Bioterrorism

History shows us that individuals have used and likely will continue to use biological agents for terrorism purposes. Bioterrorism agents can be easily disseminated, cause severe disease and high mortality rates if cases are not treated properly, and pose significant challenges for management and response. A robust public health surveillance system that includes laboratory (including routine reportable disease surveillance), syndromic, and environmental surveillance is crucial for detection of the release of a bioterrorism agent and the resulting cases. This detection can then set into motion a robust and comprehensive public health response to minimize morbidity and mortality. A large-scale bioterrorism event would be unprecedented, straining and challenging every facet of medical and public health response and would quickly become a global emergency because of both the potential risk of infection and the shock to the global economy. A robust public health and medical workforce is necessary to respond effectively and efficiently to these types of events.

Steps in Developing a Public Health Surveillance System for Fathers

Including the voice of the father in research related to fathering is essential. This chapter describes efforts to establish a new public health surveillance for fathers in the United States. The ultimate goal of this research is to study fatherhood to support healthy child development by collecting valuable information on father health and experiences in the perinatal period. Understanding fathers is key to learning about and improving family health, since fathers impact mothers and babies’ health. Studying the health of fathers during the transition to fatherhood can also provide a window into the overall health status of men, expanding the field of public health to include more specifics on the health of fathers and their impact on families. Currently surveillance systems are lacking in including the fathers’ perspective in measurement of paternal health and the transition to fatherhood. To address these issues we utilized a multi-pronged approach to inform development of a public health surveillance system for fathers: (1) review of the current literature to identify gaps in knowledge on the role of fatherhood in male and family health and identify current national-level surveillance data on fathers; (2) assessed feasibility of identifying participants to implement a surveillance system for fathers; (3) conducted formative research to develop methodology; and (4) piloted a public health surveillance system called the Pregnancy Risk Assessment Monitoring System for Dads or “PRAMS for Dads.”

Spatial and Temporal Variability of Visceral Leishmaniasis in Colombia, 2007 to 2018

Visceral leishmaniasis (VL) is a neglected tropical disease associated with poverty and is endemic in 56 countries worldwide. Brazil, Venezuela, and Colombia are the most affected countries in South America. In Colombia, the National Public Health Surveillance System (SIVIGILA) consolidates epidemiological information and monitors all VL cases nationwide. However, to date, no studies have investigated the occurrence of VL in Colombia using metadata analysis. We studied the demographic data, the spatial and temporal distribution of VL cases, and the association with vector distribution of Leishmania species in Colombia from 2007 to 2018. We found 306 VL cases reported to SIVIGILA for this period, with a coverage of 25.5 cases/year, and a mortality of 2.28% (seven deaths). The highest number of confirmed cases (N = 52) occurred in 2007; the lowest (N = 9) occurred in 2012. The cases were reported mainly in children (< 7 years) affiliated with the subsidized health regimen. Regarding the geographic distribution, the cases were reported by 42 municipalities distributed in 10 departments. The occurrence of VL cases toward the northeast of Colombia, and the distribution of vectors, such as Lutzomyia longipalpis and Lu. evansi, may be changing the panorama of VL in the country. We conclude that VL, mainly in recent years, shows a temporal and spatial variability associated with the occurrence of cases in new settings. Our findings increase our understanding and knowledge of this disease, and suggest the need to monitor and prioritize areas with changes in geographic expansion to improve prevention and control actions in the country.

Structural Transphobia, Homophobia, and Biphobia in Public Health Practice: The Example of COVID-19 Surveillance

Public health surveillance can have profound impacts on the health of populations, with COVID-19 surveillance offering an illuminating example. Surveillance surrounding COVID-19 testing, confirmed cases, and deaths has provided essential information to public health professionals about how to minimize morbidity and mortality. In the United States, surveillance has also pointed out how populations, on the basis of geography, age, and race and ethnicity, are being impacted disproportionately, allowing targeted intervention and evaluation. However, COVID-19 surveillance has also highlighted how the public health surveillance system fails some communities, including sexual and gender minorities. This failure has come about because of the haphazard and disorganized way disease reporting data are collected, analyzed, and reported in the United States, and the structural homophobia, transphobia, and biphobia acting within these systems. We provide recommendations for addressing these concerns after examining experiences collecting race data in COVID-19 surveillance and attempts in Pennsylvania and California to incorporate sexual orientation and gender identity variables into their pandemic surveillance efforts. (Am J Public Health. Published online ahead of print June 10, 2021: e1–e7. https://doi.org/10.2105/AJPH.2021.3062727 )

Evaluation of Rotavirus Surveillance System, Yemen 2018: Surveillance Evaluation (Preprint)

BACKGROUND Rotavirus kills over 185,000 children under 5 every year and responsible for over one-third of all child diarrheal deaths worldwide. The Rotavirus Surveillance System (RVSS) in Yemen was launched in 2007 in five sentinel sites to monitor the impact of vaccine on rotavirus morbidity and mortality. OBJECTIVE This study aimed to determine the level of usefulness of the RVSS, assess its performance, and identify the strengths and weaknesses of the surveillance system implementation. METHODS The Centers for Disease Control and Prevention (CDC) updated guidelines on evaluation of a public health surveillance system was used to evaluate RVSS. In this assessment, qualitative indicators of usefulness and other attributes of the system including flexibility, stability, simplicity and acceptability were assessed through in-depth interviews with the stakeholders at central level and semi-structured questionnaires with sentinel sites coordinators. Furthermore, indicators for quantitative attributes including sensitivity, Positive Predictive Value (PPV), completeness and timeliness were assessed through reviewing results of laboratory samples and a random sample of case report forms. Scores for the indicators were expressed as following: poor: <60%, average: 60 - <80%, and good: ≥ 80%. RESULTS The overall usefulness score percent of the RVSS was 73%, which indicates an average rank. The RVSS was rated as good on flexibility (score percent = 91%) and stability (score percent = 81%) attributes and was rated as an average on simplicity (score percent = 77%) and acceptability (score percent = 76%) attributes. Regarding the quantitative attributes, the system was rated as poor for sensitivity (score percent = 91%), average for PPV (score percent = 73%) and good for completeness and timeliness (score percent = 100%). CONCLUSIONS The overall RVSS performance was an average. Although the system attributes demonstrated a good flexibility, stability, data quality and timeliness, some attributes still need enhancements. The system was rated “average” on the usefulness, simplicity, and acceptability and poor for the sensitivity. To ensure sustainability, there is a need for planning gradual replacement of donor’s fund with government’s funds. Gradual scaling up of the RVSS through increasing the number of sites and governorates, and enhancement of the sensitivity of the RVSS are strongly recommended.

Public Health Surveillance System

To guard people against some grave infectious disease, the surveillance system is a key performance measure of global public health threats and vulnerability. The diseases surveillance system helps in public health monitor, control, and prevent infectious diseases. Infectious diseases remain major causes of death. It's important to monitor and surveillance worldwide for developing a framework for risk assessment and health regulation. Surveillance systems help us in understanding the factors driving infectious disease and developing new technological aptitudes with modeling, pathogen determination, characterization, diagnostics, and communications. This chapter discussed surveillance system working, progress toward global public healthy society considering perspectives for the future and improvement of infectious disease surveillance without limited and fragmented capabilities, and making even global coverage.

Changes to the sample design and weighting methods of a public health surveillance system to also include persons not receiving HIV medical care

Objectives The Medical Monitoring Project (MMP) is a public health surveillance system that provides representative estimates of the experiences and behaviors of adults with diagnosed HIV in the United States. In 2015, the sample design and frame of MMP changed from a system that only included HIV patients to one that captures the experiences of persons receiving and not receiving HIV care. We describe methods investigated for calculating survey weights, the approach chosen, and the benefits of using a dynamic surveillance registry as a sampling frame. Methods MMP samples adults with diagnosed HIV from the National HIV Surveillance System, the HIV case surveillance registry for the United States. In the methodological study presented in this manuscript, we compared methods that account for sample design and nonresponse, including weighting class adjustment vs. propensity weighting and a single-stage nonresponse adjustment vs. sequential adjustments for noncontact and nonresponse. We investigated how best to adjust for non-coverage using surveillance data to post-stratify estimates. Results After assessing these methods, we chose as our preferred procedure weighting class adjustments and a single-stage nonresponse adjustment. Classes were constructed using variables associated with respondents’ characteristics and important survey outcomes, chief among them laboratory results available from surveillance that served as a proxy for medical care. Conclusions MMPs weighting procedures reduced sample bias by leveraging auxiliary information on medical care available from the surveillance registry sampling frame. Expanding MMPs population of focus provides important information on characteristics of persons with diagnosed HIV that complement the information provided by the surveillance registry. MMP methods can be applied to other disease registries or population-monitoring systems when more detailed information is needed for a population, with the detailed information obtained efficiently from a representative sample of the population covered by the registry.