BackgroundLimited data exist on transmission dynamics and effectiveness of control measures for influenza in confined settings.ObjectivesTo investigate the transmission dynamics of a 2009 pandemic H1N1 influenza A outbreak aboard a Peruvian Navy ship and quantify the effectiveness of the implemented control measures.MethodsWe used surveillance data and a simple stochastic epidemic model to characterize and evaluate the effectiveness of control interventions implemented during an outbreak of 2009 pandemic H1N1 influenza A aboard a Peruvian Navy ship.ResultsThe serological attack rate for the outbreak was 49·1%, with younger cadets and low-ranking officers at greater risk of infection than older, higher-ranking officers. Our transmission model yielded a good fit to the daily time series of new influenza cases by date of symptom onset. We estimated a reduction of 54·4% in the reproduction number during the period of intense control interventions.ConclusionOur results indicate that the patient isolation strategy and other control measures put in place during the outbreak reduced the infectiousness of isolated individuals by 86·7%. Our findings support that early implementation of control interventions can limit the spread of influenza epidemics in confined settings.

The World Health Organization's revised International Health Regulations (IHR (2005)) call for member state compliance by mid-2012. Variation in disease surveillance and core public health capacities will affect each member state's ability to meet this deadline. We report on topics presented at the preconference workshop, "The Interaction of Disease Surveillance and the International Health Regulations," held at the 2010 International Society for Disease Surveillance conference in Park City, Utah. Presenters were from the Pan American Health Organization (PAHO), the U.S. Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), the Armed Forces Health Surveillance Center, U.S. Naval Research Unit Six, the Philippines' National Epidemiologic Center, and the French armed forces. The topics addressed were: an overview of the revised IHRs; disease surveillance systems implemented in Peru, the Philippines, and by the French armed forces; the capacity building efforts of the CDC; partnerships and contributions to IHR compliance from HHS; and the application of the IHRs to special populations. Results from the meeting evaluation indicate that many participants found the information useful in better understanding current efforts of the U.S. government and international organizations, areas for collaboration, and how the IHRs apply to their countries' public health systems. Topics to address at future workshops include progress and challenges to IHR implementation across all member states and additional examples of how disease surveillance supports the IHRs in resource-constrained countries. The preconference workshop provided the opportunity to convene public health experts from all regions of the world. Stronger collaborations and support to better detect and respond to public health events through building sustainable disease surveillance systems will not only help member states to meet IHR compliance by 2012, but will also improve pandemic preparedness and global health security.

Background: Pneumonia is one of the leading causes of death in under-5 children in India. This led the Ministry of Health & Family Welfare (MoHFW) in India to decide for the nationwide roll-out of the Pneumococcal Conjugate Vaccine (PCV). However, the introduction of PCV became more complex in the face of unprecedented challenges set forth by the COVID-19 pandemic. The study aims to assess enablers and barriers to the introduction of PCV in India during the pandemic. Methodology: Qualitative research approach involving key-informant interviews from John Snow India (JSI), the lead technical agency that supported MoHFW in the PCV expansion was employed to delineate the enablers and barriers. Principle of saturation was employed to derive the sample size. Thematic analysis using inductive approach was based on the modified World Health Organization (WHO) framework for new vaccine introduction impact on the Immunization and Health Systems, using NVIVO 12 qualitative data analysis software. Results: A total of 11 key informants (4 national-level program managers and 7 state technical officers) were telephonically interviewed. The study found social acceptance, lower cost of the vaccine, and intensive communication activities as potential enablers. Other enablers for PCV introduction included a robust vaccine supply-chain system, ample cold-chain space availability, and strong political commitment, despite the ongoing second wave. Further, the identified barriers included poor physical access, insufficient social mobilization, and limited advocacy along with a stretched workforce. Conclusion: The study delineated several enablers and barriers to introducing PCV in the country during the pandemic. The existing barriers in the PCV roll-out prompted the need to address these gaps, making key program-based recommendations to improve future new vaccine introductions during the pandemic.

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Vigila is a national electronic surveillance system implemented by the Peruvian Navy in order to monitor infectious diseases. Vigila includes 169 reporting establishments, which treat active military, retired military, dependents, and civilian employees. The goal of this study was to establish baselines of acute diarrheal disease in the Peruvian Navy and detect outbreaks of acute diarrheal disease from 2009-2013. There were 39,764 cases of acute diarrheal disease reported, and 25 outbreaks were detected using Exponentially Weighted Moving Average (EWMA) control charts. These analyses demonstrate the utility of syndromic surveillance in a resource-limited setting.