National Biosurveillance Integration Center: Overview of Avian Influenza A (H7N9) and MERS-CoV Activities

Transcription

1 National Biosurveillance Integration Center: Overview of Avian Influenza A (H7N9) and MERS-CoV Activities Steve Bennett, PhD Director National Biosurveillance Integration Center Office of Health Affairs Department of Homeland Security

2 NBIC Strategic Vision and Mission Strategic Vision Advance the safety, security, and resilience of the nation by leading an integrated biosurveillance effort that facilitates early warning and shared situational awareness of biological events. Mission Enable early warning and shared situational awareness of acute biological events and support better decisions through rapid identification, characterization, localization, and tracking. 2

3 National Biosurveillance Integration System National Biosurveillance Integration System (NBIS) Interagency community providing national biosurveillance and situational awareness Provides the collective framework to acquire, integrate, analyze, and disseminate information pertaining to emerging biological events and their impact on US interests NBIS Mission National Biosurveillance Integration System (NBIS) enhances the identification, location and tracking of biological events potentially impacting homeland security by uniquely integrating information and data and leveraging interagency communications and relationships. NBIS supports prevention and mitigation of such events by providing timely notifications and ongoing situational awareness to enhance response of government agencies. 8/13/2013 FINAL 3

4 The Role of NBIC as an Integrator NBIC (in full collaboration with its partners) connects, correlates, and contextualizes (not just aggregates) information through the production and dissemination of its analytic products by: Creating a synthesized, unified view of information from different sources, and providing a conclusion of what it could mean. This information integration has a greater impact than information aggregation alone, which is just the collecting of information to give users a single place of access. Providing a broad perspective of the impact of the combined whole of aggregated information. 4

5 NBIC Reporting Monitoring Lists reaches over 700 users across federal, state, and local agencies. Biosurveillance reports shared via Homeland Security Information Network (HSIN) and DHS Common Operating Picture (COP) Reports reach over 15,000 users in 56 states and territories Designates NBIC as biosurveillance authority within COP community and DHS NBIS weekly biosurveillance calls facilitate interagency discussion on significant worldwide biosurveillance issues Specialized, expedited reports provide early situational awareness to senior leadership for decision-support NBIS Protocol brings federal partners together on short-notice teleconference to provide information sharing on significant biological event 5 5 5

6 Avian Influenza A (H7N9) virus in China A novel strain of avian influenza A (H7N9) virus not previously reported to infect humans has been linked to 139 confirmed cases in Taiwan and China. Forty-five of these cases have resulted in death. There have been no reported cases in the United States. Over 1,000 close contacts of confirmed cases have been investigated, and there is no evidence of sustained human to human transmission of H7N9. Authorities do not yet know the source of infection; it is being investigated actively, and avian influenza A (H7N9) viruses have been recently detected in birds in the same area as human infections. Preliminary test results suggest that the virus is susceptible to antiviral medications Tamiflu and Relenza. 6

7 Avian Influenza A (H7N9) virus in China The 139 cases and 45 deaths occurred in the eastern China municipalities of Shanghai and Beijing and 8 provinces (Anhui, Fujian, Guangdong, Henan, Hunan, Jiangsu, Jiangxi, Shandong, and Zhejiang). In addition, there has been a single confirmed case in Taiwan. 7

8 Avian Influenza A (H7N9) Viruses in China Interagency Collaboration Executed the NBIS Protocol to bring together subject matters experts (SMEs) from the interagency partners to discuss the significance of this quickly evolving event on behalf of the National Security Staff (NSS). Continued to conduct these calls regularly with the interagency in order to inform senior leadership across the government of the evolving situation. Information Dissemination Created and distributed reports based on information from NBIS partners, particularly HHS-CDC and USDA-Animal and Plant Health Inspection Service (APHIS). Delivered various reports to an interagency audience, state and local partners, and senior leadership throughout the interagency and DHS. Enhanced Leadership Awareness Delivered information upon request to the interagency, DHS National Operations Center (NOC), and senior leadership within DHS. Communication with interagency partners provided early crossdomain situational awareness. Provided forum for the identification of cross-department collaboration opportunities. Mar 29 First report by China to WHO Mar 31 NBIC responds to Wildfire RFI Apr 2 NBIC issues BER Apr 3 CDC participates in NBIS weekly call Apr 5 Apr 8 Apr 12 NBIC conducts the NBIC sends NBIC begins to NBIS Protocol & out RFIs on review SLB and produces S1 Memo economic prepare 0600 repercussions briefs April 15 NBIC Sr. Leadership Attends White House daily briefing Apr 22 NBIC prepares visual analytic products 8

9 Analytical Products: Avian Influenza A(H7N9) Risk Factors Product Provides an interagency analysis of risk factors associated with specific regions in China and potential correlation to the spread of avian influenza A (H7N9) virus. Product focuses on near-term and long-term risk for A(H7N9) based on comparison to previous work performed for HPAI H5N1. Identifies clusters of different avian influenza viruses in both humans and birds and potential associations with migratory stopover spots. Relevance / Impact The large geographic range of migratory birds and their potential impact on the spread of A (H7N9) through their interaction with domesticated birds demonstrates a risk for continued spread of A(H7N9). 9

10 Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) In late September 2012, Saudi researcher, Dr. Zaki, announced the discovery of a novel coronavirus responsible for severe respiratory infection in a man from the Kingdom of Saudi Arabia (KSA). The infection was subsequently linked to a case of severe coronavirus illness from June 2012 in the United Kingdom (UK). The novel coronavirus, renamed as Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is responsible for 157 cases of illness and 66 deaths reported in 10 countries. Authorities do not yet know the source of infection; but research studies have suggested a zoonotic origin. Clusters of MERS-CoV infections in patients with no known exposures except close contact with a MERS-CoV patient with travel history to the Middle East is evidence of limited, not sustained, human-to-human transmission. 10

11 Global Cases of MERS-CoV Green Current epicenter of WHO confirmed case(s) Blue WHO confirmed case(s) Yellow Probable case(s) not confirmed by the WHO The 157 cases and 66 deaths have been reported in 10 countries, including France, Italy, Jordon, Kuwait, Oman, Qatar, Kingdom of Saudi Arabia, Tunisia, United Arab Emirates, and the United Kingdom. However, the majority of cases have been reported from or associated with travel to countries on the Arabian Peninsula. 11

12 Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Interagency Collaboration Developed situational awareness products with information from interagency partners. Information Dissemination Created and distributed reports based on information from NBIS partners, particularly HHS-CDC and DoD. Delivered various reports to an interagency audience, state and local partners, and senior leadership throughout the interagency and DHS. Enhanced Leadership Awareness Delivered information upon request to the interagency, DHS NOC, and senior leadership within DHS. NBIC coordinated with its interagency partners to provide Federal Government leadership with a comprehensive overview of the situation as it has evolved for MERS- CoV Sept. 22 UK informs WHO of novel coronavirus infections (ncov) Sept. 24 NBIC produced the first monitoring list on the ncov Sept. 25 NBIC produced the first Biosurveillance Event Report (BER) on the ncov Sept. 26 NBIC issued the first S1 memo on the ncov May 2 Saudi Arabia informed WHO of new confirmed cases of ncov May 2 NBIC updated the monitoring list and BER on ncov May 8 NBIC began discussing ncov on the NBIS weekly biosurveillance call May 30 NBIC produced an S1 daily briefing on MERS-CoV June 11 NBIC collaborates w/ CDC on border screening paper

13 Analytical Products: Infectious Disease During Hajj Product Identifies the various types religious ceremonies that draw pilgrims to Kingdom of Saudi Arabia (KSA). Reviews the common risks of communicable disease transfer in overcrowded and congested spaces created by these pilgrimages. Reviews the actions currently being taken by health organizations and governments to prevent the spread of communicable diseases during these mass gatherings. Relevance / Impact More than 3 million Muslims from around the world make religious pilgrimages to Mecca, KSA. The risk of emerging pandemic threats and the mass gathering of people create a favorable environment for the spread of communicable diseases. 13

14 NBIS Protocol Mechanism to bring federal NBIS partners together on a shortnotice teleconference to share information on a potentially significant biological event Communicate event characterization information available across the federal government and identify event-specific information or coordination needs Activation based on threshold criteria established by the NBIS partners at request of any federal NBIS partner. 14

15 NBIS Protocol Activation for Avian Influenza A (H7N9) At the request of National Security Staff, the NBIS Protocol was activated on 5 April 2013 to rapidly bring together NBIS partners to discuss the emerging avian influenza A (H7N9) situation in China. This call was followed by weekly teleconferences with the NBIS partners. As the Middle East respiratory syndrome coronavirus (MERS-CoV) began to emerge as a potential public health threat, the calls for avian influenza A (H7N9) expanded to include discussion of MERS- CoV. These weekly calls were discontinued as the two conditions became less urgent situations. NBIC continued producing reports on the topics after the teleconferenced were ceased. 15

16 NBIC Coordinated Efforts for MERS-CoV and H7N9 Interagency Coordination Established weekly interagency calls MERS-CoV and H7N9, with significant collaborative efforts from CDC and USDA, as well as participation from the interagency Coordinated distribution of reports (H7N9 and MERS-CoV), to the Association of State and Territorial Health Officials (ASTHO) and the National Association of City and Council Health Officials (NACCHO) with the CDC Influenza Coordination Unit and the CDC National Center for Immunization and Respiratory Diseases Coordination Opportunities for Future H7N9 and MERS-CoV Issues Established operating protocols through relationships with United States Department of Agriculture (USDA) Animal Public Health Inspection Service (APHIS) and National Security Staff (NSS) Newly appointed full-time, virtual liaison from the Department of Interior National Wildlife Health Center (NWHC) Surveillance of Department of Veterans Affairs data through part-time VA liaison 16

17 Biosurveillance Value of Early/Pre-Hospital Data Social Media Poison Control ED Hospital/Lab Open- source news/media Infected 911 EMS Event due to facilitated by early warning Time 17

18 NBIC Innovation Portfolio Analytics Data Decision Support Info Sharing National Collaborative for Bio-Preparedness (NCB-P) Analyzes and fuses emergency medical service (EMS), 911, poison control center, and other novel data sets Developing novel alerts using a symptoms-based surveillance approach and text analytics, providing early detection and warning of public health events to local, State, and Federal partners Food Safety Help Line Expands the information collection of poison control centers through enhanced coding of food, national guidelines, and training for a food safety help line call center Applies analytics to food-related data for possible early indications of a biological event such as food poisoning Social Media Analytics Developing methods for tracking health-related terms in Twitter using existing biosurveillance ontologies and machine learning algorithms to provide early detection of biological events NBIS Directed Pilot Interagency working group collaborating to identify a biosurveillance capability gap to be addressed in a FY13 pilot program Analytical Workbench FY13 collaboration with DoD Operational biosurveillance platform capable of detecting, monitoring, and sharing information regarding health incidents of concern 18

19 Contact Information Website:

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21 NBIC Data Gathering Tools and Methods Customer and Partner Requirements Systematic Evaluation and Selecting Target Data Feeds and Services Data, Analytics, and Process Development Tools for NBIC Analysts Tools for NBIS and other Partners 21

22 NBIC Open Source Biosurveillance in 2014 Public Internet RSS Aggregator (Feedly) Biosurveillance Real- Time Data Feed (HealthMap) NCMI Open Source (Asylum) Analy)c Workbench (CTTSO- Palan)r) Social Media Innova)on Project (Dahlgren) FY15 22

23 EMS, 911, Poison Control Data and Analytics: National Collaborative for Bio-Preparedness (NCB-P) Collaborative: University of North Carolina Chapel Hill, North Carolina State University, SAS Corporation, Accenture Objectives: Developing novel alerts using a symptoms-based surveillance approach and text analytics, providing early detection and warning of public health events to local, State, and Federal partners Recent Accomplishments: Demonstrated an operational system Analyzed and fused emergency medical service (EMS), 911, poison control center, facility resources, and other data sets Novel alerts using a symptoms-based surveillance approach and text analytics Conducted user training sessions in preparation for the Phase 3 Field Exercise Scenario-based test of the operational system 29 July 9 August National, State, local dashboards tailored to the needs of each end user 23

24 Decentralized Biosurveillance Surveillance is performed at a local level, by local public health experts. State and local officials cannot wait for national attention to address public health events Street-level view of EMS activity in Charleston County, SC SMARTT data (hospital bed availability by department) Box chart of Charleston County EMS run counts per day of the week (over 365 days) Charleston County EMS TAP trends by syndrome over time Pins represent EMS runs Charleston County GI TAP alert on 6/30/

25 NCB-P Impacts: Predicting the Influenza Season Data: NC, Google Flu Reported on Sep 1 CDC Flu Warning on Dec 3 Data: NC, EMS TAP Alerts Sep 23 Oct 17 CDC first issued a warning about this year s flu season on December 3,

26 Social Media Data and Analytics: Applied Science Performer: Naval Surface Warfare Center Dahlgren Division Objective: Develop ways to use Twitter as a sensor of the health of a population in order to detect changes in public health and provide early warning of health-related events Recent Accomplishments: Expanded classification techniques initially developed for NC to the entire United States US: ~ 1,500,000 tweets per day GPS geo-location only* Refined expert-developed ontology of English words used related to sickness based on Twitter use Expert ontology comprised 1698 words in the categories Diseases, Symptoms, Remedies New ontology comprises 152 words { 42 Diseases; 65 Symptoms; 45 Remedies} Developed a database and a GUI to allow multiple users classify tweets Machine learning algorithms required a large amount of hand classified tweets for effective training data *Geo-location is available for a small fraction of all tweets 26

27 Training the semi-supervised classifier Several machine learning algorithms have been evaluated to automate the creation and updating of the classifier Machine learning algorithms required a large amount of hand classified tweets for effective training data To maintain this training set, Naval Surface Warfare Center developed a database and a GUI to allow multiple users classify tweets Implemented with a SQL database 27

28 Social Media Data and Analytics: Operational Capability Performer: Accenture/SAS Corporation Objective: Detect changes and provide early warning of healthrelated events across multiple NBIC domains (human, plant, animal, environment, food) through analysis of health security topics in online forums, blogs, and social media sources Leverage existing commercial-off-the-shelf (COTS) tools to quickly develop an operational capability Recent Accomplishments: Applied NBIC flu queries to SAS Social Media Analytics Toolkit to capture and analyze online media related to influenza Completion of pass/fail documents has resulted in a significant reduction of noise in the system Installed live Twitter tool on the SMA portal Capabilities for early warning alerts and drilldown situational awareness context development 28

29 New NBIC Studies in 2014 NIWG Project: Characterizing Uncertainty in Biosurveillance Data (MITRE) Identify sources and types of uncertainty in BSV data sets Propose and test standardized approaches to characterizing uncertainty in BSV data for decision-makers Assess Utility of DHS Component Data for Biosurveillance (BKC-LLNL) Establish evaluation criteria for DHS data systems Evaluate >25 DHS data systems for biosurveillance relevance Validate VA Capability to Predict Dengue/ ILI Outbreaks (MITRE) Validate VA s previously developed Dengue fever/ ILI prediction algorithm using additional data sets Document work in peerreviewed publication Value-of-Information and Economic Analysis to Improve Biosurveillance (CREATE USC/RAND) Develop value-ofinformation analysis tool for new BSV capabilities Identify and evaluate economic models of relevance to biosurveillance 29