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Abstract Background Effective epidemic preparedness is critical for minimizing the health and societal impacts of viral respiratory infections. This study details the development of a data-driven early warning system (EWS) designed to improve outbreak detection and response utilizing the data integration and visualization capabilities of Microsoft Power BI. Methods This research utilized a structured three-phase approach to design a respiratory infections (RIs) management dashboard. Phase 1, focused on identifying critical variables through literature reviews and expert interviews. In Phase 2, Microsoft Power BI was employed for dashboard development, integrating data from diverse sources. Phase 3 involved usability testing with health professionals who evaluated navigation, data accuracy, decision-support features, providing feedback to enhance visualization clarity and filtering capabilities. Results Key data categories include individual-level variables, such as age, symptoms, and vaccination records, alongside population-level metrics like infection rates and regional vaccination coverage enabling functionalities such as identifying high-risk individuals, tracking infection dynamics, and optimizing resource allocation. The dashboard, developed using Power BI visualizes epidemiological trends, intervention outcomes, and resource utilization. A relational database schema ensures efficient data retrieval, facilitating comprehensive analysis. Conclusion The prototype EWS represents a scalable and integrative framework aimed at enhancing public health applications, particularly in the context of respiratory infections. By incorporating data from diverse health sectors, the system offers decision-makers access to critical epidemiological indicators, supporting early outbreak detection and improved epidemic management. Its potential to unify health institutions underscores its value in fostering a more cohesive and effective approach to epidemic preparedness. Nevertheless, while the system demonstrates significant promise, further evaluation in real-world settings is essential to determine its practical impact on public health outcomes and its ability to mitigate health crises.

Abstract Objectives Disruptive public health risks and events, including infectious disease outbreaks, are inevitable, but their effects can be mitigated by investing in prevention and preparedness. We assessed the epidemic preparedness and response capacities of health systems in 186 countries from 2018 to 2022. Methods We utilized data from the International Health Regulations (IHR) State Party Self-Assessment Annual Reporting (SPAR) submissions to assess health systems’ IHR capacities to (1) prevent, (2) detect, (3) respond, (4) enable resources and coordinate, and (5) ensure operational readiness from 2018 to 2022. We categorized the IHR capacities into five levels, with level 1 denoting the lowest level of national capacity and level 5 the highest. We calculated each index’s capacity level as the arithmetic mean of its related indicators and analyzed changes over time using the Mann–Kendall nonparametric trend test. Results SPAR reporting marginally improved from 92.9% (182 of 196 countries) in 2018 to 94.9% (186 of 196 countries) in 2022, with considerable improvement in all five capacity domains over this period: prevention (58.4 in 2018 to 66.5 in 2022), detection (74.7 to 78.3), response (56.5 to 67.8), enabling resources and coordination (63.0 to 68.3), and ensuring operational readiness (62.8 to 69.9). From the 2022 submissions, 116 (62%) countries reported functional (Level 4 or 5) prevention capacity, 162 (87%) had functional detection capacity, 118 (63%) had functional response capacity, 121 (65%) had functional enabling resources and coordination capacity, and 133 (72%) had functional operational readiness against public health events. Across all the indexes, the WHO African Region reported the fewest countries with functional capacity in these domains. Conclusions There was an overall increase in functional capacity across all five domains at both global and regional levels; and a high percentage of countries achieved functional capacity across all domains in 2022. However, a significant number of countries, particularly in the Global South, have yet to achieve functional competence in these capacities, leaving the world vulnerable to the persistent risk of epidemics and infectious biohazards. Strengthening IHR competencies through local, national, and global engagements must be urgently prioritized to achieve global health security against infectious diseases.

Abstract Background Somali Red Crescent Society (SRCS), supported by Norwegian Red Cross, has implemented community-based surveillance (CBS) in Somaliland. This methodology aims to reduce the high risk of epidemics by strengthening early warning and response from and at community level, particularly where there is a weak public health surveillance system. CBS is implemented through SRCS community volunteers, who report signals from the community via SMS to the software platform Nyss. This paper presents key findings from the CBS programme evaluation. Methods A retrospective observational mixed-methods approach to evaluate the CBS programme was conducted, using routine CBS data from 2021 for Awdal and Togdheer regions and qualitative interviews with stakeholders’ representatives. Results The usefulness of the CBS programme in preventing, detecting, and responding to disease outbreaks was acknowledged by the stakeholders’ representatives. 83% of the signals in Awdal region matched a Community Case Definition (CCD) and were escalated to the Ministry of Health and Development (MoHD)). For Togdheer region, 97% were escalated. Verification of signals by supervisors and escalation to the authorities was done timely.Alert outcome and response action was not well recorded, therefore there is limited evidence on sensitivity. The programme was shown to be simple and can be flexibly adjusted for new diseases and changing CCDs.Stakeholders appreciated being engaged, the good collaboration, their participation throughout the implementation and expressed high acceptance of the programme. Conclusion CBS can support early warning and response for a variety of public health risks. Improved documentation for alert outcomes could help to better evaluate the sensitivity of CBS. A participatory approach is vital to achieve successful community volunteer engagement. Software tools, such as the Nyss platform, can be useful to support effective and efficient CBS implementation.

Abstract Background Despite previous experience with epidemics, African healthcare systems were inadequately prepared and substantially impacted by the coronavirus disease 2019 (COVID-19) pandemic. Limited information about the level of COVID-19 preparedness of healthcare facilities in Africa hampers policy decision-making to fight future outbreaks in the region, while maintaining essential healthcare services running. Methods Between May–November 2020, we performed a survey study with SafeCare4Covid − a free digital self-assessment application − to evaluate the COVID-19 preparedness of healthcare facilities in Africa following World Health Organization guidelines. The tool assessed (i) COVID-19-related capabilities with 31 questions; and (ii) availability of essential medical supplies with a 23-supplies checklist. Tailored quality improvement plans were provided after assessments. Information about facilities’ location, type, and ownership was also collected. Results Four hundred seventy-one facilities in 11 African countries completed the capability assessment; 412 also completed the supplies checklist. The average capability score on a scale of 0–100 (n=471) was 58.0 (interquartile range 40.0–76.0), and the average supplies score (n=412) was 61.6 (39.0–83.0). Both scores were significantly lower in rural (capability score, mean 53.6 [95%CI:50.3–57.0]/supplies score, 59.1 [55.5–62.8]) versus urban facilities (capability score, 65.2 [61.7–68.7]/supplies score, 70.7 [67.2–74.1]) (P

Abstract Background Zika virus (ZIKV) emerged as a global epidemic in 2015–2016 from Latin America with its true geographical extent remaining unclear due to widely presumed underreporting. The identification of locations with potential and unknown spread of ZIKV is a key yet understudied component for outbreak preparedness. Here, we aim to identify locations at a high risk of cryptic ZIKV spread during 2015–2016 to further the understanding of the global ZIKV epidemiology, which is critical for the mitigation of the risk of future epidemics. Methods We developed an importation simulation model to estimate the weekly number of ZIKV infections imported in each susceptible spatial unit (i.e. location that did not report any autochthonous Zika cases during 2015–2016), integrating epidemiological, demographic, and travel data as model inputs. Thereafter, a global risk model was applied to estimate the weekly ZIKV transmissibility during 2015–2016 for each location. Finally, we assessed the risk of onward ZIKV spread following importation in each susceptible spatial unit to identify locations with a high potential for cryptic ZIKV spread during 2015–2016. Results We have found 24 susceptible spatial units that were likely to have experienced cryptic ZIKV spread during 2015–2016, of which 10 continue to have a high risk estimate within a highly conservative scenario, namely, Luanda in Angola, Banten in Indonesia, Maharashtra in India, Lagos in Nigeria, Taiwan and Guangdong in China, Dakar in Senegal, Maputo in Mozambique, Kinshasa in Congo DRC, and Pool in Congo. Notably, among the 24 susceptible spatial units identified, some have reported their first ZIKV outbreaks since 2017, thus adding to the credibility of our results (derived using 2015–2016 data only). Conclusion Our study has provided valuable insights into the potentially high-risk locations for cryptic ZIKV circulation during the 2015–2016 pandemic and has also laid a foundation for future studies that attempt to further narrow this key knowledge gap. Our modelling framework can be adapted to identify areas with likely unknown spread of other emerging vector-borne diseases, which has important implications for public health readiness especially in resource-limited settings.

Abstract Background Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda’s experience in EVD preparedness. Results On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. Conclusion As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a “fire-fighting” approach during public health emergencies.