ABSTRACT
Domestic wastewater, when collected and evaluated appropriately, can provide valuable health-related information for a community. As a relatively unbiased and non-invasive approach, wastewater surveillance may complement current practices towards mitigating risks and protecting population health. Spurred by the COVID-19 pandemic, wastewater programs are now widely implemented to monitor viral infection trends in sewersheds and inform public health decision-making. This review summarizes recent developments in wastewater-based epidemiology for detecting and monitoring communicable infectious diseases, dissemination of antimicrobial resistance, and illicit drug consumption. Wastewater surveillance, a quickly advancing Frontier in environmental science, is becoming a new tool to enhance public health, improve disease prevention, and respond to future epidemics and pandemics.
ABSTRACT
Pandemic infectious diseases are caused by pathogens that have adapted well to growth and reproduction within the human host and that through unique environmental, socioeconomic, and cultural circumstances are able to rapidly spread across national boundaries and even globally. Although uncommon and caused by relatively few pathogens, the extraordinary human, economic, and societal losses caused by pandemic diseases as exemplified by coronavirus disease 2019 (COVID-19) make pandemic diseases of unique importance to clinicians, immunologists, and many other scientists and healthcare professionals. The pathogenesis of pandemic diseases is complex and unique to each pathogen, but common to all is widespread immunologic naïveté within the host population. In this chapter, we consider the pathogens of greatest concern for their pandemic potential. Most of these organisms are viruses, including betacoronaviruses, alpha influenza virus, Ebola virus, and the flaviviruses, but numerous bacteria are also emerging with pandemic disease potential. For each organism, we consider the factors, especially immunologic, that lead to pandemic spread and prospects for effective therapy and prevention. © 2023 Elsevier Ltd. All rights reserved.
ABSTRACT
Background: Wastewater represents a broad, immediate, and unbiased accounting of the pathgens in the population. We aimed to develop methods to track HIV in wastewater utilizing a viral detection pipeline adapted from platforms developed to track SARS-COV-2. Method(s): We used samples from 6 wastewater treatment plants in the Houston area. We focused on regions of higher prevalence and lower prevalence. First, employing wastewater processing and nucleic acid extraction methods described by our group to detect SARS-COV-2, we tested a single high and low prevalence site in triplicate with all 3 primer sets. nucleic acid extracts from HIV and SIV cell culture supernatants were used as controls. Next, in subsequent samples, RT-PCR reactions with detections were subjected to gel electrophoresis to determine the amplified product sizes. To further confirm HIV detection, we sequenced the RT-PCR products and compared the proportion of reads which mapped to the expected amplified product. In a later set of studies, we fractionated samples into supernatant and pellet. We further tested HIV presence by performing whole virome sequencing on the extracts from some samples that produced detections and mapped reads to published genomes. A crAssphage genome was used as a negative control. Result(s): Samples from all sites resulted in signal detection at least once. Only reactions with gag and pol primers appeared to amplify the expected product. Products from the HIV positive control mapped almost exclusively to the HIV genome (97-100% of reads), with a fraction of reads from the SIV negative control doing the same (16-18% of reads). The ltr and pol products did not map the HIV genome while gag products did (34-44% of reads). Among the fractionated sample, in total, 6 supernatant fractions produced no detection compared to 7 of 8 pellet fractions. The whole virome sequencing produced reads that mapped to the HIV genome with at least 8X depth coverage. The sample with the lowest Ct detection (26) yielded HIV coverage several logs greater than those samples with higher Ct detection (37). Reads from all samples mapped to at least 20% of the HIV genome. Conclusion(s): This work provides the first evidence that HIV can be detected in municipal wastewater systems and has the potential to be developed into a new public health tool.
ABSTRACT
This analysis of the Italian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Italy has a regionalized National Health Service (SSN) that provides universal coverage largely free of charge at the point of delivery, though certain services and goods require a co-payment. Life expectancy in Italy is historically among the highest in the EU. However, regional differences in health indicators are marked, as well as in per capita spending, distribution of health professionals and in the quality of health services. Overall, Italy's health spending per capita is lower than the EU average and is among the lowest in western European countries. Private spending has increased in recent years, although this trend was halted in 2020 during the coronavirus disease 2019 (COVID-19) pandemic. A key focus of health policies in recent decades was to promote a shift away from unnecessary inpatient care, with a considerable reduction of acute hospital beds and stagnating overall growth in health personnel. However, this was not counterbalanced by a sufficient strengthening of community services in order to cope with the ageing population's needs and related chronic conditions burden. This had important repercussions during the COVID-19 emergency, as the health system felt the impact of previous reductions in hospital beds and capacity and underinvestment in community-based care. Reorganizing hospital and community care will require a strong alignment between central and regional authorities. The COVID-19 crisis also highlighted several issues pre-dating the pandemic that need to be addressed to improve the sustainability and resilience of the SSN. The main outstanding challenges for the health system are linked to addressing historic underinvestment in the health workforce, modernizing outdated infrastructure and equipment, and enhancing information infrastructure. Italy's National Recovery and Resilience Plan, underwritten by the Next Generation EU budget to assist with economic recovery from the COVID-19 pandemic, contains specific health sector priorities, such as strengthening the country's primary and community care, boosting capital investment and funding the digitalization of the health care system.Copyright World Health Organization 2022 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).
ABSTRACT
The analytical framework used in the 2019 EU Country Health Profiles defines resilience as “health systems' capacity to absorb disturbance created by changing environments, sudden shocks or crises, and to adapt and respond effectively with the provision of needed services”. These challenges can be driven by changes or shocks in supply (economic shocks, growing shortages in available resources, technological innovations) or demand (demographic changes, public health threats like the Covid-19 pandemic). The Profiles analyse relevant policy measures to assess whether countries are well prepared to face health system shocks and strains. Methods The framework distinguishes three dimensions of resilience: Ensuring long-term stability of resources: the capacity to protect or generate adequate financial, physical and human resources, as well as information necessary to address a variety of major challenges.Responding efficiently: the ability to manage the health system with limited resources, through achieving efficiencies, while not sacrificing key priorities, benefits, access or entitlements.Strengthening governance: the capacity to steer the system in order to adapt it quickly to new objectives and priorities and to respond to major challenges through key governance tools. The profiles use a harmonised approach to analyse the degree of resilience in each country across these three dimensions through a range of quantitative and qualitative indicators. Results A matrix clusters the findings from the 30 Country Profiles in 2019 (pre Covid-19 outbreak) and identifies common resilience-related challenges and risks facing EU Member States. The matrix also captures examples of countries that are successfully deploying resilience-building policy strategies. Conclusions The evidence shows that resilience is a necessary condition for health systems to mitigate the impact of adversities, as well as respond effectively to both foreseen and unforeseen challenges. Panelists Josep Figueras, Moderator, European Observatory on Health Systems and Policies Federico Pratellesi, DG SANTE, European Commission Guillaume Dedet, Health Division, OECD, Paris, France Anna Maresso, European Observatory on Health Systems and Policies, University of Technology Berlin, Germany
ABSTRACT
COVID-19 has posed huge challenges for Europe's health systems but also for European solidarity. The WHO Regional Office for Europe and the European Commission have worked to maintain an international perspective and, as part of their efforts, called on the European Observatory on Health Systems and Policies. Its response was the HSRM platform. HSRM helps countries systematically capture how they are tackling COVID. It allows policy makers to see immediately how others are 'governing' transmission, resources and service delivery. They can identify common issues and share practice. HSRM has also provided the raw material for cross-cutting analysis of key policy questions. This combination of information and analysis has generated learning. What's more, it has helped assert the importance of countries coming together in the face of an international health emergency.