Global Emerging Infections Surveillance and Response System (GEIS) Operations

Vision: Be a scientifically credible and recognized worldwide surveillance system for emerging infections, fully integrating a global network of laboratory capabilities with a comprehensive DoD health surveillance system.

Mission: Successfully develop, implement, support, and evaluate an integrated global emerging infections surveillance and response system that supports the AFHSC and contributes to force health protection in U.S. Forces, the Military Health System (MHS), and the global public health community.

Strategic Goals:

Surveillance & Response
Training & Capacity Building
Research, Innovation & Integration
Assessment & Communication of Value Added

Priority Surveillance Pillars:

Respiratory Infection (RI)
Gastrointestinal Infection (GI)
Febrile and Vector-borne Infection (FVBI)
Antimicrobial Resistance (AR)
Sexually Transmitted Infection (STI)

Background

The DoD-GEIS was established in 1997 in response to Presidential Decision Directive NSTC-7. GEIS published a strategic plan in 1998 that outlined the goals, objectives, and activities of the new program. These two documents, NSTC-7 and the strategic plan, formed the cornerstone from which DoD-GEIS grew.

With the appearance of the highly pathogenic H5N1 avian influenza in 2005, GEIS was directed in January 2006, to administer additional funds from a U.S. Congressional supplement for avian and pandemic influenza surveillance. With this supplemental funding, GEIS implemented long-term initiatives to increase influenza surveillance, laboratory support, and communication. The DoD developed a plan that followed the U.S. National Strategy for Pandemic Influenza. GEIS, through its partner network enhanced influenza laboratory capacity, increased sentinel sites and the number and coverage of countries in which surveillance is conducted, expanded laboratory diagnostic capability and BSL-3 laboratory capacity, and established centralized communications.

In a Deputy Secretary of Defense memorandum dated 26 February 2008, the DoD-GEIS became a core component of the newly formed AFHSC. Now known as the Division of GEIS Operations, GEIS joined the Defense Medical Surveillance System (DMSS) and the DoD Serum Repository (DoDSR) as part of a larger and more diverse and capable organization in the DoD.

The GEIS surveillance portfolio generates essential data that bolster the DoD and global public health efforts. The robust training efforts of GEIS continue. Many systems have expanded and additional programs have been instituted.

Recent Global Accomplishments:

1. Conducted global emerging infection surveillance and response activities and efforts with 39 partners in 111 countries.
2. Expanded the DoD global influenza surveillance program to 72 countries, 20 Navy ships, one foreign ship, and six clinics along the Mexican border (four in California, two in Mexico); increased laboratory capability system-wide; collected and analyzed more than 21,000 respiratory samples. This represents an expansion of over 230% from levels before the funding for pandemic and avian influenza became available.
3. Served as primary resource for global avian influenza surveillance throughout the world. Navy Medical Research Unit 3 [NAMRU-3 (Egypt)] confirmed 15 (three from Pakistan, 12 from Egypt) of the 57 global human H5 infections in FY08 (26%).
4. Improved laboratory infrastructure at 52 sites in 29 countries, including 16 military and 36 civilian laboratories, with emphasis on influenza and leveraged capability for other emerging infectious disease initiatives.
5. Sponsored and/or conducted 46 training exercises with more than 2,900 representatives from 53 countries.
6. Responded to more than 20 outbreaks globally in military and civilian populations. These outbreaks included influenza, dengue, yellow fever, diarrhea (norovirus and rotavirus), leptospirosis, pneumonia, Rift Valley Fever, hemorrhagic fevers, rickettsial illnesses, and poultry die-offs from suspected avian influenza.
7. Discovered emerging and reemerging pathogens:
   • New species of Anopheles mosquito in the Republic of Korea revealed by DNA sequencing at Walter Reed Army Institute or Research (WRAIR);
   • The Republic of Korea surveillance program also identified a new Hantavirus, Imjin virus, carried by the insectivore rodent Crocidura laciura;
   • Isolation and description of a new virus, Chapare virus, from a fatal case of hemorrhagic fever in Bolivia published by Naval Medical Research Center Detachment (NMRCD);
   • Reemergence of dengue serotype four found by NMRCD;
   • Emerging strains of malaria potentially expressing artesunate resistance described in Cambodia, Sudan, Thailand, and Yemen.
8. Expanded coverage in Africa with projects in Cameroon, Ethiopia, Ghana, Kenya, Libya, Morocco, Nigeria, Sierra Leone, Somalia, Sudan, and Uganda:
   • Improvements in host country diagnostic testing;
   • Emerging infectious disease outbreak detection and control;
   • Surveillance for influenza, rotavirus, and hospital-based bacterial meningitis.
9. Predicted and provided early warning of Rift Valley fever outbreaks and efficient responses in Sudan (June), South Africa (February and May), and Madagascar (February) through collaboration in ecological and climate monitoring and surveillance with National Aeronautics and Space Administration (NASA), U.S. Agency for International Development (USAID), U.S. Department of Agriculture (USDA), World Health Organization (WHO), Food and Agriculture Organization (FAO), host countries, and international partners.
10. Standardized laboratory characterization of Acinetobacter using uniform laboratory test systems and software at major U.S. military medical facilities treating service members with infected wounds. This accomplishment paves the way for laboratory standardization of other microbes of military interest.

Pandemic Influenza Surveillance Program

The goals of GEIS influenza surveillance are 1) to identify and characterize antigenically diverse strains, that affect DoD beneficiary populations and threaten global public health and 2) to collaborate with relevant organizations such as the Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), and the WHO to develop vaccines and other effective public health treatments and interventions. Laboratory-based surveillance is augmented by significant epidemiologic training and preparedness initiatives.

The influenza surveillance system is a triservice effort that strengthens force health protection and global health preparedness. The system now includes almost 400 sites in 72 countries and is implemented through the GEIS global network. It has expanded the knowledge base concerning the epidemiology of both seasonal and novel influenza strains, particularly highly pathogenic H5N1 avian influenza, in Africa and Southeast Asia. GEIS partners continue to provide training and reference services for many regions where little infrastructure exists and specimens they collect contribute to influenza vaccine development.

Populations under surveillance include active duty U.S. military and dependent populations, government employees at U.S. embassies, and host country civilian and military personnel. Findings from GEIS influenza surveillance comprise a large part of the U.S. government’s contributions to the WHO Global Influenza Surveillance Network and have helped fill longstanding surveillance gaps in Asia, Africa, and Latin America.

This spring brought the outbreak of the novel Influenza A(H1N1) virus. Two GEIS partner labs, Naval Health Research Center (NHRC), San Diego, CA, and the United States Air Force School of Aerospace Medicine (USAFSAM), San Antonio, TX, identified the very first four isolates of this strain and provided samples to the CDC. Since then, the AFHSC has been actively engaged with the public health centers of the Army, Navy and Air Force and other government organizations to:

1. Consolidate, analyze, interpret data, and monitor the evolving situation related to the outbreak of novel Influenza A(H1N1) virus;
2. Support a coordinated global surveillance and detection effort within the DoD;
3. Forward timely reports to DoD, Services, and other Federal officials.

Summary

The ability of GEIS and its partner network to successfully implement the expanded program required by its role in pandemic influenza surveillance is a strong testament to its creative and innovative vision. The current challenges of the Network are to embrace an expanded global perspective that can be expressed as follows:

Think as partners, not as individuals.
Think as systems, not as institutional programs.
Think globally, not regionally.

Now, as a division of the AFHSC, this robust laboratory surveillance system is complimented by the DoD electronic health care encounter datasets. Through these assets, our ability to address Force Health Protection and Global Public Health are greatly enhanced.

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