health information technology for disease surveillance & response: h7n9 as an example

Asia-Pacific Economic Cooperation

Chinese Taipei

Health Information Technology for Disease Surveillance & Response:

H7N9 as an Example

Jen-Hsiang Chuang, MD, PhD

Director, Epidemic Intelligence Center

Centers for Disease Control, Chinese Taipei

Email: [email protected]


Chinese Taipei


Chinese Taipei

Approach of Emerging Infectious Disease Surveillance & Response in Chinese Taipei

Paquet C, et al. Euro Surveill. 2006;11(12):pii=665.

where IT be able to facilitate


Chinese Taipei

Detection of Human Cases of a Novel H7N9 Virus in China on Mar. 31 (SUN)

1:08 pm - Xinhua news reported 3 human cases of H7N9 in China

1:25 pm - a SMS describing the outbreak sent from media watch room to all of the directors at CDC, Chinese Taipei

Media Watch Room

This outbreak was detected by Google News with keyword search for “avian flu (in Chinese)”


Chinese Taipei

CDC’s Response on March 31

Several emails & phone calls for initial risk assessment of H7N9 outbreak by 2pm

Teleconference activated at 4pm to discuss implications

A press release and a letter to doctors issued at 7pm


Chinese Taipei

Three Days Later (Apr. 3)

Listed H7N9 influenza a notifiable disease after convening an expert meeting (videoconference among 50 people)

Developed an in-house real-time RT-PCR for diagnosis

Activated Central Epidemic Command Center (CECC) for interdepartmental coordination (videoconference among 100 people)


Chinese Taipei

Indicator-based Surveillance Systems for H7N9


Chinese Taipei

Centralized Web-based Reporting System

for Communicable Diseases


Chinese Taipei

Instant Notification of Reporting Suspected Cases


Chinese Taipei

Data Warehousing Server

Notifiable

Disease Surveillance System

Laboratory Surveillance

ODSData Warehousing

Systems of CDC, Chinese Taipei

ETL Server

• SAS Analytics Platforml• Web-based applications (GIS,

Epidemic curves)

Data Analytical Server

On-line Analytical Server

On-line Analytical System • Business Objects for ad

hoc reporting

Syndromic Surveillance System

P&I Mortality Surveillance System

School-base Surveillance System

Surveillance System for Populous Institutions

. .

. . .

Infectious Disease Data Warehouse

. . .


Chinese Taipei

Web-based Query for H7N9 Reporting Cases

Reporting clinicians, local DOH staff & CDC staff can access the system to get real-time test results.

ID Name Onset dateReport

dateDisease

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County


Chinese Taipei

0

5

10

15

20

25

30

35

23-Mar 2-Apr 12-Apr 22-Apr 2-May 12-May 22-May 1-Jun 11-Jun 21-Jun

Nu

mb

er

of

Ca

ses

onset date

H7N9 H1N1 H3N2

B negative

Epidemic Curve of H7N9 Suspected Cases in Chinese Taipei, 2013

Updated July 3, 2013

Change case definition on June 1st


Chinese Taipei

Web-based Query for Epidemic Curve of H7N9 in Chinese Taipei

URL: http://nidss.cdc.gov.tw/

• Updated at 7am each day

• Free access by the public

One imported case from China announced on Apr. 24


Chinese Taipei

Event-based Surveillance Systems for H7N9


Chinese Taipei

Sina: http://roll.news.sina.com.cn/s_qlg2013_all/index.shtml Baidu: http://news.baidu.com/z/twdz/zhuanti.html Xinhua: http://www.xinhuanet.com/health/zt/2013qlg/index.htm National Health and Family Planning Commission of the People's Republic of China:

http://www.moh.gov.cn/ Shanghai Municipal Health Bureau: http://wsj.sh.gov.cn/ Official weibo of the Information Office of the Shanghai Municipal Government:

http://e.weibo.com/shanghaicity Beijing Municipal Health Bureau: http://www.bjhb.gov.cn/ Jiangsu Provincial Department of Health: http://www.jswst.gov.cn/gb/jsswst/index.html Anhui Provincial Health Department: http://www.ahwst.gov.cn/ Health Bureau of Zhejiang Province: http://www.zjwst.gov.cn/ The Health Department of Shandong Province: http://www.sdws.gov.cn/default/ Henan Provincial Health Bureau: http://www.hnwst.gov.cn/ Department of Health of Jiangxi Province: http://www.jxwst.gov.cn/ Fujian Provincial Health Bureau: http://www.fjphb.gov.cn/ Health Department of Hunan Province: http://www.21hospital.com/ Ministry of Agriculture of the People's Republic of China :http://www.moa.gov.cn/

News Surveillance for H7N9 Outbreaks in China

http://roll.news.sina.com.cn/s_qlg2013_all/index.shtml

http://news.baidu.com/z/twdz/zhuanti.html

http://www.xinhuanet.com/health/zt/2013qlg/index.htm

http://www.moh.gov.cn/

http://wsj.sh.gov.cn/

http://e.weibo.com/shanghaicity

http://www.bjhb.gov.cn/

http://www.jswst.gov.cn/gb/jsswst/index.html

http://www.ahwst.gov.cn/

http://www.zjwst.gov.cn/

http://www.sdws.gov.cn/default/

http://www.hnwst.gov.cn/

http://www.jxwst.gov.cn/

http://www.fjphb.gov.cn/

http://www.21hospital.com/

http://www.moa.gov.cn/


Chinese Taipei

Comparison of Sources’ Timeliness for Reporting H7N9 Outbreaks in China

1

3

2

4

5

5

4


Chinese Taipei

Daily Update of H7N9 Epidemic Curve in China


Chinese Taipei

Daily Update of H7N9 Map in China


Chinese Taipei

Communication for H7N9


Chinese Taipei

Some Statistics

As of June 3013 CECC meetings 51 press conferences78 press releases5 letters to doctors

8,000 doctors thru e-newsletters58 medical associations22 local DOHs


Chinese Taipei

Access of CDC Web Site

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

China’s 1st family cluster

Imported case confirmed


Chinese Taipei

Interactions with Facebook Users (1)

31 posts

426,000 people read posts


Chinese Taipei

Interactions with Facebook Users (2)

25,200 people clicked images or videos

15,600 people liked posts or left messages


Chinese Taipei

Sharing Genomic Sequencing Data of Imported H7N9 Case


Chinese Taipei

H7N9 Publications in Chinese Taipei

Chang SY, Lin PH, Tsai JC, Hung CC, Chang SC. The first case of H7N9 influenza in

Taiwan. Lancet. 2013;381(9878):1621.

Tang RB, Chen HL. An overview of the recent outbreaks of the avian-origin influenza A

(H7N9) virus in the human. J Chin Med Assoc. 2013;76(5):245-8.

Lo YC, Chen WC, Huang WT, et al. Surveillance of avian influenza A(H7N9) virus

infection in humans and detection of the first imported human case in Taiwan, 3 April to

10 May 2013. Euro Surveill. 2013;18(20).pii:20479.

Wu HS, Chuang JH, Chang FY. Taiwan faces challenges on the emerging avian

influenza A (H7N9) virus in China. J Formos Med Assoc. 2013;112(6):299-301.

Chen GW, Lai MM, Wu SC, Chang SC, Huang LM, Shih SR. Is avian influenza A

(H7N9) virus staggering its way to humans? J Formos Med Assoc. 2013;112(6):312-8.

Chang FY, Lin TY, Chiu WT. Taiwan’s response to human infection with H7N9 in

China. N Engl J Med. 2013 (Accepted).


Chinese Taipei

Conclusions

Information technology plays a key role in the

surveillance & response of emerging infectious diseases

in Chinese Taipei

Systematic collection of significant data

Analyses of these data

Timely dissemination of results to guide interventions

health information technology for disease surveillance & response: h7n9 as an example

Health & Medicine

chinese taipei url

chinese taipei email

chinese taipei paquet

h7n9 reporting cases

human cases of h7n9

disease control

listed h7n9 influenza

novel h7n9 virus