Strengthening preparedness against global health threats: A paradigm shift based on One Health approaches.

The implementation of preparedness strategies to prevent and mitigate the impact of global health threats poses several challenges. It should promptly identify cross-cutting drivers of pandemic threats, assess context-specific risks, engage multiple stakeholders, and translate complex data from multiple sources into accessible information for action. This requires a coordinated, multidisciplinary and multisectoral effort engaging systems that, most of the time, work in isolation. The One Health (OH) approach promotes the collaboration and communication among different disciplines and sectors, and could be applied across the preparedness phases at national and international level. We discuss here gaps and needs in preparedness strategies, which can benefit from the OH approach, and a set of actionable recommendations, as shared with the G20-2021 with a dedicated Policy Brief. The discussion adds to the current debate about OH operationalization and promotes a paradigm shift towards coordinated prevention and preparedness strategies for early assessment and management of global health threats.

Syndromic surveillance of epidemic-prone diseases in response to an influx of migrants from North Africa to Italy, May to October 2011.

Following civil unrest in North Africa early in 2011, there was a large influx of migrants in Italy. A syndromic surveillance system was set up in April to monitor the health of this migrant population and respond rapidly to any health emergency. In the first six months, the system produced 67 alerts across all syndromes monitored and four alarms. There were no health emergencies, however, indicating that this migration flow was not associated with an increased risk of communicable disease transmission in Italy.

EpiSouth: a network for communicable disease control in the Mediterranean region and the Balkans.

The countries around the Mediterranean Sea share epidemiological characteristics and public health problems. In 2006 the EpiSouth Project was started as a framework for collaboration for communicable diseases surveillance and training in the Mediterranean Basin. As of December 2008, 26 countries from southern Europe, the Balkans, North Africa and the Middle-East are members of EpiSouth and several international organisations and institutions collaborate: the European Commission (EC), the European Centre for Disease Prevention and Control (ECDC), the Italian Ministry of Work, Health and Social Policies and the World Health Organization (WHO). The project is coordinated by the Italian national public health institute and three work packages (WPs) Cross-border epidemic intelligence, vaccine preventable diseases and migrants and Cross-border emerging zoonoses are operated by the national institutes of France, Bulgaria and Greece. These WPs constitute technical pillars on which the project develops. Networking and Training are WPs dedicated to capacity building and are run by the Padua Teaching Hospital (Italy) and the Spanish national public health institute. A steering committee guides EpiSouth's activities while all countries collaborate through WP steering teams and focal points. A number of outcomes have been accomplished and documents with results are available from the EpiSouth website which hosts a public website and a restricted area for direct sharing of information among the participants. Five electronic bulletins were published, two trainings for 63 participants performed, national epidemic intelligence systems were evaluated, a preliminary survey on vaccine-preventable diseases and migrants performed, and a list of priorities for emerging zoonoses in the Mediterranean area was selected. Overall the network succeeded in creating cohesion, mutual trust and concrete collaboration on cross-border public health issues in a geographical area that is not addressed as a whole by any other initiative or organisation.

HIV, malaria parasites, and acute febrile episodes in Ugandan adults: a case-control study.

BACKGROUND: In sub-Saharan Africa, co-infection with HIV and malaria is probably very common. Although an interaction between the two infections is biologically plausible, it has not been investigated thoroughly. OBJECTIVES: To evaluate the association firstly between co-infection with HIV and malaria parasites and the occurrence of acute fever, and secondly between HIV infection and clinical malaria, defined as the presence of acute fever and malaria parasites. METHODS: A hospital-based case-control study was conducted in Gulu District (northern Uganda), an area endemic for malaria and with a high HIV prevalence. HIV testing and malaria parasite quantification were performed on 167 consecutive adult out-patients with acute fever and no signs or symptoms of localized infection, and on 134 consecutive adult in-patients without fever who were admitted for non-HIV-related trauma or elective surgery. RESULTS: No significant association with acute fever was observed for single infection with either malaria parasites [adjusted odds ratio (AOR), 1.75; 95% confidence interval (CI), 0.73-4.21] or HIV (AOR, 1.01; 95% CI, 0.51-2.03), whereas a significant association was observed for co-infection (AOR, 9.75; 95% CI, 1.19-80.00). An association was found between HIV infection and clinical malaria (AOR, 2.34; 95% CI, 0.89-6.17); the association became statistically significant when the definition of clinical malaria included a cut-off for parasite density (50th percentile; i.e., 586 parasites/microl; AOR, 3.61; 95% CI, 1.04-12.52). CONCLUSIONS: Despite the limited statistical power, the results of our study show an association between HIV infection and clinical malaria; if confirmed, this finding could be important for public health in sub-Saharan Africa.

Impact of insecurity, the AIDS epidemic, and poverty on population health: disease patterns and trends in Northern Uganda.

A retrospective analysis of the discharge records of 186,131 inpatients admitted to six Ugandan hospitals during 1992-1998 was performed to describe the disease patterns and trends among the population of Northern Uganda. In all hospitals, malaria was the leading cause of admission and the frequency of admissions for malaria showed the greatest increase. Other conditions, such as malnutrition and injuries, mainly increased in the sites affected by civil conflict and massive population displacement. Tuberculosis accounted for the highest burden on hospital services (approximately one-fourth of the total bed-days), though it showed a stable trend over time. A stable trend was also observed for acquired immunodeficiency syndrome (AIDS), which is in contrast to the hypothesis that AIDS patients have displaced other patients in recent years. In conclusion, preventable and/or treatable communicable diseases, mainly those related to poverty and poor hygiene, represent the leading causes of admission and death, reflecting the socioeconomic disruption in Northern Uganda.