1. INSTEDD EVOLVE MEKONG BASIN DISEASE SURVEILLANCE (MBDS) INFORMATION COMMUNICATION AND TECHNOLOGY FORUM APRIL 2 ND –3 RD, 2009, MUKDAHAN PROVINCE, THAILAND Taha Kass-Hout, MD, MS Director, Global Public Health and Informatics

2. SE Asia Early Warning & Response A collaborative early warning and response space for latest health-related events in SE Asia

3. Overview  Infectious disease events represent substantial morbidity, mortality, and socio-economic impact in SE Asia  The infectious disease event reporting in SE Asia was of:  Low socioeconomic disruption (83%),  High socioeconomic disruption (17%); with indicators of a: potential sociological crisis (16%), and disaster (0.6%)

4. Overview  Information Sources  ProMed MBDS  Veratect  From September 1, 2008 to February 27, 2009  998 near real-time reports on 46 infectious diseases that effect humans or animals Myanmar, Thailand, Laos, Cambodia, and Vietnam 220 provinces, 239 districts, and 14 cities

5. The majority of reporting was related to possible epidemic situations. This information is available for each report in Evolve and thus represents granularity down to the lowest geographic unit presented in a given report and by disease event in SE Asia Approximations of Epidemiological Features

6.  What diseases were reported to have affected different age groups in SE Asia  Reports of mortal outcomes for all age groups  Which of the infectious disease events presented as  single cases, apparently localized clusters (approximation of an “outbreak”), and  apparent multiple cases in multiple locations (approximation of an “epidemic”)

7. This information is available for each report in Evolve and thus represents granularity down to the lowest geographic unit presented in a given report and by disease event Response

8.  what level of government and non-governmental organization became involved in response by disease event

9. Local Public Community Reaction  There are two basic areas presented here:  reaction of the public  reaction of responders

10. Local Public Community Reaction  Reaction of the public  The term ‘panic’ is not indicative of true panic but rather a proxy for social concern ‘Panic with behavior’ is where we have documented non-routine public behavior such as panic buying, hoarding of medications, and so on, where concern has elicited non-routine action ‘Flight’ is the ultimate outcome where a community’s inhabitants abandon their community and for a period of time, social disintegration is observed. This is the end point of infectious disease event damage from a sociological perspective, where a community ceases (transiently) to be an integrated social unit engaged in routine daily activities Evacuation due to biological events is a rare phenomenon, but one for which we maintain a baseline for what diseases in what countries provoke such a reaction

11. Local Public Community Reaction  Reaction of responders  Responder anxiety, which follows the same conceptual framework as public anxiety  Here it is key to note those events where healthcare workers refuse to perform their duties or participate in response due to fear of exposure, illness, or death Responder avoidance of duties is a rare phenomenon

12. This information is available for each report in Evolve and thus represents granularity down to the lowest geographic unit presented in a given report and by disease event in SE Asia Infrastructure

13.  The infrastructure types affected (compromised) by infectious disease events in SE Asia either due to  absenteeism,  contamination,  work overload (i.e., response), or  any combination of the above

14. This information is available for each report in Evolve and thus represents granularity down to the lowest geographic unit presented in a given report and by disease event in SE Asia Infectious Disease Disaster

15.  The most socially disruptive events in SE Asia, by country and disease that are assessed to be potential disasters  0.6% of all disease reports in SE Asia

16. Related items (e.g., News articles) are grouped into a thread. Threads are later associated with events (hypothesized or confirmed). InSTEDD Evolve: (http://instedd.org/evolve)http://instedd.org/evolve Tag cloud and semantic heat map InSTEDD Evolve Delete/Recycle an Item Expert-generated Tags RSS Publishing Delete/Recycle an Item Save filter (by keyword, tag, topic, location, and time) and email subscription

17. Our Solution InSTEDD Evolve: (http://instedd.org/evolve)http://instedd.org/evolve InSTEDD Evolve

18. InSTEDD Evolve: (http://instedd.org/evolve)http://instedd.org/evolve Filter feature which automatically filters content by topic of interest InSTEDD Evolve Filter feature which automatically filters content by radius

19. InSTEDD Evolve: (http://instedd.org/evolve)http://instedd.org/evolve Auto-generated (machine-learning) tags. These tags are semantically ranked (a statistical probability match). Users can further train the classifier by accepting or rejecting a suggestion. Users can similarly train the geo- locator by simply accepting or rejecting and updating a location. InSTEDD Evolve

20. Automatic Classification  Current classification includes:  7 syndromes  10 transmission modes  > 100 infectious diseases  > 180 micro-organisms  > 140 symptoms  > 50 chemicals

21. Information Sources  BBC Outbreak News  BioCaster Open Source Ontology  CNN Health News  EpiSpider  Eurosurveillance  Google Outbreak News  HealthMap (Global Disease Alert Map)  HEDDS Surveillance News  Moreover Public Health News  ProMed News (including MBDS)  Veratect Corporation  WDIN Disease Map Digest  WHO Latest news on the avian influenza situation in humans around the world  WHO Outbreak News  Y! Health Cold & Flu News

22. InSTEDD Evolve InSTEDD Evolve: (http://instedd.org/evolve)http://instedd.org/evolve Tracking the recent Avian Influenza Outbreak in Egypt (reports started to appear late January 2009). Notice the pattern of reported incidents along the Nile river.

23. Acknowledgment

24. Through Funding from…

25. Thank You! Taha Kass-Hout Nicolás di Tada

26. InSTEDD 400 Hamilton Avenue, Suite 120 Palo Alto, CA 94301, USA +1.650.353.4440 +1.877.650.4440 (toll-free in the US) info@instedd.org Thank You! Cambodia, Photo taken by Taha Kass-Hout, October 2008 “this pic says it all- our kids are all the same- they deserve the same”, Comment by Robert Gregg on Facebook, October 2008

27. Backup Slides

28. Evolve Architecture and Processes Best Poster Award for Improving Public Health Investigation and Response at the Seventh Annual ISDS Conference, 2008