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US Virgin Islands Launches Modernized NBS 7 Disease Surveillance System to Transform Public Health: Implementation
Hannah M Cranford1, Terri Pietka1,2, Leah de Wilde1,2
1Epidemiology Division, United States Virgin Islands Department of Health, Charles Harwood Complex, 3500 Estate Richmond, Christiansted, United States Virgin Islands, 00820, United States, 1 340 514 7583.
Background:
During January 2024, the US Virgin Islands (USVI) Department of Health (VIDOH) identified a critical need to maintain the cloud-hosted National Electronic Disease Surveillance System Base System (NBS) instance and support the local data modernization initiative. After consulting with federal partners and subject matter experts, VIDOH's leadership chose to migrate the integrated disease surveillance system to a new platform hosted on Amazon Web Services (AWS) and update the NBS instance to the most advanced version, NBS 7.
Objective:
The primary aim was to support a USVI disease surveillance system that is modern, functional, and cost-efficient by migrating the VIDOH NBS instance from a vendor-managed environment to a jurisdiction-managed AWS cloud-based infrastructure while upgrading to NBS 7.
Methods:
The VIDOH implemented a phased migration strategy that included planning and cost-benefit assessment, deployment of NBS 7 within AWS, database migration, validation and optimization, and staged reonboarding of electronic reporting facilities.
Unlabelled:
The USVI NBS 7 instance went live on May 6, 2025, with USVI becoming the first US jurisdiction using AWS for implementation of NBS 7 and the second using NBS 7 in production, overall. Benefits of this change included nearly 90% cost savings (preliminarily estimated at 80%), additional bandwidth, real-time data ingestion and updates, an opportunity to build local informatics capacity, and the ability to have greater autonomy over the data and its end points. To date, the VIDOH successfully reonboarded 106 of 109 (97%) previously connected electronic reporting facilities and onboarded 1 new reporting laboratory previously unable to connect due to interoperability barriers.
Conclusions:
Updating the USVI database to NBS 7 in a locally owned, cloud-hosted, AWS environment has improved disease surveillance specifically by providing the most up-to-date Centers for Disease Control and Prevention-supported data system, improving timeliness of reporting by offering local providers more flexibility in electronic reporting options, and giving USVI direct control over workflow decision functionality. Furthermore, improved interoperability and maintaining a cloud-based platform were additional benefits of the database migration. This important investment in public health infrastructure will allow USVI public health professionals, clinicians, policymakers, and other stakeholders to be able to monitor and respond to disease threats quickly and inform appropriate public health action.
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