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Growing evidence highlights the negative impact of managing the COVID-19 pandemic on the wellbeing of the healthcare workforce, including in the aged care sector. We undertook a qualitative study during the pandemic's third year to explore the psychosocial impacts on nine managers of residential care facilities (RCFs) across metropolitan and rural New South Wales, the largest state in Australia. Four themes were identified: (1) Increased pressure on maintaining aged care services, (2) Increased responsibility on RCF managers, (3) Psychosocial impacts due to accumulating pressures, and (4) Experience of beneficial supports. COVID-19 compounded pre-pandemic sector challenges and added new stressors. While resilient and resourceful, RCF managers experienced workplace stress and burnout, which may affect quality of resident care and impact on staff retention. There is a need for more investment to effectively support staff, and research to identify optimal psychosocial and management supports. [ABSTRACT FROM AUTHOR]

Objective To determine the challenges met by, and needs of, the epidemiology emergency response workforce, with the aim of informing the development of a larger survey, by conducting key informant interviews of public health experts. Methods We defined our study population as public health experts with experience of epidemiology deployment. Using purposive sampling techniques, we applied random number sampling to shortlists of potential interviewees provided by key organizations to obtain 10 study participants; we identified three additional interviewees through snowballing. The same interviewer conducted all key informant interviews during May-August 2019. We thematically analysed de-identified transcripts using a qualitative data analysis computer software package. Findings Despite our interviewees having a wide range of organizational and field experience, common themes emerged. Interviewees reported a lack of clarity in the definition of an emergency response epidemiologist; the need for a broader range of skills; and inadequate leadership and mentoring in the field. Interviewees identified the lack of interpersonal skills (e.g. communication) and a lack of career progression options as limitations to the effectiveness of emergency response. Conclusion The epidemiology emergency response workforce is currently not achieving collective competence. The lack of a clear definition of the role must be addressed, and leadership is required to develop teams in which complementary skills are harmonized and those less experienced can be mentored. Epidemiology bodies must consider individual professional accreditation to ensure that the required skills are being achieved, as well as enabling continual professional development. Objectif Identifier les defis et besoins des equipes epidemiologiques chargees de l'intervention d'urgence afin d'etayer l'elaboration d'une enquete plus vaste, en menant des entretiens aupres d'intervenants cles parmi les experts en sante publique. Methodes La population que nous avons definie pour notre etude est composee d'experts en sante publique possedant de l'experience dans le deploiement en situation epidemique. Nous avons utilise des techniques d'echantillonnage raisonne pour appliquer un nombre aleatoire aux listes d'intervenants potentiels fournies par les organisations cles, et obtenu ainsi 10 participants. Nous avons selectionne trois intervenants supplementaires par effet boule de neige. Les entretiens avec tous les intervenants ont ete menes par une seule et meme personne entre mai et aout 2019. Nous avons examine les transcriptions anonymisees de facon thematique a l'aide d'un logiciel d'analyse des donnees qualitatives. Resultats Bien que nos intervenants affichent un large eventail d'experiences, tant au sein des organisations que sur le terrain, des themes communs sont apparus. Plusieurs d'entre eux ont signale un manque de clarte dans la definition de l'epidemiologiste charge de l'intervention d'urgence; ils ont exprime le besoin de combiner davantage de competences; ils estiment egalement que le leadership et l'encadrement sur le terrain sont inadequats. Par ailleurs, ils ont invoque l'absence de competences relationnelles (notamment en matiere de communication) et de perspectives d'evolution de carriere comme motifs limitant l'efficacite de l'intervention d'urgence. Conclusion A l'heure actuelle, les equipes epidemiologiques chargees de l'intervention d'urgence manquent de competences collectives. Il faut mieux definir le role a jouer et etablir un leadership afin de constituer des equipes qui reunissent des competences complementaires, ou les moins experimentes peuvent etre encadres. Les autorites epidemiologiques doivent envisager l'octroi d'accreditations pour s'assurer que chacun possede les aptitudes requises, et favoriser le developpement professionnel continu. Objetivo Identificar los retos y necesidades de los equipos de respuesta a emergencias epidemiologicas para apoyar el desarrollo de una encuesta mas amplia, a traves de entrevistas con las principales partes interesadas entre los expertos en salud publica. Metodos La poblacion que hemos definido para nuestro estudio esta compuesta por expertos en salud publica con experiencia en el despliegue de epidemias. Utilizamos tecnicas de muestreo intencional para aplicar un numero aleatorio a las listas de posibles interesados proporcionadas por las organizaciones clave, lo que dio como resultado 10 participantes. Se seleccionaron otras tres partes interesadas mediante un efecto de bola de nieve. Las entrevistas con todas las partes interesadas fueron realizadas por una persona entre mayo y agosto de 2019. Se revisaron las transcripciones anonimizadas tematicamente utilizando un software de analisis de datos cualitativos. Resultados A pesar de que los entrevistados tenian una amplia experiencia, tanto dentro de las organizaciones como sobre el terreno, surgieron varios temas comunes. Varios senalaron la falta de claridad en la definicion de un epidemiologo de respuesta a emergencias, la necesidad de mas combinaciones de habilidades y un liderazgo y orientacion inadecuados en el campo. Ademas, citaron la falta de habilidades interpersonales (incluidas las de comunicacion) y de oportunidades de desarrollo profesional como razones que limitan la eficacia de la respuesta a las emergencias. Conclusion Actualmente, el personal de respuesta a emergencias epidemiologicas no esta logrando una competencia colectiva. Hay que abordar la falta de una definicion clara de la funcion, y se necesita liderazgo para desarrollar equipos en los que se armonicen las habilidades complementarias y se pueda tutelar a los menos experimentados. Los organismos de epidemiologia deben considerar la acreditacion profesional individual para garantizar que se alcanzan las competencias requeridas, ademas de permitir el desarrollo profesional continuo., Introduction Global public health emergencies are becoming increasingly frequent and complex, partly driven by fragile and under-resourced health-care systems. For an effective response to such emergencies, investment in a strong [...]

Objectives: To understand residential aged care facility (the facility) managers' perspectives on implementing public health measures (the measures) in their facilities in terms of barriers, facilitators and suggestions for improvement, after three years of the COVID‐19 pandemic. Methods: Nine managers of the facilities without an active COVID‐19 outbreak across New South Wales, Australia, representing metropolitan and rural locations, diverse facility size and star quality rating were interviewed (April–June 2023) and data qualitatively analysed. Results: Broader policy context, the need to balance the measures with resident well‐being, facility‐built infrastructure and mask fatigue were reported as barriers to implementation. Workplace policies, cultural embedding and local innovations were reported as facilitators. Suggested strategies included recommending the measures consistent with temporal COVID‐19 risk; government agencies improving communication about the measures; mandatory staff vaccination; and simplified reporting requirements. Conclusions: We recommend that relevant government agencies develop a single source of formalised, endorsed, up‐to‐date advice for the sector‐specific COVID‐19 information and communications; streamline outbreak notification and reporting requirements; and improve consultation with the sector. [ABSTRACT FROM AUTHOR]

Passive immunisation with normal human immunoglobulin (NHIG) is recommended as post-exposure prophylaxis (PEP) for higher-risk measles contacts where vaccination is contraindicated. However, the concentration of measles-specific antibodies in NHIG depends on antibody levels within pooled donor plasma. There are concerns that measles immunity in the Australian population may be declining over time and that blood donors' levels will progressively decrease, impacting levels required to produce effective NHIG for measles PEP. A cross-sectional study of Australian plasmapheresis donors was performed using an age-stratified, random sample of recovered serum specimens, collected between October and November 2019 (n = 1199). Measles-specific IgG antibodies were quantified by ELISA (Enzygnost anti-measles virus IgG, Siemens), and negative and equivocal specimens (n = 149) also underwent plaque reduction neutralisation testing (PRNT). Mean antibody levels (optical density values) progressively decreased from older to younger birth cohorts, from 2.09 [±0.09, 95% CI] to 0.58 [±0.04, 95% CI] in donors born in 1940–1959 and 1990–2001, respectively (p < 0.0001). This study shows that mean measles-specific IgG levels are significantly lower in younger Australian donors. While current NHIG selection policies target older donors, as younger birth cohorts become an increasingly larger proportion of contributing donors, measles-specific antibody concentrations of NHIG will progressively reduce. We therefore recommend monitoring measles-specific antibody levels in future donors and NHIG products in Australia and other countries that eliminated measles before the birth of their youngest blood donors. [ABSTRACT FROM AUTHOR]

Measles is the most contagious communicable disease, causing an estimated 5.5 million cases and more than 30,000 deaths in the Western Pacific Region (WPR) during 2000. Rubella infection in a pregnant woman can be devastating for the foetus, resulting in congenital rubella syndrome (CRS) in 90% of rubella infections in early pregnancy. It was estimated that approximately 9000 CRS cases occurred in the WPR in 2010. World Health Organization (WHO) Member States in the WPR decided in 2003 to eliminate measles and in 2014 to eliminate rubella from the region. While the WPR successfully attained historically low measles incidence in 2012, it experienced a region-wide measles resurgence in 2013–2016. During the regional resurgence, WHO and Member States accumulated greater knowledge on the epidemiology of measles and rubella in the WPR and strategies to maintain gains. The implementation of the resulting new regional strategy and plan of action from 2018 has proven that measles and rubella elimination is achievable and sustainable under the pressure of multiple importations of measles virus during the world-wide measles resurgences in 2018–2019. This article discusses this progress and achievements towards achieving the global eradication of measles and rubella. [ABSTRACT FROM AUTHOR]

No vaccine has been more effective in reducing disease burden, especially in preventing child deaths, than measles-containing vaccine. The return on investment makes measles-containing vaccine one of the most cost-effective public health measures available. Exhaustive reviews of biological, technical, economic and programmatic evidence have concluded that measles can and should be eradicated, and by including rubella antigen in measles-containing vaccine, congenital rubella syndrome will also be eradicated. All World Health Organisation Regions have pledged to achieve measles elimination. Unfortunately, not all countries and global partners have demonstrated an appropriate commitment to these laudable public health goals, and the negative impact of the COVID-19 pandemic on coverage rates has been profound. Unsurprisingly, large disruptive outbreaks are already occurring in many countries with a global epidemic curve ominously similar to that of 2018/2019 emerging. The Immunization Agenda 2030 will fail dismally unless measles and rubella eradication efforts are accelerated. Over half of all member states have been verified to have eliminated rubella and endemic rubella transmission has not been re-established in any country to date. In 2023, 84 countries and areas were verified to have sustained elimination of measles. However, without a global target, this success will be difficult to sustain. Now is the time for a global eradication goal and commitment by the World Health Assembly. Having a galvanising goal, with a shared call for action, will demand adequate resourcing from every country government and global partners. Greater coordination across countries and regions will be necessary. Measles, rubella and congenital rubella syndrome eradication should not remain just a technically feasible possibility but rather be completed to ensure that future generations of children do not live under the shadow of preventable childhood death and lifelong disability. [ABSTRACT FROM AUTHOR]

Mongolia experienced a nationwide measles outbreak during 1 March 2015–31 December 2016, with 49,077 cases reported to the WHO; many were among vaccinated young adults, suggesting a possible role of vaccine failure. Advanced laboratory methods, coupled with detailed epidemiological investigations, can help classify cases as vaccine failure, failure to vaccinate, or both. In this report, we conducted a study of cases to identify risk factors for breakthrough infection for a subset of laboratory-confirmed measles cases. Of the 193 cases analyzed, only 19 (9.8%) reported measles vaccination history, and 170 (88%) were uncertain. Measles-specific IgG avidity testing classified 120 (62%) cases as low IgG avidity, indicating no prior exposure to measles. Ten of these cases with low IgG avidity had a history of measles vaccination, indicating primary vaccine failure. Overall, sixty cases (31%) had high IgG avidity, indicating breakthrough infection after prior exposure to measles antigen through vaccination or natural infection, but the IgG avidity results were highly age-dependent. This study found that among young children aged 9 months–5 years, breakthrough infection was rare (4/82, 5%); however, among young adults aged 15–25 years, breakthrough infection due to secondary vaccine failure (SVF) occurred on a large scale during this outbreak, accounting for the majority of cases (42/69 cases, 61%). The study found that large-scale secondary vaccine failure occurred in Mongolia, which highlights the potential for sustained outbreaks in post-elimination settings due to "hidden" cohorts of young adults who may have experienced waning immunity. This phenomenon may have implications for the sustainability of measles elimination in countries that remain vulnerable to the importation of the virus from areas where it is still endemic. Until global measles elimination is achieved, enhanced surveillance and preparedness for future outbreaks in post- or peri-elimination countries may be required. [ABSTRACT FROM AUTHOR]

Global measles cases are on the rise following disruptions to routine immunisation programs during the COVID-19 pandemic, with devastating consequences. According to the World Health Organization, the behavioural and social drivers of vaccination include what people think and feel about vaccines, social processes, motivation to vaccinate and practical barriers to vaccination. However, the drivers of measles vaccine uptake are not necessarily the same as those for other childhood vaccines, and we lack data on how these drivers specifically have changed during and since the COVID-19 pandemic. Without accurately measuring the behavioural and social drivers for measles vaccination, and ideally measuring them serially over time, countries cannot design, target and implement interventions that effectively increase and sustain measles vaccine coverage. This paper outlines what is and is not known about the behavioural and social drivers of measles vaccination and provides recommendations for improving their post-pandemic assessment. [ABSTRACT FROM AUTHOR]

Problem The emergence of Zika virus has challenged outbreak surveillance systems in many at-risk, low-resource countries. As the virus has been linked with Guillain-Barre syndrome, routine data on the incidence of acute flaccid paralysis (AFP) may provide a useful early warning system for the emergence of Zika virus. Approach We documented all Zika virus outbreaks and cases in 21 Pacific Islands and territories for the years 2007 to 2015. We extracted data from the Global Polio Eradication Initiative database on the reported and expected annual incidence of AFP in children younger than 15 years. Using a Poisson probability test, we tested the significance of unexpected increases in AFP in years correlating with Zika virus emergence. Data were analysed separately for each Pacific Island country and territory. Local setting In most Pacific Island countries, early warning surveillance for acute public health threats such as Zika virus is hampered by poor health infrastructure, insufficient human resources and geographical isolation. Relevant changes Only one example was found (Solomon Islands in 2015) of a significant increase in reported AFP cases correlating with Zika virus emergence. Lessons learnt We found no conclusive evidence that routinely reported AFP incidence data in children were useful for detecting emergence of Zika virus in this setting. More evidence may be needed from adult populations, who are more likely to be affected by Guillain-Barre syndrome. Reporting of AFP may be deficient in regions certified as polio-free. Probleme L'emergence du virus Zika pose un probleme pour les systemes de surveillance des epidemies dans de nombreux pays a faibles ressources et a risque. Etant donne qu'un lien a ete etabli entre ce virus et le syndrome de Guillain-Barre, les donnees systematiquement collectees sur l'incidence de la paralysie flasque aigue (PFA) pourraient peut-etre aider a etablir un systeme d'alerte anticipee pour l'emergence du virus Zika. Approche Nous avons documente toutes les flambees de virus Zika et tous les cas d'infection a virus Zika dans 21 iles et territoires du Pacifique, sur la periode 2007 a 2015. A partir de la base de donnees de l'Initiative mondiale pour l'eradication de la poliomyelite, nous avons extrait des donnees sur l'incidence annuelle signalee et l'incidence annuelle prevue de la PFA chez les enfants de moins de 15 ans. En utilisant un test de probabilite de Poisson, nous avons teste la significativite de la correlation entre les augmentations annuelles Imprevues des cas de PFA et l'emergence du virus Zika. Les donnees ont ete analysees separement pour chaque territoire et chaque ile du Pacifique. Environnement local Dans la plupart des ilesdu Pacifique, les activites de surveillance et d'alerte anticipee des menaces aigues de sante publique (telles que celle representee par le virus Zika) sont rendues difficiles par les deficiences des Infrastructures de sante, l'Insuffisance des ressources humaines et l'isolement geographique des populations. Changements significatifs Nous n'avons constate qu'un seul exemple (iles Salomon, 2015) d'une augmentation significative des cas signales de PFA coincidant avec une emergence du virus Zika. Lecons tirees Nous n'avons trouve aucune preuve concluante permettant d'affirmer que les donnees systematiquement signalees sur l'incidence de la PFA chez les enfants ont ete utiles, dans ces contextes, pour detecter une emergence du virus Zika. Des donnees complementaires pourraient etre necessaires en lien avec les populations adultes, qui sont plus susceptibles d'etre affectees par le syndrome de Guillain-Barre. Il est egalement possible que le signalement des PFA soit defaillant dans ces regions certifiees exemptes de poliomyelite. Situacion La aparicion del virus de Zika ha puesto en peligro los sistemas de control del brote en muchos paises en riesgo con escasos, recursos. Dado que el virus se ha relacionado con el sindrome de Guillain-Barre, los datos rutinarios sobre la Incidencia de paralisis flacida aguda (PFA) pueden proporcionar un sistema de advertencia temprana util para la aparicion del virus de Zika. Enfoque Se documentaron todos los brotes y casos del virus de Zika en 21 islas y territorios del Pacifico entre los anos 2007 y 2015. Se recopilo Informacion de la base de datos de la Iniciativa de Erradicacion Mundial de la Poliomielitis sobre la incidencia anual de PFA Informada y prevista en ninos menores de 15 anos. Utilizando una prueba de probabilidad de Poisson, se demostro la importancia de los aumentos inesperados de PFA en los anos correlacionados con la aparicion del virus de Zika. Se analizaron los datos por separado por cada pais y territorio de las Islas del Pacifico. Marco regional En la mayoria de los paises de las Islas del Pacifico, el control de aviso temprano para amenazas sanitarias publicas agudas como el virus de Zika se ve obstaculizado por una infraestructura sanitaria pobre, escasos recursos humanos y aislamiento geografico. Cambios importantes Unicamente se encontro un ejemplo (Islas Salomon en 2015) de un gran aumento en los casos de PFA informada que se correlacionaron con la aparicion del virus de Zika. Lecciones aprendidas No se encontraron pruebas concluyentes de que los datos de incidencia de PFA informada de forma rutinaria en ninos fueran utiles para detectar la aparicion del virus de Zika en esta region. Es posible que se necesiten mas pruebas de la poblacion adulta, ya que esta tiene mas probabilidades de ser afectada por el sindrome de Guillain-Barre. La notificacion de casos de PFA puede ser deficiente en algunas regiones sin incidencias de poliomielitis., Introduction In February 2016, in response to outbreaks in several Pacific and South American countries, (1) Zika virus was declared a Public Health Emergency of International Health Concern by the [...]