Assessment of serosurveys for H5N1.

BACKGROUND: It has been suggested that the true case-fatality rate of human H5N1 influenza infection is appreciably less than the figure of approximately 60% that is based on official World Health Organization (WHO)-confirmed case reports because asymptomatic cases may have been missed. A number of seroepidemiologic studies have been conducted in an attempt to identify such missed cases. METHODS: We conducted a comprehensive literature review of all English-language H5N1 human serology surveys with detailed attention to laboratory methodology used (including whether investigators used criteria set by the WHO to define positive cases), laboratory controls used, and the clades/genotypes involved. RESULTS: Twenty-nine studies were included in the analysis. Few reported using unexposed control groups and one-third did not apply WHO criteria. Of studies that used WHO criteria, only 4 found any seropositive results to clades/genotypes of H5N1 that are currently circulating. No studies reported seropositive results to the clade 2/genotype Z viruses that have spread throughout Eurasia and Africa. CONCLUSIONS: This review suggests that the frequency of positive H5 serology results is likely to be low; therefore, it is essential that future studies adhere to WHO criteria and include unexposed controls in their laboratory assays to limit the likelihood of false-positive results.

The eradication of smallpox--an overview of the past, present, and future.

The 30th anniversary of the declaration of smallpox eradication is a propitious time to look back on the evolutionary history of the program, its execution, and its legacy for the future. The eradication of history's most feared disease culminated a decade-long World Health Organization campaign which began despite skepticism and doubt and succeeded despite a never ending array of obstacles occasioned by floods, civil war, famine, and bureaucratic inertia. New concepts in public health management, surveillance, and the application of large-scale programs for vaccination were fostered and matured. A new generation of young health workers emerged who applied new approaches and experienced the gratification of public health achievement. A definitive legacy for the future was the extension of the program into an "Expanded Program on Immunization", now functioning world-wide and resulting in dramatic improvements in health through control of vaccine-preventable diseases. No less important are the growing number of multi-national programs whose foundations rest on the development of active case surveillance to measure achievement and to guide progress - poliomyelitis, measles, guinea worm, and rubella.

The role of research in viral disease eradication and elimination programs: lessons for malaria eradication.

By examining the role research has played in eradication or regional elimination initiatives for three viral diseases--smallpox, poliomyelitis, and measles--we derive nine cross-cutting lessons applicable to malaria eradication. In these initiatives, some types of research commenced as the programs began and proceeded in parallel. Basic laboratory, clinical, and field research all contributed notably to progress made in the viral programs. For each program, vaccine was the lynchpin intervention, but as the programs progressed, research was required to improve vaccine formulations, delivery methods, and immunization schedules. Surveillance was fundamental to all three programs, whilst polio eradication also required improved diagnostic methods to identify asymptomatic infections. Molecular characterization of pathogen isolates strengthened surveillance and allowed insights into the geographic source of infections and their spread. Anthropologic, sociologic, and behavioural research were needed to address cultural and religious beliefs to expand community acceptance. The last phases of elimination and eradication became increasingly difficult, as a nil incidence was approached. Any eradication initiative for malaria must incorporate flexible research agendas that can adapt to changing epidemiologic contingencies and allow planning for posteradication scenarios.

Comments from the Center for Biosecurity of UPMC on proposed revisions to federal quarantine rules.

On November 30, 2005, the U.S. Centers for Disease Control and Prevention (CDC) proposed changes to federal quarantine regulations (42 CFR Parts 70 and 71). As stated in the proposed rules, the intent of changes is "to clarify and strengthen existing procedures to enable CDC to respond more effectively to current and potential communicable disease threats." Parts 70 and 71 of 42 CFR authorize the Secretary of the Department of Health and Human Services (HHS) to make and enforce regulations "as in his judgement are necessary to prevent the introduction, transmission, and spread of communicable diseases" from foreign countries (Part 71) and between states (Part 70). The Center for Biosecurity of UPMC reviewed the proposed revisions to the quarantine regulations and submitted to CDC the following analysis as its official comments on the revised rules.

Navigating the storm: report and recommendations from the Atlantic Storm exercise.

Atlantic Storm was a tabletop exercise simulating a series of bioterrorism attacks on the transatlantic community. The exercise occurred on January 14, 2005, in Washington, DC, and was organized and convened by the Center for Biosecurity of UPMC, the Center for Transatlantic Relations of Johns Hopkins University, and the Transatlantic Biosecurity Network. Atlantic Storm portrayed a summit meeting of presidents, prime ministers, and other international leaders from both sides of the Atlantic Ocean in which they responded to a campaign of bioterrorist attacks in several countries. The summit principals, who were all current or former senior government leaders, were challenged to address issues such as attaining situational awareness in the wake of a bioattack, coping with scarcity of critical medical resources such as vaccine, deciding how to manage the movement of people across borders, and communicating with their publics. Atlantic Storm illustrated that much might be done in advance to minimize the illness and death, as well as the social, economic, and political disruption, that could be caused by an international epidemic, be it natural or the result of a bioterrorist attack. These lessons are especially timely given the growing concerns over the possibility of an avian influenza pandemic that would require an international response. However, international leaders cannot create the necessary response systems in the midst of a crisis. Medical, public health, and diplomatic response systems and critical medical resources (e.g., medicines and vaccines) must be in place before a bioattack occurs or a pandemic emerges.

Anthrax as a biological weapon, 2002: updated recommendations for management.

OBJECTIVE: To review and update consensus-based recommendations for medical and public health professionals following a Bacillus anthracis attack against a civilian population. PARTICIPANTS: The working group included 23 experts from academic medical centers, research organizations, and governmental, military, public health, and emergency management institutions and agencies. EVIDENCE: MEDLINE databases were searched from January 1966 to January 2002, using the Medical Subject Headings anthrax, Bacillus anthracis, biological weapon, biological terrorism, biological warfare, and biowarfare. Reference review identified work published before 1966. Participants identified unpublished sources. CONSENSUS PROCESS: The first draft synthesized the gathered information. Written comments were incorporated into subsequent drafts. The final statement incorporated all relevant evidence from the search along with consensus recommendations. CONCLUSIONS: Specific recommendations include diagnosis of anthrax infection, indications for vaccination, therapy, postexposure prophylaxis, decontamination of the environment, and suggested research. This revised consensus statement presents new information based on the analysis of the anthrax attacks of 2001, including developments in the investigation of the anthrax attacks of 2001; important symptoms, signs, and laboratory studies; new diagnostic clues that may help future recognition of this disease; current anthrax vaccine information; updated antibiotic therapeutic considerations; and judgments about environmental surveillance and decontamination.

Is there a relationship between neonatal ventilation and the development of childhood asthma in Barbadian children? - Poster abstract

OBJECTIVE: To determine whether infants given intermittent positive pressure ventilation (IPPV) has a higher incidence of asthma in the first 5 years of life, compared to children matched for birth weight but not given IPPV. METHODS: A retrospective cohort study was carried out on children of birth weight <2000 g born during 1994 at the Queen Elizabeth Hospital and admitted to the Neonatal Intensive Care Unit (NICU). Hospital records of 58/77 admissions were analyzed for variables including gender, date of birth, birth weight, clinically assessed gestation, apgar scores, requirement for IPPV and a diagnosis of respiratory distress syndrome (RDS). In addition, parents or guardians were contacted by telephone and a simple questionnaire about asthma diagnosis was administered. RESULTS: Sixteen patients received IPPV in this group and 42 did not. Surfactant was not used during this period. Of those received IPPV, 9 (56 percent) had a diagnosis of asthma/wheeze compared to 10 (13 percent) of the control cohort (p<0.05). Possible confounders were identified: birth weight, gestation, one-minute apgar score and a diagnosis of RDS (each p

Measles elimination in the Americas: evolving strategies

The strategy currently used to control measles in most countries has been to immunize each successive birth cohort through the routine health services delivery system. While measles vaccine coverage has increased markedly, significant measles outbreaks have continued to recur. During the past five years, experience in the Americas suggests that measles transmission has been interrupted in a number of countries (Cuba, Chile, and countries in the English-Speaking Caribbean and successfully controlled in all remaining countries. Since 1991 these countries have implemented one-time "catch-up" vaccination campaigns (conducted during a short period, usually 1 week to 1 month, and targeting all children 9 months through 14 years of age, regardless of previous vaccination status or measles disease history). These campaigns have been followed by improvements in routine vaccination services and in surveillance systems, so that the progress of the measles elimination efforts can be sustained and monitored. Follow-up mass vaccination campaigns for children younger than 5 years are planned to take place every 3 to 5 years (AU)

Prioridades de salud: problemas por resolver y nuevos retos / Unfinished problems and new challenges

En los últimos 25 años hemos sido testigos de cambios verdaderamente revolucionarios en el campo de la salud, en especial en los países de ingresos bajos y medios. En este artículo se discuten algunos de los problemas de salud que se deben resolver y los retos que habrán de enfrentarse. Dentro de ellos destacan el financiamiento de los servicios de salud, la atención a una población con un problema de edad cada vez mayor, la mejoría en la calidad de los servicios y la capacitación de recursos humanos para enfrentar futuras necesidades de salud dentro de un contexto de recursos cada vez mas limitados

In the last 25 years we have witnessed revolutionary changes in the field of health, particularly in the low and middle income countries. This paper discusses some of the new problems which need to be solved and some of the challenges which lie ahead Among the former we can mention the financing of health care services and the provision of health care to an aging population. Among the latter we include the need for improvement of the quality of health services and the training of appropriate health manpower.

Smallpox and its eradication / F. Fenner ... [et al.]

The definitive history of the worlds most triumphant achievement in medicine and public health. In 31 chapters, this monumental work recounts the history of one of humanity's worst diseases, moving from ancient times, through the discovery of vaccination, to the spectacular WHO-led campaign that finally vanquished the disease. Authored by experts personally involved in the eradication campaign, the book gives posterity a minutely detailed account of both how the disease once reigned and what was necessary, step by step and country by country, to eliminate the ancient scourge once and for all. Virtually everything ever known about the disease, and everything that happened during the global eradication campaign, has been collected and preserved in this richly illustrated account. For scientists and clinicians, Smallpox and its Eradication will serve as a complete and final review of knowledge on the clinical features, virology, pathology, immunology, and epidemiology of variola major and minor. For students of public health and medical history, the book offers access to a wealth of previously unpublished data and personal experiences that make up the saga of a public health event unprecedented in scope and unparalleled in the magnitude of its achievement. For posterity, Smallpox and its Eradication will serve, above all, as an inspiring reminder of the knowledge and efforts that transformed smallpox from a universally dreaded disease to one the world could safely forget