State and situation of avian influenza in the Eastern Mediterranean Region.

Avian influenza viruses have had a significant burden of disease on animal and public health in countries of the Eastern Mediterranean Region. In this review, we aimed at describing the state of avian influenza in the region from 2011 to 2021. We gathered information available through the peer-reviewed scientific literature, public gene sequence depositories, OIE World Animal Health Information System platform, World Health Organization FluNet, Joint External Evaluation reports, and governmental, Food and Agriculture Organization of the United Nations, and World Organization for Animal Health websites. We used an interdisciplinary perspective consistent with the One Health approach to perform a qualitative synthesis and making recommendations. Analysis showed that although avian influenza research in the Eastern Mediterranean Region has gained more attention during the last decade, it was limited to only few countries and to basic science research. Data highlighted the weakness in surveillance systems and reporting platforms causing underestimation of the actual burden of disease among humans and animals. Inter-sectoral communication and collaboration for avian influenza prevention, detection, and response remain weak. Influenza surveillance at the human-animal interface and the application of the One Health paradigm are lacking. Countries' animal health and public health sectors rarely publish their surveillance data and findings. This review suggested that surveillance at the human-animal interface, research, and reporting capacities should be enhanced to improve understanding and control of avian influenza in the region. Implementing a rapid and comprehensive One Health approach for zoonotic influenza in the Eastern Mediterranean Region is recommended.

Rapid assessment of case recruitment tools to inform integrated surveillance of influenza and other respiratory viruses in Eastern Mediterranean countries.

Influenza-like illness (ILI) and severe acute respiratory infection (SARI) case recruitment tools from 10 countries were reviewed. The contents of the existing tools were compared against World Health Organization's current guidelines, and we also assessed the content validity (accuracy, completeness and consistency). Five of the ILI tools and two of the SARI tools were rated as having high accuracy against WHO case definitions. ILI completeness ranged from 25% to 86% and SARI from 52% to 96%. Average internal consistency scores were 86% for ILI and 94% for SARI. Limitations in the content validity of influenza case recruitment tools may compromise recruitment of eligible cases and result in varying detection rates across countries.

The Pearl River Declaration: a timely call for enhancing health security through fostering a regional one health collaboration in the Asia-Pacific.

The Second International Symposium on One Health Research (ISOHR) was held in Guangzhou city, China on 23-24 November 2019. A transdisciplinary collaborative approach, One Health (OH), was the central theme of the symposium which brought together more than 260 experts, scholars and emerging researchers from human health, veterinary health, food safety, environmental health and related disciplines and sectors. More than 50 organizations including World Health Organization, Centers for Disease Control (USA), and Queensland Government (Australia) participated in the symposium. Scholars, experts and emerging researchers, policy-makers and practitioners in their respective fields delivered over 50 presentations at the symposium, highlighting the collective vulnerability to some of the emerging health challenges the region was combating. These included emerging infectious diseases, antimicrobial resistance, climate change, food safety and the growing burden of non-communicable diseases. The Pearl River Declaration, emanated from the symposium, called for establishing a One Health Cooperation Network in the Southeast Asia-Pacific region with a vision to strengthen regional health security through sharing each other's knowledge and experience, and making investments in workforce development, scientific innovations such as vaccine research and development, sharing epidemic intelligence, risk identification, risk communication and appropriate response measures against emerging health threats.

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Evidence for a comprehensive approach to Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews among Indigenous peoples.

BACKGROUND: Tobacco smoking is a leading cause of disease and premature mortality among Aboriginal and Torres Strait Islander (Indigenous) Australians. While the daily smoking prevalence among Indigenous Australians has declined significantly from 49% in 2001, it remains about three times higher than that of non-Indigenous Australians (39 and 14%, respectively, for age ≥15 years in 2014-15). This overview of systematic reviews aimed to synthesise evidence about reducing tobacco consumption among Indigenous peoples using a comprehensive framework for Indigenous tobacco control in Australia comprised of the National Tobacco Strategy (NTS) and National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) principles and priorities. METHODS: MEDLINE, EMBASE, systematic review and Indigenous health databases were searched (2000 to Jan 2016) for reviews examining the effects of tobacco control interventions among Indigenous peoples. Two reviewers independently screened reviews, extracted data, and assessed review quality using Assessing the Methodological Quality of Systematic Reviews. Data were synthesised narratively by framework domain. Reporting followed the PRISMA statement. RESULTS: Twenty-one reviews of varying quality were included. There was generally limited Indigenous-specific evidence of effective interventions for reducing smoking; however, many reviewers recommended multifaceted interventions which incorporate Indigenous leadership, partnership and engagement and cultural tailoring. Under the NTS priority areas, reviewers reported evidence for brief smoking cessation interventions and pharmacological support, mass media campaigns (on knowledge and attitudes) and reducing affordability and regulation of tobacco sales. Aspects of intervention implementation related to the NATSIHP domains were less well described and evidence was limited; however, reviewers suggested that cultural tailoring, holistic approaches and building workforce capacity were important strategies to address barriers. There was limited evidence regarding social media and mobile applications, for Indigenous youth, pregnant women and prisoners, and no evidence regarding interventions to protect communities from industry interference, the use of electronic cigarettes, interventions for people experiencing mental illness, juvenile justice, linguistic diversity or 'pubs, clubs and restaurants'. CONCLUSIONS: There is limited Indigenous-specific evidence for most tobacco interventions. A 'comprehensive approach' incorporating NTS and NATSIHP Principles and Priorities of partnership and engagement, evidence from other settings, programme logic and responsive evaluation plans may improve intervention acceptability, effectiveness and implementation and mitigate risks of adapting tobacco evidence for Indigenous Australians.

The effects of high temperature on cardiovascular admissions in the most populous tropical city in Vietnam.

This study examined the short-term effects of temperature on cardiovascular hospital admissions (CHA) in the largest tropical city in Southern Vietnam. We applied Poisson time-series regression models with Distributed Lag Non-Linear Model (DLNM) to examine the temperature-CHA association while adjusting for seasonal and long-term trends, day of the week, holidays, and humidity. The threshold temperature and added effects of heat waves were also evaluated. The exposure-response curve of temperature-CHA reveals a J-shape relationship with a threshold temperature of 29.6 °C. The delayed effects temperature-CHA lasted for a week (0-5 days). The overall risk of CHA increased 12.9% (RR, 1.129; 95%CI, 0.972-1.311) during heatwave events, which were defined as temperature ≥ the 99th percentile for ≥2 consecutive days. The modification roles of gender and age were inconsistent and non-significant in this study. An additional prevention program that reduces the risk of cardiovascular disease in relation to high temperatures should be developed.

Environmental health risk assessment of nickel contamination of drinking water in a country town in NSW.

OBJECTIVES: To assess the health risks associated with consumption of drinking water with elevated nickel concentration in a NSW country town named Sampleton. METHODS: We used enHealth Guidelines (2002) as our risk assessment tool. Laboratory test results for nickel in water samples were compared with the Australian Drinking Water Guidelines 2004 and the World Health Organization's (WHO) Guidelines for Drinking Water Quality 2005. RESULTS: The mean nickel concentration in the drinking water samples tested over a 4-year period (2002-2005) was 0.03 mg/L (95% CI: 0.02-0.04). The average daily consumption of two litres of water by a 70-kg adult provided 0.06 mg (0.03 mg x 2) of nickel, which was only 7% of the lowest observed adverse effect level (LOAEL) based on experiments on nickel-sensitive people in a fasting state. CONCLUSIONS: The mean nickel concentration in drinking water appears to have no health risks for the inhabitants of Sampleton.

An epidemiological investigation into an outbreak of rash illness among methadone maintenance clients in Australia.

In late 2004, NSW Health received several reports of a serious desquamating rash among clients of the methadone program. We sought to identify the extent and likely cause of this outbreak. We initiated active surveillance for cases throughout Australia, a survey of dosing points in NSW, and a case control study of clients receiving methadone syrup (MS) at two clinics. Between October 2004 and March 2005, 388 cases were identified, largely in NSW. The dosing point survey found almost all cases were clients prescribed MS (attack rate 4.5%). In multivariate analysis of data from dosing points that dispensed MS, use of take away doses or location of the dosing point in greater western Sydney were associated with illness. In the case control study, MS injection, use of street MS, high doses of MS, frequent takeaway doses, or use of benzodiazepines were associated with illness. Testing found no abnormality in associated batches of MS. Batches of MS temporally associated with the outbreak were quarantined from use and the outbreak subsided. While a direct causal link could not be established, available evidence suggests that a contaminant may have caused the outbreak. Epidemiological analyses are important for assessing concerns about product safety following marketing approval.

Salmonella typhimurium phage type 170 in a tertiary paediatric hospital with person-to-person transmission implicated.

Nosocomially-acquired salmonellosis is uncommonly reported in Australia. We report a cluster of gastroenteritis caused by Salmonella Typhimurium phage type 170 (STm 170) centred on a tertiary paediatric hospital in Sydney, New South Wales from 8 to 19 May 2004. A total of 12 children had STm 170 isolated from faecal specimens. Of the 12 cases, seven were acquired in hospital and five in the community. The mean age of the cases was 4.1 years (range: 2 months to 11.2 years). We conducted a case series investigation to generate hypotheses regarding the cause of this outbreak. Standardised interviews with cases' parents were conducted to identify potential exposures including in recently consumed food. An environmental investigation mapped the food preparation and storage areas, movements of staff caring for cases, relative case-bed locations, and duration of stay in these locations. Five of the seven hospital-acquired cases were immunocompromised with a history of prolonged and/or multiple hospital admissions. We found that STm 170 was probably brought into the hospital by a community-acquired case and spread to other in-patients through person-to-person transmission by hospital staff and/or patients. This study emphasises the importance of stringent compliance with hospital infection control practices at all times.