Global capacity for emerging infectious disease detection

Author (s): 

Emily H. Chana,b, Timothy F. Brewerc,d, Lawrence C. Madoffc,e, Marjorie P. Pollackc, Amy L. Sonrickera,b,

Mikaela Kellera,b,f, Clark C. Freifelda,b, Michael Blenchg, Abla Mawudekug, and John S. Brownsteina,b,d,f,1

aHealthMap, Children’s Hospital Informatics Program, Harvard–Massachusetts Institute of Technology Division of Health Sciences and Technology, Boston,

MA 02215; bDivision of Emergency Medicine, Children’s Hospital Boston, Boston, MA 02215; cProMED-mail, International Society for Infectious Diseases,

Brookline, MA 02446; dDepartments of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada H3A 1A2;

eDepartment of Medicine, University of Massachusetts Medical School, Worcester, MA 01655; fDepartment of Pediatrics, Harvard Medical School, Boston, MA

02215; and gGlobal Public Health Intelligence Network, Health Portfolio Operations Centre, Centre for Emergency Preparedness and Response, Public Health

Agency of Canada, Ottawa, ON, Canada K0A 0K9

The increasing number of emerging infectious disease events that have spread internationally, such as severe acute respiratory syndrome (SARS) and the 2009 pandemic A/H1N1, highlight the need for improvements in global outbreak surveillance. It is expected that the proliferation of Internet-based reports has resulted in greater communication and improved surveillance and reporting frameworks, especially with the revision of the World Health Organization’s (WHO) International Health Regulations (IHR 2005), which went into force in 2007. However, there has been no global quantitative assessment of whether and how outbreak detection and communication processes have actually changed over time. In this study, we analyzed the entire WHO public record of Disease Outbreak News reports from 1996 to 2009 to characterize spatial-temporal trends in the timeliness of outbreak discovery and public communication about the outbreak relative to the estimated outbreak start date. Cox proportional hazards regression analyses show that overall, the timeliness of outbreak discovery improved by 7.3% [hazard ratio (HR) = 1.073, 95% CI (1.038; 1.110)] per year, and public communication improved by 6.2% [HR = 1.062, 95% CI (1.028; 1.096)] per year. However, the degree of improvement varied by geographic region; the only WHO region with statistically significant (α = 0.05) improvement in outbreak discovery was the Western Pacific region [HR = 1.102 per year, 95% CI (1.008; 1.205)], whereas the Eastern Mediterranean [HR = 1.201 per year, 95% CI (1.066; 1.353)] and Western Pacific regions [HR = 1.119 per year, 95% CI (1.025; 1.221)] showed improvement in public communication. These findings provide quantitative historical assessment of timeliness in infectious disease detection and public reporting of outbreaks.


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