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

Big brother is watching - using digital disease surveillance tools for near real-time forecasting

Abstract for the International Journal of Infectious Diseases 79 (S1) (2019).https://www.ijidonline.com/article/S1201-9712(18)34659-9/abstractPublished versio

Using digital surveillance tools for near real-time mapping of the risk of infectious disease spread

Data from digital disease surveillance tools such as ProMED and HealthMap can complement the field surveillance during ongoing outbreaks. Our aim was to investigate the use of data collected through ProMED and HealthMap in real-time outbreak analysis. We developed a flexible statistical model to quantify spatial heterogeneity in the risk of spread of an outbreak and to forecast short term incidence trends. The model was applied retrospectively to data collected by ProMED and HealthMap during the 2013–2016 West African Ebola epidemic and for comparison, to WHO data. Using ProMED and HealthMap data, the model was able to robustly quantify the risk of disease spread 1–4 weeks in advance and for countries at risk of case importations, quantify where this risk comes from. Our study highlights that ProMED and HealthMap data could be used in real-time to quantify the spatial heterogeneity in risk of spread of an outbreak

Real-time Epidemic Forecasting: Challenges and Opportunities.

Infectious disease outbreaks play an important role in global morbidity and mortality. Real-time epidemic forecasting provides an opportunity to predict geographic disease spread as well as case counts to better inform public health interventions when outbreaks occur. Challenges and recent advances in predictive modeling are discussed here. We identified data needs in the areas of epidemic surveillance, mobility, host and environmental susceptibility, pathogen transmissibility, population density, and healthcare capacity. Constraints in standardized case definitions and timely data sharing can limit the precision of predictive models. Resource-limited settings present particular challenges for accurate epidemic forecasting due to the lack of granular data available. Incorporating novel data streams into modeling efforts is an important consideration for the future as technology penetration continues to improve on a global level. Recent advances in machine-learning, increased collaboration between modelers, the use of stochastic semi-mechanistic models, real-time digital disease surveillance data, and open data sharing provide opportunities for refining forecasts for future epidemics. Epidemic forecasting using predictive modeling is an important tool for outbreak preparedness and response efforts. Despite the presence of some data gaps at present, opportunities and advancements in innovative data streams provide additional support for modeling future epidemics

Chagas cardiomyopathy in Boston, Massachusetts: Identifying disease and improving management after community and hospital-based screening.

BackgroundLimited data exist regarding cardiac manifestations of Chagas disease in migrants living in non-endemic regions.MethodsA retrospective cohort analysis of 109 patients with Chagas disease seen at Boston Medical Center (BMC) between January 2016 and January 2023 was performed. Patients were identified by screening and testing migrants from endemic regions at a community health center and BMC. Demographic, laboratory, and cardiac evaluation data were collected.ResultsMean age of the 109 patients was 43 years (range 19-76); 61% were female. 79% (86/109) were diagnosed with Chagas disease via screening and 21% (23/109) were tested given symptoms or electrocardiogram abnormalities. Common symptoms included palpitations (25%, 27/109) and chest pain (17%, 18/109); 52% (57/109) were asymptomatic. Right bundle branch block (19%, 19/102), T-wave changes (18%, 18/102), and left anterior fascicular block (11%, 11/102) were the most common electrocardiogram abnormalities; 51% (52/102) had normal electrocardiograms. Cardiomyopathy stage was ascertained in 94 of 109 patients: 51% (48/94) were indeterminate stage A and 49% (46/94) had cardiac structural disease (stages B1-D). Clinical findings that required clinical intervention or change in management were found in 23% (25/109), and included cardiomyopathy, apical hypokinesis/aneurysm, stroke, atrial or ventricular arrhythmias, and apical thrombus.ConclusionsThese data show high rates of cardiac complications in a cohort of migrants living with Chagas disease in a non-endemic setting. We demonstrate that Chagas disease diagnosis prompts cardiac evaluation which often identifies actionable cardiac disease and provides opportunities for prevention and treatment

Proportion of ECG Abnormalities by Age Group.

BackgroundLimited data exist regarding cardiac manifestations of Chagas disease in migrants living in non-endemic regions.MethodsA retrospective cohort analysis of 109 patients with Chagas disease seen at Boston Medical Center (BMC) between January 2016 and January 2023 was performed. Patients were identified by screening and testing migrants from endemic regions at a community health center and BMC. Demographic, laboratory, and cardiac evaluation data were collected.ResultsMean age of the 109 patients was 43 years (range 19–76); 61% were female. 79% (86/109) were diagnosed with Chagas disease via screening and 21% (23/109) were tested given symptoms or electrocardiogram abnormalities. Common symptoms included palpitations (25%, 27/109) and chest pain (17%, 18/109); 52% (57/109) were asymptomatic. Right bundle branch block (19%, 19/102), T-wave changes (18%, 18/102), and left anterior fascicular block (11%, 11/102) were the most common electrocardiogram abnormalities; 51% (52/102) had normal electrocardiograms. Cardiomyopathy stage was ascertained in 94 of 109 patients: 51% (48/94) were indeterminate stage A and 49% (46/94) had cardiac structural disease (stages B1-D). Clinical findings that required clinical intervention or change in management were found in 23% (25/109), and included cardiomyopathy, apical hypokinesis/aneurysm, stroke, atrial or ventricular arrhythmias, and apical thrombus.ConclusionsThese data show high rates of cardiac complications in a cohort of migrants living with Chagas disease in a non-endemic setting. We demonstrate that Chagas disease diagnosis prompts cardiac evaluation which often identifies actionable cardiac disease and provides opportunities for prevention and treatment.</div

American Heart Association Classification of Chagas Cardiomyopathy.

Arrhythmias and conduction disease can occur from B1 through D stages. HF, heart failure; NYHA, New York Heart Association. Adapted from Nunes et al [2]. (DOCX)</p

Demographic and Clinical Characteristics.

BackgroundLimited data exist regarding cardiac manifestations of Chagas disease in migrants living in non-endemic regions.MethodsA retrospective cohort analysis of 109 patients with Chagas disease seen at Boston Medical Center (BMC) between January 2016 and January 2023 was performed. Patients were identified by screening and testing migrants from endemic regions at a community health center and BMC. Demographic, laboratory, and cardiac evaluation data were collected.ResultsMean age of the 109 patients was 43 years (range 19–76); 61% were female. 79% (86/109) were diagnosed with Chagas disease via screening and 21% (23/109) were tested given symptoms or electrocardiogram abnormalities. Common symptoms included palpitations (25%, 27/109) and chest pain (17%, 18/109); 52% (57/109) were asymptomatic. Right bundle branch block (19%, 19/102), T-wave changes (18%, 18/102), and left anterior fascicular block (11%, 11/102) were the most common electrocardiogram abnormalities; 51% (52/102) had normal electrocardiograms. Cardiomyopathy stage was ascertained in 94 of 109 patients: 51% (48/94) were indeterminate stage A and 49% (46/94) had cardiac structural disease (stages B1-D). Clinical findings that required clinical intervention or change in management were found in 23% (25/109), and included cardiomyopathy, apical hypokinesis/aneurysm, stroke, atrial or ventricular arrhythmias, and apical thrombus.ConclusionsThese data show high rates of cardiac complications in a cohort of migrants living with Chagas disease in a non-endemic setting. We demonstrate that Chagas disease diagnosis prompts cardiac evaluation which often identifies actionable cardiac disease and provides opportunities for prevention and treatment.</div

Rassi Risk Score to Predict Mortality Related to Chagas Disease.

*NYHA, New York Heart Association. Adapted from Keegan et al [36]. (DOCX)</p

Cardiac Findings in Chagas Disease.

BackgroundLimited data exist regarding cardiac manifestations of Chagas disease in migrants living in non-endemic regions.MethodsA retrospective cohort analysis of 109 patients with Chagas disease seen at Boston Medical Center (BMC) between January 2016 and January 2023 was performed. Patients were identified by screening and testing migrants from endemic regions at a community health center and BMC. Demographic, laboratory, and cardiac evaluation data were collected.ResultsMean age of the 109 patients was 43 years (range 19–76); 61% were female. 79% (86/109) were diagnosed with Chagas disease via screening and 21% (23/109) were tested given symptoms or electrocardiogram abnormalities. Common symptoms included palpitations (25%, 27/109) and chest pain (17%, 18/109); 52% (57/109) were asymptomatic. Right bundle branch block (19%, 19/102), T-wave changes (18%, 18/102), and left anterior fascicular block (11%, 11/102) were the most common electrocardiogram abnormalities; 51% (52/102) had normal electrocardiograms. Cardiomyopathy stage was ascertained in 94 of 109 patients: 51% (48/94) were indeterminate stage A and 49% (46/94) had cardiac structural disease (stages B1-D). Clinical findings that required clinical intervention or change in management were found in 23% (25/109), and included cardiomyopathy, apical hypokinesis/aneurysm, stroke, atrial or ventricular arrhythmias, and apical thrombus.ConclusionsThese data show high rates of cardiac complications in a cohort of migrants living with Chagas disease in a non-endemic setting. We demonstrate that Chagas disease diagnosis prompts cardiac evaluation which often identifies actionable cardiac disease and provides opportunities for prevention and treatment.</div