tag:theconversation.com,2011:/nz/topics/zika-outbreak-44648/articlesZika outbreak – The Conversation2020-03-03T21:46:48Ztag:theconversation.com,2011:article/1317462020-03-03T21:46:48Z2020-03-03T21:46:48ZCoronavirus: 5 ways to put evidence into action during outbreaks like COVID-19<figure><img src="https://images.theconversation.com/files/317976/original/file-20200302-141516-1c13163.jpg?ixlib=rb-1.1.0&rect=0%2C681%2C4955%2C2627&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Medical workers in health crisis zones need access to research evidence to inform decisions. Above, workers at a temporary hospital for COVID-19 patients in Wuhan, China on Feb. 21, 2020. </span> <span class="attribution"><span class="source">Chinatopix via AP, File</span></span></figcaption></figure><p>Health crises like the current <a href="https://theconversation.com/what-the-coronavirus-emergency-declaration-means-for-canada-130950">COVID-19 outbreak</a> have the potential to affect large numbers of people and disrupt health systems. The urgency and scale of a health crisis often mean that life-saving decisions about treatment and containment must be made quickly. </p>
<p>To ensure the best care for those infected and to limit transmission, it’s crucial that those decisions be based on evidence from research.</p>
<p>The director-general of the World Health Organization, Dr. Tedros Ghebreyesus, championed the need for <a href="https://twitter.com/DrTedros/status/1229137045634899973?s=20">research evidence to inform policy and decision-making</a> in dealing with the coronavirus. </p>
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<p>A <a href="https://www.ghsindex.org">Global Health Security Index</a>, the first comprehensive assessment and benchmarking of health security across 195 countries, found that not a single country in the world is fully prepared to handle an epidemic or pandemic, with 77 per cent of countries not demonstrating capability to collect real-time data. </p>
<p>Research evidence can help decision-makers respond in a timely manner in such situations. However, as <a href="https://www.thespec.com/news-story/9661080-mcmaster-doc-says-academic-research-needs-to-be-more-accessible/">my own research</a> confirms, <a href="https://doi.org/10.1001/dmp.2010.32.1026">the most relevant and current evidence may not always be easily accessible</a>. Based on my years of research on supporting evidence use in crisis zones, I outline five <a href="https://rdcu.be/b1VfO"></a><a href="https://doi.org/10.1186/s12961-020-0530-2">actionable strategies</a> that make health research accessible and available to those making policy and clinical decisions.</p>
<p><strong>1. Strengthen up-to-date and accessible research evidence websites.</strong> </p>
<p>Decision-makers face challenges in accessing evidence when dealing with a crisis, highlighting the need for evidence websites, such as <a href="https://www.evidenceaid.org">Evidence Aid</a>, to support timely use of evidence. <a href="https://rdcu.be/b1VfI">My research</a> has shown the importance of having a well-organized online source of relevant information that gives decision-makers fast, easy and efficient access to the best available evidence to make, inform or advocate for a decision. This includes ensuring that linked full-text articles are not behind a paywall that would prevent users from accessing the information. </p>
<p>In my research, I offer <a href="https://twitter.com/Ahmadfiraskhali/status/1214179780238680066?s=20">seven specific suggestions</a> about how to improve evidence websites to better inform decision-making when dealing with a crisis:</p>
<ul>
<li>Provide advanced search features.</li>
<li>Clearly state the site’s purpose and the kind of evidence it provides.</li>
<li>Make evidence applicable in context, such as providing actionable points for crisis zones.</li>
<li>Improve visuals for better readability and site experience, and provide infographics for key findings.</li>
<li>Provide a mobile app or optimize the site for mobile devices.</li>
<li>Increase transparency by ensuring information on funders and contributors is prominent.</li>
<li>Highlight the important role of evidence in humanitarian aid.</li>
</ul>
<p><strong>2. Establish key networks to co-ordinate and share quality and timely evidence.</strong></p>
<p>Decision-makers often <a href="https://doi.org/10.1186/s13031-019-0231-z">rely on key stakeholders to share their knowledge and expertise</a> in times of crisis. This reaffirms the importance of having networks in place to co-ordinate and share evidence. </p>
<p>For example, <a href="https://www.who.int/evidence/en/">EVIPNet</a> is a network established by the <a href="https://www.who.int">World Health Organization</a> to promote the systematic use of data and research evidence in health policy-making. EVIPNet provides important information such as country-specific summaries with the goal of sharing the information among key stakeholders. </p>
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<img alt="" src="https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/317986/original/file-20200302-18291-1pvvra5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Medical staff work in the negative-pressure isolation ward in Jinyintan Hospital, designated for critical COVID-19 patients, in Wuhan in central China’s Hubei province Thursday, Feb. 13, 2020.</span>
<span class="attribution"><span class="source">Chinatopix Via AP</span></span>
</figcaption>
</figure>
<p><strong>3. Provide rapid evidence summaries.</strong> </p>
<p>Rapid evidence summaries are useful in a crisis when concise evidence that can be easily understood by non-technical decision-makers is required in a short time frame. <a href="https://doi.org/10.1186/s12961-020-0530-2">A rapid evidence service</a> is needed to answer urgent questions with the best available evidence in a short summary format, either alone or alongside stakeholders’ insights. </p>
<p><strong>4. Turn research evidence into explicit actionable points such as checklists.</strong> </p>
<p><a href="https://doi.org/10.1186/s12961-019-0498-y">Many decision-makers</a> addressing global crises emphasize the need to develop and communicate messages with practical value in widely used languages. These can be developed by research organizations that produce syntheses or <a href="https://doi.org/10.1111/1468-0009.t01-1-00052">systematic reviews</a>, formats that lend themselves well to the development of actionable messages. </p>
<p><a href="http://doi.org/10.1186/s12961-017-0204-x">Knowledge brokers</a> can fill in gaps by acting as intermediaries between the worlds of research and decision-making, helping to turn research findings into actionable points to support their use in crisis zones.</p>
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<img alt="" src="https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318117/original/file-20200302-18279-1pq80m8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Medical workers check on the conditions of patients in Jinyintan Hospital, designated for critical COVID-19 patients, in Wuhan, China on Feb. 13, 2020.</span>
<span class="attribution"><span class="source">Chinatopix Via AP</span></span>
</figcaption>
</figure>
<p><strong>5. Increase the value of using evidence to inform interventions.</strong> </p>
<p>There is a need to increase awareness among decision-makers about the existence of available research evidence and its value in decision-making. </p>
<p><a href="https://www.evidenceaid.org/wp-content/uploads/2018/10/Evidence_Aid_Practice_Guide_52pp_DIGITAL-FINAL-VERSION-2018-10-22.pdf">Professional judgement</a> is known to play a key role in informing decisions. My research recognizes that decisions are not determined by evidence alone, but rather alongside professional opinion and other decision-making inputs. One way to increase the value of using evidence alongside professional judgement is to conduct a <a href="https://doi.org/10.1016/j.socscimed.2012.06.016">stakeholder dialogue</a> that puts the research evidence alongside the tacit knowledge, real world views and experiences of decision-makers.</p>
<p>In responding to a health crisis, decision-makers draw on different types of information. Research evidence can help clarify problems, help frame options to respond appropriately and help address implementation considerations for interventions in specific contexts. </p>
<p>These five actionable strategies to support evidence use in decision-making can help ensure that the public is well-informed and decision-makers are basing their interventions to save lives on the best available research evidence.</p><img src="https://counter.theconversation.com/content/131746/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ahmad Firas Khalid does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In a health crisis, decisions about treatment and containment must be made quickly. It’s crucial those decisions be based on research evidence, but fast and easy access is not always available.Ahmad Firas Khalid, Medical doctor, Health Policy Researcher and Advisor, Educator, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1061332018-11-02T14:02:50Z2018-11-02T14:02:50ZPrenatal blood screening may predict Zika virus-associated fetal defects<figure><img src="https://images.theconversation.com/files/243532/original/file-20181101-83632-e9ou8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">These photos show mothers or family members holding infants born with microcephaly, one of many serious medical problems caused by congenital Zika syndrome.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/The-Week-That-Was-in-Latin-America-Photo-Gallery/85c344048add4b1093762419d8a22c69/80/0">AP Photo/Felipe Dana</a></span></figcaption></figure><p><em><a href="https://theconversation.com/zika-y-embarazo-analisis-de-sangre-prenatal-podria-predecir-malformaciones-fetales-106289">Leer en español</a></em>.</p>
<p>The sudden and rampant <a href="http://www.who.int/emergencies/zika-virus/en/">outbreak of Zika virus in 2016</a> terrified pregnant women, particularly those residing in Zika-endemic regions, such as Brazil, as well as those in the U.S. Their fear was justified given the link between Zika virus infection during pregnancy with having a small head, a condition known as microcephaly, and other congenital defects.</p>
<p>The absence of early prenatal diagnosis, or treatment, for birth defects has left thousands of <a href="https://www.cdc.gov/pregnancy/zika/data/pregwomen-uscases.html">mothers-to-be</a> worrying about their baby’s well-being. Others, meanwhile, have terminated their pregnancy rather than risk having a child with <a href="https://doi.org/10.1056/NEJMc1605389">birth defects</a>. </p>
<p><a href="http://uscmmi.com/jaejunglab/">Our research</a> revolves around mosquito-borne viruses such as Chikungunya virus and Zika virus. Each causes a distinct set of symptoms. Chikungunya virus produces debilitating persistent joint pain in adults and neurological symptoms in children; Zika virus causes defects in babies. In <a href="http://uscmmi.com/jaejunglab/">Jae Jung’s lab</a> at the University of Southern California, we are investigating the mechanisms that underlie the devastating consequences of these viral infections and developing new prenatal diagnostic tests to determine whether Zika babies are in good health.</p>
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<img alt="" src="https://images.theconversation.com/files/243523/original/file-20181101-83651-peb2ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/243523/original/file-20181101-83651-peb2ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/243523/original/file-20181101-83651-peb2ik.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/243523/original/file-20181101-83651-peb2ik.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/243523/original/file-20181101-83651-peb2ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/243523/original/file-20181101-83651-peb2ik.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/243523/original/file-20181101-83651-peb2ik.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A fellow student gently strokes Jose Wesley Campos, who was born with the Zika-caused microcephaly birth defect, at an early education daycare center in Bonito, Brazil.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Brazil-Zika-Kids-Boy-in-Bucket/fe3a773313b04610b33f237ac677bf9a/5/0">AP Photo/Eraldo Peres</a></span>
</figcaption>
</figure>
<h2>Zika and pregnancy</h2>
<p>Zika is the first mosquito-borne virus known to cause congenital defects. <em>Aedes aegypti</em>, one of the most invasive and widespread species of mosquito, is the primary vector for transmitting Zika. When healthy individuals, who are not pregnant, are infected with the Zika virus the infection often escapes notice because the <a href="https://www.cdc.gov/zika/symptoms/symptoms.html">symptoms are mild</a> or negligible. However, infection during the first and second trimester of pregnancy boosts the risk of miscarriages and diverse fetal defects such as <a href="https://doi.org/10.1056/NEJMoa1602412">eye abnormalities, neurological impairment</a> and in more severe cases, <a href="http://doi.org/10.1056/NEJMp1605367">microcephaly</a>.</p>
<p>Health workers try to assess the health of Zika babies using ultrasound during the second trimester or later. But it is difficult to see from these images whether the baby has developmental abnormalities. </p>
<p>On the other hand, fetal MRI captures high-resolution snapshots of the fetus. But this imaging technique can only be used in the second or third trimesters – when it is more difficult to terminate a pregnancy. A diagnostic assay that could detect abnormalities early in the pregnancy could alleviate the mother’s stress and make it easier to make swift reproductive decisions.</p>
<h2>Developing a new diagnostic test</h2>
<p>During the Zika outbreak in Brazil, there were other co-circulating mosquito-borne viruses such as Dengue virus and Chikungunya virus. So we also chose to take blood samples from women from the U.S. where these viruses are not endemic. <a href="https://doi.org/10.1172/jci.insight.124152">In our recent research</a>, we surveyed blood samples from 74 pregnant women: 30 were Zika-positive, 30 were negative and 14 were from women in Los Angeles. This study was led by <a href="http://uscmmi.com/jaejunglab/principal-investigator">Jae Jung</a>, in collaboration with <a href="https://portal.fiocruz.br/servico/laboratorio-de-doencas-febris-agudas">Patrícia Brasil</a> of the Instituto Nacional de Infectologia Evandro Chagas in Brazil, and <a href="https://www.uclahealth.org/karin-nielsen">Karin Nielsen-Saines</a> and <a href="https://www.mbi.ucla.edu/faculty/genhong-cheng/">Genhong Cheng</a> of UCLA.</p>
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<img alt="" src="https://images.theconversation.com/files/243520/original/file-20181101-83654-4aioi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/243520/original/file-20181101-83654-4aioi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=469&fit=crop&dpr=1 600w, https://images.theconversation.com/files/243520/original/file-20181101-83654-4aioi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=469&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/243520/original/file-20181101-83654-4aioi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=469&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/243520/original/file-20181101-83654-4aioi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=590&fit=crop&dpr=1 754w, https://images.theconversation.com/files/243520/original/file-20181101-83654-4aioi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=590&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/243520/original/file-20181101-83654-4aioi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=590&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A researcher in Jae Jung’s lab investigates brain defects in specimens of fetal tissue obtained from a Zika-infected patient.</span>
<span class="attribution"><span class="source">Weiqiang Chen</span></span>
</figcaption>
</figure>
<p>Our findings revealed an elevated production of 16 specific protein biomarkers, which are present in the blood of pregnant women who gave birth to babies with developmental delays and eye abnormalities. These biomarkers are potentially useful for predicting the outcomes of Zika pregnancies simply using blood specimens from the mother-to-be at any stage of pregnancy.</p>
<p>The number of Zika cases has dramatically declined following the major outbreaks in 2016. Yet, many Zika babies are still suffering from the dire consequences of prenatal infection. With the widespread abundance of <em>Aedes</em> mosquitoes, and the fact that Zika virus has not been eradicated, new outbreaks of Zika can occur anytime. </p>
<p>We are continuing our research to understand how Zika disrupts the development of the fetus, treatment strategies for babies affected by the virus, and ways to prevent Zika infection in the first place. Only when we have a thorough understanding of Zika infections can we assure the health of future generations.</p><img src="https://counter.theconversation.com/content/106133/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is no vaccine or medicine for Zika. But researchers have identified factors in the blood that signal a fetus has Zika-related birth defects, helping mothers decide whether to terminate a pregnancy.Suan-Sin Foo, Postdoctoral scholar, University of Southern CaliforniaWeiqiang Chen, Postdoctoral scholar, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/820082017-10-19T13:45:32Z2017-10-19T13:45:32ZDealing with local diseases helps countries tackle new outbreaks<figure><img src="https://images.theconversation.com/files/191009/original/file-20171019-1048-w7aejd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tackling local diseases like rabies could help health authorities identify new outbreaks more easily.</span> <span class="attribution"><span class="source">N. Bastiaensen/World Organisation for Animal Health</span></span></figcaption></figure><p>It’s hard to predict when and where an infectious disease will emerge. It could be anywhere on the planet. And it could affect humans, animals or plants. </p>
<p>That’s why countries need surveillance systems that can detect and respond to outbreaks wherever and whenever they occur. Detecting them early is vital because it means that measures can be put in place quickly to control the spread of a disease, reducing its size and impact. </p>
<p>Good surveillance capacity to pick up the threat of a new disease depends largely on good basic public health systems in communities. To strengthen this capacity, a good place to start is for countries to develop networks and have enough skilled health workers to detect and respond to diseases that happen everyday. By tackling these threats and controlling <a href="http://science.sciencemag.org/content/357/6347/146">existing diseases</a>, countries can build the capacity they need to deal with future emerging disease threats. </p>
<p>In low and middle income countries the public health infrastructure to manage human and animal health is often limited. Gaps in capacity have implications for both the local capacity to detect and respond to existing and everyday disease threats as well as the surveillance of emerging diseases. </p>
<p>The inability of countries to first detect, and then manage, the spread of diseases can have serious economic implications. The spread of diseases affecting crops and livestock can wipe out the income of a family, and have devastating affect on the agricultural sectors of a country’s economy. This is particularly problematic in most African countries where <a href="https://www.brookings.edu/blog/africa-in-focus/2016/01/22/foresight-africa-2016-banking-on-agriculture-for-africas-future/">agriculture remains a mainstay</a> of people’s income.</p>
<h2>People, plants and animals are affected</h2>
<p>There are three ways to define an emerging disease. When they cause infections in a species for the first time, spread to new geographic areas, or cause an increasing number of cases in a particular population. The <a href="http://www.who.int/csr/disease/ebola/en/">Ebola outbreaks</a> in West Africa and the <a href="http://www.who.int/emergencies/zika-virus/en/">Zika virus</a> outbreaks in many Pacific Island countries and the Americas are examples of emerging infections in humans.</p>
<p>Around <a href="http://rstb.royalsocietypublishing.org/content/356/1411/983">75% of emerging infectious diseases are zoonoses</a> – diseases that can be transmitted between animals and people.</p>
<p>Zoonoses can affect communities in several ways. Aside from ill people there can also be profound economic effects. <a href="https://www.cdc.gov/vhf/rvf/RVF-FactSheet.pdf">Rift Valley fever</a> affects livestock such as cattle, sheep, goats and camels as well as people. Disease in these livestock affects household income as well as national trade, as was clear in several large <a href="http://www.who.int/mediacentre/factsheets/fs207/en/">outbreaks of Rift Valley fever</a> in sub-Saharan Africa in recent decades.</p>
<p>Emerging diseases can also affect plants. Some of the most economically important plant diseases affect crops such as cassava (<a href="http://www.apsnet.org/publications/apsnetfeatures/Pages/cassava.aspx">Cassava Mosaic Virus Disease</a>) , bananas (<a href="http://www.promusa.org/Xanthomonas+wilt">Banana Xanthomonas Wilt</a>) and wheat (<a href="http://www.fao.org/agriculture/crops/rust/stem/rust-report/stem-ug99racettksk/en/">Wheat Rust Ug99</a>). Outbreaks of these plant diseases can also have devastating effects on livelihoods and economies. </p>
<h2>What is needed?</h2>
<p>Whether disease outbreaks occur in people, plants or animals, countries need surveillance systems that help them detect disease and respond quickly.</p>
<p>There are several key steps and processes that are needed for effective disease surveillance. These include:</p>
<ul>
<li><p>detecting case(s), </p></li>
<li><p>collecting samples, </p></li>
<li><p>conducting lab tests to confirm the disease involved, </p></li>
<li><p>reporting the cases to the relevant authorities, and </p></li>
<li><p>organising and implementing effective responses. </p></li>
</ul>
<p>The international Ebola outbreak in 2014/2015 is a case in point. There were cases of Ebola in several countries, for example in Nigeria, that were effectively controlled because the <a href="http://www.who.int/csr/disease/ebola/one-year-report/nigeria/en/">relevant authorities in Nigeria and neighbouring countries</a> were on high alert and able to respond quickly and effectively. </p>
<p>Key factors in these successes were government level support and preparedness, strong laboratory infrastructure, rigorous and comprehensive contact tracing and follow up at the grassroots level and engagement with the community.</p>
<h2>Strengthening the chain</h2>
<p>One way to build the capacity needed to manage emerging diseases is to focus on diseases that occur regularly and directly affect members of the community where the additional capacity is needed. This approach helps local communities to get involved and stay engaged to achieve sustainable improvements in surveillance.</p>
<p>Rabies is an example of a zoonosis that has been controlled in most countries, though <a href="https://theconversation.com/how-to-end-human-deaths-from-rabies-lessons-from-kenya-84726">challenges still remain</a> in some African countries. International initiatives like <a href="https://rabiesalliance.org/world-rabies-day">World Rabies Day</a> are designed to raise awareness, encourage collaboration, and promote the implementation of disease control measures, such as making dog vaccinations available. </p>
<p>Approaches designed to tackle existing disease threats also provide a way to build the communication platforms, networks, leadership capabilities and trust between those involved in surveillance that are necessary for multiple diseases. </p>
<p>By working to control existing diseases, stronger systems can be built to fill current gaps in global surveillance capacity. These capacity gains make it possible to deal more effectively with new disease threats wherever and whenever they emerge. Successes in disease surveillance and response depend on collaboration, partnerships and trust at individual, institutional and national levels.</p><img src="https://counter.theconversation.com/content/82008/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jo Halliday receives funding from the UK Biotechnology and Biological Sciences Research Council and the UK Zoonoses and Emerging Livestock Systems Initiative (BB/L018845/1). </span></em></p>By tackling local threats and controlling existing diseases, countries are able to build the capacity needed to deal with future emerging disease threats.Jo Halliday, Institute of Biodiversity, Animal Health and Comparative Medicine, University of GlasgowLicensed as Creative Commons – attribution, no derivatives.