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1.
Clin Microbiol Rev ; 34(3)2021 06 16.
Article in English | MEDLINE | ID: covidwho-1501522

ABSTRACT

Public health laboratories (PHLs) continue to face internal and external challenges to their abilities to provide successful, timely responses to public health crises and emerging threats. These laboratories are mandated to maintain the health of their communities by identifying, diagnosing, and warning constituents of potential and real health emergencies. Due to the changing characteristics of public health threats and their cross-jurisdictional nature, laboratories are facing increased pressure to ensure that they respond in a consistent and coordinated manner. Here, the Association of Public Health Laboratories (APHL) Emerging Leader Program Cohort 11 members have compiled stories from subject matter experts (SMEs) at PHLs with direct involvement in crises to determine the characteristics of a successful response. Experts examined a diverse selection of emerging threats from across PHLs, including infectious diseases, opioids, natural disasters, and government shutdowns. While no public health crisis will be identical to another, overarching themes were consistent across subjects. Experiences from SMEs that could improve future responses to emerging threats are highlighted.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Hemorrhagic Fever, Ebola/diagnosis , Measles/diagnosis , Opioid-Related Disorders/diagnosis , Public Health/methods , COVID-19/epidemiology , Clinical Laboratory Techniques , Hemorrhagic Fever, Ebola/epidemiology , Humans , Laboratories , Measles/epidemiology , Opioid-Related Disorders/epidemiology
2.
Viruses ; 13(10)2021 10 02.
Article in English | MEDLINE | ID: covidwho-1465472

ABSTRACT

The MMR vaccination program was introduced in Spain in 1981. Consistently high vaccination coverage has led to Spain being declared free of endemic measles transmission since 2014. A few imported and import-related cases were reported during the post-elimination phase (2014 to 2020), with very low incidence: three cases per million of inhabitants a year, 70% in adults. In the post-elimination phase an increasing proportion of measles appeared in two-dose vaccinated individuals (up to 14%), posing a challenge to surveillance and laboratory investigations. Severity and clinical presentation were milder among the vaccinated. The IgM response varied and the viral load decreased, making the virus more difficult to detect. A valid set of samples (serum, urine and throat swab) is strongly recommended for accurate case classification. One third of measles in fully vaccinated people was contracted in healthcare settings, mainly in doctors and nurses, consistent with the important role of high intensity exposure in measles breakthrough cases. Surveillance protocols and laboratory algorithms should be adapted in advanced elimination settings. Reinforcing the immunity of people working in high exposure environments, such as healthcare settings, and implementing additional infection control measures, such as masking and social distancing, are becoming crucial for the global aim of measles eradication.


Subject(s)
Measles/diagnosis , Measles/epidemiology , Adolescent , Child , Child, Preschool , Disease Outbreaks/prevention & control , Epidemiological Monitoring , Female , Humans , Infant , Infant, Newborn , Male , Measles/prevention & control , Measles Vaccine/immunology , Measles Vaccine/pharmacology , Measles virus/pathogenicity , Morbillivirus/pathogenicity , Spain/epidemiology , Vaccination/trends , Vaccination Coverage/statistics & numerical data , Vaccination Coverage/trends , Young Adult
5.
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
6.
Clin Microbiol Rev ; 34(3)2021 06 16.
Article in English | MEDLINE | ID: covidwho-1226708

ABSTRACT

Public health laboratories (PHLs) continue to face internal and external challenges to their abilities to provide successful, timely responses to public health crises and emerging threats. These laboratories are mandated to maintain the health of their communities by identifying, diagnosing, and warning constituents of potential and real health emergencies. Due to the changing characteristics of public health threats and their cross-jurisdictional nature, laboratories are facing increased pressure to ensure that they respond in a consistent and coordinated manner. Here, the Association of Public Health Laboratories (APHL) Emerging Leader Program Cohort 11 members have compiled stories from subject matter experts (SMEs) at PHLs with direct involvement in crises to determine the characteristics of a successful response. Experts examined a diverse selection of emerging threats from across PHLs, including infectious diseases, opioids, natural disasters, and government shutdowns. While no public health crisis will be identical to another, overarching themes were consistent across subjects. Experiences from SMEs that could improve future responses to emerging threats are highlighted.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Hemorrhagic Fever, Ebola/diagnosis , Measles/diagnosis , Opioid-Related Disorders/diagnosis , Public Health/methods , COVID-19/epidemiology , Clinical Laboratory Techniques , Hemorrhagic Fever, Ebola/epidemiology , Humans , Laboratories , Measles/epidemiology , Opioid-Related Disorders/epidemiology
8.
J Immunol Methods ; 492: 112996, 2021 05.
Article in English | MEDLINE | ID: covidwho-1078017

ABSTRACT

Dried blood spots (DBS) are routinely used in screening newborns for treatable disorders. Immunoglobulin extraction from DBS, serum or other biological fluids loaded on filter paper cards could represent a valuable method of specimen preservation in monitoring immune response against pathogens as well as vaccination efficiency. In this study using different sources including serum, and monoclonal antibodies we established parameters for antibody extraction from the filter cards to assess antibody reactivity against Helicobacter pylori, measles virus (MV) and the novel coronavirus SARS-CoV-2 antigens. We demonstrated that DBS and dried undiluted serum result in completely preserved antibody activity for immunoassays, including in virus neutralization assays against MV. Extraction efficiency was determined by IgG concentration measurements. The plaque-reduction neutralization titer 50% of dried human serum spots remained stable after more than 10-day storage - 1:359 vs. 1:345 for the corresponding frozen sample. DBSs could be used to monitor immune response to bacterial and viral antigens following natural exposure or immunization. Mice immunized with recombinant spike protein receptor-binding domain of SARS-CoV-2 developed a strong antibody response by day 14 and reached titers above 1:64,000 on day 21 following the secondary boost immunization as measured on DBS samples in antigen-mediated ELISA. Variability in IgG concentration of eluted DBS could be influenced by factors involved in sample application, extraction process and sample characteristics. Adjustment of antibody specific activity to the eluted IgG concentration can increase accuracy of the result interpretation, including in SARS-CoV-2 serological diagnostics.


Subject(s)
Antibodies, Viral/isolation & purification , COVID-19/diagnosis , Dried Blood Spot Testing , Helicobacter Infections/diagnosis , Helicobacter pylori/physiology , Immunoassay/methods , Measles virus/physiology , Measles/diagnosis , Monitoring, Immunologic/methods , SARS-CoV-2/physiology , Animals , Antibodies, Monoclonal , Antibody Formation , Dried Blood Spot Testing/methods , Female , Humans , Immunity, Humoral , Mice , Mice, Inbred BALB C , Serologic Tests , Spike Glycoprotein, Coronavirus/immunology , Vaccination
12.
Am J Trop Med Hyg ; 103(1): 77-78, 2020 07.
Article in English | MEDLINE | ID: covidwho-658479

ABSTRACT

A 25-year-old medical student presented in Multan, Pakistan with a high fever, cough, myalgia, and diarrhea consistent with the typical signs and symptoms of novel coronavirus disease (COVID-19). The patient had traveled to high COVID-19-risk areas within Pakistan and had no significant medical and surgical history. Based on nasopharyngeal and oropharyngeal swab testing, the patient was found to be negative for COVID-19. He subsequently developed a diffuse rash and had serology consistent with dengue and measles. The patient was treated symptomatically, and his condition gradually improved over 7 days. This case highlights the high prevalence of many tropical diseases in low-income countries and the need for clinicians to consider alternate diagnoses in addition to testing for COVID-19 during the pandemic.


Subject(s)
Coronavirus Infections/diagnosis , Measles/diagnosis , Pneumonia, Viral/diagnosis , Adult , Betacoronavirus , COVID-19 , Chills , Cough , Diagnosis, Differential , Diarrhea , Fever , Humans , Male , Myalgia , Pakistan , Pandemics , SARS-CoV-2
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