Publications by authors named "Miles Stewart"

Background: The Democratic Republic of the Congo has had 15 Ebola virus disease (EVD) outbreaks, from 1976 to 2023. On June 1, 2020, the Democratic Republic of the Congo declared an outbreak of EVD in the western Équateur Province (11th outbreak), proximal to the 2018 Tumba and Bikoro outbreak and concurrent with an outbreak in the eastern Nord Kivu Province. In this Article, we assessed whether the 11th outbreak was genetically related to previous or concurrent EVD outbreaks and connected available epidemiological and genetic data to identify sources of possible zoonotic spillover, uncover additional unreported cases of nosocomial transmission, and provide a deeper investigation into the 11th outbreak.

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The increasing threat of emerging and re-emerging pathogens calls for a shared vision toward developing and maintaining global surveillance mechanisms to enable rapid characterization of pathogens, a foundational requirement for effective outbreak response. Efforts establishing new surveillance programs in low- and middle-income countries (LMICs) have repeatedly led to siloed systems that prove unsustainable or ineffective due to narrowly focused approaches, competing priorities, or lack of resourcing. Barriers inherent to LMICs, such as resource limitations, workforce strain, unreliable supply chains, and lack of enduring champions exacerbate implementation and sustainability challenges.

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Article Synopsis
  • - The COVID-19 pandemic strained healthcare systems, prompting the development of a web-based decision-support tool aimed at optimizing staffing and capacity for monoclonal antibody (mAb) infusion facilities.
  • - A discrete-event simulation model was created based on real-world data from three medical centers, evaluating 162,000 scenarios to determine the most effective staffing strategies and appointment scheduling for mAb infusions.
  • - Findings indicated that adding check-in staff and optimizing infusion time are crucial for operational efficiency, suggesting that health systems can effectively manage mAb infusion centers with minimal resource investment to better treat COVID-19 patients.
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Monoclonal antibody therapeutics to treat coronavirus disease (COVID-19) have been authorized by the US Food and Drug Administration under Emergency Use Authorization (EUA). Many barriers exist when deploying a novel therapeutic during an ongoing pandemic, and it is critical to assess the needs of incorporating monoclonal antibody infusions into pandemic response activities. We examined the monoclonal antibody infusion site process during the COVID-19 pandemic and conducted a descriptive analysis using data from 3 sites at medical centers in the United States supported by the National Disaster Medical System.

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Article Synopsis
  • Monoclonal antibodies (mAbs) show promise in treating COVID-19 by reducing hospitalizations and emergency visits, but their use is limited, especially among disadvantaged groups.
  • A study analyzed electronic health records of COVID-19 patients at a medical center, comparing those treated with mAbs to untreated patients from before the treatments were available.
  • Results indicated that treated patients had a significantly lower risk (82% less) of hospitalization or emergency visits compared to untreated patients, emphasizing the need for equitable access to mAb treatment across all demographics.
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During an Ebola virus disease (EVD) outbreak, calculating the exposure window of a confirmed case can assist field investigators in identifying the source of infection and establishing chains of transmission. However, field investigators often have difficulty calculating this window. We developed a bilingual (English/French), smartphone-based field application to assist field investigators in determining the exposure window of an EVD case.

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2020 saw the continuation of the second largest outbreak of Ebola virus disease (EVD) in history. Determining epidemiological links between cases is a key part of outbreak control. However, due to the large quantity of data and subsequent data entry errors, inconsistencies in potential epidemiological links are difficult to identify.

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Driven by the growing importance of situational awareness of bioterrorism threats, the Republic of Korea (ROK) and the United States have constructed a joint military capability, called the Biosurveillance Portal (BSP), to enhance biosecurity. As one component of the BSP, we developed the Military Active Real-time Syndromic Surveillance (MARSS) system to detect and track natural and deliberate disease outbreaks. This article describes the ROK military health data infrastructure and explains how syndromic data are derived and made available to epidemiologists.

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