On the ground at the Ebola outbreak in Guinea, CDC disease detectives Ilana Schafer, left, Erik Knudsen and Andrea McCollum use the new Epi Info tool to track down people exposed to the deadly virus. (CDC)
Health workers now have a new toolset to detect and help prevent the spread of infectious diseases — such as Ebola — as a team at the Centers for Disease Control and Prevention continues efforts to fine-tune a suite of lightweight software used by epidemiologists and other health field workers.
CDC health workers have used the latest version of the Epi Info software to track down people exposed to the deadly Ebola virus in West Africa. Meanwhile, public health experts with Brazil’s Ministry of Health, armed with tablet-based systems running the software, tested how well Epi Info could detect disease outbreaks in mass gatherings during the World Cup soccer competition.
Epi Info dates back to the 1980s when CDC researchers developed software tools that public health staff, in particular epidemiologists, could deploy in the field to assist them in collecting data for a wide variety of public health uses, said David Walker, health scientist and branch chief for the Analytic Tools and Methods Branch in CDC’s Center for Surveillance, Epidemiology and Laboratory Science.
The software has evolved over the years, first moving into the Microsoft Windows environment and now into mobile and cloud infrastructures. Health workers now have the ability to collect data with hand-held devices — such as tablets and cellphones — and transmit that data to a central collection point, perhaps an emergency operation center, via Web or cloud technology, Walker said. This latest advancement offers health workers a faster way of sharing critical information to save lives, he noted.
“The original goal of the software was to be a lightweight toolbox that could be easily downloaded for free and taken into the field, so epidemiologists and teams could work more efficiently, and develop data-entry forms on the fly as an outbreak evolves,” Walker said. “The software over the decades has continued to evolve to become more efficient and stay more lightweight and easy to use by the end-users.”
Epi Info has an analytic toolset similar to a calculator but with statistical methodologies specific to public health, as well as a variety of data-analysis and data-visualization tools. Additionally, the Epi Info platform can access a variety of different flavors of Microsoft SQL database data, Walker said.
Approximately 181 countries are using Epi Info in a variety of ways. It is general-use software where individuals can create data applications specific to their needs, Walker said.
To that end, the Epi Info Viral Hemorrhagic Fever Outbreak Management application, a new app to the suite, speeds up a difficult part of disease detection: finding everyone who was exposed to, and possibly infected, by someone with a contagious disease. The task is called contact tracing, an essential step in breaking the chain of disease transmission and ending an outbreak. The app features virus transmission diagrams that help field workers visualize outbreak spread between people and automated tools that speed contact tracing and data analysis, according to CDC.
In the World Cup pilot, tablet computers were preloaded with Epi Info so epidemiologists could collect data for a wide range of categories and indicators. The data was stored offline until Internet connectivity was available. Then it was sent to the cloud for aggregation. At an emergency operations center the data was viewed on a dashboard that was continuously updated with statistical results, charts and maps.
In addition to CDC’s efforts, a whole health IT ecosystem is being developed, which will aid in the identification of disease outbreaks, said Frances Dare, managing director for connected health services with Accenture. Social media, transactional systems, analytical tools and geographic information systems are being tied together to provide information to citizens, public health officials and first-responder health workers.
For instance, a team at Boston Children’s Hospital founded HealthMap in 2006. HealthMap brings together disparate data sources, including online news aggregators, eyewitness reports and expert-curated discussions and validated official reports, to offer a comprehensive view of the current global state of infectious diseases and their effects. Real-time intelligence on a wide range of emerging infectious diseases is provided for a diverse audience via Healthmap.org and the Outbreaks Near Me mobile app.■