EPICORE: AN INNOVATIVE GLOBAL DISEASE SURVEILLANCE TOOL FOR HUMAN, ANIMAL, AND ENVIRONMENTAL PUBLIC HEALTH EVENTS

EpiCore was launched in 2013 and is a tool designed to supplement traditional infectious disease surveillance efforts by bringing together human, animal, and environmental experts on a digital platform to provide field-based verification efforts of global public health events1,2. Public health professionals from organizations around the globe, including Ending Pandemics, HealthMap, Geosentinel, MSF-OCBA, ProMED, and EDIS-RSOE, are trained as Moderators and are able to send Requests for Information (RFIs). Moderators utilize nontraditional resources, such as social media and news articles, to identify potential health events. Through EpiCore, moderators send out a RFI to EpiCore members located in a geographic area where a new or known health event is occurring. Health experts who receive the RFI may anonymously respond with information about the health event. A moderator reviews the responses and determines whether the information verifies a new event or updates a known ongoing event. Verified and updated events are summarized and published on the EpiCore public dashboard and shared with WHO EIOS. The study period was January 2020 - July 2022. In the study period, 231 RFIs were sent requesting signals about potential health events;111 of those RFIs received responses with information that allowed moderators to confirm or negate a suspected event, or update a known ongoing event. 82% of those RFIs were responded to within 24 hours. EpiCore is a resource for public health professionals and organizations to supplement traditional infectious disease surveillance efforts. For example, information collected through EpiCore was used to provide timely details on the emerging COVID-19 outbreak in Wuhan, China in January 2020. Additionally, responses to RFIs supported surveillance efforts of the 2022 global monkeypox outbreak. Future efforts include outreach and engagement with existing and new members to expand EpiCore's member base in countries with few to no members. [ FROM AUTHOR] Copyright of International Journal of Infectious Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Global Health: An Agile Open-Source Repository of Infectious Disease Outbreaks to Support Global Surveillance and Research Efforts

Intro: The COVID-19 pandemic highlighted a need for an open-source repository of line-list case data for infectious disease surveillance and research efforts. Global.health was launched in January 2020 as a global resource for public health data research. Here, we describe the data and systems underlying the Global.health datasets and summarize the project's 2.5 years of operations and the curation of the COVID-19 and monkeypox repositories. Method(s): The COVID-19 repository is curated daily through an automated system, verified by a team of researchers. The monkeypox dataset is curated manually by a team of researchers, Monday-Friday. Both repositories include metadata fields on demographics, symptomology, disease confirmation date, and others1,2. Data is de-identified and ingested from trusted sources, such as government public health agencies, trusted media outlets, and established openaccess repositories. Finding(s): The Global.health COVID-19 dataset is the largest repository of publicly available validated line-list data in the world, with over 100 million cases from more than 100 countries, including 60+ fields of metadata, comprising over 1 billion unique data points. The monkeypox dataset has over 35,000 data entries, from 100 different countries. 7,325 users accessed the COVID-19 repository and 3,005 accessed the monkeypox repository. Conclusion(s): The Global.health repositories provide verified, de-identified case data for two global outbreaks and are used by CDC, WHO, and other national public health organizations for surveillance and forecasting efforts. The repositories were utilized to share insights into the COVID-19 pandemic and track the monkeypox outbreak using real-time data3-6. We are collaborating with WHO Hub for Pandemic and Epidemic Intelligence to improve coordination, data schemas, and downstream use of data to inform and evaluate public health policy7. Future work will focus on creating a 'turnkey' data system to be used in future outbreaks for quicker infectious disease surveillance.Copyright © 2023

Data curation during a pandemic and lessons learned from COVID-19

Detailed, accurate data related to a disease outbreak enable informed public health decision making. Given the variety of data types available across different regions, global data curation and standardization efforts are essential to guarantee rapid data integration and dissemination in times of a pandemic.

Assessing the asymptomatic proportion of SARS-CoV-2 infection with age in China before mass vaccination

Some asymptomatic individuals carrying SARS-CoV-2 can transmit the virus and contribute to outbreaks of COVID-19. Here, we use detailed surveillance data gathered during COVID-19 resurgences in six cities of China at the beginning of 2021 to investigate the relationship between asymptomatic proportion and age. Epidemiological data obtained before mass vaccination provide valuable insights into the nature of pathogenicity of SARS-CoV-2. The data were collected by multiple rounds of city-wide PCR testing with contact tracing, where each patient was monitored for symptoms through the whole course of infection. The clinical endpoint (asymptomatic or symptomatic) for each patient was recorded (the pre-symptomatic patients were classified as symptomatic). We find that the proportion of infections that are asymptomatic declines with age (coefficient = -0.006, 95% CI: -0.008 to -0.003, p < 0.01), falling from 42% (95% CI: 6-78%) in age group 0-9 years to 11% (95% CI: 0-25%) in age group greater than 60 years. Using an age-stratified compartment model, we show that this age-dependent asymptomatic pattern, together with the distribution of cases by age, can explain most of the reported variation in asymptomatic proportions among cities. Our analysis suggests that SARS-CoV-2 surveillance strategies should take account of the variation in asymptomatic proportion with age.

If you build it, will they vaccinate? The impact of COVID-19 vaccine sites on vaccination rates and outcomes

Safe and effective vaccines have vastly reduced the lethality of the COVID-19 pandemic worldwide, but disparities exist in vaccine take-up. Although the out-of-pocket price is set to zero in the U.S., time (information gathering, signing up, transportation and waiting) and misinformation costs still apply. To understand the extent to which geographic access impacts COVID-19 vaccination take-up rates and COVID-19 health outcomes, we leverage exogenous, pre-existing variation in locations of retail pharmacies participating the U.S. federal government's vaccine distribution program through which over 40% of US vaccine doses were administered. We use unique data on nearly all COVID-19 vaccine administrations in 2021. We find that the presence of a participating retail pharmacy vaccination site in a county leads to an approximately 26% increase in the per-capita number of doses administered, possibly indicating that proximity and familiarity play a substantial role in vaccine take-up decisions. Increases in county-level per capita participating retail pharmacies lead to an increase in COVID-19 vaccination rates and a decline in the number of new COVID-19 cases, hospitalizations, and deaths, with substantial heterogeneity based on county rurality, political leanings, income, and race composition. The relationship we estimate suggests that averting one COVID-19 case, hospitalization, and death requires approximately 25, 200, and 1,500 county-level vaccine total doses, respectively. These results imply a 9,500% to 22,500% economic return on the full costs of COVID-19 vaccination. Overall, our findings add to understanding vaccine take-up decisions for the design of COVID era and other public health interventions.

Assessing the Shift in Reasoning for COVID-19 Vaccine Hesitancy in the United States Using a Six-Month Cross-Sectional Analysis from December 2020 to June 2021

Purpose Vaccine hesitancy's increasing prevalence in the U.S. is hindering COVID-19 vaccination efforts. Understanding why individuals are vaccine hesitant can establish paths to increase vaccinations. As the COVID-19 vaccine landscape develops, reasons for hesitancy have likely shifted over time. Methods & Materials We gathered 757,618 responses between December 6, 2020, and June 13, 2021, from a validated web survey administered by OutbreaksNearMe.org on Momentive.ai. From December 6 to January 11, individuals self-reported on willingness to receive a COVID-19 vaccine, and starting January 12, their COVID-19 vaccination status. Those who indicated being unsure or not planning to get vaccinated were prompted to report their reasoning (non-exclusive.) Proportions of reasoning were calculated as the number indicating that reason over the total question responses. Proportions were compared across time intervals with significant vaccine, pandemic guideline, and political occurrences. Results 47.1% of the study population are vaccinated, 11.5% are unsure about vaccination, and 11.9% have no plans to get vaccinated. Prior to vaccine approval, 47.2% indicated enough hesitancy to delay vaccination, and 10.8% indicated not wanting any potential COVID-19 vaccine. Overall, the top reported hesitancy reasons were ‘The vaccine being too new/not enough data’ (60.8%) and ‘Concerns about side effects’ (60.0%). ‘Lack of trust in government’ and ‘Lack of trust in scientists’ were less prevalent initially (28.1% and 11.0%), but have been increasing since January 2021, reaching 50.2% and 40.2% in June. ‘COVID-19 being an exaggerated threat’ also follows this trend, starting at 8.7% and reaching 31.6%. ‘Already had COVID-19’ and ‘Never get any vaccine’ are also increasing in prevalence across time, at a slower rate. Different hesitancy reasons have steeper increases throughout the study period corresponding to certain events like new guidelines for vaccinated persons. Conclusion Concerns surrounding side effects and the vaccines’ newness were consistently the top reasons for COVID-19 vaccine hesitancy across the study population. Higher prevalence of lack of trust in government, science, and COVID-19 being exaggerated reasoning have been observed over time. Hesitancy reasoning seems somewhat influenced by significant events, however, those still not getting vaccinated have different reasoning for their hesitancy than was observed earlier in the pandemic.