Background: Early detection of disease outbreaks, using appropriate surveillance methods, is a basic principle for effective control of epidemics. Indicator-based surveillance methods, such as comprehensive surveillance, sentinel surveillance and syndromic surveillance, have been routinely utilized for early epidemic detection to minimize mortality and morbidity related to emerging infectious disease threats. In addition, event-based surveillance uses unstructured data sources to detect and monitor outbreaks such as media reports, social media and websites. The use of mobile phone technology is growing in many low and middle-income countries, which has made mHealth an efficient means of health communication in such countries for epidemic surveillance, mitigation and response. Mobile Apps may draw data from validated health sources or unvalidated public sources and convey information to responders. The aim of this study was to review mobile Apps used for epidemic surveillance and response.
Multiple myeloma is a group of B-cell disorders resulting in the secretion of a specific and unique monoclonal immunoglobulin (M-protein). Protein electrophoresis is advised whenever multiple myeloma is suspected. The monoclonal protein migrates as a single entity in the electric field and is detected by the non-specific protein stain as a more intensely stained band superimposed on the usual protein pattern. The M-protein usually migrates in the gamma or beta region of the normal protein pattern; very rarely it may appear in the a2 or even in a1 region. Here we have given an atypical case presentation where the patient with multiple myeloma presented with two M-spike one each in a2 and b-globulin region on agarose gel protein electrophoresis with hypoglobulinemia but with reversed A:G ratio.
On August 16th, 2018, we held Exercise Mataika to test preparedness for a worst-case scenario of a smallpox attack which begins in the Pacific and is followed by a larger scale attack in a highly populous Asian country. The exercise was underpinned by mathematical modelling which aimed to determine the duration and magnitude of the epidemic under different scenarios, the critical threshold for epidemic control, and scenarios where the current stockpile of vaccine is adequate. We constructed a modified SEIR model for smallpox transmission. We found that time to commencing the response, rates of contact tracing and ring vaccination, and rates of case isolation are all influential factors on epidemic size and duration. Ideally, the response should commence in 20 days after the attack, corresponding to 8 days after the first symptoms appear, given an average incubation period of 12 days. Every day of delay worsens the epidemic. The WHO stockpile of vaccine of 34 million doses is adequate if rates of case isolation and ring vaccination are maintained above 60%. If rates of contact tracing, ring vaccination and case isolation fall below 53%, epidemic control is lost. In such a scenario, the epidemic persists for longer than 10 years and over a billion doses of vaccine are needed for epidemic control. There are modifiable factors which can prevent a catastrophic scenario following smallpox re-emergence. These include very rapid response time and high rates of isolation and ring vaccination. Training and capacity building, as well as pre-vaccinated teams, can also assist with rapid response. In low income countries, a smallpox epidemic could overwhelm the health system and far exceed human resource capacity, so low rates of case isolation and contact tracing is a realistic possibility. The consequences of poor epidemic control are catastrophic if rates of case isolation and ring vaccination fall below 53%, the threshold for epidemic control. Global cooperation is also critical, to ensure that vaccine and other resources are directed quickly to affected areas.
Globally, natural disasters have caused a large scale of damage and destruction every year, affecting millions of people, the economy, and development – and developing countries are the most severely affected. Odisha is one of India’s most disaster-prone states. This study explores the effects of, and resilience to, cyclones, floods, droughts, and heatwaves in Odisha, and identifies government strategies that help mitigate these natural disasters. We mainly used primary data collected through a qualitative study undertaken from April 2017 to June 2017 in three districts of Odisha. We conducted in-depth interviews and focus group discussions with community members and key stakeholders at different levels. In addition, our study analyzed secondary data on natural disasters using DesInventar, a disaster information management system data source. The findings show that floods, cyclones, and drought in recent years, along with heatwaves and lightning, have severely affected the people of Odisha. The impacts of these natural disasters are calamitous – particularly on livelihoods, food security, health, water, and sanitation. These natural disasters, which have affected agriculture, fisheries, prawn cultivation, roadside vendors, and daily wage laborers, have both short- and long-term effects on the livelihoods of people in Odisha, leaving them with scarce employment opportunities. The vulnerable and marginalized sections of the population have been the most severely affected, and common coping mechanisms have included selling off livestock, borrowing food, taking loans and mortgages, and migration. The government’s measures/programs, such as an Early Warning System, Public Distribution System, Multipurpose Cyclone Rehabilitation Centers, Seasonal Residential Care Centers, and Indira Awas Yojana, play a major role in mitigating the effect of disasters among rural communities. Our study indicates that natural disasters have impacted the population of the state socioeconomically, physically, and psychologically. The effect on livelihoods, directly and indirectly, exacerbates income, food security, and health. There is an urgent need to focus on reducing people’s underlying vulnerabilities by taking proactive measures, engaging the community in decision-making, and generating alternative and sustainable livelihoods.
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