Western Pacific Surveillance and Response最新文献

Objective: Cambodia is one of seven countries globally that met Millennium Development Goal 5A: reduction of maternal deaths by at least 75% between 1990 and 2015. The maternal death audit (MDA) was instituted in 2004 to support the improvement of maternal care. We evaluated progress in MDA implementation and maternal health services in Cambodia between 2010 and 2017.

Methods: International experts and the national MDA committee members assessed all case abstracts, investigation questionnaires and audit meeting minutes covering all maternal deaths reported in Cambodia in 2010 and 2017 for quality of classification, data, care and recommendations. They convened provincial MDA committees to conduct similar assessments and develop evidence-based recommendations. Differences in data from the two years were assessed for significance using χ² and Fisher's exact tests.

Results: In 2010 and 2017, 176 and 59 maternal death cases were reported, respectively. Cases were more likely in 2017 than in 2010 to have antenatal care (90.0% vs 68.2%, P = 0.004), give birth in a facility (81.6% vs 55.3%, P = 0.01) and receive a prophylactic uterotonic (95.7% vs 73%, P < 0.02) for postpartum haemorrhage and magnesium sulfate (66.7% vs 37%, P = 0.18) for preeclampsia/eclampsia. However, additional interventions and improved timeliness of referral with equipped and competent staff were identified as critical. Data quality prevented the classification of one fourth of cases during both periods. The quality of MDA recommendations improved from 2.8% in 2011 to 42% in 2018.

Discussion: Improvements in maternal care are reflected in the increased antenatal care, facility births and better postpartum haemorrhage and preeclampsia/eclampsia management. However, additional care management improvements are needed. The MDA reporting needs to improve data completeness and make more specific recommendations to address causes of death.

Problem: Over the past two decades, there has been increased recognition of the importance of a more holistic approach to preventing, predicting, detecting and responding to public health threats. The COVID-19 pandemic highlighted the need to bring together environmental, human and animal health sectors in addressing public health threats and the need to develop skilled front-line workers to act as surge capacity during health emergencies.

Context: Papua New Guinea is a high-risk country for emerging and re-emerging pathogens. The effects of climate change, human-mediated encroachment on natural habitats and destructive land-use practices have threatened ecosystems and caused environmental damage. The movement of goods, animals and people over porous borders provides opportunities for the introduction and spread of new pathogens.

Action: In recognition of the importance of multisectoral responses to health threats in Papua New Guinea, and the need to train front-line workers, we designed and piloted a 3-month One Health in-service training programme for front-line workers from across all sectors.

Lessons learned: The co-creation of curricula was essential in ensuring the relevance of the programme to front-line workers from multiple sectors, and the development of provincial training teams was key to ensuring mentorship and programme sustainability. Bringing front-line workers together in joint trainings facilitated the building of relationships, the understanding of the roles and responsibilities of the various sectors, the identification of sectoral focal points and the development of informal networks.

Discussion: Papua New Guinea's One Health front-line Field Epidemiology Training Program demonstrated that investment in cross-sectoral training programmes can be a catalyst for the implementation of One Health approaches on the front line.

Problem: The first known locally acquired cases of Japanese encephalitis virus (JEV) infection in New South Wales (NSW), Australia, were identified in March 2022. NSW Health (the state entity for health care in NSW), with its partner agencies, conducted a serological survey to identify the prevalence of JEV antibody responses in high-risk communities in NSW.

Context: JEV infection is rare in Australia; therefore, vaccination is not recommended for the majority of Australians. Less than 1% of JEV infections in humans result in clinical disease.

Action: We conducted a cross-sectional serological survey of all age groups in five townships within NSW between June and July 2022. A summary report of the serosurvey methods and results was previously published by NSW Health. In this report, we describe the operations and lessons learned from rapidly gathering serological survey evidence to inform the public health management of JEV infection in NSW, within a country with well established health infrastructure.

Lessons learned: Resource limitations had to be addressed pragmatically during this field epidemiology research. Community participation varied between towns. The knowledge of local public health staff was important for identifying appropriate locations for clinics and community engagement activities. The consistency of data collection needs to be emphasized when multiple teams are involved. Data quality assurance issues were limited during this survey, owing to ease of communication in the field with the coordinating research team. When possible, allowing additional time for community engagement and staff orientation would be beneficial before implementing a similar survey. Further consideration of reporting serology results during the study design stage might have prevented the need for manual processing upon study completion.

Discussion: This serological survey highlights that a well trained and coordinated public health workforce can provide important, timely evidence when faced with an emerging public health issue.

Objective: Due to rising cases of foodborne illness in Cayapa village, Abra province, Philippines, a team was dispatched on 21 March 2017 to conduct an epidemiological investigation. The objectives were to confirm the diagnosis, determine the existence of an outbreak, identify risk factors and recommend prevention and control measures.

Methods: A 1:2 case-control study was conducted. We defined a suspected case as a previously well village resident who developed abdominal pain or diarrhoea, and one or more symptoms of fever, vomiting, sore throat, difficulty swallowing or lymphadenopathy between 27 February and 14 March 2017. Confirmed cases were suspected cases who tested positive for Bacillus anthracis through bacterial culture or rt-PCR. Serum and soil samples were collected for testing, and an environmental survey and key informant interviews were conducted. Stata version 13 was used for data analysis.

Results: The epidemic curve indicated a point source outbreak for the 29 cases identified. Common signs and symptoms were abdominal pain (26, 90%), fever (16, 55%) and diarrhoea (14, 48%). One case presented with lymphadenopathy. Interviews revealed that a dead carabao had been butchered and sold to the villagers. The 11 serum specimens and five soil samples tested were negative for B. anthracis. After multivariable analysis, consumption of the uncooked meat of the carabao was significantly associated with being a case (adjusted odds ratio: 6, 95% CI: 1.7-18.4).

Discussion: This outbreak was most likely associated with the consumption of the carcass of a dead carabao. Educating such farming communities on preventive measures for zoonotic diseases is recommended.

Objective: In Viet Nam, tuberculosis (TB) prevalence surveys revealed that approximately 98% of individuals with pulmonary TB have TB-presumptive abnormalities on chest radiographs, while 32% have no TB symptoms. This prompted the adoption of the "Double X" strategy, which combines chest radiographs and computer-aided detection with GeneXpert testing to screen for and diagnose TB among vulnerable populations. The aim of this study was to describe demographic, clinical and radiographic characteristics of symptomatic and asymptomatic Double X participants and to assess multilabel radiographic abnormalities on chest radiographs, interpreted by computer-aided detection software, as a possible tool for detecting TB-presumptive abnormalities, particularly for subclinical TB.

Methods: Double X participants with TB-presumptive chest radiographs and/or TB symptoms and known risks were referred for confirmatory GeneXpert testing. The demographic and clinical characteristics of all Double X participants and the subset with confirmed TB were summarized. Univariate and multivariable logistic regression modelling was used to evaluate associations between participant characteristics and subclinical TB and between computer-aided detection multilabel radiographic abnormalities and TB.

Results: From 2020 to 2022, 96 631 participants received chest radiographs, with 67 881 (70.2%) reporting no TB symptoms. Among 1144 individuals with Xpert-confirmed TB, 51.0% were subclinical. Subclinical TB prevalence was higher in older age groups, non-smokers, those previously treated for TB and the northern region. Among 11 computer-aided detection multilabel radiographic abnormalities, fibrosis was associated with higher odds of subclinical TB.

Discussion: In Viet Nam, Double X community case finding detected pulmonary TB, including subclinical TB. Computer-aided detection software may have the potential to identify subclinical TB on chest radiographs by classifying multilabel radiographic abnormalities, but further research is needed.

Problem: Many communities refer to sorcery or witchcraft to explain misfortunes such as sickness, death and disability. The effects of these beliefs on public health service delivery have long been overlooked. Beliefs in sorcery and witchcraft are significant challenges for health-care workers to understand to deliver better health outcomes and avoid inadvertently triggering accusations of witchcraft that may lead to violence.

Context: This paper examines the impacts of accusations of sorcery and related violence on the provision of health care in Papua New Guinea.

Action: The discussion focuses on a workshop held in Papua New Guinea in September 2022 with health extension officers on the topic of health-care delivery and sorcery accusations.

Lessons learned: The workshop confirmed the challenges that beliefs in sorcery and witchcraft present for health extension officers and suggested several strategies that could be used to navigate them. It identified several possible future measures that those on the front line of community health-care delivery considered most important in responding to the issue. These included educating health-care workers on how to effectively address sorcery beliefs when delivering health care and developing communication techniques on the causes of death and sickness that avoid triggering sorcery accusations.

Discussion: This paper reviews the findings of the workshop in the broader context of the effects of beliefs in witchcraft on public health delivery globally. Because of the close connections between sorcery beliefs and health, equipping health-care workers and field epidemiologists with strategies to address these beliefs effectively is critical to delivering better health care, facilitating timely response to public health events, and helping to prevent violence related to sorcery accusations. This need exists in all countries where sorcery beliefs related to health, illness, disability and death are prevalent.

Objective: To investigate the cause of a foodborne outbreak that occurred in Dong Nai province, Viet Nam, in 2024, and implement control measures.

Methods: An initial investigation was conducted to confirm the outbreak, which was followed by epidemiological and environmental investigations to find the plausible causative food item. Clinical specimens and food samples were tested to identify the pathogen.

Results: A total of 547 symptomatic cases were recorded, of whom two were in severe condition requiring extracorporeal membrane oxygenation and ventilation, one of whom died. Among 99 interviewed cases, the mean incubation time was 9 hours (range 2-24 hours), with the main symptoms being fever, abdominal pain, diarrhoea and vomiting. All patients had eaten banh mi from a local bakery. Salmonella spp. were identified in food samples and clinical specimens. The bakery halted production, and the outbreak ended after 1 week.

Discussion: All the patients were exposed to only one food in common, which facilitated the investigation process. This outbreak is a reminder to small retailers and take-away shops of the importance of food safety management in preventing similar future outbreaks. All food handlers must comply with food hygiene principles, especially in hot temperatures, which boosts bacterial growth.

Problem: The spread of mis- and disinformation on mobile and messaging apps during the COVID-19 pandemic not only fuelled anxieties and mistrust in health authorities but also undermined the effectiveness of the overall public health response.

Context: Mobile and messaging apps help users stay informed and connected to their families, friends, colleagues and communities. However, during the COVID-19 pandemic, these apps were also one of the primary channels where mis- and disinformation were circulated.

Action: Recognizing the importance of including mobile and messaging apps in risk communication and emergency response strategies, the World Health Organization (WHO) and some countries in the WHO Western Pacific Region independently piloted initiatives to reach messaging app users, meet their evolving information needs, and streamline health ministry communication.

Outcome: The enhanced use of mobile and messaging apps enabled consistent and timely communication and improved coordination during the COVID-19 pandemic. Leveraging their features also helped identify and potentially fill crucial information gaps, mitigating the harms of mis- and disinformation and fostering stronger trust in health authorities.

Discussion: The findings from the work carried out by WHO and countries in the Western Pacific Region identified some promising innovative communication interventions using mobile and messaging apps. While these interventions should be further explored and evaluated, they have demonstrated that interventions need to be proactive, flexible, and able to adapt to changes in mis- and disinformation content being shared through messaging apps.