Electronic Integrated Disease Surveillance Research Articles

Assessment of the integrated disease surveillance and response system implementation in health zones at risk for viral hemorrhagic fever outbreaks in North Kivu, Democratic Republic of the Congo, following a major Ebola outbreak, 2021

BackgroundThe Democratic Republic of the Congo (DRC) experienced its largest Ebola Virus Disease Outbreak in 2018–2020. As a result of the outbreak, significant funding and international support were provided to Eastern DRC to improve disease surveillance. The Integrated Disease Surveillance and Response (IDSR) strategy has been used in the DRC as a framework to strengthen public health surveillance, and full implementation could be critical as the DRC continues to face threats of various epidemic-prone diseases. In 2021, the DRC initiated an IDSR assessment in North Kivu province to assess the capabilities of the public health system to detect and respond to new public health threats.MethodsThe study utilized a mixed-methods design consisting of quantitative and qualitative methods. Quantitative assessment of the performance in IDSR core functions was conducted at multiple levels of the tiered health system through a standardized questionnaire and analysis of health data. Qualitative data were also collected through observations, focus groups and open-ended questions. Data were collected at the North Kivu provincial public health office, five health zones, 66 healthcare facilities, and from community health workers in 15 health areas.ResultsThirty-six percent of health facilities had no case definition documents and 53% had no blank case reporting forms, limiting identification and reporting. Data completeness and timeliness among health facilities were 53% and 75% overall but varied widely by health zone. While these indicators seemingly improved at the health zone level at 100% and 97% respectively, the health facility data feeding into the reporting structure were inconsistent. The use of electronic Integrated Disease Surveillance and Response is not widely implemented. Rapid response teams were generally available, but functionality was low with lack of guidance documents and long response times.ConclusionSupport is needed at the lower levels of the public health system and to address specific zones with low performance. Limitations in materials, resources for communication and transportation, and workforce training continue to be challenges. This assessment highlights the need to move from outbreak-focused support and funding to building systems that can improve the long-term functionality of the routine disease surveillance system.

Contribution of the one health approach to strengthening health security in Uganda: a case study

BackgroundThe One Health approach is key in implementing International Health Regulations (IHR, 2005) and the Global Health Security Agenda (GHSA). Uganda is signatory to the IHR 2005 and in 2017, the country conducted a Joint External Evaluation (JEE) that guided development of the National Action Plan for Health Security (NAPHS) 2019–2023.AimThis study assessed the contribution of the One Health approach to strengthening health security in Uganda.MethodsA process evaluation between 25th September and 5th October 2020, using a mixed–methods case study. Participants were Subject Matter Experts (SMEs) from government ministries, departments, agencies and implementing partners. Focus group discussions were conducted for five technical areas (workforce development, real-time surveillance, zoonotic diseases, national laboratory systems and emergency response operations), spanning 18 indicators and 96 activities. Funding and implementation status from the NAPHS launch in August 2019 to October 2020 was assessed with a One Health lens.ResultsFull funding was available for 36.5% of activities while 40.6% were partially funded and 22.9% were not funded at all. Majority (65%) of the activities were still in progress, whereas 8.6% were fully implemented and14.2% were not yet done. In workforce development, several multisectoral trainings were conducted including the frontline public health fellowship program, the One Health fellowship and residency program, advanced field epidemiology training program, in-service veterinary trainings and 21 district One Health teams’ trainings. Real Time Surveillance was achieved through incorporating animal health events reporting in the electronic integrated disease surveillance and response platform. The national and ten regional veterinary laboratories were assessed for capacity to conduct zoonotic disease diagnostics, two of which were integrated into the national specimen referral and transportation network. Multisectoral planning for emergency response and the actual response to prioritized zoonotic disease outbreaks was done jointly.ConclusionsThis study demonstrates the contribution of ‘One Health’ implementation in strengthening Uganda’s health security. Investment in the funding gaps will reinforce Uganda’s health security to achieve the IHR 2005. Future studies could examine the impacts and cost-effectiveness of One Health in curbing prioritized zoonotic disease outbreaks.

Uganda's experience in establishing an electronic compendium for public health emergencies.

Uganda has implemented several interventions that have contributed to prevention, early detection, and effective response to Public Health Emergencies (PHEs). However, there are gaps in collecting and documenting data on the overall response to these PHEs. We set out to establish a comprehensive electronic database of PHEs that occurred in Uganda since 2000. We constituted a core development team, developed a data dictionary, and worked with Health Information Systems Program (HISP)-Uganda to develop and customize a compendium of PHEs using the electronic Integrated Disease Surveillance and Response (eIDSR) module on the District Health Information Software version 2 (DHIS2) platform. We reviewed literature for retrospective data on PHEs for the compendium. Working with the Uganda Public Health Emergency Operations Center (PHEOC), we prospectively updated the compendium with real-time data on reported PHEs. We developed a user's guide to support future data entry teams. An operational compendium was developed within the eIDSR module of the DHIS2 platform. The variables for PHEs data collection include those that identify the type, location, nature and time to response of each PHE. The compendium has been updated with retrospective PHE data and real-time prospective data collection is ongoing. Data within this compendium is being used to generate information that can guide future outbreak response and management. The compendium development highlights the importance of documenting outbreak detection and response data in a central location for future reference. This data provides an opportunity to evaluate and inform improvements in PHEs response.

Improvements in malaria surveillance through the electronic Integrated Disease Surveillance and Response (eIDSR) system in mainland Tanzania, 2013–2021

BackgroundTanzania has made remarkable progress in reducing malaria burden and aims to transition from malaria control to sub-national elimination. In 2013, electronic weekly and monthly reporting platforms using the District Health Information System 2 (DHIS2) were introduced. Weekly reporting was implemented through the mobile phone-based Integrated Disease Surveillance and Response (eIDSR) platform and progressively scaled-up from 67 to 7471 (100%) public and private health facilities between 2013 and 2020. This study describes the roll-out and large-scale implementation of eIDSR and compares the consistency between weekly eIDSR and monthly DHIS2 malaria indicator data reporting, including an assessment of its usefulness for malaria outbreak detection and case-based surveillance (CBS) in low transmission areas.MethodsThe indicators included in the analysis were number of patients tested for malaria, number of confirmed malaria cases, and clinical cases (treated presumptively for malaria). The analysis described the time trends of reporting, testing, test positivity, and malaria cases between 2013 and 2021. For both weekly eIDSR and monthly DHIS2 data, comparisons of annual reporting completeness, malaria cases and annualized incidence were performed for 2020 and 2021; additionally, comparisons were stratified by malaria epidemiological strata (parasite prevalence: very low < 1%, low 1 ≤ 5%, moderate 5 ≤ 30%, and high > 30%).ResultsWeekly eIDSR reporting completeness steadily improved over time, with completeness being 90.2% in 2020 and 93.9% in 2021; conversely, monthly DHIS2 reporting completeness was 98.9% and 98.7% in 2020 and 2021, respectively. Weekly eIDSR reporting completeness and timeliness were highest in the very low epidemiological stratum. Annualized malaria incidence as reported by weekly eIDSR was 17.5% and 12.4% lower than reported by monthly DHIS2 in 2020 and 2021; for both 2020 and 2021, annualized incidence was similar across weekly and monthly data in the very low stratum.ConclusionThe concurrence of annualized weekly eIDSR and monthly DHIS2 reporting completeness, malaria cases and incidence in very low strata suggests that eIDSR could be useful tool for early outbreak detection, and the eIDSR platform could reliably be expanded by adding more indicators and modules for CBS in the very low epidemiological stratum.

Digital Health Solutions and State of Interoperability: Landscape Analysis of Sierra Leone.

BackgroundThe government and partners have invested heavily in the health information system (HIS) for service delivery, surveillance, reporting, and monitoring. Sierra Leone’s government launched its first digital health strategy in 2018. In 2019, a broader national innovation and digital strategy was launched. The health pillar direction will use big data and artificial intelligence (AI) to improve health care in general and maternal and child health in particular. Understanding the number, distribution, and interoperability of digital health solutions is crucial for successful implementation strategies.ObjectiveThis paper presents the state of digital health solutions in Sierra Leone and how these solutions currently interoperate. This study further presents opportunities for big data and AI applications.MethodsAll the district health management teams, all digital health implementing organizations, and a stratified sample of 72 (out of 1284) health facilities were purposefully selected from all health districts and surveyed.ResultsThe National Health Management Information System’s (NHMIS’s) aggregate reporting solution populated by health facility forms HF1 to HF9 was, by far, the most used tool. A health facility–based weekly aggregate electronic integrated disease surveillance and response solution was also widely used. Half of the health facilities had more than 2 digital health solutions in use. The different digital health software solutions do not share data among one another, though aggregate reporting data were sent as necessary. None of the respondents use any of the health care registries for patient, provider, health facility, or terminology identification.ConclusionsMany digital health solutions are currently used at health facilities in Sierra Leone. The government can leverage current investment in HIS from surveillance and reporting for using big data and AI for care. The vision of using big data for health care is achievable if stakeholders prioritize individualized and longitudinal patient data exchange using agreed use cases from national strategies. This study has shown evidence of distribution, types, and scale of digital health solutions in health facilities and opportunities for leveraging big data to fill critical gaps necessary to achieve the national digital health vision.

Cost Analysis of Health Facility Electronic Integrated Disease Surveillance and Response in One District in Sierra Leone.

Global health security depends on effective surveillance systems to prevent, detect, and respond to disease threats. Real-time surveillance initiatives aim to develop electronic systems to improve reporting and analysis of disease data. Sierra Leone, with the support of Global Health Security Agenda partners, developed an electronic Integrated Disease Surveillance and Response (eIDSR) system capable of mobile reporting from health facilities. We estimated the economic costs associated with rollout of health facility eIDSR in the Western Area Rural district in Sierra Leone and projected annual direct operational costs. Cost scenarios with increased transport costs, decreased use of partner personnel, and altered cellular data costs were modeled. Cost data associated with activities were retrospectively collected and were assessed across rollout phases. Costs were organized into cost categories: personnel, office operating, transport, and capital. We estimated costs by category and phase and calculated per health facility and per capita costs. The total economic cost to roll out eIDSR to the Western Area Rural district over the 14-week period was US$64,342, a per health facility cost of $1,021. Equipment for eIDSR was the primary cost driver (45.5%), followed by personnel (35.2%). Direct rollout costs were $38,059, or 59.2% of total economic costs. The projected annual direct operational costs were $14,091, or $224 per health facility. Although eIDSR equipment costs are a large portion of total costs, annual direct operational costs are projected to be minimal once the system is implemented. Our findings can be used to make decisions about establishing and maintaining electronic, real-time surveillance in Sierra Leone and other low-resource settings.

Evaluation of the Implementation and utilisation of a Case Based Diseases Surveillance (electronic Integrated Disease Surveillance and Reporting (eIDSR-CBS)) in the West Nile region: August 2018 to February 2019

Evaluation of the Implementation and utilisation of a Case Based Diseases Surveillance (electronic Integrated Disease Surveillance and Reporting (eIDSR-CBS)) in the West Nile region: August 2018 to February 2019

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.

Establishment of an electronic integrated disease surveillance and response system in Sierra Leone

Purpose: The 2014–16 Ebola epidemic exposed weaknesses within Sierra Leone's disease surveillance system and served as a catalyst to improve detection systems. In 2015, the national Integrated Disease Surveillance and Response (IDSR) system consisted of health facilities (HF) calling/texting or hand-delivering reports to their District Health Management Team (DHMT), DHMT staff entering IDSR data from all HF into a spreadsheet, and each DHMT emailing the file weekly to the national level. When districts lacked adequate bandwidth to upload attachments, DHMT staff emailed a curtailed IDSR data summary to the national level, which jeopardized data timeliness and accuracy. In 2016, Sierra Leone introduced an electronic IDSR (eIDSR) system to gauge feasibility and efficacy in a resource-constrained setting. Methods & Materials: The U.S. Centers for Disease Control and Prevention and eHealth Africa supported the Ministry of Health and Sanitation to establish eIDSR, which transmits data into the web-based District Health Information System (DHIS2). In 2016, district-level eIDSR was piloted then rolled out to all fourteen districts. District-level eIDSR entails HF staff calling the DHMT, then DHMT staff entering data directly into the national DHIS2 database. From 2016–17, facility-level eIDSR was piloted in one district to enable data entry using tablets at all 112 HF in the district, and in 2018, a national scale-up of facility-level eIDSR is underway to reach all 1285 HF in Sierra Leone. Results: After implementing district-level eIDSR, IDSR reporting increased from <40% of HF in 2016 to >97% in 2017, an increase maintained in 2018. The district-level pilot revealed that data-entry time decreased by 63% and errors decreased by 45%. Analyses from the facility-level eIDSR pilot found that data accuracy was 12% higher than data reported through district-level eIDSR. The Joint External Evaluation (JEE) score for real-time surveillance went from “limited” to “developed” capacity between 2016 and 2017. Conclusion: District-level eIDSR improved the timeliness and accuracy of surveillance data. Additional benefits are anticipated with completion of the national scale-up of facility-level eIDSR, and JEE scores are projected to reach the next level of “demonstrated” capacity. Lessons learned in Sierra Leone can inform other low-resource settings considering implementation of electronic disease surveillance systems.

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.

Advancing GHSA: Lessons learned about strengthening HIS and disease surveillance

ObjectiveThe objective is to discuss two decades of international experiencein health information and disease surveillance systems strengtheningand synthesize lessons learned as applicable to implementation of theGlobal Health Security Agenda (GHSA).IntroductionRTI International has worked on enhancing health informationand disease surveillance systems in many countries, includingThe Democratic Republic of the Congo (DRC), Guinea, Indonesia,Kenya, Nepal, Philippines, Tanzania, Zambia, and Zimbabwe.Strengthening these systems is critical for all three of the Prevent,Detect and Respond domains within the Global Health SecurityAgenda.We have deep experience in this area, ranging from implementingDistrict Health Information Software (DHIS), electronic medicalrecords, health facility registries, eHealth national strategies,electronic Integrated Disease Surveillance and Response system(eIDSR), mobile real-time malaria surveillance and response, nationalweekly disease surveillance, patient referral system, and communitybased surveillance. These experiences and lessons learned can informwork being done to advance the GHSA.We will discuss several examples, including activities in Zimbabweand Tanzania. RTI has been working in Zimbabwe for over six yearsto strengthen the national health information system. This workhas included the configuration and roll-out of DHIS 2, the nationalelectronic health information system. In doing so, RTI examinedand revitalized the weekly disease surveillance system, improvingdisease reporting timeliness and completeness from 40% to 90%.Additionally, RTI has integrated mobile technology to help morerapidly communicate laboratory test results, a laboratory informationmanagement systems to manage and guide test sample processing,and various other patient level systems in support of health servicedelivery at the local level. This work has involved capacity buildingwithin the ministry of health to allow for sustainable support of healthinformation systems practices and technology and improvements todata dissemination and use practices.Similarly, RTI has worked for more than five years to helpstrengthening the National HIS in Tanzania. These activities haveincluded stakeholder coordination, developing national eHealthstrategy and enterprise architecture, harmonizing indicators,redesigning routine reporting instruments, national DHIS 2 roll-out,information technology infrastructure management and user helpdesk support, reducing the number of parallel information systems,data dissemination and use, development of district health profiles,development of the national health facility registry, and supportingroll-out of the electronic integrated disease surveillance system.MethodsWe will profile selected projects and synthesize critical lessonslearned that pertain to implementation of the GHSA in resourceconstrained countries.ResultsWe will summarize our experience and lessons learned withhealth information and disease surveillance systems strengthening.Topics such as those that relate to advancing the GHSA RealTime Surveillance and Reporting Action Package areas will bediscussed, including: indicator and event based surveillance systems;interoperable, interconnected, electronic real-time reporting system;analysis of surveillance data; syndromic surveillance systems;systems for efficient reporting to WHO, FAO and OIE; and reportingnetwork and protocols in country.ConclusionsOur experience working over the past 14 years in 9 countrieson different HIS and disease surveillance system strengtheningprojects has led to a deep understanding of the challenges aroundimplementation of these systems in limited resource settings. Theseexperiences and lessons learned can inform initiatives and programsto advance the GHSA.

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.

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.

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.

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.