https://openwho.org/courses/introduction-to-ncov

Course information

Course contents

• Emerging respiratory viruses, including nCoV: Introduction:

  This brief introduction provides an overview of emerging respiratory viruses, including nCoV.

• Module A: Introduction to Emerging respiratory viruses, including nCoV:

  Overall learning objective: To be able to explain why an emerging respiratory virus, including nCoV are a global threat to human health

• Module B: Detecting Emerging respiratory viruses, including nCoV: Surveillance and Laboratory investigation:

  Overall learning objective: To describe how to detect and assess an emerging respiratory virus outbreak

• Module C: Risk Communication and Community Engagement:

  Overall learning objective: To describe what strategies should be used to communicate risk and engage communities to detect, prevent and respond to nCoV

AfricaNews

“……EWARS in a box is a custom-built solution designed for use in difficult field conditions, such as following a natural disaster or in a conflict. Each box contains 60 mobile phones, laptops and a local server to collect, report and manage disease data. A solar generator and solar chargers allow the phones and laptops to function without 24-hour electricity. A single kit costs approximately US$15 000 and can support surveillance for 50 fixed or mobile clinics serving roughly 500 000 people.

Each health site receives a mobile phone loaded with a custom-developed disease reporting application that allows health workers to enter information when they see a patient with symptoms of one of 8 priority diseases or conditions. These are acute watery diarrhoea, acute bloody diarrhoea, cholera, measles, acute flaccid paralysis (which could indicate polio), fever, malaria and jaundice.

This information is sent immediately to a central system, where the data is used to generate real-time reports that enable a rapid response to diseases before they have time to spread……”

Pandemic Influenza

Ultraviolet germicidal irradiation of influenza-contaminated N95 filtering facepiece respirators

Mills, Devin et al.

American Journal of Infection Control

CDC

Advice for Providers Treating Patients in or Recently Returned from Hurricane-Affected Areas, Including Puerto Rico and US Virgin Islands

(https://emergency.cdc.gov/han/index.asp)

Distributed via the CDC Health Alert Network
October 24, 2017, 1330 ET (1:30 PM ET)
CDCHAN-00408

Summary
The Centers for Disease Control and Prevention (CDC) is working with federal, state, territorial, and local agencies and global health partners in response to recent hurricanes. CDC is aware of media reports and anecdotal accounts of various infectious diseases in hurricane-affected areas, including Puerto Rico and the US Virgin Islands (USVI). Because of compromised drinking water and decreased access to safe water, food, and shelter, the conditions for outbreaks of infectious diseases exist.

The purpose of this HAN advisory is to remind clinicians assessing patients currently in or recently returned from hurricane-affected areas to be vigilant in looking for certain infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. Additionally, this Advisory provides guidance to state and territorial health departments on enhanced disease reporting.

 

Background
Hurricanes Irma and Maria made landfall in Puerto Rico and USVI in September 2017, causing widespread flooding and devastation. Natural hazards associated with the storms continue to affect many areas. Infectious disease outbreaks of diarrheal and respiratory illnesses can occur when access to safe water and sewage systems are disrupted and personal hygiene is difficult to maintain. Additionally, vector borne diseases can occur due to increased mosquito breeding in standing water; both Puerto Rico and USVI are at risk for outbreaks of dengue, Zika, and chikungunya.

Health care providers and public health practitioners should be aware that post-hurricane environmental conditions may pose an increased risk for the spread of infectious diseases among patients in or recently returned from hurricane-affected areas; including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. The period of heightened risk may last through March 2018, based on current predictions of full restoration of power and safe water systems in Puerto Rico and USVI.

In addition, providers in health care facilities that have experienced water damage or contaminated water systems should be aware of the potential for increased risk of infections in those facilities due to invasive fungi, nontuberculous Mycobacterium species, Legionella species, and other Gram-negative bacteria associated with water (e.g., Pseudomonas), especially among critically ill or immunocompromised patients.

Cholera has not occurred in Puerto Rico or USVI in many decades and is not expected to occur post-hurricane.

 

Recommendations

These recommendations apply to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas (e.g., within the past 4 weeks), during the period of September 2017 – March 2018.

• Health care providers and public health practitioners in hurricane-affected areas should look for community and healthcare-associated infectious diseases.
• Health care providers in the continental US are encouraged to ask patients about recent travel (e.g., within the past 4 weeks) to hurricane-affected areas.
• All healthcare providers should consider less common infectious disease etiologies in patients presenting with evidence of acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection, or other febrile illness. Some particularly important infectious diseases to consider include leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza.
• In the context of limited laboratory resources in hurricane-affected areas, health care providers should contact their territorial or state health department if they need assistance with ordering specific diagnostic tests.
• For certain conditions, such as leptospirosis, empiric therapy should be considered pending results of diagnostic tests— treatment for leptospirosis is most effective when initiated early in the disease process. Providers can contact their territorial or state health department or CDC for consultation.
• Local health care providers are strongly encouraged to report patients for whom there is a high level of suspicion for leptospirosis, dengue, hepatitis A, typhoid, and vibriosis to their local health authorities, while awaiting laboratory confirmation.
• Confirmed cases of leptospirosis, dengue, hepatitis A, typhoid fever, and vibriosis should be immediately reported to the territorial or state health department to facilitate public health investigation and, as appropriate, mitigate the risk of local transmission. While some of these conditions are not listed as reportable conditions in all states, they are conditions of public health importance and should be reported.

 

For More Information

• General health information about hurricanes and other tropical storms: https://www.cdc.gov/disasters/hurricanes/index.html
• Information about Hurricane Maria: https://www.cdc.gov/disasters/hurricanes/hurricane_maria.html
• Information for Travelers:
  • Travel notice for Hurricanes Irma and Maria in the Caribbean: https://wwwnc.cdc.gov/travel/notices/alert/hurricane-irma-in-the-caribbean
  • Health advice for travelers to Puerto Rico: https://wwwnc.cdc.gov/travel/destinations/traveler/none/puerto-rico?s_cid=ncezid-dgmq-travel-single-001
  • Health advice for travelers to the U.S. Virgin Islands: https://wwwnc.cdc.gov/travel/destinations/traveler/none/usvirgin-islands?s_cid=ncezid-dgmq-travel-leftnav-traveler
  • Resources from CDC Health Information for International Travel 2018 (the Yellow Book):
    • Humanitarian Aid Workers: https://wwwnc.cdc.gov/travel/yellowbook/2018/advising-travelers-with-specific-needs/humanitarian-aid-workers
• Post-travel Evaluation: https://wwwnc.cdc.gov/travel/yellowbook/2018/post-travel-evaluation/general-approach-to-the-returned-traveler
• Information about infectious diseases after a disaster: https://www.cdc.gov/disasters/disease/infectious.html
  • Dengue: https://www.cdc.gov/dengue/index.html
  • Hepatitis A: https://www.cdc.gov/hepatitis/HAV/index.htm
  • Leptospirosis: https://www.cdc.gov/leptospirosis/
  • Typhoid fever: https://www.cdc.gov/typhoid-fever/index.html
  • Vibriosis: https://www.cdc.gov/vibrio/index.html
• Information about other infectious diseases of concern:
  • Conjunctivitis: https://www.cdc.gov/conjunctivitis/
  • Influenza: https://www.cdc.gov/flu/index.htm
  • Scabies: https://www.cdc.gov/parasites/scabies/index.html
  • Tetanus and wound management: https://www.cdc.gov/disasters/emergwoundhcp.html
    • Tetanus in Areas Affected by a Hurricane: Guidelines for Clinicians https://emergency.cdc.gov/coca/cocanow/2017/2017sept12.asp

TFAH

Ready or Not? examines the nation’s ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies. Some key findings include:

• 26 states increased or maintained funding for public health from Fiscal Year (FY) 2014-2015 to FY 2015-2016.
• Just 10 states vaccinated at least half of their population (ages 6 months and older) against the seasonal flu during the 2015-2016 flu season (from July 2015 to May 2016).
• 45 states and Washington, D.C. increased the speed of DNA fingerprinting using pulsed-field gel electrophoresis (PFGE) testing for all reported cases of Shiga toxin-producing E. coli O157, a measure of a state’s ability to detect foodborne outbreaks.
• 10 states have a formal access program or a program in progress for getting private sector healthcare staff and supplies into restricted areas during a disaster.
• 30 states and Washington, D.C. met or exceeded the overall national average score (6.7) of the National Health Security Preparedness Index (as of 2016).
• 32 states and Washington, D.C. received a grade of C or above in States at Risk: America’s Preparedness Report Card, a national assessment of state-level preparedness for climate change-related threats – which have an impact on human health.

In addition, the report examined trends in public health preparedness over the last 15 years, finding successes and ongoing concerns.

• One-third of funds for health security and half of funds for healthcare system preparedness have been cut: Health emergency preparedness funding for states has been cut from $940 million in fiscal year (FY) 2002 to $660 million in FY 2016; and healthcare system preparedness funding for states has been cut by more than half since FY 2005 – down to $255 million.
• Some major areas of accomplishment: Improved emergency operations, communication and coordination; support for the Strategic National Stockpile and the ability to distribute medicines and vaccines during crises; major upgrades in public health labs and foodborne illness detection capabilities; and improvements in legal and liability protections during emergencies.
• Some major ongoing gaps: Lack of a coordinated, interoperable, near real-time biosurveillance system; insufficient support for research and development of new medicines, vaccines and medical equipment to keep pace with modern threats; gaps in the ability of the healthcare system to care for a mass influx of patients during a major outbreak or attack; and cuts to the public health workforce across states.

The Ready or Not? report provides a series of recommendations that address many of the major gaps in emergency health preparedness, including:

• Requiring strong, consistent baseline public health Foundational Capabilities in regions, states and communities-so that everyone is protected.
• Ensuring stable, sufficient health emergency preparedness funding to maintain a standing set of foundational capabilities alongside a complementary Public Health Emergency Fund which would provide immediate surge funding during an emergency.
• Improving federal leadership before, during and after disasters – including at the White House level.
• Recruiting and training a next generation public health workforce with expert scientific abilities to harness and use technological advances along with critical thinking and management skills to serve as the Chief Health Strategist for a community.
• Reconsidering health system preparedness for new threats and mass outbreaks by developingstronger coalitions and partnerships among providers, hospitals, insurance providers, pharmaceutical and health equipment businesses, emergency management, and public health agencies.
• Prioritizing efforts to address one of the most serious threats to human health by expanding efforts to stop Superbugs and antibiotic resistance.
• Improving rates of vaccinations for children and adults – which are one of the most effective public health tools against many infectious diseases.

Ready or Not? was released annually from 2003-2012, and more recently, TFAH has released Outbreaks: Protecting Americans from Infectious Diseases, from 2013-2015.The report was supported by a grant from the Robert Wood Johnson Foundation (RWJF).

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH’s website. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. The data for the indicators are from publicly available sources or were provided from public officials.

10 out of 10: Massachusetts

9 out of 10: North Carolina and Washington

8 out of 10: California, Connecticut, Iowa, New Jersey, Tennessee and Virginia

7 out of 10: Colorado, Delaware, Florida, Indiana, Maryland, Michigan, New Hampshire, New Mexico, New York, North Dakota, Oregon, Rhode Island, South Carolina, Utah and Wisconsin

6 out of 10: Arizona, Arkansas, District of Columbia, Georgia, Hawaii, Illinois, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Montana, Nebraska, Ohio, Pennsylvania, Texas and Vermont

5 out of 10: Alabama, Missouri, Oklahoma, South Dakota and West Virginia

4 out of 10 Nevada and Wyoming

3 out of 10: Alaska and Idaho

DAWN News

“…..diphtheria, which had almost been eliminated in most parts of the world, was thriving in few countries including Pakistan….”

NBC News