The Health Early Warning System (HEWS)
Global Center for Mass Gatherings Medicine
(WHO CC on Mass Gatherings Medicine)
Deputyship for Public Health, Ministry of Health
Global Health Security Goals
The goal of the international health regulations
(IHR 2005)is to prevent, protect against, control and provide a public health response to the international spread of disease
Key concepts in achieving this goal based on
All-hazardinclude
:• What might happen, and how likely is it to happen?
Risk assessment
• How will we know when it happens?
Surveillance
• What will we do when it happens?
Response
HEWS 5 years Milestone
Review of the surveillance
systems at MGS (2015)
Needs identification, stakeholders’ engagement (GCMGM, FETP, Regional
Directorates, WHO (2016)
Pilot syndromic surveillance (manual data collection) in Hajj (2017)
2ndPilot implementation (electronic data collection) in Hajj (Mina and Arafat)
2018
First full implementation
of HEWS in Hajj and Riyadh Season
2019
National implementa
tion for COVID-19
(2020)
The Health Early Warning System (HEWS) Characteristics
Syndromes
•Influenza-like illness (COVID-19)
•Acute febrile syndrome with rash
•Acute febrile syndrome with neurological manifestation
•Acute jaundice syndrome
•Acute flaccid paralysis (AFP)
•Acute haemorrhagic fever
•Severe acute respiratory infections (COVID-19)
•Acute respiratory distress syndrome
•Acute watery diarrhea
•Acute bloody diarrhea
Events
•Food poisoning
•Heat-related illness
•Chemical, biological, radiological and nuclear emergencies
•Trauma/injuries
•Cluster of cases or unusual health events
•Detection of unusual pathogens
•
The health early warning system (HEWS) is based on syndromic and event-based surveillance (EBS) sy•
HEWS is aIHR 2005 core capacity requirement for national disease surveillance systems and aWHOkey consideration forMGs•
Rapidly detect health threats and ongoingmonitoring of health events (situational awareness).
•
In April 2018, KSA-MoH and WHO EMROorganized an international technical consultation (TC)on HEWS, in Cairo Egypt
www.moh.gov.sa 4 HEWS Data Management
Data Extraction Data Transformation Data Visualization Command and Control
•
Facility-based data: demographic data (age, nationality) and provisional diagnosis (ICD 10)•
Non-facility based data sources- -Social media and internet -Hotline and emergency call etcDemographic data and provisional diagnosis
Provisional diagnosis mapped to priority syndromes and events for
automated alarms
Epidemiological data analysis/verification of
alarm signals
Issue signal alert for response, classify as false,
provisional or confirmed event/outbreak
HEWS Alert Dashboard : multiple dashboards for alerts notification and data analysis
HEWS Pathway
HEWS Alerts
His NHO E-link
Social media Internet
Hot line
Direct data entry School absenteeism Investigation Team
Artificial Intelligence
HEWS Dashboard
Epidemiological Unit
Event Management System
Emergency
Operational system
Proposed Task allocation
HEWS_ GCMGM NEU_ EWAS
Design alerts : Definition, thresholds, source, frequency Design the Event Management System, and event grading system
Testing and reporting alerts and field investigation teams Monitor the capacity related indicators
Declare the alert to as an event to NEU NEU to investigate the alert as an emergency event in terms of Scale, complexity, scope, scenarios for unfolding
Immediate report and follow up with Public health at regional level for development of the alert
Grading of the event and monitor the response operation
Produce a regular Epidemiological bulletin and alert characterization Produce a regular capacity development and management bulletin
Both unites to review the threshold regular and update the HEWS accordingly
Both unites to work on projected scenarios for each expected risk and response strategy
Mass Gathering Electronic Health Records (MGEHR) System
•
An HIS designed for temporary health posts at MGs, such as Hajj, G20 Summit, Saudi Seasons
•
MGEHR is integrated with the HEWS dashboard to improve surveillance for health threats at MGs
•
Captures morbidity, surveillance and
case management data
www.moh.gov.sa 9
HEWS findings 1440 Hajj Implementation: Consultation rates
0 2 4 6 8 10 12 14 16 18 20 22 24 26
0 5000 10000 15000 20000 25000
04-Jul-19 06-Jul-19 08-Jul-19 10-Jul-19 12-Jul-19 14-Jul-19 16-Jul-19 18-Jul-19 20-Jul-19 22-Jul-19 24-Jul-19 26-Jul-19 28-Jul-19 30-Jul-19 01-Aug-19 03-Aug-19 05-Aug-19 07-Aug-19 09-Aug-19 11-Aug-19 13-Aug-19 15-Aug-19 17-Aug-19 19-Aug-19 21-Aug-19 23-Aug-19 25-Aug-19 27-Aug-19 29-Aug-19 31-Aug-19 Number of hospitals (reporting sites)
Number of consultations
Hajj Patients Non-Hajj Patients Number of hospitals
Number of daily consultations from HEWS reporting sites
•
HEWS was deployed from 4 July- 31 August 2019•
A total of 409,098 consultations from emergency and out-patient departments•
~3 fold rise in consultation rate during Hajj rites (80.2% among pilgrims)•
Males represented 62.8% of consultations among pilgrims•
Double-fold reduction in consultation rate among non- pilgrimswww.moh.gov.sa 10
HEWS Findings 2 1440 Hajj: Automated alarms and alerts for response
•
121 automated alarms were generated•
0f these, 49 fieldinvestigations
•
1 alarm generated through hotline•
Daily mean response time:1.47-3.44 hours
•
2 health events wereconfirmed after
investigation
Number of auto-generated alarm signal
www.moh.gov.sa 11
0 20 40 60 80 100 120
Heat syncope Heat Fatigue, transient Effect of heat and light Heat Stroke
Heat Exhaution Unspecfied fall
•
2 non-infectious priority health conditions (HRIs and Injuries)detected•
Prompt detection of non-infectious threats
•
Events monitoredepidemiologically (who, where and when) in near real-time
•
79% of suspected HRI cases were reported in Mina and ArafatEpi-curve of confirmed HEWS priority health events during the 2019 (1440) Hajj
HEWS Findings 3 1440 Hajj: Confirmed health events
www.moh.gov.sa 12
1440 Hajj: Strengthening Risk Communication
HEWS daily bulletin Reassuring stakeholders
Regular media interviews and briefings
www.moh.gov.sa 13 HEWS Data Flow
Monitor
E-link/NHO/HEWS database False
alert
Confirmed outbreak/event
Provisional alert Epidemiological
analysis, create alerts and notify
Verification of alerts/AI Non-facility
based data
Reporting sites (hospital health records)
Inform Investigate
Monitor
HEWS Command/Epidemiol
ogical unit
Status update
