Western Pacific Surveillance and Response最新文献

Objective: To outline the management of an outbreak of invasive group A Streptococcus (iGAS) in a residential aged-care facility in rural Queensland, Australia, comparing outbreak management with the newly released Australian Series of National Guidelines (SoNG) for this disease and exploring unique aspects of rural iGAS outbreak management.

Methods: An outbreak of iGAS was identified in a rural Queensland residential facility, where two cases occurred within 24 hours. A confirmed case was defined as any individual linked to the facility who had laboratory evidence of group A Streptococcus (GAS) in a sterile site. Whole genome sequencing was performed on all confirmed cases. The public health management of this outbreak was conducted according to the Queensland Communicable Disease Control guidelines and was compared with the new SoNG.

Results: A phylogenetic tree confirmed that the two samples clustered closely together with a single allele difference. Chemoprophylaxis was offered to all residents and staff in the affected part of the facility; 95% (42/44) of residents consented to chemoprophylaxis. Increased surveillance for GAS and increased facility cleaning were recommended by the public health unit. No additional cases were identified after 30 days of surveillance. Management of the outbreak largely aligned with the SoNG except for post-outbreak surveillance, which would have been extended under the new guidelines.Discussion: This paper highlights factors unique to managing iGAS outbreaks in rural areas. Rural workforce factors and access to pathology services impact rural outbreak management, and thus involving local services and considering the local context are vital. The use of chemoprophylaxis continues to be recommended by the SoNG, and in this case was considered to be an important adjunct to other management strategies.

Objective: A response team was deployed to rural Oddar Meanchey Province, Cambodia, in mid-August 2023, immediately after a cluster of patients with acute febrile illness was reported. The team aimed to identify the cause of the outbreak and analyse the epidemiological characteristics and associated risk factors.

Methods: This retrospective cohort study involved all residents of Prasat Rumdoul Village. A case was defined as a resident with a fever ≥ 38 °C or a history of fever with symptoms such as cough, sore throat or coryza occurring from 18 July to 
18 August. Demographic data, information about infection prevention practices and clinical information were collected using structured questionnaires and analysed using binomial regression. Laboratory samples were collected, and confirmatory laboratory tests and environmental investigations were also conducted.

Results: Among the 126 villagers, 95 cases were identified (attack rate: 75.3%); 52 (54.7%) were female, and the median age was 29 years. Prolonged close contact with individuals who had influenza-like illness significantly increased the risk of infection (adjusted risk ratio [ARR]: 2.19, P = 0.002). Protective factors included mask-wearing (ARR: 0.26, P = 0.003) and regular handwashing (ARR: 0.85, P = 0.012). No villagers had been vaccinated against influenza within the past 1 year. Laboratory tests confirmed influenza type B/Victoria as the causative agent. Poor adherence to preventive measures and crowded living conditions contributed to the outbreak.

Discussion: The outbreak was caused by influenza type B/Victoria, the same strain circulating in nearby Thailand. Public health interventions to improve vaccine accessibility and hygiene-promotion activities would be useful for preventing future outbreaks.

In 2023, Republic of Korea's Korea Disease Control and Prevention Agency (KDCA) enhanced its event-based surveillance practices by using the World Health Organization's (WHO) Epidemic Intelligence from Open Sources (EIOS) to actively screen and share information about potential public health threats to the country. This report describes the preliminary assessment of the results of implementing these enhanced event-based surveillance activities from June to October 2023. During this period, 425 (0.4%) events were detected globally by the KDCA from 99 945 media articles, with the highest frequency reported in Asia (185, 43.5%) and North America (81, 19.1%). The most frequently reported diseases or conditions were dengue fever (111, 26.1%) and mpox (32, 7.5%). Eight events were detected early by the KDCA using EIOS before being officially listed on WHO's Event Information Site (EIS) or in Disease Outbreak News (DON), with an average interval of 20 days (range: 5-41) between the detection date and posting on EIS or DON. Thus, EIOS is efficient in aiding early detection of potential public health threats at the national level. This finding highlights the importance of sustaining international cooperation and support to enhance surveillance capabilities in resource-limited settings and expanding the scope of EIOS, including by incorporating additional sources and sources in additional languages, reducing noise. However, as the current report is based on a descriptive analysis, in the future a systematic evaluation of event-based surveillance using EIOS to identify relevant attributes will need to be conducted.

This regional analysis aims to provide a comprehensive review of emergency medical team development and action in health emergency response in the Western Pacific Region from 2010 to 2024. It details national, subregional and regional efforts to strengthen health emergency preparedness, response and resilience; it notes challenges faced by the teams in these efforts; and it provides examples that could be adopted or adapted to strengthen their development and action around the world. Emergency medical teams are critical components of national, regional and global health emergency workforces, enabling rapid, high-quality and self-sufficient responses to health emergencies domestically or internationally. They comprise clinical, mental health, public health, logistics and water/sanitation/hygiene personnel who collaborate in providing critical services to affected populations during health emergencies. By the end of 2024, emergency medical teams had been established in nearly every country in the Western Pacific Region, with 16 classified for international deployments, and many national teams developed to strengthen response to domestic emergencies. This analysis is based on published peer-reviewed literature on emergency medical team development and action in health emergencies in the Western Pacific Region, as well as publicly available data on team collaboration and deployment for health emergency response. This analysis considers the global evolution of the World Health Organization Emergency Medical Team Initiative and describes its development in the Western Pacific Region, including how the teams have contributed to emergency response efforts, and the key enabling factors and challenges faced as they develop and respond to emergencies. The analysis concludes by highlighting opportunities for future development, collaboration, research and insights that may be applicable to the global development of emergency medical teams.

Problem: Emergency medical teams (EMTs) responding to mass casualty incidents attend to casualties in a chaotic, high-pressure and resource-limited environment that is vastly different from their day-to-day work. The nature of mass casualty incidents and the work environment can impact psychological resilience, but the psychological resilience of members of EMTs has not been evaluated.

Context: In Singapore, EMTs are deployed from public hospitals, polyclinics and the Singapore Red Cross to disaster sites, where they triage, stabilize and treat casualties before evacuating them to public hospitals for further management.

Action: Twenty-four members of EMTs responded to a cross-sectional survey based on a psychological resilience tool developed for health-care rescuers involved in mass casualty incidents to evaluate their psychological resilience after a full-scale exercise involving an aviation accident. Respondents completed a psychological resilience tool that was developed by experts in disaster work and research using a modified Delphi approach. There were 27 items across eight domains: optimism, altruism, preparations for disaster rescue, social support, perceived control, self-efficacy, coping strategies and positive growth.

Outcome: The key observations from the survey were that (i) staff demonstrated a strong sense of altruism and had good social support; (ii) staff were not confident about their preparedness, and this led to a lack of optimism, perceived control and ability to deal with emotions; and (iii) it was necessary for respondents to reflect on their experience to find meaning to support growth after the deployment.

Discussion: Optimizing casualty survival and outcomes during mass casualty incidents requires not only excellent procedural training and robust standard operating procedures and work processes but also dedicated efforts to enhance the psychological resilience of members of EMTs.