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Background and Objectives: While coronavirus (COVID-19) is not transfusion-transmitted, the impact of the global pandemic on blood services worldwide is complex. Convalescent plasma may offer treatment, but efficacy and safety are not established. Measuring seroprevalence in donors would inform public health policy. Here, we survey blood services around the world to assess the different research programmes related to COVID-19 planned or in progress. Materials and Methods: Blood collection services were surveyed in June 2020 to determine whether they were participating in serosurveys or convalescent plasma collection and clinical trials. Results: A total of 48 countries (77% of those contacted) responded. Seroprevalence studies are planned or in progress in 73% of countries surveyed and in all continents, including low- and middle-income countries. Most aimed to inform public health policy. Convalescent plasma programmes have been initiated around the globe (79% of surveyed), about three quarters as clinical trials in high-, middle- and low-income countries. Conclusion: Blood services around the world have drawn upon their operational capacity to provide much-needed seroprevalence data to inform public health. They have rapidly implemented preparation of potential treatment when few treatments are available and mostly as clinical trials. At the same time, they must continue to provide blood products for recipients despite challenges of working in a state of emergency. It is important to track and coordinate research efforts across jurisdictions to gain a composite evidence-based view that will influence future practice and preparative strategies.

Background Information on the etiology and age-specific burden of respiratory viral infections among school-aged children remains limited. Though school aged children are often recognized as driving the transmission of influenza as well as other respiratory viruses, little detailed information is available on the distribution of respiratory infections among children of different ages within this group. Factors other than age including gender and time spent in school may also be important in determining risk of infection but have been little studied in this age group. Methods We conducted a cohort study to determine the etiology of influenza like illness (ILI) among 2519 K–12 students during the 2012–13 influenza season. We obtained nasal swabs from students with ILI-related absences. Generalized linear mixed-effect regressions determined associations of outcomes, including ILI and laboratory-confirmed respiratory virus infection, with school grade and other covariates. Results Overall, 459 swabs were obtained from 552 ILI–related absences. Respiratory viruses were found in 292 (63.6%) samples. Influenza was found in 189 (41.2%) samples. With influenza B found in 134 (70.9%). Rates of influenza B were significantly higher in grades 1 (10.1, 95% CI 6.8–14.4%), 2 (9.7, 6.6–13.6%), 3 (9.3, 6.3–13.2%), and 4 (9.9, 6.8–13.8%) than in kindergarteners (3.2, 1.5–6.0%). After accounting for grade, sex and self-reported vaccination status, influenza B infection risk was lower among kindergarteners in half-day programs compared to kindergarteners in full-day programs (OR = 0.19; 95% CI 0.08–0.45). Conclusions ILI and influenza infection is concentrated in younger schoolchildren. Reduced infection by respiratory viruses is associated with a truncated school day for kindergarteners but this finding requires further investigation in other grades and populations.

Previous research on respiratory infection transmission among university students has primarily focused on influenza. In this study, we explore potential transmission events for multiple respiratory pathogens in a social contact network of university students. University students residing in on-campus housing (n = 590) were followed for the development of influenza-like illness for 10-weeks during the 2012–13 influenza season. A contact network was built using weekly self-reported contacts, class schedules, and housing information. We considered a transmission event to have occurred if students were positive for the same pathogen and had a network connection within a 14-day period. Transmitters were individuals who had onset date prior to their infected social contact. Throat and nasal samples were analysed for multiple viruses by RT-PCR. Five viruses were involved in 18 transmission events (influenza A, parainfluenza virus 3, rhinovirus, coronavirus NL63, respiratory syncytial virus). Transmitters had higher numbers of co-infections (67%). Identified transmission events had contacts reported in small classes (33%), dormitory common areas (22%) and dormitory rooms (17%). These results suggest that targeting person-to-person interactions, through measures such as isolation and quarantine, could reduce transmission of respiratory infections on campus.

Practices that actively encourage employees to stay home when ill are crucial to reduce transmission in workplaces., We assessed determinants of work attendance during the first 3 days after onset of acute respiratory illness (ARI) among workers 19–64 years of age who had medically attended ARI or influenza during the 2017–2018 influenza season. The total number of days worked included days worked at the usual workplace and days teleworked. Access to paid leave was associated with fewer days worked overall and at the usual workplace during illness. Participants who indicated that employees were discouraged from coming to work with influenza-like symptoms were less likely to attend their usual workplace. Compared with workers without a telework option, those with telework access worked more days during illness overall, but there was no difference in days worked at the usual workplace. Both paid leave benefits and business practices that actively encourage employees to stay home while sick are necessary to reduce the transmission of ARI and influenza in workplaces.

Acute kidney injury (AKI) is the result of various causes and is associated with significant morbidity and mortality as well as long-term renal sequelae in pediatric patients.The aim of the study is to determine the causes of AKI in pediatric patients who needed renal replacement therapy (RRT) and were admitted to the Pediatric and Neonatal Intensive Care Unit (PICU and NICU) at the Pediatric Clinic, University Clinical Center Sarajevo (UCCS).Our research included 81 children with AKI who needed RRT. We used the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define AKI. Severe acute kidney injury was defined as stage 2 or 3 of AKI when plasma creatinine level ≥2 times the baseline level or urine output0.5 ml per kilogram of body weight per hour for ≥12 hours. Other laboratory findings and imaging tests were made depending on their primary disease that led to the AKI and its complications.Our research analyzed 81 children with AKI who needed RRT 38 girls and 43 boys ages from birth to 18 years. Mean age of presentation was 6.28 years. Male female ratio in this study was 1.1:1. Non-olyguric AKI was diagnosed in 12 (14.8%) of children with AKI, while the rest 69 (85.2%) had the olyguric type. Patients with AKI were analyzed after a rough division on prerenal in 57 (70.4%) children, intrarenal in 23 (28.4%) and post-renal in 1 (1.2%) patient.As the AKI plays a key role in the mortality and morbidity in pediatric patients, especially in infants, it is important to recognise and treatment on time different etiologies of this serious condition. Some causes of AKI in our country can be prevented by better organization of primary and secondary health care, which would also reduce mortality and morbidity from AKI.

BACKGROUND We assessed donor return rates, donation frequency, and factors related to the evolution of ferritin levels 2 years after entering donors into a large operational study of ferritin testing. STUDY DESIGN AND METHODS Ferritin testing was done on donors from representative clinics (n = 12,595). Low-ferritin donors (

BACKGROUND We assessed risk groups for iron deficiency and the feasibility and efficacy of ferritin testing in a large blood center. STUDY DESIGN AND METHODS Donors were informed of possible testing in the predonation pamphlet. Plasma ferritin was measured on retention samples (n = 12,595) from representative clinics. Low-ferritin donors (

We used individual-based computer simulation models at community, regional and national levels to evaluate the likely impact of coordinated pre-emptive school dismissal policies during an influenza pandemic. Such policies involve three key decisions: when, over what geographical scale, and how long to keep schools closed. Our evaluation includes uncertainty and sensitivity analyses, as well as model output uncertainties arising from variability in serial intervals and presumed modifications of social contacts during school dismissal periods. During the period before vaccines become widely available, school dismissals are particularly effective in delaying the epidemic peak, typically by 4–6 days for each additional week of dismissal. Assuming the surveillance is able to correctly and promptly diagnose at least 5–10% of symptomatic individuals within the jurisdiction, dismissals at the city or county level yield the greatest reduction in disease incidence for a given dismissal duration for all but the most severe pandemic scenarios considered here. Broader (multi-county) dismissals should be considered for the most severe and fast-spreading (1918-like) pandemics, in which multi-month closures may be necessary to delay the epidemic peak sufficiently to allow for vaccines to be implemented. Keywords: Pandemic influenza, School dismissal, Stochastic individual-based model, EpiCast

The objective of this qualitative study was to explore the perspectives of school and preparedness officials on the feasibility of implementing a range of social distancing practices to reduce influenza transmission during a pandemic. In the summer of 2017, we conducted 36 focus groups by teleconference and webinar lasting 90 min with school and preparedness stakeholders from across the United States. We identified and characterized 11 themes arising from the focus group protocol's domains as well as unanticipated emergent themes. These themes were: the need for effective stakeholder communication, the importance of partnering for buy-in, the role of social distancing in heightening anxiety, ensuring student safety, how practices work in combination, challenges with enforcement, lack of funding for school nurses, differing views about schools' role in protecting public health, the need for education and community engagement to ensure consistent implementation, the need for collaborative decision-making, and tension between standardizing public health guidance and adapting to local contexts. Addressing several crosscutting considerations can increase the likelihood that social distancing practices will be feasible and acceptable to school stakeholders. Keywords: Pandemics, Human influenza, Community health planning, school, social distancing

Objective To describe the methodology of the National Institute for Occupational Safety and Health (NIOSH) system for national surveillance of health-related workplace absenteeism among full-time workers in the United States and to present initial findings from October through July of the 2017–2018 influenza season. Introduction During an influenza pandemic, when hospitals and doctors’ offices are—or are perceived to be—overwhelmed, many ill people may not seek medical care. People may also avoid medical facilities due to fear of contracting influenza or transmitting it to others. Therefore, syndromic methods for monitoring illness outside of health care settings are important adjuncts to traditional disease reporting. Monitoring absenteeism trends in schools and workplaces provide the archetypal examples for such approaches. NIOSH’s early experience with workplace absenteeism surveillance during the 2009–2010 H1N1 pandemic established that workplace absenteeism correlates well with the occurrence of influenza-like illness (ILI) and significant increases in absenteeism can signal concomitant peaks in disease activity. It also demonstrated that, while population-based absenteeism surveillance using nationally representative survey data is not as timely, it is more valid and reliable than surveillance based on data from sentinel worksites. 1 In 2017, NIOSH implemented population-based, monthly surveillance of health-related workplace absenteeism among full-time workers. Methods Each month, NIOSH updates an influenza season-based time series of health-related workplace absenteeism prevalence among full-time workers with the previous month’s estimate (i.e., with a 1-month lag). Data for this surveillance system come from the Current Population Survey (CPS), a monthly national survey of approximately 60,000 households administered by the Bureau of Labor Statistics. The CPS collects information on employment, demographics and other characteristics of the noninstitutionalized population aged 16 years or older. A full-time worker is defined as an employed person who reports that they usually work at least 35 hours per week. Health-related workplace absenteeism is defined as working fewer than 35 hours during the reference week due to the worker’s own illness, injury, or other medical issue. Because the CPS questions refer to one week of each month, absenteeism during the other weeks is not measured. These one-week measures are intended to be representative of all weeks of the month in which they occur. Monthly absenteeism prevalence estimates for the current influenza season are compared to an epidemic threshold defined as the 95% upper confidence limit of a baseline established using data from the previous five seasons aggregated by month. Point estimates that exceed the epidemic threshold signal surveillance warnings ; estimates whose lower 95% confidence limits exceed the epidemic threshold generate surveillance alerts . Estimates of total absenteeism are calculated as are estimates stratified by sex, age group, geographic region (HHS service regions), and occupation. All analyses are weighted using the CPS composite weight and estimates of all standard errors are adjusted to account for the complex design of the CPS sample. Results During the period October 2017 through July 2018, the prevalence of health-related workplace absenteeism among full-time workers began at 1.7% (95% CI 1.6–1.8%) in October, increased sharply beginning in November, peaked in January at 3.0% (95% CI 2.8–3.2%), and declined steadily thereafter to end at a low of 1.4% (95% CI 1.3–1.5%) in July. The January absenteeism peak significantly exceeded the epidemic threshold, signaling a surveillance alert. Absenteeism remained elevated in February, but not significantly, signaling a surveillance warning. (Figure 1) Peak absenteeism in the 2017-2018 influenza season exceeded that of all of the five previous seasons except the 2012-2013 season. (Figure 2) Analyses stratified by sex generated surveillance alerts for male workers in January and February. Surveillance alerts were also signaled for the following strata: workers aged 45–64 years in January and February; workers in HHS Region 6 in January and February and Region 9 in December and March; and workers in management, business, and financial occupations and installation, maintenance, and repair occupations in January and in production and related occupations in February. Unlike surveillance alerts, the numerous surveillance warnings generated in stratified analyses are not reported due to small sample sizes in several strata. Conclusions Results of initial analyses for the 2017–2018 influenza season indicate that, among full-time workers in the United States, the prevalence of health-related workplace absenteeism began to increase in November, peaked in January and was significantly higher than the average of the previous five seasons. These findings are consistent with official characterizations of 2017–2018, based on traditional ILI, hospitalization, and virologic surveillance data, as a high severity season that accelerated in November and peaked in January and February. 2,3 Analyses further suggest that male workers; workers aged 45–64 years; workers living in HHS Regions 6 and 9; and those working in management, business, and financial; installation, maintenance, and repair; and production and related occupations may have been especially impacted. While not timely enough to serve as an early warning system, population-based workplace absenteeism is, nevertheless, a useful syndromic measure of a pandemic’s impact on the working population. It also provides information that can be used to maintain health situational awareness during the inter-pandemic period, to evaluate the impact of pandemic control measures, and to inform future pandemic preparedness and response planning. Absenteeism surveillance can provide an important supplementary measure of a pandemic’s overall impact because morbidity and mortality statistics may not fully reflect the disruption caused to the social and economic life of the community. This is especially true when disease makes people too sick to work but not sick enough to seek medical care. References 1. Groenewold MR, Konicki DL, Luckhaupt SE, Gomaa A, Koonin LM. Exploring national surveillance for health-related workplace absenteeism: Lessons learned from the 2009 Influenza Pandemic. Disaster Med Public Health Preparedness. 2013;7:160–166. 2. Garten R, Blanton L, Elal AI, et al. Update: Influenza Activity in the United States During the 2017–18 Season and Composition of the 2018–19 Influenza Vaccine. MMWR Morb Mortal Wkly Rep 2018;67:634–642. 3. World Health Organization. Review of the 2017–2018 influenza season in the northern hemisphere. Wkly Epidemiol Rec. 2018;34(93):429–444.

Settings and patterns of human congregation are risk factors and determinants for infectious and other diseases in communities because they can modulate the scope and extent of spread through modes of exposure and transmission (e.g., person-to-person, airborne, foodborne, waterborne, and vectorborne). This chapter reviews practical and legal implications for field investigations in four types of community congregate settings: (1) educational institutions, (2) workplaces, (3) mass gatherings, and (4) detention facilities. For each of these, it summarizes one or more illustrative field investigations. Challenges often associated with field investigations in community congregate settings include the potential for interference with normal business processes, data availability and access, and additional legal and confidentiality requirements. Field investigations of congregate settings can therefore be aided by thorough preparation, detailed documentation and close coordination and collaboration.

The importance of response time (RT) in sports is well known, but there is an evident lack of reliable and valid sport-specific measurement tools applicable in the evaluation of RT in trained athletes. This study aimed to identify the validity, reliability, and usefulness of four newly developed RT testing protocols among athletes from agility-saturated (AG) and non- agility-saturated (NAG) sports. Thirty-seven AG and ten NAG athletes (age: 20.9 +/- 2.9 ; eleven females) volunteered to undergo: three randomized simple response time (SRT-1, SRT-2, and SRT-3) protocols that included a single limb movement, and one complex response time (CRT) protocol that included multi joint movements and whole body transition over a short distance (1.5 and 1.8m). Each RT test involved 3 trials with 5 randomized attempts per trial. Two sensors were placed at the left- and right-hand side for SRT-1 and SRT- 2. Three sensors were positioned (left, middle, right) in SRT-3 and CRT. The intra-class- correlation coefficient (ICC) was calculated as a measure of reliability. Independent sample t- test, effect size (d), and area-under-the-curve (AUC) were calculated to define discriminative validity of the tests. The results showed the newly developed tests were more reliable and useful in the AG than NAG athletes (i.e., ICC between 0.68 and 0.97 versus 0.31 - 0.90, respectively). The RT of AG athletes was faster than that of NAG athletes in the CRT test from the left (p

We analyzed 4,352 participant- and staff-collected respiratory specimens from 2,796 subjects in the Oregon Child Absenteeism due to Respiratory Disease Study. Trained staff collected oropharyngeal specimens from school-aged children with acute respiratory illness while household participants of all ages collected their own midturbinate nasal specimens in year one and anterior nasal specimens in year two. Human ribonuclease P levels were measured using RT-PCR for all staff- and participant-collected specimens to determine adequacy, defined as Cycle threshold less than 38. Overall, staff- and participant-collected specimens were 99.9% and 96.4% adequate, respectively. Participant-collected midturbinate specimens were 95.2% adequate in year one, increasing to 97.2% in year two with anterior nasal collection. The mean human ribonuclease P Cycle threshold for participant-collected specimens was 31.18 in year one and 28.48 in year two. The results from this study suggest that community-based participant collection of respiratory specimens is comparable to staff-collected oropharyngeal specimens, is feasible, and may be optimal with anterior nasal collection.

On December 31, 2019, Chinese health officials reported a cluster of cases of acute respiratory illness in persons associated with the Hunan seafood and animal market in the city of Wuhan, Hubei Province, in central China. On January 7, 2020, Chinese health officials confirmed that a novel coronavirus (2019-nCoV) was associated with this initial cluster (1). As of February 4, 2020, a total of 20,471 confirmed cases, including 2,788 (13.6%) with severe illness,* and 425 deaths (2.1%) had been reported by the National Health Commission of China (2). Cases have also been reported in 26 locations outside of mainland China, including documentation of some person-to-person transmission and one death (2). As of February 4, 11 cases had been reported in the United States. On January 30, the World Health Organization (WHO) Director-General declared that the 2019-nCoV outbreak constitutes a Public Health Emergency of International Concern.

We assessed donor return rates, donation frequency, and factors related to the evolution of ferritin levels 2 years after entering donors into a large operational study of ferritin testing.Ferritin testing was done on donors from representative clinics (n = 12,595). Low-ferritin donors (25 μg/L) were informed and not called for 6 months to book a donation. Approximately 37% of donors had ferritin retested on a return donation. Return rate and donation frequency were monitored, and a logistic regression model was constructed.The return rate was lower in low-ferritin donors (67% vs. 78%), particularly in women who were first-time donors (36% vs. 61%). Returning low-ferritin donors made fewer donations in the 2 years after notification compared to the 2 years prenotification (4.5 vs. 7.5 for men, 3.0 vs. 5.0 for women), while donation frequency was lower and increased slightly for normal-ferritin donors (4.7 vs. 4.4 for men, 3.6 vs. 3.1 for women). An increased number of donations, shorter interdonation intervals, female sex, and younger age are associated with low ferritin levels on initial and repeat testing. Some recovery of ferritin occurred, but most low-ferritin donors continued to have low or borderline levels on retesting.Informing donors of low ferritin results had a long-lasting impact on return rates and donation frequency, requiring recruitment efforts to maintain adequacy of supply. Increasing the interdonation interval leads to some improvement in ferritin levels; more sustained efforts to encourage donors to improve iron intake are needed to achieve long-term benefit.

Objective The Oregon Child Absenteeism due to Respiratory Disease Study (ORCHARDS) was implemented to assess the relationships between cause-specific absenteeism within a school district and medically attended influenza visits within the same community. Introduction Transmission and amplification of influenza within schools has been purported as a driving mechanism for subsequent outbreaks in surrounding communities. However, the number of studies assessing the utility of monitoring school absenteeism as an indicator of influenza in the community is limited. ORCHARDS was initiated to evaluate the relationships between all-cause (a-Tot), illness-related (a-I), and influenza-like illness (ILI)-related absenteeism (a-ILI) within a school district and medically attended influenza A or B visits within the same community. Methods ORCHARDS was based at the Oregon School District (OSD), which enrolls 3,640 students at six schools in south-central Wisconsin. Parents reported influenza-like symptoms on an existing phone-based absenteeism reporting system. Attendance staff identified ILI using a simple case definition. Absenteeism was logged into the OSD’s existing electronic information system (Infinite Campus), and an automated process extracted counts of a-Tot, a-I, and a-ILI each school day from 9/02/14 through 6/08/17. Parents of students with acute respiratory infections (ARI) were invited to contact study staff who assessed the students’ eligibility for the study based on presence of ILI symptoms. From 1/05/15 through 6/08/17, data and nasal swabs were collected from eligible OSD students whose parents volunteered to have a study home visit within 7 days of ILI onset. Specimens were tested for influenza A and B at the Wisconsin State Laboratory of Hygiene using the CDC Human Influenza Virus Real-time RT-PCR Diagnostic Panel. For community influenza, we used data from the Wisconsin Influenza Incidence Surveillance Project (WIISP) that monitors medically attended influenza using RT-PCR at five primary care clinics surrounding the OSD. Data analysis: Over-dispersed Poisson generalized additive log-linear regression models were fit to the daily number of medically attended influenza cases and daily absenteeism counts from three sources (a-Tot, a-I, and a-ILI) with year and season (calendar day within year) as smooth functions (thin plate regression splines). Two subgroups of a-ILI representing kindergarten through 4th grade (K-4) and 5th-12th grade (5-12) were also evaluated. Results During the study period, 168,859 total absentee days (8.57% of student days), 36,104 illness days (1.83%), and 4,232 ILI days (0.21%) were recorded. Home visits were completed on 700 children [mean age = 10.0 ± 3.5 (sd) years]. Influenza RT-PCR results were available for 695 (99.3%) children: influenza A was identified in 54 (13.3%) and influenza B in 51 (12.6%) specimens. There were one large and early outbreak of influenza A (H3N2) followed by B in 2014/15, an extremely late combined outbreak of influenza A (H1N1) and B in 2015/16, and a combined outbreak of influenza A/(H3N2) and B in 2016/17. PCR detection of influenza A or B, as compared to no influenza, was strongly associated with a child with a-ILI-positive status (OR=4.74; 95% CI: 2.78-8.18; P

Background Social distancing is one of the community mitigation measures that may be recommended during influenza pandemics. Social distancing can reduce virus transmission by increasing physical distance or reducing frequency of congregation in socially dense community settings, such as schools or workplaces. We conducted a systematic review to assess the evidence that social distancing in non-healthcare workplaces reduces or slows influenza transmission. Methods Electronic searches were conducted using MEDLINE, Embase, Scopus, Cochrane Library, PsycINFO, CINAHL, NIOSHTIC-2, and EconLit to identify studies published in English from January 1, 2000, through May 3, 2017. Data extraction was done by two reviewers independently. A narrative synthesis was performed. Results Fifteen studies, representing 12 modeling and three epidemiological, met the eligibility criteria. The epidemiological studies showed that social distancing was associated with a reduction in influenza-like illness and seroconversion to 2009 influenza A (H1N1). However, the overall risk of bias in the epidemiological studies was serious. The modeling studies estimated that workplace social distancing measures alone produced a median reduction of 23% in the cumulative influenza attack rate in the general population. It also delayed and reduced the peak influenza attack rate. The reduction in the cumulative attack rate was more pronounced when workplace social distancing was combined with other nonpharmaceutical or pharmaceutical interventions. However, the effectiveness was estimated to decline with higher basic reproduction number values, delayed triggering of workplace social distancing, or lower compliance. Conclusions Modeling studies support social distancing in non-healthcare workplaces, but there is a paucity of well-designed epidemiological studies. Systematic review registration number PROSPERO registration # CRD42017065310. Electronic supplementary material The online version of this article (10.1186/s12889-018-5446-1) contains supplementary material, which is available to authorized users.

Background The prevalence, symptom course, and shedding in persons infected with the 4 most common human coronaviruses (HCoV)-229E, HKU1, NL63, and OC43 are poorly described. Objectives We estimate their prevalence and associated symptoms among college students identified via a social network study design. Patients/methods We collected 1-3 samples (n = 250 specimens) from 176 participants between October 2012 and January 17, 2013: participants with acute respiratory infection (ARI; cough and body aches or chills or fever/feverishness) and their social contacts. Virus was detected using RT-PCR. Results 30.4% (76/250) of specimens tested positive for any virus tested, and 4.8% (12/250) were positive for 2 or more viruses. Human coronaviruses (HCoVs [22.0%; 55/250]), rhinovirus (7.6%; 19/250), and influenza A (6.4%; 16/250) were most prevalent. Symptoms changed significantly over time among ARI participants with HCoV: the prevalence of cough and chills decreased over 6 days (P = .04, and P = .01, respectively), while runny nose increased over the same period (P = .02). HCoV-NL63 was the most frequent virus detected 6 days following symptom onset (8.9%), followed by rhinovirus (6.7%). Conclusions During a 3-month period covering a single season, HCoVs were common, even among social contacts without respiratory symptoms; specific symptoms may change over the course of HCoV-associated illness and were similar to symptoms from influenza and rhinovirus.

To reduce the risk of variant Creutzfeldt-Jakob disease (vCJD) transmission via blood transfusion in Canada, potential donors who spent a cumulative time in the United Kingdom, Western Europe or Saudi Arabia are deferred. "Stop dates" for accumulated time were later implemented for 3 months spent in the United Kingdom or France (1980-1996) and for 5 years elsewhere in Western Europe (1980-2007); Saudi Arabia deferral was implemented with the "stop date" (1980-1996). We evaluated the long-term impact of these deferrals and "stop dates", as well as the consistency of donors' answers to post-implementation screening questions.The monthly deferral rate was monitored from 2003-2015. Time series methods (ARIMA) were used with interruption when "stop dates" were implemented. A telephone survey of 1,000 donors (250 first-time, 500 repeat deferred donors, 250 non-deferred control donors) assessed travel history (response rate 62%). An anonymous mail survey of 40,000 donors assessed compliance with deferral (response rate 45.3%).When the "stop date" for UK/France travel was implemented, the deferral rate decreased for first-time (2.1% to 1.1%, p0.0001) and repeat (0.2% to 0.03%, p0.0001) donors. The deferral rate increased after Saudi Arabia was included (mean increase of 0.4% first-time, 0.02% repeat, p0.0001). After the Western Europe "stop date" the deferral rate was unchanged in first-time donors (1.0% to 1.1%, p=0.5) but decreased in repeat donors (0.03% to 0.02%, p0.002). In the telephone survey, 94% of deferred donors confirmed deferrable travel history. In the anonymous survey 0.3% of donors were non-compliant with the UK/France deferral.Donors, particularly first-time ones, continue to be lost due to vCJD travel deferral, but most deferrals are correctly applied and non-compliance is rare. The application of a "stop date" reduced deferrals for UK/France travel, but it may be too early to see the full impact of the "stop date" for Western Europe.

Table S1. PRISMA 2009 checklist. (DOC 63Â kb)

The rising importance of infectious disease modeling makes this an appropriate time for a guide for public health practitioners tasked with preparing for, and responding to, an influenza pandemic. We list several questions that public health practitioners commonly ask about pandemic influenza and match these with analytical methods, giving details on when during a pandemic the methods can be used, how long it might take to implement them, and what data are required. Although software to perform these tasks is available, care needs to be taken to understand: (1) the type of data needed, (2) the implementation of the methods, and (3) the interpretation of results in terms of model uncertainty and sensitivity. Public health leaders can use this article to evaluate the modeling literature, determine which methods can provide appropriate evidence for decision-making, and to help them request modeling work from in-house teams or academic groups.