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. 2019 Mar;19(2):140-144.
doi: 10.7861/clinmedicine.19-2-140.

Outbreak science: recent progress in the detection and response to outbreaks of infectious diseases

Affiliations

Outbreak science: recent progress in the detection and response to outbreaks of infectious diseases

Catherine F Houlihan et al. Clin Med (Lond). 2019 Mar.

Abstract

The frequency of reported outbreaks of infectious diseases has increased over the past 3 decades, with predictions that this rise will continue. Outbreak response continues to follow nine basic principles: establish the presence of an outbreak, verify the diagnosis, make a case definition, find cases and contacts, conduct basic epidemiology, test hypotheses, institute control measures, communicate the situation and establish ongoing surveillance. Within each of these areas, significant advances have been made over the past 5 years using progress in digital, laboratory, epidemiology and anthropological equipment or techniques. Irrespective of these, future outbreaks of high-consequence are inevitable, and vigilance and preparation must continue in order to prevent significant mortality, morbidity and socio-economic crisis.

Keywords: Outbreak; global health.

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Figures

Fig 1.
Fig 1.
Condensed summary of the epidemiology principles for outbreak response summarising scientific progress made in the recent past (below in teal) and future possibilities (above in blue). PCR = polymerase chain reaction; PPE = personal protective equipment; RDT = rapid diagnostic test (should be sensitive, specific, heat-stable, cheap, simple to use, electricity-free and disposable). Note: the nine outbreak steps have been condensed to seven for space.
Fig 2.
Fig 2.
(a) Map of cholera cases in Soho district of London in 1854 illustrating clustering of cases around the Broad Street pump. (b) Spread of Ebola through west Africa over time in 2014–15 based on phylogenetic tree (in Fig 2c). Lineage A is the initial focus of the outbreak from 2014. Lineage B emerged from A in 2014–15 and spread into Sierra Leone, Liberia and further into Guinea. EBOV entered Mali from two separate routes. (c) Phylogenetic probability tree illustrating EBOV lineages A and B as they emerge over time and geographical location in west Africa. Reproduced with permission from www.nature.com/articles/nature14594

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