Development of Health Indicator and Other Innovative Surveillance Tools

Emerging infections, to include bioterrorism, must be

and necessitated the development of automated, math 

recognized as promptly as possible. A consensus has

ematically based presentation techniques to prioritize

emerged that real time health indicator surveillance,

the information for further investigation.  The expanded,

to include surveillance for syndromes in addition to

global scope of ESSENCE required work to begin on

laboratory confirmed diagnoses, may promote earlier

organizing across multiple chains of command the tri 

detection of outbreaks and important sentinel events,

service human elements needed to implement timely

facilitate the evidence based allocation of rapid

follow up actions. 

response assets (e.g., drugs, vaccines, public health

responders), and provide civic leaders with the infor 

DoD GEIS also supported at the Madigan Army

mation needed for credible risk communication to

Medical Center the development of an MHS based

populations perceiving a risk.  

approach to surveillance and focal outbreak detection

based on linking Ambulatory Data System (ADS),

DoD GEIS has pioneered the development of

MHS laboratory data, and Geographic Information

ESSENCE, the Electronic Surveillance System for

System (GIS) information to enable the plotting of

the Early Notification of Community based Epidemics.

reportable disease information.  The initial effort has

Development, initially focused on daily surveillance

been focused on using both ambulatory and laboratory

of syndromes detected in DoD ambulatory care

data on syphilis, gonorrhea, and chlamydia.  Progress

clinics in the National Capitol Area, began in 1999.

during FY 2001 included achieving technical and

DoD GEIS recognized that an ideal system would be

legal access to the necessary data, acquisition of

a system of systems integrating other potentially

encryption software, and other procedural issues.  The

useful data from nurse hotlines, intensive care units,

Bloomberg School of Public Health at Johns Hopkins

pharmacies, laboratories, and veterinary surveillance

University assisted with the development and evaluation

sources.  To this end early in FY 2001 the DoD GEIS

of the GIS maps for the Madigan region.  During FY

Central Hub partnered with the Johns Hopkins

2002 the mapping software will be fully deployed and

Applied Physics Lab and several other institutions

tested in anticipation of its use by other military

and obtained a grant of more than $10 million from

treatment facilities.

the Defense Advance Research Projects Agency

(DARPA) to develop a prototype integrated civil 

DoD GEIS also continued its fruitful collaboration

military health indicator surveillance system for the

with NASA in using satellite remote sensing data to

NCA called ESSENCE II.  Enhancement of the initial

predict outbreaks with environmental correlates.  The

ESSENCE system was undertaken during the fiscal

initial focus has been Rift Valley Fever (RVF), a lethal

year through the development of new aberration

disease of human and veterinary importance that has

detection models and methods to present geographic

historically been a threat to pastoral populations in

information system data.  Access by military public

East Africa and more recently to the southern Arabian

personnel with a need to know was enhanced by

Peninsula.  Using methods developed jointly by

placement of the daily surveillance data on a secure

DoD GEIS and NASA in prior years, during FY 2001

website.  The events of September 11 prompted a rapid

DoD GEIS continued to post on its website monthly

expansion of the ESSENCE system from the NCA to

RVF predictive risk maps and related information.

all DoD Medical Treatment Facilities worldwide (121

Processing of newer forms of satellite data (1 km

Army, 110 Navy, 80 Air Force, and 2 Coast Guard).

Resolution SPOT vegetation data) was initiated that

This scale up greatly increased the amount of data

should support development of a broad spectrum of

to be interpreted every day to approximately 3,000

related surveillance activities for other diseases

syndrome specific regional and subregional charts

worldwide.  

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