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Background: Effective epidemic preparedness is critical for minimizing the health and societal impacts of viral respiratory infections. This study details the development of a data-driven early warning system (EWS) designed to improve outbreak detection and response utilizing the data integration and visualization capabilities of Microsoft Power BI. Methods: This research utilized a structured three-phase approach to design a respiratory infections (RIs) management dashboard. Phase 1, focused on identifying critical variables through literature reviews and expert interviews. In Phase 2, Microsoft Power BI was employed for dashboard development, integrating data from diverse sources. Phase 3 involved usability testing with health professionals who evaluated navigation, data accuracy, decision-support features, providing feedback to enhance visualization clarity and filtering capabilities. Results: Key data categories include individual-level variables, such as age, symptoms, and vaccination records, alongside population-level metrics like infection rates and regional vaccination coverage enabling functionalities such as identifying high-risk individuals, tracking infection dynamics, and optimizing resource allocation. The dashboard, developed using Power BI visualizes epidemiological trends, intervention outcomes, and resource utilization. A relational database schema ensures efficient data retrieval, facilitating comprehensive analysis. Conclusion: The prototype EWS represents a scalable and integrative framework aimed at enhancing public health applications, particularly in the context of respiratory infections. By incorporating data from diverse health sectors, the system offers decision-makers access to critical epidemiological indicators, supporting early outbreak detection and improved epidemic management. Its potential to unify health institutions underscores its value in fostering a more cohesive and effective approach to epidemic preparedness. Nevertheless, while the system demonstrates significant promise, further evaluation in real-world settings is essential to determine its practical impact on public health outcomes and its ability to mitigate health crises. [ABSTRACT FROM AUTHOR]

Background: In 2020, HOHM Foundation launched Homeopathy Help Now (HHN), a network of professional homeopathy telehealth practitioners, administrative volunteers, and independent researchers to work collaboratively in order to respond to the urgent need of care for the ever-growing number of COVID-19 cases in the United States. Methods: in this pragmatic case series study, cases of positively testing or probable COVID-19 (n = 3495) are analyzed using conventional quantitative analysis. The sample includes clinical data collected from clients who attended the clinic between 23 March 2020 and 31 December 2023. Results: The youngest client at the clinic was less than one year old, and the eldest was 92. Many of the participants at this clinical facility were adults (58.1%), with fewer (41.9%) aged 0–17. Many were female (61.7%), while fewer were male (32.4). Most clients found their symptoms improved at final contact (83.6%), and the majority of individual remedy responses improved symptoms (73.7%) over the course of their care. Discussion: Health Services and Public Health research projects are warranted to investigate the ways in which such a necessary stop-gap clinical service as HHN could become implemented in early- and later-phase response to pandemics. HHN's collaborative, horizontally integrated team structure was essential for the creation of the novel approach needed to address the serious symptoms of COVID-19. Moreover, HHN's organizational model draws on a mutual aid structure, whereby dynamic, flexible systems are created that empower a community to meet emerging needs, especially when more formal structures are strained, failing or simply unavailable. Further research is urgently needed into the implementation and benefits of innovative, flexible healthcare structures, such as the one used in this study, that can meet the unpredictable and fluctuating public health needs in our changing world. [ABSTRACT FROM AUTHOR]

Abstract Objectives Disruptive public health risks and events, including infectious disease outbreaks, are inevitable, but their effects can be mitigated by investing in prevention and preparedness. We assessed the epidemic preparedness and response capacities of health systems in 186 countries from 2018 to 2022. Methods We utilized data from the International Health Regulations (IHR) State Party Self-Assessment Annual Reporting (SPAR) submissions to assess health systems’ IHR capacities to (1) prevent, (2) detect, (3) respond, (4) enable resources and coordinate, and (5) ensure operational readiness from 2018 to 2022. We categorized the IHR capacities into five levels, with level 1 denoting the lowest level of national capacity and level 5 the highest. We calculated each index’s capacity level as the arithmetic mean of its related indicators and analyzed changes over time using the Mann–Kendall nonparametric trend test. Results SPAR reporting marginally improved from 92.9% (182 of 196 countries) in 2018 to 94.9% (186 of 196 countries) in 2022, with considerable improvement in all five capacity domains over this period: prevention (58.4 in 2018 to 66.5 in 2022), detection (74.7 to 78.3), response (56.5 to 67.8), enabling resources and coordination (63.0 to 68.3), and ensuring operational readiness (62.8 to 69.9). From the 2022 submissions, 116 (62%) countries reported functional (Level 4 or 5) prevention capacity, 162 (87%) had functional detection capacity, 118 (63%) had functional response capacity, 121 (65%) had functional enabling resources and coordination capacity, and 133 (72%) had functional operational readiness against public health events. Across all the indexes, the WHO African Region reported the fewest countries with functional capacity in these domains. Conclusions There was an overall increase in functional capacity across all five domains at both global and regional levels; and a high percentage of countries achieved functional capacity across all domains in 2022. However, a significant number of countries, particularly in the Global South, have yet to achieve functional competence in these capacities, leaving the world vulnerable to the persistent risk of epidemics and infectious biohazards. Strengthening IHR competencies through local, national, and global engagements must be urgently prioritized to achieve global health security against infectious diseases.

Objectives: Disruptive public health risks and events, including infectious disease outbreaks, are inevitable, but their effects can be mitigated by investing in prevention and preparedness. We assessed the epidemic preparedness and response capacities of health systems in 186 countries from 2018 to 2022. Methods: We utilized data from the International Health Regulations (IHR) State Party Self-Assessment Annual Reporting (SPAR) submissions to assess health systems' IHR capacities to (1) prevent, (2) detect, (3) respond, (4) enable resources and coordinate, and (5) ensure operational readiness from 2018 to 2022. We categorized the IHR capacities into five levels, with level 1 denoting the lowest level of national capacity and level 5 the highest. We calculated each index's capacity level as the arithmetic mean of its related indicators and analyzed changes over time using the Mann–Kendall nonparametric trend test. Results: SPAR reporting marginally improved from 92.9% (182 of 196 countries) in 2018 to 94.9% (186 of 196 countries) in 2022, with considerable improvement in all five capacity domains over this period: prevention (58.4 in 2018 to 66.5 in 2022), detection (74.7 to 78.3), response (56.5 to 67.8), enabling resources and coordination (63.0 to 68.3), and ensuring operational readiness (62.8 to 69.9). From the 2022 submissions, 116 (62%) countries reported functional (Level 4 or 5) prevention capacity, 162 (87%) had functional detection capacity, 118 (63%) had functional response capacity, 121 (65%) had functional enabling resources and coordination capacity, and 133 (72%) had functional operational readiness against public health events. Across all the indexes, the WHO African Region reported the fewest countries with functional capacity in these domains. Conclusions: There was an overall increase in functional capacity across all five domains at both global and regional levels; and a high percentage of countries achieved functional capacity across all domains in 2022. However, a significant number of countries, particularly in the Global South, have yet to achieve functional competence in these capacities, leaving the world vulnerable to the persistent risk of epidemics and infectious biohazards. Strengthening IHR competencies through local, national, and global engagements must be urgently prioritized to achieve global health security against infectious diseases. [ABSTRACT FROM AUTHOR]

The global COVID-19 pandemic has imposed unprecedented pressure on health systems and has interrupted public health efforts for other major health conditions, including HIV. It is critical to comprehensively understand how the pandemic has affected the delivery and utilization of HIV-related services and what are the effective strategies that may mitigate the negative impacts of COVID-19 and resultant interruptions. The current study thus aims to comprehensively investigate HIV service interruptions during the pandemic following a socioecological model, to assess their impacts on various outcomes of the HIV prevention and treatment cascade and to identify resilience resources for buffering impacts of interruptions on HIV treatment cascade outcomes. We will assess HIV service interruptions in South Carolina (SC) since 2020 using operational report data from Ryan White HIV clinics and HIV service utilization data (including telehealth use) based on statewide electronic health records (EHR) and cellphone-based place visitation data. We will further explore how HIV service interruptions affect HIV prevention and treatment cascade outcomes at appropriate geospatial units based on the integration of multi-type, multi-source datasets (e.g., EHR, geospatial data). Finally, we will identify institutional-, community-, and structural-level factors (e.g., resilience resources) that may mitigate the adverse impacts of HIV service interruptions based on the triangulation of quantitative (i.e., EHR data, geospatial data, online survey data) and qualitative (i.e., in-depth interviews with clinic leaders, healthcare providers, people living with HIV, and HIV clinic operational reports) data regarding health system infrastructure, social capital, and organizational preparedness. Our proposed research can lead to a better understanding of complicated HIV service interruptions in SC and resilience factors that can mitigate the negative effects of such interruptions on various HIV treatment cascade outcomes. The multilevel resilience resources identified through data triangulation will assist SC health departments and communities in developing strategic plans in response to this evolving pandemic and other future public health emergencies (e.g., monkeypox, disasters caused by climate change). The research findings can also inform public health policymaking and the practices of other Deep South states with similar sociocultural contexts in developing resilient healthcare systems and communities and advancing epidemic preparedness. [ABSTRACT FROM AUTHOR]

Abstract Background Somali Red Crescent Society (SRCS), supported by Norwegian Red Cross, has implemented community-based surveillance (CBS) in Somaliland. This methodology aims to reduce the high risk of epidemics by strengthening early warning and response from and at community level, particularly where there is a weak public health surveillance system. CBS is implemented through SRCS community volunteers, who report signals from the community via SMS to the software platform Nyss. This paper presents key findings from the CBS programme evaluation. Methods A retrospective observational mixed-methods approach to evaluate the CBS programme was conducted, using routine CBS data from 2021 for Awdal and Togdheer regions and qualitative interviews with stakeholders’ representatives. Results The usefulness of the CBS programme in preventing, detecting, and responding to disease outbreaks was acknowledged by the stakeholders’ representatives. 83% of the signals in Awdal region matched a Community Case Definition (CCD) and were escalated to the Ministry of Health and Development (MoHD)). For Togdheer region, 97% were escalated. Verification of signals by supervisors and escalation to the authorities was done timely.Alert outcome and response action was not well recorded, therefore there is limited evidence on sensitivity. The programme was shown to be simple and can be flexibly adjusted for new diseases and changing CCDs.Stakeholders appreciated being engaged, the good collaboration, their participation throughout the implementation and expressed high acceptance of the programme. Conclusion CBS can support early warning and response for a variety of public health risks. Improved documentation for alert outcomes could help to better evaluate the sensitivity of CBS. A participatory approach is vital to achieve successful community volunteer engagement. Software tools, such as the Nyss platform, can be useful to support effective and efficient CBS implementation.

Introduction: Unrecognized Ebola Virus Disease (EVD) can lead to multiple chains of transmissions if the first caretakers are not trained and prepared. This study aimed to assess healthcare workers (HCWs) preparedness in private hospitals located in Kampala, to detect, respond and prevent EVD Methodology: A descriptive cross-sectional study was carried out among HCWs in direct clinical care provision in four private hospitals, and in one Ebola Treatment Unit (ETU) using a self-administered questionnaire from March to June 2020. Results: 222 HCWs agreed to participate aged from 19 to 64 years and with 6 months to 38 years of practice where most were nurses (44%). 3/5 hospitals did not have written protocols on EVD case management, and only one (ETU) had an exclusive emergency team. 59% were not sure whether contact tracing was taking place. Private hospitals were not included in EVD trainings organized by the Ministry of Health (MoH). In addition, HCWs in private hospitals were not empowered by the MoH to take part in EVD case management. Despite these shortcomings, only 66% of HCWs showed an interest to be immunized. Knowledge about potential Ebola vaccines was generally poor. Conclusions: In Kampala, Uganda, establishment of a more comprehensive preparedness and response strategy for EVD outbreaks is imperative for HCWs in private facilities, including a wide vaccination educational program on Ebola vaccination. The findings from this study if addressed will likely improve the preparedness and management of future Ebola outbreaks in Uganda. [ABSTRACT FROM AUTHOR]

Background: Somali Red Crescent Society (SRCS), supported by Norwegian Red Cross, has implemented community-based surveillance (CBS) in Somaliland. This methodology aims to reduce the high risk of epidemics by strengthening early warning and response from and at community level, particularly where there is a weak public health surveillance system. CBS is implemented through SRCS community volunteers, who report signals from the community via SMS to the software platform Nyss. This paper presents key findings from the CBS programme evaluation. Methods: A retrospective observational mixed-methods approach to evaluate the CBS programme was conducted, using routine CBS data from 2021 for Awdal and Togdheer regions and qualitative interviews with stakeholders' representatives. Results: The usefulness of the CBS programme in preventing, detecting, and responding to disease outbreaks was acknowledged by the stakeholders' representatives. 83% of the signals in Awdal region matched a Community Case Definition (CCD) and were escalated to the Ministry of Health and Development (MoHD)). For Togdheer region, 97% were escalated. Verification of signals by supervisors and escalation to the authorities was done timely.Alert outcome and response action was not well recorded, therefore there is limited evidence on sensitivity. The programme was shown to be simple and can be flexibly adjusted for new diseases and changing CCDs.Stakeholders appreciated being engaged, the good collaboration, their participation throughout the implementation and expressed high acceptance of the programme. Conclusion: CBS can support early warning and response for a variety of public health risks. Improved documentation for alert outcomes could help to better evaluate the sensitivity of CBS. A participatory approach is vital to achieve successful community volunteer engagement. Software tools, such as the Nyss platform, can be useful to support effective and efficient CBS implementation. [ABSTRACT FROM AUTHOR]

Abstract The Nipah virus, a highly pathogenic zoonotic pathogen, has once again surfaced in the state of Kerala, India, with recent cases reported in 2023. This article delves into the epidemiological details of these cases, shedding light on the two fatalities that occurred in September 2023 and August 2023 as well as the suspected cases that have undergone testing. Nipah virus, known for its severe neurological and respiratory disease manifestations, remains a formidable health threat due to the lack of specific treatments or vaccines. The government’s response to these recent cases, including mass testing and quarantine measures, is discussed, drawing lessons from past outbreaks in the region. Kerala has experienced multiple Nipah virus outbreaks since 2018, prompting a closer examination of environmental factors, such as deforestation and urbanization, which increase the risk of zoonotic transmission. This article underscores the global implications of Nipah virus resurgence in Kerala and emphasizes the importance of preparedness and vigilance in the face of emerging infectious diseases. The lessons learned from Kerala’s experience with Nipah virus outbreaks provide valuable insights for public health professionals and policymakers worldwide.

Background Despite previous experience with epidemics, African healthcare systems were inadequately pre‑ pared and substantially impacted by the coronavirus disease 2019 (COVID-19) pandemic. Limited information about the level of COVID-19 preparedness of healthcare facilities in Africa hampers policy decision-making to fght future outbreaks in the region, while maintaining essential healthcare services running. Methods Between May–November 2020, we performed a survey study with SafeCare4Covid − a free digital selfassessment application − to evaluate the COVID-19 preparedness of healthcare facilities in Africa following World Health Organization guidelines. The tool assessed (i) COVID-19-related capabilities with 31 questions; and (ii) avail‑ ability of essential medical supplies with a 23-supplies checklist. Tailored quality improvement plans were provided after assessments. Information about facilities’ location, type, and ownership was also collected. Results Four hundred seventy-one facilities in 11 African countries completed the capability assessment; 412 also completed the supplies checklist. The average capability score on a scale of 0–100 (n=471) was 58.0 (interquartile range 40.0–76.0), and the average supplies score (n=412) was 61.6 (39.0–83.0). Both scores were signifcantly lower in rural (capability score, mean 53.6 [95%CI:50.3–57.0]/supplies score, 59.1 [55.5–62.8]) versus urban facilities (capabil‑ ity score, 65.2 [61.7–68.7]/supplies score, 70.7 [67.2–74.1]) (P<0.0001 for both comparisons). Likewise, lower scores were found for public versus private clinics, and for primary healthcare centres versus hospitals. Guidelines for triage and isolation, clinical management of COVID-19, staf mental support, and contact tracing forms were largely missing. Handwashing stations were partially equipped in 33% of facilities. The most missing medical supply was COVID-19 specimen collection material (71%), while 43% of facilities did not have N95/FFP2 respirators and 19% lacked medical masks. Conclusions A large proportion of public and private African facilities providing basic healthcare in rural areas, lacked fundamental COVID-19-related capabilities and life-saving personal protective equipment. Decentralization of epi‑ demic preparedness eforts in these settings is warranted to protect healthcare workers and patients alike in future epidemics. Digital tools are of great value to timely measure and improve epidemic preparedness of healthcare facilities, inform decision-making, create a more stakeholder-broad approach and increase health-system resilience for future disease outbreaks. [ABSTRACT FROM AUTHOR]

The Nipah virus, a highly pathogenic zoonotic pathogen, has once again surfaced in the state of Kerala, India, with recent cases reported in 2023. This article delves into the epidemiological details of these cases, shedding light on the two fatalities that occurred in September 2023 and August 2023 as well as the suspected cases that have undergone testing. Nipah virus, known for its severe neurological and respiratory disease manifestations, remains a formidable health threat due to the lack of specific treatments or vaccines. The government's response to these recent cases, including mass testing and quarantine measures, is discussed, drawing lessons from past outbreaks in the region. Kerala has experienced multiple Nipah virus outbreaks since 2018, prompting a closer examination of environmental factors, such as deforestation and urbanization, which increase the risk of zoonotic transmission. This article underscores the global implications of Nipah virus resurgence in Kerala and emphasizes the importance of preparedness and vigilance in the face of emerging infectious diseases. The lessons learned from Kerala's experience with Nipah virus outbreaks provide valuable insights for public health professionals and policymakers worldwide. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic brought about significant challenges for health systems globally, with medical professionals at the forefront of this crisis. Understanding their organizational expectations and well-being implications is crucial for crafting responsive healthcare environments. Methods: Between 2021 and 2022, an online survey was conducted among 852 medical professionals across four provinces in Poland: Mazovia, Łódź, Świętokrzyskie, and Lublin. The survey tool, based on a comprehensive literature review, comprised dichotomous questions and specific queries to gather explicit insights. A 5-point Likert scale was implemented to capture nuanced perceptions. Additionally, the Post-Traumatic Stress Disorder Checklist-Civilian (PCL-C) was utilized to ascertain the correlation between workplace organization and post-traumatic stress symptoms. Results: A noteworthy 84.6% of participants believed their employers could enhance safety measures, highlighting a discrepancy between healthcare workers' expectations and organizational implementations. Major concerns encompassed the demand for improved personal protective equipment (44.6%), structured debriefing sessions (40%), distinct building entrances and exits (38.8%), and psychological support (38.3%). Statistical analyses showcased significant variations in 'Avoidance' and 'Overall PTSD Score' between individuals who had undergone epidemic safety procedure training and those who had not. Conclusions: The results illuminate the imperative for healthcare organizations to remain agile, attentive, and deeply compassionate, especially during worldwide health emergencies. Despite showcasing remarkable resilience during the pandemic, medical professionals ardently seek an environment that underscores their safety and mental well-being. These findings reinforce the call for healthcare institutions and policymakers to champion a forward-thinking, employee-focused approach. Additionally, the data suggest a potential avenue for future research focusing on specific demographic groups, further enriching our understanding and ensuring a more comprehensive readiness for impending health crises. [ABSTRACT FROM AUTHOR]

Epidemic preparedness, the ability to prevent, respond and control epidemic outbreaks, has remained a neglected concept and policy practice for many years, detached from health policy and health systems planning. The cornerstone of epidemic preparedness is the preparedness of public health services, which consists of effective early warning systems and control of cross-border spread of communicable diseases, the ability to design and implement focused and proportional non pharmaceutical interventions, the effective epidemiological surveillance and transparent management of epidemiological data, the scientific consistency and accountability of public health authorities. The COVID-19 pandemic has revealed, both on a national and international level, the significant gaps and structural deficiencies of all the above mentioned elements of public health (services') preparedness. Current and expected future public health threats leave no room for complacency; public health services need to be urgently reorganized through integration into comprehensive public primary healthcare systems and strengthened through increased public investment in financial resources, infrastructure and healthcare workers. [ABSTRACT FROM AUTHOR]

Background: In 2020, HOHM Foundation launched Homeopathy Help Now (HHN), a network of professional homeopathy telehealth practitioners, administrative volunteers, and independent researchers to work collaboratively in order to respond to the urgent need of care for the ever-growing number of COVID-19 cases in the United States. Methods: in this pragmatic case series study, cases of positively testing or probable COVID-19 (n = 3495) are analyzed using conventional quantitative analysis. The sample includes clinical data collected from clients who attended the clinic between 23 March 2020 and 31 December 2023. Results: The youngest client at the clinic was less than one year old, and the eldest was 92. Many of the participants at this clinical facility were adults (58.1%), with fewer (41.9%) aged 0-17. Many were female (61.7%), while fewer were male (32.4). Most clients found their symptoms improved at final contact (83.6%), and the majority of individual remedy responses improved symptoms (73.7%) over the course of their care. Discussion: Health Services and Public Health research projects are warranted to investigate the ways in which such a necessary stop-gap clinical service as HHN could become implemented in early- and later-phase response to pandemics. HHN's collaborative, horizontally integrated team structure was essential for the creation of the novel approach needed to address the serious symptoms of COVID-19. Moreover, HHN's organizational model draws on a mutual aid structure, whereby dynamic, flexible systems are created that empower a community to meet emerging needs, especially when more formal structures are strained, failing or simply unavailable. Further research is urgently needed into the implementation and benefits of innovative, flexible healthcare structures, such as the one used in this study, that can meet the unpredictable and fluctuating public health needs in our changing world.

IntroductionIn Africa almost half of healthcare services are delivered through private sector providers. These are often underused in national public health responses. To support and accelerate the public sector's COVID-19 response, we facilitated recruitment of additional private sector capacity by initiating a public-private partnership (PPP) in Kisumu County, Kenya. In this manuscript we demonstrate this PPP's performance.MethodsCOVID-19 diagnostic testing formed the basis for a PPP between Kenyan Medical Research Institute (KEMRI), Department of Health Kisumu County, PharmAccess Foundation, and local faith-based and private healthcare facilities: COVID-Dx. First phase COVID-Dx was implemented from June 01, 2020, to March 31, 2021 in Kisumu County, Kenya. Trained laboratory technologists in participating healthcare facilities collected nasopharyngeal and oropharyngeal samples from patients meeting the Kenyan MoH COVID-19 case definition. Healthcare workers in participating facilities collected patient clinical data using a digitized MoH COVID-19 Case Identification Form. We shared aggregated results from these data via (semi-) live dashboards with all relevant stakeholders through their mobile phones and tablets. Statistical analyses were performed using Stata 16 to inform project processes.ResultsNine private facilities participated in the project. A patient trajectory was developed from case identification to result reporting, all steps supported by a semi-real time digital dashboard. A total of 4,324 PCR tests for SARS-CoV-2 were added to the public response, identifying 425 positives, accounting for 16% of all COVID-19 tests performed in the County over the given time-period. Geo-mapped and time-tagged information on incident cases was depicted on Google maps through PowerBI-dashboards and fed back to policymakers for informed rapid decision making. Preferential COVID-19 testing was performed on health workers at risk, with 1,009 tests performed (up to 43% of all County health workforce).ConclusionWe demonstrate feasibility of rapidly increasing the public health sector COVID-19 response through coordinated private sector efforts in an African setting. Our PPP intervention in Kisumu, Kenya was based on a joint testing strategy and demonstrated that semi-real time digitalization of patient trajectories can gain significant efficiencies, linking public and private healthcare efforts, increasing transparency, support better quality health services and informing policy makers to target interventions.

Mpox (formerly known as monkeypox) was declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization on 23rd July 2022, however cases of the disease have been detected in Nigeria since the 1970s and more recently since it began spreading in more urban areas of the country from 2017 onward. Nigeria has a strong track record of epidemic preparedness and response, spearheaded by the Nigeria Centre for Disease Control. Despite being somewhat separate architectures on paper, epidemic response (in particular, integrated disease surveillance and response) relies on a foundation of primary health care, which is inadequately funded not only in Nigeria, but globally. Situating mpox response within this wider landscape, we draw on ethnographic research from September 2022–March 2023 in southwestern Nigeria on lived experiences of mpox and mpox response, focusing on the perspectives of frontline health workers and community-based suspected or confirmed mpox cases. We aimed to understand how prioritization and resource constraints shape mpox response at a local level, including effects on the everyday work of frontline health workers in public health and clinical care who are left to "make do." We analyze their experiences interfacing with two intersecting infrastructures, community-based surveillance and primary health care. Health workers' improvisation and "repair work," which we detail, enables the surveillance system to function in some capacity. However, health workers must regularly contend with competing priorities and routine care that may be sidelined during an outbreak or epidemic. We argue that this reveals the limitations of a global health security agenda as it materializes at a local level and the need for strengthening primary health care for longer-term sustainability. • This ethnographic study examined mpox response in southwestern Nigeria. • Epidemic response infrastructure depends on a strong primary health care system. • Primary health care is underfunded in Nigeria. • Frontline health workers engage in repair and improvisation. • This is unsustainable without further primary health system strengthening. [ABSTRACT FROM AUTHOR]

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Summary: 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).

Abstract Background Zika virus (ZIKV) emerged as a global epidemic in 2015–2016 from Latin America with its true geographical extent remaining unclear due to widely presumed underreporting. The identification of locations with potential and unknown spread of ZIKV is a key yet understudied component for outbreak preparedness. Here, we aim to identify locations at a high risk of cryptic ZIKV spread during 2015–2016 to further the understanding of the global ZIKV epidemiology, which is critical for the mitigation of the risk of future epidemics. Methods We developed an importation simulation model to estimate the weekly number of ZIKV infections imported in each susceptible spatial unit (i.e. location that did not report any autochthonous Zika cases during 2015–2016), integrating epidemiological, demographic, and travel data as model inputs. Thereafter, a global risk model was applied to estimate the weekly ZIKV transmissibility during 2015–2016 for each location. Finally, we assessed the risk of onward ZIKV spread following importation in each susceptible spatial unit to identify locations with a high potential for cryptic ZIKV spread during 2015–2016. Results We have found 24 susceptible spatial units that were likely to have experienced cryptic ZIKV spread during 2015–2016, of which 10 continue to have a high risk estimate within a highly conservative scenario, namely, Luanda in Angola, Banten in Indonesia, Maharashtra in India, Lagos in Nigeria, Taiwan and Guangdong in China, Dakar in Senegal, Maputo in Mozambique, Kinshasa in Congo DRC, and Pool in Congo. Notably, among the 24 susceptible spatial units identified, some have reported their first ZIKV outbreaks since 2017, thus adding to the credibility of our results (derived using 2015–2016 data only). Conclusion Our study has provided valuable insights into the potentially high-risk locations for cryptic ZIKV circulation during the 2015–2016 pandemic and has also laid a foundation for future studies that attempt to further narrow this key knowledge gap. Our modelling framework can be adapted to identify areas with likely unknown spread of other emerging vector-borne diseases, which has important implications for public health readiness especially in resource-limited settings.

The Coronavirus Disease-2019 (COVID-19) pandemic is now well-established in Africa with cases reported from all countries on the continent. Despite the significant progress that has been made in the response to the pandemic in Nigeria, relative to the period of Ebola epidemic, the currently reported number of COVID-19 cases are likely under-estimates of the true number of cases. This is attributable to restricted testing capacity due to limited technical, infrastructural, financial, and logistical capacity to rapidly scale-up testing. In this article, we explore the impact of the COVID-19 pandemic on management of related co-morbidities and the major prevalent public health challenges, including mental health, in Nigeria, Africa’s most populous country. We also discuss the most current knowledge about candidate vaccines for the control of the novel coronavirus (SARS-CoV-2) strain. The interactions between COVID-19 and the endemic public health challenges in Nigeria further highlight the linkage between infectious diseases and poverty, and emphasise the need for a sustained increase in investments in the general public health system that is geared toward achieving Universal Health Coverage in Nigeria.

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.

Abstract 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.

Global health research partnerships with institutions from high-income countries and low- and middle-income countries are one of the European Commission’s flagship programmes. Here, we report on the ZikaPLAN research consortium funded by the European Commission with the primary goal of addressing the urgent knowledge gaps related to the Zika epidemic and the secondary goal of building up research capacity and establishing a Latin American-European research network for emerging vector-borne diseases. Five years of collaborative research effort have led to a better understanding of the full clinical spectrum of congenital Zika syndrome in children and the neurological complications of Zika virus infections in adults and helped explore the origins and trajectory of Zika virus transmission. Individual-level data from ZikaPLAN`s cohort studies were shared for joint analyses as part of the Zika Brazilian Cohorts Consortium, the European Commission-funded Zika Cohorts Vertical Transmission Study Group, and the World Health Organization-led Zika Virus Individual Participant Data Consortium. Furthermore, the legacy of ZikaPLAN includes new tools for birth defect surveillance and a Latin American birth defect surveillance network, an enhanced Guillain-Barre Syndrome research collaboration, a de-centralized evaluation platform for diagnostic assays, a global vector control hub, and the REDe network with freely available training resources to enhance global research capacity in vector-borne diseases.

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.

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.

Recent years have seen unprecedented investment in research and development for countermeasures for high-threat pathogens, including specific and ambitious objectives for development of diagnostics, therapeutics, and vaccines. The inadequate availability of biological reference materials for these pathogens poses a genuine obstacle in pursuit of these objectives, and the lack of a comprehensive and equitable framework for developing reference materials is a weakness. We outline the need for internationally standardized biological materials for high-threat pathogens as a core element of global health security. We also outline the key components of a framework for addressing this deficiency.

Global health research partnerships with institutions from high-income countries and low- and middle-income countries are one of the European Commission’s flagship programmes. Here, we report on the ZikaPLAN research consortium funded by the European Commission with the primary goal of addressing the urgent knowledge gaps related to the Zika epidemic and the secondary goal of building up research capacity and establishing a Latin American-European research network for emerging vector-borne diseases. Five years of collaborative research effort have led to a better understanding of the full clinical spectrum of congenital Zika syndrome in children and the neurological complications of Zika virus infections in adults and helped explore the origins and trajectory of Zika virus transmission. Individual-level data from ZikaPLAN`s cohort studies were shared for joint analyses as part of the Zika Brazilian Cohorts Consortium, the European Commission-funded Zika Cohorts Vertical Transmission Study Group, and the World Health Organization-led Zika Virus Individual Participant Data Consortium. Furthermore, the legacy of ZikaPLAN includes new tools for birth defect surveillance and a Latin American birth defect surveillance network, an enhanced Guillain-Barre Syndrome research collaboration, a de-centralized evaluation platform for diagnostic assays, a global vector control hub, and the REDe network with freely available training resources to enhance global research capacity in vector-borne diseases. [ABSTRACT FROM AUTHOR]

Background: Zika virus (ZIKV) emerged as a global epidemic in 2015-2016 from Latin America with its true geographical extent remaining unclear due to widely presumed underreporting. The identification of locations with potential and unknown spread of ZIKV is a key yet understudied component for outbreak preparedness. Here, we aim to identify locations at a high risk of cryptic ZIKV spread during 2015-2016 to further the understanding of the global ZIKV epidemiology, which is critical for the mitigation of the risk of future epidemics.Methods: We developed an importation simulation model to estimate the weekly number of ZIKV infections imported in each susceptible spatial unit (i.e. location that did not report any autochthonous Zika cases during 2015-2016), integrating epidemiological, demographic, and travel data as model inputs. Thereafter, a global risk model was applied to estimate the weekly ZIKV transmissibility during 2015-2016 for each location. Finally, we assessed the risk of onward ZIKV spread following importation in each susceptible spatial unit to identify locations with a high potential for cryptic ZIKV spread during 2015-2016.Results: We have found 24 susceptible spatial units that were likely to have experienced cryptic ZIKV spread during 2015-2016, of which 10 continue to have a high risk estimate within a highly conservative scenario, namely, Luanda in Angola, Banten in Indonesia, Maharashtra in India, Lagos in Nigeria, Taiwan and Guangdong in China, Dakar in Senegal, Maputo in Mozambique, Kinshasa in Congo DRC, and Pool in Congo. Notably, among the 24 susceptible spatial units identified, some have reported their first ZIKV outbreaks since 2017, thus adding to the credibility of our results (derived using 2015-2016 data only).Conclusion: Our study has provided valuable insights into the potentially high-risk locations for cryptic ZIKV circulation during the 2015-2016 pandemic and has also laid a foundation for future studies that attempt to further narrow this key knowledge gap. Our modelling framework can be adapted to identify areas with likely unknown spread of other emerging vector-borne diseases, which has important implications for public health readiness especially in resource-limited settings. [ABSTRACT FROM AUTHOR]

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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

Launched at Davos in January 2017 with funding from sovereign investors and philanthropic institutions, the Coalition for Epidemic Preparedness Innovations (CEPI) is an innovative partnership between public, private, philanthropic, and civil organisations whose mission is to stimulate, finance and co-ordinate vaccine development against diseases with epidemic potential in cases where market incentives fail. As of December 2019, CEPI has committed to investing up to $706 million in vaccine development. This includes 19 vaccine candidates against its priority pathogens (Lassa fever virus, Middle East respiratory syndrome coronavirus, Nipah virus, Chikungunya, Rift Valley fever) and three vaccine platforms to develop vaccines against Disease X, a novel or unanticipated pathogen. As an entity largely supported by public funds, ensuring equitable access to vaccines whose development it supports in low- and middle-income countries is CEPI's primary focus. CEPI developed an initial equitable access policy shortly after its formation, with key stakeholders expressing strong views about its content and prescriptive nature. The CEPI board instructed that it be revisited after a year. This paper describes the process of revising the policy, and how key issues were resolved. CEPI will continue to take an iterative, rather than prescriptive, approach to its policy—one that reflects the needs of multiple stakeholders and ensures it can meet its equitable access goals. [ABSTRACT FROM AUTHOR]

Recent disease outbreaks have demonstrated the severe health, economic and political crises that epidemics can trigger. The rate of emergence of infectious diseases is accelerating and, with deepening globalisation, pathogens are increasingly mobile. Yet the 2014–2015 West African Ebola epidemic exposed major gaps in the world's capacity to prevent and respond to epidemics. In the midst of the world's second largest ever recorded Ebola outbreak in the Democratic Republic of the Congo, we reflect on six of the many lessons learnt from the epidemic in West Africa, focusing on progress made and the challenges ahead in preparing for future threats. While Ebola and other emerging epidemics will remain a challenge in the years to come, by working in partnership with affected communities and across sectors, and by investing in robust health systems, it is within our power to be better prepared when they strike. [ABSTRACT FROM AUTHOR]

Zika Preparedness Latin American Network (ZikaPLAN) is a research consortium funded by the European Commission to address the research gaps in combating Zika and to establish a sustainable network with research capacity building in the Americas. Here we present a report on ZikaPLAN`s mid-term achievements since its initiation in October 2016 to June 2019, illustrating the research objectives of the 15 work packages ranging from virology, diagnostics, entomology and vector control, modelling to clinical cohort studies in pregnant women and neonates, as well as studies on the neurological complications of Zika infections in adolescents and adults. For example, the Neuroviruses Emerging in the Americas Study (NEAS) has set up more than 10 clinical sites in Colombia. Through the Butantan Phase 3 dengue vaccine trial, we have access to samples of 17,000 subjects in 14 different geographic locations in Brazil. To address the lack of access to clinical samples for diagnostic evaluation, ZikaPLAN set up a network of quality sites with access to well-characterized clinical specimens and capacity for independent evaluations. The International Committee for Congenital Anomaly Surveillance Tools was formed with global representation from regional networks conducting birth defects surveillance. We have collated a comprehensive inventory of resources and tools for birth defects surveillance, and developed an App for low resource regions facilitating the coding and description of all major externally visible congenital anomalies including congenital Zika syndrome. Research Capacity Network (REDe) is a shared and open resource centre where researchers and health workers can access tools, resources and support, enabling better and more research in the region. Addressing the gap in research capacity in LMICs is pivotal in ensuring broad-based systems to be prepared for the next outbreak. Our shared and open research space through REDe will be used to maximize the transfer of research into practice by summarizing the research output and by hosting the tools, resources, guidance and recommendations generated by these studies. Leveraging on the research from this consortium, we are working towards a research preparedness network.

Recent years have seen unprecedented investment in research and development for countermeasures for high-threat pathogens, including specific and ambitious objectives for development of diagnostics, therapeutics, and vaccines. The inadequate availability of biological reference materials for these pathogens poses a genuine obstacle in pursuit of these objectives, and the lack of a comprehensive and equitable framework for developing reference materials is a weakness. We outline the need for internationally standardized biological materials for high-threat pathogens as a core element of global health security. We also outline the key components of a framework for addressing this deficiency. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Zika Preparedness Latin American Network (ZikaPLAN) is a research consortium funded by the European Commission to address the research gaps in combating Zika and to establish a sustainable network with research capacity building in the Americas. Here we present a report on ZikaPLAN's mid-term achievements since its initiation in October 2016 to June 2019, illustrating the research objectives of the 15 work packages ranging from virology, diagnostics, entomology and vector control, modelling to clinical cohort studies in pregnant women and neonates, as well as studies on the neurological complications of Zika infections in adolescents and adults. For example, the Neuroviruses Emerging in the Americas Study (NEAS) has set up more than 10 clinical sites in Colombia. Through the Butantan Phase 3 dengue vaccine trial, we have access to samples of 17,000 subjects in 14 different geographic locations in Brazil. To address the lack of access to clinical samples for diagnostic evaluation, ZikaPLAN set up a network of quality sites with access to well-characterized clinical specimens and capacity for independent evaluations. The International Committee for Congenital Anomaly Surveillance Tools was formed with global representation from regional networks conducting birth defects surveillance. We have collated a comprehensive inventory of resources and tools for birth defects surveillance, and developed an App for low resource regions facilitating the coding and description of all major externally visible congenital anomalies including congenital Zika syndrome. Research Capacity Network (REDe) is a shared and open resource centre where researchers and health workers can access tools, resources and support, enabling better and more research in the region. Addressing the gap in research capacity in LMICs is pivotal in ensuring broad-based systems to be prepared for the next outbreak. Our shared and open research space through REDe will be used to maximize the transfer of research into practice by summarizing the research output and by hosting the tools, resources, guidance and recommendations generated by these studies. Leveraging on the research from this consortium, we are working towards a research preparedness network. [ABSTRACT FROM AUTHOR]

The ongoing Zika virus (ZIKV) outbreak in Latin America, the Caribbean, and the Pacific Islands has underlined the need for a coordinated research network across the whole region that can respond rapidly to address the current knowledge gaps in Zika and enhance research preparedness beyond Zika. The European Union under its Horizon 2020 Research and Innovation Programme awarded three research consortia to respond to this need. Here we present the ZikaPLAN (Zika Preparedness Latin American Network) consortium. ZikaPLAN combines the strengths of 25 partners in Latin America, North America, Africa, Asia, and various centers in Europe. We will conduct clinical studies to estimate the risk and further define the full spectrum and risk factors of congenital Zika virus syndrome (including neurodevelopmental milestones in the first 3 years of life), delineate neurological complications associated with ZIKV due to direct neuroinvasion and immune-mediated responses in older children and adults, and strengthen surveillance for birth defects and Guillain–Barré Syndrome. Laboratory-based research to unravel neurotropism and investigate the role of sexual transmission, determinants of severe disease, and viral fitness will underpin the clinical studies. Social messaging and engagement with affected communities, as well as development of wearable repellent technologies against Aedes mosquitoes will enhance the impact. Burden of disease studies, data-driven vector control, and vaccine modeling as well as risk assessments on geographic spread of ZIKV will form the foundation for evidence-informed policies. While addressing the research gaps around ZIKV, we will engage in capacity building in laboratory and clinical research, collaborate with existing and new networks to share knowledge, and work with international organizations to tackle regulatory and other bottlenecks and refine research priorities. In this way, we can leverage the ZIKV response toward building a long-term emerging infectious diseases response capacity in the region to address future challenges.

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. [ABSTRACT FROM AUTHOR]

Background: The continuing circulation of MERS in the Middle East makes the international dissemination of the disease a permanent threat. To inform risk assessment, we investigated the spatiotemporal pattern of MERS global dissemination and looked for factors explaining the heterogeneity observed in transmission events following importation.Methods: We reviewed imported MERS cases worldwide up to July 2015. We modelled importations in time based on air travel combined with incidence in Middle East. We used the detailed history of MERS case management after importation (time to hospitalization and isolation, number of hospitals visited,…) in logistic regression to identify risk factors for secondary transmission. We assessed changes in time to hospitalization and isolation in relation to collective and public health attention to the epidemic, measured by three indicators (Google Trends, ProMED-mail, Disease Outbreak News).Results: Modelled importation events were found to reproduce both the temporal and geographical structure of those observed - the Pearson correlation coefficient between predicted and observed monthly time series was large (r = 0.78, p < 10(-4)). The risk of secondary transmission following importation increased with the time to case isolation or death (OR = 1.7 p = 0.04) and more precisely with the duration of hospitalization (OR = 1.7, p = 0.02). The average daily number of secondary cases was 0.02 [0.0,0.12] in the community and 0.20 [0.03,9.0] in the hospital. Time from hospitalisation to isolation decreased in periods of high public health attention (2.33 ± 0.34 vs. 6.44 ± 0.97 days during baseline attention).Conclusions: Countries at risk of importation should focus their resources on strict infection control measures for the management of potential cases in healthcare settings and on prompt MERS cases identification. Individual and collective awareness are key to substantially improve such preparedness. [ABSTRACT FROM AUTHOR]