Evaluation of the performance of a dengue outbreak detection tool for China

An outbreak detection and response system, using time series moving percentile method based on historical data, in China has been used for identifying dengue fever outbreaks since 2008. For dengue fever outbreaks reported from 2009 to 2012, this system achieved a sensitivity of 100%, a specificity of 99.8% and a median time to detection of 3 days, which indicated that the system was a useful decision tool for dengue fever control and risk-management programs in China.This work was supported by the grants from Research and Promotion of Key Technology on Health Emergency Preparation and Dispositions (201202006), the National Key Science and Technology Project on Infectious Disease Surveillance Technique Platform of China (2012ZX10004-201) and Development of Early Warning Systems for Dengue Fever Based on Socio-ecological Factors (NHMRC APP1002608)

Hand, foot and mouth disease in China: Evaluating an automated system for the detection of outbreaks

Objective To evaluate the performance of China's infectious disease automated alert and response system in the detection of outbreaks of hand, foot and mouth (HFM) disease. Methods We estimated size, duration and delay in reporting HFM disease outbreaks from cases notified between 1 May 2008 and 30 April 2010 and between 1 May 2010 and 30 April 2012, before and after automatic alert and response included HFM disease. Sensitivity, specificity and timeliness of detection of aberrations in the incidence of HFM disease outbreaks were estimated by comparing automated detections to observations of public health staff. Findings The alert and response system recorded 106 005 aberrations in the incidence of HFM disease between 1 May 2010 and 30 April 2012 - a mean of 5.6 aberrations per 100 days in each county that reported HFM disease. The response system had a sensitivity of 92.7% and a specificity of 95.0%. The mean delay between the reporting of the first case of an outbreak and detection of that outbreak by the response system was 2.1 days. Between the first and second study periods, the mean size of an HFM disease outbreak decreased from 19.4 to 15.8 cases and the mean interval between the onset and initial reporting of such an outbreak to the public health emergency reporting system decreased from 10.0 to 9.1 days. Conclusion The automated alert and response system shows good sensitivity in the detection of HFM disease outbreaks and appears to be relatively rapid. Continued use of this system should allow more effective prevention and limitation of such outbreaks in China

An Investigation of the Public Health Informatics Research and Practice in the Past Fifteen Years from 2000 to 2014: A Scoping Review in MEDLINE

Objective: To examine the extent and nature of existing Public Health Informatics (PHI) studies in the past 15 years on MEDLINE. Methods: This thesis adopted the scientific scoping review methodology recommended by Arksey and O’Malley in 2005. It proceeded with the five main stages, which were: Stage I - identifying the research question; Stage II - identifying relevant studies; Stage III - study selection; Stage IV - charting the data; and Stage V - collating, summarizing, and reporting the results. Each methodological stage was carried out with the joint collaboration with the academic supervisor and a final result and conclusion were set forth. Results: The results of this study captured a total number of 486 articles in MEDLINE focused in PHI. Out of them, a majority belonged to the USA followed by the UK, Australia and Canada. Only about one fifth of the articles were from the rest of the world. Further, About 60% of the articles represented infectious disease monitoring, outbreak detection, and bio-terrorism surveillance. Furthermore, about 10% belonged to chronic disease monitoring; whereas public health policy system and research represented 40% of the total articles. The most frequently used information technology were electronic registry, website, and GIS. In contrast, mass media and mobile phones were among the least used technologies. Conclusion: Despite multiple research and discussions conducted in the past 15 years (starting from 2000), the PHI system requires further improvements in the application of modern PHT such as wireless devices, wearable devices, remote sensors, remote/ cloud computing etc. on various domains of PH, which were scarcely discussed or used in the available literature

Detection and diagnosis of acute viral encephalitis

Introduction Acute viral encephalitis is a severe form of brain inflammation due to sporadic infection, typically with herpes simplex virus, or epidemic/pandemic infections. Epidemiological data are particularly important for pandemic viruses. Although new reporting approaches are often considered, no real-time clinical data collection tool has been developed. These data are dependent on diagnosis of individual cases. However, the aspects of management that result in delays and missed diagnoses are not clear and it is not known if interventions can improve sample collection and diagnosis. Whilst the importance of cytokines and associated mediators is increasingly recognised, signatures associated with specific aetiologies have not been established. Also, it is not known whether these mediators correlate with clinical severity and outcome, or their impact on blood-brain barrier permeability. Methods I undertook a national surveillance study through neurology networks, and investigated alternative notification approaches. I undertook a multicentre cross-sectional study of clinical investigation, studied viral load and assessed the impact of a lumbar puncture pack. I used bead array to assess mediator profiles and assessed the albumin ratio and viral load, in samples from a Health Protection Agency study. I examined profiles with respect to aetiology, disease severity and outcome and compared this with histopathology tissue and a blood-brain barrier model. Results In the context of a pandemic influenza virus, existing mechanisms identified limited cases, and a smartphone application was developed to collect real-time data. Delays in lumbar puncture and sub-optimal sample collection were identified, in association with a lower viral load. A lumbar puncture pack improved sample collection. Mediator profiles differed between those with an infectious versus immune-mediated aetiology, and those of unknown aetiology best reflected infectious; particularly myeloperoxidase, in part relating to neutrophils in cerebrospinal fluid and parenchyma. The interleukin1 antagonists, IL1RA and IL10, were associated with coma and outcome; and IL10 with reduced blood-brain barrier permeability. Adhesion molecules may counteract this, in both clinical samples and the model. Conclusions Current limitations of detection may be augmented with novel real-time technologies. Diagnosis is limited by delayed and sub-optimal sample collection, which can be improved with a simple pack. Mediators profiles may assist in the distinction of infectious from immune-mediated encephalitis, and cytokines that act against IL1 correlated with clinical severity and outcome. This may be more closely associated with outcome than viral load, although this may reflect sample timing. These findings should direct future research to develop approaches for improved diagnostics and adjunctive therapies