1. Patients affected by highly infectious diseases:
EUNID
27-28 May 2005
Rome
Patients affected by highly infectious diseases:
definitions are an arcana
Emanuele Nicastri
National Institute for Infectious Diseases Rome Italy

2. Do you really think that the mistery is in
Yes, at all the mistery is in Rome, but in the Sistina Chapter where since 1512 most Popes have been designed

3. A careful monitoring of specific clinical syndromes can provide public
Many potential highly infectious agents initially produce nonspecific clinical manifestations and even the most astute clinician may not suspect one of these agents in the absence of more specific data.
A careful monitoring of specific clinical syndromes can provide public
health with the earliest
evidence of an outbreack?
Separation of Light from Darkness

4. With a 1% rate of foodborne reporting, what is the meaning of the reports that we do have?
Or Tip of an Iceberg?
Isolated Snow Flake?
Or it is 1/99 other cases part of the same outbreak?
One of many sporadic cases
Creation of sun, moon and plants

5. “Round up the usual suspects”
“Casablanca”
We can only find agents for which we look, and we only look for what we expect to find.
A serious problem for lab or clinical based systems.
Separation of the Earth from the Waters
“Round up the usual suspects”

6. Assumptions t Symptom Onset Severe Illness Number of Cases Days 1 2 3
Exposure
Number of Cases 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Most of the biological agents of concern have a non-specific, flu-like prodrome. This graph demonstrates one of the critical assumptions about syndromic surveillance, that the interval between the prodrome and more serious manifestations is 1-3 days. This would mean that an early warning would allow the health department time to identify those exposed and institute control measures to limit morbidity and mortality.
Days
Creation of Adam

7. Data sources for early detection of acute illness
Day exposure occurs
Day feels fine
Day headaches, fever- buys OTC meds
Day develops cough- calls provider
Day sees private doctor: “flu”
Day worsens- calls ambulance
seen in Emergency Dept.
Day admitted- “pneumonia”
Day critically ill- ICU, lab tests +
Day expires- “respiratory failure”
Pharmaceutical Sales
Nurse’s Hotline
Outpatient Visit Data
Absenteeism
Ambulance Dispatch (EMS)
ED Logs
Creation of Eve
Diagnosed
Reported

8. Data Transfer Ambulance E/A Department Absenteeism Pharmacy
The fall and the expulsion fron the Eden

9. Scenario A favoring earlier detection by means of clinical evaluation
Sacrifice of Noah
Buehler EID 03

10. Scenario B favoring earlier detection by means of syndromic surveillance
The Deluge
Buehler EID 03

11. Drunkeness of Noha

12. Good work in the small groups
What is the mistery behind the most famous Michelangelo paintings that, since half a millenium is influencing the election of each Pope?
What is the best definition of our HID, clinical, syndromic, lab linked, or epidemiological linked?