Western Pacific Surveillance and Response最新文献

Objective: We explored the experiences of women in senior or leadership roles in navigating and leading during acute public health emergencies.

Methods: Women leaders in the World Health Organization Western Pacific Region attending the Global Outbreak Alert and Response Network's Outbreak Response Leadership Training (11-18 September 2024) were invited to participate in this phenomenological study. Eleven interviews were conducted with training attendees and observational data were gathered. Inductive thematic analysis was conducted to identify key themes.

Results: Four themes associated with women-centric experiences in public health emergency response were identified: disproportionate expectations in the workplace; the use of authoritarian decision-making during planning and implementation; encompassing different perspectives and leadership styles compared to men; and requesting additional opportunities and equitable prospects for career growth. Four themes that reflect non-gender-exclusive challenges experienced during emergency responses were also detailed. Themes observed were related to: barriers to efficiency; consequences of working within this field; and needs and necessities during emergency response.

Discussion: This study highlights both gender-specific and systemic challenges experienced by women leaders in public health emergency responses, revealing how sociocultural norms and operational barriers intersect during times of crisis. We identified opportunities to assist women leaders through the recognition and promotion of different leadership styles, establishing a support network for women, and addressing systemic and organizational barriers that impact women.

Objective: Following the notification of two cases of typhoid fever to the Kudat District Health Office in February 2019, an investigation was conducted in a rural district in Sabah, East Malaysia, to determine the extent, characteristics and source of the outbreak.

Methods: This epidemiological study used both active and passive case detection. Environmental samples were taken from water sources, food-handling areas and waste sites, and were analysed for the presence of Salmonella enterica serotype Typhi as part of the standard protocol during an announced typhoid fever outbreak. Clinical specimens underwent culture and sensitivity testing, with samples that were positive for S. Typhi analysed using pulsed-field gel electrophoresis to determine clonal relationships.

Results: A total of 35 cases of typhoid fever were identified during 3 months. Twenty-eight cases (80.0%) occurred among Sabah's indigenous ethnic groups, and 12 of these (34.3%) occurred in people aged 7-17 years. The index case, along with six other cases, had a history of consuming smashed fried chicken from a local restaurant. Analysis revealed three clonal clusters of S. Typhi isolates, with a dominant pattern found in 18 cases, which included the index case and a food handler from the implicated restaurant. Two paediatric patients experienced a relapse after initial treatment with intravenous antibiotics.

Discussion: The source of the outbreak was most likely the infected restaurant worker who prepared chicken without wearing gloves; transmission most likely occurred through contaminated food or surfaces. Immediate steps to control the outbreak included chlorinating water wells, disinfecting waste disposal areas and promptly vaccinating all food handlers, including those working in street food settings. Recommendations for preventing future outbreaks include strengthening surveillance systems for acute gastroenteritis, conducting education campaigns to promote safe food-handling practices and implementing measures to improve vaccination coverage against typhoid fever among food handlers.

The aim of this study was to assess the effectiveness of safety regulations governing traditional Mongolian horse racing on the frequency and severity of injuries among child jockeys. Regulations introduced in 2019 mandate the wearing of helmets and protective clothing, prohibit the participation of jockeys aged < 7 years, and ban horse racing during the cold season (November-April). National injury surveillance data were used to compare the profile of injuries that occurred among children aged < 15 years in the 4-year periods before and after the introduction of the regulations (2015-2018 and 2019-2022) and to investigate whether injuries continued to occur among underage children and during the banned season. The proportion of head injuries among injured children was calculated before and after the regulations were introduced. During the study periods, 6309 animal-riding injuries were recorded among children aged 3-14 years; 2539 occurred before the regulations were introduced and 3770 occurred after. Following the introduction of the regulations, the proportion of injured children aged < 7 years decreased slightly. However, during 2019-2022, 294 animal-riding injuries were observed among underage children and 855 during the banned season. The proportion of head injuries among children with animal-riding injuries remained unchanged before and after the regulations were implemented (33.7% and 34.6%, respectively). The regulations have been ineffective. To reduce the burden of injuries among child jockeys, safety regulations need to be enforced throughout the year, and more stringent penalties for noncompliance should be imposed.

Antimicrobial resistance (AMR) is a global concern. However, in Cambodia, as in other countries in the World Health Organization's Western Pacific Region, the magnitude of the problem is largely unknown. Thus, this study aimed to determine the prevalence of AMR in common pathogens, namely Escherichia coli and Staphylococcus aureus, isolated from blood cultures at one provincial hospital, a national sentinel site for AMR surveillance, during a 3-year period. Sample processing and analysis were conducted at the hospital's on-site microbiology laboratory. Blood cultures were processed manually, and conventional methods were used for bacterial identification. Antibiotic susceptibility testing (AST) was performed by disk diffusion and Etest minimum inhibitory concentration measurement, in accordance with current Clinical and Laboratory Standards Institute guidelines. Blood culture data from 1 January 2020 to 31 December 2022 were extracted from the hospital's microbiology database and, for the AST analysis, deduplicated to include results only for the first isolate per patient per year. Of 6102 blood cultures collected, 529 (9%) were positive. The most common blood culture pathogens found were E. coli (150, 28% of positive isolates) and S. aureus (65, 12% of positive isolates). For E. coli, resistance to ceftriaxone was detected in 110/148 (74%) isolates and resistance to imipenem in 3/147 (2%). For S. aureus, 18/56 (32%) isolates were methicillin-resistant, but vancomycin resistance was not detected. These rates of resistance to first-line treatments are of concern and have the potential to negatively impact patient outcomes.

Objective: Lamongan District Health Office received a report of a suspected measles outbreak from a community health centre and two hospitals in Brondong subdistrict, Lamongan district, Indonesia. An outbreak investigation team was deployed to verify the diagnosis and to determine the magnitude of the outbreak.

Methods: This retrospective, 1:1 matched case-control study involved 51 suspected or laboratory-confirmed measles cases and 51 controls selected from household contacts and/or playmates within the same village who did not have measles. Data on case characteristics, clinical symptoms, vaccination status, as well as contact and travel histories were collected via interview. Blood specimens were collected from 25 of the children for laboratory confirmation. Univariate and multivariable logistic regression analyses were conducted to investigate risk factors for measles infection.

Results: Nineteen of the 51 measles cases (37.3%) were laboratory-confirmed. All 51 cases exhibited fever and rash (100%) and ranged in age from 11 months to 12 years; 29 (56.9%) were female, and 32 (62.7%) were hospitalized. Over half of the cases occurred in Sedayulawas village (31/51, 60.8%), showing a propagated epidemic pattern. The index case was a 2-year-old girl. Transmission predominantly occurred within the same village through household or playmate contacts. Immunization status and contact history were significantly associated with measles infection.

Discussion: The measles outbreak was attributed to a decline in immunization coverage, particularly for the second dose of the measles-rubella vaccine. This decrease was driven by multiple factors, including the impact of the COVID-19 pandemic, misconceptions related to religious beliefs, and the long interval between the first and second vaccine doses, which contributed to the patients who were lost to follow-up. Collectively, these factors increased the vulnerability of children to measles infection.

The COVID-19 pandemic impacted tuberculosis epidemiology worldwide, and Japan was no exception. This report analysed Japan's national tuberculosis surveillance data to explore the potential impact of COVID-19 on tuberculosis, by age group and place of birth, and to explore possible reasons behind the impact, if any. Overall since 2019, the observed number of notified cases was significantly lower than the number of expected cases. However, closer examination revealed that among Japan-born patients, this was true only for those aged 35-54 years and ≥ 65 years, while among those aged 25-34 years, the observed number of notified cases significantly exceeded the expected cases. Among foreign-born patients, the observed number of notified cases was significantly lower than that of expected cases for those aged 0-24 years and ≥ 65 years. Examination of changes in the modes of detection during the pre- and post-COVID-19 periods revealed that the impact of COVID-19 affected screening opportunities for tuberculosis among various populations differently, which in turn may partially explain the discrepancies between the observed and expected cases among those in different age groups and with different places of birth. A detailed study may be helpful in further understanding the interaction between the impact of COVID-19 on tuberculosis in the short and long-term.

Since its inception in April 2000, the Global Outbreak Alert and Response Network has played a pivotal role in coordinating the rapid deployment of technical experts to support countries, when requested, during public health emergencies. This paper presents a regional analysis of the Network's deployments within, to and from the World Health Organization Western Pacific Region over the past 24 years. The findings emphasize the critical importance of a well coordinated surge workforce and advocate for enhanced partner engagement with strategic utilization of regional and global expertise to strengthen future outbreak responses.