BackgroundTrachoma is the leading infectious cause of blindness globally. The WHO has recommended the SAFE (Surgery, Antibiotics, Facial cleanliness and Environmental improvements) strategy to eliminate trachoma as a public health problem. The F and E arms of the strategy will likely be important for sustained disease reductions, yet more evidence is needed detailing relationships between hygiene, sanitation and trachoma in areas with differing endemicity. This study addressed whether the regional differences in water, sanitation, and hygiene (WASH) variables were associated with the spatial distribution of trachomatous inflammation-follicular (TF) among children aged 1 to 9 years in the Amhara National Regional State of Ethiopia.MethodsData from 152 multi-stage cluster random trachoma surveys were used to understand the degree of clustering of trachoma on two spatial scales (district and village) in Amhara using a geographical information system and the Getis-Ord Gi* (d) statistic for local clustering. Trained and certified graders examined children for the clinical signs of trachoma using the WHO simplified system. Socio-demographic, community, and geoclimatic factors thought to promote the clustering of the disease were included as covariates in a logistic regression model.ResultsThe mean district prevalence of TF among children aged 1 to 9 years in Amhara was 25.1% (standard deviation = 16.2%). The spatial distribution of TF was found to exhibit global spatial dependency with neighboring evaluation units at both district and village level. Specific clusters of high TF were identified at both the district and the village scale of analysis using weighted estimates of the prevalence of the disease. Increased prevalence of children without nasal and ocular discharge as well as increased prevalence of households with access to a water source within 30 minutes were statistically significantly negatively associated with clusters of high TF prevalence.ConclusionsWater access and facial cleanliness were important factors in the clustering of trachoma within this hyperendemic region. Intensified promotion of structural and behavioral interventions to increase WASH coverage may be necessary to eliminate trachoma as a public health problem in Amhara and perhaps other hyper-endemic settings.
BackgroundInformation from historical infectious disease outbreaks provides real-world data about outbreaks and their impacts on affected populations. These data can be used to develop a picture of an unfolding outbreak in its early stages, when incoming information is sparse and isolated, to identify effective control measures and guide their implementation.ObjectiveThis study aimed to develop a publicly accessible Web-based visual analytic called Analytics for the Investigation of Disease Outbreaks (AIDO) that uses historical disease outbreak information for decision support and situational awareness of an unfolding outbreak.MethodsWe developed an algorithm to allow the matching of unfolding outbreak data to a representative library of historical outbreaks. This process provides epidemiological clues that facilitate a user’s understanding of an unfolding outbreak and facilitates informed decisions about mitigation actions. Disease-specific properties to build a complete picture of the unfolding event were identified through a data-driven approach. A method of analogs approach was used to develop a short-term forecasting feature in the analytic. The 4 major steps involved in developing this tool were (1) collection of historic outbreak data and preparation of the representative library, (2) development of AIDO algorithms, (3) development of user interface and associated visuals, and (4) verification and validation.ResultsThe tool currently includes representative historical outbreaks for 39 infectious diseases with over 600 diverse outbreaks. We identified 27 different properties categorized into 3 broad domains (population, location, and disease) that were used to evaluate outbreaks across all diseases for their effect on case count and duration of an outbreak. Statistical analyses revealed disease-specific properties from this set that were included in the disease-specific similarity algorithm. Although there were some similarities across diseases, we found that statistically important properties tend to vary, even between similar diseases. This may be because of our emphasis on including diverse representative outbreak presentations in our libraries. AIDO algorithm evaluations (similarity algorithm and short-term forecasting) were conducted using 4 case studies and we have shown details for the Q fever outbreak in Bilbao, Spain (2014), using data from the early stages of the outbreak. Using data from only the initial 2 weeks, AIDO identified historical outbreaks that were very similar in terms of their epidemiological picture (case count, duration, source of exposure, and urban setting). The short-term forecasting algorithm accurately predicted case count and duration for the unfolding outbreak.ConclusionsAIDO is a decision support tool that facilitates increased situational awareness during an unfolding outbreak and enables informed decisions on mitigation strategies. AIDO analytics are available to epidemiologists across the globe with access to internet, at no cost. In this study, we presented a new approac...
Background Currently, the identification of infectious disease re-emergence is performed without describing specific quantitative criteria that can be used to identify re-emergence events consistently. This practice may lead to ineffective mitigation. In addition, identification of factors contributing to local disease re-emergence and assessment of global disease re-emergence require access to data about disease incidence and a large number of factors at the local level for the entire world. This paper presents Re-emerging Disease Alert (RED Alert), a web-based tool designed to help public health officials detect and understand infectious disease re-emergence. Objective Our objective is to bring together a variety of disease-related data and analytics needed to help public health analysts answer the following 3 primary questions for detecting and understanding disease re-emergence: Is there a potential disease re-emergence at the local (country) level? What are the potential contributing factors for this re-emergence? Is there a potential for global re-emergence? Methods We collected and cleaned disease-related data (eg, case counts, vaccination rates, and indicators related to disease transmission) from several data sources including the World Health Organization (WHO), Pan American Health Organization (PAHO), World Bank, and Gideon. We combined these data with machine learning and visual analytics into a tool called RED Alert to detect re-emergence for the following 4 diseases: measles, cholera, dengue, and yellow fever. We evaluated the performance of the machine learning models for re-emergence detection and reviewed the output of the tool through a number of case studies. Results Our supervised learning models were able to identify 82%-90% of the local re-emergence events, although with 18%-31% (except 46% for dengue) false positives. This is consistent with our goal of identifying all possible re-emergences while allowing some false positives. The review of the web-based tool through case studies showed that local re-emergence detection was possible and that the tool provided actionable information about potential factors contributing to the local disease re-emergence and trends in global disease re-emergence. Conclusions To the best of our knowledge, this is the first tool that focuses specifically on disease re-emergence and addresses the important challenges mentioned above.
ObjectiveThe application of spatial analysis to improve the awareness and use of surveillance data.IntroductionThe re-emergence of an infectious disease is dependent on social, political, behavioral, and disease-specific factors. Global disease surveillance is a requisite of early detection that facilitates coordinated interventions to these events. Novel informatics tools developed from publicly available data are constantly evolving with the incorporation of new data streams. Re-emerging Infectious Disease (RED) Alert is an open-source tool designed to help analysts develop a contextual framework when planning for future events, given what has occurred in the past. Geospatial methods assist researchers in making informed decisions by incorporating the power of place to better explain the relationships between variables.MethodsDisease incidence and indicator data derived for the RED Alert project were analyzed for spatial associations. Using aggregate country-level data, spatial and spatiotemporal clusters were identified in ArcMap 10.5.1. The identified clusters were then used as the outcome for a series of binary logistic regression models to determine significant covariates that help explain global hotspots. These methods will continue to evolve and be incorporated into the RED Alert decision support ecosystem to provide analysts with a global perspective on potential re-emergence.ResultsHotspots of high disease incidence in relation to neighboring countries were identified for measles, cholera, dengue, and yellow fever between 2000 and 2014. Disease-specific predictors were identified using aggregate estimates from World Bank indicator dataset. Data was imputed where possible to enhance the validity of the Gi * statistic for clustering. In the future, as data streams become more readily available, hotspot modeling at a finer resolution will help to improve the precision of spatial epidemiology.ConclusionsSpatial methods enhance the capability of understanding complex population and disease relationships, which in turn improves surveillance and the ability to predict re-emergence. With tools like RED Alert, public health analysts can better prepare to respond rapidly to future re-emerging disease threats.
Objective: Analytics for the Investigation of Disease Outbreaks (AIDO) is a web-based tool designed to enhance a user’s understanding of unfolding infectious disease events. A representative library of over 650 outbreaks across a wide selection of diseases allows similar outbreaks to be matched to the conditions entered by the user. These historic outbreaks contain detailed information on how the disease progressed as well as what measures were implemented to control its spread, allowing for a better understanding within the context of other outbreaks.Introduction: Situational awareness, or the understanding of elemental components of an event with respect to both time and space, is critical for public health decision-makers during an infectious disease outbreak. AIDO is a web-based tool designed to contextualize incoming infectious disease information during an unfolding event for decision-making purposes.Methods: Public health analysts of the Biology Division at Los Alamos National Laboratory curated a diverse library of historic disease outbreaks from publicly available official reports and peer reviewed literature to serve as a representation of the range of potential outbreak scenarios for a given disease. Available outbreak metadata are used to identify properties that relate to the magnitude and/or duration of the outbreak. Properties vary by disease, as they are related to disease-specific characteristics like transmission, disease manifestation, risk factors related to disease severity, and environmental factors specific to the given location. These properties are then incorporated into a similarity algorithm (s in Figure 1) to identify outbreaks that are similar to user inputs.Results: AIDO currently includes libraries for 39 diseases that are diverse across pathogen type (viral, bacterial and parasitic) as well as transmission type (vectorborne (e.g., Dengue, Malaria), foodborne (e.g., Salmonella, Campylobacteriosis), waterborne (e.g., Cholera), and person-to-person transmitted (e.g., Measles)). In addition to providing a similarity score to the user’s outbreak, we provide aggregated comparisons to multiple historical outbreaks, descriptive statistics to show the distribution of property values for each disease, and extensive contextual information about each outbreak.Conclusions: The analytics provided by AIDO allow users to interact with a unique data set of historic outbreaks and the associated metadata to contextualize incoming information and generate hypotheses about appropriate decisions. The tool is continually updated with new functionalities and additional data.
BACKGROUND Information from historical infectious disease outbreaks provides real-world data about outbreaks and their impacts on affected populations. These data can be used to develop a picture of an unfolding outbreak in its early stages, when incoming information is sparse and isolated, to identify effective control measures and guide their implementation. OBJECTIVE This study aimed to develop a publicly accessible Web-based visual analytic called Analytics for the Investigation of Disease Outbreaks (AIDO) that uses historical disease outbreak information for decision support and situational awareness of an unfolding outbreak. METHODS We developed an algorithm to allow the matching of unfolding outbreak data to a representative library of historical outbreaks. This process provides epidemiological clues that facilitate a user’s understanding of an unfolding outbreak and facilitates informed decisions about mitigation actions. Disease-specific properties to build a complete picture of the unfolding event were identified through a data-driven approach. A method of analogs approach was used to develop a short-term forecasting feature in the analytic. The 4 major steps involved in developing this tool were (1) collection of historic outbreak data and preparation of the representative library, (2) development of AIDO algorithms, (3) development of user interface and associated visuals, and (4) verification and validation. RESULTS The tool currently includes representative historical outbreaks for 39 infectious diseases with over 600 diverse outbreaks. We identified 27 different properties categorized into 3 broad domains (population, location, and disease) that were used to evaluate outbreaks across all diseases for their effect on case count and duration of an outbreak. Statistical analyses revealed disease-specific properties from this set that were included in the disease-specific similarity algorithm. Although there were some similarities across diseases, we found that statistically important properties tend to vary, even between similar diseases. This may be because of our emphasis on including diverse representative outbreak presentations in our libraries. AIDO algorithm evaluations (similarity algorithm and short-term forecasting) were conducted using 4 case studies and we have shown details for the Q fever outbreak in Bilbao, Spain (2014), using data from the early stages of the outbreak. Using data from only the initial 2 weeks, AIDO identified historical outbreaks that were very similar in terms of their epidemiological picture (case count, duration, source of exposure, and urban setting). The short-term forecasting algorithm accurately predicted case count and duration for the unfolding outbreak. CONCLUSIONS AIDO is a decision support tool that facilitates increased situational awareness during an unfolding outbreak and enables informed decisions on mitigation strategies. AIDO analytics are available to epidemiologists across the globe with access to internet, at no cost. In this study, we presented a new approach to applying historical outbreak data to provide actionable information during the early stages of an unfolding infectious disease outbreak.
Objective: Although relying on verbal definitions of "re-emergence", descriptions that classify a “re-emergence” event as any significant recurrence of a disease that had previously been under public health control, and subjective interpretations of these events is currently the conventional practice, this has the potential to hinder effective public health responses. Defining re-emergence in this manner offers limited ability for ad hoc analysis of prevention and control measures and facilitates non-reproducible assessments of public health events of potentially high consequence. Re-emerging infectious disease alert (RED Alert) is a decision-support tool designed to address this issue by enhancing situational awareness by providing spatiotemporal context through disease incidence pattern analysis following an event that may represent a local (country-level) re-emergence. The tool’s analytics also provide users with the associated causes (socioeconomic indicators) related to the event, and guide hypothesis-generation regarding the global scenario.Introduction: Definitions of “re-emerging infectious diseases” typically encompass any disease occurrence that was a historic public health threat, declined dramatically, and has since presented itself again as a significant health problem. Examples include antimicrobial resistance leading to resurgence of tuberculosis, or measles re-appearing in previously protected communities. While the language of this verbal definition of “re-emergence” is sensitive enough to capture most epidemiologically relevant resurgences, its qualitative nature obfuscates the ability to quantitatively classify disease re-emergence events as such.Methods: Our tool automatically computes historic disease incidence and performs trend analyses to help elucidate events which a user may considered a true re-emergence in a subset of pertinent infectious diseases (measles, cholera, yellow fever, and dengue). The tool outputs data visualizations that illustrate incidence trends in diverse and informative ways. Additionally, we categorize location and incidence-specific indicators for re-emergence to provide users with associated indicators as well as justifications and documentation to guide users’ next steps. Additionally, the tool also houses interactive maps to facilitate global hypothesis-generation.Results: These outputs provide historic trend pattern analyses as well as contextualization of the user’s situation with similar locations. The tool also broadens users' understanding of the given situation by providing related indicators of the likely re-emergence, as well as the ability to investigate re-emergence factors of global relevance through spatial analysis and data visualization.Conclusions: The inability to categorically name a re-emergence event as such is due to lack of standardization and/or availability of reproducible, data-based evidence, and hinders timely and effective public health response and planning. While the tool will not explicitly call out a user scenario as categorically re-emergent or not, by providing users with context in both time and space, RED Alert aims to empower users with data and analytics in order to substantially enhance their contextual awareness; thus, better enabling them to formulate plans of action regarding re-emerging infectious disease threats at both the country and global level.
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