Ebola Virus Pandemic Shield

Swine Influenza

Swine Influenza

SWINE INFLUENZA frightening you? CONCERNED about the health implications? Coughs and Sneezes Spread Diseases! Stop The Swine Flu from Spreading. Follow the advice to keep your family and friends safe from this virus and not become another victim. These simple cost free guidelines will help you to protect yourself from the swine flu.

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Pandemic Preparedness Guide

Inside this information dense guide youll discover: Water & Food: The 2 common water storage containers that are breading grounds for bacteria that could kill you so you know to avoid them. How 8 drops of this common household chemical will instantly sterilize any drinking water container (its not vinegar or ammonia) so your can drink safely. The 21 dried foods you Must have stored to remain self-contained until the threat passes so your family can eat when grocery stores are bare. How to reduce energy and heat to cook by 70% with this special pot that only costs about $17 at Wal-Mart (It also doubles as a sterilizer) so your cooking fuel last 3X longer. How to create an inner home cocoon so you dont have to heat or cool your entire house so you save on heat and energy when the power is out or sporadic. How to recharge batteries an Unlimited number of times just using the sun so you can power your devices forever. How to create a resilient community in your neighborhood Now so you are not alone in defending your area so you can keep the infected and even looters out. The one plant that will keep intruders from coming in through your windows and openings in your home so you remain safe. How to train your dog to act when strangers are near your home so you know when and how to protect yourself. 3 weird uses for a fire extinguisher in a pandemic. The formula for the Ultimate protection against infection, so even our youngest family members remain disease free. How to create an isolated environment for the sick so they dont get everyone else sick while you are waiting for emergency workers. The one kind of phone that is most likely to work in a disaster so you can have constant communication with the outside world even if the power is completely out The one way to Never communicate with your family in a crisis so you dont create panic and unrest in a tense situation.

Pandemic Preparedness Guide Summary


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The 1918 Pandemic Of Influenza

Influenza caused a sudden increase in mortality in the United States (see Figure 2.1) and other countries (Reid et al., 2004). This outbreak was termed a pandemic because of its worldwide scope. It killed at least FIGURE 2.2 Emergency hospital during influenza epidemic, Camp Funston, Kansas. Forces Institute of Pathology, Washington, DC.) FIGURE 2.2 Emergency hospital during influenza epidemic, Camp Funston, Kansas. Forces Institute of Pathology, Washington, DC.) FIGURE 2.3 Influenza pandemic mortality in American and Europe during 1918 and 1919. (From the National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, DC.) FIGURE 2.3 Influenza pandemic mortality in American and Europe during 1918 and 1919. (From the National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, DC.) To elucidate whether the 1918 strain was a product of reas-sortment or mutation, over the past decade, researchers have...

Ebola and Marburg Fever

Ebola virus is said to be the most virulent pathogen known to infect humans. It is named after the Ebola river in the Democratic Republic of Congo (DRC) (formerly Zaire), where the first known outbreak of Ebola VHF occurred in 1976. Since then, nearly 2,000 cases with over 1,200 deaths have been documented from this disease. Subsequent to these original descriptions of Ebola and Marburg VHF there have been a number of well documented outbreaks of both these VHFs. Four subtypes of Ebola virus (Zaire, Sudan, Ivory Coast, and Reston) have been described and these have been responsible for outbreaks in the DRC, Gabon, Republic of Congo, Sudan, Uganda and Ivory Coast. Most recently, an outbreak in the Republic of Congo from April to June 2005 was responsible for 12 cases including 9 deaths. The Reston subtype of Ebola virus is unique in causing disease only in non-human primates. It was first described in Reston, Virginia in the USA in 1989 in Cynomol-gus monkeys (Macacca fascicularis)...

Ebola and Marburg Viruses

Ebola and Marburg viruses are filamentous or bacillus form with a uniform diameter of 80 nanometres but a variable length between 860 and 1086 nanometres that can help distinguish Marburg and the different subtypes of Ebola viruses. These viruses contain non-segmented negative-strand RNA with a 19 kb genome that encodes 7 structural (and in the case of Ebola also one non-structural) proteins. Ebola and Marburg viruses have 55 nucleotide homology. The viruses are coated with an envelope that contains glycoprotein peplomers on the surface, which is believed to be an important virulence factor.

Matrix Scaffold Attachment Regions MSARs

By attaching chromatin to the nuclear matrix, matrix-scaffold attachment regions (M SARs) are thought to participate in chromatin loop formation (77,78) and represent initiation sites for chromosome condensation (79). Recently, Ioudinkova et al. (80) hybridized a DNAse I digested nuclear matrix containing the M SAR elements to a 60mer oligonucleotide arrays covering the chicken a-globin locus and identified a co-localization of 40-kb a-globin chromatin loop attachment region with the nuclear M SAR and the previously described CTCF-dependent enhancer blocker elements (81).

Expression Glycosylation and Modification of the Spike S Glycoprotein of SARS CoV

The spike (S) glycoprotein of coronaviruses is known to be essential in the binding of the virus to the host cell at the advent of the infection process. To study the maturation pathway of the S glycoprotein of the severe acute respiratory syndrome (SARS)-coronavirus (CoV) within the host cell, a T7 vaccinia virus-based expression system coupled to immunoprecipitation with anti-S antibodies was used to test and analyze different forms of the S glycoprotein. The state of maturity of the S glycoprotein can be deduced from its sensitivity to hydrolysis by endoglycosidase H (EndoH) or W-glycosi-dase F (N-Gly F). A fully matured S glycoprotein will be modified with complex oli-gosaccharides which makes it resistant to cleavage by EndoH but not by N-Gly F. By exploiting this characteristic, it is then possible to determine which forms of the immu-noprecipitated S protein are properly processed by the host cell. With this system, many different constructs of the S glycoprotein can be...

Matrix attachment sites

Matrix or scaffold attachment sites (MAR SARs), are DNA sequences isolated as fragments that remain attached to nuclear structures after stringent extraction with high salt or detergent. They are usually A T rich and are thought to be the sequences where DNA attaches to the nuclear

Outbreak Characterization

Outbreak investigations range in size from a small inquiry conducted by a single investigator to a major multinational investigation. A seasoned investigator may need only a 10-minute phone call to determine that a suspected outbreak is small, self-limited, and not worthy of additional investigation. An outbreak that is spreading rapidly and killing many individuals (such as the SARS outbreak in 2003) may warrant deployment of thousands of investigators and researchers. Geographic information systems are modern descendants of Snow's painstakingly developed map. These systems partly automate spatial analysis. Spatial scans (see Chapter 16) are computer algorithms that more fully automate spatial analysis these scans construct and search maps automatically for clusters of disease like that around the Broad Street pump. They can ask and answer questions such as the following If I were to map the people in a community who developed pneumonia in the past week by using their work addresses,...

Pathogenesis of HIV1 Infection

In addition, new problems relating to the short- and long-term toxicity of drug treatments and the occurrence of resistance mutations in both circulating and transmitted viruses are emerging. In most countries in South East Asia and Africa, the incidence and prevalence of HIV-1 infection continues to increase and surpass that of Europe and North America. However, due to the high costs of drug regimens and the lack of a healthcare infrastructure in these developing countries, the widespread use of HAART is currently still difficult. The further course of the HIV-1 pandemic, therefore, mainly depends on how and to what degree the developing countries with a high HIV-1 prevalence are able to take advantage of the medical progress achieved in Europe and North America, and whether an effective prophylactic vaccine becomes available in the near future.

Human Endogenous Retroviruses

Contains a so-called immunosuppressive domain, a conserved 17mer with effects on the proliferation and differentiation of lymphocytes (60,61). Interestingly, the immunosuppressive domains of mammalian C-type retroviruses, including some HERV families, are similar to the analogous segments in the envelope glycoprotein of filoviruses (negative-strand RNA viruses) such as Ebola or Marburg viruses (62). HERVs also may contain other auxiliary genes. Several class II and III families code deoxyuridine triphosphatase (dUTPase) (63,64 RU). Some HERV-K elements encode a 105 aa functional homolog of the Rev Rex proteins found in human immunodeficiency virus (HIV)-1 and human T-cell leukemia virus (HTLV), respectively. These proteins mediate nuclear transport of unspliced RNAs via the host factor CRM1 (65,66).

The NTDs as the Ancient Afflictions of Stigma and Poverty

The NTDs are caused by parasitic worms, protozoa, and the bacterial agents of leprosy, Buruli ulcer, and trachoma (Table 3.1). Unlike the well-publicized newly emerging infections, such as Ebola, West Nile fever, or avian influenza, the NTDs have burdened humanity since the beginning of recorded history (WHO, 2003). Descriptions of leprosy, schistosomiasis, guinea worm, hookworm, trachoma and other NTDs are found in the Bible (Dirckx, 1985 Hulse, 1971 Ceccarelli, 1994), the Talmud (Ostrer, 2002), Papyrus Ebers (c.1550 B.C.), Kahun papyrus

Infections in Human Populations

To be considered as this also affects how rapidly an infection may spread in the population. One more factor which may or may not be significant is the length of the prepatient period, the time between infection and symptoms becoming apparent, as the onset of symptoms may result in relative isolation from the rest of the population. Some infections, such as herpes simplex or hepatitis B (HBV), may be symptomatic in some individuals but to a greater or lesser degree asymptomatic in others with corresponding differences shown in infectivity, and the tendency to symptomatic vs. asymptomatic infection may vary according to age, as is shown very strongly in the case of hepatitis B (Medley et al., 2001). HBV is also a good example of an infection that may manifest itself as an initial asymptomatic infection or an acute primary infection (in this case lasting a few weeks) leading to recovery or to a persistent chronic infection which for HBV may last several decades or be effectively...

Prevention and Control Measures 91 Vaccine

A number of strategies have been used for the development of both Lassa and Ebola virus vaccines (Baize et al., 2001 Fisher-Hoch and McCormick, 2004 Sullivan et al., 2000). One novel approach involving immunisation with a DNA priming vaccine followed by a booster immunisation containing recombinant adeno-virus expressing glycoprotein was associated with the development of both humoral and cellular immunity against Ebola virus in Cynomolgus monkeys (Sullivan et al., 2000). Recently, the threat of bioterrorism using VHF agents has underpinned renewed impetus and enthusiasm for the development of effective vaccines (Baize, 2005 Jones et al., 2005 Peters, 2005).

Sehaam Khan Mah Lee Ng and Yee Joo

The Bac-to-Bac Baculovirus expression system was used to generate a recombinant baculovirus capable of expressing the severe acute respiratory syndrome (SARS)-coronavirus (CoV) 3a protein. Using the same expression system, two structural proteins, membrane (M) and envelope (E), were co-expressed to form SARS-CoV virus-like particles (VLPs) within an insect cell. Expression of viral proteins was confirmed by Western blot analysis and the formation of VLPs was studied by transmission electron microscopy. Key Words Bac-to-Bac Baculovirus expression system severe acute respiratory syndrome coronavirus SARS-CoV 3a protein membrane protein (M) envelope protein (E) virus-like particles (VLPs) transmission electron microscopy Western Blot.

Iiis Obesity Preventable

A number of chapters in this handbook have indicated that the rates of obesity throughout both the developed and the developing world are increasing at a dramatic rate. Indeed, the pandemic of overweight and obesity is now so advanced and so widespread that few regions of the world (with the possible exception of parts of sub-Saharan Africa) appear to have escaped the effects of this major public health problem. Previous chapters have highlighted the strong biological influences that Despite these concerns about the effectiveness of current obesity prevention approaches, there is indirect evidence from a range of sources that supports the view that prevention is not only feasible, but offers the only solution to controlling the worldwide epidemic of obesity. Bouchard (4) indicates that the heritability of obesity and body fat stores is only moderate and that recent increases in obesity rates have occurred at a rate too fast to be explained by changes in the frequency of obesity genes...

The CoExpression of Two Structural Proteins for VLP Formation

Expression of severe acute respiratory syndrome (SARS)-coronavirus (CoV) 3a protein in insect cells. Sf9 cells were infected with a recombinant myc-3a baculovirus at a multiplicity of infection of 1 (lane 1). Cells were harvested at 72 h positinfection, lysed, and the cell lysate subjected to Western blot analysis using (A) anti-3a antibody and (B) anti-myc antibody. Two forms of myc-3a were detected by anti-3a antibody as previously reported (19-21). Mock infected Sf9 cells were used as a negative control (lane 2). Fig. 3. Expression of severe acute respiratory syndrome (SARS)-coronavirus (CoV) 3a protein in insect cells. Sf9 cells were infected with a recombinant myc-3a baculovirus at a multiplicity of infection of 1 (lane 1). Cells were harvested at 72 h positinfection, lysed, and the cell lysate subjected to Western blot analysis using (A) anti-3a antibody and (B) anti-myc antibody. Two forms of myc-3a were detected by anti-3a antibody as previously reported (19-21). Mock...

Perfecting Case And Outbreak Detection

3 Physicians are taught (and reminded incessantly) when you hear hoof beats, don't think of zebras. This adage is an informal statement that when the evidence available about a particular patient supports equally a diagnosis of either influenza or SARS (e.g., the patient has constitutional symptoms and no history of exposure to SARS), they should conclude that the diagnosis of influenza is far more likely than SARS.

Postencephalitic Parkinsonism

Parkinsonism following encephalitis lethargica during the influenza pandemic between 1916 and 1926 is known as postencephalitic parkinsonism (PEP). During the recovery phase of the acute viral encephalitis, parkinsonian rigidity developed with the most characteristic clinical features being oculogyric crises. The PEP brain has NFTs in the cortex, basal ganglia, thalamus, hypothalamus, substantia nigra, brainstem tegmentum, and cerebellar dentate nucleus (48). The distribution of the pathology overlaps with PSP and, in some studies, it has not been possible to distinguish the two disorders by histopathologic analysis alone (48). Biochemical studies of abnormal insoluble tau in PEP have features similar to AD with three major bands (68, 64 and 60 kDa) on western blot studies, and electron microscopy shows paired helical filaments similar to those in AD (49).

Computerinterpretable Case Definitions

Case definitions, as currently written, are not well suited for automation. The authors of the SARS case definition intended it for use by physicians and epidemiologists, not computers. The clause findings of lower respiratory illness (e.g., cough, shortness of breath, difficulty breathing) does not enumerate all findings of lower respiratory illness. A computer requires a complete enumeration of all findings that it should count as evidence of lower respiratory illness (e.g., cough, shortness of breath, difficulty breathing, wheezing, cyanosis, tachypnea, dullness to percussion, fremitus, whispered pectoriloquy, rales, and rhonchi). The findings would also have to be described more precisely. For example, a physician or an epidemiologist would not count chronic cough or cough associated with asthma as a finding of lower respiratory illness when applying this case definition, but a computer would (unless told otherwise). Note that it is difficult, if not impossible, to enumerate all...

Telomeric Rearrangements

Chromosomal anomalies may be numerical or structural. Structural changes result from the breakage and rearrangement of chromosome parts, and animal experiments have shown that they can be induced by a variety of exposures, including ionizing radiation and certain viral infections and toxic substances. They occur as duplications, deletions, translocations, insertions, or inversions of chromosome parts or as rings on selected chromosomes. Numerical anomalies arise through nondisjunction during meiosis or mitosis, through lagging of chromosomes at anaphase of cell division, or through fertilization by two sperm (i.e., triploidy). Chromosomal anomalies as a whole contribute more to fetal loss than to live births and MR. Kline, Stein, and Susser (1989) estimated that from 8 weeks after the last menstrual period, the proportion of chromosomal aberrations lost by miscarriage exceeds 90 for all but trisomy 21 (DS), XXX, XXY (Klinefelter syndrome), and XYY. In survivors after birth in...

Discourse Relationships Among Sentences

Sentences in a patient report are not meant to stand alone-they often convey a story about the differential diagnosis and treatment process for a patient. Some of the variables our example SARS expert system would need cannot be obtained without integrating and disambiguating information from the entire report. Once the individual variables have been located in a report, some type of discourse processing must integrate values for the variables to answer questions such as (1) Were the relevant findings reported for the patient or for someone else (e.g., a family member, as in patient's mother died at the age of 48 with an MI'') (2) Did the relevant findings occur at the current hospital visit (versus past history or hypothetical findings) (3) Is it likely the patient has a respiratory disease or disorder Three discourse techniques that may help answer these questions are section identification, co-reference resolution, and diagnostic modeling. Patient reports are semistructured,...

Evaluation Methods For Nlp In Biosurveillance

The first step in evaluating an NLP application is to validate its ability to classify, extract, or encode features from text (feature detection). Most evaluations of NLP technology in the biomedical domain have focused on this phase of evaluation. Once we validate feature detection performance, we can evaluate the ability of the encoded features to diagnose individual cases of interest (case detection). Finally, we can perform summative evaluations addressing the ability to detect epidemics (epidemic detection). Figure 17.4 shows how the three levels of evaluation relate to one another, using the diagnostic system for SARS as an example.

Epidemiology of Bacterial Pneumonia in Children

Staphylococcus aureus is a well-known and greatly-feared cause of community-acquired pneumonia in children, particularly in young infants (Rebhan and Edwards, 1960 Chartrand and McCracken, 1982), but has been a relatively uncommon pathogen in most series of pediatric pneumonia. Staphylococcal pneumonia was first reported as a complication of influenza during the 1918 Spanish Flu pandemic (Chickering and Park, 1919). Two large pediatric studies of patients with staphylococcal pneumonia have been published both reports found that most childhood cases of staphylococcal pneumonia occurred in young infants. In the series of 329 patients from Toronto published in 1960, 68 of the children with staphylococcal pneumonia were less than 1 year of age (Rebhan and Edwards, 1960). Similarly, in the experience published by McCracken and colleagues in Dallas, the median age of 79 children with staphylococcal pneumonia was 6 months (Chartrand and McCracken, 1982). Staphylococcus aureus is recognized...

Historical perspective

These diseases are now under control in developed countries and eradication has been possible for smallpox and soon polio, the emergence of new diseases such as AIDS, Ebola and West Nile virus mean that studies of genetic susceptibility to infectious disease remain extremely relevant in the fight against disease.

Using Bayes Theorem to Compute Posterior Probability of Disease

From biosurveillance data about that patient, because the real-world purpose of such an algorithm would be to screen individuals for SARS. The preferred method (and standard practice) has two parts. First, the evaluator measures and reports only sensitivity and specificity. Second, consumers of this information (system developers or biosurveillance , - P (Algorithm Pos I SARS) P (SARS) P(SARS I Algorithm Pos) ,--,--.-' -- -r 1 ' P (Algorithm Pos I SARS) P (SARS) + P (Algorithm Pos I No SARS) P (No SARS) , , P (Algorithm Neg I No SARS) P (No SARS) (No SARS I Algorithm Neg) ,-1 - ,-f--.-' -- -7 1 ' P (Algorithm Neg I SARS) P (SARS) + P (Algorithm Neg I No SARS) P (No SARS) If the background prevalence of SARS in the population is one case per 100,000 people, the predictive probabilities of disease status given the test result are P(SARS I Alg Pos) P ( No SARS I A lg Neg )

Twin studies and adoption studies

It should be noted however, that it is becoming increasingly clear that the TLRs are not the only PAMP-recognition molecules of importance in disease susceptibility. Recently, as well as NOD family and related intracellular receptors, C-type lectins have been identified as mediators of pathogen recognition as part of innate immunity. The best known example of this is CD209, perhaps better known as DC-SIGN. The gene product was originally isolated on the basis of HIV-1 gp120-binding capability (Curtis et al., 1992) in 1992 but it was not until 2000 that it was recognized as a dendritic-cell-specific receptor for ICAM3 which mediated dendritic-cell and resting T-cell interaction as part of the primary immune response (Geijtenbeek et al., 2000b) and consequently, enhanced HIV-1 trans-infection of T-cells (Geijtenbeek etal., 2000a). Subsequently, DC-SIGN has been shown to mediate dendritic-cell responses to many microorganisms, including Aspergillus fumigatus (Serrano-Gomez et al., 2005),...

Analyzing Glycosylation Changes

Numerous factors exist which lead to differential glycosylation of glycopro-teins. Viral envelope proteins expressed by different viral strains may be differentially glycosylated, as demonstrated for the Ebola virus by Lin et al. (10). Variability in the sequence of viral envelope proteins among different isolates may directly lead to loss of oligosaccharide acceptor sites or may alter protein conformation, thereby preventing access of the cellular glycosylation machinery to potential glycosylation sites (2). Secondly, changes in culture conditions or producer-cell type may result in the expression of a number of different gly-coforms, because different cell types may differ in the repertoire of glycosyl-transferases and glycosidases expressed, and in the time taken for proteins to transit the secretory pathway. For instance, the glycosylation of HIV gp120 varies significantly between CD4+ T cells and macrophages, the two cellular targets of HIV infection in vivo, with Env produced in...

Obesity a major public health threat

Challenging and accurate methods are not applicable to large populations, therefore, surrogates such as the Body Mass Index (BMI) (weight in kilograms divided by the square of the height in metres) are most often used in population studies and in the clinic. The World Health Organization has defined obesity as a BMI exceeding 30 kg m2. Using this definition, currently at least 20 of the population of the USA and most Western countries is obese and at least 50 are either overweight (BMI > 25 kg m2) or obese. There is clear evidence, from many developing countries, of an increasing prevalence of obesity over the past two decades (Seidell, 2000). There is little doubt that the pandemic of obesity represents a major public health problem.

Expression Analysis of the Viral Glycoprotein in Mammalian Cells and Immunoprecipitation of Radiolabeled Viral Proteins

The next step involves a pulse-chase labeling experiment to investigate the maturation of SARS-CoV S protein. This includes infection of Cos7 cells with vaccinia virus vTF7-3 followed by transfection with pKT-S (Subheading 3.2.1.), radiolabeling of cells with 35S -methionine cysteine and chasing with cold methionine cysteine for 0.5, 1, 2, 4, and 6 h (Subheading 3.2.2.), and immuno-precipitation of the S protein with rabbit anti-S antibodies followed by separation of protein in SDS-PAGE and visualization by autoradiography (Subheading 3.2.3.).

Internet As Sentinel I Promedmail

ProMED-mail demonstrated its value during the 2003 outbreak of SARS. On February 10, 2003, ProMED-mail disseminated a posting entitled Pneumonia-China (Guandong) RFI'' asking for information on an outbreak of pneumonia in the Guandong province of China (ProMED-mail, 2003e). Figure 26.2 reproduces this and the second posting in what was subsequently renamed the SARS thread'' on ProMED-mail. There were 15 additional postings between February 10 and March 14. On March 14, ProMED-mail disseminated five reports of outbreaks of deadly or severe respiratory illness in four countries in East Asia (Singapore, Taiwan, Vietnam, and China), many in hospitals, and all with no known etiology (ProMED-mail, 2003b). That same day, ProMED-mail disseminated a Government of Ontario Press Release about four cases of atypical pneumonia in Canada (Toronto and British Columbia), and the editor noted an unconfirmed report that the British Columbia case had a travel history to Hong Kong (ProMED-mail, 2003a)....

Ramona Sunderworth md

The AIDS epidemic is a major pediatric threat not only from infection but with regard to the risk of orphanhood. AIDS kills more than 1 million children per year. Over 10 million children have already been orphaned and many forced into the streets, victims of abusive child labor entrapment, deprived of the most basic health care, societal support, and rudimentary education. By 2010 it is predicted that more than 40 million children will have become orphans from the AIDS pandemic.

Standard Evaluation Method for Evaluating a Classifier

Review of laboratory test results (e.g., microbiological cultures), or by asking experts to review medical or veterinarian records. The evaluator assembles the set of control patients by random selection.The control patients could be healthy individuals, or they could be individuals whose malady resembles the condition of interest, such as patients that have influenzalike illness, but do not have SARS. The choice depends on the intended use of the algorithm. If the algorithm will be used, for example, in an emergency department (ED) setting to automatically differentiate patients presenting with influenza-like symptoms into has SARS'' and does not have SARS,'' the evaluator would select controls from the set of all patients presenting with influenza-like symptoms determined not to have SARS. If the intended use is to differentiate SARS patients automatically from all other patients presenting to the ED, the evaluator would draw the control group from the set of all patients presenting...

CDCTM Severe Acute Respiratory Syndrome

Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2 SUPPLEMENT B SARS SURVEILLANCE_ Appendix B1 Revised CSTE SARS Surveillance Case Definition Possible exposure to SARS-associated coronavirus (SARS-CoV) One or more of the following exposures in the 10 days before Travel to a foreign or domestic location with documented or suspected recent transmission of SARS-CoV2 or Close contact3 with a person with mild-to-moderate or severe respiratory illness and with history of travel in the 10 days before onset of symptoms to a foreign or domestic location with documented or suspected recent transmission of SARS-CoV2 Likely exposure to SARS-CoV Close contact3 with a confirmed case of SARS-CoV disease or Close contact3 with a person with mild-moderate or severe respiratory illness for whom a chain of transmission can be linked to a confirmed case of SARS-CoV disease in the 10 days before onset of symptoms Tests to detect...

Epilogue The Future of Biosurveillance

The volume of travel and trade among cities and countries is increasing steadily. The globalization megatrend will increase the number of outbreaks caused by imported disease. It will also amplify the economic impact of such outbreaks. For example, the economic impact of SARS on East Asia was approximately US 18 billion equivalent to 0.6 of the gross domestic product of the region (Fan, 2003). This impact was disproportionate to its effect on health alone, which comprised approximately 8000 people infected worldwide with 800 deaths. The economic impact of a pandemic of avian influenza could be as high as US800 billion (World Bank East Asia and Pacific Region, 2005). At present, the world reacts to diseases such as SARS by curtailing travel and trade. If globalization is to continue at its current pace, the international community must develop biosurveillance systems that not only contribute to the containment of outbreaks before they become pandemics, but also provide real-time,...

Examples Of Economic Analyses In Biosurveillance

The study demonstrated not only that the outbreak had a substantial economic impact (in Milwaukee, 96.2 million) but that decreased worker productivity represented the largest economic consequence of the outbreak ( 64.6 million), a finding confirmed by studies of outbreaks of other diseases such as severe acute respiratory syndrome (SARS) (Achonu et al., 2005) and hepatitis A (Sansom et al., 2003). One implication of these studies for biosurveillance economic analyses is that any cost-of-illness study that fails to include productivity losses may seriously underestimate the potential impact of an outbreak. Outbreaks can be devastating to not only the health care system and directly affected individuals but also many businesses and the economy. This result, if further developed, may perhaps persuade individuals and organizations initially uninterested in biosurveillance to reconsider their stance. In fact, the Milwaukee study actually underestimated productivity costs by not accounting...

Biosurveillance Of The Healthcare System

The origins of ISCP can be traced to a pandemic of staphylo-coccal infections in hospitals in the mid 1950s in the United States. In response to this problem, hospitals organized infection control committees. Over the ensuring decade, a few hospitals developed organized infection control programs, initially using physicians and then adding trained infection control nurses. By the mid 1970s, most hospitals had adopted this practice.

Contextual Information

Any expert system attempting to increase timeliness in outbreak detection must distinguish between findings that occurred in past history and current problems. For example, one of the variables in our SARS detector is whether the patient has an acute respiratory finding. The definition of acute is not straightforward. However, at the least, an NLP application attempting to determine the value of this variable should be able to accurately assign the value yes to pleuritic chest pain in sentence 13 and no to pneumonia in sentence 14. Some findings can occur with multiple anatomic locations. For detection of SARS, our expert system needs to know whether the edema described in sentence 17 was found in the lung or in the skin.

Argentina Biosurveillance

The OIE also lists diseases that cause significant socioeconomic disturbance or health risk within an affected country but generally do not cross national boundaries (Table 4.4). These diseases (formerly called List B diseases) are associated with requirements for reporting and demonstrating freedom from the disease or agent that are less severe than those for the pandemic agents described above nonetheless, they are still quite restrictive.

Functional Requirements for Biosurveillance

Chapters 2 and 3 described biosurveillance as the world has practiced it for the latter half of the 20th century. During that time, the basic methods for detecting cases, detecting outbreaks, and characterizing outbreaks changed little. The methods used to detect and characterize the 1975 Lyme disease outbreak and the 2003 severe acute respiratory syndrome (SARS) pandemic differed primarily in microbiological techniques (e.g., the increasing use of genetic analysis) and the speed at which outbreaks were investigated.


This is not the place for a detailed description of the epidemiological situation of the HIV pandemic. The prevalence and incidence of HIV AIDS vary considerably from continent to continent, from country to country, from region to region. Several countries in sub-Saharan Africa report infection rates of 30 , especially in urban areas. In other countries, HIV prevalence still remains low. However, low national prevalence rates can be misleading. They often disguise serious epidemics that are initially concentrated in certain localities or among specific population groups and that threaten to spill over into the wider population. By far the best and most comprehensive overview is given by the joint United Nations program on HIV AIDS (UNAIDS). The annual AIDS epidemic update of UNAIDS reports on the latest developments in the global HIV AIDS epidemic. With maps and regional summaries, it provides the most recent estimates of the epidemic's scope and explores new trends in the epidemic's...

Outbreak Detection

The 2004 SARS outbreak and the foot-and-mouth disease (FMD) outbreak in the United Kingdom, described in Chapter 2, illustrate a common means by which outbreaks are detected that is a clinician, veterinarian, or pathologist encounters an individual with a rare disease. Outbreaks of measles, botulism, and tuberculosis often come to attention in this manner. The outbreaks of Lyme disease, hepatitis A, AIDS, cryp-tosporidium, SARS (2003), and Legionnaire's disease were detected by an astute observer who noticed a cluster of illness and reported its existence to a health department. Outbreaks caused by contamination of food are often discovered when affected individuals who have dined together phone each other upon waking up sick the next day, and one of them calls the health department. The ability of a human or a computer to notice an anomalous number of cases above the background number of cases depends on the diagnostic precision of the surveillance data. For example, if a...


The outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003 has raised the specter of rapid and uncontrolled spread of acute respiratory infections through the homeless population. The 2003 SARS outbreak in Toronto was almost entirely confined to travelers returning from abroad, health care workers, and their household contacts (Svoboda, et al., 2004). No homeless person became infected with SARS. If this had happened, the large, transient, and difficult-to-locate shelter population would have made it almost impossible for Toronto public health officials to implement their core strategy of identifying and quarantining all household contacts of patients with SARS. Such a situation could have had devastating effects on efforts to prevent the outbreak from spreading into the city's general population. Given the threat of a recurrence of SARS or the possible emergence of other new and potentially deadly respiratory infections, infection control measures to deal with a severe acute...


The fifth pattern results from person-to-person transmission of a contagious disease, such as influenza, SARS, measles, or rubella (German measles). The timeliness requirement for this type of outbreak is not paramount because people become infected in waves. The recognition of this pattern involves biosurveillance components capable of collecting and analyzing social networks and contact information.


The cancer patient and their community face many medical and nonmedical challenges of cancer survivorship. As cancer therapy continues to improve, survivorship will become even more important leading to the pandemic of cancer survivorship. Urgently required are additional investment into research resources for better understanding, training of health care personnel, and provision for the complete management of both medical and nonmedical issues of cancer survivorship.34

Flu Virus Role of NA

Influenza remains a major cause of mortality and morbidity worldwide. Vaccination affords some protection but must be reformulated each year based on a prediction of the most likely strains circulating in the coming flu season. The antigenic drift and shift characteristic of the virus limits the effectiveness of the vaccine, and some warn of a re-emergence of a catastrophic pandemic strain such as occurred in 1918 the so called Spanish flu 1 . Two antiviral drugs (amantadine and rimantadine) have existed for some time that target the viral ion-channel protein M2 2 , but these are ineffective against the type B influenza virus and cause unwanted side effects. Of the several influenza virus proteins, the surface glycoprotein neuraminidase (NA) has emerged as the most successful target for antiviral development, although other work has been carried out on the hemagglutinin (HA) 3,4 and endonuclease 5 .


Supportive measures are the mainstay of treatment of VHFs. There is no effective treatment for Ebola and Marburg VHF. In contrast, ribavirin is effective in Lassa VHF when started within 7 days. In one study in Sierra Leone it was associated with a reduction in mortality from 55 to 5 in patients with severe disease associated with a high AST (McCormick et al., 1986). Other drugs, such as cysteine protease inhibitors, are in developmental phase only. The use of convales

Federal Laboratories

The DoD has established laboratories worldwide in locations such as Peru, Indonesia, Egypt, Thailand, and Kenya. DoD laboratories serve the needs of the armed forces and function as screening or sentinel laboratories for infectious diseases. The U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) has the capability to detect unusual biological agents that often require advanced testing techniques. This laboratory, located in Maryland, is a member of the Laboratory Response Network (LRN discussed later) and one of a few laboratories worldwide that can isolate and identify the most dangerous human agents, such as Ebola, smallpox and Marburg viruses.

Infectious diseases

There is strong evidence for association of only a few infectious diseases with the MHC (Table 9.1, Figure 9.1) although infection is believed to drive MHC variation (see Chapter 18). It has been proposed that the emphasis on autoimmunity is largely because research funding for studying these diseases, prevalent in western populations, has greatly exceeded that for infections that are more usually consigned to poorer countries. In fact, the funding emphasis has shifted considerably since the emergence of modern infectious diseases such as AIDS and SARS.


Its prevalence is increasing in almost all countries developed and developing (1). To curtail and eventually reverse the rise in obesity prevalence rates, a broad, population-based approach will be needed (1,2). The majority of the current global effort on obesity, however, is centered around establishing biological mechanisms related to energy imbalance and finding appropriate methods of treatment for individuals with obesity. The move to tackling whole populations with obesity requires conceptual shifts at many levels.


As stated, the search for carbohydrate ligands of high affinity and specificity is of prime interest in glycobiology. While classical structure-activity relationships (SARs) have led to the development of only a limited number of effective inhibitors through exhaustive enterprises, the rational design of glycoclusters or glycomimetics spanning cooperative pharmacophores has furthered our fundamental understanding of carbohydrate-protein interactions. Moreover, multivalent glycoforms may assist unraveling cooperative binding interactions as they really appear in in vivo experiments, a situation not always prevailing with isolated protein receptors or their recombinant forms. It is also stimulating to imagine the implications of glycoclusters in signal transduction.


Implication in medical reports can occur at the sentence level and at the report level. A simple example is the sentence, The patient had her influenza vaccine.'' If our SARS expert system had a variable for influenza, even a layperson reading the previous sentence could determine that the value for the variable would probably be no, because the patient was vaccinated. This inference requires domain knowledge that a vaccine generally prevents the target disease. In the radiology study reported above, evidence for pneumonia in positive reports was not always explicitly stated by the radiologist. Instead, the radiologist described hazy opacities'' or ill-defined densities'' in the lobes of the lung, which can be inferred to mean localized infiltrates. Once the inference at the sentence level has been correctly made, a physician reading the radiology report can integrate the findings described throughout the entire report and can infer that because the chest x-ray shows localized...

Feature Detection

The first type of NLP evaluation should measure the application's ability to detect features from text. The question being addressed when quantifying the performance of feature detection for the domain of biosurveillance is How well does the NLP application determine the values to the variables of interest from text For our SARS detector, examples of feature detection evaluations include how well the NLP application can determine whether a patient has a respiratory-related chief complaint, whether an ED report describes fever in a patient, or whether a patient has radiological evidence of pneumonia in a radiograph report.

Case Detection

The question being addressed when measuring the case detection ability of an NLP application for the domain of biosurveillance is How well does the NLP application identify relevant patients from textual data For our SARS detector, examples of case detection evaluations include how well the NLP application can determine whether a patient has a respiratory syndrome, whether a patient has a fever, whether a patient has radiological evidence of pneumonia, or whether a patient has SARS.

Epidemic Detection

The question being addressed when measuring the epidemic detection performance of an NLP application in the domain of biosurveillance is How well does the NLP application contribute to detection of an outbreak Evaluating epidemic detection is difficult. The first requirement for an epidemic detection study is reference standard identification of an outbreak. Outbreaks of respiratory and GI illnesses, such as influenza, pneumonia, and gastroenteritis, occur yearly throughout the country. Outbreaks of other infectious or otherwise concerning diseases, such as anthrax, West Nile virus, hemor-rhagic fever, or SARS, rarely occur in the United States. Once an outbreak is identified, the next requirement for an epidemic detection evaluation is having access to textual data for an adequate sample of patients living in the geographical area of the outbreak.


Early, reliable detection of outbreaks of disease, whether natural (e.g., West Nile virus and SARS) or bioterrorist induced (e.g., anthrax and smallpox), is a critically important problem today. We need to detect outbreaks as early as possible in order to provide the best response and treatment, as well as improve the chances of identifying the source.

Clinical Features

Marburg and Ebola virus infections are likely the most feared of the VHFs. The high mortality (ranging to 90 ) coupled with DIC make them particularly worrisome. After an incubation period of 3 to 9 (Marburg) or 3 to 18 (Ebola) days, an abrupt onset of headache, backache, and myalgias begins. Nausea, vomiting, and profuse watery and bloody diarrhea occur about 3 days later. A maculopapular rash erupts, and by days 4-5 diffuse hemorrhage occurs. Death occurs frequently by day 8 or 9. Leukopenia, thrombocytopenia, clotting abnormalities, proteinuria, and amylasemia will occur. EKG changes may also reflect myocardial involvement. Case fatality reaches 30 with Marburg and 90 with Ebola.

Viral Infections

The antiviral activity demonstrated in animal and in vitro trials provide a theoretical basis for its use in the treatment of SARS-associated CV (Cinatl et al 2003), HIV (Hattori et al 1989, Sasaki et al 2002-03), influenza (Utsunomiya et al 1997), EBV (Lin 2003a) and HSV-1 (Pompei et al 1979, Sekizawa et al 2001). Until controlled studies are available, the clinical effectiveness of this treatment remains unknown.


The concept of a syndrome is important in medical care (and in epidemiology). A syndrome is a constellation of symptoms, possibly combined with risk factors and demographic characteristics of patients (e.g., age and gender). Familiar examples of syndromes are SARS (severe acute respiratory syndrome) and AIDS (acquired immune deficiency syndrome). A syndrome plays the same role as a diagnosis in medical care it guides the physician in selection of treatments for patients. In this chapter, we will be discussing syndromes such as respiratory that are far less diagnostically precise than SARS or AIDS. The syndromes used in automated analysis of chief complaints and ICD codes are diagnostically imprecise by intent. The developers of these syndromes recognize that chief complaints (and ICD-coded diagnoses obtained close to the time of admission) in general do not contain sufficient diagnostic information to classify a patient as having SARS or other more diagnostically precise syndrome....


This advantage is important because new syndromes emerge with regularity, so it is important to be able to create a new syndrome definition quickly. Human biology changes very slowly, so new symptoms do not occur and the NLP conversion from free-text to symptom will be relatively stable, except as the language patients and triage nurses use to record chief complaints slowly evolves (e.g., the first time a patient uttered I think I have SARS'').

Biologic Isolation

Communicable diseases, which occur naturally, such as SARS, and potential bioterrorism agents, such as smallpox and pneumonic plague, make it essential that hospitals rapidly identify and isolate these patients. All medical staff should be educated in the recognition and immediate isolation and treatment of these patients. Triage should have appropriate signage instructing patients to identify themselves if they have a fever and a rash or if they have a fever and a cough and have traveled to area of the world known to be endemic for SARS. Once a patient has been identified they should be placed in an isolation room. Healthcare workers should use appropriate precautions and don an N-95 respirator (employees should be fit tested), gown, gloves, and eye protection. Procedures should be in place for safely moving the patient from triage to the treatment area, quarantining the waiting room, notifying public health officials, and providing educational materials to quarantined patients,...


Many detection algorithms (Goldenberg et al., 2002, Zhang et al., 2003, Fawcett and Provost, 1997) assume that the observed data consist of cases from background activity, which we will refer to as the baseline, plus any cases from irregular behavior. Under this assumption, detection algorithms operate by subtracting away the baseline from recent data and raising an alarm if the deviations from the baseline are significant. The challenge facing all such systems is to estimate the baseline distribution using data from historical data. In general, determining this distribution is extremely difficult due to the different trends present in surveillance data. Seasonal variations in weather and temperature can dramatically alter the distribution of surveillance data. For example, influenza season typically occurs during mid-winter, resulting in an increase in ED cases involving respiratory problems. Disease outbreak detectors intended to detect epidemics such as severe acute respiratory...