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Contagious Cities was a cultural project that explored how urban environments in different parts of the world have coped with infectious diseases. Its theme of how populations prepare for and deal with epidemics is a core strategic concern for Wellcome – the large health and medicine foundation behind the project. Thoroughly interdisciplinary in their approach, the variety of exhibitions, events and other cultural activities the project supported placed a special emphasis on the illuminating potential for artists to investigate medical, scientific and social phenomena. The initiative also drew inspiration from Wellcome’s track record of curating interdisciplinary projects in its own museum in London, and approached its international ambitions (in Geneva, New York, Hong Kong and Berlin) through partnership and co-production. This article looks back at this unusual project, which ironically was concluded just before the world plunged into the current pandemic. The emphasis here, however, is somewhat less on the project’s themes – the fascinating and frightening implications of human co-existence with microbes in crowded contexts. Instead, we have focused on the complexities of working with multiple stakeholders in very different contexts, and we reflect on Wellcome’s role as an experienced, knowledgeable and creative, but also powerful and well-funded partner cum commissioner.

Background: As we live in an interconnected globalized world, people and the diseases they carry can be easily transmitted to any place in a matter of hours. SARS-CoV-2 began like all new viruses with an ordinary moment when a cluster of patients admitted to a hospital with pneumonia turned out to have a new strain of coronavirus. The virus’s high transmissibility made the epidemic in China turn into a global pandemic with an ongoing daily reporting of new cases and deaths. However, as fast as viruses spread, the detection of pandemics and taking early measures has become much easier due to the advancement of science in today’s world. The early responses and measures adopted by China, such as early reporting and situation monitoring, large-scale surveillance, and preparation of medical facilities and supplies, were all successful in reducing the epidemic in China generally and in the epicenter Wuhan specifically. The purpose of this review is to focus on the effectiveness of the measures taken by the Chinese government to stop COVID-19 spreading by comparing the country’s response to SARS and CO­VID-19 outbreaks, which will provide an example for the communities, health managers, and leaders of countries to follow on how to prepare, detect, and respond to potential outbreaks. Method: For this article, epidemic preparedness and management strategies under comparison were derived from the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) frameworks and guidelines. Other data related to COVID-19 and reported cases were taken from more than 25 official public health organization reports and relevant articles using various databases (e.g., Google Scholar, PubMed and Science Direct). Results: Working on developing resilient systems against infectious diseases should be one of the top priorities of any country. China embraced resilience in its battle against COVID-19 and proved its capability to cope with the outbreak crisis. Despite succeeding in altering the course of the outbreak, healthcare experts warned about possible epidemic recurrence and stressed the need for caution as the pandemic is still ongoing and most of the infected cases are presenting with only mild symptoms.

L’épidémie de maladie à virus Ebola (2014-2016) et la pandémie de COVID‑19 rappellent instamment la nécessité de prendre en compte les questions socioculturelles dans les politiques de préparation et de réponse aux épidémies. Cet article s’inscrit dans la même perspective. Il a pour objectif de montrer les enjeux liés au réaménagement des rites funéraires en contexte d’épidémie et de discuter comment des contre-rites et fenêtres d’opportunité peuvent servir de points d’ancrage pour co-construire avec les parties prenantes des réponses sociales aux épidémies. Les analyses reposent sur 26 observations, couplées à des discussions quotidiennes, des prises de vue et 30 entretiens semi-structurés, ainsi que sur la recension de documents et la recherche bibliographique. Ce travail montre que les rites funéraires impliquent de multiples enjeux. Toutefois, les contre-rites et les fenêtres d’opportunité existant dans la culture peuvent servir d’ancrage pour co-construire des réponses inclusives en contexte épidémique. Ceci impose une approche par les impératifs funéraires : rechercher les interdits, les obligations, les permissions ou autorisations, selon notamment les types de mort et les circonstances de décès. L’opérationnalisation de ces savoirs socioanthropologiques nécessite une anthropologie des épidémies ayant une culture de l’action et privilégiant l’approche systémique de la co-construction., The Ebola virus disease outbreak (2014-2016) and the COVID-19 pandemic are urgent reminders of the need to take sociocultural issues into account in epidemic preparedness and response policies. The following article considers this perspective, as it aims to show the issues involved in rearranging funeral rites in the context of an epidemic and discuss how counter-rites and windows of opportunity can serve as anchor points for co-constructing social responses to epidemics with stakeholders. The analyses are based on 26 observations, coupled with daily discussions, interviews and 30 semi-structured interviews, as well as document review and bibliographic research. This work shows that funeral rites involve multiple issues. However, a culture’s counter-rites and windows of opportunity can serve as an anchor for co-constructing inclusive responses in an epidemic context. This imposes an approach based on funerary imperatives: looking for prohibitions, obligations, permissions, or authorizations, according to the type and the circumstances of death. Operationalizing this socioanthropological knowledge requires an anthropology of epidemics with a culture of action and a focus on a systemic approach to co-construction., El brote de la enfermedad por el virus del Ébola (2014-2016) y la pandemia de COVID- 19 son un recordatorio urgente de la necesidad de tener en cuenta las cuestiones socioculturales en las políticas de preparación y respuesta a las epidemias. Este artículo se inscribe en la misma perspectiva. Su objetivo es mostrar los problemas que conlleva la reorganización de los ritos funerarios en el contexto de una epidemia y debatir cómo los contra-ritos y las ventanas de oportunidad pueden servir como puntos de anclaje para co-construir las respuestas sociales a las epidemias con las partes interesadas. Los análisis se basan en 26 observaciones, junto con discusiones diarias, entrevistas y 30 entrevistas semiestructuradas, así como en la revisión de documentos y la investigación bibliográfica. Este trabajo muestra que los ritos funerarios implican múltiples cuestiones. Sin embargo, los contra-ritos y las ventanas de oportunidad que existen en la cultura pueden servir de anclaje para co-construir respuestas inclusivas en un contexto epidémico. Esto impone un enfoque basado en los imperativos funerarios: buscar prohibiciones, obligaciones, permisos o autorizaciones, según el tipo de muerte y las circunstancias del fallecimiento. La operacionalización de este conocimiento socioantropológico requiere una antropología de las epidemias que tenga una cultura de la acción y favorezca el enfoque sistémico de la co-construcción.

Objective: This study evaluates the usefulness, safety, and outcomes of operating a pretriage screening clinic and an expanded preemptive quarantine area in the emergency department (ED) during a regional coronavirus disease 2019 (COVID-19) outbreak. Methods: A descriptive cross-sectional, retrospective study conducted in a single institution. General patient demographic data, initial vital sign, symptoms, and patient outcome was collected from January to March of 2020. Data were compared according to the implementation of a new protocol involving pretriage screening and risk stratification. Outcome was also analyzed according to quarantine areas, including conventional, negative pressured, cohort, or preemptive quarantine area. Results: The pretriage clinic lowered the volume of low severity patients entering emergency department. Preemptive and cohort quarantine area provided more care to febrile patients compared with conventional quarantine area with longer length of hospital stay and lower mortality. After implementing the new protocol, emergency department in the study hospital was not closed again. Conclusions: In a regional outbreak of an epidemic, pretriage clinic safely screened infectious patients from entering ED. Expanded preemptive quarantine area increased surge capacity on quarantine area. An infectious disease protocol implementing 2 treatment areas may contribute to preserve and maintain ED function.

Influenza preparedness planning by Mongolia Red Cross Society in 2019 has provided a strong foundation for engagement with COVID-19 preparedness and response. The experience underscores the importance and value of investing in epidemic preparedness, and the importance of doing so well in advance of disease outbreaks.

Background: Development and evaluation of diagnostics for diseases of epidemic potential are often funded during epidemics, but not afterwards, leaving countries unprepared for the next epidemic. United Nations Children's Emergency Fund (UNICEF) partnered with the United States Agency for International Development (USAID) to address this important gap by investing in an advance purchase commitment (APC) mechanism to accelerate the development and evaluation of Zika rapid diagnostic tests (RDTs) for case detection and surveillance. This paper describes the performance evaluation of five Zika RDTs eligible for procurement. Methods: A network of European Union-funded ZikaPLAN sites in Africa, Asia, Latin America with access to relevant serum specimens were selected to evaluate RDTs developed for the UNICEF APC mechanism. A standardised protocol and evaluation panels were developed and a call for specimens for the evaluation panels issued to different sites. Each site contributed specimens to the evaluation from their biobank. Data were collated, analysed and presented to the UNICEF Procurement Review Group for review. Findings: Three RDTs met the criteria for UNICEF procurement of sensitivity and specificity of 85% against a refence standard. The sensitivity/specificity of the ChemBio anti-Zika Virus (ZIKV) immunoglobulin M (IgM) test was 86.4 %/86.7% and the ChemBio ZCD system for anti-ZIKV IgM was 79.0%/97.1%, anti-dengue virus (DENV) IgM 90.0%/89.2%, anti-Chikungunya virus (CHIKV) IgM 90.6%/97.2%. The sensitivity/specificity of the SD Biosensor anti-ZIKV IgM was 96.8 %/90.8%, anti-DENV IgM 71.8%/83.5%, the DENV nonstructural protein 1 (NS1) glycoprotein 90.0%/90.2%, anti- yellow fever virus (YFV) IgM 84.6%/92.4%, anti-CHIKV IgM 86.3%/97.5%. Interpretation: Three RDTs fulfilled the performance thresholds set by WHO and were eligible for UNICEF procurement. These tests will improve the diagnosis of ZIKV and other arboviral infections as well as providing countries with better tools for surveillance and response to future epidemics. Funding: This work was supported by the USAID grant GHA-G-00-07-00007 and ZikaPLAN (European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No. 734584).

To effectively control the COVID-19 (coronavirus disease 2019) outbreak in later stages in Vietnam requires addressing the existing gaps in the national health emergency framework, consolidate, and inform its structure, we conducted this study to evaluate the importance and collaborative mechanism between health and community service workers with intersectional organizations at grassroots levels in Vietnam. A cross-sectional, web-based survey was conducted from 12/2019 to 02/2020 on 581 participants (37 health workers, 473 medical students, and 71 community service workers). The snowball sampling technique was used to recruit participants. We used exploratory factor analysis to test the construct validity of the questionnaire measuring the perceived efficiency of involving community service workers in health care–related activities and Tobit models to examine its associated factors. The results showed the importance of local organizations in epidemic preparedness and response at grassroots levels, with scores ranging from 6.4 to 7.1, in which the Vietnam Youth Federation played the most important role (mean = 7.1, SD = 2.2). Of note, community service workers were viewed as performing well in health communication and education at agencies, schools, and other localities. Medical students perceived higher efficiency of involving community service workers in health care–related activities at grassroots levels as compared to health workers. We encourage the government to promote intersectoral collaboration in epidemic preparedness and response, giving attention to scale up throughout training as well as interdistrict and interprovincial governance mechanisms.

Background Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda’s experience in EVD preparedness. Results On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. Conclusion As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a “fire-fighting” approach during public health emergencies.

The Coalition for Epidemic Preparedness Innovations (CEPI) was formed in the aftermath of the 2014–2015 Ebola outbreak in west Africa to support the development of vaccines that could improve the world’s preparedness against outbreaks of epidemic infectious diseases. Since its launch in 2017, CEPI has mobilized more than US$750 million to support its mission to develop vaccines against agents such as Lassa virus, Middle East respiratory syndrome coronavirus, and Nipah virus, as well as several rapid-response vaccine platforms to accelerate response times to unexpected epidemic threats. CEPI has also played a leading role in fostering institutional partnerships between public- and private-sector organizations to optimize allocation of resources for vaccine development against its priority pathogens. CEPI’s priorities include diversification of its current vaccine research and development investment portfolio to include additional pathogens, such as Rift Valley fever and chikungunya; establishment of technical and regulatory pathways for vaccine development across CEPI’s portfolio; development of sustainable manufacturing solutions for vaccine candidates nearing completion of safety and immunogenicity testing in humans; and creation of investigational stockpiles of its vaccine candidates for use in emergency situations. This commentary provides an overview of the global health challenges CEPI was established to address and its achievements to date, and indicates priorities for funding and coordination in the coming years.

Objectives To review the evidence for the application of tools for dengue outbreak prediction/detection and trend monitoring in passive and active disease surveillance systems in order to develop recommendations for endemic countries and identify important research needs. Methods This systematic literature review followed the protocol of a review from 2008, extending the systematic search from January 2007 to February 2013 on PubMed, EMBASE, CDSR, WHOLIS and Lilacs. Data reporting followed the PRISMA statement. The eligibility criteria comprised (i) population at risk of dengue, (ii) dengue disease surveillance, (iii) outcome of surveillance described and (iv) empirical data evaluated. The analysis classified studies based on the purpose of the surveillance programme. The main limitation of the review was expected publication bias. Results A total of 1116 papers were identified of which 36 articles were included in the review. Four cohort-based prospective studies calculated expansion factors demonstrating remarkable levels of underreporting in the surveillance systems. Several studies demonstrated that enhancement methods such as laboratory support, sentinel-based reporting and staff motivation contributed to improvements in dengue reporting. Additional improvements for passive surveillance systems are possible by incorporating simple data forms/entry/electronic-based reporting; defining clear system objectives; performing data analysis at the lowest possible level (e.g. district); seeking regular data feedback. Six studies showed that serotype changes were positively correlated with the number of reported cases or with dengue incidence, with lag times of up to 6 months. Three studies found that data on internet searches and event-based surveillance correlated well with the epidemic curve derived from surveillance data. Conclusions Passive surveillance providing the baseline for outbreak alert should be strengthened and appropriate threshold levels for outbreak alerts investigated. Additional enhancement tools such as syndromic surveillance, laboratory support and motivation strategies can be added. Appropriate alert signals need to be identified and integrated into a risk assessment tool. Shifts in dengue serotypes/genotype or electronic event-based surveillance have also considerable potential as indicator in dengue surveillance. Further research on evidence-based response strategies and cost-effectiveness is needed. Objectifs Analyser les resultats de l'application d'outils pour la prediction/detection des epidemies de dengue et la surveillance des tendances dans les systemes de surveillance active et passive des maladies, afin d’elaborer des recommandations pour les pays endemiques et identifier les besoins importants de recherche.

Epidemic prone diseases threaten public health security. These include diseases such as cholera, meningitis, and hemorrhagic fevers, especially Lassa fever for which Nigeria reports considerable morbidity and mortality annually. Interestingly, where emergency epidemic preparedness plans are in place, timely detection of outbreaks is followed by a prompt and appropriate response. Furthermore, due to the nature of spread of Lassa fever in an outbreak setting, there is the need for health-care workers to be familiar with the emerging epidemic management framework that has worked in other settings for effective preparedness and response. This paper, therefore, discussed the principles of epidemic management using an emergency operating center model, review the epidemiology of Lassa fever in Nigeria, and provide guidance on what is expected to be done in preparing for epidemic of the disease at the health facilities, local and state government levels in line with the Integrated Disease Surveillance and Response strategy.

This paper provides a review of a recently published series of studies that give a detailed and comprehensive documentation of the severe acute respiratory syndrome (SARS) epidemic in mainland China, which severely struck the country in the spring of 2003. The epidemic spanned a large geographical extent but clustered in two areas: first in Guangdong Province, and about 3 months later in Beijing with its surrounding areas. Reanalysis of all available epidemiological data resulted in a total of 5327 probable cases of SARS, of whom 343 died. The resulting case fatality ratio (CFR) of 6.4% was less than half of that in other SARS-affected countries or areas, and this difference could only partly be explained by younger age of patients and higher number of community acquired infections. Analysis of the impact of interventions demonstrated that strong political commitment and a centrally coordinated response was the most important factor to control SARS in mainland China, whereas the most stringent control measures were all initiated when the epidemic was already dying down. The long-term economic consequence of the epidemic was limited, much consumption was merely postponed, but for Beijing irrecoverable losses to the tourist sector were considerable. An important finding from a cohort study was that many former SARS patients currently suffer from avascular osteo­necrosis, as a consequence of the treatment with corticosteroids during their infection. The SARS epidemic provided valuable information and lessons relevant in controlling outbreaks of newly emerging infectious diseases, and has led to fundamental reforms of the Chinese health system. In particular, a comprehensive nation-wide internet-based disease reporting system was established.