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 !

HansUlrichHoltherm@bundeswehr.orgPhone: +49 431-384-7520