Armed Forces Health Surveillance Center Predictive Surveillance Program A Multidisciplinary Approach for the Early Detection and Response to Disease Outbreaks CAPT Clara Witt, USPHS Armed Forces Health Surveillance Center Division of GEIS Operations February Jacksonville Florida Feb UNCLASSIFIED1

Feb UNCLASSIFIED Vision and Mission Vision: to provide relevant, timely, actionable, and comprehensive health surveillance information and support to the Armed Forces for military and military-associated populations Mission: to promote, maintain, or enhance the health of military and military-associated populations – Acquire, analyze and interpret, recommend, and disseminate information – Develop, refine and improve standardized surveillance methods – Serve as focal point for sharing health surveillance products, expertise and information – Delineate roles, responsibilities, and mutually supporting relationships among the Armed Forces health surveillance activities Armed Forces Health Surveillance Center

Feb UNCLASSIFIED AFHSC Operating Structure DIRECTOR Armed Forces Health Surveillance Center Dep Dir, AFHSC/ Director, GEIS DoD Serum Repository AFHSC HQ Support Science Advisor Executive Officer Resource Mgr Chief, Information Officer Chief, Data and Analysis Chief, Communications, Standards, & Training Chief, GEIS Operations Data Management Epidemiology/ Analysis Surveillance Operations & Communications Surveillance Standards & Training AI/PI Surveillance GEIS Core Liaisons USPHS DHS WHO

Feb UNCLASSIFIED Vision: Successfully develop, implement, support, and evaluate an integrated global emerging infectious disease surveillance and response system that supports the AFHSC and promotes preparedness in US Forces, the Military Health System and the Global Public Health community. Mission: C ontribute to Force Health Protection and Global Public Health by centrally coordinating a global system of partners that conduct emerging infectious disease surveillance and response; training and capacity building; research, innovation and integration; and assessment of value added in a timely, efficient, comprehensive and communicative manner. “Partnering in the Fight against Emerging Infections” Division of GEIS Operations (DOD GEIS)

Strategic Goals and Priority Pillars ARD GI DRO STI RI = Respiratory Infection GI = Gastrointestinal Infection FVBI = Febrile and Vector-borne Infection AR = Antimicrobial Resistance STI = Sexually Transmitted Infection AFHSC/DOD-GEIS Assessment and Communication of Value Added Research, Innovation and Integration Surveillance and Response Training and Capacity Building RI GI AR STI FVBI Force Health Protection Feb UNCLASSIFIED

AFHSC Global Network DOD’s Unique Assets – Overseas Presence with OCONUS Labs Peru Kenya Egypt Thailand Indonesia Navy Hub Air Force Hub WRAIR, NMRC AFIP Germany Korea Feb UNCLASSIFIED

Predictive Surveillance Benefit WHO World Health Report 2007 Feb UNCLASSIFIED

Predictive Surveillance Model Feb UNCLASSIFIED8

Predictive Surveillance Timeline Event Action Human illness Human outbreak and response Human case reported Convergence of Vector environment /Climate requirements Eco/climate event or anomaly Vector detected Animal/reservoir illness Competent vector crosses abundance threshold Retrospective data Threat predicition Eco/climate analysis Risk alert Risk advisory Animal/reservoir case reported Weather/vector surveillance Weeks/Months Feb UNCLASSIFIED

Continuous Remote Sensing Eco/Climate Anomalies A Anyamba, NASA Feb UNCLASSIFIED

Ground Truthing J Small, NASA Unclassified Feb

Ground Truthing T Klein, J Grieco, A Anyamba,K Linthicum USAMRU-K Mosquito samplings sites Feb UNCLASSIFIED

Country / Region Alert to Outbreak (months) 2008South Africa2 – :Sudan :East Africa4 Predictive Surveillance RVF Outbreaks In press A Anyamba, NASA Feb UNCLASSIFIED

Refining the RVF Model Feb UNCLASSIFIED Anyamba et al, PNAS, 106(3)955 (2009). Climatic Factors: heavy and widespread rainfall Coastal Flood Plain Aedes species followed by Culex in large number Culex species – Important secondary vector in RVF

Mosquito MapTaxonomic+ Point occurrence + Environmental Mosquito Distribution Models Foley, et al. J Med Ento, 46 (3) 2009 Feb UNCLASSIFIED

Animal Reservoir Feb UNCLASSIFIED

Human Disease Surveillance Data management OUTBREAK RESPONSE Absenteeism Radiology Diagnostic Labs Poison Control Prescriptions Physician Office Visits Nurse Call Center Over the Counter Sales Data sources detection reporting S Lewis, JHU/APL Feb UNCLASSIFIED

AFHSC Template Feb UNCLASSIFIED1

Feb UNCLASSIFIED 1 NASA-GSFC: A Anyamba, J Small, J Pinzon, CJ Tucker, E Pak USDA: K Linthicum WRBU: D Foley, P Rueda, R Wilkerson USUHS: P Masuoka, J Grieco, N Achee USAMRU-K: J Cook, D Schnabel KEMRI: R Sang AFRIMS: J Richardson, J Pavlin 65 th Medical Brigade: T Klein JHU/APL: S Lewis, B Feighner, A Buczac Acknowledgements