Finding Outbreaks Faster - Questioning Outbreak Thresholds

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Nov 16, 2018
by Oscar Tollast
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Finding Outbreaks Faster - Questioning Outbreak Thresholds

Salzburg Global Fellows consider varying definitions of "outbreak" and whether specific case count thresholds exist for different diseases Participants of Finding Outbreaks Faster: How Do We Measure Progress? in Parker Hall

How would you define an outbreak? Do you apply specific case count thresholds for different diseases? How are these selected? These are several of the questions participants considered on the second day of the program.

Finding Outbreaks Faster: How Do We Measure Progress?, convened by Salzburg Global Seminar and Ending Pandemics, sought to advance a common framework for monitoring progress toward pandemic preparedness in every country. But before they could assess this framework, participants had to learn how outbreaks can be perceived differently.

Participants working in 16 countries and territories were divided into five pre-determined breakout groups to explore this topic further.

The first group to report on its discussions indicated there were two definitions. An outbreak could be where there are more cases than usual, or an outbreak could be when an unusual event has occurred. Participants within this group also considered the political obstacles, economic pressures, and the requirements needed to declare an outbreak.

If “unusual” became the theme of the first group’s discussion, “diversity” was the theme of the second group’s presentation. Participants highlighted how much diversity already existed among and within countries. While certain diseases are going to have similar metrics, there will be variations when this is drilled down to a regional level.

Considering the role of standardization could be helpful. Participants discussed the potential use of an algorithm-based support tool which would be flexible enough to be utilized in different localities. This tool would also have to be simple and easy to adopt.

From a logistical point of view, there are challenges behind declaring outbreaks. For example, some regions require an epidemiologist to undertake a site visit before an outbreak can be declared.

There needs to be an outbreak definition which is practical and adaptable. At the basic level, an outbreak can be considered a number of cases exceeding the number of expected cases. Is there existing training taking place which could be leveraged?

Words which ran through each of the break-out group discussions included unknown, unusual, and unexpected. These are three words, however, which mean different things. Toward the end of this session, one participant suggested there was a need to separate the definition for outbreak and what could be described as an early warning alert. They are different yet both important.


The program Finding Outbreaks Faster: How Do We Measure Progress? is being held in partnership with Ending Pandemics and the University of Minnesota. To keep up to date with the conversations taking place during the program, please follow #SGShealth on Twitter and Instagram.