Development of a risk assessment tool for contact tracing people after contact with infectious patients while travelling by bus or other public ground transport: a Delphi consensus approach.

BACKGROUND: Tracing persons who have been in contact with an infectious patient may be very effective in preventing the spread of communicable diseases. However, criteria to decide when to conduct contact tracing are not well established. We have investigated the available evidence for contact tracing with a focus on public ground transport aiming to give guidance in what situations contact tracing should be considered. METHODS: Relevant infectious diseases suitable for contact tracing in ground transport and a set of disease-specific epidemiological criteria were defined through literature search and structured multistep expert consultations. We developed continuous scales for each criterion to be rated for its relevance to contact tracing in ground transport. We used the Delphi method with an international expert panel to position the values of criteria on the respective scales. RESULTS: The study led to the development of the 'Contact Tracing-Risk Assessment Profile' (CT-RAP), a decision-making instrument, taking into account pathogen-specific as well as situation-specific criteria. This report describes the methodology of this instrument and presents two examples of ready-to-use CT-RAP for tuberculosis and for meningococcal disease in public ground transport. DISCUSSION: The systematic and transparent use of the CT-RAP for tuberculosis and meningococcal disease is likely to facilitate reasonable, efficient and user-friendly decisions with respect to contact tracing. New CT-RAPs for additional pathogens and different settings such as schools and kindergartens are being planned.

Infection control measures on ships and in ports during the early stage of pandemic influenza A (H1N1) 2009.

Shipping companies were surveyed to evaluate the effect of public health measures during the influenza A (H1N1) pandemic of 2009 on ship and port operations. Of 31 companies that operated 960 cruise, cargo, and other ships, 32% experienced health-screening measures by port health authorities. Approximately a quarter of ports (26%) performed screening at embarkation and 77% of shipping companies changed procedures during the early stage of the pandemic. Four companies reported outbreaks of pandemic influenza A (H1N1) 2009 on ships, which were ultimately stopped through infection control practices. Public health measures did not interfere substantially with port and ship operations with the exception of some port authorities that delayed embarking and disembarking procedures in a few ships. However, in the shipping companies' experience, measures were inconsistent between port health authorities. Access to antiviral drugs and pandemic vaccine was not provided in all ports. Current guidelines on medical care, hygiene, and emergency procedures on ships need to address pandemic influenza preparedness in future revisions.

O regulamento sanitário internacional (2005) e a vigilância em saúde / The International Health Regulations (2005) and Health Surveillance

Aborda-se no presente artigo a participação do Brasil e do Mercado Comum do Sul (MERCOSUL) no processo de revisão do Regulamento Sanitário Internacional da Organização Mundial da Saúde (OMS), que teve início em 1995 e foi finalizado em maio de 2005. Numa visão retrospectiva ­ a partir do exame documental e de relatos da experiência do autor, enquanto testemunha ocular desse processo ­ são analisadas as principais mudanças introduzidas neste instrumento de direito internacional, bem como as medidas necessárias para a sua implementação em cada país e, especificamente, no Brasil. As conclusões apontam para a necessidade de uma ampla articulação entre os diversos segmentos do setor de saúde e demais setores envolvidos no tráfego e comércio entre países, além da cooperação internacional e do apoio da própria OMS, objetivando evitar a propagação internacional de doenças e seus agentes patógenos.