An interactive patient transfer network and model visualization tool for multidrug-resistant organism prevention strategies

Background: The CDC’s new Public Health Strategies to Prevent the Spread of Novel and Targeted Multidrug-Resistant Organisms (MDROs) were informed by mathematical models that assessed the impact of implementing preventive strategies directed at a subset of healthcare facilities characterized as influential or highly connected based on their predicted role in the regional spread of MDROs. We developed an interactive tool to communicate mathematical modeling results and visualize the regional patient transfer network for public health departments and healthcare facilities to assist in planning and implementing prevention strategies. Methods: An interactive RShiny application is currently hosted in the CDC network and is accessible to external partners through the Secure Access Management Services (SAMS). Patient transfer volumes (direct and indirect, that is, with up to 30 days in the community between admissions) were estimated from the CMS fee-for-service claims data from 2019. The spread of a carbapenem-resistant Enterobacterales (CRE)–like MDROs within a US state was simulated using a deterministic model with susceptible and infectious compartments in the community and healthcare facilities interconnected through patient transfers. Individuals determined to be infectious through admission screening, point-prevalence surveys (PPSs), or notified from interfacility communication were assigned lower transmissibility if enhanced infection prevention and control practices were in place at a facility. Results: The application consists of 4 interactive tabs. Users can visualize the statewide patient-sharing network for any US state and select territories in the first tab (Fig. 1). A feature allows users to highlight a facility of interest and display downstream or upstream facilities that received or sent transfers from the facility of interest, respectively. A second tab lists influential facilities to aid in prioritizing screening and prevention activities. A third tab lists all facilities in the state in descending order of their dispersal rate (ie, the rate at which patients are shared downstream to other facilities), which can help identify highly connected facilities. In the fourth tab, an interactive graph displays the predicted reduction of MDRO prevalence given a range of intervention scenarios (Fig. 2). Conclusions: Our RShiny application, which can be accessed by public health partners, can assist healthcare facilities and public health departments in planning and tailoring MDRO prevention activity bundles

From recognition to action: A strategic approach to foster sustainable collaborations for rabies elimination.

The World Health Organization (WHO), World Organisation for Animal Health (OIE), Food and Agricultural Organization of the United Nations (FAO), and Global Alliance for Rabies Control (GARC) have established a global goal for the elimination of dog-mediated human rabies deaths by 2030. A significant number of rabies endemic countries have also committed themselves, individually or as a group, to eliminate rabies from their territories. Although tools to eliminate canine rabies are available, financial resources for rabies control are scarce. Public—private partnerships have shown effective results in the control of certain neglected tropical diseases—like filariasis elimination championed by the Global Alliance for the Elimination of Lymphatic Filariasis (GAELF) and Guinea worm control spearheaded by the Carter Center-and could prove a possible strategy for rabies. The funding to achieve global elimination of dog-mediated human rabies deaths has not yet been realized, and it is unlikely that a single external partner would be able to provide all resources necessary to develop an endemic country’s comprehensive, multiyear rabies control program. Instead, the fiscal investment and infrastructural development will, in many instances, need to be driven in part from the endemic country’s government. Indeed, just as rabies elimination is a global public good, national governments should recognize that freedom of dog rabies is a national public good, for which public funds should be invested. National governments should also take the lead in making the final decisions on the overall strategy and the day to day implementation of rabies elimination or control activities. Support from external sources, including international agencies, public entities, donor governments, and private partners, may assist with bridging the funding gap and should aim to fund objectives that align with, or promote, the development of a sustainable government-operated rabies program.http://www.plosntds.orgam2019BiochemistryGeneticsMicrobiology and Plant Patholog