Halting Epidemics at the Outset: Community-Based Surveillance (CBS) in an Epidemic Preparedness Model for Early Detection and Early Action

ABSTRACT

Purpose: An innovative epidemic preparedness model establishing an SMS real-time community-based surveillance (CBS) system enables earlier detection and earlier action to control outbreaks at the outset. Methods & Materials The One Health preparedness program has been piloted in 5 countries Guinea, Indonesia, Kenya, Sierra Leone and Uganda, since 2019. A tiered model building on a foundation of volunteer skill-building, community health and epidemic awareness activities, building trust and motivating communities, and establishing connections with local health and veterinary authorities. CBS extends on that foundation establishing a simple, low-cost, real-time system for community volunteers to identify and notify of potentially serious health events triggering investigation and response by local authorities. Communities are prepared to take immediate actions to halt the spread. Materials and methodology are standardised mobile phone SMS to signal alerts, Kobo application to log and monitor alerts, training packages, and job aids. Results: Volunteers and communities have successfully raised CBS alerts, taken action, and controlled outbreaks of measles, polio, acute watery diarrhoea, anthrax and rabies which minimised the spread and impact. To be effective CBS must achieve timely notification of alerts, accuracy to minimise needless investigation, action must be taken, and volunteers must remain engaged. Results from July 2020 – March 2021 show successful rapid notification 76% of alerts were communicated to authorities within 24hrs. Volunteers accurately recognised the key signs for 77% of alerts. Owing to the relationships with local Government an average of 75% of alerts were investigated, although human health alerts have higher investigation rates than animal alerts. Volunteer reliability fluctuates from 44% to 88% across the 5 countries. Positive predictive value for human alerts is high in most countries;63% of alerts overall were confirmed positive as epidemic diseases. This established CBS system has readily incorporated detection of COVID-19 and been rapidly scaled-up during Ebola high-alert demonstrating agility for detection of emerging threats. Conclusion: Communities themselves have the potential to identify and combat epidemic threats. Preparedness programs which engage communities, build skills, establish simple and effective surveillance mechanisms and connect with local service providers, can control outbreaks at the outset and communities can enjoy greater resilience.