| 1. Background and objectivesSince the beginning of the new century, emerging infectious diseasesappeared frequently and threatened human health, i.e., the SARS epidemic in2003, influenza A (H1N1) in2009and human infections with avian influenzaA (H7N9) virus in2013.. There have also been frequent natural disasters, i.e.,the Wenchuan earthquake in2008and the Yushu earthquake and Zhouqumudslides in2010. In some underdeveloped areas, information of infectiousdisease emergencies in fields was diffecult to be collected timely due tolimited medical, health, and communication conditions. All these above arelikely to cause pandemic outbreaks of infectious diseases.. In addition, it isalso likely to cause diffusion of infectious diseases in some remote areas dueto lack of professional equipment and experiences for response to infectiousdisease emergences. Effective control of outbreaks of infectious diseasesdepends on obtains of information quickly in fields and targeted interventions.To understand the epidemiological knowledge, the environment of thelocation of outbreaks and historical incidence of infectious diseases is helpfulfor the staff of prevention and control to develop reasonable prevention andcontrol measures in fields. According to the reasons above, it’s necessary toestablish a flexible decision support system for infectious emergency. Thisstudy, based on the development of China, combined the software andhardware technology to build a perfect platform used for decision supportsystem for infectious disease emergency based on WebGIS and mobile service.The effective application of the system platform could enhance the efficiencyof the infectious disease field investigation and outbreak emergency responseand provide an effective tool for the disposal of unexpected infectious diseasesoutbreaks and public health events.2. Research contentsThis study integrated wireless communication, network technique, andWebGIS technique build an infectious disease prevention, emergency disposal and decision support system, it’s include software and hardware.Software is a decision support platform for infectious disease emergencybased on WebGIS and mobile service. Include the functions of fieldinvestigation and data collection, epidemiology detection, epidemiologicalstatistical analysis, guide of emergency disposal of infectious disease,epidemiological questionnaire custom-tailor, epidemiology expertise enquiryand so on. It’s a platform for prevention and emergency disposal of infectiousdisease. The utility of this system can obtain information in the field andstatistical the data in real time. The system can provide professionalinstruction for the people who engaged in the work of infectious diseaseprevention, enhanced the efficiency of disposal, to avoid epidemicwide-bound. This system apply to low-income and middle-income countriesand districts, it’s used convenient and cheaply. The system has two accessinterfaces, computer and Personal Data Assistant (PDA and mobile phone).Users can access the system by computer, PDA and Mobile Phone, it’soperated easily. Through global position system (GPS) and fast positionfunction, the users determine the location of the epidemic and detected thenatural condition and historic infectious diseases in the field. Through thefunction of information acquisition, we can collect the data of the fieldimmediately, reporting and analysis them real time. Through the site messagefunction, the workers in the field and decision makers in the office cancommunicated with each other, the officer instruct the work of the field, raiseefficiency of the field investigation.Hardware is portable infectious disease emergency operation box,include electronic module and medical module. Hardware is used forspecimen collection, storage and transportation in sudden outbreaks ofinfectious diseases and other public health emergencies. Electronic moduleinclude rugged computer, dogvane, PDA, camera, voice recorder, built-inwireless card and other electronic equipments. Field investigation workers useelectronic module can collect the information and can analyse andtransmission in real time. The collected data include audio, video, picture andquestionnaire. Using electronic module, the field workers and rear expertscould communicate with each other in real time, the experts and decisionmakers can guide the field work in real time and provide technical support. Medical module include alcohol lamp, reagent bottles, stainless steeldisinfection box, specimen collection tubes, hemostatic clamp, protectiveclothing and other protective equipments. Medical module can be used tocollect animal organ specimens, insects, animal body fluids, urine and otherspecimens, and can standardize the collected data and do simple test operation.Medical module case using modular design, users can combination and carrydifferent investigation items according every scene investigation task, it’s veryconvenient.3. MethodsCollected the historic infectious disease data Chinese CDC, include allcategories of infectious disease and incident number in different countries allover China. Collected host animals of all countries in China. Collected themeteorology data of all countries in China, include average temperature,maximum temperature, minimum temperature, medial humidity, average airpressure, and rainfall, all these data provide decision support information forprevention and emergency disposal of infectious disease. Collected the pathand traffic data, landform data, population structure data, and hospitalsinformation in China, integrated the information in the system, and providesupport for infectious disease workers. All the data were used in epidemiologyinformation support system. The system also provides hazard assessment forinfectious disease pathogens by aerosol release, epidemiological questionnairecustomization and diseases intelligent judgment.Users access the system by PC and mobile phone, Google Maps is thedisplaying platform of geographic relevant information. The users obtainedthe geographic locations by keyword polling and GPS, according the locationinformation users acquire the epidemic information, climate condition, hostanimal information, and landform of these areas. Users report the epidemicinformation by text, pictures, and questionnaires in the investigation field, theexperts and decision makers in the office analyze the data real-time and thenguide the work in the field by station message according to the results ofanalysis results.Portable infectious disease emergency operation box include two cases,named electronic module and medical module. Electronic module iscomposed by reinforce computer, attachments and waterproof safety box. Most functions of the portable infectious disease emergency operation boxintegrated in the reinforce computer, and some other functions were realizedby attachments, reinforce computer and attachments were placed inwaterproof safety box. The main body of medical module is also a waterproofsafety box, include blood collection module, stainless steel box, excretacollection tube, insect box, animal organ specimen collection tubes, protectionmodule, storage and transport module and so on. Users can take differentitems according to the task in the field.Portable infectious disease emergency operation box designed byourselves, through field testing to determine the model and produced byspecialized factory.4. ResultsThis study created a decision support system for infectious diseaseemergencies based on WebGIS and mobile service, users can access thesystem by PC and PDA. PC users access http://www.geoepi.com to acquireservice, PDA and mobile user access http://m.geoepi.com to acquire service.4.1Field infectious disease information collection and analysis inreal-timeInformation including questionnaire results, text, pictures, voice recordingsand video recorded in the field can be collected and sent to the database viawireless internet services from PCs, PDAs and mobile phones in real time bydifferent users. Experts and officials can analyze the data to understand thedynamics of the infectious disease emergency, the temporal and spatialdistributions of patients, the population at risk, the susceptible population, andprobable influencing factors.More than200types of questionnaires including individual casesquestionnaires and epidemic-case questionnaires are provided by the system.The system also provides epidemiological questionnaires customized accordingto users’ actual demands in the field. In addition, the geographic location isimportant for field investigations. In this study, location information is collectedby a GPS unit or keyword enquiry, and the information of longitude and latitudeis then integrated into the report data. The spatial distribution maps, figures ofthe epidemic curve, and patterns of gender, age and occupation can be createdquickly, and epidemiologic analyses are conducted in real time. Additionally, users can export these additional data to an Excel spreadsheet for furtherepidemiology analysis in professional software, such as SPSS or STATA.4.2Epidemiological information support function based on GoogleMapsTo understand the historic information related with infectious disease inthe locality, can raise efficiency of emergency disposal of epidemic situation.In this system, users searched the location by GPS and keyword enquiry, andthen review the information about this district, their location information andepidemiological information can displaying on Google Maps. Theepidemiological information include distribution of historical infectiousdisease in different countries in China, landform types, distribution of hostanimals, historical climate information, traffic information, distribution ofsanitary institution and so on, understand these information support the fieldinvestigation and emergency disposal.According to the demanding of field investigation and emergencydisposal of epidemic situation, the system integrated the infectious diseaseknowledge and created a database, when infectious disease outbreak, theinfectious disease workers search the repository through PC or mobile phone,this function increased the specialty knowledge and provide informationsupport for emergency disposal workers and decision makers. Infectiousdisease repository include infectious disease expertise, emergency scheme forepidemic situation, classic cases, defend and epidemic prevention, guide ofinfectious disease documents, profession skills, laws about infectious diseaseand sanitation resources.4.3Hazard assessment via aerosol dissemination based on GoogleMaps API visualization methodsGoogle Maps API (Google Maps application programming interface)provides mapping and spatial analysis capabilities, we use these functions andcombined with the aerosol diffusion model and population density data toaccess the scope of harm and the number of persons affected by pathogenicmicroorganisms through aerosol release. The assessment process and results candynamic visualizing simulation and displaying on the map. This method canprovide decision support information for the prevention and control anddecision-makers when the pathogenic microbiological hazard occurred. Theinformation include the scope of impact, impacted persons and districts, it’suseful for rapid developing prevention and control measures and reducing harmful of the biological hazards.4.4Guides to Handling an Infectious Disease EmergencyThis study integrates flow diagrams for the handling of an emergency,including handling cases of severe infectious diseases, emerging infectiousdiseases, food poisoning, nuclear, chemical and biologic hazards and otherpublic health emergencies. Disposal workers and decision makers can beassisted by the flow diagrams in different emergencies, and can also be providedwith information relating to the emergency, information for the prevention andcontrol of infectious diseases, information relating to laboratory diagnosis,information relating to law, and information relating to medical services,disinfection, insecticides and sterilization, and case analyses.4.5Epidemiological questionnaire custom-tailorThe system provides the function that novel questionnaires can becustomized in the field by users. Administrative users have the permission tomanage questionnaires, including new questionnaires that are customized andoptimized versions of existing questionnaires. Common users have thepermission to put in, browse, modify, enquire about, and analyze questionnairedata and to export the information in a table format. Investigation and disposalworkers can use the existing questionnaires or create novel questionnaires usingthe custom-tailor according to their needs in the field. Options for filling outquestionnaires are readily provided by the system, and include uni-selections,multiple-selections, text, tables, and times. Users can choose the format of thequestionnaire according to whether they are using a PC or PDA, and they areable to fill out, send, or review questionnaires online. The data of reportedquestionnaires are written to the database directly. Permitted users can analyzethe data and transmit the results to the investigation worker in real time; it’shelpful for the field investigation and handling an infectious disease emergency.4.6Portable infectious disease emergency operation boxAccording to the need of field epidemiological investigation, this studydeveloped a new generation of portable infectious disease emergency operationbox, include electronic module and medical module. Using this equipmentallow the field investigation workers quickly communicated withdecision-makers in the office, enhance the real-time and scientific of the fieldepidemiological investigation. 5. ConclusionDecision support system for the infectious disease emergency and newportable infectious disease emergency operation box composed a completedplatform for field epidemiological investigation. The platform integrated thefunctions include field information collection and transmission, field specimencollection and transportation, data analysis, epidemiological questionnairecustom-tailor and so on. The operation box portable, flexible and low-cost, it’sapplicable to different-level users do epidemiological investigation andspecimen collection in the field. The effective application of the systemplatform can improve the level of information and efficiency of fieldepidemiological investigation and provide a powerful tool for handinginfectious disease and public health emergencies. |
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