Global Infectious Disease Surveillance and Detection Assessing the Challenges–Finding Solutions: Workshop Summary (2007) / Chapter Skim
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2 Surveillance Networks
2 Surveillance Networks
Pages 107-157
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From page 107... ...
The papers collected in this chapter describe a variety of electronic surveillance networks, designed to gather and integrate information on infectious disease from a variety of nontraditional sources (e.g., Internet sites, news outlets, observers with little or no medical training) and to disseminate alerts broadly and rapidly.
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From page 108... ...
The concluding paper of the chapter describes a different sort of electronic surveillance network: one powered by cell phones, enabling observers in some of the world's most remote and impoverished communities to report disease outbreaks. The authors are workshop speakers Pamela Johnson of Voxiva, a company that provides information technology to establish surveillance networks in low-resource settings, and David Blazes, of the U.S.
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From page 109... ...
, we must learn to expect the unexpected. It is widely agreed that one of the most important measures for both emerging and existing infectious diseases is an effective early warning system, that is to say, global infectious disease surveillance.
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Hughes (then at CDC) , John LaMontagne (then at NIH's National Institute of Allergy and Infectious Diseases, or NIAID)
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From page 111... ...
Since 1995, the system has been available on the Web,4 as well as by e-mail subscription. The partnership between ProMED and SatelLife continued fruitfully until 1999, when the ProMED reporting network was transferred to the International Society for Infectious Diseases (ISID)
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All subscribers are free to comment or add information after reading the posting. In addition to the full list, which includes outbreak reports and discussions on human, veterinary, and plant diseases, there are several sublists for those who want only certain parts of this information.
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From page 113... ...
This strategy was originally adopted by GPHIN (the Canadian government's Global Public Health Intelligence Network) , which is described in another chapter.
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From page 114... ...
In addition to outbreak reporting, it provides the ability for people to recognize that what they are observing may be happening elsewhere, too. An initial report may encourage others to contribute local information that may help to estimate the extent and numbers of an infectious disease outbreak, and to monitor spread.
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From page 115... ...
Joseph (formerly New York City Health Commissioner, Dean of the Minnesota School of Public Health, and Assistant Secretary of Defense for Health Affairs) referred to PMM as "the CNN of infectious diseases" (Personal communication, S
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From page 116... ...
Any global surveillance system has to overcome several challenges; basically, it requires a good system for communications to and from the field to get timely collection, analysis, and dissemination of data, and to be able to force political decisions and allocation of resources. However, susceptibility to infectious diseases and increased risks of infection are usually associated with poverty, and poverty is more frequent in those countries where epidemiological and laboratory surveillance is defective or nonexistent (Heymann and Rodier, 2001)
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From page 117... ...
The use of nontraditional surveillance systems has contributed to the improvement of epidemic intelligence used for the early detection of potential public health threats. This has enabled WHO and other public health organizations such as the European Center for Disease Control (ECDC)
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From page 118... ...
All these surveillance systems disseminate relevant reports to the public health community in a timely manner. Global Public Health Intelligence Network GPHIN is an early warning system that takes advantage of existing information technology to continuously scrutinize news media sources through news aggregators who have contracts with newspapers around the world, as well as with health and science websites.
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From page 119... ...
. Its mission is "to provide early warning, 7 days a week year around, of outbreaks of emerging infectious diseases and episodes of acute toxicity, and the spread of antibiotic and disease vector resistance, worldwide, free of charge by e-mail" (Woodall, 2001; Woodall and Calisher, 2001)
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From page 120... ...
, and information technology are used liberally by the news media and the public; this makes possible the rapid dissemination of worldwide news about events of public health concern. Such proliferation of information has made it challenging for the public health community, with limited resources, to be aware of and 10 See http://medusa.jrc.it/medisys/homeedition/all/home.html.
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From page 121... ...
In such a collaboration, ProMED's team of experts would provide reports of relevant events; GPHIN's would add a team of multilingual, multidisciplinary analysts plus its technical capacity to process high volumes of disparate multilingual data; and MedISys would add its capacity to monitor the Internet for news in more than 20 languages, improving the gathering of information about potential public health threats in remote areas. In addition, this collaboration would make possible the dissemination of synthesized information (from the numerous news sources)
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From page 122... ...
Mandl, M.D., M.P.H. Children's Hospital Boston Although many developed countries are strengthening their traditional clinically based surveillance capacities, the required health information infrastructure is lacking in parts of the world that may be most vulnerable to emerging health threats. At the same time, an enormous amount of information providing situational awareness about infectious diseases is found in web-accessible information sources, such as Internet-based discussion sites, disease reporting networks, news outlets, and blogs.
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From page 123... ...
At the same time, an enormous amount of information providing situational awareness about infectious diseases is found in web-accessible information sources, such as Internet-based discussion sites, disease reporting networks, news outlets, and blogs (Heymann and Rodier, 2001; Grein et al., 2000; M'Ikanatha et al., 2006)
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HealthMap also addresses the computational challenges of integrating multiple sources of unstructured online information in order to generate robust meta-alerts of disease outbreaks. Through this approach, we achieve a unified and comprehensive view of current global infectious disease outbreaks in space and time.
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FIGURE 2-3 Screenshot of the HealthMap system. SOURCE: http://www.healthmap.org.
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From page 126... ...
. While Internet-based surveillance represents a paradigm shift from indicator-based to event-based sources of information, the existing framework is designed to support the evaluation of all public health surveillance systems.
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. Over this period, HealthMap found 3,194 news reports of infectious disease outbreaks (a mean of 22.8 per day, 95 percent confidence interval, 20.6–25.0)
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News media reports may also be subject to bias about which diseases are covered. Our evaluation found that the richness of pathogen reporting across news sources was substantial, with 66 unique infectious diseases reported through Google News in the 20-week period (Table 2-1)
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Characterization Although free and unrestricted websites have large quantities of useful information about infectious diseases, the information is not well organized. News media output usually comes as unstructured free text, making analysis of the geographic and temporal relationships between different reports and data sources difficult.
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0 FIGURE 2-5 HealthMap geographic coverage, October 1, 2006–February 16, 2007. SOURCE: Brownstein (2006)
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To mitigate this problem, we process the input in stages: If the classifier cannot identify location and disease from the initial input provided by the feed, namely the modified headline, it can request more text from the feed. For example, in the case of the Google News aggregator, the system examines the headline, then the description, which usually consists of the first one or two sentences of the article, and finally the publication name.
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From page 132... ...
could be an ideal mechanism for classification, severity assignment, conflict resolution, geocoding, and confirmation of reports on outbreaks of rare or even infectious diseases of unknown identity (Giles, 2005)
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From page 133... ...
. In our evaluation, we used officially confirmed outbreaks obtained from WHO Outbreak News, available in the public domain, as a "gold standard" indicator of an infectious disease outbreak (WHO, 2007)
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From page 134... ...
Clearly a critical audience is public health officials interested in real-time updates of infectious disease status in their geographic region. However, whether these systems should be freely available and open to the public is an area of active debate.
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From page 135... ...
Although Internet-based informal sources on outbreaks are becoming a critical tool for global infectious disease surveillance, important challenges still need to be addressed. In particular, an unavoidable pitfall of a system-of-systems approach is that it is inherently subject to the limitations of the primary data collected by the individual component systems.
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From page 136... ...
USING CELL PHONE TECHNOLOGY FOR INFECTIOUS DISEASE SURVEILLANCE IN LOW-RESOURCE ENVIRONMENTS: A CASE STUDY FROM PERU Pamela R Johnson, Ph.D.15 Voxiva David L
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From page 137... ...
Many new and emerging infectious diseases -- including SARS, H5N1, HIV/AIDS -- trace their origins to these often densely populated environments. However, despite their demographic and epidemiologic significance, most developing countries, where microbial threats to global health are most likely to emerge, also possess the weakest surveillance systems.
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FIGURE 2-6 Distribution of the earth's population. SOURCE: Worldmapper (2007)
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From page 139... ...
In the developing world there are 1.2 billion phones and a million new mobile phone subscribers every day. Approximately 80 percent of people who live today are within reach of a mobile phone signal, according to the ITU.
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From page 140... ...
Over the past six years, we have learned a number of lessons for building IT systems for use in low-resource environments, leveraging cell phones and other forms of information technology. Building on Available Infrastructure The global mobile phone network is increasingly the most important globally deployed communications infrastructure that covers the developing world.
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SAMPLE DATA PCs/ PDA/ Cell Pay Local Internet Paper phone smartphone Phone phone applications FIGURE 2-7 Being able to enter and access data from any available communications channels can optimize the use of existing infrastructure. SOURCE: Voxiva.
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Ninety percent of the sites report program indicators and register patients using the phone. They use their own cell phones, call a toll-free number -- the first in Rwanda -- log in using their password, and enter basic data digitally using the keypad.
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From page 143... ...
Shared Database, Role-Based Access If data are collected at the source and transmitted to a core database, organizations can make that data available to authorized users according to the specific roles they play. For example, the same set of data could be viewed in a variety of ways: • Health staff can get confirmation that their report has been received, notification of cases of interest from neighboring locations, and results of a case investigation; • A district health official could see reports from health clinics and posts immediately -- then edit or approve them; • Senior health officials could review aggregate data; • Surveillance officers could get lists of nonreporting sites; and • Outbreak investigation teams or vaccination teams could get short message service (SMS)
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From page 144... ...
Pandemics by definition involve the global dissemination of disease. Military populations historically have been involved in the dissemination of a number of infectious diseases, including their well-documented role in the spread of H1N1 influenza in 1918–1919 (Oxford et al., 2005)
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From page 145... ...
Furthermore, in establishing this surveillance system, we have attempted to change the culture within this population to approach disease characterization and transmission from a broader perspective, that of epidemiology and public health. The System The Alerta electronic disease surveillance system uses a countrywide network of health-care facilities that encompasses more than 95 percent of the population of the Peruvian navy and its civilian dependents in most regions of Peru (over 120,000 people)
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From page 146... ...
Data are collected on standard clinical forms during patient encounters, then entered into the system by nurses or physicians via cell phones, toll-free public telephones, or by Internet if accessible. Several extremely remote sites are beyond the cellular footprint, and in these, the Peruvian navy personnel use a radio phone to relay data to the next nearest site that has either a cell phone or access to public phones or the Internet.
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SOURCE: Dr. Carmen Mundaca, Naval Medical Research Center Detachment (NMRCD)
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SOURCE: Dr. Carmen Mundaca, NMRCD.
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From page 149... ...
Since its implementation through November 2006, 80,747 events have been reported, including 3,789 in 2003; 9,454 in 2004; 25,246 in 2005; and 42,258 through November 2006. The Peruvian navy has embraced Alerta DISAMAR and the culture of epidemiology surrounding it.
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From page 150... ...
0 ADD Ancon Base Weekly number of cases Monthly incidence Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 200 200.0 160 160.0 120 120.0 80 80.0 Number of cases Incidence x 1,000 inh x month 40 40.0 0 0.0 34 39 44 49 1 6 11 16 21 26 31 36 41 46 51 4 9 14 19 24 Epidemiological week FIGURE 2-11 Outbreak of diarrhea as reported by the system.
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From page 151... ...
We have trained more than 600 public health personnel in the Peruvian navy in basic epidemiology and the use of this electronic disease surveillance system. Throughout South America, we have also trained more than 1,300 epidemiologists in the basics of outbreak detection and management.
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From page 152... ...
. GEIS serves as just one component of a growing network of public health assets that are increasingly being used to control infectious diseases with pandemic potential, complementing many global public health community efforts (Chrétien et al., 2006)
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Emerging Infectious Diseases 10(6)
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2004. Seasonality of infectious diseases and severe acute respiratory syndrome -- what we don't know can hurt us.
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2001. Hot spots in a wired world: WHO surveillance of emerging and re-emerging infectious diseases.
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Emerging Infectious Diseases 8(10)
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Emerging Infectious Diseases 1(2)
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