This work improves the accessibility of data of the WHO’s DONs reports and promotes future research efforts focused on analyzing WHO-confirmed infectious disease outbreaks. The availably of the data will allow for detailed analyses including descriptive work examining correlations between infectious disease outbreaks and other contextual factors, such as climatic events or conflict. Such analyses could help to predict future infectious disease outbreaks.
There are several notable shortcomings related to consistency, standardization practices, accuracy, and transparency that should be addressed. Regarding consistency, there is no clear format or structure for DONs reports. The reports and information included therein seem to be contingent on the specific disease, the information provided by the source or country, and even the report author. Reports can vary greatly in length and amount of detail provided. The inclusion of data tables, charts or links in reports can provide useful information, but their inclusion is infrequent and does not adhere to specific patterns or methodologies. While the lack of structure may improve flexibility and reflect the information reported to the WHO, these inconsistencies make it difficult to quickly identify important information.
Attempting to characterize the reports also presented a challenge while creating our database. While we strove to adhere strictly to the information contained in DONs reports, the reports do not employ a standardized list of pathogens or naming convention. For example, various DONs reports relating to Ebola referred to the disease as ‘Ebola,’ ‘Ebola Haemorrhagic Fever,’ ‘EHV,’ ‘Ebola Virus Disease,’ and ‘EVD.’ Additionally, the DONs reports often switch between spellings of cities or provinces; for example, certain cities in Egypt appeared in consecutive reports with several different spellings. This oversight could make outbreaks appear to be more severe to those not intimately familiar with the geography of the outbreak by suggesting that the disease is spreading to other localities.
To this end, we believe that the WHO could improve DONs reports by implementing a consistent and systematized reporting format. An appropriate place to start is with the criteria put forward by Smolinski and colleagues ; case total tables organized by defined probable, suspected and confirmed cases; and subsections for appropriate or priority contextual factors, such as meteorology or climate hazards, community resistance, conflict, migration, or mass gatherings. Doing so would make information easier to find, ensure consistent reporting, and could allow for the reports to become machine-readable, and thus a more accessible source of information.
The DONs reports also occasionally contained errors that could call the validity of reported results into question. For example, a report on avian influenza in Vietnam published on January 11, 2009 reports that an individual first developed symptoms on January 28, 2009 and was hospitalized on January 31, 2009, several weeks after the report was published . Other reports contain similar errors and chronological inconsistencies. These include the same report published twice on consecutive days , and conflicting information regarding the subject of the report .
Closely related to the issues surrounding inconsistencies and errors in the DONs reports, transparency regarding how the reports are compiled presents an additional concern. The WHO does not publish any secondary information about the DONs reports or catalog. Many questions arise in the absence of this information – namely with regard to the author of reports, the information included in the reports, and the prioritization of pathogens or geographies. We posit that this information isn’t included not out of enigmatic intentions, but rather as a result of the aforementioned inconsistencies and reporting errors. We recommend the WHO publish secondary information detailing how reports are prepared and compiled. Establishing these parameters and guidelines would improve the transparency and standardization of the reporting process, could act to improve confidence in the reports themselves as the single authoritative collection of disease outbreaks and might allow for it to be more easily adapted and used for analytic purposes.
Additionally, while reviewing DONs reports, it became clear that there exist significant discrepancies between the coverage allocated to various diseases. Some diseases, such as H5N1 influenza, Ebola virus disease, and MERS-CoV enjoy consistent, precise, and timely coverage. Still, reports on other infectious diseases may not materialize into a DONs report until months after the WHO is notified. Cholera, for example, is the fourth most commonly reported disease in the DONs, but some reports are not published until months after initial reporting of the outbreak to relevant authorities . Furthermore, we identified multiple events that received support from the Contingency Fund for Emergencies (CEF) that are not included in the DONs. For example, a 2017 outbreak of dengue fever in Pakistan received funding from the CEF, as did a 2018 outbreak of malaria in Nigeria, but both were omitted from the DONs reports. On the premise that these events constitute important health threats that warrant the allocation of millions of dollars for response efforts, their notable absence in DONs reports is surprising, and ultimately supports the conclusion that, though the WHO’s catalog of DONs reports represents the only official source of surveillance data, it is far from a comprehensive summary of priority outbreaks.
To remedy these challenges, we recommend the WHO decide upon and publish a set of criteria outlining what events merit a DONs report. Acknowledging that a majority of emerging infectious diseases are zoonotic in nature [2, 4], discussions surrounding pathogen detection in animal and non-human reservoirs must also be a part of this conversation. At present, some DONs reports contain information regarding the detection of pathogens in animals in the absence of any human cases, but these are not consistent nor comprehensive.
We believe the standardized methodology we provide addresses many of these limitations while maintaining the integrity of the data in the DONs reports and hope that our efforts to create a searchable, standardized database of DONs reports will inform important global health analyses and policy decisions.