Zika virus disease-knowledge, attitudes and practices among pregnant women-implications for public health practice

OBJECTIVE

Mosquito-borne diseases continue to pose a threat to Latin America and the Caribbean. Zika virus disease entered the Caribbean in 2013 with increased reporting of cases across the region in 2016, affecting more than 50 countries. This study aimed to ascertain the knowledge of, attitudes and practices towards Zika virus disease among antenatal clinic attenders in Trinidad and Tobago during the 2016 outbreak.

STUDY DESIGN

A cross-sectional questionnaire survey was undertaken.

METHODS

A knowledge attitudes and practices survey was conducted among antenatal clinic attenders at publicly funded primary care health centres. All counties of Trinidad (except St Patrick, Caroni and Victoria) and Tobago were included in the study. Within each county, three health centres were selected at random. At the antenatal clinic of each selected health centre, antenatal clients were selected by randomly selecting their patient file from that day's antenatal clinic patient files. Data collection occurred from September to November 2016. The knowledge, attitudes and practice survey was administered by an interviewer-administered questionnaire. The World Health Organization Knowledge, Attitudes and Practice surveys Zika virus disease and potential complications Resource pack was adapted for use as the data collection tool. All data collected were analysed using SPSS software, version 23. Tests with P-values less than 0.05 were deemed significant.

RESULTS

Seventy-four percent (74%) of responders did not think there was a link between sexual transmission and Zika. About 19% stated that abstaining could prevent Zika but only 6.6% actually practiced this. Seventy-six percent knew the risk of microcephaly, and this knowledge of the risk of microcephaly was found to be significantly associated with the number of weeks' gestation. Less than 40% knew the risk of Guillain-Barre syndrome. Doctors at health centres followed by private doctors were the top two trusted information sources for responders. Responders thought that the government could spray insecticide, clean drains, educate community members and clean overgrown vacant lots of land.

CONCLUSION

The government and healthcare workers need to reach specific target groups with accurate messages to minimize the associated morbidity and thereby safeguarding national and global health security.

Contact tracing following exposure to measles at a wedding party in the United Kingdom, October 2007

On 22 October 2007, a case of suspected measles in an unvaccinated two-year-old was notified to Thames Valley Health Protection Unit by North East and North Central London Health Protection Unit.

Are we prepared for a deliberate release of a biological agent?

OBJECTIVES

Following the events of 11 September 2001 in New York, planning for the deliberate release of chemical, biological, radiological and nuclear agents has intensified in the UK, with Department of Health recommendations for National Health Service and public health action. A consequence of this was to assess preparedness across the West Midlands region of England for mounting an effective response to a deliberate release of a biological agent.

STUDY DESIGN

Descriptive study.

SETTING

West Midlands, UK. This work involved key organizations and entailed obtaining information from those responsible for and likely to be involved in managing incidents via questionnaire surveys based around preparedness and planning arrangements.

RESULTS

Findings revealed that plans delineating action to take during an incident do exist. However, staff training (40%) in acute trusts and testing of plans in primary care trusts (45%) could be improved. Communication arrangements in hospitals require support.

CONCLUSION

Work is ongoing but there is more to do. Trusts should provide staff training and engage in exercises to test plans and communication arrangements.

Global surveillance for chemical incidents of international public health concern

OBJECTIVE

In December 2001, an expert consultation convened by WHO identified strengthening national and global chemical incident preparedness and response as a priority. WHO is working towards this objective by developing a surveillance and response system for chemical incidents. This report describes the frequency, nature and geographical location of acute chemical incidents of potential international concern from August 2002 to December 2003.

METHODS

Acute chemical incidents were actively identified through several informal (e.g. Internet-based resources) and formal (e.g. various networks of organizations) sources and assessed against criteria for public health emergencies of international concern using the then proposed revised International Health Regulations (IHR). WHO regional and country offices were contacted to obtain additional information regarding identified incidents.

FINDINGS

Altogether, 35 chemical incidents from 26 countries met one or more of the IHR criteria. The WHO European Region accounted for 43% (15/35) of reports. The WHO Regions for Africa, Eastern Mediterranean and Western Pacific each accounted for 14% (5/35); South-East Asia and the Americas accounted for 9% (3/35) and 6% (2/35), respectively. Twenty-three (66%) events were identified within 24 hours of their occurrence.

CONCLUSION

To our knowledge this is the first global surveillance system for chemical incidents of potential international concern. Limitations such as geographical and language bias associated with the current system are being addressed. Nevertheless, the system has shown that it can provide early detection of important events, as well as information on the magnitude and geographical distribution of such incidents. It can therefore contribute to improving global public health preparedness.

Chemical incidents: are we ready in the West Midlands? Testing the communication arrangements of on-call public health doctors

Primary care trusts are responsible for handling major chemical hazards. This includes the testing and exercising of plans in a regular and routine manner. The Chemical Hazards and Poisons Division (Birmingham), which provides a 24-h, 365-day resource for the West Midlands region in the UK, undertook an audit to test the out-of-hours communication arrangements of public health doctors. The audit revealed that there is an urgent need to: (1) review contact details within on-call packs; (2) ensure that doctors performing on-call duties know, at the very least, the names of the primary care trusts/local authorities, county councils/other trusts in the area; and (3) ensure a failsafe method for contacting the person on call for public health.

Chest physicians' and microbiologists' awareness and demand for drug monitoring in the treatment of TB

There is a role for therapeutic drug monitoring (TDM) to achieve the optimum therapeutic concentration of anti-tuberculous drugs. This work aimed to determine the current awareness of TDM in TB control among chest physicians and to estimate the demand for this service. Responses from a sample of chest physicians in the West Midlands revealed that 60% were aware of TDM and 33% had used it. Responses were received from half of a UK group of microbiologists who reported a median of nine requests in the past year. It appeared that more was known about services for rifampicin and streptomycin than other first-line drugs. There appears to be a need for both increased awareness among potential service users and for coordination of assay services.

Childhood dengue shock syndrome in Trinidad

Dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS) is a major cause of hospitalisation and mortality among children in South East Asia. We now report, for the first time, the occurrence of DHF/DSS in Trinidadian children. The presence of vomiting, abdominal pain and hepatomegaly in the setting of a dengue epidemic should alert clinicians to the possibility of DHF/DSS. Timely diagnosis and aggressive supportive treatment are essential for a successful outcome. Source reduction, vector control and community participation are also necessary to avert the South East Asian scenario from emerging in the Caribbean.