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Ratnayake R, Tammaro M, Tiffany A, Kongelf A, Polonsky JA, McClelland A. People-centred surveillance: a narrative review of community-based surveillance among crisis-affected populations. Lancet Planet Health 2020; 4:e483-e495. [PMID: 33038321 PMCID: PMC7542093 DOI: 10.1016/s2542-5196(20)30221-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
Outbreaks of disease in settings affected by crises grow rapidly due to late detection and weakened public health systems. Where surveillance is underfunctioning, community-based surveillance can contribute to rapid outbreak detection and response, a core capacity of the International Health Regulations. We reviewed articles describing the potential for community-based surveillance to detect diseases of epidemic potential, outbreaks, and mortality among populations affected by crises. Surveillance objectives have included the early warning of outbreaks, active case finding during outbreaks, case finding for eradication programmes, and mortality surveillance. Community-based surveillance can provide sensitive and timely detection, identify valid signals for diseases with salient symptoms, and provide continuity in remote areas during cycles of insecurity. Effectiveness appears to be mediated by operational requirements for continuous supervision of large community networks, verification of a large number of signals, and integration of community-based surveillance within the routine investigation and response infrastructure. Similar to all community health systems, community-based surveillance requires simple design, reliable supervision, and early and routine monitoring and evaluation to ensure data validity. Research priorities include the evaluation of syndromic case definitions, electronic data collection for community members, sentinel site designs, and statistical techniques to counterbalance false positive signals.
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Affiliation(s)
- Ruwan Ratnayake
- International Rescue Committee, New York, NY, USA; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Meghan Tammaro
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Jonathan A Polonsky
- World Health Organization, Geneva, Switzerland; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Amanda McClelland
- International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
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2
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Carrasco-Escobar G, Manrique E, Tello-Lizarraga K, Miranda JJ. Travel Time to Health Facilities as a Marker of Geographical Accessibility Across Heterogeneous Land Coverage in Peru. Front Public Health 2020; 8:498. [PMID: 33042942 PMCID: PMC7524891 DOI: 10.3389/fpubh.2020.00498] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/31/2020] [Indexed: 12/19/2022] Open
Abstract
To better estimate the travel time to the most proximate health care facility (HCF) and determine differences across heterogeneous land coverage types, this study explored the use of a novel cloud-based geospatial modeling approach. Geospatial data of 145,134 cities and villages and 8,067 HCF were gathered with land coverage types, roads and river networks, and digital elevation data to produce high-resolution (30 m) estimates of travel time to HCFs across Peru. This study estimated important variations in travel time to HCFs between urban and rural settings and major land coverage types in Peru. The median travel time to primary, secondary, and tertiary HCFs was 1.9-, 2.3-, and 2.2-fold higher in rural than urban settings, respectively. This study provides a new methodology to estimate the travel time to HCFs as a tool to enhance the understanding and characterization of the profiles of accessibility to HCFs in low- and middle-income countries.
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Affiliation(s)
- Gabriel Carrasco-Escobar
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt, " Universidad Peruana Cayetano Heredia, Lima, Peru.,Division of Infectious Diseases, Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Edgar Manrique
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt, " Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kelly Tello-Lizarraga
- Facultad de Salud Publica y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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3
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Oliver N, Lepri B, Sterly H, Lambiotte R, Deletaille S, De Nadai M, Letouzé E, Salah AA, Benjamins R, Cattuto C, Colizza V, de Cordes N, Fraiberger SP, Koebe T, Lehmann S, Murillo J, Pentland A, Pham PN, Pivetta F, Saramäki J, Scarpino SV, Tizzoni M, Verhulst S, Vinck P. Mobile phone data for informing public health actions across the COVID-19 pandemic life cycle. SCIENCE ADVANCES 2020; 6:eabc0764. [PMID: 32548274 PMCID: PMC7274807 DOI: 10.1126/sciadv.abc0764] [Citation(s) in RCA: 268] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 05/19/2023]
Affiliation(s)
- Nuria Oliver
- ELLIS, the European Laboratory for Learning and Intelligent Systems, Alicante, Spain
- DataPop Alliance, New York, NY, USA
| | - Bruno Lepri
- DataPop Alliance, New York, NY, USA
- Fondazione Bruno Kessler, Trento, Italy
| | | | - Renaud Lambiotte
- University of Oxford, Oxford, UK
- The Alan Turing Institute, London, UK
| | | | | | - Emmanuel Letouzé
- DataPop Alliance, New York, NY, USA
- Open Algorithms (OPAL) collaborative project, New York, NY, USA
| | - Albert Ali Salah
- DataPop Alliance, New York, NY, USA
- Utrecht University, Utrecht, Netherlands
| | | | - Ciro Cattuto
- University of Turin, Turin, Italy
- Orange Group, Paris, France
| | - Vittoria Colizza
- INSERM, Sorbonne Université, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | | | | | - Till Koebe
- DataPop Alliance, New York, NY, USA
- Freie University, Berlin, Germany
| | - Sune Lehmann
- Technical University of Denmark, Copenhagen, Denmark
| | | | - Alex Pentland
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Phuong N Pham
- DataPop Alliance, New York, NY, USA
- Harvard University, Cambridge, MA, USA
| | | | | | | | | | | | - Patrick Vinck
- DataPop Alliance, New York, NY, USA
- Harvard University, Cambridge, MA, USA
- Corresponding author.
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4
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Lewnard JA, Reingold AL. Emerging Challenges and Opportunities in Infectious Disease Epidemiology. Am J Epidemiol 2019; 188:873-882. [PMID: 30877295 PMCID: PMC7109842 DOI: 10.1093/aje/kwy264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 12/12/2022] Open
Abstract
Much of the intellectual tradition of modern epidemiology stems from efforts to understand and combat chronic diseases persisting through the 20th century epidemiologic transition of countries such as the United States and United Kingdom. After decades of relative obscurity, infectious disease epidemiology has undergone an intellectual rebirth in recent years amid increasing recognition of the threat posed by both new and familiar pathogens. Here, we review the emerging coalescence of infectious disease epidemiology around a core set of study designs and statistical methods bearing little resemblance to the chronic disease epidemiology toolkit. We offer our outlook on challenges and opportunities facing the field, including the integration of novel molecular and digital information sources into disease surveillance, the assimilation of such data into models of pathogen spread, and the increasing contribution of models to public health practice. We next consider emerging paradigms in causal inference for infectious diseases, ranging from approaches to evaluating vaccines and antimicrobial therapies to the task of ascribing clinical syndromes to etiologic microorganisms, an age-old problem transformed by our increasing ability to characterize human-associated microbiota. These areas represent an increasingly important component of epidemiology training programs for future generations of researchers and practitioners.
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Affiliation(s)
- Joseph A Lewnard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
- Correspondence to Dr. Joseph A. Lewnard, Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA 94720 (e-mail: )
| | - Arthur L Reingold
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
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5
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Ashley EA, Shetty N, Patel J, van Doorn R, Limmathurotsakul D, Feasey NA, Okeke IN, Peacock SJ. Harnessing alternative sources of antimicrobial resistance data to support surveillance in low-resource settings. J Antimicrob Chemother 2019; 74:541-546. [PMID: 30544186 PMCID: PMC6406030 DOI: 10.1093/jac/dky487] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
One of the most pressing challenges facing the global surveillance of antimicrobial resistance (AMR) is the generation, sharing, systematic analysis and dissemination of data in low-resource settings. Numerous agencies and initiatives are working to support the development of globally distributed microbiology capacity, but the routine generation of a sustainable flow of reliable data will take time to establish before it can deliver a clinical and public health impact. By contrast, there are a large number of pharma- and academia-led initiatives that have generated a wealth of data on AMR and drug-resistant infections in low-resource settings, together with high-volume data generation by private laboratories. Here, we explore how untapped sources of data could provide a short-term solution that bridges the gap between now and the time when routine surveillance capacity will have been established and how this could continue to support surveillance efforts in the future. We discuss the benefits and limitations of data generated by these sources, the mechanisms and barriers to making this accessible and how academia and pharma might support the development of laboratory and analytical capacity. We provide key actions that will be required to harness these data, including: a mapping exercise; creating mechanisms for data sharing; use of data to support national action plans; facilitating access to and use of data by the WHO Global Antimicrobial Resistance Surveillance System; and innovation in data capture, analysis and sharing.
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Affiliation(s)
- Elizabeth A Ashley
- Myanmar–Oxford Clinical Research Unit (MOCRU), Yangon, Myanmar
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Nandini Shetty
- National Infection Service, Public Health England, 61 Colindale Avenue, Colindale, London, UK
| | - Jean Patel
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rogier van Doorn
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ha Noi, Vietnam
| | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas A Feasey
- The Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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6
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Ming D, Rawson T, Sangkaew S, Rodriguez-Manzano J, Georgiou P, Holmes A. Connectivity of rapid-testing diagnostics and surveillance of infectious diseases. Bull World Health Organ 2019; 97:242-244. [PMID: 30992638 PMCID: PMC6453318 DOI: 10.2471/blt.18.219691] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/30/2018] [Accepted: 12/25/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Damien Ming
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Hammersmith Hospital Campus, London W12 0NN, England
| | - Timothy Rawson
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Hammersmith Hospital Campus, London W12 0NN, England
| | - Sorawat Sangkaew
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Hammersmith Hospital Campus, London W12 0NN, England
| | | | - Pantelis Georgiou
- Department of Electrical and Electronic Engineering, Imperial College, London, England
| | - Alison Holmes
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Hammersmith Hospital Campus, London W12 0NN, England
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Desai AN, Madoff LC. Bending the epidemic curve: advancements and opportunities to reduce the threat of emerging pathogens. Epidemiol Infect 2019; 147:e168. [PMID: 30955504 PMCID: PMC6518771 DOI: 10.1017/s095026881900058x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 11/22/2022] Open
Abstract
This invited editorial introduces a special issue of Epidemiology & Infection while also discussing advances in emerging infectious diseases.
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Affiliation(s)
- Angel N. Desai
- Department of Infectious Disease, Brigham and Women's Hospital, Boston, USA
- International Society for Infectious Disease, Brookline, USA
| | - Lawrence C. Madoff
- International Society for Infectious Disease, Brookline, USA
- University of Massachusetts Medical School, Worcester, USA
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8
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Abstract
Spatial epidemiology is a rapidly advancing field, pushing our abilities to measure, monitor and map pathogens at increasingly finer spatiotemporal scales. However, these scales often do not align with the abilities of control programmes to act at them, building a disconnect between academia and implementation. Efforts are being made to feed innovations into government, build spatial data skills, and strengthen links between disease control programmes and universities, yet work remains to be done if goals for disease control, elimination and 'leaving no one behind' are to be met.
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Affiliation(s)
- Andrew J Tatem
- WorldPop, Department of Geography and Environment, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
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Beard R, Wentz E, Scotch M. A systematic review of spatial decision support systems in public health informatics supporting the identification of high risk areas for zoonotic disease outbreaks. Int J Health Geogr 2018; 17:38. [PMID: 30376842 PMCID: PMC6208014 DOI: 10.1186/s12942-018-0157-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Zoonotic diseases account for a substantial portion of infectious disease outbreaks and burden on public health programs to maintain surveillance and preventative measures. Taking advantage of new modeling approaches and data sources have become necessary in an interconnected global community. To facilitate data collection, analysis, and decision-making, the number of spatial decision support systems reported in the last 10 years has increased. This systematic review aims to describe characteristics of spatial decision support systems developed to assist public health officials in the management of zoonotic disease outbreaks. METHODS A systematic search of the Google Scholar database was undertaken for published articles written between 2008 and 2018, with no language restriction. A manual search of titles and abstracts using Boolean logic and keyword search terms was undertaken using predefined inclusion and exclusion criteria. Data extraction included items such as spatial database management, visualizations, and report generation. RESULTS For this review we screened 34 full text articles. Design and reporting quality were assessed, resulting in a final set of 12 articles which were evaluated on proposed interventions and identifying characteristics were described. Multisource data integration, and user centered design were inconsistently applied, though indicated diverse utilization of modeling techniques. CONCLUSIONS The characteristics, data sources, development and modeling techniques implemented in the design of recent SDSS that target zoonotic disease outbreak were described. There are still many challenges to address during the design process to effectively utilize the value of emerging data sources and modeling methods. In the future, development should adhere to comparable standards for functionality and system development such as user input for system requirements, and flexible interfaces to visualize data that exist on different scales. PROSPERO registration number: CRD42018110466.
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Affiliation(s)
- Rachel Beard
- College of Health Solutions, Arizona State University, Phoenix, AZ USA
- Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, AZ USA
| | - Elizabeth Wentz
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ USA
| | - Matthew Scotch
- College of Health Solutions, Arizona State University, Phoenix, AZ USA
- Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, AZ USA
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Fukuda K, Limmathurotsakul D, Okeke IN, Shetty N, van Doorn R, Feasey NA, Chiara F, Zoubiane G, Jinks T, Parkhill J, Patel J, Reid SW, Holmes AH, Peacock SJ. Surveillance and Epidemiology of Drug Resistant Infections Consortium (SEDRIC): Supporting the transition from strategy to action. Wellcome Open Res 2018; 3:59. [PMID: 29904730 PMCID: PMC5989141 DOI: 10.12688/wellcomeopenres.14586.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 01/28/2023] Open
Abstract
In recognition of the central importance of surveillance and epidemiology in the control of antimicrobial resistance and the need to strengthen surveillance at all levels, Wellcome has brought together a new international expert group SEDRIC (Surveillance and Epidemiology of Drug Resistant Infections Consortium). SEDRIC aims to advance and transform the ways of tracking, sharing and analysing rates of infection and drug resistance, burden of disease, information on antibiotic use, opportunities for preventative measures such as vaccines, and contamination of the environment. SEDRIC will strengthen the availability of information needed to monitor and track risks, including an evaluation of access to, and utility of data generated by pharma and research activities, and will support the translation of surveillance data into interventions, changes in policy and more effective practices. Ways of working will include the provision of independent scientific analysis, advocacy and expert advice to groups, such as the Wellcome Drug Resistant Infection Priority Programme. A priority for SEDRIC's first Working Group is to review mechanisms to strengthen the generation, collection, collation and dissemination of high quality data, together with the need for creativity in the use of existing data and proxy measures, and linking to existing in-country networking infrastructure. SEDRIC will also promote the translation of technological innovations into public health solutions.
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Affiliation(s)
- Keiji Fukuda
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulum, Hong Kong
| | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Iruka N. Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Nandini Shetty
- National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - Rogier van Doorn
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Nicholas A. Feasey
- The Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | | | | | | | - Jean Patel
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | | | | | - Sharon J. Peacock
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Surveillance and Epidemiology of Drug Resistant Infections Consortium (SEDRIC)
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulum, Hong Kong
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
- National Infection Service, Public Health England, London, NW9 5EQ, UK
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam
- The Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Wellcome Trust, London, NW1 2BE, UK
- Wellcome Sanger Institute, Hinxton, CB10 1SA, UK
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
- Royal Veterinary College, Hatfield, AL9 7TA, UK
- Imperial College London, London, W12 0HS, UK
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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11
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Fukuda K, Limmathurotsakul D, Okeke IN, Shetty N, van Doorn R, Feasey NA, Chiara F, Zoubiane G, Jinks T, Parkhill J, Patel J, Reid SWJ, Holmes AH, Peacock SJ. Surveillance and Epidemiology of Drug Resistant Infections Consortium (SEDRIC): Supporting the transition from strategy to action. Wellcome Open Res 2018. [PMID: 29904730 DOI: 10.12688/wellcomeopenres.14586.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In recognition of the central importance of surveillance and epidemiology in the control of antimicrobial resistance and the need to strengthen surveillance at all levels, Wellcome has brought together a new international expert group SEDRIC (Surveillance and Epidemiology of Drug Resistant Infections Consortium). SEDRIC aims to advance and transform the ways of tracking, sharing and analysing rates of infection and drug resistance, burden of disease, information on antibiotic use, opportunities for preventative measures such as vaccines, and contamination of the environment. SEDRIC will strengthen the availability of information needed to monitor and track risks, including an evaluation of access to, and utility of data generated by pharma and research activities, and will support the translation of surveillance data into interventions, changes in policy and more effective practices. Ways of working will include the provision of independent scientific analysis, advocacy and expert advice to groups, such as the Wellcome Drug Resistant Infection Priority Programme. A priority for SEDRIC's first Working Group is to review mechanisms to strengthen the generation, collection, collation and dissemination of high quality data, together with the need for creativity in the use of existing data and proxy measures, and linking to existing in-country networking infrastructure. SEDRIC will also promote the translation of technological innovations into public health solutions.
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Affiliation(s)
- Keiji Fukuda
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulum, Hong Kong
| | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Nandini Shetty
- National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - Rogier van Doorn
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Nicholas A Feasey
- The Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | | | | | | | - Jean Patel
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | | | | | - Sharon J Peacock
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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