Infectious Disease

The National Biosurveillance Integration Center (NBIC) has the responsibility to integrate, analyze, and share the nation’s biosurveillance information provided from capabilities distributed across public and private sectors. The integration of information enables early warning and shared situational awareness of biological events to inform critical decisions directing response and recovery efforts. In addition to its interagency partners, NBIC supports the Office of Health Affairs and DHS components responsible for safeguarding U.S. ports of entry. More than 150 U.S. international airports process an estimated two billion passengers and 50 million metric tons of cargo arriving in the U.S. from more than 1,000 international airports located outside the U.S. Entry and customs screening are points where travelers from international destinations pass; a logical location for assessing health of incoming travelers in order to identify and control import of diseases of emerging diseases. NBIC examined peer-reviewed literature, region-specific disease spectrum/frequency, and air travel patterns to assess options for ports of entry health screening as well as the challenges and potential benefits for active screening programs.

Objective

NBIC analysts evaluated the options and effectiveness of airport symptom-based health screening programs available during emerging disease outbreaks occurring outside the U.S.

West Africa recently experienced the most persistent epidemic of EVD recorded in history. The reported morbidity and mortality of the highly virulent, emerging zoonotic filovirus infection is far larger than all previous epidemics combined. Its spread to Nigeria (Africa’s most populous country) and to densely populated Lagos (a city in Nigeria with approximate combined population of Guinea, Sierra Leone, and Liberia) raised significant public health concern. The Federal Ministry of Health was notified of a suspected case of viral haemorrhagic fever on the 22nd July, 2014. A 40-year old male Liberian presented in a private health facility on account of fever, vomiting and diarrhea. On the 23rd July, the index case was confirmed to have EVD and on 25th July, he died.

Objective

To describe the socio-demographic characteristics of Ebola virus disease (EVD) patients and their contacts, magnitude of the outbreak and factors associated with outcome in patients.

Clostridium difficile (CD), a gram-negative, anaerobic, sporeforming bacterium causes symptoms ranging from mild to severe diarrhea and may result in death. Approximately 75% of CDI cases have symptom onset outside of health care settings. Annual US costs of treatment and infection containment have surpassed $4.8 billion. Risk factors for CDI include recent broad-spectrum antibiotic exposure, advanced age, severe underlying morbidities, immunocompromised status, long-term hospital stays, and residence in long-term-care facilities. Nationally, CO-CA cases have increased from 2.8/100,000 person in 1993 to 14.9/100,000 person in 2005.

Objective

Identify population-based Clostridium difficile infection (CDI) incidence stratified by Health Care Facility Onset (HCFO), Community Onset-Healthcare Facility Associated (CO-HCFA), and Community Onset-Community Associated (CO-CA) CDI in Denver County from 2011 - 2013 and describe demographic, health care facility exposure, and medication use risk factors.

Public health practitioners endeavor to expand and refine their syndromic and other advanced surveillance systems which are designed to supplement their existing laboratory testing and disease surveillance toolkit. While much of the development and widespread implementation of these systems was previously supported by public health preparedness funding, the reduction of these monies has greatly constrained the ability of public health agencies to staff and maintain these systems. The appearance of highly-pathogenic avian influenza (HPAI) H3N2v, and other novel influenza A viruses required agencies to carefully identify systems which provide the most cost-effective data to support their public health practice. The global emergence of influenza A (H7N9), Ebola virus strains, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and other viruses associated with high mortality, emphasize the importance of maintaining vigilance for the presence of emerging diseases.

Objective

To continue efforts in characterizing the challenges experienced by influenza surveillance coordinators and other practitioners conducting surveillance for the presence of avian influenza, novel respiratory diseases, and other globally emerging viruses in an era of limited resources among public health agencies.

Norovirus, commonly referred to as the winter vomiting disease, is the most common cause of gastroenteritis worldwide, with the total number of cases reported per year in Ontario second only to the common cold. The disease is highly infectious, requires a low infectious dose, and is well-known to cause large outbreaks in closely confined populations. While deaths are rare, hospitalization and longterm sequelae are more likely to occur in at-risk populations, such as the elderly or immunocompromised. Action to reduce the number of norovirus infections per year is required due to its health and economic burden. It is estimated that norovirus infections cost the United States 2.5 billion CAD and the United Kingdom close to 200 million CAD per year in health care costs alone. While laboratory surveillance is practiced in Ontario to detect norovirus outbreaks, early detection remains a challenge. This project aims to utilize syndromic surveillance with TeleHealth Ontario data in order to develop an early warning system mitigating the impact of norovirus outbreaks.

As part of this surveillance study for Avian Influenza both active and passive surveillance samples were tested using PCR and also utilized to validate the LAMP method. Active surveillance samples include pathological material and tracheal and cloacal swabs from ill poultry, which were subsequently assessed for avian influenza during diagnosis, and birds collected by hunters. Passive surveillance included environmental samples such as sand and bird faeces. Active surveillance samples were taken mostly from poultry farms across Ukraine, where infected birds are required to be diagnosed by State Scientific Research Institute of Laboratory Diagnostics and Veterinary Sanitary Expertise (SSRILDVSE) by Ukraine Law. Passive surveillance samples were taken primarily during the annual bird migration season. Development of simple, sensitive, and cheap methods for diagnostics of avian influenza is a very important task for practical veterinary medicine. LAMP is one of such methods. The technique is based on isothermal amplification of nucleic acids. It does not require special conditions and equipment (PCR cyclers), therefore it is cheaper in comparison with PCR. Accurate diagnosis is necessary for determining the risk associated with avian influenza in Ukraine and along the Dnipro River during the migratory season.

Objective

The performance of comparative analysis of sensitivity and results of detection of avian influenza virus by real time polymerase chain reaction (PCR-RT) and loop-mediated isothermal amplification of the nucleic acids (LAMP) was the main goal of the study.

To immediately monitor disease outbreaks, the application of laboratory-based surveillance is more popular in recent years. Taiwan Centers for Disease Control (TCDC) has developed LARS to collect the laboratory-confirmed cases caused by any of 20 pathogens daily via automated submitting of reports from hospital laboratory information system (LIS) to LARS since 2014 [1]. LOINC is used as standardized format for messaging inspection data [1, 2]. There are 37 hospitals have joined LARS, coverage rate about 59% of all hospitals in Taiwan. Recently, more than 10,000 of data are collected weekly and used in monitoring pathogen activity [3]. Therefore, it is important to ensure data quality that the data will lead to valuable information for public health surveillance.

Objective

To improve data quality and sustain a good quality data collected by Laboratory Automated Reporting System (LARS), we use a Threestage Data Quality Correction (3DQC) strategy to ensure data accuracy.

In France, the surveillance of GE is performed by several complementary systems including specific and syndromic surveillance systems.

The GP’s emergency associations “SOS Médecins” are part of the French syndromic surveillance system SurSaUD since 2006. SOS Médecins functions as a liberal medical regulation. In 9 years, the network has become almost exhaustive and contribute to the surveillance of seasonal and non-seasonal health events at different geographical scales, in the fields of infectious diseases and environmental health. GE is one of the 50 indicators daily followed by the by the French Institute for Public Health Surveillance (InVS) syndromic surveillance unit.

Objective

To illustrate the complementarity and added value of the GP’s emergency network “SOS Médecins” through an example of an epidemic of gastroenteritis (GE).

NYS (excluding NYC) has a very robust Communicable Disease Electronic Surveillance System (CDESS). This system provides disease specific modules, as well as a tracking system for contacts, and a perinatal infant tracking system. This system provides an easy way for users to quickly download a file with all of their data.

NYS (excluding NYC) tracks, on average, 300 infants of hepatitis B surface antigen (HBsAg) positive mothers annually. CDESS provides an infant tracking module for local health departments (LHDs) to enter and monitor vaccine information, add multiple infants per mother, and track patient movement and loss to follow-up. The tool allows LHDs to analyze infants’ data by birth year cohort, with all of their current vaccination and serology information available in one record.

In 2013 and 2014, more than 13,000 cases of gonorrhea were reported to CDESS in NYS (excluding NYC). From November 2013 through May 2014, only 61% of cases were adequately treated with a regimen recommended by the Centers for Disease Control and Prevention (CDC) STD Treatment Guidelines for Gonorrhea , and 29% were missing treatment information. The CDESS system allows the LHDs to track patients who have inadequate and/or missing treatment information.

Objective

Improved methods for user analysis of communicable disease surveillance data in New York State (NYS), excluding New York City (NYC).

Foodborne illness affects 1 in 4 Americans, annually. However, only a fraction of affected individuals seek medical attention. To supplement traditional approaches to foodborne disease surveillance, researchers and public health departments are considering reports of foodborne illness on social media sites. In this project, we work with local public health departments to develop a platform that uses digital data sources such as, Twitter and Yelp, to supplement foodborne disease surveillance efforts. In addition to monitoring reports of illness, this platform can also be used to respond to suspected foodborne illness reports and spur restaurant inspections to ensure food safety. To this end, we have developed a Dashboard that monitors social media chatter for reports of food poisoning in real-time. The Dashboard facilitates responding to illness reports and contacting consumers to provide additional information through a reporting form. The Dashboard is low cost, easy to use and designed to enable easy implementation for any region.

Objective

Develop a platform to enable local surveillance of foodborne illness reported on social media and restaurant review sites for supplementing traditional foodborne disease surveillance programs. In this presentation, we will discuss our collaboration with local public health departments to develop a foodborne disease surveillance Dashboard.