National Public Health Response to Candida auris in England

This paper highlights the key steps undertaken by a national public health agency, working in close collaboration with academic partners and experienced healthcare professionals, in developing a response to the rapid emergence of a novel nosocomial pathogen. It details the key activities in national incident management team formation, surveillance activities, epidemiological investigations, laboratory developments, scientific advances, and collaborative activities. It discusses commonalities that can be adapted for dealing with the emergence of future new pathogens.

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Responsibility and Blame

10.1093/oso/9780190697211.003.0010 ◽

2018 ◽

Author(s):

Joshua M. Sharfstein

Keyword(s):

Public Health ◽

Health Agency ◽

Public Health Response ◽

Difficult Situation ◽

Health Training ◽

Health Response ◽

Public Health Training ◽

Health Agencies ◽

Sincere Apology

Issues of responsibility and blame are very rarely discussed in public health training, but are seldom forgotten in practice. Blame often follows a crisis, and leaders of health agencies should be able to think strategically about how to handle such accusations before being faced with the pain of dealing with them. When the health agency is not at all at fault, officials can make the case for a strong public health response without reservation. When the agency is entirely to blame, a quick and sincere apology can allow the agency to retain credibility. The most difficult situation is when the agency is partly to blame. The goal in this situation is to accept the appropriate amount of blame while working quickly to resolve the crisis.

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Not your typical “historian”

Disaster Prevention and Management An International Journal ◽

10.1108/dpm-05-2018-0136 ◽

2018 ◽

Vol 27 (5) ◽

pp. 523-533

Author(s):

Adrienne Lefevre ◽

Madison Walter-Garcia ◽

Kimberly Hanson ◽

Julia Smith-Easley

Keyword(s):

Public Health ◽

Lessons Learned ◽

Incident Management ◽

Public Health Response ◽

Content Type ◽

Incident Command ◽

Health Community ◽

Health Response ◽

Decision Making Processes

Purpose In the incident command system (ICS) structure, response documentation is formally found within the planning section. However, longer term emergency responses have demonstrated the need for a flexible and innovative role that encompasses a variety of activities, including response documentation, communications science, real-time evaluation of major themes, and information management. The paper aims to discuss this issue. Design/methodology/approach This need can be universally met through the functional role of “Historian,” a term specific to ICS, or in the case of public health response, incident management system (IMS). It should be noted that the Historian role discussed is not related to the academic study of history, but to archiving key successes and challenges during a response. Ideally the Historian should be activated at the start of an emergency response and remain active to capture the overall picture of the response, including internal information, such as lessons learned, response activities, and decision-making processes. Findings The Historian compiles details of response activities that inform leadership, donors and external communications products while alleviating pressures on the planning section. The primary, minimum output of an IMS Historian is a response timeline, which notes major internal and external events during a response with emphasis on major themes, lessons learned, and creating a user-friendly interface to display this information (see the list “Abbreviated Example of Hurricane Matthew Response Timeline” in the text). Originality/value In a world with competing priorities and ongoing emergencies, the Historian’s role of archiving details of response efforts can help the international public health community to share lessons learned and contribute to lower morbidity and mortality among those affected by emergencies.

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Tracing the evolutionary history and global expansion of Candida auris using population genomic analyses

10.1101/2020.01.06.896548 ◽

2020 ◽

Cited By ~ 4

Author(s):

Nancy A. Chow ◽

José F. Muñoz ◽

Lalitha Gade ◽

Elizabeth Berkow ◽

Xiao Li ◽

...

Keyword(s):

Public Health ◽

Population Structure ◽

Healthcare Facility ◽

Antifungal Resistance ◽

Nosocomial Transmission ◽

Phylogenetic Study ◽

Candida Auris ◽

Public Health Response ◽

Fluconazole Resistance ◽

Health Response

AbstractCandida auris has emerged globally as a multidrug-resistant yeast that can spread via nosocomial transmission. An initial phylogenetic study of isolates from Japan, India, Pakistan, South Africa, and Venezuela revealed four populations (Clades I, II, III, and IV) corresponding to these geographic regions. Since this description, C. auris has been reported in over 30 additional countries. To trace this global emergence, we compared the genomes of 304 C. auris isolates from 19 countries on six continents. We found that four predominant clades persist across wide geographic locations. We observed phylogeographic mixing in most clades; Clade IV, with isolates mainly from South America, demonstrated the strongest phylogeographic substructure. C. auris isolates from two clades with opposite mating types were detected contemporaneously in a single healthcare facility in Kenya. We estimated a Bayesian molecular clock phylogeny and dated the origin of each clade within the last 339 years; outbreak-causing clusters from Clades I, III, and IV originated 34-35 years ago. We observed high rates of antifungal resistance in Clade I, including four isolates resistant to all three major classes of antifungals. Mutations that contribute to resistance varied between the clades, with Y132F in ERG11 as the most widespread mutation associated with azole resistance and S639P in FKS1 for echinocandin resistance. Copy number variants in ERG11 predominantly appeared in Clade III and were associated with fluconazole resistance. These results provide a global context for the phylogeography, population structure, and mechanisms associated with antifungal resistance in C. auris.ImportanceIn less than a decade, C. auris has emerged in healthcare settings worldwide; this species is capable of colonizing skin and causing outbreaks of invasive candidiasis. In contrast to other Candida species, C. auris is unique in its ability to spread via nosocomial transmission and its high rates of drug resistance. As part of the public health response, whole-genome sequencing has played a major role in characterizing transmission dynamics and detecting new C. auris introductions. Through a global collaboration, we assessed genome evolution of isolates of C. auris from 19 countries. Here, we described estimated timing of the expansion of each C. auris clade and of fluconazole resistance, characterized discrete phylogeographic population structure of each clade, and compared genome data to sensitivity measurements to describe how antifungal resistance mechanisms vary across the population. These efforts are critical for a sustained, robust public health response that effectively utilizes molecular epidemiology.

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Mental Health and the COVID-19 Pandemic: A Call for Action

The Open Public Health Journal ◽

10.2174/1874944502013010411 ◽

2020 ◽

Vol 13 (1) ◽

pp. 411-412

Author(s):

G. Kalcev ◽

A. Preti ◽

G. Orrù ◽

M.G. Carta

Keyword(s):

Public Health ◽

Mental Health ◽

Well Being ◽

Burnout Syndrome ◽

Physical And Mental Health ◽

Public Health Response ◽

Health Response ◽

National Public Health ◽

The Impact

The current COVID-19 pandemic is likely to affect the physical and mental health and the well-being of people globally. The physicians and nurses on the frontline of patients care will be among the most affected in their psychosocial well-being, being exposed to trauma consequences and burnout syndrome. It is still unknown whether the COVID-19 infection will have direct neuropsychiatric consequences. The impact of the quarantine lockdown on mental health, too, has to be taken into account. The inclusion of mental health as part of national public health response to the COVID-19 pandemic is mandatory in assisting all those in need.

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Revealing the Influence of National Public Health Response for the Outbreak of the SARS-CoV-2 Epidemic in Wuhan, China Through Status Dynamic Modeling

SSRN Electronic Journal ◽

10.2139/ssrn.3550027 ◽

2020 ◽

Cited By ~ 1

Author(s):

Tianyi Qiu ◽

Han Xiao

Keyword(s):

Public Health ◽

Dynamic Modeling ◽

Public Health Response ◽

Health Response ◽

National Public Health

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Tracing the Evolutionary History and Global Expansion of Candida auris Using Population Genomic Analyses

mBio ◽

10.1128/mbio.03364-19 ◽

2020 ◽

Vol 11 (2) ◽

Cited By ~ 20

Author(s):

Nancy A. Chow ◽

José F. Muñoz ◽

Lalitha Gade ◽

Elizabeth L. Berkow ◽

Xiao Li ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Population Structure ◽

Antifungal Resistance ◽

Nosocomial Transmission ◽

Candida Auris ◽

Public Health Response ◽

Fluconazole Resistance ◽

Content Type ◽

Health Response

ABSTRACT Candida auris has emerged globally as a multidrug-resistant yeast that can spread via nosocomial transmission. An initial phylogenetic study of isolates from Japan, India, Pakistan, South Africa, and Venezuela revealed four populations (clades I, II, III, and IV) corresponding to these geographic regions. Since this description, C. auris has been reported in more than 30 additional countries. To trace this global emergence, we compared the genomes of 304 C. auris isolates from 19 countries on six continents. We found that four predominant clades persist across wide geographic locations. We observed phylogeographic mixing in most clades; clade IV, with isolates mainly from South America, demonstrated the strongest phylogeographic substructure. C. auris isolates from two clades with opposite mating types were detected contemporaneously in a single health care facility in Kenya. We estimated a Bayesian molecular clock phylogeny and dated the origin of each clade within the last 360 years; outbreak-causing clusters from clades I, III, and IV originated 36 to 38 years ago. We observed high rates of antifungal resistance in clade I, including four isolates resistant to all three major classes of antifungals. Mutations that contribute to resistance varied between the clades, with Y132F in ERG11 as the most widespread mutation associated with azole resistance and S639P in FKS1 for echinocandin resistance. Copy number variants in ERG11 predominantly appeared in clade III and were associated with fluconazole resistance. These results provide a global context for the phylogeography, population structure, and mechanisms associated with antifungal resistance in C. auris. IMPORTANCE In less than a decade, C. auris has emerged in health care settings worldwide; this species is capable of colonizing skin and causing outbreaks of invasive candidiasis. In contrast to other Candida species, C. auris is unique in its ability to spread via nosocomial transmission and its high rates of drug resistance. As part of the public health response, whole-genome sequencing has played a major role in characterizing transmission dynamics and detecting new C. auris introductions. Through a global collaboration, we assessed genome evolution of isolates of C. auris from 19 countries. Here, we described estimated timing of the expansion of each C. auris clade and of fluconazole resistance, characterized discrete phylogeographic population structure of each clade, and compared genome data to sensitivity measurements to describe how antifungal resistance mechanisms vary across the population. These efforts are critical for a sustained, robust public health response that effectively utilizes molecular epidemiology.

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