Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE): Overview, Components, and Public Health Applications.

BACKGROUND: The Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) is a secure web-based tool that enables health care practitioners to monitor health indicators of public health importance for the detection and tracking of disease outbreaks, consequences of severe weather, and other events of concern. The ESSENCE concept began in an internally funded project at the Johns Hopkins University Applied Physics Laboratory, advanced with funding from the State of Maryland, and broadened in 1999 as a collaboration with the Walter Reed Army Institute for Research. Versions of the system have been further developed by Johns Hopkins University Applied Physics Laboratory in multiple military and civilian programs for the timely detection and tracking of health threats. OBJECTIVE: This study aims to describe the components and development of a biosurveillance system increasingly coordinating all-hazards health surveillance and infectious disease monitoring among large and small health departments, to list the key features and lessons learned in the growth of this system, and to describe the range of initiatives and accomplishments of local epidemiologists using it. METHODS: The features of ESSENCE include spatial and temporal statistical alerting, custom querying, user-defined alert notifications, geographical mapping, remote data capture, and event communications. To expedite visualization, configurable and interactive modes of data stratification and filtering, graphical and tabular customization, user preference management, and sharing features allow users to query data and view geographic representations, time series and data details pages, and reports. These features allow ESSENCE users to gather and organize the resulting wealth of information into a coherent view of population health status and communicate findings among users. RESULTS: The resulting broad utility, applicability, and adaptability of this system led to the adoption of ESSENCE by the Centers for Disease Control and Prevention, numerous state and local health departments, and the Department of Defense, both nationally and globally. The open-source version of Suite for Automated Global Electronic bioSurveillance is available for global, resource-limited settings. Resourceful users of the US National Syndromic Surveillance Program ESSENCE have applied it to the surveillance of infectious diseases, severe weather and natural disaster events, mass gatherings, chronic diseases and mental health, and injury and substance abuse. CONCLUSIONS: With emerging high-consequence communicable diseases and other health conditions, the continued user requirement-driven enhancements of ESSENCE demonstrate an adaptable disease surveillance capability focused on the everyday needs of public health. The challenge of a live system for widely distributed users with multiple different data sources and high throughput requirements has driven a novel, evolving architecture design.

An Overview of Biorepositories-Past, Present, and Future.

The collection, storage, and distribution of biological materials for research and improving health have been employed for more than a century. Biorepositories have been used to maintain and reallocate these specimens. Historically, the Department of Defense (DoD) has been maintaining biorepositories and using the materials stored to expand our understanding of diseases and for developing medical countermeasures since the Civil War. Other U.S. Government and nongovernmental organizations are also engaged in curating human and other samples for future studies, as are organizations in other countries. The reasons for collection and the possible uses of specimens maintained within repositories have changed with the advent of novel technologies and the genomics discipline. However, over the years, many of the issues faced by repositories have remained largely the same, although of increased importance more recently because of limited funding and enhanced ethical concerns. These issues include what samples to collect; how to collect, transport, and store the samples; legal and ethical matters relating to sample collection and use; durability of analytes of interest in stored specimens; assessing the quality of stored specimens and providing researchers with statements of specimen quality; costs; maintenance and sustainability of the repository; and, implementing and maintaining laboratory quality programs and possibly accreditation. National and international scientific groups are working to identify and define best practices, but universal standards and practices remain challenges for the future. To begin addressing the above issues, the DoD implemented several initiatives, which are described elsewhere in this Military Medicine Supplement. Additionally, staff members working on the issues saw potential value in identifying other biorepository groups and similar work being done by these groups with the expectation of developing lines of communication and, eventually, even collaboration in establishing universal standards and practices. The repositories identified are briefly discussed in this report.

Induction of dendritic cell production of type I and type III interferons by wild-type and vaccine strains of measles virus: role of defective interfering RNAs.

The innate immune response to viral infection frequently includes induction of type I interferons (IFN), but many viruses have evolved ways to block this response and increase virulence. In vitro studies of IFN production after infection of susceptible cells with measles virus (MeV) have often reported greater IFN synthesis after infection with vaccine than with wild-type strains of MeV. However, the possible presence in laboratory virus stocks of 5' copy-back defective interfering (DI) RNAs that induce IFN independent of the standard virus has frequently confounded interpretation of data from these studies. To further investigate MeV strain-dependent differences in IFN induction and the role of DI RNAs, monocyte-derived dendritic cells (moDCs) were infected with the wild-type Bilthoven strain and the vaccine Edmonston-Zagreb strain with and without DI RNAs. Production of type I IFN, type III IFN, and the interferon-stimulated genes (ISGs) Mx and ISG56 by infected cells was assessed with a flow cytometry-based IFN bioassay, quantitative reverse transcriptase PCR (RT-PCR), and immunoassays. Bilthoven infected moDCs less efficiently than Edmonston-Zagreb. Presence of DI RNAs in vaccine stocks resulted in greater maturation of moDCs, inhibition of virus replication, and induction of higher levels of IFN and ISGs. Production of type I IFN, type III IFN, and ISG mRNA and protein was determined by both the level of infection and the presence of DI RNAs. At the same levels of infection and in the absence of DI RNA, IFN induction was similar between wild-type and vaccine strains of MeV.