The AFHSC-Division of GEIS Operations Predictive Surveillance Program: a multidisciplinary approach for the early detection and response to disease outbreaks

The Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System Operations (AFHSC-GEIS) initiated a coordinated, multidisciplinary program to link data sets and information derived from eco-climatic remote sensing activities, ecologic niche modeling, arthropod vector, animal disease-host/reservoir, and human disease surveillance for febrile illnesses, into a predictive surveillance program that generates advisories and alerts on emerging infectious disease outbreaks. The program’s ultimate goal is pro-active public health practice through pre-event preparedness, prevention and control, and response decision-making and prioritization. This multidisciplinary program is rooted in over 10 years experience in predictive surveillance for Rift Valley fever outbreaks in Eastern Africa. The AFHSC-GEIS Rift Valley fever project is based on the identification and use of disease-emergence critical detection points as reliable signals for increased outbreak risk. The AFHSC-GEIS predictive surveillance program has formalized the Rift Valley fever project into a structured template for extending predictive surveillance capability to other Department of Defense (DoD)-priority vector- and water-borne, and zoonotic diseases and geographic areas. These include leishmaniasis, malaria, and Crimea-Congo and other viral hemorrhagic fevers in Central Asia and Africa, dengue fever in Asia and the Americas, Japanese encephalitis (JE) and chikungunya fever in Asia, and rickettsial and other tick-borne infections in the U.S., Africa and Asia

Seroprevalence and distribution of arboviral infections among rural Kenyan adults: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Arthorpod-borne viruses (arboviruses) cause wide-spread morbidity in sub-Saharan Africa, but little research has documented the burden and distribution of these pathogens.</p> <p>Methods</p> <p>Using a population-based, cross-sectional study design, we administered a detailed questionnaire and used ELISA to test the blood of 1,141 healthy Kenyan adults from three districts for the presence of anti-viral Immunoglobulin G (IgG) antibodies to the following viruses: dengue (DENV), West Nile (WNV), yellow fever (YFV), Chikungunya (CHIKV), and Rift Valley fever (RVFV).</p> <p>Results</p> <p>Of these, 14.4% were positive for DENV, 9.5% were WNV positive, 9.2% were YFV positive, 34.0% were positive for CHIKV and 0.7% were RVFV positive. In total, 46.6% had antibodies to at least one of these arboviruses.</p> <p>Conclusions</p> <p>For all arboviruses, district of residence was strongly associated with seropositivity. Seroprevalence to YFV, DENV and WNV increased with age, while there was no correlation between age and seropositivity for CHIKV, suggesting that much of the seropositivity to CHIKV is due to sporadic epidemics. Paradoxically, literacy was associated with increased seropositivity of CHIKV and DENV.</p

Genomics for public health and international surveillance of antimicrobial resistance.

Historically, epidemiological investigation and surveillance for bacterial antimicrobial resistance (AMR) has relied on low-resolution isolate-based phenotypic analyses undertaken at local and national reference laboratories. Genomic sequencing has the potential to provide a far more high-resolution picture of AMR evolution and transmission, and is already beginning to revolutionise how public health surveillance networks monitor and tackle bacterial AMR. However, the routine integration of genomics in surveillance pipelines still has considerable barriers to overcome. In 2022, a workshop series and online consultation brought together international experts in AMR and pathogen genomics to assess the status of genomic applications for AMR surveillance in a range of settings. Here we focus on discussions around the use of genomics for public health and international AMR surveillance, noting the potential advantages of, and barriers to, implementation, and proposing recommendations from the working group to help to drive the adoption of genomics in public health AMR surveillance. These recommendations include the need to build capacity for genome sequencing and analysis, harmonising and standardising surveillance systems, developing equitable data sharing and governance frameworks, and strengthening interactions and relationships among stakeholders at multiple levels

Automated real time detection of Arboviruses in culture

Background: Major methods of isolating and identifying arboviruses viruses from human and vector populations are tissue culture – based. Viral growth in culture is monitored by the detection of cytopathic effects (CPE) by microscopy. Some viruses do not cause visible CPE or have delayed CPE and can easily be missed because the assay is subjective and tedious. Host cell anomalies can mask or mimic true CPE. Cell culture assays are also limited by the difficulty in identifying novel or multiple infections, the high cost of culture reagents, and the ability to perform adequate quality controls. Objective: The automated XCELLigence system (Roche) uses plates lined with electrodes to continuously measure changes in electric impedance in cultured cells. This system was tested to validate its utility in addressing the challenges associated with cell-culture based assays. Methodology: Viruses were inoculated into VERO (green monkey kidney) cells in 96-well or 24-well plates and incubated at 37°C in a humidified CO2 incubator. Cells were monitored for CPE using the XCELLigence system in real-time or daily by microscopy. For the neutralization test viruses were serially diluted and combined with -positive serum, incubated for 30 minutes, inoculated onto VERO cells and monitored after using plaque assays after 3 days or the xCELLigence system. Results: On xCELLigence®, CPE was detected earlier than by microscopic with a signature proliferation profile that could be distinguished from cellular anomalies and other virus profiles and required only ~5 minutes of staff time daily to monitor. The automated methods for virus detection and neutralization gave more consistent and reliable results compared to the conventional assay, had internal quality control capabilities, and minimized reagent use significantly. Conclusions: Automated monitoring of virus cultures improves reproducibility and early virus detection, reduces staff time and error, provides quality control for cell lines and allows for virus quantification

Genomics for public health and international surveillance of antimicrobial resistance

Historically, epidemiological investigation and surveillance for antimicrobial resistant (AMR) bacteria has relied on relatively low-resolution isolate-based phenotypic analyses undertaken at local and national reference laboratories. Genomic sequencing has the potential to provide a far more high-resolution picture of AMR evolution and transmission and is already beginning to revolutionize how public health surveillance networks monitor and tackle AMR bacteria. However, the routine integration of genomics in surveillance pipelines still has considerable barriers to overcome. In 2022, a workshop series and online consultation brought together international experts in AMR and pathogen genomics to assess the status of genomic applications for AMR surveillance in a range of settings. Here we focus on discussions around the use of genomics for public health and international AMR surveillance, noting the potential advantages of, and barriers to, implementation and proposing recommendations from the working group to help drive the adoption of genomics in public health AMR surveillance. These include the need to build capacity for genome sequencing and analysis, harmonising, and standardising surveillance systems, developing equitable data sharing and governance frameworks and strengthening interactions and relationships among stakeholders at multiple levels.KSB reports funding from the BBSRC and MRC and partial salary cover from Wellcome Trust and UKHSA over the course of this work. EJ had partial salary cover from Wellcome Trust over the course of this work. SWL has received Receive Robert Austrian Research Award sponsored by Pfizer in 2022. DGA reports funding from the NIHR. INO reports funding from the Bill and Melinda Gates Foundation, JPIAMR, Wellcome Trust, Grand Challenges Africa Award, UK MCR, royalties for Genetics: Genes, Genomes and Evolution (Oxford University Press), Divining Without Seeds and for Antimicrobial Resistance in Developing Countries (Springer), consulting fees from Wellcome Trust, honoraria for Harvard University seminars and Peter Wildy Lecture Award 2023. DGA, BE, RSH, INO report receiving funding from the UK Department of Health and Social Care: grant managed by the Fleming Fund and work performed under the auspices of the SEQAFRICA project. LSB reports funding by Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, Valencia (Spain), under Plan GenT (Ref. CDEI-06/20-B). NAF reports funding from the BMGF, UKRI and NIHR. SJP is a member of the Scientific Advisory Board of Next Gen Diagnostics and was supported by Illumina to attend the ECCMID conference. All other authors declare no conflicts of interest