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World Cup serving as real-world test for new disease detection technology

Categories: global disease detection, global health security, health systems strengthening, infectious disease


World Cup soccer ball


With the World Cup underway in all its frenzied glory, you can be forgiven for missing another major effort currently underway in Brazil that represents the first large scale, real-life, real-world test of important new technology.

And no, it’s not the goal-line technology that’s being used for the first time at soccer’s biggest competition.

This technology uses computer tablets, sophisticated software designed by CDC and public health experts from Brazil’s Ministry of Health (MOH) trained in the Field Epidemiological Training Program (FETP) to provide the most complete, detailed and timely information about disease threats and other public health concerns.

The tablet-based system and the Epi Info software driving it are seen as an important advance in disease surveillance that gives users the ability to identify outbreaks earlier and with more precision. That ability is especially important in “mass gatherings” such as the World Cup and other major events which is why this disease detection system is being tested this month.

The tablet-based system and the Epi Info software driving it are seen as an important advance in disease surveillance that gives users the ability to identify outbreaks earlier and with more precision.

The tablet-based system and the Epi Info software driving it are seen as an important advance in disease surveillance that gives users the ability to identify outbreaks earlier and with more precision.

The effort also highlights something else – the long and deep relationship between CDC and Brazilian health authorities.

In this case, CDC developed the tools and helped train Brazilian officials to use the technology. Many of the officials trained to use the software are graduates of the Brazil MOH’s FETP, a highly successful program that has taught scores of “disease detectives.”

The roles are clear and distinct. The technology and all the data collected during the mass gatherings, for example, are controlled entirely by Brazilian health authorities and not shared with CDC or any other outside entity. The same is true for where the system is used; the decisions rest solely with the Ministry of Health.

Mass gatherings like the World Cup represent ideal opportunities because they are planned events, fixed in time allowing us to be more prepared for use of this new technology in an unpredictable event such as a natural disaster, said Victor Caceres of CDC’s FETP Branch.

The effort, two years in the making, is being put to the test in the current “mass gathering” of fans, players, and others at the World Cup. It is the first large-scale (both numerically and geographically) system designed to collect, then stream data seamlessly in real time to a central location where public health officials will have access to a comprehensive set of data.

That goal is achieved through a surveillance system that collects real time health data and displays this information in a centrally located dashboard for analysis and response. And by using a popular tech gadget – a computer tablet.

There’s also geographic diversity. The World Cup is being played in 12 locations across Brazil with dramatically different climate and even health profiles of the population.

Analysis of results

Analysis of results

In fact, the system was tested prior to the World Cup in three small events in Brazil that confirmed the design and the promise of the technology. The first test-run was in January at Aparecida, São Paolo when 250,000 people came to the national shrine. The focus was to test the mobile survey tool’s ability and reliability to collect data in real time and observe data collection on a dashboard in the operations center in real time.

“In this partnership, beyond the improvement of these new features of Epi Info, we have the opportunity to enhance surveillance in mass events and to understand the use of data collection in real time in response to public health emergencies,” said Dr. Wanderson Oliveira, Director of Surveillance and Emergency Response for Brazil’s MOH. “The Ministry of Health intends to adopt this strategy to increase the speed in investigations of outbreaks and other emergencies.”

The next trial came in February and March for carnival in the city of Fortaleza where more than 2 million people converged. The final test came in May during a gay pride event in São Paolo attended by 4 million people. The added feature in this trial was that, in addition to providing surveillance at hospitals and clinics the system was also used in major transportation hubs such as airports and rail stations.

The software is the key. Tablets are pre-loaded with specialized CDC developed software known as Epi Info that allows field deployed epidemiologists to collect data for a wide array of categories and indicators. The data is stored offline until Internet connectivity is available, at which point it is sent to “cloud” computer storage for aggregation. At a “home base” that is often an emergency operations center the data can then be viewed on a dashboard that is continuously updated with statistical results, charts, and maps.

The capability will allow outbreaks to be detected far quicker than with previous technology. That ability is important at any time but even more crucial at mass gatherings such as the World Cup or Olympics or in natural disasters where disease can spread faster and in less predictable ways.

Staff responsible for the technologyIlanit Kateb, a public health advisor for the Center for Global Health was deeply involved in developing the project and helping Brazilian officials use it, said Brazil was the perfect collaborative environment. She cited CDC’s long and close relationship with the Ministry of Health and fact that the country’s FETP program is thriving and that Brazil has a long and successful history in public health.

“Brazil is a high-capacity partner,” she said, “and it openly accepted this program and our collaboration.”

This system, Kateb said, shows how FETP is adapting and evolving, using new technology and techniques for a new generation of disease detectives.

With the system functioning well after the first two weeks of the World Cup, Asad Islam, CDC’s Epi Info team lead, said that it is conceivable to take the lessons learned there and apply them to other public health surveillance and response activities related to outbreaks, natural disasters or humanitarian crises.

That remains in the future, however. As successful as the World Cup experience has been to date, Kateb emphasized the system is still in pilot stage. More tests and evaluation are needed before it can be released into wide use by FETP “disease detectives” globally.

No one doubts, however, that that goal will be reached. The only question, they say, is, when?

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The Value of CDC’s Work in Thailand

Categories: HIV/AIDS, global disease detection, global health security, health systems strengthening, infectious disease, noncommunicable diseases (NCDs), refugee health, tuberculosis (TB), violence and injury


Thai monk


When I became country director in 2013 the relationships between Thailand’s public health officials and CDC were already strong and well established.

Mitch Wolfe, MD MPH, Director, CDC-Thailand

Mitch Wolfe, MD MPH, Director, CDC-Thailand

That wasn’t surprising. CDC’s collaboration with the Ministry of Public Health, after all, began 30 years ago and the partnership has been prospering  – and expanding – ever since. And there is a strong history between the two countries – this year Thailand and the US are celebrating 180 years of Friendship.

The reasons are well established too. And numerous.

Last summer, while visiting family, I was asked by a U.S. border guard, “Why is America working abroad for public health?” I was happy to get this question, as it was an opportunity to deepen understanding for why CDC works abroad – to protect Americans from health threats, to build important relationships with strategic partners, and to learn lessons that can be expanded to other parts of the world.

Kenya’s progress towards sustainable health

Categories: HIV/AIDS, global disease detection, tuberculosis (TB)


Dr. Tom KenyonRecent events in Nairobi have understandably focused the world on security challenges in Kenya. In that context it is important to recognize inspiring public health advances that represent innovative collaboration between CDC and our Kenyan partners to increase health security for Kenya and the global community. I made a two-day trip to visit our CDC-Kenya programs – a quick stop before commissioning the new CDC Global Disease Detection Center in Dhaka, Bangladesh. While I have previously worked as CDC Country Director in Ethiopia and had a general idea of what to expect, visiting Kenya reminded me that each of our CDC country offices has developed unique programs and solutions to address public health issues affecting local populations.

Uganda Makes Impressive Progress on Health

Categories: HIV/AIDS, global disease detection, global health security, health systems strengthening, mosquito-borne disease, women's/maternal health


This blog was originally posted in the Huffington Post on August 8, 2013.


CDC Director Dr. Tom Frieden peers into Python Cave.

CDC Director Dr. Tom Frieden peers into Python Cave.

Last month I was in Uganda. As I planned for this trip, I wasn’t sure what to expect. Uganda is the only country served by the president’s Emergency Plan for AIDS Relief (PEPFAR) with a rising HIV incidence; I anticipated that there might be problems.

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

What I saw instead was impressive progress.

Although Uganda will have challenges for many years as a result of increased HIV infections over the past decade, and has much more to do, I was struck by how much headway they’ve made in the past couple of years. The country has scaled up lifesaving anti-HIV treatment as well as voluntary medical male circumcisions, which sharply reduce the chance of becoming infected.

While in Uganda, I got to peer into a cave — the same cave where two tourists got Marburg virus in 2007. This deadly virus, similar to Ebola, was unknown in this location until identified by CDC staff.

This is Python Cave — and I was awed to see the python, which is at least 12 feet long and 24

Community Survey for Nodding Syndrome in Northern Uganda – CDC an Unfailing Hope

Categories: global disease detection

James Sejvar advises the healthcare workers on a completed NS questionnaire

James Sejvar advises the healthcare workers on a completed NS questionnaire

On a hot afternoon under the shade of a drought-ridden tree, fourteen year old Ojok Daniel (name changed) suddenly stopped eating. Ojok began staring into the distance and his head started to nod every 8-10 seconds. This episode lasted for about 5 minutes. Unfortunately, this is neither the first nor the last occurrence for Ojak. Described as Nodding Syndrome, a form of atypical seizures, Ojok is one among the many children in his village who are afflicted with this disease. Health officials have seen Nodding Syndrome in geographically defined regions of northern Uganda, South Sudan and Tanzania.  The descriptions of the syndrome include head nodding that gets worse over time and is sparked by exposure to cold weather and familiar food, with additional cognitive and neurological dysfunction over time.

Sudhir Bunga, MD, MBBS, Analyst for Global Disease Detection Operations Center

Sudhir Bunga, MD, MBBS, Analyst for Global Disease Detection Operations Center

The road from Kampala to Kitgum District is scenic, with the quietly streaming Nile River providing a light background noise along parts of the journey. However, very abruptly the drive became rough as our vehicle careened onto a dirt road, the only indication of its existence being tire tracks of an earlier vehicle. This served as our welcome to the epicenter of Nodding Syndrome in Uganda. Northern Uganda in February and March still manages to reach anywhere from 85 to 95 degrees Fahrenheit which, coupled with torrential rains and strong winds, made my two week trip anything but easy. The U.S. Government's Official Web PortalDepartment of Health and Human Services
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