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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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Communication Matters in Global Health Deployments

Categories: global health security, infectious disease

During the simulation exercise, ECN trainees deployed to the site of a mock disaster in Avully, Switzerland.

During the simulation exercise, ECN trainees deployed to the site of a mock disaster in Avully, Switzerland.

Communication matters.

Gaya Gamhewage, MD, Coordinator, WHO Communication Capacity Building Team; Founder, WHO Emergency Communication Network

Gaya Gamhewage, MD, Coordinator, WHO Communication Capacity Building Team; Founder, WHO Emergency Communication Network

That’s not a new idea. Many of us have learned this the hard way. This concept is being applied in a new, more comprehensive way for a key purpose—to help the World Health Organization (WHO) communicate more effectively, with more clarity and purpose during humanitarian and public health emergencies.

The idea is to better integrate communications specialists from WHO, CDC, ministries of health and a wide array of other humanitarian and global health organizations into a cohesive, specially trained team that can be dispatched on short notice when public health or humanitarian emergencies occur.

The logic is based on the idea that communications is part and parcel of emergency health response. Communicating in a crisis not only provides the public and policy maker clear and critical information, it also can help the technical side of the response. It connects those affected with those willing to help and can make sure that resources are aligned to the most important needs.

Public Health Informatics in Action in Malawi: Making life easier for healthcare workers and patients while improving quality through an innovative national Electronic Medical Record System

Categories: HIV/AIDS, child health, global health security, women's/maternal health

Instituting an Electronic Medical Record System reduces the need to manage and store growing volumes of patient charts, a major challenge in resource-limited settings.

Instituting an Electronic Medical Record System reduces the need to manage and store growing volumes of patient charts, a major challenge in resource-limited settings.

Denise Giles, M.P.H., Health Scientist, CDC-Malawi

Denise Giles, M.P.H., Health Scientist, CDC-Malawi

Keeping track of even one patient undergoing treatment for HIV/AIDS can be complicated enough.

Doing it for over 472,865 patients when you’re a low income country coping with high demand and a sputtering economy magnifies the complexity.

Which is why Malawi’s story – and its solution – is attracting attention and praise. It’s a story of how Electronic Medical Record System (EMRS) technology is being used and the foresight needed to bring it to reality.

You don’t have to look far to see the positive results.

FETP Work in South Sudan Benefits the Whole World

Categories: global health security, health systems strengthening

I’ve been with the Field Epidemiology Training Program (FETP) for 2.5 years now, where I am currently the resident advisor (RA) in South Sudan. My epidemiology training has provided me with the opportunity to gain a wide variety of experiences; prior to joining FETP, I served as an epidemiologist with Médecins Sans Frontières-Switzerland (MSF-CH), working in the refugee camp in Dadaab, Kenya, and have also worked in Dawei (Tavoy), Burma . I am glad to be able to pass on my knowledge about epidemiology to future leaders in the field. As an RA I assist with basic FETP implementation for county and state surveillance officers as well as immunization managers and supervisors. I also advise on outbreak response for priority diseases as well as assist with cascade training for the health facility staff who provide immunization services.

Helsinki, Finland – The Next Step in Accelerating Global Health Security

Categories: global health security

The Global Health Security Agenda Commitment Development meeting is being hosted by Finland, May 5-6, 2014 at Finlandia Hall in Helsinki.

The Global Health Security Agenda Commitment Development meeting is being hosted by Finland, May 5-6, 2014 at Finlandia Hall in Helsinki.

When senior leaders from more than 30 countries and 4 international organizations converge on Helsinki on May 5th for two days of intensive discussion, the over-arching topic will be one that is closely associated with Finland’s capital city – security.

CAPT (USPHS) Eric Kasowski, DVM, MD, MPH – Chief, CDC Global Health Security Branch

CAPT (USPHS) Eric Kasowski, DVM, MD, MPH – Chief, CDC Global Health Security Branch

But this time, unlike 1975 when Helsinki hosted the Conference on Security and Cooperation in Europe, or 1990 when President George Bush met President Mikhail Gorbachev met in the same city for a path-breaking U.S. – Soviet summit, the leaders arriving in Helsinki will be working on a new aspect of security, one that will better protect the world from infectious disease threats.

The Helsinki meeting is the next major step in a historic partnership unveiled Feb. 13 in Washington, D.C., called the Global Health Security (GHS) Agenda. This effort is aimed at improving our ability worldwide to prevent, detect and respond to infectious disease outbreaks at a time when diseases of all types can travel greater distances in less time than ever before and potentially threaten a larger number of people no matter where they live.

DPDx: 15 Years of Strengthening Laboratory Capacity for Parasitic Disease Diagnosis

Categories: global health security, parasitic diseases

 

CDC’s DPDx helps labs around the world identify parasites like Taenia saginata. (Photo courtesy of David Snyder/CDC Foundation)

CDC’s DPDx helps labs around the world identify parasites like Taenia saginata. (Photo courtesy of David Snyder/CDC Foundation)

The inquiries and images come from almost every state in the United States, and often with a sense of urgency. Still others arrive from Argentina and Germany, Italy, Japan, China, New Zealand, India—and dozens more countries around the globe. Each time the question for CDC’s parasite identification laboratory, known as DPDx, is the same: What is it?

Alexandre J. da Silva, PhD, CDC DPDx

Alexandre J. da Silva, PhD, CDC DPDx

The diagnostic parasitology experts on CDC’s Division of Parasitic Diseases and Malaria’s DPDx team provide answers.

DPDx is the effective merger of technology, laboratory science, and CDC’s unparalleled expertise in parasite identification and the diseases they cause.

DPDx is a unique online educational resource that includes visual depictions of parasite lifecycles, a reference library of free images of parasites, and guidance on proper laboratory techniques for diagnostic parasitology. But it is much more than a Web site.

The primary role of DPDx is reference diagnosis, wherein CDC laboratory scientists confirm diagnoses or discover that the diagnosis is something altogether different from what was originally thought. In both cases, but especially in the latter cases, DPDx impacts treatment. For example, Babesia microti is one of the parasites that cause the tick-borne disease babesiosis; it can be misidentified as Plasmodium falciparum, which causes malaria. The two diseases require different treatments and on many occasions, the DPDx team has corrected a misdiagnosis, ensuring that the patient is appropriately treated.

Strengthening Global Health Security Protects Americans

Categories: HIV/AIDS, flu, global health security, infectious disease, malaria, parasitic diseases

 

This blog was originally posted on CNN.com on February 13, 2014.

 

The 5 Ways Diseases in Other Countries Can Kill You

The world is smaller and people are more mobile than at any time in history. This makes it easier than ever for what’s happening anywhere on the globe to harm Americans’ health. 
 
Here are five ways diseases in other countries pose a threat:

1) The flu could threaten millions. Even in a mild year for flu, in the United States alone, there are thousands of deaths, hundreds of thousands of hospitalizations, and billions of dollars in productivity losses.
 
In a pandemic, millions of people worldwide could be killed. H7N9 influenza, also known as bird flu, is spreading in China, though fortunately it has not mutated to become an infectious disease outbreak that could threaten the health of people around the world.

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

2) Antibiotic resistance is on the rise. Antibiotic resistance just might be the most urgent health threat facing us now.

The nightmare strain of bacteria known as CRE, carbapenem-resistant Enterobacteriaceae, arose abroad and was introduced to one state in the United States. Now it’s in at least 44 states. It can resist all or almost all antibiotics, kills many of the people who get it in their blood, and spreads its resistance capabilities to other bacteria.

The World Health Organization estimates multidrug-resistant tuberculosis already has infected a half a. million people across the globe.

Improving Disease Surveillance and Outbreak Response in the Latin American and Caribbean Region through the Field Epidemiology Training Program

Categories: global health security, health systems strengthening, infectious disease, noncommunicable diseases (NCDs)

 

FETP residents taking water sample to test for cholera (2013)

FETP residents taking water sample to test for cholera (2013)

Dr. Victor Caceres, CDC Field Epidemiology Training Program Branch

Dr. Victor Caceres, CDC Field Epidemiology Training Program Branch

With increased global travel, everyone is more vulnerable to emerging and reemerging public health threats. This vulnerability is why every country needs a team of highly trained epidemiologists that can detect and rapidly respond to outbreaks and is why CDC is committed to working with countries to establish and support Field Epidemiology Training Programs (FETPs) all over the world including the Latin American and Caribbean (LAC) region.

For the last three years, CDC has been working with the Dominican Republic’s Ministry of Health (MoH), in collaboration with the University of Puerto Rico, to strengthen basic and intermediate-level training capacity for epidemiologists and laboratory personnel as part of the three-tiered “pyramid” training model developed and implemented by countries in Central America. 

Fresh Voices From the Field: Building Partnerships for Global Health Security in Vietnam

Categories: flu, global health security

Lauren Anderson (right) and Wayne Lowe (Department of Defense/Defense Threat Reduction Agency) are behind the scenes observing emergency response activities during a joint project exercise involving the U.S. CDC and Vietnam’s Ministry of Health.

Lauren Anderson (right) and Wayne Lowe (Department of Defense/Defense Threat Reduction Agency) are behind the scenes observing emergency response activities during a joint project exercise involving the U.S. CDC and Vietnam’s Ministry of Health.

This is the sixth in our ongoing “Fresh Voices From the Field” series, where we hear from ASPPH (Association of School and Programs of Public Health) Global Health Fellows working throughout the world. Global Health Fellows are recent Master of Public Health or Doctoral graduates placed in CDC global health offices in Atlanta and abroad. They work on a range of priority public health issues and bring a fresh perspective to CDC’s efforts in the field. (See other “Fresh Voices” blogs.) 

  

Lauren Anderson, ASPPH Program Management Fellow

Lauren Anderson, ASPPH Program Management Fellow

As part of a joint project exercise, the U.S. CDC and Vietnam’s Ministry of Health pretended there were suspect cases of avian influenza A (H7N9) and coronaviruses that surfaced in Vietnam. Then CDC and Vietnamese experts convened to observe Vietnam’s public health machinery spring to life. 

Calls were made; emails were sent; samples were collected and laboratories began testing. The Ministry of Health was notified of the pending emergency. They performed several different types of analyses, compared the results to seasonal trends, and practiced reporting out to decision-making bodies. A strategically organized effort to contain and prevent additional cases was in full swing. 

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.

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