Surveillance of R-plasmids.

The surveillance of R-plasmids consists of: (1.) Ecological and epidemiological investigations. (1.1.) Prevalence of R-plasmids in pathogenic and apathogenic bacteria occurring in the biotic environment (man, animal); in the abiotic environment (sewage, food, feed); under high selection pressure (hospital, animal production, plant production). (2.) Biological investigations. (2.1.) Genetic properties of R-plasmids: (2.2.) Plasmid induced variations of the properties of the host bacteria (virulence, phage pattern, antigenic pattern, serological properties). The problems resulting from plasmid-mediated drug resistance call for a strict chemotherapeutic drug policy with the regard to ecological processes.     

Surveillance for polioviruses.

Clinical case-driven surveillance for poliovirus remains the cornerstone of monitoring the progress of the poliomyelitis eradication initiative (PEI). It includes notification and careful investigation of cases of acute flaccid paralysis (AFP), timely collection of stool specimens from the patient, and virological examination of the specimens in an accredited laboratory. Successful high quality APF surveillance requires painstaking perseverance and smooth interplay of several different groups of health care workers in a country. Environmental surveillance (ES) may in certain situations be more sensitive than AFP surveillance in detecting wild type poliovirus or vaccine derived poliovirus circulation. However, apart from being highly labour intensive, it cannot be optimally applied in large parts of the world because of the lack of converging sewage systems. Under these conditions, the very rationale of ES, examining of individual samples representing large groups (hundreds of thousands) of people cannot be readily exploited. Whatever approach of poliovirus surveillance is used, we will always be monitoring subgroups of potential poliovirus excreting people only. Therefore, several years long poliovirus-free monitoring period is needed to confirm that poliovirus transmission has stopped in a given population.     

Surveillance of antibiotic resistance

Surveillance involves the collection and analysis of data for the detection and monitoring of threats to public health. Surveillance should also inform as to the epidemiology of the threat and its burden in the population. A further key component of surveillance is the timely feedback of data to stakeholders with a view to generating action aimed at reducing or preventing the public health threat being monitored. Surveillance of antibiotic resistance involves the collection of antibiotic susceptibility test results undertaken by microbiology laboratories on bacteria isolated from clinical samples sent for investigation. Correlation of these data with demographic and clinical data for the patient populations from whom the pathogens were isolated gives insight into the underlying epidemiology and facilitates the formulation of rational interventions aimed at reducing the burden of resistance. This article describes a range of surveillance activities that have been undertaken in the UK over a number of years, together with current interventions being implemented. These activities are not only of national importance but form part of the international response to the global threat posed by antibiotic resistance.     

Rotavirus Surveillance at a WHO-Coordinated Invasive Bacterial Disease Surveillance Site in Bangladesh: A Feasibility Study to Integrate Two Surveillance Systems

The World Health Organization (WHO) currently coordinates rotavirus diarrhea and invasive bacterial disease (IBD) surveillance at 178 sentinel sites in 60 countries. However, only 78 sites participate in both surveillance systems using a common sentinel site. Here, we explored the feasibility of extending a WHO-IBD surveillance platform to generate data on the burden of rotaviral diarrhea and its epidemiological characteristics to prepare the countries to measure the impact of rotaviral vaccine. A six-month (July to December, 2012) surveillance, managed by IBD team, collected stool samples and clinical data from under-five children with acute watery diarrhea at an IBD sentinel site. Samples were tested for rotavirus antigen by ELISA and genotyped by PCR at the regional reference laboratory (RRL). Specimens were collected from 79% (n = 297) of eligible cases (n = 375); 100% of which were tested for rotavirus by ELISA and 54% (159/297) of them were positive. At RRL, all the cases were confirmed by PCR and genotyped (99%; 158/159). The typing results revealed the predominance of G12 (40%; 64/159) genotype, followed by G1 (31%; 50/159) and G9 (19%; 31/159). All in all, this exploratory surveillance collected the desired demographic and epidemiological data and achieved almost all the benchmark indicators of WHO, starting from enrollment number to quality assurance through a number of case detection, collection, and testing of specimens and genotyping of strains at RRL. The success of this WHO-IBD site in achieving these benchmark indicators of WHO can be used by WHO as a proof-of-concept for considering integration of rotavirus surveillance with WHO-IBD platforms, specifically in countries with well performing IBD site and no ongoing rotavirus surveillance.     

Immune Surveillance via Self Digestion

The adaptive immune system is orchestrated by CD4⁺ T cells. These cells detect peptides presented on Major Histocompatiblity Complex (MHC) class II molecules, which are loaded in late endosomes with products of lysosomal proteolysis. One pathway by which proteins gain access to degradation in lysosomes is macroautophagy. We recently showed that constitutive macroautophagy can be detected in cells relevant for the immune system, including dendritic cells. In these antigen presenting cells, autophagosomes frequently fused with MHC class II antigen loading compartments and targeting of Influenza matrix protein 1 (MP1) for macroautophagy enhanced MHC class II presentation to MP1-specific CD4⁺ T cell clones up to 20 fold. Our findings indicate that macroautophagy is a constitutive and efficient pathway of antigen delivery for MHC class II presentation. We suggest that this pathway samples intracellular proteins for immune surveillance and induction of tolerance in CD4⁺ T cells, and could be targeted for improved MHC class II presentation of vaccine antigens.

Addendum to:

MHC Class II Antigen Loading Compartments Continuously Receive Input from Autophagosomes

Dorothee Schmid, Marc Pypaert and Christian Münz

Immunity 2006; In press     

Surveillance considerations for malaria elimination

ABSTRACT: Constant malaria monitoring and surveillance systems have been highlighted as critical for malaria elimination. The absence of robust monitoring and surveillance systems able to respond to outbreaks in a timely manner undeniably contributed to the failure of the last global attempt to eradicate malaria. Today, technological advances could allow for rapid detection of focal outbreaks and improved deployment of diagnostic and treatment supplies to areas needing support. However, optimizing diffusion activities (e.g., distributing vector controls and medicines, as well as deploying behaviour change campaigns) requires networks of diverse scholars to monitor, learn, and evaluate data and multiple organizations to coordinate their intervention activities. Surveillance systems that can gather, store and process information, from communities to national levels, in a centralized, widely accessible system will allow tailoring of surveillance and intervention efforts. Different systems and, thus reactions, will be effective in different endemic, geographical or socio-cultural contexts. Investing in carefully designed monitoring technologies, built for a multiple-acter, dynamic system, will help to improve malaria elimination efforts by improving the coordination, timing, coverage, and deployment of malaria technologies.     

Disease Surveillance Strategies in Swine

Preparations derived from plants were the original therapeutic interventions used by man to control diseases (including parasites), both within humans and livestock. Development of herbal products depended upon local botanical flora with the result that different remedies tended to develop in different parts of the world. Nevertheless, in some instances, the same or related plants were used over wide geographic regions, which also was the result of communication and/or the importation of plant material of high repute. Thus, the Nordic countries have an ancient, rich and diverse history of plant derived anthelmintic medications for human and animal use. Although some of the more commonly used herbal de-wormers were derived from imported plants, or their products, many are from endemic plants or those that thrive in the Scandinavian environment. With the advent of the modern chemotherapeutic era, and the discovery, development and marketing of a seemingly unlimited variety of highly efficacious, safe synthetic chemicals with very wide spectra of activities, herbal remedies virtually disappeared from the consciousness – at least in the Western world. This attitude is now rapidly changing. There is a widespread resurgence in natural product medication, driven by major threats posed by multi-resistant pest, or disease, organisms and the diminishing public perceptions that synthetic chemicals are the panacea to health and disease control. This review attempts to provide a comprehensive account of the depth of historical Nordic information available on herbal de-wormers, with emphasis on livestock and to provide some insights on potentially rewarding areas of "re-discovery" and scientific evaluation in this field.     

Influenza-Like Illness Sentinel Surveillance in Peru

Background

Acute respiratory illnesses and influenza-like illnesses (ILI) are a significant source of morbidity and mortality worldwide. Despite the public health importance, little is known about the etiology of these acute respiratory illnesses in many regions of South America. In 2006, the Peruvian Ministry of Health (MoH) and the US Naval Medical Research Center Detachment (NMRCD) initiated a collaboration to characterize the viral agents associated with ILI and to describe the clinical and epidemiological presentation of the affected population.

Methodology/Principal Findings

Patients with ILI (fever ≥38°C and cough or sore throat) were evaluated in clinics and hospitals in 13 Peruvian cities representative of the four main regions of the country. Nasal and oropharyngeal swabs, as well as epidemiological and demographic data, were collected from each patient. During the two years of this study (June 2006 through May 2008), a total of 6,835 patients, with a median age of 13 years, were recruited from 31 clinics and hospitals; 6,308 were enrolled by regular passive surveillance and 527 were enrolled as part of outbreak investigations. At least one respiratory virus was isolated from the specimens of 2,688 (42.6%) patients, with etiologies varying by age and geographical region. Overall the most common viral agents isolated were influenza A virus (25.1%), influenza B virus (9.7%), parainfluenza viruses 1, 2, and 3, (HPIV-1,-2,-3; 3.2%), herpes simplex virus (HSV; 2.6%), and adenoviruses (1.8%). Genetic analyses of influenza virus isolates demonstrated that three lineages of influenza A H1N1, one lineage of influenza A H3N2, and two lineages of influenza B were circulating in Peru during the course of this study.

Conclusions

To our knowledge this is the most comprehensive study to date of the etiologic agents associated with ILI in Peru. These results demonstrate that a wide range of respiratory pathogens are circulating in Peru and this fact needs to be considered by clinicians when treating patients reporting with ILI. Furthermore, these data have implications for influenza vaccine design and implementation in South America.     

Medical Surveillance for Biological Terrorism Agents

The first recognition of a bioterrorist attack may be sick patients. Recognition and subsequent notification of an attack at the earliest possible moment will assist in rapidly instituting protective measures. New methods of medical surveillance can assist with rapid detection. Syndromic surveillance is the use of newly created or pre-existing databases to track the health of communities. The data can include medical and non-medical information, but typically contains non-specific indicators of health status. These systems are currently being tested and fielded in multiple locations, and nationwide systems are being developed in the United States. Retrospective and prospective analyses have demonstrated the ability of the data to detect disease outbreaks, but the systems have yet to be proven to lead to more effective interventions.     

医院病房环境真菌监测分析

目的 调查医院各病区环境中真菌含量及分布特点.方法 运用分离培养及DNA测序方法对医院不同病区、不同环境中真菌进行监测分析.结果 医院不同病区真菌含量不同,呼吸科、血液科、小儿科空气中真菌含量较高,分别为400、225和200 CFU/m3,其中以烟曲霉菌( 325 CFU/m3)、黄曲霉菌( 275 CFU/m3)、枝孢霉菌( 125 CFU/m3)、根霉( 125 CFU/m3)为主;老年病科、肿瘤科和血液科空调出气口真菌含量较高,分别为0.559、0.500和0.323 CFU/cm2,以链格孢霉(0.441 CFU/cm2)、根霉(0.412 CFU/cm2)、烟曲霉菌(0.294 CFU/cm2)为主;不同环境中真菌含量不同,其中以空气和空调出气口真菌含量最高,分别为130 CFU/m3、0.173 CFU/cm2.结论 真菌广泛存在于医院环境中,且不同病区、不同环境真菌污染程度不同,因而我们必须制订健全的消毒管理制度,预防医院真菌感染.