Infectious Disease

NBIC is charged with enhancing the capability of the Federal Government to enable early warning and shared situational awareness of acute biological events to support better decisions through rapid identification, characterization, localization, and tracking. A key aspect of this mission is the requirement to integrate and collaborate with federal and, state, local, tribal, and territorial (SLTT) government agencies. NBIC develops and disseminates a variety of products to its stakeholders, including daily reports, ad-hoc reports, analytic collaborations, and leadership briefings upon request. Stakeholders interact with and utilize NBIC’s products in different ways, depending on the mission and jurisdiction involved. Specific collaborations with individual stakeholders are most frequent and evident during major infectious disease events, such as the recent Zika epidemic in the Americas and the associated microcephaly and other neurological disorders PHEIC. Collaborative efforts and known outcomes among varying levels of government are described in detail below in order to highlight NBIC’s integration focus and capabilities in this role.

Objective:

An important part of the National Biosurveillance Integration Center’s (NBIC) mission is collaboration with federal, state, local, tribal, and territorial governments for the purpose of enhancing early warning, shared situational awareness, and related decision support for infectious disease events. Several such collaborations occurred at multiple jurisdictional levels during the recent Zika epidemic in the Americas and the associated microcephaly and other neurological disorders Public Health Event of International Concern (PHEIC). The collaborations and their known outcomes from this major infectious disease event are described below, and NBIC stands ready to support similar efforts for future events.

Hepatitis A virus (HAV) infections have persisted in the United States despite the availability of an effective vaccine. Recent outbreaks of HAV infections among unvaccinated adults attributed to consumption of HAV-contaminated food, or person-to-person contact in certain populations (e.g., men who have sex with men) or settings (e.g., homeless shelters) have emphasized the importance of targeted vaccination of at-risk adults.

Objective:

To evaluate the use of commercial laboratory data for monitoring trends in HAV infections over time and identifying geographic and demographic characteristics of HAV case clusters for the purpose of targeting interventions.

EV-D68 is a non-polio enterovirus, primarily resulting in respiratory illness, with clinical symptoms ranging from mild to severe. Infection has also been associated with severe neurological conditions like acute flaccid myelitis (AFM). EV-D68 was first discovered in 1962, with infrequent case reports until 2014 at which point a widespread multi-national outbreak mostly affecting the pediatric population occurred across North America, Europe, Southeast Asia and Africa. This outbreak was associated with an increase in AFM, with cases being reported in Canada, the United States, Norway, and France. With this new and emerging threat, public health and other organizations were called upon to implement response measures such as establishment of case definitions, surveillance mechanisms, and recommendations for clinical and public health management. The response to the 2014 outbreak in Canada highlighted several important EV-D68 evidence gaps including a lack of risk factor and clinical information available for non-severe cases, and uncertainty around seasonal, cyclical and secular trends. Given the increased reporting of EV-D68 cases associated with severe outcomes, it's critical that public health establishes what is known about EV-D68 in order to support decision-making, education and other preparedness activities and to highlight priority areas for future research to fill critical knowledge gaps. Scoping reviews provide a reproducible and updateable synthesis research methodology to identify and characterise all the literature on a broad topic as a means to highlight where evidence exists and where there are knowledge gaps. In order to systematically characterise the EV-D68 knowledge base, a scoping review was conducted to map the current body of evidence.

Objective:

To create a scoping review on enterovirus D-68 (EV-D68) that will serve as a useful tool to guide future research with the aim of filling critical information gaps and supporting the development of public health preparedness activities.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It is a contagious disease that affects the skin, mucous membrane, and nerves causing discoloration and lumps on the skin and in severe cases disfigurement and deformities. The mode of transmission remains uncertain, but is believed that M.leprae is spread from person to person primarily as a nasal droplet infection. The incubation period for a bacterial disease generally is 5 – 7 years. Progress in the fight against leprosy has been one of the greatest public health success and in the country, was eliminated in the mid-1990s. However on the 22nd August 2017 a confirmed leprosy cases was reported by the National Referral Hospital.

Objective:

To strengthen public health surveillance to monitor neglected tropical diseases (NTDs) like leprosy as a control measure to avert disabilities in the Kingdom of Swaziland.

Influenza infection is caused by the influenza virus, a single-stranded RNA virus belonging to the Orthomyxoviridae family. Influenza viruses are classified as types A, B and C. Influenza A and B viruses can cause epidemic disease in humans and type C viruses usually cause a mild, cold-like illness. The influenza virus spreads rapidly around the world in seasonal epidemics, resulting in significant morbidity and mortality. On the 10th of July 2017, a case of confirmed Influenza A/H1N1 was reported through the immediate disease notification system from a private hospital in the Hhohho region. A 49 year old female was diagnosed of Influenza A/H1N1 after presenting with flu-like symptoms. Contacts of the index case were followed and further positive cases were identified.

Objective:

To establish morbidity patterns of influenza A/H1N1 in Swaziland from 10th July to 15th August 2017.

The Ebola Virus Disease (EVD) outbreak in West Africa was unprecedented in spread and its attendant response. There were over 15 000 confirmed cases and over 9 000 suspected cases. The response to the outbreak was massive within Africa and beyond. The outbreak in Nigeria affected 19 people and led to 7 deaths (CFR 37%).There were more than 891 contacts of these cases under surveillance as at 23rd September 2014. Nigeria was declared EVD free by the World Health Organization in October 2014. Nationwide there was targeted preparedness to prevent and control EVD. In Zaria, this led to the formation of a joint committee of the Ahmadu Bello University (ABU) and the Ahmadu Bello University Teaching Hospital (ABUTH) to prevent and control EVD in Zaria and the sub region as a whole.

Objective:

To assess the formation and function of a joint committee of the Ahmadu Bello University (ABU) and the Ahmadu Bello University Teaching Hospital (ABUTH) to prevent and control EVD in Zaria and the North West sub region of Nigeria.

Since 2004, the French syndromic surveillance system SurSaUD® coordinated by the French Public Health Agency (Sante publique France) daily collects morbidity data from two data sources: the emergency departments (ED) network Oscour® and the emergency general practitioners associations SOS Medecins. Almost 92% of the French ED attendances are recorded by the system. SOS Medecins network is a group of 62 associations of general practitioners, dispatched all over the territory. Sante publique France received data from 61 out of 62 associations. Both data sources collect medical diagnosis, using ICD10 codes in the ED network and specific medical thesaurus in SOS Medecins associations. These data are routinely analyzed to detect and follow-up various expected or unusual public health events all over the territory. The system is also used for reassurance of decision makers. In that framework, in March 2017, the French Ministry of Health requested Sante publique France to validate a potential scarlet fever outbreak in France.

Objective:

Describe a case study of validation of a scarlet fever outbreak using syndromic surveillance data sources.

As a part of the Zika Birth Defects Surveillance, a national effort coordinated by the Centers for Disease Control and Prevention (CDC), NYC is conducting enhanced surveillance of all births with defects included in the congenital Zika syndrome (CZS) phenotype among infants born in NYC beginning in 2016. The intent of the project is to provide background on the prevalence of these conditions, regardless of cause. The surveillance project builds on the New York State (NYS) Congenital Malformations Registry, a passive, mandatory reporting system that relies on reporting from hospitals and providers. For the Surveillance project, potential cases of Zika-related birth defects (ZBD) are identified by hospital and administrative data of birth records with one or more of the International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes associated with CZS.1 The list of included diagnostic codes was specified by the NYS registry following guidance established by CDC. Full medical record chart abstraction of the birth hospital visit of potential cases is then conducted applying further inclusion guidelines to identify ZBD cases. Recent reports of late presentation of birth defects consistent with CZS suggest that some cases are being missed due to identification and diagnosis of the condition after birth.2 As one component of a broader strategy to obtain a more accurate surveillance count, we seek to identify potential ZBD cases first diagnosed in the 6-month postpartum period using Medicaid claims data.

Objective:

To assess the use of Medicaid claims data to conduct surveillance for cases of Zika-related birth defects identified after birth among infants born in New York City (NYC).

Varicella (chickenpox) is a highly transmissible childhood disease. Between 2010 and 2015,it displayed two epidemic waves annually among school populations in Shenzhen, China. However, their transmission dynamics remain unclear and there is no school-based vaccination programme in Shenzhen to-date. In this study, we developed a mathematical model to compare a school-based vaccination intervention scenario with a baseline (i.e. no intervention)scenario.

Objective:

To modell the transmission dynamics of varicella among school children in Shenzhen,to determine the effect of the school-based vaccination intervention.

Public health agencies worldwide all enjoy the same mission—providing healthcare warnings, guidance, and support to the public and healthcare professionals they represent. A critical element in achieving this mission is accessing timely and comprehensive surveillance information about disease in their regions of responsibility. Advances in diagnostic technologies for infectious disease and in the wireless conveyance of information hold great promise for advancing the quality of surveillance information and in facilitating the delivery of timely, accurate, and impactful public health information. Quidel Corporation has developed a cloud–based, wireless communications system that is fully integrated with its Sofia fluorescence immunoassay (FIA) platform for rapid, point-of-care diagnosis of infectious disease. The system, called the Virena Global Wireless Surveillance System (hereinafter, Virena) provides test results to public health organizations and other appropriate entities in near-real time. Currently, more than 4,000 Sofia instruments are transmitting results automatically by Virena. This presentation describes the use of Virena in surveilling influenza in the U.S. in the 2016-2017 influenza season, when over 700,000 influenza-like-illness (ILI) patient results were transmitted. The methods employed, results, and the promise of this innovative system will be discussed.

Objective:

Demonstrate performance of the Virena Global Wireless Surveillance System, an automated platform utilized in conjunction with the Sofia FIA Analyzer, for near real-time transmission of infectious disease test results to public health and other healthcare organizations.