Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System A Program Review (2001) / Chapter Skim
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7 GEIS Central Hub and Military Health System Activities
7 GEIS Central Hub and Military Health System Activities
Pages 121-158
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From page 121... ...
do not constitute a domestic program per se but are conceptually linked to GEIS as a whole as part of a system of global emerging infectious disease surveillance. As a triservice program, GEIS has taken an approach that pursues gaps in the MHS's capability to identify and address emerging infectious diseases and works to remedy those gaps by building infrastructure, facilitating and supporting response capabilities, providing training and education, and strengthening surveillance capabilities.
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To better understand the nature of the domestic and global emerging infections surveillance activities of the DoD, committee members made a site visit to San Diego, California, in lanuary 2001. There the committee visited the Naval Health Research Center (NHRC)
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. Identification of a testing site can be particularly difficult for rare or emerging infectious diseases, as frequently only one laboratory is capable of performing tests (Ascher, 2000~.
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Collabor; USAMRI. Madigan ESSENCE (syndromic surveillance for emerging infectious diseases and bioterrorism events in National Capital Area)
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GEIS CENTRAL HUB AND MILITARY HEALTH SYSTEM ACTIVITIES 125 Budgeted Lead Agents and GEIS Funding, GEIS Funding, Project Primary Collaborators FY 2000 FY 2001a Status AFIP $60,000 $320,000b Prototype capacity USAMRIID $125,000C $135,000C Ongoing Tricare Management $15,000 $55,000 CHCS II in Activity development iruses A NHRC $650,000 $705,000 Funded projects under way tboratory- AFIERA $508,000 $590,000 Ongoing 1) AFIP $100,000 $105,000b Additional CHPPM component in development ct Central Hub in $20,000 Beginning at collaboration with sentinel site in CDC, WHO, and Hawaii, domestic and overseas expansion military sites planned pilot project Central Hub in $64,000 $60,000 Beginning at collaboration with Army sentinel site in and Air Force medical Hawaii, centers; CRDA between expansion GEIS, WRAIR, and MRL planned Pharmaceuticals, Inc.
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Army Medical Research Institute of Infectious Diseases; NHRC, Naval Health Research Center; AFIERA, Air Force Institute for Environmental Safety and Occupational Health Risk Analysis; ESSENCE, Electronic Surveillance System for the Early Notification of Community-Based Epidemics; CHPPM, Center for Health Promotion and Preventive Medicine, U.S.
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Gubenia, Department of Defense Global Emerging Infections Surveillance and Response System, June 21, 2001. CDirect GEIS funding.
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GEIS supports the USAMRIID infrastructure as a means of maintaining capacity for emerging infectious disease surveillance and response. This support is provided on the basis of the assertion that a broad, operationally oriented DoD reference laboratory for the isolation and identification of unusual etiologic agents and the diagnosis of infectious diseases requiring high levels of containment is in the interest of GEIS (GEIS, 2000b)
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From page 131... ...
However, at the Military Public Health Laboratory Symposium and Workshop held in September 1999, the workshop group recommended that all requests for testing made as part of the DoD Directory of Public Health Laboratory Services be entered into the DoD's laboratory information system, the CHCS (or CHCS II) , to create an audit trail for test requests, to make results quickly available to those with system access, and to promote proper archiving of data (Bolton and Gaydos, 2000~.
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Laboratory staff conduct surveillance for the emergence of new pathogenic strains and the development of antibiotic resistance. The laboratory team also follows large cohorts of military personnel in prospective epidemiological studies of respiratory disease and conducts large clinical trials of interventions for the prevention or treatment of respiratory diseases (NHRC, 2001b)
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From page 133... ...
, coupled with GEIS funding, fueled program expansion in 1998. The Air Forces's etiology-based surveillance program, formerly called Project Gargle, is now the Department of Defense Laboratory-Based Influenza Surveillance Program, in which 19 global sentinel sites, 49 nonsentinel sites, and 3 DoD overseas medical research laboratories participate (GEIS, 2000b, 2001e)
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, which is linked to GEISWeb. GEIS-supported, AFIERA-managed activities also include additional surveillance work (e.g., trainee health surveillance and West Nile virus surveillance)
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, a project for syndromic surveillance for emerging infectious diseases and bioterrorism events in the National Capital Area)
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This program is intended to detect emerging infectious disease epidemics, including bioterrorist events, for the purposes of instigating a timely response, promoting rapid epidemiology-based targeting of limited response assets (e.g., personnel and drugs) , and equipping leaders in civil government to communicate risk
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Navy and U.S. Marine Corps forces are continuously deployed to remote regions throughout the world and thus are at increased risk of encountering emerging infectious diseases.
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GEIS also sponsors a separate surveillance activity, conducted by Navy Environmental and Preventive Medicine Units 2 (NEPMU-2)
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Most of the collaboration is with the Goddard Space Flight Center, but GEIS also collaborates with several other agencies. The objectives of the program are to identify links between the environment and emerging diseases, develop methods to detect linked environmental events by remote sensing, conduct surveillance, predict emerging infectious diseases by use of remote sensing, and publish maps of areas of risk on the World Wide Web for use by the WHO and other agencies.
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From page 140... ...
The National Institutes of Health Fogarty International Center serves as the secretariat of the alliance, although the Wellcome Trust has served in this capacity in the past. MIM is funded primarily by the National Institute of Allergy and Infectious Diseases, the WHO Special Program for Research and Training in Tropical Diseases (which administers MIM scientific projects)
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From page 141... ...
. Also, through participation in military medical conferences, AFEB and IOM meetings, meetings of the Joint Preventive Medicine Policy Group and other staff meetings, and review of documents, GEIS attempts to identify emerging infectious disease problem areas, document these problems, develop an awareness regarding the problems, and develop and recommend solutions and foster the implementation and evaluation of interventions.
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Army Health Facilities Planning Agency Support to the Caribbean Epidemiology Center In 1996, WRAIR staff, dispatched to the Caribbean region at the request of the Atlantic Command, determined that the existing public health surveillance capacity was insufficient (Writer, 2001b)
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Emerging Infectious Diseases Working Group acknowledged the creation of a DoD Internet-based Central Communications Hub (a GEIS website) as one of the early accomplishments of GEIS.
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The GEIS Central Hub has access to a flag-level3 advisory board (Lister, 1997~. The GEIS Advisory Board is chaired by DoD (Health Affairs)
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: · International Conference on Emerging Infectious Diseases (1998 and 2000) · Military Public Health Laboratory Symposium and Workshop, September 21-23, 1999
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Within the MHS and through the Central Hub, GEIS is supporting a number of infectious disease surveillance projects that have the potential to detect emerging infections. These projects encompass GEIS pillar targets, such as drug resistance (e.g., antimalarial drug resistance surveillance, antimicrobial resistance surveillance pilot project, GISP site development)
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From page 147... ...
and detracts from the development of a cohesive, recognizable program whole. GEIS, with its triservice focus and coordinating role, can contribute substantially to DoD training activities relevant to emerging infectious disease surveillance and response.
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For instance, development of the ESSENCE bioterrorism surveillance system, development of an emerging infectious disease alert component for the new DoD mortality surveillance system, support of the exploratory use of GIS and remote-sensing techniques for surveillance purposes (e.g., surveillance for STDs at Madigan Army Hospital and remote-sensing collaborations with NASA) , and many other projects exemplify GEIS's commitment to using new and diverse methods to create a DoD surveillance system that is sensitive to emerging infectious diseases.
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In particular, the Central Hub has, to date, been opportunistically focused on identifying and filling critical gaps in DoD infectious disease surveillance and response capabilities and establishing a base of projects in support of GEIS goals. In doing so, GEIS has amassed an array of projects that, although all valuable in their own right, do not fit together smoothly as part of a cohesive, conspicuous GEIS whole.
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If constructed wisely,5 the DoD Directory of Public Health Laboratory Services and the broader concept of the Virtual Public Health Laboratory can help make DoD laboratory resources more accessible to GEIS sites and others, encouraging collaboration and use of the full spectrum of DoD laboratory capabilities in the conduct of GEIS projects. GEISWeb also plays a role in fostering communication and the dissemination of information regarding GEIS projects.
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military population and for support of the efforts of the overseas medical research laboratories. GEIS investment in MHS public health laboratory activities should focus on developing strong capabilities for identifying and responding to emerging infectious diseases and cultivating collaborative relationships among laboratories so that capabilities are optimally used.
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· GEIS can contribute substantially to DoD training activities relevant to emerging infectious disease surveillance and response. The Overseas Medical Research Laboratory Orientation Training Program and other ad hoc training activities currently in place are noteworthy and important, but additional GEIS involvement in the training of research and public health professionals including, but not limited to, DoD personnel can make existing training activities more efficient, productive, and visible and can help encourage the development of additional training programs.
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Consistently interact with staff directing GEIS projects to monitor project progress, evolving potential for collaboration, and needs for assistance. · It is important that projects be directed by regionally appropriate overseas and MHS-based laboratories.
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154 PERSPECTIVES ON GEIS 1300-1345 Lunch at NHRC 1345-1415 Tour of NHRC GEIS CAPT Gray 1415-1500 Travel to NEPMU 1500-1525 Review of NEHC GEIS Activities CDR Murphy 1525-1545 Review of NEPMU GEIS Activities CDR Thornton 1545-1605 Tour of NEPMU CAPT Tueller 1605-1635 Travel to Naval Hospital, San Diego 1635-1710 Presentation on Antibiotic Resistance Surveillance CAPT Davis 1710-1800 Naval hospital laboratory and questions for and laboratory staff on laboratory-based surveillance for reportable infections and antibiotic resistance 1900 Dinner for presenters and IOM committee members Wednesday, January 10, 2001 (at NHRC) 0800-0845 ESSENCE, and Syndromic Surveillance MAr Pavlin 0845-0910 Madigan STD Project COL Gunzenhauser 0910-0940 Korea Malaria Surveillance MAr Pavlin and LTC Klein 0940-1010 Uganda Projects MAr Pavlin 1010-1100 Follow-questions and discussions 1100 IOM committee members to return to hotel for working session Fifth Meeting of the Institute of Medicine Committee to Review the Department of Defense Global Emerging Infections Surveillance and Response System Washington, DC 66, 7, 8 March 2001 Tuesday, March 6, 2001: Site Visit, Ft.
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Philip Brachman AFIP Virtual Public Health Laboratory Dr. Joel Gaydos and Dr.
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Davis, Department of Defense Global Emerging Infections Surveillance and Response System, Division of Preventive Medicine, Walter Reed Army Institute of Research, Silver Spring, Maryland Matthew DiFranco, collaborator, Naval Health Research Center respiratory disease surveillance projects, San Diego, California Benedict Diniega, Chemical and Biological Defense Health Affairs, U.S. Department of Defense, Washington, District of Columbia Maria Gabriela Fernandez-DiFranco, Naval Health Research Center, San Diego, California Joel Gaydos, Department of Defense Global Emerging Infections Surveillance and Response System, Division of Preventive Medicine, Walter Reed Army Institute of Research, Silver Spring, Maryland Michele Ginsberg, San Diego County Health Department, San Diego, California John Frazier Glenn, Medical Research and Materiel Command, Ft.
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Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland Victor Macintosh, Preventive Medicine Division, Air Force Medical Operations Agency Marrietta Malasig, Naval Health Research Center, San Diego, California AbuBakr Marzouk, Office of the Air Force Medical Examiner, Armed Forces Institute of Pathology, Washington, District of Columbia Michael McCarthy, Department of Defense Global Emerging Infections Surveillance and Response System, Division of Preventive Medicine, Walter Reed Army Institute of Research, Silver Spring, Maryland ramie McKeehan, Naval Health Research Center, San Diego, California Wilbur K
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158 PERSPECTIVES ON GEIS lames Writer, Department of Defense Global Emerging Infections Surveillance and Response System, Division of Preventive Medicine, Walter Reed Army Institute of Research, Silver Spring, Maryland
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