Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin Workshop Summary (2008) / Chapter Skim
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4 Diseases in Humans: Early Warning Systems
4 Diseases in Humans: Early Warning Systems
Pages 53-68
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From page 53... ...
The ideal disease surveillance system, described by those focusing on animal health, was an interconnected system across species where outbreaks in animal populations could be detected and risks of human exposure could be identified early on and addressed to minimize or prevent disease in humans. Surveillance for zoonotic diseases in humans is similarly focused on early warning.
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From page 54... ...
GPHIN officials to ensure accuracy of the automated process." Libel noted that additional analyses by the human experts precede any publication with an alert that is then distributed automatically to subscribers. GPHIN is designed to pay particular attention to a small number of human diseases that are of particular concern for even one case per the International Health Regulations: influenza, polio, Severe Acute Respira
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From page 55... ...
Libel listed GOARN's primary goals as the following: • Assist countries with disease control efforts by ensuring rapid, appropriate technical support to affected populations; • Investigate and characterize disease events and assess the potential for rapidly emerging epidemic disease threats; and • Support national outbreak preparedness by ensuring that responses contribute to sustained containment of epidemic threats. To provide a sense of the scope of GOARN's efforts, Libel noted that the network and its partners coordinated responses in 63 countries, mobilizing more than 500 experts in response to 97 events between 2000 and 2007.
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From page 56... ...
Another benefit, he explained, is that WHO can also use informal sources of information Regional d Tr ize Pr ainin Networks ial ks og ec r ram g Sp etwo s N Steering Committee Collabo- + rating Operational WHO Centres Support Team (FIMS) Nat i Cen onal Os tres NG UNOs FIGURE 4-1 Structure of the Global Outbreak Alert and Response Network.
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From page 57... ...
Another system that tracks information about disease outbreaks around the world was described by Peter Cowen, of North Carolina State University. ProMED-mail, or the Program for Monitoring Emerging Diseases, is a project of the International Society for Infectious Diseases set up in 1994 to provide a means of quickly disseminating information about infectious disease outbreaks.
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From page 58... ...
But personal communication is key to success, he said in closing: "If we are ever going to do real monitoring for emerging diseases, I think it is important that we develop collegial relationships, we get to know each other. These things are always done person to person, and certainly one of the reasons ProMED-mail works is that we know each other very well and we trust each other." From the vantage point of an animal health professional, he Russia Canada Kazakhstan United States Iran China Algeria India Sudan Number Pathogens 50…60+ Brazil 40…50 30…40 Australia 20…30 10…20 ≤0…10 FIGURE 4-2 Pathogens reported by global location via ProMED.
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From page 59... ...
Department of Defense (DoD) to monitor and respond to infectious diseases that are a threat to military personnel or their families, that reduce medical readiness, or that present a risk to national security (DoD-GEIS, 2008)
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From page 60... ...
disease, antimicrobial resistance, and sexually transmitted infections. The GEIS network includes partners and laboratory facilities in many parts of the world (see Figure 4-4)
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From page 61... ...
DuVernoy also noted that DoD is now funding new integrated surveillance activities in Peru in its recognition of the growing importance of the interaction between human and animal health. In this effort, they are attempting to pilot the Alerta system to incorporate not only human surveillance, but also animal disease information by working with both the ministries of agriculture and of public health.
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From page 62... ...
Examples of important human pathogens include the four dengue viruses, West Nile virus, yellow fever virus, and Japanese encephalitis virus. Rift Valley fever, Nairobi sheep disease, Venezuelan equine encephalitis, and Bluetongue are examples of veterinary diseases caused by infection with arboviruses (Miller et al., 2008)
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From page 63... ...
For the neuroinvasive disease, the data are used to calculate rates of disease, project the total number of cases and infections, and compare trends over time. Figure 4-5 shows the incidence of West Nile virus neuroinvasive disease in the United States in 2007.
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From page 64... ...
The presence of virus in mosquito populations is not reportable, but many health departments use traps to monitor the presence of West Nile -- nearly 8,100 mosquito pools tested positive for the virus in 2007. The strengths of ArboNET are that it is a comprehensive system that collects human, animal, and ecological data, and that it can provide detailed data down to the county level, Fischer said.
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From page 65... ...
• Do animal and ecological data help predict human disease and provide timely warning of local outbreaks? • Can the data be used to develop predictive models for arboviral disease risk factors or trends?
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From page 66... ...
These may be about drug shortages or toxicities, but also diseases such as Hantavirus Pulmonary Syndrome or West Nile. The surveys help establish the scope of a problem, common treatment responses, and other information to support CDC in determining what steps it needs to take.
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From page 67... ...
Developing countries frequently lack personnel capacity to carry out surveillance to detect outbreaks, to conduct disease outbreak investigations, and to respond once an outbreak is identified, and international groups may face additional challenges in "quickly identifying the best people" on the ground to participate in a rapid response. Consequently, some regions are poorly represented in surveillance systems, which are often hotspot regions with a high likelihood of emerging diseases where surveillance is most needed.
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From page 68... ...
On the other hand, though, many seemed to agree that "we have to go beyond just sending out alerts and receiving signals and learn how to put people in touch with each other." New technologies and Internet tools may make significant improvements possible, but "what we really need is information, usable information." In the end, one participant noted that it will be key to identify the critical priorities. The existing networks prove that disease surveillance is clearly achievable if it becomes a priority within the broader context of disease prevention, response, and control.
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