Measuring Timeliness of Outbreak Response in the World Health Organization African Region, 2017–2019

Impouma, Benido; Roelens, M.; Williams, George S.B.; Flahault, Antoine; Codeço, Cláudia Torres; Moussana, Fleury; Farham, Bridget; Hamblion, Esther; Mboussou, Franck; Keiser, Olivia

doi:10.3201/eid2611.191766

Cited by 21 publications

(26 citation statements)

References 15 publications

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“…WHO AFRO’s Weekly Bulletin on Outbreaks and Emergencies provides an existing template which can feed into such a global database [ 20 ]. WHO AFRO has used this tool to provide annual metrics of timeliness in outbreak response for epidemic-prone diseases from 2017 to 2019, demonstrating reduced time from symptom onset of the primary case to outbreak detection (defined as alerting national authorities) from 14 (IQR 6–37) days in 2017 to 4 (IQR 1–11) days in 2019 [ 188 ].…”

Section: Discussionmentioning

confidence: 99%

Early detection of cholera epidemics to support control in fragile states: estimation of delays and potential epidemic sizes

Ratnayake

Finger²,

Edmunds

et al. 2020

BMC Med

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Background Cholera epidemics continue to challenge disease control, particularly in fragile and conflict-affected states. Rapid detection and response to small cholera clusters is key for efficient control before an epidemic propagates. To understand the capacity for early response in fragile states, we investigated delays in outbreak detection, investigation, response, and laboratory confirmation, and we estimated epidemic sizes. We assessed predictors of delays, and annual changes in response time. Methods We compiled a list of cholera outbreaks in fragile and conflict-affected states from 2008 to 2019. We searched for peer-reviewed articles and epidemiological reports. We evaluated delays from the dates of symptom onset of the primary case, and the earliest dates of outbreak detection, investigation, response, and confirmation. Information on how the outbreak was alerted was summarized. A branching process model was used to estimate epidemic size at each delay. Regression models were used to investigate the association between predictors and delays to response. Results Seventy-six outbreaks from 34 countries were included. Median delays spanned 1–2 weeks: from symptom onset of the primary case to presentation at the health facility (5 days, IQR 5–5), detection (5 days, IQR 5–6), investigation (7 days, IQR 5.8–13.3), response (10 days, IQR 7–18), and confirmation (11 days, IQR 7–16). In the model simulation, the median delay to response (10 days) with 3 seed cases led to a median epidemic size of 12 cases (upper range, 47) and 8% of outbreaks ≥ 20 cases (increasing to 32% with a 30-day delay to response). Increased outbreak size at detection (10 seed cases) and a 10-day median delay to response resulted in an epidemic size of 34 cases (upper range 67 cases) and < 1% of outbreaks < 20 cases. We estimated an annual global decrease in delay to response of 5.2% (95% CI 0.5–9.6, p = 0.03). Outbreaks signaled by immediate alerts were associated with a reduction in delay to response of 39.3% (95% CI 5.7–61.0, p = 0.03). Conclusions From 2008 to 2019, median delays from symptom onset of the primary case to case presentation and to response were 5 days and 10 days, respectively. Our model simulations suggest that depending on the outbreak size (3 versus 10 seed cases), in 8 to 99% of scenarios, a 10-day delay to response would result in large clusters that would be difficult to contain. Improving the delay to response involves rethinking the integration at local levels of event-based detection, rapid diagnostic testing for cluster validation, and integrated alert, investigation, and response.

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Section: Discussionmentioning

confidence: 99%

Early detection of cholera epidemics to support control in fragile states: estimation of delays and potential epidemic sizes

Ratnayake

Finger²,

Edmunds

et al. 2020

BMC Med

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“…Moreover, the epidemic intelligence activities undertaken at AFRO may have contributed to the early detection of outbreaks and indirectly influenced the timeliness of WHO response actions to support member states in mounting public health response to outbreaks with potential for international spread. Impouma et al found that the timeliness of detection and control of outbreaks across the African region improved from 2017 to 2019, attributed to enhanced epidemic intelligence, among other factors [45]. For example, in 2017 WHO received initial information on a cluster of cases presenting with EVD-like symptoms in the Democratic Republic of the Congo three days before the event was confirmed and officially notified by the country.…”

Section: Discussionmentioning

confidence: 99%

Implementing epidemic intelligence in the WHO African region for early detection and response to acute public health events

et al. 2021

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Epidemic intelligence activities are undertaken by the WHO Regional Office for Africa to support Member States in early detection and response to outbreaks to prevent the international spread of diseases. We reviewed epidemic intelligence activities conducted by the organization from 2017 to 2020, processes used, key results, and how lessons learned can be used to strengthen preparedness, early detection and rapid response to outbreaks that may constitute a public health event of international concern.A total of 415 outbreaks were detected and notified to WHO, using both indicator-based and event-based surveillance. Media monitoring contributed to the initial detection of a quarter of all events reported. The most frequent outbreaks detected were vaccine-preventable diseases, followed by food-and-water-borne diseases, vector-borne diseases, and viral hemorrhagic fevers.Rapid risk assessments generated evidence and provided the basis for WHO to trigger operational processes to provide rapid support to Member States to respond to outbreaks with a potential for international spread. This is crucial in assisting Member States in their obligations under the International Health Regulations (IHR) (2005). Member States in the region require scaled-up support, particularly in preventing recurrent outbreaks of infectious diseases and enhancing their event-based surveillance capacities with automated tools and processes.

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“…These represented 2.3% of the confirmed COVID-19 cases and 2.3% of COVID-19-related deaths globally [ 2 ]. This figure, although small, is significant in a region that records more than 100 significant public health emergencies annually [ 3 ], many of which result in high morbidity, mortality, disability and socioeconomic disruptions, threatening national, regional and global health security. As a result, the region developed robust infectious disease control regimens well before the current COVID-19 pandemic [ 4 – 6 ].…”

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confidence: 99%

“…These initiatives have tangible, measurable outcomes in terms of number of events detected, speed of detection of events and speed of response to events [ 3 ]. Time to detection of events decreased from 14 days in 2017, to 7 in 2018 and 4 in 2019, while outbreaks ended faster; the time to declaration of end of outbreak decreased from 131 days in 2017 to 45 days in 2019.…”

mentioning

confidence: 99%

“…Early detection and rapid response to outbreaks greatly contributed to reducing the illness and death associated with these events. Moreover, improved communication and transparency during outbreaks is evidenced by systematic notification of more than 348 substantiated public health events reported to WHO in the African region from 2017 to 2019 [ 3 ]. Critical information products, such as the Weekly Bulletin on Outbreaks and Emergencies [ 7 ], along with regular external situation reports and other ad hoc publications, contribute to this.…”

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confidence: 99%

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Leadership, collaboration and using data science to fight COVID-19 in the WHO African region

Moeti

2021

Epidemiol. Infect.

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with initial cases introduced by travellers from Europe into Egypt and Algeria [1]. By the end of 2020, there were 1 842 444 cases and 40 958 deaths reported across the 47 Member States within the WHO African region. These represented 2.3% of the confirmed COVID-19 cases and 2.3% of COVID-19 related deaths globally [2]. This figure, although small, is significant in a region which records more than 100 significant public health emergencies annually [3], many of which result in high morbidity, mortality, disability and socioeconomic disruptions, threatening national, regional and global health security. As a result, the region developed robust infectious disease control regimens well before the current COVID-19 pandemic [4,5,6].However, the COVID-19 pandemic represented, for the first time, an infectious disease threat that has affected the entire region almost simultaneously, resulting in both public health consequences and major social and economic disruption, with largescale implications for regional and global health security. The sheer scale of the pandemic has required leadership at the very highest levels, both regionally and nationally. This is predicated on the known and established links between politics, science, security and economy that have been evident in the responses to infectious disease outbreaks and other emergencies across the WHO African region, such as Ebola virus disease outbreak in West Africa in 2014-2016, pandemic influenza (H1N1) in 2009, Ebola virus disease in the Democratic Republic of the Congo between 2017 and 2020 and a multitude of other infectious disease outbreaks during this time, perhaps unparalleled in any other region.

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Measuring Timeliness of Outbreak Response in the World Health Organization African Region, 2017–2019

Cited by 21 publications

References 15 publications

Early detection of cholera epidemics to support control in fragile states: estimation of delays and potential epidemic sizes

Early detection of cholera epidemics to support control in fragile states: estimation of delays and potential epidemic sizes

Implementing epidemic intelligence in the WHO African region for early detection and response to acute public health events

Leadership, collaboration and using data science to fight COVID-19 in the WHO African region

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