3rd International One Health Congress: New Website & Info

  

 3^rd INTERNATIONAL ONE HEALTH CONGRESS

 launches new website

www.iohc2015.com  FOLLOW US

Online registration is possible from 1 April, 2014

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CONGRESS THEME: PREVENTION AT THE SOURCE 

The 3rd International One Health Congress brings science and policy together aiming at

the early recognition and control of emerging (infectious) diseases, now and in the years to come. 

Prevention at the source is key in controlling (infectious) diseases that have a growing impact on humans, animals and their ecosystems. 

Visit www.iohc2015.com for more information about scientific focus and program.

Webinar: Global Public Health Surveillance, Governance, and Viral Sovereignty

Hosted by the ISDS Global Outreach Committee
Date and Time: Wednesday, August 14, 2013 3:00 PM - 4:00 PM EDT

Presenters

• Affan Shaikh, M.P.H, Senior Epidemiologist, Public Health Practie, LLC
• Scott McNabb, Ph.D., M.S., Research Professor, Emory University, Rollins School of Public Health | Managing Partner, Public Health Practice, LLC 

Contributors

• Qanta Ahmed, M.D., Attending Sleep Disorders Medicine, Winthrop University Hospital | Associate Professor of Medicine, State University of New York (SUNY) at Stony Brook, New York
• Ziad Memish, M.D., Deputy Minister of Public Health, Ministry of Health, Kingdom of Saudi Arabia

 

Description

Microbes carry no national passports; neither do they recognize geo-political boundaries or state sovereignty. Yet a recent violation of viral sovereignty has brought up unresolved governance issues, challenged ethical public health practice, and added unnecessary global security risk.  Viral sovereignty refers to a sovereign state’s ownership rights over pathogens found within national borders.  First coined in the wake of tensions rising from the Indonesian government’s decision to conditionally withhold samples of H5N1 avian influenza virus in early 2007, viral sovereignty has been interpreted both in a positive light as a guiding, ethical rule to govern control of modern pandemics on the one hand and a potential risk to global health security on the other.

While the World Health Organization (WHO) revised the International Health Regulations (IHR [2005]) to provide a global framework to prevent, protect against, control, and facilitate a public health response to the global spread of disease, its success firmly rests on the delicate balance of trust and transparency.  Current disputes now highlight the imbalance between respecting and trusting legitimate national sovereignty while complying with global transparency in reporting.

This webinar reviews the history and role of the IHR 2005.  In it, we discuss the rights and responsibilities of various parties for public health surveillance and global health security.  We also discuss the origins and implications of viral sovereignty. And through two case studies, we point out the critical and current issues to be discusses and weigh the pros and cons of various options to move forward to greater global health security.

Learning Objectives

By the conclusion of this webinar, participants will be able to:

• Describe the history and role of the International Health Regulations (IHR [2005])
• Review the authority and obligations of National Ministries of Health and the World Health Organization (WHO) for public health surveillance
• Delineate national and global rights and responsibilities for public health surveillance
• Define viral sovereignty and its impact on global health security
• Illustrate a way forward

Register here to attend!

Join the conversation on twitter! Use the hashtag #ViralSovereignty

Highlight ISDS Workshop: Assessment tools to meet the core capacities of the surveillance goal of the 2005 International Health Regulations

2012 Pre-Conference Workshops

Sheraton San Diego Hotel and Marina

1380 Harbor Island Drive, San Diego, California 92101 

Resolution WHA65.23, developed at the World Health Assembly in May 2012, recognizes the importance of having tools and procedures available for the continuous monitoring of core capacities specified in the 2005 International Health Regulations (IHRs). The resolution urges state parties, “… to take the necessary steps to prepare and carry out appropriate national implementation plans in order to ensure the required strengthening, development and maintenance of the core public health capacities...”

 

In order to directly address the needs discussed at the World Health Assembly, ISDS, with support from WHO, is developing a one-day, hands-on training designed to help nations meet the core capacities of the surveillance goal of the 2005 IHRs. The training will feature an overview of the IHRs (2005) by Dr. Stella Chungong, lead of the IHR Monitoring Team at the World Health Organization. This overview will be followed by an introduction to concepts and tools to assess current performance and gaps in performance by Dr. Scott McNabb, Public Health Practice, LLC. Participants will also have an opportunity to implement these tools on indicators specific to their country (or on sample indicators).

The final session of the Pre-Conference Workshop is called the ‘Swap Meet’ – an interactive session during which participants may walk around to tables and informally discuss topics and systems with system developers, users, and content experts.

Reserve your space and register now.

Find information on other Pre-Conference Workshop Track options here.

This Pre-Conference Workshop Track is being sponsored in part by the Defense Threat Reduction Agency.

ISDS's Global Outreach Committee hosted an International Health Regulations Webinar Series featuring both Dr. Chungong and Dr. McNabb. View the recordings here.

International Health Regulations Webinar Series

The International Health Regulations (2005) came into effect in 2007 and mandate that each signatory country be capable of detecting, analyzing, reporting, and responding to a public health event of international concern by 2012.  Some countries are capable of this at present, but these are generally clustered in resource-limited settings.  Many more countries will not be fully capable of compliance by 2012, some because of insufficient surveillance systems.

The ISDS Global Outreach Committee, in order to provide a learning opportunity to better understand the IHR requirements and data elements required by the World Health Organization (WHO), has put together a webinar series for summer 2011.

Monday, June 27th, 2011; 11:00 am - 12:00 pm EST
Introduction to IHR and IHR Requirements and Indicators for Monitoring Core Capacity Development

• Speaker:  Dr. Stella Chungong, Lead, IHR Monitoring Team, World Health Organization

Tuesday, August 9th, 2011; 12:00 - 1:00 pm EST
Illuminating Impediments to IHR Implementation and Possible Interventions

• Speaker:  Dr. Scott McNabb, Emory University

Register for this event

More information

Triple S Project: Syndromic Surveillance Survey and Assessment towards Guidelines for Europe

The International Society for Disease Surveillance is pleased to announce its role as an advisory member of the Triple-S Project in Europe.  Former Board Director Duncan Cooper will be serving as ISDS' liaison throughout the project, and will continue to provide updates as they become available. 

Below is the project's first press release:

Triple S (Syndromic Surveillance Survey and Assessment towards Guidelines for Europe) is a European project to develop guidelines to strengthen public health surveillance and rapid response to prevent and assess health threat impact has been announced. This work covers health threat or impact from both infectious and environmental hazards. The programme, co-financed by the European commission, involves twenty four organisations from fourteen countries. It aims to produce a handbook for member states to allow future early warning systems to be developed and assessed.

The Public Health Action Programme Triple S (Syndromic Surveillance Survey, Assessment towards Guidelines for Europe, grant agreement GA 2009.11.12) will review and analyse European syndromic surveillance systems. The program is co-financed by the European commission through the Executive Agency for Health and Consumers. It encompasses an inventory of existing and proposed syndromic surveillance systems, including country visits for an in-depth understanding of selected systems. The project will also provide scientific and technical guidance for the development and implementation of syndromic surveillance systems for both human and animal health, according to the needs and expectations of the member states. The aim of the Triple S project is to increase the European capacity for real-time or near-real time surveillance and monitoring of the health burden of expected and unexpected health related events.

The first meeting for this three-year project, coordinated by the French Institute for Public Health Surveillance (InVS), was held in Luxembourg from November 22nd to 25th, 2010. The Health and Consumer Directorate General of the European Commission (DG Sanco), the European Centre for Disease Prevention and Control (ECDC), the World Health Organization Europe (WHO/Europe) and the International Society for Disease Surveillance (ISDS) are members of the advisory board, to ensure good exchange of practices and expertise at both the European and the global level.

For further information please contact Duncan Cooper.

Upcoming Webinar: Rates of Hospital-Acquired Respiratory Illness in Bangladeshi Tertiary Care Hospitals

The ISDS Global Outreach and Research Committees are pleased to welcome Emily Gurley as the guest speaker for their next joint webinar. She will present on her recently published work entitled, "Rates of Hospital-Acquired Respiratory Illness in Bangladeshi Tertiary Care Hospitals: Results from a Low-Cost Pilot Surveillance Strategy":

Respiratory infections can spread quickly in crowded hospitals with limited infection control infrastructure, and these facilities typically also lack surveillance systems to detect hospital acquired disease. We piloted a simple, syndromic surveillance strategy for hospital acquired respiratory infections in 3 tertiary care hospitals in Bangladesh and found that clusters of disease were frequent and that approximately 6 such infection occurred per 1000 patient days at risk. This low-tech surveillance strategy could be used in resource-poor hospital settings to better define burden of disease and evaluate the impact of infection control interventions.

The webinar will take place on Tuesday, July 6th from 12:00 pm - 1:00 pm EST.

Register here.

Global Outreach Webinar: “Developing Strategic Learning Capabilities in Regional Disease Surveillance Networks”

The ISDS Global Outreach Committee will be hosting a special webinar presented by the Global Health and Security Initiative entitled "Developing Strategic Learning Capabilities in Regional Disease Surveillance Networks" on Monday, May 17th from 10:00-11:00 AM EST. Louise Gresham and colleagues will be speaking about the CHORDS Project and its role in developing IHR competencies around the world.

Full event details including registration and speaker information available here.

Global Outreach Committee Annual Meeting Summary

At its meeting during the 8th Annual ISDS Conference in Miami, FL, the Global Outreach Committee acknowledged the work of Duncan Cooper over the past year as Board Liaison. Jean-Paul Chretien, newly elected to the Board of Directors, will step up as Board Liaison for 2010, along with Louise Wilson, who has agreed to be the Committee Chair.

The meeting began with a review of the Global Outreach mission, which includes ensuring that international needs of the Society are met, and that the group aligns itself with the overall strategy of the ISDS.

2009 was met with many successes, including the continuation of the Committee’s newsletter, “The Network.” The newsletter has been well received by the ISDS Board of Directors, and may potentially serve as a model for a Society-wide publication in the future. Volunteers within the Committee will be needed to help keep the newsletter moving forward.

In 2010, the Committee hopes to renew its goal of increasing international awareness of the ISDS and what has to offer, as well as liaising with other ISDS Committees to increase their international perspective. The Committee will continue to host regular teleconferences and foster collaboration so that its members can share best practices and common elements of surveillance.

In order to increase international awareness of the ISDS, it was suggested that informational flyers could be dispersed at meetings in Europe and beyond. Another possibility is strengthening the European ISDS network to form a European chapter of the Committee. A European chapter could potentially explore ISDS co-branding at other meetings and focus on convening at key conferences outside of North America in 2010.

Looking forward to the 9th Annual ISDS Conference, to be held in Utah, it is hoped that the Committee can provide advice to the 2010 program planners on increasing international content, and possibly pursuing funding for international travelers.

Other suggestions for how the Committee can expand its outreach included: leverage of the Distribute Project outside of the U.S., involvement with International Health Regulations (IHR) and major event surveillance (such as the Olympics).

Next Meeting: Wednesday, January 27th at 10:00 am U.S. EST.

Links to International Novel A (H1N1) Influenza Picture

The following list of links was compiled for the Global Outreach Committee's blog series on the Novel A (H1N1) influenza virus.

Centers for Disease Control (US): International Map

BBC - United Kingdom (Source: WHO): Swine Flu by Country

HealthMap - Harvard Medical School, US
(Diseases last 30 days - select none then Swine flu)

H1N1: A Veterinary Perspective

The following article was written by Victor Del Rio Vilas, DVM, MBA, MSc, PhD, for the Global Outreach Committee's blog series on the Novel A (H1N1) influenza virus.

To date, four incidents of pandemic H1N1 2009 virus in domestic species have been reported worldwide (OIE). The first incident was reported in Canada and affected pigs. Pigs were also reported from Argentina and Australia. The fourth incident, in Chile, affected two commercial breeding turkey farms. This last incident in turkeys is the first report of birds being infected with the pandemic H1N1 2009 virus. This finding is at odds with previous evidence that showed that poultry (chickens) were refractory to infection (Lange et al., 2009). In all four cases there was some evidence that personnel working or visiting the premises showed some flu-like illness. In the Australian incident, pandemic H1N1 2009 virus was isolated from staff.

UK’s Government position, referring to disease in pigs, is one of collaboration with the industry. To date, UK’s animal authorities consider novel influenza in pigs an industry’s problem and so the industry should lead. UK’s authorities have supported the industry and provided advice in the production of a code of practice against influenza viruses (not only pandemic H1N1 2009). Other approaches have been developed elsewhere (e.g. the development of contingency plans for novel influenza in swine herds in the Netherlands). With regard to poultry, the British Veterinary Association (2009) has issued warnings to poultry keepers to prevent staff with flu-like illness from working with poultry.

There appears to be a consensus that infection in swine herds would not constitute a significant source of infection to humans, compared to human to human transmission, in a situation of widespread infection of the human population. However, there is uncertainty as to what it would be the impact of pandemic H1N1 2009 incidents in animal populations once the peak of the epidemic in humans has passed. At the tail of the epidemic in humans, if H1N1 does not become a recurrent event as it is the case of regular flu, the relevance of animal transmission to humans, and the surveillance value of reverse zoonosis incidents might increase. This would resemble the situation at the start of the epidemic when the first case reported in Canada in pigs had some value in the detection of human infection hidden to the regular Public Health surveillance systems.

The importance of pandemic H1N1 2009, from a veterinary perspective, goes beyond its Public Health impact. Following UK’s four reasons for Government intervention (welfare impact, Public Health impact, wider society impact and trade impact), novel influenza in any domestic species could result, as it has happened already, in trade restrictions. So far, infection in animals has shown mild disease presentations, in swine and birds, with rapid recovery. On this basis, the impact on the welfare appears to be reduced. Finally, the impact on the wider society, at the peak of the epidemic in humans, is likely to be, in comparison to the potential disruption caused by the human form, insignificant. This assessment may or course change in the future if the epidemic in humans recedes.

Surveillance of potential pandemic H1N1 2009 incidents in Great Britain relies on submissions of suspect cases by farmers. The number of submissions in 2009 remains steady. This is a positive result that challenges initial fears of a drop in the number of submissions by farmers due to potential retail pressures.

OIE (2009)
Lange E., Kalthoff D., Blohm U., Teifke J.P., Breithaupt A., Maresch C., Starick E., Fereidouni S., Hoffmann B., Mettnleiter T.C., Beer C., Vahlenkamp T.W. (2009). Pathogenesis and transmission of the novel swine-origin influenza virus A/H1N1 after experimental infection of pigs. Journal of General Virology 90, 2119-2123.

About the Author:
Victor J Del Rio Vilas, DVM, MBA, MSc, PhD
UK
*The views expressed above are solely those of the author.

Novel A (H1N1) Influenza Virus Medical and Clinical Issues for Epidemiologists

The following list of recommendations and resources was compiled by Larissa May, MD, MSPH, for the Global Outreach Committee's blog series on the Novel A (H1N1) influenza virus.

***All recommendations are based on CDC and WHO guidelines and are based on the current relatively mild disease noted in patients in the developed world. These recommendations are subject to ongoing review and change. In the event of increased virulence of the novel A (H1N1) strain, or changes in morbidity and mortality, or regional variations in pattern of disease, recommendations are likely to change.***

Clinical Features:
Novel Influenza A (H1N1) presents in a similar fashion to seasonal influenza. Symptoms include fever, cough, sore throat, nasal congestion, myalgias, headache, chills, and fatigue/malaise. 25% of persons, including adults, may have GI-related symptoms, including vomiting and diarrhea (CDC, 2009) (Dawood F et al, 2009).

Diagnosis:
Clinicians should consider testing persons with ILI who are severely ill or at risk of influenza-related complications. In the event of a pandemic, the diagnosis of influenza will typically be made clinically by the treating provider, and most information on viral strains will be available through laboratory-based surveillance mechanisms. CDC is no longer recommending testing of all persons with suspected influenza infection.

Vaccination:

Seasonal Influenza:
This year, the CDC’s Advisory Committee on Immunization Practices (ACIP) has extended the recommendations for annual seasonal influenza vaccination to include those individuals 6 months to 18 years of age, in addition to the traditional target groups:
• Healthcare workers
• Individuals greater than 65 years of age
• Individuals with comorbidities such as asthma, cardiopulmonary disease, chronic neurological issues, and immune suppression.
(CDC ACIP, 2009)

Novel A (H1N1) Influenza:
While a novel Influenza A (H1N1) vaccine is currently undergoing clinical trials, the expected dates for distribution are unknown due to uncertainty in clinical trial completion dates and time required for manufacture. In the event of a pandemic due to the novel Influenza A (H1N1) strain, in the United States it is likely the vaccine will be distributed via public health authorities through special allocation. Requirements for vaccine administration are yet to be finalized regarding the possibility of concurrent administration of seasonal and H1N1 vaccines and number of doses required. The ACIP is expected to revise their recommendations before the 2009-2010 influenza season. Currently, in terms of prioritization, the focus is on schools grades K-12, pregnant women, children 6 months to age 4, household contacts of infants less than 6 months, those under 65 at risk for severe influenza, and health care workers and first responders (CDC, 2009).

Treatment Recommendations:
Persons at risk are:
• Children younger than 5
• Persons aged 65 or older
• Children and young adults under 18 on long term aspirin therapy
• Pregnant women, adults and children with asthma
• Chronic pulmonary, cardiovascular, hepatic, hematologic, neurologic/neuromusuclar or metabolic disorders including diabetes)
• Adults and children with immunosuppression (includes HIV and immune suppressive medications)
• Residents of nursing homes or other long term care facilities.

Antiviral Medications:
According to the CDC, antiviral medications with activity against influenza are useful adjuncts in the prevention and early treatment of influenza (CDC ACIP, 2009).

Four antiviral agents are currently FDA licensed: amantadine, rimantadine, zanamivir, and olsetamivir. During the 2007-2008 and 2008-2009 influenza seasons, influenza A (H1N1) viruses with a mutation conferring resistance to olsetamavir commonplace in United States (99% resistance rate) and other countries (Lackenby et al, 2008; Meijia et al, 2009; WHO, 2009, CDC, 2008). However, the novel A (H1N1) strain has shown susceptibility to olsetamivir (Dharan et al, 2009).

During the novel A (H1N1) outbreak in May 2009, CDC published interim guidelines for treatment and prophylaxis of influenza in patients diagnosed with the novel H1N1 virus (CDC H1N1 Recommentations).

These guidelines recommend that all hospitalized patients with confirmed, probable or suspected H1N1 and persons at high risk for complications be treated with antiviral agents. Clinical judgment should be reserved for others on a case by case basis. Either olsetamivir or zanamivir may be used for treatment or prophylaxis. Chemoprophylaxis is recommended for close contacts of influenza cases who are at high risk, including healthcare workers, first responders and public health workers. Post exposure prophylaxis should be continued for ten days beyond the date of last exposure. Pre-exposure prophylaxis can be considered for persons at high risk who cannot avoid contact with an individual with influenza, i.e. caregivers of persons with influenza who are in high-risk categories. For ongoing occupational risk, temporary reassignment for persons at risk is recommended, or the use of personal protective equipment where exposure cannot be avoided. Consultation with local public health and medical experts is recommended (CDC, 2009).

Infection Control in Healthcare Settings:
CDC guidelines for contact and droplet precautions should be followed. Routine cleaning and disinfection protocols should be followed. In the event that a high risk procedure is undertaken (i.e. elective intubation, aerosol generating procedures such as the administration of nebulized medications, etc), airborne isolation in a negative pressure room with 6 to 12 air changes per hour should be instituted. If patients must be transported outside the room, a surgical mask should be placed on the patient. Although there is little evidence that use of an N95 respirator provides improved protection over a surgical mask, CDC is recommending all healthcare workers entering the room of a patient with influenza wear an N95 or equivalent respirator and be fit tested. Isolation precautions should be continued for 7 days or until symptoms resolve, whichever is longer. Healthcare workers in high risk categories should consider temporary reassignment, or if this is not possible, the use of a respirator. If a healthcare worker shows signs and symptoms of ILI, they should self-isolate at home and not return to work for 7 days or until symptoms resolve, whichever is longer (CDC Infection Control Guidelines).

Self-Isolation of Ill Persons with ILI:
Persons with ILI suspected of having influenza should self-isolate at home. They should separate themselves from other members of the household, particularly those at risk of developing complications of influenza, such as: infants under 6 months of age, the elderly, and those with comorbidities such as cardiopulmonary disease, diabetes, or immunosuppression. They should not return to work or school until 24 hours after resolution of fever or symptoms, whichever is longer. This is a change from the initial recommendation to stay away from others for 7 days (CDC Home Care Guidance) (CDC Exclusion Guidelines).

Use of Masks in the Non-Healthcare Setting:
For persons ill with confirmed, probable or suspected novel A (H1N1) (in the event of a pandemic, anyone with ILI), self isolation at home is recommended. Ill persons should stay at least 6 feet away from healthy individuals. Where this is not possible and in common areas of the home, the person should wear a facemask if tolerable, or tissue to cover their cough and sneeze. Persons at increased risk of severe illness due to influenza should avoid being the caregiver to a person with ILI. If unavoidable, they should consider the use of a facemask or respirator. Otherwise, routine use of masks by household contacts is not recommended.

For non-healthcare occupational settings, facemasks and respirators are not generally recommended, although they can be considered in those at risk of severe influenza where temporary reassignment is not possible (CDC Mask Recommendations).

Preparedness for H1N1:
United States: pandemicflu.gov
International: WHO Pandemic Preparedness

Resources:
• Updates:
CDC International Situation Update
CDC Situation Update
• Guidance: CDC H1N1 Guidance

References:
H1N1 General Information

CDC Interim Guidance on Antiviral Recommendations for Patients with Novel Influenza A (H1N1) Virus Infection and Their Close Contacts

Dawood FS, Jain S, Finelli L, et al. Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans. NEJM 2009; 361:1-10.

Fiore AE. Shay DK. Broder K, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices. MMWR 2009: (58 Early Release): 1-52.

Dharan NJ, Gubavera LV, Meyer JJ, et al. Olsetamivir Working Group. Infections with Olsetamivir-Resistant Influenza A (H1N1) Virus in the United States. JAMA 2009; 301 (10): 1034-41.


About the Author:
Larissa May, M.D., M.S.P.H.
Associate Director of Clinical Research
Assistant Professor, Emergency Medicine,Microbiology, and Epidemiology
Co-director, MS in Public Health Microbiology and Emerging Infectious Diseases
The George Washington University
Washington, D.C.

EDDP 2010: Of Special Interest to European ISDS Members

View Flyer

EDDP 2010
Join us in Munich, Germany from February 25 – 28, 2010
for the International Conference on Early Disease Detection and Prevention

We are delighted to announce the launch of the Preliminary Program.

Abstract submission deadline is September 15, 2009.
Submit your abstract now – don't miss out !!!

We are proud to present the EDDP 2010 committee members
For further information click here.

Chairman:
Yoram Yagil

Co-Chairpersons:
George Bakris
Hermann Haller
Reuven Zimlichman

Steering Committee:
Mark Cooper, Daniel Duprez, Harlambos Gavras, Pavel Hamet, Doron Lancet, Friedrich C Luft

Scientific Committees:
Cardiac Disease:
Enrico Agabiti Rosei, Daniel Duprez, Anthony Heagerty, Amos Katz, Sverre Kjeldsen,
John Lekakis, Athanasios Manolis, Robert Phillips, Ton Rabelink, Reuven Zimlichman

Hypertension:
George Bakris, Michael Burzstyn, Arun Chockalingham, Carlos Ferrario,
Haralambos Gavras, Pavel Hamet, Lawrence Krakoff, Friedrich C Luft, Ernesto Schiffrin

Renal Disease:
Lise Bankir, Hermann Haller, Reinhold Kreutz,
Friedrich C Luft, Steve Scheinman , Joshua Weissgarten

Diabetes and Metabolism:
Mark E Cooper,Nish Chaturvedi, Youfei Guan, Peter Rossing, James Sowers, Sho-ichi Yamagishi

Health Policy:
Arun Chockalingham, Moshe Leshno, Uwe Siebert

For further information visit us at:
www.paragon-conventions.com/eddp2010

Paragon Conventions
18 Avenue Louis-Casai, 1209 Geneva, Switzerland
Tel: +41-22-5330-948, Fax: +41-22-5802-953
eddp2010-at-paragon-conventions.com

July Global Outreach Committee Meeting

When: Thursday, July 30th at 10:00 am EDT

Agenda:
1. Influenza H1N1 'swine flu' surveillance - collection of international experience for a special edition of the Network
2. DiSTRIBuTE (Distributed Surveillance Taskforce for Real-time Influenza Burden Tracking and Evaluation) - international participation
3. International Skills Survey - feedback and next steps
4. Any other business

Discussion:
1. Special edition of "The Network" on H1N1: The Committee discussed the possibility of publishing a special edition of their newsletter, "The Network" focused on H1N1. It was decided that contributions will be added to the ISDS blog on a rolling basis, which will allow for further feedback to be solicited in the form of reader comments. The articles, along with a summary of their commentary, will then be published into the next edition of "The Network," which will hopefully be put out in the fall. The topic areas in which the Committee is accepting submissions are:

A. Schools
B. Using surveillance for planning
C. General surveillance issues
D. Background clinical/medial advice for epidemiologists - high risk groups
E. Veterinary issues/reverse zoonosis

2. Don Olson gave an update on the current status of the DiSTRIBuTE project, and called for international participation. In the coming flu season, if it continues to be funded, it is hoped that the project can be expanded to both US and international sites.

3. International Skills Survey: The survey developed for the Committee is currently being placed on hold. It is hoped that the scope survey can be extended to the entire ISDS membership. Until the necessary changes have been made and the timing has been decided, the survey will remain inactive.

Next Meeting:
Thursday, October 1st at 10:00 am EDT.

PDF of "The Network" Now Available

The Spring 2009 issue of the Global Outreach Committee's newsletter, "The Network" is now available in pdf format.

Since newsletter is a public domain document, ISDS members are encouraged to forward it on to colleagues and non-ISDS members.

Finally, the Global Outreach Committee is interested in receiving submissions for the next issue of "The Network." If you would like to contribute a short article that would be of relevance and interest to an international audience, please contact rviola@syndromic.org.

A reminder that the next Global Outreach Committee meeting will be taking place on Thursday, July 30th at 10:00 am EDT.

"The Network" Newsletter, Part 4: HealthMap Update

by John Brownstein, PhD, ISDS Board of Directors

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!

Developed by the Children’s Hospital Informatics Program (CHIP) at the Harvard Medical School, the HealthMap prototype (HealthMap.org) is an openly available public health intelligence system that brings together disparate data sources to produce a unified and comprehensive view of the current global state of infectious diseases and their effect on human and animal health. HealthMap is a multi-stream and multilingual real-time surveillance platform that continually aggregates reports on new and ongoing infectious disease outbreaks. The system monitors, organizes, integrates, filters, visualizes and disseminates online information about emerging diseases, facilitating knowledge management and early detection. It serves to bring structure to an information flow that would otherwise be overwhelming to the user or obscure important and urgent elements. HealthMap relies on a variety of electronic media sources including online news sources through aggregators such as Google News, expert-curated discussion such as ProMED-mail, and validated official reports from organizations such as the WHO. Currently, the system collects reports from 18 sources, which in turn represent information from over 20,000 Web sites, every hour, 24 hours a day. Internet search criteria include disease names (scientific and common), symptoms, keywords and phrases. The system collects an average of 300 reports per da. HealthMap has processed over 200,000 alerts across 171 disease categories and 202 countries or semi-autonomous/overseas territories since it was launched in October of 2006.

HealthMap is designed to provide a starting point for real-time intelligence on a broad range of emerging infectious diseases for a diverse range of end users, from public health officials to international travelers. The system currently serves as a direct information source for approximately 10,000 unique visitors per day, as well as a resource for libraries, local health departments, governments (e.g., the US Department Health and Human Services and Department of Defense), multinational agencies (e.g., the United Nations) and nonprofit organizations (Wildlife Conservation Society, PBS), which use the HealthMap data stream for day-to-day surveillance activities. Many regular users come from the WHO, the US Centers for Disease Control and Prevention, and the European Centre for Disease Prevention and Control. Through a direct RSS feed, a number of organizations, ranging from local health departments to national organizations such as US Health and Human Services (e.g.: used during the 2008 Democratic and Republican National Conventions), the US Department of Defense, USGS, and the Wildlife Conservation Society all leverage the HealthMap data stream for day-to-day surveillance activities. HealthMap has also been featured in a number of mainstream media and scientific publications, including Wired News, Lancet, Nature, and Science, indicating the broad utility of such a system, extending beyond public health practice. Preliminary descriptions of HealthMap have now been published as peer-reviewed articles in the New England Journal of Medicine, the Canadian Medical Association Journal, the Journal of the American Medical Informatics Association, EuroSurveillance and PLoS Medicine.


Swine Flu News on HealthMap

"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.

April Global Outreach Committee Meeting

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

Agenda:
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

Discussion:
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

"The Network" Newsletter, Part 1: A Case for Distributed Flu Surveillance

A Case for Distributed Flu Surveillance: The International Society for Disease Surveillance (ISDS) Distributed Surveillance Taskforce for Real-time Influenza Burden Tracking and Evaluation (DiSTRIBuTE)

by Don Olson

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 DiSTRIBuTE project was proof of concept effort initiated in October 2006 at the Annual ISDS Conference in Baltimore. It was developed as an approach to influenza morbidity surveillance based on existing state and local electronic syndromic surveillance capabilities and expertise. The projects design, implementation and evolution has involved ongoing collaboration with local, state and national health departments and a multidisciplinary team representing the ISDS membership. Supported by the Markle Foundation and the US Centers for Disease Control and Prevention (CDC), through a cooperative agreement with the National Association of County and City Health Officials (NACCHO), the ISDS DiSTRIBuTE Project has established a model for international distributed influenza surveillance by building on existing national, state and local programs.

The project enrolls volunteer health departments that conduct electronic syndrome-based surveillance from emergency department or outpatient settings. The participant agencies report electronically summarized daily counts of illness and total visits by broad age group (<2, 2-4, 5-17, 18-44, 45-64, 65+ yrs) and geographic area (as US 3-digit zip code, or larger region) to a secure internet site. Weekly aggregate ratios of febrile, respiratory and influenza-like syndromes, based on each region’s routine syndromic criteria for seasonal influenza, to total visits, are visualized as regional time-series and age-specific temporal epidemic response surface plots (see Figure).

Created with a distributed architecture, the DiSTRIBuTE project requires that all individual-level data remain local, and only broad aggregate counts by reported out. While many electronic syndromic surveillance efforts have focused on central collection in huge individual level databases, the DiSTRIBuTE project asks for data based on the question What summarized level of data are epidemiologically needed? And as the limitations of this model are reached, the project is investigating how standardization of syndromes, generalizability of the model, ad hoc investigation and system evaluation can be conducted through reverse queries, where the questions are asked of the participating sites, the data are reaggregated locally and the new summarized counts are shared.

The DiSTRIBuTE project’s approach is based on distributed data collection and analysis with central monitoring of summary information. For influenza-related morbidity, limiting the data request to the information that is truly the minimum required (summarized counts), the system has retained the ability to demonstrate robust monitoring, quickly and cost effectively. The very low risk of privacy breach has encouraged trust among data sources and has facilitated voluntary participation at both the national and international levels.

For more information, or if your city, county, state or national surveillance system is interested in joining the project, please contact Don Olson at distribute@syndromic.org




Figure: Draft visualizations by US jurisdiction, 2006-2009: fever, respiratory, influenza-like syndrome time-series as ratios, with national US CDC sentinel and viral influenza isolate data (top); and age-specific temporal epidemic response surface (TERS) plots (bottom).