18 December 2014
04 December 2014
This is an official
CDC HEALTH ADVISORY
CDC Health Advisory Regarding the Potential for Circulation of Drifted Influenza A (H3N2) Viruses
CDC is reminding clinicians of the benefits of influenza antiviral medications and urging continued influenza vaccination of unvaccinated patients this influenza season.
Influenza activity is currently low in the United States as a whole, but is increasing in some parts of the country. This season, influenza A (H3N2) viruses have been reported most frequently and have been detected in almost all states.
During past seasons when influenza A (H3N2) viruses have predominated, higher overall and age-specific hospitalization rates and more mortality have been observed, especially among older people, very young children, and persons with certain chronic medical conditions compared with seasons during which influenza A (H1N1) or influenza B viruses have predominated.
Influenza viral characterization data indicates that 48% of the influenza A (H3N2) viruses collected and analyzed in the United States from October 1 through November 22, 2014 were antigenically "like" the 2014-2015 influenza A (H3N2) vaccine component, but that 52% were antigenically different (drifted) from the H3N2 vaccine virus. In past seasons during which predominant circulating influenza viruses have been antigenically drifted, decreased vaccine effectiveness has been observed. However, vaccination has been found to provide some protection against drifted viruses. Though reduced, this cross-protection might reduce the likelihood of severe outcomes such as hospitalization and death. In addition, vaccination will offer protection against circulating influenza strains that have not undergone significant antigenic drift from the vaccine viruses (such as influenza A (H1N1) and B viruses).
Because of the detection of these drifted influenza A (H3N2) viruses, this CDC Health Advisory is being issued to re-emphasize the importance of the use of neuraminidase inhibitor antiviral medications when indicated for treatment and prevention of influenza, as an adjunct to vaccination.
The two prescription antiviral medications recommended for treatment or prevention of influenza are oseltamivir (Tamiflu®) and zanamivir (Relenza®). Evidence from past influenza seasons and the 2009 H1N1 pandemic has shown that treatment with neuraminidase inhibitors has clinical and public health benefit in reducing severe outcomes of influenza and, when indicated, should be initiated as soon as possible after illness onset. Clinical trials and observational data show that early antiviral treatment can:
· shorten the duration of fever and illness symptoms;
· reduce the risk of complications from influenza (e.g., otitis media in young children and pneumonia requiring antibiotics in adults); and
· reduce the risk of death among hospitalized patients.
As of November 22, influenza activity has increased slightly in most parts of the United States. Surveillance data indicate that influenza A (H3N2) viruses have predominated so far, with lower levels of detection of influenza B viruses and even less detection of H1N1 viruses. During the week ending November 22, 1,123 (91.4%) of the 1,228 influenza-positive tests reported to CDC were influenza A viruses and 105 (8.6%) were influenza B viruses. Of the 85 influenza A (H3N2) viruses collected by U.S. laboratories and antigenically or genetically characterized at CDC since October 1, 2014, 44 (52%) are significantly different (drifted) from A/Texas/50/2012, the U.S. H3N2 vaccine virus. Drifted H3N2 viruses were first detected in late March 2014, after World Health Organization (WHO) recommendations for the 2014-2015 Northern Hemisphere vaccine had been made in mid-February. At that time, a very small number of these viruses had been found among the thousands of specimens that had been collected and tested, but these viruses have become more predominant over time. Most of the drifted H3N2 viruses are A/Switzerland/9715293/2013 viruses, which is the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. These drifted viruses will likely continue to circulate in the United States throughout the season. All influenza viruses tested for resistance to neuraminidase inhibitors this season have shown susceptibility to both oseltamivir and zanamivir. Given the likelihood that the drifted influenza A (H3N2) viruses will continue to circulate this season, CDC is issuing the following recommendations to remind clinicians of CDC’s guidance for the use of influenza antiviral medications.
Recommendations for Health Care Providers
· Clinicians should encourage all patients 6 months and older who have not yet received an influenza vaccine this season to be vaccinated against influenza. There are several influenza vaccine options for the 2014-15 influenza season (see http://www.cdc.gov/flu/protect/vaccine/vaccines.htm).
· Clinicians should encourage all persons with influenza-like illness who are at high risk for influenza complications (see list below) to seek care promptly to determine if treatment with influenza antiviral medications is warranted.
Summary of CDC Recommendations for Influenza Antiviral Medications for the 2014-2015 Season:
Clinicians should continue to vaccinate patients who have not yet received influenza vaccine this season.
Clinical benefit is greatest when antiviral treatment is administered early. When indicated, antiviral treatment should be started as soon as possible after illness onset, ideally within 48 hours of symptom onset. However, antiviral treatment might still have some benefits in patients with severe, complicated, or progressive illness and in hospitalized patients when started after 48 hours of illness onset.
Antiviral treatment with oseltamivir or zanamivir is recommended as early as possible for any patient with confirmed or suspected influenza who:
· is hospitalized;
· has severe, complicated, or progressive illness; or
· is at higher risk for influenza complications. This list includes:
o children aged younger than 2 years;
o adults aged 65 years and older;
o persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), and metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);
o persons with immunosuppression, including that caused by medications or by HIV infection;
o women who are pregnant or postpartum (within 2 weeks after delivery);
o persons aged younger than 19 years who are receiving long-term aspirin therapy;
o American Indians/Alaska Natives;
o persons who are morbidly obese (i.e., body-mass index is equal to or greater than 40); and
o residents of nursing homes and other chronic-care facilities.
Clinical judgment, on the basis of the patient’s disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for high-risk outpatients. Decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza.
Oseltamivir is approved for treatment of influenza in persons aged two weeks and older, and for chemoprophylaxis to prevent influenza in people one year of age and older, while zanamivir is approved for treatment of persons seven years and older and for prevention of influenza in persons five years and older. Because high levels of resistance to adamantane antiviral medications continue to be observed among circulating influenza A viruses, adamantanes (rimantadine and amantadine) are not recommended for treatment or prevention of influenza.
Antiviral treatment also can be considered on the basis of clinical judgment for any previously healthy, symptomatic outpatient who is not considered “high risk” with confirmed or suspected influenza, if treatment can be initiated within 48 hours of illness onset.
Special Considerations for Institutional Settings
Use of antiviral chemoprophylaxis to control outbreaks among high risk persons in institutional settings is recommended. An influenza outbreak is likely when at least two residents are ill within 72 hours, and at least one has laboratory confirmed influenza. When influenza is identified as a cause of a respiratory disease outbreak among nursing home residents, use of antiviral medications for chemoprophylaxis is recommended for residents (regardless of whether they have received influenza vaccination) and for unvaccinated health care personnel. For newly-vaccinated staff, antiviral chemoprophylaxis can be administered up to two weeks (the time needed for antibody development) following influenza vaccination. Chemoprophylaxis may also be considered for all employees, regardless of their influenza vaccination status, if the outbreak is caused by a strain of influenza virus that is not well matched by the vaccine. Antiviral chemoprophylaxis should be administered for a minimum of two weeks, and continue for at least seven days after the last known case was identified.
To reduce the substantial burden of influenza in the United States, CDC continues to recommend a three-pronged approach:
(1) influenza vaccination. The influenza vaccine contains three or four influenza viruses depending on the influenza vaccine—an influenza A (H1N1) virus, an influenza A (H3N2) virus, and one or two influenza B viruses. Therefore, even if vaccine effectiveness is reduced against drifted circulating viruses, the vaccine will protect against non-drifted circulating vaccine viruses. Further, there is evidence to suggest that vaccination may make illness milder and prevent influenza-related complications. Such protection is possible because antibodies created through vaccination with one strain of influenza viruses will often “cross-protect” against different but related strains of influenza viruses;
(2) use of neuraminidase inhibitor medications when indicated for treatment or prevention. Antiviral treatment with oseltamivir or zanamivir is recommended as early as possible for any patient with confirmed or suspected influenza who: is hospitalized; has severe, complicated, or progressive illness; or is at higher risk for influenza complications. Antiviral chemoprophylaxis should be used for prevention of influenza when indicated for institutional influenza outbreaks, and may be considered for those who have contraindications to influenza vaccination. CDC recommends antiviral chemoprophylaxis for a minimum of two weeks, and continuing for at least seven days after the last known case was identified.
(3) use of other preventive health practices that may help decrease the spread of influenza, including respiratory hygiene, cough etiquette, social distancing (e.g., staying home from work and school when ill, staying away from people who are sick) and hand washing.
For More Information:
· Influenza Vaccines Available in United States, 2014–15 Influenza Season
· Information for healthcare professionals on the use of influenza antiviral medications: http://www.cdc.gov/flu/professionals/antivirals/
· Summary of Influenza Antiviral Treatment Recommendations for clinicians: http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#summary
· Diagnostic Testing for Influenza:
· Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities: http://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm
03 December 2014
24 November 2014
Training for Surveillance of Heart Disease, Stroke and Other Chronic Diseases in State Health Departments
Please see the message below regarding the National Association of Chronic Disease Directors Geographic Information Systems (GIS) Training for Surveillance of Heart Disease, Stroke and Other Chronic Diseases in State Health Departments (SHDs).
Eligible State Health Department Applicants:
State health departments from any of the 50 US states and the District of Columbia are eligible to apply, with the exception of Arkansas, California, Colorado, Florida, Kansas, Louisiana, Idaho, Indiana, Iowa, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Vermont, and Wisconsin. These states are excluded because they have already participated in the GIS Training for Surveillance of Heart Disease, Stroke and Other Chronic Diseases.
State Applications are due January 9, 2015; notification of award by February 16, 2015.
You can find the application attached here:
18 November 2014
The Pandemics team at the Skoll Global Threats Fund would like to share some information about our upcoming Data Challenge that we've developed in partnership with Innocentive. Since 2011 Flu Near You, a collaboration between the American Public Health Association, HealthMap of Boston Children's Hospital, and the Skoll Global Threats Fund, has collected weekly reports of influenza-like illness symptoms from volunteers in the United States and Canada. With well over 100,000 user registrations and recently surpassing 1,000,000 total reports, we've shown that we really can put the PUBLIC back into public health.
Now that Flu Near You has demonstrated its current value and future potential as a public health surveillance tool, we'd like to engage researchers, data scientists, statisticians, epidemiologists and others in answering a fundamental question that will guide our continued development of Flu Near You - how many volunteer reports do we need to meet our public health surveillance goals? We've developed this Challenge to solicit a wide variety of ideas and approaches to answering this question. We would encourage you to take a look HERE and share widely within your networks.
12 November 2014
An In-Depth Look at Track 4:
Mapping and Biosurveillance: Using ArcGIS
Date/Time: December 9, 2014 - 8:00am - 4:15pm
Location: Hyatt Regency at Penn's Landing, Philadelphia, PA
The target audience of this training is public health practitioners, graduate students and researchers.
Advances in geographical information systems (GIS) and mapping technologies have created exciting new opportunities for public health professionals to collect, analyze, display, and share multiple types of data and information. Biosurveillance has benefitted greatly from these tolls and continues to be enhanced as more individuals learn the nuances of GIS. ArcGIS, the mapping software developed by ESRI, has become the industry standard and is used in most public health departments in the U.S. This session will provide an introduction and focused examples of how the ArcGIS platform can be used for biosurveillance. Topics covered include: introduction to ArcGIS Online; introduction to Esri Maps for Office and integration of Esri Maps for Office and ArcGIS Online; and introduction to Community Analyst/Business Analyst. There will be a didactic session for each topic, followed by a hands-on session to apply the skills learned. Typical geocoded tabular health data will be provided for the hands-on sessions.
Learn more about the 2014 ISDS Pre-Conference Trainings here.
11 November 2014
Call for Abstracts: Pathways Into Health 2015 Conference October 12-14, Seattle, WA - Abstracts due February 20
ACHIEVING EXCELLENCE, HARMONY, AND BALANCE:
Uniting and Sustaining Pathways into Health Professions
Submission Deadline: February 20
Pathways Into Health invites abstracts to be considered for presentation at the 8th National Conference on October 12-14, 2015 in Seattle, WA. The theme of the 2015 conference, Uniting and Sustaining Pathways into Health Professions, explores opportunities to unite, enhance, and sustain new and existing pathways into health professions for American Indian and Alaska Native individuals and communities.
Call for Abstracts
Our aim is to make the Pathways Conference the premier venue for cutting-edge educational methodologies for engaging AI/AN populations in health professions and for making findings, programs, and resources useable by non-scientists. The 2015 conference agenda will have four core concepts of focus:
1 Cultural Attunement
2 Interprofessional Education (IPE)
3 Distance Learning/Telehealth Technologies
4 Health career development through the life span
Pathways welcomes abstracts related to successful implementation of programs, initiatives, and policies that engage AI/AN individuals and communities in health professions. We particularly encourage abstracts that address the conference theme and inform strategies for uniting and sustaining pathways into health professions. Abstracts must focus on one or more of the four core concepts.
Read the full Call for Abstracts here:
The submission deadline is February 20, 2015. Notifications will be sent out in early May.
05 November 2014
Dear One Health Friends and Colleagues:
The One Health Commission (OHC) is pleased to announce the 1st International Who's Who in One Health Webinar to be held November 10, 2014. The Webinar will bring together noted One Health leaders, advocates, professionals and students in real-time to discuss global One Health efforts while providing a forum for dialogue within and across disciplines.
The main objectives of the Webinar are to:
- Connect One Health stakeholders around the world to better understand, share and highlight individual- and agency-level efforts;
- Educate Webinar participants about the One Health paradigm and way of thinking towards improved health outcomes; and
- Create new strategic partnerships and networks for collective, purposeful and coordinated action
Already there are 240 registrants from 50 countries. The goal of this webinar is to connect with as many One Health leaders/supporters around the world as possible on November 10. We hope you might join in for part or all of this day long webinar. Also, as an advocate for One Health, please consider sharing this information with your own networks and listservs (email, website, social media etc). Feel free to add this information directly to your own website and hyperlink back to the OHC International Webinar page (www.onehealthcommission.org/globalwebinar). Thank you!
Hope you can join in.
The One Health Commission
Who’S Who in One Health International Webinar Team
Who’S Who in One Health International Webinar Team
03 November 2014
Strengthening health systems through interprofessional education (SHINE) is the focus of Project SHINE. The Applied Public Health Informatics Fellowship (APHIF), Health Systems Integration Program (HSIP), and Informatics Training in Place Program (I-TIPP) are one-year fellowship programs that provide capacity building opportunities at health departments in health systems, informatics, and epidemiology. The fellowship programs’ mission is to meet the nation’s increasing and urgent need for applied public health informatics and epidemiology workforce capacity in state and local health departments. Project SHINE is supported by Association of State and Territorial Health Officials, Centers for Disease Control and Prevention, Council of State and Territorial Epidemiologists, National Association of County and City Health Officials, and Public Health Informatics Institute. This email describes each of the three SHINE fellowship programs.
Applied Public Health Informatics Fellowship (APHIF)-- APHIF was established in 2012 to train recent graduates in the expanding field of applied public health informatics. The goal of the fellowship is to provide a high quality training experience for the Fellow while providing service to the host agency and to secure long-term career placement for Fellows at the state or local level. Participating Fellows will receive one year of on-the-job training at a local or state health agency under the guidance of experienced mentors. For more information on APHIF host site requirements (including an archived information webinar session) and the application, click here. Note: an email was previously sent with APHIF host site application information.
Health Systems Integration Program (HSIP)-- HSIP aims to place experienced public health professionals at State, Tribal, Local, and Territorial health departments for one year. The recent push for improved outcomes in population health has called for these public health and primary care sectors to collaborate more effectively. The Fellows will be involved in activities that address 1) community epidemiologic surveillance to support community health needs assessments, 2) the public health interface and use of electronic health records, and 3) lessons learned from successful public health and primary care professional partnerships. For more information on HSIP host site requirements (including an archived information webinar session) and the application, click here.
Informatics Training in Place Program (I-TIPP)-- I-TIPP is an innovative-approach to bring relevant on-the-job training to appropriate State, Tribal, Local, Territorial (STLT) health department staff. “Training-In-Place” is defined as the systematic approach to deliver an applied training curriculum in the workplace. I-TIPP aims to train members of existing workforce while they are employed in a STLT health department. Delivered over a one year period, this program is designed for individuals with an interest in gaining more training in public health informatics. This applied training program will provide an overview of various topics within public health informatics with a particular emphasis on meaningful use (MU) and surveillance system improvement. There will be an information session on “I-TIPP Strategies for Successful Applications” on December 3rd. For more information on this session, I-TIPP host site requirements, and the application, click here.
To learn more about each of the above programs, please visit http://shinefellows.org/.
Please note that each SHINE fellowship program has different application deadlines,
which are detailed in this table:
|10/30/14||APHIF & HSIP Strategies for Successful Applications Information Session|
|12/1/14||I-TIPP Strategies for Successful Applications Information Session|
17 October 2014
An In-Depth Look at Track 2:
Biosurveillance and Policy Issues for Experts
Date/Time: December 9, 2014 - 8:00am - 4:15pm
Location: Hyatt Regency at Penn's Landing, Philadelphia, PA
The target audience of this training is healthcare and public health professionals with experience in biosurveillance practice.
This training will provide experience biosurveillance professionals with a forum for learning about and discussing current topics and policies essential to biosurveillance, as well as an opportunity to collaborate with other experts in the field to develop practical, concrete products and tools. It will include panel discussions on natural disaster surveillance and the OneHealth initiative, as well as a plenary roundtable session on the "Meaningful Use"* of electronic health data. In addition, the track will feature breakout sessions to discuss current policy topics, such as ICD-10, data sharing, animal surveillance, and chronic disease surveillance. Ultimately, this trainings is intended to leverage the collective expertise of the group to advance participants' understanding and practice and to allow for a high-quality and seamless translation of the knowledge gained in the workshop within the participants' organizations. *"Meaningful Use" refers to the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Programs, a major component of the Health Information Technology for Economic and Clinical Health (HITECH) Act within the 2009 American Recovery and Reinvestment Act (ARRA) legislation.
Learn more about Meaningful Use here.
Learn more about the 2014 ISDS Pre-Conference Trainings here.
15 October 2014
Date: Thursday, October 16, 2014
Time: 1:00 pm to 2:30pm Eastern Time
The meeting agenda and the registration information for a special webinar are provided below.
· GoToWebinar tool will be used and pre-registration is required.
· Even if you have already registered for our monthly webinars, this is a special session hence please follow the registration instructions listed below to receive an email with information on how to join this webinar.
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· If you register for this webinar and cannot locate your unique participant link, please use the registration link provided below and your unique participant link will be resent to your email address.
When- Date: 10/16/2014 Time: 1p.m. to 2.30p.m. EDT
What- Special Webinar- Public Health and Electronic Health Records Vendor Collaboration Initiative
· Presentation Title: 2014 Ebola Response in the U.S. – Use of Travel History within Clinical Workflow [45 minutes]
- Question and Answer Session - [45 minutes]
- Dana Meaney Delman – Deputy Lead Medical Care Task Force (Ebola Response), Centers for Disease Control & Prevention (CDC)
- Timothy M. Uyeki- Clinical Team lead (Ebola Response), Centers for Disease Control & Prevention (CDC)
- Jon White – Office of the National Coordinator for Health IT (ONC)
- Jim Daniel – Office of the National Coordinator for Health IT (ONC)
- Brian Lee- Centers for Disease Control & Prevention (CDC)
- Laura Conn- Centers for Disease Control & Prevention (CDC)
In light of the confirmed U.S. cases of Ebola in Dallas, there is a lot of attention on electronic health records (EHRs) and their intersection with public health. The EHR vendor community has responded with components within their respective tools to address Ebola and assist within a healthcare environment.
The Centers for Disease Control and Prevention (CDC) and the Office of the National Coordinator for Health IT (ONC) will convene key stakeholders to encourage collaboration in the development of Ebola electronic screening tools. The CDC Ebola team will review the CDC clinical algorithm and checklist for evaluation of individuals with suspected Ebola Virus Disease (EVD), with the intent to explore the inclusion of travel history and assessment of pertinent clinical signs and symptoms into a electronic format that will alert clinicians to consider the diagnosis of EVD. Additionally, the ONC will lead a discussion on how existing products may be configured to support screening protocols. The presentations will be followed by a Question & Answer session for EHR vendors and public health practitioners.
Webinar Registration Instructions
Pre-register for this online event at: https://attendee.gotowebinar.com/register/7081033365571067649
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09 October 2014
25 September 2014
In response to the 2014 Ebola outbreak in West Africa, ISID has searched for ways to assist the people most affected. We are pleased to announce that we are sponsoring a limited number of travel grants to individuals who are attending one of the Centers for Disease Control and Prevention (CDC) Ebola Safety Training Courses. The courses will help prepare healthcare personnel to provide medical care to Ebola patients in an established Ebola Treatment Unit (ETU).
The first CDC Ebola Safety Training Course starts on Oct 6, 2014 and the schedule currently extends through the end of this year. The courses are open to healthcare workers from all over the world and are being offered free of charge, but participants are responsible for paying for their own travel to the course in Alabama. Full information on the CDC course: http://www.cdc.gov/vhf/ebola/hcp/safety-training-course/index.html
Only individuals who have been accepted to the CDC Ebola Safety Training Course and who will deploy to West Africa after completion of the course will be eligible for ISID funding. Travel grants of $500 each will be awarded to US residents and $1000 to residents of other countries. For more information on the ISID CDC Ebola Safety Training travel grant please go to: http://www.isid.org/grants/grant_ebola_training_travel.shtml
Also, I hope that you are aware of the excellent coverage that our program, ProMED, has provided in daily updates on the Ebola outbreak. You can sign up for ProMED alerts for free at: http://www.promedmail.org.
Britta Lassmann, MD
ISID Program Director
Larry Madoff, MD
Jon Cohen, MD
19 September 2014
Surveillance for Emerging Infectious Diseases - A Letter from ISDS Board of Directors' President Richard Hopkins
In case we needed any reminding, new infectious disease threats keep emerging, as evidenced by Middle East Respiratory Syndrome (MERS), chikungunya in the western hemisphere, and Ebola in West Africa. As surveillance professionals, we are likely to be looked to for data to support detection and response efforts, but also for advice as to where strategic investments in surveillance should be made in the course of an epidemic to support the response. Deciding on the optimal surveillance strategy requires the advice of a seasoned surveillance practitioner, but also an understanding of the goals of the outbreak response and of the control measures being put into place. The system needs to generate the information that is needed for decision-making by those leading the response, in time to be useful.
There are several important tasks for the surveillance function — all of course in support of more effective prevention and control:
— recognize the introduction of an infectious agent into a new population as early as possible.
— for diseases with a case-by-case public health response, identify every case promptly so that control measures can be taken
— identify the population groups at greatest risk of infection, of disease, and of severe disease or death
— monitor population impact of severe as well as mild disease
— monitor the geographic distribution, size, trajectory and end of the outbreak, epidemic or pandemic that may result from an introduction
— help to determine whether control measures are being effective
Some kinds of important questions probably can’t be answered through surveillance, but instead would be answered through focused case and contact investigations during outbreaks, or by planned cohort, cross-sectional or case-control studies. For example, when in the natural course of infection and illness are people infectious to others? How many asymptomatic infections are occurring?
The tools we have at hand to accomplish surveillance goals are diverse, and the right mix of these tools will vary depending on the disease, the epidemiologic situation, and the stage of the event:
— individual case reports of suspected cases from clinicians, both through the reportable disease mechanism and as clinician calls to public health authorities about unusual or alarming cases of disease
— laboratory reports from clinical laboratories, including reference laboratories, and from public health laboratories, either of increased detection of the condition of interest or of inability to characterize certain infections
— notifications of or queries about apparent disease outbreaks, by any of a wide variety of reporters: physicians, school nurses, child care center operators, organizers of group events, news media reporters, etc.
— increased chatter or mention of certain symptoms or diseases on blogs, internet news sites, social media sites, etc
— numbers of deaths recorded with certain causes of death mentioned on the death certificate
— numbers of visits to sentinel practices with a syndrome suggesting the presence of the emerging pathogen
— number of hospital admissions, or ICU admissions, with a syndrome suggesting the presence of the emerging pathogen, or with a suggestive admitting diagnosis
— numbers of visits to emergency departments, urgent care centers and other sites participating in syndromic surveillance, either with a syndrome suggesting the presence of the emerging pathogen or with mention of the name of the pathogen in free-text chief complaint or diagnostic fields.
For all these tools, it is easiest to recognize cases of an emerging infection if the disease caused by the infectious agent has clinical characteristics that make it distinctive, or if there is a specific laboratory test. Detection is also aided, early in an event, if a specific unusual travel history or other exposure is associated with likelihood of illness. The more generic the symptoms are — which is especially likely early in the illness — the harder it will be to detect likely cases by presenting illness alone, and either a specific exposure history or laboratory testing will be necessary to detect likely cases. Even with fairly generic symptoms, however — as is the case with the syndrome of influenza-like illness — tallying of healthcare visits by syndrome in comparison to a baseline can be helpful in monitoring the size, scope and direction of an established epidemic. Alternatively, surveillance can be focused on fully-developed disease which is more clinically distinctive, but this has a cost in sensitivity and timeliness of case and outbreak detection.
The underlying point of this little essay is that the optimal surveillance strategy for an emerging infection will depend on the disease's clinical and epidemiologic characteristics, the current stage of the outbreak, the control strategy that needs to be supported, and the relative costs of missing true significant events and of investigating large numbers of unimportant events. The optimal strategy will depend on the desired balance among sensitivity, positive predictive value, and timeliness (whether for cases or for outbreaks). These three are always in tension with each other. Optimizing one of these attributes leads to compromises in at least one of the others, unless there is significant system change. Those in charge of the response to a threat from an emerging pathogen, with a given set of surveillance systems available to them, will need to decide what the desired balance is between high sensitivity (with its cost of false alarms), high positive predictive value (with its costs of decreased sensitivity and slower detection) and increased timeliness (with its costs in both decreased positive predictive value and decreased sensitivity).
Improvements in key characteristics of surveillance systems can decrease the danger from these tradeoffs. For example, implementing electronic laboratory reporting can improve timeliness of case detection with little or no cost in sensitivity or positive predictive value, as can implementing electronic (as opposed to manual) syndromic surveillance. New diagnostic tests that can be performed at the bedside, or even in the field by EMTs, can in theory improve all three parameters, depending on how reliable they are under bedside or field conditions.
ISDS Board of Directors' President
18 September 2014
17 September 2014
An In-Depth Look at Track 1:
Biosurveillance for Beginners
Date/Time: December 9, 2014 - 8:00am - 4:15pm
Location: Hyatt Regency at Penn's Landing, Philadelphia, PA
The target audience of this trainings is healthcare and public health professionals new to biosurveillance practice, as well as graduate students ad researchers interested in obtaining a better understanding of biosurveillance.
This training will provide exposure to key topics central to biosurveillance and serve to orient those who are new to the field. the objective of Track 1 is to "bridge the knowledge gap" to enable participants to better understand and apply public health data for informed and meaningful decision-making and to communicate outcomes or results. It includes an overview of biosurveillance, as well as demonstrations of the integration of novel data sources (emergency department chief complaints, emergency medical services, school absenteeism and poison control center calls) with syndromic surveillance systems and their application in daily biosurveillance practice. .Track 1 is being developed based on feedback from participants who attended the 2013 ISDS Pre-Conference Workshops; therefore, it is sure to be a high quality training opportunity relevant to the practical needs of those who are new to biosurveillance.
Learn more about the 2014 ISDS Pre-Conference Trainings here.
16 September 2014
Dear Friend of CUGH,
The Ebola crisis in West Africa is rapidly worsening. As of the writing of this note, over 3,500 people have been infected with the virus and over 1,700 people have been killed. Alarmingly, the disease is spreading into densely populated urban areas.
There is an acute shortage of medical supplies, experienced healthcare workers, and funds in the region. Doctors without Borders has been bravely shouldering the greatest responsibility to not only care for those infected with Ebola, but also treat people affected with the numerous other diseases and health challenges in this, one of the poorest regions of the world.
We at CUGH are trying to help MSF and USAID identify individuals with the experience and skills needed to stop the spread of this virus and provide essential medical care in the affected countries. Please see MSF's request by clicking on this link and USAID's request by clicking on this link and share these with your colleagues widely. Help us identify individuals who can address this crisis before it spreads much further and advocate for greater funding to purchase essential supplies.
We have also been engaging with the State Department and other US government agencies to address this crisis. Please see my Op-Ed in the Toronto Star on a civil-military humanitarian relief effort to urgently save lives and stop the spread of this deadly disease.
Thank you for your assistance.
Keith Martin, MD
Consortium of Universities for Global Health