The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant (B.1.1.529) rapidly replaced Delta (B.1.617.2) to become dominant in England. Our study assessed differences in transmission between Omicron and Delta using two independent data sources and methods. Omicron and Delta cases were identified through genomic sequencing, genotyping and S-gene target failure in England from 5–11 December 2021. Secondary attack rates for named contacts were calculated in household and non-household settings using contact tracing data, while household clustering was identified using national surveillance data. Logistic regression models were applied to control for factors associated with transmission for both methods. For contact tracing data, higher secondary attack rates for Omicron vs. Delta were identified in households (15.0% vs. 10.8%) and non-households (8.2% vs. 3.7%). For both variants, in household settings, onward transmission was reduced from cases and named contacts who had three doses of vaccine compared to two, but this effect was less pronounced for Omicron (adjusted risk ratio, aRR 0.78 and 0.88) than Delta (aRR 0.62 and 0.68). In non-household settings, a similar reduction was observed only in contacts who had three doses vs. two doses for both Delta (aRR 0.51) and Omicron (aRR 0.76). For national surveillance data, the risk of household clustering, was increased 3.5-fold for Omicron compared to Delta (aRR 3.54 (3.29–3.81)). Our study identified increased risk of onward transmission of Omicron, consistent with its successful global displacement of Delta. We identified a reduced effectiveness of vaccination in lowering risk of transmission, a likely contributor for the rapid propagation of Omicron.

Türkiye experienced 2 of the most catastrophic earthquakes of the last century on February 6, 2023. The first earthquake with a magnitude of 7.7 occurred at 4:17 am in Kahramanmaraş City. Nine hours later, the second earthquake with a magnitude of 7.6 hit a region, which has 10 cities and over 16 million people. After the earthquakes, the Director-General of the World Health Organization, Hans Kluge, announced that a level 3 emergency was declared. One of the problems that should be solved at the earliest period in earthquakes is the problem of orphans or unaccompanied children. These children, referred to as “earthquake orphans”, can be potential victims of violence, organized crime, organ trafficking, drug addiction, sexual exploitation, or human trafficking. The already low socioeconomic level of the region, the magnitude of the earthquake, and the turmoil in the emergency rescue organization cause concern that the number of fragile children in this population will be higher than expected. The problem of orphaned children experienced in previous major destructive earthquakes provides important experiences for earthquake preparation.

We evaluated the short-term effects of mitigation measures imposed by the Italian government on the first 10 municipalities affected by Sars-Cov-2 spread. Our results suggest that the effects of containment measures can be appreciated in about approximately 2 wk.

Predicting the magnitude of the annual seasonal peak in influenza-like illness (ILI)-related emergency department (ED) visit volumes can inform the decision to open influenza care clinics (ICCs), which can mitigate pressure at the ED. Using ILI-related ED visit data from the Alberta Real Time Syndromic Surveillance Net for Edmonton, Alberta, Canada, we developed (training data, 1 August 2004–31 July 2008) and tested (testing data, 1 August 2008–19 February 2014) spatio-temporal statistical prediction models of daily ILI-related ED visits to estimate high visit volumes 3 days in advance. Our Main Model, based on a generalised linear mixed model with random intercept, incorporated prediction residuals over 14 days and captured increases in observed volume ahead of peaks. During seasonal influenza periods, our Main Model predicted volumes within ±30% of observed volumes for 67%–82% of high-volume days and within 0.3%–21% of observed seasonal peak volumes. Model predictions were not as successful during the 2009 H1N1 pandemic. Our model can provide early warning of increases in ILI-related ED visit volumes during seasonal influenza periods of differing intensities. These predictions may be used to support public health decisions, such as if and when to open ICCs, during seasonal influenza epidemics.

Climate change is increasingly forcing population displacement, better described by the phrase environmentally induced forced migration. Rising global temperatures, rising sea levels, increasing frequency and severity of natural disasters, and progressive depletion of life-sustaining resources are among the drivers that stimulate population mobility. Projections forecast that current trends will rapidly accelerate. This will lead to an estimated 200 million climate migrants by the year 2050 and create dangerous tipping points for public health and security.

Among the public health consequences of climate change, environmentally induced forced migration is one of the harshest and most harmful outcomes, always involving a multiplicity of profound resource and social losses and frequently exposing migrants to trauma and violence. Therefore, one particular aspect of forced migration, the effects of population displacement on mental health and psychosocial functioning, deserves dedicated focus. Multiple case examples are provided to elucidate this theme. (Disaster Med Public Health Preparedness. 2019;13:116–122)

The limitations for self-reporting of dietary patterns are widely recognised as a major vulnerability of FFQ and the dietary screeners/scales derived from FFQ. Such instruments can yield inconsistent results to produce questionable interpretations. The present article discusses the value of psychometric approaches and standards in addressing these drawbacks for instruments used to estimate dietary habits and nutrient intake. We argue that a FFQ or screener that treats diet as a ‘latent construct’ can be optimised for both internal consistency and the value of the research results. Latent constructs, a foundation for item response theory (IRT)-based scales (e.g. Patient Reported Outcomes Measurement Information System) are typically introduced in the design stage of an instrument to elicit critical factors that cannot be observed or measured directly. We propose an iterative approach that uses such modelling to refine FFQ and similar instruments. To that end, we illustrate the benefits of psychometric modelling by using items and data from a sample of 12 370 Soldiers who completed the 2012 US Army Global Assessment Tool (GAT). We used factor analysis to build the scale incorporating five out of eleven survey items. An IRT-driven assessment of response category properties indicates likely problems in the ordering or wording of several response categories. Group comparisons, examined with differential item functioning (DIF), provided evidence of scale validity across each Army sub-population (sex, service component and officer status). Such an approach holds promise for future FFQ.

The role of public health surveillance in disaster response continues to expand as timely, accurate information is needed to mitigate the impact of disasters. Health surveillance after a disaster involves the rapid assessment of the distribution and determinants of disaster-related deaths, illnesses, and injuries in the affected population. Public health disaster surveillance is one mechanism that can provide information to identify health problems faced by the affected population, establish priorities for decision makers, and target interventions to meet specific needs. Public health surveillance traditionally relies on a wide variety of data sources and methods. Poison center (PC) data can serve as data sources of chemical exposures and poisonings during a disaster. In the US, a system of 57 regional PCs serves the entire population. Poison centers respond to poison-related questions from the public, health care professionals, and public health agencies. The Centers for Disease Control and Prevention (CDC) uses PC data during disasters for surveillance of disaster-related toxic exposures and associated illnesses to enhance situational awareness during disaster response and recovery. Poison center data can also be leveraged during a disaster by local and state public health to supplement existing surveillance systems. Augmenting traditional surveillance data (ie, emergency room visits and death records) with other data sources, such as PCs, allows for better characterization of disaster-related morbidity and mortality. Poison center data can be used during a disaster to detect outbreaks, monitor trends, track particular exposures, and characterize the epidemiology of the event. This timely and accurate information can be used to inform public health decision making during a disaster and mitigate future disaster-related morbidity and mortality.

WolkinA, SchnallAH, LawR, SchierJ. Using Poison Center Data for Postdisaster Surveillance. Prehosp Disaster Med. 2014;29(5):1-4.

This study describes the incidence rate of reported lymphogranuloma venereum (LGV) in men who have sex with men (MSM) in Barcelona from 2007 to 2012. Epidemiological, clinical and sexual behaviour characteristics of LGV cases are described. Seroadaptive behaviours as a transmission risk factor were assessed by a telephone questionnaire during 2012. Data were handled on a strictly confidential basis. LGV annual rate ratios in MSM were compared with cases from 2007. Differences were statistically analysed with a Poisson test. The incidence rate of LGV in MSM aged 15–69 years ranged from 32·1/105 MSM per year in 2007 to 182·7/105 MSM per year in 2012. In 2012, 31/51 LGV cases (61%) answered the telephone questionnaire, of which 84% (26/31) were HIV positive, 39% (12/31) reported having sex according to their partners’ serostatus and 7% (2/31) used strategic positioning. The incidence of LGV has increased since 2007 and mainly affects HIV-positive MSM. It is probable that seroadaptation has facilitated LGV transmission.

Rheumatic fever (RF) is an important public health problem in New Zealand (NZ). There are three sources of RF surveillance data, all with major limitations that prevent NZ generating accurate epidemiological information. We aimed to estimate the likely RF incidence using multiple surveillance data sources. National RF hospitalization and notification data were obtained, covering the periods 1988–2011 and 1997–2011, respectively. Data were also obtained from four regional registers: Wellington, Waikato, Hawke's Bay and Rotorua. Coded patient identifiers were used to calculate the proportion of individuals who could be matched between datasets. Capture–recapture analyses were used to calculate the likely number of true RF cases for the period 1997–2011. A range of scenarios were used to correct for likely dataset incompleteness. The estimated sensitivity of each data source was calculated. Patients who were male, Māori or Pacific, aged 5–15 years and met the Jones criteria, were most likely to be matched between national datasets. All registers appeared incomplete. An average of 113 new initial cases occurred annually. Sensitivity was estimated at 80% for the hospitalization dataset and 60% for the notification dataset. There is a clear need to develop a high-quality RF surveillance system, such as a national register. Such a system could link important data sources to provide effective, comprehensive national surveillance to support both strategy-focused and control-focused activities, helping reduce the incidence and impact of this disease. It is important to remind clinicians that RF cases do occur outside the well-characterized high-risk group.

Mental health is an important aspect of public health after a disaster. This article describes what is known and what remains to be learned regarding the mental health impact of the January 12, 2010, earthquake in Haiti. Public health surveillance efforts in Haiti and the United States in the first 2 months after the earthquake are described. Challenges in clinical assessment and public health surveillance are explored. Potential implications for survivors and public health officials are considered.

(Disaster Med Public Health Preparedness. 2011;5:154–157)

Laboratory data are the cornerstone in surveillance of infectious disease. We investigated whether changes in reported incidence of Campylobacter and Salmonella infection might be explained by changes in stool sampling rates. Data were extracted from a national database on 585 843 patient stool samples tested by microbiology laboratories in Wales between 1998 and 2008. Salmonella incidence fell from 43 to 19 episodes/100 000 population but Campylobacter incidence after declining from 111/100 000 in 1998 to 84/100 000 in 2003 rose to 119/100 000 in 2008. The proportion of the population sampled rose from 2·0% in 1998 to 2·8% in 2008, mostly due to increases in samples from hospital patients and older adults. The proportion of positive samples declined for both Salmonella and Campylobacter from 3·1% to 1·1% and from 8·9% to 7·5%, respectively. The decline in Salmonella incidence is so substantial that it is not masked even by increased stool sampling, but the recent rise in Campylobacter incidence may be a surveillance artefact largely due to the increase in stool sampling in older people.

A new established pilot husky voice clinic with agreed referral protocols for patients at risk of developing laryngeal malignancy was audited. Thirty-four patients were seen, 41.2 per cent having abnormal findings on flexible nasendoscopy, 29.4 per cent requiring rigid endoscopy, 38.1 per cent were discharged after the initial visit. One case of early laryngeal cancer was picked up during this period from this group of patients. The data for the remaining population in Portsmouth was examined, and a further eight cases of laryngeal cancer were diagnosed in keeping with national incidences. A rapid access clinic with agreed protocols that referring practitioners adhered to, was useful for diagnosing laryngeal cancer and should meet the requirements of the government’s 14-day rule.

The improved cost-effectiveness of gadolinium-enhanced magnetic resonance imaging (MRIg) as a diagnostic tool for vestibular schwannoma has resulted in smaller tumours being diagnosed. There has been a change in the clinical presentation of these tumours and up to four per cent may present with unilateral tinnitus. The limitation of auditory brain stem response (ABR) as a screening tool that detects small tumours is recognized and there is a strong argument for using MRIg as the initial investigation.

Various screening guidelines have been proposed, some include submitting patients with unilateral tinnitus for MRIg. This report describes the findings in a group of 174 patients presenting with unilateral tinnitus who underwent MRIg as part of a guideline-directed screen to exclude vestibular schwannoma. Five patients had a cause for their tinnitus diagnosed, one a vestibular schwannoma. Two had intracranial aneurysms and another three had pathology revealed that merited onward referral. A further nine patients had incidental findings that neither accounted for their symptoms nor needed further investigation or referral.

The rationale for screening these patients with MRIg is discussed.