Diretor-Geral da OMS declara surto de mpox como uma emergência de saúde pública de importância internacional

O diretor-geral da Organização Mundial da Saúde (OMS), Tedros Adhanom Ghebreyesus, determinou que o aumento de casos de mpox na República Democrática do Congo (RDC) e em um número crescente de países na África, constitui uma emergência de saúde pública de importância internacional (ESPII) no marco do Regulamento Sanitário Internacional (2005) (RSI).

Perguntas e respostas sobre o vírus Oropouche/Preguntas y respuestas sobre el virus Oropouche/ Q&A – Oropouche fever

Washington D.C., 24 de julho de 2024 (OPAS) [Atualizado em 26 de julho de 2024] – Em julho deste ano, a Organização Pan-Americana da Saúde (OPAS) emitiu alerta epidemiológico sobre um aumento nos casos notificados do vírus Oropouche (OROV) em cinco países (Brasil, Bolívia, Peru, Cuba e Colômbia) na Região das Américas. Washington D.C., 24 de julio de 2024 (OPS) [Actualizado el 26 de julio de 2024] – En julio de este año, la Organización Panamericana de la Salud (OPS) emitió una alerta epidemiológica sobre un aumento de casos reportados del virus Oropouche (OROV) en cinco países (Brasil, Bolivia, Perú, Cuba y Colombia) de la Región de las Américas. Washington D.C., 24 July 2024 (PAHO) [Updated 26 July 2024] – In July this year, the Pan American Health Organization (PAHO) issued an epidemiological alert on an increase in reported cases of Oropouche virus (OROV) in five countries (Brazil, Bolivia, Peru, Cuba and Colombia) in the Region of the Americas.

Factors influencing integrated disease surveillance and response system in selected districts in the Eastern Region of Ghana.

BACKGROUND: Ghana adopted the Integrated Disease Surveillance and Response (IDSR) system, which is an integration of the various programs in the surveillance system and can contain disease outbreaks and pandemics. Implementation of the IDSR is influenced by several factors which can affect its functionality and ability to contain disease outbreaks. This study assessed the factors influencing the IDSR system in selected districts in the Eastern Region of Ghana. METHOD: A cross-sectional study was conducted between February-March, 2022 in Fanteakwa North, Abuakwa South and New Juaben South districts in the Eastern Region of Ghana among health care workers who are involved in IDRS activities. Both primary and secondary data were collected and analyzed using descriptive statistics and regression analysis at 0.05 significant level with 95% confidence interval. RESULTS: Three hundred and forty-seven (347) health care workers participated in the study with 56.2% (195/347) indicating that rumor registers were available at the health facilities. Most of the respondents (64.8%, 225/347) had means of transport for disease surveillance activities while majority (61.9%, 215/347) had case-based forms for case investigation. About half (51.9%, 180/347) of the participants revealed that they did not receive any feedback from the next higher level in the past year. Availability of transport for IDSR activities was almost 3.4 times more likely to contribute positively to IDSR system compared to facilities without transport (AOR = 3.36; 95% CI = 1.44-7.83; p = 0.005). Respondents who have the capacity to apply case definition are 2 times more likely to contribute to an effective IDSR system compared to health workers who cannot apply case definition (AOR = 1.94; 95% CI = 1.17-3.21; p = 0.013). Respondents who did not receive feedback from the next higher level were 52% less likely to have an effective IDSR system compared to respondents who received feedback from the next higher level (AOR = 0.48; 95% CI = 0.23-1.00; p = 0.05). CONCLUSION: Effective operation of IDSR is affected by the application of case definition and means of transport at health facilities. In addition, the capacity of health care workers to provide feedback can influence the smooth operation of the IDSR in the studied area in Ghana.

Comprehensive contact tracing during an outbreak of alpha-variant SARS-CoV-2 in a rural community reveals less viral genomic diversity and higher household secondary attack rates than expected.

Sequencing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes throughout the COVID-19 pandemic has generated a wealth of data on viral evolution across populations, but only a few studies have so far explored SARS-CoV-2 evolution across large connected transmission networks. Here, we couple data from SARS-CoV-2 sequencing with contact tracing data from an outbreak with a single origin in a rural Norwegian community where samples from all exposed persons were collected prospectively. A total of 134 nasopharyngeal samples were positive by PCR. Among the 121 retrievable genomes, 81 were identical to the genome of the introductor, thus demonstrating that genomics beyond clustering genotypically similar viral genomes to confirm relatedness offers limited additional value to manual contact tracing. In the cases where mutations were discovered, five small genetic clusters were identified. We observed a household secondary attack rate of 77%, with 92% of household members infected among households with secondary transmission, suggesting that SARS-CoV-2 introduction into large families is likely to affect all household members. IMPORTANCE: In outbreak investigations, obtaining a full overview of infected individuals within a population is seldom achieved. We here present an example where a single introduction of B1.1.7 SARS-CoV-2 within a rural community allowed for tracing of the virus from an introductor via dissemination through larger gatherings into households. The outbreak occurred before widespread vaccination, allowing for a "natural" outbreak development with community lockdown. We show through sequencing that the virus can infect up to five consecutive persons without gaining mutations, thereby showing that contact tracing seems more important than sequencing for local outbreak investigations in settings with few alternative introductory transmission pathways. We also show how larger households where a child introduced transmission appeared more likely to promote further spread of the virus compared to households with an adult as the primary introductor.

Biogeochemical conditions controlling the intensity of paralytic shellfish poisoning (PSP) outbreak caused by Alexandrium blooms: Results from 6-year field observations in Jinhae-Masan Bay, Korea.

Previous field observations from 2018 to 2019 revealed that paralytic shellfish poisoning (PSP) caused by the blooms of toxic dinoflagellate Alexandrium species occurred under low concentrations of dissolved inorganic nitrogen (DIN) and high concentrations of dissolved organic nitrogen (DON) and humic-like fluorescent dissolved organic matter (FDOMH) in Jinhae-Masan Bay, Korea. In this study, we obtained more data for DIN, DON, FDOMH, and Alexandrium cell density from 2020 to 2023 to further validate environmental conditions for the PSP outbreak. We also measured total hydrolyzed amino acids (THAA) to determine the bioavailability of DON fueling the PSP outbreak. Over the 6-year observations, there was a consistent pattern of low DIN concentrations and high DON and FDOMH concentrations during the PSP outbreak periods. The Alexandrium cell densities, together with the PSP toxin concentrations, increased rapidly under this environmental condition. The PSP outbreak occurs when a large amount of DIN originating from the stream waters near the upstream sites is transformed into DON by biological production before entering the PSP outbreak area. The produced DON is characterized by high bioavailability based on the various AA-derived indices (enantiomeric ratio, degradation index, non-protein AA mole%, and nitrogen-normalized AA yield). In addition, the intensities of PSP outbreaks are mainly dependent on the conversion stage of DIN to DON and enhanced FDOMH. We found that the strong PSP outbreak occurred consistently under a low level of DIN (<1.0 µM) and high levels of DON (>9.0 µM) and FDOMH (>1.5 R.U.). Thus, our results suggest that the monitoring data of environmental conditions can be used to predict the PSP outbreak in the coastal oceans.

Outbreak response capacity of the Global Outbreak Alert and Response Network across WHO's South-East Asia and Western Pacific regions.

Objective: The COVID-19 pandemic challenged the Global Outbreak Alert and Response Network's (GOARN) mechanism used to rapidly deploy technical support for international responses and highlighted areas that require strengthened capacity within the Network. GOARN's partners in the World Health Organization's (WHO) South-East Asia and Western Pacific regions were engaged to explore their levels of preparedness, readiness and ability to respond to international public health emergencies. Methods: Consultative discussions were held and a survey was conducted with GOARN's partners from the two WHO regions. Discussion topics included partners' capacity to support and participate in a GOARN deployment, training, research and collaboration. Descriptive and content analyses were conducted. Results: Barriers to engaging in GOARN's international outbreak response efforts included limited numbers of personnel trained to respond to outbreaks; institutional, financial and administrative hurdles; and limited collaboration opportunities. Partners identified innovative solutions that could strengthen their engagement with deployment, such as financial subsidies, mentorship for less experienced staff, and the ability to provide remote support. Discussion: GOARN plays an important role in enabling WHO to fulfil its international alert and response duties during disease outbreaks and humanitarian crises that have the potential to spark disease outbreaks. Yet without systematic improvement to strengthen national outbreak capacity and regional connectedness, support for international outbreak responses may remain limited. Thus, it is necessary to integrate novel approaches to support international deployments, as identified in this study.

AI-based epidemic and pandemic early warning systems: A systematic scoping review.

Background: Timely detection of disease outbreaks is critical in public health. Artificial Intelligence (AI) can identify patterns in data that signal the onset of epidemics and pandemics. This scoping review examines the effectiveness of AI in epidemic and pandemic early warning systems (EWS). Objective: To assess the capability of AI-based systems in predicting epidemics and pandemics and to identify challenges and strategies for improvement. Methods: A systematic scoping review was conducted. The review included studies from the last 5 years, focusing on AI and machine learning applications in EWS. After screening 1087 articles, 33 were selected for thematic analysis. Results: The review found that AI-based EWS have been effectively implemented in various contexts, using a range of algorithms. Key challenges identified include data quality, model explainability, bias, data volume, velocity, variety, availability, and granularity. Strategies for mitigating AI bias and improving system adaptability were also discussed. Conclusion: AI has shown promise in enhancing the speed and accuracy of epidemic detection. However, challenges related to data quality, bias, and model transparency need to be addressed to improve the reliability and generalizability of AI-based EWS. Continuous monitoring and improvement, as well as incorporating social and environmental data, are essential for future development.

Multisectoral approach for the control of cholera outbreak - lessons and challenges from Lusaka district - Zambia, October 2023 - February 2024.

Introduction: on October 18, 2023, the Ministry of Health declared an outbreak of cholera in the Lusaka district. Public health interventions were implemented using a multisectoral approach in the Lusaka district and other hotspots in the country. We documented the multisectoral response efforts and their impacts on the cholera epidemic in the Lusaka district of Zambia. We highlighted the major challenges and their associated impacts on the epidemiologic patterns of disease in hotspot areas. Methods: we conducted a descriptive observational study of cholera response activities in the Lusaka district. We used quantitative and qualitative non-participant techniques using the Centers for Disease Prevention and Control's direct in-person observation tool in healthcare settings. We reviewed surveillance records to estimate the magnitude of the outbreak, and characterized cases by person, place, and time. We documented the response interventions and challenges using situation reports. Results: during the 2023 - 2024 cholera outbreak, Lusaka district was the most affected district with 13,122 cases and 498 deaths as of 12th February 2024. Despite having a well-established system for coordinating technical support and resource mobilization, inadequate sanitation and limited access to clean water remained potential risks for cholera outbreaks in Lusaka district. Conclusion: Lusaka district may have experienced one of the most severe cholera epidemics in the nation's history, as indicated by its rapid spread and increased mortality reported from both the community and treatment centers. A multisectoral coordination for improved sanitary systems, access to clean water, health education strategies, and vaccination campaigns contributed to the decline in cholera cases.

Epidemiological characteristics and early predict model of children Mycoplasma Pneumoniae Pneumonia outbreaks after the COVID-19 in Shandong.

Since October 2023, a significant outbreak of Mycoplasma Pneumoniae Pneumonia (MPP) has been observed in children in northern China. Chinese health authorities have attributed this epidemiological to immune debt resulting from the relaxation of coronavirus disease 2019 (COVID-19) control measures. This study described the epidemiological features of Mycoplasma pneumoniae (MP) prevalence in children and developed a straightforward prediction model to differentiate between MPP and viral pneumonia in children. The infection rate of MP in children notably increased from 8.12 in 2022 to 14.94% in 2023, peaking between October and November, especially among school-age children. Logistic regression screening identified four key indicators: Age, D-Dimer levels, erythrocyte sedimentation rate, and gender. The developed nomogram exhibited a receiver operator characteristic curve-area under the curve (ROC-AUC) of 0.858, with external validation confirming an ROC-AUC of 0.794. This study examined the epidemiological characteristics of MPP prevalence in children in Shandong Province during and after the COVID-19 pandemic. An early predict model was developed and validated to differentiate between Mycoplasma Pneumoniae and viral infections.

Assessment of epidemic risk state and its change trend of public hospital in underdeveloped area in different stages.

Objective: Epidemics are sudden and rapidly spreading. Hospitals in underdeveloped areas are particularly vulnerable in case of an outbreak. This paper aims to assess the epidemic risk state and its change trend of hospitals in different epidemic stages, identify the key factors affecting hospital epidemic risk change, provide priority reference for hospital epidemic risk control, and enhance the hospital's ability to respond to sudden epidemics. Methods: Based on Grounded theory, the epidemic risk indicators that affect hospital safety are summarized. The concept of epidemic risk state and its random state space is proposed according to Markov chain theory. The impact of each indicator on the random risk state and its change is comprehensively assessed from two aspects: risk occurrence probability and risk loss. Finally, the assessment of the hospital epidemic risk state and its change at different stages is achieved. Results: The stable risk states of public hospitals in underdeveloped areas in non-epidemic stage t0, early epidemic stage t1, and outbreak stage t2 are P ^ t 0 ( S n ) = { 0 . 142 , 0 . 546 , 0 . 220 , 0 . 093 } , P ^ t 1 ( S n ) = { 0 . 025 , 0 . 364 , 0 . 254 , 0 . 357 } , and P ^ t 2 ( S n ) = { 0 . 020 , 0 . 241 , 0 . 191 , 0 . 548 } , respectively. In non-epidemic stage, the key factor in improving the hospital epidemic risk state is emergency funding. In early epidemic stage, the key factors in improving the hospital epidemic risk state are the training of medical staff in epidemic prevention skills and the management of public health. In outbreak state, the key factor in improving the hospital epidemic risk state is the training of medical staff in epidemic prevention skills and psychological awareness. Conclusion: This paper proposes the concept of epidemic risk state, providing an effective assessment method for the epidemic risk state and its change trend in public hospitals. According to the assessment, public hospitals in underdeveloped areas in different epidemic stages should adopt different risk control strategies to improve their current risk state. Blind risk control is inefficient and may even cause the epidemic risk to transition toward a more dangerous state.

Attitude towards cholera vaccination and its related factors in Jordan amid the 2022 Middle East outbreak.

BACKGROUND: An outbreak of cholera was reported in the Middle East by the second half of 2022. Raising public awareness and vaccination against cholera represent critical factors in the preventive efforts. The current study aimed to assess the knowledge of cholera and attitude towards its vaccination among a sample of the general public residing in Jordan. METHODS: An online self-administered questionnaire was distributed to the residents in Jordan using a snowball convenience-based sampling approach. The questionnaire based on previously published studies included items to evaluate sociodemographic variables, knowledge about cholera symptoms, transmission, and prevention and the willingness to accept cholera vaccination. Additionally, four items based on the validated 5 C scale in Arabic were included to assess the psychological factors influencing attitude to cholera vaccination. RESULTS: The final study sample comprised 1339 respondents, of whom 1216 (90.8%) heard of cholera before the study. Among those who heard of cholera, and on a scale from 0 to 20, the overall mean cholera Knowledge score (K-score) was 12.9 ± 3.8. In multivariate analysis, being over 30 years old and occupation as healthcare workers or students in healthcare-related colleges were significantly associated with a higher K-score compared to younger individuals and students in non-healthcare-related colleges. Overall, the acceptance of cholera vaccination if cases are recorded in Jordan, and if the vaccine is safe, effective, and provided freely was reported among 842 participants (69.2%), while 253 participants were hesitant (20.8%) and 121 participants were resistant (10.0%). In linear regression, the significant predictors of cholera vaccine acceptance were solely the three psychological factors namely high confidence, low constraints, and high collective responsibility. CONCLUSIONS: In this study, the identified gaps in cholera knowledge emphasize the need to enhance educational initiatives. Although cholera vaccine acceptance was relatively high, a significant minority of the respondents exhibited vaccination hesitancy or resistance. The evident correlation between the psychological determinants and attitudes toward cholera vaccination emphasizes the need to consider these factors upon designing public health campaigns aimed at cholera prevention. The insights of the current study highlight the importance of addressing both knowledge gaps and psychological barriers to optimize cholera control strategies.

Spatial mapping of dengue fever prevalence and its association with geo-climatic factors in Lahore, Pakistan.

A vector-borne disease of concern for global public health, dengue fever has been spreading its endemicity and several cases in recent years, particularly in Lahore Pakistan. Dengue transmission is influenced by geo-climatic conditions. This study aimed to map the spatial prevalence of dengue fever in Lahore and its association with geo-climatic factors during the epidemic of the year 2021. In this study, geo-climatic factors that could potentially encourage the growth of the virus are chosen for this study, and their temporal and spatial changeability relate to dengue cases. The objective of this study is to use meteorological, satellite data and Geographic Information System (GIS) techniques to map dengue outbreaks and identify the risk-prone areas by relating geo-climatic factors with dengue outbreaks. The dengue patients and their locations data were collected from the Directorate General of Health Services (DGHS) Lahore. This study uses Google Earth and Landsat-8 OLI/TIRs images to extract geo-climatic and land use parameters. The dot density maps technique was used to represent the spatiotemporal distribution of dengue cases. The hotspot analysis was applied to show the hotspots of dengue cases in district Lahore at the Union Council (UC) level. The Normalised Difference Vegetation Index (NDVI), Normalised Difference Water Index (NDWI), built-up area, population density, precipitation, and Land Surface Temperature (LST) are the factors employed. In this study, correlation was performed to test the significance between precipitation and the prevalence of dengue fever in Lahore. The results show that the incidence and prevalence of dengue fever month-wise at the UC level in Lahore. The distribution pattern of dengue outbreaks in the Lahore area and its demographic factors were found to be associated. It concludes that the increase in the spread of dengue fever is associated with the monsoon rains. The prevalence of dengue is associated with water bodies and high land surface temperature, but it does not represent any significant relation with vegetation cover and land use in Lahore during the year 2021. The study pinpointed the locations that are most susceptible and require care to prevent such outbreaks in the future.

Bluetongue virus serotype 3 in ruminants in the Netherlands: Clinical signs, seroprevalence and pathological findings.

BACKGROUND: The bluetongue virus serotype 3 (BTV-3) outbreak in the Netherlands in 2023 caused severe clinical signs in ruminants. The clinical and pathological signs in ruminants and their spread during the outbreak in 2023 are described. METHODS: Data from the Dutch monitoring and surveillance system were available to describe clinical signs and pathological findings related to BTV-3 in sheep, cattle and goats. During the outbreak, 13 farms (five sheep, five cattle and three dairy goats) were closely monitored. RESULTS: In 2023, BTV-3 infections were confirmed by real-time polymerase chain reaction in sheep flocks (n = 1807), cattle herds (n = 1864), goat herds (n = 62), alpaca and/or llama herds (n = 15) and one dog. Sheep exhibited the most severe clinical signs and had the highest mortality. In other animal species, a large variation in both occurrence and severity of clinical signs was observed. LIMITATION: Only 13 farms were closely monitored. CONCLUSIONS: The clinical signs observed in affected animals during the 2023 BTV-3 outbreak seem to be more severe than those observed during the BTV-8 outbreak between 2006 and 2008. It seems likely that BTV-3 will overwinter, similar to BTV-8. Therefore, the availability of an effective and safe vaccine is crucial to limit the future impact of BTV-3.

Typhoid fever: the challenging diagnosis of a pseudo-outbreak in Benguet, Philippines.

Objective: The event-based surveillance and response report from the municipality of Buguias in the Philippines covering the period 1 January to 29 October 2022 indicated an unusual increase in the number of typhoid cases that surpassed the epidemic threshold for consecutive weeks. An investigation was conducted to confirm the existence of an outbreak, identify the source(s) of transmission and recommend prevention and control measures. Methods: The investigation employed a descriptive design. Medical records were reviewed to verify diagnoses and to identify cases that met case definitions. Key informant interviews were conducted to identify possible sources of transmission and investigate the reporting of cases in the Philippine Integrated Disease Surveillance and Response (PIDSR) system. Results: A total of 220 cases of typhoid fever were captured by the PIDSR system. Of the 208 suspected cases that were reviewed, only 15 (7.2%) met the case definition used in this investigation. Fourteen of these 15 verified cases were interviewed; five (35.7%) were farmers and 13 (92.8%) reported using springs as their main water source and source of drinking-water. Reporting of cases in the PIDSR system was largely based on the final chart diagnosis or a positive Typhidot or Tubex rapid diagnostic test result. The PIDSR case definition was not followed in the reporting of cases. Discussion: This study provides evidence of endemicity of typhoid fever in Buguias, Benguet, Philippines. However, from January to October 2022, cases were overreported by the surveillance system. Medical record reviews showed that most reported suspected cases did not meet case definition criteria. This finding emphasizes the need to improve typhoid guidelines with regards to diagnosis using rapid diagnostic tests and to investigate the cost-effectiveness of making confirmatory laboratory tests for typhoid available in the Philippines.