1. IDO 2008 Dengue Ontology, User-Developer perspective

2. Overview Biology Current system A decision support system as a solution What is Dengue? What is Dengue? Really, what is Dengue? Really, what is Dengue? The DDSS The DDSS Control Vocabulary Control Vocabulary Dengue Ontology Dengue Ontology

3. Disease and Mosquito Cycle 1 Main mosquito vector 1 Main disease target 3 Disease manifestations 4 Virus serotypes 9 Day from egg to adult* 14 day to become infectious* * Temperature dependent http://www.entm.purdue.edu/publichealth/images/downloads/lifecycle-mosquito.jpg

4. http://en.wikipedia.org/wiki/Dengue http://www.who.int/mediacentre/factsheets/fs117/en/ Merida 500 000 (estimated) DHF cases require hospitalization each year 2.5% of those affected die 2.5 billion people at risk

5. Urban Area of Merida Because of the interaction of three semi-independent components the vector borne disease behave differently from communicable diseases. Total cases in 2007 Merida

8. Potential for rapid outbreak response based on clinical syndromic surveillance

9. What is Dengue? Disambiguation Disambiguation Dengue Virus is_a Pathogen Dengue Virus is_a Pathogen Dengue Fever is_a Disease Dengue Fever is_a Disease Dengue Fever is_a Diagnosis Dengue Fever is_a Diagnosis Dengue Fever Clasic is_a Manifestation Dengue Fever Clasic is_a Manifestation Dengue Case instance_of Dengue Fever? Dengue Case instance_of Dengue Fever?

10. What is Dengue? WHO WHO Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile diseases, found in the tropics and Africa, and caused by four closely related virus serotypes of the genus Flavivirus, family Flaviviridae. Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile diseases, found in the tropics and Africa, and caused by four closely related virus serotypes of the genus Flavivirus, family Flaviviridae. (Some) Health Departments (Some) Health Departments What WHO Says but, it is not Dengue until it was been confirmed by the laboratory. What WHO Says but, it is not Dengue until it was been confirmed by the laboratory.

11. What is Dengue? Most dengue cases are usually clinically diagnose Most dengue cases are usually clinically diagnose No Pathognomonic symptom No Pathognomonic symptom The list includes more than 50 The list includes more than 50 They can drastically vary by subject and by outbreak. They can drastically vary by subject and by outbreak. There are 3 WHO recognized diagnosis (manifestations) ‏ There are 3 WHO recognized diagnosis (manifestations) ‏ Dengue Fever a.k.a Classic Dengue Dengue Fever a.k.a Classic Dengue Dengue Hemorrhagic Fever (Thrombocytopenia <1x 10 5 platelets/mm³ Dengue Hemorrhagic Fever (Thrombocytopenia <1x 10 5 platelets/mm³ Dengue Shock syndrome Dengue Shock syndrome Dengue Fever with hemorrhagic manifestations Dengue Fever with hemorrhagic manifestations

12. What is Dengue? What is Diagnosis? What is Diagnosis? What is Disease? What is Disease? Disease Ontology Workshop The Ontology of Diagnosis (to be quoted as work in progress) Baltimore, MD, USA. November 7, 2006

13. Juan Perez Dengue was diagnosed byPCR Diagnosing Person Disease method instance-of at t 1 inst-of at t 2 Pedro Juarez DHF was diagnosed byPCR instance-of at t 1 inst-of at t 2 inst-of at t 2 inst-of at t 2

14. Juan Perez Dengue was diagnosed byPCR Diagnosing Person Disease method instance-of at t 1 inst-of at t 2 Pedro Juarez DHF was diagnosed byPCR PersonDengue FeverDengue Virus Symptoms depend_on caused_by depend_on

15. Juan’s headache Juan’s mialgya Juan’s bleeding gums Juan’s head Juan’s muscles Juan’s gums Person Symptoms has_location Head gum has_part instance-of at t depens_on

16. A well-formed diagnosis of dengue? Dengue Fever caused_by is_a? Disease Juan’s Dengue Juan’s portion of viruses instance-of at t

17. A well-formed diagnosis of dengue? Dengue Fever caused_by Disease Juan’s Dengue instance-of at t Asymptomatic Dengue Fever Dengue FeverHemorrhagic Dengue Fever Hem. Manif. Dengue Fever Shock syndrome Dengue is_a Dengue virus Realization_of Diagnosis is_ahas_symptom HeadacheEpistaxis has_symptom

18. Juan Perez Dengue was found in 320 South street #456 Finding Person Disease Place instance-of at t 1 inst-of at t 2 Pedro Juarez DHF was found in 12 North street #123 instance-of at t 1 inst-of at t 2 inst-of at t 2 inst-of at t 2

19. Dengue Fever caused_by Disease Juan’s Dengue instance-of at t is_a Dengue virus located_in 320 South street #456 Premise instance-of at t Block MX1235 located_in Block instance-of at t Merida located_in Populated place instance-of at t

20. Problems of using English Street Ni▄os Caj¬¯n and Ninos Cajon and Nignos Cajon are not Niños Cajón Street Ni▄os Caj¬¯n and Ninos Cajon and Nignos Cajon are not Niños Cajón Add all the characters of all the lenguajes Add all the characters of all the lenguajes Is not just annotation. Wrong characters renders the terms useless. Is not just annotation. Wrong characters renders the terms useless. Jorgue Guachintón located_in Guayomin located_in Yunited Estates is not George Washington…. Jorgue Guachintón located_in Guayomin located_in Yunited Estates is not George Washington….

21. Juan Perez Dengue was diagnosed by symptoms … Diagnosing Person Disease symptoms instance-of at t 1 inst-of at t 2 Pedro Juarez DHF was diagnosed by symptoms.. instance-of at t 1 inst-of at t 2 inst-of at t 2 inst-of at t 2

22. A well-formed diagnosis of dengue? Juan’s Dengue instance-of at t x Asymptomatic Dengue Fever Dengue FeverHemorrhagic Dengue Fever Hem. Manif. Dengue Fever Shock syndrome Dengue has_symptom Headache onset Epistaxis has_symptom t Juan goes to the doctor Juan is hospitalized Low blood pressure

23. Functional definition of Decision Support System: An interactive and adaptable system that aids the process of gathering and analyzing information, gaining new insights, generating alternatives, and making decisions DDSS (1): System flow scheme

24. DDSS (2): Essential DDSS characteristics  Integrates into existing vector/dengue control programs at local/regional levels (single DDSS) or national levels (DDSS network).  DDSS application packages will be made accessible in English and Spanish language versions.  Self-application concept provides potential for rapid world-wide implementation.  Flexible DDSS implementation to fit a wide range of resource environments.  Minimum capital investment for implementation of a basic DDSS is estimated at $1,500 per location (low-end computer, basic GPS unit and software).  User-friendly; designed for use by regular vector control personnel.  Standardized data entry formats to facilitate compilation of data from multiple locally operated DDSS for national level analysis.

25. DDSS (3)

26. DDSS (5)

27. Disease and Vector control/surveillance activities http://www.entm.purdue.edu/publichealth/images/downloads/lifecycle-mosquito.jpg Infected Count -- Case Reports Surveillance Counts and ndexes Breeding Sites Case Reports Control Activities ULV Insecticide spray Immature Control Breeding site control Control Activities (Reactive) Control Activities (Reactive) -

28. DDSS (7): Selected outputs from DDSS-1  Documentation to support operational logistics: - Workload and cost related to different program activities. - Spatial coverage of surveillance and control activities. - Insecticide types and quantities used.  Entomological data display outputs showing: - Seasonal and spatial patterns of vector abundance. - Contribution of different container types to vector production. - Effect of implemented control strategies on vector abundance.  Epidemiological data display outputs showing: - Distribution of DF and DHF cases by sex and age group. - Seasonal and spatial patterns of occurrence of DF and DHF cases. - Seasonal and spatial patterns of DF and DHF incidence (if population census data are available). - Effect of implemented vector control strategies on DF and DHF incidence (based on passively collected data).  Priority Area classification for vector control.  GIS-backbone to support vector/dengue control (and build public health capacity).

29. DDSS (8): Expected outcomes from DDSS-1  Evidence-based decision making and use of locally appropriate vector/dengue control program strategies and methodologies.  Improved capacity for data entry, storage, retrieval, analysis and display.  Better use of available resources through improved understanding of the relative costs and benefits of different surveillance and control approaches.  Better targeting of limited resources for vector control to high risk areas.  Improved capacity for effective emergency vector control response through more rapid flow of information between public health institutions and vector/dengue control programs.

30. DDSS (4): Evolution of DDSS system design Past GUI: MS Visual Basic Database: Access or SQL Server Express 2–tier system (GUI – Database) Present 2–tier system (GUI – Database) GUI: MS Visual Basic Database: PostgreSQL with PostGIS extension Future 3–tier system (GUI – Business Logic - Database) Java VB-Java PostgreSQL with PostGIS extension

31. IDO Need Logo ZedGraph PostgreSQL R Stats Pack Plotting Library Reporting Google Earth DDSS (5): Use of open source software

32. Thank you