Emergency and Epidemic Data Kit

Background

Infectious disease outbreak emergencies and humanitarian emergencies require urgent intervention to prevent their effects from worsening. In the context of an outbreak, rapid mapping, data collection, analysis and response can limit the extent to which infection can continue to spread. Good emergency management starts with good preparedness and one of the most important things that we must be prepared for is to be able to rapidly equip field teams to collect huge amounts of data in a short time period, to support analysts to make sense of that data and then to communicate the findings to people who need to use the data to make important decisions.

At the London School of Hygiene and Tropical Medicine we have been using Android tablets and an app called ODK to collect data for more than 250 research studies. We believe that this and other software could be ideal ‘ready-to-go’ options for emergency response data collection. In this project we are developing electronic data tools for use in outbreak emergency situations. We will not only help to drive further development of the ODK system, but we will add extra apps, software and protocols that will make geographical mapping much faster and which will allow us to add web-surveys and other data collection methods to the list of ways we can gather data. We also plan to automate a lot of the hard work at the back end so that data and results get where they need to be much faster.

Who can use it?

Any group or agency involved in humanitarian emergency response and relief work is invited to discuss their data needs with us.

What can we do?

Host 2048-bit encrypted data on our UK-based secure double fire-walled servers.

Conceptualise and co-develop bespoke data systems for use in emergency responses.

Design and test electronic data collection forms for use with Open Data Kit and Enketo web-forms.

Lend Android devices to use with our system.

Support with rapid mapping and geographical information systems.

Development of reporting mechanisms, including semi-automated analysis and reporting.

Expert statistical analysis and modelling.

How much does it cost?

Nothing.

We’ll provide support to all our users but we won’t charge anyone for our services, so anyone can use them.

We will also make all of our outputs such as papers, computer programs, methods and training materials available for free (on open licenses) via the internet.

What’s the timeline for a new deployment?

We try to have servers active within 24 hours.

Form development can be time consuming when the data structures are complex, but for many projects we anticipate that we will be able to have everything up and running in between 24 and 96 hours.

What’s it all about?

Our primary goal is to improve the way that data are collected, aggregated, analysed and reported to key stakeholders during humanitarian emergencies and infectious disease outbreaks. Data management is a fundamental component of all research, but few academic in public health focus on data science as a discrete research discipline. A key focus of the project is therefore to operationalise data science principles within the domain of global health and to build and evaluate new systems for electronic data management during emergency research. Given that most health emergencies occur in areas which lack infrastructure, another focus is on ensuring that all these tools can work off-grid and in inhospitable settings including outbreak and conflict zones.

Successes so far

In the very first week of the project’s timeline (April 2018), the EDK team were asked by the World Health Organization to assist them by developing and deploying a bespoke electronic data collection system to support their work in attempting for the first time to vaccine-halt an outbreak of Ebola Virus in the Équateur region of Democratic Republic of Congo.
This outbreak ended swiftly but was immediately followed by the now ongoing 2018-19 Kivu outbreak, which has so far seen around 200,000 individuals vaccinated using the same ‘Ring Vaccination’ strategy that was used in the successful campaign to eradicate smallpox during 1970s.
Because the vaccine being used (Merck’s VSV-ZEBOV-GP) is an experimental & unlicensed product, it is only available under so called “compassionate use” agreements and in the context of research studies.
This means that vaccinees have to be followed up after receiving the vaccine, both to evaluate its safety and its effectiveness. These heightened monitoring activities are linked to vast quantities of data which must be processed and analysed in near-real-time.

The EDK project provided data collection, management and coordination systems, as well as analytical support, to many of the ongoing interventions in the Kivu outbreak. This means that electronic devices and automated data systems have replaced pen and paper and removed the need for field teams to transcribe data to computer at a later date. During the outbreak, EDK removed the need to handle an estimated 15 million pieces of paper and hundreds of thousands of data-clerk/analyst hours.

The project ensured that field activities occurring today were documented, assessed and reported back to the field in time for the next day’s work.

The majority of data emerging from the use of VSV-ZEBOV-GP were collected, aggregated, analysed and reported using systems developed and managed by the EDK project. This included daily line-lists and registers for field vaccination teams, summary reports and maps of activities, safety monitoring & data for efficacy analyses.

EDK also supported a program of prophylactic vaccination of Front Line Workers (FLWs) and Healthcare Workers (HCWs) during the North Kivu outbreak. This included prophylactic vaccination of at-risk HCWs (Nurses, Doctors, etc) and FLWs (Burial teams, Ambulance drivers, etc) in DRC and four other countries which border it. As with ring vaccination, this involved safety followup monitoring

Several novel therapeutic products were tested during the Kivu outbreak and both a randomised control trial (RCT) and Monitored Emergency Use of Unregistered and Investigational Interventions for Ebola Virus Disease (MEURI) protocol were used to allow access to these experimental drugs.
The EDK project worked with WHO and Min Santé RDC to collect and manage data from the participants of the MEURI studies.

Have EDK activities led to more effective treatment and management of outbreaks or lives saved?

The use of vaccines and novel treatments during the Kivu Ebola outbreak was unprecedented. Data already released show that the VSV-ZEBOV-GP vaccine is safe and has an estimated efficacy of 97.5%, 95% CI [95.8 – 98.5%].
This suggests that even under the most conservative of estimates, many thousands of cases of infection are likely to have been prevented through its use in this outbreak. This response intervention is an international collaboration of many partners which has been led to great effect by the DRC. The work of the EDK team has provided key support to the main actors in this multi-lateral response and the data they have gathered were the basis of a successful application for global licensing of the VSV-ZEBOV-GP vaccine.

To date, the EDK project has worked with WHO and Ministries of Health to vaccinate more than 300,000 people in DRC, Burundi, Rwanda, South Sudan
and Uganda 

Beyond the Kivu Ebola outbreak, all of the tools and software developments that have emerged from the work are being released as open resources, some of which can be read about here. This means that all software and systems can be reused and repurposed at no cost and by anyone in the world. The long duration of the Kivu outbreak has provided opportunities to field-test and iterate on new developments in software and operating procedures. The project has enhanced several important areas of electronic data science for field epidemiology. This includes developments in…

  • Use of EDC in registered clinical trials Encryption of participant and study data
  • Off-grid data Systems
  • Handling big data
  • Automated analyses
  • Open Software & Hardware

The project team are already working with a variety of partners to further develop these tools for the surveillance and control of a number of other key diseases affecting people in low and middle income countries. Our current work focuses on the COVID-19 pandemic, during which we are undertaking clinical, epidemiological and anthropological research in LMICs and (using additional funding from other sources) in the UK.

 

Project Information

The LSHTM Emergency and Epidemic Data Kit

(NIHR ref : PR-OD-1017-20001)

Funding & Timelines

The project is funded by NIHR Policy Research Programme Call : PRP (ODA-02-01) ODA: Epidemiology for Vaccinology Funded amount : £539,143
Dates : 2018-04-01 to 2021-03-31

Principal Investigator

Dr. Chrissy h. Roberts
Associate Professor, Clinical Research Department, LSHTM
Lead Scientist, LSHTM Global Health Analytics group

Co-Investigators

Dr Hannah Brindle : Research Fellow, CRD, LSHTM
Dr Rosalind Eggo : Mathematical Modeller, Epidemiology & Public Health, LSHTM
Mr Hamish Gibbs : Geospatial Modeller, EPH, LSHTM
Mr Chris Grundy : Geospatial Information Systems expert, EPH, LSHTM
Dr Catherine Houlihan : Virologist & Ebola response clinician, LSHTM/University College London
Dr Patrick Keating : Epidemiology Advisor at Médecins Sans Frontières
Dr Sham Lal : Assistant Professor, CRD, LSHTM
Dr Michael Marks : Clinical Associate Professor, CRD, LSHTM
Mrs Haleema Shakur-Still, Co-Director Clinical Trials Unit, LSHTM
Mr Conall Watson : Consultant in Health Protection and Global Public Health, Public Health England
Prof. James Whitworth : Professor of International Public Health

 

Partners in Ebola Response Work

UK Public Health Rapid Support Team
World Health Organization
Ministère de la Santé de la République Démocratique du Congo Ministry of Health, Rwanda
Ministry of Health, Republic of South Sudan
Ministry of Health, Republic of Uganda
Institut National de Recherche Biomédicale (INRB), Kinshasa, DRC Nafundi, San Diego, Ca. USA
The Open Data Kit community