1. 9-Dec-15 COL Dr. Holtherm COMEDS FHP Expert Panel / Chairman DSC subpanel Development of a Near-Real-Time Disease Surveillance Capability (DSC) for NATO

2. 9-Dec-15 Disease Surveillance - Definition - The ongoing systematic collection and analysis of data and the provision of information which leads to action being taken to prevent and control a disease (usually one of an infectious disease)

3. NATO initiative(s) NATO Summit 2002 Prague –Identification of capability gaps in the light of the 2001/2002 terrorist attacks in the USA –Need for an early warning system for CBRN related / naturally occurring outbreaks –ACT task for the CBRN community to do a situation analysis and proposal for a development programme –Transfer of the task to the COMEDS FHP EP –ACT experiment / exercise plan for DSC development –Creation of a DSC subpanel within the FHP EP

4. 9-Dec-15 Disease Surveillance in NATO - Status Quo Situation - NATO Epidemiological Reporting Center (NERC) – not functional EPI - NATO – (modified actual version) existing MEDICS – Long Term Planning (~2012) Deployment Health Surveillance Center – Mid Term Planning (~2011) Disease Surveillance and Analysis Capability (DSC) for symptom- based “near real time Surveillance” – Short Term Planning (~ 2010) on the basis of the 2006 / 2008 ACT experiment series FHP EP/ MedCIS EP/ BioMedAC / DGP (involved NATO bodies)

5. 9-Dec-15 Disease Surveillance - Principle & Situation - Analysis Centre Data Collection DetectionDetection Medical Advisor Commander

6. 9-Dec-15 12% 100% 71% 29% 0% 20% 40% 60% 80% 100% D0D2D3D4D5D6D7D9D12D14D18D21 DAY COUNTERMEASURES/ THERAPY INITIATED PERCENT CASUALTIES AVOIDED (AVERAGE) Exposure Disease Surveillance Clinical Diagnosis Day 3, NATO Disease Surveillance Avoid 71% of Casualties Day 4, National Disease Surveillance Avoid 29% of Casualties Day 5, Clinical Diagnosis Confirmed Avoid 12% of Casualties Day 0, Biotechnology Avoid 100% of Casualties D1 Disease Surveillance - Timelines & Impact -

7. 9-Dec-15 Analysis Centre Data Collection Disease Surveillance - Concept - Analysis Centre Data Collection DetectionDetection Medical Advisor Commander Central Analysis Center

8. MoD Medical Office as Central Analysis Center Medical Office as Central Analysis Center Central Institute of JMS, Koblenz Inst MikroBio, Munich Inst PharmTox, Munich Inst RadBio, Munich Inst MikroBio, Munich Inst PharmTox, Munich Inst RadBio, Munich Section of Tropical Medicine, at the Bernhard-Nocht-Institute Hamburg Institute of Occupational and Environmental Medicine, Berlin Bundeswehr Medical Office Munich Dpt V – Preventive Medicine V 1.4 Medical Intelligence Dpt VII – Veterinary Medicine Dpt IX – Med. CBRN Protection Dpt X – Med. Concept Development Bundeswehr Medical Office Munich Dpt V – Preventive Medicine V 1.4 Medical Intelligence Dpt VII – Veterinary Medicine Dpt IX – Med. CBRN Protection Dpt X – Med. Concept Development

9. The Civil-Military Network

10. – MEDINT – NBCMED – Epidemiology – Veterinarian –…. Reference baselineReference baseline Epidemiological reach backEpidemiological reach back Semi automated analysisSemi automated analysis Data ConversionData Conversion Data fusionData fusion Data StorageData Storage Human Analysis by SME Analysis Centre Data Collection Detection Analysis Centre Data Collection Detection DSC Experimentation Cell Disease Surveillance - Concept 2006 Experiment -

11. Better sensitivity in multinational deployment areas than national DSC systems Better specificity in multinational deployment areas than national DSC systems Pure virtual approach is not feasible Core multinational analysis team (~ 8) is permanently needed in the analysis center Bundeswehr Medical Office has all the needed expertise for technical and additional specialist support ACT decision: Perform a DSC-pilot in a NATO deployment area Results of 2006 DSC experiment

12. 9-Dec-15 Disease Surveillance - Concept KFOR DSC Exercise- – MEDINT – NBCMED – Epidemiology – Veterinarian –…. Reference baselineReference baseline Epidemiological reach backEpidemiological reach back Data ConversionData Conversion Data fusionData fusion Data StorageData Storage Human Analysis by SME Data Collection Detection Detection Feed-Back ASTER System KFOR

13. Results of 2008 KFOR DSC exercise Multinational „Near real time syndromic surveillance“ is technically feasible Transmission times are flexible (immediate / periodic) Transmission stability has to be improved Practicability of the signs + symptoms list in a multinational deployment area has been evaluated Practicability of the system architecture for multinational surveillance Suitability of the Bundeswehr Medical Office to serve as the Central Analysis Center

14. Disease Surveillance Capability Next Steps Task of the COMEDS Plenary to develop a DHSC for NATO (May 2008) Strong committment for support of the COMEDS Surgeons General for the further development process of DSC (May 2008) Development of a conceptual framework for implementation Implementation of the core element of a NATO Deployment Health Surveillance Center (2010) Step by step integration of i.e. ICD 10 or Snomed coded diseases, Vet - / Lab Data, EPI NATO (2011)

15. Disease Surveillance Capability Continued support of ACO, ACT, NC3A Use and adaptation of the FRA ASTER system Commitment and participation of the partner nations to contribute to a Deployment Health Surveillance Capability for NATO in Munich Further Requirements

16. 9-Dec-15 Center Director Database administrator Systems design Applications development Systems maintenance Data quality assurance Reporting standardization Website management Email alerts Security and Privacy System Cell Analysis Cell Early warning ! Epidemiological analysis Interpret findings (e.g., SMEs) Special projects, e.g.: -- Deployment environmental -- Vaccine compliance, safety -- Reportable events -- Deployment health -- Outbreak detection -- Emerging infections -- Injuries -- Seroepidemiology Operations Cell Military judgement / expertise Receive/define requests Staff Ops Center Current ops awareness Prepare/deliver reports -- information papers -- briefings -- risk assessments -- risk communication Specified Functions

17. 9-Dec-15 Governance, Standards, Policy Disseminate results/reports Interpret findingsSummarize/analyze data Manage data Collect & integrate data Respond Track compliance, monitor effects; feedback for policy and process improvement Data FunctionOps Function Analysis Function Governance, Standards, Policy Disseminate results/reports Interpret findingsSummarize/analyze data Manage data Collect & integrate data Respond Track compliance, monitor effects; feedback for policy and process improvement System FunctionOps Function Analysis Function 1-IM/IT 1-Ops Officer 1-Technical Writer 2-Epidemiologist 1-Center Manager * Plus a “virtual network” of multi-national SMEs DHSC Possible initial structure and personnel

18. 9-Dec-15 MEDICS Tactical CC Operational JFC, JC, CJTF StrategicSC MEDICS MEDICS Force Health Status Disease Surveillance Patient Tracking Patient Regulating MEDEVAC Reporting acc. to (Bi-SC 80-3) Medical Supply Medical Certification Management Epidemiology Environmental Health Factors Add. Environmental Hazards Med. Infrastructure and Capabilities Intelligence OPlan MASCAL- Plans Casualty Rate Estimates Plans

19. Disease Surveillance Capability Deployment Health Surveillance Capability for NATO in Munich Questions ? Comments ? Open discussion ! HansUlrichHoltherm@bundeswehr.org Phone: +49 431-384-7520