Infectious Disease

Swimming in contaminated pools can cause gastroenteritis from water contaminated by viruses, bacteria, or parasites. Germs that cause gastroenteritis are shed in feces of infected persons, and easily spread to uninfected persons swimming in pools. Symptoms of gastrointestinal illness can include nausea, vomiting, watery or bloody diarrhea, and weight loss. Common causes of swimming-related gastroenteritis included viruses (norovirus), parasites (giardia, cryptosporidium), and bacteria (Escherichia coli, Shigella). Cryptosporidium is most common agent associated with swimming pool outbreaks. In 2011-2012, public health officials from 32 States reported 90 swimming-pool associated outbreaks to CDC’s Waterborne Disease and Outbreak Surveillance System (WBDOSS). These 90 outbreaks resulted in 1,788 cases, 95 hospitalizations, 1 death. 52% of these outbreaks were caused by Cryptosporidium.

Objective:

To prevent and identify gastrointestinal outbreaks due to swimming pools using a two-part surveillance system i) Model Aquatic Health Code (MAHC) Guideline Survey and ii) syndromic surveillance

One in twenty-five patients in acute care hospitals develop at least one health care associated infection (HAI); this resulted in approximately 75,000 preventable deaths in 2011. Risk factors associated with developing HAIs include older patients, serviced at a large hospital, central catheter placement, receiving medical ventilation, and placement in a critical care unit. In Pinellas County, individuals 65 years of age and older comprise approximately 24% of the total population.

Objective:

To assess healthcare facilities’ level of readiness to respond to an HAI outbreak, the Florida Department of Health in Pinellas County (DOH-Pinellas) conducted an HAI outbreak tabletop exercise (TTX) on June 6, 2017. Other benefits of this TTX were to provide opportunities for collaborative learning, building community partnerships and evaluation of HAI preparedness activities in Pinellas County healthcare facilities.

Nigeria is one of the three countries in the world with ongoing wild poliovirus (WPV) transmission, alongside Afghanistan and Pakistan. Nigeria also experiences outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2). Following the detection of WPV1 in northern Nigeria in 2016, after more than two years without WPV transmission, the country continues to implement an emergency response to the detected WPV1 and cVDPV2 strains. This resurgence of polio cases underscores the risk posee by low-level undetected transmission and the need to strengthen subnational surveillance. High quality acute flaccid paralysis (AFP) surveillance is essential to rapidly detect and respond to on-going polio transmission.

Objective:

We evaluated the Ebonyi state AFP surveillance system to assess its usefulness, performance and key system attributes.

NBIC is charged with enhancing the capability of the Federal Government to enable early warning and shared situational awareness of acute biological events to support better decisions through rapid identification, characterization, localization, and tracking. A key aspect of this mission is the requirement to integrate and collaborate with federal and, state, local, tribal, and territorial (SLTT) government agencies. NBIC develops and disseminates a variety of products to its stakeholders, including daily reports, ad-hoc reports, analytic collaborations, and leadership briefings upon request. Stakeholders interact with and utilize NBIC’s products in different ways, depending on the mission and jurisdiction involved. Specific collaborations with individual stakeholders are most frequent and evident during major infectious disease events, such as the recent Zika epidemic in the Americas and the associated microcephaly and other neurological disorders PHEIC. Collaborative efforts and known outcomes among varying levels of government are described in detail below in order to highlight NBIC’s integration focus and capabilities in this role.

Objective:

An important part of the National Biosurveillance Integration Center’s (NBIC) mission is collaboration with federal, state, local, tribal, and territorial governments for the purpose of enhancing early warning, shared situational awareness, and related decision support for infectious disease events. Several such collaborations occurred at multiple jurisdictional levels during the recent Zika epidemic in the Americas and the associated microcephaly and other neurological disorders Public Health Event of International Concern (PHEIC). The collaborations and their known outcomes from this major infectious disease event are described below, and NBIC stands ready to support similar efforts for future events.

Hepatitis A virus (HAV) infections have persisted in the United States despite the availability of an effective vaccine. Recent outbreaks of HAV infections among unvaccinated adults attributed to consumption of HAV-contaminated food, or person-to-person contact in certain populations (e.g., men who have sex with men) or settings (e.g., homeless shelters) have emphasized the importance of targeted vaccination of at-risk adults.

Objective:

To evaluate the use of commercial laboratory data for monitoring trends in HAV infections over time and identifying geographic and demographic characteristics of HAV case clusters for the purpose of targeting interventions.

EV-D68 is a non-polio enterovirus, primarily resulting in respiratory illness, with clinical symptoms ranging from mild to severe. Infection has also been associated with severe neurological conditions like acute flaccid myelitis (AFM). EV-D68 was first discovered in 1962, with infrequent case reports until 2014 at which point a widespread multi-national outbreak mostly affecting the pediatric population occurred across North America, Europe, Southeast Asia and Africa. This outbreak was associated with an increase in AFM, with cases being reported in Canada, the United States, Norway, and France. With this new and emerging threat, public health and other organizations were called upon to implement response measures such as establishment of case definitions, surveillance mechanisms, and recommendations for clinical and public health management. The response to the 2014 outbreak in Canada highlighted several important EV-D68 evidence gaps including a lack of risk factor and clinical information available for non-severe cases, and uncertainty around seasonal, cyclical and secular trends. Given the increased reporting of EV-D68 cases associated with severe outcomes, it's critical that public health establishes what is known about EV-D68 in order to support decision-making, education and other preparedness activities and to highlight priority areas for future research to fill critical knowledge gaps. Scoping reviews provide a reproducible and updateable synthesis research methodology to identify and characterise all the literature on a broad topic as a means to highlight where evidence exists and where there are knowledge gaps. In order to systematically characterise the EV-D68 knowledge base, a scoping review was conducted to map the current body of evidence.

Objective:

To create a scoping review on enterovirus D-68 (EV-D68) that will serve as a useful tool to guide future research with the aim of filling critical information gaps and supporting the development of public health preparedness activities.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It is a contagious disease that affects the skin, mucous membrane, and nerves causing discoloration and lumps on the skin and in severe cases disfigurement and deformities. The mode of transmission remains uncertain, but is believed that M.leprae is spread from person to person primarily as a nasal droplet infection. The incubation period for a bacterial disease generally is 5 – 7 years. Progress in the fight against leprosy has been one of the greatest public health success and in the country, was eliminated in the mid-1990s. However on the 22nd August 2017 a confirmed leprosy cases was reported by the National Referral Hospital.

Objective:

To strengthen public health surveillance to monitor neglected tropical diseases (NTDs) like leprosy as a control measure to avert disabilities in the Kingdom of Swaziland.

Influenza infection is caused by the influenza virus, a single-stranded RNA virus belonging to the Orthomyxoviridae family. Influenza viruses are classified as types A, B and C. Influenza A and B viruses can cause epidemic disease in humans and type C viruses usually cause a mild, cold-like illness. The influenza virus spreads rapidly around the world in seasonal epidemics, resulting in significant morbidity and mortality. On the 10th of July 2017, a case of confirmed Influenza A/H1N1 was reported through the immediate disease notification system from a private hospital in the Hhohho region. A 49 year old female was diagnosed of Influenza A/H1N1 after presenting with flu-like symptoms. Contacts of the index case were followed and further positive cases were identified.

Objective:

To establish morbidity patterns of influenza A/H1N1 in Swaziland from 10th July to 15th August 2017.