1
|
Levin-Rector A, Kulldorff M, Peterson ER, Hostovich S, Greene SK. Prospective Spatiotemporal Cluster Detection Using SaTScan: Tutorial for Designing and Fine-Tuning a System to Detect Reportable Communicable Disease Outbreaks. JMIR Public Health Surveill 2024; 10:e50653. [PMID: 38861711 PMCID: PMC11200039 DOI: 10.2196/50653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/05/2023] [Accepted: 02/02/2024] [Indexed: 06/13/2024] Open
Abstract
Staff at public health departments have few training materials to learn how to design and fine-tune systems to quickly detect acute, localized, community-acquired outbreaks of infectious diseases. Since 2014, the Bureau of Communicable Disease at the New York City Department of Health and Mental Hygiene has analyzed reportable communicable diseases daily using SaTScan. SaTScan is a free software that analyzes data using scan statistics, which can detect increasing disease activity without a priori specification of temporal period, geographic location, or size. The Bureau of Communicable Disease's systems have quickly detected outbreaks of salmonellosis, legionellosis, shigellosis, and COVID-19. This tutorial details system design considerations, including geographic and temporal data aggregation, study period length, inclusion criteria, whether to account for population size, network location file setup to account for natural boundaries, probability model (eg, space-time permutation), day-of-week effects, minimum and maximum spatial and temporal cluster sizes, secondary cluster reporting criteria, signaling criteria, and distinguishing new clusters versus ongoing clusters with additional events. We illustrate how to support health equity by minimizing analytic exclusions of patients with reportable diseases (eg, persons experiencing homelessness who are unsheltered) and accounting for purely spatial patterns, such as adjusting nonparametrically for areas with lower access to care and testing for reportable diseases. We describe how to fine-tune the system when the detected clusters are too large to be of interest or when signals of clusters are delayed, missed, too numerous, or false. We demonstrate low-code techniques for automating analyses and interpreting results through built-in features on the user interface (eg, patient line lists, temporal graphs, and dynamic maps), which became newly available with the July 2022 release of SaTScan version 10.1. This tutorial is the first comprehensive resource for health department staff to design and maintain a reportable communicable disease outbreak detection system using SaTScan to catalyze field investigations as well as develop intuition for interpreting results and fine-tuning the system. While our practical experience is limited to monitoring certain reportable diseases in a dense, urban area, we believe that most recommendations are generalizable to other jurisdictions in the United States and internationally. Additional analytic technical support for detecting outbreaks would benefit state, tribal, local, and territorial public health departments and the populations they serve.
Collapse
Affiliation(s)
- Alison Levin-Rector
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States
| | | | - Eric R Peterson
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States
| | - Scott Hostovich
- Information Management Services, Inc, Calverton, MD, United States
| | - Sharon K Greene
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States
| |
Collapse
|
2
|
Haq Z, Nazir J, Manzoor T, Saleem A, Hamadani H, Khan AA, Saleem Bhat S, Jha P, Ahmad SM. Zoonotic spillover and viral mutations from low and middle-income countries: improving prevention strategies and bridging policy gaps. PeerJ 2024; 12:e17394. [PMID: 38827296 PMCID: PMC11144393 DOI: 10.7717/peerj.17394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/25/2024] [Indexed: 06/04/2024] Open
Abstract
The increasing frequency of zoonotic spillover events and viral mutations in low and middle-income countries presents a critical global health challenge. Contributing factors encompass cultural practices like bushmeat consumption, wildlife trade for traditional medicine, habitat disruption, and the encroachment of impoverished settlements onto natural habitats. The existing "vaccine gap" in many developing countries exacerbates the situation by allowing unchecked viral replication and the emergence of novel mutant viruses. Despite global health policies addressing the root causes of zoonotic disease emergence, there is a significant absence of concrete prevention-oriented initiatives, posing a potential risk to vulnerable populations. This article is targeted at policymakers, public health professionals, researchers, and global health stakeholders, particularly those engaged in zoonotic disease prevention and control in low and middle-income countries. The article underscores the importance of assessing potential zoonotic diseases at the animal-human interface and comprehending historical factors contributing to spillover events. To bridge policy gaps, comprehensive strategies are proposed that include education, collaborations, specialized task forces, environmental sampling, and the establishment of integrated diagnostic laboratories. These strategies advocate simplicity and unity, breaking down barriers, and placing humanity at the forefront of addressing global health challenges. Such a strategic and mental shift is crucial for constructing a more resilient and equitable world in the face of emerging zoonotic threats.
Collapse
Affiliation(s)
- Zulfqarul Haq
- ICMR project, Division of Livestock Production and Management, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, India, Srinagar, Jammu and Kashmir, India
| | - Junaid Nazir
- Department of Clinical Biochemistry, Lovely Professional University, Phagwara, Punjab, India
- Division of Animal Biotechnology, Faculty of veterinary Sciences, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, India, Srinagar, Jammu and Kashmir, India
| | - Tasaduq Manzoor
- Division of Animal Biotechnology, Faculty of veterinary Sciences, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, India, Srinagar, Jammu and Kashmir, India
| | - Afnan Saleem
- Division of Animal Biotechnology, Faculty of veterinary Sciences, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, India, Srinagar, Jammu and Kashmir, India
| | - H. Hamadani
- ICMR project, Division of Livestock Production and Management, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, India, Srinagar, Jammu and Kashmir, India
| | - Azmat Alam Khan
- ICMR project, Division of Livestock Production and Management, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, India, Srinagar, Jammu and Kashmir, India
| | - Sahar Saleem Bhat
- Division of Animal Biotechnology, Faculty of veterinary Sciences, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, India, Srinagar, Jammu and Kashmir, India
| | - Priyanka Jha
- Department of Clinical Biochemistry, Lovely Professional University, Phagwara, Punjab, India
| | - Syed Mudasir Ahmad
- Division of Animal Biotechnology, Faculty of veterinary Sciences, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, India, Srinagar, Jammu and Kashmir, India
| |
Collapse
|
3
|
Petrella RJ. The Eruptive Fevers at Sixes and Sevens. Open Access Emerg Med 2024; 16:101-105. [PMID: 38706755 PMCID: PMC11067716 DOI: 10.2147/oaem.s448246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Sixth Disease (roseola infantum) and its primary causative agent, HHV-6, share names that numerically concur. This article examines and answers the question of whether that correspondence is by design or coincidental by briefly reviewing the history and nomenclature of the HHV viruses and the classic febrile rashes of childhood while highlighting some clinical and microbiologic features of HHV-6 infection.
Collapse
Affiliation(s)
- Robert J Petrella
- Harvard Medical School, Boston, MA, USA
- Department of Chemistry & Chemical Biology, Harvard University, Cambridge, MA, USA
- Emergency Departments, CharterCARE Health Partners, Providence and North Providence, RI, USA
- Emergency Department, Boston VA Medical Center, Boston, MA, USA
- Emergency Departments, Steward Health Care Systems, Boston and Methuen, MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| |
Collapse
|
4
|
Awwad S, Al-Hamdani M, Abdallah AM, Abu-Madi M. Laboratory testing efficiency during the COVID pandemic: Findings from the Primary Health Care Corporation laboratories in the State of Qatar. J Infect Public Health 2024; 17:681-686. [PMID: 38471258 DOI: 10.1016/j.jiph.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Little is known about how the COVID-19 pandemic altered laboratory testing efficiency in the State of Qatar. The aim of this study was to assess laboratory testing efficiency with respect to the total number and proportion of C-reactive protein (CRP), complete blood count (CBC), and comprehensive metabolic panel (CMP) tests completed on time in 2019-2021 in several ordinary and COVID-converted Primary Health Care Corporation (PHCC) health centers across Qatar. METHODS Secondary data from 2019 to 2021 were accessed from the PHCC-Clinical Information System center. Six randomly selected centers from three regions of Qatar (Northern, Central, and Western), two of which were COVID-converted, were analyzed. RESULTS A total of 404,316 laboratory tests were analyzed. There were decreasing, U-shaped, and inverted-U-shaped patterns in the numbers of tests conducted in different regions between 2019 and 2021 according to test type. The proportion of urgent (STAT) CBC and CMP tests increased from 2019 to 2021, and the proportion of tests completed by COVID-converted health centers increased for CRP and CBC and decreased for CMP between 2019 and 2021. Northern and Western regions in Qatar showed higher efficiency than the Central region with respect to the proportion of STAT tests completed on time in 2019-2021. COVID-converted centers completed fewer STAT CBC tests on time than ordinary centers. CONCLUSION Pandemics such as COVID-19 shift the allocation of resources from routine tests to urgent tests, as exemplified by the increase in STAT test proportions in 2019 to 2021. High population densities, as noted in the Central region of Qatar, may require additional resources during pandemics to complete urgent tests more efficiently. The conversion of centers to COVID-converted centers may not necessarily translate into higher urgent test efficiency, as exemplified by the STAT CBC test results.
Collapse
Affiliation(s)
- Sara Awwad
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Mohammed Al-Hamdani
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Atiyeh M Abdallah
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Marawan Abu-Madi
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
| |
Collapse
|
5
|
Craney A, Miller S. Present and Future Non-Culture-Based Diagnostics: Stewardship Potentials and Considerations. Clin Lab Med 2024; 44:109-122. [PMID: 38280793 DOI: 10.1016/j.cll.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
The medical microbiologist plays a key role in the transition from culture-based to molecular test methods for diagnosis of infectious diseases. They must understand the scientific and technical bases underlying these tests along with their associated benefits and limitations and be able to educate administrators and patient providers on their proper use. Coordination of testing practices between clinical departments and the spectrum of public health and research laboratories is essential to optimize health care delivery.
Collapse
Affiliation(s)
- Arryn Craney
- Center for Infectious Disease Diagnostics and Research, Diagnostic Medicine Institute, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822, USA
| | - Steve Miller
- Delve Bio, Inc. and Department of Laboratory Medicine, University of California San Francisco, 953 Indiana Street, San Francisco, CA 94107, USA.
| |
Collapse
|
6
|
Choudhary P, Shafaati M, Abu Salah MAH, Chopra H, Choudhary OP, Silva-Cajaleon K, Bonilla-Aldana DK, Rodriguez-Morales AJ. Zoonotic diseases in a changing climate scenario: Revisiting the interplay between environmental variables and infectious disease dynamics. Travel Med Infect Dis 2024; 58:102694. [PMID: 38336336 DOI: 10.1016/j.tmaid.2024.102694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Priyanka Choudhary
- Department of Veterinary Microbiology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Rampura Phul, Bathinda, 151103, Punjab, India
| | - Maryam Shafaati
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Infectious Diseases Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mai Abdel Haleem Abu Salah
- Department of Medical Laboratory Sciences, Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, Amman, Jordan
| | - Hitesh Chopra
- Department of Biosciences, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Om Prakash Choudhary
- Department of Veterinary Anatomy, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Rampura Phul, Bathinda, 151103, Punjab, India
| | - Kenneth Silva-Cajaleon
- Masters of Climate Change and Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
| | | | - Alfonso J Rodriguez-Morales
- Masters of Climate Change and Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru; Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas-Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia; Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 36, Lebanon.
| |
Collapse
|
7
|
Gaspari M. A Low-Cost Early Warning Method for Infectious Diseases with Asymptomatic Carriers. Healthcare (Basel) 2024; 12:469. [PMID: 38391844 PMCID: PMC10888077 DOI: 10.3390/healthcare12040469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
At the beginning of 2023, the Italian former prime minister, the former health minister and 17 others including the current president of the Lombardy region were placed under investigation on suspicion of aggravated culpable epidemic in connection with the government's response at the start of the COVID-19 pandemic. The charges revolve around the failure by authorities to take adequate measures to prevent the spread of the virus in the Bergamo area, which experienced a significant excess of deaths during the initial outbreak. The aim of this paper is to analyse the pandemic data of Italy and the Lombardy region in the first 10 days of the pandemic, spanning from the 24th of February 2020 to the 4th of March 2020. The objective is to determine whether the use of early warning indicators could have facilitated the identification of a critical increase in infections. This identification, in turn, would have enabled the timely formulation of strategies for pandemic containment, thereby reducing the number of deaths. In conclusion, to translate our findings into practical guidelines, we propose a low-cost early warning method for infectious respiratory diseases with asymptomatic carriers.
Collapse
Affiliation(s)
- Mauro Gaspari
- Department of Computer Science and Engineering, University of Bologna, 40126 Bologna, Italy
| |
Collapse
|
8
|
Schlesinger M, Prieto Alvarado FE, Borbón Ramos ME, Sewe MO, Merle CS, Kroeger A, Hussain-Alkhateeb L. Enabling countries to manage outbreaks: statistical, operational, and contextual analysis of the early warning and response system (EWARS-csd) for dengue outbreaks. Front Public Health 2024; 12:1323618. [PMID: 38314090 PMCID: PMC10834665 DOI: 10.3389/fpubh.2024.1323618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Dengue is currently the fastest-spreading mosquito-borne viral illness in the world, with over half of the world's population living in areas at risk of dengue. As dengue continues to spread and become more of a health burden, it is essential to have tools that can predict when and where outbreaks might occur to better prepare vector control operations and communities' responses. One such predictive tool, the Early Warning and Response System for climate-sensitive diseases (EWARS-csd), primarily uses climatic data to alert health systems of outbreaks weeks before they occur. EWARS-csd uses the robust Distribution Lag Non-linear Model in combination with the INLA Bayesian regression framework to predict outbreaks, utilizing historical data. This study seeks to validate the tool's performance in two states of Colombia, evaluating how well the tool performed in 11 municipalities of varying dengue endemicity levels. Methods The validation study used retrospective data with alarm indicators (mean temperature and rain sum) and an outbreak indicator (weekly hospitalizations) from 11 municipalities spanning two states in Colombia from 2015 to 2020. Calibrations of different variables were performed to find the optimal sensitivity and positive predictive value for each municipality. Results The study demonstrated that the tool produced overall reliable early outbreak alarms. The median of the most optimal calibration for each municipality was very high: sensitivity (97%), specificity (94%), positive predictive value (75%), and negative predictive value (99%; 95% CI). Discussion The tool worked well across all population sizes and all endemicity levels but had slightly poorer results in the highly endemic municipality at predicting non-outbreak weeks. Migration and/or socioeconomic status are factors that might impact predictive performance and should be further evaluated. Overall EWARS-csd performed very well, providing evidence that it should continue to be implemented in Colombia and other countries for outbreak prediction.
Collapse
Affiliation(s)
- Mikaela Schlesinger
- Global Health Research Group, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Franklyn Edwin Prieto Alvarado
- Directorate of Surveillance and Risk Analysis in Public Health, Instituto Nacional de Salud (INS) de Colombia, Bogota, Colombia
| | - Milena Edith Borbón Ramos
- Directorate of Surveillance and Risk Analysis in Public Health, Instituto Nacional de Salud (INS) de Colombia, Bogota, Colombia
| | - Maquins Odhiambo Sewe
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Corinne Simone Merle
- Special Program for Research and Training in Tropical Diseases (TDR-WHO), World Health Organization, Geneva, Switzerland
| | - Axel Kroeger
- Freiburg University, Center for Medicine, and Society (ZMG)/Institute of Infection Prevention, Freiburg, Germany
| | - Laith Hussain-Alkhateeb
- Global Health Research Group, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Population Health Research Section, King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| |
Collapse
|
9
|
Owusu I, Adu C, Aboagye RG, Mpangah RA, Acheampong GK, Akyereko E, Bonsu EO, Peprah P. Preparing for future outbreaks in Ghana: An overview of current COVID-19, monkeypox, and Marburg disease outbreaks. Health Promot Perspect 2023; 13:202-211. [PMID: 37808942 PMCID: PMC10558975 DOI: 10.34172/hpp.2023.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/18/2023] [Indexed: 10/10/2023] Open
Abstract
Amidst the ongoing COVID-19 pandemic, Ghana is currently grappling with simultaneous outbreaks of Marburg virus disease and human monkeypox virus. The coexistence of these outbreaks emphasizes the imperative for a collaborative and global approach to enhance surveillance and expedite case detection. While Ghana has made efforts to respond to these outbreaks, this paper outlines the lessons learned and proposes recommendations in this regard. It is crucial to intensify response efforts at the local, regional, and national levels to effectively contain the spread of these infectious diseases. Therefore, this paper suggests prioritizing the following recommendations as crucial for assisting Ghana in adequately preparing for future outbreaks and safeguarding global public health: strengthening surveillance system through digitization, rapid and effective response; risk communication and community engagement; healthcare system readiness; and research and collaboration. Also, prioritizing building healthy public policies and developing personal skills of health personnel across the country is key for future outbreak response.
Collapse
Affiliation(s)
- Isaac Owusu
- Ghana Health Service, Headquarters, Accra, Ghana
| | - Collins Adu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland 4811, Australia
| | - Richard Gyan Aboagye
- Fred Newton Binka School of Public Health, University of Health, and Allied Sciences, Hohoe, Ghana
| | | | | | - Ernest Akyereko
- Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
| | - Emmanuel Osei Bonsu
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Prince Peprah
- Centre for Primary Health Care and Equity/Social Policy Research Centre, University of New South Wales, Sydney, Australia
| |
Collapse
|