A Novel Approach for Managing Outbreaks: An Ebola Pilot

BACKGROUND:   Outbreaks often unfold very quickly, leading to difficulties in ensuring up-to-date, accurate data for real-time analysis and intervention. Outbreaks that span multiple jurisdictions are particularly problematic as information is often fragmented in stand-alone databases. Additionally, outbreaks often stretch public health resources, and require some prioritization of response efforts; a process that relies heavily on accurate, timely data. We developed a novel outbreak management system (OMS) that minimizes many of the challenges public health faces when responding to outbreaks, and have used the Ebola response as a test for this system.

METHODS:   Our OMS pulls data real-time from Utah’s integrated communicable disease surveillance system (TriSano) and produces pre-populated outbreak summary tables and an outbreak line-listing. The line-listing flags individual cases for common or anticipated problems, and includes an automatic numbering designation that identifies each individual associated with the outbreak as to the cluster, morbidity event, contact event, and generation to produce a transmission phylogeny.

RESULTS:   The outbreak summary provides a basic overview of the outbreak through a number of aggregate tables. For the Ebola response, these tables allow public health to view events by jurisdiction, risk level, monitoring method, travel restrictions, and cluster size. The outbreak line-listing provides detailed data on the individuals associated with the outbreak. Automatic flags direct attention to potentially concerning cases and assist in the prioritization of interventions. For the Ebola response, the line-listing displays the infectious period for cases or the monitoring period for contacts, and grays out people who have “aged out” of active monitoring. The flags available for Ebola contacts include when contact has not occurred for 24 hours, when contact has not occurred for 48 hours, when a contact is willfully non-compliant, and when a contact is symptomatic and potentially in need of a medical evaluation. Finally, the automatic numbering designation produces a transmission phylogeny that can be used for social network analysis or to identify clusters of disease that are less controlled.

CONCLUSIONS:   Our OMS was designed to be entirely contained within TriSano, which reduces stand-alone databases by producing valuable outbreak summary data and automatic intervention flags that incentivize investigators to enter and update case and contact information in TriSano. Because the OMS leverages infrastructure used in everyday disease surveillance, outbreak management response is more integrated into standardized processes. The OMS can be used for outbreaks of any disease that involve multiple contacts, as long as the data is maintained within TriSano.