Establishing a National Endemic Disease Surveillance Initiative (NEDSI)
总结
全球大流行病会造成重大人类和金融损失。我们的国家几乎遭受了a million deathsassociated with COVID-19 to date. The Congressional Budget Office estimates that COVID-19 will cost the United States$7.6 trillion in lost economic outputover the next decade. While much has rightly been written onpreventing the next pandemic,远不如一直注意减轻the compounding effects of endemic diseases. Endemic diseases are consistently present over time and typically restricted to a defined geographic region. Such diseases can exacerbate pandemic-associated financial losses, complicate patient care, and delay patient recovery. In a clinical context, endemic diseases can worsen existing infections and compromise patient outcomes. For example, co-infections with endemic diseasesincrease the likelihood of patient mortalityfrom pandemic diseases like COVID-19 and H1N1 influenza.
Accurate and timely data on the prevalence of endemic diseases enables public-health officials to minimize the above-cited burdens through proactive response. Yet the U.S. government does not mandate reporting and/or monitoring of many endemic diseases. The Biden-Harris administration should use American Rescue Plan funds to establish a National Endemic Disease Surveillance Initiative (NEDSI), within the National Notifiable Disease Surveillance System (NNDSS), to remove barriers to monitoring endemic, infectious diseases and to incentivize reporting. The NEDSI will support the goals of the Centers for Disease Control and Prevention (CDC)’sData Modernization Initiative通过在美国通常被忽视的疾病套房提供强大的感染数据。具体而言,Nedsi将:
- 为医疗保健从业人员提供实施/升级数字疾病报告的资源。
- Support effective allocation of funding to hospitals, clinics, and healthcare providers in regions with severe endemic disease.
- Prepare quarterly memos updating healthcare providers about endemic disease prevalence and spread.
- Alert citizens and health-care practitioners in real time of notable infections and disease outbreaks.
- Track and predict endemic-disease burden, enabling strategic-intervention planning within the CDC and with partner entities.
Challenge and Opportunity
The COVID-19 pandemic highlighted the need for a multilevel approach to addressing endemic diseases. Endemic diseases are defined as those that persist at relatively stable case numbers within a defined geographic region. Though endemic diseases are typically geographically restricted, changes in population movement, population behaviors, and environmental conditions are increasing the incidence of endemic diseases. For example, Valley fever, a fungal respiratory disease endemic to the California Central Valley and the American Southwest, ispredicted to spread to the American Midwest by 2060由于气候变化。
Better preparing the United States for future pandemics depends partly on better countering endemic disease. Effective patient care during a pandemic requires clinicians to treat not only the primary infection, but also potential secondary infections arising from endemic pathogens taking advantage of a weakened, preoccupied host immune system. Though typically not dangerous on their own, secondary infections from even common fungi such asAspergillusor念珠菌可能会变得致命if the host is pre-infected with a respiratory virus. On the individual level, secondary infections with endemic diseases adversely impact patient recovery and survival rates. On the state level, secondary infections impose major healthcare costs by prolonging patient recovery and increasing medical intervention needs. And on the national level, poor endemic-disease management in one state can cause disease persistence and spread to other states.
Robust surveillance is integral to endemic-disease management. The case ofendemic schistosomiasis in the Sichuan province of Chinaillustrates the point. Though the province successfully controlled the disease initially, decreased funding for disease tracking and management—and hence lack of awareness and apathy among stakeholders—caused the disease to re-emerge and case numbers to grow. During active endemic-disease outbreaks, comprehensive data improves decision-making by reflecting the real-time state of infections. In between outbreaks, high-quality surveillance data enables more accurate prediction and thus timely, life-saving intervention. Yet the U.S. government mandates reporting and/or monitoring of relatively few endemic diseases.
问题的一部分是,在我们的国家基础设施中需要改进来跟踪和报告关注的疾病。大约95% of all hospitals在美国,使用某种形式的电子健康记录(EHR)保存,但not all hospitals have the same resourcesto maintain or use EHR systems. For example,农村医院generally have poorer capacity to send, receive, find, and integrate patient-care reports. This results in drastic variation in case-reporting quality across the United States: and hence drastic variation in availability of the standardized, accurate data that policy and decision makers need to maximize public health.
考虑到这些问题,拜登 金博宝正规网址- 哈里斯管理局应使用美国救援计划(ARP)资金在疾病预防控制中心(CDC)的国家通知疾病监视系统(NNDSS)内建立全国性疾病监测计划(NEDSI)。与个体大流行病作斗争是足够困难的。我们需要更好的系统来阻止地方性疾病使战斗变得更糟。实施Nedsi将为决策者提供满足实时需求所需的数据,从而保护我们国家的经济,更重要的是,我们的人民的生活。
行动计划
要构建NEDSI,CDC应使用一部分$500 million allocated in the ARPto strengthen surveillance and analytic infrastructure and build infectious-disease forecasting systems. NEDSI will support the goals of the CDC’sData Modernization Initiative通过分配资源来实施和/或升级数字疾病报告功能,以获取有关地方性疾病的强大感染数据。具体而言,Nedsi将努力通过以下四项行动来最大程度地减少特有疾病的医疗保健负担:
- Disease monitoring.NEDSI will identify and track notable endemic infectious diseases for each state, including but not exclusive to (i) existing infectious diseases with historical presence and/or relevance, and (ii) infectious diseases that disproportionately impact particular workers. For example, Valley fever disproportionately impacts those employed in outdoor occupations related to ground/soil work (such as agricultural workers, solar farmers, construction workers, etc.). Endemic-disease reporting under NEDSI will follow reporting templates and frameworks that have already been developed by the NNDSS, but will also include information on co-infections (i.e., whether a reported endemic-disease case was a primary, secondary, or higher-order infection).
- 疾病通知。作为监测的一部分,将自动标记以高于历史规范的案例报告,以向社区成员,医疗保健提供者,公共卫生官员和其他利益相关者提示警报。
- Alerts to community members will be geotargeted (for example, by city, county, or region), enabling residents and travelers in endemic zones to take precautions. Alerts will be text-message-based and include resource links vetted by public-health experts.
- 对医疗保健提供者的警报将包含指向资源的链接,提供有关准确诊断和适当治疗有关疾病的最新信息。这将使提供者能够快速识别出新兴的疾病病例,并为特定治疗和设备的使用/需求高于平均水平做准备。
- Alerts to public-health officials will help shape recommendations for travel restrictions, emergency-funding requests and allocations, and rapid-response resources.
- Disease prediction.NEDSI将与CDC和美国国家卫生研究院(NIH)合作,建立一个特有的疾病预测模型,该模型对美国地理区域的当前和预期的地方性疾病负担的严重程度进行了排名,从而对新兴威胁产生了积极的干预。
- 模型洞察力将与联邦紧急事务管理局(FEMA)和州卫生部门共享,以告知资金分配(例如,从联邦面对州和州县级别)来支持公共卫生。
- 关键模型见解也可以发布在CDC的网站上,并在通知中传输给区域公共卫生官员和医疗保健从业人员,尤其是在预测的风险和感染趋势很高时。
- Data underlying the model should be made publicly available and accessible to support external disease-modeling and -prediction efforts.
- 为了与数据现代化计划的优先级和美国大流行准备计划保持一致,CDC还可以考虑与Nedsi和/或使用NEDSI数据合作进行的外部研究工作提供财政援助(例如,通过赠款或合作协议)。NEDSI和NNDS应该努力识别关键的研究目标,并在资助机会的通知中适当推广它们。
- Health education.The NNDSS, utilizing data and model outputs from NEDSI, should prepare quarterly memos synthesizing key information related to endemic diseases in the United States, including (i) summary statistics of endemic-disease case numbers and co-infections by state and county; (ii) an up-to-date list of available treatments, medications, and therapies for different endemic diseases, and (iii) predicted disease trends for coming months and years. Memos should be published digitally and archived on the CDC website. Publication of each memo should be accompanied by a digital campaign to help spread the resource to healthcare practitioners, public-health authorities, and other stakeholders. NEDSI representatives should also prioritize participation in disease-specific research/clinical conferences to ensure that the latest scientific findings and developments are reflected in the memos.
结论
尽管地方病im的明显的负担pose, such diseases are still在很大程度上进行了研究和了解不足。Until we have better knowledge of immunology related to endemic-disease co-infections, our best “treatment” is robust surveillance of opportunistic co-infections—surveillance that will enable proactive steps to minimize endemic-disease impacts on already vulnerable populations. Establishing a National Endemic Disease Surveillance Initiative within the National Notifiable Disease Surveillance System will close a critical gap in our nation’s disease-monitoring and -reporting infrastructure, helping reduce healthcare burdens while strengthening pandemic preparedness.
与其他标准化和简化疾病报告的系统一样,NEDSI将使医疗保健从业人员能够有效地(在某些情况下自动)分享有关地方性疾病的数据。这种实时,一致的数据对于通知公共卫生响应以及未来的紧急计划是无价的。
An ounce of endemic-disease prevention is worth far more than a pound of cure—and effective prevention depends on effective monitoring. Research shows that endemic diseases account foran alarming number of co-infections with COVID-19。这些共同感染具有detrimental impacts on patient outcomes。Further,population growth and migration trendsare increasing transmission of and exposure to endemic diseases. Mitigating the severity of future epidemics and pandemics hence requires near-term investment in endemic-disease monitoring.
Yes: even in non-pandemic times, co-infections represent a major risk for the immunocompromised and elderly.艾滋病患者屈服于继发感染由于其原发性HIV感染使免疫功能受损的直接结果。年度流感季节恶化通过投机取巧co-infections. Monitoring and tracking endemic diseases and their co-infection rates will help mitigate existing healthcare burdens even outside the scope of a pandemic.
由于资金挑战和缺乏研究进度/理解的结合,地方性疾病监测直到最近才被确定为整体传染病的准备差距。但是现在分配了funds from the American Rescue Plan为了加强监视和传染性预测系统,有一个历史性的机会来投资这一重要领域
通过按需基础设施将氧气作为公用事业,可以在全球范围内提高访问和死亡率。医疗保健专家提出,由美国国际开发署(USAID)领导的国际联盟如何改变低收入国家和中等收入国家的医疗氧气市场,以确保每个患者拥有所需的氧气。
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