#Genomic #Epidemiology as a #PublicHealth #Tool to Combat #Mosquito-Borne Virus #Outbreaks (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Genomic Epidemiology as a Public Health Tool to Combat Mosquito-Borne Virus Outbreaks

S Pollett, J R Fauver, Irina Maljkovic Berry, M Melendrez, A Morrison, L D Gillis, M A Johansson, R G Jarman, N D Grubaugh

The Journal of Infectious Diseases, jiz302, https://doi.org/10.1093/infdis/jiz302

Published: 10 November 2019



Next-generation sequencing technologies, exponential increases in the availability of virus genomic data, and ongoing advances in phylogenomic methods have made genomic epidemiology an increasingly powerful tool for public health response to a range of mosquito-borne virus outbreaks. In this review, we offer a brief primer on the scope and methods of phylogenomic analyses that can answer key epidemiological questions during mosquito-borne virus public health emergencies. We then focus on case examples of outbreaks, including those caused by dengue, Zika, yellow fever, West Nile, and chikungunya viruses, to demonstrate the utility of genomic epidemiology to support the prevention and control of mosquito-borne virus threats. We extend these case studies with operational perspectives on how to best incorporate genomic epidemiology into structured surveillance and response programs for mosquito-borne virus control. Many tools for genomic epidemiology already exist, but so do technical and nontechnical challenges to advancing their use. Frameworks to support the rapid sharing of multidimensional data and increased cross-sector partnerships, networks, and collaborations can support advancement on all scales, from research and development to implementation by public health agencies.

Topic: epidemiology – dengue fever – culicidae – disease outbreaks – genome – yellow fever – public health medicine – viruses – surveillance, medical – zika virus

Issue Section: supplement articles

Keywords: Arbovirus; Public Health; Mosquitoes; Genetics.


The #Threat of Emerging and Re-emerging #Infections in #Indonesia (Acta Med Indones., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Acta Med Indones. 2019 Jul;51(3):195-196.

The Threat of Emerging and Re-emerging Infections in Indonesia.

Nelwan EJ1.

Author information: 1 Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia. erni.juwita@ui.ac.id.



Human immunodeficiency virus (HIV) is one example of an emerging infection with total of 386 district of all province in Indonesia reported having such infection; with cumulative number of HIV infected patient from the year 1987 to 2014 is 150,296 while AIDS is 55,799 patients. The access to care only available for 153,887 patients among all HIV/AIDS patients of whom 70% are eligible for anti-retroviral (ARV) treatment and of these only half adhered to ARV treatment. In addition to that, there is an increased risk of other emerging diseases such as Zika virus, Monkey pox or Hanta pulmonary syndrome since a sporadic cases were reported around the region.

Beside new diseases, tuberculosis, dengue virus, malaria and diphteria are continuously reported in Indonesia and classified as re-emerging illnesses. On this edition data on diphteria epidemiology in Indonesia will be shown by Karyanti et al.6 A recent outbreak of diphteria in Indonesia which involved almost all province in the country has led to a response named ORI (outbreak response of Immunization). Regardless of immunization, proper treatment including the distribution of anti-toxin and antibiotics are needed to stop the spread of this particular bacteria, further decreasing the mortality rate. In conclusion, the author of this paper mentioned that immunization gap needs to be handle systematically. Immunization data released on 2017 showed that complete immunization was given only to 20% of targeted group, while almost 75% were either unvaccinated or unknown. During the outbreak of diphteria in Indonesia, the WHO also reported several countries with similar problem such as Bangladesh, Haiti and Yamen. It was shown that a coordination between doctors in clinic/hospital with public health officer to conduct an epidemiological investigation, in conjunction with giving prophylaxis and assuring the logistics of anti-diphteria toxin and antibiotics were accessible were  the key of success in eliminating diphteria like it was in Bangladesh.

Adherence to treatment are multifactorial for all illnesses. First, is the duration of treatment and the potential adverse event due to the medication. The Ministry of Health of the Republic of Indonesia has support the early diagnosis of HIV and delivering treatment as soon as possible, in order to avoid transmission of the disease. Second, looking at another side of the story for HIV infected patients, receiving ARV treatment as a long life treatment could possibly cause an adverse event somewhere along the line. Budiman et.al reported factors that might contribute to liver injury. His study shows that measuring baseline liver function test AST routinely might minimize the toxicity of ARV to patients particularly with a low body mass index. Last, despite the adherence to treatment and procedures in minimizing the risk of adverse event to medication, we are now facing the primary resistance virus that transmitted in the community as mentioned by Megasari et al.8 on her report regarding the transmission of drug resistance HIV virus to naïve patients in Bali.

The Indonesian government through the Indonesian Ministry of Health has established a collaboration and one health approaches to tackle the threat of diseases in the country, particularly in infectious diseases.

KEYWORDS: AIDS; HIV; Infection; Virus

PMID: 31699941

Keywords: Indonesia; Public Health; Diphtheria; HIV/AIDS.


The #publichealth #crisis of #underimmunisation: a global plan of action (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

The public health crisis of underimmunisation: a global plan of action

Prof Lawrence O Gostin, JD, Prof James G Hodge Jr, JD, Prof Barry R Bloom, MD, Ayman El-Mohandes, MD, Prof Jonathan Fielding, MD, Prof Peter Hotez, MD, Dean Ann Kurth, PhD, Prof Heidi J Larson, PhD, Prof Walter A Orenstein, Kenneth Rabin, PhD, Prof Scott C Ratzan, MD, Prof Daniel Salmon, PhD

Published: November 06, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30558-4



Vaccination is one of public health’s greatest achievements, responsible for saving billions of lives. Yet, 20% of children worldwide are not fully protected, leading to 1·5 million child deaths annually from vaccine-preventable diseases. Millions more people have severe disabling illnesses, cancers, and disabilities stemming from underimmunisation. Reasons for falling vaccination rates globally include low public trust in vaccines, constraints on affordability or access, and insufficient governmental vaccine investments. Consequently, an emerging crisis in vaccine hesitancy ranges from hyperlocal to national and worldwide. Outbreaks often originate in small, insular communities with low immunisation rates. Local outbreaks can spread rapidly, however, transcending borders. Following an assessment of underlying determinants of low vaccination rates, we offer an action based on scientific evidence, ethics, and human rights that spans multiple governments, organisations, disciplines, and sectors.

Keywords: Vaccines; Society; Politics; Public Health.


A comprehensive #analysis of #mortality-related #health #metrics associated with #mental #disorders: a nationwide, register-based cohort study (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study

Oleguer Plana-Ripoll, PhD, Prof Carsten Bøcker Pedersen, DrMed, Prof Esben Agerbo, DrMed, Yan Holtz, MSc, Annette Erlangsen, PhD, Vladimir Canudas-Romo, PhD, Prof Per Kragh Andersen, PhD, Fiona J Charlson, PhD, Maria K Christensen, MSc, Holly E Erskine, PhD, Alize J Ferrari, PhD, Kim Moesgaard Iburg, PhD, Natalie Momen, PhD, Prof Preben Bo Mortensen, DrMed, Prof Merete Nordentoft, DrMed, Damian F Santomauro, PhD, James G Scott, PhD, Prof Harvey A Whiteford, PhD, Nanna Weye, MSc, Prof John J McGrath, MD  †, Prof Thomas M Laursen, PhD †

Published: October 24, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32316-5




Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder.


In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death.


7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57–28·82] vs 12·95 deaths [12·93–12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91–1·94) for mood disorders to 3·91 (3·87–3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36–5·48) for organic disorders in females to 14·84 years (14·70–14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher.


Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death.


Danish National Research Foundation.

Keywords: Psychiatry; Society.


New #psychoactive #substances: challenges for #drug #surveillance, control, and public health responses (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

New psychoactive substances: challenges for drug surveillance, control, and public health responses

Amy Peacock, PhD, Raimondo Bruno, PhD, Natasa Gisev, PhD, Prof Louisa Degenhardt, PhD, Prof Wayne Hall, PhD, Roumen Sedefov, MD, Prof Jason White, PhD, Prof Kevin V Thomas, DSc, Prof Michael Farrell, MD, Paul Griffiths, MSc

Published: October 23, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32231-7



The rapid emergence since the mid-2000s of a large and diverse range of substances originally designed as legal alternatives to more established illicit drugs (pragmatically clustered and termed new psychoactive substances; [NPS]) has challenged traditional approaches to drug monitoring, surveillance, control, and public health responses. In this section of the Series, we describe the emergence of NPS and consider opportunities for strengthening the detection, identification, and responses to future substances of concern. First, we explore the definitional complexity of the term NPS. Second, we describe the origins and drivers surrounding NPS, including motivations for use. Third, we summarise evidence on NPS availability, use, and associated harms. Finally, we use NPS as a case example to explore challenges and opportunities for future drug monitoring, surveillance, control, and public health responses. We posit that the current means of responding to emerging substances might no longer be fit for purpose in a world in which different substances can be rapidly introduced, and where people who use drugs can change preferences on the basis of market availability.

Keywords: Illicit drugs; Society; Public Health; Psychiatry.


#Global #patterns of #opioid use and dependence: #harms to populations, interventions, and future action (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Global patterns of opioid use and dependence: harms to populations, interventions, and future action

Prof Louisa Degenhardt, PhD, Prof Jason Grebely, PhD, Jack Stone, PhD, Prof Matthew Hickman, PhD, Prof Peter Vickerman, PhD, Brandon D L Marshall, PhD, Prof Julie Bruneau, MD, Prof Frederick L Altice, MD, Prof Graeme Henderson, PhD, Prof Afarin Rahimi-Movaghar, PhD, Sarah Larney, PhD

Published: October 23, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32229-9



We summarise the evidence for medicinal uses of opioids, harms related to the extramedical use of, and dependence on, these drugs, and a wide range of interventions used to address these harms. The Global Burden of Diseases, Injuries, and Risk Factors Study estimated that in 2017, 40·5 million people were dependent on opioids (95% uncertainty interval 34·3–47·9 million) and 109 500 people (105 800–113 600) died from opioid overdose. Opioid agonist treatment (OAT) can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes—eg, by reducing overall mortality and key causes of death, including overdose, suicide, HIV, hepatitis C virus, and other injuries. Mathematical modelling suggests that scaling up the use of OAT and retaining people in treatment, including in prison, could avert a median of 7·7% of deaths in Kentucky, 10·7% in Kiev, and 25·9% in Tehran over 20 years (compared with no OAT), with the greater effects in Tehran and Kiev being due to reductions in HIV mortality, given the higher prevalence of HIV among people who inject drugs in those settings. Other interventions have varied evidence for effectiveness and patient acceptability, and typically affect a narrower set of outcomes than OAT does. Other effective interventions focus on preventing harm related to opioids. Despite strong evidence for the effectiveness of a range of interventions to improve the health and wellbeing of people who are dependent on opioids, coverage is low, even in high-income countries. Treatment quality might be less than desirable, and considerable harm might be caused to individuals, society, and the economy by the criminalisation of extramedical opioid use and dependence. Alternative policy frameworks are recommended that adopt an approach based on human rights and public health, do not make drug use a criminal behaviour, and seek to reduce drug-related harm at the population level.

Keywords: Opioids; Public Health; Society; Psychiatry.


Is #war a man-made #publichealth problem? (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

Is war a man-made public health problem?

Oliver Razum, Henrique Barros, Robert Buckingham, Mary Codd, Katarzyna Czabanowska, Nino Künzli et al.

Published: October 16, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)31900-2



Wars and armed conflicts have devastating consequences for the physical and mental health of all people involved, for the social life within and surrounding the war-affected regions, and for the health of the environment. Wars destroy health infrastructure, undoing years of health advancement, and severely compromise health systems’ capacity to respond to the direct and indirect health consequences of fighting. Millions of people have been internally displaced or forced to flee their countries because of armed conflict. Forced migration creates further physical and mental health problems during transit, in enforced encampment, and because of restricted entitlement to health care in countries hosting refugees.1,  2,  3



Copyright © 2019 Bakr Alkasem/Getty Images

OR, HB, RB, MC, KC, NK, KL, and CS are the executive board members of ASPHER; RO is director at ASPHER; JM is president of ASPHER.

Keywords: Wars; Society; Public Health.