Poliomyelitis, or polio, is a highly infectious disease and can result in permanent flaccid paralysis of the limbs. Singapore was certified polio-free by the World Health Organization (WHO) on 29 October 2000, together with 36 other countries in the Western Pacific Region. The last imported case of polio in Singapore was in 2006. Fortunately, polio is vaccine-preventable-the world saw the global eradication of wild poliovirus types 2 and 3 achieved in 2015 and 2019, respectively. However, in late 2022, a resurgence of paralytic polio cases from vaccine-derived poliovirus (VDPV) was detected in countries like Israel and the US (specifically, New York); VDPV was also detected during routine sewage water surveillance with no paralysis cases in London, UK. Without global eradication, there is a risk of re-infection from importation and spread of wild poliovirus or VDPV, or new emergence and circulation of VDPV. During the COVID-19 pandemic, worldwide routine childhood vaccination coverage fell by 5% to 81% in 2020-2021. Fortunately, Singapore has maintained a constantly high vaccination coverage of 96% among 1-year-old children as recorded in 2021. All countries must ensure high poliovirus vaccination coverage in their population to eradicate poliovirus globally, and appropriate interventions must be taken to rectify this if the coverage falters. In 2020, WHO approved the emergency use listing of a novel oral polio vaccine type 2 for countries experiencing circulating VDPV type 2 outbreaks. Environmental and wastewater surveillance should be implemented to allow early detection of "silent" poliovirus transmission in the population, instead of relying on clinical surveillance of acute flaccid paralysis based on case definition alone.
Child ; Humans ; Infant ; Public Health Surveillance ; Pandemics ; Wastewater ; Wastewater-Based Epidemiological Monitoring ; COVID-19/epidemiology* ; Poliomyelitis/prevention & control* ; Poliovirus ; Poliovirus Vaccine, Oral ; Vaccination ; Global Health

Objective: To estimate the consumption level of four drugs in Beijing using wastewater-based epidemiology (WBE). Methods: The primary sludge from one large wastewater treatment plants (WWTPs) was collected in Beijing from July 2020 to February 2021. The concentrations of codeine, methadone, ketamine and morphine in the sludge were detected through solid-phase extraction-liquid chromatography-tandem mass spectrometry. The consumption, prevalence and number of users of four drugs were estimated by using the WBE approach. Results: Among 416 sludge samples, codeine had the highest detection rate (82.93%, n=345) with a concentration [M (Q₁, Q₃)] of 0.40 (0.22-0.8) ng·g^-1, and morphine had the lowest detection rate (28.37%,n=118) with a concentration [M (Q₁, Q₃)] of 0.13 (0.09, 0.17) ng·g^-1. There was no significant difference in the consumption of the four drugs on working days and weekends (all P values>0.05). Drug consumption was significantly higher in winter than that in summer and autumn (all P values <0.05). The consumption [M (Q₁, Q₃)] of codeine, methadone, ketamine and morphine in winter was 24.9 (15.58, 38.6), 9.39 (4.57, 26.72), 9.84 (5.18, 19.45) and 5.67 (3.57, 13.77) μg·inhabitant^-1·day^-1, respectively. For these drugs, there was an upward trend in the average drug consumption during summer, autumn and winter (the Z values of the trend test were 3.23, 3.16, 2.19, and 3.32, respectively and all P values<0.05). The prevalence [M (Q₁, Q₃)] of codeine, methadone, ketamine and morphine were 0.0056% (0.003 4%, 0.009 2%), 0.0148% (0.009 6%, 0.026 7%),0.0333% (0.0210%, 0.0710%) and 0.0072% (0.003 8%, 0.011 7%), respectively. The estimated number of drug users [M (Q₁, Q₃)] was 918 (549, 1 511), 2 429 (1 578, 4 383), 5 451 (3 444, 11 642) and 1 173 (626, 1 925),respectively. Conclusion: Codeine, methadone, ketamine and morphine have been detected in the sludge of WWTPs in Beijing, and the consumption level of these drugs varies in different seasons.
Humans ; Beijing ; Wastewater-Based Epidemiological Monitoring ; Sewage/analysis* ; Wastewater ; Ketamine/analysis* ; Codeine/analysis* ; Methadone/analysis* ; Water Pollutants, Chemical/analysis*

OBJECTIVE: The benefits of targeted temperature management (TTM) for resuscitated out of hospital cardiac arrest (OHCA) with an initial non-shockable rhythm are still unclear. This study examined whether TTM reduces the mortality and improves the neurological outcomes of OHCA with a non-shockable initial rhythm. METHODS: This study analyzed the clinical outcome of 401 resuscitated patients with an initial non-shockable rhythm among a total of 1,616 OHCA patients who were registered in Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance. The impact of TTM was investigated after accounting for the patients' propensity for TTM. The primary outcome was a 30-day in-hospital course with a neurologically favorable outcome defined by a cerebral performance categories scale ≤2. RESULTS: TTM was performed in 89 patients (22%) with an initial non-shockable rhythm. Patients who has received TTM had a tendency to be younger, more likely to be female, and more likely to undergo percutaneous coronary intervention. The clinical outcome of the patients in the initial non-shockable rhythm treated by TTM was superior to those without TTM (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.27–0.46). Further analysis after propensity score matching or inverse probability of treatment weighting (IPTW) showed consistent findings (propensity score matching: HR, 0.32; 95% CI, 0.22–0.45; IPTW: HR, 0.40; 95% CI, 0.31–0.52; P<0.001, all). CONCLUSION: In this nationwide OHCA registry, TTM was related to an approximately three-fold better 30-day neurologically favorable survival of resuscitated patients with TTM treatment than patients without TTM in the initial non-shockable rhythm.
Cardiopulmonary Resuscitation ; Epidemiological Monitoring ; Female ; Heart Arrest ; Humans ; Hypothermia, Induced ; Mortality ; Out-of-Hospital Cardiac Arrest ; Percutaneous Coronary Intervention ; Prognosis ; Propensity Score

PURPOSE: This study examined the association between the prothrombin time (PT) prolongation during cardiopulmonary resuscitation (CPR) and the outcome after an out-of-hospital cardiac arrest (OHCA). METHODS: From the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance database, CPR-attempted and adult OHCAs with a cardiac etiology transported to emergency departments (EDs) from January to December 2014 were included. The PT was measured immediately after arrival to the ED during CPR, and PT prolongation was categorized into 3 groups, the normal group (international normalized ratio [INR] < 1.1), mild group (1.1≤INR < 1.4), and severe group (1.4≤INR). The primary and secondary outcomes were survival to hospital discharge and a good cerebral performance scale (CPC) of 1 or 2. The potential confounders were adjusted for calculating the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) in multivariable logistic regression analysis. RESULTS: The survival and good CPC rates were 17.2% and 11.8% in the normal group, 12.2% and 4.5% in the mild group, and 3.6% and 0.6% in the severe group, respectively (p < 0.01). The AORs (95% CIs) on survival were 0.72 (0.41 to 1.27) for the mild group and 0.28 (0.11 to 0.69) for the severe group. The AORs (95% CIs) for good CPC were 0.41 (0.19 to 0.91) for the mild group and 0.14 (0.02 to 0.83) for the severe group. CONCLUSION: The PT prolongation measured at the ED was found to be associated with poor outcomes in adult OHCAs with cardiac etiology.
Adult ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Epidemiological Monitoring ; Heart Arrest ; Humans ; Logistic Models ; Observational Study ; Odds Ratio ; Out-of-Hospital Cardiac Arrest ; Prothrombin Time ; Prothrombin

Japanese encephalitis (JE) is a serious public health issue. This study was undertaken to better understand the relationship between JE distribution and environmental factors in China. JE data from 2005 to 2010 were retrieved from National Notifiable Disease Report System. ArcGIS, remote sensing techniques, and R software was used to exhibit and explore the relationship between JE distribution and environmental factors. Our results indicated that JE cases were mostly concentrated in warm-temperate, semitropical and tropical zones with annual precipitation > 400 mm; Broad-leaved evergreen forest, shrubs, paddy field, irrigated land, dryland, evergreen coniferous forest, and shrubland were risk factors for JE occurrence, and the former five were risk factors for counties with high JE incidence. These findings will inform the effective allocation of limited health resources such as intensive vaccination, surveillance and training in areas with high environmental risk factors.
China ; epidemiology ; Encephalitis, Japanese ; epidemiology ; virology ; Environment ; Epidemiological Monitoring ; Humans ; Incidence ; Risk Factors

Several epidemiological studies have reported an association between environmental pollution and various health conditions in individuals residing in industrial complexes. To evaluate the effects of pollution from industrial complex on human health, we performed a pooled analysis of environmental epidemiologic monitoring data for residents living near national industrial complexes in Korea. The respiratory and allergic symptoms and the prevalence of acute and chronic diseases, including cancer, were used as the outcome variables for health effects. Multiple logistic regression analysis was used to analyze the relationship between exposure to pollution from industrial complexes and health conditions. After adjusting for age, sex, smoking status, occupational exposure, level of education, and body mass index, the residents near the industrial complexes were found to have more respiratory symptoms, such as cough (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.06 to 1.31) and sputum production (OR, 1.13; 95% CI, 1.03 to 1.24), and symptoms of atopic dermatitis (OR, 1.10; 95% CI, 1.01 to 1.20). Among residents of the industrial complexes, the prevalence of acute eye disorders was approximately 40% higher (OR, 1.39; 95% CI, 1.04 to 1.84) and the prevalence of lung and uterine cancer was 3.45 times and 1.88 times higher, respectively, than those among residents of the control area. This study showed that residents living in the vicinity of industrial complexes have a high risk of acute and chronic diseases including respiratory and allergic conditions. These results can be used as basic objective data for developing health management measures for individuals residing near industrial complexes.
Body Mass Index ; Chronic Disease ; Cough ; Dermatitis, Atopic ; Education ; Employment ; Environmental Pollution* ; Epidemiologic Studies ; Epidemiological Monitoring ; Humans ; Korea* ; Logistic Models ; Lung ; Prevalence ; Smoke ; Smoking ; Sputum ; Uterine Neoplasms

BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly being reported throughout the world, which is a significant problem for patient treatment and infection control. Carbapenem-resistance in Enterobacteriaceae is mainly due to carbapenem-hydrolyzing β-lactamase, which tends to spread through genetic mobile elements. Therefore, the detection of carbapenemase-producing Enterobacteriaceae (CPE) carriers is particularly important for the prevention and epidemiological monitoring of these infections. In this study, we performed surveillance cultures for CPE in patients admitted to the hospital and evaluated the prevalence of CPE. METHODS: Stool cultures were obtained from a total of 228 patients at our tertiary-care hospital between March and May 2017. Stool specimens were inoculated on ChromID CARBA agar (bioMérieux, France) and incubated for 18-24 hours. Suspicious colonies with pink or bluish-green color were screened for CPE by the modified Hodge test (MHT) and carbapenemase inhibition test (CIT). We performed PCR to detect five carbapenemase genes, bla(KPC), bla(IMP), bla(VIM), bla(NDM), and bla(OXA-48). RESULTS: Among 228 isolates, seven were suspicious for CPE: four Klebsiella pneumoniae, one Escherichia coli, one Enterobacter aerogenes, and one Serratia marcescens. Two K. pneumoniae isolates showed positive reactions in both the modified Hodge test and inhibition test with phenylboronic acid. By PCR, bla(KPC) was identified in these two K. pneumoniae isolates. CONCLUSION: Our results showed a very low prevalence (2/228, 0.9%) of CPE in our tertiary-care hospital based on surveillance culture in a recent three month period.
Agar ; Enterobacter aerogenes ; Enterobacteriaceae* ; Epidemiological Monitoring ; Escherichia coli ; Humans ; Infection Control ; Klebsiella pneumoniae ; Pneumonia ; Polymerase Chain Reaction ; Prevalence ; Serratia marcescens

BACKGROUND: Invasive Streptococcus agalactiae (group B streptococcus, GBS) infection most commonly occurs in infants; however, cases of GBS infection in adults, particularly in the elderly with significant underlying diseases, are being increasingly reported. We analyzed the serotype specific opsonophagocytic antibodies (the major mechanism of protection against GBS) in infants, adults, and the elderly. METHODS: The opsonization indices (OIs) of antibodies against serotype Ia, Ib, II, III, and V GBS were studied in 89 infants, 35 adults (age, 30–50 years), and 62 elderly individuals (age, 65–85 years) according to the University of Alabama at Birmingham GBS opsonophagocytic killing assay protocol (www.vaccine.uab.edu). RESULTS: In infants, adults, and elderly groups respectively, geometric mean of OI against GBS serotype Ia were 3, 7, and 32; against GBS serotype Ib were 7, 242, and 252; against serotype II were 93, 363, and 676; against serotype III were 8, 212, and 609; and against serotype V were 4, 639, and 610. The seropositive rate (% of subjects with OI ≥ 4) increased significantly in older age group for all five serotypes. CONCLUSION: During infancy, only a limited proportion of infants have functional immunity against serotype Ia, Ib, II, III, and V GBS. Furthermore, a lack of opsonic activities against GBS observed in some adults and the elderly might predispose such individuals to the risk of invasive GBS infection. Epidemiological monitoring and development of suitable vaccine for these populations are needed.
Adult ; Aged ; Alabama ; Antibodies* ; Epidemiological Monitoring ; Homicide ; Humans ; Infant ; Prevalence ; Seroepidemiologic Studies* ; Serogroup* ; Streptococcus agalactiae ; Streptococcus*

OBJECTIVES: Prompt detection is a cornerstone in the control and prevention of infectious diseases. The Integrated Disease Surveillance Project of India identifies outbreaks, but it does not exactly predict outbreaks. This study was conducted to assess temporal correlation between Google Trends and Integrated Disease Surveillance Programme (IDSP) data and to determine the feasibility of using Google Trends for the prediction of outbreaks or epidemics. METHODS: The Google search queries related to malaria, dengue fever, chikungunya, and enteric fever for Chandigarh union territory and Haryana state of India in 2016 were extracted and compared with presumptive form data of the IDSP. Spearman correlation and scatter plots were used to depict the statistical relationship between the two datasets. Time trend plots were constructed to assess the correlation between Google search trends and disease notification under the IDSP RESULTS: Temporal correlation was observed between the IDSP reporting and Google search trends. Time series analysis of the Google Trends showed strong correlation with the IDSP data with a lag of −2 to −3 weeks for chikungunya and dengue fever in Chandigarh (r > 0.80) and Haryana (r > 0.70). Malaria and enteric fever showed a lag period of −2 to −3 weeks with moderate correlation. CONCLUSIONS: Similar results were obtained when applying the results of previous studies to specific diseases, and it is considered that many other diseases should be studied at the national and sub-national levels.
Communicable Diseases ; Dataset ; Dengue ; Disease Notification ; Disease Outbreaks* ; Epidemiological Monitoring ; India* ; Malaria ; Public Health Surveillance ; Typhoid Fever

OBJECTIVES: We reviewed digital epidemiological studies to characterize how researchers are using digital data by topic domain, study purpose, data source, and analytic method. METHODS: We reviewed research articles published within the last decade that used digital data to answer epidemiological research questions. Data were abstracted from these articles using a data collection tool that we developed. Finally, we summarized the characteristics of the digital epidemiological studies. RESULTS: We identified six main topic domains: infectious diseases (58.7%), non-communicable diseases (29.4%), mental health and substance use (8.3%), general population behavior (4.6%), environmental, dietary, and lifestyle (4.6%), and vital status (0.9%). We identified four categories for the study purpose: description (22.9%), exploration (34.9%), explanation (27.5%), and prediction and control (14.7%). We identified eight categories for the data sources: web search query (52.3%), social media posts (31.2%), web portal posts (11.9%), webpage access logs (7.3%), images (7.3%), mobile phone network data (1.8%), global positioning system data (1.8%), and others (2.8%). Of these, 50.5% used correlation analyses, 41.3% regression analyses, 25.6% machine learning, and 19.3% descriptive analyses. CONCLUSIONS: Digital data collected for non-epidemiological purposes are being used to study health phenomena in a variety of topic domains. Digital epidemiology requires access to large datasets and advanced analytics. Ensuring open access is clearly at odds with the desire to have as little personal data as possible in these large datasets to protect privacy. Establishment of data cooperatives with restricted access may be a solution to this dilemma.
Cell Phones ; Communicable Diseases ; Data Collection ; Dataset ; Epidemiologic Studies* ; Epidemiological Monitoring ; Epidemiology* ; Geographic Information Systems ; Humans ; Information Storage and Retrieval ; Internet ; Life Style ; Machine Learning ; Mental Health ; Methods ; Privacy ; Public Health Surveillance ; Social Media