SORMAS: Mobile Ebola Surveillance
Surveillance of Ebola infections by real-time mobile data transmission in Nigeria
The ongoing Ebola virus epidemic in West Africa and the possible re-emergence of new Ebola virus infections in countries such as Nigeria require to strengthen the disease surveillance and control capabilites in these countries.
The aim of the project "EBOKON 10" is to exploit information technology to support in identifying emerging infections and Ebola suspected cases as well as their contacts immediately. In this way, further spread of infections can be prevented. Together with the Nigerian "Programme for Field Epidemiology and Laboratory Training" the Department of Epidemiology at the HZI (Prof. Dr. Krause) has initiated that project to address this challenge.
In order to meet the specific technical requirements of West African countries, a management tool for infection control and for real time transmission of epidemiological data will be developed. It will run on normal mobile phones that are widely spread in West African countries. The complexity of the data processing is, however, handled by a high-performance data management platform and the use of cloud technology provided by SAP, a German Software Corporation.
Robert Koch-Institut (RKI), Berlin
Federal Ministry of Health (FMOH), Abuja, Nigeria
Deutsche Zentrum für Infektionsforschung (DZIF), Braunschweig
SORMAS: Surveillance of Ebola Virus Disease by real-time data transmission
Since the declaration of the Ebola Virus Disease (EVD) outbreak as Public Health Emergency of International Concern in August 2014 by the DG of the WHO, the Ebola Virus Outbreak is ongoing in West Africa. Despite the successful containment of the EVD outbreak in Nigeria, the ongoing outbreaks in neighbouring countries increase the potential for the introduction of new cases in Nigeria and other countries. Re-introduction of EVD in the community in Nigeria is of particular concern for further EVD spread given the population size and the high mobility of individuals living in Nigeria. So far, no specific treatment or vaccine is available for EVD. Furthermore, EVD itself shows a variety of unspecific signs and symptoms at disease onset with a high risk of human-to-human transmission, which indicates the need for enhanced surveillance measures. Therefore and for the foreseeable future, the containment of the Ebola outbreak will have to rely on a rapid and comprehensive identification of suspect cases, swift verification and assessment of contact persons. This signifies particular challenges in highly mobile populations living in areas with less reliable communication infrastructure and overwhelmed health care systems.
In order to strengthen existing surveillance for infectious diseases in Nigeria and to prevent new EVD outbreaks to be introduced to Nigeria, the aims and related activities of SORMAS are:
1. The rapid and sensitive notification of EVD cases and suspected EVD cases and identification of contacts using mobile phone based case finding and contact tracing tools.
- Swift notification by health care facilities of suspected or laboratory diagnosed cases ensuring laboratory-based diagnosis and/or coordinated medical case Management
- Systematic and structured recording of contact persons beyond administrative boundaries by the local health authorities
- Documentation of the 21 days monitoring of contacts (fever and other symptoms) and synchronization with existing surveillance
- Swift notification of contacts presenting symptoms and immediate referral to designated isolation center to assure comprehensive and continuously updated overview of current knowledge and tracing activities with respect to persons who had contact to cases
- Routine data analysis to ensure timely reporting and presentation to facilitate response. Data analysis encompasses epidemiologic indicators (e.g. case fatality rates) and system performance indicators (e.g. intervals between reporting and referral to isolation centre/quarantine).
- The continuous monitoring of case-, clinical- and infection control status of reported cases and support the management of cases by public health officers and officials.
2. The timely notification of acute illnesses and deaths of health care workers using mobile phone based case finding tool in Health Facilities.
- The systematic and structured documentation of the investigation of health care workers suffering from an acute illness to exclude EVD
- The systematic and structured documentation of the investigation of the death of a health care worker due to an acute illness (1 – 2 weeks) or unexplained death.
3. The verification and tracking of rumors of EVD cases with documentation of outcome.
A central IT-system for mobile real-time transmission of notification reports and response will be developed which includes options for bi-directional and mobile information exchange. The high performance data management system SAP HANA will ibn combination with cloud technology will provide flexible and rapid processing of complex data while health care workers in the field will access the system through common cell phones which do not need further configurations or installation. Core functions of the system encompass case ascertainment and contact tracing in real time and the timely transmission of data to public health officials and to the national Nigerian Ebola Emergency Operation Center, which is responsible for the coordination and the monitoring of the response. The analysis of real-time surveillance and laboratory data will be done routinely and will provide the basis for a comprehensive understanding of the epidemiological situation beyond administrative borders/districts. Central objectives are that the new system be fully integrated within the already existing Infectious Disease Surveillance and Reporting System and that also the private health care sector be included to assure high sensitivity of the surveillance system.
It is foreseen to pilot SORMAS in June 2015 in two state in Nigeria, Kano and Oyo. During the pilot phase, surveillance will focus on measles, cholera, and H5N1. The EVD module will be tested with simulated data and predefined scenarios at the same period of time
Subject to a systematic evaluation in July 2015, additional funding application will be submitted for further roll-out in Nigeria and implementation in another West African country. In order to assure quality and avoid unnecessary use of resources, strict criteria for project continuation have been defined. Among them are those related to the epidemiologic situation itself and the acceptance by the national government, the public health service, and by the general population.
A successful implementation of this project can be used as a template for enhanced surveillance in West African countries where so far no EVD cases have been reported thus supporting the containment of EVD in West Africa and to prevent the international spread. Furthermore, it is envisaged to apply the methodology proposed to other endemic or highly prevalent infectious diseases with similar surveillance and infection control measures. The guiding criteria is to strictly avoid duplication of work and to not impose on existing documentation or infection control efforts of local and national public health services.