Disparities in Age-specific Morbidity and Mortality From SARS-CoV-2 in China and the Republic of Korea.

We analyzed age-/sex-specific morbidity and mortality data from the SARS-CoV-2 pandemic in China and Republic of Korea (ROK). Data from China exhibit a Gaussian distribution with peak morbidity in the 50-59-year cohort, while the ROK data have a bimodal distribution with the highest morbidity in the 20-29-year cohort.

Climate Change in the North American Arctic: A One Health Perspective.

Climate change is expected to increase the prevalence of acute and chronic diseases among human and animal populations within the Arctic and subarctic latitudes of North America. Warmer temperatures are expected to increase disease risks from food-borne pathogens, water-borne diseases, and vector-borne zoonoses in human and animal populations of Arctic landscapes. Existing high levels of mercury and persistent organic pollutant chemicals circulating within terrestrial and aquatic ecosystems in Arctic latitudes are a major concern for the reproductive health of humans and other mammals, and climate warming will accelerate the mobilization and biological amplification of toxic environmental contaminants. The adverse health impacts of Arctic warming will be especially important for wildlife populations and indigenous peoples dependent upon subsistence food resources from wild plants and animals. Additional research is needed to identify and monitor changes in the prevalence of zoonotic pathogens in humans, domestic dogs, and wildlife species of critical subsistence, cultural, and economic importance to Arctic peoples. The long-term effects of climate warming in the Arctic cannot be adequately predicted or mitigated without a comprehensive understanding of the interactive and synergistic effects between environmental contaminants and pathogens in the health of wildlife and human communities in Arctic ecosystems. The complexity and magnitude of the documented impacts of climate change on Arctic ecosystems, and the intimacy of connections between their human and wildlife communities, makes this region an appropriate area for development of One Health approaches to identify and mitigate the effects of climate warming at the community, ecosystem, and landscape scales.

Age-specific and sex-specific morbidity and mortality from avian influenza A(H7N9).

We used data on age and sex for 136 laboratory confirmed human A(H7N9) cases reported as of 11 August 2013 to compare age-specific and sex-specific patterns of morbidity and mortality from the avian influenza A(H7N9) virus with those of the avian influenza A(H5N1) virus. Human A(H7N9) cases exhibit high degrees of age and sex bias: mortality is heavily biased toward males >50 years, no deaths have been reported among individuals <25 years old, and relatively few cases documented among children or adolescents. The proportion of fatal cases (PFC) for human A(H7N9) cases as of 11 August 2013 was 32%, compared to a cumulative PFC for A(H5N1) of 83% in Indonesia and 36% in Egypt. Approximately 75% of cases of all A(H7N9) cases occurred among individuals >45 years old. Morbidity and mortality from A(H7N9) are lowest among individuals between 10 and 29 years, the age group which exhibits the highest cumulative morbidity and case fatality rates from A(H5N1). Although individuals <20 years old comprise nearly 50% of all human A(H5N1) cases, only 7% of all reported A(H7N9) cases and no deaths have been reported among individuals in this age group. Only 4% of A(H7N9) cases occurred among children<5 years old, and only one case from the 10 to 20 year age group. Age- and sex-related differences in morbidity and mortality from emerging zoonotic diseases can provide insights into ecological, economic, and cultural factors that may contribute to the emergence and proliferation of novel zoonotic diseases in human populations.

Rapid diagnosis of avian influenza virus in wild birds: use of a portable rRT-PCR and freeze-dried reagents in the field.

Wild birds have been implicated in the spread of highly pathogenic avian influenza (HPAI) of the H5N1 subtype, prompting surveillance along migratory flyways. Sampling of wild birds for avian influenza virus (AIV) is often conducted in remote regions, but results are often delayed because of the need to transport samples to a laboratory equipped for molecular testing. Real-time reverse transcriptase polymerase chain reaction (rRT-PCR) is a molecular technique that offers one of the most accurate and sensitive methods for diagnosis of AIV. The previously strict lab protocols needed for rRT-PCR are now being adapted for the field. Development of freeze-dried (lyophilized) reagents that do not require cold chain, with sensitivity at the level of wet reagents has brought on-site remote testing to a practical goal. Here we present a method for the rapid diagnosis of AIV in wild birds using an rRT-PCR unit (Ruggedized Advanced Pathogen Identification Device or RAPID, Idaho Technologies, Salt Lake City, UT) that employs lyophilized reagents (Influenza A Target 1 Taqman; ASAY-ASY-0109, Idaho Technologies). The reagents contain all of the necessary components for testing at appropriate concentrations in a single tube: primers, probes, enzymes, buffers and internal positive controls, eliminating errors associated with improper storage or handling of wet reagents. The portable unit performs a screen for Influenza A by targeting the matrix gene and yields results in 2-3 hours. Genetic subtyping is also possible with H5 and H7 primer sets that target the hemagglutinin gene. The system is suitable for use on cloacal and oropharyngeal samples collected from wild birds, as demonstrated here on the migratory shorebird species, the western sandpiper (Calidrus mauri) captured in Northern California. Animal handling followed protocols approved by the Animal Care and Use Committee of the U.S. Geological Survey Western Ecological Research Center and permits of the U.S. Geological Survey Bird Banding Laboratory. The primary advantage of this technique is to expedite diagnosis of wild birds, increasing the chances of containing an outbreak in a remote location. On-site diagnosis would also prove useful for identifying and studying infected individuals in wild populations. The opportunity to collect information on host biology (immunological and physiological response to infection) and spatial ecology (migratory performance of infected birds) will provide insights into the extent to which wild birds can act as vectors for AIV over long distances.

Field detection of avian influenza virus in wild birds: evaluation of a portable rRT-PCR system and freeze-dried reagents.

Wild birds have been implicated in the spread of highly pathogenic avian influenza (HPAIV) of the H5N1 subtype, prompting surveillance along migratory flyways. Sampling of wild birds is often conducted in remote regions, but results are often delayed because of limited local analytical capabilities, difficulties with sample transportation and permitting, or problems keeping samples cold in the field. In response to these challenges, the performance of a portable real-time, reverse transcriptase-polymerase chain reaction (rRT-PCR) unit (RAPID((R)), Idaho Technologies, Salt Lake City, UT) that employed lyophilized reagents (Influenza A Target 1 Taqman; ASAY-ASY-0109, Idaho Technologies) was compared to virus isolation combined with real-time RT-PCR conducted in a laboratory. This study included both field- and experimental-based sampling. Field samples were collected from migratory shorebirds captured in northern California, while experimental samples were prepared by spiking fecal material with an H6N2 AIV isolate. Results indicated that the portable rRT-PCR unit had equivalent specificity to virus isolation with no false positives, but sensitivity was compromised at low viral titers. Use of portable rRT-PCR with lyophilized reagents may expedite surveillance results, paving the way to a better understanding of wild bird involvement in HPAIV H5N1 transmission.

Long-distance dispersal and accelerating waves of disease: empirical relationships.

Classic approaches to modeling biological invasions predict a "traveling wave" of constant velocity determined by the invading organism's reproductive capacity, generation time, and dispersal ability. Traveling wave models may not apply, however, for organisms that exhibit long-distance dispersal. Here we use simple empirical relationships for accelerating waves, based on inverse power law dispersal, and apply them to diseases caused by pathogens that are wind dispersed or vectored by birds: the within-season spread of a plant disease at spatial scales of <100 m in experimental plots, historical plant disease epidemics at the continental scale, the unexpectedly rapid spread of West Nile virus across North America, and the transcontinental spread of avian influenza strain H5N1 in Eurasia and Africa. In all cases, the position of the epidemic front advanced exponentially with time, and epidemic velocity increased linearly with distance; regression slopes varied over a relatively narrow range among data sets. Estimates of the inverse power law exponent for dispersal that would be required to attain the rates of disease spread observed in the field also varied relatively little (1.74-2.36), despite more than a fivefold range of spatial scale among the data sets.

Aerial dispersal and multiple-scale spread of epidemic disease.

Disease spread has traditionally been described as a traveling wave of constant velocity. However, aerially dispersed pathogens capable of long-distance dispersal often have dispersal gradients with extended tails that could result in acceleration of the epidemic front. We evaluated empirical data with a simple model of disease spread that incorporates logistic growth in time with an inverse power function for dispersal. The scale invariance of the power law dispersal function implies its applicability at any spatial scale; indeed, the model successfully described epidemics ranging over six orders of magnitude, from experimental field plots to continental-scale epidemics of both plant and animal diseases. The distance traveled by epidemic fronts approximately doubled per unit time, velocity increased linearly with distance (slope ~(1/2)), and the exponent of the inverse power law was approximately 2. We found that it also may be possible to scale epidemics to account for initial outbreak focus size and the frequency of susceptible hosts. These relationships improve understanding of the geographic spread of emerging diseases, and facilitate the development of methods for predicting and preventing epidemics of plants, animals, and humans caused by pathogens that are capable of long-distance dispersal.

New challenges for public health care: biological and chemical weapons awareness, surveillance, and response.

Recent events in the United States have demonstrated a critical need for recognizing nurses and emergency health care providers as important elements of the nation's first line of defense and response against terrorist attacks involving biological, chemical, or radiological weapons. The anthrax letter attacks of September/October 2001 demonstrate the importance of vigilance and attention to detail while interviewing and attending patients and when entering, reviewing, and cataloging patient records. Nursing professionals, emergency care responders, and physicians can perform a crucial role in our first-line defense against terrorism by detecting and reporting unusual or anomalous illness(es) consistent with possible exposure to biological or chemical agents. Nursing professionals should become more familiar with the etiology and clinical symptoms of biological agents of greatest current concern (smallpox, anthrax, tularemia, plague) and be alert for potentially anomalous or unfamiliar combinations of symptoms that could point to unwitting exposure to biological toxins, toxic chemicals, or cryptic radiological agents. Public health surveillance systems must be developed that encourage and facilitate the rapid reporting and follow-up investigation of suspect illnesses and potential disease outbreaks that will ensure early identification and response for covert attacks involving biological, chemical, or radiological weapons.