epidemiological modeling in the dod: capabilities...
TRANSCRIPT
Epidemiological modeling inthe DoD: Capabilities &
Coordination
JeanJean--Paul Chretien, MD PhDPaul Chretien, MD PhD
LCDR MC USNLCDR MC USN
Assistant Director, Division of IntegratedAssistant Director, Division of Integrated BiosurveillanceBiosurveillance, AFHSC, AFHSC
FAZD Center Modeling WorkshopFAZD Center Modeling Workshop
2424--26 Sep 201326 Sep 2013
Outline
• AFHSC background
• Epidemiological modeling in DoD – previousassessments
• DoD epidemiological modeling working group:– Purpose
– Approach
– Results
– Recommendations
• Next steps for epidemiological modeling in DoD
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Armed Forces Health Surveillance Center
Vision: To be the central epidemiological resource and a global
health surveillance proponent for the U.S. Armed Forces
Mission: Provide timely, relevant, actionable, and
comprehensive health surveillance information in order topromote, maintain, and enhance the health of military and military-associated populations• Acquire, analyze/interpret, disseminate information, and recommend evidence-
based policy
• Develop, refine, and improve standardized surveillance methods
• Serve as focal point for sharing health surveillance products, expertise, andinformation
• Coordinate a global program of militarily relevant infectious disease surveillance
Authority established by DoD Directive 6490.02E : “Comprehensive Health Surveillance”
AFHSC Surveillance Assets
Defense Medical Surveillance System (DMSS)• Data on medical events affecting Service members throughout their careers.
• 2 billion data records on 10 million Service members and other beneficiaries.
DoD Serum Repository (DoDSR)• 55 million serial serum specimens from > 10 million individuals.
• Collected from mandatory HIV testing, and pre-and post-deployment.
• Each specimen is linked to the Service member’s record in DMSS.
Global Emerging Infections & Surveillance Response System (GEIS)• Conducts global surveillance for emerging infectious diseases.
• Performed with > 70 partner countries.
Medical Surveillance Monthly Report (MSMR)• Flagship publication for AFHSC.
• Estimates of the incidence , distribution, impact and trends of illness and injury
among military members and other beneficiaries.
Epidemiologicalmodeling in DoD – previousassessments
• Various DoD organizations support or conductepidemiological modeling to:– Guide planning(e.g., exercises, pre-deployment preparation)– Aid in identifyingoutbreaks using electronic data streams– Guide response to public health emergencies– Evaluate epidemic control measures
• Previous assessments of epidemiological modeling inthe DoD have identified coordination shortcomings:– Many organizations, models, assumptions, and
recommendations– Policy and decision-makers have varied expectations– No formal procedures for communication, coordination, or
collaboration
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• 2005 meeting:– Models used for planning have varied assumptions and methods.– Modeling groups are not connected.
• 2008 meeting:– DoD epidemiologcal modeling community should be identified.
– Develop plan for long-term communication and collaboration.
• 2010 meeting:– 2009 H1N1: “plethora of influenza models . . . many with widely
different results and recommendations”– “. . . time to capitalize on the current increased interest in
infectious disease modeling to move from discussion to action”
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Chretien et al. Emerg Infect Dis 2006;Jan.
Feighner et al. Emerg Infect Dis 2009;Sep.
Feighner et al. Mil Med 2010;175:6.
Epidemiologicalmodeling in DoD – previousassessments (continued)
• Formed as part of new biosurveillance partnership between AssistantSecretary of Defense for Nuclear, Chemical, and Biological Defense Programsand Assistant Secretary of Defense (Health Affairs).
• Members: AFHSC, BARDA, DTRA JSTO, DTRA Technical Reachback, JPM-TMT,NCMI, OASD(NCB)
• Scope: Quantitative or qualitative modeling to make predictions about thecurrent or future state of human population health, including disease riskand other disease-related variables, in time and/or space.
• Objectives:
1. Identify, describe, assess the usefulness of current DoD epidemiologicalmodeling systems.
2. Assess coordination across DoD epidemiological modeling programs.
3. Provide recommendations to advance DoD epidemiological modeling.
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DoD Epidemiological Modeling WorkingGroup (2013-)
• Purpose
• Sponsor
• Modeling approach
• Operational status (operational, pre-operational)
• Operational application (planning, response)
• Military specificity (military-specific, not military-specific)
• Intervention assessment (capability, no capability)
• Usefulness
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Attributes of modeling systems
System Sponsor Current scope
Op
erat
ion
al
Pla
nn
ing
Res
po
nse
Mili
tary
Inte
rven
tio
n
VectorMap AFHSC Vector-borne *
RVF Monitor AFHSC Vector-borne * * *
HPAC DTRA CBRN * * *
NBC CREST DTRA CBRN * * *
CNIMS DTRA CBRN * * *
Military flu forecasting DTRA (NCMI) ILI * * *
PRISM JPM-TMT (AFHSC) Vector-borne * *
CHAMP/Global Watch NCMI Chem/rad * *
IDRA NCMI Various diseases * * *
Ecological risk mapping NCMI Vector-borne * *
JMPT NHRC Medical planning * * *
ESSENCE OASD(HA) Various syndromes * * *
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VectorMap(http://vectormap.org/)
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Rift Valley Fever Monitor(http://www.ars.usda.gov/Business/docs.htm?docid=23464)
Predicting Infectious Diseases ScalableModel (PRISM)
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ILI modeling: US military bases
Riley et al. Multiple estimates of transmissibility for the 2009 influenzapandemic based on influenza-like illness data from small US militarypopulations. PLoS Comput Biol 2013;9:e1003064.
Infectious Disease Risk Assessments (IDRA)
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Electronic Surveillance System for the Early Notificationof Community-based Epidemics (ESSENCE)
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Discontinued systems: Pandemic InfluenzaPolicy Model (PIPM)
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Feighner et al. The pandemic influenza policy model: a planning toolfor military public health officials. Mil Med 2009;174:557.
Discontinued systems: GryphonTM
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Quantum Leap Innovations.
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Assessment of Usefulness
• Operational systems are in routine use; e.g.:– RVF Monitorsupported response to several outbreaks (US
Army & CDC Kenya labs).
– DoD policy requires ESSENCE use.
– Plannersand public health personnel routinely use NCMI’sproducts (IDRA, CHAMP/Global Watch).
– DTRA Reachback routinely uses HPAC for real-time response.
• Some pre-operational systems are promising; e.g.:– CNIMS (pandemic exercises, pandemic planning).
– PRISM for dengue forecasting in Peru.
Recommendations
• Develop policy and procedures to coordinateepidemiological modeling (coordination hub + partnernetwork).
• Systematically identify modeling efforts/opportunitiesacross DoD and capabilities beyond DoD.
• Address key opportunities already evident (military-specificforecasting/intervention assessment; V&V standards;dialogue between modelers and decision-makers).
• AFHSC continue to coordinate the working group,advance/monitor agenda above.
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Next Steps
• Developing a concept for epidemiological modelingcoordination across DoD.– Central Hub: Receive requests for modeling.– Technical Working Group: SMEs/stakeholders; assess requests,
identify appropriate methods, data, and SMEs.– Operations Group: Perform modeling.
• Focus on influenza forecasting– Completed literature review (analyzed ~40 studies).– Pilot using military healthcare (DMSS) data (several partners)
• Epidemic modeling for Senior Level Exercise 27 Sep (DTRA,VA Tech – VA Bioinformatics Institute)
• Forecasting technology market analysis (JPM-IS)
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