Evidence of co-circulation of multiple arboviruses transmitted by Aedes species based on laboratory syndromic surveillance at a health unit in a slum of the Federal District, Brazil

Background Vector-borne diseases, especially arboviruses transmitted by Aedes sp. mosquitos, should be a health policy priority in Brazil. Despite this urgency, there are significant limitations in the traditional surveillance system, mainly in vulnerable areas. This study aimed to investigate the circulation of dengue (DENV), Zika (ZIKV), and chikungunya viruses (CHIKV) by laboratory syndromic surveillance (LSS) in a slum area of the Federal District of Brazil, comparing the results with traditional surveillance data. Methods LSS for acute febrile and/or exanthematous symptoms was developed at a health unit of Cidade Estrutural, in order to identify the circulation of arboviruses transmitted by Aedes sp. mosquitos. Between June 2019 and March 2020, 131 valid participants were identified and sera tested by reverse transcription polymerase chain reaction (RT-PCR) for DENV (by serotype), ZIKV, and CHIKV acute infection and by immunoglobulin M enzyme-inked immunosorbent assay (ELISA-IgM) for DENV and CHIKV 15–21 days after symptom onset, when the participant reported no respiratory signs (cough and/or coryza). The results obtained were compared with traditional surveillance data for the study area and period. Results At least three DENV-1 (2.3%), four DENV-2 (3%), and one CHIKV (0.7%) cases were confirmed in the laboratory, showing evidence of hyperendemicity even though LSS had not reached the historic peak dengue fever months in the Federal District (April–May). When the results obtained here were compared with traditional surveillance, a significant discrepancy was observed, including underreporting of CHIKV infection. Conclusions In addition to the risks posed to the study population, the area investigated with its respective socio-environmental profile may be a potential site for spread of the virus, given the cosmopolitan presence of Aedes sp. and human mobility in the Federal District. It is also suggested that traditional epidemiological surveillance may be reporting acute viral infections other than DENV as dengue fever, while underreporting other arboviruses transmitted by Aedes sp. mosquitos in the Federal District. Graphical Abstract

Worldwide evolution of vaccinable and non-vaccinable viral skin infections: a Google Trends analysis (Preprint)

BACKGROUND Most common viral skin infections are not reportable conditions. Studying the population dynamics of these viral epidemics using traditional field methods is costly and time consuming, especially over wide geographical areas OBJECTIVE To explore the evolution, seasonality and distribution of vaccinable and non-vaccinable viral skin infections through analysis of Google Trends. METHODS Worldwide search trends from 2004 through May 2021 for viral skin infections were extracted from Google Trends, quantified and analysed. RESULTS Time series decomposition showed that total search term volume for warts, zoster, roseola, measles, hand, foot, and mouth disease (HFMD), varicella and rubella increased worldwide over the study period while the interest for Pityriasis rosea and herpes simplex decreased. Internet searches for HFMD, varicella and measles exhibited the highest seasonal patterns. The interest for measles and rubella was more pronounced in African countries while the interest for HFMD and roseola was more pronounced in East Asia. CONCLUSIONS Harnessing data generated by web searches may increase the timeliness of traditional surveillance systems and strengthens the suspicion that the incidence of some vaccinable viral skin infections such as varicella, measles, rubella may be globally increasing. CLINICALTRIAL Ethics approval for this type of study was not required as none of the queries in the Google database can be associated with any identity and/or physical location, as specified in Google’s privacy policy (www.google.com/privacypolicy.html).

93. Early Recognition and Response to Increases in Surgical Site Infections (SSI) using Optimized Statistical Process Control (SPC) Charts – the Early 2RIS Trial: A Multicenter Stepped Wedge Cluster Randomized Controlled Trial (RCT)

Background Traditional approaches for SSI surveillance have deficiencies that can delay detection of SSI outbreaks and other clinically important increases in SSI rates. Optimized SPC methods for SSI surveillance have not been prospectively evaluated. Methods We conducted a prospective multicenter stepped wedge cluster RCT to evaluate the performance of SSI surveillance and feedback performed with optimized SPC plus traditional surveillance methods compared to traditional surveillance alone. We divided 13 common surgical procedures into 6 clusters (Table 1). A cluster of procedures at a single hospital was the unit of randomization and analysis, and 105 total clusters across 29 community hospitals were randomized to 12 groups of 8-10 clusters (Figure 1). After a 12-month baseline observation period (3/2016-2/2017), the SPC surveillance intervention was serially implemented according to stepped wedge assignment over a 36-month intervention period (3/2017-2/2020) until all 12 groups of clusters had received the intervention. The primary outcome was the overall SSI prevalence rate (PR=SSIs/100 procedures), evaluated with a GEE model with Poisson distribution. Table 1 Figure 1 Schematic for stepped wedge design. The 12-month baseline observation period was followed by the 36-month intervention period, comprised of 12 3-month steps. Results Our trial involved prospective surveillance of 237,704 procedures that resulted in 1,952 SSIs (PR=0.82). The overall SSI PR did not differ significantly between clusters of procedures assigned to SPC surveillance (781 SSIs/89,339 procedures; PR=0.87) and those assigned to traditional surveillance (1,171 SSIs/148,365 procedures; PR=0.79; PR ratio=1.10 [95% CI, 0.94–1.30]; P=.25) (Table 2). SPC surveillance identified 104 SSI rate increases that required formal investigations, compared to only 25 investigations generated by traditional surveillance. Among 10 best practices for SSI prevention, 453 of 502 (90%) SSIs analyzed due to SPC detection of SSI rate increases had at least 2 deficiencies (Table 3). Table 2 Poisson regression models comparing surgical site infection (SSI) prevalence rates for procedure clusters receiving statistical process control surveillance to SSI rates for clusters receiving traditional control surveillance. Table 3 Compliance with 10 best practices for surgical site infection (SSI) prevention among 502 SSIs analyzed during SSI investigations generated by statistical process control surveillance. Conclusion SPC methods more frequently detected important SSI rate increases associated with deficiencies in SSI prevention best practices than traditional surveillance; however, feedback of this information did not lead to SSI rate reductions. Further study is indicated to determine the best application of SPC methods to improve adherence to SSI quality measures and prevent SSIs. Disclosures Arthur W. Baker, MD, MPH, Medincell (Advisor or Review Panel member) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)

Data and Digital Solutions to Support Surveillance Strategies in the Context of the COVID-19 Pandemic

Background: In order to prevent spread and improve control of infectious diseases, public health experts need to closely monitor human and animal populations. Infectious disease surveillance is an established, routine data collection process essential for early warning, rapid response, and disease control. The quantity of data potentially useful for early warning and surveillance has increased exponentially due to social media and other big data streams. Digital epidemiology is a novel discipline that includes harvesting, analysing, and interpreting data that were not initially collected for healthcare needs to enhance traditional surveillance. During the current COVID-19 pandemic, the importance of digital epidemiology complementing traditional public health approaches has been highlighted.Objective: The aim of this paper is to provide a comprehensive overview for the application of data and digital solutions to support surveillance strategies and draw implications for surveillance in the context of the COVID-19 pandemic and beyond.Methods: A search was conducted in PubMed databases. Articles published between January 2005 and May 2020 on the use of digital solutions to support surveillance strategies in pandemic settings and health emergencies were evaluated.Results: In this paper, we provide a comprehensive overview of digital epidemiology, available data sources, and components of 21st-century digital surveillance, early warning and response, outbreak management and control, and digital interventions.Conclusions: Our main purpose was to highlight the plausible use of new surveillance strategies, with implications for the COVID-19 pandemic strategies and then to identify opportunities and challenges for the successful development and implementation of digital solutions during non-emergency times of routine surveillance, with readiness for early-warning and response for future pandemics. The enhancement of traditional surveillance systems with novel digital surveillance methods opens a direction for the most effective framework for preparedness and response to future pandemics.

Estimating SARS-CoV-2 prevalence from large-scale wastewater surveillance: insights from combined analysis of 44 sites in England

Accurate surveillance of the COVID-19 pandemic can be weakened by under-reporting of cases, particularly due to asymptomatic or pre-symptomatic infections, resulting in bias. Quantification of SARS-CoV-2 RNA in wastewater (WW) can be used to infer infection prevalence, but uncertainty in sensitivity and considerable variability has meant that accurate measurement remains elusive. Data from 44 sewage sites in England, covering 31% of the population, shows that SARS-CoV-2 prevalence is estimated to within 1.1% of estimates from representative prevalence surveys (with 95% confidence). Using machine learning and phenomenological models, differences between sampled sites, particularly the WW flow rate, influence prevalence estimation and require careful interpretation. SARS-CoV-2 signals in WW appear 4–5 days earlier in comparison to clinical testing data but are coincident with prevalence surveys suggesting that WW surveillance can be a leading indicator for asymptomatic viral infections. Wastewater-based epidemiology complements and strengthens traditional surveillance, with significant implications for public health.

Evidence of Co-Circulation of Multiples Arbovirus Transmitted by Aedes Sp. Based on Laboratorial Syndromic Surveillance At Health Unit in Slum Area of Federal District, Brazil

Background: Mosquito-borne disease, especially arbovirus transmitted by Aedes mosquitoes, must be priority of Brazilian public health policies, mainly with others infectious agents in circulation. Laboratorial syndromic surveillance for fever or/and exanthematic acute syndrome was performed at health unit in slum area of Federal District. Methods: between June/2019 and March/2020, stopped by COVID-19 pandemic, 131 valid participants were identified and tested by RT-PCR for dengue (by serotype), chikungunya and Zika virus; and by serological IgM for dengue and chikungunya virus, with serologic assay performed when the participant did not present respiratory symptoms (cough or/and coryza). Results: 3 DENV-1 (2.3%), 4 DENV-2 (3%) and 1 CHIKV (0.7%) was lab-confirmed, showing evidence of hiperendemicity area even with the laboratorial syndromic surveillance not reaching the months of historical peak of dengue in Federal District (April-May). When compared the results of laboratorial syndromic surveillance with traditional epidemiologic surveillance data, is verified significant discrepancy between probable cases (from traditional surveillance) and lab-confirmed cases (from laboratorial syndromic surveillance). Conclusions: beyond the risks of local population are exposed, the socio-environment profile can be an able potential area to spread arbovirus, according to Aedes sp. dynamics and human mobility of the Federal District. Also, traditional surveillance may be misreporting probable cases for dengue infection, and underreporting confirmed cases for other arbovirus in the Federal District.

Media Reports as a Tool for Timely Monitoring of COVID-19–Related Deaths Among First Responders—United States, April 2020

We aimed to describe coronavirus disease 2019 (COVID-19) deaths among first responders early in the COVID-19 pandemic. We used media reports to gather timely information about COVID-19–related deaths among first responders during March 30–April 30, 2020, and evaluated the sensitivity of media scanning compared with traditional surveillance. We abstracted information about demographic characteristics, occupation, underlying conditions, and exposure source. Twelve of 19 US public health jurisdictions with data on reported deaths provided verification, and 7 jurisdictions reported whether additional deaths had occurred; we calculated the sensitivity of media scanning among these 7 jurisdictions. We identified 97 COVID-19–related first-responder deaths during the study period through media and jurisdiction reports. Participating jurisdictions reported 5 deaths not reported by the media. Sixty-six decedents worked in law enforcement, and 31 decedents worked in fire/emergency medical services. Media reports rarely noted underlying conditions. The media scan sensitivity was 88% (95% CI, 73%-96%) in the subset of 7 jurisdictions. Media reports demonstrated high sensitivity in documenting COVID-19–related deaths among first responders; however, information on risk factors was scarce. Routine collection of data on industry and occupation could improve understanding of COVID-19 morbidity and mortality among all workers.

Development and Usability Assessment of Classroom Surveillance System for Campus Security and Productivity

Classroom Surveillance System is an excellent system for higher learning institutions to ensure the security of students, faculty, office personnel, and its physical facilities. This study aimed to develop a classroom surveillance system for campus security and productivity. The study utilized developmental research. There were four Deans, 24 IT professionals, and 24 students utilized as respondents of the study. The instrument used in the study included the Deans’ monitoring scheme of teaching/non-teaching personnel, school facilities, and student’s assessment on the surveillance functionality, reliability, usability, efficiency, maintainability, and accuracy of the newly developed and designed classroom surveillance system. The statistical tools used were the frequency count, ranking, and weighted mean. The study revealed that the developed Classroom Surveillance System was very much functional, very much reliable, very much usable, very much efficient, very much maintainable, and very much accurate. The university administration should adopt the Classroom Surveillance System to provide excellent surveillance and monitoring of teaching personnel, non-teaching personnel, classroom facilities, and students of the University. Hence, the university should shift from utilizing the traditional surveillance system into a technologically oriented surveillance system.

Integrating technology and data in public health disease surveillance in Africa: case study of the AVADAR program (Preprint)

BACKGROUND Sub-saharan Africa, Afghanistan and Pakistan are the last frontiers with the prevalence of wild poliovirus (WPV). Following joint efforts and partnerships some of which were instituted in the last 20 years, Africa was declared free of WPV in August 2020. While efforts now focus on eliminating circulating vaccine derived poliovirus (cVDPV), it is important to review some of the interventions that resulted in a polio-free certification for the continent. OBJECTIVE The Auto-visual AFP detection and response (AVADAR) program was one of such interventions. AVADAR helped with a more focused, technology and data driven campaign, to ensure that surveillance was broad, inclusive, and responsive. With the infusion of mobile health technology, the project became a success as it reported, investigated and confirmed more cases of AFP compared to the existing traditional surveillance systems. This study attempts a review of the AVADAR intervention with a view to understand the role played by technology and data. METHODS This study comparatively reviewed the data generated over a three year period, across nine countries where the AVADAR project was implemented. It sought to understand how AVADAR was an improvement over traditional surveillance systems. RESULTS The AVADAR program confirmed more reported AFP cases, when compared with the traditional (paper-based) system. It was found that more true AFP cases were found through the AVADAR system. AVADAR accounted for 76% of cases reported across eight countries. CONCLUSIONS Evidently, data and technology - in this case - the AVADAR tool, addressed most of the challenges of Public Health Surveillance in the target countries. The challenge of erratic surveillance data gathering, and feedback was reduced as the AVADAR program demonstrated coordinated data gathering, active case search, timely response to alerts, and ultimately, improved confirmation of true cases. It contributes lessons that could be useful in enhancing surveillance systems across the developing world particularly in Africa.