Value of syndromic surveillance within the Armed Forces for early warning during a dengue fever outbreak in French Guiana in 2006

<p>Abstract</p> <p>Background</p> <p>A dengue fever outbreak occured in French Guiana in 2006. The objectives were to study the value of a syndromic surveillance system set up within the armed forces, compared to the traditional clinical surveillance system during this outbreak, to highlight issues involved in comparing military and civilian surveillance systems and to discuss the interest of syndromic surveillance for public health response.</p> <p>Methods</p> <p>Military syndromic surveillance allows the surveillance of suspected dengue fever cases among the 3,000 armed forces personnel. Within the same population, clinical surveillance uses several definition criteria for dengue fever cases, depending on the epidemiological situation. Civilian laboratory surveillance allows the surveillance of biologically confirmed cases, within the 200,000 inhabitants.</p> <p>Results</p> <p>It was shown that syndromic surveillance detected the dengue fever outbreak several weeks before clinical surveillance, allowing quick and effective enhancement of vector control within the armed forces. Syndromic surveillance was also found to have detected the outbreak before civilian laboratory surveillance.</p> <p>Conclusion</p> <p>Military syndromic surveillance allowed an early warning for this outbreak to be issued, enabling a quicker public health response by the armed forces. Civilian surveillance system has since introduced syndromic surveillance as part of its surveillance strategy. This should enable quicker public health responses in the future.</p

Technical handbook for dengue surveillance, dengue outbreak prediction/detection and outbreak response (Model contingency plan)

This handbook was produced by TDR together with WHO’s Neglected Tropical Diseases (NTD) Department and WHO regional offices in the context of a European Union-financed research programme, the International Research Consortium on Dengue Risk Assessment, Management and Surveillance (IDAMS), to develop an evidence-based handbook for the early outbreak detec-tion and management of dengue fever outbreaks. The handbook targets public health providers, in particular those at national level. It is not an implementation guideline, but a framework for developing a national contingency plan with local adaptations that acknowledge micro-level pro-gramme components. Response planning requires contextual details encompassing the structure of the health and vector control services, the availability of infrastructure and budget, and human resources, and the willingness of staff to cooperate, among others. The aim of this “model contingency plan” is to assist programme managers and planners in devel-oping a national, context-specific, dengue outbreak response plan in order to: (a) detect a dengue outbreak at an early stage through clearly defined and validated alarm signals; (b) precisely define when a dengue outbreak has started; and (c) organize an early response to the alarm signals or an “emergency response” once an outbreak has started. A summary of this document, "Dengue Contingency Planning: From Research to Policy and Practice" (PNTD-D-16-00407R1) has also been published in PLOS Neglected Tropical Diseases

International Society for Disease Surveillance Conference 2011: Building the Future of Public Health Surveillance: Building the Future of Public Health Surveillance

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-04204pubpub1117

Key dimensions for the prevention and control of communicable diseases in institutional settings. a scoping review to guide the development of a tool to strengthen preparedness at migrant holding centres in the EU/EEA

Migrant centres, as other institutions hosting closed or semi-open communities, may face specific challenges in preventing and controlling communicable disease transmission, particularly during times of large sudden influx. However, there is dearth of evidence on how to prioritise investments in aspects such as human resources, medicines and vaccines, sanitation and disinfection, and physical infrastructures to prevent/control communicable disease outbreaks. We analysed frequent drivers of communicable disease transmission/issues for outbreak management in institutions hosting closed or semi-open communities, including migrant centres, and reviewed existing assessment tools to guide the development of a European Centre for Disease Prevention and Control (ECDC) checklist tool to strengthen preparedness against communicable disease outbreaks in migrant centres. Among articles/reports focusing specifically on migrant centres, outbreaks through multiple types of disease transmission were described as possible/occurred. Human resources and physical infrastructure were the dimensions most frequently identified as crucial for preventing and mitigating outbreaks. This review also recognised a lack of common agreed standards to guide and assess preparedness activities in migrant centres, thereby underscoring the need for a capacity-oriented ECDC preparedness checklist tool

A New Approach to Monitoring Dengue Activity

Discusses informal surveillance tools for monitoring dengue activity, such as ProMED, GPHIN HealthMap and BioCaster

One health in the U.S. military: a review of existing systems and recommendations for the future

2014 Summer.Includes bibliographical references.Background: The merging of the former U.S. Army Veterinary Command (VETCOM) with the former U.S. Army Center for Health Promotion and Preventive Medicine (USACHPPM) into the U.S. Army Public Health Command (USAPHC) in 2011 created an opportunity for the military to fully embrace the One Health concept. That same year, the USAPHC began work on a Zoonotic Disease Report (ZDR) aimed at supporting critical zoonotic disease risk assessments by combining zoonotic disease data from human, entomological, laboratory, and animal data sources. The purpose of this dissertation is to facilitate the creation of a military Zoonotic Disease Surveillance program that combines disease data from both military human and animal sources. Methods: Five of the most commonly used human military medical data systems were systematically reviewed using a standardized template based on Centers for Disease Control and Preventive Medicine (CDC) guidelines. The systems were then compared to each other in order to recommend the one(s) best suited for use in the USAPHC ZDR. The first stage of the comparison focused on each system's ability to meet the specific goals and objectives of the ZDR, whereas the second stage applied capture-recapture methodology to data system queries in order to evaluate each system's data quality (completeness). A pilot study was conducted using Lyme borreliosis to investigate the utility of military pet dogs as sentinel surveillance for zoonotic disease in military populations. Canine data came from 3996 surveys collected from 15 military veterinary facilities from 1 November 2012 through 31 October 2013. Surveys simultaneously collected Borrelia burgdorferi (Bb) seroprevalence and canine risk factor data for each participating pet dog. Human data were obtained by querying the Defense Medical Surveillance System for the same 15 military locations and the same time period. The correlation of military pet dog Bb seroprevalence and military human Lyme disease (borreliosis) data was estimated using the Spearman Rank Correlation. The difference between military pet dog data and civilian pet dog data was examined through the use of the chi-squared test for proportions. Multivariable logistic regression was then used to investigate the potential for identified risk factors to impact the observed association. Results: The comparison of human military medical data systems found the Military Health System Management Analysis and Reporting Tool (M2) data system most completely met the specific goals and objects of the ZDR. In addition, completeness calculation showed the M2 data source to be the most complete source of human data; 55% of total captured cases coming from the M2 system alone. The pilot study found a strong positive correlation between military human borreliosis data and military pet dog Bb seroprevalence data by location (rs = 0.821). The study showed reassuring similarities in pet dog seroprevalence by location for the majority of sites, but also showed meaningful differences between two locations, potentially indicating military pet dogs as more appropriate indicators of Lyme disease risk for military populations than civilian pet dog data. Unfortunately, whether canine Bb seroprevalence is influenced by the distribution of identified risk factors could not be determined due to limited study power. Conclusions: Based on this study M2 was recommended as the primary source of military human medical data for use in the Public Health Command Zoonotic Disease Report. In addition, it was recommended that Service member pet dog data be incorporated as a sensitive and convenient measure of zoonotic disease risk in human military populations. The validity of the data, however, should be evaluated further with either larger sample sizes and/or a zoonotic disease with higher prevalence

Enhancing outbreak early warning surveillance in resource-limited Pacific island countries and territories

Comprehensive, timely, and accurate health data are essential for the detection of outbreak-prone diseases. If these go unnoticed or are identified late, they pose significant risks to the health of a population. In the Pacific islands, a syndrome-based surveillance strategy, known as the Pacific Syndromic Surveillance System (PSSS), is employed for the early detection of outbreaks. The PSSS, implemented in 2010, has provided a mechanism by which resource-limited Pacific island governments have been able to perform routine surveillance activities and address many of their national and international health protection needs and obligations. Despite being a cornerstone of health protection for many Pacific islands, the surveillance system had not been comprehensively evaluated. Nor had behavioural, technical, or upstream health system factors that influence its performance been investigated. This thesis assesses whether the PSSS is meeting its stated objectives and produces evidence to augment technical and operational elements of the system. The thesis answers the following questions: (i) is the PSSS meeting its stated objectives? (ii) are algorithm-based approaches to outbreak detection appropriate in the Pacific island systems and context?; (iii) how can the PSSS be enhanced to meet information needs during public health emergencies?; and (iv) what factors enable and constrain surveillance nurses’data collection and reporting practice? The thesis found that the surveillance system is simple, well regarded, trusted, and context-relevant mechanism that Pacific island governments from across the development spectrum have been able to adopt and maintain with minimal external technical or financial support. Despite these positive findings, the research identified several statistical, procedural, and broader systems barriers to optimal performance, including chronic staffing and other resource constraints, insufficient data on which to base outbreak detection analysis, and poor integration of health information systems. Looking ahead, the thesis identifies practical opportunities for system improvement and highlights areas for further research

Catching the flu: syndromic surveillance, algorithmic governmentality and global health security

This thesis offers a critical analysis of the rise of syndromic surveillance systems for the advanced detection of pandemic threats within contemporary global health security frameworks. The thesis traces the iterative evolution and ascendancy of three such novel syndromic surveillance systems for the strengthening of health security initiatives over the past two decades: 1) The Program for Monitoring Emerging Diseases (ProMED-mail); 2) The Global Public Health Intelligence Network (GPHIN); and 3) HealthMap. This thesis demonstrates how each newly introduced syndromic surveillance system has become increasingly oriented towards the integration of digital algorithms into core surveillance capacities to continually harness and forecast upon infinitely generating sets of digital, open-source data, potentially indicative of forthcoming pandemic threats. This thesis argues that the increased centrality of the algorithm within these next-generation syndromic surveillance systems produces a new and distinct form of infectious disease surveillance for the governing of emergent pathogenic contingencies. Conceptually, the thesis also shows how the rise of this algorithmic mode of infectious disease surveillance produces divergences in the governmental rationalities of global health security, leading to the rise of an algorithmic governmentality within contemporary contexts of Big Data and these surveillance systems. Empirically, this thesis demonstrates how this new form of algorithmic infectious disease surveillance has been rapidly integrated into diplomatic, legal, and political frameworks to strengthen the practice global health security – producing subtle, yet distinct shifts in the outbreak notification and reporting transparency of states, increasingly scrutinized by the algorithmic gaze of syndromic surveillance

Improving public health preparedness : strengthening biosurveillance systems for enhanced situational awareness

This report is designed to aid state, territorial, tribal, and local public health leaders as they improve their capacity to achieve situational awareness during a public health emergency. We intend this report to serve as a concise reference work public health leaders can use to help design and manage biosurveillance systems to be used during an anticipated public health emergency. We hope public health staff will find it helpful in answering the question, \u201cWhat information do I need to support decision making during a public health emergency and how do I get this information?\u201d To address this question, we focused on information needs for situational awareness using three scenarios: a mass gathering, a natural disaster, or a large outbreak.During these events, information on population health status, health risks, and health services must be readily available to those managing the public health response to the event (Figure 1). This report lists \u201ccore\u201d information needed to effectively manage the public health aspects of an event such as an outbreak, a natural disaster, or a mass gathering. Furthermore, the report describes guiding principles and system capabilities that assure surveillance information systems meet relevant standards, while addressing the need for flexibility to adapt to unique and changing circumstances.We intend for the report\u2019s findings and recommendations to be used by CDC grantees to prioritize activities related to the use of Public Health Emergency Preparedness (PHEP) funding (as well as funding from other CDC cooperative agreements) in the development, maintenance, and optimization of biosurveillance systems. In particular, we intend that our findings and recommendations will delineate specific action steps which will complement and supplement existing guidance contained in the recently developed PHEP capabilities.This research was carried out by the North Carolina Preparedness and Emergency Response Research Center (NCPERRC) at the University of North Carolina at Chapel Hill\u2019s Gillings School of Global Public Health and was supported by the Centers for Disease Control and Prevention (CDC) Grant 1PO1 TP 000296.BiosurvReport_092013.pdfgrant 1PO1 TP00029

Countering Terrorism on Tomorrow’s Battlefield: Critical Infrastructure Security and Resiliency (NATO COE-DAT Handbook 2)

Every day, malicious actors target emerging technologies and medical resilience or seek to wreak havoc in the wake of disasters brought on by climate change, energy insecurity, and supply-chain disruptions. Countering Terrorism on Tomorrow’s Battlefield is a handbook on how to strengthen critical infrastructure resilience in an era of emerging threats. The counterterrorism research produced for this volume is in alignment with NATO’s Warfighting Capstone Concept, which details how NATO Allies can transform and maintain their advantage despite new threats for the next two decades. The topics are rooted in NATO’s Seven Baseline requirements, which set the standard for enhancing resilience in every aspect of critical infrastructure and civil society. As terrorists hone their skills to operate lethal drones, use biometric data to target innocents, and take advantage of the chaos left by pandemics and natural disasters for nefarious purposes, NATO forces must be prepared to respond and prevent terrorist events before they happen. Big-data analytics provides potential for NATO states to receive early warning to prevent pandemics, cyberattacks, and kinetic attacks. NATO is perfecting drone operations through interoperability exercises, and space is being exploited by adversaries. Hypersonic weapons are actively being used on the battlefield, and satellites have been targeted to take down wind farms and control navigation. This handbook is a guide for the future, providing actionable information and recommendations to keep our democracies safe today and in the years to come.https://press.armywarcollege.edu/monographs/1953/thumbnail.jp