Investing in health preparedness, response and resilience: a genomics costing tool focused on next generation sequencing.

Is Africa prepared for tackling the COVID-19 (SARS-CoV-2) epidemic. Lessons from past outbreaks, ongoing pan-African public health efforts, and implications for the future

The seventh International Conference on Emerging Infectious Diseases (ICEID) was held in Atlanta, Georgia, USA, July 11-14, 2010. The conference goal was to bring together public health professionals to encourage exchange of scientific and public health information on global emerging infectious disease issues. The conference was organized by the Centers for Disease Control and Prevention (CDC), American Society for Microbiology, the Council of State and Territorial Epidemiologists, the Association of Public Health Laboratories, and the World Health Organization; additional support was provided by 40 other multidisciplinary public health partners.

The World Health Organization (WHO) monitors the spread of diseases globally and maintains a list of diseases with epidemic or pandemic potential. Currently listed diseases include Chikungunya, cholera, Crimean-Congo hemorrhagic fever, Ebola virus disease, Hendra virus infection, influenza, Lassa fever, Marburg virus disease, Neisseria meningitis, MERS-CoV, monkeypox, Nipah virus infection, novel coronavirus (COVID-19), plague, Rift Valley fever, SARS, smallpox, tularemia, yellow fever, and Zika virus disease. The associated pathogens are increasingly important on the global stage. The majority of these diseases have neurological manifestations. Those with less frequent neurological manifestations may also have important consequences. This is highlighted now in particular through the ongoing COVID-19 pandemic and reinforces that pathogens with the potential to spread rapidly and widely, in spite of concerted global efforts, may affect the nervous system. We searched the scientific literature, dating from 1934 to August 2020, to compile data on the cause, epidemiology, clinical presentation, neuroimaging features, and treatment of each of the diseases of epidemic or pandemic potential as viewed through a neurologist's lens. We included articles with an abstract or full text in English in this topical and scoping review. Diseases with epidemic and pandemic potential can be spread directly from human to human, animal to human, via mosquitoes or other insects, or via environmental contamination. Manifestations include central neurologic conditions (meningitis, encephalitis, intraparenchymal hemorrhage, seizures), peripheral and cranial nerve syndromes (sensory neuropathy, sensorineural hearing loss, ophthalmoplegia), post-infectious syndromes (acute inflammatory polyneuropathy), and congenital syndromes (fetal microcephaly), among others. Some diseases have not been well-characterized from a neurological standpoint, but all have at least scattered case reports of neurological features. Some of the diseases have curative treatments available while in other cases, supportive care remains the only management option. Regardless of the pathogen, prompt, and aggressive measures to control the spread of these agents are the most important factors in lowering the overall morbidity and mortality they can cause.

Ten years have elapsed since the World Health Organization issued its first global alert for an unexplained illness named severe acute respiratory syndrome (SARS). The anniversary provides an opportunity to reflect on the international response to this new global microbial threat. While global surveillance and response capacity for public health threats have been strengthened, critical gaps remain. Of 194 World Health Organization member states that signed on to the International Health Regulations (2005), <20% had achieved compliance with the core capacities required by the deadline in June 2012. Lessons learned from the global SARS outbreak highlight the need to avoid complacency, strengthen efforts to improve global capacity to address the next pandemic using all available 21st century tools, and support research to develop new treatment options, countermeasures, and insights while striving to address the global inequities that are the root cause of many of these challenges.

Background and Purpose: National AIDS indicator surveys generate large volumes of specimens and associated data, necessitating the preparedness of systems and processes in the reference laboratory. Specimen management is often more routine while management of data becomes secondary. However, complete and accurate laboratory results are essential to ensure data quality. Robust laboratory informatics solutions for managing data are needed to increase data accuracy and reduce turnaround time. Methods: During the 2012 Kenya AIDS Indicator Survey (KAIS), 62,435 samples were collected from respondent households and transferred to the National HIV Reference Laboratory (NHRL) for testing. The Association of Public Health Laboratories (APHL) collaborated with the Kenya Ministry of Health in laboratory process improvement, laboratory information system design and governance focusing on preparing the laboratory to manage the large volume of samples and associated data. This task included developing detailed work flow and data flow diagrams for the entire process, from field specimen and data collection, to receipt, testing and storage. These diagrams were used for training and for reference during the survey process. They were also used to define KAIS 2012 requirements for the existing laboratory information management system (LIMS). Laboratory processes were documented and matched up with the configurations developed in the LIMS. The team also designed specimen tracking and receiving forms based on KAIS 2012 protocol and LIMS requirements. They matched these forms with data elements in the LIMS for data harmonization. The KAIS survey team developed contingency plans for every KAIS 2012 laboratory activity to ensure NHRL implemented uniform procedures when normal operations did not occur. These plans focused on the management and standardization of human resources as appropriate personnel and associated procedures are integral to optimal information system performance. The team defined staff roles and responsibilities and developed procedures for managing forms, specimens and electronic data, including quality and use aligned with survey protocols. During the project, the KAIS team provided knowledge transfer to NHRL to ensure the development of local capacity and long-term sustainability. Results: Due to the informatics processes in place, NHRL was able to share laboratory test results from KAIS with other stakeholders within a day of being received. NHRL was also able to immediately access data on storage locations of all samples that were previously managed using paper systems – a significant challenge before the project. Visualization, mapping and contingency planning for each step of the process ensured that laboratory support to KAIS 2012 was timely, and of high quality, regardless of digressions from standard operating procedures caused by unexpected circumstances. While contingency plans are not routine, they can be critical to the success of the survey. Conclusions: Preparedness is key. Finalization of the survey protocol three months before the pilot, training and piloting all aspects of laboratory services a month prior to the survey ensured informatics solutions are appropriate and robust. Engaging all stakeholders -- particularly survey, laboratory and LIMS staff -- in laboratory informatics solutions planning, implementation, monitoring is critical to developing the most efficient systems and processes for a large national sero survey. During execution, constant and ongoing communication is essential to adapt to the evolving needs of the survey and its participants. Keywords: LIMS/LIS, Informatics, survey

Human resources for health in the Americas

After years of decline tuberculosis has re-emerged as a serious public health problem worldwide. In 1993 the World Health Organization (WHO) declared tuberculosis to be a global emergency and according to a recent WHO report there were 7.96 million new cases in 1997 with 2 million deaths. Factors contributing to the resurgence of tuberculosis include the HIV epidemic immigration of persons from countries with high incidence rates and political turmoil in some developing countries which hinder efforts to control the disease. The spread of the disease poses a public health concern especially with increased drug resistance among M. tuberculosis strains which have acquired varying degrees of resistance to firstline anti-tuberculous drugs. The underlying causes of single drug-resistant M. tuberculosis (SDR-TB) and/or multidrug-resistant M. tuberculosis (MDR-TB) have been suggested to be the result of incorrect treatment poor compliance shortage of anti-tuberculous drugs due to financial constraints in some developing countries and deficient or deteriorating TB control programs resulting in inadequate administration of effective chemotherapy. Previous reports indicate that single-drug resistance and multi-drug resistance to M. tuberculosis are on the increase in both developed and developing countries. The prevalence of SDR-TB or MDR-TB in the Kingdom of Saudi Arabia is largely unknown except for a few studies confined to large centers. The objective of this article is to review published materials from different regions of the Kingdom on the prevalence of SDR-TB and MDR-TB and to draw a conclusion of the actual status of drug-resistant tuberculosis in Saudi Arabia with a discussion of the findings. (excerpt)

Improving pain management for trauma patients at two Rwandan emergency departments

Background: West Africa experienced the largest outbreak of Ebola in 2014 in history involving three Mano River States of Sierra Leone, Liberia and Guinea. The World Health Organization (WHO) coordinated an emergency response from WHO Country Offices in many areas, including human resources for health services. WHO Zambia deployed human resources (HR) focal persons to Sierra Leone and Liberia to strengthen operations. The purpose of this paper is to document the contributions made by WHO Zambia human resources staff that were deployed for more than six weeks during this outbreak and areas of value of this exposure experience.Methods: A review of standard operating procedures (SOPs) in an Ebola setting and experiences gained during the deployment of staff in Sierra Leone and Liberia were recorded systematically. Comparisons were made between experiences gained in the WHO offices situated in the Ebola outbreak setting and one outside such a setting. Lessons learned from this deployment were documented and where appropriate documentation adapted by staff upon return from the Ebola setting. The staffs were in an emergency setting for over six weeks in either Sierra Leone or Liberia.Results: There were major similarities in settings affected by Ebola. Both the local and international staff members that visited the Ebola affected areas worked as a team towards the goal of ending the epidemic quickly. At these sites, staff members discharged a variety of duties which involved facilitating recruitment, deployment, appointments, Special Service Agreements (SSA), Consultancies and Agreements of Performance of Work (APW). The HR staffs were also responsible for travel and logistics of international staff and consultants on duty travel and entitled for rest and recuperation. Recruitment processes were shorter with HR waivers being applied where necessary unlike in a WHO country non-Ebola office setting. Working hours were longer including weekends and it was normal for staff to be found working at the WHO office after office working hours, weekends and official holidays. People working at WHO compound avoided bodily contact, including a specified contact distance, to minimize the risk of exposure.Discussion: The participation or exposure of staff to an Ebola setting during an outbreak built a strong culture of staff enabling them to work under harsh conditions which were characterized by long hours and constant recognition of the threat of disease enabling a quick adaptation to different culture and lifestyle which had a positive impact. Some of the lessons learnt included improved work efficiency, built staff resilience to work long hours under stressful conditions and consciously managing aseptic techniques.Conclusion: Exposure to some adverse conditions such as managing work operations in the midst of a deadly outbreak such as Ebola may have a positive impact on the work culture of the individual exposed to this setting and the organization as a whole.

Avian influenza (AI) virus detections occurred frequently in 2022 and continue to pose a health, economic, and food security risk. The most recent global analysis of official reports of animal outbreaks and human infections with all reportable AI viruses was published almost a decade ago. Increased or renewed reports of AI viruses, especially high pathogenicity H5N8 and H5N1 in birds and H5N1, H5N8, and H5N6 in humans globally, have established the need for a comprehensive review of current global AI virus surveillance data to assess the pandemic risk of AI viruses. This study aims to provide an analysis of global AI animal outbreak and human case surveillance information from the last decade by describing the circulating virus subtypes, regions and temporal trends in reporting, and country characteristics associated with AI virus outbreak reporting in animals; surveillance and reporting gaps for animals and humans are identified. We analyzed AI virus infection reports among animals and humans submitted to animal and public health authorities from January 2013 to June 2022 and compared them with reports from January 2005 to December 2012. A multivariable regression analysis was used to evaluate associations between variables of interest and reported AI virus animal outbreaks. From 2013 to 2022, 52.2% (95/182) of World Organisation for Animal Health (WOAH) Member Countries identified 34 AI virus subtypes during 21,249 outbreaks. The most frequently reported subtypes were high pathogenicity AI H5N1 (10,079/21,249, 47.43%) and H5N8 (6722/21,249, 31.63%). A total of 10 high pathogenicity AI and 6 low pathogenicity AI virus subtypes were reported to the WOAH for the first time during 2013-2022. AI outbreaks in animals occurred in 26 more Member Countries than reported in the previous 8 years. Decreasing World Bank income classification was significantly associated with decreases in reported AI outbreaks (P<.001-.02). Between January 2013 and June 2022, 17/194 (8.8%) World Health Organization (WHO) Member States reported 2000 human AI virus infections of 10 virus subtypes. H7N9 (1568/2000, 78.40%) and H5N1 (254/2000, 12.70%) viruses accounted for the most human infections. As many as 8 of these 17 Member States did not report a human case prior to 2013. Of 1953 human cases with available information, 74.81% (n=1461) had a known animal exposure before onset of illness. The median time from illness onset to the notification posted on the WHO event information site was 15 days (IQR 9-30 days; mean 24 days). Seasonality patterns of animal outbreaks and human infections with AI viruses were very similar, occurred year-round, and peaked during November through May. Our analysis suggests that AI outbreaks are more frequently reported and geographically widespread than in the past. Global surveillance gaps include inconsistent reporting from all regions and human infection reporting delays. Continued monitoring for AI virus outbreaks in animals and human infections with AI viruses is crucial for pandemic preparedness.

Mpox, declared a Public Health Emergency of International Concern by the World Health Organization (WHO), poses a growing global threat. The resurgence, driven by the highly transmissible and severe clade Ib strain from the Democratic Republic of the Congo, raises concerns about a potential pandemic. This narrative review aims to identify actionable strategies to mitigate the current Mpox outbreak by leveraging lessons from past health crises, particularly COVID-19, and to highlight future research priorities essential for global preparedness. A comprehensive literature review from 2018 to 2024 was conducted using Google Scholar, Scopus, and PubMed databases, focusing on Mpox transmission, vaccine efficacy, antiviral treatments, and public health responses. Our findings revealed that the resurgence of Mpox is fueled by viral evolution, ecological changes, and inadequate surveillance, exacerbated by inequitable healthcare access and insufficient public health infrastructure. While existing vaccines, such as Jynneos and ACAM2000, offer protection, their long-term efficacy and safety across diverse populations require further study. Antiviral treatments, including tecovirimat and brincidofovir, show promise but lack optimized care protocols and face challenges such as emerging resistance. Lessons from the COVID-19 response underscore the importance of enhancing global surveillance systems, strengthening healthcare infrastructure, ensuring equitable vaccine distribution, and fostering community engagement. Effective Mpox management also requires standardized treatment guidelines and the integration of genomic monitoring to track viral evolution and drug resistance. Urgent international collaboration is needed to avert a potential Mpox pandemic. Priorities include advancing research on long-term vaccine efficacy, optimizing antiviral therapies, and improving care for severe cases. Actionable recommendations include robust policies, sustainable funding, and global collaboration to strengthen pandemic preparedness and mitigate Mpox’s impact.

Pandemic Preparedness and Responses to the 2009 H1N1 Influenza: Crisis Management and Public Policy Insights

In the years following the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002–2003, the World Health Organization (WHO) created a new system for global disease outbreak surveillance. The system relied on timely reporting by nation-states and gave the WHO a leading role in the global response. It also recognized the value of a multiplicity of sources of information, including from open-source media scanning. The post-SARS system faced its most significant task with the outbreak of the COVID-19 pandemic in the People’s Republic of China and its rapid spread in 2020. The WHO architecture for early warning of disease outbreaks arguably failed and gives rise to questions about how the international community can better respond to pandemic threats in future. This article explores the inter-connectedness of Canada’s system for global health surveillance, featuring the work of the Global Public Health Intelligence Network and that of the WHO, and argues that, while Canada has positioned itself as a global leader, much work needs to be done in Canada, and globally, if the concept of collective health security and shared early warning is to be maintained in the future.

Letter from Singapore: The clinical and research response to COVID‐19

As part of the framework of preparedness and response to influenza viruses with pandemic potential, the World Health Organization (WHO) has developed a protocol for the characterization of a series of first cases and contacts of an agent with pandemic potential (FFX). At the end of 2019, PAHO/WHO invited Colombia to be among the pilot countries for implementing this protocol. It was conducted by the National Institute of Health of Colombia. The WHO generic protocol was reviewed and adapted to Colombia. In its implementation, a series of 99 cases of COVID-19 and 360 total contacts (159 positive contacts) were evaluated between August 2020 and January 2021 in three municipalities of Colombia. Surveys were conducted, along with RT-PCR and antibody titer tests. Sociodemographic, clinical, and virological transmission conditions were analyzed to calculate the main epidemiological indicators of viral transmission using measures of central tendency and absolute and relative frequencies. A total of 258 cases were confirmed to be positive for COVID-19 for a secondary attack rate of 43%. The most common symptoms were cough, fever, headache, and odynophagia. The percentage of symptomatic contacts, clinical attack rate, incubation period, and serial interval were 34%, 16.2%, 4.6 days, and 4.7 days, respectively. The significant rate of infection and incubation periods among contacts was similar to those reported worldwide. The implementation of the WHO FFX protocol in a novel context allowed the country to test its capacity to implement global studies to determine early public health interventions. The study faced limitations due to the selection bias towards severe cases and challenges in case recruitment and contact tracing.