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Dec 20, 2013

Joint International Tropical Medicine Meeting (JITMM), 11 - 13 Dec, 2013 Bangkok, Thailand

Recently attended Joint International Tropical Medicine Meeting (JITMM) held on 11 - 13 Dec, 2013 in Bangkok, Thailand. This 3 days meeting was attended by infectious disease researchers all around the world especially from Asian countries. There was also presentation on parasitology, which was an attraction for many delegates with special sessions on malaria & its related issues like Aretemesin Result FP malaria. I presented a poster titled "Cholera in Nepal". Cholera is a public health issue that still hounds rural areas in the country that can be associated with eith man made or natural disaster. My message was primarily that health authorities must emphasize on disease surveillance and timely preventive measures. Please find here the link for abstract book:

Nov 25, 2013

WHO and the Philippine Government launch mass vaccination campaign

MANILA, Philippines – WHO and the Philippine Department of Health have launched a vaccination campaign to prevent outbreaks of measles and polio among survivors of Typhoon Haiyan (Yolanda)…The campaign targets children in areas hardest hit by the disaster – starting with the evacuation centres in the city of Tacloban and at receiving centres in Cebu, where evacuated families are finding temporary shelter. Children under 5 years old are being vaccinated against polio and measles and given Vitamin A drops to boost their immune systems. ..WHO worked with the Department of Health to finalize plans and procure all necessary vaccines and supplies to carry out the campaign and set up immunization stations…WHO is working with partners to arrange for the delivery of vaccines using gas-powered and generator-powered fridges, freezers, vaccine-cases, cold boxes and ice packs for affected areas that have lost power. This “cold chain” is necessary to keep the vaccines from being spoiled. USAID has sent 6 solar-powered refrigerators to Tacloban.
WHO – Humanitarian Health Action
WHO responding to health needs caused by typhoon Haiyan (Yolanda) 2013 – Health Cluster Bulletin – 20 November 2013

Nov 19, 2013

Definition: Emerging and Re - Emerging Infectious diseases

"Emerging infectious diseases are diseases that (1) have not occurred in humans before (this type of emergence is difficult to establish and is probably rare); (2) have occurred previously but affected only small numbers of people in isolated places (AIDS and Ebola hemorrhagic fever are examples); or (3) have occurred throughout human history but have only recently been recognized as distinct diseases due to an infectious agent (Lyme disease and gastric ulcers are examples). "
"Re-emerging infectious diseases are diseases that once were major health problems globally or in a particular country, and then declined dramatically, but are again becoming health problems for a significant proportion of the population (malaria and tuberculosis are examples). Many specialists in infectious diseases include re-emerging diseases as a subcategory of emerging diseases."

Nov 16, 2013


Vaccination is protects you from something that might happen in the future.

Nov 11, 2013

Very Relevant Article re: Natural Disasters, Armed Conflict with its implication on Global Health

Review Article - Global Health

Natural Disasters, Armed Conflict, and Public Health
Jennifer Leaning, M.D., and Debarati Guha-Sapir, Ph.D.
N Engl J Med 2013; 369:1836-1842November 7, 2013DOI: 10.1056/NEJMra1109877
Natural disasters and armed conflict have marked human existence throughout history and have always caused peaks in mortality and morbidity. But in recent times, the scale and scope of these events have increased markedly. Since 1990, natural disasters have affected about 217 million people every year,1 and about 300 million people now live amidst violent insecurity around the world.The immediate and longer-term effects of these disruptions on large populations constitute humanitarian crises. In recent decades, public health interventions in the humanitarian response have made gains in the equity and quality of emergency assistance…
The effects of armed conflict and natural disasters on global public health are widespread. Much progress has been made in the technical quality, normative coherence, and efficiency of the health care response. But action after the fact remains insufficient. In the years ahead, the international community must address the root causes of these crises. Natural disasters, particularly floods and storms, will become more frequent and severe because of climate change. Organized deadly onslaughts against civilian populations will continue, fueled by the availability of small arms, persistent social and political inequities, and, increasingly, by a struggle for natural resources. These events affect the mortality, morbidity, and well-being of large populations. Humanitarian relief will always be required, and there is a demonstrable need, as in other areas of global health, to place greater emphasis on prevention and mitigation.

Nov 4, 2013

WHO: Oral Cholera Vaccine Stockpile

A global stockpile of oral cholera vaccine (OCV) has been created, as an additional tool to help control cholera epidemics. Over the period July 2013 /June 2014 the stockpile will have available 2 million doses of vaccine.
The OCV stockpile, is managed as a rotating fund, by the International Coordinating Group (ICG) which already manages similar stockpiles of meningococcal meningitis and Yellow Fever vaccines for outbreak response.
The ICG is comprised of four decision making partners: the International Federation of Red Cross and Red Crescent Societies (IFRC), Médecins Sans Frontières (MSF), United Nations Children’s Fund (UNICEF) and WHO, which also serves as the Secretariat.
The ICG members will continue to communicate with partners and stakeholders to increase awareness of the OCV stockpile, placing vaccine in the context of an integrated cholera response which is based around early detection, case management, provision of safe water, sanitation, and raising awareness among the affected communities.
November 2013
More information, applications and guidance is available here:

Oct 16, 2013

Vaccine Preventable Diseases (VPDs)

            We are living in 21st century, the age of supercomputers. With the story of super computers, we should not forget that millions of people are still living with abject poverty and millions of children having to lose their life before fifth birthday. If we go through pages of human history, we will read of global pandemics that created havocs across Europe to Asia. Millions of people had to lose their invaluable life to cholera, flu pandemics, smallpox, tuberculosis, and thousands of children got handicapped and live crippled life due to paralytic poliomyelitis. So this is a story that we should not forget in the backdrop of increasing population, climate change, poverty and rise in multi drug resistant micro – organisms due to inadvertent use of antibiotics.

As a fruit of science has ripened, so do we have various tools to deal with many infectious diseases of impoverished like cholera. Among those tools available, one is vaccines, which are safe, effective and affordable compared to other measures. Vaccine should be understood as a biological product that when given in the form of injection, droplet, skin patch or aerosol protect against targeted diseases producing protective response. I have a faith in vaccine and its long term health impact thereby its contribution in reducing childhood illness and death. So, I do say again and again that vaccine is boon to human kind. As an example, the greatest achievement in the human history is the eradication of small pox so far. The last case of this disease was detected in Ethiopia in 1980s. Another success story can be the endgame of paralytic poliomyelitis, which will soon be eradicated from this globe.

A decade long experience as a disease detective (surveillance medical officer - SMO) in hard to reach area (HRA) of Nepal searching for vaccine preventable diseases (VPDs) is a testimony to my faith in vaccine. During my tenure as a medical officer, we had to manage infectious diseases like Malaria, Visceral leishmaniasis, Cholera, Enteric fever, Japanese encephalitis, Dengue fever / Dengue Hemorrhagic fever, Worm infestation, Acute gastroenteritis, Protein Energy Malnutrition, Acute / Chronic viral hepatitis, Measles / rubella, Vitamin deficiency, micro- nutrient deficiencies. These diseases are rampant and many people even lose their life bringing socio –economic rift in family as well as community as a consequence. Now, the government of Nepal (GoN) has successfully controlled various infectious diseases through introduction of vaccines against diseases like measles & rubella, poliomyelitis, neonatal tetanus, Japanese encephalitis. Some of these diseases are virtually eliminated and some in the process of elimination. Therefore, the introduction of vaccines along with other public health measures has contributed significantly in reducing under 5 mortality. I also have to say and should not forget that the role of health professionals from centre to periphery is commendable. In this efficient public health delivery mechanism, thousands of female community health volunteers (FCHVs) are the backbone in its delivery to the community. They are like a bridge between health system and community. Though, there was a time, Nepal was going through political instability all over the country, it was FCHVs who made routine immunization (RI) run in its usual course and mass vaccination like polio / measles campaign happen throughout country a successful story. However, there are still some diseases like cholera, enteric fever, viral hepatitis, which need attention from government and international organization.  

In Nepal, a large proportion of people rely on unimproved sources for drinking water.  Around half of the population (49 %) opts for open defecation, more so in the rural areas. Only 17 % of populations have adequate access to proper sewage conditions in urban areas, whereas it is almost non - existent in rural areas. Also, there are major limitations in disease reporting through government health system due to incomplete data, and irregular and inconsistent data reporting, so that the burden of disease is seriously under - reported. In 2009, there was a huge cholera outbreak in hilly districts of mid western region, where thousands of people succumbed to this deadly infectious disease. This disease created havoc in the region that led to panicky situation causing socio – political disruption. Since the hilly regions of Nepal is geographically challenging in terms of access to health care and its delivery, many people have to lose their life and bear unnecessary suffering. Therefore, the Government of Nepal (GoN) needs to strengthen surveillance and consider cholera vaccination as a supplement to other preventive measures (i.e. provision of clean water, sanitation and personal hygiene) and the provision of treatment, particularly in high risk areas.
Anuj Bhattachan
15th Oct, 2013

Oct 12, 2013

International Vaccine Institute

We are living in 21st century, the age of supercomputers. For some of us, diseases related with poor water / food supply and sanitation may sound as a story of medieval period. However, it is a fact that millions of people are still living with abject poverty and millions of children have to lose their life before fifth birthday. Even if we go through pages of our history, we read global pandemics that created havocs across Europe to Asia. Millions of people lost their invaluable life to cholera, flu pandemics, smallpox, tuberculosis, and thousands of children got handicapped & live crippled life due to paralytic poliomyelitis.  On positive note, however, we have successfully controlled, eliminated or even eradicated many of these infectious diseases with the use of vaccine and public health measures since science took its foothold in the society from early 1900s. As an example, the greatest achievement in the human history is the eradication of small pox. The last case of this disease was detected in Ethiopia in 1980s. Now, we are almost nearing poliomyelitis eradication from the globe. In the backdrop of this success story, however, people in developing countries are still fighting death and illnesses caused by waterborne, airborne & vector borne diseases in whatever capacity they can through local and modern remedies available.  But on sad note, this is further compounded by increasing population density, deforestation, climate changes, increasing numbers of multi – drug resistance bacteria, urbanization and poverty.  It is reported that millions of children still miss regular vaccination either zero dose or incomplete dose.  The reasons are related with gap in access and utilization of vaccination that are available through government health care delivery services. This means that all these missed children are at increased risk of vaccine preventable diseases and thus, outbreaks in the community. These unfortunate missed children are usually from poor family, especially tribal community, who are under – privileged and illiteracy rampant. So, International vaccine Institute (IVI) has a mission to reach these High Risk populations and provide them access to safe, effective and affordable vaccine against diseases of impoverished using science as its means. IVI's ultimate goal is therefore to transcend vaccine science research from laboratory to the reach of community in high risk areas of developing countries.

Oct 7, 2013

India: launched indigenious JE vaccine

"The Union Health and Family Welfare Minister, Shri Ghulam Nabi Azad launched the indigenously produced Japanese Encephalitis (JE) vaccine JENVAC, here today. The vaccine has been jointly developed by scientists of NIV, ICMR and Bharat Biotech Ltd.

Shri Azad said that JENVAC is a completely indigenous vaccine and an outstanding example of public private partnership (PPP), and a remarkable milestone in the emergence of our country as an innovative and self-sufficient technology hub. He congratulated all those involved in this project of national importance."

To read more:

GPEI Update: Polio this week - As of 02 October 2013

Global Polio Eradication Initiative
Full report:

:: Three wild poliovirus type 1 (WPV1) cases were reported from South Sudan this week. Genetic sequencing is underway to determine the origin of the isolated viruses and possible relation to the ongoing Horn of Africa outbreak. The cases are from North Bahr El Gazal state (close to the border to Sudan) and Eastern Equatoria state (close to the border with Kenya and Uganda). The cases have triggered a full outbreak response from the Global Polio Eradication Initiative (GPEI) operational perspective. For more information see the ‘Horn of Africa’ section below.
:: Eight new WPV cases were reported from north-west Pakistan. Seven are from the Federally Administered Tribal Areas (FATA) and one from Khyber Pakhtoon (KP). The majority (67%) of WPV from Pakistan this year are from FATA, the bulk of which are from North Waziristan (10) and Khyber (10).
:: Pakistan’s Prime Minister Nawaz Sharif reasserted Pakistan’s commitment to eradicate polio in a speech at the UN General Assembly on Friday 27 September 2013: “We have also made eradication of polio in Pakistan a matter of great importance for my Government, as we are determined to make Pakistan a polio free country.”

:: The Independent Monitoring Board met 1-2 October in London, UK. The IMB reviewed the latest epidemiology and programme developments. The next IMB report is expected to be issued within two weeks of the meeting…
:: On 26 September, the Polio Oversight Board (POB) met with donors and other key stakeholders to review progress against the GPEI’s Polio Eradication and Endgame Strategic Plan 2013-2018, launched earlier this year…[see full text of statement below]
:: Two new WPV cases were reported from two previously infected districts in the past week. The two cases were reported from Watapur district in Kunar province and Batikot, Nangahar province. The total number of WPV cases for 2013 is now six. All six are WPV1 and all reported from Eastern Region. The most recent WPV1 case had onset of paralysis on 27 August, from Kunar province…
:: Two new WPV cases were reported this week. The cases were reported from two previously infected districts, one from Bauchi Local Government Area (LGA) in Bauchi state and one from Bichi LGA in Kano state. The total number of WPV cases for 2013 is now 49 (all WPV1s). The most recent WPV1 case in the country had onset of paralysis on 10 September (from Kano)
:: Eight new WPV cases were reported in the past week. Seven of the cases were reported from FATA province (five from North Waziristan, one from Khyber and one from a newly infected district – FR Dikhan).
:: One WPV was reported in Peshawar, KP.
:: The total number of WPV1 cases for 2013 is now 36. Of these, the majority, 24 (67%), are from FATA, of which 10 are from North Waziristan and 10 from Khyber…
:: The situation in North Waziristan is particularly concerning, as it is in an area where immunizations have been suspended by local leaders since last June. Immunizations in neighbouring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.
:: The most recent cases in FATA underscore the risk of ongoing polio transmission (be it due to WPV or cVDPV) in this area and the threat it continues to pose to children everywhere, in particular to children living in areas where access has not been possible for extended periods of time. FATA is the major poliovirus reservoir in Pakistan and in Asia, with confirmed circulation of both WPV1 and cVDPV2. More than 350,000 children in this area are regularly missed in inaccessible areas, during immunization activities. Efforts are ongoing to curb transmission in this area, including through vaccination at transit points and conducting Short Interval Additional Dose (SIADs) campaigns in areas that have recently become accessible.
Chad, Cameroon and Central African Republic
:: …In Cameroon, one new cVDPV2 case was reported in Kolofata, Extreme-Nord in the past week. The total number of cVDPV2 cases for 2013 is now four. The most recent case had onset of paralysis on 12 August (from Extreme-Nord). NIDs are planned for 11-13 October.
:: Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad, ongoing insecurity and humanitarian crises, and destruction of health infrastructure. :: To minimize the risk and consequences of potential re-infection, SNIDs were conducted 30 September – 2 October and NIDs are planned for end October.
Horn of Africa
:: Three cases were reported from North Bahr El Gazal and Eastern Equatoria areas over the past week, all three with onset of paralysis between 15-24 August. The new cases have triggered a full country outbreak response from a GPEI operational perspective.
:: South Sudan will launch immediate response covering children up to 15 years of age in the infected areas, targeting 140,000 children. This will be followed by a SNID in mid-October using bivalent oral polio vaccine (bOPV). Two national immunization days (NIDs) were already planned for November and December…
:: One new wild poliovirus case has been reported from the previously infected Somali region of Ethiopia. Onset of paralysis 7 September. No new WPV1 cases were reported from Somalia and Kenya in the past week. The total number of WPV1 cases for 2013 in the Horn of Africa is now 196 (175 from Somalia, 14 from Kenya, four from Ethiopia and three from South Sudan). The most recent WPV1 case in the region had onset of paralysis on 7 September (from Ethiopia).


Sep 30, 2013

Vaccine Clears Away Monkey AIDS virus

AIDS virus particles (pink) budding from the surface of an immune cell. Image by R. Dourmashkin, Wellcome Images. All rights reserved by Wellcome Images.

An experimental vaccine given to monkeys triggered a lasting immune attack that eliminated all traces of an AIDS-causing virus after a year or more. The finding points to a possible new strategy in the search for an effective AIDS vaccine. HIV, which causes AIDS in people, and the similar monkey virus known as SIV have long been thought to cause permanent infections once established in the body. Even the best antiretroviral therapies can control but not eliminate these infections. Recent studies, though, suggest that both SIV and HIV might be vulnerable to attack and clearance in the first few hours or days after exposure to the virus.

To exploit this vulnerability, a team led by Dr. Louis Picker of the Oregon Health and Science University has been developing and testing a genetically engineered vaccine that includes genes encoding SIV proteins within a modified cytomegalovirus (CMV). CMV is a common, often harmless virus that causes a permanent infection and can thus trigger and sustain a lasting immune response. CMV can cause serious problems, though, in newborns and people with weakened immune systems.

In 2011, Picker and his colleagues showed that when 24 vaccinated monkeys were exposed to an aggressive form of SIV, they all initially became infected. But within several weeks, about half of the monkeys were able to fight the infection and eventually reduce SIV to undetectable levels. In the year after infection, occasional viral “blips” occurred in the bloodstream but waned over time.
In the new study, Picker and his colleagues took a closer look at how the CMV/SIV vaccine elicits immune responses and viral clearance in monkeys. They studied different routes of SIV infection: intravenous, vaginal, and rectal. Their research was funded in part by NIH’s National Institute of Allergy and Infectious Diseases (NIAID) and National Cancer Institute (NCI). The study appeared online in Nature on September 11, 2013.

As in the earlier study, vaccinated animals initially became infected after challenge with an aggressive SIV strain. Viable SIV could be detected in blood and lymph nodes for weeks to months after challenge, regardless of the route of infection. Over time, however, about half of the vaccinated monkeys lost all evidence of SIV. Even ultrasensitive tests couldn’t detect blood- or tissue-associated virus up to 3.5 years after infection.

Additional analysis showed that the vaccine had prompted production of SIV-specific effector memory T cells in protected monkeys. This type of “killer” T cell responds to previously encountered cell-surface molecules—including the fragments of SIV proteins encoded by the genes in the CMV/SIV vaccine—and destroys SIV-infected cells. The researchers found evidence that the SIV-targeting T cells may remain indefinitely on patrol in the body. When the virus emerges, these cells can quickly respond and wipe out infected cells.

“Through this method we were able to teach the monkey's body to better prepare its defenses to combat the disease," Picker says. “Our vaccine mobilized a T-cell response that was able to overtake the SIV invaders in 50% of the cases treated. We are hopeful that pairing our modified CMV vector with HIV will lead to a similar result in humans.”

In hope of further improving the vaccine, the researchers are now examining why it works in only about half of the vaccinated monkeys.

— by Vicki Contie


Sep 22, 2013

Remembering Albert Bruce Sabin and his legacy

Born: August 26, 1906

Died: March 3, 1993
Major Contribution:
Albert Sabin developed the widely-used, oral, attenuated ("live") poliovirus vaccine (OPV). A form of the oral attenuated vaccine is used today in the worldwide effort to eradicate acute poliomyelitis. However, some countries including the United States, recommend the IPV (inactivated polio vaccine).
Note: Poliomyelitis is next disease that is targeted for eradication after smallpox.

Sep 9, 2013

Ms. Sang Hee Lee, Talented Violiist and IVI supporter

The popular, loyal and talented violinist and IVI supporter, Ms. Sang Hee Lee will be performing another concert to benefit IVI. Ms. Sang Hee Lee has been hosting this concert annually for IVI for nearly 10 years. All profits raised are donated to IVI.

Date: September 29, 2013  (Sun)
Place: Yongsan Art Hall
Time: 7:30 pm


Sep 6, 2013

Re definining the purpose of this blog: Concept paper


To gather and share knowledge on Emerging and Re-emerging infectious diseases in South Asian
countries especially Nepal.
  • To welcome members from all sphere to engage in scientific dialogue
  • To encourage innovative ideas and discussion on them
  • To keep up with literature
  • To improve critical thinking
  • To demonstrate continuing educationt
  • To promote evidence –based practice
  • To promote social contact
Blog Members:
Blog membership will run on a voluntary basis.
Roles and Responsibilities:
The most important criterion for this blog membership is a deep interest in research discussion, so as to nurture the purpose of this blog.
  • Sets the ground rules for this blog
  • Makes sure blog posts are timely
  • Coordinates to bring relevant science agenda for posting
  • Promotes this blog through social media

The post for this blog will be published from now onwards once in a week.

  • Twitter
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  • Linkedin

Future Plans:
Connect + Connect + Connect = continuity = visibility

Sep 5, 2013

John D Clemens and his thoughts on Female Health Community Voluteers

During my almost 5 years of surveillance medical officer (SMO) experience, I travelled to > 60 districts out of 75 distrcts in Nepal, I have observed and found that female community volunteers are the foundation for delivering public health services at the level of family. Without them, I am of the opinion, Nepal would not have achieved success like Bangladesh has, in the field of mother and child's health.

Link for below:

A good article to read:

John D. Clemens
Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh

Article Highlight:

While there are no “magic bullets” that can help developing nations reach MDGs 4 and 5 by 2015, lessons can be learned from Bangladesh’s equity focus, in particular the effective use of young, well-trained, local women to deliver an integrated package of family planning and primary healthcare to their communities.

Malnutrition in Nepal

Abstract from a paper:

This paper sheds light on infectious diseases and the status of malnutrition in Nepal, a Himalayan country located in South Asia. In spite of efforts by both Government and non-government sectors, infectious diseases are rampant in the countries constituting a major cause of morbidity and mortality, which in turn, impose a socio-economic and public health burden for the country. Intestinal parasitic infection has been implicated in the causation of malnutrition. Malnutrition associated with child mortality is more common among children aged less than five years. Nepalese women suffer from chronic malnutrition. People in rural areas are more affected by malnutrition than those in urban areas. This has been attributed to poverty, lack of education, and rampant infectious diseases.


Sep 2, 2013

Vaccination Myths Vs. reality

A report from CNN - Anderson Cooper 360 degree on recent measles outbreak in a Church, Texas. He talks with CNN Health Correspondent Dr. Sanjay Gupta. I think, this is a lesson all of us have to learn from.

Aug 24, 2013

Decade of Vaccines - Global Vaccine Action Plan 2011 - 2020

The Global Vaccine Action Plan (GVAP) ― endorsed by the 194 Member States of the World Health Assembly in May 2012 ― is a framework to prevent millions of deaths by 2020 through more equitable access to existing vaccines for people in all communities.

GVAP aims to strengthen routine immunization to meet vaccination coverage targets; accelerate control of vaccine-preventable diseases with polio eradication as the first milestone; introduce new and improved vaccines and spur research and development for the next generation of vaccines and technologies.



European Centre for Disease Control (ECDC)

To explain ECDC's role and activities, the Centre has produced a new corporate video illustrating its areas of work and how ECDC supports protecting public health across Europe.



Source: Modified from WHO World Health Report, 2000

Aug 8, 2013

ISDS Webinar: Global Public Health Surveillanc, Governance and Viral Sovereignty


Affan Shaikh, M.P.H, Senior Epidemiologist, Public Health Practice, LLC 

Scott JN McNabb, Ph.D., M.S., Research Professor, Emory University, Rollins School of Public Health | Managing Partner, Public Health Practice, LLC

Qanta Ahmed, M.D., Attending Sleep Disorders Medicine, Winthrop University Hospital | Associate Professor of Medicine, State University of New York (SUNY) at Stony Brook, New York

Ziad Memish, M.D., Deputy Minister of Public Health, Ministry of Health, Kingdom of Saudi Arabia

Date: Wednesday, August 14, 2013

Time: 3:00 PM - 4:00 PM EDT

Microbes carry no national passports; neither do they recognize geo-political boundaries or state sovereignty. Yet claims of viral sovereignty brings up unresolved controversies that challenge ethical public health governance and add unnecessary risk of global pandemics.  Viral sovereignty refers to a sovereign state's ownership rights over pathogens found within their border.  It was first coined to describe tensions rising from the Indonesian government's decision to conditionally withholding samples of H5N1 avian influenza in early 2007.

While the World Health Organization's (WHO) 2005 revised International Health Regulations (IHR [2005]) provide a global framework to prevent, protect against, control, and facilitate a public health response to the international spread of disease, its success firmly rests on mutual trust and transparency among parties.  Claims of viral sovereignty indicate the critical balance between respecting legitimate national sovereignty and complying with responsible global transparency is far from achieved.

This webinar reviews the origins of viral sovereignty as well as the rights of global health security and responsibilities of transparency required by the IHR (2005) for successful global public health surveillance today.  It points out the critical, current issues and weighs the pros and cons of various options to move forward.

Hosted by the ISDS Global Outreach Committee


Aug 7, 2013

The Remarkable adaptability of syndromic surveillance to meet public health needs

Article accessed on August 8, 013

Volume 3, Issue 1, March 2013, Pages 41–47



The goal of syndromic surveillance is the earlier detection of epidemics, allowing a timelier public health response than is possible using traditional surveillance methods. Syndromic surveillance application for public health purposes has changed over time and reflects a dynamic evolution from the collection, interpretation of data with dissemination of data to those who need to act, to a more holistic approach that incorporates response as a core component of the surveillance system. Recent infectious disease threats, such as severe acute respiratory syndrome (SARS), avian influenza (H5N1) and pandemic influenza (H1N1), have all highlighted the need for countries to be rapidly aware of the spread of infectious diseases within a region and across the globe. The International Health Regulations (IHR) obligation to report public health emergencies of international concern has raised the importance of early outbreak detection and response. The emphasis in syndromic surveillance is changing from automated, early alert and detection, to situational awareness and response. Published literature on syndromic surveillance reflects the changing nature of public health threats and responses. Syndromic surveillance has demonstrated a remarkable ability to adapt to rapidly shifting public health needs. This adaptability makes it a highly relevant public health tool.

  • Syndromic surveillance;
  • Outbreaks;
  • International Health Regulations;
  • Infectious diseases;
  • Public health

Aug 4, 2013

Risk Map of Cholera Infection for Vaccine Deployment: The Eastern Kolkotta Case

Posted on 3

PLoS One
[Accessed 3 August 2013]

Research Article

Risk Map of Cholera Infection for Vaccine Deployment: The Eastern Kolkata Case
Young Ae You, Mohammad Ali, Suman Kanungo, Binod Sah, Byomkesh Manna, Mahesh Puri, G. Balakrish Nair, Sujit Kumar Bhattacharya, Matteo Convertino, Jacqueline L. Deen, Anna Lena Lopez, Thomas F. Wierzba, John Clemens, Dipika Sur


Despite advancement of our knowledge, cholera remains a public health concern. During March-April 2010, a large cholera outbreak afflicted the eastern part of Kolkata, India. The quantification of importance of socio-environmental factors in the risk of cholera, and the calculation of the risk is fundamental for deploying vaccination strategies. Here we investigate socio-environmental characteristics between high and low risk areas as well as the potential impact of vaccination on the spatial occurrence of the disease.

Methods and Findings
The study area comprised three wards of Kolkata Municipal Corporation. A mass cholera vaccination campaign was conducted in mid-2006 as the part of a clinical trial. Cholera cases and data of the trial to identify high risk areas for cholera were analyzed. We used a generalized additive model (GAM) to detect risk areas, and to evaluate the importance of socio-environmental characteristics between high and low risk areas. During the one-year pre-vaccination and two-year post-vaccination periods, 95 and 183 cholera cases were detected in 111,882 and 121,827 study participants, respectively. The GAM model predicts that high risk areas in the west part of the study area where the outbreak largely occurred. High risk areas in both periods were characterized by poor people, use of unsafe water, and proximity to canals used as the main drainage for rain and waste water. Cholera vaccine uptake was significantly lower in the high risk areas compared to low risk areas.

The study shows that even a parsimonious model like GAM predicts high risk areas where cholera outbreaks largely occurred. This is useful for indicating where interventions would be effective in controlling the disease risk. Data showed that vaccination decreased the risk of infection. Overall, the GAM-based risk map is useful for policymakers, especially those from countries where cholera remains to be endemic with periodic outbreaks.

Citation: You YA, Ali M, Kanungo S, Sah B, Manna B, et al. (2013) Risk Map of Cholera Infection for Vaccine Deployment: The Eastern Kolkata Case. PLoS ONE 8(8): e71173. doi:10.1371/journal.pone.0071173

Editor: Matteo Convertino, University of Florida, United States of America

Received: April 11, 2013; Accepted: June 25, 2013; Published: August 2, 2013

Funding: This study is supported by the Bill & Melinda Gates Foundation through the Diseases of the Most Impoverished Program and the Cholera Vaccine Initiative. Additional funding is provided by the Swedish International Development Cooperation Agency and the Governments of South Korea, Sweden, and Kuwait. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Aug 3, 2013

Measles like illness outbreak in Upper Mustang, Nepal

Science and Technology Conference 2009, Huachiew Chalermprakiet University, Thailand; 10/2009

Background: Since 2004, there have been increasing reports of rubella outbreaks in Nepal, through the Vaccine Preventable Diseases (VPDs) surveillance network. This report details an investigation of a suspected “measles-like illness” outbreak in Mustang, a remote and hard to reach Himalayan district in the Western part of Nepal.

Methods: The Mustang District Rapid Response Team (RRT) investigated the outbreak in Chhonup and Lomanthang villages in Mustang, beginning on the 17th of June 2008, following the standard measles outbreak investigation guidelines. Blood samples were collected from seven children within 4 to 28 days of rash onset. All the samples were tested for both measles and rubella IgM antibodies in the National Public Health Laboratory (NPHL) in Kathmandu, Nepal

Results: Forty-eight cases were detected at the time of the investigation. There were two waves in the outbreak. The first occurred at the beginning of April, and the second from mid-May to mid-June. The primary attack rates were 1% and 4% in Lomanthang and Chhonup respectively. The primary attack rates were highest in the 1 – 9 year old population. No deaths in children with measles-like illness were reported from either village during this investigation. All children found with measles-like illness had been immunized against measles. All 7 serum samples were confirmed to be IgM positive for anti-rubella. The remaining 41 cases with measles like illness were considered epidemiologically linked to these laboratory-confirmed cases, and classified as rubella.

Conclusion: Since there is no vaccination against rubella in Nepal, the number of rubella susceptible individuals in the population has increased. Once the virus was introduced into the community, it spread very quickly and affected many susceptible individuals. It is highly recommended that rubella vaccinations be included in the National Immunization Programme (NIP) of Nepal.

Chhonup Village

Dengue Outbreak in Honduras


Death =  83
Illness = > 66000


Death    = 16
Illness   = 12000

Revisiting Cholera Outbreak in Jajarkot, Nepal, 2009

In 2009, it took around two months before the health authorities and public knew the acute watery diarrhea (AWD) outbreak in hilly districts of Mid Western region of Nepal as cholera. That year, > 15,000 people were affected and > 200 people lost their life. There were joint Government of Nepal (GON), UNICEF and other organizations for implementation of medical and behavioral control activities. This incident demands acute need for enhanced surveillance, hygiene and sanitation promotion and selective vaccination in a high risk, remote area of the country.
Risk factors: In general, illiteracy and poverty are risk factors for cholera, as any other infectious diseases outbreaks in remote areas. We can add, this is further compounded by combination of following reasons:

1.     Poor or difficult access to source of drinking water

2.     Water and food contamination during monsoon due to sanitation runoff and flooding disrupting everyday life exposing community to all possible infectious diseases

3.     Poor hygiene practices like hand washing after cleaning of dirt or waste / working in the field or defecation. This may be due to poor knowledge on disease causation or simply no supplies (e.g. soap)

4.     No latrines / open defaecation – this is general picture in hard to reach areas of the country.

5.     Poor access to health care, which is geographically remote from most people. Even if there is health centre in the vicinity, there can be a situation when there is lack of health personnel and medicines.


1.     Geography - remote with little road access and probably limited or no electricity there. These challenges make it an important to be innovative, but it is not impossible carry out preventive measures provided we have combination of dedicated staffs / leadership with adequate resources. 

2.     Carry out effective as well as put sustainable surveillance system in place throughout country with focus to reach hard to reach areas. This demands trained health staffs and budget, which is greater challenge for low income countries.

Anuj in Himalayas

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