Measles remains a significant threat to children worldwide despite the availability of effective vaccines. The COVID-19 pandemic exacerbated the situation by leading to the postponement of supplementary measles immunization activities. Along with this postponement, measles surveillance also deteriorated, with the lowest number of submitted specimens in over a decade. In this study, we focus on measles as a challenging case study due to its high vaccination coverage, which leads to smaller outbreaks and potentially weaker signals on Google Trends. Our research aimed to explore the feasibility of using Google Trends for real-time monitoring of infectious disease outbreaks. We evaluated the correlation between Google Trends searches and clinical case data using the Pearson correlation coefficient and Spearman\'s rank correlation coefficient across 30 European countries and Japan. The results revealed that Google Trends was most suitable for monitoring acute disease outbreaks at the regional level in high-income countries, even when there are only a few weekly cases. For example, from 2017 to 2019, the Pearson correlation coefficient was 0.86 (p-value< 0.05) at the prefecture level for Okinawa, Japan, versus 0.33 (p-value< 0.05) at the national level for Japan. Furthermore, we found that the Pearson correlation coefficient may be more suitable than Spearman\'s rank correlation coefficient for evaluating the correlations between Google Trends search data and clinical case data. This study highlighted the potential of utilizing Google Trends as a valuable tool for timely public health interventions to respond to infectious disease outbreaks, even in the context of diseases with high vaccine coverage.

BACKGROUND: With increased attention to the importance of integrating the One Health approach into zoonotic disease surveillance and response, a greater understanding of the mechanisms to support effective communication and information sharing across animal and human health sectors is needed. The objectives of this qualitative case study were to describe the communication channels used between human and animal health stakeholders and to identify the elements that have enabled the integration of the One Health approach.
METHODS: We combined documentary research with interviews with fifteen stakeholders to map the communication channels used in human and swine influenza surveillance in Alberta, Canada, as well as in the response to a human case of H1N2v in 2020. A thematic analysis of the interviews was also used to identify the barriers and facilitators to communication among stakeholders from the animal and human health sectors.
RESULTS: When a human case of swine influenza emerged, the response led by the provincial Chief Medical Officer of Health involved players at various levels of government and in the human and animal health sectors. The collaboration of public and animal health laboratories and of the swine sector, in addition to the information available through the surveillance systems in place, was swift and effective. Elements identified as enabling smooth communication between the human and animal health systems included preexisting relationships between the various stakeholders, a relationship of trust between them (e.g., the swine sector and their perception of government structures), the presence of stakeholders acting as permanent liaisons between the ministries of health and agriculture, and stakeholders\' understanding of the importance of the One Health approach.
CONCLUSIONS: Information flows through formal and informal channels and both structural and relational features that can support rapid and effective communication in infectious disease surveillance and outbreak response.

Background: Public health emergencies require integration between multiple stakeholders in different sectors to monitor the situation and carry out an appropriate response. As a country with a large land area consisting of thousands of islands, Indonesia\'s centralized Public Health Emergency Operation Center (PHEOC) system is currently unable to effectively contain diseases. A PHEOC system reform is required to accommodate Indonesia\'s circumstances, particularly at the regional level. We have outlined potential models at the sub-national level for PHEOC based on existing evidence. Policy Options and Recommendations: Based on existing evidence of PHEOC models internationally, we have formulated three policy models for regional-level PHEOC. These models (the ad hoc agency model, the independent agency model, and the Province Health Office (PHO)-based model) entail different chains of command, and each has its own benefits. Conclusion: We recommend that the Ministry of Health in Indonesia adopt the third PHEOC policy model, in which the chain of command lies under the PHO. This is the most practical approach, as the PHO has the authority to mobilize units and access resources in response to imminent public health emergencies. Further training and capacity-building are required to support the PHO as the commander of the regional PHEOC.

As of May 2022, a new outbreak of the human monkeypox (MPOX) disease appeared in multiple countries, where the 2022 human MPOX disease spread to more than 109 cases, excluding the suspected cases up to the end of 2022. The deaths of the 2022 human MPOX exceeded 200 cases up to the same date. The human MPOX is not a new disease, this disease was once endemic in some countries on the African continent. Despite this, this disease began to spread in a number of countries around the world in 2022. The first case of the 2022 human MPOX was recorded in the United Kingdom in May. After that date, this disease began to become a pandemic in a number of other countries, such as the United States, Spain, and Brazil. The 2022 human MPOX is a type of viral disease caused by a viral virus, the MPOX virus, and this virus causes rashes and lesions over the skin of the patient, as well as in the mouth of the patient. Multiple effective indicators are employed for the study of the 2022 of the human MPOX, such as the herd immunity of the human MPOX (HIhMPOX), the basic reproduction number of the human MPOX (BRNhMPOX), and the infection period of the human MPOX. This study focuses on the study of the herd immunity of, and the basic reproduction number of the 2022 outbreak of human MPOX in multiple countries around the world. This study employed the semianalytical method of the Susceptible compartment S, Infectious compartment I, Recovered compartment R (SIR) pandemic model including the mortality for the study of the herd immunity, and the basic reproduction number of the 2022 human MPOX disease. It is found that the average value of the herd immunity for the human MPOX disease in 2022 equals to 0.2194, that is, 21.94% for multiple countries, and equals to 35.52% for the United States, and 30.99% for Spain. Also, it is found that the average value of the basic reproduction number of the 2022 human MPOX disease equals to 1.2810 for multiple countries. It is concluded from these values that 21.94% of the total susceptible population has to be immunized in an effective way to prevent the spreading of the disease. Also, based on the previous values, it is concluded that the status of the 2022 MPOX disease is spreading as a pandemic.

Potentially more at risk of contracting the monkeypox virus are healthcare workers. Most healthcare workers come into direct contact with the disease\'s infected people, which can spread directly and indirectly. Healthcare professionals must contact patients with the disease and any infected objects or fluids to effectively manage the disease, which further increases the risk of transmission. It is crucial to put safety measures in place and protect healthcare workers. To stop the spread of the monkeypox virus, countries must develop the necessary safeguards and countermeasures. In this emergency, healthcare systems must be strengthened. All healthcare systems should offer staff sufficient personal protective equipment (PPE) and facilitate risk assessment among those with a high risk of exposure. Any suspected case of monkeypox requires caution on the part of healthcare professionals. They must abide by infection control safety rules and protective measures.

On February 2, 2020, the head of a visually impaired school notified similar eye symptoms among the students. We investigated the cluster to confirm the diagnosis, identify potential exposures, and propose recommendations.
We defined a case as redness/watering/discharge from any eye among the students and staff, January-February 2020. We actively searched for the cases and calculated attack rates. We drew epicurve by date of symptoms onset. We conducted a retrospective cohort study of students and staff. We collected data on potential exposures and calculated Risk Ratio (RR), 95% Confidence Interval (95%CI), and Population Attributable Risk (PAR). We sent a conjunctival swab of the three cases for microbiological analysis.
We diagnosed the cases as acute conjunctivitis and identified 39 (76%) cases among 51 individuals. All the 39 cases reported watering and redness; 28 (72%) and 12 (31%) reported eye pain and discharge, respectively. The median age of the case was 11 years (range: 6-48 years). The attack rate didn\'t differ significantly between males [77% (20/26)] and females [76% (19/25), p = 0.9]. The attack rate was higher among the students [86%, (38/44)] than staffs [14%, (1/7), p = <0.01]. Contact with a case [RR = 2.5, 95%CI = 1.3-4.8, PAR = 51%] and staying inside campus [RR = 6.0, 95%CI = 1.0-37.3, PAR = 81%] were associated with the acute conjunctivitis outbreak. All the three conjunctival swabs were negative for bacterial growth.
Close contact with the case and staying inside the campus led to the outbreak of acute conjunctivitis among the students and staff of the visually impaired school.

Indirect costs of animal disease outbreaks often significantly exceed the direct costs. Despite their importance, indirect costs remain poorly characterized due to their complexity. In this study, we developed a framework to assess the indirect costs of a hypothetical African swine fever outbreak in Switzerland. We collected data through international and national stakeholder interviews, analysis of national disease control regulations and industry data. We developed a framework to capture the resulting qualitative and quantitative data, categorize the impacts of these regulations, and rank the impacts in order of importance. We then developed a spreadsheet model to calculate the indirect costs of one category of control measure for an individual group of stakeholders. We developed a decision tree model to guide the most economically favourable implementation plan for a given control measure category, under different outbreak scenarios. Our results suggest that the most important measure/impact categories were \'Transport logistics\', \'Consumer demand\', \'Prevention of wild boar and domestic pig contact\' and \'Slaughter logistics\'. In our hypothetical scenario, the greatest costs associated with \'Prevention of wild boar and domestic pig contact\' were due to assumed partial or total depopulation of fattening pig farms in order to reduce herd size to comply with the simulated control regulations. The model also provides suggestions on the most economically favourable strategy to reduce contact between wild boar and domestic pigs in control areas. Our approach provides a new framework to integrate qualitative and quantitative data to guide disease control strategy. This method could be useful in other countries and for other diseases, including in data- and resource-poor settings, or areas with limited experience of animal disease outbreaks.

BACKGROUND: A hot topic on the relationship between a popular avian-origin food and avian influenza occurred on social media during the outbreak of the emerging avian influenza A (H7N9). The misinformation generated from this topic had caused great confusion and public concern.
OBJECTIVE: Our goals were to analyze the trend and contents of the relevant posts during the outbreak. We also aimed to understand the characteristics of the misinformation and to provide suggestions to reduce public misconception on social media during the emerging disease outbreak.
METHODS: The original microblog posts were collected from China\'s Sina Weibo and Tencent Weibo using a combination of keywords between April 1, 2013 and June 2, 2013. We analyzed the weekly and daily trend of the relevant posts. Content analyses were applied to categorize the posts into 4 types with unified sorting criteria. The posts\' characteristics and geographic locations were also analyzed in each category. We conducted further analysis on the top 5 most popular misleading posts.
RESULTS: A total of 1680 original microblog posts on the topic were retrieved and 341 (20.30%) of these posts were categorized as misleading messages. The number of relevant posts had not increased much during the first 2 weeks but rose to a high level in the next 2 weeks after the sudden increase in number of reported cases at the beginning of week 3. The posts under \"misleading messages\" occurred and increased from the beginning of week 3, but their daily posting number decreased when the daily number of posts under \"refuting messages\" outnumbered them. The microbloggers of the misleading posts had the lowest mean rank of followers and previous posts, but their posts had a highest mean rank of posts. The proportion of \"misleading messages\" in places with no reported cases was significantly higher than that in the epidemic areas (23.6% vs 13.8%). The popular misleading posts appeared to be short and consisted of personal narratives, which were easily disseminated on social media.
CONCLUSIONS: Our findings suggested the importance of responding to common questions and misconceptions on social media platforms from the beginning of disease outbreaks. Authorities need to release clear and reliable information related to the popular topics early on. The microbloggers posting correct information should be empowered and their posts could be promoted to clarify false information. Equal importance should be attached to clarify misinformation in both the outbreak and nonoutbreak areas.

OBJECTIVE: This research aims to describe the effect of standard care (control) versus a clinical management pathway (intervention) on patient length of stay and admission rates during a public health emergency at one Australian ED.
METHODS: A retrospective audit of hospital records for patients who presented in May 2013 with gastroenteritis-like symptoms was undertaken following a surge in patient presentations from a Salmonella outbreak. Patients who presented with gastroenteritis-like symptoms between 15 and 19 May 2013 received care according to a clinical management pathway (intervention). The focus of the intervention was based on symptom management, including a standardised approach to analgesia, anti-emetics and rehydration. Patient characteristics, such as age and gender are described using descriptive statistics. A Mann-Whitney test was used to compare continuous data, and a Fisher\'s exact test was used to compare categorical data, between the two groups.
RESULTS: Over an 8 day period, 110 patients presented with gastroenteritis-like symptoms. The median length of stay was statistically different between the two groups (P < 0.001). More patients were admitted to hospital from the control group (n = 5) when compared with the intervention group (n = 0); however, given the small number of patients in these groups, inferential statistical analysis was not a reasonable consideration.
CONCLUSIONS: The length of stay for patients between the two groups was statistically different, suggesting that the implementation of a clinical management pathway for patients with gastroenteritis-like symptoms reduced the ED length of stay. This finding is useful in future planning for similar public health emergency responses and/or for use when patients present with gastroenteritis-like symptoms on a daily basis.

BACKGROUND: The standard of outbreak reports must be improved to a level where they are robust enough to properly influence preventive strategies. We aimed to verify compliance with mandatory outbreak notification, describing epidemiologic characteristics and management, and evaluating the quality of outbreak reports on health care-associated infections in São Paulo State, Brazil.
METHODS: A systematic search was carried out on PubMed, the Latin American and Caribbean Health Sciences Literature database, Embase, Outbreak Database, the Annals of Brazilian Conferences on Healthcare-Associated Infection Prevention and Infectious Diseases, and reports from the São Paulo State Hospital Infection Division. The quality of reports was evaluated according to the Outbreak Reports and Intervention studies of Nosocomial Infection (ORION) statement guidelines.
RESULTS: A total of 87 outbreak reports were identified; however, only 15 outbreaks (17.2%) were reported to the São Paulo State Hospital Infection Division. Bloodstream infection and neonatal intensive care units were mostly implicated (23% and 19.5%, respectively). Quality, evaluated according to ORION statement recommendations, was generally poor. The ORION categories of Background, Objectives, Participants, Setting, Infection-Related Outcomes, and Generality were properly described in 32.2%, 74.7%, 2.3%, 46%, 2.3%, and 12.6% of reports, respectively. Interventions and Culture-Typing were described with details in 51.9% and 55.2% of outbreak reports, respectively.
CONCLUSIONS: Our findings pointed out the need for strategies to improve competence in outbreak reports, and the ORION statement guidelines may help in this matter. Efforts to promote confidence and consequent compliance with mandatory notification of outbreak reports are essential.