Embedding risk monitoring in infectious disease surveillance for timely and effective outbreak prevention and control

Epidemic intelligence efforts aim to predict, timely detect and assess (re-)emerging pathogens, guide and evaluate infectious disease prevention or control. We emphasise the underused potential of integrating the monitoring of risks related to exposure, disease or death, particularly in settings where limited diagnostic capacity and access to healthcare hamper timely prevention/control measures. Monitoring One Health exposures, human behaviour, immunity, comorbidities, uptake of control measures or pathogen characteristics can complement facility-based surveillance in generating signals of imminent or ongoing outbreaks, and in targeting preventive/control interventions or epidemic preparedness to high-risk areas or subpopulations. Low-cost risk data sources include electronic medical records, existing household/patient/environmental surveys, Health and Demographic Surveillance Systems, medicine distribution and programmatic data. Public health authorities need to identify and prioritise risk data that effectively fill gaps in intelligence that facility-based surveillance can not timely or accurately answer, determine indicators to generate from the data, ensure data availability, regular analysis and dissemination.