Public Health Lessons for Non-Vaccine Influenza Interventions Looking Past COVID-19 (2022) / Chapter Skim
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2 Surveillance
2 Surveillance
Pages 19-54
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For example, the Global Health Security Index (GHSI) draws on open-source informa 19
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have been used for evaluating a country's ability to prevent, detect, and respond to infectious diseases and outbreaks. Countries ranked higher in terms of preparedness according to GHSI, JEEs, and other indicators would be expected to respond more effectively to an actual pandemic event; however, that was not the case for COVID-19.
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Syndromic Surveillance for Infectious Diseases Over the past two decades, syndromic surveillance has been used as a strategy for detecting and monitoring public health events based on individual- or population-level indicators in advance of confirmed diagnoses of an emerging infectious disease. For example, data on symptoms or clinical diagnoses such as influenza-like illness (ILI)
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: Since 1952, the GISRS has protected people from seasonal, pandemic, and zoonotic influenza through collaboration and virus and data sharing. The system serves as a global platform for monitoring influenza epidemiology, an alert system for novel influenza viruses and other respiratory pathogens of concern, and a mechanism for influenza surveillance, preparedness, and response.
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One Health approaches are particularly relevant to emerging infectious diseases, of which greater than 60 percent are zoonotic, and to diseases that have a strong link to environmental conditions (e.g., water- and vector-borne diseases)
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. It also developed a Strategic Framework for One Health Approach to Infectious Diseases in 2012, which was endorsed by the Ministry of Health with widespread support (IEDCR, 2012)
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More recently, the country has deployed a syndromic surveillance system in domestic and wild animals, using a mobile phone application for reporting and analysis, with hopes to improve real-time surveillance within the animal health sector. Stakeholders involved in this effort believe that "the adoption of the One Health program and approach in Kenya has led to rapid detection and control of zoonotic disease outbreaks at their source and thereby enhanced global health security" (Munyua et al., 2019)
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. Challenges to Achieving an Effective One Health Approach Many experts recognize the barriers to widespread, practical implementation of a One Health approach across contexts.
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To be optimally effective, One Health collaborative approaches should be truly international -- not just interagency -- and leverage the power of established regional and global health organizations. Expanded collaboration among national development agencies, such as the United States Agency for International Development, as well as multilateral organizations (e.g., WHO, Food and Agriculture Organization of the United Nations, World Organisation for Animal Health, United Nations Environment Programme, and World Bank and regional equivalents)
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. An analysis of the use of influenza surveillance networks to estimate U.S.-state-specific SARS-CoV-2 prevalence has suggested that during the early phases of the pandemic, greater than 80 percent of infections were undetected (Silverman et al., 2020)
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The consortium includes partners from the National Health Service, public health agencies, academic partners, lighthouse labs, and the Wellcome Sanger Institute. Individual- and Population-Level Testing At the individual level, COVID-19 testing strategies include quantitative PCR (qPCR)
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. Contact Tracing Contact tracing can contribute to not only curbing transmission of an infectious disease threat -- via identifying and isolating exposed contacts -- but also reducing case fatality rates through early detection and referral to care (Yalaman et al., 2021)
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. In summer 2020, as case numbers began to decline, many countries devoted more resources to increasing testing capacity than to building contact tracing capacity or ensuring that people who became infected could appropriately isolate (Loh, 2020)
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. CHALLENGES IN PUBLIC HEALTH SURVEILLANCE HIGHLIGHTED DURING THE COVID-19 PANDEMIC COVID-19 has revealed multiple limitations of current public health surveillance systems and tools, which were primarily designed for ongoing surveillance of known pandemics and seasonal influenza rather than for early detection and mitigation of respiratory pathogens with pandemic potential.
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. For example, using case fatality rates based on hospital fatality rates, which include only a small subset of individuals with the disease, has led to misunderstanding that alarmed the public and inaccurate comparisons of disease severity between COVID-19 and Ebola (Winters et al., 2020)
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Variability in Estimating Infectiousness and Fatality Rates Wide variability has been observed between country- and state-level COVID-19 infectiousness and fatality rates. For instance, a Bayesian modeling study -- which was designed to minimize ascertainment bias -- analyzed confirmed data on COVID-19 cases, deaths, and recoveries from U.S.
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. In contrast, an early analysis in Italy found crude case fatality rates of 10.6 percent nationwide and 18.3 percent in Lombardy, much higher than the rates estimated based on data from outbreaks in China and aboard the Diamond Princess cruise ship (1 percent)
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Reporting could also be strengthened by involving the communities -- training and providing tools to frontline public health workers and community workers in accurately detecting, reporting, and analyIng during routine public health surveillance for priority diseases; this can help to ensure timely, complete, and accurate data for decision making. Using a case study designed to train resident epidemiologists in BOX 2-5 Examples of Research Topics Regarding Transmission • Determining the mode of transmission of emerging new strains (e.g., airborne versus large droplets)
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. The COVID-19 pandemic and other epidemics of zoonotic origin of recent decades have underscored the need for One Health approaches to strengthen zoonotic surveillance efforts, detect viral strains with larger antigenic drifts, and develop better strategies to understand the degree of potential threat posed by emerging strains.
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. These findings suggest that SSA countries should leverage the convergence of public health, veterinary, and environmental government departments across African and global health organizations -- such as the One Health consortia and the Pan-African network PANDORA-ID-Net -- to implement a collaborative One Health approach to pandemic preparedness and response (Elton et al., 2021)
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However, a scoping review found that social media data were not leveraged for real-time surveillance to detect or predict cases during the COVID-19 pandemic as they have been for other infectious diseases, such as malaria and influenza (Tsao et al., 2021)
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. To augment traditional approaches, countries such as South Korea, China, and Singapore have implemented digital contact tracing strategies that are regarded as having contributed to successfully controlling spread (Lancet Digital Health, 2020)
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. Wastewater surveillance for infectious diseases holds great potential value for population-wide monitoring and enabling detection of early signals of transmission dynamics, particularly when testing capacity is limited or the time to reporting of diagnostic test results is lengthy or delayed (Peccia et al., 2020)
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. Similar sources of rapid epidemic intelligence include ProMED, Healthmap in the United States, the Global Public Health Intelligence Network (GPHIN)
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. CONCLUSIONS AND RECOMMENDATIONS Detection of Potential Threats Conclusion: COVID-19 has further emphasized the need to use the One Health approach to better target surveillance, including by build ing on currently existing platforms for influenza surveillance in wild birds, poultry, and livestock.
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Epidemiologists should be alert to potential ascertainment biases regarding sampling frames and other methodological pitfalls, account for such biases during analysis and interpretation of the data, notify authorities to take these biases into account, and seek support for im proving surveillance methods to better achieve representativeness and sufficient geographical coverage. Tracing the Arrival and Community Transmission of a Virus Conclusion: COVID-19 showed that countries and intergovernmen tal bodies need to bolster their surveillance capacities, especially the ability to look for the unexpected and unobserved and to sustain surveillance during disease surges.
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For example, disciplin ing local officials for reporting novel pathogens disincentivizes health surveillance. The first step in eliminating such barriers is to recognize their existence; such recognition can come from the parties involved or from observers.
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2020. The Global Health Security Index is not predictive of coronavirus pandemic responses among Organizations for Economic Cooperation and Development countries.
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2020. Global public health surveillance using media reports: Redesigning GPHIN.
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2017. De tecting, reporting, and analysis of priority diseases for routine public health surveillance in Liberia.
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2012. Strategic framework for One Health approach to infectious diseases in Bangladesh.
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2020. Implementing One Health approaches to confront emerging and re-emerging zoonotic disease threats: Lessons from PREDICT.
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https://www.nbcnewyork.com/news/local/our-9-11-moment-new-york-braces as-nations-top-doctor-warns-saddest-week-ahead/2361336 (accessed June 25, 2021)
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The Lancet Infectious Diseases 16(2)
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Emerging Infectious Diseases 14(6)
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2021. Cross-country evidence on the association between contact tracing and COVID-19 case fatality rates.
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