a practical tool to implement hospital-based syndromic surveillance: SCM

Background: syndromic surveillance has been widely used for the early warning of infectious disease outbreaks, especially in mass gatherings, but the collection of electronic data on symptoms in hospitals is one of the fundamental challenges that must be overcome during operating a syndromic surveillance system. The objective of our study is to describe and evaluate the implementation of a symptom-clicking-module (SCM) as a part of the enhanced hospital-based syndromic surveillance during the 41st World Exposition in Shanghai, China, 2010.Methods: the SCM, including 25 targeted symptoms, was embedded in the sentinels’ Hospital Information Systems (HIS). The clinicians used SCM to record these information of all the visiting patients, and data were collated and transmitted automatically in daily batches. The symptoms were categorized into seven targeted syndromes using pre-defined criteria, and statistical algorithms were applied to detect temporal aberrations in the data series.Results: SCM was deployed successfully in each sentinel hospital and was operated during the 184-day surveillance period. A total of 1,730,797 patient encounters were recorded by SCM, and 6.1 % (105,352 visits) met the criteria of the seven targeted syndromes. Acute respiratory and gastrointestinal syndromes were reported most frequently, accounted for 92.1 % of reports in all syndromes, and the aggregated time-series presented an obvious day-of-week variation over the study period. In total, 191 aberration signals were triggered, and none of them were identified as outbreaks after verification and field investigation.Conclusions: SCM has acted as a practical tool for recording symptoms in the hospital-based enhanced syndromic surveillance system during the 41st World Exposition in Shanghai, in the context of without a preexisting electronic tool to collect syndromic data in the HIS of the sentinel hospitals

Using large-scale syndromic datasets to support epidemiology and surveillance

Using large-scale syndromic datasets to support epidemiology and surveillance Healthcare and the healthcare industry have traditionally produced huge amounts of data and information; patient care necessitates accurate record keeping, records of attendances and often details of the reason for contact with healthcare and outcomes.7 During the past decade, there has been a dramatic shift to digitize healthcare related information, with a view to both increasing efficiencies in these areas, and to generate new insights.8 These rich, but often unstructured data sources can present both opportunities and challenges to data scientists and epidemiologists. Syndromic surveillance (SS) is the real-time (or near real-time) collection, analysis, interpretation, and dissemination of health-related data to enable the early identification of the impact (or absence of impact) of potential human or veterinary public-health threats which require effective public-health action.9 In England, Public Health England (PHE) coordinates a suite of national real-time syndromic surveillance systems. Underpinning their operation is the collation, analysis and interpretation of large-scale datasets (“big data”). This PhD by Published Works describes work which has evaluated, developed or utilised a number of these large healthcare datasets for both surveillance and epidemiology of public health events. The thesis is divided into four themes covering critical aspects of SS. Firstly, developing SS systems using novel data sources; something which is currently under-reported in the literature. Secondly, using syndromic data systems for non-infectious disease epidemiology; understanding how these systems can inform public health insight and action outside of their original remit. Thirdly, determining the utility in identifying outbreaks which was one of the original envisioned purposes of SS, using gastrointestinal illness (GI) as a case-study. The final theme is understanding how SS is used in the context of mass gatherings; again, a key original aspect of syndromic surveillance. The thesis collates a portfolio of indexed works, all of which use (combined with other data sources) large, health-related data collated and operated by the PHE Real-Time Syndromic Surveillance Team (ReSST) and employ a range of different methodologies to translate data into public health action. These include describing the development of a novel system, observational studies and time series analysis. Key findings from the papers include; learning how to develop these systems, demonstration of their utility in non-infectious disease epidemiology, leading to new insights into the socio-demographic distribution and causes of presentations to healthcare with Allergic Rhinitis, understanding the challenges and limitations of syndromic surveillance in identifying outbreaks of GI disease and how they can be used during mass gatherings. Using diverse methodologies and data as a collective, the papers have led to significant public health impacts; both in terms of how these systems are used in England currently and how they have influenced global development of this small but growing specialit

Analyzing The Restriction Of Mass Gatherings And School Closures/reopening In China And Iran During The Covid-19 Pandemic With A Public Health Ethics Framework

The COVID-19 pandemic has undoubtedly elevated the status of public health. Concurrently, public health ethics has been brought to the forefront of the field and its practices in several ways. Over the past year, SARS-CoV-2 has affected nearly every country. In both high and low resource settings, policymakers turned to public health to ease the tension placed on health care systems by COVID-19. Governments implemented measures ranging from lockdown orders to mask mandates, all with the primary goal of curbing the spread of SARS-CoV-2. The effectiveness of these interventions has become a salient topic in public health research, and much epidemiological data has been published to inform ongoing responses to the pandemic. However, little attention has been given to the broader consequences of these policies. More specifically, ethics has rarely been considered in the development and evaluation of COVID-19 policies. Without the proper inclusion of ethics and human rights in public health responses, equitable outcomes cannot be guaranteed. This thesis aims to apply an ethical framework to analyze two types of COVID-19 policies: the restriction of mass gatherings and school closures/reopening. These measures were analyzed using a public health ethics framework to assess their effectiveness and outcomes as well as to facilitate comparisons between China and Iran, two countries with vastly different political structures and experiences during the pandemic. The analysis revealed that, while these policies were effective to some degree, neither policy was ethically justified in either China or Iran due to the unequal distribution of benefits and burdens across populations which has induced ramifications that extend beyond the current pandemic. These results demonstrate that public health officials and political leaders have an obligation to serve all populations and aspects of health especially during a public health crisis; controlling a pandemic itself does not ensure full health for all. Ethics should play an essential role in public health to avoid past mistakes and guarantee the right to health around the world

Data and Digital Solutions to Support Surveillance Strategies in the Context of the COVID-19 Pandemic

Background: In order to prevent spread and improve control of infectious diseases, public health experts need to closely monitor human and animal populations. Infectious disease surveillance is an established, routine data collection process essential for early warning, rapid response, and disease control. The quantity of data potentially useful for early warning and surveillance has increased exponentially due to social media and other big data streams. Digital epidemiology is a novel discipline that includes harvesting, analysing, and interpreting data that were not initially collected for healthcare needs to enhance traditional surveillance. During the current COVID-19 pandemic, the importance of digital epidemiology complementing traditional public health approaches has been highlighted. Objective: The aim of this paper is to provide a comprehensive overview for the application of data and digital solutions to support surveillance strategies and draw implications for surveillance in the context of the COVID-19 pandemic and beyond. Methods: A search was conducted in PubMed databases. Articles published between January 2005 and May 2020 on the use of digital solutions to support surveillance strategies in pandemic settings and health emergencies were evaluated. Results: In this paper, we provide a comprehensive overview of digital epidemiology, available data sources, and components of 21st-century digital surveillance, early warning and response, outbreak management and control, and digital interventions. Conclusions: Our main purpose was to highlight the plausible use of new surveillance strategies, with implications for the COVID-19 pandemic strategies and then to identify opportunities and challenges for the successful development and implementation of digital solutions during non-emergency times of routine surveillance, with readiness for early-warning and response for future pandemics. The enhancement of traditional surveillance systems with novel digital surveillance methods opens a direction for the most effective framework for preparedness and response to future pandemics

Factors Affecting the Routine Immunization Activities During a Disease Outbreak, Epidemic and Covid-19 Pandemic in Africa

Background: The emerging disease outbreaks and pandemics affect immunization activities. In Africa, it has contributed to a significant decline in vaccination coverage and the provision of essential health services. The contributing factors which affect the immunization activities are unclear and vary as per the country's situation and response strategy to the emerging outbreaks and pandemics. Hence, we aimed to explore those factors related to disease outbreak, epidemic, and covid-19 pandemic affecting the delivery of immunization services in Africa. Methods: Our study is qualitative exploratory research, which included five countries selected using convenience sampling according to the regional classification of Africa by ACDC. Factors affecting routine immunization activities in the countries were identified through interviews with relevant stakeholders involved in vaccination services. The interviewees were selected using snowballing sampling, 4 participants from each country, twenty key informants ranking (routine immunization directors, national immunization officers, EPI officers, and some health workers and caregivers) were included for open-ended and semi-structured virtual in-depth interviews. Additionally, some parents were interviewed for their perceptions about vaccinating their children during the current pandemic. We also did a literature review on the impact of previous emerging disease outbreaks on routine immunization activities in the countries and the current situation of the COVID-19 pandemic. Supportive trend data based on measles vaccination coverage and disease rates based on WHO country reports over time were included. Data generated from the literature review and in-depth interviews were transcribed verbatim and analyzed using thematic analysis. We used the thematic framework to organize our findings; each country was identified according to the following variables: Country name, the current situation of covid-19, covid-19 impact on the following factors (health system, governance, and community), and the impact of a previous disease outbreak on the measles immunization coverage. Findings were grouped according to the country's perspective. We compared factors during previous outbreaks and covid-19 pandemics in Africa and addressed some interventions that can support immunization activities during disease x outbreak. Results: 40% of our participants emphasized that fear of infection was behind the interruption in the immunization activities during covid-19 pandemics. 35% agreed that movement restrictions limited many activities. Resource limitation and misinformation comes as an individual barrier representing 10-15%. Some of the addressed health system factors included: surveillance defect, human resource shortage, lack of training, infrastructure, and PPE inadequacy. On the community base: misinformation, vaccine hesitancy and refusal, and fear of infection were identified. Governance factors included: movement restriction, travel ban, closed health facilities, lockdown, and social distancing factors were addressed. Few gaps were identified, as providing the proper training to the health workers and the caregivers, community engagement, national planning, building a proper registry system with implementing the proper plans for fast service recovery after a pandemic. By fulfilling those gaps, we may be able to provide better access to routine immunization during a disease outbreak, epidemic, and pandemic. Conclusions: The study addressed the various factors affecting Africa’s routine immunization activities during disease outbreaks and pandemics. It also addressed the impact of a previous disease outbreak on the measles immunization coverage, which may predict the covid-19 impact on the immunization coverage. It is, therefore, essential for decision-makers to address those factors to ensure immunization coverage without any missed opportunities. Keywords: vaccination, outbreaks, covid-19, factors, Africa, misinformation, hesitancy.open석

Taking the pulse of COVID-19: A spatiotemporal perspective

The sudden outbreak of the Coronavirus disease (COVID-19) swept across the world in early 2020, triggering the lockdowns of several billion people across many countries, including China, Spain, India, the U.K., Italy, France, Germany, and most states of the U.S. The transmission of the virus accelerated rapidly with the most confirmed cases in the U.S., and New York City became an epicenter of the pandemic by the end of March. In response to this national and global emergency, the NSF Spatiotemporal Innovation Center brought together a taskforce of international researchers and assembled implemented strategies to rapidly respond to this crisis, for supporting research, saving lives, and protecting the health of global citizens. This perspective paper presents our collective view on the global health emergency and our effort in collecting, analyzing, and sharing relevant data on global policy and government responses, geospatial indicators of the outbreak and evolving forecasts; in developing research capabilities and mitigation measures with global scientists, promoting collaborative research on outbreak dynamics, and reflecting on the dynamic responses from human societies.Comment: 27 pages, 18 figures. International Journal of Digital Earth (2020