Decreased incidence of acute hemorrhagic conjunctivitis associated with enhanced public health intervention during the COVID-19 epidemic in China, 2020.

Outbreaks of acute hemorrhagic conjunctivitis (AHC) are associated with a high disease burden. In this study, we investigated the association between enhanced public health intervention and the incidence of AHC during the COVID-19 pandemic in China. A total of 212,526 AHC cases were reported in China during 2015-2020. The overall yearly incidence rate and number of AHC cases decreased by 23.08% and 22.15%, respectively, during the COVID-19 epidemic, compared with the previous 5 years (all p < 0.001). Significant reductions in AHC incidence were found both during the emergency period and after the relaxation of emergency measures in 2020 compared to the previous 5 years (22.22% and 28.00% reduction, respectively; p < 0.001). Enhanced public health initiatives during the COVID-19 pandemic in China were therefore associated with lower transmission of pathogens causing AHC.

Community-based surveillance advances the Global Health Security Agenda in Ghana.

Ghana Health Service (GHS) has strengthened community-based surveillance (CBS) to facilitate early detection and rapid reporting of health events of all origins. Since June 2017, GHS has employed an event-based surveillance approach at the community level in a phased manner. CBS coverage has broadened from 2 to 30 districts across Ghana. Through this effort, capacity was built across all administrative levels in these districts to detect, report, triage, and verify signals, and to perform risk assessment and investigate events. Data were collected and analyzed during an evaluation of initial 2-district implementation in March 2018 and during expanded 30-district implementation in March 2019. Between September 2018 and March 2019, 317 health events were detected through CBS. These events included vaccine-preventable disease cases, acute hemorrhagic conjunctivitis outbreaks, clusters of unexpected animal deaths, and foodborne illness clusters. Eighty-nine percent of the 317 events were reported to district-level public health staff within 24 hours of detection at the community level, and 87% of all detected events were responded to within 48 hours of detection. CBS detected 26% of all suspected vaccine-preventable disease cases that were reported from implementing districts through routine disease surveillance. GHS strengthened CBS in Ghana to function as an early warning system for health events of all origins, advancing the Global Health Security Agenda.

Forecast of the trend in incidence of acute hemorrhagic conjunctivitis in China from 2011-2019 using the Seasonal Autoregressive Integrated Moving Average (SARIMA) and Exponential Smoothing (ETS) models.

BACKGROUND: This study aimed to explore the demographic and distributive features of acute hemorrhagic conjunctivitis (AHC). We constructed seasonal autoregressive integrated moving average (SARIMA) and exponential smoothing (ETS) models to predict its trend in incidence in mainland China and provided evidence for the government to formulate policies regarding AHC prevention. METHODS: Data regarding the distribution and demographic characteristics of AHC in China from 2011-2016 were retrieved from the Public Health Scientific Data website. Monthly AHC data from January 2011 to June 2019 were used to establish and evaluate the SARIMA and ETS models. RESULTS: During 2011-2016, a total of 213,325 cases were reported; 46.01% were farmers, patients aged ≤9 years had the highest risk, and the male:female ratio was 1.31:1. Guangxi and Guangdong had the highest number of reported AHC cases. The SARIMA (0, 0, 1) (2, 0, 0) 12 model with the minimum root mean squared error and mean absolute percentage error were finally selected for in-sample simulation. CONCLUSIONS: AHC remains a serious public health problem in Southern and Eastern China that mainly affects farmers and children younger than 9 years. It is recommended that the health administration strengthen the publicity and education regarding AHC prevention among farmers and accelerate the development of related vaccines and treatment measures.

Dynamic modelling of strategies for the control of acute haemorrhagic conjunctivitis outbreaks in schools in Changsha, China (2004-2015).

Outbreaks of acute haemorrhagic conjunctivitis (AHC) - a rapidly progressing and highly contagious infection - often occur in schools during summer and autumn. We used dynamic modelling to evaluate the efficacy of interventions to control AHC outbreaks in schools. A susceptible-infected-recovered (SIR) model was built to simulate AHC outbreaks in Chinese schools, with isolation or school closure added into the model. We used outbreak data from the period 2004-2015 in our models to estimate the effective reproduction number and assess the efficacy of interventions. The median effective reproduction number (uncontrolled) of AHC outbreaks was 7·00 (range 1·77-25·87). The median effective reproduction number (controlled) of AHC outbreaks was 0·16 (range 0·00-2·28). Intervention efficacy is affected by the timing of isolation; earlier isolation is associated with a lower morbidity peak and smaller total attack rate (TAR). School closures were not effective; TARs were almost 100% and did not change even when different school closure durations were adopted. Isolation and school closure as a combined intervention strategy was used to simulate outbreak control, but the efficacy was the same as isolation alone. An isolation programme could be an effective primary intervention during AHC outbreaks in schools. However, school closure is not recommended.

A major outbreak of conjunctivitis caused by coxsackievirus A24, Réunion, January to April 2015.

From January to April 2015, Réunion experienced a major outbreak of acute haemorrhagic conjunctivitis (AHC) caused by coxsackievirus A24, which heavily impacted the healthcare system. According to the general practitioners' (GP) sentinel network, the number of medical consultations due to conjunctivitis during this period was estimated at ca 100,000. This report describes the characteristics of the outbreak, which were obtained through several different yet complementary surveillance systems on the island. These included the network of hospital emergency departments (OSCOUR network), the GPs' sentinel network, an Internet-based population cohort ('Koman i lé') participating in a survey on distinct symptoms including 'red eyes' and the monitoring of eye drop sales. Overall the results of the different surveillance approaches were in good agreement regarding the outbreak dynamic. A peak of patients with conjunctivitis was detected in the first 15 days of March (week 10 and 11), coinciding with increased eye drop sales on the island. Strains recovered from outbreak cases belonged to genotype IV and were most closely related to strains identified in AHC outbreaks in China, Egypt and Japan since 2010. Continued surveillance of AHC in Réunion remains important not only locally, but also because frequent exchanges between the island and mainland France may lead to introduction of this virus in Europe.

[Study on the efficacy of quarantine during outbreaks of acute hemorrhagic conjunctivitis outbreaks at schools through the susceptive-infective-quarantine-removal model].

To assess the efficacy of quarantine for acute hemorrhagic conjunctivitis (AHC) outbreaks control in schools, by using the Compartment Model. Through combining the characters of both AHC and compartment model, we built a susceptive-infective-removal (SIR) model suited for AHC outbreaks control in schools, and then quarantine was added into the model to develop a susceptive-infective-quarantine-removal (SIQR) model. An outbreak of AHC in Changsha in 2011 was employed as a sample to assess the effect of quarantine for the prevention and control of AHC. Basic reproduction number (λ0) of the AHC outbreak without intervention was 6.80, thus the transmission speed of the disease became quite fast. If no intervention had been adopted, almost all the students, faculties and staff members would have been infected within 23 days, and the accumulative cases would become 738, with the total attack rate (TAR) as 99.73%. The peak of the outbreak was at Sep. 11th and the number of new cases was 126 on that day. The efficacy would have been different if quarantine forces had been taken at different time and differently. The bigger and earlier the quarantine force had been adopted, the lower morbidity peak and the smaller TAR would have been appeared, with better efficacy of outbreak control. If the quarantine rate had been taken at the level of 90% on the sixth day, the accumulative case would have been reduced to 132 and the TAR had become 17.84% consequently. Quarantine program could be used as a main intervention approach to be employed for ACH outbreak at schools.

A peptide vaccine based on a B-cell epitope on the VP1 protein of enterovirus 70 induces a strong antibody response.

Enterovirus 70 (EV70) is the causative agent of acute hemorrhagic conjunctivitis (AHC), for which no effective vaccine is available. This study revealed a high reactivity of the N-terminal region of EV70 VP1 (VP1-1) with an anti-EV70 mouse serum. The analysis of overlapping synthetic peptides of VP1-1 identified a B-cell epitope in this region. The E-peptide (14-ANTVESEIKAELGVI-28) showing the highest reactivity with the anti-EV70 serum induced neutralizing antibodies in mice and reduced the virus titer in the eyes, suggesting that it is a candidate vaccine against AHC caused by EV70.

[Application of Susceptible-Infected-Recovered model in dealing with an outbreak of acute hemorrhagic conjunctivitis on one school campus].

To simulate intervention measures in controlling an outbreak of acute hemorrhagic conjunctivitis on one school campus by using the Susceptible-Infected-Recovered (SIR) model, to provide evidence for preparedness and response to the epidemic. Classical SIR model was used to model the epidemic. Malthusian exponential decline method was employed to estimate the infective coefficient ß for interventions. The initial value of parameters was determined based on empirical data. The modeling was implemented using Matlab 7.1 software. Without interventions, the outbreak was expected to experience three phrases: (1) early stage (the first 5 days) in which the epidemic developed slowly and could be intervened easily; (2) rapid growing stage (6 - 15 days) in which the number of infected cases increased quickly and the epidemic could not be well controlled; and (3) medium and late stage (16 days and later) in which more than 90% of the susceptible persons were infected but the intervention measures failed to prevent the epidemic. With the implementation of interventions, the epidemic was predicted to be controlled in the early stage, under the SIR model. The simulation based on the SIR model kept an acceptable consistency with the actual development of epidemic after the implementation of intervention measures. The SIR model seemed effective in modeling interventions to the epidemic of acute hemorrhagic conjunctivitis in the schools.

Taipei's use of a multi-channel mass risk communication program to rapidly reverse an epidemic of highly communicable disease.

BACKGROUND: In September 2007, an outbreak of acute hemorrhagic conjunctivitis (AHC) occurred in Keelung City and spread to Taipei City. In response to the epidemic, a new crisis management program was implemented and tested in Taipei. METHODOLOGY AND PRINCIPAL FINDINGS: Having noticed that transmission surged on weekends during the Keelung epidemic, Taipei City launched a multi-channel mass risk communications program that included short message service (SMS) messages sent directly to approximately 2.2 million Taipei residents on Friday, October 12th, 2007. The public was told to keep symptomatic students from schools and was provided guidelines for preventing the spread of the disease at home. Epidemiological characteristics of Taipei's outbreak were analyzed from 461 sampled AHC cases. Median time from exposure to onset of the disease was 1 day. This was significantly shorter for cases occurring in family clusters than in class clusters (mean+/-SD: 2.6+/-3.2 vs. 4.39+/-4.82 days, p = 0.03), as well as for cases occurring in larger family clusters as opposed to smaller ones (1.2+/-1.7 days vs. 3.9+/-4.0 days, p<0.01). Taipei's program had a significant impact on patient compliance. Home confinement of symptomatic children increased from 10% to 60% (p<0.05) and helped curb the spread of AHC. Taipei experienced a rapid decrease in AHC cases between the Friday of the SMS announcement and the following Monday, October 15, (0.70% vs. 0.36%). By October 26, AHC cases reduced to 0.01%. The success of this risk communication program in Taipei (as compared to Keelung) is further reflected through rapid improvements in three epidemic indicators: (1) significantly lower crude attack rates (1.95% vs. 14.92%, p<0.001), (2) a short epidemic period of AHC (13 vs. 34 days), and (3) a quick drop in risk level (1 approximately 2 weeks) in Taipei districts that border Keelung (the original domestic epicenter). CONCLUSIONS AND SIGNIFICANCE: The timely launch of this systematic, communication-based intervention proved effective at preventing a dangerous spike in AHC and was able to bring this high-risk disease under control. We recommend that public health officials incorporate similar methods into existing guidelines for preventing pandemic influenza and other emerging infectious diseases.

Management of enteroviral conjunctivitis outbreaks in the Singapore military in 2005.

Between 8 August and 9 October 2005, tropical Singapore experienced a national epidemic of acute viral conjunctivitis. We report the epidemiological and virological findings of outbreaks of viral conjunctivitis in military facilities during the same time period, and the outbreak control measures taken. Outbreaks of viral conjunctivitis were identified by medical officers in military medical facilities. Epidemiological and virological investigations were carried out, and a standard set of control measures was instituted for each outbreak upon detection. Eight outbreaks of viral conjunctivitis occurred in the time period, corresponding to the national outbreak. Delayed detection and institution of preventive measures during the outbreaks were associated with delayed effectiveness of the control measures. Every delay in outbreak detection by one day resulted in a delay in terminating the outbreak by 0.82 days (p = 0.01). Coxsackievirus A24 was identified from some of the conjunctival swab samples taken.

Control sanitario internacional. Pesquisas especiales a becarios extranjeros a su arribo a Cuba / International sanitary control. Special screening on foreign students arriving in Cuba

Se dan a conocer la metodología y el resultado de la pesquisa que se realiza al arribo a Cuba de los viajeros extranjeros que vienen a residir en el país por varios años (becarios extranjeros). El trabajo abarca el período correspondiente a los años 1987 a 1990, durante el mismo se controló un total de 13 025 becarios procedentes de 36 países, resultaron positivos a alguna enfermadad infecciosa 1 110, la mayor parte de ellos fueron positivos a paludismo (838), 220 casos se diagnosticaron con conjuntivitis hemorrágica epidémica y 58 tuvieron una serología positiva al virus de la inmunodeficiencia humana. Todos los casos positivos fueron controlados y tratados por los Servicios Médicos del Instituto Tropical "Pedro Kourí".

Control sanitario internacional. Pesquisas especiales a becarios extranjeros a su arribo a Cuba / International sanitary control. Special screening on foreign students arriving in Cuba

Se dan a conocer la metodología y el resultado de la pesquisa que se realiza al arribo a Cuba de los viajeros extranjeros que vienen a residir en el país por varios años (becarios extranjeros). El trabajo abarca el período correspondiente a los años 1987 a 1990, durante el mismo se controló un total de 13 025 becarios procedentes de 36 países, resultaron positivos a alguna enfermadad infecciosa 1 110, la mayor parte de ellos fueron positivos a paludismo (838), 220 casos se diagnosticaron con conjuntivitis hemorrágica epidémica y 58 tuvieron una serología positiva al virus de la inmunodeficiencia humana. Todos los casos positivos fueron controlados y tratados por los Servicios Médicos del Instituto Tropical "Pedro Kourí"

Estudio epidemiológico de la conjuntivitis hemorrágica en el área metropolitana de San Pedro de macorís

Se realizó un estudio observacional y transversal acerca del comportamiento epidemiológico de la conjuntivitis epidémica vírica en el área metropolitana de San Pedro de Macorís, República Dominicana, durante el período septiembre - diciembre de 1986. El estudio consistió en la realización de una encuesta entre las viviendas de diez sectores seleccionados de la ciudad. Se tomaron 100 viviendas de cada sector mediante muestreo no probabilístico. Durante el último cuatrimestre de 1986 fueron visitadas mil viviendas con una población total de 4 mil 454 personas; de éstas el 66% padeció la enfermedad. El 61,3% presentó conjuntivitis epidémica viral y el resto conjuntivitis bacteriana. El 89% de los casos no recibió tratamiento médico; el barrio Sarmiento resultó el más afectado. En función de nuestro resultado recomendamos medidas preventivas generales

Uso del interferón alfa 2-recombinante en la prevención de la conjuntivitis hemorrágica aguda / Use of alpha 2b recombinant interferon for the prevention of acute hemorrhagic conjunctivitis

Se describen los resultados de un ensayo controlado, a doble ciegas, de prevención de la conjuntivitis hemorágica aguda causada por el virus Coxsackie A-24 durante el brote epidémico de 1986 en Cuba. El estudio se llevó a cabo en una escuela secundaria básica en el campo (con régimen de internado) con el consentimiento del Consejo de escuela. Se distribuyeron 30 estudiantes (ambos sexos, 12 a 14 años) al azar y a doble ciegas, entre dos grupos uno recibió colirio de IFN alfa-2b producido en Cuba (500 000 UI/ml, 2 gotas cada 6 horas) y el otro colirio placebo según el mismo esquema. El tratamiento duró 3 días. Los estudiantes fueron examinados diariamente por un oftalmólogo durante 9 días. Fue mayor el número de estudiantes que desarrollaron la enfermedad en el grupo que recibió placebo que en el que se trató con IFN. La diferencia máxima se produjo entre los días 4 y 7 (10/15 vs 3/15), pero fue estadísticamente significativa (test chi-cuadrado, p 0,05) a partir del día 2 hasta el 8, por lo que el efecto protector del interferón estuvo presente hasta seis días después de haber concluido el tratamiento. No hubo reacciones locales o sistémicas adversas. Este resultado, constituye el primer reporte del efecto beneficioso del IFN en forma de colirio en la prevención de esta molesta enfermedad

Uso del interferón alfa 2-recombinante en la prevención de la conjuntivitis hemorrágica aguda / Use of alpha 2b recombinant interferon for the prevention of acute hemorrhagic conjunctivitis

Se describen los resultados de un ensayo controlado, a doble ciegas, de prevención de la conjuntivitis hemorágica aguda causada por el virus Coxsackie A-24 durante el brote epidémico de 1986 en Cuba. El estudio se llevó a cabo en una escuela secundaria básica en el campo (con régimen de internado) con el consentimiento del Consejo de escuela. Se distribuyeron 30 estudiantes (ambos sexos, 12 a 14 años) al azar y a doble ciegas, entre dos grupos uno recibió colirio de IFN alfa-2b producido en Cuba (500 000 UI/ml, 2 gotas cada 6 horas) y el otro colirio placebo según el mismo esquema. El tratamiento duró 3 días. Los estudiantes fueron examinados diariamente por un oftalmólogo durante 9 días. Fue mayor el número de estudiantes que desarrollaron la enfermedad en el grupo que recibió placebo que en el que se trató con IFN. La diferencia máxima se produjo entre los días 4 y 7 (10/15 vs 3/15), pero fue estadísticamente significativa (test chi-cuadrado, p 0,05) a partir del día 2 hasta el 8, por lo que el efecto protector del interferón estuvo presente hasta seis días después de haber concluido el tratamiento. No hubo reacciones locales o sistémicas adversas. Este resultado, constituye el primer reporte del efecto beneficioso del IFN en forma de colirio en la prevención de esta molesta enfermedad (AU)

Management and prevention of ocular viral and chlamydial infections.

A majority of cases of preventable and/or curable ocular morbidity and blindness are caused by ocular infections. They may account for 70 to 90% of all ocular morbidity seen by family doctors, general practitioners, health centers, and local ophthalmologists in both developed and developing countries. Unfortunately, most health authorities and doctors, including ophthalmologists, consider these diseases to be of little or no importance because they are not fully aware of the high prevalence of these infections and the blinding sequelae which may occur following incorrect diagnosis and treatment. Also, they are not aware of the social and economic impact of these infections in the absence of proper management and implementation of preventive measures. In this review, we examine present knowledge of chlamydial and common viral ocular infections. We discuss the problems of diagnosis, management, and prevention and propose solutions relevant to developed and developing countries.