Nursing ethics for prevention and control of major infectious disease outbreaks:Chinese expert consensus

Background Major infectious disease has become a serious threat to people’s health worldwide.As the world’s largest healthcare workforce and the core forces fighting against the epidemic,nurses are on the frontline of this battle.A number of ethical issues have given rise to numerous concerns that have largely affected nurses in different ways as they respond to the epidemic.In addition,excessive expectations from people can exert undue pressure,which can easily lead to burnout in nurses.Methods In this consensus,the expert panel method was used to develop and reach a consensus.The members involved in the formation of the consensus included an expert discussion panel and a consensus writing expert group,a methodologist,and four secretaries.After 16 rounds of online expert consultation and two rounds of expert panel meetings,the writing team analyzed and reviewed the 78 amendments suggested by the experts to develop a consensus on nursing ethics for prevention and control of major infectious disease outbreaks based on the ethical vision of life care.Results This expert consensus focuses on five essential domains:the responsibilities and rights of nurses,the nurse-patient relationship,the doctor-nurse relationship,and the relationship between society and nurses throughout the epidemic.Conclusions We hope this consensus can help nurses better understand and respond to the ethical issues and challenges in public health emergencies,and raise reasonable public expectations of the roles and responsibilities of nurses in these situations.

‘Outbreak Gold Standard’Selection to Provide Optimized Threshold for Infectious Diseases Early-alert Based on China Infectious Disease Automated-alert and Response System

The China Infectious Disease Automated-alert and Response System（CIDARS） was successfully implemented and became operational nationwide in 2008. The CIDARS plays an important role in and has been integrated into the routine outbreak monitoring efforts of the Center for Disease Control（CDC） at all levels in China. In the CIDARS, thresholds are determined using the ？Mean＋2SD？ in the early stage which have limitations. This study compared the performance of optimized thresholds defined using the ？Mean ＋2SD？ method to the performance of 5 novel algorithms to select optimal ？Outbreak Gold Standard（OGS）？ and corresponding thresholds for outbreak detection. Data for infectious disease were organized by calendar week and year. The ？Mean＋2 SD？, C1, C2, moving average（MA）, seasonal model（SM）, and cumulative sum（CUSUM） algorithms were applied. Outbreak signals for the predicted value（Px） were calculated using a percentile-based moving window. When the outbreak signals generated by an algorithm were in line with a Px generated outbreak signal for each week, this Px was then defined as the optimized threshold for that algorithm. In this study, six infectious diseases were selected and classified into TYPE A（chickenpox and mumps）, TYPE B（influenza and rubella） and TYPE C [hand foot and mouth disease（HFMD） and scarlet fever]. Optimized thresholds for chickenpox（P_（55））, mumps（P_（50））, influenza（P_（40）, P_（55）, and P_（75））, rubella（P_（45） and P_（75））, HFMD（P_（65） and P_（70））, and scarlet fever（P_（75） and P_（80）） were identified. The C1, C2, CUSUM, SM, and MA algorithms were appropriate for TYPE A. All 6 algorithms were appropriate for TYPE B. C1 and CUSUM algorithms were appropriate for TYPE C. It is critical to incorporate more flexible algorithms as OGS into the CIDRAS and to identify the proper OGS and corresponding recommended optimized threshold by different infectious disease types.

Epidemiological Descriptive Analysis of Disease Outbreaks in 2019 in Sudan

Background: Sudan has often faced outbreaks of malaria, the life-threatening waterborne disease. In 2019, the country experienced an outbreak of six different infectious diseases, i.e., cholera, chikungunya, dengue fever, diphtheria, malaria, and Rift Valley fever. Objectives: The aim of this study was to perform an epidemiological descriptive analysis of data of these disease outbreaks to determine the spatial and temporal patterns of outbreaks and to estimate the magnitude of the diseases. Methods: The data consisted of the number of cases and deaths due to disease outbreaks of cholera, chikungunya, dengue fever, diphtheria, malaria, and Rift Valley fever. We analyzed the reports of an investigation conducted by the World Health Organization and the Federal Ministry of Health, Sudan. Descriptive statistics and case fatality rate (CFR) were used in this study. Results: The frequency of disease occurrence was as follows: cholera (344 cases), chikungunya (308 cases), dengue fever (4236 cases), diphtheria (105 cases), malaria (5,188,135 cases) and River Valley fever (567 cases). The CFRs for cholera, chikungunya, are diphtheria were 4.3%, 2.05%, and 9.5%, respectively. The mortality rate of malaria was 0.0013. The states most affected by outbreaks of these diseases in Sudan were the western states. Women were at a higher risk for all diseases, except River Valley fever. Conclusions: This study highlights the patterns of the outbreak of these diseases in Sudan and provides a basis for future scientific research.

H2 strain attenuated live hepatitis A vaccines:protective efficacy in a hepatitis A outbreak

AIM:To investigate the protective efficacy of H2 strain attenuated live hepatitis A vaccines (H2-strain vaccines) in hepatitis A (HA) outbreaks.METHODS:With the permission of their parents, 5551 pre-school and grade 1-3 primary school children were inoculated with 1 dose (10(6.5) TCID(50)) of H2 strain vaccines in a nonrandomized, controlled trial conducted in Fucheng County, Hebei Province in May 1997.Another 6485 children in the same grades and compatible in gender and age were enrolled as controls. Epidemiological and serological survey was conducted to evaluate the protective efficacy of the vaccines. ELISA was used to detect serum IgM anti-HAV.RESULTS:HA outbreak started in early May 1998, peaked in the middle of the same month, and lasted about 80 days. Overall 302 HA cases were found, 192(63.58%) were 5-9 years old. One vaccinee and 25 control cases were found to have hepatitis A, which account for 0.28% (1/356) and 5.92% (25/422) of all vaccinees and controls in the 14 villages, respectively. The protective efficacy of vaccines was 95.27% (95% CI: 85.83%-104.72%). In subjects tested for anti-HAV IgM from 13 villages, 1(0.40%) overt and 11(4.06%) asymptomatic HAV cases were found in 271 vaccinees but 21(6.69%) of overt and asymptomatic ones were found in 314 controls.CONCLUSION:H2 strain vaccines were excellent in preventing overt hepatitis A,but not so effective in preventing asymptomatic hepatitis A virus infection.A booster dose might be needed to get permanent reliable immunity.

Emergency management of nursing human resources and supplies to respond to coronavirus disease 2019 epidemic

Objective:To introduce the emergency management of nursing human resources and supplies of a large general hospital when facing the outbreak of coronavirus disease 2019(COVID-19).Method:The Nursing Department of the hospital fully executed its functional authority to establish a three-level echelon of sustainable support,allocate human recourses dynamically,organize pre-service training,supervise the key working steps,formulate positive incentive methods,and deploy medical supplies scientifically.Result:By taking these strategies,the hospital effectively improved the coping capacity of the nursing team and played a positive role in the prevention and treatment of COVID-19.Conclusion:The emergency management of nursing human resources and material resources for COVID-19 of the hospital is successful.But several deficiencies were identified as well,which indicated that the hospital needs to establish an efficient emergency management system,and pay attention to the practice of nursing emergency plans to enhance coping capacities in public health emergencies.

Measles outbreaks in the Kyeongin area of the Republic of Korea,2013-2014:A single-center experience in a country of measles elimination

Objective: To identify the source of infection and determine the clinical features and laboratory finding of measles infection,Methods: In 27 measles patients,except for 3 adult patients,the rest of 24 pediatric measles cases were analyzed with regard to age,sex,immunization status,transmission routes and molecular genotyping of measles virus,Eighteen measles patients who admitted in isolation ward were set apart to investigate clinical findings and its correlation with laboratory characteristics,Retrospective analysis of cases was conducted in this study,Results: Of the 24 pediatric patients,23(95.8%) had not received any measles-containing vaccine(MCV),Sixteen of the patients(66.7%) were aged <12 months,The suspicious index case of a girl aged 34 months was not vaccinated with MCV1 and got measles after a trip to Philippines,and molecular genotype was revealed as B3,Measles outbreaks in the community such as a restaurant were followed by this one imported case,According to analysis of 18 patients admitted in isolation ward,the median level of C-reactive protein(CRP) was 0.38 mg/d L and that of lactate dehydrogenase(LDH) was 1 200 IU/L,All of the 18 patients had LDH levels above the normal range,Age correlated with CRP(ρ = 0.528,P = 0.024) and LDH(ρ = 0.501,P = 0.034),The duration of fever was correlated with the duration of fever before rash(ρ = 0.898,P < 0.01),The duration of hospitalization was correlated with CRP(ρ = 0.586,P = 0.011),The white blood cell counts were correlated with the levels of LDH(ρ = 0.505,P = 0.033),aspartate aminotransferase(ρ = 0.507,P = 0.032),and alanine aminotransferase(ρ = 0.481,P = 0.043),Conclusions: Early weaning of maternally derived measles antibodies therefore vaccination of MCV1 at a young age from 9 months to 12 months should be considered in situations of early exposure,Furthermore there is a call for consideration of scheduling an earlier age for the first dose of MMR vaccine in Europe,It is necessary for Korea to investigate the duration of the presence and quantitative analysis of maternal measles antibodies in infants and to reconsider the timing of MCV1.

Monkeypox: A Viral Zoonotic Disease of Rising Global Concern

Monkeypox(mpox)is a rare viral zoonotic disease,endemic to Central and West Africa,caused by the monkeypox virus,an orthopoxvirus similar to the variola virus(smallpox).Although sporadic travel-associated cases have historically occurred outside Africa,in May 2022,mpox began spreading globally in multiple nonendemic countries across several continents.In 2024,there has been an increase in globally reported confirmed cases of mpox and deaths from mpox,making it a public health emergency of international concern.The reasons for the unusual global spread are under investigation but likely relate to increased travel and waning population immunity to orthopoxviruses.Transmission now appears to be mainly through close,intimate contact,especially among men who have sex with men.Mpox is usually a self-limited disease.Although limited approved antiviral treatments are available,such as tecovirimat,which the European Medicines Agency approved in January 2022 for the treatment of mpox,their widespread availability and effectiveness in the current outbreak remain to be investigated.Public health control measures include surveillance,case identification/isolation,contact tracing,and targeted vaccination of contacts at high risk of exposure.However,challenges remain in curtailing the current unprecedented outbreak.Critical knowledge gaps include animal reservoir(s)responsible for initial spillover events,viral mutations that may enhance transmissibility,optimal diagnostics for noninvasive specimens,effective antiviral therapies,next-generation vaccines providing longer-term immunity,and building global capacity for outbreak response.This review summarizes the current literature on mpox virology,epidemiology,pathogenesis,clinical manifestations,diagnostics,treatment,prevention,and public health control measures.Ongoing investigation and research are needed to better understand mpox’s evolving epidemiology,pathogenicity,transmissibility,and ecology to guide strategies for containing the outbreak and preventing future global emergence.

A reflection on the anti-epidemic response of COVID-19 from the perspective of disaster management

The outbreak of coronavirus disease 2019(COVID-19)shocked the world as it spread rapidly from continent to continent,and finally,it became a pandemic resulting in many infected patients,with an increasing number of deaths,and a devastating effect on worldwide economics.People only know that epidemic or pandemic is a rapid spread of infection,but in fact it can also be regarded as a biological disaster,which can be managed from a perspective of disaster management.This article discusses the current situation of the anti-epidemic response of COVID-19,and suggests using a disaster management approach to better handle this pandemic situation through mitigation,preparedness,response and recovery.

A review on the Ebola virus,outbreak history and the current research tools to control the disease

The Ebola virus is a zoonotic pathogen causing hemorrhagic fever disease with a high mortality rate.The distribution of this pathogen has been limited to woodlands from Central and West Africa and the forest-savannah ecotone in East Africa.The likely reservoir species are frugivorous bats living in these areas.This pathogen is becoming an increasing threat to human populations since its distribution range is expanding faster than expected.The current Ebola outbreaks in Western Africa and in the Democratic Republic of Congo have rapidly spread infecting high numbers of individuals in five African countries.The disease has reached the United States and Spain.This expansion is due partly to increasing global connectivity.This situation represents a new challenge to control the spread of the disease.Experimental drugs have been used to treat a few infected people with promising results.This gives hope for an effective treatment against Ebola hemorrhagic fever in the near future,though thousands of people remain at risk of infection.The present review aims to give an update of the knowledge on the disease,including features of the Ebola virus,the history of disease outbreaks in Africa and the tools that are being developed in order to control this re-emergent disease.

Guillain–Barré syndrome, transverse myelitis and infectious diseases

Guillain–Barrésyndrome(GBS)and transverse myelitis(TM)both represent immunologically mediated polyneuropathies of major clinical importance.Both are thought to have a genetic predisposition,but as of yet no specific genetic risk loci have been clearly defined.Both are considered autoimmune,but again the etiologies remain enigmatic.Both may be induced via molecular mimicry,particularly from infectious agents and vaccines,but clearly host factor and co-founding host responses will modulate disease susceptibility and natural history.GBS is an acute inflammatory immune-mediated polyradiculoneuropathy characterized by tingling,progressive weakness,autonomic dysfunction,and pain.Immune injury specifically takes place at the myelin sheath and related Schwann-cell components in acute inflammatory demyelinating polyneuropathy,whereas in acute motor axonal neuropathy membranes on the nerve axon(the axolemma)are the primary target for immune-related injury.Outbreaks of GBS have been reported,most frequently related to Campylobacter jejuni infection,however,other agents such as Zika Virus have been strongly associated.Patients with GBS related to infections frequently produce antibodies against human peripheral nerve gangliosides.In contrast,TM is an inflammatory disorder characterized by acute or subacute motor,sensory,and autonomic spinal cord dysfunction.There is interruption of ascending and descending neuroanatomical pathways on the transverse plane of the spinal cord similar to GBS.It has been suggested to be triggered by infectious agents and molecular mimicry.In this review,we will focus on the putative role of infectious agents as triggering factors of GBS and TM.

On the transmission pattern of Kyasanur Forest disease (KFD) in India

Kyasanur Forest disease(KFD),a tick-borne viral hemorrhagic fever,is endemic in five districts of Karnataka state,India.Recent reports of the spread of disease to neighboring districts of the Western Ghats,namely Chamarajanagar district in Karnataka,Nilgiri district in Tamil Nadu,Wayanad and Malappuram districts in Kerala,and Pali village in Goa are a cause for concern.Besides vaccination of the affected population,establishing an event-based surveillance system for monkey deaths in the national parks,wildlife sanctuaries and reserve forests of the Western Ghats would help detect the disease early and thereby help implement appropriate control measures.

Cross-Sectional Survey of Views on COVID-19 and Its Vaccines Among Pregnant Women

Objective:The objective of this study is to evaluate the acceptance of pregnant women with regards to coronavirus disease 2019 (COVID-19) vaccination during pregnancy and to identify any significant changes in their anxiety and knowledge on COVID-19 compared to our previous study.Methods:This cross-sectional survey was performed in the antenatal clinics of United Christian Hospital and Tseung Kwan O Hospital of Hong Kong,China.Questionnaires were distributed to pregnant women for self-completion when attending follow-up from August to October 2021.Apart from basic demographic data,the questionnaire comprised of questions including knowledge on COVID-19 and its vaccines in pregnancy as well as attitudes and behaviors of pregnant women and their partners toward COVID-19.Continuous variables were analyzed by Student’s test and Levene’s test was used to confirm normal distribution and homogeneity of variance for continuous variables,whereas categorical variables were analyzed by the Chi-squared test or Fisher’s exact test as appropriate.AP value of <0.05 was considered to be statistically significant.Results:A total of 816 completed questionnaires were included for analysis.Pregnant women were less worried about COVID-19 in the current survey as compared to the last survey (393/816,48.2%vs.518/623,83.1%,P<0.001).Fewer pregnant women believed that pregnancy were more susceptible to contract SARS-CoV-2 as compared to the last survey (265/816,32.5%vs.261/623,41.9%,P<0.001).They have significant knowledge gap and concerns about COVID-19 vaccines.Nearly half of the participants believed that pregnant women cannot have COVID-19 vaccination (402/816,49.3%) and it is unsafe to fetus (365/816,44.7%).Around a third of women perceived that they were more prone to the side effects and complications of COVID-19 vaccines than the general population (312/816,38.2%) and did not recognize that maternal COVID-19 vaccination could effect transferral of antibodies to the fetus to promote postnatal passive immunity (295/816,36.2%).Most of them had not been vaccinated (715/816,87.6%) and only (12/715) 1.7% of them would consider vaccination during pregnancy.Conclusion:Despite the local and international recommendations for pregnant women to be vaccinated,the uptake of COVID-19 vaccines during pregnancy remained extremely low.Efforts should be made to effectively provide information about the safety and benefits of COVID-19 vaccines during pregnancy.There is an urgent need to booster vaccination rates in pregnant women to avoid excessive adverse pregnancy outcomes related to COVID-19.

HIV/AIDS epidemiology and prevention in China

Objective To review HIV/AIDS epidemic history, current situation and prevention policy in China. Data sources Information included in this article was identified by searching PUBMED （1997-2006） online resources using the key terms ＂HIV/AIDS＂, ＂epidemic＂, ＂prevention＂, and ＂China＂. Study selection Original milestone articles and critical reviews written by major pioneer investigators of the field were selected. Results The key issues related to the HIV/AIDS epidemic situation in China and Chinese government prevention policy were summarized. HIV/AIDS epidemic groups and trends for HIV transmission were discussed. Conclusion In January 2006, 650 000 people were estimated to be living with HIV in China. The overall HIV/AIDS epidemic is at a low level （0.05%） and concentrated in several at risk populations. However, the data show that new cases of HIV infection are growing every year and spreading from at risk populations to the general population. Premier WEN Jia-bao announced the ＂Four frees and one care＂ policy and the Chinese government has developed a series of programs with strong policy measures to stop the spread of HIV/AIDS in China.

SEIR-SW, Simulation Model of Influenza Spread Based on the Small World Network

This study modeled the spread of an influenza epidemic in the population of Oran, Algeria. We investigated the mathematical epidemic model, SEIR（Susceptible-Exposed-Infected-Removed）, through extensive simulations of the effects of social network on epidemic spread in a Small World（SW） network, to understand how an influenza epidemic spreads through a human population. A combined SEIR-SW model was built, to help understand the dynamics of infectious disease in a community, and to identify the main characteristics of epidemic transmission and its evolution over time. The model was also used to examine social network effects to better understand the topological structure of social contact and the impact of its properties. Experiments were conducted to evaluate the combined SEIR-SW model. Simulation results were analyzed to explore how network evolution influences the spread of desease, and statistical tests were applied to validate the model. The model accurately replicated the dynamic behavior of the real influenza epidemic data, confirming that the susceptible size and topological structure of social networks in a human population significantly influence the spread of infectious diseases. Our model can provide health policy decision makers with a better understanding of epidemic spread,allowing them to implement control measures. It also provides an early warning of the emergence of influenza epidemics.

Mozambique’s response to cyclone Idai:how collaboration and surveillance with water,sanitation and hygiene (WASH) interventions were used to control a cholera epidemic

Cyclone Idai,which hit Mozambique in March 2019,was one of the worst climate-related natural disasters on record in the Southern Hemisphere causing massive destruction of housing and disruption to vital infrastructure including the electrical grid,communications and water supply.Almost two million people were affected with over 600 deaths,hundreds of thousands of people displaced accompanied by rapid spread of cholera.We describe emergency measures taken by the Government of Mozambique,in collaboration with multilateral partners,to establish a real-time disease surveillance system,implement interventions recommended by a Water,Sanitation and Hygiene(WASH)taskforce and rapidly scale up a massive community vaccination program to control a cholera epidemic.

Balancing timeliness of reporting with increasing testing probability for epidemic data

Reporting of epidemiological data requires coordinated action by numerous agencies,across a multitude of logistical steps.Using collated and reported information to inform direct interventions can be challenging due to associated delays.Mitigation can,however,occur indirectly through the public generation of concern,which facilitates adherence to protective behaviors.We utilized a coupled-dynamic multiplex network model with a communication-and disease-layer to examine how variation in reporting delay and testing probability are likely to impact adherence to protective behaviors,such as reducing physical contact.Individual concern mediated adherence and was informed by new-or active-case reporting,at the population-or community-level.Individuals received information from the communication layer:direct connections that were sick or adherent to protective behaviors increased their concern,but absence of illness eroded concern.Models revealed that the relative benefit of timely reporting and a high probability of testing was contingent on how much information was already obtained.With low rates of testing,increasing testing probability was of greater mitigating value.With high rates of testing,maximizing timeliness was of greater value.Population-level reporting provided advanced warning of disease risk from nearby communities;but we explore the relative costs and benefits of delays due to scale against the assumption that people may prioritize community-level information.Our findings emphasize the interaction of testing accuracy and reporting timeliness for the indirect mitigation of disease in a complex social system.

Countries at risk of importation of chikungunya virus cases from Southern Thailand: A modeling study

Southern Thailand has been experiencing a large chikungunya virus(CHIKV)outbreak since October 2018.Given the magnitude and duration of the outbreak and its location in a popular tourist destination,we sought to determine international case exportation risk and identify countries at greatest risk of receiving travel-associated imported CHIKV cases.We used a probabilistic model to estimate the expected number of exported cases from Southern Thailand between October 2018 and April 2019.The model incorporated data on CHIKV natural history,infection rates in Southern Thailand,average length of stay for tourists,and international outbound air passenger numbers from the outbreak area.For countries highly connected to Southern Thailand by air travel,we ran 1000 simulations to estimate the expected number of imported cases.We also identified destination countries with conditions suitable for autochthonous CHIKV transmission.Over the outbreak period,we estimated that an average of 125(95%credible interval(CrI):102e149)cases would be exported from Southern Thailand to international destinations via air travel.China was projected to receive the most cases(43,95%CrI:30e56),followed by Singapore(7,95%CrI:2e12)and Malaysia(5,95%CrI:1e10).Twenty-three countries were projected to receive at least one imported case,and 64%of these countries had one or more regions that could potentially support autochthonous CHIKV transmission.The overall risk of international exportation of CHIKV cases associated with the outbreak is Southern Thailand is high.Our model projections are consistent with recent reports of CHIKV in travelers returning from the region.Countries should be alert to the possibility of CHIKV infection in returning travelers,particularly in regions where autochthonous transmission is possible.