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CITATION: Petersen, E. et al. 2020. COVID-19 travel restrictions and the International Health Regulations : call for an open debate on easing of travel restrictions. International Journal of Infectious Diseases, 94:88–90, doi:10.1016/j.ijid.2020.04.029.

To describe a crowdsourced disease surveillance project (EpiCore) and evaluate its usefulness in obtaining information regarding potential disease outbreaks.Volunteer human, animal and environmental health professionals from around the world were recruited to EpiCore and trained to provide early verification of health threat alerts in their geographical region via a secure, easy-to-use, online platform. Experts in the area of emerging infectious diseases sent requests for information on unverified health threats to these volunteers, who used local knowledge and expertise to respond to requests. Experts reviewed and summarized the responses and rapidly disseminated important information to the global health community through the existing event-based disease surveillance network, ProMED.From March 2016 to September 2017, 2068 EpiCore volunteers from 142 countries were trained in methods of informal disease surveillance and use of the EpiCore online platform. These volunteers provided 790 individual responses to 759 requests for information addressing unverified health threats in 112 countries; 361 (45%) responses were considered to be useful. Most responses were received within hours of the requests. The responses led to 194 ProMED posts, of which 99 (51%) supported verification of an outbreak, were published on ProMED and sent to over 87 000 subscribers.There is widespread willingness among health professionals around the world to voluntarily assist efforts to verify and provide supporting information on unconfirmed health threats in their region. By linking this member network of health experts through a secure online reporting platform, EpiCore enables faster global outbreak detection and reporting.Décrire un projet participatif de surveillance des maladies (EpiCore) et évaluer son utilité pour obtenir des informations sur d'éventuelles flambées épidémiques.Des professionnels bénévoles de la santé humaine, animale et environnementale du monde entier ont été recrutés dans le cadre du système EpiCore. Ces professionnels ont été formés pour effectuer une vérification rapide des alertes sanitaires dans leur région géographique par l'intermédiaire d'une plate-forme en ligne sécurisée et facile à utiliser. Des experts des maladies infectieuses émergentes ont envoyé des demandes d'informations sur des menaces sanitaires non vérifiées à ces bénévoles, qui ont utilisé les connaissances et l'expertise disponibles localement pour y répondre. Les experts ont examiné et synthétisé les réponses fournies, puis ont rapidement diffusé les informations importantes à la communauté sanitaire mondiale par le biais de ProMED, un réseau de surveillance des maladies fondée sur des faits.Entre mars 2016 et septembre 2017, 2068 bénévoles EpiCore originaires de 142 pays différents ont été formés aux méthodes de surveillance informelle des maladies et à l'utilisation de la plate-forme en ligne EpiCore. Ces bénévoles ont fourni 790 réponses individuelles aux 759 demandes d'informations portant sur des menaces sanitaires non vérifiées dans 112 pays; 361 (45%) réponses ont été jugées utiles. La plupart des réponses ont été reçues quelques heures après la demande. Les réponses ont donné lieu à 194 articles ProMED, dont 99 (51%) soutenaient la vérification d'une épidémie et ont été publiés sur ProMED et envoyés à plus de 87 000 abonnés.De nombreux professionnels de santé du monde entier sont prêts à soutenir bénévolement les efforts visant à vérifier les menaces sanitaires non confirmées dans leur région et à fournir des informations complémentaires à leur égard. En reliant les membres de ce réseau d'experts de la santé par l'intermédiaire d'une plate-forme en ligne sécurisée, EpiCore permet d'accélérer la détection des épidémies mondiales et l'établissement de rapports.Describir un proyecto de control de enfermedades con participación pública (EpiCore) y evaluar su utilidad para obtener información sobre potenciales brotes de enfermedad.Se reunieron a profesionales de salud humana, animal y medioambiental de todo el mundo para el proyecto EpiCore y se capacitaron para proporcionar verificación temprana de alertas de amenazas para la salud en su región geográfica a través de una plataforma segura, fácil de usar y en línea. Los expertos en el área de enfermedades infecciosas emergentes enviaron solicitudes de información sobre amenazas para la salud no verificadas a estos voluntarios, quienes utilizaron el conocimiento local y la experiencia para responder a las solicitudes. Los expertos revisaron y resumieron las respuestas y rápidamente distribuyeron información importante a la comunidad mundial de salud a través de la red de control de enfermedades basada en eventos existentes, ProMED.Desde marzo de 2016 hasta septiembre de 2017, 2068 voluntarios de EpiCore de 142 países se formaron en métodos de control de enfermedades casuales y el uso de la plataforma en línea de EpiCore. Estos voluntarios proporcionaron 790 respuestas individuales a 759 solicitudes de información sobre amenazas para la salud no verificadas en 112 países; de estas respuestas, 361 (45%) se consideraron útiles. La mayoría de las respuestas se recibieron en cuestión de horas a partir de la solicitud. Las respuestas condujeron a 194 artículos de ProMED, de los cuales 99 (51%) respaldaron la verificación de un brote, se publicaron en ProMED y se enviaron a más de 87 000 suscriptores.Existe una amplia disposición entre los profesionales de la salud de todo el mundo para ayudar voluntariamente con los esfuerzos de verificación y respaldo de la información sobre amenazas para la salud no confirmadas en sus regiones. Al conectar esta red de miembros expertos de la salud mediante una plataforma de información en línea segura, EpiCore facilita la detección y comunicación más rápida de brotes en el mundo.وصف مشروع مراقبة المرض الجماعي (إيبكور) والوقوف على مدى أهميته في تجميع المعلومات المتعلقة بالحوادث المحتملة لانتشار الأمراض.انضم متطوعون من المتخصصين في صحة الإنسان والحيوان والبيئة من جميع أنحاء العالم في مشروع إيبكور وخضعوا للتدريب للكشف المبكر عن الإنذارات المتعلقة بالمخاطر التي تهدد الصحة في منطقتهم الجغرافية عبر منصحة آمنة سهلة الاستخدام عبر الإنترنت. ويرسل الخبراء في مجال الأمراض المعدية الناشئة طلبات للحصول على معلومات بشأن المخاطر الصحية غير المثبتة إلى المتطوعين، والذين استعانوا بدورهم بالخبرة والمعرفة المحلية للرد على هذه الطلبات. وقام الخبراء بمراجعة تلك الردود وتلخيصها ونشر المعلومات الهامة سريعًا في أوساط المجتمع الصحي العالمي عن طريق الشبكة الحالية لمراقبة الأمراض المعتمدة على الوقائع، والمعروفة باسم ProMED.في الفترة من مارس/آذار 2016 حتى 10 سبتمبر/أيلول 2017، خضع 2068 متطوعًا تابعًا لإيبكور من 142 دولة للتدريب على طرق مراقبة الأمراض بشكلٍ غير رسمي واستخدام منصة إيبكور على الإنترنت. وقدم المتطوعون 790 ردًا فرديًا على 759 طلبًا للمعلومات فيما يتعلق بالمخاطر الصحية غير المثبتة في 112 دولة؛ وتم اعتبار 361 ردًا (بنسبة 45‏%) ضمن الردود المفيدة. وتم استلام أغلب الردود خلال ساعات من إرسال الطلبات. ونتج عن تلك الردود نشر 194 منشورًا تابعًا لـ ProMED، حيث قدم 99 (‏51%) منها دليلاً على تفشي المرض، وتم نشرها على ProMED وإرسالها إلى أكثر من 87 ألف مشترك.هناك استعداد واسع النطاق بين الأخصائيين الصحيين حول العالم لتقديم مساعدات في الجهود المبذولة طوعًا للكشف وتقديم معلومات تثبت وجود مخاطر صحية غير أكيدة في منطقتهم. وبفضل الاتصال بشبكة الأعضاء المكونة من خبراء الصحة خلال منصة إبلاغ آمنة على الإنترنت، تعمل إيبكور على تمكين الكشف السريع عن تفشي الأمراض عالميًا والإبلاغ عنها.旨在描述众包疾病监测项目 (EpiCore) 并评估其在获取潜在疾病突发信息方面的有用性。.从世界各地招募人类、动物和环境卫生方面的专业人员志愿者至 EpiCore，并且通过安全、易于使用的在线平台让志愿者在其所处的地理区域接受培训，从而提供公共卫生威胁警报的早期证实。新兴传染病领域的专家向这些志愿者发出针对尚未证实卫生威胁的信息请求，这些志愿者得以运用其对当地情况的了解和专业知识，对相应请求做出回应。专家对这些回应进行审查和归纳，同时通过现有基于事件的疾病监测网络——ProMED，将重要信息迅速传播至全球卫生社区。.2016 年 3 月至 2017 年 9 月，来自 142 个国家的 2068 名 EpiCore 志愿者接受了非正式疾病监测以及 EpiCore 在线平台使用的培训。这些志愿者针对 759 份关于解决 112 个国家尚未证实卫生威胁的信息请求，提供了 790 份个人回答，其中 361 (45%) 份回答显示为有用。大多数回应能够在信息请求发出后数小时之内收到。这些回应生成了 194 份 ProMED 帖子，其中 99 (51%) 份为疾病突发的证实提供了支持。这些帖子被发布在 ProMED 上并被发给 87000 多名订阅者。.在全世界的卫生专业人员中，很多人愿意主动协助，提供其所在地区尚未确定卫生威胁的证实情况和支持信息。通过一个安全的在线报告平台连接卫生专家成员网络，EpiCore 加快了全球疾病突发的监测与报告。.Описать проект для наблюдения и контроля заболеваний (EpiCore), организованный по принципу краудсорсинга, и оценить его практическую ценность в получении информации о потенциальных вспышках заболеваний.Компанией EpiCore со всего мира были на добровольных началах набраны специалисты по охране здоровья человека, животных и окружающей среды, которые прошли подготовку по обеспечению ранних проверок предупреждений об угрозах для здоровья в своем географическом регионе с помощью безопасной и простой в использовании онлайн-платформы. Эксперты в области возникающих инфекционных заболеваний направили запросы на получение информации о непроверенных угрозах здоровью этим добровольцам, которые использовали местные знания и опыт для ответа на запросы. Эксперты рассмотрели и обобщили ответы и быстро распространили важную информацию среди мирового сообщества специалистов здравоохранения с помощью существующей, основанной на событиях сети мониторинга заболеваний ProMED.С марта 2016 года по сентябрь 2017 года 2068 добровольцев компании EpiCore из 142 стран прошли обучение методам неофициального наблюдения и контроля заболеваний и использованию онлайн-платформы EpiCore. Эти добровольцы предоставили 790 индивидуальных ответов на 759 запросов на получение информации, касающейся непроверенных угроз здоровью в 112 странах; 361 ответ (45%) был признан полезным. Большинство ответов было получено в течение нескольких часов после поступления запроса. Ответы послужили основой для публикации в ProMED 194 сообщений, отправленных более чем 87 000 подписчиков, в 99 из этих сообщений (51%) была предоставлена подтверждающая информация о вспышках заболеваний.Специалисты в области здравоохранения во всем мире проявляют готовность добровольно содействовать усилиям по проверке и предоставлению вспомогательной информации о неподтвержденных угрозах для здоровья в их регионе. Используя эту сеть экспертов в области здравоохранения с помощью безопасной онлайн-платформы для сообщения данных, EpiCore обеспечивает более быстрое глобальное обнаружение вспышек заболеваний и составление отчетности.

To compare the timeliness of nongovernmental and governmental communications of infectious disease outbreaks and evaluate trends for each over time, we investigated the time elapsed from the beginning of an outbreak to public reporting of the event. We found that governmental sources improved the timeliness of public reporting of infectious disease outbreaks during the study period.

The increasing number of emerging infectious disease events that have spread internationally, such as severe acute respiratory syndrome (SARS) and the 2009 pandemic A/H1N1, highlight the need for improvements in global outbreak surveillance. It is expected that the proliferation of Internet-based reports has resulted in greater communication and improved surveillance and reporting frameworks, especially with the revision of the World Health Organization's (WHO) International Health Regulations (IHR 2005), which went into force in 2007. However, there has been no global quantitative assessment of whether and how outbreak detection and communication processes have actually changed over time. In this study, we analyzed the entire WHO public record of Disease Outbreak News reports from 1996 to 2009 to characterize spatial-temporal trends in the timeliness of outbreak discovery and public communication about the outbreak relative to the estimated outbreak start date. Cox proportional hazards regression analyses show that overall, the timeliness of outbreak discovery improved by 7.3% [hazard ratio (HR) = 1.073, 95% CI (1.038; 1.110)] per year, and public communication improved by 6.2% [HR = 1.062, 95% CI (1.028; 1.096)] per year. However, the degree of improvement varied by geographic region; the only WHO region with statistically significant (α = 0.05) improvement in outbreak discovery was the Western Pacific region [HR = 1.102 per year, 95% CI (1.008; 1.205)], whereas the Eastern Mediterranean [HR = 1.201 per year, 95% CI (1.066; 1.353)] and Western Pacific regions [HR = 1.119 per year, 95% CI (1.025; 1.221)] showed improvement in public communication. These findings provide quantitative historical assessment of timeliness in infectious disease detection and public reporting of outbreaks.

Poster: "18th ICID / Fri_Station_03.2 / The role of regional surveillance networks in enhancing global outbreak reporting" by: "E. Joh1, L. Madoff2, Z. Haddad2, M. Carrion2, S. Mekaru3, M. Pollack2, B. Lassmann2; 1Toronto, ON/CA, 2Brookline/US, 3Boston/US"

Objective—To identify emerging animal and zoonotic diseases and associated geographic distribution, disease agents, animal hosts, and seasonality of reporting in the Program for Monitoring Emerging Diseases (ProMED)-mail electronic early warning system. Design—Retrospective study. Sample Population—10,490 disease reports. Procedures—Descriptive statistics were collated for all animal disease reports appearing on the ProMED-mail system from January 1, 1996, to December 31, 2004. Results—Approximately 30% of reports concerned events in the United States; reports were next most common in the United Kingdom, Canada, Australia, Russia, and China. Rabies, bovine spongiform encephalopathy, and anthrax were reported consistently over the study period, whereas avian influenza, Ebola virus, and Hantavirus infection were reported frequently in approximately half of the study years. Reports concerning viral agents composed more than half of the postings. Humans affected by zoonotic disease accounted for a third of the subjects. Cattle were affected in 1,080 reports, and wildlife species were affected in 825 reports. For the 10,490 postings studied, there was a retraction rate of 0.01 and a correction rate of 0.02. Conclusions and Clinical Relevance—ProMED-mail provided global coverage, but gaps in coverage for individual countries were detected. The value of a global electronic reporting system for monitoring emerging diseases over a 9-year period illustrated how new technologies can augment disease surveillance strategies. The number of animal and zoonotic diseases highlights the importance of animals in the study of emerging diseases.

(See the Editorial Commentary by Polgreen and Polgreen on pages 525–6.) The dynamics of infectious disease emergence and spread is a complex process, but it has been recognized that they are at least partly propelled by changes in socioeconomic, environmental, and biological factors [1, 2]. In this study, we turned our attention to the socioeconomic perspective specifically in aiming to better understand infectious disease risk for a population. Socioeconomic factors span a hierarchical continuum from distal to proximate (Figure ​(Figure1)1) [3]. At the distal end of the spectrum are population-level factors such as inequality, education, gross domestic product, and public health spending, whereas individual-level factors such as personal wealth, nutritional status, and access to healthcare lie at the proximate end. Studies assessing individual level risk factors have been plentiful, but calls for more research from a population-level perspective in the 1990s highlighted the scarcity of work at the distal range of the spectrum [4, 5]. Since then, a rich literature has built up connecting macro-level socioeconomic factors to population health outcomes such as infant mortality [3] and life expectancy [6]. Broadly speaking, these outcomes have been shown to improve as a country becomes increasingly “developed,” with variation being partly attributed to externalities related to inequality [7] or social cohesion [8]. It would be expected that these trends extend to infectious disease outcomes as well, although in fact the role of population-level socioeconomic factors in infectious disease outcomes has received relatively little attention [9]. Figure 1. A socioeconomic model of disease outbreaks. The present study is concerned with the distal factors contributing to outbreak emergence. Adapted with permission from authors Schell, Reilly, Rosling, Peterson, and Ekstrom [3]. In this study, we examined the association between national-level socioeconomic variables and national-level risk for infectious disease outbreaks, as approximated by the number of outbreaks reported in the World Health Organization's (WHO) Disease Outbreak News reports for which a country was the first to have cases. Efforts toward a better understanding of how various factors drive emergence and spread are critical for formulating policies that optimize strategies for the prevention, detection, and management of outbreaks. Understanding geographic risk is also important to determine whether global resources are being properly allocated, especially as efforts for infectious disease surveillance and research are skewed toward a limited set of wealthier countries [10].