Fridays from the Archives: Viral Sovereignty

Friday, May 30, 2014: Viral Sovereignty

Since the beginning of May, two cases of MERS-CoV have been identified in the United States. In addition to prompting concerns related to the symptoms and case-fatality rate of MERS, the spread of disease also renews interest in a relatively new concept, viral sovereignty.

Viral sovereignty is defined as  "a sovereign state's ownership rights over pathogens found within their border." The term was first coined in 2007 when Indonesia failed to share samples of the H5N1 virus, claiming that they had viral sovereignty over the samples. Similarly, with MERS, there was a delay between when researchers identified the pathogen and when they notified authorities at the Ministry of Health (MOH). These circumstances raise a slew of issues for public health as researchers struggle between supporting intellectual property rights and the ensuring health of the public.

Last August Scott JN McNabb, PhD, MS and Affan Shaikh, MPH presented on the intersection between International Health Regulations (IHRs) and viral sovereignty in the webinar Global Public Health Surveillance, Governance, and Viral Sovereignty. With additional contributions from Qanta Ahmed, MD, Associate Professor of Medicine at SUNY Stony Brook, and Ziad Memish, MD, Deputy Minister of Public Health, Kingdom of Saudi Arabia, this presentation provides a dynamic combination of context, anecdotes, scientific knowledge, and in-person experience.

To learn more about this webinar or to review the recording please see the ISDS webinar archive.


This post is part of the series Fridays from the Archives. You can access all posts in the series here.

Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org). 

Fridays from the Archives: Surveillance & Integration

Friday, February 21, 2014: Surveillance & Integration

Public health practitioners are increasingly focused on understanding cross-border syndromic surveillance data. Here in the US, ISDS encourages inter-state data understanding and sharing through regional workshops. In Europe, practitioners have been working since 2010 on gathering data and creating a framework for integrating syndromic surveillance. This has occurred under the scope of work of the Triple-S project. 

In 2012 Duncan Cooper, a Registrar in Public Health under the UK's National Health Service,  spoke about gathering data from European countries on their syndromic surveillance systems. In Towards Integrated Syndromic Surveillance in Europe?, Dr. Cooper describes Triple-S's work to meet the objective of "increasing the European capacity for real-time or near-real time surveillance and monitoring the health burden of expected and unexpected health related events". 

First, the presentation addresses practical concerns. Prior to integrating syndromic surveillance systems, the project needs data. Not syndromic surveillance data, per se, but metadata on the systems themselves. For instance, who are the key stakeholders? What are individual syndromic surveillance systems used for? Is there even a syndromic surveillance system in all target countries?

To answer these questions the Triple-S project team identified key stakeholders and lined up site visits throughout Europe. They also sent questionnaires to 28 European Union countries, including subsequent in-depth follow up questionnaires. With this data, the project progressed to identifying next steps, including developing a minimum dataset, communication materials, common evaluation criteria, and checklists. 

Perhaps most importantly, this project established trust and communication between a variety of public health jurisdictions. Going forward, the EU can integrate reporting on syndromic surveillance functions such as outbreak detection and general public-health surveillance, a vital function in a very inter-connected world.

This post is part of the series Fridays from the Archives. You can access all posts in the series here.

Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org).

Fridays from the Archives: Smart Phones

Friday, January 10, 2014: Smart Phones

At the 2013 ISDS Conference in New Orleans in December we learned about innovative surveillance methods used across the globe. As technology evolves, so too does the ability to improve surveillance strategy and technique.

The Boston University School of Public Health Electronic Data Capture Team worked on integrating existing technologies in new ways, mainly focusing internationally. In 2011 three members of the team, Marion McNabb, MPH, Laura Khurana (then MPH candidate) and Chris Gill, MD, MS presented on their work in Data Collection, Management, and Surveillance: Using Smart Phones in Smart Ways.

Data from smart phones have a number of advantages including accessibility and ease of transmission and receipt. Though some technologies see sudden surges with equally sudden declines in use, cellphone use in general is still rapidly increasing worldwide. As of 2011, phones had been successfully used in surveillance for a number of uses including: Dengue Fever monitoring in Mexico; Real-time outbreak monitoring in mass gatherings, such as the 2009 Hajj; and infectious disease reporting after an earthquake in China (additional details on slide #36 of presentation).

With a number of disparate uses, smart phone surveillance can work with traditional surveillance methods, as well as in place of them. In low resource settings this combination is particularly useful.

This post is part of the series Fridays from the Archives. You can access all posts in the series here.


Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org)

Have an idea that could overcome a global health challenge? Send a proposal to The Grand Challenges in Global Health Initiative!

The Bill & Melinda Gates Foundation and its funding partners in the Grand Challenges family of grant programs invite you to apply for four new grant opportunities:

1) Grand Challenges Explorations, an initiative to encourage innovative and unconventional global health and development solutions, is now accepting grant proposals for its latest application round. Applicants can be at any experience level; in any discipline; and from any organization, including colleges and universities, government laboratories, research institutions, non-profit organizations and for-profit companies.

Proposals are being accepted online until November 12, 2013 on the following topics:

• Innovations in Feedback & Accountability Systems for Agricultural Development
• Inciting Healthy Behaviors: nudge, leapfrog, disrupt, reach
• Novel Enabling Tools and Models Supporting the Development of Interventions for Severe Diarrhea and Enteric Dysfunction
• Develop the Next Generation of Condom
• The "One Health" Concept: Bringing Together Human and Animal Health

Initial grants will be US $100,000 each, and projects showing promise will have the opportunity to receive additional funding of up to US $1 million. Full descriptions of the new topics and application instructions are available at: www.grandchallenges.org/explorations.

2) Achieving Healthy Growth through Agriculture and Nutrition, the first program launched through the Grand Challenges India partnership, is now accepting applications. This program joins others within the Grand Challenges family of grant programs supported by the Gates Foundation and its partners. It seeks a comprehensive set of approaches - spanning innovation in  nutrition and agriculture and social innovation - to 1) reduce the high incidence of low birth weight, early stunting, and wasting in Indian children less than 2 years of age and 2) prevent undernutrition in women of reproductive age and in children from 0-2 years of age.

The application deadline is October 31, 2013. Details on how to apply for a grant can be found at http://www.grandchallenges.org/GrantOpportunities/Pages/GCIndia_healthygrowth.aspx.

3) Records for Life: A Design Contest that can Save Lives. This new grant opportunity seeks individuals or teams to re-examine the current child health record and design new ways to accurately track vaccine doses, increase ease of interpretation and use, and incite behavior change to make the record a valued asset for health professionals and families alike.

The application deadline is October 31, 2013. Details on how to apply for a grant can be found at http://www.gatesfoundation.org/How-We-Work/General-Information/Grant-Opportunities/Records-for-Life-RFP.

4) This October researchers are invited to attend Advancing Vaccines in the Genomic Era, a meeting held as part of the Keystone Symposia Global Health Series supported by the Bill & Melinda Gates Foundation. The meeting will be held October 31 - November 4, 2013 in Rio de Janeiro, Brazil. More information can be found at http://www.keystonesymposia.org/13T1.

The Grand Challenges team looks forward to receiving innovative ideas from around the world and from all disciplines, so if you have a great idea, please apply. And if you know someone else who may have a great idea, share the message!

Thank you for your commitment to solving the world's greatest health and development challenges.

~The Grand Challenges Team

Highlighting the 2012 Pre-Conference Workshops

Sheraton San Diego Hotel and Marina
December 3, 2012

1380 Harbor Island Drive | San Diego, California 92101

Don’t miss the 2012 ISDS Pre-Conference Workshops! The workshops include options for professionals with varying levels of experience – from students to seasoned practitioners. ISDS invites professionals from around the world to develop core disease surveillance skills and collaborate with their peers.

ISDS Pre-Conference Tracks will be lead by respected leaders in the field, including Dr. Howard Burkom, Johns Hopkins Applied Physics Laboratory (Data Analysis Methods 101); Mr. James Daniel, Office of the National Coordinator for Health Information Technology (Meaningful Use Overview); Dr. Scott McNabb, Emory School of Public Health (Track 3 Sessions), among others.

Concurrent Pre-Conference Tracks

Track 1: Syndromic Surveillance, Informatics, Data Analysis, and Anomaly Investigation: The 101 Series. This workshop will provide an overview of key topics to introduce professionals to core public health and surveillance competencies. The track will include an overview of syndromic surveillance, public health informatics, data analysis methods, anomaly detection, investigation techniques, and data visualization methods using “R” statistical software. The objective of this track is to “bridge the knowledge gap” in order to better understand and apply public health data for informed and meaningful decision-making.

Track 2: Public Health and Meaningful Use: Closing the Surveillance Loop. This workshop is designed to facilitate discussions around Meaningful Use and the need for closing the surveillance loop between healthcare providers and public health practitioners in order to increase the effectiveness and capacity of disease surveillance. The track will include an overview of Meaningful Use and Health Information Exchanges (HIEs), including best practices, lessons learned, and next steps. Interactive break-out sessions will focus on the healthcare provider onboarding process, data transport mechanisms, data quality issues, analytics, attestation, and other group-specified topics. The break-out groups will have an opportunity to summarize and report their findings to the larger group. The workshop will conclude with a panel discussion, integrating the perspectives of public health practitioners and healthcare providers on the “meaning” of meaningful use data.

Track 3: Assessment tools to meet the core capacities of the International Health Regulations (IHRs). This hands-on workshop will introduce participants to concepts and tools to assess the gaps and current performance of public health practice needed to meet the core requirements for both biosafety and biosurveillance under the International Health Regulations (IHR). Attendees will learn about IHR requirements and assessment concepts, plus use hands-on tools to measure country-specific opportunities and challenges in implementing public health interventions that fill gaps and improve performance. They will discuss specific approaches to measurement of impediments to IHR target compliance by correlating their assessment findings into recommendations for public health stakeholders.

Swap Meet

All tracks will also feature access to the Swap Meet session. The Swap Meet is an exciting opportunity to walk around to tables and informally discuss topics or systems with system developers, system users, and experts.

Reserve your space and register now: http://www.syndromic.org/annual-conference/2012/registration.

*Please note that Continuing Medical Education credits (CME) will not be offered for 2012 Pre-Conference Workshop attendance.

ISDS Member Publication

ISDS member, Dr. Scott McNabb, and ISDS Board member, Dr. John Brownstein, were among the contributing authors of the article "Infectious disease surveillance and modelling across geographic frontiers and scientific specialties" that was recently published in the The Lancet Infectious Diseases. This article discusses the sharing of epidemic intelligence across global frontiers using new technologies and modelling that crosses scientific specialties for improved infectious disease surveillance for mass gatherings.

Read a summary of this article below and the full text in The Lancet to learn more.

Infectious disease surveillance and modelling across geographic frontiers and scientific specialties

Dr Kamran Khan MD a b n , Scott JN McNabb PhD c, Prof Ziad A Memish MD d e n, Rose Eckhardt MA b, Wei Hu BSc b, David Kossowsky BA b, Jennifer Sears BSc b, Julien Arino PhD f, Anders Johansson PhD g h, Maurizio Barbeschi PhD i n, Brian McCloskey MDj n, Bonnie Henry MD k n, Martin Cetron MD l, John S Brownstein PhD m n

Summary: 

Infectious disease surveillance for mass gatherings (MGs) can be directed locally and globally; however, epidemic intelligence from these two levels is not well integrated. Modelling activities related to MGs have historically focused on crowd behaviours around MG focal points and their relation to the safety of attendees. The integration of developments in internet-based global infectious disease surveillance, transportation modelling of populations travelling to and from MGs, mobile phone technology for surveillance during MGs, metapopulation epidemic modelling, and crowd behaviour modelling is important for progress in MG health. Integration of surveillance across geographic frontiers and modelling across scientific specialties could produce the first real-time risk monitoring and assessment platform that could strengthen awareness of global infectious disease threats before, during, and immediately after MGs. An integrated platform of this kind could help identify infectious disease threats of international concern at the earliest stages possible; provide insights into which diseases are most likely to spread into the MG; help with anticipatory surveillance at the MG; enable mathematical modelling to predict the spread of infectious diseases to and from MGs; simulate the effect of public health interventions aimed at different local and global levels; serve as a foundation for scientific research and innovation in MG health; and strengthen engagement between the scientific community and stakeholders at local, national, and global levels.
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