This document discusses vaccine-preventable diseases among refugee and internally displaced populations during humanitarian emergencies. It reviews 50 articles on outbreaks of diseases like measles, polio, and meningitis in these vulnerable groups. Key challenges discussed are the breakdown of health services during crises, overcrowding in camps increasing transmission, and issues providing vaccination due to insecurity or infrastructure damage. Maintaining surveillance and responding quickly to outbreaks with vaccination is important for control. Coordination with partners and vaccination of surrounding communities is also recommended when immunity gaps exist in both displaced and host populations.
The document discusses vaccine-preventable diseases among refugee and internally displaced populations during humanitarian emergencies. It reviews 50 articles on outbreaks of diseases like measles, polio, meningitis, yellow fever and hepatitis A among displaced communities. Mass population movements, overcrowding and poor sanitation in refugee camps increase risk of disease transmission and outbreaks. Vaccination is critical for protection but humanitarian crises pose challenges to vaccine delivery and can threaten global eradication efforts. The increasing number of emergencies globally requires new approaches to vaccination for vulnerable displaced groups.
This review summarizes evidence on the burden of tuberculosis in populations affected by crises such as armed conflict, displacement, and natural disasters. 51 reports were identified that provided data on tuberculosis notification rates, prevalence, incidence, case fatality ratios, and drug resistance levels among crisis-affected populations. Most studies found elevated notification rates and prevalence compared to reference populations, with incidence and prevalence ratios over 2 in 11 of 15 reports that could make comparisons. Case fatality ratios were generally below 10% and drug resistance levels were usually comparable to background levels, with some exceptions. Analysis of surveillance data from refugee camps also suggested a pattern of excess tuberculosis risk. National tuberculosis notification data analysis found that more intense conflicts were associated with decreases in reported tuberculosis cases
International and Humanitarian Disaster Management for Diseases of the Displa...studywriters
Disasters often disrupt healthcare systems and services like immunizations, allowing vaccine-preventable diseases (VPDs) to spread among displaced populations. Living in crowded conditions without clean water or sanitation further increases risks. Disease outbreaks are common in refugee camps due to lack of access to healthcare, nutrition, and hygiene. Potential solutions include vaccination programs, education on risks and prevention, and improving living conditions in camps. International cooperation is also important for an effective response, as seen with Ebola outbreaks in Congo.
International and Humanitarian Disaster Management for Diseases of the Displa...write4
Disasters often disrupt healthcare systems and services like immunizations, allowing vaccine-preventable diseases (VPDs) to spread among displaced populations. Living in crowded conditions without clean water or sanitation further increases risks. Disease outbreaks are common in refugee camps due to lack of access to healthcare, nutrition, and hygiene. Potential solutions include vaccination programs, education on risks and prevention, and improving living conditions in camps. International cooperation is also key to effectively respond to outbreaks like cholera in Yemen or Ebola in Congo.
The document discusses immunization and infectious diseases. The main goals are to increase immunization rates and reduce preventable infectious diseases. Immunization works by stimulating the body's natural defenses to recognize and attack specific bacteria or viruses. This helps prevent disease or reduce severity if exposed. While vaccines have reduced many diseases, some remain issues and new threats may emerge. Maintaining surveillance and immunization programs is important for protecting public health.
The value of real-world evidence for clinicians and clinical researchers in t...Arete-Zoe, LLC
In the midst of a rapidly spreading global pandemic, real-world evidence can offer invaluable insight into the most promising treatments, risk factors, and not only predict but suggest how to improve outcomes. Despite overwhelming news coverage, significant knowledge gaps regarding COVID-19 persist. The current uncertainties regarding incidence and the case fatality rate can only be addressed by widespread testing. But the paucity of testing, and diversity of approaches implemented in different countries, particularly among the general asymptomatic public, perpetuates a lack of understanding about spread and infectivity. The essential indicators that would describe the pandemic more accurately can be obtained using real-world data (RWD). To that purpose, we designed a data collection tool to collect data from hospitals that treat COVID-19 patients. The captured data will enhance our understanding of the COVID-19 pandemic, identify risk factors relevant for triage, relate to other similar seasonal infections and gain insight into the safety and efficacy of experimental and off-label therapies. Knowledge derived from a focused data collection effort will enable clinicians to adjust rapidly clinical protocols and discontinue interventions that turn out to be ineffective or harmful. By deploying our elegantly designed survey to capture routine clinical indicators, we avoid placing an additional burden on practitioners. Systematically generating real-world evidence can decrease the time to insight compared to randomized clinical trials, improving the odds for patients in rapidly changing conditions.
Rural Healthcare in Light of a Multinational Pandemic: A Global Perspectivepateldrona
Abstract Rural healthcare recently came into international spotlight, with recent reported influx of the COVID-19 into rural regions. This article focuses on susceptibilities of the rural population to pandemics and mitigating measures to prevent formation of disease epicentre. Rural Healthcare is by far one of the most neglected areas of medicine. The discrepancies in quality of rural healthcare has been evident for decades, yet no lasting measures have been able to bridge this gap till date. Lessons gleaned from the recent SARS and H1N1 pandemics has once again fallen through the cracks in a futile attempt to curb urban spread.
Rural Healthcare in Light of a Multinational Pandemic: A Global Perspectivegeorgemarini
Abstract Rural healthcare recently came into international spotlight, with recent reported influx of the COVID-19 into rural regions. This article focuses on susceptibilities of the rural population to pandemics and mitigating measures to prevent formation of disease epicentre. Rural Healthcare is by far one of the most neglected areas of medicine. The discrepancies in quality of rural healthcare has been evident for decades, yet no lasting measures have been able to bridge this gap till date. Lessons gleaned from the recent SARS and H1N1 pandemics has once again fallen through the cracks in a futile attempt to curb urban spread. http://dx.doi.org/10.47829/ACMCR.2021.61801
The document discusses vaccine-preventable diseases among refugee and internally displaced populations during humanitarian emergencies. It reviews 50 articles on outbreaks of diseases like measles, polio, meningitis, yellow fever and hepatitis A among displaced communities. Mass population movements, overcrowding and poor sanitation in refugee camps increase risk of disease transmission and outbreaks. Vaccination is critical for protection but humanitarian crises pose challenges to vaccine delivery and can threaten global eradication efforts. The increasing number of emergencies globally requires new approaches to vaccination for vulnerable displaced groups.
This review summarizes evidence on the burden of tuberculosis in populations affected by crises such as armed conflict, displacement, and natural disasters. 51 reports were identified that provided data on tuberculosis notification rates, prevalence, incidence, case fatality ratios, and drug resistance levels among crisis-affected populations. Most studies found elevated notification rates and prevalence compared to reference populations, with incidence and prevalence ratios over 2 in 11 of 15 reports that could make comparisons. Case fatality ratios were generally below 10% and drug resistance levels were usually comparable to background levels, with some exceptions. Analysis of surveillance data from refugee camps also suggested a pattern of excess tuberculosis risk. National tuberculosis notification data analysis found that more intense conflicts were associated with decreases in reported tuberculosis cases
International and Humanitarian Disaster Management for Diseases of the Displa...studywriters
Disasters often disrupt healthcare systems and services like immunizations, allowing vaccine-preventable diseases (VPDs) to spread among displaced populations. Living in crowded conditions without clean water or sanitation further increases risks. Disease outbreaks are common in refugee camps due to lack of access to healthcare, nutrition, and hygiene. Potential solutions include vaccination programs, education on risks and prevention, and improving living conditions in camps. International cooperation is also important for an effective response, as seen with Ebola outbreaks in Congo.
International and Humanitarian Disaster Management for Diseases of the Displa...write4
Disasters often disrupt healthcare systems and services like immunizations, allowing vaccine-preventable diseases (VPDs) to spread among displaced populations. Living in crowded conditions without clean water or sanitation further increases risks. Disease outbreaks are common in refugee camps due to lack of access to healthcare, nutrition, and hygiene. Potential solutions include vaccination programs, education on risks and prevention, and improving living conditions in camps. International cooperation is also key to effectively respond to outbreaks like cholera in Yemen or Ebola in Congo.
The document discusses immunization and infectious diseases. The main goals are to increase immunization rates and reduce preventable infectious diseases. Immunization works by stimulating the body's natural defenses to recognize and attack specific bacteria or viruses. This helps prevent disease or reduce severity if exposed. While vaccines have reduced many diseases, some remain issues and new threats may emerge. Maintaining surveillance and immunization programs is important for protecting public health.
The value of real-world evidence for clinicians and clinical researchers in t...Arete-Zoe, LLC
In the midst of a rapidly spreading global pandemic, real-world evidence can offer invaluable insight into the most promising treatments, risk factors, and not only predict but suggest how to improve outcomes. Despite overwhelming news coverage, significant knowledge gaps regarding COVID-19 persist. The current uncertainties regarding incidence and the case fatality rate can only be addressed by widespread testing. But the paucity of testing, and diversity of approaches implemented in different countries, particularly among the general asymptomatic public, perpetuates a lack of understanding about spread and infectivity. The essential indicators that would describe the pandemic more accurately can be obtained using real-world data (RWD). To that purpose, we designed a data collection tool to collect data from hospitals that treat COVID-19 patients. The captured data will enhance our understanding of the COVID-19 pandemic, identify risk factors relevant for triage, relate to other similar seasonal infections and gain insight into the safety and efficacy of experimental and off-label therapies. Knowledge derived from a focused data collection effort will enable clinicians to adjust rapidly clinical protocols and discontinue interventions that turn out to be ineffective or harmful. By deploying our elegantly designed survey to capture routine clinical indicators, we avoid placing an additional burden on practitioners. Systematically generating real-world evidence can decrease the time to insight compared to randomized clinical trials, improving the odds for patients in rapidly changing conditions.
Rural Healthcare in Light of a Multinational Pandemic: A Global Perspectivepateldrona
Abstract Rural healthcare recently came into international spotlight, with recent reported influx of the COVID-19 into rural regions. This article focuses on susceptibilities of the rural population to pandemics and mitigating measures to prevent formation of disease epicentre. Rural Healthcare is by far one of the most neglected areas of medicine. The discrepancies in quality of rural healthcare has been evident for decades, yet no lasting measures have been able to bridge this gap till date. Lessons gleaned from the recent SARS and H1N1 pandemics has once again fallen through the cracks in a futile attempt to curb urban spread.
Rural Healthcare in Light of a Multinational Pandemic: A Global Perspectivegeorgemarini
Abstract Rural healthcare recently came into international spotlight, with recent reported influx of the COVID-19 into rural regions. This article focuses on susceptibilities of the rural population to pandemics and mitigating measures to prevent formation of disease epicentre. Rural Healthcare is by far one of the most neglected areas of medicine. The discrepancies in quality of rural healthcare has been evident for decades, yet no lasting measures have been able to bridge this gap till date. Lessons gleaned from the recent SARS and H1N1 pandemics has once again fallen through the cracks in a futile attempt to curb urban spread. http://dx.doi.org/10.47829/ACMCR.2021.61801
Rural Healthcare in Light of a Multinational Pandemic: A Global Perspectivekomalicarol
Rural healthcare recently came into international spotlight, with
recent reported influx of the COVID-19 into rural regions. This article focuses on susceptibilities of the rural population to pandemics and mitigating measures to prevent formation of disease epicentre. Rural Healthcare is by far one of the most neglected areas
of medicine. The discrepancies in quality of rural healthcare has
been evident for decades, yet no lasting measures have been able
to bridge this gap till date. Lessons gleaned from the recent SARS
and H1N1 pandemics has once again fallen through the cracks in a
futile attempt to curb urban spread. Adequate provisions and delivery of healthcare to rural areas, early identification, isolation and
implementation of precautionary measures, re-evaluation of rural
healthcare infrastructure and strategies on rural healthcare worker retention are quintessential to equity of healthcare worldwide.
Only robust, sincere and well-tailored measures would result in a
resilient and enduring rural population
This document discusses infectious diseases and public health. It defines key terms like pandemic, outbreak, endemic, and epidemic. It describes the epidemiological triad and phases of infectious disease. It also discusses major causes of death among children like diarrheal diseases, tuberculosis, HIV/AIDS, malaria, and acute respiratory infections. The document outlines strategies for public health intervention and controlling infectious diseases, including education, vaccination, quarantine, and providing insecticide-treated nets. It describes three levels of infectious disease prevention: primary, secondary, and tertiary.
This document discusses the use of subtractive genomics to identify potential drug targets for pathogenic organisms. Subtractive genomics involves subtracting the sequences between a host and pathogen's proteome to identify proteins essential to the pathogen but not present in the host. This approach has been applied to identify drug targets for multi-drug resistant pathogens like Salmonella typhi and Listeria monocytogenes, as well as pathogens with no existing effective drugs like Leishmania donovani and Clostridium botulinum. Identifying novel drug targets through subtractive genomics can help develop new defenses against antibiotic-resistant pathogens and treat diseases currently lacking effective treatments.
The document provides an overview of communicable diseases and approaches to mounting an effective global response. It defines communicable diseases and discusses their importance, impact and burden. Key diseases discussed include tuberculosis, malaria, HIV/AIDS and avian influenza. Challenges in controlling these diseases are outlined. Approaches to intervention discussed include personal responsibility, utilitarian approaches, regulations and laws, and partnerships. The role of the World Bank in financing responses is summarized.
The document provides an overview of communicable diseases and approaches to mounting a global response. It defines communicable diseases and their modes of transmission. Key points made include that communicable diseases account for a significant global disease burden, especially in low and middle income countries. Effective response requires approaches like strengthening health systems, partnerships, regulations, and personal responsibility. Selected diseases discussed in more detail include tuberculosis, malaria, HIV/AIDS, avian influenza, and neglected tropical diseases.
This document provides an overview of communicable diseases and their impact on human security. It defines communicable diseases as conditions transmitted directly or indirectly from infected people or animals. Selected diseases discussed include tuberculosis, malaria, HIV/AIDS, and avian influenza. These diseases place a significant burden on low and middle income countries and can have social, economic, and security impacts. Approaches to control discussed include personal responsibility, public health interventions, regulations and laws, and partnerships. Effective response requires a global approach as communicable diseases respect no borders in an increasingly interconnected world.
this ppt is made by shrikrishna kesharwani , student of urban planning,4th year, Manit , Bhopal,
in this ppt, I have discussed how to do pandemic or epidemic management in detail.,
Imperial college-covid19-npi-modelling-16-03-2020Mumbaikar Le
This document summarizes the results of epidemiological modelling to assess the potential impact of non-pharmaceutical interventions (NPIs) aimed at reducing COVID-19 transmission in the UK and US. It finds that while mitigation strategies could reduce healthcare demand and deaths, hundreds of thousands may still die and healthcare systems would be overwhelmed. Suppression, including social distancing and case isolation, is the preferred option but would need to be maintained until a vaccine is available, around 18 months. Intermittent distancing may allow temporary relaxation but cases would likely rebound without continuous measures. Experience in China and South Korea shows suppression is possible short-term, but long-term feasibility and economic costs require further analysis.
The document discusses communicable diseases and human security. It provides an overview of communicable diseases, outlining their importance and selected diseases of public health concern such as tuberculosis, malaria, HIV/AIDS, and avian influenza. It discusses the global response required, including approaches such as public health interventions, regulations, and partnerships. The World Bank plays a role in mounting a global response by collaborating with other organizations as part of global health partnerships.
Consider this scenario A cyber-attack occurred in a healthcare orAlleneMcclendon878
A cyberattack on a healthcare organization resulted in significant data loss. As an information security consultant, the document outlines recommendations for a 12-slide presentation on an incident response plan for the executive board. The plan would define the goal and scope, analyze impact through a business impact analysis, identify communication requirements, explain the response process, describe relationships to other processes, and recommend priorities and resources.
EPIDEMIOLOGY- Revised (1) (1) Spring 2023(1).pptxJanieRamirez1
This document provides an overview of epidemiology and its role in community health nursing. It defines epidemiology as the study of the distribution and determinants of health-related states or events in populations and the application of that study to disease control. Key aspects covered include the conceptual frameworks of epidemiology like the epidemiologic triad; modes of disease transmission; defense mechanisms like herd immunity; the origins and early contributors to epidemiology like John Snow; and epidemiologic models. Community health nurses use epidemiologic principles and data to understand disease factors, develop prevention programs, and evaluate health services.
This document provides an overview of vaccine classification and development. It begins by discussing the history of vaccines from early variolation techniques to Edward Jenner's pioneering smallpox vaccine. Modern vaccines are typically classified as live attenuated, inactivated, subunit, conjugate, or virus-like particles. Safety concerns are driving the field away from whole organism vaccines towards recombinant and subunit approaches. Despite success in reducing mortality, obstacles like antigenic drift and public perception have slowed progress, necessitating new vaccines for diseases like HIV, malaria and tuberculosis.
This document discusses the importance of defining the epidemiology of COVID-19 through various studies and surveillance methods. It outlines key questions about the virus that need answers, such as its full disease severity spectrum, transmissibility, most infectious individuals, and risk factors for severe illness. It recommends approaches like syndromic surveillance, household studies, and community studies. Conducting these simultaneously can help characterize the trajectory and severity of the epidemic to inform response efforts. Early investment in such studies will improve understanding and control of the outbreak.
A guide for the media on communicating in public health emergencies Jamaity
A public health crisis or emergency is characterised by its ability to cause ill health and death among hundreds, thousands or sometimes millions of people.
In a health crisis, the media has the power to save lives.
Effective communication can help to prevent or reduce the
spread of disease, and guide those affected towards health
services and treatment.
This manual provides tips for media practitioners on how to
help audiences during health emergencies.
It can be read in conjunction with BBC Media Action’s
Lifeline Production Manual (available online) which provides
more general guidance on how to communicate with
people affected by humanitarian crises in order to help save
lives and reduce suffering.
Public health emergencies can start quickly or very slowly.
This manual will address those that start relatively quickly: rapid onset public health emergencies.
Public Health Response to Ebola Statement of Dr. FriedenDawn Dawson
House Energy and Commerce Committee Subcommittee on Oversight and Investigations Public Health Response to Ebola October 16, 2014
Statement of Dr. Thomas R. Frieden, M.D., M.P.H.
Director, Centers for Disease Control and Prevention
In the intricate tapestry of the global ecosystem, the emergence of infectious diseases has always been a formidable challenge. As we stand on the precipice of the third decade of the 21st century, the specter of emerging infectious diseases looms larger than ever. The world has witnessed the devastating impact of diseases like HIV/AIDS, Ebola, and the H1N1 influenza, underscoring the critical need for a comprehensive understanding of these complex phenomena. In this blog, we will delve into the realm of emerging infectious diseases, exploring their causes, dynamics, and the collective efforts required to address them.
Defining Emerging Infectious Diseases:
Emerging infectious diseases (EIDs) are those that have recently appeared within a population or those whose incidence or geographic range is rapidly increasing. These diseases can be caused by new or previously unidentified infectious agents, the spread of known agents to new populations, or changes in the environment that facilitate disease emergence.
Dengue viral infections are caused by one of four viruses and transmitted by mosquitoes. The disease ranges in severity from asymptomatic to severe and fatal. Most cases are mild, but some develop shock and hemorrhage. Treatment is supportive and focuses on fluid management to resolve shock while preventing fluid overload. Dengue has spread globally and is a major public health problem in over 100 countries.
Disease Mitigation Measures in the Control of Pandemic InfluenzaSantiago Montiveros
This document discusses disease mitigation measures that have been proposed to lessen the impact of an influenza pandemic, including isolation, quarantine, social distancing, and other actions. It reviews the limited evidence on the effectiveness of such measures from past pandemics and studies. While models provide some guidance, they have significant limitations and cannot predict real-world behavioral or economic impacts. Most mitigation measures would be extremely difficult to implement on a large scale for the months-long duration of a pandemic. Decision-makers must consider not just epidemiological impacts but also logistical feasibility, social consequences, and potential unintended economic and political effects of different response strategies.
Week 4: Week 4 - Epidemiology—Introduction
Epidemiology—Introduction
The study of epidemics is epidemiology. Its primary focus is on the distribution and causes of disease in populations. Epidemiology involves developing and testing ways to prevent and control disease by studying its origin, spread, and vulnerabilities.
As a discipline, epidemiologic research addresses a variety of health-related questions of societal importance. Epidemiologic research methods are used by clinical investigators and scientists who conduct observational and experimental research on the prevention and treatment of disease.
The Cholera epidemic, a case from the 19th century, was enabled by the global movement of people. Having appeared in India in 1817, it spread throughout Asia and the Middle East within a decade. It was reported in Moscow in 1830 and then spread to Warsaw, Hamburg, Berlin, and London in 1831 (Snow, 1855, 2002). When it crossed the Atlantic to reach North America, Cholera gained the notoriety of the first truly global disease.
The modern day world is dominated by free trade and rapid transportation. An unprecedented rate of global interchange of food, consumer products, and organisms—including humans—is occurring. The threat of pandemics in the 21st century has heightened the importance of epidemiology at national and international levels.
Although diseases such as Influenza A (H1N1), Severe Acute Respiratory Syndrome (SARS), Acquired Immunodeficiency Syndrome (AIDS), West Nile Virus, Salmonella, are commonly recognized as epidemics, as they cause large scale disruption of health in populations. The field of epidemiology also addresses epidemics of obesity (Ogden et al., 2007), diabetes (Zimmet, 2001), mental health (Insel & Fenton, 2005), and any other disease that may cause large scale disruption of health in populations.
In general, there are ten stages to an outbreak investigation:
1. Investigation preparation
2. Outbreak confirmation
3. Case definition
4. Case identification
5. Descriptive epidemiology
6. Hypothesis generation
7. Hypothesis evaluation
8. Environmental studies
9. Control measures
10. Information dissemination
Investigation preparation requires a health crisis manager to identify a team of professionals who will lead the outbreak investigation, review the scientific literature, and notify local, state, and national organizations of the potential outbreak.
Outbreak confirmation requires actual laboratory confirmation of the disease, which may involve the collection of blood, urine, and stool samples from ill people and performing bacteriologic, virologic, or parasitic testing of those samples.
Case definition is the process by which we establish a set of standard criteria to determine who is and is not infected with respect to a specific outbreak; that is, a protocol is developed to determine case patients.
Case identification requires the health crisis manager and team of professionals to conduct a systematic and organize.
You are the information technology manager of an.docx4934bk
The IT manager of an 80-bed long-term care facility was tasked by the Board of Directors and CIO to create a 1-2 page report on private databases and doctor-patient privilege. The report aims to summarize the types of data stored in private health databases and whether it is protected by specific regulations or doctor-patient privilege. Private databases store confidential patient information like medical history and treatment plans. This data is regulated under laws like HIPAA which require security and privacy of sensitive medical information. Doctor-patient privilege legally protects confidential patient information and communications, though it has limits such as in response to court orders.
Your parents gave you up for adoption at a.docx4934bk
Your biological parents gave you up for adoption as a young child because they could not financially support you at the time. Thirty years later, they found you and one of your biological parents needs a kidney transplant. You are the best match to donate a kidney. You must determine whether you have a moral obligation to donate your kidney to your biological parent based on philosophical perspectives of ethics and your own cultural worldview.
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Similar to depth and details answer the following discussion board question.docx
Rural Healthcare in Light of a Multinational Pandemic: A Global Perspectivekomalicarol
Rural healthcare recently came into international spotlight, with
recent reported influx of the COVID-19 into rural regions. This article focuses on susceptibilities of the rural population to pandemics and mitigating measures to prevent formation of disease epicentre. Rural Healthcare is by far one of the most neglected areas
of medicine. The discrepancies in quality of rural healthcare has
been evident for decades, yet no lasting measures have been able
to bridge this gap till date. Lessons gleaned from the recent SARS
and H1N1 pandemics has once again fallen through the cracks in a
futile attempt to curb urban spread. Adequate provisions and delivery of healthcare to rural areas, early identification, isolation and
implementation of precautionary measures, re-evaluation of rural
healthcare infrastructure and strategies on rural healthcare worker retention are quintessential to equity of healthcare worldwide.
Only robust, sincere and well-tailored measures would result in a
resilient and enduring rural population
This document discusses infectious diseases and public health. It defines key terms like pandemic, outbreak, endemic, and epidemic. It describes the epidemiological triad and phases of infectious disease. It also discusses major causes of death among children like diarrheal diseases, tuberculosis, HIV/AIDS, malaria, and acute respiratory infections. The document outlines strategies for public health intervention and controlling infectious diseases, including education, vaccination, quarantine, and providing insecticide-treated nets. It describes three levels of infectious disease prevention: primary, secondary, and tertiary.
This document discusses the use of subtractive genomics to identify potential drug targets for pathogenic organisms. Subtractive genomics involves subtracting the sequences between a host and pathogen's proteome to identify proteins essential to the pathogen but not present in the host. This approach has been applied to identify drug targets for multi-drug resistant pathogens like Salmonella typhi and Listeria monocytogenes, as well as pathogens with no existing effective drugs like Leishmania donovani and Clostridium botulinum. Identifying novel drug targets through subtractive genomics can help develop new defenses against antibiotic-resistant pathogens and treat diseases currently lacking effective treatments.
The document provides an overview of communicable diseases and approaches to mounting an effective global response. It defines communicable diseases and discusses their importance, impact and burden. Key diseases discussed include tuberculosis, malaria, HIV/AIDS and avian influenza. Challenges in controlling these diseases are outlined. Approaches to intervention discussed include personal responsibility, utilitarian approaches, regulations and laws, and partnerships. The role of the World Bank in financing responses is summarized.
The document provides an overview of communicable diseases and approaches to mounting a global response. It defines communicable diseases and their modes of transmission. Key points made include that communicable diseases account for a significant global disease burden, especially in low and middle income countries. Effective response requires approaches like strengthening health systems, partnerships, regulations, and personal responsibility. Selected diseases discussed in more detail include tuberculosis, malaria, HIV/AIDS, avian influenza, and neglected tropical diseases.
This document provides an overview of communicable diseases and their impact on human security. It defines communicable diseases as conditions transmitted directly or indirectly from infected people or animals. Selected diseases discussed include tuberculosis, malaria, HIV/AIDS, and avian influenza. These diseases place a significant burden on low and middle income countries and can have social, economic, and security impacts. Approaches to control discussed include personal responsibility, public health interventions, regulations and laws, and partnerships. Effective response requires a global approach as communicable diseases respect no borders in an increasingly interconnected world.
this ppt is made by shrikrishna kesharwani , student of urban planning,4th year, Manit , Bhopal,
in this ppt, I have discussed how to do pandemic or epidemic management in detail.,
Imperial college-covid19-npi-modelling-16-03-2020Mumbaikar Le
This document summarizes the results of epidemiological modelling to assess the potential impact of non-pharmaceutical interventions (NPIs) aimed at reducing COVID-19 transmission in the UK and US. It finds that while mitigation strategies could reduce healthcare demand and deaths, hundreds of thousands may still die and healthcare systems would be overwhelmed. Suppression, including social distancing and case isolation, is the preferred option but would need to be maintained until a vaccine is available, around 18 months. Intermittent distancing may allow temporary relaxation but cases would likely rebound without continuous measures. Experience in China and South Korea shows suppression is possible short-term, but long-term feasibility and economic costs require further analysis.
The document discusses communicable diseases and human security. It provides an overview of communicable diseases, outlining their importance and selected diseases of public health concern such as tuberculosis, malaria, HIV/AIDS, and avian influenza. It discusses the global response required, including approaches such as public health interventions, regulations, and partnerships. The World Bank plays a role in mounting a global response by collaborating with other organizations as part of global health partnerships.
Consider this scenario A cyber-attack occurred in a healthcare orAlleneMcclendon878
A cyberattack on a healthcare organization resulted in significant data loss. As an information security consultant, the document outlines recommendations for a 12-slide presentation on an incident response plan for the executive board. The plan would define the goal and scope, analyze impact through a business impact analysis, identify communication requirements, explain the response process, describe relationships to other processes, and recommend priorities and resources.
EPIDEMIOLOGY- Revised (1) (1) Spring 2023(1).pptxJanieRamirez1
This document provides an overview of epidemiology and its role in community health nursing. It defines epidemiology as the study of the distribution and determinants of health-related states or events in populations and the application of that study to disease control. Key aspects covered include the conceptual frameworks of epidemiology like the epidemiologic triad; modes of disease transmission; defense mechanisms like herd immunity; the origins and early contributors to epidemiology like John Snow; and epidemiologic models. Community health nurses use epidemiologic principles and data to understand disease factors, develop prevention programs, and evaluate health services.
This document provides an overview of vaccine classification and development. It begins by discussing the history of vaccines from early variolation techniques to Edward Jenner's pioneering smallpox vaccine. Modern vaccines are typically classified as live attenuated, inactivated, subunit, conjugate, or virus-like particles. Safety concerns are driving the field away from whole organism vaccines towards recombinant and subunit approaches. Despite success in reducing mortality, obstacles like antigenic drift and public perception have slowed progress, necessitating new vaccines for diseases like HIV, malaria and tuberculosis.
This document discusses the importance of defining the epidemiology of COVID-19 through various studies and surveillance methods. It outlines key questions about the virus that need answers, such as its full disease severity spectrum, transmissibility, most infectious individuals, and risk factors for severe illness. It recommends approaches like syndromic surveillance, household studies, and community studies. Conducting these simultaneously can help characterize the trajectory and severity of the epidemic to inform response efforts. Early investment in such studies will improve understanding and control of the outbreak.
A guide for the media on communicating in public health emergencies Jamaity
A public health crisis or emergency is characterised by its ability to cause ill health and death among hundreds, thousands or sometimes millions of people.
In a health crisis, the media has the power to save lives.
Effective communication can help to prevent or reduce the
spread of disease, and guide those affected towards health
services and treatment.
This manual provides tips for media practitioners on how to
help audiences during health emergencies.
It can be read in conjunction with BBC Media Action’s
Lifeline Production Manual (available online) which provides
more general guidance on how to communicate with
people affected by humanitarian crises in order to help save
lives and reduce suffering.
Public health emergencies can start quickly or very slowly.
This manual will address those that start relatively quickly: rapid onset public health emergencies.
Public Health Response to Ebola Statement of Dr. FriedenDawn Dawson
House Energy and Commerce Committee Subcommittee on Oversight and Investigations Public Health Response to Ebola October 16, 2014
Statement of Dr. Thomas R. Frieden, M.D., M.P.H.
Director, Centers for Disease Control and Prevention
In the intricate tapestry of the global ecosystem, the emergence of infectious diseases has always been a formidable challenge. As we stand on the precipice of the third decade of the 21st century, the specter of emerging infectious diseases looms larger than ever. The world has witnessed the devastating impact of diseases like HIV/AIDS, Ebola, and the H1N1 influenza, underscoring the critical need for a comprehensive understanding of these complex phenomena. In this blog, we will delve into the realm of emerging infectious diseases, exploring their causes, dynamics, and the collective efforts required to address them.
Defining Emerging Infectious Diseases:
Emerging infectious diseases (EIDs) are those that have recently appeared within a population or those whose incidence or geographic range is rapidly increasing. These diseases can be caused by new or previously unidentified infectious agents, the spread of known agents to new populations, or changes in the environment that facilitate disease emergence.
Dengue viral infections are caused by one of four viruses and transmitted by mosquitoes. The disease ranges in severity from asymptomatic to severe and fatal. Most cases are mild, but some develop shock and hemorrhage. Treatment is supportive and focuses on fluid management to resolve shock while preventing fluid overload. Dengue has spread globally and is a major public health problem in over 100 countries.
Disease Mitigation Measures in the Control of Pandemic InfluenzaSantiago Montiveros
This document discusses disease mitigation measures that have been proposed to lessen the impact of an influenza pandemic, including isolation, quarantine, social distancing, and other actions. It reviews the limited evidence on the effectiveness of such measures from past pandemics and studies. While models provide some guidance, they have significant limitations and cannot predict real-world behavioral or economic impacts. Most mitigation measures would be extremely difficult to implement on a large scale for the months-long duration of a pandemic. Decision-makers must consider not just epidemiological impacts but also logistical feasibility, social consequences, and potential unintended economic and political effects of different response strategies.
Week 4: Week 4 - Epidemiology—Introduction
Epidemiology—Introduction
The study of epidemics is epidemiology. Its primary focus is on the distribution and causes of disease in populations. Epidemiology involves developing and testing ways to prevent and control disease by studying its origin, spread, and vulnerabilities.
As a discipline, epidemiologic research addresses a variety of health-related questions of societal importance. Epidemiologic research methods are used by clinical investigators and scientists who conduct observational and experimental research on the prevention and treatment of disease.
The Cholera epidemic, a case from the 19th century, was enabled by the global movement of people. Having appeared in India in 1817, it spread throughout Asia and the Middle East within a decade. It was reported in Moscow in 1830 and then spread to Warsaw, Hamburg, Berlin, and London in 1831 (Snow, 1855, 2002). When it crossed the Atlantic to reach North America, Cholera gained the notoriety of the first truly global disease.
The modern day world is dominated by free trade and rapid transportation. An unprecedented rate of global interchange of food, consumer products, and organisms—including humans—is occurring. The threat of pandemics in the 21st century has heightened the importance of epidemiology at national and international levels.
Although diseases such as Influenza A (H1N1), Severe Acute Respiratory Syndrome (SARS), Acquired Immunodeficiency Syndrome (AIDS), West Nile Virus, Salmonella, are commonly recognized as epidemics, as they cause large scale disruption of health in populations. The field of epidemiology also addresses epidemics of obesity (Ogden et al., 2007), diabetes (Zimmet, 2001), mental health (Insel & Fenton, 2005), and any other disease that may cause large scale disruption of health in populations.
In general, there are ten stages to an outbreak investigation:
1. Investigation preparation
2. Outbreak confirmation
3. Case definition
4. Case identification
5. Descriptive epidemiology
6. Hypothesis generation
7. Hypothesis evaluation
8. Environmental studies
9. Control measures
10. Information dissemination
Investigation preparation requires a health crisis manager to identify a team of professionals who will lead the outbreak investigation, review the scientific literature, and notify local, state, and national organizations of the potential outbreak.
Outbreak confirmation requires actual laboratory confirmation of the disease, which may involve the collection of blood, urine, and stool samples from ill people and performing bacteriologic, virologic, or parasitic testing of those samples.
Case definition is the process by which we establish a set of standard criteria to determine who is and is not infected with respect to a specific outbreak; that is, a protocol is developed to determine case patients.
Case identification requires the health crisis manager and team of professionals to conduct a systematic and organize.
You are the information technology manager of an.docx4934bk
The IT manager of an 80-bed long-term care facility was tasked by the Board of Directors and CIO to create a 1-2 page report on private databases and doctor-patient privilege. The report aims to summarize the types of data stored in private health databases and whether it is protected by specific regulations or doctor-patient privilege. Private databases store confidential patient information like medical history and treatment plans. This data is regulated under laws like HIPAA which require security and privacy of sensitive medical information. Doctor-patient privilege legally protects confidential patient information and communications, though it has limits such as in response to court orders.
Your parents gave you up for adoption at a.docx4934bk
Your biological parents gave you up for adoption as a young child because they could not financially support you at the time. Thirty years later, they found you and one of your biological parents needs a kidney transplant. You are the best match to donate a kidney. You must determine whether you have a moral obligation to donate your kidney to your biological parent based on philosophical perspectives of ethics and your own cultural worldview.
The document provides instructions for writing a paper that examines messages and images in various forms of media from a social science perspective. Students are asked to choose a type of media, observe advertisements or other elements, note any themes in how groups are portrayed, analyze the data socially and scientifically, and write a 3 page paper with sections for description of the media examined, descriptions of ads or elements, an analysis, and a conclusion.
This document outlines a research plan to study Apple Airpod consumers and sales. The plan involves conducting ethnographic research through visits to Apple stores to observe customer interactions with Airpod displays and paths through the store. It also includes online research and surveying Airpod users about their purchase decisions and opinions of the product. The type of data to be collected is listed as answers from Airpod users, store traffic patterns, Airpod sales data, and purchased complementary products. A questionnaire for Airpod users and tools for tracking purchases and mapping customer traffic are presented as the means of data collection.
Europeans initially settled along the Atlantic coast for economic reasons like fishing and fur trading. England gradually took control of land held by other European countries like France and Spain through military conflicts and agreements. The early English colonies were strongly influenced by religion as different religious groups fled persecution in Europe and established colonies with religious freedom and self-governance in mind, though these colonies were still subject to oversight and laws passed in English Parliament.
Write about interactions in the premodern world.docx4934bk
Friar John of Pian de Carpine and William of Rubruck each provided descriptions of the Mongol court in the 13th century. Using these primary sources, the essay argues that the Mongol Empire significantly shaped cross-cultural exchange through its interactions with other societies. The analysis focuses specifically on the assigned course materials regarding the Mongol Empire and the primary source descriptions of the Mongol court to make a persuasive case about the Empire's role in cultural diffusion across Eurasia.
The document instructs students to watch two Frontline videos, "The Confessions" and "The Plea", and write a 2-4 page reaction paper about one of the videos. Students must watch "The Confessions" by week 11 and "The Plea" during week 11. Their paper should summarize the content of the chosen video and discuss their reaction to it based on course materials and personal experiences. The paper is due by the end of week 12.
This document provides instructions for a short research paper on a topic related to World War II or the 1920s. The paper must be 3-5 double-spaced pages long using 12-point Times New Roman font with 1-inch margins. At least two credible academic sources must be cited using APA, MLA, or Chicago style. The paper should include a cover page with identifying information, bibliography, clear thesis statement, argument defending the thesis, and conclusion restates the argument. Acceptable topics include specific events like D-Day or social developments like flappers and fashion. The source material and all non-original content must be properly cited.
The document summarizes instructions for writing a summary of two assigned readings: Women’s Work and Chicano Families by Patricia Zavella, and Opting Out? by Pamela Stone. Zavella examines the roles of women and families in the Chicano community through interviews and ethnographic research. Stone explores why high-achieving women leave their careers through analyses of surveys and interviews. Students are asked to write a three paragraph summary that introduces the authors, topics, and central arguments of the readings. The second paragraph should provide an example from one of the author's analyses. The final paragraph should connect the readings to course topics and discussions.
The document provides instructions for a 1,000-1,200 word literary essay based on the memoir "Greetings From Bury Park" by Sarfraz Manzoor. Students must develop a thesis that answers either how the author uses America/Bruce Springsteen's music to show struggles OR what role the author's father plays in his struggles. The thesis must be supported using quotes from the memoir without outside research. Lenses from the "Lenses for Reading Literature" handout should also be applied. A sample thesis is given addressing how Springsteen/music show the author's desire for independence from his family and need to escape confines as a young Pakistani in Britain.
Why are the ancient legends of China of interest to.docx4934bk
The document discusses why ancient Chinese legends are of interest to historians. Historians can use both scholarly secondary sources and primary sources from ancient China to understand Chinese culture and history. Quotes from primary sources should be used to support arguments, while paraphrases and limited quotes from secondary sources provide context. A bibliography of all sources is also required.
Why and how did the loom large in focus on.docx4934bk
The document discusses how the role of women was an important issue in anti-colonial thought, using Egypt as a case study. It examines why women were often problematic for nationalism and what roles they played in anti-colonial struggles. The readings consider whether feminism and anti-colonial nationalism were complementary or contradictory. Key works analyzed include those by Kandiyoti, Baron, and Badran on the role of women in Egyptian nationalism and the development of feminism in relation to the anti-colonial movement.
Why did the Roman Catholic Church consider the sin of.docx4934bk
The Roman Catholic Church saw blasphemy as a threat to social order because it undermined religious authority and morality. The Inquisition prosecuted blasphemers to enforce religious orthodoxy. Indigenous people and those of mixed race often faced charges of blasphemy due to tensions with colonial rule. Prosecutions declined in the 1700s as the Church's power began to wane.
The document discusses how the "woman question" was an important issue in anti-colonial thought, using Egypt as a case study. It notes that women were often seen as a problem or issue for nationalism and asks what roles women played in anti-colonial struggles. It also questions whether feminism and anti-colonial nationalism were complementary or contradictory. It lists many relevant readings on these topics focused on historical cases in Egypt, India, and other regions that analyze the relationship between gender, nationalism, and colonial modernity.
What similarities do you notice between organizations for the.docx4934bk
Organizations across Celtic regions focused on preserving and reviving traditional music and dance have several similarities. They aimed to collect and document cultural works at risk of being lost, through establishing groups led by passionate individuals. Events and movements in each area also celebrated and shared these musical and dance traditions with modern audiences.
Who invented the printing and how did it have an.docx4934bk
1. The Byzantine Emperor Alexius I appealed to Pope Urban for help against invaders in the Holy Land. The Pope responded by calling for the First Crusade to aid the Byzantines and recapture the Holy Land for Christianity. Crusaders gained politically by acquiring new lands and spiritually by gaining redemption for sins. Europeans benefited intellectually from exposure to other cultures.
2. The 14th century plague negatively impacted laborers through mass deaths but positively impacted survivors through higher wages. It weakened the Catholic Church and local governments' influence as they struggled to provide support and order.
3. The Hundred Years' War began in 1337 due to a dispute over the French throne between the houses of Plantagenet and
Which is the true statement regarding the criteria for prioritizing.docx4934bk
The document discusses various nursing concepts and questions. The key points are:
- Community capacity and willingness to change is an important criteria when prioritizing needs.
- Evidence-based practice includes the best evidence from research as well as nursing expertise and patient values and preferences.
- Telehealth can be conducted in various settings including home, clinic, and prisons.
- Shared governance is when staff nurses are included in decision making for practice and management.
This document discusses factors contributing to the failure of LGBT individuals to use health care services and potential nursing interventions to address this issue. It identifies biological, psychological, environmental, socio-cultural, behavioral, and health system factors that may prevent LGBT individuals from seeking care, such as higher health risks, stigma, lack of access or insurance, and provider cultural incompetence. It recommends population health nursing interventions like increasing access to services, providing cultural competency training for providers, advocating for inclusive policies, and reducing stigma in the health care system and community to promote more effective use of services by the LGBT population.
What was the threat posed to western style democracy in.docx4934bk
Fascist regimes threatened western democracies in the US, Europe, and Asia in the early 20th century. Fascism emphasized extreme nationalism, often scapegoating ethnic or religious minorities, and opposed liberal democracy and Marxism. It typically gained support from those feeling threatened by the social changes brought about by industrialization and a growing middle class empowered working class.
What stereotypes did Catholics have of Protestants and Protestants of.docx4934bk
Catholics and Protestants held negative stereotypes of each other that helped fuel violence between the groups. Catholics viewed Protestants as heretics while Protestants saw Catholics as idolaters. These stereotypes allowed both sides to justify attacks on the other by portraying the other group in a dehumanizing light and questioning their religious legitimacy.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
2. *Correspondence to: Eugene Lam; Email: elam@cdc.gov Submitted: 06/10/2015; Revised:
09/11/2015; Accepted: 09/16/2015 http://dx.doi.org/10.1080/21645515.2015.1096457
www.tandfonline.com Refugees (UNHCR), there were 51.2 million people displaced by the
end of 2013 due to conflict situations.2 In 2014, there were 4 Level 3 large-scale
emergencies which led to the displacement of 5.5 million people in the Central African
Republic, Iraq, South Sudan and Syria; this was in addition to a number of other crises in the
Democratic Republic of the Congo (DRC), Libya, Nigeria, Somalia, and Ukraine.2 Displaced
populations may include refugees who flee to escape a crisis by crossing recognized
international borders and internally displaced persons (IDPs) who flee but remain within
the borders of their own country. Security issues and logistic challenges associated with
emergency settings can hamper the ability of affected populations to access routine health
services and receive a complete series of recommended vaccinations. In certain
emergencies, health services may be destroyed all together. Disruption of immunization
services increases the number of susceptible individuals and the likelihood of outbreaks of
vaccine-preventable diseases (VPDs).3 VPDs reported in the literature during humanitarian
emergencies include measles, polio, and depending on geographical location, meningococcal
meningitis, yellow fever, hepatitis A, and cholera. Camp settings, especially informal ones,
increase a population’s susceptibility to VPD’s due to over-crowding, suboptimal living
conditions, poor nutrition, scarcity of safe water and sanitation, and poor nutritional
status.3,4 Furthermore, the forced migration of populations may exacerbate pre-existing
health conditions. Risk factors for outbreaks are inextricably linked to excess risk of
morbidity and mortality from VPDs, the reduction of which is the aim of public-health
interventions during humanitarian crises. The 2013 publication by the World Health
Organization (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) on
vaccination in acute humanitarian emergencies was the first WHO document to provide a
framework on decision making regarding vaccination strategies in emergencies.5 This
review article aims to build on the WHO SAGE framework by providing a more current
review of the available literature on VPDs among refugees and IDPs. The objectives of this
article are to describe the risk factors for outbreaks of VPDs in emergency settings, key
issues and challenges related to vaccination activities, and possible solutions to crisis-
related impacts on vaccination efforts among displaced populations. Human Vaccines &
Immunotherapeutics 2627 Methods We searched the PubMed database for articles
published from January 1st, 2000 to March 18th, 2015, providing a 15-year overview of
VPDs among refugees and IDPs. Figure 1 provides the search terms used and the selection
process of articles. The initial search term results with restriction to the 15 year time frame
yielded 484 results, which were further reduced to 305 articles when accounting for articles
only in English and related to human subjects. Review of the articles and abstracts further
narrowed the search to 50 original articles, literature reviews, and published perspective
pieces such as commentaries and letters to the editor. We defined a humanitarian crisis as a
socio-political conflict or instability that threatened a population’s safety and well-being by
increasing morbidity and mortality above baseline and resulting in significant breakdown of
national authority. We selected articles that addressed refugees or IDPs in the acute
emergency phase as well as in the long-term phase recognizing that some crises may
3. become protracted for years. Articles addressing influenza or H1N1 pandemic situations
were excluded from this review as influenza vaccines are not often recommended in
emergency situations. We excluded articles focused on natural disasters because the
response to these events may differ from that of humanitarian emergencies. Articles
focused on refugee resettlement were excluded because health issues and resources
available to migrants may differ from those of refugees and IDPs. Articles addressing
vaccinations among responders, national preparedness activities, capacity building, and
serological surveys were also excluded. Results All articles from the final search results
were grouped by disease and refugee or IDP status for review. A summary of the articles
categorized by VPD and displacement status is presented in Table 1 and a reference list of
articles by VPD, authors, and title in Table 2. The following provides a summary of the
literature review according to various VPD groupings from the search term results. Measles,
mumps, and rubella Measles is a well-documented epidemic-prone VPD in the emergency
context. An assessment of risk factors for measles mortality in a 2011 outbreak among
Somali refugees in Kenya found that gastrointestinal and respiratory complications of
measles were common, and increased mortality was associated with malnutrition and
neurologic complications.6 This was compounded by factors related to severe famine and
drought and an intensified civil war resulting in mass population displacement from
Somalia to neighboring countries. Case fatality rates (CFR) of measles cases among
displaced populations are often higher than those observed in stable populations.3,4,6
Recommendations for case management include vitamin A supplementation, enrollment in
feeding programs if necessary, as well as oral rehydration and/or antibacterial treatment as
needed.4,7 However, diagnosis and 2628 management of severe measles complications in
refugee camps and other resource-limited settings can be extremely difficult; therefore
every effort should be made to achieve >95% 2-dose measles vaccination coverage to
prevent outbreaks as an effective alternative.6 We reviewed articles related to measles
outbreaks among displaced populations in Tanzania, Ivory Coast, Darfur, Ethiopia, Somalia
and Kenya.8-11 Movement of new arrivals into a refugee camp may introduce measles
transmission. For example, initial cases in concurrent measles outbreaks in the Dollo Ado
refugee camp in Ethiopia and the Dadaab refugee camp in Kenya during 2010 and 2011
were likely new arrivals from Somalia, a country that was also experiencing an ongoing
measles outbreak.11,12 A 2000–2001 outbreak of measles in 4 established Burundi refugee
camps in Tanzania was an extension of an outbreak in Burundi and precipitated by a large
influx and inadequate vaccination of new arrivals.9 Therefore, priority should be placed on
disease surveillance to camp areas with the newest refugee arrivals where timely and
reliable disease reporting is likely to be weakest.6 Although camp conditions are common
risk factors for measles transmission, movement between camp and host populations also
contributes to measles outbreaks.9-11,13 Close interactions between Liberian refugees and
Ivorian host community in the urban setting of Abidjan contributed to an outbreak of
measles and rubella in 2003 and 2004 in transit camps within Ivory Coast.10 When both the
displaced and host communities have apparent immunity gaps for VPDs, it is therefore
recommended to vaccinate both groups of susceptibles, as was done in the mass measles
vaccination efforts of both refugee and non-displaced populations in Abidjan.10 Although
4. not always possible due to political and security reasons, establishment of transit and
reception centers at crossing points can ensure timely screening of those with measles and
help provide appropriate case management during mass population movement.6 Various
target age-groups were reported for measles vaccination campaigns in the available
literature within the African region.11,14,15 Over the past 15 years, increasing
consideration in examining the local epidemiology and context of measles virus
transmission in various settings are reflected in the evoluation of recommendations and
different target age groups in outbreak response.16 Collaboration with key agency and
community partners are also crucial in outbreak response vaccination strategies. In 2004,
grassroots community organizations and mass media were engaged to social mobilize IDP
camps of West and North Darfur for a measles vaccination campaign targeting those aged 9
months to 15 years.8 Given the insecurity in Western Darfur and limited access due to the
rainy season, this large-scale vaccination campaign was made possible through stakeholder
cooperation including negotiations with opposition forces which allowed for vaccinations to
take place in hard-to-reach areas.8,15 Outbreaks of rubella and mumps have also been
reported among displaced populations. In the 2003–2004 measles and rubella outbreak in
Ivory Coast transit camps, incidence of rubella was highest among children aged 5–15 years
old. Cases among relatively older children may have resulted from limited Human Vaccines
& Immunotherapeutics Volume 11 Issue 11 Figure 1. Literature search inclusion and
exclusion criteria. www.tandfonline.com Human Vaccines & Immunotherapeutics 2629
Table 1. Summary of articles by vaccine-preventable diseases and population type By
disease Polio Measles Rubella Mumps Meningitis Yellow Fever Hepatitis A Hepatitis B
Hepatitis E Rotavirus Cholera Tetanus Pneumococcus Varicella Total* Refugees IDPs Both 4
7 1 0 1 1 1 0 0 1 4 1 1 1 25 1 5 0 1 2 1 0 1 2 0 1 0 0 0 17 0 4 0 0 1 0 0 0 1 0 0 0 0 0 8 *Total
reflects number of articles; some articles addressed multiple antigens Abbreviations: IDPs D
internally displaced persons. exposure to infection when living in remote areas.10 This
study also highlights the importance of testing for both measles and rubella in febrile rash
outbreaks in refugee settings. In addition, index cases among refugees were not vaccinated
in transit camps on arrival; these situations highlight the importance of early vaccination
upon arrival at camps according to existing guidelines.17 From 2003 to 2005, a large
mumps outbreak among 6 to 15 year olds was reported in Palestinian refugee camps. While
mumps remained endemic in the Palestinian West Bank, cases among individuals born after
1994 with historical vaccination coverage over 85% suggested inadequate protection
against mumps with only one dose of measles-mumps-rubella (MMR) vaccination. As a
result of this mumps outbreak, a campaign using MMR vaccine took place in May of 2005
targeting grades 1–12 and college students.18 Polio Despite significant progress in the
global polio eradication efforts, outbreaks of poliomyelitis can take place in displaced
populations until poliovirus transmission is stopped in all countries globally. Due to
political instability, inadequate sanitation, and displacement of unvaccinated individuals in
highly dense urban centers, a polio outbreak took place in Luanga province of Angola.19 In
addition, the presence of landmines and collapsed infrastructure resulted in reduced access
to health services in many districts of the country. This outbreak highlights the impact of
war on access to routine immunizations and vaccination campaigns for all children during
5. periods of conflict and displacement. In 2015, only 3 countries continue to have endemic
circulation of wild polio virus: Afghanistan, Pakistan, and Nigeria, and the last reported
WPV case in Nigeria was in July 2014. After airstrikes in Afghanistan in 2001, Afghani
refugees were expected to enter Pakistan thereby raising concerns of increasing
transmission of polio between the 2 countries.20,21 As 2630 a result, National
Immunization Days were conducted in Pakistan and Afghanistan in September of 2001
vaccinating over 30 million children under the age of 5 years. Moreover, all incoming
refugee children were preemptively vaccinated against polio and measles in Pakistan.21
After more than 10 years without polio, laboratory-confirmed cases reemerged in Syria in
2013 due to recent conflicts, following confirmation of poliovirus in the sewers of Egypt,
Israel, and West Bank, Gaza. 22 Outbreaks can provide opportunities to sensitize
populations at risk and strengthen eradication efforts. In addition to the local outbreak
response immunization efforts in Syria, regional vaccination responses were launched in
surrounding countries of Lebanon, Jordan, Turkey, Palestine, and Egypt. Another example of
a post-outbreak opportunity to eradicate poliomyelitis was the response to a 2013 outbreak
of wild polio virus that took place in the Horn of Africa.23 As part of the vaccination
response, a combined inactivated poliovirus (IPV) and oral poliovirus vaccine (OPV)
campaign targeting children under 5 years of age took place in refugee camps and
surrounding communities near the Kenya-Somalia border.23 The addition of IPV in the
response was to boost population immunity among children who have received OPV to
ensure interruption of any residual polio virus transmission and prevent any future
outbreaks from new importations. Meningitis Meningitis outbreaks can have significant
economic and psychological impacts on households and communities, particularly when the
majority of cases are among adults and adolescents. In endemic situations, meningococcal
meningitis mostly affects young children; however, persons aged 15 to 29 years old were
the most affected in the outbreaks reported among displaced populations in Angola. The
greater number of cases in this older age group is not unusual in epidemics within areas of
high density such as refugees and IDP camps. The International Coordinating Group on
Vaccine Provision for Epidemic Meningitis Control is tasked with maintaining an emergency
vaccine stockpile to respond to meningitis outbreaks globally.24 In the Yambala area in
Angola, insecurity constrained outbreak response immunization activities and disease
transmission in inaccessible areas stopped only with the onset of the rainy season.
Population movement across borders also raised concerns about the spread of disease
outside of the meningitis belt. Six meningococcal meningitis outbreaks in Angola affected
displaced populations during the civil conflict.25 Mass population movements due to civil
war, rampant urbanization, and formation of informal camps and settlements contribute to
meningococcal disease transmission. Economic decline and the collapse of public health and
health service infrastructure in Angola highlighted the crisis-related impacts of
implementing surveillance and outbreak response to communicable diseases. After a large
influx of Sudanese refugees into camps in Northern Uganda in 1994, there were 2
consecutive outbreaks of group A meningococcal meningitis.26 Maintaining effective
surveillance system in refugee settings was proved difficult with competing health care
priorities including concurrent epidemics of measles Human Vaccines &
6. Immunotherapeutics Volume 11 Issue 11 Table 2. Reference list of articles by vaccine-
preventable disease, authors, and title Author Year Published Valente, F., et al. 2000 Ahmad,
K. Mohammadi, D. Sheikh, M. A., et al. 2001 2013 2014 Bonn, D. Kamugisha, C., et al. Talley L,
Salama P. 2001 2003 2003 WHO WER CDC MMWR Mupere, E., et al. 2004 2004 2005
Guerrier, G., et al. 2009 Kouadio, I. K., et al. 2010 Kamadjeu, R., et al. 2011 Grais, R. F., et al.
2011 WHO WER Polonsky, J. A., et al. 2012 2013 Mahamud, A., et al. 2013 Navarro-Colorado,
C., et al. 2014 Kaiser, R. 2014 Kouadio, I. K., et al. Hindiyeh, M. Y., et al. 2009 2009
Santaniello-Newton, A., Hunter, P. R. Gaspar, M., et al. Iriso, R., et al. 2000 2001 2008 WHO
WER 2014 Nathan, N. Huhn, G. D., et al. 2001 2006 Kaic, B., et al. Alavian, S. M., et al. Boccia,
D., et al. 2001 2007 2006 CDC MMWR 2013 Ope, M., et al. 2014 Chaignat, C. L., Monti, V.
2007 Verma, R., et al. Porta, M. I., et al. 2012 2014 Martin, S., et al. 2014 Name of Article
Massive outbreak of poliomyelitis caused by type-3 wild poliovirus in Angola in 1999. Fears
that Afghan exodus threatens polio eradication Middle Eastern countries scramble to stop
spread of polio Combined use of inactivated and oral poliovirus vaccines in a large-scale
campaign in refugee camps and host communities Infectious diseases threaten refugees
entering Pakistan. An outbreak of measles in Tanzanian refugee camps Short report:
assessing field vaccine efficacy for measles in famine-affected rural Ethiopia. Prevention of
measles deaths in Darfur, Sudan. Emergency measles control activities–Darfur, Sudan
Impact of emergency mass immunisations on measles control in displaced populations in
Gulu district, northern Uganda. Malnutrition and mortality patterns among internally
displaced and nondisplaced population living in a camp, a village or a town in Eastern Chad.
Measles outbreaks in displaced populations: a review of transmission, morbidity and
mortality associated factors Measles control and elimination in Somalia: the good, the bad,
and the ugly. Measles vaccination in humanitarian emergencies: a review of recent practice
Measles–Horn of Africa High levels of mortality, malnutrition, and measles, among
recentlydisplaced Somali refugees in Dagahaley camp, Dadaab refugee camp complex,
Kenya, 2011. Risk factors for measles mortality among hospitalized Somali refugees
displaced by famine, Kenya, 2011. Measles outbreak response among adolescent and adult
Somali refugees displaced by famine in Kenya and Ethiopia, 2011. Emergency settings: be
prepared to vaccinate persons aged 15 and over against measles Outbreak of measles and
rubella in refugee transit camps. Characterization of large mumps outbreak among
vaccinated Palestinian refugees Management of an outbreak of meningococcal meningitis in
a Sudanese refugee camp in Northern Uganda. Epidemiology of meningococcal meningitis in
Angola, 1994–2000 Bacterial meningitis following introduction of Hib conjugate vaccine in
northern Uganda. Meningococcal disease control in countries of the African meningitis belt,
2013. Shortage of vaccines during a yellow fever outbreak in Guinea. Vaccination coverage
survey versus administrative data in the assessment of mass yellow fever immunization in
internally displaced persons–Liberia, 2004. Hepatitis A control in a refugee camp by active
immunization. The changing epidemiology of viral hepatitis B in Iran. High mortality
associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan.
Investigation of hepatitis E outbreak among refugees – Upper Nile, South Sudan, 2012–2013
Rotavirus enteritis in Dadaab refugee camps: implications for immunization programs in
Kenya and Resettlement Countries. Use of oral cholera vaccine in complex emergencies:
7. what next? Summary report of an expert meeting and recommendations of WHO. Cholera
vaccine: new preventive tool for endemic countries. Feasibility of a preventive mass
vaccination campaign with 2 doses of oral cholera vaccine during a humanitarian
emergency in South Sudan Post-licensure deployment of oral cholera vaccines: a systematic
review. Vaccine-Preventable Disease Polio Polio Polio Polio Polio, Measles Measles Measles
Measles Measles Measles Measles Measles Measles Measles Measles Measles Measles
Measles Measles Measles, Rubella Mumps Meningitis Meningitis Meningitis Meningitis
Yellow fever Yellow fever Hepatitis A Hepatitis B Hepatitis E Hepatitis E Rotavirus Cholera
Cholera Cholera Cholera (Continued on next page) www.tandfonline.com Human Vaccines
& Immunotherapeutics 2631 Table 2. Reference list of articles by vaccine-preventable
disease, authors, and title (Continued) Author Year Published WHO WER 2014 Howard, N.,
et al. Moszynski, P. 2011 2013 Shimakawa, Y., et al. Morris, K. Koop, D. G., et al. 2010 2000
2001 Leus, X., et al. Bhatia, S., et al. Connolly, M. A., et al. Avogo, W. A., Agadjanian, V.
Moodley, K., et al. 2001 2002 2004 2010 2013 Caplan, A. L., Curry, D. R. Devi, S. 2015 2015
Name of Article Oral cholera vaccine campaign among internally displaced persons in South
Sudan. Reproductive health for refugees by refugees in Guinea III: maternal health. Refugees
in South Sudan to receive pneumococcal vaccine after delays over price. Outbreak of
chickenpox in a refugee camp of northern Thailand. Agency warns of crisis in beleaguered
Democratic Republic of Congo. Results of the expanded program on immunization in the
Macedonian refugee camps. Internally displaced persons A social and demographic study of
Tibetan refugees in India. Communicable diseases in complex emergencies: impact and
challenges Forced migration and child health and mortality in Angola. Ethical
considerations for vaccination programmes in acute humanitarian emergencies. Refugees,
humanitarian aid and the right to decline vaccinations Long-term planning needed for Iraq’s
displaced. Vaccine-Preventable Disease Cholera Tetanus Pneumococcus Varicella General
General General General General General General General General Abbreviations: CDC,
Centers for Disease Control and Prevention; MMWR, Morbidity and Mortality Weekly
Report; WHO, World Health Organization; WER, Weekly Epidemiological Report. and
malnutrition. As part of the response, mass vaccination of 1 to 30 year olds was successfully
conducted to control the initial outbreak. The decision to extend the upper limit of the
target age-group to 30 years was based on analysis of age-specific attack rates. The sudden
influx of refugees overwhelmed screening at registration resulting in 11,000 refugees not
being screened or vaccinated upon arrival. This may have led to the second consecutive
meningitis outbreak that required a catch-up vaccination campaign in 1995. However, this
outbreak demonstrated the effectiveness of rapid mass vaccination campaigns with high
coverage in controlling outbreaks of serogroup A meningococcal meningitis among refugee
population. Cholera and rotavirus Diarrheal diseases are one of the leading causes of death
among children under 5 years of age in emergency settings. Rotavirus has not been well
studied among displaced populations. WHO recommends introduction of rotavirus vaccine
into national immunization programs for countries where diarrheal deaths account for 10%
of mortality among children under 5 years of age. In 2011, a diarrheal disease surveillance
system implemented in the Dadaab refugee camp in Kenya found rotavirus circulating year-
round with 23% of children under 5 years of age presenting with diarrhea in a health
8. facility to be infected with rotavirus.27 This study supports the use of rotavirus vaccination
in refugee camps; however, additional evaluation in other refugee settings is needed to
provide further evidence of its efficacy among refugee populations. Several oral cholera
vaccines (OCV) have been developed as a public health intervention for vulnerable
populations in emergency settings.28,29 Mass vaccinations with OCV acquired from the
global stockpile have been used in several emergency contexts to prevent outbreaks of
cholera in camp situations.28-32 A meeting among WHO experts noted that OCV could be
used as a 2632 preventive intervention in humanitarian emergencies.29 Further studies are
needed to determine the possible cost-benefit of OCV, number of doses needed for adequate
protection, and best practices for cold chain implementation in the emergency context.29 In
2012–2014 the first use of the global OCV stockpile was conducted in OCV campaigns in IDP
camps and surrounding communities in South Sudan during a humanitarian crisis. The OCV
campaigns were completed through fixed outreach posts and mobile door-to-door teams
targeting individuals >1 year of age, excluding pregnant women.31,33 Distribution of
vaccination cards were used to track immunization status, and soap as an incentive to
receive the second OCV dose.31,32 However, despite the success of campaigns, there were
security, logistical, and financial challenges related to the 2 dose administration schedule as
well as weakened cold chain capacity due to the ongoing conflict.31 Furthermore, additional
costs were required to transport OCV via charter flights due to insecurity. Curfew and
access constraints limited staff movement and resulted in restricted and delayed
operations. This study showed that mass OCV campaigns in emergency settings is possible
but not without additional human resources, cold-chain capacity, logistical and
communications support from all relevant partners.31 Yellow fever The mosquito vector
Aedes aegypti for yellow fever thrives in densely-populated areas such as urban areas and
camps. In 2004, 2 yellow fever mass vaccination campaigns were launched in IDP camps
and surrounding communities in Liberia after reports of 4 lab-confirmed cases.33 Due to
the 14 years of civil war, much of Liberia’s healthcare infrastructure, public health disease
surveillance, and immunization programs were severely disrupted. Survey assessment of
vaccination coverage reported 90% by selfreport and 80% by proof of vaccination card. The
success of the Human Vaccines & Immunotherapeutics Volume 11 Issue 11 mass
vaccination efforts among IDPs required intensive social mobilization, efficient logistical
networks, well-trained health staff, and safe vaccine delivery.33 During a time Liberian and
Sierra Leonean refugees and IDPs were in Guinea, a yellow fever outbreak was reported
with 688 cases and 225 deaths (CFR 33%) in 2000.34 Movement through the forested areas
of Guinea where yellow fever is endemic into densely-populated camps and urban areas
may have led to increased transmission. In addition, this outbreak highlighted at that time
the global shortage of available yellow fever vaccines, which ultimately resulted in the
creation of the UNICEF stockpile of 2 million doses of yellow fever vaccine to be used in
response to future outbreaks. Hepatitis A and E Several types of viral hepatitis were noted
among displaced populations in our review. In 1999, a hepatitis A outbreak among Kosovar
refugees in Croatia was primarily a result of poor sanitation and housing.35 Outbreak
response included sanitation improvement, health education, screening of children 1–15
years of age and vaccination for seronegative children. Serological studies conducted 4
9. weeks post-vaccination reported 97% seroconversion. The authors suggested active
vaccination was a successful component in disrupting hepatitis A transmission in this
refugee population.35 Hepatitis E virus (HEV) infection is generally a self-limiting condition
with low fatality to the general population, although there is high case-fatality among
pregnant women. In 2004, a HEV outbreak in Mornay IDP Camp, Darfur, reported a CFR of
33% among pregnant women highlighting the need for rapid interventions to prevent
mortality in this special population.36 A 2012–2013 outbreak of HEV in the refugee camps
of Maban County in South Sudan had a CFR of 10% among pregnant women.37 HEV
transmission control often includes improvements to water and sanitation, clinical care, and
surveillance. Although there is currently no HEV vaccine available globally, recent
developments of a hepatitis E vaccine in China may have utility in controlling outbreaks
among displaced populations.38 The vaccine has yet to achieve WHO prequalification and
requires further studies regarding safety in children and pregnant women. Additional
research is needed to assess appropriate dosing regimen and efficacy of HEV vaccine to
control outbreaks among refugees and IDPs. Varicella Varicella is not included in most
national routine vaccination programs, though outbreaks may be of particular concern
among displaced populations in tropical settings. While the majority of individuals in
temperate climates develop natural immunity from previous infection before adolescence,
high levels of seronegativity are typically still observed among adults in tropical regions.
Adults infected with varicella may suffer from increased disease severity and greater
complications. Moving from rural areas of low population density to densely populated
refugee camps may also increase transmission. In 2008, a varicella outbreak in refugee
settings was documented among Lao Hmong refugees in www.tandfonline.com Thailand.39
The affected population was between 3 months and 53 years old in this outbreak with 14%
of cases 15 years old or older. Moreover, hospitalizations occurred exclusively among adults
aged 15 years. Preventive varicella vaccination may be warranted in refugee camps if
epidemiological evidence suggests increased risk of an outbreak with high levels of
morbidity. Routine immunizations Establishment of routine immunization services is not
well studied in the emergency context. Three articles discussed integration of routine
vaccination schedules of host country national expanded program on immunization (EPI)
program for refugee populations.40-42 Tibetan refugees in India were provided routine
childhood immunizations according to the national EPI schedule of the India Ministry of
Health.40 The program reported challenges in delivery of vaccine to the target population,
with less than half of the Tibetan refugee children reported as fully vaccinated.40 As a
solution to improve routine immunization coverage among displaced populations, the
Macedonian Ministry of Health delivered vaccines to Albanian Kosovar refugees living in
camps and the surrounding communities through weekly mobile immunization clinics.42 In
Guinea, more than 90% of Liberian and Sierra Leonean refugee mothers knew about
tetanus vaccination during pregnancy, though only 11–42% utilized the free antenatal care
in government facilities sponsored by UNHCR.41 EPI programs for refugees may differ
between that of host nations and their countries of origin thereby creating both ethical and
logistical challenges.43,44 Ethical concerns have also been raised regarding the ability of
the host nations to deny humanitarian assistance to refugees refusing vaccinations during
10. emergency situations. Such was the case in 2014 during the response of the governments of
Lebanon, to resistance from Syrian refugees, and Pakistan, to Afghan refugees, in receiving
polio vaccination upon entrance into camps.45 The authors argued that host governments
and supporting agencies have the responsibility to require such vaccinations in
humanitarian emergencies where the risk of VPD outbreaks can endanger both host and
displaced communities. EPI programs can often become non-functional during
humanitarian emergencies.46-48, To address this, multiple opportunities for vaccination,
including child health days and catch-up vaccination campaigns, can be used to boost
population immunity.48 Protracted emergencies reinforce the importance of thinking
beyond the emergency mindset and including long-term strategies in basic health service
provisions.48,49 WHO and other UN agencies can play a critical role in coordinating the
establishment of regular health services, including routine immunizations, in situations
where the national government is unwilling or unable to provide the necessary aid to
IDPs.50 In regards to financing and use of newer vaccines among displaced populations, 2
articles mentioned the support of the Global Alliance for Vaccines and Immunization (GAVI)
in acquiring Haemophilus influenza type b (Hib) and pneumococcal conjugate vaccine (PCV)
in emergencies.51,52 GAVI has helped fund the provision of pentavalent vaccines for IDPs
in Uganda from 2002 to 2006 and PCV for Yida refugee camp in South Sudan in 2013.51,52
Human Vaccines & Immunotherapeutics 2633 Discussion Mass population movement can
increase risk of VPDs among IDPs, refugees, and host communities. Displaced populations
can introduce endemic pathogens to a new place as well as make contact with new
pathogens either on their journey or within the host community. The same conditions that
increase transmission of communicable diseases—high prevalence of malnutrition,
unsanitary conditions, population displacement, overcrowding, and lack of clean water—
can result in VPD outbreaks and high rates of morbidity and mortality. The primary
objective of vaccination in an acute humanitarian emergency is to rapidly reduce the risk of
disease to protect a population during periods of extreme vulnerability.5 While the goals of
vaccination during an acute phase of an emergency focus on limiting the number of
preventable deaths, the goals of routine vaccination programs aim to ensure longterm
protection against a given disease through progressive increase of population immunity. In
particular, protracted emergencies need to consider reestablishing regular immunization
services as soon as possible given the rapid accumulation of susceptible populations with
missed opportunities of routine vaccinations. According to UNHCR, protracted camps with
25,000 or more displaced persons should implement routine services equivalent to host
country immunization policies with occasional supplementary vaccination campaigns.11
Mass vaccination campaigns in camps may consider administering multiple antigens with
the aim of reducing administrative and logistical costs.8,15,33 Forced migration may result
in incomplete vaccinations of routine immunizations placing both the displaced and the
host population at an elevated risk for contracting disease. In situations where the displaced
population is unstable or there is frequent population movement, mobile clinics have been
used to effectively achieve high vaccination coverage.23,33,34,42 Vaccination schedules in
the country of origin may not always align with that of the host country, thereby creating
challenges in providing interventions that are well understood by the displaced population.
11. Intensive social mobilization is needed in situations where the perceived importance of
vaccination is low.41 Opportunities for defaulter tracing activities and catch up campaigns
should also be in place for those who may have missed routine vaccinations during the
emergency. Destruction of cold chain equipment and infrastructure for transportation
provide significant challenges to vaccination during humanitarian conflicts. Growing
insecurities, as seen in the increasing number of targeted attacks on health workers in
recent years during polio eradication efforts in Pakistan, can dramatically limit the ability of
humanitarian players to provide the necessary vaccinations.53-55 These issues may be
even more pronounced in IDP camps, where operations are within the borders of a country
in conflict and the status of protection and assistance from the international community
may not apply.50 Collaboration with defacto local authorities to deliver vaccination to
chronically insecure areas are warranted at times.48 Other major challenges in addition to
insecurity, logistical, and access issues encountered during emergencies may include 2634
insufficiently trained staff, insufficient supplies and equipment, communication issues and
perception within the host community, and limited camp capacity after massive population
influx.4,33 For example, observation of polio vaccination teams in 2013 in Kenya noted
errors in the injection technique of IPV in the field and cold chain issues during the OPV and
IPV combined campaign; thereby stressing the need for appropriate training of vaccinators
and supervisors.23 In a 2014 mass OCV vaccination campaign in South Sudan, there was
lower participation from men who believed vaccination was for women and children.33
There may be local resistance to the idea of expanding refugee or IDP camps to
accommodate new arrivals that can lead to unplanned transition camps.11,56 In addition,
new waves of displaced persons can come suddenly and overwhelm existing capacity.
Guidelines to protect populations against VPDs in conflict settings include the UNHCR
handbook for emergencies, the UNICEF’s code of conduct, the WHO SAGE framework
document, and the Sphere handbook which includes internationally recognized principles
and universal minimum standards for response to humanitarian emergencies.5,17,57,58
Recent WHO position papers also provide guidance on vaccinations during emergencies,
including development of new OCVs and their safety, effectiveness, and efficacy profiles.59.
WHO also released a new Meningococcal position paper in 2015 addressing the conjugate
vaccine safety, schedule, and efficacy based on preventive mass campaigns, along with
updated recommendations that are particularly relevant in the African meningitis belt.60 In
2012, polio was declared a global public health emergency; the WHO position paper on
polio vaccination recommends the inclusion of one dose of IPV for routine immunization
programs in countries using only OPV.61 Limitations of this review include possible
omission of articles, as this review was restricted to articles written in English and available
on PubMed. The articles were also restricted by publication date from 2000 to 2015.
However, this review provides an update on the available literature regarding vaccinations
among a highly vulnerable population and describes the unique challenges of VPDs during
humanitarian emergencies. Further operational research is needed to evaluate the
prioritization of public health interventions such as vaccinations, timing of implementation
during the various phases of emergencies, and the use of newer vaccines including PCV,
OCV, Hib, rotavirus, and pentavalent vaccines. Epidemic-prone VPDs are of particular
12. concern during acute emergencies. Displaced populations are at an increased risk for
outbreaks of VPDs due to creation or exacerbation of factors associated with disease
transmission such as mass population movements, overcrowding, malnutrition, and poor
water and sanitation conditions. Vaccination is one of the most basic and critical health
interventions for protecting vulnerable populations during emergencies. While highly
effective vaccines and guidelines to combat VPDs are available, the trend of increasing
number of humanitarian emergencies globally poses new and emerging challenges in
ensuring all susceptible individuals have access to life saving vaccines. Human Vaccines &
Immunotherapeutics Volume 11 Issue 11 Disclosure of Potential Conflicts of Interest
Acknowledgments None of the authors have a commercial or other financial interest
associated with the information presented in this article. The findings and conclusions in
this report are those of the authors and do not necessarily represent the official position of
the Centers for Disease Control and Prevention. We would like to thank Jennifer Head,
MPHc, and Anyie Li, MPHc, from the Rollins School of Public Health, Emory University, for
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