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The changing face of crises and aid in the Asia-Pacific. 亚太地区危机和援助的变化。
Pub Date : 2014-11-01 DOI: 10.1089/bsp.2014.0025
Elin A Gursky, Frederick M Burkle, David W Hamon, Peter Walker, Georges C Benjamin

Both US foreign policy and global attention attest to the strategic, economic, and political importance of Asia. Yet, the region faces urgent challenges that must be addressed if it is to remain stable and prosperous. The densely populated countries of the Asia-Pacific are beleaguered by poverty, population displacement, decreasing access to potable water and adequate sanitation, and high rates of disease morbidity and mortality. New and reemerging diseases known to have originated in Asia over the past decades have spread globally by international trade, tourism, worker migration, and agricultural exportation. Unremitting naturally occurring and man-made disasters have strained Southeast Asia's already fragile disaster and public health response infrastructures and the essential services they provide (eg, surveillance, vaccination, maternal and child health, and mental health programs). Following disasters, governments often contract with the broader humanitarian community (eg, indigenous and international NGOs) and seek the assistance of militaries to provide essential services. Yet, their roles and capabilities in addressing acute and chronic health issues in the wake of complex disasters remain unclear. Current mechanisms of nation-state and outside organization interaction, including dissimilar operational platforms, may limit true partnership on behalf of the health security mission. Additionally, concerns regarding skill sets and the lack of standards-based training raise questions about the balance between developing internal response capabilities and professionalizing external, deployable resources. Both the mega-disasters that are forecast for the region and the global health security threats that are expected to emanate from them require an increased focus on improving the Asia-Pacific's emergency preparedness and response posture.

美国的外交政策和全球关注都证明了亚洲在战略、经济和政治上的重要性。然而,如果该地区要保持稳定和繁荣,就必须解决这些紧迫的挑战。亚太地区人口稠密的国家受到贫穷、人口流离失所、获得饮用水和适当卫生设施的机会减少以及疾病发病率和死亡率高的困扰。过去几十年已知起源于亚洲的新发和再发疾病已通过国际贸易、旅游、工人迁移和农业出口在全球传播。不断发生的自然灾害和人为灾害使东南亚本已脆弱的灾害和公共卫生应对基础设施及其提供的基本服务(如监测、疫苗接种、妇幼保健和心理健康项目)变得紧张。灾难发生后,政府经常与更广泛的人道主义团体(例如,当地和国际非政府组织)签订合同,并寻求军队的援助,以提供基本服务。然而,它们在复杂灾害发生后处理急性和慢性健康问题方面的作用和能力仍不清楚。目前的民族国家和外部组织互动机制,包括不同的业务平台,可能会限制代表卫生安全使命的真正伙伴关系。此外,对技能组合和缺乏基于标准的培训的关注,使人们对发展内部反应能力和使外部可部署资源专业化之间的平衡产生了疑问。预测本区域将发生的特大灾害以及预计将由此产生的全球卫生安全威胁,都要求我们更加注重改善亚太地区的应急准备和反应态势。
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引用次数: 12
Re: optimization of interventions in ebola. 关于:优化埃博拉干预措施。
Pub Date : 2014-11-01 DOI: 10.1089/bsp.2014.1031
Viroj Wiwanitkit
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引用次数: 0
Regional collaboration among Urban Area Security Initiative regions: results of the Johns Hopkins urban area survey. 城市地区安全倡议区域之间的区域合作:约翰霍普金斯城市地区调查的结果。
Pub Date : 2014-11-01 DOI: 10.1089/bsp.2014.0057
Nicole A Errett, Calvin Bowman, Daniel J Barnett, Beth A Resnick, Shannon Frattaroli, Lainie Rutkow

Regional collaboration has been identified as a potential facilitator of public health preparedness efforts. The Urban Area Security Initiative (UASI) grant program, administered by the Federal Emergency Management Agency (FEMA) since 2003, has provided 64 high-risk metropolitan areas funding to enhance their regional preparedness capabilities. This study describes informal and formal regional collaboration infrastructure, as well as regional collaboration-related activities and assessment methods, in FFY2010 UASI regions. A cross-sectional online survey was administered via Survey Monkey from September through December 2013. Points of contact from FFY2010 funded UASI metropolitan areas completed the survey, with a response rate of 77.8% (n=49). Summary statistics were calculated to describe the current informal and formal regional collaboration infrastructure. Additionally, the cross-sectional survey collected rates of agreement with 8 collaborative preparedness statements at 3 time points. The survey found that UASI regions are engaging in collaborative activities and investments to build capabilities, with most collaboration occurring in the prevention, protection, and response mission areas. Collaborative relationships in preparedness among emergency managers and municipal chief executive officers improved during the FFY2010 UASI performance period compared to the pre-UASI award period, with lasting effects. The majority of UASI regions reported conducting independent assessments of capabilities and their measurement at the UASI region level. Urban areas that received a FFY2010 UASI grant award are engaging in collaborative activities and have established interjurisdictional relationships in preparedness. The use of grant funds to encourage collaboration in preparedness has the potential to leverage limited resources and promote informed investments.

区域合作已被确定为公共卫生防范工作的潜在促进因素。自2003年以来,由联邦紧急事务管理局(FEMA)管理的“城市地区安全倡议”(UASI)赠款项目为64个高风险大都市地区提供了资金,以增强其区域防备能力。本研究描述了2010财年UASI地区非正式和正式的区域合作基础设施,以及与区域合作相关的活动和评估方法。2013年9月至12月,通过survey Monkey进行了一项横断面在线调查。来自2010年FFY2010资助的UASI大都市地区的联络点完成了调查,回复率为77.8% (n=49)。计算了简要统计数据,以描述当前非正式和正式的区域合作基础设施。此外,横断面调查收集了在3个时间点对8个协作准备陈述的同意率。调查发现,UASI地区正在参与合作活动和投资,以建立能力,大多数合作发生在预防、保护和响应任务领域。在2010财政年度UASI执行期间,应急管理人员和市政首席执行官之间的备灾合作关系与UASI之前的奖励期间相比有所改善,并产生了持久的影响。大多数UASI区域报告了在UASI区域一级对能力及其测量进行的独立评估。获得2010年度UASI拨款的城市地区正在开展合作活动,并在准备工作中建立了跨司法管辖区的关系。利用赠款资金鼓励在备灾方面的合作,有可能利用有限的资源并促进知情投资。
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引用次数: 1
Travel bans will increase the damage wrought by ebola. 旅行禁令将增加埃博拉造成的损害。
Pub Date : 2014-11-01 DOI: 10.1089/bsp.2014.1030
Jennifer B Nuzzo, Anita J Cicero, Richard Waldhorn, Thomas V Inglesby
Cases of Ebola that have turned up in Dallas and New York City have prompted calls for a travel ban to prohibit travelers from Sierra Leone, Liberia, and Guinea from entering the US during the ongoing Ebola outbreak. But travel bans have not worked in past epidemics and will not stop Ebola from spreading. Banning travel would slow the movement of people and goods to those countries, harm the international response to the outbreak in West Africa, and increase the prospect of ongoing global spread of Ebola. In addition, travel bans could lead to complete isolation of those 3 countries and would further worsen the economic and humanitarian toll of this crisis. US travel bans would also run counter to international agreements and could encourage other countries to impose their own bans against the United States and other countries in future outbreaks. The occurrence of secondary cases in 2 US nurses who treated the first Ebola patient in Dallas, and the corresponding lack of secondary cases occurring among members of the broader community, underscores the importance of focusing our Ebola control efforts on US hospitals and ensuring that clinicians in these settings have all of the training and protective equipment necessary to safely diagnose and treat Ebola patients.
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引用次数: 13
Sociocultural dimensions of the ebola virus disease outbreak in Liberia. 利比里亚埃博拉病毒病爆发的社会文化层面。
Pub Date : 2014-11-01 DOI: 10.1089/bsp.2014.1002
Sanjana J Ravi, Eric M Gauldin
S ince December 2013, an outbreak of Ebola virus disease in the West African nation of Guinea has rapidly evolved into a humanitarian crisis of unforeseen proportions, overwhelming vulnerable communities in Liberia, Sierra Leone, Nigeria, and Senegal. While previous outbreaks of Ebola cumulatively resulted in 2,486 cases and 1,590 deaths, the current Ebola epidemic has so far resulted in 8,376 infections and claimed 4,024 lives (as of October 10, 2014), prompting the World Health Organization (WHO) to designate it as a public health emergency of international concern. Officials from the US Centers for Disease Control and Prevention (CDC) estimate that, in the absence of public health interventions, Liberia and Sierra Leone could experience as many as 550,000 cases (or 1.4 million after correcting for underreporting) by January 2015. Few research initiatives thus far have analyzed the community dynamics of Ebola outbreaks. Similarly, current relief efforts have not focused on ways to address the social and cultural factors shaping West Africans’ perceptions of and responses to Ebola or their perceptions of the international community’s efforts to mitigate the epidemic. To date, surveillance and infection control measures have failed to stop the outbreak, prompting WHO to call for greater community engagement efforts to enhance ongoing relief activities. This article examines some of the social and cultural factors at play in the Ebola outbreak in Liberia and suggests the type of sociocultural investigation that has been largely absent in attempts to thwart the Ebola threat. WHO assessments show that Liberia has borne the brunt of the current outbreak, having reported the most cases (more than 3,000) and deaths (nearly 2,000), as well as the highest case-fatality rate (70.8%). Some of the practices and social norms shaping the trajectory of the Liberian outbreak include funeral rituals, disparate gender roles, and the stigma faced by those who contract Ebola.
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引用次数: 18
Enhancing US-Japan cooperation to combat antimicrobial resistance. 加强美日合作,抗击抗菌素耐药性。
Pub Date : 2014-11-01 DOI: 10.1089/bsp.2014.0034
C Sachi Gerbin

The Global Health Security Agenda (GHSA) is aimed at preventing, detecting, and responding to infectious disease threats. To move toward these goals, the United States has committed to partner with at least 30 countries around the world. One of the objectives of the GHSA includes "[p]reventing the emergence and spread of antimicrobial drug resistant organisms." Antimicrobial resistance (AMR) has become a growing global health security problem, with inappropriate use of antimicrobial medications in humans and animals and a lack of new antimicrobial medications contributing to this problem. While AMR is a growing global concern, working on it regionally can make this multifaceted problem more manageable. The United States and Japan, both world leaders in the life sciences, are close allies that have established cooperative programs in medical research and global health that can be used to work on combating AMR and advance the GHSA. Although the United States and Japan have cooperated on health issues in the past, their cooperation on the growing problem of AMR has been limited. Their existing networks, cooperative programs, and close relationships can and should be used to work on combating this expanding problem.

全球卫生安全议程(GHSA)旨在预防、发现和应对传染病威胁。为了实现这些目标,美国承诺与世界上至少30个国家建立伙伴关系。GHSA的目标之一包括“防止抗微生物药物耐药性生物的出现和传播”。抗菌素耐药性(AMR)已成为一个日益严重的全球卫生安全问题,在人类和动物中不当使用抗菌素药物以及缺乏新的抗菌素药物加剧了这一问题。虽然抗生素耐药性是一个日益受到全球关注的问题,但在区域范围内开展工作可以使这个多方面的问题更易于管理。美国和日本都是生命科学领域的世界领先者,是密切的盟友,两国在医学研究和全球卫生领域建立了合作项目,可用于抗击抗生素耐药性和推进全球安全战略。尽管美国和日本过去在卫生问题上进行了合作,但它们在日益严重的抗微生物药物耐药性问题上的合作有限。它们现有的网络、合作项目和密切的关系可以而且应该用来对付这一日益扩大的问题。
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引用次数: 10
Optimization of interventions in ebola: differential contagion. 埃博拉干预措施的优化:不同的传染。
Pub Date : 2014-11-01 DOI: 10.1089/bsp.2014.0925
Amesh A Adalja, D A Henderson
Managing any contagious infectious disease outbreak involves breaking the chain of transmission from those who are infected with the pathogen to those who are not. Not all pathogens, however, are equal in their contagiousness, and considerable variation exists. The viral disease measles, for example, is considered to be one of the most contagious human diseases. Its high rate of contagion is driven by 2 attributes: the ability to spread through the air via small particles (ie, airborne transmission) and the fact that one of the symptoms of measles is coughing, an effective means of expelling those particles. On average, a person infected with measles can infect 15 other people through the course of his or her illness.1 Diseases like tetanus and anthrax, on the other hand, are not contagious at all because they lack the ability to spread between humans. In between these 2 extremes lie all the other infectious diseases. Another factor that affects infectiousness is the course of illness. Disease symptoms such as coughing, vomiting, and diarrhea can serve to heighten the transmission of a pathogen. For example, a person with whooping cough is more contagious when he is coughing than when he is not because the expelling of infectious material renders him more contagious. Ebola viral disease (EVD) is no different. Ebola is spread exclusively through blood and bodily fluids. Thus, those Ebola patients experiencing symptoms of vomiting and diarrhea—because they are literally expelling infectious bodily fluids—would be expected to be more contagious than those without these symptoms, who may have less opportunity to spread the illness. Another feature of Ebola is the hemorrhagic manifestations that occur in approximately half of patients. This often terminal manifestation includes bleeding from multiple bodily orifices, IV sites, needle punctures, and gums. An individual who is hemorrhaging, much like the vomiting patient, would be expected to be more contagious since viral particles are being emitted into the environment from the patient's body via blood. The phenomenon of varied contagiousness was seen in the 1972 smallpox outbreak in the former Yugoslavia, in which 1 individual with hemorrhagic smallpox spread the virus to 38 contacts. Other victims transmitted infection to only 2 to 3 others.2 If this differential contagiousness occurs with Ebola as well, it could be employed to optimize isolation and contact tracing activities—essential in a resource-challenged setting such as West Africa. If those individuals with hemorrhagic disease, vomiting, and diarrhea are the most infectious, then infection control should be prioritized to ensure that these patients are cared for with the appropriate protective measures in place. When contact tracing activities are performed, prioritizing the location of those who had contact with such cases could occur. Close contacts should be identified whenever possible and either kept under surveillance
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引用次数: 6
Engaging the States of the former soviet union in health security. 使前苏联各国参与卫生安全。
Pub Date : 2014-11-01 DOI: 10.1089/bsp.2014.0063
David R Franz
While it would be comforting to assure that the job would be finished when our cooperative programs—the Department of Defense’s Nunn-Lugar Cooperative Threat Reduction Program, begun for biology in 1994, or the Department of State’s Biological Engagement Program, launched in 2006— complete their assignments and depart any country, the answer to the verification question will always be beyond our grasp, particularly in regions where we lack open and transparent relationships. The BWC is necessary but not sufficient for our national and global biosecurity. Verifying that any individual nation state is in compliance is not possible. The BWC is an important international norm and law; as a nation, it is critical that we demonstrate globally and consistently our full support of it and work with other signatories to enforce the norm and law it represents. The Department of State takes the lead on BWC issues, but to enhance security from external biological attack requires an integrated international effort by the whole-ofgovernment, academe, industry, and nongovernmental organizations. A robust network of multinational partnerships is also needed. Finally, the US government must understand the power of human relationships in this complex biological world. As a relevant 2009 National Academy of Sciences (NAS) report stated, we should ‘‘recognize that personal relationships and professional networks that are developed through USG Cooperative Threat Reduction programs contribute directly to our national security.’’ The Global Health Security Agenda concept newly introduced by the White House appears to be compatible with that principle.
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引用次数: 1
Biosurveillance capability requirements for the global health security agenda: lessons from the 2009 H1N1 pandemic. 全球卫生安全议程的生物监测能力要求:2009年H1N1大流行的教训
Pub Date : 2014-09-01 DOI: 10.1089/bsp.2014.0030
Michael A Stoto

The biosurveillance capabilities needed to rapidly detect and characterize emerging biological threats are an essential part of the Global Health Security Agenda (GHSA). The analyses of the global public health system's functioning during the 2009 H1N1 pandemic suggest that while capacities such as those identified in the GHSA are essential building blocks, the global biosurveillance system must possess 3 critical capabilities: (1) the ability to detect outbreaks and determine whether they are of significant global concern, (2) the ability to describe the epidemiologic characteristics of the pathogen responsible, and (3) the ability to track the pathogen's spread through national populations and around the world and to measure the impact of control strategies. The GHSA capacities-laboratory and diagnostic capacity, reporting networks, and so on-were essential in 2009 and surely will be in future events. But the 2009 H1N1 experience reminds us that it is not just detection but epidemiologic characterization that is necessary. Similarly, real-time biosurveillance systems are important, but as the 2009 H1N1 experience shows, they may contain inaccurate information about epidemiologic risks. Rather, the ability of scientists in Mexico, the United States, and other countries to make sense of the emerging laboratory and epidemiologic information that was critical-an example of global social capital-enabled an effective global response. Thus, to ensure that it is meeting its goals, the GHSA must track capabilities as well as capacities.

快速发现和确定新出现的生物威胁特征所需的生物监测能力是《全球卫生安全议程》的重要组成部分。对2009年H1N1流感大流行期间全球公共卫生系统运作的分析表明,虽然《全球卫生安全战略》中确定的能力是必不可少的组成部分,但全球生物监测系统必须具备3项关键能力:(1)发现疫情并确定它们是否引起重大全球关注的能力;(2)描述病原的流行病学特征的能力;(3)跟踪病原在国家人群和世界各地的传播并衡量控制战略的影响的能力。GHSA的能力——实验室和诊断能力、报告网络等等——在2009年是必不可少的,在未来的事件中肯定也会如此。但是2009年H1N1流感的经验提醒我们,不仅是检测,而且流行病学特征也是必要的。同样,实时生物监测系统也很重要,但正如2009年H1N1流感的经验所表明的那样,它们可能包含有关流行病学风险的不准确信息。相反,墨西哥、美国和其他国家的科学家对新兴实验室和流行病学信息的理解能力——这是全球社会资本的一个例子——使全球做出了有效的反应。因此,为了确保实现其目标,GHSA必须跟踪能力和容量。
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引用次数: 10
Special issue on the global health security agenda. 关于全球卫生安全议程的特刊。
Pub Date : 2014-09-01 DOI: 10.1089/bsp.2014.0731
Gigi Gronvall, Tom Inglesby
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引用次数: 0
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Biosecurity and bioterrorism : biodefense strategy, practice, and science
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