Implementing a One Health Approach to Rabies Surveillance: Lessons From Integrated Bite Case Management

As part of the ‘Zero by 30' strategy to end human deaths from dog-mediated rabies by 2030, international organizations recommend a One Health framework that includes Integrated Bite Case Management (IBCM). However, little is understood about the implementation of IBCM in practice. This study aims to understand how IBCM is conceptualized, exploring how IBCM has been operationalized in different contexts, as well as barriers and facilitators to implementation. Semi-structured interviews were conducted with seventeen practitioners and researchers with international, national, and local expertise across Africa, Asia, and the Americas. Thematic analysis was undertaken using both inductive and deductive approaches. Four main themes were identified: 1) stakeholders' and practitioners' conceptualization of IBCM and its role in rabies elimination;2) variation in how IBCM operates across different contexts;3) barriers and facilitators of IBCM implementation in relation to risk assessment, PEP provisioning, animal investigation, One Health collaboration, and data reporting;and 4) the impact of the COVID-19 pandemic on IBCM programs. This study highlights the diversity within experts' conceptualization of IBCM, and its operationalization. The range of perspectives revealed that there are different ways of organizing IBCM within health systems and it is not a one-size-fits-all approach. The issue of sustainability remains the greatest challenge to implementation. Contextual features of each location influenced the delivery and the potential impact of IBCM. Programs spanned from highly endemic settings with limited access to PEP charged to the patient, to low endemicity settings with a large patient load associated with free PEP policies and sensitization. In practice, IBCM was tailored to meet the demands of the local context and level of rabies control. Thus, experts' experiences did not necessarily translate across contexts, affecting perceptions about the function, motivation for, and implementation of IBCM. To design and implement future and current programs, guidance should be provided for health workers receiving patients on assessing the history and signs of rabies in the biting animal. The study findings provide insights in relation to implementation of IBCM and how it can support programs aiming to reach the Zero by 30 goal.

Trabajo agrícola e inseguridad alimentaria de la población siria refugiada en Oriente Medio durante la primera ola de COVID-19

Resumen A partir de datos etnográficos de los proyectos SyrianFoodFutures (2019) y From the FIELD (2020), se proporciona evidencia sobre los primeros efectos de la pandemia de COVID-19 en el trabajo agrícola de refugiadas y refugiados en Iraq, Jordania, el Líbano, Siria y Turquía. En la primavera de 2020, las restricciones de movimientos y las interrupciones de la cadena de suministro hicieron que las y los trabajadores agrícolas sirios desplazados perdieran sus empleos y se enfrentaran a una mayor inseguridad alimentaria. Los autores destacan el uso de la ambigüedad legal por parte de los países de acogida hacia la población refugiada, la dependencia de la agricultura de Oriente Medio de la mano de obra migrante y la prolongada inseguridad alimentaria de la región. Llegan a la conclusión de que la formalización del trabajo de la población refugiada no es suficiente para hacer frente a la explotación.

La situation des réfugiés syriens employés dans l'agriculture au Moyen-Orient au début de la pandémie de COVID-19 sous l'angle du travail et de la sécurité alimentaire

Résumé Les auteurs utilisent des données ethnographiques issues de deux enquêtes auprès de réfugiés syriens employés dans l'agriculture au Moyen-Orient (SyrianFoodFutures et From the FIELD) pour décrire les premiers effets de la pandémie sur cette population particulière. Ils montrent que les restrictions de déplacement et la perturbation des chaînes d'approvisionnement ont compromis l'activité et la sécurité alimentaire de ces migrants, en rappelant certaines données du contexte régional: l'ambiguïté juridique entourant le statut de réfugié, la dépendance de l'agriculture à la main-d'?uvre immigrée et une insécurité alimentaire endémique. Ils concluent qu'il ne suffira pas de régulariser la situation des réfugiés au travail pour empêcher leur exploitation.

Exploring vaccination coverage and attitudes of health care workers towards influenza vaccine in Cyprus.

Seasonal influenza is a major public health problem. Nosocomial influenza is particularly concerning as it may affect patients at high risk for complications. Unvaccinated health care workers (HCWs) are an important source of nosocomial influenza and therefore a priority target group for vaccination. Despite the fact that some European countries have high coverage rates such as UK (76.8% in season 2020/21), others continue to have low coverage rates for influenza vaccines. This study aims to estimate vaccination coverage in HCWs in Cyprus, an island country located in the Eastern Mediterranean region and describe their attitudes towards influenza vaccination. METHODS: This is a questionnaire based, nation-wide study assessing flu vaccination coverage in 2019-2020 and attitudes related to vaccination acceptance, of 962 HCWs in both public and private health care facilities. Multivariable logistic regression was used to investigate factors associated with flu vaccination status. RESULTS: Flu vaccination coverage was estimated as 31.8%. The top two reasons for getting vaccinated were to protect their family (81.4%) and themselves (77.4%). The top two reasons for not getting immunised, besides "no particular reason" (25.7%), included disbelief for vaccine effectiveness (21.5%) and safety (29.3%). The regression model showed that doctors compared to nurses had 10 times the odds of being vaccinated. Other factors positively associated with flu vaccination were encouragement by the supervisor, having sufficient knowledge on flu and flu vaccination and easy access to vaccination. A percentage of 54.8% of participants stated that COVID-19 pandemic strongly or somewhat influenced their decision to get vaccinated. CONCLUSION: Flu vaccination coverage in HCWs in Cyprus is rather low, similar to some other European countries. Barriers and facilitators in this study can be considered in strategies to increase flu vaccination uptake. Such questionnaire-based surveys should be repeated in order to evaluate effectiveness of targeted vaccination campaigns.

Syrian refugee labour and food insecurity in Middle Eastern agriculture during the early COVID-19 pandemic

Drawing on ethnographic data from the 2019 SyrianFoodFutures and 2020 From the FIELD projects, this article provides insights into the early effects of the COVID-19 pandemic on refugee labour in agriculture in Jordan, Turkey, Lebanon, Iraq, and Syria. In spring 2020, movement restrictions and supply chain disruptions caused displaced Syrian farmworkers to lose their jobs and experience increased food insecurity. We situate our findings in the context of host countries' use of legal ambiguity for governing refugees, Middle Eastern agriculture's reliance on migrant labour, and the region's longstanding food insecurity. We conclude that formalising refugee labour is not enough to address exploitation.

Exploring the factors associated with the mental health of frontline healthcare workers during the COVID-19 pandemic in Cyprus.

INTRODUCTION: The spread of COVID-19 into a global pandemic has negatively affected the mental health of frontline healthcare-workers. This study is a multi-centre, cross-sectional epidemiological study that uses nationwide data to assess the prevalence of stress, anxiety, depression and burnout among health care workers managing COVID-19 patients in Cyprus. The study also investigates the mechanism behind the manifestation of these pathologies, as to allow for the design of more effective protective measures. METHODS: Data on the mental health status of the healthcare workers were collected from healthcare professionals from all over the nation, who worked directly with Covid patients. This was done via the use of 64-item, self-administered questionnaire, which was comprised of the DASS21 questionnaire, the Maslach Burnout Inventory and a number of original questions. Multivariable logistic regression models were used to investigate factors associated with each of the mental health measures. RESULTS: The sample population was comprised of 381 healthcare professionals, out of which 72.7% were nursing staff, 12.9% were medical doctors and 14.4% belonged to other occupations. The prevalence of anxiety, stress and depression among the sample population were 28.6%, 18.11% and 15% respectively. The prevalence of burnout was 12.3%. This was in parallel with several changes in the lives of the healthcare professionals, including; working longer hours, spending time in isolation and being separated from family. DISCUSSION: This study indicates that the mental health of a significant portion of the nation's workforce is compromised and, therefore, highlights the need for an urgent intervention particularly since many countries, including Cyprus, are suffering a second wave of the pandemic. The identified risk factors should offer guidance for employers aiming to protect their frontline healthcare workers from the negative effects of the COVID-19 pandemic.

Real-time monitoring of COVID-19 in Scotland.

BACKGROUND: To manage the public health risk posed by COVID-19 and assess the impact of interventions, policymakers must be able to closely monitor the epidemic's trajectory. METHODS: Here we present a simple methodology based on basic surveillance metrics for monitoring the spread of COVID-19 and its burden on health services in Scotland. RESULTS: We examine how the dynamics of the epidemic have changed over time and assess the similarities and differences between metrics. DISCUSSION: We illustrate how our method has been used throughout the epidemic in Scotland, explore potential biases and conclude that our method has proven to be an effective tool for monitoring the epidemic's trajectory.