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

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 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.

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 Paulo 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 Paulo 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.

Ilanit 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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