Redefining pandemic preparedness: Multidisciplinary insights from the CERP modelling workshop in infectious diseases, workshop report

In July 2023, the Center of Excellence in Respiratory Pathogens organized a two-day workshop on infectious diseases modelling and the lessons learnt from the Covid-19 pandemic. This report summarizes the rich discussions that occurred during the workshop. The workshop participants discussed multisource data integration and highlighted the benefits of combining traditional surveillance with more novel data sources like mobility data, social media, and wastewater monitoring. Significant advancements were noted in the development of predictive models, with examples from various countries showcasing the use of machine learning and artificial intelligence in detecting and monitoring disease trends. The role of open collaboration between various stakeholders in modelling was stressed, advocating for the continuation of such partnerships beyond the pandemic. A major gap identified was the absence of a common international framework for data sharing, which is crucial for global pandemic preparedness. Overall, the workshop underscored the need for robust, adaptable modelling frameworks and the integration of different data sources and collaboration across sectors, as key elements in enhancing future pandemic response and preparedness.

A New Model for Ranking Schools of Public Health: The Public Health Academic Ranking

Objectives: As there is no ranking designed for schools of Public Health, the aim of this project was to create one. Methods: To design the Public Health Academic Ranking (PHAR), we used the InCites Benchmarking and Analytics™ software and the Web Of Science™ Core Collection database. We collected bibliometric data on 26 schools of Public Health from each continent, between August and September 2022. We included 11 research indicators/scores, covering four criteria (productivity, quality, accessibility for readers, international collaboration), for the period 2017-2021. For the Swiss School of Public Health (SSPH+), a network gathering faculties across different universities, a specific methodology was used, with member-specific research queries. Results: The five top schools of the PHAR were: London School of Hygiene and Tropical Medicine, Public Health Foundation of India, Harvard T.H. Chan School of Public Health, SSPH+, Johns Hopkins Bloomberg School of Public Health. Conclusion: The PHAR allows worldwide bibliometric ordering of schools of Public Health. As this is a pilot project, the results must be taken with caution. This article aims to critically discuss its methodology and future improvements.

[Scientific consensus-building to promote the link between science and public policy]

Consensus, defined as the position on which most scientists specialized in a given field agree at a given time, is a key aspect in increasing the readability, credibility and, ultimately, the use of scientific knowledge in public (evidence-based health policy). This article presents several methods aiming at developing scientific consensus between experts, such as the conventional or rapid Delphi approach, the nominal group technique, the RAND-UCLA appropriateness method and the consensus development conference. These methods are used to synthesize expert judgements when uncertainties persist in the literature - each with its own specificities in terms of duration, number of steps and expert participants enlisted, as well as the ways in which they are involved.

Indoor Air Quality and COVID-19: A Scoping Review

Objectives: The COVID-19 pandemic has been a major public health concern for the past 3 years. Scientific evidence on the relationship between SARS-CoV-2 infection and indoor air quality still needs to be demonstrated. This scoping review aims to study the association between air quality indoors and COVID-19. Methods: A scoping review analyzing the association between indoor air quality and epidemiological outcomes was conducted. Papers published between 1 January 2020 and 31 October 2022 were included. Hospital settings were excluded from the study. Results: Eight relevant articles met the inclusion criteria. Indoor settings included workplaces, schools, restaurants, and public transport. Types of ventilation used to improve indoor air quality were dilution methods (opening windows) and mechanical systems with or without filtration or purifier. CO2 sensors were employed in one study. All the studies showed a positive association between indoor air quality and its improvement and epidemiological indicators. Conclusion: The findings of this scoping review indicate that indoor air quality, which can be improved with ventilation methods, may reduce the risk of developing COVID-19. Ventilation could thus be viewed as a possible effective mitigating method.

Asymptomatic dengue infection rate: A systematic literature review

Objectives

Dengue infection is spreading worldwide. The clinical spectrum is broad and includes asymptomatic infections. This review provides an overview of the different proportions of asymptomatic infections described in epidemiological studies according to definitions, study designs, and detection methods.

Methods

Medline and Embase databases were searched without restriction of date or language. Studies were included if they reported data on the incidence or prevalence of asymptomatic dengue infections. The data were summarized and classified according to the definitions of the term 'asymptomatic'.

Results

A total of 74 studies were included. The mean proportion of asymptomatic infections among dengue-infected persons was 54% in 50 included studies. The prevalence of dengue infections detected in healthy persons was 0.2% in 24 included studies. The term 'asymptomatic' has been used to refer to 'clinically undetectable infection', but also to 'undiagnosed infection' or 'mild infection'. Only 8% were clinically undetectable laboratory-confirmed dengue infections.

Conclusion

The proportion of asymptomatic dengue infections varied greatly. Studies proving data on clinically undetectable laboratory-confirmed dengue infections were very few, but provided consistent results of low proportions of asymptomatic infections. These data challenge the assumption that the majority of dengue cases are asymptomatic.

Impact of rituximab on humoral response to SARS-CoV-2 vaccination in previously vaccinated patients with autoimmune diseases

SARS-CoV-2 infection is more severe in patients undergoing rituximab (RTX) treatment. Humoral response to vaccination is severely impaired in patients already treated with RTX, but data on antibody persistence in patients initiating RTX are lacking. We evaluated the impact of RTX initiation on humoral response to SARS-CoV-2 vaccination in previously vaccinated patients with immune-mediated inflammatory diseases. We performed a retrospective, multicenter study evaluating the evolution of anti-spike antibodies and breakthrough infections after initiation of RTX in previously vaccinated patients with protective levels of anti-SARS-CoV-2 antibodies. Threshold for anti-S antibodies positivity and protection were 30 and 264 BAU/mL, respectively. We included 31 previously vaccinated patients initiating RTX (21 female, median age 57 years). At first RTX infusion, 12 (39%) patients had received 2 doses of vaccine, 15 (48%) had received 3 doses, and 4 (13%) had received 4 doses. The most frequent underlying diseases were ANCA-associated vasculitis (29%) and rheumatoid arthritis (23%). Median anti-S antibody titers at RTX initiation, 3 months, and 6 months were 1620 (589-2080), 1055 (467-2080), and 407 (186-659) BAU/mL, respectively. Overall, antibody titers waned by almost two-fold at 3 months and four-fold at 6 months. Median antibody titers were significantly higher in patients who received ≥3 doses compared to those who received only 2 doses. Three patients developed SARS-CoV-2 infection without any severe symptom. Anti-SARS-CoV-2 antibody titers in previously vaccinated patients decline after RTX initiation similarly to general population. Specific monitoring is useful to anticipate prophylactic strategies. Key Points • Anti-SARS-CoV-2 antibody titers in previously vaccinated patients decline after rituximab initiation similarly to the general population. • The number of dose of vaccine before rituximab initiation is associated with higher antibody titers at month 3. • Monitoring antibody levels is mandatory to initiate prophylactic strategies in this population.

[Epidemic forecasting and COVID-19]

Since December 2019, the COVID-19 pandemic has had a major impact on global health and the economy. Epidemiological forecasts are crucial for governmental decisions, healthcare officials, and the general public. A collaboration between the Institute of Global Health at the University of Geneva and the Swiss Data Science Center created an interactive dashboard providing forecasts for over 200 countries and territories. This dashboard has been a valuable tool for the public and authorities alike. The pandemic has highlighted the importance of international collaborations and a robust national surveillance system. Data collection systems, pathogen-agnostic models, and communication tools need to be consolidated and maintained in operation.

Psychiatric consequences and issues of long COVID on patients with prior psychiatric comorbidities: a scoping review

SARS-CoV-2 is a growing field of research and mental health in long COVID is one of its interesting domains. This scoping review aims at studying the outcomes of mental health in patients already known for psychiatric illness. This was done by researching the literature in two databases (Embase and PubMed) for articles studying mental health consequences of long COVID in patients already known for psychiatric history. Eleven studies were included. 6/11 studies found an effect of long COVID, with varying severity of outcomes studied, with either a worsening in length or severity. 4/11 did not find any correlation between worsening symptoms and psychiatric history. The methods for assessing which psychiatric symptoms to include and how to determine prior history were heterogeneous, making direct comparison sometimes difficult. The data seem to show worse effects of long COVID on mental health of patients with prior mental illness, with limitations regarding the heterogeneity of the studies' designs and focuses. It also highlights how neglected this population of patients is in the current state of research.

A community-based contact isolation strategy to reduce the spread of Ebola virus disease: an analysis of the 2018-2020 outbreak in the Democratic Republic of the Congo

INTRODUCTION

Despite tremendous progress in the development of diagnostics, vaccines and therapeutics for Ebola virus disease (EVD), challenges remain in the implementation of holistic strategies to rapidly curtail outbreaks. We investigated the effectiveness of a community-based contact isolation strategy to limit the spread of the disease in the Democratic Republic of Congo (DRC).

METHODS

We did a quasi-experimental comparison study. Eligible participants were EVD contacts registered from 12 June 2019 to 18 May 2020 in Beni and Mabalako Health Zones. Intervention group participants were isolated to specific community sites for the duration of their follow-up. Comparison group participants underwent contact tracing without isolation. The primary outcome was measured as the reproduction number (R) in the two groups. Secondary outcomes were the delay from symptom onset to isolation and case management, case fatality rate (CFR) and vaccination uptake.

RESULTS

27 324 EVD contacts were included in the study; 585 in the intervention group and 26 739 in the comparison group. The intervention group generated 32 confirmed cases (5.5%) in the first generation, while the comparison group generated 87 (0.3%). However, the 32 confirmed cases arising from the intervention contacts did not generate any additional transmission (R=0.00), whereas the 87 confirmed cases arising from the comparison group generated 99 secondary cases (R=1.14). The average delay between symptom onset and case isolation was shorter (1.3 vs 4.8 days; p<0.0001), CFR lower (12.5% vs 48.4%; p=0.0001) and postexposure vaccination uptake higher (86.0% vs 56.8%; p<0.0001) in the intervention group compared with the comparison group. A significant difference was also found between intervention and comparison groups in survival rate at the discharge of hospitalised confirmed patients (87.9% vs 47.7%, respectively; p=0.0004).

CONCLUSION

The community-based contact isolation strategy used in DRC shows promise as a potentially effective approach for the rapid cessation of EVD transmission, highlighting the importance of rapidly implemented, community-oriented and trust-building control strategies.

Severe SARS-CoV-2 infection as a marker of undiagnosed cancer: a population-based study

No study has yet investigated if a severe SARS-CoV-2 infection represents a marker of an undiagnosed cancer. This population-based study, using the SNDS database, identified from 02/15/2020 to 08/31/2021, 41,302 individuals hospitalized in intensive care unit due to SARS-CoV-2 (ICU-gr) and 713,670 control individuals not hospitalized for SARS-CoV-2 (C-gr). Individuals were matched according to year of birth, sex and French department. The cancer incidence was compared in the two groups during the follow-up period (index date-12/31/2021), using Cox proportional hazards models adjusted on matching variables, socioeconomic characteristics and comorbidities. In the ICU-gr, 2.2% (n = 897) was diagnosed with a cancer in the following months, compared to 1.5% (n = 10,944) in the C-gr. The ICU-gr had a 1.31 higher risk of being diagnosed with a cancer following hospital discharge compared to the C-gr (aHR 1.31, 95% CI 1.22-1.41). A global similar trend was found when competing risk of death was taken into account (aHR 1.25, 95% CI 1.16-1.34). A significant higher risk was found concerning renal (aHR 3.16, 95% CI 2.33-4.27), hematological (aHR 2.54, 95% CI 2.07-3.12), colon (aHR 1.72, 95% CI 1.34-2.21), and lung (aHR 1.70, 95% CI 1.39-2.08) cancers. This suggests that a severe SARS-CoV-2 infection may represent a marker of an undiagnosed cancer.

Genetic characterization of dengue virus serotype 1 circulating in Reunion Island, 2019-2021, and the Seychelles, 2015-2016

BACKGROUND

An unprecedent increase in the number of cases and deaths reported from dengue virus (DENV) infection has occurred in the southwestern Indian ocean in recent years. From 2017 to mid-2021 more than 70,000 confirmed dengue cases were reported in Reunion Island, and 1967 cases were recorded in the Seychelles from 2015 to 2016. Both these outbreaks displayed similar trends, with the initial circulation of DENV-2 which was replaced by DENV-1. Here, we aim to determine the origin of the DENV-1 epidemic strains and to explore their genetic characteristics along the uninterrupted circulation, particularly in Reunion.

METHODS

Nucleic acids were extracted from blood samples collected from dengue positive patients; DENV-1 was identified by RT-qPCR. Positive samples were used to infect VERO cells. Genome sequences were obtained from either blood samples or infected-cell supernatants through a combination of both Illumina or MinION technologies.

RESULTS

Phylogenetic analyses of partial or whole genome sequences revealed that all DENV-1 sequences from Reunion formed a monophyletic cluster that belonged to genotype I and were closely related to one isolate from Sri Lanka (OL752439.1, 2020). Sequences from the Seychelles belonged to the same major phylogenetic branch of genotype V, but fell into two paraphyletic clusters, with greatest similarity for one cluster to 2016-2017 isolate from Bangladesh, Singapore and China, and for the other cluster to ancestral isolates from Singapore, dating back to 2012. Compared to publicly available DENV-1 genotype I sequences, fifteen non-synonymous mutations were identified in the Reunion strains, including one in the capsid and the others in nonstructural proteins (NS) (three in NS1, two in NS2B, one in NS3, one in NS4B, and seven in NS5).

CONCLUSION

In contrast to what was seen in previous outbreaks, recent DENV-1 outbreaks in Reunion and the Seychelles were caused by distinct genotypes, all likely originating from Asia where dengue is (hyper)endemic in many countries. Epidemic DENV-1 strains from Reunion harbored specific non-synonymous mutations whose biological significance needs to be further investigated.

Investigation of Dengue Infection in Asymptomatic Individuals during a Recent Outbreak in La Réunion

The number of dengue cases has increased dramatically over the past 20 years and is an important concern, particularly as the trends toward urbanization continue. While the majority of dengue cases are thought to be asymptomatic, it is unknown to what extent these contribute to transmission. A better understanding of their importance would help to guide control efforts. In 2019, a dengue outbreak in La Reunion resulted in more than 18,000 confirmed cases. Between October 2019 and August 2020, 19 clusters were investigated in the south, west, and east of the island, enabling the recruitment of 605 participants from 368 households within a 200 m radius of the home of the index cases (ICs). No active asymptomatic infections confirmed by RT-PCR were detected. Only 15% were possible asymptomatic dengue infections detected by the presence of anti-dengue IgM antibodies. Only 5.3% of the participants had a recent dengue infection confirmed by RT-PCR. Although the resurgence of dengue in La Réunion is very recent (2016), the rate of anti-dengue IgG positivity, a marker of past infections, was already high at 43% in this study. Dengue transmission was focal in time and space, as most cases were detected within a 100-m radius of the ICs, and within a time interval of less than 7 days between infections detected in a same cluster. No particular demographic or socio-cultural characteristics were associated with dengue infections. On the other hand, environmental risk factors such as type of housing or presence of rubbish in the streets were associated with dengue infections.

Prevalence and predictors of psychological distress before, during, and after a COVID-19 pandemic wave in Switzerland, 2021

There are concerns about acute and long-term mental health effects of the COVID-19 pandemic. This study examined the prevalence and predictors of psychological distress before, during, and after a pandemic wave in Switzerland, 2021. Prevalence of psychological distress was estimated in adults aged 35-96 years using the General Health Questionnaire-12 administered in June 2021 (Specchio-COVID19 cohort, N = 3965), and compared to values from 2003 to 2006 (CoLaus|PsyCoLaus cohort, N = 5667). Anxiety and depression were assessed from February to June 2021 using the Generalised Anxiety Disorder scale-2 and the Patient Health Questionnaire-2, respectively. Prevalence of psychological distress in June 2021, after the pandemic wave (16.0% [95% CI, 14.6%-17.4%]) was comparable to pre-pandemic levels (15.1% [14.0%-16.2%]). Anxiety and depression were highest at the start of the pandemic wave in February 2021, and declined from February to June with the relaxation of measures. Predictors of psychological distress included being younger, female, a single parent, unemployed, a change in working hours or job loss in the past 6 months, greater perceived severity and contagiousness of COVID-19, and self-reported post COVID-19. By June 2021, following a pandemic wave, prevalence of psychological distress in Switzerland was closer to pre-pandemic levels. These findings highlight the need for additional mental health support during times of stricter government policies relating to COVID-19; yet they also suggest that individuals can adapt relatively quickly to the changing context.

Social media and internet search data to inform drug utilization: A systematic scoping review

Introduction

Drug utilization is currently assessed through traditional data sources such as big electronic medical records (EMRs) databases, surveys, and medication sales. Social media and internet data have been reported to provide more accessible and more timely access to medications' utilization.

Objective

This review aims at providing evidence comparing web data on drug utilization to other sources before the COVID-19 pandemic.

Methods

We searched Medline, EMBASE, Web of Science, and Scopus until November 25th, 2019, using a predefined search strategy. Two independent reviewers conducted screening and data extraction.

Results

Of 6,563 (64%) deduplicated publications retrieved, 14 (0.2%) were included. All studies showed positive associations between drug utilization information from web and comparison data using very different methods. A total of nine (64%) studies found positive linear correlations in drug utilization between web and comparison data. Five studies reported association using other methods: One study reported similar drug popularity rankings using both data sources. Two studies developed prediction models for future drug consumption, including both web and comparison data, and two studies conducted ecological analyses but did not quantitatively compare data sources. According to the STROBE, RECORD, and RECORD-PE checklists, overall reporting quality was mediocre. Many items were left blank as they were out of scope for the type of study investigated.

Conclusion

Our results demonstrate the potential of web data for assessing drug utilization, although the field is still in a nascent period of investigation. Ultimately, social media and internet search data could be used to get a quick preliminary quantification of drug use in real time. Additional studies on the topic should use more standardized methodologies on different sets of drugs in order to confirm these findings. In addition, currently available checklists for study quality of reporting would need to be adapted to these new sources of scientific information.

The impact of the Ebola epidemics on children's rights: a scoping review

BACKGROUND

The Ebola virus is known as one of the deadliest pathogens to infect humans. Children represent a minority of Ebola Virus Disease cases globally. Yet, the different Ebola outbreaks in Africa had a wide impact on children's lives and children' rights.

OBJECTIVE

Review the published literature to date on Children's rights during Ebola outbreaks. Outcomes shall contribute to get a better understanding of the main limitations or violations of children's rights, identify potential gaps in the literature and support the promotion and protection of children's rights for current and future health crisis.

METHODS

A scoping review from PubMed, Medline, Cochrane Library and Web of Science was performed using PRISMA-ScR guidelines. Articles, reports and editorial, published on Ebola Outbreaks between 1976 and 2020 were retrieved. The UNCRC clusters of rights and treaty specific guidelines were used as a framework. Documents were found through a targeted search of websites from international or regional organisations involved in Ebola crises and children's protection.

RESULTS

48 articles and reports were reviewed. Few documents focused solely on children's rights. Several articles covered the topic of children and Ebola outbreaks. Most of the data are linked to basic health, education, discrimination of orphans and survivors. 31% of the reviewed articles underline the violence against the children (rape, abuse, Female genital mutilations), while 21% focus on the right to education. 23% cover the topic of orphans. Impact on mental health and SRH were amongst the other covered topics.

CONCLUSION

A lack of data on children's rights and their violations during epidemics is observed. Regional and international collaboration is needed to document the situation of children in health emergencies. Health measures and strategies based on children's opinions and raising awareness of their crucial role in society is key. Child-centred guidelines should be developed based on these elements.

Impact de l’initiation d’un traitement par rituximab sur la réponse humoral à la vaccination anti-SARS-CoV-2 chez des patients ayant une maladie auto-immune et préalablement vaccinés

Introduction

L’infection à SARS-CoV-2 est plus sévère chez les patients ayant une maladie auto-immune traitée par rituximab. La réponse humorale à la vaccination anti-SARS-CoV-2 est fortement altérée chez les patients sous rituximab avec une production d’anticorps neutralisants corrélée au taux de lymphocytes B circulants. Notre objectif était d’évaluer l’impact de l’initiation d’un traitement par rituximab sur la réponse humorale au vaccin anti-SARS-CoV-2 chez des patients ayant une maladie auto-immune et préalablement vaccinés.

Patients et méthodes

Nous avons réalisé une étude rétrospective, descriptive, bicentrique, incluant des patients ayant été préalablement vaccinés par au moins 2 doses de vaccin anti-SARS-CoV-2 avec un taux d’anticorps anti-Spike protecteur (supérieur à 264 BAU/mL), et chez qui un traitement par rituximab était initié pour une maladie auto-immune, ou repris après plus d’un an d’interruption. Les critères de jugement principaux étaient l’évolution du taux d’anticorps anti-Spike à 3 mois et 6 mois après initiation du rituximab et la survenue d’une COVID-19. Un taux d’anticorps protecteur était défini par des IgG anti-Spike > 264 BAU/mL et une sérologie positive par un taux > 30 BAU/mL.

Résultats

Nous avons inclus 24 patients traités de novo par rituximab (17 femmes, âge médian 55 ans). Les pathologies les plus fréquentes étaient la polyarthrite rhumatoïde (29,2 %) et les vascularites associées aux ANCA (25 %). Le traitement le plus souvent associé était la corticothérapie orale (71 % des cas) avec une dose médiane de 17,5 (IQR : 6–40) mg/jour. Au moment de l’initiation du traitement par rituximab, 13 patients avaient reçu 2 doses de vaccin (54,2 %), 9 patients avaient reçu 3 doses (37,5 %) et 2 patients avaient reçu 4 doses (8,3 %). Le vaccin majoritaire était le BNT162B2 (83 %). Le délai médian entre la dernière dose de vaccin et l’administration du rituximab était de 35 jours (IQR : 15–54). Le taux d’anticorps était divisé par 3 à 3 mois de l’initiation du rituximab, et par presque 5 à 6 mois. À 3 mois, 13/14 (92,9 %) patients avaient un taux détectable d’anticorps anti-spike et 11/14 patients (78,6 %) avaient un taux protecteur. À 6 mois, 19/19 (100 %) des patients avaient un taux détectable et 13/19 (68,4 %) avaient un taux protecteur. Neuf patients ont reçu une dose supplémentaire de vaccin entre la première perfusion de rituximab et l’analyse à 6^e mois sans impact significatif sur l’évolution du taux d’anticorps. Aucune variable n’était significativement associée à un taux protecteur d’anticorps à 6 mois, notamment les pathologies, les traitements associés et le taux d’IgG total. Cependant, une tendance vers des taux d’anticorps plus élevés à 6 mois était observée chez les patients ayant reçu 3 doses de vaccins avant le rituximab en comparaison avec ceux ayant reçu 2 doses. Trois patients ont développé une COVID-19 après initiation du traitement par rituximab, de forme modérée et sans nécessité d’hospitalisation dans tous les cas.

Conclusion

La baisse du taux d’anticorps anti-spike après initiation d’un traitement par rituximab semble rapide, mais comparable à la baisse constatée dans la population générale [1], avec néanmoins une majorité des patients gardant des taux protecteurs d’anticorps. Une fois le traitement par rituximab débuté, une dose de vaccin supplémentaire ne semblait pas permettre l’augmentation des taux d’anticorps.

Trend estimation and short-term forecasting of COVID-19 cases and deaths worldwide

Since the beginning of the COVID-19 pandemic, many dashboards have emerged as useful tools to monitor its evolution, inform the public, and assist governments in decision-making. Here, we present a globally applicable method, integrated in a daily updated dashboard that provides an estimate of the trend in the evolution of the number of cases and deaths from reported data of more than 200 countries and territories, as well as 7-d forecasts. One of the significant difficulties in managing a quickly propagating epidemic is that the details of the dynamic needed to forecast its evolution are obscured by the delays in the identification of cases and deaths and by irregular reporting. Our forecasting methodology substantially relies on estimating the underlying trend in the observed time series using robust seasonal trend decomposition techniques. This allows us to obtain forecasts with simple yet effective extrapolation methods in linear or log scale. We present the results of an assessment of our forecasting methodology and discuss its application to the production of global and regional risk maps.

[The COVID-19 pandemic from a One Health perspective]

The "One Health" approach is essential to better understand and manage a pandemic of animal origin. Sensitive geopolitical considerations seem to hamper the investigations into the origin of the pandemic, but everything points to the Rhinolophus bat as the starting point of this devastating pandemic. Through a phenomenon of reverse zoonosis, several hundred cases of contamination of animals by SARS-CoV-2 have been identified worldwide, involving about twenty species of mammals. The virus has also passed from animals to humans in the case of infected mink farms in Denmark or through contact with hamsters in Hong Kong. For the development of vaccines and treatments and to help detect COVID-19 in train stations or airports, the animal has confirmed its role as a valuable auxiliary resource for humans in the fight against the pandemic.

[Teaching planetary health in pregraduate medical curriculum in Switzerland]

Environmental degradation, including climate change, is causing increasing threats to human health. To address these issues, health professionals, including future physicians, need to be educated in planetary health and sustainable healthcare. This article discusses possible content for pre-graduate education in planetary health and methods of implementation in the curriculum. It outlines several projects carried out in medical universities in Switzerland and underlines the effectiveness of students-led initiatives supported by faculties.

Mobility during the pandemic: how did our movements shape the course of COVID-19?

In this manuscript, we critically assess the evidence around various methods of reducing mobility, and how these have impacted the course of the coronavirus disease 2019 (COVID-19) pandemic. We further highlight the difficulty in assessing the effectiveness of such measures before giving directions for future research.

Knowledge, Attitudes, Beliefs, and Practices Regarding Dengue in La Réunion Island, France

Since 2017, La Réunion island has been facing a major epidemic of dengue. Despite actions carried out by the anti-vector control department, public authorities have failed to contain this epidemic. As individual involvement is key to success in vector control, we carried out a mixed-methods study on population knowledge, attitudes, beliefs, and practices (KABP) regarding dengue infection risk in La Réunion. The study combined quantitative data collected through a questionnaire administered to a representative sample of 622 people to assess the use of protective measures and the perception of severity and risk of dengue, and a sample of 336 people to assess the level of knowledge and concern about dengue, as well as qualitative data collected through semi-structured interviews among 11 individuals who had previously completed the questionnaire. The study results show that 63% of the surveyed population had a good level of knowledge associated with age, education, and socio-professional category variables—78% considered dengue to be a serious threat, and concern was estimated at 6/10, while 71% were likely to use protective measures. The interviews revealed contradictory behaviors in the implementation of recommended actions, in conflict with personal beliefs regarding respect of human body and nature. The study also revealed a loss of confidence in public authorities.

Time to death and risk factors associated with mortality among COVID-19 cases in countries within the WHO African region in the early stages of the COVID-19 pandemic

This study describes risk factors associated with mortality among COVID-19 cases reported in the WHO African region between 21 March and 31 October 2020. Average hazard ratios of death were calculated using weighted Cox regression as well as median time to death for key risk factors. We included 46 870 confirmed cases reported by eight Member States in the region. The overall incidence was 20.06 per 100 000, with a total of 803 deaths and a total observation time of 3 959 874 person-days. Male sex (aHR 1.54 (95% CI 1.31–1.81); P < 0.001), older age (aHR 1.08 (95% CI 1.07–1.08); P < 0.001), persons who lived in a capital city (aHR 1.42 (95% CI 1.22–1.65); P < 0.001) and those with one or more comorbidity (aHR 36.37 (95% CI 20.26–65.27); P < 0.001) had a higher hazard of death. Being a healthcare worker reduced the average hazard of death by 40% (aHR 0.59 (95% CI 0.37–0.93); P = 0.024). Time to death was significantly less for persons ≥60 years (P = 0.038) and persons residing in capital cities (P < 0.001). The African region has COVID-19-related mortality similar to that of other regions, and is likely underestimated. Similar risk factors contribute to COVID-19-associated mortality as identified in other regions.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies, risk factors for infection and associated symptoms in Geneva, Switzerland: a population-based study

Aims: To assess SARS-CoV-2 seroprevalence over the first epidemic wave in the canton of Geneva, Switzerland, as well as risk factors for infection and symptoms associated with IgG seropositivity. Methods: Between April and June 2020, former participants of a representative survey of the 20-74-year-old population of canton Geneva were invited to participate in the study, along with household members aged over 5 years. Blood samples were tested for anti-SARS-CoV-2 immunoglobulin G. Questionnaires were self-administered. We estimated seroprevalence with a Bayesian model accounting for test performance and sampling design. Results: We included 8344 participants, with an overall adjusted seroprevalence of 7.8% (95% credible interval 6.8-8.9). Seroprevalence was highest among 18-49 year-olds (9.5%), and lowest in 5-9-year-old children (4.3%) and individuals >65 years (4.7-5.4%). Odds of seropositivity were significantly reduced for female retirees and unemployed men compared to employed individuals, and smokers compared to non-smokers. We found no significant association between occupation, level of education, neighborhood income and the risk of being seropositive. The symptom most strongly associated with seropositivity was anosmia/dysgeusia. Conclusions: Anti-SARS-CoV-2 population seroprevalence remained low after the first wave in Geneva. Socioeconomic factors were not associated with seropositivity in this sample. The elderly, young children and smokers were less frequently seropositive, although it is not clear how biology and behaviours shape these differences.

Non-Migrant Paid Domestic Workers and Depressive Symptoms: A Mixed-Methods Systematic Review

Health of non-migrant paid domestic workers (PDWs) has seldom been studied. This review examines the relationship between being a non-migrant paid domestic worker and manifesting depressive symptoms (DS). Following a mixed-methods systematic review protocol, we found 10 relevant cross-sectional studies conducted in African, Asian, and Latin American countries. Depressive symptoms prevalence reported in quantitative studies ranged from 28% (CI: 22-35) to 53% (CI: 46-60). Qualitative evidence points towards structural conditions (poverty and intersectional discrimination) as drivers of female job placement in domestic work. Qualitative and quantitative evidence suggest that DS occurs more frequently in PDWs than other workers in the informal labor market. Psychosocial risks, working conditions, and workplace abuse play an intervening role in the development of DS. Future longitudinal research and adequate sampling methods are needed to examine protective factors, perceptions of working conditions, and work-family conflict in PDWs to better assess the development of DS among them.

Are People Optimistically Biased about the Risk of COVID-19 Infection? Lessons from the First Wave of the Pandemic in Europe

Unrealistic optimism, the underestimation of one's risk of experiencing harm, has been investigated extensively to understand better and predict behavioural responses to health threats. Prior to the COVID-19 pandemic, a relative dearth of research existed in this domain regarding epidemics, which is surprising considering that this optimistic bias has been associated with a lack of engagement in protective behaviours critical in fighting twenty-first-century, emergent, infectious diseases. The current study addresses this gap in the literature by investigating whether people demonstrated optimism bias during the first wave of the COVID-19 pandemic in Europe, how this changed over time, and whether unrealistic optimism was negatively associated with protective measures. Taking advantage of a pre-existing international participative influenza surveillance network (n = 12,378), absolute and comparative unrealistic optimism were measured at three epidemic stages (pre-, early, peak), and across four countries-France, Italy, Switzerland and the United Kingdom. Despite differences in culture and health response, similar patterns were observed across all four countries. The prevalence of unrealistic optimism appears to be influenced by the particular epidemic context. Paradoxically, whereas absolute unrealistic optimism decreased over time, comparative unrealistic optimism increased, suggesting that whilst people became increasingly accurate in assessing their personal risk, they nonetheless overestimated that for others. Comparative unrealistic optimism was negatively associated with the adoption of protective behaviours, which is worrying, given that these preventive measures are critical in tackling the spread and health burden of COVID-19. It is hoped these findings will inspire further research into sociocognitive mechanisms involved in risk appraisal.

Risks of Infection with SARS-CoV-2 Due to Contaminated Surfaces: A Scoping Review

The COVID-19 outbreak is a global health concern. Understanding the transmission modes of the SARS-CoV-2 virus is key to limit the spread of the pandemic. A lack of knowledge about the possibility of SARS-CoV-2 transmission and infection through contaminated surfaces is noticeable and recent studies have stated conflicting findings. This scoping review aims to understand the risks of contaminations via fomites better. Relevant publications were selected through Google Scholar, Web of Science, PubMed, Embase, Medline, and Cochrane Library, with related keywords. PRISMA-ScR guidelines were followed. Out of the 565 articles found, exclusion criteria were applied, duplicates removed, and a total of 25 articles were finally included in the study. The included documents were assessed by the contamination risk: "low" (37.5%), "high" (16.7%), "plausible" (8.3%), "unlikely" (8.3%) risk, and "insufficient evidence" (29.2%). Research in hospital settings was found as the main setting in the reviewed papers, which precisely indicated the risk of contaminated surfaces. This scoping review underscores the risk of SARS-CoV-2 infection via contaminated surfaces assessed as low in the majority of the reviewed articles. Further evaluation of the risk of the virus transmission by fomites and providing adequate information on its infectivity via contaminated surfaces in real-life conditions is essential.

Clinical characterization of Lassa fever: A systematic review of clinical reports and research to inform clinical trial design

BACKGROUND

Research is urgently needed to reduce the morbidity and mortality of Lassa fever (LF), including clinical trials to test new therapies and to verify the efficacy and safety of the only current treatment recommendation, ribavirin, which has a weak clinical evidence base. To help establish a basis for the development of an adaptable, standardised clinical trial methodology, we conducted a systematic review to identify the clinical characteristics and outcomes of LF and describe how LF has historically been defined and assessed in the scientific literature.

METHODOLOGY

Primary clinical studies and reports of patients with suspected and confirmed diagnosis of LF published in the peer-reviewed literature before 15 April 2021 were included. Publications were selected following a two-stage screening of abstracts, then full-texts, by two independent reviewers at each stage. Data were extracted, verified, and summarised using descriptive statistics.

RESULTS

147 publications were included, primarily case reports (36%), case series (28%), and cohort studies (20%); only 2 quasi-randomised studies (1%) were found. Data are mostly from Nigeria (52% of individuals, 41% of publications) and Sierra Leone (42% of individuals, 31% of publications). The results corroborate the World Health Organisation characterisation of LF presentation. However, a broader spectrum of presenting symptoms is evident, such as gastrointestinal illness and other nervous system and musculoskeletal disorders that are not commonly included as indicators of LF. The overall case fatality ratio was 30% in laboratory-confirmed cases (1896/6373 reported in 109 publications).

CONCLUSION

Systematic review is an important tool in the clinical characterisation of diseases with limited publications. The results herein provide a more complete understanding of the spectrum of disease which is relevant to clinical trial design. This review demonstrates the need for coordination across the LF research community to generate harmonised research methods that can contribute to building a strong evidence base for new treatments and foster confidence in their integration into clinical care.

Scoping future outbreaks: a scoping review on the outbreak prediction of the WHO Blueprint list of priority diseases

BACKGROUND

The WHO's Research and Development Blueprint priority list designates emerging diseases with the potential to generate public health emergencies for which insufficient preventive solutions exist. The list aims to reduce the time to the availability of resources that can avert public health crises. The current SARS-CoV-2 pandemic illustrates that an effective method of mitigating such crises is the pre-emptive prediction of outbreaks. This scoping review thus aimed to map and identify the evidence available to predict future outbreaks of the Blueprint diseases.

METHODS

We conducted a scoping review of PubMed, Embase and Web of Science related to the evidence predicting future outbreaks of Ebola and Marburg virus, Zika virus, Lassa fever, Nipah and Henipaviral disease, Rift Valley fever, Crimean-Congo haemorrhagic fever, Severe acute respiratory syndrome, Middle East respiratory syndrome and Disease X. Prediction methods, outbreak features predicted and implementation of predictions were evaluated. We conducted a narrative and quantitative evidence synthesis to highlight prediction methods that could be further investigated for the prevention of Blueprint diseases and COVID-19 outbreaks.

RESULTS

Out of 3959 articles identified, we included 58 articles based on inclusion criteria. 5 major prediction methods emerged; the most frequent being spatio-temporal risk maps predicting outbreak risk periods and locations through vector and climate data. Stochastic models were predominant. Rift Valley fever was the most predicted disease. Diseases with complex sociocultural factors such as Ebola were often predicted through multifactorial risk-based estimations. 10% of models were implemented by health authorities. No article predicted Disease X outbreaks.

CONCLUSIONS

Spatiotemporal models for diseases with strong climatic and vectorial components, as in River Valley fever prediction, may currently best reduce the time to the availability of resources. A wide literature gap exists in the prediction of zoonoses with complex sociocultural and ecological dynamics such as Ebola, COVID-19 and especially Disease X.

Building a multisystemic understanding of societal resilience to the COVID-19 pandemic

The current global systemic crisis reveals how globalised societies are unprepared to face a pandemic. Beyond the dramatic loss of human life, the COVID-19 pandemic has triggered widespread disturbances in health, social, economic, environmental and governance systems in many countries across the world. Resilience describes the capacities of natural and human systems to prevent, react to and recover from shocks. Societal resilience to the current COVID-19 pandemic relates to the ability of societies in maintaining their core functions while minimising the impact of the pandemic and other societal effects. Drawing on the emerging evidence about resilience in health, social, economic, environmental and governance systems, this paper delineates a multisystemic understanding of societal resilience to COVID-19. Such an understanding provides the foundation for an integrated approach to build societal resilience to current and future pandemics.

Measuring Timeliness of Outbreak Response in the World Health Organization African Region, 2017-2019

Large-scale protracted outbreaks can be prevented through early detection, notification, and rapid control. We assessed trends in timeliness of detecting and responding to outbreaks in the African Region reported to the World Health Organization during 2017–2019. We computed the median time to each outbreak milestone and assessed the rates of change over time using univariable and multivariable Cox proportional hazard regression analyses. We selected 296 outbreaks from 348 public reported health events and evaluated 184 for time to detection, 232 for time to notification, and 201 for time to end. Time to detection and end decreased over time, whereas time to notification increased. Multiple factors can account for these findings, including scaling up support to member states after the World Health Organization established its Health Emergencies Programme and support given to countries from donors and partners to strengthen their core capacities for meeting International Health Regulations.

Insights into household transmission of SARS-CoV-2 from a population-based serological survey

Understanding the risk of infection from household- and community-exposures and the transmissibility of asymptomatic infections is critical to SARS-CoV-2 control. Limited previous evidence is based primarily on virologic testing, which disproportionately misses mild and asymptomatic infections. Serologic measures are more likely to capture all previously infected individuals. We apply household transmission models to data from a cross-sectional, household-based population serosurvey of 4,534 people ≥5 years from 2,267 households enrolled April-June 2020 in Geneva, Switzerland. We found that the risk of infection from exposure to a single infected household member aged ≥5 years (17.3%,13.7-21.7) was more than three-times that of extra-household exposures over the first pandemic wave (5.1%,4.5-5.8). Young children had a lower risk of infection from household members. Working-age adults had the highest extra-household infection risk. Seropositive asymptomatic household members had 69.4% lower odds (95%CrI,31.8-88.8%) of infecting another household member compared to those reporting symptoms, accounting for 14.5% (95%CrI, 7.2-22.7%) of all household infections.

A multidimensional framework for rating health system performance and sustainability: A nine plus one ranking system

Background

Health Care provision in terms of prevention, detection and treatment is primarily dependent on the quality of the hosting Health System. In its health report 2000, the WHO's attempt to assess and rank health systems’ quality Worldwide was heavily criticized. We propose a novel framework for health system performance and ranking using three indicators for three domains; general health system performance, clinical outcome of treatment applied to the main causes of death and health system sustainability domains.

Methods

Each domain was rated as “A – high”, “B – intermediate” or “C – poor” according to the aggregate score values of its three indicators. Hence the highest rank a health system can achieve is “AAA” and the lowest is “CCC”. If there is a need to define a “numerical rank” to further differentiate health systems with similar rating from one another, the total health expenditure per capita per year was used as an additional “number 10” indicator to achieve that level of differentiation. The framework was applied to Health Systems serving most of the World population including China, India, Brazil, USA, Russia, Germany, Japan, UK, France, Singapore and Switzerland. Data pertinent to each indicator was captured from published reports in peer-reviewed journals and/or from official websites. A Delphi survey was conducted for data not available online.

Results

Among the 11 health systems tested, no one scored AAA, Switzerland, France, Germany and Japan scored AAB, Singapore scored ABB, UK scored BBB, USA, Russia and China scored BBC, Brazil scored BCC while India scored CCC. Total health expenditure per capita per year lead to ranking Switzerland first followed by France, Germany, and Japan.

Conclusion

This novel ranking system is a practical and an applicable tool that test health system performance and sustainability. It can be utilized to guide all organizations, people and actions whose primary intent is to promote, restore or maintain health to achieve their targets. An International Health System Ranking database that will be hosted by the Institute of Global, Health, Faculty of Medicine, University of Geneva, Switzerland.

[Swiss Precision and Global Predictions]

A consortium of Swiss universities has set up a dashboard providing daily 7-day epidemic forecasting for 209 countries and territories around the world. Relayed on social networks, international media, and the sites of major public health agencies, these forecasts can help guiding public policy. However, the time horizon of these forecasts is limited and their accuracy is sometimes questionable, even at 7 days. Interdisciplinary research aimed at increasing the complexity of mathematical models can improve the accuracy of the forecasts provided.