Infectious disease and dermatologic conditions in evacuees and rescue workers after Hurricane Katrina--multiple states, August-September, 2005

On August 29, 2005, Hurricane Katrina struck states along the Gulf Coast of the United States. In the days after the hurricane struck, approximately 750 evacuation centers were established in at least 18 states to accommodate more than 200,000 evacuees. State and local health departments, with assistance from CDC, initiated enhanced infectious disease surveillance and outbreak response activities, implemented by teams of public health and rescue workers, including military personnel. Outbreak monitoring included direct reporting of conditions of public health significance to public health agencies; daily contact between CDC and local public health officials; canvassing of reports from CDC, public health departments, and news media for potential infectious disease outbreaks; and investigation of reports of infectious disease with outbreak potential. This report summarizes infectious disease and dermatologic conditions reported during the first 3 weeks after the hurricane, before effective local surveillance was fully implemented. One outbreak of norovirus was reported among evacuees in Texas; no other outbreaks requiring unusual mobilization of public health resources were reported among evacuees or rescue workers.     

A Mobile App and Dashboard for Early Detection of Infectious Disease Outbreaks: Development Study

BackgroundOutbreaks of infectious diseases pose great risks, including hospitalization and death, to public health. Therefore, improving the management of outbreaks is important for preventing widespread infection and mitigating associated risks. Mobile health technology provides new capabilities that can help better capture, monitor, and manage infectious diseases, including the ability to quickly identify potential outbreaks.ObjectiveThis study aims to develop a new infectious disease surveillance (IDS) system comprising a mobile app for accurate data capturing and dashboard for better health care planning and decision making.MethodsWe developed the IDS system using a 2-pronged approach: a literature review on available and similar disease surveillance systems to understand the fundamental requirements and face-to-face interviews to collect specific user requirements from the local public health unit team at the Nepean Hospital, Nepean Blue Mountains Local Health District, New South Wales, Australia.ResultsWe identified 3 fundamental requirements when designing an electronic IDS system, which are the ability to capture and report outbreak data accurately, completely, and in a timely fashion. We then developed our IDS system based on the workflow, scope, and specific requirements of the public health unit team. We also produced detailed design and requirement guidelines. In our system, the outbreak data are captured and sent from anywhere using a mobile device or a desktop PC (web interface). The data are processed using a client-server architecture and, therefore, can be analyzed in real time. Our dashboard is designed to provide a daily, weekly, monthly, and historical summary of outbreak information, which can be potentially used to develop a future intervention plan. Specific information about certain outbreaks can also be visualized interactively to understand the unique characteristics of emerging infectious diseases.ConclusionsWe demonstrated the design and development of our IDS system. We suggest that the use of a mobile app and dashboard will simplify the overall data collection, reporting, and analysis processes, thereby improving the public health responses and providing accurate registration of outbreak information. Accurate data reporting and collection are a major step forward in creating a better intervention plan for future outbreaks of infectious diseases.     

Syndromic surveillance for influenzalike illness in ambulatory care network

Conventional disease surveillance mechanisms that rely on passive reporting may be too slow and insensitive to rapidly detect a large-scale infectious disease outbreak; the reporting time from a patient's initial symptoms to specific disease diagnosis takes days to weeks. To meet this need, new surveillance methods are being developed. Referred to as nontraditional or syndromic surveillance, these new systems typically rely on prediagnostic data to rapidly detect infectious disease outbreaks, such as those caused by bioterrorism. Using data from a large health maintenance organization, we discuss the development, implementation, and evaluation of a time-series syndromic surveillance detection algorithm for influenzalike illness in Minnesota.     

Use of Unstructured Event-Based Reports for Global Infectious Disease Surveillance

Free or low-cost sources of unstructured information, such as Internet news and online discussion sites, provide detailed local and near real-time data on disease outbreaks, even in countries that lack traditional public health surveillance. To improve public health surveillance and, ultimately, interventions, we examined 3 primary systems that process event-based outbreak information: Global Public Health Intelligence Network, HealthMap, and EpiSPIDER. Despite similarities among them, these systems are highly complementary because they monitor different data types, rely on varying levels of automation and human analysis, and distribute distinct information. Future development should focus on linking these systems more closely to public health practitioners in the field and establishing collaborative networks for alert verification and dissemination. Such development would further establish event-based monitoring as an invaluable public health resource that provides critical context and an alternative to traditional indicator-based outbreak reporting.     

Social Media and Internet‐Based Data in Global Systems for Public Health Surveillance: A Systematic Review

Context: The exchange of health information on the Internet has been heralded as an opportunity to improve public health surveillance. In a field that has traditionally relied on an established system of mandatory and voluntary reporting of known infectious diseases by doctors and laboratories to governmental agencies, innovations in social media and so-called user-generated information could lead to faster recognition of cases of infectious disease. More direct access to such data could enable surveillance epidemiologists to detect potential public health threats such as rare, new diseases or early-level warnings for epidemics. But how useful are data from social media and the Internet, and what is the potential to enhance surveillance? The challenges of using these emerging surveillance systems for infectious disease epidemiology, including the specific resources needed, technical requirements, and acceptability to public health practitioners and policymakers, have wide-reaching implications for public health surveillance in the 21st century.Methods: This article divides public health surveillance into indicator-based surveillance and event-based surveillance and provides an overview of each. We did an exhaustive review of published articles indexed in the databases PubMed, Scopus, and Scirus between 1990 and 2011 covering contemporary event-based systems for infectious disease surveillance.Findings: Our literature review uncovered no event-based surveillance systems currently used in national surveillance programs. While much has been done to develop event-based surveillance, the existing systems have limitations. Accordingly, there is a need for further development of automated technologies that monitor health-related information on the Internet, especially to handle large amounts of data and to prevent information overload. The dissemination to health authorities of new information about health events is not always efficient and could be improved. No comprehensive evaluations show whether event-based surveillance systems have been integrated into actual epidemiological work during real-time health events.Conclusions: The acceptability of data from the Internet and social media as a regular part of public health surveillance programs varies and is related to a circular challenge: the willingness to integrate is rooted in a lack of effectiveness studies, yet such effectiveness can be proved only through a structured evaluation of integrated systems. Issues related to changing technical and social paradigms in both individual perceptions of and interactions with personal health data, as well as social media and other data from the Internet, must be further addressed before such information can be integrated into official surveillance systems.     

非洲感染性疾病监测现状

感染性疾病的流行与暴发是危害非洲人民健康和全球卫生安全的主要问题之一。感染性疾病监测体系的建立以及持续、规范、系统地开展监测工作,对于感染性疾病防控至关重要。随着我国“一带一路”战略逐步实施,中非之间交流合作不断深入,积极了解和参与非洲感染性疾病监测与防控工作,有助于保障全球卫生安全和促进中非经贸合作。本文主要从整个非洲、非洲不同区域以及部分非洲国家等3个层面介绍与分析非洲感染性疾病的监测现状,为我国开展输入性感染性疾病防控和卫生援外工作提供参考。     

Pacific-wide simplified syndromic surveillance for early warning of outbreaks

The International Health Regulations require timely detection and response to outbreaks. Many attempts to set up an outbreak early warning system in Pacific island countries and territories (PICTs) have failed. Most were modelled on systems from large countries; large amounts of data often overwhelmed small public health teams. Many conditions required overseas laboratory confirmation, further reducing timeliness and completeness. To improve timeliness and reduce the data burden, simplified surveillance was proposed, with case definitions based on clinical signs and symptoms without the need for laboratory confirmation or information on symptoms, location, sex and age. After trials in three PICTs, this system was implemented throughout the Pacific. Enthusiastic adoption by public health staff resulted in 20 of 22 PICTs reporting weekly to the World Health Organization within 12 months of starting to use the system. In the first year, the system has detected many infectious disease outbreaks and facilitated timely implementation of control measures. For several Pacific countries and territories, this is the first functional and timely infectious disease surveillance system. When outbreak detection is the principal objective, simplification of surveillance should be a priority in countries with a limited public health system capacity.     

Training initiatives within the AFHSC-Global Emerging Infections Surveillance and Response System: support for IHR (2005)

Training is a key component of building capacity for public health surveillance and response, but has often been difficult to quantify. During fiscal 2009, the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supported 18 partner organizations in conducting 123 training initiatives in 40 countries for 3,130 U.S. military, civilian and host-country personnel. The training assisted with supporting compliance with International Health Regulations, IHR (2005). Training activities in pandemic preparedness, outbreak investigation and response, emerging infectious disease (EID) surveillance and pathogen diagnostic techniques were expanded significantly. By engaging local health and other government officials and civilian institutions, the U.S. military's role as a key stakeholder in global public health has been strengthened and has contributed to EID-related surveillance, research and capacity-building initiatives specified elsewhere in this issue. Public health and emerging infections surveillance training accomplished by AFHSC-GEIS and its Department of Defense (DoD) partners during fiscal 2009 will be tabulated and described.     

Lessons from the severe acute respiratory syndrome outbreak in Hong Kong

Severe acute respiratory syndrome (SARS) is now a global public health threat with many medical, ethical, social, economic, political, and legal implications. The nonspecific signs and symptoms of this disease, coupled with a relatively long incubation period and the initial absence of a reliable diagnostic test, limited the understanding of the magnitude of the outbreak. This paper outlines our experience with public health issues that have arisen during this outbreak of SARS in Hong Kong. We confirmed that case detection, reporting, clear and timely dissemination of information, and strict infection control measures are essential in handling such an infectious disease outbreak. The need for an outbreak response unit is crucial to combat any future outbreak.     

湖北省2005年突发公共卫生事件分析及监测系统评价

[目的]了解湖北省突发公共卫生事件的流行病学规律,及时发现和报告突发疫情,有效预防控制疾病。[方法]根据国家疾病监测信息网络直报、湖北省全年24 h疫情报告、突发疫情月报监测数据,使用Excel软件进行统计分析。[结果]2005年湖北省共报告突发疫情151起,丙类和非法定传染病所致突发疫情占74.8%;3～6月突发疫情明显增多,突发疫情主要集中在学校,发病人群以学生为主;监测系统收集的数据比较全面,但突发公共卫生事件报告的及时性较差。[结论]针对高发季节和高危人群做好突发疫情的监测和预防控制工作,同时需进一步规范突发公共卫生事件监测报告工作。     

Responding to global infectious disease outbreaks: lessons from SARS on the role of risk perception, communication and management

With increased globalisation comes the likelihood that infectious disease appearing in one country will spread rapidly to another, severe acute respiratory syndrome (SARS) being a recent example. However, although SARS infected some 10,000 individuals, killing around 1000, it did not lead to the devastating health impact that many feared, but a rather disproportionate economic impact. The disproportionate scale and nature of this impact has caused concern that outbreaks of more serious disease could cause catastrophic impacts on the global economy. Understanding factors that led to the impact of SARS might help to deal with the possible impact and management of such other infectious disease outbreaks. In this respect, the role of risk--its perception, communication and management--is critical. This paper looks at the role that risk, and especially the perception of risk, its communication and management, played in driving the economic impact of SARS. It considers the public and public health response to SARS, the role of the media and official organisations, and proposes policy and research priorities for establishing a system to better deal with the next global infectious disease outbreak. It is concluded that the potential for the rapid spread of infectious disease is not necessarily a greater threat than it has always been, but the effect that an outbreak can have on the economy is, which requires further research and policy development.     

Notifiable disease surveillance and practicing physicians

Primary care physicians in Germany are essential participants in infectious disease surveillance through mandatory reporting. Feedback on such surveillance should reflect the needs and attitudes of these physicians. These issues were investigated in a questionnaire survey among 8,550 randomly sampled physicians in Germany in 2001. Of the 1,320 respondents, 59.3% claimed not to have received any feedback on infectious disease surveillance, and 3.7% perceived feedback as not important. Logistic regression analysis showed that physicians in the former East Germany were 2.2 times more likely to have received feedback than those in the former West Germany. Physicians preferred to receive occasional reports (e.g., in case of outbreaks, 31.6%) as opposed to actively having to search for constantly updated information on the Internet (7.8%). The preferred formats were fax (31.7%), mail (30.9%), and the official organ of the German Medical Association (Deutsches Arzteblatt) (30.5%). Feedback of surveillance data to physicians should be delivered through occasional nonelectronic reports on current issues of local public health importance.     

Legal foundations for a national public health agency in Canada

This commentary addresses some of the key legal challenges associated with establishing a national public health agency in Canada. These include issues related to privacy and confidentiality of personal health information in the public health context, constraints on the jurisdiction and powers of a national agency, the need to respect individual rights and freedoms in an outbreak situation, and international cooperation in infectious disease control. The authors are part of a research initiative, comprised of experts in law, public health policy and medicine, that is currently analyzing legal considerations that may influence the mandate of a national public health agency in regard to infectious disease activities. This article discusses critical issues raised at a meeting in August 2004 that brought the research team together with key federal and provincial policy-makers and members of the public health community. The commentary emphasizes that law sets the foundation for public health activities, and the promise of a national public health agency will only be realized if significant legal issues are examined early on to ensure the agency is built on a robust legal and policy framework.     

Gov. Wilson vetoes California legislation for coded identifiers

California governor Pete Wilson vetoed legislation which would have created the world's largest HIV case surveillance program that uses unique identifiers. Public health experts and AIDS policy advocates had reached a consensus on a program using unique identifiers and were unhappy when the program was vetoed. As a result, California does not have an AIDS surveillance program, and public health officials say they will not be able to adequately monitor the epidemic or target prevention programs. The governor and some physicians say AIDS reporting should use names to track the epidemic, similar to other infectious disease reporting programs. Because of recent elections and turnover in the legislature, it will be several months before the issue is discussed again.     

A review of strategies for enhancing the completeness of notifiable disease reporting.

Notifiable disease surveillance systems provide essential data for infectious disease prevention and control programs at the local, state, and national levels. Given that reporting completeness is known to vary considerably, this review identifies methods that can reliably enhance completeness of reporting. These surveillance-related activities include initiating active surveillance when appropriate; implementing automated, electronic laboratory-based reporting; strengthening ties with clinicians and other key partners in notifiable disease reporting; and increasing the use of laboratory diagnostic tests in identifying new cases. Despite ample data in support of these strategies, notifiable disease surveillance continues to receive insufficient attention and resources. Recent attention to public health preparedness provides an opportunity to strengthen notifiable disease surveillance and enhance completeness of reporting.     

Surveillance in eradication and elimination of infectious diseases: a progression through the years

During the years since certification of smallpox eradication, the power of infectious disease surveillance has been greatly increased by new biotechnical and electronic technologies. These technologies have transformed the way that surveillance can be used to contribute to public health, and to infectious disease eradication and elimination. In addition to permitting precise geographical placement of infections by incorporating the most up to date geographical positioning systems, infectious disease surveillance can now also provide more comprehensive understanding of the spread and risks of infections because of genomic sequencing that leads to more meaningful epidemiological analysis. These new technologies have made infectious disease surveillance an even more powerful and timely tool than it was during the period of smallpox eradication. Future surveillance will continue to refine these technologies, and adapt newer ones such as rapid point of care diagnostics and hand held communication devices that will lead to more timely and accurate reporting from health facilities. These technologies will also lead to the possibility of direct participation in surveillance by individuals who will be able to report their own disease syndromes, those of their neighbors, or those of domestic and wild animals at the animal/human interface.     

Lessons from SARS and H1N1/A: employing a WHO-WTO forum to promote optimal economic-public health pandemic response

No formal system exists to review trade restrictions imposed during international public health emergencies rapidly. Failure to put one in place creates disincentives for surveillance and reporting, thereby undermining protection efforts. The 2003 SARS outbreak exposed weaknesses in global governance that caused uncoordinated public health and economic responses. New International Health Regulations (IHR), applied first during the 2009 H1N1 influenza outbreak, demonstrated improvement. Yet they failed to allow for management of public health emergencies in a way that balanced threats to health and those to economies and trade. Establishment of a joint WHO-WTO committee to adjudicate these conflicts might better achieve that balance.     

舆情监测在重大传染病预防控制工作中的应用

目的建立网络舆情监测机制和基于预防控制（简称防控）工作的舆情监测模型,并在重大传染病防控中应用与实践。方法以近期人感染H7N9禽流感防控为主要监测对象,通过对网络舆情的监测与分析、评估,建立适合公共卫生工作的舆情监测体系,规范信息的获取、处理、挖掘分析、利用等方法。结果建立了包括疫情追踪、防控进展、公众关注等9大模块的舆情监测分析体系,全面及时地向各级领导、专业人员提供信息支持与分析。结论新的舆情监测模式,在重大传染病防控中,起到了重要的决策信息支持与分析的作用,并可以在突发公共卫生事件、公众关注的重要公共卫生问题处理时,发挥重要的作用。研究结果能为各级行政部门在重大传染病疫情发生的情况下,快速建立舆情防控提供进一步理论支撑。     

The Global Emerging Infection Surveillance and Response System (GEIS), a U.S. government tool for improved global biosurveillance: a review of 2009

The Armed Forces Health Surveillance Center, Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) has the mission of performing surveillance for emerging infectious diseases that could affect the United States (U.S.) military. This mission is accomplished by orchestrating a global portfolio of surveillance projects, capacity-building efforts, outbreak investigations and training exercises. In 2009, this portfolio involved 39 funded partners, impacting 92 countries. This article discusses the current biosurveillance landscape, programmatic details of organization and implementation, and key contributions to force health protection and global public health in 2009.     

The Black Canyon Forecast Station: Experiences And Lessons Learned

Objective

To evaluate the sociological effect on indigenous biological event signature recognition and community resilience due to the operational activities of an infectious disease forecast station.

Introduction

The nation’s first operational infectious disease forecast station, modeled after warning protocols developed in the meteorology community, was activated in 2011. The approach was originally pioneered in Haiti following the 2010 earthquake.

Methods

We assembled global event signature and forecast libraries that reflected locally diagnosed infectious disease activity and infrastructure impact in a rural community from a public health, veterinary, and human clinical medicine perspective. The deployment site is home to a variety of infectious disease including hantavirus, plague, tularemia, and West Nile in the context of high wildlife-livestock-human interfacing. Information derived from the issuance of forecasts coupled to situational awareness was shared with the public, local officials, public health officers, veterinarians, healthcare providers, and patients through various social media methods.

Results

Provision of 30-60-90 day forecasts for routine and non-routine endemic infectious disease activity and impact facilitated better coordination of public health messaging and daily conversation with patients in the inpatient and outpatient settings. The signature of an unusual, infrastructure-disruptive outbreak of metapneumovirus and respiratory syncytial virus was recognized and communicated with enough time to activate effective clinical mitigation protocols. Cost estimates demonstrated financial benefit at a local level to anticipating surges of infectious disease activity with enough time to mitigate patient demand. Community-wide engagement with infectious disease forecasts and live event advisories included the promotion of proactive infection control and public health surveillance and response, healthcare provider recognition of non-routine infectious disease, clinical sampling and diagnostic testing protocols, clinician and patient education, and synchronization of proactive disease reporting both in the routine daily clinical setting and in times of crisis. Collateral benefit of consistent messaging delivered to the public by the participating entities was noted. Community awareness of the repertoire of indigenous infectious disease activity was expanded beyond the official public health notification list. Neither issuance of infectious disease forecasts nor advisories issued during crises triggered an influx of anxious well phone calls or visits to the medical system that was deemed operationally relevant.

Conclusions

Activation of a local infectious disease forecast station modeled after a local weather station promotes routine communication of a broader array of infectious disease activity than that monitored by public health; facilitates proactive, cost effective healthcare; and enabled recognition of unusual, disruptive infectious activity with enough time to enable mitigation of clinical, infrastructure, and financial impact to the community. Routine communication of comprehensive infectious disease forecast and situational awareness information promotes community adaptive fitness to a wide variety of infectious hazards. The results suggest it is possible to transform the traditional public health model of data collection and analysis to one of transparent and open data availability to support innovative reduction in morbidity and mortality.