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The potential for measles transmission in England
Yoon Choi, Nigel Gay, Graham Fraser, Mary Ramsay
BMC Public Health , 2008, DOI: 10.1186/1471-2458-8-338
Abstract: Quarterly MMR coverage data for children aged two and five years resident in each district health authority in England were used to estimate susceptibility to measles by age. The effective reproduction numbers for each district and strategic health authority were calculated and possible outbreak sizes estimated.In 2004/05, about 1.9 million school children and 300,000 pre-school children were recorded as incompletely vaccinated against measles in England, including more than 800,000 children completely unvaccinated. Based on this, approximately 1.3 million children aged 2–17 years were susceptible to measles. In 14 of the 99 districts, the level of susceptibility is sufficiently high for R to exceed 1, indicating the potential for sustained measles transmission. Eleven of these districts are in London. Our model suggests that the potential exists for an outbreak of up to 100,000 cases. These results are sensitive to the accuracy of reported vaccination coverage data.Our analysis identified several districts with the potential for sustaining measles transmission. Many London areas remain at high risk even allowing for considerable under-reporting of coverage. Primary care trusts should ensure that accurate systems are in place to identify unimmunised children and to offer catch-up immunisation for those not up to date for MMR.Measles vaccination was introduced in the UK in 1968 for children in the second year of life [1]. Coverage gradually improved from approximately 50% during the 1970s to 86% when MMR vaccine replaced single antigen vaccine in 1988, and reached 92% in 1995. As a result, measles epidemics, which had occurred biennially in the pre-vaccination period with hundreds of thousands of notified cases, became smaller and less frequent. Control of measles reached a new level following a national vaccination campaign in November 1994, when measles-rubella vaccine was offered to all school children aged 5–16 years to prevent a predicted epidemic of measles; co
Possible nosocomial transmission of measles in unvaccinated children in a Singapore public hospital  [cached]
Constance Low,Koh Cheng Thoon,Raymond Lin,Ariel Chua
Western Pacific Surveillance and Response , 2012,
Abstract: Introduction: Measles is an acute, highly communicable viral disease, with measles outbreaks usually occuring in settings where there are unvaccinated populations. After being notified of a cluster of five measles cases in a Singapore public hospital in August 2011, the Ministry of Health Singapore conducted an outbreak investigation.Methods: Active case detection was conducted, and all notified cases’ movement history within the hospital were reviewed to determine any common exposures in place and time. Cases were classified as nosocomial if they had contact with other measles cases in the hospital seven to 21 days before onset dates. Laboratory testing included serological and molecular diagnostic methods.Results: Of the 14 cases, seven cases were nosocomial cases. Investigations identified two wards where cases were epidemiologically linked. Two cases in Ward A were of D8 genotype and genotypically 100% identical, thus confirming a common source of infection. The six cases in Ward B (including one transferred from Ward A) had overlapping periods of admission and three cases were of the same D8 genotype, with a single nucleotide difference.Discussion: The epidemiological linkages of the cases and laboratory findings suggest nosocomial transmission in Wards A and B. As a result of this investigation, the hospital implemented a new policy of isolating suspected measles cases instead of waiting until they had been laboratory confirmed. This investigation emphasizes the importance of early identification and isolation of suspected measles cases within health care institutions and reinforces the requirement for high measles vaccination coverage of health care workers.
Modelling and Simulation of the Dynamics of the Transmission of Measles
E.A. Bakare,Y.A. Adekunle,K.O Kadiri
International Journal of Computer Trends and Technology , 2012,
Abstract: We derive a compartmental mathematical model of the dynamics of measles within a particular population with variable size. We used the compartmental model which we expressed as a set of differential equations to see the dynamics of measles infection. The stability of the disease-free and endemic equilibrium is addressed. Numerical Simulation are carried out.We discussed in details the implications of our analytical and numerical findings.
The waiting room: vector for health education? the general practitioner's point of view
Maxime Gignon, Hadjila Idris, Cecile Manaouil, Olivier Ganry
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-511
Abstract: A cross-sectional study was conducted on a representative sample of GPs using semi-structured, face-to-face interviews. A structured grid was used to describe the documents. Quantitative and qualitative analysis was performed. Sixty GPs participated in the study. They stated that a waiting room had to be pleasant, but agreed that it was a useful vector for providing health information. The GPs stated that they distributed documents designed to improve patient care by encouraging screening, providing health education information and addressing delicate subjects more easily. However, some physicians believed that this information can sometimes make patients more anxious. A large number of documents were often available, covering a variety of topics.General practitioners intentionally use their waiting rooms to disseminate a broad range of health-related information, but without developing a clearly defined strategy. It would be interesting to correlate the topics addressed by waiting room documents with prevention practices introduced during the visit.
Elimination of endemic measles transmission in Australia
Heywood,Anita E; Gidding,Heather F; Riddell,Michaela A; McIntyre,Peter B; MacIntyre,C Raina; Kelly,Heath A;
Bulletin of the World Health Organization , 2009, DOI: 10.1590/S0042-96862009000100015
Abstract: elimination of endemic measles transmission is the culmination of a range of control measures at a national level. current documentation of elimination proposed by who's regional offices requires achieving specific targets for surveillance process indicators. we demonstrate how australia, although not meeting these specific targets, has satisfied multiple criteria that justify the formal declaration of measles elimination. our review shows that few countries previously declaring measles elimination have satisfied the current who surveillance targets. we argue that the requirements for recognition of measles elimination should not restrict countries to a particular type of surveillance system or surveillance criteria.
An Algorithm That Predicts CSI to Allocate Bandwidth for Healthcare Monitoring in Hospital's Waiting Rooms  [PDF]
Di Lin,Fabrice Labeau
International Journal of Telemedicine and Applications , 2012, DOI: 10.1155/2012/843527
Abstract: In wireless healthcare monitoring systems, bandwidth allocation is an efficient solution to the problem of scarce wireless bandwidth for the monitoring of patients. However, when the central unit cannot access the exact channel state information (CSI), the efficiency of bandwidth allocation decreases, and the system performance also decreases. In this paper, we propose an algorithm to reduce the negative effects of imperfect CSI on system performance. In this algorithm, the central unit can predict the current CSI by previous CSI when the current CSI is not available. We analyze the reliability of the proposed algorithm by deducing the standard error of estimated CSI with this algorithm. In addition, we analyze the efficiency of the proposed algorithm by discussing the system performance with this algorithm. 1. Introduction The increasing number of cases on waiting room death, which refers to the death of patients while staying in a hospital’s waiting room to be given a medical examination, underscores the significance of improving healthcare quality [1]. Most of these cases occur when patients are left alone in waiting rooms, such as when healthcare staff are taking a break or being busy performing other clinical and non-clinical functions. As a potential way of improving healthcare quality, a wireless healthcare monitoring system (illustrated in Figure 1 and detailed later) could help healthcare staff monitor the condition of patients by automatically collecting patient’s data, making some initial decisions on patient condition, and transmitting these decisions and medical data to a doctor’s office via wireless local area network (WLAN). Once emergent condition of a particular patient occurs, healthcare staff would be alerted. Figure 1: Architecture of our healthcare monitoring system. From a network design perspective, a wireless healthcare monitoring system should be capable of supporting the number of patients that will be using the system; being able to assess the network’s capability to serve a given number of patients is a critical factor in promoting adoption of such systems. Therefore, the network patient capacity, which we define as the number of patients that one WLAN deployment can support, is a critical design criterion and performance metric for wireless healthcare monitoring systems. From a practical standpoint, if the hospital’s patient capacity exceeds the network patient capacity, then another WLAN will need to be deployed in parallel within the hospital. Beyond the cost of deploying several networks in parallel, their co-existence
Measles transmission from an anthroposophic community to the general population, Germany 2008
Maria Wadl, Anette Siedler, Wolfgang Kr?mer, Maria E Haindl, Stephan Gebrande, Irene Krenn-Lanzl, Annette Mankertz, Wolfgang Hautmann
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-474
Abstract: We applied the German national case-definition for measles and collected data using the national surveillance system and a questionnaire. Measles cases with disease onset a maximum of 18 days apart and spatial contact (e.g. same household, same school) were summed up in clusters. Two different interventions, which were implemented in schools and kindergartens in Bavaria, were compared by their impact on the size and duration of measles clusters. Susceptible persons were excluded from schools or kindergartens either with the first (intervention A) or second (intervention B) measles case occurring in the respective institution.Among the 217 Bavarian measles cases identified from March-July 2008, 28 (13%) cases were attendees of the anthroposophic school in Austria. In total, vaccination status was known in 161 (74%) cases and 156 (97%) of them were not vaccinated. The main factor for non-vaccination was "fear of vaccine-related adverse events" (33%). Twenty-nine (18%) of 161 cases suffered complications. Exclusively genotype D5 was detected. Overall, 184 cases could be epidemiologically grouped into 59 clusters. Of those, 41 clusters could be linked to households and 13 to schools or kindergartens. The effect of intervention A and B was analysed in 10 school or kindergarten clusters. Depending on the respective intervention A or B, the median number of cases per cluster was 3 versus 13 (p = 0.05), and the median duration of a cluster was 3 versus 26 days (p = 0.13).Introduction of measles virus into a pocket of susceptible persons (e.g. vaccination opponents or sceptics) may lead to large outbreaks in the general population, if the general population's vaccination coverage is below the WHO recommended level. Education on the safety of measles vaccine needs to be strengthened to increase measles vaccination coverage. Early intervention may limit spread in schools or kindergartens. Suspected measles has to be reported immediately to the local health authorities in order
The laboratory confirmation of suspected measles cases in settings of low measles transmission: conclusions from the experience in the Americas
Dietz,Vance; Rota,Jennifer; Izurieta,Héctor; Carrasco,Peter; Bellini,William;
Bulletin of the World Health Organization , 2004, DOI: 10.1590/S0042-96862004001100010
Abstract: the americas have set a goal of interrupting indigenous transmission of measles using a strategy developed by the pan american health organization (paho). this strategy includes recommendations for vaccination activities to achieve and sustain high immunity in the population and is complemented by sensitive epidemiological surveillance systems developed to monitor illnesses characterized by febrile rash, and to provide effective virological and serological surveillance. a key component in ensuring the success of the programme has been a laboratory network comprising 22 national laboratories including reference centres. commercially available indirect enzyme immunoassay kits (eia) for immunoglobulin m (igm)-class antibodies are currently being used throughout the region. however, because there are few or no true measles cases in the region, the positive predictive value of these diagnostic tests has decreased. false-positive results of igm tests can also occur as a result of testing suspected measles cases with exanthemata caused by parvovirus b19, rubella and human herpesvirus 6, among others. in addition, as countries maintain high levels of vaccination activity and increased surveillance of rash and fever, the notification of febrile rash illness in recently vaccinated people can be anticipated. thus, managers in the measles elimination programme must be prepared to address the interpretation of a positive result of a laboratory test for measles igm when clinical and epidemiological data may indicate that the case is not measles. the interpretation of an igm-positive test under different circumstances and the definition of a vaccine-related rash illness in a setting of greatly reduced, or absent, transmission of measles is discussed.
Waiting rooms utilization arrangement optimization in railway passenger stations

ZHANG Yinggui
, WANG Haifeng, LEI Dingyou, SONG Xiaodong

- , 2018,
Abstract: 以铁路客运站候车室运用计划编制为研究对象,构造候车区能力差额函数,以旅客走行距离最短为第一优化目标、候车能力利用最大为第二优化目标,建立铁路客运站候车室运用计划编制优化模型,设计基于区、室、时刻和交互优先策略的解改进优化策略,提出相应的启发式求解算法。算例结果表明:所提出的方法能够快速合理地制订出铁路客运站候车室运用计划。
Taking the waiting rooms utilization arrangement as our research objective and through designing a waiting areas capacity balance function, an optimal model for waiting rooms utilization arrangement in railway passenger stations was constructed to minimize the passenger walking distance and maximize the capacity utilization in waiting rooms. Then, several improved optimization strategies, such as area, room, time and interactive priority strategy, and a heuristic algorithm are all designed. The instance show that the method put forward in the paper can make a reasonable waiting rooms utilization arrangement quickly and effectively
Potential for airborne transmission of infection in the waiting areas of healthcare premises: stochastic analysis using a Monte Carlo model
Clive B Beggs, Simon J Shepherd, Kevin G Kerr
BMC Infectious Diseases , 2010, DOI: 10.1186/1471-2334-10-247
Abstract: A stochastic Monte Carlo model was constructed to analyse the transmission of airborne infection in a hypothetical 132 m3 hospital waiting area in which occupancy levels, waiting times and ventilation rate can all be varied. In the model the Gammaitoni-Nucci equation was utilized to predict probability of susceptible individuals becoming infected. The model was used to assess the risk of transmission of three infectious diseases, TB, influenza and measles. In order to allow for stochasticity a random number generator was applied to the variables in the model and a total of 10000 individual simulations were undertaken. The mean quanta production rates used in the study were 12.7, 100 and 570 per hour for TB, influenza and measles, respectively.The results of the study revealed the mean probability of acquiring a TB infection during a 30-minute stay in the waiting area to be negligible (i.e. 0.0034), while that for influenza was an order of magnitude higher at 0.0262. By comparison the mean probability of acquiring a measles infection during the same period was 0.1349. If the duration of the stay was increased to 60 minutes then these values increased to 0.0087, 0.0662 and 0.3094, respectively.Under normal circumstances the risk of acquiring a TB infection during a visit to a hospital waiting area is minimal. Likewise the risks associated with the transmission of influenza, although an order of magnitude greater than those for TB, are relatively small. By comparison, the risks associated with measles are high. While the installation of air disinfection may be beneficial, when seeking to prevent the transmission of airborne viral infection it is important to first minimize waiting times and the number of susceptible individuals present before turning to expensive technological solutions.Although many infections that are transmissible from person to person are acquired through direct contact between individuals [1], a minority, notably tuberculosis (TB) [2-5], measles [
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