Four steps to precision public health

Abstract

A mother and her child at a hospital in South Sudan, one country where precise public-health data are lacking.© 2 0 1 6 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .

Precision Surveillance for Viral Respiratory Pathogens: Virome Capture Sequencing for the Detection and Genomic Characterization of Severe Acute Respiratory Infection in Uganda

“…In sub-Saharan Africa, a region accounting for nearly half of global mortality from acute respiratory infections, public health programs have historically relied on data collected from population-based and sentinel surveillance systems [5][6][7][8]. For syndromic SARI surveillance, such programs accumulate incidence data from multiple sources across a catchment area, after which they use a variety of nonstatistical methods to detect a public health signal of concern.…”

“…For syndromic SARI surveillance, such programs accumulate incidence data from multiple sources across a catchment area, after which they use a variety of nonstatistical methods to detect a public health signal of concern. These signal detection methods, challenged by difficulties adjusting for natural temporal and geographical variation and adequate population-at-risk data, are limited by poor specificity and imprecise spatiotemporal resolution [5][6][7][8]. Following signal detection, molecular diagnostics such as agent-specific or multiplexed polymerase chain reaction (PCR) may be employed, but these are restricted by limited numbers of target sequences and lack genomic characterization and depth needed to understand complex transmission dynamics.…”

“…Precision surveillance applies spatiotemporal analytics to routinely collected surveillance data to identify loci with increased risk of disease (ie, SARI) incidence, and combines this data with genomic sequencing to provide sensitive detection and high-resolution characterization of circulating pathogens [8][9][10][11]. This approach could allow for rapid detection and characterization of epidemic-prone respiratory viruses prior to large-scale emergence, identification of populations at risk for severe outcomes, and targeted investment of public health resources (ie, vaccination) among heavily affected subpopulations [8][9][10][11].…”

Toward precision public health

“…Insights and discoveries from robust data sources can be used to target policies and programs. This may more effectively allocate public health resources to address and reduce health disparities .…”

US Centers for Disease Control and Prevention and Its Partners’ Contributions to Global Health Security

“…Ten countries have expanded surveillance systems to include more vaccine-preventable diseases (VPDs), which should strengthen national vaccine delivery systems, including the capacity for emergency vaccination to mitigate an outbreak. For example, community-level monitoring can accelerate targeted immunization, halving the number of vaccine-preventable meningococcal disease cases in West Africa outbreaks ( 29 , 30 ). …”