30 April 2009

"The Network" Newsletter, Part 3: Syndromic Surveillance in Developing Countries – Literature Search

by Larissa May (MD, MS), Chair, ISDS Education and Training Committee

This article is a part of a series that will be published in the Global Outreach newsletter, "The Network." A pdf version of "The Network" is coming soon!

The commonly established concept of syndromic surveillance in developed regions encompasses the use of pre-diagnostic information in a near real time fashion for further investigation for public health action. Syndromic surveillance is widely used in North America and Europe, and is typically thought of as a highly complex, technology driven automated tool for early detection of outbreaks. Nonetheless, low technology applications of syndromic surveillance are already being used worldwide to augment traditional surveillance, and may improve compliance with the revised International Health Regulations, which require notification of infectious diseases of international health importance, even if the causative agent is unknown.

To review work that is being done in syndromic surveillance in developing areas, we have compiled a collection of peer-reviewed articles and other resources on the use of syndromic surveillance systems in these regions. For the purposes of this list, we have excluded citations from North America and Europe, which as high resource regions use complex, highly automated and technology-intensive systems which have been in existence for a much longer period than the systems being used in less resource rich nations.

Visit the ISDS wiki to view the literature search

"The Network" Newsletter, Part 2: Lessons in implementation of a disease surveillance system in Peru

by C. Cecilia Mundaca, MD, MPH, Uniformed Services University of the Health Sciences

This article is a part of a series that will be published in the Global Outreach newsletter, "The Network." A pdf version of "The Network" is coming soon!

While employed at the US Naval Medical Research Center Detachment in Lima, Peru I had the opportunity to lead the implementation of a technology-based disease surveillance system (i.e. Alerta) at sites across the nation. This project was a public-private partnership involving the Peruvian Navy, the US Navy and a private company. Alerta provided the mechanism for reporting of 45 diseases/syndromes via a telephone or a computer with Internet access. It was launched as a pilot project in 2002 and was expanded nationwide in the Peruvian Navy by 2006. Its success led to the incorporation of the Peruvian Army with a total of almost 200 sites in 2007. There were several important lessons that might be of value to others planning a similar experience:

• Securing political commitment early was critical to program success. A Peruvian Navy Surgeon General directive was issued to establish the mandatory nature of the program. The directive was useful to enforce the surveillance duties of healthcare personnel but it also established its priority for their superiors. Consequently, surveillance staff members were allowed access to the limited telecommunications and computer support at the sites.

• Mandatory formal reporting to leadership. To ensure constant support from the Peruvian military leadership, weekly formal reports with the system’s performance and a summary of the diseases’ notified were submitted.

• Pilot sites before broad implementation. Beginning implementation with a pilot phase allowed continuous monitoring of every site, supervision visits to the regional hubs and the early development of evaluation indicators. The small scope allowed for investigation of noncompliant sites.

• Quality assurance site visits. Our team conducted site visits to compare electronic reporting to Alerta with local paper charting. During the visits the team identified and addressed challenges (e.g. use of limited resources, confusion about task) while using the opportunity for immediate training.

• Evaluation metrics were critical. We embraced CDC guidelines to develop indicators designed to measure the system’s usefulness and performance. Our evaluation data were used to refine training material, improve our assessment indicators and also to identify noncompliant sites.

• Initial and ongoing training and technical assistance critical. Our team learned that training was important to motivate the surveillance staff. It was insufficient to train them on how to use the technology tool to report diseases but we needed to offer broad-based training courses on the importance of surveillance, epidemiology of the most prevalent diseases in the area, and the basics of outbreak detection and response. We also supported site outbreak response with technical assistance and laboratory supplies.

• Regular feedback as a motivator. Feedback through the distribution of epidemiological bulletins was also very important. Staff observed how their reporting efforts were translated to useful information for their organization.

• Use of incentives. Our team sent congratulations letters to the surveillance staff of sites with the highest performance. We offered free attendance to continuing education conferences. Promotional materials used pictures of the surveillance staff in action. Cumulatively, the use of incentives to reinforce positive behavior was deemed valuable.

27 April 2009

BioSecure 2009

BioSecure 2009
Biosurveillance and Biosecurity Workshop: International Perspectives

Taipei, Semptember 24-25, 2009

More information

The 2009 Biosurveillance and Biosecurity Workshop (BioSecure 09) will continue the annual biosurveillance and biosecurity workshop series, with technical co-sponsorship from ISDS. BioSecure 09 will be held in Taipei hosted by the Taiwan National University; it will be the first time this workshop is held in the Asia-Pacific region.

The key objectives of Biosecure 09 are: (a) fostering collaboration between biosurveillance and biosecurity researchers and practitioners in Asia-Pacific countries and the rest of the world, (b) sharing international perspectives of biosurveillance practice, (c) discussing international data sources, and (d) promoting cross-cutting research among public health and computer/information sciences research communities.

Paper submissions are due on June 10, 2009. Long (12 pages), short (6 pages) papers, and extended abstracts (2 pages) may be submitted electronically via the workshop website. A formal publication with the Springer Lecture Notes in Computer Science series (Bioinformatics sub-series) is planned.

23 April 2009

April Literature Summaries Now Available

Summaries of the articles discussed on today's Literature Review call can now be found on the ISDS wiki, along with a copy of Dr. Marianne Frisén's presentation.

The next Literature Review will take place on Wednesday, May 27th at 10:00 am EDT.

Looking ahead to June, Anette Hulth and her colleagues of the Swedish Institute for Infectious Disease Control have accepted the invitation to present their paper entitled "Web Queries as a Source for Syndromic Surveillance." The presentation will take place on Thursday, June 18th at 10:00 am EDT.

21 April 2009

How to Receive Notifications from the ISDS Wiki

As a part of its monthly Literature Review, the Research Committee is hoping to start wiki based discussions centered around the presentations and papers of invited speakers.

In an initiative to more actively engage Society members in wiki discussion threads, ISDS has created a document with instructions on how to subscribe to notifications indicating when changes have been made.

When choosing to receive notifications, several options are available:

Type of information:
-Discussion changes (recommended)
-Page changes (any edits that are made)
-All changes

Notification method:
-Page Feeds (RSS)

In addition to highlighting the wiki subscription methods, the instructions also contain a section on choosing and configuring an RSS reader. Any one of the various RSS readers will also allow you to subscribe to a feed for this blog, or for the ISDS Twitter account.

To download a pdf of the instructions, please visit the ISDS Wikispaces page.

16 April 2009

Education and Training Committee Meeting

When: Thursday, April 16th at 1:00 pm EDT.

1. Pre-conference workshop planning (selection of track chairs, format, inclusion of syndromic 101 session)
2. Expansion of syndromic 101 course
3. Inclusion on our WIKI of some epi materials provided by the Global Outreach Committee

1. Planning for the 2009 pre-conference workshop is under way. Currently, the ETC is in the process of selecting a program committee and deciding on the workshop format. It is hoped that this year's workshop will be more interactive, and include an introductory syndromic surveillance lecture at the beginning of the day. This year, the workshop will be held off-site at the Miami Dade County Health Department.

2. As a collaboration with the Global Outreach Committee, Larissa May is working to make an ISDR training tool and a surveillance cost tool available to the Society.

Next meeting:
The next Education and Training Committee meeting will take place on Monday, May 11th at 1:00 pm EDT.

April Literature Review Webinar Registration Info

ISDS April Literature Review
Join us for a Webinar on April 23

Space is limited. Reserve your seat here:

The Research Committee will be holding its monthly Literature Review on Thursday, April 23rd 2009 at 10:00 am EDT. This month, Professor Marianne Frisén of the University of Gothenburg has been invited to present her recent article, "Robust outbreak surveillance of epidemics in Sweden."

The first 30 minutes of the call will be spent discussing the month's article summaries, and then Prof. Frisén will make her presentation followed by a discussion, starting promptly at 10:30 am EDT.

Title: ISDS April Literature Review
Date: Thursday, April 23, 2009
Time: 10:00 AM - 11:00 AM EDT

After registering you will receive a confirmation email containing information about joining the Webinar.

System Requirements
PC-based attendees
Required: Windows® 2000, XP Home, XP Pro, 2003 Server, Vista
Macintosh®-based attendees
Required: Mac OS® X 10.4 (Tiger®) or newer

09 April 2009

Articles for April Literature Review

The Research Committee will be holding its monthly Literature Review on Thursday, April 23rd 2009 at 10:00 am EDT. This month, Professor Marianne Frisén of the University of Gothenburg has been invited to present her recent article, "Robust outbreak surveillance of epidemics in Sweden."

The first 30 minutes of the call will be spent discussing the month's article summaries, and then Prof. Frisén will make her presentation followed by a discussion, starting promptly at 10:30 am EDT.

Below are recent selections from our PubCrawler search, which are collected by the Research Committee's gmail account. To download pdf versions of the articles, Committee members are invited to log in to the account. Please see the following contact information to get the gmail account details.

Please email your input on any selected articles by April 22, 2009 to rviola@syndromic.org.

As always, this call is optional for contributors but is an opportunity to help, express concerns, and make suggestions.

Please note any articles of high quality and broad appeal for inviting the authors for online presentation or for consideration for ISDS recognition in its annual awards.

To clarify the process for our growing list of participants, the submissions should be brief structured summaries rather than formal reviews. Submit a summary only if you feel that the article is worthy of posting.

Tokars JI, Burkom H, Xing J, English R, Bloom S, Cox K, Pavlin JA.
Enhancing Time-Series Detection Algorithms for Automated Biosurveillance.
Emerg Infect Dis. 2009 Apr;15(4):533-539.

Eysenbach G.
Infodemiology and infoveillance: framework for an emerging set of public health informatics methods to analyze search, communication and publication behavior on the Internet.
J Med Internet Res. 2009 Mar 27;11(1):e11

Yli-Hietanen J, Niiranen S, Aswell M, Nathanson L.
Domain-specific analytical language modeling-The chief complaint as a case study.
Int J Med Inform. 2009 Mar 21;.

Huaman MA, Araujo-Castillo RV, Soto G, Neyra JM, Quispe JA, Fernandez MF, Mundaca CC, Blazes DL., Impact of two interventions on timeliness and data quality of an electronic disease surveillance system in a resource limited setting (Peru): a prospective evaluation.
BMC Med Inform Decis Mak. 2009 Mar 10;9(1):16.

Gault G, Larrieu S, Durand C, Josseran L, Jouves B, Filleul L.
Performance of a syndromic system for influenza based on the activity of general practitioners, France. J Public Health (Oxf). 2009 Mar 5;. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=19269992

Deepa TM, Venkata Rao E, Patil RR, Samuel R.
Operational feasibility of establishing community reporting systems.
Natl Med J India. 2008 Jul-Aug;21(4):166-70.

Hripcsak G, Soulakis ND, Li L, Morrison FP, Lai AM, Friedman C, Calman NS, Mostashari F., Syndromic Surveillance Using Ambulatory Electronic Health Records.
J Am Med Inform Assoc. 2009 Mar 4;. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=19261941

02 April 2009

April Global Outreach Committee Meeting

When: Thursday, April 2nd, 10:00 am EDT

1. Expertise database
2. “The Network” newsletter
3. DiSTRIBuTE (influenza surveillance)
4. Webpages
5. Funding opportunity - http://www.fic.nih.gov/recovery/challenge/ict.htm
6. Public Health/Research webinar
7. Any other business
8. Next meeting

1. DiSTRIBuTE - Until now, DiSTRIBuTE has been a US-focused project, but the goal is to expand to international sites in the next phase. By next flu season, hopefully international data should be incorporated. However, there are still some barriers in sharing data that must be resolved. There are 7-8 countries in the European Union that may be interested in participating, and could start the proof-of-concept phase in Europe. Don Olson will be starting an email conversation soon to recruit international participants.

2. NIH Challenge Grant (see link above)- The Committee discussed how the DiSTRIBuTE project might fit within the grant parameters. In the coming weeks Don Olson will look more closely at the grant to assess how the DiSTRIBuTE project could be linked with a low income country, and existing NIH grant participant. The GOC will then be in a stronger position to foster help for the bid.

3. Newsletter - The Committee is getting ready to publish the next issue of its newsletter, "The Network." Several articles have been submitted, and are currently being translated into French and Spanish by some Committee volunteers. The final version will be sent around as a pdf.

4. RC/PHPC Webinar - Duncan Cooper suggested that the GOC submit a few joint abstracts for the May 28 webinar. Some of the Committee members are submitting individual abstracts as well.

5. Survey for Expertise Database - Sheri Lewis has been helping to develop the GO survey. The goal of the survey is to collect information about the type of work that ISDS members are doing in order to build a database.

Next meeting:
Tuesday, June 2nd, 10:00 am EDT