The #SpanishFlu, #Epidemics, and the Turn to #Biomedical #Responses (Am J Public Health, abstract)

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

Am J Public Health. 2018 Nov;108(11):1455-1458. doi: 10.2105/AJPH.2018.304581. Epub 2018 Sep 25.

The Spanish Flu, Epidemics, and the Turn to Biomedical Responses.

Schwartz JL1.

Author information: 1 The author is with the Department of Health Policy and Management, Yale School of Public Health, and Section of the History of Medicine, Yale School of Medicine, New Haven, CT.



A century ago, nonpharmaceutical interventions such as school closings, restrictions on large gatherings, and isolation and quarantine were the centerpiece of the response to the Spanish Flu. Yet, even though its cause was unknown and the science of vaccine development was in its infancy, considerable enthusiasm also existed for using vaccines to prevent its spread. This desire far exceeded the scientific knowledge and technological capabilities of the time. Beginning in the early 1930s, however, advances in virology and influenza vaccine development reshaped the relative priority given to biomedical approaches in epidemic response over traditional public health activities. Today, the large-scale implementation of nonpharmaceutical interventions akin to the response to the Spanish Flu would face enormous legal, ethical, and political challenges, but the enthusiasm for vaccines and other biomedical interventions that was emerging in 1918 has flourished. The Spanish Flu functioned as an inflection point in the history of epidemic responses, a critical moment in the long transition from approaches dominated by traditional public health activities to those in which biomedical interventions are viewed as the most potent and promising tools in the epidemic response arsenal.

PMID: 30252511 DOI: 10.2105/AJPH.2018.304581 [Indexed for MEDLINE]

Keywords: Pandemic Influenza; Pandemic Preparedness; Spanish Flu; Infectious diseases; Vaccines; Quarantine measures.


Inevitable #isolation and the change of #stress markers in #hemodialysis patients during the 2015 #MERS-CoV #outbreak in #Korea (Sci Rep., abstract)

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

Sci Rep. 2019 Apr 5;9(1):5676. doi: 10.1038/s41598-019-41964-x.

Inevitable isolation and the change of stress markers in hemodialysis patients during the 2015 MERS-CoV outbreak in Korea.

Kim YG1, Moon H1, Kim SY1, Lee YH1, Jeong DW1, Kim K1, Moon JY1, Lee YK2, Cho A2, Lee HS3, Park HC4, Lee SH5.

Author information: 1 Division of Nephrology, Kyung Hee University College of Medicine, Seoul, Korea. 2 Hallym University College of Medicine, Internal Medicine, Seoul, Korea. 3 Hallym University College of Medicine, Psychiatry, Seoul, Korea. 4 Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea. 5 Division of Nephrology, Kyung Hee University College of Medicine, Seoul, Korea.



During the outbreak of Middle East respiratory syndrome coronavirus(MERS-CoV) in 2015, one hemodialysis patient was infected with MERS-CoV, and the remaining hemodialysis(HD) patients (n = 83) and medical staff (n = 12) had to undergo dialysis treatment in an isolated environment. This study was performed to investigate the effects of stress caused by dialysis treatment under isolation. Plasma samples from the HD patients and medical staff were collected at the time of isolation(M0), the following month(M1), and three months after isolation(M3). Parameters for stress included circulating cell-free genomic DNA(ccf-gDNA), circulating cell-free mitochondria DNA(ccf-mtDNA), and pentraxin-3(PTX-3). Decreased values of Hct, kt/v and ca x p were recovered after the end of two weeks of isolation. The levels of ccf-gDNA and ccf-mtDNA were the highest at M0 and decreased gradually in both HD patients and the medical staff. The normalization of ccf-gDNA and ccf-mtDNA was significantly delayed in HD patients compared with the response in the medical staff. PTX-3 increased only in HD patients and was highest at M0, and it then gradually decreased. Medical isolation and subnormal quality of care during the MERS outbreak caused extreme stress in HD patients. Plasma cell-free DNA and PTX-3 seems to be good indicators of stress and quality of care in HD patients.

PMID: 30952879 DOI: 10.1038/s41598-019-41964-x

Keywords: MERS-CoV; Nosocomial Outbreaks; S. Korea.


A #decision-support #framework to optimize #border #control for #global #outbreak #mitigation (Sci Rep., abstract)

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

Sci Rep. 2019 Feb 18;9(1):2216. doi: 10.1038/s41598-019-38665-w.

A decision-support framework to optimize border control for global outbreak mitigation.

Zlojutro A1, Rey D1, Gardner L2,3.

Author information: 1 School of Civil and Environmental Engineering, University of New South Wales (UNSW) Sydney, Sydney, NSW, 2052, Australia. 2 School of Civil and Environmental Engineering, University of New South Wales (UNSW) Sydney, Sydney, NSW, 2052, Australia. 3 Department of Civil Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA.



The introduction and spread of emerging infectious diseases is increasing in both prevalence and scale. Whether naturally, accidentally or maliciously introduced, the substantial uncertainty surrounding the emergence of novel viruses, specifically where they may come from and how they will spread, demands robust and quantifiably validated outbreak control policies that can be implemented in real time. This work presents a novel mathematical modeling framework that integrates both outbreak dynamics and outbreak control into a decision support tool for mitigating infectious disease pandemics that spread through passenger air travel. An ensemble of border control strategies that exploit properties of the air traffic network structure and expected outbreak behavior are proposed. A stochastic metapopulation epidemic model is developed to evaluate and rank the control strategies based on their effectiveness in reducing the spread of outbreaks. Sensitivity analyses are conducted to illustrate the robustness of the proposed control strategies across a range of outbreak scenarios, and a case study is presented for the 2009 H1N1 influenza pandemic. This study highlights the importance of strategically allocating outbreak control resources, and the results can be used to identify the most robust border control policy that can be implemented in the early stages of an outbreak.

PMID: 30778107 DOI: 10.1038/s41598-019-38665-w

Keywords: Pandemics; Pandemic Preparedness; Pandemic Influenza; Quarantine measures; Border closures; Infectious diseases; Emerging diseases; Global health.


#REDCap for #Biocontainment #Worker Symptom #Monitoring (Health Secur., asbtract)

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

Health Secur. 2019 Feb 6. doi: 10.1089/hs.2018.0086. [Epub ahead of print]

REDCap for Biocontainment Worker Symptom Monitoring.

O’Keefe AL1, Buss BF2,3, Koirala S4,5, Gleason MX6, Mudgapalli A7, Schwedhelm S8.

Author information: 1 Anne L. O’Keefe, MD, is Senior Epidemiologist, Douglas County Health Department, Omaha, Nebraska. 2 Bryan F. Buss, DVM, is a Career Epidemiology Field Officer, the Nebraska Department of Health and Human Services, Lincoln, Nebraska. 3 Bryan F. Buss, DVM, the Center for Preparedness and Response, Division of State and Local Readiness, Centers for Disease Control and Prevention (CDC), Lincoln, NE. 4 Samir Koirala, MBBS, is a CDC Temporary Epidemiology Field Assignee, the Nebraska Department of Health and Human Services, Lincoln, Nebraska. 5 Samir Koirala, MBBS, the Center for Preparedness and Response, Division of State and Local Readiness, Centers for Disease Control and Prevention (CDC), Lincoln, NE. 6 Michael X. Gleason, PhD, is a Programmer/Analyst, the Research IT Office, University of Nebraska Medical Center, Omaha. 7 Ashok Mudgapalli, PhD, is Director, the Research IT Office, University of Nebraska Medical Center, Omaha. 8 Shelly Schwedhelm, MSN, is Executive Director, Emergency Management & Biopreparedness, Nebraska Medicine, Omaha.



The Ebola epidemic of 2014 demonstrated that outbreaks of high-consequence infectious diseases, even in remote parts of the world, can affect communities anywhere in the developed world and that every healthcare facility must be prepared to identify, isolate, and provide care for infected patients. The Nebraska Biocontainment Unit (NBU), located at Nebraska Medicine in Omaha, Nebraska, cared for 3 American citizens exposed in West Africa and confirmed with Ebola virus disease (EVD). Symptom monitoring of healthcare workers caring for these patients was implemented, which included twice daily contact to document the absence or presence of signs of fever or illness. This article describes the symptom monitoring experience of the NBU and local and state public health agencies. Based on lessons learned from that experience, we sought a more efficient solution to meet the needs of both the healthcare facility and public health authorities. REDCap, an open-source application used commonly by academic health centers, was used to develop an inexpensive symptom monitoring application that could reduce the burden of managing these activities, thus freeing up valuable time. Our pilot activities demonstrated that this novel use of REDCap holds promise for minimizing costs and resource demands associated with symptom monitoring while offering a more user-friendly experience for people being monitored and the officials managing the response.

KEYWORDS: Biocontainment; Epidemic management/response; Hospital preparedness; Infectious diseases

PMID: 30724610 DOI: 10.1089/hs.2018.0086

Keywords: Infectious Diseases; Emerging Diseases; Biocontainment; HCWs.


#WHO tracking mechanism for #IHR additional #health measures (Lancet, abstract)

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

WHO tracking mechanism for IHR additional health measures

Adam Kamradt-Scott, Carmen Dolea, Corinne Poncé, Guénaël Rodier, Margaret Lamunu, Patrick Drury, Sophie Ioos

Published: November 08, 2018 / DOI:


In February, 2018, WHO in collaboration with The University of Sydney, NSW, Australia, launched a new tool to monitor compliance with the International Health Regulations (2005) (IHR 2005) requirements regarding additional health measures. The initiative is part of the WHO Secretariat’s commitment to strengthening the IHR framework, which is a legally binding instrument to protect global public health and prevent unnecessary disruption to international traffic and trade; this framework has been adopted by 196 States Parties, including all 194 Member States of WHO. The new tool relies on media reports to identify potential outbreak-related trade and travel sanctions, and it uses a standard set of procedures for verification and compliance. Researchers from The University of Sydney are working with the WHO Secretariat in Geneva, Switzerland, to integrate the tool into existing notification and reporting systems to enable timely monitoring. Integration will enable WHO to track in real time when countries impose trade or travel sanctions that can substantially harm national and regional economies, and to work constructively with governments to remove the sanctions. It is a crucial step in strengthening the implementation of IHR 2005, which remains the only international treaty specifically designed to safeguard global health security.


Keywords: Global Health; Public Health; IHR(2005); Travel Restrictions.


Contact #tracing #performance during the #Ebola #epidemic in #Liberia, 2014-2015 (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]


Contact tracing performance during the Ebola epidemic in Liberia, 2014-2015

Krista C. Swanson , Chiara Altare, Chea Sanford Wesseh, Tolbert Nyenswah, Tashrik Ahmed, Nir Eyal, Esther L. Hamblion, Justin Lessler, David H. Peters, Mathias Altmann

Published: September 12, 2018 / DOI: / This is an uncorrected proof.




During the Ebola virus disease (EVD) epidemic in Liberia, contact tracing was implemented to rapidly detect new cases and prevent further transmission. We describe the scope and characteristics of contact tracing in Liberia and assess its performance during the 2014–2015 EVD epidemic.

Methodology/Principal findings

We performed a retrospective descriptive analysis of data collection forms for contact tracing conducted in six counties during June 2014–July 2015. EVD case counts from situation reports in the same counties were used to assess contact tracing coverage and sensitivity. Contacts who presented with symptoms and/or died, and monitoring was stopped, were classified as “potential cases”. Positive predictive value (PPV) was defined as the proportion of traced contacts who were identified as potential cases. Bivariate and multivariate logistic regression models were used to identify characteristics among potential cases.

We analyzed 25,830 contact tracing records for contacts who had monitoring initiated or were last exposed between June 4, 2014 and July 13, 2015. Contact tracing was initiated for 26.7% of total EVD cases and detected 3.6% of all new cases during this period. Eighty-eight percent of contacts completed monitoring, and 334 contacts were identified as potential cases (PPV = 1.4%). Potential cases were more likely to be detected early in the outbreak; hail from rural areas; report multiple exposures and symptoms; have household contact or direct bodily or fluid contact; and report nausea, fever, or weakness compared to contacts who completed monitoring.


Contact tracing was a critical intervention in Liberia and represented one of the largest contact tracing efforts during an epidemic in history. While there were notable improvements in implementation over time, these data suggest there were limitations to its performance—particularly in urban districts and during peak transmission. Recommendations for improving performance include integrated surveillance, decentralized management of multidisciplinary teams, comprehensive protocols, and community-led strategies.


Author summary

Contact tracing is comprised of three main steps: identifying, listing, and monitoring persons who have been exposed to infected individuals, with the goal of rapidly diagnosing and treating new cases and preventing further spread of infection. This approach has been used to control transmission of infectious diseases including smallpox, tuberculosis, HIV, and syphilis, and while contact tracing has been used in prior outbreaks of hemorrhagic fever, these outbreaks were small in scale. During the 2014–2015 Ebola virus disease (EVD) epidemic in Liberia, contact tracing was implemented in all 15 counties on a scale that was unprecedented, particularly within both rural and crowded urban settings. This work provides insight into the magnitude that which contact tracing was implemented, its characteristics, as well as an assessment on its performance. Given that contract tracing is a critical tool for controlling disease spread, these findings aid in informing future planning and decision making for its implementation.


Citation: Swanson KC, Altare C, Wesseh CS, Nyenswah T, Ahmed T, Eyal N, et al. (2018) Contact tracing performance during the Ebola epidemic in Liberia, 2014-2015. PLoS Negl Trop Dis 12(9): e0006762.

Editor: Benjamin Althouse, Institute for Disease Modeling, UNITED STATES

Received: April 1, 2018; Accepted: August 16, 2018; Published: September 12, 2018

Copyright: © 2018 Swanson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The datasets used and/or analyzed during the current study were done so with permission from the Liberia MOH. All relevant data are within this paper and its Supporting Information files.

Funding: This work was funded in part by U.S. Agency for International Development Office of Foreign Disaster Assistance.The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors declare that they have no competing interests.

Keywords: Ebola; Quarantine measures; Liberia.


A Case of #Lassa Fever Diagnosed at a Community #Hospital – #Minnesota 2014 (Open Forum Infect Dis., abstract)

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

Open Forum Infect Dis. 2018 Jul 16;5(7):ofy131. doi: 10.1093/ofid/ofy131. eCollection 2018 Jul.

A Case of Lassa Fever Diagnosed at a Community Hospital-Minnesota 2014.

Choi MJ1, Worku S2, Knust B3, Vang A4, Lynfield R1, Mount MR2, Objio T4, Brown S3, Griffith J1, Hulbert D2, Lippold S4, Ervin E3, Ströher U3, Holzbauer S1, Slattery W2, Washburn F4, Harper J1, Koeck M1, Uher C2, Rollin P3, Nichol S3, Else R2, DeVries A1.

Author information: 1 Minnesota Department of Health, St. Paul, Minnesota. 2 Mercy Hospital, Allina Health, Coon Rapids, Minnesota. 3 Viral Special Pathogens Branch, Atlanta, Georgia. 4 Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia.




In April 2014, a 46-year-old returning traveler from Liberia was transported by emergency medical services to a community hospital in Minnesota with fever and altered mental status. Twenty-four hours later, he developed gingival bleeding. Blood samples tested positive for Lassa fever RNA by reverse transcriptase polymerase chain reaction.


Blood and urine samples were obtained from the patient and tested for evidence of Lassa fever virus infection. Hospital infection control personnel and health department personnel reviewed infection control practices with health care personnel. In addition to standard precautions, infection control measures were upgraded to include contact, droplet, and airborne precautions. State and federal public health officials conducted contract tracing activities among family contacts, health care personnel, and fellow airline travelers.


The patient was discharged from the hospital after 14 days. However, his recovery was complicated by the development of near complete bilateral sensorineural hearing loss. Lassa virus RNA continued to be detected in his urine for several weeks after hospital discharge. State and federal public health authorities identified and monitored individuals who had contact with the patient while he was ill. No secondary cases of Lassa fever were identified among 75 contacts.


Given the nonspecific presentation of viral hemorrhagic fevers, isolation of ill travelers and consistent implementation of basic infection control measures are key to preventing secondary transmission. When consistently applied, these measures can prevent secondary transmission even if travel history information is not obtained, not immediately available, or the diagnosis of a viral hemorrhagic fever is delayed.

KEYWORDS: Lassa fever; contact tracing; infection control; sensorineural hearing loss

PMID: 30035149 PMCID: PMC6049013 DOI: 10.1093/ofid/ofy131

Keywords: Lassa fever; USA; Minnesota.