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Crawley AW, Mercy K, Shivji S, Lofgren H, Trowbridge D, Manthey C, Tebeje YK, Clara AW, Landry K, Salyer SJ. An indicator framework for the monitoring and evaluation of event-based surveillance systems. Lancet Glob Health 2024; 12:e707-e711. [PMID: 38364834 DOI: 10.1016/s2214-109x(24)00034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/20/2023] [Accepted: 01/14/2024] [Indexed: 02/18/2024]
Abstract
Event-based surveillance (EBS) systems have been implemented globally to support early warning surveillance across human, animal, and environmental health in diverse settings, including at the community level, within health facilities, at border points of entry, and through media monitoring of internet-based sources. EBS systems should be evaluated periodically to ensure that they meet the objectives related to the early detection of health threats and to identify areas for improvement in the quality, efficiency, and usefulness of the systems. However, to date, there has been no comprehensive framework to guide the monitoring and evaluation of EBS systems; this absence of standardisation has hindered progress in the field. The Africa Centres for Disease Control and Prevention and US Centers for Disease Control and Prevention have collaborated to develop an EBS monitoring and evaluation indicator framework, adaptable to specific country contexts, that uses measures relating to input, activity, output, outcome, and impact to map the processes and expected results of EBS systems. Through the implementation and continued refinement of these indicators, countries can ensure the early detection of health threats and improve their ability to measure and describe the impacts of EBS systems, thus filling the current evidence gap regarding their effectiveness.
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Affiliation(s)
- Adam W Crawley
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kyeng Mercy
- Division for Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Sabrina Shivji
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hannah Lofgren
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniella Trowbridge
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine Manthey
- Division of Global Health Protection, Global Health Center, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yenew Kebede Tebeje
- Division for Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Alexey Wil Clara
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kimberly Landry
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephanie J Salyer
- Division of Global Health Protection, Global Health Center, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Division for Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
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Divi N, Mantero J, Libel M, Leal Neto O, Schultheiss M, Sewalk K, Brownstein J, Smolinski M. Using EpiCore to Enable Rapid Verification of Potential Health Threats: Illustrated Use Cases and Summary Statistics. JMIR Public Health Surveill 2024; 10:e52093. [PMID: 38488832 PMCID: PMC10980988 DOI: 10.2196/52093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/26/2023] [Accepted: 01/31/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The proliferation of digital disease-detection systems has led to an increase in earlier warning signals, which subsequently have resulted in swifter responses to emerging threats. Such highly sensitive systems can also produce weak signals needing additional information for action. The delays in the response to a genuine health threat are often due to the time it takes to verify a health event. It was the delay in outbreak verification that was the main impetus for creating EpiCore. OBJECTIVE This paper describes the potential of crowdsourcing information through EpiCore, a network of voluntary human, animal, and environmental health professionals supporting the verification of early warning signals of potential outbreaks and informing risk assessments by monitoring ongoing threats. METHODS This paper uses summary statistics to assess whether EpiCore is meeting its goal to accelerate the time to verification of identified potential health events for epidemic and pandemic intelligence purposes from around the world. Data from the EpiCore platform from January 2018 to December 2022 were analyzed to capture request for information response rates and verification rates. Illustrated use cases are provided to describe how EpiCore members provide information to facilitate the verification of early warning signals of potential outbreaks and for the monitoring and risk assessment of ongoing threats through EpiCore and its utilities. RESULTS Since its launch in 2016, EpiCore network membership grew to over 3300 individuals during the first 2 years, consisting of professionals in human, animal, and environmental health, spanning 161 countries. The overall EpiCore response rate to requests for information increased by year between 2018 and 2022 from 65.4% to 68.8% with an initial response typically received within 24 hours (in 2022, 94% of responded requests received a first contribution within 24 h). Five illustrated use cases highlight the various uses of EpiCore. CONCLUSIONS As the global demand for data to facilitate disease prevention and control continues to grow, it will be crucial for traditional and nontraditional methods of disease surveillance to work together to ensure health threats are captured earlier. EpiCore is an innovative approach that can support health authorities in decision-making when used complementarily with official early detection and verification systems. EpiCore can shorten the time to verification by confirming early detection signals, informing risk-assessment activities, and monitoring ongoing events.
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Affiliation(s)
- Nomita Divi
- Ending Pandemics, San Francisco, CA, United States
| | - Jaś Mantero
- Ending Pandemics, San Francisco, CA, United States
| | - Marlo Libel
- Ending Pandemics, San Francisco, CA, United States
| | - Onicio Leal Neto
- Ending Pandemics, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Kara Sewalk
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States
| | - John Brownstein
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Harvard University, Boston, MA, United States
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Lata H, Saad Duque NJ, Togami E, Miglietta A, Perkins D, Corpuz A, Kato M, Babu A, Dorji T, Matsui T, Almiron M, Cheng KY, MacDonald LE, Pukkila JT, Williams GS, Andraghetti R, Dolea C, Mahamud A, Morgan O, Olowokure B, Fall IS, Awofisayo-Okuyelu A, Hamblion E. Disseminating information on acute public health events globally: experiences from the WHO's Disease Outbreak News. BMJ Glob Health 2024; 9:e012876. [PMID: 38413101 PMCID: PMC10900317 DOI: 10.1136/bmjgh-2023-012876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/20/2023] [Indexed: 02/29/2024] Open
Abstract
WHO works, on a daily basis, with countries globally to detect, prepare for and respond to acute public health events. A vital component of a health response is the dissemination of accurate, reliable and authoritative information. The Disease Outbreak News (DON) reports are a key mechanism through which WHO communicates on acute public health events to the public. The decision to produce a DON report is taken on a case-by-case basis after evaluating key criteria, and the subsequent process of producing a DON report is highly standardised to ensure the robustness of information. DON reports have been published since 1996, and up to 2022 over 3000 reports have been published. Between 2018 and 2022, the most frequently published DON reports relate to Ebola virus disease, Middle East respiratory syndrome, yellow fever, polio and cholera. The DON web page is highly visited with a readership of over 2.6 million visits per year, on average. The DON report structure has evolved over time, from a single paragraph in 1996 to a detailed report with seven sections currently. WHO regularly reviews the DON report process and structure for improvements. In the last 25 years, DON reports have played a unique role in rapidly disseminating information on acute public health events to health actors and the public globally. They have become a key information source for the global public health response to the benefit of individuals and communities.
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Affiliation(s)
- Harsh Lata
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | | | - Eri Togami
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | | | - Devin Perkins
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | - Aura Corpuz
- Health Emergencies, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Masaya Kato
- World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Amarnath Babu
- World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Tshewang Dorji
- Health Emergencies, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Tamano Matsui
- World Health Organization Regional Office for the Western Pacific, Manila, The Philippines
| | - Maria Almiron
- Health Emergencies, Pan American Health Organization, Washington, District of Columbia, USA
| | - Ka Yeung Cheng
- Health Emergencies, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Lauren E MacDonald
- Health Emergencies, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Jukka Tapani Pukkila
- Health Emergencies, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - George Sie Williams
- Health Emergencies, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Carmen Dolea
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | | | - Oliver Morgan
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | - Babatunde Olowokure
- Health Emergencies, World Health Organization Regional Office for the Western Pacific, Manila, The Philippines
| | | | | | - Esther Hamblion
- Health Emergencies, World Health Organization, Geneva, Switzerland
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Kploanyi EE, Kenu J, Atsu BK, Opare DA, Asiedu-Bekoe F, Schroeder LF, Dowdy DW, Yawson AE, Kenu E. An assessment of the laboratory network in Ghana: A national-level ATLAS survey (2019-2020). Afr J Lab Med 2023; 12:1844. [PMID: 36873292 PMCID: PMC9982496 DOI: 10.4102/ajlm.v12i1.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 09/29/2022] [Indexed: 02/10/2023] Open
Abstract
Background Integrated health systems with strong laboratory networks are critical in improving public health. The current study assessed the laboratory network in Ghana and its functionality using the Assessment Tool for Laboratory Services (ATLAS). Intervention A national-level laboratory network survey was conducted among stakeholders of the Ghanaian laboratory network in Accra. Face-to-face interviews were conducted from December 2019 to January 2020, with follow-up phone interviews between June and July 2020. Also, we reviewed supporting documents provided by stakeholders for supplementary information and transcribed these to identify themes. Where possible, we completed the Laboratory Network scorecard using data obtained from the ATLAS. Lessons learnt The Laboratory Network (LABNET) scorecard assessment was a valuable addition to the ATLAS survey as it quantified the functionality of the laboratory network and its overall advancement toward achieving International Health Regulations (2005) and Global Health Security Agenda targets. Two significant challenges indicated by respondents were laboratory financing and delayed implementation of the Ghana National Health Laboratory Policy. Recommendations Stakeholders recommended a review of the country's funding landscape, such as funding laboratory services from the country's internally generated funds. Also, they recommended laboratory policy implementation to ensure adequate laboratory workforce and standards.
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Affiliation(s)
- Emma E Kploanyi
- School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Joseph Kenu
- School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Benedicta K Atsu
- School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - David A Opare
- National Public Health and Reference Laboratory, Ghana Health Service, Accra, Ghana
| | | | - Lee F Schroeder
- Department of Pathology and Clinical Laboratories, University of Michigan, Ann Arbor, Michigan, United States
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Alfred E Yawson
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | - Ernest Kenu
- School of Public Health, University of Ghana, Legon, Accra, Ghana
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Mremi IR, Rumisha SF, Sindato C, Kimera SI, Mboera LEG. Comparative assessment of the human and animal health surveillance systems in Tanzania: Opportunities for an integrated one health surveillance platform. Glob Public Health 2023; 18:2110921. [PMID: 35951768 DOI: 10.1080/17441692.2022.2110921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/02/2022] [Indexed: 11/04/2022]
Abstract
Globally, there have been calls for an integrated zoonotic disease surveillance system. This study aimed to assess human and animal health surveillance systems to identify opportunities for One Health surveillance platform in Tanzania. A desk review of policies, acts and strategies addressing disease surveillance that support inter-sectoral collaboration was conducted. A semi-structured questionnaire was administered to key informants from the two sectors. Databases with potential relevance for surveillance were assessed. One Health-focused policies, acts, strategic plans and guidelines emphasising inter-sectoral collaboration strengthening were in place. Stable systems for collecting surveillance data with trained staff to implement surveillance activities at all levels in both sectors were available. While the human surveillance system was a mix of paper-based and web-based, the animal health system was mainly paper-based. The laboratory information system existed in both sectors, though not integrated with the epidemiological surveillance systems. Both the animal and human surveillance systems had low sensitivity to alert outbreaks. The findings indicate that individual, organisational, and infrastructure opportunities that support the integration of surveillance systems from multiple sectors exist. Challenges related to data sharing and quality need to be addressed for the effective implementation of the platform.
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Affiliation(s)
- Irene R Mremi
- SACIDS Foundation for One Health, Africa Centre of Excellence for Infectious Diseases of Human and Animals, Sokoine University of Agriculture, Morogoro, Tanzania
- National Institute for Medical Research, Dar es Salaam, Tanzania
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Susan F Rumisha
- National Institute for Medical Research, Dar es Salaam, Tanzania
- Malaria Atlas Project, Geospatial Health and Development, Telethon Kids Institute, West Perth, Australia
| | - Calvin Sindato
- SACIDS Foundation for One Health, Africa Centre of Excellence for Infectious Diseases of Human and Animals, Sokoine University of Agriculture, Morogoro, Tanzania
- National Institute for Medical Research, Tabora Research Centre, Tabora, Tanzania
| | - Sharadhuli I Kimera
- SACIDS Foundation for One Health, Africa Centre of Excellence for Infectious Diseases of Human and Animals, Sokoine University of Agriculture, Morogoro, Tanzania
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Leonard E G Mboera
- SACIDS Foundation for One Health, Africa Centre of Excellence for Infectious Diseases of Human and Animals, Sokoine University of Agriculture, Morogoro, Tanzania
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Dos S Ribeiro C, van Roode M, Farag E, Nour M, Moustafa A, Ahmed M, Haringhuizen G, Koopmans M, van de Burgwal L. A framework for measuring timeliness in the outbreak response path: lessons learned from the Middle East respiratory syndrome (MERS) epidemic, September 2012 to January 2019. Euro Surveill 2022; 27:2101064. [PMID: 36695460 PMCID: PMC9716647 DOI: 10.2807/1560-7917.es.2022.27.48.2101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 09/21/2022] [Indexed: 12/03/2022] Open
Abstract
BackgroundEpidemics are a constant threat in the 21st century, particularly disease outbreaks following spillover of an animal virus to humans. Timeliness, a key metric in epidemic response, can be examined to identify critical steps and delays in public health action.AimTo examine timeliness, we analysed the response to the Middle East respiratory syndrome (MERS) epidemic, with a focus on the international and One Health response efforts.MethodsWe performed a historical review of the MERS epidemic between September 2012 and January 2019 in three steps: (i) the construction of a timeline identifying critical events in the global response, (ii) the performance of a critical path analysis to define outbreak milestones and (iii) a time gap analysis to measure timeliness in the execution of these milestones.ResultsWe proposed 14 MERS-specific milestones at different phases of the epidemic, assessing timeliness of the public health response as well as at the animal-human interface, where we identified the most significant delays.ConclusionsWhen comparing timeliness across three coronavirus epidemics, i.e. MERS (2012), SARS (2002) and COVID-19 (2019), we identified clear improvements over time for certain milestones including laboratory confirmation and diagnostics development, while this was not as apparent for others, as the identification of zoonotic hosts. To more efficiently respond to emerging threats, the global health community should widely assess and tackle specific delays in implementing response interventions by addressing challenges in the sharing of information, data and resources, as well as efficiency, quality, transparency and reliability of reporting events.
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Affiliation(s)
- Carolina Dos S Ribeiro
- Vrije Universiteit (VU) Amsterdam, Faculty of Science, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Amsterdam, the Netherlands
- The Netherlands National Institute for Public Health and the Environment (RIVM), Center for Infectious Disease Control, Bilthoven, the Netherlands
| | - Martine van Roode
- Erasmus Medical Center (EMC), Viroscience Department, Pandemic and Disaster Preparedness Centre, Rotterdam, the Netherlands
| | | | - Mohamed Nour
- Ministry of Public Health, Department of Public health, Doha, Qatar
| | - Aya Moustafa
- Ministry of Public Health, Department of Public health, Doha, Qatar
| | - Minahil Ahmed
- Ministry of Public Health, Department of Public health, Doha, Qatar
| | - George Haringhuizen
- The Netherlands National Institute for Public Health and the Environment (RIVM), Center for Infectious Disease Control, Bilthoven, the Netherlands
| | - Marion Koopmans
- Erasmus Medical Center (EMC), Viroscience Department, Pandemic and Disaster Preparedness Centre, Rotterdam, the Netherlands
| | - Linda van de Burgwal
- Vrije Universiteit (VU) Amsterdam, Faculty of Science, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Amsterdam, the Netherlands
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Fieldhouse JK, Randhawa N, Fair E, Bird B, Smith W, Mazet JA. One Health timeliness metrics to track and evaluate outbreak response reporting: A scoping review. EClinicalMedicine 2022; 53:101620. [PMID: 36097540 PMCID: PMC9463558 DOI: 10.1016/j.eclinm.2022.101620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/31/2022] [Accepted: 08/03/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND As the global population soars, human behaviours are increasing the risk of epidemics. Objective performance evaluation of outbreak responses requires that metrics of timeliness, or speed in response time, be recorded and reported. We sought to evaluate how timeliness data are being conveyed for multisectoral outbreaks and make recommendations on how One Health metrics can be used to improve response success. METHODS We conducted a scoping review of outbreaks reported January 1, 2010- March 15, 2020, in organizational reports and peer-reviewed literature on PubMed and Embase databases. We tracked 11 outbreak milestones and calculated timeliness metrics, the median time in days, between the following: 1) Predict; 2) Prevent; 3) Start; 4) Detect; 5) Notify; 6) Verify; 7) Diagnostic; 8) Respond; 9) Communication; 10) End; and 11) After-Action Review. FINDINGS We identified 26783 outbreak reports, 1014 of which involved more than just the human health sector. Only six of the eleven milestones were mentioned in >50% of reports. The time between most milestones was on average shorter for outbreaks reporting both Predict (alert of a potential outbreak) and Prevent (response to predictive alert) events. INTERPRETATION Tracking progress in timeliness during outbreaks can focus efforts to prevent outbreaks from evolving into epidemics or pandemics. Response to predictive alerts demonstrated improved expediency in time to most milestones. We recommend the adoption of universally defined One Health outbreak milestones, including After Action Review, such that timeliness metrics can be used to assess outbreak response improvements over time. FUNDING This study was made possible by the United States Agency for International Development's One Health Workforce-Next Generation Project (Cooperative Agreement 7200AA19CA00018).
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Affiliation(s)
- Jane K. Fieldhouse
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- One Health Institute, University of California, Davis, California, USA
- Corresponding authors at: One Health Institute, 1089 Veterinary Medicine Drive VetMed 3B, Ground Floor West, Davis, CA 95616, USA.
| | - Nistara Randhawa
- One Health Institute, University of California, Davis, California, USA
| | - Elizabeth Fair
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Brian Bird
- One Health Institute, University of California, Davis, California, USA
| | - Woutrina Smith
- One Health Institute, University of California, Davis, California, USA
| | - Jonna A.K. Mazet
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- One Health Institute, University of California, Davis, California, USA
- Corresponding authors at: One Health Institute, 1089 Veterinary Medicine Drive VetMed 3B, Ground Floor West, Davis, CA 95616, USA.
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8
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Exploring relationships between drought and epidemic cholera in Africa using generalised linear models. BMC Infect Dis 2021; 21:1177. [PMID: 34809609 PMCID: PMC8609751 DOI: 10.1186/s12879-021-06856-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Temperature and precipitation are known to affect Vibrio cholerae outbreaks. Despite this, the impact of drought on outbreaks has been largely understudied. Africa is both drought and cholera prone and more research is needed in Africa to understand cholera dynamics in relation to drought. Methods Here, we analyse a range of environmental and socioeconomic covariates and fit generalised linear models to publicly available national data, to test for associations with several indices of drought and make cholera outbreak projections to 2070 under three scenarios of global change, reflecting varying trajectories of CO2 emissions, socio-economic development, and population growth. Results The best-fit model implies that drought is a significant risk factor for African cholera outbreaks, alongside positive effects of population, temperature and poverty and a negative effect of freshwater withdrawal. The projections show that following stringent emissions pathways and expanding sustainable development may reduce cholera outbreak occurrence in Africa, although these changes were spatially heterogeneous. Conclusions Despite an effect of drought in explaining recent cholera outbreaks, future projections highlighted the potential for sustainable development gains to offset drought-related impacts on cholera risk. Future work should build on this research investigating the impacts of drought on cholera on a finer spatial scale and potential non-linear relationships, especially in high-burden countries which saw little cholera change in the scenario analysis. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06856-4.
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Stephens PR, Gottdenker N, Schatz AM, Schmidt JP, Drake JM. Characteristics of the 100 largest modern zoonotic disease outbreaks. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200535. [PMID: 34538141 PMCID: PMC8450623 DOI: 10.1098/rstb.2020.0535] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 12/19/2022] Open
Abstract
Zoonotic disease outbreaks are an important threat to human health and numerous drivers have been recognized as contributing to their increasing frequency. Identifying and quantifying relationships between drivers of zoonotic disease outbreaks and outbreak severity is critical to developing targeted zoonotic disease surveillance and outbreak prevention strategies. However, quantitative studies of outbreak drivers on a global scale are lacking. Attributes of countries such as press freedom, surveillance capabilities and latitude also bias global outbreak data. To illustrate these issues, we review the characteristics of the 100 largest outbreaks in a global dataset (n = 4463 bacterial and viral zoonotic outbreaks), and compare them with 200 randomly chosen background controls. Large outbreaks tended to have more drivers than background outbreaks and were related to large-scale environmental and demographic factors such as changes in vector abundance, human population density, unusual weather conditions and water contamination. Pathogens of large outbreaks were more likely to be viral and vector-borne than background outbreaks. Overall, our case study shows that the characteristics of large zoonotic outbreaks with thousands to millions of cases differ consistently from those of more typical outbreaks. We also discuss the limitations of our work, hoping to pave the way for more comprehensive future studies. This article is part of the theme issue 'Infectious disease macroecology: parasite diversity and dynamics across the globe'.
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Affiliation(s)
- Patrick R. Stephens
- Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, 30602 GA, USA
| | - N. Gottdenker
- Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, 30602 GA, USA
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, 30602 GA, USA
| | - A. M. Schatz
- Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, 30602 GA, USA
| | - J. P. Schmidt
- Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, 30602 GA, USA
| | - John M. Drake
- Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, 30602 GA, USA
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Impouma B, Roelens M, Williams GS, Flahault A, Codeço CT, Moussana F, Farham B, Hamblion EL, Mboussou F, Keiser O. Measuring Timeliness of Outbreak Response in the World Health Organization African Region, 2017-2019. Emerg Infect Dis 2021; 26:2555-2564. [PMID: 33079032 PMCID: PMC7588517 DOI: 10.3201/eid2611.191766] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Large-scale protracted outbreaks can be prevented through early detection, notification, and rapid control. We assessed trends in timeliness of detecting and responding to outbreaks in the African Region reported to the World Health Organization during 2017–2019. We computed the median time to each outbreak milestone and assessed the rates of change over time using univariable and multivariable Cox proportional hazard regression analyses. We selected 296 outbreaks from 348 public reported health events and evaluated 184 for time to detection, 232 for time to notification, and 201 for time to end. Time to detection and end decreased over time, whereas time to notification increased. Multiple factors can account for these findings, including scaling up support to member states after the World Health Organization established its Health Emergencies Programme and support given to countries from donors and partners to strengthen their core capacities for meeting International Health Regulations.
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11
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Stone KW, Felkner M, Garza E, Perez-Patron M, Schmit CD, McDonald TJ, Horney JA. Changes to Timeliness and Completeness of Infectious Disease Reporting in Texas After Implementation of an Epidemiologic Capacity Program. Public Health Rep 2021; 137:679-686. [PMID: 33930278 DOI: 10.1177/00333549211009490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The objective of this study was to characterize the changes in timeliness and completeness of disease case reporting in Texas in response to an increasing number of foodborne illnesses and high-consequence infectious disease investigations and the Texas Department of State Health Services' new state-funded epidemiologist (SFE) program. METHODS We extracted electronic disease case reporting data on 42 conditions from 2012 through 2016 in all local health department (LHD) jurisdictions. We analyzed data on median time for processing reports and percentage of complete reports across time and between SFE and non-SFE jurisdictions using Mann-Whitney t tests and z scores. RESULTS The median time of processing improved from 13 days to 10 days from 2012 to 2016, and the percentage of disease case reports that were complete improved from 19.6% to 27.7%. Most reports were for foodborne illnesses; both timeliness (11 to 7 days) and completeness (20.9% to 23.5%) improved for these reports. CONCLUSIONS Disease reporting improvements in timeliness and completeness were associated with the SFE program and its enhancement of epidemiologic capacity. SFEs were shown to improve surveillance metrics in LHDs, even in jurisdictions with a high volume of case reports. Adding epidemiologist positions in LHDs produces a tangible outcome of improved disease surveillance.
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Affiliation(s)
- Kahler W Stone
- 5235 Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Marilyn Felkner
- 12330 Department of Public Health, University of Texas School of Human Ecology, Austin, TX, USA
| | - Eric Garza
- 8193 Emerging and Acute Infectious Disease Branch, Texas Department of State Health Services, Austin, TX, USA
| | - Maria Perez-Patron
- 14736 Department of Epidemiology and Biostatistics, Texas A&M School of Public Health, College Station, TX, USA
| | - Cason D Schmit
- Department of Health Policy and Management, Texas A&M School of Public Health, College Station, TX, USA
| | - Thomas J McDonald
- Department of Environmental and Occupational Health, Texas A&M School of Public Health, College Station, TX, USA
| | - Jennifer A Horney
- 5972 Department of Epidemiology, University of Delaware, Newark, DE, USA
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12
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Crawley AW, Divi N, Smolinski MS. Using Timeliness Metrics to Track Progress and Identify Gaps in Disease Surveillance. Health Secur 2021; 19:309-317. [PMID: 33891487 DOI: 10.1089/hs.2020.0139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Timely outbreak detection and response can translate into illnesses averted and lives saved. As such, timeliness is an important criterion for evaluating performance of infectious disease surveillance systems. Through the use of clearly defined outbreak milestones, timeliness metrics can capture the speed of outbreak detection, verification, response, and other key actions across the timeline of an outbreak and evaluate progress over time. In this article, we describe a series of country-level pilot studies designed to assess the feasibility and utility of tracking timeliness metrics and highlight key findings. We then discuss subsequent efforts to develop a timeliness metrics measurement framework through expert consultation and provide recommendations for implementation. National surveillance programs, international agencies, and donor organizations can use timeliness metrics to identify gaps in surveillance performance and track progress toward improved global health security.
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Affiliation(s)
- Adam W Crawley
- Adam Wade Crawley, MPH, is a Program Officer; Nomita Divi, MSPH, is Director; and Mark S. Smolinski, MD, MPH, is President; all at Ending Pandemics, San Francisco, CA
| | - Nomita Divi
- Adam Wade Crawley, MPH, is a Program Officer; Nomita Divi, MSPH, is Director; and Mark S. Smolinski, MD, MPH, is President; all at Ending Pandemics, San Francisco, CA
| | - Mark S Smolinski
- Adam Wade Crawley, MPH, is a Program Officer; Nomita Divi, MSPH, is Director; and Mark S. Smolinski, MD, MPH, is President; all at Ending Pandemics, San Francisco, CA
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13
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Twitter vs. Zika—The role of social media in epidemic outbreaks surveillance. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2020.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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14
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Durmuş V. Is the country-level income an important factor to consider for COVID-19 control? An analysis of selected 100 countries. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2021. [DOI: 10.1108/ijhg-10-2020-0121] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PurposeThe purpose of this study is to evaluate the association between economic activity in a country, as measured by the gross domestic product (GDP) and the control of the COVID-19 pandemic outcomes, as measured by the rate of incidence and mortality increase per 100,000 population in different countries using up-to-date data, in the light of public health security capacities including prevention, detection, respond, enabling function, operational readiness, as measured by the 2019 State Party self-assessment annual reporting (SPAR) submissions of 100 countries.Design/methodology/approachFor this analytical study, multiple linear regression analyses were performed for each variable with the COVID-19 incidence and mortality rates, while controlling for Human Development Index (HDI) and GDP.FindingsCountries with higher income levels were significantly more likely to have a higher incidence and mortality rate per 100,000 population. Among the public health capacity categories, prevention of the infectious disease and detection of the pathogens were significantly associated with lower incidence and mortality of the COVID-19 pandemic. The country-level income was found to be an important negative predictor of COVID-19 control.Practical implicationsThese findings present to decision-makers in organizing mitigation strategies to struggle emerging infectious pandemics and highlight the role of country-level income while trying to control COVID-19. In order to determine the priority settings for the fight against pandemic, national policy-makers and international organizations should notice that countries in a high-income group had better health security capacities than that of other income groups, particularly in low- and lower-middle-income groups. The results of the capabilities of health security by the income group can assist health policy makers and other international agencies in resource allocation decisions and in mitigating risk with more informed resource planning.Social implicationsThe income level of countries may have a positive effect on public health strategies to mitigate the risk of infection of COVID-19. This study may assist the local public authorities to gain a better level of understanding on the relationship country-level income and COVID-19 outcomes in order to take appropriate measures at the local level. The results also highlighted the importance role of public health security capacities for the pandemic control policy.Originality/valueAlthough previous studies have examined to assess the public health capability by country-level and to describe cases and deaths by continent and by country, very limited studies have evaluated the rate of incidence and mortality of COVID-19 by country-level income and by health expenditure using the data on the health security capacities with analytical and practical approaches.
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15
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Ratnayake R, Finger F, Edmunds WJ, Checchi F. Early detection of cholera epidemics to support control in fragile states: estimation of delays and potential epidemic sizes. BMC Med 2020; 18:397. [PMID: 33317544 PMCID: PMC7737284 DOI: 10.1186/s12916-020-01865-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/23/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Cholera epidemics continue to challenge disease control, particularly in fragile and conflict-affected states. Rapid detection and response to small cholera clusters is key for efficient control before an epidemic propagates. To understand the capacity for early response in fragile states, we investigated delays in outbreak detection, investigation, response, and laboratory confirmation, and we estimated epidemic sizes. We assessed predictors of delays, and annual changes in response time. METHODS We compiled a list of cholera outbreaks in fragile and conflict-affected states from 2008 to 2019. We searched for peer-reviewed articles and epidemiological reports. We evaluated delays from the dates of symptom onset of the primary case, and the earliest dates of outbreak detection, investigation, response, and confirmation. Information on how the outbreak was alerted was summarized. A branching process model was used to estimate epidemic size at each delay. Regression models were used to investigate the association between predictors and delays to response. RESULTS Seventy-six outbreaks from 34 countries were included. Median delays spanned 1-2 weeks: from symptom onset of the primary case to presentation at the health facility (5 days, IQR 5-5), detection (5 days, IQR 5-6), investigation (7 days, IQR 5.8-13.3), response (10 days, IQR 7-18), and confirmation (11 days, IQR 7-16). In the model simulation, the median delay to response (10 days) with 3 seed cases led to a median epidemic size of 12 cases (upper range, 47) and 8% of outbreaks ≥ 20 cases (increasing to 32% with a 30-day delay to response). Increased outbreak size at detection (10 seed cases) and a 10-day median delay to response resulted in an epidemic size of 34 cases (upper range 67 cases) and < 1% of outbreaks < 20 cases. We estimated an annual global decrease in delay to response of 5.2% (95% CI 0.5-9.6, p = 0.03). Outbreaks signaled by immediate alerts were associated with a reduction in delay to response of 39.3% (95% CI 5.7-61.0, p = 0.03). CONCLUSIONS From 2008 to 2019, median delays from symptom onset of the primary case to case presentation and to response were 5 days and 10 days, respectively. Our model simulations suggest that depending on the outbreak size (3 versus 10 seed cases), in 8 to 99% of scenarios, a 10-day delay to response would result in large clusters that would be difficult to contain. Improving the delay to response involves rethinking the integration at local levels of event-based detection, rapid diagnostic testing for cluster validation, and integrated alert, investigation, and response.
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Affiliation(s)
- Ruwan Ratnayake
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. .,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK. .,Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - W John Edmunds
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
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Bang HN, Mbah MF, Ndi HN, Ndzo JA. Gauging Cameroon’s resilience to the COVID-19 pandemic: implications for enduring a novel health crisis. TRANSFORMING GOVERNMENT- PEOPLE PROCESS AND POLICY 2020. [DOI: 10.1108/tg-08-2020-0196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose
This paper aims to examine Cameroon’s health service resilience in the first five months (March–July 2020) of the coronavirus (COVID-19) outbreak. The motive is to diagnose sub-optimal performance in sustaining health-care services during the pandemic to identify areas for improvement and draw lessons for the future.
Design/methodology/approach
This is principally qualitative, exploratory, analytical and descriptive research that involves the collation of empirical, primary and secondary data. A conceptual framework [health systems resilience for emerging infectious diseases (HSREID)] provides structure to the study and an anchor for interpreting the findings. The research validity has been established by analysing the aims/objectives from multiple perspectives in the research tradition of triangulation.
Findings
Cameroon has exerted much effort to combat the COVID-19 pandemic. Yet, several constraints and gaps exist. The findings reveal limitations in Cameroon’s response to the COVID-19 pandemic in the provision of fundamental health-care services under contextual themes of health infrastructure/medical supplies, human capital, communication/sensitisation/health education, governance and trust/confidence. Analysis of the identified impediments demonstrates that Cameroon’s health-care system is not resilient enough to cope with the COVID-19 pandemic and provides several insights for an enhanced response as the pandemic accelerates in the country.
Originality/value
This is one of the first scholarly articles to examine how Cameroon’s health-care system is faring in COVID-19 combat. Underscored by the novel HSREID model, this study provides initial insights into Cameroon’s resilience to COVID-19 with a view to enhancing the health system’s response as the pandemic unfolds and strengthens readiness for subsequent health crises.
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Kim JH, Im J, Parajulee P, Holm M, Cruz Espinoza LM, Poudyal N, Mogeni OD, Marks F. A Systematic Review of Typhoid Fever Occurrence in Africa. Clin Infect Dis 2020; 69:S492-S498. [PMID: 31665777 PMCID: PMC6821235 DOI: 10.1093/cid/ciz525] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Our current understanding of the burden and distribution of typhoid fever in Africa relies on extrapolation of data from a small number of population-based incidence rate estimates. However, many other records on the occurrence of typhoid fever are available, and those records contain information that may enrich our understanding of the epidemiology of the disease as well as secular trends in reporting by country and over time. METHODS We conducted a systematic review of typhoid fever occurrence in Africa, published in PubMed, Embase, and ProMED (Program for Monitoring Emerging Diseases). RESULTS At least one episode of culture-confirmed typhoid fever was reported in 42 of 57 African countries during 1900-2018. The number of reports on typhoid fever has increased over time in Africa and was highly heterogeneous between countries and over time. Outbreaks of typhoid fever were reported in 15 countries, with their frequency and size increasing over time. CONCLUSIONS Efforts should be made to leverage existing typhoid data, for example, by incorporating them into models for estimating the burden and distribution of typhoid fever.
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Affiliation(s)
- Jong-Hoon Kim
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Justin Im
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Prerana Parajulee
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Marianne Holm
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Ligia Maria Cruz Espinoza
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Nimesh Poudyal
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Ondari D Mogeni
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Florian Marks
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea.,Department of Medicine, University of Cambridge, United Kingdom
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Steele L, Orefuwa E, Bino S, Singer SR, Lutwama J, Dickmann P. Earlier Outbreak Detection-A Generic Model and Novel Methodology to Guide Earlier Detection Supported by Data From Low- and Mid-Income Countries. Front Public Health 2020; 8:452. [PMID: 33014967 PMCID: PMC7516212 DOI: 10.3389/fpubh.2020.00452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 07/21/2020] [Indexed: 12/01/2022] Open
Abstract
Infectious disease outbreaks can have significant impact on individual health, national economies, and social well-being. Through early detection of an infectious disease, the outbreak can be contained at the local level, thereby reducing adverse effects on populations. Significant time and funding have been invested to improve disease detection timeliness. However, current evaluation methods do not provide evidence-based suggestions or measurements on how to detect outbreaks earlier. Key conditions for earlier detection and their influencing factors remain unclear and unmeasured. Without clarity about conditions and influencing factors, attempts to improve disease detection remain ad hoc and unsystematic. Methods: We developed a generic five-step disease detection model and a novel methodology to use for data collection, analysis, and interpretation. Data was collected in two workshops in Southeast Europe (n = 33 participants) and Southern and East Africa (n = 19 participants), representing mid- and low-income countries. Through systematic, qualitative, and quantitative data analyses, we identified key conditions for earlier detection and prioritized factors that influence them. As participants joined a workshop format and not an experimental setting, no ethics approval was required. Findings: Our analyses suggest that governance is the most important condition for earlier detection in both regions. Facilitating factors for earlier detection are risk communication activities such as information sharing, communication, and collaboration activities. Impeding factors are lack of communication, coordination, and leadership. Interpretation: Governance and risk communication are key influencers for earlier detection in both regions. However, inadequate technical capacity, commonly assumed to be a leading factor impeding early outbreak detection, was not found a leading factor. This insight may be used to pinpoint further improvement strategies.
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Affiliation(s)
- Lindsay Steele
- New York City Department of Health and Mental Hygiene, New York, NY, United States.,Connecting Organizations for Regional Disease Surveillance (CORDS), Lyon, France
| | - Emma Orefuwa
- Connecting Organizations for Regional Disease Surveillance (CORDS), Lyon, France
| | - Silvia Bino
- Institute of Public Health, Southern European Center for Surveillance and Control of Infectious Diseases (SECID), Tirana, Albania
| | | | - Julius Lutwama
- East African Integrated Disease Surveillance Network (EAIDSNet), Kampala, Uganda
| | - Petra Dickmann
- Connecting Organizations for Regional Disease Surveillance (CORDS), Lyon, France.,Department of Anaesthesiology and Intensive Care, Jena University Hospital, Jena, Germany.,Dickmann Risk Communication Drc
- , London, United Kingdom
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Tsuei SHT. How previous epidemics enable timelier COVID-19 responses: an empirical study using organisational memory theory. BMJ Glob Health 2020; 5:e003228. [PMID: 32967981 PMCID: PMC7513424 DOI: 10.1136/bmjgh-2020-003228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION There has been little systematic exploration into what affects timeliness of epidemic response, despite the potential for earlier responses to be more effective. Speculations have circulated that previous exposure to major epidemics helped health systems respond more quickly to COVID-19. This study leverages organisational memory theory to test whether health systems with any, more severe, or more recent exposure to major epidemics enacted timelier COVID-19 policy responses. METHODS A data set was constructed cataloguing 846 policies across 178 health systems in total, 37 of which had major epidemics within the last 20 years. Hypothesis testing used OLS regressions with World Health Organization region fixed effects, controlling for several health system expenditure and political variables. RESULTS Results show that exposure to any major epidemics was associated with providing earlier response in the following policy categories: all policies, surveillance/response, distancing, and international travel policies. The effect was about 6-10 days earlier response. The significance of this variable was largely nullified with the addition of the other two independent variables. Neither total cases nor years since previous epidemics showed no statistical significance. CONCLUSION This study suggests that health systems may learn from past major epidemics. Policymakers ought to institutionalise lessons from COVID-19. Future studies can examine specific generalisable lessons and whether timelier responses correlated with lower health and economic impacts.
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Affiliation(s)
- Sian Hsiang-Te Tsuei
- Global Health and Populations, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada
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20
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Almaghlouth I, Islam T, Alamro N, Alsultan A, Alfadda A, Al-Muhsen S, Almasry A, Almadi MA, Hersi A, BaHammam A. Mapping COVID-19 related research from Saudi Arabia, a scoping review. Between reality and dreams. Saudi Med J 2020; 41:791-801. [PMID: 32789418 PMCID: PMC7502955 DOI: 10.15537/smj.2020.8.25163] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To map research production by Saudi-affiliated investigators in order to identify areas of strength and weakness. Method: We followed the Arksey and O'Malley (2005) framework. Medline and Cochrane databases were searched with a focus on identifying articles related to COVID-19 and Saudi Arabia following the PRISMA protocol. The study was conducted at King Saud University, Riyadh, Saudi Arabia between March and May 2020. Results: A total of 53 articles were ultimately included. Most of the research production from Saudi Arabia was opinion and narrative reviews related to the clinicopathological features of COVID-19 as well as control and prevention of virus spread. Conclusion: The results of this scoping review identify a relative deficiency in original research, which requires further investigation.
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Affiliation(s)
- Ibrahim Almaghlouth
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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21
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Romero-Alvarez D, Parikh N, Osthus D, Martinez K, Generous N, Del Valle S, Manore CA. Google Health Trends performance reflecting dengue incidence for the Brazilian states. BMC Infect Dis 2020; 20:252. [PMID: 32228508 PMCID: PMC7104526 DOI: 10.1186/s12879-020-04957-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Dengue fever is a mosquito-borne infection transmitted by Aedes aegypti and mainly found in tropical and subtropical regions worldwide. Since its re-introduction in 1986, Brazil has become a hotspot for dengue and has experienced yearly epidemics. As a notifiable infectious disease, Brazil uses a passive epidemiological surveillance system to collect and report cases; however, dengue burden is underestimated. Thus, Internet data streams may complement surveillance activities by providing real-time information in the face of reporting lags. Methods We analyzed 19 terms related to dengue using Google Health Trends (GHT), a free-Internet data-source, and compared it with weekly dengue incidence between 2011 to 2016. We correlated GHT data with dengue incidence at the national and state-level for Brazil while using the adjusted R squared statistic as primary outcome measure (0/1). We used survey data on Internet access and variables from the official census of 2010 to identify where GHT could be useful in tracking dengue dynamics. Finally, we used a standardized volatility index on dengue incidence and developed models with different variables with the same objective. Results From the 19 terms explored with GHT, only seven were able to consistently track dengue. From the 27 states, only 12 reported an adjusted R squared higher than 0.8; these states were distributed mainly in the Northeast, Southeast, and South of Brazil. The usefulness of GHT was explained by the logarithm of the number of Internet users in the last 3 months, the total population per state, and the standardized volatility index. Conclusions The potential contribution of GHT in complementing traditional established surveillance strategies should be analyzed in the context of geographical resolutions smaller than countries. For Brazil, GHT implementation should be analyzed in a case-by-case basis. State variables including total population, Internet usage in the last 3 months, and the standardized volatility index could serve as indicators determining when GHT could complement dengue state level surveillance in other countries.
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Affiliation(s)
- Daniel Romero-Alvarez
- Department of Ecology & Evolutionary Biology and Biodiversity Institute, University of Kansas, Lawrence, Kansas, USA. .,Information Systems and Modeling (A-1), Los Alamos National Laboratory, Los Alamos, NM, USA.
| | - Nidhi Parikh
- Information Systems and Modeling (A-1), Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Dave Osthus
- Statistical Sciences (CCS-6), Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Kaitlyn Martinez
- Information Systems and Modeling (A-1), Los Alamos National Laboratory, Los Alamos, NM, USA.,Applied Math and Statistics, Colorado School of Mines, Golden, CO, USA
| | - Nicholas Generous
- National Security & Defense Program Office (GS-NSD), Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Sara Del Valle
- Information Systems and Modeling (A-1), Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Carrie A Manore
- Information Systems and Modeling (A-1), Los Alamos National Laboratory, Los Alamos, NM, USA
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Researching Zika in pregnancy: lessons for global preparedness. THE LANCET. INFECTIOUS DISEASES 2020; 20:e61-e68. [PMID: 32085848 DOI: 10.1016/s1473-3099(20)30021-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 01/09/2020] [Accepted: 01/12/2020] [Indexed: 11/20/2022]
Abstract
Our understanding of congenital infections is based on prospective studies of women infected during pregnancy. The EU has funded three consortia to study Zika virus, each including a prospective study of pregnant women. Another multi-centre study has been funded by the US National Institutes of Health. This Personal View describes the study designs required to research Zika virus, and questions whether funding academics in the EU and USA to work with collaborators in outbreak areas is an effective strategy. 3 years after the 2015-16 Zika virus outbreaks, these collaborations have taught us little about vertical transmission of the virus. In the time taken to approve funding, agree contracts, secure ethics approval, and equip laboratories, Zika virus had largely disappeared. By contrast, prospective studies based on local surveillance and standard-of-care protocols have already provided valuable data. Threats to fetal and child health pose new challenges for global preparedness requiring support for the design and implementation of locally appropriate protocols. These protocols can answer the key questions earlier than externally designed studies and at lower cost. Local protocols can also provide a framework for recruitment of unexposed controls that are required to study less specific outcomes. Other priorities include accelerated development of non-invasive tests, and longer-term storage of neonatal and antenatal samples to facilitate retrospective reconstruction of cohort studies.
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Worsnop CZ. Concealing Disease: Trade and Travel Barriers and the Timeliness of Outbreak Reporting. INTERNATIONAL STUDIES PERSPECTIVES 2019; 20:344-372. [PMID: 38626279 PMCID: PMC7149472 DOI: 10.1093/isp/ekz005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Slow outbreak reporting by states is a key challenge to effectively responding to global health emergencies like Zika, Ebola, and H1N1. Current policy focuses on improving domestic outbreak surveillance capacity globally in order to reduce reporting lags. However, governments also face economic and political incentives to conceal outbreaks, and these incentives largely are ignored in policy discussions. In spite of the policy implications for outbreak response, the "capacity" and "will" explanations have not been systematically examined. Analysis of a dataset coding the timeliness of outbreak reporting from 1996-2014 finds evidence that states' unwillingness to report-rather than just their inability-leads to delayed reporting. The findings suggest that though building surveillance capacity is critical, doing so may not be sufficient to reduce reporting lags. Policy aimed at encouraging rapid reporting must also mitigate the associated economic and political costs.
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Hannah H, Brezak A, Hu A, Chiwanda S, Simckes M, Revere D, Shambira G, Tshimanga M, Mberikunashe J, Juru T, Gombe N, Kasprzyk D, Montaño D, Baseman J. Field-based evaluation of malaria outbreak detection and response in Mudzi and Goromonzi districts, Zimbabwe - 2017. Glob Public Health 2019; 14:1898-1910. [PMID: 31303135 DOI: 10.1080/17441692.2019.1642367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
National-level evaluations may fail to identify capacity improvements for detecting and responding to outbreaks which begin and are first detected at the local level. In response to this issue, we conducted a field-based assessment of the malaria outbreak surveillance system in Mashonaland East, Zimbabwe. We visited eleven clinics in Mudzi and Goromonzi districts. Twenty-one interviews were conducted with key informants from the provincial (n = 2), district (n = 7), and clinic (n = 12) levels. Interviews focused on surveillance system activities, preparedness, data quality, timeliness, stability, and usefulness. Main themes were captured utilising standard qualitative data analysis techniques. While the surveillance system detects malaria outbreaks at all levels, we identified several gaps. Clinics experience barriers to timely and reliable reporting of outbreaks to the district level and staff cross-training. Stability of resources, including transportation (33% of informants, n = 7) and staff capacity (48% of informants, n = 10), presented barriers. Strengthening these surveillance barriers may improve staff readiness to detect malaria outbreaks, resulting in timelier outbreak response and a reduction in malaria outbreaks, cases, and deaths. By focusing at the local level, our assessment approach provides a framework for identifying and addressing gaps that may be overlooked when utilising tools that evaluate surveillance capacity at the national level.
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Affiliation(s)
- Haylea Hannah
- Department of Epidemiology, School of Public Health, University of Washington , Seattle , WA , United States of America
| | - Audrey Brezak
- Department of Epidemiology, School of Public Health, University of Washington , Seattle , WA , United States of America
| | - Audrey Hu
- Department of Epidemiology, School of Public Health, University of Washington , Seattle , WA , United States of America
| | - Simbarashe Chiwanda
- Department of Community Medicine, Field Epidemiology Training Program, University of Zimbabwe , Harare , Zimbabwe
| | - Maayan Simckes
- Department of Epidemiology, School of Public Health, University of Washington , Seattle , WA , United States of America
| | - Debra Revere
- Department of Health Services, School of Public Health, University of Washington , Seattle , United States of America
| | - Gerald Shambira
- Department of Community Medicine, Field Epidemiology Training Program, University of Zimbabwe , Harare , Zimbabwe
| | - Mufuta Tshimanga
- Department of Community Medicine, Field Epidemiology Training Program, University of Zimbabwe , Harare , Zimbabwe
| | - Joseph Mberikunashe
- Ministry of Health and Child Care, National Malaria Control Program , Harare , Zimbabwe
| | - Tsitsi Juru
- Department of Community Medicine, Field Epidemiology Training Program, University of Zimbabwe , Harare , Zimbabwe
| | - Notion Gombe
- Department of Community Medicine, Field Epidemiology Training Program, University of Zimbabwe , Harare , Zimbabwe
| | - Danuta Kasprzyk
- Departments of Family and Child Nursing and Global Health, University of Washington , Seattle , WA , United States of America
| | - Daniel Montaño
- Departments of Family and Child Nursing and Global Health, University of Washington , Seattle , WA , United States of America
| | - Janet Baseman
- Department of Epidemiology, School of Public Health, University of Washington , Seattle , WA , United States of America.,Department of Health Services, School of Public Health, University of Washington , Seattle , United States of America
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Worsnop CZ. The Disease Outbreak-Human Trafficking Connection: A Missed Opportunity. Health Secur 2019; 17:181-192. [PMID: 31173508 DOI: 10.1089/hs.2018.0134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article examines the connection between disease outbreaks and human trafficking. A central challenge in combating trafficking is poor data on its nature and scope. One way to deal with these gaps in knowledge and still target resources effectively is to identify key "push and pull" factors that increase the likelihood of trafficking from origin countries and to destination countries. One under-examined push factor is the outbreak of disease. Outbreaks are associated with several well-documented trafficking risk factors, from the breakdown of rule of law and increase in criminal activity to competition for resources and diminished economic opportunity. Disease outbreaks can also disrupt family ties. For example, the 2014 Ebola outbreak in West Africa left thousands of orphans at increased risk of exploitation. The article outlines possible mechanisms through which outbreaks could increase trafficking risk and, using data on disease outbreaks and trafficking across states over the past 2 decades, provides evidence that countries that have recently experienced a disease outbreak are more likely to have trafficking outflows. The findings point to the importance of integrating trafficking prevention into outbreak response and call for a research agenda more fully examining the connection between trafficking and outbreaks (and potentially other types of natural disasters as well).
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Affiliation(s)
- Catherine Z Worsnop
- Catherine Z. Worsnop, PhD, is an Assistant Research Professor in the School of Public Policy, University of Maryland, College Park, Maryland
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Oppenheim B, Gallivan M, Madhav NK, Brown N, Serhiyenko V, Wolfe ND, Ayscue P. Assessing global preparedness for the next pandemic: development and application of an Epidemic Preparedness Index. BMJ Glob Health 2019; 4:e001157. [PMID: 30775006 PMCID: PMC6352812 DOI: 10.1136/bmjgh-2018-001157] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/24/2018] [Accepted: 12/03/2018] [Indexed: 01/15/2023] Open
Abstract
Introduction Robust metrics for national-level preparedness are critical for assessing global resilience to epidemic and pandemic outbreaks. However, existing preparedness assessments focus primarily on public health systems or specific legislative frameworks, and do not measure other essential capacities that enable and support public health preparedness and response. Methods We developed an Epidemic Preparedness Index (EPI) to assess national-level preparedness. The EPI is global, covering 188 countries. It consists of five subindices measuring each country’s economic resources, public health communications, infrastructure, public health systems and institutional capacity. To evaluate the construct validity of the EPI, we tested its correlation with proxy measures for preparedness and response capacity, including the timeliness of outbreak detection and reporting, as well as vaccination rates during the 2009 H1N1 influenza pandemic. Results The most prepared countries were concentrated in Europe and North America, while the least prepared countries clustered in Central and West Africa and Southeast Asia. Better prepared countries were found to report infectious disease outbreaks more quickly and to have vaccinated a larger proportion of their population during the 2009 pandemic. Conclusion The EPI measures a country’s capacity to detect and respond to infectious disease events. Existing tools, such as the Joint External Evaluation (JEE), have been designed to measure preparedness within a country over time. The EPI complements the JEE by providing a holistic view of preparedness and is constructed to support comparative risk assessment between countries. The index can be updated rapidly to generate global estimates of pandemic preparedness that can inform strategy and resource allocation.
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Affiliation(s)
| | | | | | - Naor Brown
- Metabiota, San Francisco, California, USA
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27
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Global Emerging Pathogens, Poverty and Vulnerability: An Ethical Analysis. SOCIO-CULTURAL DIMENSIONS OF EMERGING INFECTIOUS DISEASES IN AFRICA 2019. [PMCID: PMC7123202 DOI: 10.1007/978-3-030-17474-3_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the last few decades, the world has witnessed the emergence and re-emergence of new and old infectious diseases. Emerging infectious diseases (EIDs) have the capacity to spread rapidly from one region of the world to another, within a very short time, due to world travel and increased global interdependence. The impact of this varies from one region to another. Resource poor countries suffer the most due to an already high disease burden, poor infrastructures, lack of clean, potable water and sanitation, as well as an acute shortage of qualified health personnel to manage, control and contain the crisis/spread. Poor and marginalized communities are the most vulnerable because infectious diseases cause not only suffering and death, but also severe economic hardship. The outbreak of HIV/AIDS, tuberculosis and Ebola Virus Disease (EVD) in the developing world has shown the extent to which economic and social conditions can affect vulnerable populations. These socio-economic, cultural and environmental conditions accelerate the spread of, and exacerbate the negative impact of emerging pathogens. This chapter will undertake an analysis of the trend in global emerging pathogens, their economic impact, the global vulnerability status and ethical implications.
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Lawpoolsri S, Kaewkungwal J, Khamsiriwatchara A, Sovann L, Sreng B, Phommasack B, Kitthiphong V, Lwin Nyein S, Win Myint N, Dang Vung N, Hung P, S. Smolinski M, W. Crawley A, Ko Oo M. Data quality and timeliness of outbreak reporting system among countries in Greater Mekong subregion: Challenges for international data sharing. PLoS Negl Trop Dis 2018; 12:e0006425. [PMID: 29694372 PMCID: PMC5937798 DOI: 10.1371/journal.pntd.0006425] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 05/07/2018] [Accepted: 04/02/2018] [Indexed: 11/19/2022] Open
Abstract
Cross-border disease transmission is a key challenge for prevention and control of outbreaks. Variation in surveillance structure and national guidelines used in different countries can affect their data quality and the timeliness of outbreak reports. This study aimed to evaluate timeliness and data quality of national outbreak reporting for four countries in the Mekong Basin Disease Surveillance network (MBDS). Data on disease outbreaks occurring from 2010 to 2015 were obtained from the national disease surveillance reports of Cambodia, Lao PDR, Myanmar, and Vietnam. Data included total cases, geographical information, and dates at different timeline milestones in the outbreak detection process. Nine diseases or syndromes with public health importance were selected for the analysis including: dengue, food poisoning & diarrhea, severe diarrhea, diphtheria, measles, H5N1 influenza, H1N1 influenza, rabies, and pertussis. Overall, 2,087 outbreaks were reported from the four countries. The number of outbreaks and number of cases per outbreak varied across countries and diseases, depending in part on the outbreak definition used in each country. Dates on index onset, report, and response were >95% complete in all countries, while laboratory confirmation dates were 10%-100% incomplete in most countries. Inconsistent and out of range date data were observed in 1%-5% of records. The overall timeliness of outbreak report, response, and public communication was within 1-15 days, depending on countries and diseases. Diarrhea and severe diarrhea outbreaks showed the most rapid time to report and response, whereas diseases such as rabies, pertussis and diphtheria required a longer time to report and respond. The hierarchical structure of the reporting system, data collection method, and country's resources could affect the data quality and timeliness of the national outbreak reporting system. Differences in data quality and timeliness of outbreak reporting system among member countries should be considered when planning data sharing strategies within a regional network.
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Affiliation(s)
- Saranath Lawpoolsri
- The Center for Biomedical and Public Health Informatics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jaranit Kaewkungwal
- The Center for Biomedical and Public Health Informatics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Amnat Khamsiriwatchara
- The Center for Biomedical and Public Health Informatics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ly Sovann
- Department of Communicable Disease Control, Ministry of Health, Phnom Penh, Cambodia
| | - Bun Sreng
- Department of Communicable Disease Control, Ministry of Health, Phnom Penh, Cambodia
| | | | | | - Soe Lwin Nyein
- Department of Public Health, Ministry of Health and Sports, Naypyidaw, Myanmar
| | - Nyan Win Myint
- Department of Public Health, Ministry of Health and Sports, Naypyidaw, Myanmar
| | - Nguyen Dang Vung
- Institute for Preventive Medicine & Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Pham Hung
- Department of Disease Control, Ministry of Health, Hanoi, Vietnam
| | - Mark S. Smolinski
- Ending Pandemics, San Francisco, California, United States of America
| | - Adam W. Crawley
- Ending Pandemics, San Francisco, California, United States of America
| | - Moe Ko Oo
- Mekong Basin Disease Surveillance Foundation, Nonthaburi, Thailand
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Lorthe TS, Pollack MP, Lassmann B, Brownstein JS, Cohn E, Divi N, Herrera-Guibert DJ, Olsen J, Smolinski MS, Madoff LC. Evaluation of the EpiCore outbreak verification system. Bull World Health Organ 2018; 96:327-334. [PMID: 29875517 PMCID: PMC5985427 DOI: 10.2471/blt.17.207225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/18/2017] [Accepted: 02/19/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To describe a crowdsourced disease surveillance project (EpiCore) and evaluate its usefulness in obtaining information regarding potential disease outbreaks. Methods Volunteer human, animal and environmental health professionals from around the world were recruited to EpiCore and trained to provide early verification of health threat alerts in their geographical region via a secure, easy-to-use, online platform. Experts in the area of emerging infectious diseases sent requests for information on unverified health threats to these volunteers, who used local knowledge and expertise to respond to requests. Experts reviewed and summarized the responses and rapidly disseminated important information to the global health community through the existing event-based disease surveillance network, ProMED. Findings From March 2016 to September 2017, 2068 EpiCore volunteers from 142 countries were trained in methods of informal disease surveillance and use of the EpiCore online platform. These volunteers provided 790 individual responses to 759 requests for information addressing unverified health threats in 112 countries; 361 (45%) responses were considered to be useful. Most responses were received within hours of the requests. The responses led to 194 ProMED posts, of which 99 (51%) supported verification of an outbreak, were published on ProMED and sent to over 87 000 subscribers. Conclusion There is widespread willingness among health professionals around the world to voluntarily assist efforts to verify and provide supporting information on unconfirmed health threats in their region. By linking this member network of health experts through a secure online reporting platform, EpiCore enables faster global outbreak detection and reporting.
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Affiliation(s)
- Taryn Silver Lorthe
- International Society for Infectious Diseases, 9 Babcock Street, Brookline, Massachusetts, 02446, United States of America (USA)
| | - Marjorie P Pollack
- International Society for Infectious Diseases, 9 Babcock Street, Brookline, Massachusetts, 02446, United States of America (USA)
| | - Britta Lassmann
- International Society for Infectious Diseases, 9 Babcock Street, Brookline, Massachusetts, 02446, United States of America (USA)
| | - John S Brownstein
- HealthMap, Harvard Medical School, Boston's Children's Hospital, Boston, USA
| | - Emily Cohn
- HealthMap, Harvard Medical School, Boston's Children's Hospital, Boston, USA
| | | | | | | | | | - Lawrence C Madoff
- International Society for Infectious Diseases, 9 Babcock Street, Brookline, Massachusetts, 02446, United States of America (USA)
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Halliday JEB, Hampson K, Hanley N, Lembo T, Sharp JP, Haydon DT, Cleaveland S. Driving improvements in emerging disease surveillance through locally relevant capacity strengthening. Science 2018; 357:146-148. [PMID: 28706036 DOI: 10.1126/science.aam8332] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Emerging infectious diseases (EIDs) threaten the health of people, animals, and crops globally, but our ability to predict their occurrence is limited. Current public health capacity and ability to detect and respond to EIDs is typically weakest in low- and middle-income countries (LMICs). Many known drivers of EID emergence also converge in LMICs. Strengthening capacity for surveillance of diseases of relevance to local populations can provide a mechanism for building the cross-cutting and flexible capacities needed to tackle both the burden of existing diseases and EID threats. A focus on locally relevant diseases in LMICs and the economic, social, and cultural contexts of surveillance can help address existing inequalities in health systems, improve the capacity to detect and contain EIDs, and contribute to broader global goals for development.
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Affiliation(s)
- Jo E B Halliday
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Katie Hampson
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Nick Hanley
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, Scotland, UK
| | - Tiziana Lembo
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Joanne P Sharp
- School of Geographical and Earth Sciences, University of Glasgow, Glasgow, UK
| | - Daniel T Haydon
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
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Suthar AB, Allen LG, Cifuentes S, Dye C, Nagata JM. Lessons learnt from implementation of the International Health Regulations: a systematic review. Bull World Health Organ 2017; 96:110-121E. [PMID: 29403114 PMCID: PMC5791773 DOI: 10.2471/blt.16.189100] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 10/26/2017] [Accepted: 11/14/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To respond to the World Health Assembly call for dissemination of lessons learnt from countries that have begun implementing the International Health Regulations, 2005 revision; IHR (2005). Methods In November 2015, we conducted a systematic search of the following online databases and sources: PubMed®, Embase®, Global Health, Scopus, World Health Organization (WHO) Global Index Medicus, WHO Bulletin on IHR Implementation and the International Society for Disease Surveillance. We included identified studies and reports summarizing national experience in implementing any of the IHR (2005) core capacities or their components. We excluded studies that were theoretical or referred to IHR (1969). Qualitative systematic review methodology, including meta-ethnography, was used for qualitative synthesis. Findings We analysed 51 articles from 77 countries representing all WHO Regions. The meta-syntheses identified a total of 44 lessons learnt across the eight core capacities of IHR (2005). Major themes included the need to mobilize and sustain political commitment; to adapt global requirements based on local sociocultural, epidemiological, health system and economic contexts; and to conduct baseline and follow-up assessments to monitor the status of IHR (2005) implementation. Conclusion Although experiences of IHR (2005) implementation covered a wide global range, more documentation from Africa and Eastern Europe is needed. We did not find specific areas of weakness in monitoring IHR (2005); sustained monitoring of all core capacities is required to ensure effective systems. These lessons learnt could be adapted by countries in the process of meeting IHR (2005) requirements.
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Affiliation(s)
- Amitabh B Suthar
- South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa
| | - Lisa G Allen
- TMF Health Quality Institute, Austin, United States of America (USA)
| | - Sara Cifuentes
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, USA
| | - Christopher Dye
- Department of Strategy, Policy and Information, World Health Organization, Geneva, Switzerland
| | - Jason M Nagata
- Department of Pediatrics, University of California San Francisco, San Francisco, USA
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Abstract
Rapid detection, reporting, and response to an infectious disease outbreak are critical to prevent localized health events from emerging as pandemic threats. Metrics to evaluate the timeliness of these critical activities, however, are lacking. Easily understood and comparable measures for tracking progress and encouraging investment in rapid detection, reporting, and response are sorely needed. We propose that the timeliness of outbreak detection, reporting, laboratory confirmation, response, and public communication should be considered as measures for improving global health security at the national level, allowing countries to track progress over time and inform investments in disease surveillance.
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