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author:("pesi, nick T.")
1.  Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 west African outbreak 
Lancet  2015;385(9962):29-35.
The WHO declared the 2014 west African Ebola epidemic a public health emergency of international concern in view of its potential for further international spread. Decision makers worldwide are in need of empirical data to inform and implement emergency response measures. Our aim was to assess the potential for Ebola virus to spread across international borders via commercial air travel and assess the relative efficiency of exit versus entry screening of travellers at commercial airports.
We analysed International Air Transport Association data for worldwide flight schedules between Sept 1, 2014, and Dec 31, 2014, and historic traveller flight itinerary data from 2013 to describe expected global population movements via commercial air travel out of Guinea, Liberia, and Sierra Leone. Coupled with Ebola virus surveillance data, we modelled the expected number of internationally exported Ebola virus infections, the potential effect of air travel restrictions, and the efficiency of airport-based traveller screening at international ports of entry and exit. We deemed individuals initiating travel from any domestic or international airport within these three countries to have possible exposure to Ebola virus. We deemed all other travellers to have no significant risk of exposure to Ebola virus.
Based on epidemic conditions and international flight restrictions to and from Guinea, Liberia, and Sierra Leone as of Sept 1, 2014 (reductions in passenger seats by 51% for Liberia, 66% for Guinea, and 85% for Sierra Leone), our model projects 2·8 travellers infected with Ebola virus departing the above three countries via commercial flights, on average, every month. 91 547 (64%) of all air travellers departing Guinea, Liberia, and Sierra Leone had expected destinations in low-income and lower-middle-income countries. Screening international travellers departing three airports would enable health assessments of all travellers at highest risk of exposure to Ebola virus infection.
Decision makers must carefully balance the potential harms from travel restrictions imposed on countries that have Ebola virus activity against any potential reductions in risk from Ebola virus importations. Exit screening of travellers at airports in Guinea, Liberia, and Sierra Leone would be the most efficient frontier at which to assess the health status of travellers at risk of Ebola virus exposure, however, this intervention might require international support to implement effectively.
Canadian Institutes of Health Research.
PMCID: PMC4286618  PMID: 25458732
2.  Nowcasting the Spread of Chikungunya Virus in the Americas 
PLoS ONE  2014;9(8):e104915.
In December 2013, the first locally-acquired chikungunya virus (CHIKV) infections in the Americas were reported in the Caribbean. As of May 16, 55,992 cases had been reported and the outbreak was still spreading. Identification of newly affected locations is paramount to intervention activities, but challenging due to limitations of current data on the outbreak and on CHIKV transmission. We developed models to make probabilistic predictions of spread based on current data considering these limitations.
Methods and Findings
Branching process models capturing travel patterns, local infection prevalence, climate dependent transmission factors, and associated uncertainty estimates were developed to predict probable locations for the arrival of CHIKV-infected travelers and for the initiation of local transmission. Many international cities and areas close to where transmission has already occurred were likely to have received infected travelers. Of the ten locations predicted to be the most likely locations for introduced CHIKV transmission in the first four months of the outbreak, eight had reported local cases by the end of April. Eight additional locations were likely to have had introduction leading to local transmission in April, but with substantial uncertainty.
Branching process models can characterize the risk of CHIKV introduction and spread during the ongoing outbreak. Local transmission of CHIKV is currently likely in several Caribbean locations and possible, though uncertain, for other locations in the continental United States, Central America, and South America. This modeling framework may also be useful for other outbreaks where the risk of pathogen spread over heterogeneous transportation networks must be rapidly assessed on the basis of limited information.
PMCID: PMC4128737  PMID: 25111394
3.  Notifications of Public Health Events under the International Health Regulations – 5 Year U.S. Experience 
PMCID: PMC4050911
global health; risk assessment; event notification; international health regulations
4.  Investigation of Inhalation Anthrax Case, United States 
Emerging Infectious Diseases  2014;20(2):280-283.
Inhalation anthrax occurred in a man who vacationed in 4 US states where anthrax is enzootic. Despite an extensive multi-agency investigation, the specific source was not detected, and no additional related human or animal cases were found. Although rare, inhalation anthrax can occur naturally in the United States.
PMCID: PMC3901464  PMID: 24447835
anthrax; epidemiology; zoonoses; Bacillus anthracis; bacteria; United States
5.  Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults 
Emerging Infectious Diseases  2014;20(2):e130687.
The Centers for Disease Control and Prevention convened panels of anthrax experts to review and update guidelines for anthrax postexposure prophylaxis and treatment. The panels included civilian and military anthrax experts and clinicians with experience treating anthrax patients. Specialties represented included internal medicine, pediatrics, obstetrics, infectious disease, emergency medicine, critical care, pulmonology, hematology, and nephrology. Panelists discussed recent patients with systemic anthrax; reviews of published, unpublished, and proprietary data regarding antimicrobial drugs and anthrax antitoxins; and critical care measures of potential benefit to patients with anthrax. This article updates antimicrobial postexposure prophylaxis and antimicrobial and antitoxin treatment options and describes potentially beneficial critical care measures for persons with anthrax, including clinical procedures for infected nonpregnant adults. Changes from previous guidelines include an expanded discussion of critical care and clinical procedures and additional antimicrobial choices, including preferred antimicrobial drug treatment for possible anthrax meningitis.
PMCID: PMC3901462  PMID: 24447897
anthrax; Bacillus anthracis; bacteria; bioterrorism and preparedness; antitoxin; raxibacumab; expert panel meeting; prevention; treatment; adults; Centers for Disease Control and Prevention
6.  Lethal Factor and Anti-Protective Antigen IgG Levels Associated with Inhalation Anthrax, Minnesota, USA 
Emerging Infectious Diseases  2014;20(2):310-314.
Bacillus anthracis was identified in a 61-year-old man hospitalized in Minnesota, USA. Cooperation between the hospital and the state health agency enhanced prompt identification of the pathogen. Treatment comprising antimicrobial drugs, anthrax immune globulin, and pleural drainage led to full recovery; however, the role of passive immunization in anthrax treatment requires further evaluation.
PMCID: PMC3901492  PMID: 24447456
Inhalation anthrax; anthrax; anthrax immune globulin; critical care; anti-protective antigen; anti-PA; lethal factor; Minnesota; USA; Bacillus anthracis; zoonoses
7.  Workshop on Treatment of and Postexposure Prophylaxis for Burkholderia pseudomallei and B. mallei Infection, 2010 
The US Public Health Emergency Medical Countermeasures Enterprise convened subject matter experts at the 2010 HHS Burkholderia Workshop to develop consensus recommendations for postexposure prophylaxis against and treatment for Burkholderia pseudomallei and B. mallei infections, which cause melioidosis and glanders, respectively. Drugs recommended by consensus of the participants are ceftazidime or meropenem for initial intensive therapy, and trimethoprim/sulfamethoxazole or amoxicillin/clavulanic acid for eradication therapy. For postexposure prophylaxis, recommended drugs are trimethoprim/sulfamethoxazole or co-amoxiclav. To improve the timely diagnosis of melioidosis and glanders, further development and wide distribution of rapid diagnostic assays were also recommended. Standardized animal models and B. pseudomallei strains are needed for further development of therapeutic options. Training for laboratory technicians and physicians would facilitate better diagnosis and treatment options.
PMCID: PMC3557896  PMID: 23171644
Burkholderia pseudomallei; melioidosis; Burkholderia mallei; glanders; drug therapy; postexposure prophylaxis; ceftazidime; carbapenems; trimethoprim/sulfamethoxazole; combination; amoxicillin/potassium clavulanate; clavulanic acid bacteria; antibiotic; antibacterial drugs; antimicrobial drugs; bacteria; Suggested citation for this article: Lipsitz R; Garges S; Aurigemma R; Baccam P; Blaney DD; Cheng AC; et al. Workshop on treatment of and postexposure prophylaxis for Burkholderia pseudomallei and B. mallei infection; 2010. Emerg Infect Dis [Internet]. 2012 Dec [date cited].
8.  Syndromic Surveillance in Bioterrorist Attacks 
Emerging Infectious Diseases  2005;11(9):1396-400.
PMCID: PMC3310639  PMID: 16673516
syndromic surveillance; bioterrorist; anthrax; commentary

Results 1-8 (8)