-
Prehospital and Disaster Medicine Dec 2021Category A agents are biological pathogens that could pose a threat to health and human safety if used as bioweapons. The exploration and possibility of these threats...
Category A agents are biological pathogens that could pose a threat to health and human safety if used as bioweapons. The exploration and possibility of these threats must be comprehensively reviewed to create a preparedness plan to recognize outbreaks, to educate the public, and to offer vaccinations and/or treatment options, if available. A scoping review using PRISMA guidelines was performed to categorize current information on Category A biological agents as well as understand their potential for future threats. The results used 34 articles and found that while botulin neurotoxins were the most lethal, anthrax posed the most likely threat for use as a bioweapon. Most research was conducted on plague, though it is not the most likely threat. Smallpox is the most likely agent to vaccinate against as there is already a working vaccine that has proven effective and the issue at hand is the need for a larger stockpile. Ultimately, preparedness efforts should include vaccinations and continued research and development of them. Category A agents are a serious public health concern; updated and reformed bioterrorism preparedness plans could greatly minimize panic and mortality.
Topics: Anthrax; Bioterrorism; Disease Outbreaks; Humans; Plague; Smallpox
PubMed: 34615562
DOI: 10.1017/S1049023X21001072 -
Orphanet Journal of Rare Diseases Aug 2021Osteomyelitis variolosa is a self-limiting disease triggered by variola virus that cannot be prevented or repaired. Smallpox has been eradicated for 40 years, and... (Review)
Review
BACKGROUND
Osteomyelitis variolosa is a self-limiting disease triggered by variola virus that cannot be prevented or repaired. Smallpox has been eradicated for 40 years, and complications that remain after smallpox has been cured have become a remarkable diagnostic challenge for contemporary physicians. In this systematic review, we searched PubMed (MEDLINE), Web of Science, and Google Scholar for cases on complications, diagnosis, and treatment for osteomyelitis variolosa between January 1980 and February 2021.
RESULTS
Ten papers and eleven finished cases, all patients from India, were included for comparison with the present case. In total, 100% of patients presented with bilateral elbow deformities, the ankle was the second most common site of lesion in 50%, and knee lesions accounted for 25% in this study. Flexion contracture, joint instability, secondary arthritis, and fracture are common complications of osteomyelitis variolosa, and most patients receive conservative treatment, while internal fixation has good results for combined fractures.
CONCLUSIONS
Although osteomyelitis variolosa is not a direct threat to the safety of patients, severe skeletal deformities can have a significant impact on quality of life. With advances in surgical techniques, clinicians are offering an increasing number of treatment options for patients with osteomyelitis variolosa. However, most importantly, smallpox has basically been removed from the historical arena, and for areas where smallpox was once endemic, physicians need to deepen the understanding of this disease again.
Topics: Humans; Joint Instability; Osteomyelitis; Quality of Life; Smallpox; Variola virus
PubMed: 34362412
DOI: 10.1186/s13023-021-01985-0 -
The Journal of Dermatological Treatment May 2022Molluscum contagiosum (MC) is a self-limited cutaneous viral infection. Topical 10% potassium hydroxide (KOH) has been used for treating MC. However, it remains unclear... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Molluscum contagiosum (MC) is a self-limited cutaneous viral infection. Topical 10% potassium hydroxide (KOH) has been used for treating MC. However, it remains unclear whether it is beneficial or not to apply topical 10% KOH for treating MC.
METHODS
To confirm the efficacy and safety of topical 10% KOH compared with placebo as well as other treatments for MC, meta-analysis was used. Up to September 2020, we performed a comprehensive search of literature based on three databases with following keywords including 'molluscum contagiosum' and 'potassium hydroxide'.
RESULTS
Our meta-analyses demonstrated a significant difference between topical 10% KOH and placebo for complete clearance of MC (RR: 2.96, 95% CI: 1.69 - 5.17, = .0001), while there were no statistical differences between them in the number of patients with adverse events (RR: 1.73, 95% CI: 0.67 - 4.45, = .2562). Also, topical 10% KOH was as effective as mechanical treatments for MC (RR: 0.95, 95% CI: 0.84 - 1.07, = .3833).
CONCLUSION
We demonstrate that application of topical 10% KOH may be one of effective and appropriate methods for the treatment of MC compared with awaiting spontaneous resolution due to its safety and effectiveness.
Topics: Administration, Topical; Humans; Hydroxides; Molluscum Contagiosum; Potassium
PubMed: 33667150
DOI: 10.1080/09546634.2021.1898527 -
BMC Public Health Dec 2020Previous initiatives have aimed to document the history and legacy of the Smallpox Eradication Program (SEP) and the Global Polio Eradication Initiative (GPEI). In this...
A multi-pronged scoping review approach to understanding the evolving implementation of the Smallpox and Polio eradication programs: what can other Global Health initiatives learn?
BACKGROUND
Previous initiatives have aimed to document the history and legacy of the Smallpox Eradication Program (SEP) and the Global Polio Eradication Initiative (GPEI). In this multi-pronged scoping review, we explored the evolution and learning from SEP and GPEI implementation over time at global and country levels to inform other global health programs.
METHODS
Three related reviews of literature were conducted; we searched for documents on 1) the SEP and 2) GPEI via online database searches and also conducted global and national-level grey literature searches for documents related to the GPEI in seven purposively selected countries under the Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE) project. We included documents relevant to GPEI implementation. We conducted full text data analysis and captured data on Expert Recommendations for Implementing Change (ERIC) implementation strategies and principles, tools, outcomes, target audiences, and relevance to global health knowledge areas.
RESULTS
200 articles were included in the SEP scoping review, 1885 articles in the GPEI scoping review, and 963 documents in the grey literature review. M&E and engagement strategies were consistently translated from the SEP to GPEI; these evolved into newer approaches under the GPEI. Management strategies including setting up robust record systems also carried forward from SEP to GPEI; however, lessons around the need for operational flexibility in applying these strategies at national and sub-national levels did not. Similarly, strategies and lessons around conducting health systems readiness assessments prior to implementation were not carried forward from SEP to GPEI. Differences in the planning and communication strategies between the two programs included fidelity to implementation blueprints appeared to be higher under SEP, and independent monitoring boards and communication and media strategies were more prominent under GPEI.
CONCLUSIONS
Linear learning did not always occur between SEP and GPEI; several lessons were lost and had to be re-learned. Implementation and adaptation of strategies in global health programs should be well codified, including information on the contextual, time and stakeholders' issues that elicit adaptations. Such description can improve the systematic translation of knowledge, and gains in efficiency and effectiveness of future global health programs.
Topics: Communication; Disease Eradication; Global Health; Health Education; Humans; Immunization Programs; Poliomyelitis; Smallpox
PubMed: 33339517
DOI: 10.1186/s12889-020-09439-1 -
Veterinary Research Communications Nov 2020Lumpy skin disease (LSD) is a viral disease caused by lumpy skin disease virus (LSDV), a member of Capripoxvirus genus of Poxviridae family. It is a transboundary...
Lumpy skin disease (LSD) is a viral disease caused by lumpy skin disease virus (LSDV), a member of Capripoxvirus genus of Poxviridae family. It is a transboundary disease of the economic importance affecting cattle and water buffaloes. The disease is transmitted by arthropod vectors and causes high morbidity and low mortality. LSD has recently been reported first time in India with 7.1% morbidity among cattle. Generally, fever, anorexia, and characteristic nodules on the skin mucous membrane of mouth, nostrils, udder, genital, rectum, drop in milk production, abortion, infertility and sometimes death are the clinical manifestations of the disease. The disease is endemic in African and Middle East countries but has started spreading to Asian and other countries. It has been recently reported from China and Bangladesh sharing borders with India. We have summarized occurrence of LSD outbreaks in last 10 years in Asian countries for the first time. In India, currently epidemiological status of the disease is unknown. Vaccination along with strict quarantine measures and vector control could be effective for preventing the spread of the disease. This review aims to summarise the latest developments in the epidemiology with the focus on transboundary spread, aetiology and transmission, clinical presentations, diagnostics and management of the disease.
Topics: Animals; Buffaloes; Cattle; Cattle Diseases; Disease Outbreaks; India; Lumpy Skin Disease; Lumpy skin disease virus
PubMed: 32857262
DOI: 10.1007/s11259-020-09780-1 -
Planta Medica Oct 2020Viruses have a high mutation rate, and, thus, there is a continual emergence of new antiviral-resistant strains. Therefore, it becomes imperative to explore and develop...
Viruses have a high mutation rate, and, thus, there is a continual emergence of new antiviral-resistant strains. Therefore, it becomes imperative to explore and develop new antiviral compounds continually. The search for pharmacological substances of plant origin that are effective against animal viruses, which have a high mortality rate or cause large economic losses, has garnered interest in the last few decades. This systematic review compiles 130 plant species that exhibit antiviral activity on 37 different virus species causing serious diseases in animals. The kind of extract, fraction, or compound exhibiting the antiviral activity and the design of the trial were particularly considered for review. The literature revealed details regarding plant species exhibiting antiviral activities against pathogenic animal virus species of the following families-, and that cause infections, among others, in poultry, cattle, pigs, horses, shrimps, and fish. Overall, 30 plant species exhibited activity against various influenza viruses, most of them causing avian influenza. Furthermore, 30 plant species were noted to be active against Newcastle disease virus. In addition, regarding the pathogens most frequently investigated, this review provides a compilation of 20 plant species active against bovine herpesvirus, 16 against fowlpox virus, 12 against white spot syndrome virus in marine shrimps, and 10 against suide herpesvirus. Nevertheless, some plant extracts, particularly their compounds, are promising candidates for the development of new antiviral remedies, which are urgently required.
Topics: Animal Diseases; Animals; Antiviral Agents; Cattle; Horses; Orthomyxoviridae; Plant Extracts; Plants, Medicinal; Swine; Veterinary Medicine
PubMed: 32777833
DOI: 10.1055/a-1224-6115 -
PLoS Neglected Tropical Diseases Oct 2019Monkeypox is a vesicular-pustular illness that carries a secondary attack rate in the order of 10% in contacts unvaccinated against smallpox. Case fatality rates range... (Meta-Analysis)
Meta-Analysis
Monkeypox is a vesicular-pustular illness that carries a secondary attack rate in the order of 10% in contacts unvaccinated against smallpox. Case fatality rates range from 1 to 11%, but scarring and other sequelae are common in survivors. It continues to cause outbreaks in remote populations in Central and West Africa, in areas with poor access and weakened or disrupted surveillance capacity and information networks. Recent outbreaks in Nigeria (2017-18) and Cameroon (2018) have occurred where monkeypox has not been reported for over 20 years. This has prompted concerns over whether there have been changes in the biology and epidemiology of the disease that may in turn have implications for how outbreaks and cases should best be managed. A systematic review was carried out to examine reported data on human monkeypox outbreaks over time, and to identify if and how epidemiology has changed. Published and grey literature were critically analysed, and data extracted to inform recommendations on outbreak response, use of case definitions and public health advice. The level of detail, validity of data, geographical coverage and consistency of reporting varied considerably across the 71 monkeypox outbreak documents obtained. An increase in cases reported over time was supported by literature from the Democratic Republic of Congo (DRC). Data were insufficient to measure trends in secondary attack rates and case fatality rates. Phylogenetic analyses consistently identify two strains of the virus without evidence of emergence of a new strain. Understanding of monkeypox virulence with regard to clinical presentation by strain is minimal, with infrequent sample collection and laboratory analysis. A variety of clinical and surveillance case definitions are described in the literature: two definitions have been formally evaluated and showed high sensitivity but low specificity. These were specific to a Congo-Basin (CB) strain-affected area of the DRC where they were used. Evidence on use of antibiotics for prophylaxis against secondary cutaneous infection is anecdotal and limited. Current evidence suggests there has been an increase in total monkeypox cases reported by year in the DRC irrespective of advancements in the national Integrated Disease Surveillance and Response (IDSR) system. There has been a marked increase in number of individual monkeypox outbreak reports, from outside the DRC in between 2010 and 2018, particularly in the Central African Republic (CAR) although this does not necessarily indicate an increase in annual cases over time in these areas. The geographical pattern reported in the Nigeria outbreak suggests a possible new and widespread zoonotic reservoir requiring further investigation and research. With regards to outbreak response, increased attention is warranted for high-risk patient groups, and nosocomial transmission risks. The animal reservoir remains unknown and there is a dearth of literature informing case management and successful outbreak response strategies. Up-to-date complete, consistent and longer-term research is sorely needed to inform and guide evidence-based response and management of monkeypox outbreaks.
Topics: Africa, Western; Animals; Central African Republic; Databases, Factual; Disease Outbreaks; Humans; Mpox (monkeypox); Monkeypox virus; Phylogeny; Public Health; Virulence
PubMed: 31618206
DOI: 10.1371/journal.pntd.0007791 -
Military Medicine Dec 2019Smallpox has been eradicated but advances in synthetic biology have increased the risk of its re-emergence. Residual immunity in individuals who were previously...
INTRODUCTION
Smallpox has been eradicated but advances in synthetic biology have increased the risk of its re-emergence. Residual immunity in individuals who were previously vaccinated may mitigate the impact of an outbreak, but there is a high degree of uncertainty about the duration and degree of residual immunity. Both cell-mediated and humoral immunity are thought to be important but the exact mechanisms of protection are unclear. Guidelines usually suggest vaccine-induced immunity wanes to zero after 3-10 years post vaccination, whereas other estimates show long term immunity over decades.
MATERIALS AND METHODS
A systematic review of the literature was conducted to quantify the duration and extent of residual immunity to smallpox after vaccination.
RESULTS
Twenty-nine papers related to quantifying residual immunity to smallpox after vaccination were identified: neutralizing antibody levels were used as immune correlates of protection in 11/16 retrospective cross-sectional studies, 2/3 epidemiological studies, 6/7 prospective vaccine trials and 0/3 modeling studies. Duration of protection of >20 years was consistently shown in the 16 retrospective cross-sectional studies, while the lowest estimated duration of protection was 11.7 years among the modeling studies. Childhood vaccination conferred longer duration of protection than vaccination in adulthood, and multiple vaccinations did not appear to improve immunity.
CONCLUSIONS
Most studies suggest a longer duration of residual immunity (at least 20 years) than assumed in smallpox guidelines. Estimates from modeling studies were less but still greater than the 3-10 years suggested by the WHO Committee on International Quarantine or US CDC guidelines. These recommendations were probably based on observations and studies conducted while smallpox was endemic. The cut-off values for pre-existing antibody levels of >1:20 and >1:32 reported during the period of endemic smallpox circulation may not be relevant to the contemporary population, but have been used as a threshold for identifying people with residual immunity in post-eradication era studies. Of the total antibodies produced in response to smallpox vaccination, neutralizing antibodies have shown to contribute significantly to immunological memory. Although the mechanism of immunological memory and boosting is unclear, revaccination is likely to result in a more robust response. There is a need to improve the evidence base for estimates on residual immunity to better inform planning and preparedness for re-emergent smallpox.
Topics: Humans; Immunity; Smallpox; Smallpox Vaccine
PubMed: 31369103
DOI: 10.1093/milmed/usz181 -
American Journal of Clinical Dermatology Dec 2018Topical cantharidin is routinely used for the treatment of molluscum contagiosum and warts. The objective of this systematic review is to assess the efficacy and safety...
BACKGROUND AND OBJECTIVE
Topical cantharidin is routinely used for the treatment of molluscum contagiosum and warts. The objective of this systematic review is to assess the efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts.
METHODS
We performed a systematic review of studies assessing topical cantharidin treatment of molluscum contagiosum or warts. We searched the databases of Cochrane, EMBASE, GREAT, LILACS, MEDLINE, and Scopus. Two authors performed the study selection and data extraction.
RESULTS
Twenty studies (1958-2018) met inclusion/exclusion criteria. Twelve studies assessed warts, and eight studies assessed molluscum contagiosum. Overall, 1752 patients were included (range 0.3-62 years; specified in 15 studies). Clearance rates with topical cantharidin for molluscum contagiosum were variable (range 15.4-100%). Significant clearance of warts with maintenance of clearance was demonstrated with topical cantharidin alone. Topical cantharidin in combination with podophyllotoxin and salicylic acid demonstrated efficacy for plantar warts (pediatric and adult; clearance rate range 81-100%; four studies had 100% clearance), with the majority clearing after a single treatment. Satisfaction with cantharidin therapy was high, especially in molluscum contagiosum. Pain (7-85.7%), blistering (10-100%), and hyper-/hypopigmentation (1.8-53.3%) were the most commonly occurring adverse effects with cantharidin treatment.
CONCLUSION
Topical cantharidin demonstrated clearance of warts, particularly in combination with podophyllotixin and salicylic acid, and modest benefit for pediatric molluscum contagiosum with good tolerability and safety.
Topics: Administration, Cutaneous; Blister; Cantharidin; Drug Therapy, Combination; Humans; Incidence; Irritants; Keratolytic Agents; Molluscum Contagiosum; Pain; Patient Satisfaction; Podophyllotoxin; Salicylic Acid; Skin Pigmentation; Treatment Outcome; Warts
PubMed: 30097988
DOI: 10.1007/s40257-018-0375-4 -
Military Medicine Jul 2018Globally eradicated in 1980, smallpox is listed as a category A bioterrorism agent. If smallpox were to re-emerge, it may be due to an act of bioterrorism or a...
BACKGROUND
Globally eradicated in 1980, smallpox is listed as a category A bioterrorism agent. If smallpox were to re-emerge, it may be due to an act of bioterrorism or a laboratory accident, and the impact is likely to be severe. Preparedness against smallpox is subject to more uncertainty than other infectious diseases because it is eradicated, there is uncertainty about population immunity, and the current global health workforce has no practical experience or living memory of smallpox. In the event of re-emergence of smallpox, mathematical modeling plays a crucial role in improving the evidence base to inform preparedness, mitigation, and response activities. However, the predictions of mathematical models about outbreak magnitude and impact depend critically on the assumptions and disease parameters used. We aimed to identify modeling studies that would be applicable to re-emerging smallpox and to evaluate consistency and the certainty of the evidence published about the key parameters used.
METHODS
We conducted a systematic review using PRISMA criteria, of assumptions used in modeling studies on duration of latent, prodromal, and infectious period, as well as the choice of the basic reproduction number (R0) for re-emerging smallpox. We performed a literature search using PubMED, Scopus, Web of Science, and EMBASE and included peer-reviewed articles that focused on smallpox models, stated at least three of the aforementioned parameters and published in English.
FINDINGS
A total of 42 studies were selected for inclusion. There was general agreement on the duration of latent and prodromal periods, being 11-12 d (88%) and 3 d (59%), respectively. The duration of the infectious period varied from 4 to 20 d. Most models assumed 16 d (19%), 12 d (16.7%), and 8.6 d (12%) of infectiousness. In 25/34 studies, R0 ranged between 3 and 5, generally lower than the R0 calculated from past outbreaks.
DISCUSSION
Models of smallpox re-emergence also tend to use the same limited available historical data sources but assume a wide range of different estimates for key parameters. Models use very optimistic assumptions of decreased population immunity, despite high uncertainty about duration and magnitude of post-vaccination immunity. This review reveals a paradox. A substantial proportion of the modern population is unvaccinated, never exposed to boosting from wild-type smallpox, or immunocompromised; furthermore, vaccine-induced immunity wanes over time. Failure to consider these factors in a model will lead to underestimating the true impact of a re-emergent smallpox epidemic in the contemporary population.
Topics: Communicable Diseases, Emerging; Data Accuracy; Disease Outbreaks; Humans; Models, Theoretical; Smallpox
PubMed: 29425329
DOI: 10.1093/milmed/usx092