Office of Border Health
New Mexico Department of Health - Division of Policy and Performance
Early Warning Infectious Disease Surveillance (EWIDS)
In 2003, the Department of Health and Human Services (HHS) designated $5 million per year to be allocated to the northern and southern states bordering Canada and Mexico for the Early Warning Infectious Disease Surveillance System. The existing Centers for Disease Control (CDC) Public Health Emergency Preparedness Cooperative Agreement is the funding mechanism for the twenty states that have chosen to participate. Twenty of the 21 border states participate in EWIDS (Illinois chose not to participate).
The goal of EWIDS was to improve cross-border activities in early detection, identification, and reporting of infectious diseases associated with potential bio-terrorism agents or other major threats to public health.
EWIDS Objectives were to:
- Detect, identify, and report outbreaks of infectious diseases (whether terrorist-induced or naturally occurring)
- Conduct epidemiological investigations
- Develop laboratory capability to rapidly identify and characterize biological agents
- Share clinical, laboratory and epidemiological information electronically with public health officials in neighboring jurisdictions (both Mexican and U.S.)
- Train public health personnel in surveillance and epidemiology
The Early Warning Infectious Disease Program (EWIDS) represents a unique collaboration of state, federal and international partners who collaborate to provided rapid and effective laboratory confirmation of urgent infectious disease case reports in the border regions of the United States, Canada, and Mexico. Activities can include assessing surveillance and laboratory capacity on each side of the international border, improving electronic sharing of laboratory information, maintaining a database of all sentinel/clinical labs, and work to develop and agree on a list of notifiable conditions. However, the states decided to expand beyond laboratory and epidemiology issues that include working on cross border Memoranda of Understanding (MOUs), pandemic influenza tabletop exercises, expanding the Health Alert Network (HAN) into Canada and cross-training in laboratory procedures. There were many issues surrounding working with countries on our borders, including stockpiling prophylaxis medications, quarantine and movement of documented workers into their home country in the event of a public health emergency.
In the case of EWIDS in New Mexico, the Office of Border Health collaborates with the Department of Health’s Epidemiology and Response Division/Infectious Disease Epidemiology Bureau to catalyze activities with relevant health authorities in West Texas and Chihuahua State Health Services, and with non-government healthcare services providers operating in New Mexico’s border counties. These activities have included:
- United States-Mexico Border Infectious Disease Surveillance, Epidemiology and Laboratory Capacity Survey in El Paso County Texas, Southwestern New Mexico, and Northern Chihuahua State. Included in the final report of this survey is: i) a description of how notifiable diseases are reported in each of the three states, and with Mexican and U.S. surveillance authorities; ii) recommendations for improving the surveillance and reporting of infectious diseases, including binational notification; and iii) an updated directory of staffs of laboratories, public health authorities, hospitals, community health centers, correctional facilities, and federal agencies involved in epidemiology and surveillance of infectious diseases in the tri-state binational border region.
- Participation in periodic meetings that focused on communication and surveillance and other information sharing with Mexico through the Border Epidemiology Surveillance Team (BEST), a binational, tri-state forum established for this purpose with Chihuahua State Health Services, El Paso City Public Health Department, and Texas Department of State Health Services Region 9/10.
- Professional epidemiological and laboratory staff exchanges between Chihuahua State Health Services in Chihuahua and Juarez, and the Department of Health’s Scientific Laboratory Division and Epidemiology and Response Division. The objective of these exchanges is to build professional relationships and collegial support and training opportunities among epidemiology and surveillance staffs in both states.
- Implementation of the 2007-2008 Paso del Norte Seasonal Influenza Surveillance Pilot Project. The project establishes a sentinel site in the Juarez Health Clinic “B” for surveillance of seasonal influenza. The project was co-financed with funds of the US-Mexico Border Health Commission and EWIDS Project. Chihuahua Social Development Secretary Carlos Carrera and DOH Secretary Dr. Alfredo Vigil signed a cooperative agreement to implement the project—the first bilateral agreement ever signed between the governments of Chihuahua and New Mexico in the health sector, and the first truly binational infectious disease surveillance project along the US-Mexico Border. Two additional sentinel sites were established under this initiative in Columbus and Sunland Park, New Mexico. The Border Influenza Surveillance Network was established as a reporting platform, with weekly reports on flu activity sent to all participants in health authorities in Chihuahua, Texas and New Mexico. The surveillance program has been expanded for the 2008-2009 influenza season, incorporating additional sentinel sites in the Juarez Health Jurisdiction, as well as Ojinaga and Nuevo Casas Grandes in the northern State of Chihuahua.
- Development of a survey to assess the ability of county, state and federal detention and correctional facilities along the border to diagnose and identify binational infectious disease cases.
- Electronic distribution of weekly and monthly updates on notifiable diseases of the New Mexico Electronic Disease Surveillance System to counterpart organizations in Chihuahua and Texas.
Collaboration of New Mexico Department of Health and Chihuahua State Health Services on Binational Surveillance of Seasonal Influenza
Last year, the New Mexico Department of Health (NMDOH) and Chihuahua State Health Services (CSHS) implemented the binational “2007-2008 Paso del Norte Seasonal Influenza Surveillance Pilot Project”. NMDOH staff from the Office of Border Health (OBH), Public Health Region 5, the Epidemiology and Response Division (ERD) and Scientific Laboratory Division (SLD) collaborated with the CSHS State Epidemiologist and staff of Health Jurisdiction #2 in Juárez to establish a seasonal influenza sentinel site at Health Clinic B in central Juárez. The pilot had multiple objectives of improving binational disease surveillance, sharing of real-time epidemiological information, and support of avian and pandemic influenza preparedness in the binational border region. On August 30, 2007, NMDOH staff trained 14 of Chihuahua State Health Services clinicians, laboratorians and epidemiologists in the use of rapid test kits (Quickview Influenza A+B) and record keeping and reporting protocols to implement the pilot project. Co-financing for this pilot project was initially provided by the US-Mexico Border Health Commission, and has been continued by the Centers for Disease Control and Prevention.
The pilot yielded positive results and lessons learned, including detecting the first positive influenza case at Clinic B on December 14 using the rapid test kit protocol, just two days before the first positive case was reported in Deming, New Mexico, in the border region on the U.S. side. Specimens were collected from these patients and sent to the SLD in Albuquerque for culturing, returning confirmations of the first seasonal flu case in Juárez. Influenza surveillance data was then incorporated on a weekly basis into the new Border Influenza Sentinel Surveillance Network managed by the NMDOH Infectious Disease Epidemiology Bureau, and weekly reports are sent to all participating organizations and the Centers for Disease Control and Prevention in Atlanta. The Border Influenza Surveillance Network includes selected sentinel sites in the US-Mexico Border Region, including Luna and Doña Ana Counties and northern Chihuahua State. Influenza types A and B were been confirmed on both sides of the Chihuahua-New Mexico border.
Based on the success of the pilot project, in addition to continuing surveillance at Health Clinic B, CSHS requested that the project be expanded to four new sentinel sites in northern Chihuahua: Águilas de Zaragoza and Anapra (Juarez Municipality), Nuevo Casas Grandes and Ojinaga,. In response, OBH and ERD staff delivered a training session related to the Border Influenza Surveillance Network initiative to CSHS staff working in these new locations on September 10, 2008. Clinical and epidemiology staff of these new sites and Clinic B, the Chihuahua State Epidemiologist, the Juarez Health Jurisdiction Director and the Jurisdiction’s Epidemiologist, and staff from the Chihuahua State Laboratory and Juarez laboratories, as well as two epidemiologists of Texas Department of State Health Services Region 9/10, attended the training. Co-financing for this expanded project is being provided under the Early Warning Infectious Disease Surveillance (EWIDS) project administered by the Centers for Disease Control and Prevention.
The Network is being considered by the Centers of Disease Control and Prevention as a potential model to deploy all along the US-Mexico Border Region. NMDOH and CSHS is also in the process to expand collaborations to include improved binational surveillance and control of tuberculosis, improved surveillance and reducing and treating sexually transmitted diseases, including HIV/AIDS, and binational preparedness and response to avian influenza and a potential pandemic.