Using GIS in Pan Flu ResponseUsing GIS in Pan Flu Response

Seth Wiafe, M.P.H.Seth Wiafe, M.P.H.Loma Linda University School of Public Health Loma Linda University School of Public Health

Center for Public Health PreparednessCenter for Public Health Preparedness

UCLA Center for Public Health and DisastersUCLA Center for Public Health and DisastersPractical Aspects of Pandemic Flu Planning Workshop SeriesPractical Aspects of Pandemic Flu Planning Workshop Series

Los Angeles Dec 5, 2006Los Angeles Dec 5, 2006

OutlineOutline• Overview of Avian Influenza

• Spatial Implications in Pan Flu Preparedness & Response

• Understanding GIS Technology

• The Role GIS in Pan Flu Response

• Using GIS for Pan Flu Preparedness Planning & Response

• Resources

Pandemic Flu OverviewPandemic Flu Overview

• Types– Avian flu– Seasonal flu– Pandemic flu

• Recent pandemics– 1918-1919: ‘Spanish Flu’- a severe

pandemic with estimates of 50-100m deaths– 1957-1958: ‘Asian flu’- over 1m deaths– 1968-1969: ‘Hong Kong flu’- 750,000 deaths

• Anticipated global impact on next pandemic – Greater Economic & Social Disruption– Widespread Illness– Inadequate Medical Supplies– Larger number of Deaths

““IF avian flu crosses to human AND becomes efficient at human IF avian flu crosses to human AND becomes efficient at human to human transmission, potential for pandemicto human transmission, potential for pandemic””

Pandemic Pandemic –– Outbreak of Outbreak of infectious disease that strikes infectious disease that strikes a very wide areaa very wide area

http://www.cdc.gov/ncidod/eid/vol5no5/meltzer.htm

Expected Responsibilities of Public Expected Responsibilities of Public Health AuthoritiesHealth Authorities

• Increase awareness of healthcare professionals and the public

• Vigilant monitoring of spread of flu virus

• Early identification of infected persons or animals

• Real-time reporting of suspected and documented infections

• Rapid isolation of infected humans and animals

• Destruction of infected hosts

““We have to work with countries all over the world and instill a We have to work with countries all over the world and instill a sense that if itsense that if it happens happens anywhere, itanywhere, it’’s a risk s a risk everywhereeverywhere”” –– Leavitt, Newsweek Oct 31, 2005Leavitt, Newsweek Oct 31, 2005

Spatial Implications in Pan Flu StrategySpatial Implications in Pan Flu Strategy

• Decision Support System -critical in large outbreaks

• Provide accurate geographic representation of infection

• Critical for community–level intervention strategies– Distribution of vaccines &

antivirals– Specific geographic locations

of points of infection– Point of contacts of agency in

charge of outbreak control

Understanding GIS Technology Understanding GIS Technology

• Geography as a common ground for managing and communicating information

• Selected capabilities of GIS– Data capture & storage– Database management– Spatial data analysis– Data display– Data sharing

• Delivery mechanisms– Online– Print

GIS GIS ToolsTools

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Selected Global Flu Response Selected Global Flu Response • WHO

– Flu Ministerial Appointments – Published Checklist for

Influenza– Published paper on

Strengthening pandemic influenza preparedness and response

• USA – Launched international

Partnership on Avian and Pan Flu

– Aid for Vietnam village based surveillance system

– National Pandemic Influenza Strategy-www.whitehouse.gov/homeland/pandemic-influenza.html

– New website launched –www.pandemicflu.gov

• CDC– Published Travel Advisory– Improving Asia Flu surveillance– Flu briefing sheet

• DHHS– HHS Pandemic Influenza Plan –

www.hhs.gov/pandemicflu/plan• States preparedness plan –

www.cste.org/specialprojects/influenzaplans/StateMap.asp

• Australia – Hosted a high level regional

meeting on Avian Influenza• US AID

– Prioritized effective and coordinated response to avian and pandemic influenza threat

What is GIS ?What is GIS ?

• An information systems technology that uses digital maps to interpret data

• A decision support tool that displays relationships of data as they exist in the real world

GIS ComponentsGIS Components

GIS Data & SoftwareGIS Data & Software•• Software Types Software Types

–– Desktop GISDesktop GIS–– Mobile GISMobile GIS–– Internet GISInternet GIS–– Enterprise GISEnterprise GIS–– Map ViewersMap Viewers–– Professional GISProfessional GIS

•• Data Data –– SpatialSpatial–– Non SpatialNon Spatial

•• Spatial Spatial –– VectorVector–– RasterRaster

•• MetadataMetadata•• OthersOthers

–– ProjectionProjection–– Scale/ResolutionScale/Resolution

Why GIS is Important to Public Why GIS is Important to Public Health PracticeHealth PracticeGIS is needed to accomplish the core functions of public health

• Assessment– Public health programs and services can

be evaluated over time by location

• Policy development– The geographic distribution of public

health needs can be analyzed, enabling programs and resources for specific public health issues to be directed to the locations of greatest need

• Assurance – GIS can be used to evaluate

effectiveness, accessibility, and quality of personal and population-based health services and the effect of services on selected preventable health outcomes

Role of GIS in Pan Flu Response I Role of GIS in Pan Flu Response I

• Analysis– Cases & spread– Points of entry – ports,

airports– Infrastructure –

hospitals, quarantine stations

– Factors related to occurrence of epidemic

• Visualization– Location of cases– Status of labs– Status of resources

• Reporting– Tracking of cases– Status of infrastructure– Tracking of resources

• Data Integration & Sharing– Vital Events– Population– Environmental– Services

Role of GIS in Pan Flu Response IIRole of GIS in Pan Flu Response II• Planning & Coordination

– Planning and targeting interventions• Monitoring & Assessment

– Monitoring diseases and interventions over time

– Integration of data from multiple information systems

– Stratifying risk factors• Prevention & Containment

– Educating health professionals and the public

– Assessing resource allocation• Health System Response

– Mapping populations at risk• Communication

– GeoInformatics– Visualization

• Facilitates policy development– Analyzing spatial and temporal trends

GIS for Pandemic Flu PreparednessGIS for Pandemic Flu Preparedness

Geographic Information Systems (GIS)

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NationalInfluenza

Strategy

GIS in Pandemic Influenza StrategyGIS in Pandemic Influenza Strategy

Location Location Location

GIS for Preparedness and GIS for Preparedness and CommunicationCommunication

• Address management & geocoding– Delivery of medical

interventions

• Vaccine distribution & tracking

• Risk assessment • Risk communication &

notification– First Responders– Community Leadership– General Public

Ideally, accurate geographic information Ideally, accurate geographic information should be included as part of any should be included as part of any international, federal, state, or local health international, federal, state, or local health information.information.

Web Services ApplicationsWeb Services Applications

Internet Map Service of Current Bird Flu Human CasesInternet Map Service of Current Bird Flu Human Cases

http://gisweb.apsu.edu/website/birdflu/viewer.htm

Interactive Map Interactive Map -- Spread of H5N1 Spread of H5N1

Contributing Factors

http://www.pbs.org/wnet/wideangle/shows/vietnam/map.html

Integrating Mapping Functionality & Integrating Mapping Functionality & GIS into Web Browser GIS into Web Browser

Avian flu Avian flu outbreaks on outbreaks on Google EarthGoogle Earth

GIS for Surveillance and DetectionGIS for Surveillance and Detection

• Vector & animal surveillance– Real-time systems for

reporting

• Early detection –SyndromicSurveillance

• Laboratory specimen tracking (human, animals, environment)

• Data quality• System usefulness• Flexibility• System acceptability• Portability• System stability

GIS System Specification for SurveillanceGIS System Specification for Surveillance

WHO WHO FluNetFluNet-- Improving Global Improving Global Influenza ProgramInfluenza Program

• Data Query• Interactive maps• Maps & Resources• Outputs

– Charts– Reports– Summary Statistics– Print

European Influenza Surveillance European Influenza Surveillance SchemeScheme• Geographical activity

– Collecting and exchanging timely information

– Weekly Surveillance Report• Current & historical

situational maps• Historic graphs• Season tables

FluWatchFluWatch -- CanadaCanada

• Types of Maps– Single– Dual – Animated

CDC CDC –– Coordinates Flu Activities Coordinates Flu Activities Reports & Surveillance Methods Reports & Surveillance Methods

• Flu clinic locator• Flu activity by state• Analysis of confirmed cases• Where you live

GIS in Response & ContainmentGIS in Response & Containment

• Contact tracing/Quarantine• Facility siting

– Vaccination Sites– Influenza clinics– Alternative care sites– Group quarantine locations

• Community outbreak response environment• Mass casualty incident management strategy

– Transferring patients to other facilities– Diverting critical patients to specialized care facilities

Asian Influenza MapsAsian Influenza Maps

• Outbreak per species

http://www.fao.org/ag/againfo/programmes/en/empres/maps.html

• Outbreak by month

Outbreaks of H5N1 in Asia 2003Outbreaks of H5N1 in Asia 2003--66

• Risk assessment• Identify

vulnerable population

• Monitor geographic spread of disease

http://ec.europa.eu/health/ph_threats/com/Influenza/ai_recent_en.htm

Situational Awareness and ResponseSituational Awareness and Response

• 27/7 availability• Continuous stream of

Clinical and veterinary data • High speed secured internet• Adoption of GIS technology• Dissemination agreements

between various health organizations

• Written plan for maintaining the system

LLUMC DISCOVERY GIS PROJECTAutomated visualization and situational awareness support tool that provides the emergency services with current communication and mapping tools.

Project facilitates assessment, handing and tracking of patients at the incident site (car accident, fire, cardiac arrest, violent crime, etc)

Desirable Global Mapping System Desirable Global Mapping System • Fully integrated reporting and management system

– Real-time tracking– Quick and easy reporting of suspected outbreaks– Attachments of scientific data of virus strain– Number of deaths– Specific geographic location of all points of infection– Virus verifying instruments and agency – Agency in charge of infection

• Dynamic distribution of vaccines and antivirals• A click-through graphic user interface that allows drill down

capability to a single infected individual• An alert function to initiate communication to a predefined

distribution list when certain conditions are met

ReferencesReferences• U.S. Pandemic Flu website • National Vaccine Program Office• CIDRAP• Canada Pandemic Flu site:• WHO Pandemic preparedness site: • CDC Avian Influenza website• Cliff AD, Haggett P. Statistical modeling of measles and influenza

outbreaks. Statl Methods Med Res 1993;2:43-73.• Meltzer MI, Cox NJ, Fukuda K. 1999a and 1999b• Simonsen L, Clarke MJ, Williamson GD, et al. • Spatial Aspects of Influenza Epidemics by A. D. Cliff, P. Haggett, J. K. Ord

• Refer to handout for more…..

ConclusionConclusion• GIS technology has the capacity to integrate information from a

variety of sources into a spatial context • GIS can act as a tool in supporting decision making process in

evaluating certain alternatives for a specific objective• It is the decision maker, who determines the criteria, the factors and

the constraints that may enhance or reduce uncertainty in the decision rules

• “… When skillfully constructed and analyzed, a GIS-based approach may permit quantum jumps in our knowledge of cancer epidemiologies, AIDS, and other diseases” (S. A. Matthews. Epidemiology Using a GIS. 1990)

• “Geographic Information System (GIS) technology may be the decade’s single most important analytical tool for the advancement of the health and well being of the world’s population and environment”(W. E. Bertrand and N. B. Mock. 1995)

Questions?Questions?