The role of regional surveillance networks in enhancing global outbreak reporting

BACKGROUND: The Program for Monitoring Emerging Diseases (ProMED) is a moderated electronic reporting system dedicated to the rapid, global dissemination of outbreak reports. Its moderators are globally diverse, carefully selected, highly trained specialists. To improve cross-border communication and rapidly identify regional health threats, ProMED created regional networks where locally-based moderators use their access to local and regional medical and public health networks and media sources to obtain information not readily available outside of their region. In this analysis, we assess the impact of the establishment of ProMED's Middle East/North Africa (MENA) and South Asia (SoAs) regional networks in April 2014 on ProMED's outbreak reports for these regions. METHODS & MATERIALS: Outbreak reports in countries within the two regions were extracted from ProMED's database, and included country, disease name, species type, spatial coordinates, and report issue date. Data analysis included visualizing spatial information, identifying unique reports, and reporting trends per country and region. Data processing and analysis were conducted using R 3.4.0 statistical software. Rates of outbreak events per total number of ProMED reports per year were calculated to adjust for temporal trends in the total number of reports posted on ProMED. Rate comparison used a two-sided t-test; P < 0.05 was considered statistically significant. RESULTS: The mean monthly incidence of ProMED reports concerning outbreaks in the MENA region increased from 28 reports (May 2012 - April 2014) to 83 reports after the establishment of the networks (May 2014 - April 2016), and from 29 reports to 101 reports concerning outbreaks in the SoAs region over the same time period. The number of reports per total number of ProMED reports increased by 259% for MENA, and 289% for SoAs (P < 0.01). MENA reports most often addressed MERS (32.3%), foot-and-mouth disease (7.0%), avian influenza (6.7%), and measles (3.8%); whereas SoAs most often addressed dengue (14.9%), anthrax (7.3%), Japanese encephalitis (7.0%), CCHF (4.9%), and rabies (4.8%). CONCLUSION: The establishment of MENA and SoAs regional networks with locally-based, expert moderators resulted in a significant increase in ProMED's outbreak reports from these regions and an increased flow of disease information across regional borders and to the global public health community