The scale of the outbreak of highly pathogenic avian influenza (HPAI) in 2021-23 due to the influenza A/H5N1 virus is unprecedented.
An online survey was designed to explore veterinarians' ...experiences of and confidence in treating avian species, experiences of dealing with suspected HPAI and perspectives on control measures in the UK. The survey ran between December 2021 and March 2022.
Survey responses were received from 26 veterinarians. Although veterinarians are well placed to communicate HPAI-related information and guidance, a lack of confidence around treating birds and dealing with suspected cases of HPAI represent key barriers for non-specialist practices, and this limits opportunities to educate clients.
This study presents the views of a small group of self-selected respondents and may over-represent veterinarians with existing interests in avian species and/or avian influenza and who engage with online fora.
Improved training and resources designed to increase confidence with avian species, along with guidance on diagnosing and reporting notifiable diseases, are needed for first opinion practices. Governing bodies should clarify regulations on treating birds in veterinary practices when HPAI outbreak numbers are high.
This article presents the first systematic study of the spatial transmission of the 1929–33 epidemic of meningococcal meningitis and its association with local coal mining communities in three ...adjacent high incidence counties of England; Nottinghamshire, Derbyshire, and the West Riding of Yorkshire. Drawing on a robust method of spatial epidemiological analysis (swash‐backwash model), we demonstrate a gradient response with local levels of employment in coal mining for each of three key parameters of the epidemic wave: spatial velocity of transmission; duration of infectivity; and spatial reach. Partial least squares regression analysis identifies the relatively young and fertile demographic of local mining communities as the principal determinant of the resulting epidemic burden. Other sociodemographic parameters, including established risk factors for invasive meningococcal disease (low social class, high residential density, and overcrowding) are found to play little, or no, role in the spatial distribution of the disease. Our findings have importance for understanding the historic links between the coal mining industry and epidemic meningococcal meningitis, and point to possible present‐day opportunities for intervention through the designation of coal mining communities as defined risk groups for meningococcal vaccines.
This paper uses techniques of binary logistic regression to identify the spatial determinants of the last national epidemic of smallpox to spread in England and Wales, the variola minor epidemic of ...1921–34. Adjusting for age and county-level variations in vaccination coverage in infancy, the analysis identifies a dose-response gradient with increasing odds of elevated smallpox rates in local government areas with (i) medium (odds ratio OR = 5.32, 95% Confidence Interval 95% CI 1.96–14.41) and high (OR = 11.32, 95% CI 4.20–31.59) coal mining occupation rates and (ii) medium (OR = 16.74, 95% CI 2.24–125.21) and high (OR = 63.43, 95% CI 7.82–497.21) levels of residential density. The results imply that the spatial transmission of variola virus was facilitated by the close spatial packing of individuals, with a heightened transmission risk in coal mining areas of the country. A syndemic interaction between common respiratory conditions arising from exposure to coal dust and smallpox virus transmission is postulated to have contributed to the findings. We suggest that further studies of the geographical intersection of coal mining and acute infections that are transmitted via respiratory secretions are warranted.
•Spatial risk-modifiers for epidemic smallpox in England and Wales are examined.•The 1921–34 smallpox epidemic was centred on coal mining areas.•A dose-response gradient existed between mining occupation rates and smallpox rates.•A syndemic interaction between respiratory conditions and smallpox is postulated.•The spatial intersection of coal mining and acute infections merits further study.
The hypothesized role of deep coal mining in the development of community-based outbreaks of meningococcal meningitis has gone largely unexplored. Taking the coalfields of Britain as a ...historical testbed, techniques of linear and binomial logistic regression were used to assess the association between meningococcal meningitis rates and male occupation rates for coal mining in England and Wales during the national epidemic of 1931–32 and in its aftermath. Adjusting for the epidemiological effects of age, residential density, recent changes in the number of families, housing stock and low social class, the analysis yielded evidence of a significant and positive association between coal mining occupation rates and notified levels of meningitis activity in the epidemic period. Communities in areas of the world that currently maintain substantial deep coal extraction industries may be at increased risk for the epidemic transmission of meningococcal meningitis.
•The 1931–32 epidemic of meningococcal meningitis was focussed on coal mining areas.•A dose-response gradient existed between mining occupation rates and disease rates.•Coal mining may be a risk-modifier for outbreaks of meningococcal meningitis.
The Nazi ghetto system was one of the principal vehicles for the persecution of Jewish and other peoples in German-occupied Europe in World War II. Transport and confinement—twin pillars of the ...ghetto system—were intrinsically geographical matters that operated on scales from the international to the local and that shaped the demographic and epidemiological character of ghettos across Eastern Europe. This article uses geographical techniques of map-based visualization and spatial analysis to portray the demographic and epidemic history of the Nazi “model” camp-ghetto at Theresienstadt (Terezín) in the former German Protectorate of Bohemia and Moravia, 1941–45. Our study reconstructs the space-time pattern and demographic structure of transports of Jewish prisoners to the ghetto and their association with substantial outbreaks of communicable diseases in the ghetto. The study highlights the importance of a geographical approach to an understanding of the demographic and public health impacts of both the Holocaust and other genocidal events.
Since its appearance in Wuhan (China) in late December 2019, the geographical spread of COVID-19 and its constituent waves varied in pace and intensity around the world. Responses to the pandemic ...also varied across the world with high variation in case rates, death rates, and estimated excess mortality rates. This article addresses the political factors that may have shaped this variation. We test the proposition that the observed variation in case rates, death rates, and estimated excess mortality can be partly explained by differences across levels of democracy and autocracy, while controlling for additional possible confounding factors using a cross-section time-series data set for 155 countries between January 2020 and December 2021. The analysis begins with a theoretical consideration of the different ways in which democratic and authoritarian governments can respond to national emergencies such as a global pandemic and the expected effect of regime features on that response. For reported case rates and death rates, our analysis shows that democracies have a far worse record of pandemic response and control than autocracies. For estimated excess mortality rates and the ratio of these rates to reported death rates, however, our analysis shows that variation is more tightly captured by clusters of poor democracies and poor autocracies in particular geographies in the world. The difference in results for recorded COVID data and estimated excess mortality suggest that transparency in reporting within democracies may explain an otherwise spurious relationship between regime type and COVID response. Our findings suggest that future pandemics and other public health threats require much better coordination, control, and transparent reporting protocols that are less encumbered by politics than has been observable during the COVID-19 pandemic.
Understanding how smallscale (‘backyard’) poultry keepers interpret and respond to governmental directives designed to reduce the transmission of highly pathogenic avian influenza (HPAI) is of ...paramount importance in preparing for future HPAI outbreaks. Qualitative insights from open questions in an online survey conducted during the 2021–22 HPAI season (1,559 responses) shed light on smallscale poultry keepers' understanding of, and responses to, governmental directives to control HPAI exposure and onwards transmission. A follow-up participatory workshop (21 participants) explored the HPAI-related information sources used by smallscale poultry keepers, their trust in these sources, perceptions of HPAI-related risk, and interpretation of, opinions on and adherence to government regulations and communications regarding biosecurity and housing measures. This paper draws on a multi-scale behaviour change model to explore barriers to compliance with HPAI-related regulations. Insights from behaviour settings theory reveal how poultry-keeping settings and routines might be ‘disrupted’ and ‘re-configured’ to improve long-term biosecurity and reduce the risk of HPAI exposure. The findings highlight the need for HPAI-related guidance that is tailored to smallscale poultry keepers. This guidance should include clear action points and simple, practical, affordable and sustainable suggestions for improving compliance with biosecurity measures.
•Smallscale poultry keepers' responses to avian influenza regulations are explored•IBM-WASH and settings theory are applied to poultry keeping for the first time•These approaches identified barriers and potential enablers to improving biosecurity•Smallscale poultry keepers need tailored guidance on avian influenza prevention
The work of the Medical Research Council School Epidemics Committee—established in 1929 to undertake a study of 'droplet infections' in the 'semi-isolated' populations of England's public ...schools—represents a little-known chapter in the historical development of applied medical statistics. Drawing on documents in the National Archives, London, we trace the original scheme for the Committee to Miss Ethel Newbold (1882—1933), a Fellow and Council member of the Royal Statistical Society and the first woman to be awarded the Society's Guy Medal (1928, in silver). Using the Committee's surviving records, databases of disease incidence are constructed for a multicentre cohort of 27 boarding schools, 1930—1939. Exploratory analysis of the data is illustrated by applying non-metric multi-dimensional scaling and Poisson regression to the themes of disease comorbidity and frequency of outbreak. Prompted by the emerging epidemiological concepts of pathogen—pathogen interaction and syndemicity, the multi-dimensional scaling analysis highlights the apparent epidemiological independence of common acute childhood infections (including chickenpox, measles, mumps, rubella, scarlet fever and whooping cough) in the disease system. Poisson regression reveals a complex pattern of controls on the frequency of school epidemics that vary by disease. The results that are obtained underscore the continuing relevance of the historical disease records of semi-isolated institutions, such as boarding schools, to an epidemiological understanding of common acute childhood infections and other ailments.
Metapopulation dynamics play a critical role in driving endemic persistence and transmission of childhood infections. The endemic threshold concept, also referred to as critical community size (CCS), ...is a key example and is defined as the minimum population size required to sustain a continuous chain of infection transmission. The concept is fundamental to the implementation of effective vaccine-based disease control programmes. Vaccination serves to increase endemic threshold population size, promoting disease fadeout and eventual elimination of infection. To date, empirical investigations of the relationship between vaccination and endemic threshold population size have tended to focus on isolated populations in island communities. Very few studies have examined endemic threshold dynamics in ‘mainland’ regional populations with complex hierarchical spatial structures and varying levels of connectivity between subpopulations. The present paper provides the first spatially explicit analysis of the temporal changes in endemic threshold populations for one vaccine-preventable childhood infection (pertussis) in two dynamic regions of England and Wales: Lancashire and South Wales. Drawing upon weekly disease records of the Registrar-General of England and Wales over a 30-year period (January 1940–December 1969) regression techniques were used to estimate the endemic threshold size for pertussis in the two study regions. Survival analyses were performed to compare disease fadeout duration and probability for both regions in the pre-vaccine and vaccine eras, respectively. Our findings reveal the introduction of mass vaccination led to a considerable increase in threshold size for both Lancashire (~387,333) and South Wales (~1,460,667). Significant growth in fadeout duration was observed in the vaccine era for pertussis non-hotspots in both regions, consistent with geographical synchronisation of epidemic activity. Regional differences in endemic threshold populations reflect significant regional variations in spatial connectivity, population dispersion and level of geographical isolation.
•Endemic threshold estimates vary considerably by region over space and time.•Divergent spatial structures and connectivity influence endemic persistence.•Increased population density limits growth of endemic threshold after vaccination.•Endemic threshold population can serve as guide for spatially targeted vaccination.•Pertussis vaccination increases fadeout duration and reduces rate of reintroduction.
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