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Hepatitis A (Hep A) can cause sporadic or epidemic disease and has been frequently linked to contamination of the global food chain. Global surveillance data on Hep A are unavailable, and in some countries, reporting is incomplete or not timely, either because of lack of human resources or sensitivities around reporting. The use of vast open-source data such as news-feeds and social media however can overcome barriers to surveillance and provide timely data on global epidemics. In this study we use EpiWATCH, semi-automated outbreak scanning service to review the global epidemiology of Hep A reports from 2016-2018. We reviewed the EpiWATCH Outbreak Alerts database for reports on the Hep A dated between August 1, 2016, to April 31, 2018 which was the analysed by outbreak clusters, location, and time. Of 5098 total entries in the database a total of 169 non-duplicate Hep A outbreak reports were found and included for descriptive analysis. The majority of outbreak reports (68.6%%; N=116/169) originated from the United States of America (USA). The largest Hep A outbreaks were multi-country outbreaks in the European region, and multistate outbreaks in the USA and Australia. Homelessness (mainly in US outbreaks) was the predominant risk factor (40.2%), followed by foodborne outbreaks (26.6%) and outbreaks in men who have sex with men (6.5%). Using EpiWATCH we found that the emergence of outbreaks in homeless people has dominated the epidemiology of Hep A in the U.S and this appears a relatively new phenomenon. Epidemic intelligence systems such as EpiWATCH are a useful proxy for global surveillance of Hep A outbreaks and using open-source data can provide epidemic intelligence and outbreak alerts where global data is unavailable.

A review on the use of non-pharmaceutical interventions (NPI) was conducted in long-term care facilities. The use of personal protective equipment, isolation and re-testing of COVID-19 were protective against the infection. Facilities which implemented NPIs prior to the outbreak had fewer COVID-19 outbreaks, odds ratio=0.70. Re-testing of asymptomatic people during outbreaks is crucial.

Bioterrorism and pandemics pose great risk to the health and safety of our modern world. Pandemic scenario exercises commonly use diseases that are most likely to cause moderate harm in an epidemic scenario such as influenza. Despite the generalisable nature of most pandemic responses, exercises often fail to take account of the broader impacts of a pandemic scenario. In August 2018, The Exercise Mataika pandemic workshop was conducted by the NHMRC Centre for Research Excellence Integrated Systems for Epidemic Response at the University of New South Wales, Australia. By utilising a high risk, worst case scenario – the deliberate release of Smallpox in Fiji and a much larger Asian country – impacts not often considered in pandemic planning, such as the resiliency of the health system, absenteeism, social cohesion, and broader impacts on society were considered, and compared, across geographic and social groupings. This study aimed to collect and analyse participant perceptions and evaluation of Exercise Mataika. A mixed methods study collecting participants ratings of experience, value and utility aspects of the scenario coupled with a thematic analysis of qualitative responses was conducted. Quantitative ratings for the activity were overwhelmingly positive, with respondents highlighting that the activity was useful, different in format, identified issues not often explored in pandemic exercises, and was a valuable educational and networking opportunity. Qualitative analysis and combined mixed-methods analysis revealed more nuanced findings. While respondents remained positive about the exercise format, subgroups highlighted potential missed opportunities and areas within the scenario where greater focus could have been directed. Overall the findings highlighted the value of including a wide range of exercise attendees both across sectors and nationalities, and addressing a far broader set of considerations across multiple domains. These findings will guide future d

Background:Internet-based surveillance systems have become invaluable tools to complement traditional surveillance in the early detection of infectious disease outbreaks. Search results limited to only English-language sources may lead to missed opportunities in global outbreak monitoring efforts. The Malay language has 290 million native speakers across the Southeast Asian region (Indonesia, Malaysia, Brunei, Singapore and the southern parts of Thailand and the Philippines), which is an important region for outbreaks. The aim of this research is to determine the completeness of reports of Malay language outbreak detection by commonly used open source surveillance platforms.Methods:We searched ProMED-mail, HealthMap, and Google News to investigate outbreak events in Malaysia and Indonesia between 1st August 2016 and 31st August 2017. We also cross-checked published epidemic reports in Medline to determine the proportion of outbreaks that are published.Results:A total of 371 entries from ProMED-mail and HealthMap were included. A Google News search query using Malay language keywords resulted in 453 news outbreak reports, 98 of which were missed by either or both ProMED-mail and HealthMap. During the study time frame, only 40 published epidemic reports were found in MEDLINE, showing the importance of informal data sources to identify outbreaks. Some diseases such as mumps, dengue and avian influenza had different local terminology in Indonesia and Malaysia.Conclusions:Search results limited to only English-language sources may lead to reduced outbreak detection. The inclusion of keywords in the Malay language improves epidemic intelligence in the region, but needs to be nuanced for local terminology, which may differ between countries. Informal Internet-based surveillance can improve compliance with International Health Regulations (IHR) for low income countries, because it is less resource-intensive than formal surveillance. However, there is a need to include local

On August 16th, 2018, we held Exercise Mataika to test preparedness for a worst-case scenario of a smallpox attack which begins in the Pacific and is followed by a larger scale attack in a highly populous Asian country. The exercise was underpinned by mathematical modelling which aimed to determine the duration and magnitude of the epidemic under different scenarios, the critical threshold for epidemic control, and scenarios where the current stockpile of vaccine is adequate. We constructed a modified SEIR model for smallpox transmission. We found that time to commencing the response, rates of contact tracing and ring vaccination, and rates of case isolation are all influential factors on epidemic size and duration. Ideally, the response should commence in 20 days after the attack, corresponding to 8 days after the first symptoms appear, given an average incubation period of 12 days. Every day of delay worsens the epidemic. The WHO stockpile of vaccine of 34 million doses is adequate if rates of case isolation and ring vaccination are maintained above 60%. If rates of contact tracing, ring vaccination and case isolation fall below 53%, epidemic control is lost. In such a scenario, the epidemic persists for longer than 10 years and over a billion doses of vaccine are needed for epidemic control. There are modifiable factors which can prevent a catastrophic scenario following smallpox re-emergence. These include very rapid response time and high rates of isolation and ring vaccination. Training and capacity building, as well as pre-vaccinated teams, can also assist with rapid response. In low income countries, a smallpox epidemic could overwhelm the health system and far exceed human resource capacity, so low rates of case isolation and contact tracing is a realistic possibility. The consequences of poor epidemic control are catastrophic if rates of case isolation and ring vaccination fall below 53%, the threshold for epidemic control. Global cooperation is also criti

Smallpox was declared eradicated in 1980, with known seed stock retained in two high security Biosafety Level 4 laboratories in the United States and Russia. Experts agree the likelihood of theft from these laboratories is low, and that synthetic creation of smallpox is a theoretical possibility. Until 2017 it was believed that synthetic smallpox was technically too complex a task to be a serious threat. However, in 2017, Canadian scientists synthesised a closely related orthopoxvirus, horsepox, using mail order DNA and $100,000. Simultaneously, terrorist groups have declared intent to conduct biological attacks. In this context an exercise was held on August 16th 2018, with international and cross-sectoral stakeholders to review preparedness for a bioterrorism attack in the Asia-Pacific region and globally. The exercise was conducted by The National Health and Medical Research Council (NHMRC) Centre for Research Excellence, Integrated Systems for Epidemic Response, with contextual input from the Ministry of Health and Medical Services Fiji. The scenario involved a deliberate release in Fiji, followed by a larger release in a more populous Asian country. Mathematical modelling was used to underpin epidemic projections under different conditions. The exercise alternated between clinical, public health, emergency and societal responses, with participants making real-time decisions on cross-sectoral response across the region and the world. Key weak points which are influential in determining the final size and impact of the epidemic were identified (based on mathematical modelling of transmission in Fiji and globally). We identified potential gaps in preparedness for smallpox and factors which influence the severity of a smallpox epidemic. This included identifying which determinants of epidemic size are potentially within our control, and which are not. Influential factors within our control include: preventing an attack through intelligence, law enforcement and legi

Objective: To understand the global outbreak surveillance needs of stakeholders involved in epidemic response in selected countries and areas in the Asia–Pacific region in order to inform development of an epidemic observatory, Epi-watch. Methods: We designed an online, semi-structured stakeholder questionnaire to collect information on global outbreak surveillance sources and limitations from participants who use epidemic intelligence and outbreak alert services in their work in government and nongovernment organizations in the Asia–Pacific region. Results: All respondents agreed that it was important to remain up to date with global outbreaks. The main reason cited for following global outbreak news was as an early warning for serious epidemics. Mainstream media and specialist Internet sources such as the World Health Organization (n = 54/91; 59%), the Program for Monitoring Emerging Diseases (ProMED)-mail (n = 45/91; 49%) and the United States Centers for Disease Control and Prevention (n = 31/91; 34%) were the most common sources for global outbreak news; rapid intelligence services such as HealthMap were less common (n = 9/91; 10%). Only 51% (n = 46/91) of respondents thought that their sources of outbreak news were timely and sufficient for their needs. Conclusion: For those who work in epidemic response, epidemic intelligence is important and widely used. Stakeholders are less aware of and less frequently use rapid sources such as HealthMap and rely more on validated but less timely traditional sources of disease surveillance. Users identified a need for more timely and reliable epidemic intelligence.