Seasonal meanderings and novel virus strains.

Sitting by the pool, albeit briefly between sessions at an international conference on health policy in Jerusalem, it is difficult to ignore the irony of the prospect of completing this Editorial, while wondering about all the risks that surround us. Firstly, given the brief reference to the immediate environment, we view our fellow ‘pool dwellers’ with renewed suspicion about their showering habits prior to leaping into the pool: naturally, this is of no consequence whatever to those of us whose sojourn by the pool is too short to consider even the shedding of a shoe, let alone the shedding of countless epidermal cells and their associated debris, but it is a distraction nonetheless, particularly after reading the paper on this subject in this issue of . Another issue that might not normally pass through one's mind is how people with disabilities manage to cope with everyday obstacles: in this case, how do people who are visually impaired cope with public toilets? Well, a paper in this issue addresses this valid research question, too. Then there is the risk of novel virus transmission, another potential hazard for the unsuspecting conference goer – or any other business or leisure traveller.

While minding one's business inside the conference centre, where the main issue being addressed is maintaining and improving health care during a period of significant austerity, it might be easy to forget that not far away is the source of an outbreak of a new Coronavirus, Middle East respiratory syndrome coronavirus (MERS-CoV), that was first identified in September 2012 and causes a severe respiratory illness in at least some of those who become infected. This virus is different from any other coronavirus previously found in people. It is also different from the coronavirus that caused SARS (Severe Acute Respiratory Syndrome) in 2003. However, like the SARS virus, MERS-CoV is most similar to coronaviruses found in bats.The number of cases reported since the first was reported last year has remained small (<100 cases at time of writing), and it remains as yet unknown whether this is a common mild infection which therefore goes largely unnoticed, or a relatively rare, but severe infection. Whilst most cases identified outside outside the Middle East have been returning travellers, there has been limited local transmission among patients who had not been to the Middle East but had been in close contact with the laboratory-confirmed or probable cases. So the World Health Organisation has advised clinicians globally to be vigilant in considering the source and managing the risk of cross infection in patients suspected of having MERS-CoV.

In addition to watching out for imported cases of the MERS-CoV, clinicians in the UK and many other countries have been reminded to be vigilant not to miss possible cases of the latest strain of avian influenza virus to infect humans, influenza A (H7N9), originating from China. As with MERS, numbers of confirmed cases to date are small (132 confirmed cases at end May 2013), but again it remains to be discovered whether this is a virus causing frequent mild illness, and only rarely causes severe symptoms, as represented by the reported cases, or if it is an uncommon virus which is regularly a cause of severe disease. To date there is no evidence of sustained human-to-human transmission of H7N9, but of course there is a need for careful ongoing surveillance.

So the epidemiological surveillance of both these new strains will be very important in the coming months, to ensure our understanding of the viruses with a view to controlling their spread and limiting the harm they may cause. The identification and surveillance of these two novel viral strains recently has demonstrated substantial international cooperation and openness between very diverse nations, which we in the public health community should welcome and celebrate. If the same could apply to a myriad of other global issues, the world would be making real progress towards its sustainable and peaceful future: perhaps sitting in an international conference in Jerusalem, speaking with people of all cultures, ethnicities and religions is influencing our level of optimism, but it is good to be optimistic when there is at least some evidence pointing in that direction.

However, at a time when much energy and effort is expended in the most developed nations, largely appropriately, on non-communicable disease control, it seems we can rely upon Mother Nature to remind us and ensure that we do not take our public health eyes away from scanning the communicable disease horizon.

What a season this is turning out to be.

Competing interest

Fiona Sim was an invited speaker at the 5th Jerusalem International Conference on Health Policy, June 2013.

In what might be viewed as a ‘summer special’, we include findings from work on health related behaviours among users of swimming pools in Italy. Enough to put you off your gnocci, perhaps, but plenty of scope for health improvement messages, which may well be applicable to many other countries. So an evaluation of an English initiative designed to make every contact with a health worker count towards healthier living, is welcomed, although it is clear that much more effort is needed to enable such initiatives to be effective on an industrial scale, if we are ever to achieve that elusive ‘fully engaged’ scenario for our populations. Whilst keen to promote equity and to remove discrimination, we are often guilty by neglect: a paper in this issue that explores access to public toilets reminds readers of the needs of people with disabilities, some of which would be missed without the participation of the potential users themselves. A review article about folic acid intake and a possible link with pancreatic cancer sets out clearly the evidence, some of which is conflicting, to date. And we make no apology for including another paper that reports on the Wenchuan earthquake, this one attempting to identify the determinants of post-traumatic stress disorder, which may have relevance to the handling of many other major traumatic events around the globe.