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Elazar S, Zelikovich Y, Levine H, Tzurel-Ferber A, Galor I, Hartal M. Secular trends in 1,192 diarrheal outbreaks in the Israel Defence Forces between 1988-2011. DISASTER AND MILITARY MEDICINE 2015; 1:14. [PMID: 28265429 PMCID: PMC5330014 DOI: 10.1186/s40696-015-0004-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/14/2015] [Indexed: 12/05/2022]
Abstract
Background In the military, outbreaks of infectious diarrhea pose a significant health problem. In this descriptive analysis of data collected by the IDF on all infectious diarrhea outbreaks between 1988–2011, we analysed temporal, seasonal, and unit-type trends in 1,192 diarrheal outbreaks in the Israel Defence Forces (IDF) over a 24-year period, and described the long-term trends in seasonality and the effects of strategic preventive measures on outbreak frequency among populations at risk. Results We found two distinct phases in annual outbreak occurrence. The mean annual number of outbreaks during the period 1988–1996 was 75.8 (±14.50) but dropped to 34.0 (±8.13) during the period 1997–2011 (P < 0.0001). Overall, a downward trend continued through the 1990’s, while from 2000 onwards outbreak counts fluctuated annually. A significantly higher number of outbreaks occurred during the summer season, throughout the study period. The greatest number of outbreaks occurred in deployed units, although the proportion of outbreaks in this unit type decreased over time. Accordingly, the proportion of outbreaks in training units more than doubled during the study window. When we looked at outbreak size, summer outbreaks increased in magnitude over time, and during all periods outbreaks were larger, on average, in training units than in deployed units. Conclusions The changing patterns in diarrheal outbreaks in the Israel Defence Forces require maintenance of a higher level of vigilance than ever before. Lack of a clear peak period require the use of all available preventive measures throughout the year. This is especially true in training units, where the increased number of outbreaks coincides with increased trainee volume, regardless of season.
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Affiliation(s)
- Sharon Elazar
- Israel Defense Forces Medical Corps, Department of Public Health, Tel Aviv, Israel
| | - Yifat Zelikovich
- Israel Defense Forces Medical Corps, Department of Public Health, Tel Aviv, Israel
| | - Hagai Levine
- Israel Defense Forces Medical Corps, Department of Public Health, Tel Aviv, Israel.,Hebrew University-Hadassah Braun School of Public Health, Jerusalem, Israel
| | - Anat Tzurel-Ferber
- Israel Defense Forces Medical Corps, Department of Public Health, Tel Aviv, Israel
| | - Inbal Galor
- Israel Defense Forces Medical Corps, Department of Public Health, Tel Aviv, Israel
| | - Michael Hartal
- Israel Defense Forces Medical Corps, Department of Public Health, Tel Aviv, Israel.,Department of Military Medicine, Hebrew University Faculty of Medicine, Jerusalem, Israel
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Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, Schuster M, MacDonald NE, Wilson R. Measuring vaccine hesitancy: The development of a survey tool. Vaccine 2015; 33:4165-75. [PMID: 25896384 DOI: 10.1016/j.vaccine.2015.04.037] [Citation(s) in RCA: 494] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In March 2012, the SAGE Working Group on Vaccine Hesitancy was convened to define the term "vaccine hesitancy", as well as to map the determinants of vaccine hesitancy and develop tools to measure and address the nature and scale of hesitancy in settings where it is becoming more evident. The definition of vaccine hesitancy and a matrix of determinants guided the development of a survey tool to assess the nature and scale of hesitancy issues. Additionally, vaccine hesitancy questions were piloted in the annual WHO-UNICEF joint reporting form, completed by National Immunization Managers globally. The objective of characterizing the nature and scale of vaccine hesitancy issues is to better inform the development of appropriate strategies and policies to address the concerns expressed, and to sustain confidence in vaccination. The Working Group developed a matrix of the determinants of vaccine hesitancy informed by a systematic review of peer reviewed and grey literature, and by the expertise of the working group. The matrix mapped the key factors influencing the decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine-specific. These categories framed the menu of survey questions presented in this paper to help diagnose and address vaccine hesitancy.
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Affiliation(s)
- Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom and Department of Global Health, University of Washington, Seattle, USA.
| | - Caitlin Jarrett
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom and Department of Global Health, University of Washington, Seattle, USA
| | - William S Schulz
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom and Department of Global Health, University of Washington, Seattle, USA
| | | | | | - Eve Dube
- Institut National de Santé Publique du Québec, Canada
| | | | - Noni E MacDonald
- Department of Paediatrics, Dalhousie University, Canadian Centre for Vaccinology, IWK Health Centre, Halifax, Canada
| | - Rose Wilson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom and Department of Global Health, University of Washington, Seattle, USA
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Porter CK, Fitamaurice G, Tribble DR, Armstrong AW, Mostafa M, Riddle MS. Willingness to receive a hypothetical avian influenza vaccine among US military personnel in mid-deployment. Hum Vaccin Immunother 2013; 9:2613-7. [PMID: 23917256 DOI: 10.4161/hv.25910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Though no avian influenza vaccine currently exists, development efforts have increased. Given recent reports of suboptimal vaccination rates among US military personnel, we sought to assess factors associated with a willingness to receive a hypothetical avian influenza vaccine. A self-administered questionnaire was completed by US military personnel during mid-deployment to Iraq, Afghanistan, and surrounding regions. Respondents were predominately male (86.2%), Army (72.1%), and enlisted (86.3%) with a mean age of 29.6 y. The majority (77.1%) agreed to receive an avian influenza vaccine if available. Exploratory factor analysis (EFA) identified two factors, vaccine importance and disease risk, that best described the individual perceptions and both were associated with an increased willingness to receive the hypothetical vaccine (OR: 8.2 and 1.6, respectively). Importantly, after controlling for these factors differences in the willingness to receive this hypothetical vaccine were observed across gender and branch of service. These results indicated that targeted education on vaccine safety and efficacy as well as disease risk may modify vaccination patterns in this population.
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Affiliation(s)
- Chad K Porter
- Naval Medical Research Center; Enteric Diseases Department; Silver Spring, MD USA
| | - Gina Fitamaurice
- George Washington University; School of Public Health and Health Services; Washington, DC USA
| | - David R Tribble
- Infectious Diseases Clinical Research Program; Uniformed Services University; Bethesda, MD USA
| | | | - Manal Mostafa
- United States Naval Medical Research Unit No. 3; Cairo, Egypt
| | - Mark S Riddle
- Naval Medical Research Center; Enteric Diseases Department; Silver Spring, MD USA
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Connor P, Hutley E, Mulcahy HE, Riddle MS. Enteric disease on Operation HERRICK. J ROY ARMY MED CORPS 2013; 159:229-36. [DOI: 10.1136/jramc-2013-000084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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McNeil MM, Arana J, Stewart B, Hartshorn M, Hrncir D, Wang H, Lamias M, Locke M, Stamper J, Tokars JI, Engler RJ. A cluster of nonspecific adverse events in a military reserve unit following pandemic influenza A (H1N1) 2009 vaccination—Possible stimulated reporting? Vaccine 2012; 30:2421-6. [DOI: 10.1016/j.vaccine.2012.01.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/20/2012] [Accepted: 01/23/2012] [Indexed: 10/14/2022]
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Money NN, Maves RC, Sebeny P, Kasper MR, Riddle MS, Wu M, Lee JE, Schnabel D, Bowden R, Oaks EV, Ocaña V, Acosta L, Gotuzzo E, Lanata C, Ochoa T, Aguayo N, Bernal M, Meza R, Canal E, Gregory M, Cepeda D, Listiyaningsih E, Putnam SD, Young S, Mansour A, Nakhla I, Moustafa M, Hassan K, Klena J, Bruton J, Shaheen H, Farid S, Fouad S, El-Mohamady H, Styles T, Shiau LCDRD, Espinosa B, McMullen K, Reed E, Neil D, Searles D, Nevin R, Von Thun A, Sessions C. Enteric disease surveillance under the AFHSC-GEIS: current efforts, landscape analysis and vision forward. BMC Public Health 2011; 11 Suppl 2:S7. [PMID: 21388567 PMCID: PMC3092417 DOI: 10.1186/1471-2458-11-s2-s7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The mission of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) is to support global public health and to counter infectious disease threats to the United States Armed Forces, including newly identified agents or those increasing in incidence. Enteric diseases are a growing threat to U.S. forces, which must be ready to deploy to austere environments where the risk of exposure to enteropathogens may be significant and where routine prevention efforts may be impractical. In this report, the authors review the recent activities of AFHSC-GEIS partner laboratories in regards to enteric disease surveillance, prevention and response. Each partner identified recent accomplishments, including support for regional networks. AFHSC/GEIS partners also completed a Strengths, Weaknesses, Opportunities and Threats (SWOT) survey as part of a landscape analysis of global enteric surveillance efforts. The current strengths of this network include excellent laboratory infrastructure, equipment and personnel that provide the opportunity for high-quality epidemiological studies and test platforms for point-of-care diagnostics. Weaknesses include inconsistent guidance and a splintered reporting system that hampers the comparison of data across regions or longitudinally. The newly chartered Enterics Surveillance Steering Committee (ESSC) is intended to provide clear mission guidance, a structured project review process, and central data management and analysis in support of rationally directed enteric disease surveillance efforts.
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Affiliation(s)
- Nisha N Money
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
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