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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

Biosurveillance Integration: Coverage From the Biodefense World Summit

Perhaps one of the most captivating topics addressed at the 2017 Biodefense World Summit was biosurveillance integration. Here I present an overview of some of my favorite talks during this engaging and insightful breakout session.
Alina Deshpande, PhD, from Los Alamos National Laboratory spoke about “Tools and Apps to Enhance Situational Awareness for Global Disease Surveillance.” This was particularly interesting as right away I was curious what exactly “situational awareness” meant in this situation. Drawing on a classic definition that included the perception of the elements in one’s environment within a given time and space, Dr. Deshpande’s talk centered around the analytics used for investigating a disease outbreak, specifically how one might contextualize the outbreak.

She remarked on how there are two functionalities at play during an outbreak: understanding the unfolding outbreak and learning about representative global historical outbreaks. These two components aid in short-term forecasting and help provide structure as an outbreak begins to unfold.
Dr. Deshpande also highlighted several decision-support tools for biosurveillance, such as Analytics for Investigation of Disease Outbreaks (AIDO), Red Alert, Biosurveillance Resource Directory (BRD), and Epi Archive. By using these tools and addressing certain components—such as herd immunity, nosocomial transmission, etc—one can help predict and respond to outbreaks in a more efficient and effective manner.
Luther Lindler, PhD, from Bio Programs within the Department of Homeland Security (DHS) presented perhaps one of my favorite talks regarding biosurveillance and its application as a measure of homeland security. Dr. Lindler highlighted the role of biosurveillance within the scope of DHS by pointing to the threat space, which ranges from deliberate use of biological weapons (by states or terrorists), accidents or negligence, to natural outbreaks. Within the biodefense realm, the DHS plays an integral role and utilizes a four-pronged approach—threat awareness, prevent and protect, surveillance and detection, and response and recover.
Perhaps one of the most eye-opening points Dr. Lindler made was when remarking on a day in the life of those officers who work in Customs and Border Patrol (CBP). A typical day includes reviewing and processing over 1 million passengers and pedestrians, $6.3 billion worth of imported products, 404 pests discovered at US ports of entry, and 4638 materials held for quarantine.

These operations are conducted in 51 countries, and are just a glimpse into the overwhelming efforts that are needed to monitor and protect health security within the United States. Biosensors and biodetection efforts are also a large part of these efforts and an ongoing application for biodefense efforts within buildings for large events such as the Super Bowl, and other high risk environments. DHS biosurveillance efforts encompass a magnitude of scenarios and environments, which Dr. Lindler highlighted through his examples of CBP as just one facet of American biodefense efforts.
Dr. Lindler also highlighted the airport screening processes that were used during the Ebola outbreak and how non-invasive screening is often done during such global public health events. Overall, there is a multitude of biosurveillance components that DHS relies on for biodefense efforts, whether it be at ports, airports, or government buildings. DHS must ensure biosurveillance efforts are just as diverse as the variety of biological threats the United States faces.
Finally, one of the most meaningful (and relevant) talks of this section of the summit was led by Chris R. Taitt, PhD, from the US Naval Research Laboratory, who discussed biosurveillance in resource limited environments. Traditionally, we tend to think about biosurveillance in terms of the United States or other industrialized countries, which have a wealth of resources and personnel; however, in the art of global health security and biodefense, we are only as strong as the weakest country. Ensuring biosurveillance at all levels is vital for this goal.
Because infectious diseases are a global problem, and as Dr. Taitt highlighted, a military problem, there is a need for real-time biosurveillance. To this end, Dr. Taitt pointed to the Defense Threat Reduction Agency’s (DTRA), 24-Month Challenge to get real-time biosurveillance up and running in a resource-limited country. Sierra Leone was chosen as the test site. To truly understand the challenges, we have to consider everything, from power availability, road conditions, to the weather, and more.
The 24-Month Challenge included 2863 enrolled subjects and a series of tests from diseases such as malaria, Dengue, and other tropical diseases (tested via peripheral whole blood). In addition to the biosurveillance the researchers captured, there were also some unexpected findings, such as the modifications that are needed in developing nations with regards to literacy, sample collection, and familiarity with standard supplies. Aside from modifying these practices and training personnel, there existed a significant potential for co-infections and the simple truth that basic devices and tests that are expected to work, just won’t in a resource-limited country.
Dr. Taitt drew our attention to the fact that, overall, resource-limited countries present new and unique challenges in terms in biosurveillance; however, addressing and acknowledging these challenges will be vital for overall global health security efforts. 
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