Comparative assessment of analytical approaches to quantify the risk for introduction of rare animal diseases: the example of avian influenza in Spain

Trade of animals and animal products imposes an uncertain and variable risk for exotic animal diseases introduction into importing countries. Risk analysis provides importing countries with an objective, transparent, and internationally accepted method for assessing that risk. Over the last decades, European Union countries have conducted probabilistic risk assessments quite frequently to quantify the risk for rare animal diseases introduction into their territories. Most probabilistic animal health risk assessments have been typically classified into one-level and multilevel binomial models. One-level models are more simple than multilevel models because they assume that animals or products originate from one single population. However, it is unknown whether such simplification may result in substantially different results compared to those obtained through the use of multilevel models. Here, data used on a probabilistic multilevel binomial model formulated to assess the risk for highly pathogenic avian influenza introduction into Spain were reanalyzed using a one-level binomial model and their outcomes were compared. An alternative ordinal model is also proposed here, which makes use of simpler assumptions and less information compared to those required by traditional one-level and multilevel approaches. Results suggest that, at least under certain circumstances, results of the one-level and ordinal approaches are similar to those obtained using multilevel models. Consequently, we argue that, when data are insufficient to run traditional probabilistic models, the ordinal approach presented here may be a suitable alternative to rank exporting countries in terms of the risk that they impose for the spread of rare animal diseases into disease-free countries.     

Modeling exotic highly pathogenic avian influenza virus entrance risk through air passenger violations

The highly pathogenic avian influenza virus (HPAIV) is able to survive in poultry products and could be carried into a country by air travelers. An assessment model was constructed to estimate the probability of the exotic viable HPAIV entering Taiwan from two neighboring areas through poultry products carried illegally by air passengers at Taiwan's main airports. The entrance risk was evaluated based on HPAIV-related factors (the prevalence and the incubation period of HPAIV; the manufacturing process of poultry products; and the distribution-storage-transportation factor event) and the passenger event. Distribution functions were adopted to simulate the probabilities of each HPAIV factor. The odds of passengers being intercepted with illegal poultry products were estimated by logistic regression. The Monte Carlo simulation established that the risk caused by HPAIV-related factors from area A was lower than area B, whereas the entrance risk by the passenger event from area A was similar to area B. Sensitivity analysis showed that the incubation period of HPAIV and the interception of passenger violations were major determinants. Although the result showed viable HPAIV was unlikely to enter Taiwan through meat illegally carried by air passengers, this low probability could be caused by incomplete animal disease data and modeling uncertainties. Considering the negative socioeconomic impacts of HPAIV outbreaks, strengthening airport quarantine measures is still necessary. This assessment provides a profile of HPAIV entrance risk through air travelers arriving from endemic areas and a feasible direction for quarantine and public health measures.     

Use of generalized estimating equations in a trial in influenza to explore treatment effects over time

For trials with repeated measurements of outcome, analyses often focus on univariate outcomes, such as analysis of summary measures or of the last on‐treatment observation. Methods which model the whole data set provide a rich source of approaches to analysis. For continuous data, mixed‐effect modelling is increasingly used. For binary and categorical data, models based on use of generalized estimating equations account for intra‐subject correlation and allow exploration of the time course of response, as well as providing a useful way to account for missing data, when such data can be maintained as missing in the analysis. The utility of this approach is illustrated by an example from a trial in influenza. Copyright © 2004 John Wiley & Sons Ltd.     

甲型流感防控中的若干法律问题

在应对甲型流感疫情的过程中,关于危害公共安全的行为人的责任问题．关于公共卫生安全维护与人权保护的争议,关于维护公共安全与发展国际经济的关系争议此起彼伏。从法律责任角度来看．对传播疾病的行为,不仅各国可以依据国内法追究行为人的民事、行政和刑事责任,而且,国际社会应当将危害全人类的传播疾病的犯罪行为归为国际犯罪,由各国行使普遍管辖权。在人权问题上,分析了国际人权法的规定,指出国际人权法在强调保护人权的同时,也尊重各国为维护公共安全而采取必要的限制人权的措施。根据世界贸易组织和世界卫生组织对成员国义务的规定,驳斥了某些西方国家认为我国采取的防止流感病毒传播的措施违反国际条约的规定、阻碍经济发展的看法。     

基于甲型H1N1流感潜在影响的世博疾控应急策略探析

文章从政治、经济、社会等视角分析了当前爆发的甲型H1N1流感疫情对世博会的潜在影响,剖析了产生潜在影响的致灾因子,提出建立世博疾控平时常态管理与战时应急管理有效切换的制度准则,形成平时减缓阶段的风险管理和准备阶段的危险要素管理、战时响应阶段的应急管理及恢复阶段的灾害管理四位一体的全主体、全要素、全过程应对世博突发公共卫生危机的行动策略。     

Mad Cows and Sick Birds: Financing International Responses to Animal Disease in Developing Countries

Because many animal diseases have strong transboundary attributes, their control can be reasonably characterised as an international public good. The potential for reservoirs of transboundary diseases to persist in developing countries that lack the capacity or incentives to control them implies a need for international financial transfers to fund control. However, the costs of control can be large compared with development assistance budgets, and the benefits small compared with the global benefits of control and the local benefits of other priority investments. This article outlines a framework for setting priorities for international development assistance for animal disease control based on the incidence of market and non‐market impacts and the context in which outbreaks take place in endemic and susceptible countries.     

Community health workers on a college campus: Effects on influenza vaccination

Objective: To assess the impact of a campus community health worker program (HealthPALs) on student influenza vaccination. Participants: Undergraduate students at a northeastern US university (enrollment 6650), influenza seasons 2011–2012 through 2015–2016. Methods: Study design: Difference-in-differences analysis of student vaccination at campus dormitory influenza clinics during intervention vs. baseline. Intervention: In the first intervention year, HealthPALs conducted in-person peer outreach at several campus dormitory flu clinics. Subsequent years, HealthPALs conducted an enhanced intervention, with the addition of a personalized, dormitory-specific social media campaign appealing to students' community identity. Results: The initial intervention increased vaccinations by 66% (IRR = 1.66, 95%CI 1.39-1.97) at intervention clinics relative to control. The enhanced intervention increased vaccinations by 85% (IRR = 1.85, 95%CI 1.75-1.96).

Conclusion: Community health workers can be a highly effective, low-cost strategy for increasing influenza vaccination among college students. This model could also be used to address other campus health challenges where student engagement is key.     

A/H1N1 Vaccine Intentions in College Students: An Application of the Theory of Planned Behavior

Abstract

Objective: To test the applicability of the Theory of Planned Behavior (TPB) in college students who have not previously received the A/H1N1 vaccine. Participants: Undergraduate communication students at a metropolitan southern university. Methods: In January–March 2010, students from voluntarily participating communication classes completed a hardcopy survey assessing TPB and clinically significant constructs. Hierarchical regression equations predicted variance in vaccine intentions of students who had not received a flu shot (N = 198; 70% Caucasian). Results: The TPB model explained 51.7% (p < .001) of variance in vaccine intentions. Controlling for side effects, self-efficacy and perceived comparative susceptibility predicted intentions when entered in the first block, whereas attitudes, subjective norms, and perceived behavioral control significantly contribute when entered in the second block. Conclusions: For students who have not previously received a flu vaccine, vaccine communication should utilize self-efficacy and perceived comparative susceptibility to employ the TPB to promote vaccine intentions.     

2009–2010 Seasonal Influenza Vaccination Coverage Among College Students From 8 Universities in North Carolina

Abstract

Objective: The authors sought to describe the 2009–2010 seasonal influenza vaccine coverage of college students. Participants: A total of 4,090 college students from 8 North Carolina universities participated in a confidential, Web-based survey in October–November 2009. Methods: Associations between self-reported 2009–2010 seasonal influenza vaccination and demographic characteristics, campus activities, parental education, and e-mail usage were assessed by bivariate analyses and by a mixed-effects model adjusting for clustering by university. Results: Overall, 20% of students (range 14%–30% by university) reported receiving 2009–2010 seasonal influenza vaccine. Being a freshman, attending a private university, having a college-educated parent, and participating in academic clubs/honor societies predicted receipt of influenza vaccine in the mixed-effects model. Conclusions: The self-reported 2009–2010 influenza vaccine coverage was one-quarter of the 2020 Healthy People goal (80%) for healthy persons 18 to 64 years of age. College campuses have the opportunity to enhance influenza vaccine coverage among its diverse student populations.     

突发公共卫生事件中的“相称性原则”探讨

探讨公共卫生领域中相称性原则产生的必要性、含义和构成要素,并分析相称性原则在突发公共卫生事件（如H1N1流感）中的应用,这无疑具有重大意义。