Global Emerging Infections Surveillance and Response System (GEIS)
www.geis.fhp.osd.mil

Purpose
The Global Emerging Infections Surveillance and Response System (GEIS) is a surveillance and response system that links Department of Defense (DoD) laboratories, research facilities, and the military health system to facilitate rapid recognition and response to protect the health of the forces and national security.‡49,50

History and operational characteristics
The GEIS network was established by DoD in 1997 in response to 1996 Presidential Decision Directive NSTC-7. Within the U.S., each of the three military branches has a hub that collects disease surveillance information: the Naval Health Research Center (San Diego), the Walter Reed Army Institute of Research (Silver Spring, Maryland), and the Air Force Institute for Operational Health (Brooks City-Base, Texas). Walter Reed Army Institute of Research serves as the central hub, providing guidance and support to all DoD-GEIS global partners on disease outbreak investigations, including unusual diseases and specific clusters of disease among soldiers. It also evaluates the effectiveness of medical interventions.

GEIS conducts clinical and laboratory surveillance for emerging diseases as well as for specific diseases such as influenza and other respiratory diseases, enteric diseases (e.g., norovirus), acute febrile illness (e.g., malaria), acute hemorrhagic fevers (e.g., dengue fever), antibiotic resistant microbes resistance, and sexually transmitted diseases.

Additional domestic support comes from other military centers, including the U.S. Army Center for Health Promotion and Preventive Medicine (Aberdeen Proving Ground, Maryland), the U.S. Army Medical Research Institute of Infectious Diseases (Fort Detrick, Maryland), and the Naval Environmental Health Center (Norfolk, Virginia).

The international GEIS network is primarily conducted by five DoD overseas medical research laboratories on three continents, some of which have been operational since the 1940s:

• Armed Forces Research Institute of Medical Science (AFRMIS), Thailand
• U.S. Army Medical Research Unit, Kenya
• U.S. Naval Medical Research Unit (NAMRU)-3, Egypt
• U.S. Naval Medical Research Unit (NAMRU)-2, Indonesia
• Naval Medical Research Center Detachment (NMRCD), Peru

The laboratories in Thailand, Egypt, and Indonesia are WHO Collaborating Centers.

GEIS uses morbidity and mortality and laboratory data from the host country as well as those of U.S. military personnel stationed in the region to identify and confirm disease outbreaks. GEIS-supported laboratories have molecular- and culture-based diagnostic capabilities; each receives and analyzes samples collected from patients presenting with the syndromes of interest (e.g., influenzalike illness or hemorrhagic fever).

The NAMRU-2 Laboratory in Indonesia collaborated to establish two regional programs for global disease surveillance and response. The Early Warning Outbreak Recognition System (EWORS), established in 1998, is a hospital-based computer database used in Indonesia, Cambodia, Laos, Vietnam, and Peru to collect and analyze clinical signs and symptoms of patients seen by participating healthcare providers. The system is aimed at detecting communicable disease outbreaks early, based on identifying unusual diseases and unusual clusters of diseases (e.g., increased case rates). After healthcare providers enter patient data into the electronic EWORS system, the information is analyzed by the country’s EWORS host. In Indonesia, for example, the EWORS host is the Ministry of Health’s National Institute of Health Research and Development. The host then provides appropriate feedback to healthcare sites and determines if other facilities should be advised to look for similar cases. (See http://www.science.org.au/events/indonesia/sedyaningsih-mamahit.pdf.) In 2005, the EWORS database was upgraded to facilitate the identification of influenzalike illness cases.51

The other program, ASEAN-Outbreak.Net, is a web-based outbreak response tool used by the Association of Southeast Asian Nations (ASEAN). Developed collaboratively with the Indonesian Ministry of Health, the tool is the official web-based platform of the ten ASEAN countries “for reporting and tracking of infectious disease outbreaks between member countries and the WHO regional offices.”50

Communication and collaboration between WHO and the GEIS system is facilitated by several mechanisms: (1) use of an electronic communication system (e.g., websites and portals) that can be accessed by GEIS, CDC, and WHO; (2) the Naval Health Research Center (San Diego) and the Air Force Institute for Operational Health (Brooks City-Base) provide weekly U.S. surveillance information and influenza virus specimens to CDC and WHO during the annual influenza season; (3) DoD has an officer with public health training stationed at WHO in Geneva; and (4) three of the five DoD overseas laboratories provide WHO with regional influenza surveillance data and clinical specimens; in 2005, NAMRU-2 supported the identification of H5N1 from wildfowl specimens in Kazakhstan.

Region/countries served
United States (military bases), Thailand, Kenya, Egypt, Indonesia, Peru, and regions surrounding each; global, as a GOARN partner

Funding/budget/staff
The GEIS core budget is programmed in the DoD through FY2009 at approximately $11.5 million. The core budget can be supplemented to meet special threats, as was done to improve surveillance for highly pathogenic avian influenza virus.