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1.
Emerg Med Clin North Am ; 39(3): 453-465, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1263258

ABSTRACT

The role of the emergency provider lies at the forefront of recognition and treatment of novel and re-emerging infectious diseases in children. Familiarity with disease presentations that might be considered rare, such as vaccine-preventable and non-endemic illnesses, is essential in identifying and controlling outbreaks. As we have seen thus far in the novel coronavirus pandemic, susceptibility, severity, transmission, and disease presentation can all have unique patterns in children. Emergency providers also have the potential to play a public health role by using lessons learned from the phenomena of vaccine hesitancy and refusal.


Subject(s)
Communicable Diseases, Emerging/epidemiology , Pediatrics , COVID-19/diagnosis , COVID-19/therapy , COVID-19/transmission , Chickenpox/diagnosis , Chickenpox/therapy , Chickenpox/transmission , Chikungunya Fever/diagnosis , Chikungunya Fever/therapy , Chikungunya Fever/transmission , Child , Communicable Diseases, Emerging/immunology , Decision Trees , Dengue/diagnosis , Dengue/therapy , Dengue/transmission , Emergency Medicine , Hemorrhagic Fever, Ebola/diagnosis , Hemorrhagic Fever, Ebola/therapy , Hemorrhagic Fever, Ebola/transmission , Humans , Incidence , Malaria/diagnosis , Malaria/therapy , Malaria/transmission , Measles/diagnosis , Measles/therapy , Measles/transmission , Physician's Role , Public Health , SARS-CoV-2 , Systemic Inflammatory Response Syndrome , Travel-Related Illness , Vaccination , Vaccination Refusal , Whooping Cough/diagnosis , Whooping Cough/therapy , Whooping Cough/transmission , Zika Virus Infection/diagnosis , Zika Virus Infection/therapy , Zika Virus Infection/transmission
2.
Bull Soc Pathol Exot ; 113(4): 222-227, 2020.
Article in French | MEDLINE | ID: covidwho-1172022

ABSTRACT

This article focuses on some representations of the origin of AIDS and Ebola in Burkina Faso, against a new background of Covid-19 which began in early 2020 in connection with two animals: the spider and the bat. These are also, if not first and foremost, heroes of oral literature (from tales to myths) from this region of West Africa. It is up to anthropologists to explore the meandering symbolism and imagination of these liminal animals that move back and forth between the worlds inhabited by humans and the "bush" worlds of non-humans. Here arises a mythological anamnesis. These "trickster" animals challenge categories and understanding of both virologists and anthropologists.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , Chiroptera/virology , Hemorrhagic Fever, Ebola , Spiders/virology , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/history , Acquired Immunodeficiency Syndrome/transmission , Africa, Western/epidemiology , Animals , Burkina Faso/epidemiology , COVID-19/epidemiology , COVID-19/history , COVID-19/transmission , Communicable Diseases, Emerging/epidemiology , Communicable Diseases, Emerging/history , Congresses as Topic , Disease Vectors , Epidemics , HIV/physiology , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/history , Hemorrhagic Fever, Ebola/transmission , History, 21st Century , Host-Pathogen Interactions/physiology , Humans , Museums , SARS-CoV-2/physiology
4.
Am J Trop Med Hyg ; 103(6): 2168-2170, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-869186

ABSTRACT

COVID-19 is a highly contagious disease that has affected all African countries including the Democratic Republic of Congo (DRC). Formidable challenges limit precautionary measures which were instituted by the government to curb the pandemic. Insufficient COVID-19 testing laboratories, limited medical and personal protective equipment, and an inadequate number of health workers leave the country ill-equipped in the fight against the pandemic. Lack of assistance from the government to those who lost their jobs due to lockdown forced these individuals to go outside to find provisions, thus increasing the spread of the virus. Moreover, the fragile healthcare system is overburdened by civil conflicts and other epidemics and endemics amid the COVID-19 pandemic. The conflicts have led to thousands of deaths and hundreds of thousands of displacements and deprived many people of basic health services. The 11th outbreak of Ebola has been increasing at an alarming pace, and it is expected to soar because of a shortfall of funds and insufficient numbers of health workers. The DRC with the cooperation of regional powers needs to address these challenges in a manner similar to that used in the previous Ebola epidemics. Moreover, the government should have a balance in shifting the available resources between COVID-19 and other diseases. Until a vaccine is available, the DRC needs to be prudent when lifting restrictions to prevent explosion of new cases.


Subject(s)
COVID-19/epidemiology , Ebolavirus/pathogenicity , Health Services Accessibility/economics , Hemorrhagic Fever, Ebola/epidemiology , Pandemics , SARS-CoV-2/pathogenicity , COVID-19/economics , COVID-19/transmission , Democratic Republic of the Congo/epidemiology , Ethnic Violence , Health Services/supply & distribution , Hemorrhagic Fever, Ebola/economics , Hemorrhagic Fever, Ebola/transmission , Humans , Incidence , Quarantine , Social Isolation
5.
Pan Afr Med J ; 36: 365, 2020.
Article in English | MEDLINE | ID: covidwho-820396

ABSTRACT

Religious and spiritual observances that draw large people together are pervasive in many parts of the world, including Africa. With the recent emergence of COVID-19, these mass religious gatherings may pose significant threats to human health. Given the compromised healthcare systems in many parts of Africa, faith-based institutions have a huge responsibility towards the management of the potential spread of the virus through effective organizational strategies or interventions. This essay sheds light on what the novel virus has to do with religion, the role of religious practices in inhibiting or spreading COVID-19, and what appropriate evidence-based interventions religious or faith-based organizations could adopt to help prevent the spread of the disease in Africa through a unity of thoughts for religious action.


Subject(s)
COVID-19/transmission , Religion and Medicine , SARS-CoV-2 , Africa/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Christianity , Faith Healing , Faith-Based Organizations , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/psychology , Hemorrhagic Fever, Ebola/transmission , Humans , Hygiene , Islam , Pandemics
7.
Appl Environ Microbiol ; 86(17)2020 08 18.
Article in English | MEDLINE | ID: covidwho-767717

ABSTRACT

The infection of health care workers during the 2013 to 2016 Ebola outbreak raised concerns about fomite transmission. In the wake of the coronavirus disease 2019 (COVID-19) pandemic, investigations are ongoing to determine the role of fomites in coronavirus transmission as well. The bacteriophage phi 6 has a phospholipid envelope and is commonly used in environmental studies as a surrogate for human enveloped viruses. The persistence of phi 6 was evaluated as a surrogate for Ebola virus (EBOV) and coronaviruses on porous and nonporous hospital surfaces. Phi 6 was suspended in a body fluid simulant and inoculated onto 1-cm2 coupons of steel, plastic, and two fabric curtain types. The coupons were placed at two controlled absolute humidity (AH) levels: a low AH of 3.0 g/m3 and a high AH of 14.4 g/m3 Phi 6 declined at a lower rate on all materials under low-AH conditions, with a decay rate of 0.06-log10 PFU/day to 0.11-log10 PFU/day, than under the higher AH conditions, with a decay rate of 0.65-log10 PFU/h to 1.42-log10 PFU/day. There was a significant difference in decay rates between porous and nonporous surfaces at both low AH (P < 0.0001) and high AH (P < 0.0001). Under these laboratory-simulated conditions, phi 6 was found to be a conservative surrogate for EBOV under low-AH conditions in that it persisted longer than Ebola virus in similar AH conditions. Additionally, some coronaviruses persist longer than phi 6 under similar conditions; therefore, phi 6 may not be a suitable surrogate for coronaviruses.IMPORTANCE Understanding the persistence of enveloped viruses helps inform infection control practices and procedures in health care facilities and community settings. These data convey to public health investigators that enveloped viruses can persist and remain infective on surfaces, thus demonstrating a potential risk for transmission. Under these laboratory-simulated Western indoor hospital conditions, we assessed the suitability of phi 6 as a surrogate for environmental persistence research related to enveloped viruses, including EBOV and coronaviruses.


Subject(s)
Bacteriophage phi 6/isolation & purification , Bacteriophage phi 6/physiology , Coronavirus/physiology , Ebolavirus/physiology , Environmental Microbiology , Fomites/virology , Virus Inactivation , Betacoronavirus/physiology , COVID-19 , Coronavirus/isolation & purification , Coronavirus Infections/transmission , Coronavirus Infections/virology , Ebolavirus/isolation & purification , Hemorrhagic Fever, Ebola/transmission , Hemorrhagic Fever, Ebola/virology , Hospitals , Humans , Humidity , Pandemics , Pneumonia, Viral/transmission , Porosity , SARS-CoV-2 , Temperature
9.
Am J Trop Med Hyg ; 102(5): 924-925, 2020 05.
Article in English | MEDLINE | ID: covidwho-686952

ABSTRACT

This article describes similarities and differences in the response of governments and the international community to the current 2019 coronavirus disease (COVID-19) and the 2014 West African Ebola epidemic. It expresses the opinion that the speed and scale of the response to COVID-19 are affected by the important role that China plays in the global economy. By contrast, insufficient and less timely action was initially undertaken in West African countries during the 2014 Ebola epidemic. It concludes by stating why preparedness for and response to all disease outbreaks, also in countries of lower economic importance, should become a priority in the global health agenda.


Subject(s)
Coronavirus Infections , Disaster Planning , Ebolavirus , Global Burden of Disease/economics , Global Health , Hemorrhagic Fever, Ebola , Pneumonia, Viral , Africa, Western/epidemiology , Betacoronavirus , COVID-19 , China/epidemiology , Coronavirus Infections/economics , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Disease Outbreaks , Global Health/economics , Hemorrhagic Fever, Ebola/economics , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/transmission , Humans , International Cooperation , Pandemics , Pneumonia, Viral/economics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2
10.
Cochrane Database Syst Rev ; 5: CD011621, 2020 05 15.
Article in English | MEDLINE | ID: covidwho-380915

ABSTRACT

BACKGROUND: In epidemics of highly infectious diseases, such as Ebola, severe acute respiratory syndrome (SARS), or coronavirus (COVID-19), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Personal protective equipment (PPE) can reduce the risk by covering exposed body parts. It is unclear which type of PPE protects best, what is the best way to put PPE on (i.e. donning) or to remove PPE (i.e. doffing), and how to train HCWs to use PPE as instructed. OBJECTIVES: To evaluate which type of full-body PPE and which method of donning or doffing PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and CINAHL to 20 March 2020. SELECTION CRITERIA: We included all controlled studies that evaluated the effect of full-body PPE used by HCW exposed to highly infectious diseases, on the risk of infection, contamination, or noncompliance with protocols. We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training on the same outcomes. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data and assessed the risk of bias in included trials. We conducted random-effects meta-analyses were appropriate. MAIN RESULTS: Earlier versions of this review were published in 2016 and 2019. In this update, we included 24 studies with 2278 participants, of which 14 were randomised controlled trials (RCT), one was a quasi-RCT and nine had a non-randomised design. Eight studies compared types of PPE. Six studies evaluated adapted PPE. Eight studies compared donning and doffing processes and three studies evaluated types of training. Eighteen studies used simulated exposure with fluorescent markers or harmless microbes. In simulation studies, median contamination rates were 25% for the intervention and 67% for the control groups. Evidence for all outcomes is of very low certainty unless otherwise stated because it is based on one or two studies, the indirectness of the evidence in simulation studies and because of risk of bias. Types of PPE The use of a powered, air-purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.17 to 0.43) but was more difficult to don (non-compliance: RR 7.5, 95% CI 1.81 to 31.1). In one RCT (59 participants) coveralls were more difficult to doff than isolation gowns (very low-certainty evidence). Gowns may protect better against contamination than aprons (small patches: mean difference (MD) -10.28, 95% CI -14.77 to -5.79). PPE made of more breathable material may lead to a similar number of spots on the trunk (MD 1.60, 95% CI -0.15 to 3.35) compared to more water-repellent material but may have greater user satisfaction (MD -0.46, 95% CI -0.84 to -0.08, scale of 1 to 5). According to three studies that tested more recently introduced full-body PPE ensembles, there may be no difference in contamination. Modified PPE versus standard PPE The following modifications to PPE design may lead to less contamination compared to standard PPE: sealed gown and glove combination (RR 0.27, 95% CI 0.09 to 0.78), a better fitting gown around the neck, wrists and hands (RR 0.08, 95% CI 0.01 to 0.55), a better cover of the gown-wrist interface (RR 0.45, 95% CI 0.26 to 0.78, low-certainty evidence), added tabs to grab to facilitate doffing of masks (RR 0.33, 95% CI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Donning and doffing Using Centers for Disease Control and Prevention (CDC) recommendations for doffing may lead to less contamination compared to no guidance (small patches: MD -5.44, 95% CI -7.43 to -3.45). One-step removal of gloves and gown may lead to less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28) than separate removal. Double-gloving may lead to less viral or bacterial contamination compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28). Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4) and to fewer contamination spots (MD -5, 95% CI -8.08 to -1.92). Extra sanitation of gloves before doffing with quaternary ammonium or bleach may decrease contamination, but not alcohol-based hand rub. Training The use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7). A video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) than a traditional lecture. Face-to-face instruction may reduce noncompliance with doffing guidance more (odds ratio 0.45, 95% CI 0.21 to 0.98) than providing folders or videos only. AUTHORS' CONCLUSIONS: We found low- to very low-certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. Modifications to PPE design, such as tabs to grab, may decrease the risk of contamination. For donning and doffing procedures, following CDC doffing guidance, a one-step glove and gown removal, double-gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than folder-based training. We still need RCTs of training with long-term follow-up. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best. Consensus on simulation of exposure and assessment of outcome is urgently needed. We also need more real-life evidence. Therefore, the use of PPE of HCW exposed to highly infectious diseases should be registered and the HCW should be prospectively followed for their risk of infection.


Subject(s)
Coronavirus Infections , Hemorrhagic Fever, Ebola , Infection Control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics , Personal Protective Equipment , Pneumonia, Viral , Severe Acute Respiratory Syndrome , Betacoronavirus , Body Fluids , COVID-19 , Computer Simulation , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Gloves, Protective , Health Personnel , Hemorrhagic Fever, Ebola/prevention & control , Hemorrhagic Fever, Ebola/transmission , Humans , Infection Control/methods , Odds Ratio , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Protective Clothing , Respiratory Protective Devices , SARS-CoV-2 , Severe Acute Respiratory Syndrome/prevention & control , Severe Acute Respiratory Syndrome/transmission
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