Public Health Informatics in Global Health Surveillance: A Review

Background: Surveillance is the backbone for effective public health practice. Traditionally, surveillance system relies on the collection of information regarding health-related events through healthcare facilities, disease notification system from the physician, syndromic notification networks, selected sentinel healthcare facilities, or by event-based data. However, there are several limitations in using conventional surveillance. Methods: With the advancement of technology and computer science, overcoming those limitations and complementing the traditional method has been recommended. Three leading emerging technologies are applied in public health surveillance: the internet of things, artificial intelligence, and blockchain. Results: Application of informatics in public health surveillance could raise several issues including accessibility and affordability of innovations; public health informatics’ experts, law, and regulation to protect patients’ information; social and ethical considerations, norms, and standards of implementing new technologies; data ownership; privacy and sharing of information; biosecurity; biosafety; and cybersecurity. Conclusion: This article aimed to review several applications of informatics system in public health surveillance practice and its several issues related to the use of technology. Several applications of informatics could be useful for incoming challenges in public health. However, application of informatics can pose significant issues and must be taken into consideration in public health practice.

Factors Associated with a Malaria Outbreak at Tongogara Refugee Camp in Chipinge District, Zimbabwe, 2021: A Case-Control Study

Background: Malaria is a leading cause of morbidity and mortality among forcibly displaced populations including refugees, approximately two-thirds of whom reside in malaria endemic regions. Data from the rapid disease notification system (RDNS) reports for Manicaland Province in Zimbabwe showed that despite implementation of malaria control initiatives, there was an increase in number of malaria cases above action thresholds at Tongogara Refugee Camp in Chipinge District during weeks 12-14. We investigated the malaria outbreak describing the outbreak by person, place and time, assessing malaria emergency preparedness and response and appropriateness of case management. We also determined the factors associated with contracting malaria to enable the formulation of appropriate interventions, establish control and prevent future malaria outbreaks among this vulnerable population.Methods: We conducted a 1:1 unmatched case control study involving 80 cases and 80 controls using interviewer-administered questionnaires at household level. Data was entered using Epi Data version 3.1 and analyzed using Epi InfoTM version 7.2.4 to generate medians, proportions, odds ratios and their 95% confidence intervals.Results: Malaria cases were distributed throughout the 10 residential sections within Tongogara Refugee Camp, the majority being from section 7, 28/80 (35%). Despite constituting 11% of the total population, Mozambican nationals accounted for 36/80 (45%) cases. Males constituted 47/80 (59%) among cases versus controls 43/80 (54%), p=0.524. Median age for cases was also lower compared to controls; 15 years [Interquartile range (IQR), 9-26] versus 17 years (IQR, 10-30). Several natural and manmade potential vector breeding sites were observed around the camp. Risk factors associated with contracting malaria were engaging in outdoor activities at night [AOR 4.26 (95% CI, 1.43-12.68)], wearing clothes that do not cover the whole body [AOR=2.74 (95% CI 1.04-7.22) while sleeping in a refugee housing unit reduced the risk of contracting malaria [AOR=0.18 (CI, 0.06-0.55)]. Conclusions: The malaria outbreak at Tongogara Refugee Camp reemphasizes the role of behavioral factors in malaria transmission. We recommend intensified health education to address human behaviors that expose residents to malaria and habitat modification with larviciding to eliminate mosquito breeding sites.

Effect of COVID-19 on vaccination coverage in Brazil

During the COVID-19 pandemic, recommendations for maintaining physical distance, restricted mobility measures, as well as fear of mass transmission by going to health centers have significantly contributed to the general vaccination coverage, which by and large is decreasing worldwide; thus, favoring the potential re-emergence of vaccine-preventable diseases. In this study, we have used the existing data on vaccination coverage during the pre-pandemic (2019) as well as the pandemic (2020) period to evaluate the impact of coronavirus outbreaks during the vaccination drive in Brazil. Furthermore, we have accumulated data since 2015 among the different regions of the country to acquire more consistent information. The various vaccines analyzed in our study were meningococcal C conjugate, Triple antigen vaccine, 10-valent pneumococcal conjugate, and BCG; subsequently, the data were obtained from the National Disease Notification System. This study revealed that the ongoing immunization drive saw a steep decline of around 10 to 20% during the (2019–2020) pandemic period in Brazil. These results provide strong evidence towards the decreasing trends following the vaccination programs during the COVID-19 pandemic period in Brazil. Furthermore, our results also highlight the importance of adopting widespread multi-component interventions to improve vaccination uptake rates.

Reliability of Wastewater Analysis for Monitoring COVID-19 Incidence Revealed by a Long-Term Follow-Up Study

Wastewater-based epidemiology has been used for monitoring human activities and waterborne pathogens. Although wastewaters can also be used for tracking SARS-CoV-2 at the population level, the reliability of this approach remains to be established, especially for early warning of outbreaks. We collected 377 samples from different treatment plants processing wastewaters of >1 million inhabitants in Valencia, Spain, between April 2020 and March 2021. Samples were cleaned, concentrated, and subjected to RT-qPCR to determine SARS-CoV-2 concentrations. These data were compared with cumulative disease notification rates over 7 and 14 day periods. We amplified SARS-CoV-2 RNA in 75% of the RT-qPCRs, with an estimated detection limit of 100 viral genome copies per liter (gc/L). SARS-CoV-2 RNA concentration correlated strongly with disease notification rates over 14-day periods (Pearson r = 0.962, P < 0.001). A concentration >1000 gc/L showed >95% sensitivity and specificity as an indicator of more than 25 new cases per 100,000 inhabitants. Albeit with slightly higher uncertainty, these figures were reproduced using a 7-day period. Time series were similar for wastewaters data and declared cases, but wastewater RNA concentrations exhibited transient peaks that were not observed in declared cases and preceded major outbreaks by several weeks. In conclusion, wastewater analysis provides a reliable tool for monitoring COVID-19, particularly at low incidence values, and is not biased by asymptomatic cases. Moreover, this approach might reveal previously unrecognized features of COVID-19 transmission.

Factors associated with a malaria outbreak at Tongogara Refugee Camp in Chipinge District, Zimbabwe, 2021: A case-control study

BackgroundMalaria is a leading cause of morbidity and mortality among forcibly displaced populations including refugees, approximately two-thirds of whom reside in malaria endemic regions. Data from the rapid disease notification system (RDNS) reports for Manicaland Province in Zimbabwe showed that despite implementation of malaria control initiatives, there was an increase in number of malaria cases above action thresholds at Tongogara Refugee Camp in Chipinge District during weeks 12-14. We investigated the malaria outbreak describing the outbreak by person, place and time, assessing malaria emergency preparedness and response and appropriateness of case management. We also determined the factors associated with contracting malaria to enable the formulation of appropriate interventions, establish control and prevent future malaria outbreaks among this vulnerable population.MethodsWe conducted a 1:1 unmatched case control study involving 80 cases and 80 controls using interviewer-administered questionnaires at household level. Data was entered using Epi Data version 3.1 and analyzed using Epi InfoTM version 7.2.4 to generate medians, proportions, odds ratios and their 95% confidence intervals.ResultsMalaria cases were distributed throughout the 10 residential sections within Tongogara Refugee Camp, the majority being from section 7, 28/80 (35%). Despite constituting 11% of the total population, Mozambican nationals accounted for 36/80 (45%) cases. Males constituted 47/80 (59%) among cases versus controls 43/80 (54%), p=0.524. Median age for cases was also lower compared to controls; 15 years [Interquartile range (IQR), 9-26] versus 17 years (IQR, 10-30). Several natural and manmade potential vector breeding sites were observed around the camp. Risk factors associated with contracting malaria were engaging in outdoor activities at night [AOR 4.26 (95% CI, 1.43-12.68)], wearing clothes that do not cover the whole body [AOR=2.74 (95% CI 1.04-7.22) while sleeping in a refugee housing unit reduced the risk of contracting malaria [AOR=0.18 (CI, 0.06-0.55)]. ConclusionsThe malaria outbreak at Tongogara Refugee Camp reemphasizes the role of behavioral factors in malaria transmission. We recommend intensified health education to address human behaviors that expose residents to malaria and habitat modification with larviciding to eliminate mosquito breeding sites.

Protecting privacy in mandatory reporting of infectious diseases during the COVID-19 pandemic: perspectives from a developing country

Mandatory reporting of infectious diseases (MRID) is an essential practice to prevent disease outbreaks. Disease notification is a mandatory procedure for most infectious diseases, even during non-pandemic periods in healthcare. The main rationale behind MRID is the protection of public health. The information and data provided by infectious disease reports are used for many purposes, such as preventing the spread and potential negative impact of infectious diseases, assessing the national and global situation regarding reported diseases, conducting scientific research and planning health policy. In this context, the relevant information benefits public health, health systems and scientific work. Additionally, the follow up and treatment of individuals with infectious diseases is a necessity in certain cases to protect those who cohabit with them. However, these benefits cannot be accepted as unrestricted justifications for MRID, since it is evident that reporting should be conducted within ethical and legal boundaries. MRID should only be devised and implemented with due regard to balancing potential benefits between all individuals, as well as between the individual and the rest of society. Disease notification systems that are not designed with a balancing and harm-reductionist approach may lead to stigmatisation and discrimination. This study aims to investigate the legal framework and ethical issues regarding the reporting of individuals diagnosed with COVID-19 in Turkey—which is a primary example of a developing country.

Vertical disease programs and their effect on integrated disease surveillance and response: perspectives of epidemiologists and surveillance officers in Nigeria

Background Integrated Disease Surveillance and Response (IDSR) is a cost-effective surveillance system designed to curb the inefficiency associated with vertical (disease-specific) programs. The study determined the existence and effect of vertical programs on disease surveillance and response in Nigeria. Methods A cross-sectional study involving 14 State epidemiologists and Disease Notification Surveillance Officers (DSNOs) in 12 states located within the 6 geopolitical zones in Nigeria. Data was collected using mailed electronic semi-structured self-administered questionnaires. Response rate was 33.3%. The data was analyzed using SPSS version 20. Results Half of the respondents were males (50.0%) and State epidemiologists (50.0%). Malaria, HIV/AIDS, tuberculosis, and other diseases were ongoing vertical programs in the States surveyed. In over 90% of cases, vertical programs had different personnel, communication channels and supportive supervision processes different from the IDSR system. Although less than 50% acknowledged the existence of a forum for data harmonization, this forum was ineffectively utilized in 83.3% of cases. Specific disease funding was higher than that of IDSR (92.9%) and only 42.9% reported funding for IDSR activities from development partners in the State. Poor data management, low priority on IDSR priority diseases, and donor-driven programming were major negative effects of vertical programs. Improved funding, political ownership, and integration were major recommendations preferred by the respondents. Conclusion We found that vertical programs in the surveyed States in the Nigerian health system led to duplication of efforts, inequitable funding, and inefficiencies in surveillance. We recommend integration of existing vertical programs into the IDSR system, increased resource allocation, and political support to improve IDSR.

COVID-19 in socially vulnerable quilombola populations in Salvaterra, Pará, Eastern Amazon, Brazil

Introduction: COVID-19 is a severe respiratory syndrome caused by the SARS-CoV-2 virus. In Brazil the highest infection rates are associated with socially vulnerable populations. This study therefore sought to analyze the spatial distribution of the disease and its relation with geographic, socioeconomic and public health policy characteristics associated with quilombola communities in Salvaterra municipality, state of Pará, for the period of March to September, 2020. Methodology: This cross-sectional and ecological study used data from the Disease Notification System and the National Registry of Health Establishments of the Ministry of Health, the Income Transfer Registry of the Ministry of Citizenship and the 2010 census of the Brazilian Institute of Geography and Statistics. Statistical and spatial analysis of the data was done through percentages of cases and Flow and Kernel map techniques. Results: Seventy-five notified cases of COVID-19 distributed among 7 quilombola communities in the municipality were analyzed. The epidemiological profile followed a national trend, with a higher percentage of cases among persons who were female, adults with low schooling levels, working as family farmers and with an outcome ending in recovery. The spatial distribution of the disease was not homogenous and showed clusters of cases and high incidence rates, especially in communities close to the municipal seat or to highways. Conclusions: The use of data analysis techniques was satisfactory for providing an understanding of the socioeconomic production of the disease in the areas studied. Accordingly, the need for intensifying epidemiological survey actions in the quilombola communities of the municipality is emphasized.

Environmental and social effects on the incidence of tuberculosis in three Brazilian municipalities and in Federal District

Introduction: The territorial characteristics, heterogeneities of landscapes, and the regional profiles of Brazil show great disparities in the spatial distribution of tuberculosis burden. Objective of this study is to analyze the effects of environmental and social factors on tuberculosis incidence in three Brazilian municipalities and in the Federal District of Brazil. Methodology: We performed an ecological study carried out with 131,576 new cases of tuberculosis registered in the Brazilian national disease notification system. For our research we used climatic data, topographic data and socioeconomic data. Results: Wind speed and vapor pressure increased the risk of tuberculosis infection between 4.6 and 5.8 times in the 3 municipalities, in comparison with the Federal District. In Recife socioeconomic aspects showed a greater association with tuberculosis. Lack of garbage collection, poor basic sanitation, and access to drinking water, respectively, increased 49, 33, and 28 times the risk of infection. In the multiple regression analysis, Rio de Janeiro showed several environmental characteristics – such as precipitation (p = 0.002), radiation (p = 0.020) and water vapor (p = 0.055) – and social characteristics associated with tuberculosis – such as the lack of sewage treatment, which revealed a 13.5-fold higher risk of infection (p < 0.001). Conclusions: Incidence in the areas studied was influenced by environmental and social conditions at different levels depending on the territory where the problem was identified. The results make it possible to guide an urban and social policy to reach the targets set out in the WHO End tuberculosis Strategy in large Brazilian urban agglomerations.

Reliability of wastewater analysis for monitoring COVID-19 incidence revealed by a long-term follow-up study

Background: Wastewater-based epidemiology has been used for monitoring human activities and waterborne pathogens. Although wastewaters can also be used for tracking SARS-CoV-2 at the population level, the reliability of this approach remains to be established, especially for early warning of outbreaks. Methods: We collected 377 samples from different treatment plants processing wastewaters of >1 million inhabitants in Valencia, Spain, between April 2020 and March 2021. Samples were cleaned, concentrated, and subjected to RT-qPCR to determine SARS-CoV-2 concentrations. These data were compared with cumulative disease notification rates over 7 and 14 day periods. Results: We amplified SARS-CoV-2 RNA in 75% of the RT-qPCRs, with an estimated detection limit of 100 viral genome copies per liter (gc/L). SARS-CoV-2 RNA concentration correlated strongly with disease notification rates over 14-day periods (Pearson r = 0.962, P < 0.001). A concentration >1000 gc/L showed >95% sensitivity and specificity as an indicator of more than 25 new cases per 100,000 inhabitants. Albeit with slightly higher uncertainty, these figures were reproduced using a 7-day period. Time series were similar for wastewaters data and declared cases, but wastewater RNA concentrations exhibited transient peaks that were not observed in declared cases and preceded major outbreaks by several weeks. Interpretation: Wastewater analysis provides a reliable tool for monitoring COVID-19, particularly at low incidence values, and is not biased by asymptomatic cases. Moreover, this approach might reveal previously unrecognized features of COVID-19 transmission.