Responding to a school SARS-CoV-2 outbreak: Insights and policy implications emerging from the pandemic.

Background: The SARS-CoV-2 pandemic has affected also the school environment. Prolonged closures and the weakness of available data prevent a definitive answer to the question of school transmission. We report our experience of responding to COVID-19 cases in the school setting, presenting a case study of the management of an outbreak in a large school. Methods: The LHA/ASL Roma 1 has organized the School Units with a structure firmly rooted in the territory. At the local level, the District Unit mainly manages the relationship with schools, while the Hygiene and Public Health Service of the Prevention Department holds a coordinating and facilitating role. The HPHS carries out contact tracing activities facilitated by the schools, through the figure of the COVID-19 Contact Person, who is specifically trained to manage the preliminary stages of the reports. Results: Following several reports of COVID-19 suspect cases from two schools and, after a complex phase of contact tracing, it was possible to identify the major transmission chains. Furthermore, we performed a population-based screening on the entire school. Beyond the known transmission chains, for which quarantine was already in place, only five additional cases emerged, all asymptomatic, out of 1,231 swabs tested with RT-PCR. Conclusions: Our experience confirms that an active interaction between the school and the School Unit made it possible to quickly control a potentially dangerous outbreak. The large-scale screening test demonstrated the substantial absence of collateral transmission chains. Effective contact tracing allowed to set forth a successful response. Our model of intervention can be used to support public health protocols regarding school outbreaks.

When is a disease eradicable? 100 years of lessons learned.

Since the 1915 launch of the first international eradication initiative targeting a human pathogen, much has been learned about the determinants of eradicability of an organism. The authors outline the first 4 eradication efforts, summarizing the lessons learned in terms of the 3 types of criteria for disease eradication programs: (1) biological and technical feasibility, (2) costs and benefits, and (3) societal and political considerations.

[Endemic dracunculiasis in new villages: re-emergence of the disease or failure of the surveillance system]. / Les nouveaux villages d'endémie de la dracunculose: réémergence de la maladie ou dysfonctionnement du système de surveillance.

According to data sent to Bamako in March 1998 for the annual review of National Programs for the Eradication of the Guinea Worm (NPEGV), dracunculiasis was observed in 211 villages in Burkina Faso in 1997. Of this total, 110 (52 p. 100) were new villages not previously reporting dracunculiasis. A study focusing on these new villages was carried out in June 1998. The aim of the study was to evaluate the quality of the disease monitoring system and determine if endemicity was spreading to new villages. A twofold method was used first to analyze the data used in the geographic information section of the disease monitoring system and second to test the validity of this data in field surveys. Findings showed the actual number of new villages showing endemicity could be reduced from 46 p. 100 to 12 p. 100 since 67 p. 100 of the new villages had in fact previously reported endemicity but had been wrongly eliminated from monitoring records. This probably long-standing problem has been uncovered with a decrease in the number of villages showing endemicity and an increase in prevention activities. In addition this study identified several confounding factors and defects in disease monitoring and data reporting techniques. Based on this study, several recommendations were made to improve the quality of the disease monitoring system.

Epidemiological data on burn injuries in Angola: a retrospective study of 7230 patients.

This study describes the work carried out at the Burn Unit of the Neves Bendinha Hospital, Luanuda, Angola, during the 3-year period July 1991 to June 1994. During this period we admitted 2569 burned patients to our burn unit, and 4661 were treated on an outpatient basis. The data from the patients were analysed to indicate the distribution according to age, sex, TBSA, cause of the lesion and mortality. Our study gives some epidemiological data on burns in an undeveloped country undergoing a war, outlining the specific problems compared to the reality in civilized countries.

Post-emergency epidemiological surveillance in Iraqi-Kurdish refugee camps in Iran.

In 1991 a computerized, comprehensive epidemiological surveillance system was developed to monitor health trends in approximately 25,000 acutely displaced Kurds in Nowsood and Saryas refugee camps, Bakhtaran region, Northwestern Iran. In addition, community-based surveys offered information unobtainable from health facilities. Weekly population movements, attack rates, point-prevalence estimates, and case fatality ratios were calculated, and the data were analysed and compared. The overall crude mortality rate (CMR) in the camps under study was still 9 times higher than the reported CMR for Iraq. Health problems with very low rates (less than 1.0/1,000 population/week) included the triad of measles, meningitis and tetanus. However, morbidity for the most common conditions (acute respiratory infections, diarrhoea, skin infections, eye diseases and, finally, typhoid fever) was shown to increase at the end of the intervention, highlighting that the pressure of repatriation on refugees made them progressively worse. This article concludes that epidemiological surveillance systems should be implemented during mass-migrations in developing countries also in post-emergency settings. Furthermore, surveillance appears to be indispensable in order for the international agencies to keep abreast of events and to safeguard human rights when international attention subsides.