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Several factors contribute to the high mortality attributed to severe infections in resource-limited settings. While improvements in survival and processes of care have been made in high-income settings among patients with severe conditions, such as sepsis, guidelines necessary for achieving these improvements may lack applicability or have not been tested in resource-limited settings. The World Health Organizations recent publication of the Integrated Management of Adolescent and Adult Illness District Clinician Manual provides details on how to optimize management of severely ill, hospitalized patients in such settings, including specific guidance on the management of patients with septic shock and respiratory failure without shock. This manuscript provides the context, process and underpinnings of these sepsis guidelines. In light of the current deficits in care and the limitations associated with these guidelines, the authors propose implementing these standardized best practice guidelines while using them as a foundation for sepsis research undertaken in, and directly relevant to, resource-limited settings.

Abstract Several factors contribute to the high mortality attributed to severe infections in resource-limited settings. While improvements in survival and processes of care have been made in high-income settings among patients with severe conditions, such as sepsis, guidelines necessary for achieving these improvements may lack applicability or have not been tested in resource-limited settings. The World Health Organization’s recent publication of the Integrated Management of Adolescent and Adult Illness District Clinician Manual provides details on how to optimize management of severely ill, hospitalized patients in such settings, including specific guidance on the management of patients with septic shock and respiratory failure without shock. This manuscript provides the context, process and underpinnings of these sepsis guidelines. In light of the current deficits in care and the limitations associated with these guidelines, the authors propose implementing these standardized best practice guidelines while using them as a foundation for sepsis research undertaken in, and directly relevant to, resource-limited settings.

Introduction The emergence and global spread of a novel strain of human influenza A/H1N1 during 2009 (pandemic [H1N1] 2009 influenza, or H1N1pdm) has highlighted the importance of data from both [...]

A novel influenza A (H1N1) virus has spread rapidly across the globe. Judging its pandemic potential is difficult with limited data, but nevertheless essential to inform appropriate health responses. By analyzing the outbreak in Mexico, early data on international spread, and viral genetic diversity, we make an early assessment of transmissibility and severity. Our estimates suggest that 23,000 (range 6000 to 32,000) individuals had been infected in Mexico by late April, giving an estimated case fatality ratio (CFR) of 0.4% (range: 0.3 to 1.8%) based on confirmed and suspected deaths reported to that time. In a community outbreak in the small community of La Gloria, Veracruz, no deaths were attributed to infection, giving an upper 95% bound on CFR of 0.6%. Thus, although substantial uncertainty remains, clinical severity appears less than that seen in the 1918 influenza pandemic but comparable with that seen in the 1957 pandemic. Clinical attack rates in children in La Gloria were twice that in adults (

We conducted two antibody surveys to assess risk factors for Marburg hemorrhagic fever in an area of confirmed Marburg virus transmission in the Democratic Republic of the Congo. Questionnaires were [...]

Among the core functions of the World Health Organization (WHO) are to provide 'leadership on matters critical to health' and to shape 'the research agenda and stimulate the generation, translation, [...]

In February 2016, the World Health Organization (WHO) declared the Zika virus-related cluster of microcephaly cases and other neurological disorders reported in Brazil, a Public Health Emergency of International Concern [...]

The public health benefits of data-sharing have been widely recognized over the past decade. A recent statement signed by over 30 research funders, nongovernmental organizations and publishers highlighted the importance [...]

A conference paper about the epidemic and pandemic alert and response of the World Health Organization (WHO) is presented. Several factors of the changing world that may lead to an increased risk of pandemic disease are presented. Also given is an overview of the strategic approach of WHO in handling any public health emergency. Described, as well, are key strategic actions of WHO in tackling human pandemic influenza.

Presents letters to the editor of 'British Medical Journal.' Discussion of the policy of this journal concerning clinical trials without economic evaluations; Self help smoking cessation in pregnancy; Advocation of the World Health Organization for investment in global infrastructure for outbreaks such as smallpox; Possible use of polyspecific snake antivenom in Africa; Randomized controlled trial for twin delivery with planned Cesarean section; Thrombolysis with recombinant streptokinase in Cuba; Suggestion that checklists for myocardial infarction be precise; Copying letters to patients and omitting information.

Nipah virus causes highly lethal disease, with case-fatality rates ranging from 40% to 100% in recognised outbreaks. No treatments or licensed vaccines are currently available for the prevention and control of Nipah virus infection. In 2019, WHO published an advanced draft of a research and development roadmap for accelerating development of medical countermeasures, including diagnostics, therapeutics, and vaccines, to enable effective and timely emergency response to Nipah virus outbreaks. This Personal View provides an update to the WHO roadmap by defining current research priorities for development of Nipah virus medical countermeasures, based primarily on literature published in the last 5 years and consensus opinion of 15 subject matter experts with broad experience in development of medical countermeasures for Nipah virus or experience in the epidemiology, ecology, or public health control of outbreaks of Nipah virus. The research priorities are organised into four main sections: cross-cutting issues (for those that apply to more than one category of medical countermeasures), diagnostics, therapeutics, and vaccines. The strategic goals and milestones identified in each section focus on key achievements that are needed over the next 6 years to ensure that the necessary tools are available for rapid response to future outbreaks of Nipah virus or related henipaviruses., Competing Interests: Declaration of interests CCB declares grant U19AI142764 from the National Institute of Allergy and Infectious Diseases (NIAID), the National Institutes of Health (NIH). CCB received royalties from the licensing of Hendra sG to Zoetis (Equivac HeV), Auro Vaccines (subsidiary of Aurobindo Pharma USA), and monoclonal antibodies to Henipaviruses, Absolute Antibody, UK, created and operating under the laws of the UK. CCB declares patents planned, issued, or pending for “Soluble forms of Hendra and Nipah virus G glycoprotein” (Australian patent number 2005327194; US patent numbers 8865171, 9045532, 9056902, 9533038, and 10053495); “Soluble forms of Hendra and Nipah virus F glycoprotein and uses thereof” (Australian patent numbers 2013276968; US patent numbers 10040825 and 10590172); “Human monoclonal antibodies against Hendra and Nipah viruses” (US patent numbers 7988971, 8313746, and 8858938); “Antibodies against F glycoprotein of Hendra and Nipah viruses” (US patent numbers 9982038 and 10738104); and “Cedar virus and methods of use” (US patent number 10227664). EdW received financial support from the Intramural Research Program, NIAID, NIH; and royalties related to the vesicular stomatitis virus Nipah vaccine mentioned in this manuscript. ESG received funding (through a grant to ESG's institution) from Stanford University (Coalition for Epidemic Preparedness Innovations [CEPI] was the primary donor) to work on two studies related to development of Nipah vaccines, including development of consent documents for future trials in Bangladesh. ESG is also the principal investigator of a U01 (cooperative agreement) from NIAID, NIH for the study of Nipah virus spillovers in Bangladesh. ESG also received funding (grant to institution) from the Defense Advanced Research Projects Agency to study the dynamics of Nipah virus transmission in bats in Bangladesh. ESG received a consultancy contract from Montana State University to provide technical guidance to a study collecting biological samples from bats in Bangladesh; and served as an unpaid elected board member for the American Society for Tropical Medicine and Hygiene. LTM received financial support as a science consultant at FIND; and received consulting fees as a science consultant at FIND. SPL received research funding from CEPI to support the development of two vaccine candidates against Nipah virus. SP received research funding from Public Health Vaccines through a subaward from Stanford University. CFS declares patents planned, issued, or pending for “Nipah Henipavirus virus replicon particles and their use” (US patent number WO2023/133077 A1). KAM, AJM, NMM, JTO, MTO, and AKU received financial support for the completion of this Personal View from the Wellcome Trust (grant number 226538/Z/22/Z; payments were made to the University of Minnesota). Wellcome supported travel to attend the workshop identified in this Personal View for CCB, EdW, ANF, ESG, KH, SPL, LTM, KAM, JTO, M-PP, MTO, SP, and MR. PCF, PJH, and JPG worked at the Wellcome Trust during the time that this Personal View was completed. No authors were paid by a pharmaceutical company or any other agency to write this Personal View. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

In 2016, WHO designated Lassa fever a priority disease for epidemic preparedness as part of the WHO Blueprint for Action to Prevent Epidemics. One aspect of preparedness is to promote development of effective medical countermeasures (ie, diagnostics, therapeutics, and vaccines) against Lassa fever. Diagnostic testing for Lassa fever has important limitations and key advancements are needed to ensure rapid and accurate diagnosis. Additionally, the only treatment available for Lassa fever is ribavirin, but controversy exists regarding its effectiveness. Finally, no licensed vaccines are available for the prevention and control of Lassa fever. Ongoing epidemiological and behavioural studies are also crucial in providing actionable information for medical countermeasure development, use, and effectiveness in preventing and treating Lassa fever. This Personal View provides current research priorities for development of Lassa fever medical countermeasures based on literature published primarily in the last 5 years and consensus opinion of 20 subject matter experts with broad experience in public health or the development of diagnostics, therapeutics, and vaccines for Lassa fever. These priorities provide an important framework to ensure that Lassa fever medical countermeasures are developed and readily available for use in endemic and at-risk areas by the end of the decade., Competing Interests: Declaration of interests KAM, AJM, NMM, JTO, MTO, and AKU declare receiving financial support for the completion of this Personal View from Wellcome (grant number 226538/Z/22/Z), payments were made to the University of Minnesota. ADTB is a member of the Vaccine Research, Development and Manufacturing Committee of the Coalition for Epidemic Preparedness Innovations (CEPI). DME is employed by FIND. RFG declares grants U01AI151812, U19AI135995, R01AI132223, R01AI132244, and U19AI142790, all awarded from the National Institute of Allergy and Infectious Diseases, LEAP4WA awarded by the European & Developing Countries Clinical Trials Partnership, and ESEP1904 and INTU1901, both awarded by CEPI; stocks in and royalties or licenses from Zalgen Labs; ownership of a monoclonal antibody patent (WO2018106712A1); and travel support from Wellcome to attend the workshop identified in this Personal View. SG declares financial support for this Personal View from WHO and Wellcome; the receipt of drugs for clinical trials from Toyama–Fujifilm; grants (all payments were made to SG's institutions) from the German Research Foundation (grants GU 883/4-2, GU 883/5-1, and GU 883/7-1), the European Commission (project 101103204—INTEGRATE), the German Government, Ministry of Health (projects ZMI1-2521WHO002 and ZMII2-2523GHP006), CEPI (framework agreement for implementing partner services); the Kirmser Foundation (donation of equipment); speaker honoraria for continuing medical education on viral haemorrhagic fevers; and support for attending meetings from WHO, Wellcome, and CEPI, including travel support from Wellcome to attend the workshop identified in this Personal View. LTM declares being a science consultant at FIND, for which she receives grants, contracts, and consulting fees; and travel support from Wellcome to attend the workshop identified in this Personal View. SAO declares a consulting contract with CEPI (payments made to SAO); is a member of the INTEGRATE consortium with grants from the European & Developing Countries Clinical Trials Partnership (payments made to SAO's institution); and support from CEPI and EDCTP funds (payments made to travel agencies and through SAO's institution). CR declares participation on a Data Safety Monitoring Board or Advisory Board (this advisory board was designated after CR's participation in the work leading to this Personal View). WKA is Executive Director of the African Vaccine Manufacturing Initiative, and Cheif Executive of National Vaccine Institute, Ghana. DAA, IMA, WKA, ADTB, DGB, EF-C, IdC, DSG, SBG, MJ, KAM, JTO, MTO, AKU, and CSS declare Wellcome supported for travel to attend the workshop identified in this Personal View. PCF, PJH, and JPG worked at Wellcome during the time that this Personal View was completed. All other authors declare no competing interests. No authors were paid by a pharmaceutical company or any other agency to write this Personal View. The authors alone are responsible for the views expressed in this Personal View and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Objective: This work evaluated seasonal variations and spatio-temporal pattern of respiratory tract infections (RTI) in geriatric nursing homes in order to improve effective surveillance, prevention, control and management of RTI., Methods: Prospective surveillance of RTI (Low Respiratory Tract infections and Influenza Like Illnesses) was conducted in 11 sites in Alsace over a 10-year period with clinical case definitions and rapid tests (Immunoassay) to identify influenza virus., Results: Influenza national epidemic was a period at high risk of RTI in nursing homes with variable impacts depending on the seasonal period. 2004-2005, 2008-2009, 2011-2012 and 2012-2013 were the periods with the highest impacts. The higher risk was not well understood during these four influenza epidemics and outbreaks occurred in numerous nursing homes despite the alerts and surveillance., Conclusion: Information about seasonal variability and spatio-temporal patterns of the RTI during the national epidemic periods is essential for the nursing homes in order to help the health care workers and the visitors to understand the risk for the residents and then to improve the implementation of the control and prevention measures., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)