Real-Time Standard Analysis of Disease Investigation (SADI)-A Toolbox Approach to Inform Disease Outbreak Response

An incursion of an important exotic transboundary animal disease requires a prompt and intensive response. The routine analysis of up-to-date data, as near to real time as possible, is essential for the objective assessment of the patterns of disease spread or effectiveness of control measures and the formulation of alternative control strategies. In this paper, we describe the Standard Analysis of Disease Investigation (SADI), a toolbox for informing disease outbreak response, which was developed as part of New Zealand's biosecurity preparedness. SADI was generically designed on a web-based software platform, Integrated Real-time Information System (IRIS). We demonstrated the use of SADI for a hypothetical foot-and-mouth disease (FMD) outbreak scenario in New Zealand. The data standards were set within SADI, accommodating a single relational database that integrated the national livestock population data, outbreak data, and tracing data. We collected a well-researched, standardised set of 16 epidemiologically relevant analyses for informing the FMD outbreak response, including farm response timelines, interactive outbreak/network maps, stratified epidemic curves, estimated dissemination rates, estimated reproduction numbers, and areal attack rates. The analyses were programmed within SADI to automate the process to generate the reports at a regular interval (daily) using the most up-to-date data. Having SADI prepared in advance and the process streamlined for data collection, analysis and reporting would free a wider group of epidemiologists during an actual disease outbreak from solving data inconsistency among response teams, daily "number crunching," or providing largely retrospective analyses. Instead, the focus could be directed into enhancing data collection strategies, improving data quality, understanding the limitations of the data available, interpreting the set of analyses, and communicating their meaning with response teams, decision makers and public in the context of the epidemic.