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PubMed2007

Issues in applied statistics for public health bioterrorism surveillance using multiple data streams: research needs.

The objective of this report is to provide a basis to inform decisions about priorities for developing statistical research initiatives in the field of public health surveillance for emerging threats. Rapid information system advances have created a vast opportunity of secondary data sources for information to enhance the situational and health status awareness of populations. While the field of medical informatics and initiatives to standardize healthcare-seeking encounter records continue accelerating, it is necessary to adapt analytic and statistical methodologies to mature in sync with sibling information science technologies. One major right-of-passage for statistical inference is to advance the optimal application of analytic methodologies for using multiple data streams in detecting and characterizing public health population events of importance. This report first describes the problem in general and the data context, then delineates more specifically the practical nature of the problem and the related issues. Approaches currently applied to data with time-series, statistical process control and traditional inference concepts are described with examples in the section on Statistics and the Role of the Analytic Surveillance Data Monitor. These are the techniques that are providing substance to surveillance professionals and enabling use of multiple data streams. The next section describes use of a more complex approach that takes temporal as well as spatial dimensions into consideration for detection and situational awareness regarding event distributions. The space-time statistic has successfully been used to detect and track public health events of interest. Important research questions which are summarized at the end of this report are described in more detail with respect to the methodological application in the respective sections. This was thought to help elucidate the research requirements as summarized later in the report. Following the description of the space-time scan statistical application; this report extends to a less traditional area of promise given what has been observed in recent application of analytic methods. Bayesian networks (BNs) represent a conceptual step with advantages of flexibility for the public health surveillance community. Progression from traditional to the more extending statistical concepts in the context of the dynamic status quo of responsibility and challenge, leads to a conclusion consisting of categorical research needs. The report is structured by design to inform judgment about how to build on practical systems to achieve better analytic outcomes for public health surveillance. There are references to research issues throughout the sections with a summarization at the end, which also includes items previously unmentioned in the report.

Algorithms↗
PubMed2003

Syndromic surveillance using minimum transfer of identifiable data: the example of the National Bioterrorism Syndromic Surveillance Demonstration Program.

Several health plans and other organizations are collaborating with the Centers for Disease Control and Prevention to develop a syndromic surveillance system with national coverage that includes more than 20 million people. A principal design feature of this system is reliance on daily reporting of counts of individuals with syndromes of interest in specified geographic regions rather than reporting of individual encounter-level information. On request from public health agencies, health plans and telephone triage services provide additional information regarding individuals who are part of apparent clusters of illness. This reporting framework has several advantages, including less sharing of protected health information, less risk that confidential information will be distributed inappropriately, the prospect of better public acceptance, greater acceptance by health plans, and less effort and cost for both health plans and public health agencies. If successful, this system will allow any organization with appropriate data to contribute vital information to public health syndromic surveillance systems while preserving individuals' privacy to the greatest extent possible.

Bioterrorism↗
PubMed2003

The bioterrorism preparedness and response Early Aberration Reporting System (EARS).

Data from public health surveillance systems can provide meaningful measures of population risks for disease, disability, and death. Analysis and evaluation of these surveillance data help public health practitioners react to important health events in a timely manner both locally and nationally. Aberration detection methods allow the rapid assessment of changes in frequencies and rates of different health outcomes and the characterization of unusual trends or clusters. The Early Aberration Reporting System (EARS) of the Centers for Disease Control and Prevention allows the analysis of public health surveillance data using available aberration detection methods. The primary purpose of EARS is to provide national, state, and local health departments with several alternative aberration detection methods. EARS helps assist local and state health officials to focus limited resources on appropriate activities during epidemiological investigations of important public health events. Finally, EARS allows end users to select validated aberration detection methods and modify sensitivity and specificity thresholds to values considered to be of public health importance by local and state health departments.

Bioterrorism↗
PubMed2004

Bioterrorism: is it a real threat?

The Geneva Protocol of 1925 commits the signatory nations to refraining from the use of biological weapons. However, the terrorist assaults of September 2001 and, subsequently, the anthrax-containing letters are cause for great concerns: new threats to the security of nations are expected, as terrorist organizations seem to increasingly explore novel ways of spreading terror. In this context, naturally emerging diseases such as SARS, monkeypox or West Nile fever assume new importance because it is difficult to distinguish between natural epidemics and possible bioweapon assaults. Great efforts on the part of governments and public health authorities are necessary to counteract these threats.

Anthrax↗
PubMed2005

Commensal bacteria as a novel delivery system for subunit vaccines directed against agents of bioterrorism.

Following the anthrax attacks of 2001 and the recent SARS outbreak, concerns about emerging and re-emerging infectious diseases have catalyzed a renewed interest in developing new vaccination strategies that provide rapid and flexible response options to future threats. Because the probability of encountering one of these exotic agents is unknown, it is essential that new vaccine formulations employ methods that provide effective protection and extremely good safety profiles if they are to be used by either military or civilian populations. One approach, which potentially satisfies these criteria, is the use of live recombinant Gram-positive commensal bacteria as expression vectors. This review provides an overview of the system, its advantages and limitations, and details an example of how Gram-positive commensal bacteria are being developed as a fifth generation vaccine against a Class A biowarfare pathogen, namely smallpox.

Animals↗
PubMed2005

Emerging infections and pregnancy: West Nile virus, monkeypox, severe acute respiratory syndrome, and bioterrorism.

As new infectious diseases, such as West Nile virus, monkeypox, and severe acute respiratory syndrome (SARS) are recognized in the United States, there are critical questions about how these infectious diseases will affect pregnant women and their infants. In addition, the implications of bioterrorist attacks for exposed pregnant women need to be considered. In this article, the authors address the following questions for a number of infectious disease threats: (1) does pregnancy affect the clinical course of these novel infectious diseases?, (2) what are the implications for prophylaxis and treatment of exposed or infected pregnant women?, and (3) are these novel infectious diseases transmitted during pregnancy, labor and delivery, or breastfeeding?

Bioterrorism↗