Internet-based Biosurveillance Systems Documents/Day 2/Medical-Dental... · Examples of internet event based systems used for surveillance ... System to promote, protect, improve,

Internet-based Biosurveillance Systems:

Their utility and role in assessment of health threats and early detection of disease outbreaks

ARMED FORCES RESEARCH

INSTITUTE OF MEDICAL SCIENCES ( A F R I M S )

h t t p : / / w w w . a f r i m s . o r g

Alden L. Weg MD, MPH COL, US Army

2 August 2016

Deputy Chief, Department of Virology

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U N C L A S S I F I E D

Disclaimer

Material has been reviewed by the Walter Reed Army Institute of Research. There is no objection to its presentation and/or publication. The opinions or assertions contained herein are the private views of the author, and are not to be construed as official, or as reflecting the views of the U.S. Department of the Army, the U.S. Department of Defense, or the U.S. Government.

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Agenda

Introduction

Disease Surveillance and Force Health Protection

Methods of Surveillance Comparison of traditional (disease specific), syndromic, and event-based

surveillance

Examples of internet event based systems used for surveillance

How effective are internet based surveillance systems?

Conclusion

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Introduction

It is estimated that 65% of world’s first news about infectious disease events now comes from informal sources (which includes the internet and press reports).¹

Traditional surveillance systems are often times slow to identify disease outbreaks

Advances in electronic event-based biosurveillance systems offer the possibility of gathering near real time information from around the world to aid in epidemiologic intelligence and outbreak investigations.²

¹Heymann DL, Rodier GR (2001) Hot spots in a wired world: WHO surveillance of emerging and re-emerging infectious diseases. Lancet Infectious Diseases 1:345-353

²Gajewski KN, et al. (2014) A Review of Evaluations of Electronic Event-Based Biosurveillance Systems. PLoS ONE 9(10): e111222. doi:10.1371/journal.pone.0111222

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Disease surveillance and Force Health

Protection

Public health (or disease) surveillance: “The ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health.”¹

Force Health Protection (FHP): “All measures taken by commanders, supervisors, individual Service members, and the Military Health System to promote, protect, improve, conserve, and restore the mental and physical well being of Service members across the range of military activities and operations. These measures enable the fielding of a healthy and fit force, prevention of injuries and illness and protection of the force from health hazards, and provision of medical and rehabilitative care to those who become sick or injured anywhere in the world.”²

¹Thacker SB., Berkelman RL. Public health surveillance in the United States. Epidemiol Rev 1988;10:164-190 ²DoD Directive 6200.04, “Force Health Protection (FHP)," April 23, 2007

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Methods of Surveillance

Traditional surveillance (Disease-specific surveillance)

Syndromic surveillance

Event-based surveillance

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Surveillance of specific diseases, pathogens, or syndromes in a target population Based on notifiable disease reporting, using case reports sent by practitioners and positive results from clinical labs

Advantages

Surveillance of a wide range of pathogens

Useful to follow global trends of surveyed pathogens

Can be used to monitor public health measures

Limitations

Standardization of data used is necessary

Usually underestimates the prevalence of the event under surveillance

Targets (pathogens, diseases, syndromes, ad population) must be clearly identified before starting surveillance

Disease-specific surveillance (Traditional Surveillance)

Abat C et al. Traditional and syndromic surveillance of infectious diseases and pathogens. International Journal of Infectious Diseases 2016; 48: 22-28.

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Real-time or near real-time collection, analysis, interpretation, and dissemination of health-related data for early identification potential health threats. Data are “non-specific health indicators including clinical signs, symptoms, and other proxy measures” collected for other purposes than surveillance and usually can be automatically generated.

Advantages

Can be used in emergency cases

High sensitivity because lab confirmation is not needed

Possible deployment in low-income/limited resource countries

Rapid to implement

Limitations

Low specificity

Efficiency depends on pathogens and patient characteristics

Lack of human and technological resources can affect data collection, management, timeliness, and sharing

Syndromic surveillance


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Real-time or near real-time manual or automatic collection and analysis of unstructured information from numerous text and internet sources and in various languages to detect potential or confirmed health hazards occurring worldwide from reports and rumors.

Advantages

Rapid detection and report of possible health hazards

Can be used in countries with low-income/limited resources and no formal public health surveillance

Gathering and analysis of data published in various different languages

Limitations

Detected events need to be confirmed using reliable sources of data

Event-based surveillance


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Examples of internet event based systems that

can/have been used for surveillance

Source: Hartley, DM et al. Landscape of international event-based biosurveillance. Emerging Health Threats Journal 2010 3:e3. doi: 10.3134/ehtj.10.003

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Source: Hartley, DM et al. Landscape of international event-based biosurveillance. Emerging Health Threats Journal 2010 3:e3. doi: 10.3134/ehtj.10.003

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Social Media Google Flu

Google Dengue Trends

Google (and other web browsers) search queries

Twitter feeds

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How effective are the internet based

surveillance systems

Numerous examples of good correlation between outbreaks/alerts identified by internet based systems and traditional epidemiologic investigations Many times internet based systems identified public health events notifiable under

the International Health Regulations (2005) in advance of official confirmation by WHO.

Examples¹ • 2013 polio outbreak in Cameroon. ProMED and GPHIN reported the outbreak at day 23,

WHO official report came on day 51.

• 2014 polio outbreak in Equatorial Guinea beginning in January was reported by ProMED (March 21) and GPHIN (March 27) well before the official WHO report (April 17) and the declaration of a public health emergency of international concern (May 5)

• For all 7 WHO –reported polio outbreaks in 2013-2014, digital reports preceded official reports by an average of 14.6 days (range 0-40)

• Ebola outbreak in 2014. Healthmap was first to put this on their site (March 14) after a French news website reported a strange fever associated with deaths, anal and nasal bleeding. WHO did not release their statement until March 22.

¹Anema A, et. al. (2014) Digital surveillance for enhanced detection and response to outbreaks. Lancet Infectious Diseases. 14(11): 1035-1037. doi:10.1016/S1473-3099(14)70953-3

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How effective are the internet based

surveillance systems

Although these systems generally show good correlation, there are examples when they have missed outbreaks, overestimated outbreaks, or have not identified outbreaks sooner than traditional surveillance systems

Butler D. When Google got flu wrong. Nature 2013;494:155-6


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Conclusion

Internet-based biosurveillance systems offer an effective and important tool for disease surveillance

The lack of high specificity in some cases highlights the need to use these internet based systems in conjunction with traditional surveillance systems

These internet based systems were developed primarily for use by civilian public health agencies, but a working knowledge of these internet-based systems will significantly benefit military medical providers and planners responsible for development of force health protection plans


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References

1. Heymann DL, Rodier GR (2001) Hot spots in a wired world: WHO surveillance of emerging and re-emerging infectious diseases.

Lancet Infectious Diseases 1:345-353

2. Thacker SB, Berkelman RL. Public health surveillance in the United States. Epidemiol Rev 1988;10:164-190

3. DoD Directive 6200.04, “Force Health Protection (FHP)," April 23, 2007

4. Abat C, Chaudet H, Rolain JM, Colson P, Raoult, D. Traditional and syndromic surveillance of infectious diseases and pathogens. International Journal of Infectious Diseases 2016; 48: 22-28

5. Gajewski KN, Peterson AE, Chitale RA, Pavlin JA, Russell KL, et al. (2014) A Review of Evaluations of Electronic Event-Based Biosurveillance Systems. PLoS ONE 9(10): e111222. doi:10.1371/journal.pone.0111222

6. Anema A, Kluberg S, Wilson K, Hogg, RS, Khan K, Hay, SI, Tatem, AJ, Brownstein, JS. (2014) Digital surveillance for enhanced detection and response to outbreaks. Lancet Infectious Diseases. 14(11): 1035-1037. doi:10.1016/S1473-3099(14)70953-3.

7. Butler D. When Google got flu wrong. Nature 2013;494:155-6

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Questions?