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Table 1 Concepts for the AFHSC-GEIS Vector-Borne Infection (VBI) Surveillance Program

From: Malaria and other vector-borne infection surveillance in the U.S. Department of Defense Armed Forces Health Surveillance Center-Global Emerging Infections Surveillance program: review of 2009 accomplishments

Concept Rationale
Programmatic organization of surveillance efforts as VBIs is a useful principle to prioritize surveillance efforts Strict adherence to a VBI-only surveillance program must be balanced with an understanding of prevailing disease threats
VBI surveillance efforts should be closely coordinated with human surveillance Although disease burden in zoonotic or vector populations is of interest, it is so primarily because of the potential impact on humans
Human VBI case definitions should require laboratory confirmation Clinical diagnoses of most VBI are of limited sensitivity and specificity; pathogen level identification will guide effective treatment
Case definitions employed should be able to be applied consistently across disparate geographies and longitudinally If surveillance goal is to map disease in areas of sparse infrastructure, simpler laboratory techniques may be preferable
Advancing technologies should be evaluated continually and incorporated without jeopardizing capability for analysis of longitudinal trends Balance must be achieved between newer diagnostic technologies and adherence to established laboratory case definitions. Substitution of more sensitive methods may erroneously mimic disease emergence
Standardized laboratory and clinical approaches should be judiciously applied and implemented based on proximal impact on human health The imperative for a “standardized” surveillance system must be tempered with consideration for the cost-benefit ratio of implementing such standards
To properly power epidemiological studies over a broad geography, laboratory case definitions may diverge from those typically used to guide clinical diagnoses Example: Studies intended to define the geospatial extent of antimicrobial drug resistance might seek to characterize genotypes from extracted DNA rather than rely on determination of minimum inhibitory concentrations (MICs) from viable organisms, despite the fact that the latter may be more predictive of clinical outcome
Patient samples and associated clinical data must be recorded and maintained in a data and specimen repository in a consistent manner over time Longitudinal trends can be better assessed if specimens and associated demographic data are catalogued in a manner to allow for retrospective trend analysis
Full use must be made of existing, appropriately collected and catalogued sample sets for retroactive analysis As technology advances, capability to diagnose previously “undiscovered” pathogens can be applied retroactively to banked specimens to better determine the pace of emergence