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Crawley AW, Divi N, Smolinski MS. Using Timeliness Metrics to Track Progress and Identify Gaps in Disease Surveillance. Health Secur 2021; 19:309-317. [PMID: 33891487 DOI: 10.1089/hs.2020.0139] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Timely outbreak detection and response can translate into illnesses averted and lives saved. As such, timeliness is an important criterion for evaluating performance of infectious disease surveillance systems. Through the use of clearly defined outbreak milestones, timeliness metrics can capture the speed of outbreak detection, verification, response, and other key actions across the timeline of an outbreak and evaluate progress over time. In this article, we describe a series of country-level pilot studies designed to assess the feasibility and utility of tracking timeliness metrics and highlight key findings. We then discuss subsequent efforts to develop a timeliness metrics measurement framework through expert consultation and provide recommendations for implementation. National surveillance programs, international agencies, and donor organizations can use timeliness metrics to identify gaps in surveillance performance and track progress toward improved global health security.
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Affiliation(s)
- Adam W Crawley
- Adam Wade Crawley, MPH, is a Program Officer; Nomita Divi, MSPH, is Director; and Mark S. Smolinski, MD, MPH, is President; all at Ending Pandemics, San Francisco, CA
| | - Nomita Divi
- Adam Wade Crawley, MPH, is a Program Officer; Nomita Divi, MSPH, is Director; and Mark S. Smolinski, MD, MPH, is President; all at Ending Pandemics, San Francisco, CA
| | - Mark S Smolinski
- Adam Wade Crawley, MPH, is a Program Officer; Nomita Divi, MSPH, is Director; and Mark S. Smolinski, MD, MPH, is President; all at Ending Pandemics, San Francisco, CA
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Ryan U, Hijjawi N, Feng Y, Xiao L. Giardia: an under-reported foodborne parasite. Int J Parasitol 2018; 49:1-11. [PMID: 30391227 DOI: 10.1016/j.ijpara.2018.07.003] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/26/2022]
Abstract
Foodborne zoonotic pathogens are a serious public health issue and result in significant global economic losses. Despite their importance to public health, epidemiological data on foodborne diseases including giardiasis caused by the enteric parasite, Giardia duodenalis, are lacking. This parasite is estimated to cause ∼28.2 million cases of diarrhoea each year due to contamination of food, but very few foodborne outbreaks have been documented due to the limitations of current detection as well as surveillance methods. The current method for the recovery of Giardia cysts from food matrices using immunomagnetic separation requires further standardisation and cost reduction before it can be widely used. It also should incorporate downstream molecular procedures for genotyping, and traceback and viability analyses. Foodborne giardiasis can be potentially controlled through improvements in national disease surveillance systems and the establishment of Hazard Analysis and Critical Control Point interventions across the food chain. Studies are needed to assess the true prevalence and public health impact of foodborne giardiasis.
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Affiliation(s)
- Una Ryan
- School of Veterinary and Life Sciences, Vector- and Water-Borne Pathogen Research Group, Murdoch University, Murdoch, Western Australia 6150, Australia.
| | - Nawal Hijjawi
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, The Hashemite University PO Box 150459, Zarqa 13115, Jordan
| | - Yaoyu Feng
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Lihua Xiao
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
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Kluberg SA, Mekaru SR, McIver DJ, Madoff LC, Crawley AW, Smolinski MS, Brownstein JS. Global Capacity for Emerging Infectious Disease Detection, 1996-2014. Emerg Infect Dis 2018; 22:E1-6. [PMID: 27649306 PMCID: PMC5038396 DOI: 10.3201/eid2210.151956] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The speed with which disease outbreaks are recognized is critical for establishing effective control efforts. We evaluate global improvements in the timeliness of outbreak discovery and communication during 2010-2014 as a follow-up to a 2010 report. For all outbreaks reported by the World Health Organization's Disease Outbreak News, we estimate the number of days from first symptoms until outbreak discovery and until first public communication. We report median discovery and communication delays overall, by region, and by Human Development Index (HDI) quartile. We use Cox proportional hazards regression to assess changes in these 2 outcomes over time, along with Loess curves for visualization. Improvement since 1996 was greatest in the Eastern Mediterranean and Western Pacific regions and in countries in the middle HDI quartiles. However, little progress has occurred since 2010. Further improvements in surveillance will likely require additional international collaboration with a focus on regions of low or unstable HDI.
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Ryan U, Hijjawi N, Xiao L. Foodborne cryptosporidiosis. Int J Parasitol 2017; 48:1-12. [PMID: 29122606 DOI: 10.1016/j.ijpara.2017.09.004] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/26/2022]
Abstract
Foodborne illness, the majority of which is caused by enteric infectious agents, costs global economies billions of dollars each year. The protozoan parasite Cryptosporidium is particularly suited to foodborne transmission and is responsible for >8 million cases of foodborne illness annually. Procedures have been developed for sensitive detection of Cryptosporidium oocysts on fresh produce and molecular diagnostic assays have been widely used in case linkages and infection source tracking, especially during outbreak investigations. The integrated use of advanced diagnostic techniques with conventional epidemiological studies is essential to improve our understanding of the occurrence, source and epidemiology of foodborne cryptosporidiosis. The implementation of food safety management tools such as Good Hygienic Practices (GHP), Hazard Analysis and Critical Control Points (HACCP), and Quantitative Microbial Risk Assessment (QMRA) in industrialised nations and Water, Sanitation, and Hygiene (WASH) in developing countries is central for prevention and control and foodborne cryptosporidiosis in the future.
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Affiliation(s)
- Una Ryan
- School of Veterinary and Life Sciences, Vector- and Water-Borne Pathogen Research Group, Murdoch University, Murdoch, Western Australia 6150, Australia.
| | - Nawal Hijjawi
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, The Hashemite University, PO Box 150459, Zarqa 13115, Jordan
| | - Lihua Xiao
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Analysis of enteric disease outbreak metrics, British Columbia Centre for Disease Control, 2005-2014. ACTA ACUST UNITED AC 2017; 43:1-6. [PMID: 29770040 DOI: 10.14745/ccdr.v43i01a01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background For enteric disease outbreaks, effective control depends on timely intervention. Routine collection of metrics related to outbreak identification, investigation and control can help evaluate and improve interventions and inform further analyses and modelling of intervention effectiveness. Objective To analyze data from enteric disease outbreaks in British Columbia, generate outbreak metrics and assess their use in evaluating the impact of outbreak interventions. Methods This descriptive study analyzed data from 57 provincial and national enteric disease outbreak investigations involving the British Columbia Centre for Disease Control from 2005 to 2014. Data were extracted from internal files and the Canadian Network for Public Health Intelligence. Outbreak metrics analyzed included days to initiate investigation, days to intervention, number and type of interventions, duration of investigation, duration of outbreak and the total number of cases. Results The median time to initiate an outbreak investigation was 36 days and the median duration of investigations was 39 days. The median duration of outbreaks was 40 days and the median time to intervene was 10 days. Identification of the source was associated with use of one or more interventions (P<0.0001). The duration of outbreaks was correlated with the number of days to initiate an investigation (rs =0.72, P<0.0001) and number of days to intervene (rs =0.51, P=0.025). Conclusion Identification and analysis of outbreak metrics establishes benchmarks that can be compared to other jurisdictions. This may support continuous quality improvement and enhance understanding of the impact of public health activities. Date information for public health actions is essential for evaluating the timing and effectiveness of outbreak interventions.
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Langley JM, MacDougall DM, Halperin BA, Swain A, Halperin SA, Top KA, McNeil SA, MacKinnon-Cameron D, Marty K, De Serres G, Dubé E, Bettinger JA. Rapid surveillance for health events following a mass meningococcal B vaccine program in a university setting: A Canadian Immunization Research Network study. Vaccine 2016; 34:4046-9. [PMID: 27302338 DOI: 10.1016/j.vaccine.2016.06.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/17/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
An outbreak of Neisseria meningitidis serotype B infection occurred at a small residential university; public health announced an organizational vaccination program with the 4-component Meningococcal B (4CMenB) vaccine (Bexsero(TM), Novartis/GlaxoSmithKline Inc.) several days later. Since there were limited published data on reactogenicity of 4CMenB in persons over 17years of age, this study sought to conduct rapid surveillance of health events in vaccinees and controls using an online survey. Vaccine uptake was 84.7% for dose 1 (2967/3500) and 70% (2456/3500) for dose 2; the survey response rates were 33.0% (987/2967) and 18.7% (459/2456) in dose 1 and dose 1 recipients respectively, and 12% in unvaccinated individuals (63/533). Most students were 20-29years of age (vaccinees, 64.0%; controls, 74.0). A new health problem or worsening of an existing health problem was reported by 30.0% and 30.3% of vaccine recipients after doses 1 and 2 respectively; and by 15.9% of controls. These health problems interfered with the ability to perform normal activities in most vaccinees reporting these events (74.7% post dose 1; 62.6% post dose 2), and in 60% of controls. The health problems led to a health care provider visit (including emergency room) in 12.8% and 14.4% of vaccinees post doses 1 and 2, respectively and in 40% of controls. The most common reactions in vaccinees were injection site reactions (20.6% post dose 1, 16.1% post dose 20 and non-specific systemic complaints (22.6% post dose 1, 17.6% post dose 2). No hospitalizations were reported. An online surveillance program during an emergency meningococcal B vaccine program was successfully implemented, and detected higher rates of health events in vaccinees compared to controls, and high rates of both vaccinees and controls seeking medical attention. The types of adverse events reported by young adult vaccinees were consistent with those previously.
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Affiliation(s)
- J M Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Halifax, Nova Scotia (NS), Canada.
| | | | - B A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Halifax, Nova Scotia (NS), Canada
| | - A Swain
- Acadia University, Wolfville, NS, Canada
| | - S A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Halifax, Nova Scotia (NS), Canada
| | - K A Top
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Halifax, Nova Scotia (NS), Canada
| | - S A McNeil
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Halifax, Nova Scotia (NS), Canada
| | - D MacKinnon-Cameron
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Halifax, Nova Scotia (NS), Canada
| | - K Marty
- Vaccine Evaluation Centre, B.C. Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - G De Serres
- Institut National de Santé Publique du Quebec, Quebec, Canada
| | - E Dubé
- Institut National de Santé Publique du Quebec, Quebec, Canada
| | - J A Bettinger
- Vaccine Evaluation Centre, B.C. Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Selection of population controls for a Salmonella case-control study in the UK using a market research panel and web-survey provides time and resource savings. Epidemiol Infect 2015; 144:1220-30. [DOI: 10.1017/s0950268815002290] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYTimely recruitment of population controls in infectious disease outbreak investigations is challenging. We evaluated the timeliness and cost of using a market research panel as a sampling frame for recruiting controls in a case-control study during an outbreak of Salmonella Mikawasima in the UK in 2013. We deployed a web-survey by email to targeted members of a market research panel (panel controls) in parallel to the outbreak control team interviewing randomly selected public health staff by telephone and completing paper-based questionnaires (staff controls). Recruitment and completion of exposure history web-surveys for panel controls (n = 123) took 14 h compared to 15 days for staff controls (n = 82). The average staff-time cost per questionnaire for staff controls was £13·13 compared to an invoiced cost of £3·60 per panel control. Differences in the distribution of some exposures existed between these control groups but case-control studies using each group found that illness was associated with consumption of chicken outside of the home and chicken from local butchers. Recruiting market research panel controls offers time and resource savings. More rapid investigations would enable more prompt implementation of control measures. We recommend that this method of recruiting controls is considered in future investigations and assessed further to better understand strengths and limitations.
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