID-19 pandemic, stifling war, and spiking food prices, the Yemeni people are at the brink of famine with women and children especially malnourished. Desperate to feed their families, civilians are forced to resort to begging, participate in child marriages, or plunge into debt. An inflated currency has significantly diminished the purchasing power of the Yemeni population, and COVID-19 restrictions have made acquisition of food and essential commodity imports arduous. Immediate action by global and local governments is essential to prevent the deaths of thousands of people in the wake of severe food scarcity.

Zika, Nipah and Kala-azar: Emerging lethal infectious diseases amid COVID-19 as an escalating public health threat in South India.

As of 6 June 2022, a sum 25,782 of active cases and 524,701 deaths due to Coronavirus disease-19 (COVID-19) have been recorded in India. Stewing in the flares of the pandemic, Kerala is entwined in the wrath of multiple emerging infectious diseases. India, a home to 1.3 billion people, recently faced a devastating second wave of COVID-19 during May of 2021, with a ruckus of chronic shortage of medicine, oxygen supplies, ventilators, besides, being challenged by secondary infections and chronic health ailments. The state of Kerala, alone contributes to 50% COVID-19 caseload, besides, recent simultaneous outbreaks of Zika Virus Disease (ZVD), Nipah Virus Disease (NiVD) and Kala-azar (black fever) on July 8, September 5 and 8, 2021 respectively. Syndemicity and a high case fatality rates of these highly contagious diseases coupled with post infection sequelae, overwhelm the already fragile healthcare system. Thus, these lethal infectious diseases along with an anticipated third wave of COVID-19 pose a serious public health threat in and around South India. With this narrative review, we aim to discuss the challenges that the emergence of intersecting outbreaks of Zika, Nipah, Kala-azar presents with, in the nation, amidst the global pandemic of COVID-19 and provide recommendations so as to help alleviate the situation. The syndemicity of COVID-19 with other infectious diseases, calls for adequate surveillance and monitoring of diseases' outbreaks. To avoid the worst situations like pandemic, the health ministry, public and private health stakeholders in India should strengthen the public healthcare delivery system and providence of quick medical facilities to control the rate of mortality and morbidity during outbreaks.

The effect of child malnourishment on measles spread amidst the COVID-19 pandemic in Afghanistan.

Child malnourishment is a long-lasting concern that Afghanistan has been facing for many years now. This major factor amongst countless others like growing socioeconomic disparity, ineffective healthcare due to lack of funding and political instability has caused increase in nutritional instability through Afghanistan. This has increased the likelihood of numerous malnourished children contracting deadly infectious diseases like measles. Despite receiving nutritional aid, vaccines (reduce measles spread) and funding from international organizations much of these efforts have fell short due to the political instability and lack of sustained support. Emergence of COVID-19 has further intensified the already existing challenges faced by vulnerable Afghan children. The pandemic has impeded with the eradication of measles and vaccine coverage as much of the funding and attention has shifted to containing COVID-19 spread posing a greater threat for malnourished children. The combined effect of both infections has exacerbated and increased mortality in malnourished children as rate of measle spread increases. Afghan healthcare systems are now struggling more as much of their efforts are ineffectual due to lack of facilities and resources.

Maternal mortality in Afghanistan: Challenges, efforts, and recommendations

Maternal mortality is a major concern in Afghanistan. Even though the mortality rate is decreasing, Afghanistan still ranks below most countries in terms of maternal mortality. Challenges such as political instability, the COVID-19 pandemic, and unskilled staff are proving to be a burden on the healthcare system of Afghanistan, which has become an obstacle for the aim of further reducing the rate. Along with the struggling healthcare system, illiteracy and ignorance are further exacerbating the maternal health issues. In order to address these challenges, the Taliban must work alongside international organizations on improving the basic healthcare facilities, build more maternity clinics, provide better training for the medical staff, and educate citizens.

Afghanistan's humanitarian crisis and its impacts on the mental health of healthcare workers during COVID-19.

Afghanistan's humanitarian crisis has severely impacted the mental health of frontline workers. With the introduction of the Taliban government, ongoing civil unrest, and other forms of violent attacks, healthcare workers (HCWs) continue to provide patient care despite minimal resources. A severe contraction in the economy, poor supply of medications, political turmoil, and insufficient humanitarian aid have added to pre-existing problems. High levels of insecurity and instability as well as decades of traumatic experiences have contributed to increasing mental health challenges amongst frontline workers. Despite the scarcity of mental health services, HCWs continue to persevere with their service to the community. However, inadequate interventions may have serious implications for HCWs bearing the brunt of multiple traumas. Thus, governmental and international involvement is needed to address both the economic and psychological needs of HCWs in Afghanistan.

Dengue Virus Cases Surge Amidst COVID-19 in Pakistan: Challenges, Efforts and Recommendations.

Pakistan is currently facing two outbreaks, dengue and COVID-19; both have strained its healthcare system resulting in multiple concerns including the co-diagnosis of two. Due to poor healthcare capacity, low vaccination rate, increasing COVID-19 variants, socioeconomic disparities, and misinformation, it is inevitable that implications will prove to be damaging to both healthcare workers and civilians. Among these challenges, it is important to note the need for stronger epidemiological surveillance for both COVID-19 and dengue and the implementation of public health measures without endangering sources of livelihood. To sustain this, cooperation between WHO and Pakistan's government must continue through smart lockdowns, dengue awareness campaigns, and double laboratory procedures.

Measles in Afghan refugees: Challenges, efforts and recommendations

Recently, measles outbreaks have been reported across Afghanistan, and in many refugees. Although, Afghanistan has a previous history of measles outbreaks, the presence of such epidemics during a humanitarian crisis is burdening a fragile healthcare system. In addition, it is creating new challenges for Afghan refugees who are endangered by political conditions of the country. Despite efforts such as vaccination to reduce the number of cases in Afghanistan, there are still multiple outbreaks. Various factors such as political conflict, insecurity, internal displacement, supply chain issues and, most recently, COVID-19 have hampered the eradication of measles. High mortality rate, faster transmission, and clinical similarities with COVID-19 are exacerbating challenges for refugees, who are now facing delays in resettlement, especially in the United States. To curb the spread of measles, refugees need immediate and effective vaccination measures, and access to healthcare information in their own languages.