The peculiar epidemiology of dracunculiasis in Chad.

Dracunculiasis was rediscovered in Chad in 2010 after an apparent absence of 10 years. In April 2012 active village-based surveillance was initiated to determine where, when, and how transmission of the disease was occurring, and to implement interventions to interrupt it. The current epidemiologic pattern of the disease in Chad is unlike that seen previously in Chad or other endemic countries, i.e., no clustering of cases by village or association with a common water source, the average number of worms per person was small, and a large number of dogs were found to be infected. Molecular sequencing suggests these infections were all caused by Dracunculus medinensis. It appears that the infection in dogs is serving as the major driving force sustaining transmission in Chad, that an aberrant life cycle involving a paratenic host common to people and dogs is occurring, and that the cases in humans are sporadic and incidental.

Research priorities for syndromic surveillance systems response: consensus development using nominal group technique.

OBJECTIVE: To identify a set of fundable and practically feasible research priorities in the field of syndromic surveillance response on the basis of expert consensus. METHODS: The nominal group technique was used to structure an expert panel meeting in February 2009. Eleven national experts participated in the meeting, representing health departments at the city, county, state, and federal levels as well as academia and the military. RESULTS: The expert panel identified 3 research topics as consensus research priorities. These included the following: (1) How should different types of evidence and complementary data systems be integrated (merging data, visualizations)? (2) How can syndromic surveillance best be used in an electronic medical record environment? and (3) What criteria should be used to prioritize alerts? All identified research priorities were considered to be moderately highly fundable and feasible by an external group of experts with a record of obtaining grant funding in the field of biosurveillance. CONCLUSIONS: Prioritized research needs clustered around the common theme of how best to integrate diverse types and sources of information to inform action; thus, the major challenge that health departments are facing appears to be how to process abundant alert data from dissimilar sources. The nominal group technique in this study provided a method for systems' monitors to communicate their needs to the research community and can influence the commissioning of research by funding institutions.

A survey of usage protocols of syndromic surveillance systems by state public health departments in the United States.

OBJECTIVE: To broadly describe current syndromic surveillance systems in use throughout the United States and to provide basic descriptive information on responses to syndromic system signals. METHODS: Cross-sectional survey (telephone and e-mail) of state epidemiologists in all 50 states and the District of Columbia. RESULTS: Forty-one states participated in the survey for a response rate of 80 percent. Thirty-three states (80%) had at least one syndromic surveillance system in addition to BioSense operating within the state. Every state with an urban area at highest risk of a terrorist attack reported monitoring syndromic surveillance data, and a state's overall preparedness level was not related to the presence (or lack) of operational syndromic surveillance systems. The most common syndromic surveillance systems included BioSense (n = 20, 61%) and RODS (n = 13, 39%). Seventy-six percent of states with syndromic surveillance initiated investigations at the state level, 64 percent at the county level, and 45 percent at both the state and county levels. CONCLUSIONS: The majority of states reported using syndromic surveillance systems, with greatest penetration in those at highest risk for a terrorist attack. Most states used multiple systems and had varied methods (central and local) of responding to alerts, indicating the need for detailed response protocols.

Framework for the development of response protocols for public health syndromic surveillance systems: case studies of 8 US states.

OBJECTIVES: To describe current syndromic surveillance system response protocols in health departments from 8 diverse states in the United States and to develop a framework for health departments to use as a guide in initial design and/or enhancement of response protocols. METHODS: Case study design that incorporated in-depth interviews with health department staff, textual analysis of response plans, and a Delphi survey of syndromic surveillance response experts. RESULTS: All 8 states and 30 of the 33 eligible health departments agreed to participate (91% response rate). Fewer than half (48%) of surveyed health departments had a written response protocol, and health departments reported conducting in-depth investigations on fewer than 15% of syndromic surveillance alerts. A convened panel of experts identified 32 essential elements for inclusion in public health protocols for response to syndromic surveillance system alerts. CONCLUSIONS: Because of the lack of guidance, limited resources for development of response protocols, and few examples of syndromic surveillance detecting previously unknown events of public health significance, health departments have not prioritized the development and refinement of response protocols. Systems alone, however, are not effective without an organized public health response. The framework proposed here can guide health departments in creating protocols that will be standardized, tested, and relevant given their goals with such systems.