One Health timeliness metrics to track and evaluate outbreak response reporting: A scoping review

Abstract

Background: As the global population soars, human behaviours are increasing the risk of epidemics. Objective performance evaluation of outbreak responses requires that metrics of timeliness, or speed in response time, be recorded and reported. We sought to evaluate how timeliness data are being conveyed for multisectoral outbreaks and make recommendations on how One Health metrics can be used to improve response success.

Methods: We conducted a scoping review of outbreaks reported January 1, 2010- March 15, 2020, in organizational reports and peer-reviewed literature on PubMed and Embase databases. We tracked 11 outbreak milestones and calculated timeliness metrics, the median time in days, between the following: 1) Predict; 2) Prevent; 3) Start; 4) Detect; 5) Notify; 6) Verify; 7) Diagnostic; 8) Respond; 9) Communication; 10) End; and 11) After-Action Review.

Findings: We identified 26783 outbreak reports, 1014 of which involved more than just the human health sector. Only six of the eleven milestones were mentioned in >50% of reports. The time between most milestones was on average shorter for outbreaks reporting both Predict (alert of a potential outbreak) and Prevent (response to predictive alert) events.

Interpretation: Tracking progress in timeliness during outbreaks can focus efforts to prevent outbreaks from evolving into epidemics or pandemics. Response to predictive alerts demonstrated improved expediency in time to most milestones. We recommend the adoption of universally defined One Health outbreak milestones, including After Action Review, such that timeliness metrics can be used to assess outbreak response improvements over time.

Funding: This study was made possible by the United States Agency for International Development's One Health Workforce-Next Generation Project (Cooperative Agreement 7200AA19CA00018).

Keywords: One Health; Outbreaks; Pandemic preparedness; Timeliness metrics.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analysisflow diagram of search and selection strategy for scoping review of timeliness metrics. All outbreak reports identified, screened, and considered for inclusion in the scoping review were published January 2010-March 2020.

Figure 2

Map of outbreaks reports included in final scoping review analysis by number of One Health sectors involved in outbreaks. Map colour gradient depicts the number of outbreaks as well as the number of sectors involved in each outbreak ranging from two to four of the One Health sectors: animals, the environment, humans, and plants.

Figure 3

Stacked bar chart of milestones reported in the outbreak reports included in the scoping review analysis where n= milestones reported with either a specific date, vague date, or a mentioned but with no date. Each square represents 100% of the 1014 reports, for which the stacked bar chart is proportional to the frequency of the reported milestones.

Figure 4

Timeliness metrics, defined as the median time in days between two outbreak milestones, where n = number of outbreak reports reporting specific date of both milestones. Range of dates in parentheses. Milestones have been organized in sequential order, from left to right, recognizing that several milestones between Detect and Communication may not always occur in the exact order of events.