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Zadran A, Ho AVD, Zadran L, Ventura Curiel IJ, Pham TT, Thuan DTB, Kost GJ. Optimizing Public Health Preparedness for Highly Infectious Diseases in Central Vietnam. Diagnostics (Basel) 2022; 12:diagnostics12092047. [PMID: 36140451 PMCID: PMC9497681 DOI: 10.3390/diagnostics12092047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Our primary objectives were (a) to determine the need for and the availability of point-of-care testing (POCT) for infectious diseases and (b) to recommend point-of-care testing strategies and Spatial Care PathsTM (SCPs) that enhance public health preparedness in the regional districts of Thua Thien Hue Province (TTHP), Central Vietnam, where we conducted field surveys. Medical professionals in seven community health centers (CHCs), seven district hospitals (DHs) and one provincial hospital (PH) participated. Survey questions (English and Vietnamese) determined the status of diagnostic testing capabilities for infectious diseases and other acute medical challenges in TTHP. Infectious disease testing was limited: six of seven CHCs (86%) lacked infectious disease tests. One CHC (14%, 1/7) had two forms of diagnostic tests available for the detection of malaria. All CHCs lacked adequate microbiology laboratories. District hospitals had few diagnostic tests for infectious diseases (tuberculosis and syphilis), blood culture (29%, 2/7), and pathogen culture (57%, 4/7) available. The PH had broader diagnostic testing capabilities but lacked preparedness for highly infectious disease threats (e.g., Ebola, MERS-CoV, SARS, Zika, and monkeypox). All sites reported having COVID-19 rapid antigen tests; COVID-19 RT-PCR tests were limited to higher-tier hospitals. We conclude that infectious disease diagnostic testing should be improved and POC tests must be supplied near patients’ homes and in primary care settings for the early detection of infected individuals and the mitigation of the spread of new COVID-19 variants and other highly infectious diseases.
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Affiliation(s)
- Amanullah Zadran
- Point-of-Care Testing Center for Teaching and Research (POCT CTR) Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, CA 95616, USA
- Correspondence: (A.Z.); (G.J.K.); Tel.: +1-(510)-779-8698 (A.Z.)
| | - An V. D. Ho
- Department of Orthopedics and Rehabilitation, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 70000, Vietnam
| | - Layma Zadran
- Point-of-Care Testing Center for Teaching and Research (POCT CTR) Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, CA 95616, USA
| | - Irene J. Ventura Curiel
- Point-of-Care Testing Center for Teaching and Research (POCT CTR) Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, CA 95616, USA
| | - Tang-Tung Pham
- Faculty of Medicine, Phan Chau Trinh University, No 9 Nguyen Gia Thieu St, Dien Ban Ward, Dien Ngoc District, Danang City 550000, Vietnam
| | - Duong Thi Bich Thuan
- College of Health Sciences, VinUniversity, Vinhomes Ocean Park, Gia Lam District, Hanoi 100000, Vietnam
| | - Gerald J. Kost
- Point-of-Care Testing Center for Teaching and Research (POCT CTR) Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, CA 95616, USA
- Correspondence: (A.Z.); (G.J.K.); Tel.: +1-(510)-779-8698 (A.Z.)
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Li Y, Wang H, Jin XR, Li X, Pender M, Song CP, Tang SL, Cao J, Wu H, Wang YG. Experiences and challenges in the health protection of medical teams in the Chinese Ebola treatment center, Liberia: a qualitative study. Infect Dis Poverty 2018; 7:92. [PMID: 30134982 PMCID: PMC6103862 DOI: 10.1186/s40249-018-0468-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 07/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background Health care workers are at the frontline in the fight against infectious disease, and as a result are at a high risk of infection. During the 2014–2015 Ebola outbreak in West Africa, many health care workers contracted Ebola, some fatally. However, no members of the Chinese Anti-Ebola medical team, deployed to provide vital medical care in Liberia were infected. This study aims to understand how this zero infection rate was achieved. Methods Data was collected through 15 in-depth interviews with participants from the People’s Liberation Army of China medical team which operated the Chinese Ebola Treatment Center from October 2014 to January 2015 in Liberia. Data were analysed using systematic framework analysis. Results This study found numerous bio-psycho-socio-behavioural risk factors that directly or indirectly threatened the health of the medical team working in the Chinese Ebola Treatment Center. These factors included social and emotional stress caused by: (1) the disruption of family and social networks; (2) adapting to a different culture; (3) and anxiety over social and political unrest in Liberia. Exposure to Ebola from patients and local co-workers, and the incorrect use of personal protective equipment due to fatigue was another major risk factor. Other risk factors identified were: (1) shortage of supplies; (2) lack of trained health personnel; (3) exposure to contaminated food and water; (4) and long working hours. Comprehensive efforts were taken throughout the mission to mitigate these factors. Every measure was taken to prevent the medical team’s exposure to the Ebola virus, and to provide the medical team with safe, comfortable working and living environments. There were many challenges in maintaining the health safety of the team, such as the limited capability of the emergency command system (the standardized approach to the command, control, and coordination of an emergency response), and the lack of comprehensive international protocols for dealing with emerging infectious disease pandemics. Conclusions The comprehensive and multidisciplinary measures employed to protect the health of the medical team proved successful even in Liberia’s resource-limited setting. The global health community can learn valuable lessons from this experience which could improve the safety of health care workers in future emergencies. These lessons include: establishing capable command systems; implementing effective coordination mechanisms; providing adequate equipment; providing training for medical teams; investing in the development of global health professionals; and improving research on ways to protect health care workers. Electronic supplementary material The online version of this article (10.1186/s40249-018-0468-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Huan Wang
- Bureau of Medical Affairs Administration, First affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xu-Rui Jin
- The Cadet Brigade of Clinic Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Xiang Li
- The Cadet Brigade of Clinic Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Michelle Pender
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Cai-Ping Song
- Bureau of nurse Administration, Second affiliated hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Sheng-Lan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jia Cao
- Department of Hygienic Toxicology, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hao Wu
- Bureau of Medical Affairs Administration, First affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yun-Gui Wang
- Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba district, Chongqing, 400038, China.
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Harmon JR, Nichol ST, Spiropoulou CF, McElroy AK. Whole Blood-Based Multiplex Immunoassays for the Evaluation of Human Biomarker Responses to Emerging Viruses in Resource-Limited Regions. Viral Immunol 2017; 30:671-674. [PMID: 28937957 DOI: 10.1089/vim.2017.0088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Many emerging viruses such as Ebola and Lassa occur in resource-limited areas of the world. The advent of multiplex immunoassays has facilitated the study of biomarkers of disease since only small amounts of clinical material are required; however, such assays are designed and validated for only plasma or serum. This is a significant impediment when studying infectious diseases in the context of an outbreak in a developing nation. Plasma or serum can be difficult to obtain in the field due to the need for additional processing of infectious materials. Evaluation of multiplex immunoassays using frozen and thawed human whole blood (WB) would permit additional analysis using a more readily available human clinical sample. In this study, frozen and thawed human WB was directly compared with frozen and thawed plasma from normal healthy donors in a series of multiplexed immunoassays for 59 different biomarkers. We demonstrate that most important biomarkers can be evaluated using thawed WB, which will facilitate the study of human cytokine and other biomarker responses to viruses emerging in resource-limited regions.
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Affiliation(s)
- Jessica R Harmon
- 1 U.S. Centers for Disease Control and Prevention , Viral Special Pathogens Branch, Atlanta, Georgia
| | - Stuart T Nichol
- 1 U.S. Centers for Disease Control and Prevention , Viral Special Pathogens Branch, Atlanta, Georgia
| | - Christina F Spiropoulou
- 1 U.S. Centers for Disease Control and Prevention , Viral Special Pathogens Branch, Atlanta, Georgia
| | - Anita K McElroy
- 1 U.S. Centers for Disease Control and Prevention , Viral Special Pathogens Branch, Atlanta, Georgia .,2 Division of Pediatric Infectious Disease, Emory University School of Medicine , Atlanta, Georgia .,3 Division of Pediatric Infectious Disease, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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McElroy AK, Harmon JR, Flietstra TD, Campbell S, Mehta AK, Kraft CS, Lyon MG, Varkey JB, Ribner BS, Kratochvil CJ, Iwen PC, Smith PW, Ahmed R, Nichol ST, Spiropoulou CF. Kinetic Analysis of Biomarkers in a Cohort of US Patients With Ebola Virus Disease. Clin Infect Dis 2016; 63:460-7. [PMID: 27353663 DOI: 10.1093/cid/ciw334] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/07/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Ebola virus (EBOV) infection causes a severe and often fatal disease. Despite the fact that more than 30 000 individuals have acquired Ebola virus disease (EVD), the medical and scientific community still does not have a clear understanding of the mechanisms by which EBOV causes such severe disease. METHODS In this study, 54 biomarkers in plasma samples serially collected from 7 patients with EVD were analyzed in an attempt to define the kinetics of inflammatory modulators. Two clinical disease groups were defined (moderate and severe) based on the need for clinical support. Biomarkers were evaluated for correlation with viremia and clinical disease in an effort to identify pathways that could be useful targets of therapeutic intervention. RESULTS Patients with severe disease had higher viremia than those with moderate disease. Several biomarkers of immune activation and control were significantly elevated in patients with moderate disease. A series of pro-inflammatory cytokines and chemokines were significantly elevated in patients with severe disease. CONCLUSIONS Biomarkers that were associated with severe EVD were proinflammatory and indicative of endothelial or coagulation cascade dysfunction, as has been seen historically in patients with fatal outcomes. In contrast, biomarkers that were associated with moderate EVD were suggestive of a strong interferon response and control of both innate and adaptive responses. Therefore, clinical interventions that modulate the phenotype and magnitude of immune activation may be beneficial in treating EVD.
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Affiliation(s)
- Anita K McElroy
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention Division of Pediatric Infectious Disease
| | - Jessica R Harmon
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention Division of Pediatric Infectious Disease
| | - Timothy D Flietstra
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention
| | - Shelley Campbell
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention
| | | | - Colleen S Kraft
- Division of Infectious Diseases Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | - Philip W Smith
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center College of Medicine, Omaha
| | | | - Stuart T Nichol
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention
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Geisen C, Kann G, Strecker T, Wolf T, Schüttfort G, van Kraaij M, MacLennan S, Rummler S, Weinigel C, Eickmann M, Fehling SK, Krähling V, Seidl C, Seifried E, Schmidt M, Schäfer R. Pathogen-reduced Ebola virus convalescent plasma: first steps towards standardization of manufacturing and quality control including assessment of Ebola-specific neutralizing antibodies. Vox Sang 2016; 110:329-35. [PMID: 26766162 DOI: 10.1111/vox.12376] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Ebola virus disease is a public health emergency of international concern, and enormous efforts are being made in the development of vaccines and therapies. Ebola virus convalescent plasma is a promising anti-infective treatment of Ebola virus disease. Therefore, we developed and implemented a pathogen-reduced Ebola virus convalescent plasma concept in accordance with national, European and global regulatory framework. MATERIALS AND METHODS Ebola virus convalescent plasma manufacture and distribution was managed by a collection centre, two medical centres and an expert group from the European Blood Alliance. Ebola virus convalescent plasma was collected twice with an interval of 61 days from a donor recovering from Ebola virus disease in Germany. After pathogen reduction, the plasma was analysed for Ebola virus-specific immunoglobulin G (IgG) antibodies and its Ebola virus neutralizing activity. RESULTS Convalescent plasma could be collected without adverse events. Anti-Ebola virus IgG titres and Ebola-specific neutralizing antibodies in convalescent plasma were only slightly reduced after pathogen reduction treatment with S59 amotosalen/UVA. A patient in Italy with Ebola virus disease was treated with convalescent plasma without apparent adverse effects. DISCUSSION As proof of principle, we describe a concept and practical implementation of pathogen-reduced Ebola virus convalescent plasma manufacture, quality control and its clinical application to an Ebola virus disease patient.
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Affiliation(s)
- C Geisen
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt am Main, Germany
| | - G Kann
- Department of Infectious Diseases, Goethe University Hospital, Frankfurt am Main, Germany
| | - T Strecker
- Institute of Virology, Philipps University Marburg, Marburg, Germany
| | - T Wolf
- Department of Infectious Diseases, Goethe University Hospital, Frankfurt am Main, Germany
| | - G Schüttfort
- Department of Infectious Diseases, Goethe University Hospital, Frankfurt am Main, Germany
| | | | | | - S Rummler
- Institute of Transfusion Medicine, University Hospital Jena, Jena, Germany
| | - C Weinigel
- Institute of Transfusion Medicine, University Hospital Jena, Jena, Germany
| | - M Eickmann
- Institute of Virology, Philipps University Marburg, Marburg, Germany
| | - S K Fehling
- Institute of Virology, Philipps University Marburg, Marburg, Germany
| | - V Krähling
- Institute of Virology, Philipps University Marburg, Marburg, Germany
| | - C Seidl
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt am Main, Germany
| | - E Seifried
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt am Main, Germany
| | - M Schmidt
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt am Main, Germany
| | - R Schäfer
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt am Main, Germany
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