Electronic Integrated Disease Surveillance System Research Articles

Surveillance on Arboviral Infections in Georgia by using One Health Approach

ObjectiveIdentify cases of West Nile virus in Black Sea region of Georgia through active surveillance.IntroductionArbovirus infections are causing enormous global burden, while their geographic distribution expands and affects new regions and areas. West Nile virus (WNV), one of the most important pathogens among arboviruses, was historically associated with causing mild febrile illness, however, after the outbreak occurred in the North America, which caused more severe illness, it has received wider recognition. It is believed that the disease can reemerge after a hiatus of several years, and affect new territories, which has happened in 2018 in Greece, with 31 dead among 271 infections by the end of September. In Georgia, there is a lack of clinical suspicion on WNV because of the low awareness among medical society, and the existent passive surveillance system seems to be improved.MethodsIn order to assess the situation in Georgia, medical histories and Electronic Integrated Disease Surveillance System (EIDSS) database was studied, and active surveillance has been conducted with the following case selection criteria: residence - Black Sea region; diagnosis - fever of unknown origin (FUO). Enzyme-linked immunosorbent assay (ELISA) was performed. Mosquitoes were obtained by using light traps and aspirators, and are now being studied. Medical personnel was trained on using WNV case definition.ResultsThree laboratory positive cases were identified from 36 suspected cases. Two of them were males (66%). Age distribution – 28-35 y.o. All three cases resided in the city of Batumi in the Adjara region. A total of 572 mosquitoes were obtained. According to preliminary analysis, the species include: Culex pipiens, Aedes albopictus, A. aegypti, A. caspius, A. geniculatus, Anopheles claviger.ConclusionsThe preliminary data suggests that the burden of WNV in Georgia should be studied with more in-depth approaches and with just passive surveillance activities. It is very important to establish coordinated rapid efforts for disease identification by physicians and veterinarians; and to provide better harmonization of diagnostic tools and integrated national surveillance system. Disease transmission risk needs to be assessed for adequate planning of preventive measures. At this stage, no animals were studied, however, in order to fulfill the One Health approach, we are planning to study horses in the near future.

Assessment of laboratory diagnostic and surveillance system for enteric infections in Azerbaijan

Purpose: Our study sought to gain a better understanding of the etiology of infections that fall within the generalized diagnosis of enteric infections with unassigned etiological agent. We hypothesized that meticulous assessment of patient diagnostic and surveillance data from enteric infections in Azerbaijan would increase our knowledge of the enteric disease situation in the country. In consequence, our ability to assign causative agents to enteric infections would be enhanced and gaps in public health detection and reporting requirements could be identified. Methods & Materials: Given the high number of AEI cases with unknown etiology in Azerbaijan, AEI patient data from 2014 to 2016 were analyzed using the Electronic Integrated Disease Surveillance System (EIDSS) and patient information from annual reports from the Bacteriology Laboratory at the Republican Center of Hygiene and Epidemiology. Results: The analysis revealed that yersinosis (0.3% of the cases), shigellosis (0.6%), and salmonellosis (5.7%) were the most common AEI cases. Opportunistic bacterial infections accounted for remaining cases. Between 2014 and 2016, notification of enteric infections improved with every year (i.e., 2014: 67.4% of timely notifications; 2015: 80.4%; 2016: 87.3%). EIDSS entry deficiencies included the lack of antibiotic treatment information in 57.4% of the cases, and an overwhelming incidence of AEI diagnosis based on clinical-epidemiological data (78.6%) and not confirmatory laboratory assays, indicating that treatment received was not etiologically substantiated. Absence of point-of-care, pathogen detection assays covering more agents, especially viral agents, might in part explain the high rate of clinical diagnosis of AEIs as "acute enteric infections of unknown etiology". In fact, in Azerbaijan, only rotaviruses are currently tested when viral enteric infections are suspected. Conclusion: Better communication among health system databases with established minimum data entry requirements, including treatment and disease chronology information, capability for multiple pathogen testing and improvement in the quality of EIDSS entries to reconcile electronic and paper forms of notification are needed. Use of rapid immunological or molecular diagnostic methods, or test strips using immunochromatographic technology, rather than traditional long-term culture assays, should expedite pathogen identification. Altogether, such efforts will improve diagnosis, treatment and spread control of diarrheal diseases in the country.

Isolation of Brucella Melitensis in Azerbaijan in 2014

Purpose: Republican Anti-Plague Station (RAPS) in Azerbaijan provides confirmatory tests for especially dangerous pathogens (e.g.Yersinia pestis, Bacillus anthracis, Brucella spp., Francisella tularensis). In Azerbaijan RAPS and its regional Anti-Plague Divisions (APDs) are responsible for testing human samples for abovementioned pathogens. RAPS receives samples for confirmatory test from patients referred by Baku, regional hospitals and APDs.The aim of this study was to isolate and identify Brucella cultures from human blood samples. Methods & Materials: In 2014, 1,137 blood samples were collected by RAPS from patients with clinical symptoms such as high temperature, perspiration, chills, myalgia, arthralgia, headache, fatigue, lack of appetite. All samples were tested using the Azerbaijan Ministry of Health (EDPs Laboratory Guidelines, 2013) algorithm via bacteriology and serology tests. Blood serum was tested for the presence of the antibodies of Brucella spp. via Huddleson reaction, Rose Bengal test and Wright's reaction. Samples positive for Brucella spp. per Huddleson and Rose-Bengal reactions further were tested by Wright's reaction. Positive blood samples by Wright's reaction with titers 1/200 and higher were then cultured. Isolated pure cultures were examined by biochemical (Urease, Oxidase, Catalase, TSI/H2S, Dye sensitivities) and serology (Trypaflavine, Agglutination with specific polyvalent serum, anti -A and anti -M monospecific sera) tests. Results: Data showed that 54.3% from total number of serum samples were positive by Huddleson reaction; 35.6% from total were positive by Rose-Bengal reaction and 38.7% from total samples were positive by Wright's reaction. Positive blood samples with titer 1/200 and higher from first diagnosed patients (n = 89) were cultured. All isolates were identified as Brucella melitensis (an overall isolation rate was 16.9%). The reports about positive results are sent to the Ministry of Health and State Veterinary Control Service (SVCS) and entered into the Electronic Integrated Disease Surveillance System (EIDSS) database of the Ministry of Health of Azerbaijan. Data from the system allows tracking the incidence of brucellosis and making operational decisions. Conclusion: Future genetic analyses of these isolates can help identify subtypes of Brucella melitensis and establish the origin of B.melitensis circulating in the Azerbaijan territory and compare the results with those of neighboring countries.

Rates and risk factors for human cutaneous anthrax in the country of Georgia: National surveillance data, 2008–2015

IntroductionAnthrax is endemic in the country of Georgia. The most common cutaneous anthrax form accounts for 95% of anthrax cases and often is self-resolving. Humans are infected from processing contaminated animal products, contacting sick animals, or by insect bites.ObjectiveWe aimed to describe the burden of human cutaneous anthrax and associated risk factors using the national surveillance data.MethodsWe extracted all human cutaneous anthrax cases from Electronic Integrated Disease Surveillance System (EIDSS) from 1 January 2008 to 31 December 2015. We conducted descriptive analyses to characterize the number of confirmed, probable and suspected cases by age groups, gender, ethnicity, year and geographic area.ResultsOut of 911 reported cutaneous anthrax cases, 299 (33%) were rejected. Out of remaining 612 cases, 437 (71%), 172 (28%), and 3 (<0.004%) were classified as confirmed, probable and suspected cases of cutaneous Anthrax, respectively; 467 (76.3%) were male. Georgians accounted for 56% (343/612) of cutaneous anthrax cases. Handling animal products (aOR 4.36, 95% CI 2.61–7.26) and living near pastoralist routes (aOR 2.74, 95%CI 1.57–4.76) were associated with cutaneous anthrax.ConclusionsThis study provides eight-year trends for cutaneous anthrax in humans in the country of Georgia. A comprehensive explanation for the observed rise and fall of the incidence rates of human cutaneous anthrax in 2008–2015 remains to be clarified but is likely associated with discontinuation of mandatory national livestock vaccination in 2008 coupled with weakened human and animal national health systems which were disrupted after the Soviet Union collapsed. Our analysis identifies living near pastoralist routes, handling animal products and travel to endemic areas within two weeks before the disease onset as risk factors for cutaneous anthrax. The evidence underscores the importance of One Health recommendations to activate anthrax awareness campaigns, supervise the destruction of known anthrax carcasses, record global position system coordinates of sites and disinfect infected soils and introduce a participatory health education tool on anthrax.

Successful implementation of electronic disease reporting in Georgia

ObjectiveThe objective of this study was to evaluate several aspects of theelectronic disease reporting system and its abilities used in Georgia.Also, the study assessed if the system abilities are tailored to thenational surveillance requirements. User attitudes (system strengthand weaknesses) toward the system was also surveyed.IntroductionThe Ministry of Health of Georgia accepted the ElectronicIntegrated Disease Surveillance System (EIDSS) as an officialdisease reporting system in 2012. The Georgian government adoptedelectronic reporting for both veterinary and human diseases in2015. We conducted a comparative assessment of progress in theimplementation of electronic reporting.MethodsA face-to-face initial survey was conducted in 2012, a follow-upsurvey (through telephone interviews) was performed in 2016. Theinitial survey was conducted in regions that had EIDSS installedand the follow-up survey was conducted in all regions. Standardizedquestionnaires were used and data was analyzed in Epi Info.ResultsOut of 450 trained EIDSS users, 32% were interviewed in theinitial survey and 25% (of 550) EIDSS trained users were interviewedin the follow-up survey. Of 147 respondents in the initial survey and138 in the follow-up survey, 44% and 79%, believed that they wereusing EIDSS effectively, respectively. The follow-up survey showeda 23% increase in respondents who acknowledge an improvement ofthe electronic reporting; acceptance of EIDSS increased from 80.3%to 97.8%. Of those interviewed in the follow-up survey, 19.7%mentioned that the main success in development of the system is dueto improved collaboration between institutes. However, 17.36% of therespondents in the follow-up survey reported non-sufficient qualitydata.ConclusionsOur study suggests that the acceptance and use of EIDSS hasnoticeably improved, indicating the successful implementation ofelectronic reporting. Recommendations have been made to furtherimprove the data quality by conducting regular data cleaning andadditional user training. We recommend the continuation of EIDSStraining.

The prevalence of rabies cases in the territory of Azerbaijan, January 2015-June 2016

Objectiveto show the instability of an epizootic situation on rabies casesof animals in the Republic of Azerbaijan, on the example of thecases analysis in Electronic Integrated Disease Surveillance System(EIDSS) electronic reporting systemIntroductionRabies is an infectious disease which was and remains to be oneof the most serious diseases of all species of hematothermal animalsand humans, in many regions of the world. The epizootic situation onrabies in the Republic of Azerbaijan has been unfavorable for manyyears, which is confirmed by scientific data and the veterinary casesreporting in the EIDSS system. This system was introduced in thecountry in 2009 and is the electronic System of disease control. Theprogram allows to provide monitoring and prevention of diseaseswithin the concept “One World - One Health System” by integrationof systems of observation of animal diseases, human diseases, anddisease carriers.MethodsOn the basis of the data on rabies cases entered in special formsand also aggregative data collected on anti-rabies vaccination, theanalysis of information on quantity of cases and their prevalence onadministrative and territorial units (rayons) of the country is carriedout. The graphical analysis (charts and the map) on the basis ofnecessary criteria are constituted in the analyses module, visualizationof the AVR reporting and in the Microsoft Excel program.ResultsThe analysis of the rabies cases confirmed at the Virologydepartment of the Republican Veterinary Laboratory shows thatrabies has been identified in 36 cases in 2015, 25 cases in January- June, 2016, in total 61 cases has been registered for the periodof “January 2015 – June 2016”. An epizootologically unfavorablesituation is revealed in 27 regions. The most unfavorable situation isthe northwest regions of the country, the most part of which is coveredwith mountainy-forest area with domination of wild fauna. Specificstructure of animals: dogs – 31 cases in 19 areas (51%), cattle – 21cases in 12 areas (34%), a small cattle-1 case (2%), wild animals(specify types) - 8 cases in 8 areas (13%) that is visually shown oncharts 1 and 2. The cattle were bitten by wolves and jackals.ConclusionsThus, prevalence of rabies cases of different species of animalsin the country, once again proves natural and focal character of thedisease: the reservoir of rabies is in the wild nature and geographicalconditions impact the spread of rabies.Cases of rabies in animals are registered annually. In 2015,vaccination captured about 250000 dogs, and 244400 dogs werevaccinated in the first 6 months of 2016. Despite a huge group ofvaccinations, restriction of rabies spread isn’t observed and thetendency is trending to the increase of rabies case indicators amongstthe dogs.It is necessary to pay close attention to preventive vaccination ofdomestic (including non-productive) animals. If materiel resourcesare available, it is possible to carry out the vaccination of the cattlein the territories adjacent to the forests. In the threatened territorieswith woodlands, there is no alternative to oral vaccinations, whichis confirmed by positive experience of many countries. There is anextreme need of carrying out of oral vaccination of wild carnivorousanimals with obligatory control of the immune status.

Post-vaccination rabies sero-survey in Georgia, 2015

ObjectiveThe objective of this survey was to study vaccination coverage andquality in dogs in Georgia through the detection of post-vaccinationantibodies.IntroductionRabies is endemic in Georgia with up to 100 confirmed cases inanimals per year. There is an estimated 350,000 domestic and straydogs/cats in Georgia. The prophylactic vaccination of domesticanimals against rabies was reestablished in Georgia in 2013. Each yearsince 2013, coverage has increased aiming to cover approximately70% of the total population of dogs/cats in Georgia.MethodsOnly vaccinated dog populations were included in the sero-survey. Using random selection, five locations were selected. Thesurvey was conducted over a period of 4-8 weeks after vaccination.In order to study vaccination coverage, the total dog population wasregistered. Samples were taken only from vaccinated dogs (confirmedby vaccination papers) and samples were sent to the Laboratory ofthe Ministry of Agriculture where they were tested for the presenceof antibodies using ELISA. Epidemiological information and GPScoordinates were recorded in the electronic integrated diseasesurveillance system (EIDSS) and geographic information system(GIS).ResultsOut of 572 dogs in sampled villages, 373 animal’s vaccination wasconfirmed leading to 65% vaccination coverage. Out of 255 samples,241 were suitable for testing; 237 samples (98.3%) were positive forthe existence of antibodies. Antibody titer was not measured.ConclusionsBased on the results of the survey, it can be seen that vaccinationcoverage is generally not high (65%) and needs improvement.The vaccination quality (as determined through the existence ofantibodies) is good (98.3%). In further surveys, antibody titersmust be measured in order to extract more information regardingvaccination quality.

Patterns of brucellosis infection symptoms in azerbaijan: a latent class cluster analysis.

Brucellosis infection is a multisystem disease, with a broad spectrum of symptoms. We investigated the existence of clusters of infected patients according to their clinical presentation. Using national surveillance data from the Electronic-Integrated Disease Surveillance System, we applied a latent class cluster (LCC) analysis on symptoms to determine clusters of brucellosis cases. A total of 454 cases reported between July 2011 and July 2013 were analyzed. LCC identified a two-cluster model and the Vuong-Lo-Mendell-Rubin likelihood ratio supported the cluster model. Brucellosis cases in the second cluster (19%) reported higher percentages of poly-lymphadenopathy, hepatomegaly, arthritis, myositis, and neuritis and changes in liver function tests compared to cases of the first cluster. Patients in the second cluster had a severe brucellosis disease course and were associated with longer delay in seeking medical attention. Moreover, most of them were from Beylagan, a region focused on sheep and goat livestock production in south-central Azerbaijan. Patients in cluster 2 accounted for one-quarter of brucellosis cases and had a more severe clinical presentation. Delay in seeking medical care may explain severe illness. Future work needs to determine the factors that influence brucellosis case seeking and identify brucellosis species, particularly among cases from Beylagan.

EIDSS Application for CCHF Foci Activity Epi-Analysis and Prediction in Kazakhstan

Electronic Integrated Disease Surveillance System (EIDSS) was used to applied epi-analysis and prediction capabilities for situation in CCHF foci in Kazakhstan. Three indicators were used: population density in the CCHF-disadvantaged area; tick infection rate; human incidence rate. Maps generated in EIDSS allowed visualizing information and conducting a milti-factor epi-analysis. The CCHF outbreaks risk areas were identified. EIDSS software is easy to use, available for practical epidemiologists and can be used for analysis and prediction of vector-borne virus infections foci. EIDSS can serve as a basic working tool for field epidemiologists and the basis for managerial decision-making by the concerned ministries.

One Health Surveillance with Electronic Integrated Disease Surveillance System

Electronic Integrated Disease Surveillance System (EIDSS) improves one-health surveillance in medical, veterinary and environmental sectors by providing a capability to rapidly collect disseminate and analyze data on infectious diseases. In this showcase the system is demonstrated on CCHF research example from Kazakhstan. It covers all steps of the process including a data gathering on human cases on the district levels using handhelds, web access or desktop applications, conducting vector surveillance campaigns for ticks investigations, linking laboratory results, sharing the data across organizations and a one-click integrated analysis of epidemiological situation with CCHF for epidemiologists on national and regional level.

Electronic Integrated Disease Surveillance System and Pathogen Asset Control System

Electronic Integrated Disease Surveillance System (EIDSS) has been used to strengthen and support monitoring and prevention of dangerous diseases within One Health concept by integrating veterinary and human surveillance, passive and active approaches, case-based records including disease-specific clinical data based on standardised case definitions and aggregated data, laboratory data including sample tracking linked to each case and event with test results and epidemiological investigations. Information was collected and shared in secure way by different means: through the distributed nodes which are continuously synchronised amongst each other, through the web service, through the handheld devices. Electronic Integrated Disease Surveillance System provided near real time information flow that has been then disseminated to the appropriate organisations in a timely manner. It has been used for comprehensive analysis and visualisation capabilities including real time mapping of case events as these unfold enhancing decision making. Electronic Integrated Disease Surveillance System facilitated countries to comply with the IHR 2005 requirements through a data transfer module reporting diseases electronically to the World Health Organisation (WHO) data center as well as establish authorised data exchange with other electronic system using Open Architecture approach. Pathogen Asset Control System (PACS) has been used for accounting, management and control of biological agent stocks. Information on samples and strains of any kind throughout their entire lifecycle has been tracked in a comprehensive and flexible solution PACS.Both systems have been used in a combination and individually. Electronic Integrated Disease Surveillance System and PACS are currently deployed in the Republics of Kazakhstan, Georgia and Azerbaijan as a part of the Cooperative Biological Engagement Program (CBEP) sponsored by the US Defense Threat Reduction Agency (DTRA).

Burden of dengue infection in children and adults of Bang Phae district, Ratchaburi province: The DVI project in Thailand

Methods: Electronic Integrated Disease Surveillance System EIDSS) was developed to address the shortcomings of the existing ystemsparticularly in especially dangerous infections surveillance nd than expanded to address all reportable diseases. Development s based on cutting-edge expertise from the Centers for Disease ontrol and Prevention, Walter Reed Army Institute of Research, nd others with more than 100 thousand man-hours of expertise ncorporated. Implementation of EIDSS normally takes from 3 to years and involves piloting of a vertical slice, customization to djust to health priorities, implementation of reports and standard ase definitions, building the backbone of the system, establishngevaluation criteria andperformancemonitoring, andevaluation f the system through test scenarios, table top exercises, legislaive reform, etc. Information security is paid close attention to ddress local legislation on security and personal data protection. omprehensive training program ranges from basics of computer nowledge to advanceddata analysis, and is provided through faceo-face, on-the-job to train-the-trainer and CBT (Computer Based raining) approaches. Early planning of system support, funding, nstitutionalizing training program is important for successful interal system sustainment. Results: EIDSS is currently deployed and sustained t more than 350 sites in the Republics of Kazahstan,Georgia,Azerbaijan,UkraineandArmeniaas a part of the ooperative Biological Engagement Program (CBEP) sponsored by he U.S. Defense Threat Reduction Agency (DTRA). EIDSS has fully eplaced paper reporting with electronic reporting inAzerbaijanith the rest of the countries on the way to fully accepting the lectronic system. Tens of thousand of cases are entered into the IDSS systems across these countries. Conclusion: Transformation of national human and veterinary isease surveillance system from paper into integrated electronic orm improved timeliness (it takes few minutes to proliferate otification through the system), increased data collection qualty through standardized formats, provided ability for integral data nalysis at different levels of the national system.