9-Dec-15 COL Dr. Holtherm COMEDS FHP Expert Panel / Chairman DSC subpanel Development of a...
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Transcript of 9-Dec-15 COL Dr. Holtherm COMEDS FHP Expert Panel / Chairman DSC subpanel Development of a...
Apr 21, 2023Apr 21, 2023
COL Dr. HolthermCOMEDS FHP Expert Panel / Chairman DSC subpanel
Development of a
Near-Real-Time Disease Surveillance Capability (DSC)
for NATO
Apr 21, 2023Apr 21, 2023
Disease Surveillance - Definition -
The ongoing systematic collection and analysis of data and the provision of information which leads to action being taken to prevent and control a disease (usually one of an infectious disease)
NATO initiative(s)
• NATO Summit 2002 Prague– Identification of capability gaps in the light of the
2001/2002 terrorist attacks in the USA– Need for an early warning system for CBRN related /
naturally occurring outbreaks– ACT task for the CBRN community to do a situation
analysis and proposal for a development programme– Transfer of the task to the COMEDS FHP EP– ACT experiment / exercise plan for DSC development– Creation of a DSC subpanel within the FHP EP
Apr 21, 2023Apr 21, 2023
Disease Surveillance in NATO- Status Quo Situation -
• NATO Epidemiological Reporting Center (NERC) – not functional
• EPI - NATO – (modified actual version) existing
• MEDICS – Long Term Planning (~2012)
• Deployment Health Surveillance Center – Mid Term Planning (~2011)
• Disease Surveillance and Analysis Capability (DSC) for symptom-based “near real time Surveillance” – Short Term Planning(~ 2010) on the basis of the 2006 / 2008 ACT experiment series
• FHP EP/ MedCIS EP/ BioMedAC / DGP (involved NATO bodies)
Apr 21, 2023Apr 21, 2023
Disease Surveillance- Principle & Situation -
AnalysisAnalysisCentreCentre
AnalysisAnalysisCentreCentre
Data Data CollectionCollection
Data Data CollectionCollection
DetectionDetection DetectionDetection
Medical Medical AdvisorAdvisor
CommanderCommander
Apr 21, 2023Apr 21, 2023
12%
100%
71%
29%
0%
20%
40%
60%
80%
100%
D0 D2 D3 D4 D5 D6 D7 D9 D12 D14 D18 D21
DAY COUNTERMEASURES/ THERAPY INITIATED
PE
RC
EN
T C
AS
UA
LT
IES
AV
OID
ED
(A
VE
RA
GE
)
Exposure
DiseaseSurveillance
ClinicalDiagnosis
Day 3, NATO Disease SurveillanceAvoid 71% of Casualties
Day 4, National Disease SurveillanceAvoid 29% of Casualties
Day 5, Clinical Diagnosis ConfirmedAvoid 12% of Casualties
Day 0, BiotechnologyAvoid 100% of Casualties
D1
Disease Surveillance- Timelines & Impact -
Apr 21, 2023Apr 21, 2023
AnalysisAnalysisCentreCentre
Data Data CollectionCollection
Disease Surveillance - Concept -
AnalysisAnalysisCentreCentre
Data Data CollectionCollection
DetectionDetection DetectionDetection
Medical Medical AdvisorAdvisor
CommanderCommander
CentralCentral
AnalysisAnalysis
CenterCenter
NATO DSCNATO DSC
MoDMoD
Medical Office as Central Analysis CenterMedical Office as Central Analysis Center
Central Institute of JMS, Koblenz
Central Institute of JMS, Koblenz
Inst MikroBio, Munich
Inst PharmTox, Munich
Inst RadBio, Munich
Inst MikroBio, Munich
Inst PharmTox, Munich
Inst RadBio, Munich
Section of Tropical Medicine, at the Bernhard-Nocht-Institute Hamburg
Section of Tropical Medicine, at the Bernhard-Nocht-Institute Hamburg
Institute of Occupational and Environmental Medicine, Berlin
Institute of Occupational and Environmental Medicine, Berlin
Bundeswehr Medical Office Munich
Dpt V – Preventive Medicine
V 1.4 Medical Intelligence
Dpt VII – Veterinary Medicine
Dpt IX – Med. CBRN Protection
Dpt X – Med. Concept Development
Bundeswehr Medical Office Munich
Dpt V – Preventive Medicine
V 1.4 Medical Intelligence
Dpt VII – Veterinary Medicine
Dpt IX – Med. CBRN Protection
Dpt X – Med. Concept Development
The Civil-Military Network
– MEDINTMEDINT
– NBCMEDNBCMED
– EpidemiologyEpidemiology
– VeterinarianVeterinarian
–……..
•Reference baselineReference baseline
•Epidemiological reach backEpidemiological reach back
•Semi automated analysisSemi automated analysis
•Data ConversionData Conversion
•Data fusionData fusion
•Data StorageData Storage
Human Analysis by Human Analysis by SMESME
AnalysisAnalysisCentreCentre
Data Data CollectionCollection
DetectionDetection
AnalysisAnalysisCentreCentre
Data Data CollectionCollection
DetectionDetection
DSC DSC ExperimentationExperimentation
CellCell
Disease Surveillance- Concept 2006 Experiment -
• Better sensitivity in multinational deployment areas than national DSC systems• Better specificity in multinational deployment areas than national DSC systems• Pure virtual approach is not feasible• Core multinational analysis team (~ 8) is permanently needed in the analysis center• Bundeswehr Medical Office has all the needed expertise for technical and additional specialist supportACT decision: Perform a DSC-pilot in a NATO deployment area
Results of 2006 DSC experiment
Apr 21, 2023Apr 21, 2023
Disease Surveillance- Concept KFOR DSC Exercise-
– MEDINTMEDINT
– NBCMEDNBCMED
– EpidemiologyEpidemiology
– VeterinarianVeterinarian
–……..
•Reference baselineReference baseline
•Epidemiological reach backEpidemiological reach back
•Data ConversionData Conversion
•Data fusionData fusion
•Data StorageData Storage
Human Analysis by Human Analysis by SMESME
Data Data CollectionCollection
DetectionDetection
Data Data CollectionCollection
DetectionDetection
Feed-BackFeed-Back
ASTER ASTER SystemSystem
KFORKFOR
ASTER ASTER SystemSystem
ASTER ASTER SystemSystem
Results of 2008 KFOR DSC exercise
• Multinational „Near real time syndromic surveillance“ is technically feasible
• Transmission times are flexible (immediate / periodic)• Transmission stability has to be improved• Practicability of the signs + symptoms list in a
multinational deployment area has been evaluated• Practicability of the system architecture for
multinational surveillance• Suitability of the Bundeswehr Medical Office to serve
as the Central Analysis Center
Disease Surveillance Capability
Next Steps• Task of the COMEDS Plenary to develop a DHSC
for NATO (May 2008)• Strong committment for support of the COMEDS
Surgeons General for the further development process of DSC (May 2008)
• Development of a conceptual framework for implementation
• Implementation of the core element of a NATO Deployment Health Surveillance Center (2010)
• Step by step integration of i.e. ICD 10 or Snomed coded diseases, Vet - / Lab Data, EPI NATO (2011)
Disease Surveillance Capability
• Continued support of ACO, ACT, NC3A• Use and adaptation of the FRA ASTER
system
• Commitment and participation of the partner nations to contribute to a Deployment Health Surveillance Capability for NATO in Munich
Further Requirements
Apr 21, 2023Apr 21, 2023
Center Director
Database administratorSystems designApplications developmentSystems maintenanceData quality assuranceReporting standardizationWebsite managementEmail alertsSecurity and Privacy
System Cell Analysis Cell
Early warning !Epidemiological analysisInterpret findings (e.g., SMEs)Special projects, e.g.:-- Deployment environmental-- Vaccine compliance, safety-- Reportable events-- Deployment health-- Outbreak detection-- Emerging infections-- Injuries-- Seroepidemiology
Operations Cell
Military judgement / expertiseReceive/define requestsStaff Ops CenterCurrent ops awarenessPrepare/deliver reports -- information papers -- briefings -- risk assessments -- risk communication
Specified Functions
Apr 21, 2023Apr 21, 2023
Governance, Standards,
Policy
Disseminateresults/reports
Interpret findings Summarize/analyze data
Manage data
Collect & integrate dataRespond
Track compliance, monitor effects;
feedback for policy and process
improvement
Data FunctionOps Function
Analysis Function
Governance, Standards,
Policy
Disseminateresults/reports
Interpret findings Summarize/analyze data
Manage data
Collect & integrate dataRespond
Track compliance, monitor effects;
feedback for policy and process
improvement
System FunctionOps Function
Analysis Function
1-IM/IT
1-IM/IT
1-Ops Officer
1-Technical Writer
2-Epidemiologist
1-Center Manager
* Plus a “virtual network” of multi-national SMEs
DHSC Possible initial structure and personnel
Apr 21, 2023Apr 21, 2023
MEDICS
Tactical CC
OperationalJFC, JC, CJTF
Strategic SC
MEDICSMEDICS
Force Health Status
Disease Surveillance
Surveillance
Patient TrackingPatient RegulatingMEDEVACReporting acc. to (Bi-SC 80-3)Medical SupplyMedical Certification
Management
EpidemiologyEnvironmental Health Factors
Add. Environmental Hazards
Med. Infrastructure and Capabilities
Intelligence
OPlan MASCAL- Plans
Casualty Rate Estimates
Plans
Disease Surveillance Capability
Deployment Health Surveillance Capability for NATO in Munich
Questions ?Comments ?
Open discussion !
[email protected]: +49 431-384-7520