Multiple Outbreaks Research Articles

Notes from the field: Multiple cyclosporiasis outbreaks — United States, 2018

Notes from the field: Multiple cyclosporiasis outbreaks — United States, 2018

Evolution of corporate reputation during an evolving controversy

PurposeThe purpose of this paper is to investigate the evolution of online sentiments toward a company (i.e. Chipotle) during a crisis, and the effects of corporate apology on those sentiments.Design/methodology/approachUsing a very large data set of tweets (i.e. over 2.6m) about Company A’s food poisoning case (2015–2016). This case was selected because it is widely known, drew attention from various stakeholders and had many dynamics (e.g. multiple outbreaks, and across different locations). This study employed a supervised machine learning approach. Its sentiment polarity classification and relevance classification consisted of five steps: sampling, labeling, tokenization, augmentation of semantic representation, and the training of supervised classifiers for relevance and sentiment prediction.FindingsThe findings show that: the overall sentiment of tweets specific to the crisis was neutral; promotions and marketing communication may not be effective in converting negative sentiments to positive sentiments; a corporate crisis drew public attention and sparked public discussion on social media; while corporate apologies had a positive effect on sentiments, the effect did not last long, as the apologies did not remove public concerns about food safety; and some Twitter users exerted a significant influence on online sentiments through their popular tweets, which were heavily retweeted among Twitter users.Research limitations/implicationsEven with multiple training sessions and the use of a voting procedure (i.e. when there was a discrepancy in the coding of a tweet), there were some tweets that could not be accurately coded for sentiment. Aspect-based sentiment analysis and deep learning algorithms can be used to address this limitation in future research. This analysis of the impact of Chipotle’s apologies on sentiment did not test for a direct relationship. Future research could use manual coding to include only specific responses to the corporate apology. There was a delay between the time social media users received the news and the time they responded to it. Time delay poses a challenge to the sentiment analysis of Twitter data, as it is difficult to interpret which peak corresponds with which incident/s. This study focused solely on Twitter, which is just one of several social media sites that had content about the crisis.Practical implicationsFirst, companies should use social media as official corporate news channels and frequently update them with any developments about the crisis, and use them proactively. Second, companies in crisis should refrain from marketing efforts. Instead, they should focus on resolving the issue at hand and not attempt to regain a favorable relationship with stakeholders right away. Third, companies can leverage video, images and humor, as well as individuals with large online social networks to increase the reach and diffusion of their messages.Originality/valueThis study is among the first to empirically investigate the dynamics of corporate reputation as it evolves during a crisis as well as the effects of corporate apology on online sentiments. It is also one of the few studies that employs sentiment analysis using a supervised machine learning method in the area of corporate reputation and communication management. In addition, it offers valuable insights to both researchers and practitioners who wish to utilize big data to understand the online perceptions and behaviors of stakeholders during a corporate crisis.

Dexamethasone treatment did not exacerbate Seneca Valley virus infection in nursery-age pigs

BackgroundSenecavirus A, commonly known as Seneca Valley virus (SVV), is a picornavirus that has been infrequently associated with porcine idiopathic vesicular disease (PIVD). In late 2014 there were multiple PIVD outbreaks in several states in Brazil and samples from those cases tested positive for SVV. Beginning in July of 2015, multiple cases of PIVD were reported in the United States in which a genetically similar SVV was also detected. These events suggested SVV could induce vesicular disease, which was recently demonstrated with contemporary US isolates that produced mild disease in pigs. It was hypothesized that stressful conditions may exacerbate the expression of clinical disease and the following experiment was performed. Two groups of 9-week-old pigs were given an intranasal SVV challenge with one group receiving an immunosuppressive dose of dexamethasone prior to challenge. After challenge animals were observed for the development of clinical signs and serum and swabs were collected to study viral shedding and antibody production. In addition, pigs were euthanized 2, 4, 6, 8, and 12 days post inoculation (dpi) to demonstrate tissue distribution of virus during acute infection.ResultsVesicular disease was experimentally induced in both groups with the duration and magnitude of clinical signs similar between groups. During acute infection [0–14 days post infection (dpi)], SVV was detected by PCR in serum, nasal swabs, rectal swabs, various tissues, and in swabs from ruptured vesicles. From 15 to 30 dpi, virus was less consistently detected in nasal and rectal swabs, and absent from most serum samples. Virus neutralizing antibody was detected by 5 dpi and lasted until the end of the study.ConclusionTreatment with an immunosuppressive dose of dexamethasone did not drastically alter the clinical disease course of SVV in experimentally infected nursery aged swine. A greater understanding of SVV pathogenesis and factors that could exacerbate disease can help the swine industry with control and prevention strategies directed against this virus.

Zoonotic disease research in East Africa

BackgroundThe East African region is endemic with multiple zoonotic diseases and is one of the hotspots for emerging infectious zoonotic diseases with reported multiple outbreaks of epidemic diseases such as Ebola, Marburg and Rift Valley Fever. Here we present a systematic assessment of published research on zoonotic diseases in the region and thesis research in Kenya to understand the regional research focus and trends in publications, and estimate proportion of theses research transitioning to peer-reviewed journal publications.MethodsWe searched PubMed, Google Scholar and African Journals Online databases for publications on 36 zoonotic diseases identified to have occurred in the East Africa countries of Burundi, Ethiopia, Kenya, Tanzania, Rwanda and Uganda, for the period between 1920 and 2017. We searched libraries and queried online repositories for masters and PhD theses on these diseases produced between 1970 and 2016 in five universities and two research institutions in Kenya.ResultsWe identified 771 journal articles on 22, and 168 theses on 21 of the 36 zoonotic diseases investigated. Research on zoonotic diseases increased exponentially with the last 10 years of our study period contributing more than half of all publications 460 (60%) and theses 102 (61%) retrieved. Endemic diseases were the most studied accounting for 656 (85%) and 150 (89%) of the publication and theses studies respectively, with publications on epidemic diseases associated with outbreaks reported in the region or elsewhere. Epidemiological studies were the most common study types but limited to cross-sectional studies while socio-economics were the least studied. Only 11% of the theses research transitioned to peer-review publications, taking an average of 2.5 years from theses production to manuscript publication.ConclusionOur findings demonstrate increased attention to zoonotic diseases in East Africa but reveal the need to expand the scope, focus and quality of studies to adequately address the public health, social and economic threats posed by zoonoses.

Genomic Epidemiology of Campylobacter jejuni Transmission in Israel.

Objectives: Campylobacter jejuni is responsible for 80% of Campylobacter infections in Israel, a country with a high incidence reaching 91/100,000 population. We studied the phylogeny, diversity and prevalence of virulence factors using whole genome sequencing (WGS) of a national sample of C. jejuni clinical, food, and animal isolates collected over a 10-year period (2003–2012).Methods: C. jejuni isolates (n = 263) were subject to WGS using Illumina sequencing (PE 250bpx2). Raw reads and de novo assemblies were analyzed with the BioNumerics whole genome MLST (wgMLST) pipeline. Reads were screened for 71 virulence genes by the SRST2 script. Allelic profiles were analyzed to create minimum spanning trees and allelic core distances were investigated to determine a reliable cutoff for strain determination.Results: wgMLST analysis of 263 C. jejuni isolates indicated significant diversity among the prevalent clonal complexes (CCs) with CC-21 and CC-353 being the most diverse, and CC-574 the most clonal. Within CC-21, sequence type (ST)-1359 created a separate clade. Human, poultry and bovine isolates clustered together across the different STs. Forty four percent of studied isolates were assigned to 29 genetic clusters. Temporal and geographical relatedness were found among the minority of clusters, while most phylogenetically associated cases appeared diffuse and unassociated epidemiologically. The majority of virulence factors were highly prevalent across the dataset and not associated with genotype, source of isolation or invasiveness. Conversely, all 13 genes associated with type VI secretion system (T6SS) were lineage-related and identified in only 18% of the isolates. T6SS was detected in 95.2% of ST-1359, a common type in Israel.Conclusions: wgMLST supported the assessment that poultry and cattle are likely food sources of infection in Israel. Substantial genetic clustering among C. jejuni isolates suggested multiple point source and diffuse outbreaks that were previously unreported in Israel. The high prevalence of T6SS among ST-1359 isolates is unique to Israel, and requires further investigation. This study exemplifies the importance of studying foodborne pathogens using advanced genomic approaches across the entire spectrum of One Health.

Isolation and characterization of H5Nx highly pathogenic avian influenza viruses of clade 2.3.4.4 in Russia

In 2016–2017, several subtypes of the highly pathogenic avian influenza (HPAI) virus were isolated on the territory of Russia. In the autumn of 2016, during the avian influenza virus surveillance in the territory of the Kamchatka region of Russia the HPAI A(H5N5) influenza virus was isolated. Then, during 2016–2017, multiple outbreaks among wild birds and poultry caused by HPAI A(H5N8) avian influenza virus were recorded in European part of Russia. At the end of 2017, an outbreak among poultry caused by HPAI A(H5N2) influenza virus was recorded in the European part of Russia. Phylogenetic analysis of HA of the A(H5N5), A(H5N8), A(H5N2) showed the strains belong to the clade 2.3.4.4 b. All isolated strains were antigenically closely related to candidate vaccine viruses of clade 2.3.4.4 and showed high virulence in mice. Genetic analysis revealed presence of genetic markers potentially related to high virulence in mice in all studied viruses.

Development and comparison of two H5N8 influenza A vaccine candidate strains.

Avian influenza viruses circulating in birds have caused outbreaks of infection in poultry and humans, thereby threatening public health. Recently, a highly pathogenic avian influenza (HPAI) virus (H5N8) of clade 2.3.4.4 emerged in Korea and other countries and caused multiple outbreaks in domestic and wild birds, with concerns for human infection. To combat HPAI viral infections, novel vaccines are likely to be the most effective approach. Therefore, in this study, we generated H5N8 vaccine candidate viruses based on a Korean isolate (A/broiler duck/Korea/Buan2/2014). The vaccine candidate viruses were 2:6 reassortants expressing the two surface glycoproteins of A/broiler duck/Korea/Buan2/2014 on an A/Puerto Rico/8/34 (PR8) backbone generated by using an eight-plasmid-based reverse genetics system with or without replacement of the multi-basic amino acid cleavage motif (MBCM, a crucial pathogenic factor in HPAI virus) with a bi-basic amino acid cleavage motif (BBCM) in their HA. An H5N8 vaccine candidate virus containing the BBCM showed attenuated pathogenesis in embryonated eggs and exhibited less virulence in the infected mice compared with the wild H5N8 virus containing an MBCM. Vaccination with an inactivated preparation of the vaccine candidate virus protected mice from lethal H5N8 viral challenge. This is the first report of the development and evaluation of H5N8 vaccine strains (with an MBCM or BBCM) of HA clade 2.3.4.4 as vaccine candidates. Our findings suggest that H5N8 strains with a BBCM instead of an MBCM might be considered for H5N8 vaccine seed virus development or as a reference vaccine against H5N8 viral strains.

Notes from the Field: Multiple Cyclosporiasis Outbreaks - United States, 2018.

The 2018 outbreak season is noteworthy for multiple outbreaks of cyclosporiasis associated with different fresh produce items and the large number of reported cases. In 2018, two multistate outbreaks resulted in 761 laboratory-confirmed cases.

Genetic variability of Panstrongylus geniculatus (Reduviidae: Triatominae) in the Metropolitan District of Caracas, Venezuela

Panstrongylus geniculatus has become the most frequently registered vector of Chagas disease in the metropolitan area of Caracas, Venezuela. This triatomine species has invaded urban areas in recent years and has been implicated in multiple oral outbreaks of Chagas disease in the region. The study of genetic variability and spatial structure in P. geniculatus populations can provide information about possible events of domiciliation and aid intervention programs against triatomine species rapidly adapting to urban ecotopes. We sequenced a region of the cytochrome-b gene in 114 specimens of P. geniculatus from the Metropolitan District of Caracas and assessed patterns of gene flow and phylogenetic relationships among these individuals. A total of 29 haplotypes were detected in the two sampled municipalities, Sucre and Libertador. Though high genetic connectivity was observed between the municipalities (FST = 0.10796; Nm = 11.20), subtle genetic structuring was also observed in particular geographic sub regions. Based on neutrality tests and the observed allele-frequency distribution, the Panstrongylus geniculatus population appears to be expanding and adapting to different microhabitats present in the study area. Our findings affirm the capacity of this insect to adapt to different environments and emphasize its principal role in the epidemiology of Chagas disease in northern Venezuela.

Characteristics of Large Mumps Outbreaks in the United States, July 2010-December 2015.

Mumps is an acute viral illness that classically presents with parotitis. Although the United States experienced a 99% reduction in mumps cases following implementation of the 2-dose vaccination program in 1989, mumps has resurged in the past 10 years. We assessed the epidemiological characteristics of mumps outbreaks with ≥20 cases reported in the United States electronically through the National Notifiable Diseases Surveillance System and from supplemental outbreak data through direct communications with jurisdictions from July 2010 through December 2015. Mumps cases were defined using the 2012 Council of State and Territorial Epidemiologists case definition. Twenty-three outbreaks with 20-485 cases per outbreak were reported in 18 jurisdictions. The duration of outbreaks ranged from 1.5 to 8.5 months (median, 3 months). All outbreaks involved close-contact settings; 18 (78%) involved universities, 16 (70%) occurred primarily among young adults (median age, 18-24 years), and 9 (39%) occurred in highly vaccinated populations (2-dose measles-mumps-rubella vaccine coverage ≥85%). During 2010-2015, multiple mumps outbreaks among highly vaccinated populations in close-contact settings occurred. Most cases occurred among vaccinated young adults, suggesting that waning immunity played a role. Further evaluation of risk factors associated with these outbreaks is warranted.

Identification of a conserved neutralizing epitope in the G-protein of Chandipura virus.

Chandipura virus (CHPV), associated with an encephalitic illness in humans, has caused multiple outbreaks with high mortality in central and western India in recent years. The present study compares surface glycoprotein (G-protein) from prototype and recent outbreak strains using in silico tools and in vitro experiments. In silico epitope predictions (B-cell and T-helper cell) for the sequences, 3D structure prediction and comparison of the G-proteins of the strains: I653514 (Year 1965), CIN0327 (Year 2003) and 148974 (Year 2014) revealed that the CHPV G-protein is stable and antigenic determinants are conserved. A monoclonal antibody developed against strain CIN0327 (named NAbC) was found to neutralize prototype I653514 as well as the currently circulating strain 148974. In silico antigen-antibody interaction studies using molecular docking of predicted structures of NAbC and G-proteins of various CHPV strains led to the identification of a conserved neutralizing epitope in the fusion domain of G-protein, which also contained a putative T-helper peptide. The identification of a conserved neutralizing epitope in domain IV (fusion domain amino acids 53 to 172) of CHPV G-protein is an important finding that may have the scope towards the development of protective targets against CHPV infection.

Stochastic dynamics of an epidemic with recurrent spillovers from an endemic reservoir

Most emerging human infectious diseases have an animal origin. While zoonotic diseases originate from a reservoir, most theoretical studies have principally focused on single-host processes, either exclusively humans or exclusively animals, without considering the importance of animal to human transmission (i.e. spillover transmission) for understanding the dynamics of emerging infectious diseases. Here we aim to investigate the importance of spillover transmission for explaining the number and the size of outbreaks. We propose a simple continuous time stochastic Susceptible-Infected-Recovered model with a recurrent infection of an incidental host from a reservoir (e.g. humans by a zoonotic species), considering two modes of transmission, (1) animal-to-human and (2) human-to-human. The model assumes that (i) epidemiological processes are faster than other processes such as demographics or pathogen evolution and that (ii) an epidemic occurs until there are no susceptible individuals left. The results show that during an epidemic, even when the pathogens are barely contagious, multiple outbreaks are observed due to spillover transmission. Overall, the findings demonstrate that the only consideration of direct transmission between individuals is not sufficient to explain the dynamics of zoonotic pathogens in an incidental host.

Multiple outbreaks in epidemic spreading with local vaccination and limited vaccines

How to prevent the spread of human diseases is a great challenge for the scientific community and so far there are many studies in which immunization strategies have been developed. However, these kind of strategies usually do not consider that medical institutes may have limited vaccine resources available. In this manuscript, we explore the susceptible-infected-recovered model with local dynamic vaccination, and considering limited vaccines. In this model, susceptibles in contact with an infected individual, are vaccinated -with probability ω- and then get infected -with probability β. However, when the fraction of immunized individuals reaches a threshold VL, the vaccination stops, after which only the infection is possible. In the steady state, besides the critical points βc and ωc that separate a non-epidemic from an epidemic phase, we find for a range of VL another transition points, β* > βc and ω* < ωc, which correspond to a novel discontinuous phase transition. This critical value separates a phase where the amount of vaccines is sufficient, from a phase where the disease is strong enough to exhaust all the vaccination units. For a disease with fixed β, the vaccination probability ω can be controlled in order to drastically reduce the number of infected individuals, using efficiently the available vaccines. Furthermore, the temporal evolution of the system close to β* or ω*, shows that after a peak of infection the system enters into a quasi-stationary state, with only a few infected cases. But if there are no more vaccines, these few infected individuals could originate a second outbreak, represented by a second peak of infection. This state of apparent calm, could be dangerous since it may lead to misleading conclusions and to an abandon of the strategies to control the disease.

Zika Virus: A Review of Literature.

Zika virus (ZIKV) is an arthropod-borne virus that was first isolated in 1947. Since then, multiple outbreaks of ZIKV have been reported in different countries. It is transmitted mostly by Aedes mosquitoes, and the symptoms of fever, joint pain, red eyes, headache, and maculopapular rash closely resemble chikungunya and dengue. The most severe complications of ZIKV infection include the risk of microcephaly and other congenital brain anomalies in infected pregnant women. It is a condition that can be easily prevented with proper education. In this review, we focussed on different aspects of the recent outbreaks of Zika virus disease, including its epidemiological background, transmission routes, presentation, as well as diagnosis and prevention.

Attachment of Salmonella enterica on Mangoes and Survival Under Conditions Simulating Commercial Mango Packing House and Importer Facility.

Consumption of raw mangoes has led to multiple Salmonella-associated foodborne outbreaks in the United States. Although several studies have investigated the epiphytic fitness of Salmonella on fresh produce, there is sparse information available on the survival of Salmonella on mangoes under commercial handling and storage conditions. Hence, the objective of the study was to evaluate the survival of Salmonella on mangoes under ambient conditions simulating the mango packing house and importer facility. Further, the ability of the pathogen to adhere and attach on to the mango fructoplane was also investigated. For the attachment assays, mango skin sections were inoculated with fifty microliters of S. Newport suspension (6.5 log CFU/skin section) and minimum time required for adhesion and attachment were recorded. With the survival assays, unwaxed mangoes were spot inoculated with the Salmonella cocktail to establish approximately 4 and 6.5 log CFU/mango. The fruits were then subjected to different storage regimens simulating fruit unloading, waxing, and storage at the packing house and ripening and storage at the importer facility. Results of our study reveal that Salmonella was able to adhere on to the fructoplane immediately after contact. Further, formation of attachment structures was seen as early as 2 min following inoculation. With the survival assays, irrespective of the inoculum levels, no significant increase or decrease in pathogen population was observed when fruit were stored either at ambient (29–32°C and RH 85–95%, for 48 h), ripening (20–22°C and RH 90–95% for 9 days) or refrigerated storage (10–15°C and 85–95% for 24–48 h) conditions. Therefore, once contaminated, mangoes could serve as potential vehicles in the transmission of Salmonella along the post-harvest environment. Hence development and adoption of effective food safety measures are warranted to promote the microbiological safety of mangoes.

The Anti-vaccination Movement: A Regression in Modern Medicine.

There have been recent trends of parents in Western countries refusing to vaccinate their children due to numerous reasons and perceived fears. While opposition to vaccines is as old as the vaccines themselves, there has been a recent surge in the opposition to vaccines in general, specifically against the MMR (measles, mumps, and rubella) vaccine, most notably since the rise in prominence of the notorious British ex-physician, Andrew Wakefield, and his works. This has caused multiple measles outbreaks in Western countries where the measles virus was previously considered eliminated. This paper evaluates and reviews the origins of the anti-vaccination movement, the reasons behind the recent strengthening of the movement, role of the internet in the spread of anti-vaccination ideas, and the repercussions in terms of public health and safety.

Did Zika Virus Mutate to Cause Severe Outbreaks?

Zika virus (ZIKV) has challenged the assumed knowledge regarding the pathobiology of flaviviruses. Despite causing sporadic and mild disease in the 50 years since its discovery, Zika virus has now caused multiple outbreaks in dozens of countries worldwide. Moreover, the disease severity in recent outbreaks, with neurological disease in adult and devastating congenital malformations in fetuses, was not previously seen. One hypothesis is that the virus has acquired mutations that have increased its virulence. Indeed, mutations in other arboviruses, such as West Nile virus (WNV), chikungunya virus (CHIKV), and Venezuelan equine encephalitis virus (VEEV), have enhanced outbreaks. This possibility, as well as alternative hypotheses, are explored here.

Enhancing preparation for large Nipah outbreaks beyond Bangladesh: Preventing a tragedy like Ebola in West Africa

The Nipah virus has been transmitted from person-to-person via close contact in non-urban parts of India (including Kerala May 2018), Bangladesh, and the Philippines. It can cause encephalitis and pneumonia, and has a high case fatality rate. Nipah is a One Health zoonotic infectious disease linked to fruit bats, and sometimes pigs or horses. We advocate anticipating and preparing for urban and larger rural outbreaks of Nipah. Immediate enhanced preparations would include standardized guidance on infection prevention and control, and personal protective equipment, from the World Health Organization (WHO) on their OpenWHO website and 2018 “Managing Epidemics” handbook, along with adding best clinical practices by experts in countries with multiple outbreaks such as Bangladesh and India. Longer-term enhanced preparations include accelerating development of field diagnostics, antiviral drugs, immune-based therapies, and vaccines. WHO-coordinated multi-partner protocols to test investigational treatments, diagnostics, and vaccines are needed, by analogy to such protocols for Ebola during the unanticipated pan-epidemic in Guinea, Liberia, and Sierra Leone. Anticipating and preparing now for urban and rural Nipah outbreaks in nations with no experience with Nipah will help avoid the potential for what the United Nations 2016 report on Ebola in West Africa called a “preventable tragedy”.

Prevalence of Inadequate Immunity to Measles, Mumps, Rubella, and Varicella in MLB and NBA Athletes.

Background:Multiple outbreaks of vaccine-preventable viral diseases have occurred in professional sports in recent years. Currently, there is no established protocol for vaccination or immunity screening for professional athletes.Hypothesis:There are significant differences in the prevalence of inadequate immunity dependent on age, sport, country of birth, and participation in collegiate sports.Study Design:Cross-sectional cohort study.Level of Evidence:Level 4.Methods:A sample of Major League Baseball (MLB) and National Basketball Association (NBA) players were screened for serologic evidence of immunity to measles, mumps, rubella, and varicella prior to the 2015 and 2016 seasons. The results were designated as adequate (immune) or inadequate (equivocal or nonimmune) based on laboratory criteria. Comparison with an age-matched control group was performed using data from the National Health and Nutrition Examination Survey (NHANES).Results:A total of 98 athletes (62 MLB, 36 NBA) were screened. The prevalence of inadequate immunity for any virus was 35.5% in MLB players and 33.3% in NBA players. There was a significantly greater risk of inadequate immunity to rubella (risk ratio, 6.38; P < 0.01) and varicella (risk ratio, 4.21; P < 0.01) in athletes compared with the age-matched NHANES population. Our analysis did not reveal differences in rates of immunity based on sport, country of birth (US born vs international), or participation in college athletics. There was a lower rate of inadequate immunity to varicella with increasing age (odds ratio, 0.72; P = 0.05).Conclusion:One-third of athletes studied had inadequate immunity to 1 of the 4 viruses tested. Younger players had a significantly greater risk of inadequate immunity to varicella. Birth outside the US and lack of participation in college athletics were not found to influence immunity rates.Clinical Relevance:These results can inform the development of future screening programs to prevent outbreaks of viral infections in professional athletes.

Analytics for Investigation of Disease Outbreaks (AIDO)

Objective: Analytics for the Investigation of Disease Outbreaks (AIDO) is a web-based tool designed to enhance a user’s understanding of unfolding infectious disease events. A representative library of over 650 outbreaks across a wide selection of diseases allows similar outbreaks to be matched to the conditions entered by the user. These historic outbreaks contain detailed information on how the disease progressed as well as what measures were implemented to control its spread, allowing for a better understanding within the context of other outbreaks.Introduction: Situational awareness, or the understanding of elemental components of an event with respect to both time and space, is critical for public health decision-makers during an infectious disease outbreak. AIDO is a web-based tool designed to contextualize incoming infectious disease information during an unfolding event for decision-making purposes.Methods: Public health analysts of the Biology Division at Los Alamos National Laboratory curated a diverse library of historic disease outbreaks from publicly available official reports and peer reviewed literature to serve as a representation of the range of potential outbreak scenarios for a given disease. Available outbreak metadata are used to identify properties that relate to the magnitude and/or duration of the outbreak. Properties vary by disease, as they are related to disease-specific characteristics like transmission, disease manifestation, risk factors related to disease severity, and environmental factors specific to the given location. These properties are then incorporated into a similarity algorithm (s in Figure 1) to identify outbreaks that are similar to user inputs.Results: AIDO currently includes libraries for 39 diseases that are diverse across pathogen type (viral, bacterial and parasitic) as well as transmission type (vectorborne (e.g., Dengue, Malaria), foodborne (e.g., Salmonella, Campylobacteriosis), waterborne (e.g., Cholera), and person-to-person transmitted (e.g., Measles)). In addition to providing a similarity score to the user’s outbreak, we provide aggregated comparisons to multiple historical outbreaks, descriptive statistics to show the distribution of property values for each disease, and extensive contextual information about each outbreak.Conclusions: The analytics provided by AIDO allow users to interact with a unique data set of historic outbreaks and the associated metadata to contextualize incoming information and generate hypotheses about appropriate decisions. The tool is continually updated with new functionalities and additional data.