Public Health Responses to a Dengue Outbreak in a Fragile State: A Case Study of Nepal

Objectives. The number of countries reporting dengue cases is increasing worldwide. Nepal saw its first dengue outbreak in 2010, with 96% of cases reported in three districts. There are numerous policy challenges to providing an effective public health response system in a fragile state. This paper evaluates the dengue case notification, surveillance, laboratory facilities, intersectoral collaboration, and how government and community services responded to the outbreak.Methods. Qualitative data were collected through 20 in-depth interviews, with key stakeholders, and two focus-group discussions, with seven participants.Results. Limitations of case recognition included weak diagnostic facilities and private hospitals not incorporated into the case reporting system. Research on vectors was weak, with no virological surveillance. Limitations of outbreak response included poor coordination and an inadequate budget. There was good community mobilization and emergency response but no routine vector control.Conclusions. A weak state has limited response capabilities. Disease surveillance and response plans need to be country-specific and consider state response capacity and the level of endemicity. Two feasible solutions for Nepal are (1) go upwards to regional collaboration for disease and vector surveillance, laboratory assistance, and staff training; (2) go downwards to expand upon community mobilisation, ensuring that vector control is anticipatory to outbreaks.

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Species abundance and temporal variation of arbovirus vectors in Brownsville, Texas

Revista Panamericana de Salud Pública ◽

10.26633/rpsp.2017.28 ◽

2017 ◽

Vol 41 ◽

pp. 1 ◽

Cited By ~ 2

Author(s):

Krithika Srinivasan ◽

Beatriz Tapia ◽

Arturo Rodriguez ◽

Robert Wood ◽

Jennifer J Salinas

Keyword(s):

Public Health ◽

High Risk ◽

Disease Incidence ◽

South Texas ◽

Late Winter ◽

Surveillance Program ◽

Public Health Department ◽

Mosquito Vector ◽

Vector Surveillance ◽

Public Health Response

The recent outbreaks of the dengue fever and West Nile viruses and the looming threats of the Zika and chikungunya viruses highlight the importance of establishing effective, proactive arboviral surveillance in communities at high risk of transmission, such as those on the Texas–Mexico border. Currently, there are no approved human vaccines available for these mosquito-borne diseases, so entomological control and case management are the only known methods for decreasing disease incidence. The principal vectors, which include Culex quinquefasciatus, Aedes aegypti, and Ae. Albopictus, all have an established presence in South Texas. The public health response to most arbovirus outbreaks in the region has been reactionary rather than proactive. However, after the 2005 dengue outbreak and subsequent fatality, the City of Brownsville Public Health Department began collecting data on mosquito vector abundance and incidence. The objective of this study was to describe the various species of mosquitoes found in vector surveillance in Brownsville, Texas, during 2009–2013; quantify their prevalence; and identify any associations with temporal or weather-related variations. The results confirm a significant mosquito population in Brownsville in late winter months, indicating a high risk of arbovirus transmission in South Texas year-round, and not just until November, previously considered the end date of arbovirus season by state health services. The data from Brownsville’s surveillance program can help characterize local vector ecology and facilitate more proactive mitigation of future arboviral threats in South Texas.

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Participatory COVID-19 Surveillance Tool in Rural Appalachia

Public Health Reports ◽

10.1177/0033354921990372 ◽

2021 ◽

pp. 003335492199037

Author(s):

Jennifer D. Runkle ◽

Maggie M. Sugg ◽

Garrett Graham ◽

Bryan Hodge ◽

Terri March ◽

...

Keyword(s):

Public Health ◽

Low Cost ◽

Local Level ◽

Local Health ◽

Public Health Response ◽

Health History ◽

Regional Collaboration ◽

Health Response ◽

Participatory Surveillance ◽

Rural Appalachia

Introduction Few US studies have examined the usefulness of participatory surveillance during the coronavirus disease 2019 (COVID-19) pandemic for enhancing local health response efforts, particularly in rural settings. We report on the development and implementation of an internet-based COVID-19 participatory surveillance tool in rural Appalachia. Methods A regional collaboration among public health partners culminated in the design and implementation of the COVID-19 Self-Checker, a local online symptom tracker. The tool collected data on participant demographic characteristics and health history. County residents were then invited to take part in an automated daily electronic follow-up to monitor symptom progression, assess barriers to care and testing, and collect data on COVID-19 test results and symptom resolution. Results Nearly 6500 county residents visited and 1755 residents completed the COVID-19 Self-Checker from April 30 through June 9, 2020. Of the 579 residents who reported severe or mild COVID-19 symptoms, COVID-19 symptoms were primarily reported among women (n = 408, 70.5%), adults with preexisting health conditions (n = 246, 70.5%), adults aged 18-44 (n = 301, 52.0%), and users who reported not having a health care provider (n = 131, 22.6%). Initial findings showed underrepresentation of some racial/ethnic and non–English-speaking groups. Practical Implications This low-cost internet-based platform provided a flexible means to collect participatory surveillance data on local changes in COVID-19 symptoms and adapt to guidance. Data from this tool can be used to monitor the efficacy of public health response measures at the local level in rural Appalachia.

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COVID-19 in pastoral contexts in the greater Horn of Africa: Implications and recommendations

Pastoralism Research Policy and Practice ◽

10.1186/s13570-020-00178-x ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Evan F. Griffith ◽

Loupa Pius ◽

Pablo Manzano ◽

Christine C. Jost

Keyword(s):

Public Health ◽

One Health ◽

World Health ◽

Intersectoral Collaboration ◽

Horn Of Africa ◽

Public Health Response ◽

Effective Response ◽

Health Measures ◽

The World ◽

Greater Horn Of Africa

Abstract COVID-19 is a global pandemic that continues to spread around the world, including to Africa where cases are steadily increasing. The African Centres for Disease Control and Prevention is leading the pandemic response in Africa, with direction from the World Health Organization guidelines for critical preparedness, readiness, and response actions. These are written for national governments, lacking nuance for population and local differences. In the greater Horn of Africa, conditions unique to pastoralists such as inherent mobility and limited health and service infrastructure will influence the dynamics of COVID-19. In this paper, we present a One Health approach to the pandemic, consisting of interdisciplinary and intersectoral collaboration focused on the determinants of health and health outcomes amongst pastoralists. Our contextualized public health strategy includes community One Health teams and suggestions for where to implement targeted public health measures. We also analyse the interaction of COVID-19 impacts, including those caused directly by the disease and those that result from control efforts, with ongoing shocks and vulnerabilities in the region (e.g. desert locusts, livestock disease outbreaks, floods, conflict, and development displacement). We give recommendations on how to prepare for and respond to the COVID-19 pandemic and its secondary impacts on pastoral areas. Given that the full impact of COVID-19 on pastoral areas is unknown currently, our health recommendations focus on disease prevention and understanding disease epidemiology. We emphasize targeting pastoral toponymies with public health measures to secure market access and mobility while combating the direct health impacts of COVID-19. A contextualized approach for the COVID-19 public health response in pastoral areas in the Greater Horn of Africa, including how the pandemic will interact with existing shocks and vulnerabilities, is required for an effective response, while protecting pastoral livelihoods and food, income, and nutrition security.

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Implementing the International Health Regulations (2005) in Europe

Eurosurveillance ◽

10.2807/esm.11.12.00664-en ◽

2006 ◽

Vol 11 (12) ◽

pp. 3-4 ◽

Cited By ~ 9

Author(s):

G Rodier ◽

M Hardiman ◽

B Plotkin ◽

B Ganter

Keyword(s):

Public Health ◽

International Health ◽

World Health ◽

Intersectoral Collaboration ◽

The European Union ◽

International Health Regulations ◽

Public Health Response ◽

Member States ◽

Federal States ◽

Health Regulations

The adoption of the International Health Regulations (2005) (also referred to as IHR(2005) or the revised Regulations) provides a remarkable new legal tool for the protection of international public health. Upon entry into force on 15 June 2007, Article 2 (‘Purpose and scope‘) provides that the overall focus of the efforts of States Parties (and World Health Organization's efforts) under the revised Regulations will be to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with the public health risks and which avoid unnecessary interference with international traffic. Health measures under the revised Regulations will be implemented with respect for travellers’ human rights, with several specific new requirements in this area. To comply with the IHR (2005), States Parties (WHO member states that will be bound by the IHR(2005)) will have to have core public health capacities in disease surveillance and response, as well as additional capacities at designated international ports, airports and land crossings. This unique collective commitment will require close collaboration between WHO and the States Parties, but also intersectoral collaboration within the States themselves, including collaboration among different administrative or governmental levels, a particular issue for federal states, and horizontally across ministries and disciplines. Collaboration among States Parties is a key aspect of the revised Regulations, whether among neighbours, or with trading partners, members of regional economic integration organisations or other regional groups, or simply members of the international community. This collaboration is particularly relevant for the Member States of the European Union.

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DENGUE OUTBREAK;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.01.613 ◽

2012 ◽

Vol 20 (01) ◽

pp. 045-053

Author(s):

MUHAMMAD ASIF SHAHZAD ◽

ABDUL RAUF ◽

HUMAYUN SUQRAT HASAN IMAM ◽

Rameesha Humayun

Keyword(s):

Vector Control ◽

Rural Areas ◽

Urban Areas ◽

Disease Surveillance ◽

Larval Growth ◽

Case Fatality ◽

Vector Surveillance ◽

Female Ratio ◽

Dengue Outbreak ◽

Male To Female

Background: This longitudinal study was conducted during August to December 2011 in District Faisalabad to analyzeepidemiological pattern of dengue outbreak in the district. Weekly trends of all cases (893) reported through Disease Surveillance Systemfrom week No.33 to 54 were monitored. On the basis of this continuous flow of information, different ongoing vector control measureswere adopted simultaneously in different areas of the district and larval indices were calculated. Methods: The Surveillance data was usedto monitor the trends of the outbreak in terms of time, person and place. Teams of 3102 trained workers were formed to conduct varioussurveillance activities like vector surveillance, fogging, larviciding, and indoor residual sprays. During indoor and outdoor vectorsurveillance, teams also calculated the larval indices for vector control. Results: The rural to urban ratio of cases was 1:3. Maximumcases (215) were reported from Jinnah Town in urban area and (102) cases were reported from Tehsil Sadar among the rural areas. Mostcases of dengue fever were observed during the 40-45 weeks of the year 2011. Mean age was 29±14.7 years for rural and 35±16.5years for urban. Male to Female ratio was 1.2:1 in urban and 1.8:1 in rural areas. Majority of the cases belonged to the age group 21-30.The case fatality rate was 6/1000 cases. The house lndex was 1.03%, the indoor container index was 0.26% and the breateu index wasfound 1.21%. Conclusions: Maximum cases occurred during 44th and 45th weeks. Male were affected more as compare to females.Jinnah Town in urban areas and Tehsil Sadar among the rural areas reported maximum number of cases. The different calculated larvalindices like house index, indoor/outdoor container index and breateu index showed moderate larval growth and hence, the outbreak waswithin control.

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