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

Infectious disease outbreaks among forcibly displaced persons: an analysis of ProMED reports 1996-2016

Background: The United Nations Refugee Agency (UNHCR) estimates the number of forcibly displaced people increased from 22.7 million people in 1996 to 67.7 million people in 2016. Human mobility is associated with the introduction of infectious disease pathogens. The aim of this study was to describe the range of pathogens in forcibly displaced populations over time using an informal event monitoring system. Methods: We conducted a retrospective analysis of ProMED, a digital disease monitoring system, to identify reports of outbreak events involving forcibly displaced populations between 1996 and 2016. Number of outbreak events per year was tabulated. Each record was assessed to determine outbreak location, pathogen, origin of persons implicated in the outbreak, and suspected versus confirmed case counts. Results: One hundred twenty-eight independent outbreak events involving forcibly displaced populations were identified. Over 840,000 confirmed or suspected cases of infectious diseases such as measles, cholera, cutaneous leishmaniasis, dengue, and others were reported in 48 destination countries/territories. The average rate of outbreak events concerning forcibly displaced persons per total number of reports published on ProMED per year increased over time. The majority of outbreak events (63%) were due to acquisition of disease in the destination country. Conclusion: This study found that reports of outbreak events involving forcibly displaced populations have increased in ProMED. The events and outbreaks detected in this retrospective review underscore the importance of capturing displaced populations in surveillance systems for rapid detection and response

Data journalism and the COVID-19 pandemic: opportunities and challenges

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PECAM-1 stabilizes blood-brain barrier integrity and favors paracellular T-Cell diapedesis across the blood-brain barrier during neuroinflammation

Breakdown of the blood-brain barrier (BBB) and increased immune cell trafficking into the central nervous system (CNS) are hallmarks of the pathogenesis of multiple sclerosis (MS). Platelet endothelial cell adhesion molecule-1 (PECAM-1; CD31) is expressed on cells of the vascular compartment and regulates vascular integrity and immune cell trafficking. Involvement of PECAM-1 in MS pathogenesis has been suggested by the detection of increased levels of soluble PECAM-1 (sPECAM-1) in the serum and CSF of MS patients. Here, we report profound upregulation of cell-bound PECAM-1 in initial (pre-phagocytic) white matter as well as active cortical grey matter MS lesions. Using a human in vitro BBB model we observed that PECAM-1 is not essential for the transmigration of human CD4+ T-cell subsets (Th1, Th1*, Th2, and Th17) across the BBB. Employing an additional in vitro BBB model based on primary mouse brain microvascular endothelial cells (pMBMECs) we show that the lack of endothelial PECAM-1 impairs BBB properties as shown by reduced transendothelial electrical resistance (TEER) and increases permeability for small molecular tracers. Investigating T-cell migration across the BBB under physiological flow by in vitro live cell imaging revealed that absence of PECAM-1 in pMBMECs did not influence arrest, polarization and crawling of effector/memory CD4+ T cells on the pMBMECs. Absence of endothelial PECAM-1 also did not affect the number of T cells able to cross the pMBMEC monolayer under flow, but surprisingly favored transcellular over paracellular T-cell diapedesis. Taken together, our data demonstrate that PECAM-1 is critically involved in regulating BBB permeability and although not required for T-cell diapedesis itself, its presence or absence influences the cellular route of T-cell diapedesis across the BBB. Upregulated expression of cell-bound PECAM-1 in human MS lesions may thus reflect vascular repair mechanisms aiming to restore BBB integrity and paracellular T-cell migration across the BBB as it occurs during CNS immune surveillance

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

Place of International Congresses in the Diffusion of Knowledge in Infectious Diseases

Through digital resources, physicians, microbiologists, and researchers around the world can stay up-to-date with the newest developments in their field and are therefore less dependent on medical congresses as a provider of knowledge and education. The role of the medical congress in spreading knowledge in the face of this changing environment needs to be reexamined. The result is a new paradigm that thinks about the dissemination of medical knowledge and discovery as ongoing conversations between professionals and their extended networks, rather than activities that happen only during the congress. Even though the tools we use to deliver information and knowledge are rapidly evolving, there is confidence in the lasting value of meetings for medical professionals. Medical congresses are environments uniquely conducive to generating new ideas and solutions to problems. As organizers explore new ways of sharing knowledge globally, it is crucial that the high quality of medical congresses be maintained

Highlights from the 6th International Meeting on Emerging Diseases and Surveillance (IMED 2016) Vienna, Austria from Nov 3 to 7, 2016

Emerging infectious diseases remain at the center of the world\u27s attention. The current threats posed by Zika, Yellow Fever, MERS-CoV, and pandemic influenza, the recent Ebola outbreak that devastated West Africa, and the realization that new infectious diseases may be recognized at any time, in any place, has dramatically increased public awareness of infectious diseases and underscored the need to understand emerging pathogens. As with each prior iteration, IMED 2016 fully embodied the “One Health” model of emerging diseases, recognizing the commonality of human, environmental and animal health by bringing together human and veterinary health clinicians, scientists, and policy makers from more than 100 countries. With more than 90 talks and 400 poster presentations, it\u27s impossible to adequately summarize all of the important insights conveyed at IMED 2016. Here is a sampling of some of the topics that caught our interest

Increase in vector-borne disease reporting affecting humans and animals in Syria and neighboring countries after the onset of conflict: A ProMED analysis 2003-2018.

ObjectivesThe protracted and violent conflict in Syria has resulted in large-scale displacement of people and destruction of health and sanitation infrastructure. The aim of this study was to examine epidemiological trends in vector-borne disease (VBD) outbreaks before and following the onset of the Syrian conflict (2011).MethodsProMED, a digital disease surveillance tool, was queried for VBD outbreak reports affecting humans and animals in Syria and select bordering countries between 2003 and 2018. Data were normalized by dividing the number of unique VBD events by the total number of unique outbreak events reported by ProMED for each year. Suspected and confirmed case counts and deaths were manually extracted.ResultsReports on VBDs increased from a mean of 2.9/year pre-2011 to 12.8/year post-2011, a 343.5% (p &lt; 0.05) increase. After normalization, reports increased by 485.5% (p &lt; 0.05) over the time periods. Post-2011, the most commonly reported VBDs were leishmaniasis, Crimean-Congo hemorrhagic fever, and lumpy skin disease. Reported numbers of suspected and confirmed cases and deaths increased during the conflict period.ConclusionsVBD outbreak events in ProMED increased in Syria and select bordering countries after the onset of the Syrian conflict in 2011. Enhanced disease surveillance is critical to detect and manage outbreaks in conflict settings