Climate Induced Virus Generated Communicable Diseases:Management Issues and Failures

In the present review article human diseases caused by various groups of pathogens have been explained with its etiology,epidemiology and treatment.In addition,effect of climatic changes on parasites and pathogens has been demarcated with rising incidences of diseases.In response to environmental changes,mainly external and internal microenvironment of body and drug regimens taken by patients;virus is regularly changing its form and new mutant variants are coming out.These are circulating in many Indian states and cross border countries and causing high infectivity and mortality in human patients.These variants with new mutations are challenging existing drugs and other prophylactic measures and massively disrupting functions of a tissue,organ,or entire organism.Diseases caused by viruses are showing new trends in virulence,with high infectivity,morbidity and mortality.Due to climatic effect and drug resistance and new mutations in pathogens disease burden has been exacerbated enormously at global level.In all cases of helminthes,protozoan’s,fungi,bacteria,virus pathogens and parasites available drug structure seem to be failed or their usefulness has been much reduced due to evolution of new mutant variants with multiple drug resistance.There are serious failures at the level of operation,management and control of disease.The utmost failure is due to lack of appropriate vaccine,drug regimens,clinical care and awareness among people.These are major reasons that is why diseases become uncontrolled and unmanageable.

ANY PROGRESS IN BATTLE AGAINST COMMON COLD?——Interview With William Jordan,M.D.,Expert on Communicable Diseases

Q:Dr.Jordan,do we know any more thesedays about the commnon cold and what eauses it? A:We used to think that the common eold was a simple,single disease.Now we know that it ean becaused by more than 100 different vjruses and rharsome nonviral agentsl resPonsible for allergies caneause similar symPtoms.Whatever the cause,the symPtofns are similar:The nose runs and getselogged;the throat is irritated:there is sneezing andsome coughing.

Impact of COVID-19 on mortality trends and patterns in a tertiary care hospital of Central India:A retrospective study

Objective:To investigate the impact of COVID-19 on the mortality trends and patterns in a tertiary teaching hospital in Raipur,Chhattisgarh,India.Methods:A hospital-based retrospective study was conducted to analyze the case reports of all deaths from January 2016 to December 2021 in a tertiary teaching hospital in Raipur,Chhattisgarh,India.The socio-demographic profile and the pattern of causes of death were recorded.The deaths were classified according to the 10th revision of the International Classification of Diseases.Results:A total of 6128 deaths were registered from 2016 to 2021 and the maximum death number was observed in 2021(38.2%)followed by 2020(32.5%)when the country was hit by the COVID-19 pandemic.The highest number of deaths was observed in the age group of 51 to 65 years i.e.,31.1%of the total deaths.In all five years,male deaths were more than female deaths,and more than 50%occurred within three days of hospitalization during the study period.Conclusions:Even though there is a rise in the death rate due to the sudden hit of COVID-19,the burden of both communicable and non-communicable diseases remains gradually increasing over the five years.There is a need for health awareness in the community about changing lifestyles and their harmful effects on health.

Brazilian Spotted Fever Mortality Profile: 2018 to 2022

Background: Spotted Fever (SF) is an acute febrile zoonosis of variable severity that typically occurs in an endemic manner with worldwide distribution. Considering that SF is a disease of significant public health importance, this study aims to identify the mortality profile due to SF in Brazil from 2018 to 2022. Methods: Quantitative and descriptive cross-sectional approach. Data were collected from Brazilian Spotted Fever (BSF) cases registered in the Notifiable Diseases Information System (SINAN-DATASUS) across all regions of Brazil. The data collected includes information on the following variables: year of symptom, evolution, sex, race, environment of infection, region of notification, and age group. Subsequently, the data was entered into Microsoft Excel to create tables and graphs. The chi-square test was then applied to statistically analyze the associations between qualitative variables. A modified Poisson regression model with robust variance was constructed to analyze the age group data and determine which categories had different probabilities of death. The results show the estimates obtained for prevalence ratios, as well as their respective confidence intervals and p-values. The statistical software SAS version 9.4 was used to perform the analysis and a significance level of 5% was considered. Results: From 2018 to 2022, a total of 1126 cases of BSF were reported. Out of these cases, 59.3% (668) were cured, 32.4% (364) resulted in death, 1.1% (13) died from other causes and 7.2% (81) had no recorded outcome. Regarding the region with the highest death rate, the Southeast region led with 99.45% (362) of cases, followed by the Northeast region with 0.45% (2). As for the age group, the majority (63.7%) fell between the ages of 20 and 59 years old. In terms of race/color, 52.7% of the population identified as white. Regarding the contamination environment, 39.3% were in leisure areas. The outcome of death by BSF showed statistically significant associations with sex (p-value = 0.03) and age group (p-value = 0.003). Conclusion: The profile of deaths from Brazilian Spotted Fever primarily affects individuals from the Southeast region of the country, particularly men, and whites aged 20 years or older being contaminated mainly in leisure environments. This study provides a detailed understanding of the pattern of BSP-related deaths, providing crucial information for public health authorities. These insights provide valuable support for formulating informed policies and effective BSP control and prevention strategies.

Capacity Development of National Reference Centers (NRC) to Face the Challenges of Emerging Infections in Côte d’Ivoire

Background: Some national and international strategies for the detection and prevention of emerging infectious diseases have been established across sectors. The capacity to carry out these tasks varies from country to country, and that remains largely undervalued. The Pasteur Institute of C?te d’Ivoire has created and implemented the capacity of national reference centers to fight against emerging and other infectious diseases. Objective: Show on the one hand the strategies used to develop the National Reference Centers and the IPCI and on the other hand the results obtained by performing these strategies. Method: Datas collection by documentary analysis (published scientific articles and grey literature) was done on Google Scholar, PUBMED and institutional reference documents. The documentary research was carried out to have a better understanding of strategies used to create and develop the NRCs in microbiology of communicable diseases. Results: Seven integrated strategies were launched: 1-training and workforce development;2-investigation of epidemics or public health events;3-strengthening laboratory epidemiological research;4-strengthening surveillance systems;5-improving communication with partners and stakeholders;6-building national and international collaborations;and 7-strengthening technical and technological platforms. In two decades, the number of researchers has risen from 10 in 2004 to ninety (90) in 2021, with 12 senior researchers and 32 junior researchers. A number of health service staff had attended a qualifying training course, 27 investigations into outbreaks and other public health events had been carried out, 18 short-term research projects had been launched, major surveillance programs and epidemiological research efforts on vector-borne, food-borne and nosocomial infections had begun, and several scientific manuscripts had been published or were edited in the writting press. Conclusion: The Ivorian experience shows that, with concerted effort, considerable progress can be made in the development and implementation of an infectious disease control program.

Needs and concerns of patients in isolation care units - learnings from COVID-19: A reflection

With strict measures in place to contain the spread of coronavirus disease 2019,many have been isolated as suspected or confirmed cases.Being isolated causes much inconvenience for the patients and family.Patients'and next-of-kins’needs and concerns during isolation will be shared together with suggestions for key process improvements.Our hospital’s Senior Patient Experience Managers contact all patients admitted to the isolation wards on a daily basis to provide some form of support.Common issues raised were gathered and strategies to help with their needs and concerns were discussed.Being in isolation is a challenging period for both patients and family.Nonetheless,we can implement measures to mitigate against the adverse effects of isolation.Patient education,effective and efficient means of communication,close monitoring for signs of distress and anxiety,and early intervention could help patients cope better with the whole isolation experience.Nursing management may want to consider implementing the measures shared in the article to manage patient’s stress while not compromising on staff safety.

Clinical diagnosis of severe COVID-19:A derivation and validation of a prediction rule

BACKGROUND The widespread coronavirus disease 2019(COVID-19)has led to high morbidity and mortality.Therefore,early risk identification of critically ill patients remains crucial.AIM To develop predictive rules at the time of admission to identify COVID-19 patients who might require intensive care unit(ICU)care.METHODS This retrospective study included a total of 361 patients with confirmed COVID-19 by reverse transcription-polymerase chain reaction between January 19,2020,and March 14,2020 in Shenzhen Third People’s Hospital.Multivariate logistic regression was applied to develop the predictive model.The performance of the predictive model was externally validated and evaluated based on a dataset involving 126 patients from the Wuhan Asia General Hospital between December 2019 and March 2020,by area under the receiver operating curve(AUROC),goodness-of-fit and the performance matrix including the sensitivity,specificity,and precision.A nomogram was also used to visualize the model.RESULTS Among the patients in the derivation and validation datasets,38 and 9 participants(10.5%and 2.54%,respectively)developed severe COVID-19,respectively.In univariate analysis,21 parameters such as age,sex(male),smoker,body mass index(BMI),time from onset to admission(>5 d),asthenia,dry cough,expectoration,shortness of breath,asthenia,and Rox index<18(pulse oxygen saturation,SpO2)/(FiO2×respiratory rate,RR)showed positive correlations with severe COVID-19.In multivariate logistic regression analysis,only six parameters including BMI[odds ratio(OR)3.939;95%confidence interval(CI):1.409-11.015;P=0.009],time from onset to admission(≥5 d)(OR 7.107;95%CI:1.449-34.849;P=0.016),fever(OR 6.794;95%CI:1.401-32.951;P=0.017),Charlson index(OR 2.917;95%CI:1.279-6.654;P=0.011),PaO2/FiO2 ratio(OR 17.570;95%CI:1.117-276.383;P=0.041),and neutrophil/lymphocyte ratio(OR 3.574;95%CI:1.048-12.191;P=0.042)were found to be independent predictors of COVID-19.These factors were found to be significant risk factors for severe patients confirmed with COVID-19.The AUROC was 0.941(95%CI:0.901-0.981)and 0.936(95%CI:0.886-0.987)in both datasets.The calibration properties were good.CONCLUSION The proposed predictive model had great potential in severity prediction of COVID-19 in the ICU.It assisted the ICU clinicians in making timely decisions for the target population.

Monkeypox awareness,knowledge,and attitude among undergraduate preclinical and clinical students at a Malaysian dental school:An emerging outbreak during the COVID-19 era

Objective:To evaluate the awareness,knowledge,and attitude on monkeypox viral infection among preclinical and clinical dental students in Malaysia.Methods:A cross-sectional study was conducted among 229 preclinical and clinical dental students via an online self-reported questionnaire.The questionnaire included 3 items on awareness,15 items on knowledge,9 items on attitude and 2 open-ended questions.Data were presented as frequencies and percentages.Chi-square test was used to compare knowledge and awareness scores between preclinical and clinical dental students and content analysis was performed for open-ended responses.Results:Preclinical and clinical dental students were aware of the existence of monkeypox(89.5%and 94.4%,respectively),that the disease emerged in non-endemic countries(81.0%and 87.1%,respectively)and that it was declared a public health emergency of international concern by the World Health Organization(73.3%and 79.0%,respectively).Clinical dental students’overall knowledge level was significantly higher than preclinical dental students(P=0.014).Both preclinical(95.2%)and clinical(96.8%)dental students demonstrated positive attitudes toward monkeypox with no significant difference(P=0.736)noted between them.Three themes emerged from the open-ended questions:(1)reimplementation of nationwide lockdown,(2)impact on the economy and health,and(3)disruption to the educational system.Students also anticipated their face-to-face learning to be reduced should there be a new outbreak.Conclusions:Both preclinical and clinical dental students showed comparable awareness and attitudes,while the latter demonstrated greater satisfactory knowledge toward the re-emergence of monkeypox during the COVID-19 pandemic.Nonetheless,efforts to improve dental students’understanding of this alarming outbreak are required,to safeguard their health and minimise transmission.

Prevention of Gastrointestinal Pathologies: Comparative Study of the Microbial Flora of the Sanitary Surfaces of the Toilets of Students and Staff of the Félix Houphouët-Boigny University

Pathologies transmissible by hand such as gastrointestinal pathologies constitute a real public health problem, especially in sub-Saharan Africa where hygienic conditions are precarious. This study took place at Félix Houphouët-Boigny University from April to August 2018. The samples were taken from toilet surfaces such as doorknobs, tap heads, flush push buttons and seats WC. A total of three hundred and sixty-eight (368) samples were obtained, including 170 from the staff toilets and 198 from the student toilets. The results revealed the presence of total coliforms, Escherichia spp and Salmonella spp. The surfaces of student toilets were the most contaminated surfaces. The presence of entero-bacteria on the contact surfaces of the toilets of the Félix Houphouët-Boigny university represents a health risk for the university population.

A scoping review on the field validation and implementation of rapid diagnostic tests for vector-borne and other infectious diseases of poverty in urban areas

Background:Health personnel face challenges in diagnosing vector-borne and other diseases of poverty in urban settings.There is a need to know what rapid diagnostic technologies are available,have been properly assessed,and are being implemented to improve control of these diseases in the urban context.This paper characterizes evidence on the field validation and implementation in urban areas of rapid diagnostics for vector-borne diseases and other diseases of poverty.Main body:A scoping review was conducted.Peer-reviewed and grey literature were searched using terms describing the targeted infectious diseases,diagnostics evaluations,rapid tests,and urban setting.The review was limited to studies published between 2000 and 2016 in English,Spanish,French,and Portuguese.Inclusion and exclusion criteria were refined post hoc to identify relevant literature regardless of study design and geography.A total of 179 documents of the 7806 initially screened were included in the analysis.Malaria(n=100)and tuberculosis(n=47)accounted for the majority of studies that reported diagnostics performance,impact,and implementation outcomes.Fewer studies,assessing mainly performance,were identified for visceral leishmaniasis(n=9),filariasis and leptospirosis(each n=5),enteric fever and schistosomiasis(each n=3),dengue and leprosy(each n=2),and Chagas disease,human African trypanosomiasis,and cholera(each n=1).Reported sensitivity of rapid tests was variable depending on several factors.Overall,specificities were high(>80%),except for schistosomiasis and cholera.Impact and implementation outcomes,mainly acceptability and cost,followed by adoption,feasibility,and sustainability of rapid tests are being evaluated in the field.Challenges to implementing rapid tests range from cultural to technical and administrative issues.Conclusions:Rapid diagnostic tests for vector-borne and other diseases of poverty are being used in the urban context with demonstrated impact on case detection.However,most evidence comes from malaria rapid diagnostics,with variable results.While rapid tests for tuberculosis and visceral leishmaniasis require further implementation studies,more evidence on performance of current tests or development of new alternatives is needed for dengue,Chagas disease,filariasis,leptospirosis,enteric fever,human African trypanosomiasis,schistosomiasis and cholera.

Potential for broad-scale transmission of Ebola virus disease during the West Africa crisis:lessons for the Global Health security agenda

Background:The 2014-2016 Ebola crisis in West Africa had approximately eight times as many reported deaths as the sum of all previous Ebola outbreaks.The outbreak magnitude and occurrence of multiple Ebola cases in at least seven countries beyond Liberia,Sierra Leone,and Guinea,hinted at the possibility of broad-scale transmission of Ebola.Main text:Using a modeling tool developed by the US Centers for Disease Control and Prevention during the Ebola outbreak,we estimated the number of Ebola cases that might have occurred had the disease spread beyond the three countries in West Africa to cities in other countries at high risk for disease transmission(based on late 2014 air travel patterns).We estimated Ebola cases in three scenarios:a delayed response,a Liberia-like response,and a fast response scenario.Based on our estimates of the number of Ebola cases that could have occurred had Ebola spread to other countries beyond the West African foci,we emphasize the need for improved levels of preparedness and response to public health threats,which is the goal of the Global Health Security Agenda.Our estimates suggest that Ebola could have potentially spread widely beyond the West Africa foci,had local and international health workers and organizations not committed to a major response effort.Our results underscore the importance of rapid detection and initiation of an effective,organized response,and the challenges faced by countries with limited public health systems.Actionable lessons for strengthening local public health systems in countries at high risk of disease transmission include increasing health personnel,bolstering primary and critical healthcare facilities,developing public health infrastructure(e.g.laboratory capacity),and improving disease surveillance.With stronger local public health systems infectious disease outbreaks would still occur,but their rapid escalation would be considerably less likely,minimizing the impact of public health threats such as Ebola.Conclusions:The Ebola outbreak could have potentially spread to other countries,where limited public health surveillance and response capabilities may have resulted in additional foci.Health security requires robust local health systems that can rapidly detect and effectively respond to an infectious disease outbreak.

iLABMED,why now and how in the future?

Nowadays,public health is facing many challenges,mainly including non‐communicable diseases and communicable diseases.Communicable diseases,particularly emerging infectious diseases,have also attracted attention due to their enormous impact on public health and the global economy.The most prominent example is the current global Coronavirus Disease 2019(COVID‐19)pandemic.The unprece-dented and ongoing COVID‐19 pandemic has high-lighted the necessity for readily available,accurate,and rapid laboratory medicine(LM)practices.Nevertheless,current LMs and journals in particular have a window for improvement.First,there are limited numbers of professionals available in this field compared to the other disciplines.The current status quo is that most LM manuscripts must be submitted to comprehensive journals or other journals related to the research disease.Second,most LM journals are run by laboratory personnel who are often more concerned with technical advances than with clinical needs.Lastly,several young LM scientists expressed their desire to have a dedicated platform to discuss,communicate,and publish their works on LM.We were therefore motivated to launch iLABMED,an international public forum dedicated to LMs.The establishment of iLABMED adopts the“four I”strat-egy,namely“Innovation,”“Intelligence,”“Integra-tion,”and“International.”We are attempting to establish a top‐tier journal in the field of LM.

Revisiting classical SIR modelling in light of the COVID-19 pandemic

Background:Classical infectious disease models during epidemics have widespread usage,from predicting the probability of new infections to developing vaccination plans for informing policy decisions and public health responses.However,it is important to correctly classify reported data and understand how this impacts estimation of model parameters.The COVID-19 pandemic has provided an abundant amount of data that allow for thorough testing of disease modelling assumptions,as well as how we think about classical infectious disease modelling paradigms.Objective:We aim to assess the appropriateness of model parameter estimates and preiction results in classical infectious disease compartmental modelling frameworks given available data types(infected,active,quarantined,and recovered cases)for situations where just one data type is available to fit the model.Our main focus is on how model prediction results are dependent on data being assigned to the right model compartment.Methods:We first use simulated data to explore parameter reliability and prediction capability with three formulations of the classical Susceptible-Infected-Removed(SIR)modelling framework.We then explore two applications with reported data to assess which data and models are sufficient for reliable model parameter estimation and prediction accuracy:a classical influenza outbreak in a boarding school in England and COVID-19 data from the fall of 2020 in Missoula County,Montana,USA.Results:We demonstrated the magnitude of parameter estimation errors and subsequent prediction errors resulting from data misclassification to model compartments with simulated data.We showed that prediction accuracy in each formulation of the classical disease modelling framework was largely determined by correct data classification versus misclassification.Using a classical example of influenza epidemics in an England boarding school,we argue that the Susceptible-Infected-Quarantined-Recovered(SIQR)model is more appropriate than the commonly employed SIR model given the data collected(number of active cases).Similarly,we show in the COVID-19 disease model example that reported active cases could be used inappropriately in the SIR modelling framework if treated as infected.Conclusions:We demonstrate the role of misclassification of disease data and thus the importance of correctly classifying reported data to the proper compartment using both simulated and real data.For both a classical influenza data set and a COVID-19 case data set,we demonstrate the implications of using the“right”data in the“wrong”model.The importance of correctly classifying reported data will have downstream impacts on predictions of number of infections,as well as minimal vaccination requirements.

A case of leprosy in Malawi. Making the final push towards eradication: a clinical and public health perspective

Statistically speaking,Malawi has achieved the World Health Organisation's target for the elimination of leprosy(<1 case per 10000 people),yet the disease is still considered a leading cause of long term physical disability.In this case study the authors discuss the presentation of a 39-year-old gentleman to a district hospital in Malawi with multibacillary,lepromatous leprosy.The condition was initially managed in the community as an‘allergy’which suggests that local barriers currently hinder the detection of leprosy in this developing primary care system.Leprosy is a multi-system disease and this gentleman demonstrated evidence of lepromatous orchitis.Promoting an awareness of these systemic manifestations will increase the the detection of complications and circumvent long term morbidity.Efforts to optimise systems of detection,management and public and professional education are essential to drive eradication in these at-risk populations.At an international level,we must strive to fulfil the objectives outlined by the‘Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy for 2011–2015’.At a national level,local research should delineate community factors that impede the eradication of leprosy.Developing new diagnostic and epidemiologic tools,more efficacious chemoprophylactic regimens and vaccination for endemic regions would facilitate these efforts.

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.

A novel IDEA: The impact of serial interval on a modified- Incidence Decay and Exponential Adjustment (m-IDEA) model for projections of daily COVID-19 cases

The SARS-CoV-2 virus causes the disease COVID-19,and has caused high morbidity and mortality worldwide.Empirical models are useful tools to predict future trends of disease progression such as COVID-19 over the near-term.A modified Incidence Decay and Exponential Adjustment(m-IDEA)model was developed to predict the progression of infectious disease outbreaks.The modification allows for the production of precise daily estimates,which are critical during a pandemic of this scale for planning purposes.The m-IDEA model was employed using a range of serial intervals given the lack of knowledge on the true serial interval of COVID-19.Both deterministic and stochastic approaches were applied.Model fitting was accomplished through minimizing the sum-of-square differences between predicted and observed daily incidence case counts,and performance was retrospectively assessed.The performance of the m-IDEA for projection cases in the nearterm was improved using shorter serial intervals(1e4 days)at early stages of the pandemic,and longer serial intervals at mid-to late-stages(5e9 days)thus far.This,coupled with epidemiological reports,suggests that the serial interval of COVID-19 might increase as the pandemic progresses,which is rather intuitive:Increasing serial intervals can be attributed to gradual increases in public health interventions such as facility closures,public caution and social distancing,thus increasing the time between transmission events.In most cases,the stochastic approach captured the majority of future reported incidence data,because it accounts for the uncertainty around the serial interval of COVID-19.As such,it is the preferred approach for using the m-IDEA during dynamic situation such as in the midst of a major pandemic.