History

July — GeoSentinel initiated in Atlanta, USA by M. Cetron, P. Kozarsky and D. Freedman as a working group of nine US-based ISTM member travel clinics collaborating as an emerging infections sentinel network of travel/tropical medicine clinics. ISTM provides seed money.

Three members of ISTM proposed a framework for GeoSentinel; U.S. government recognizes that real-time evaluation of illness in travelers, both during and after travel, across multiple sites in multiple continents could serve as an early warning for incipient epidemics, while also alerting the U.S. and other countries to the introduction of emerging infectious diseases.

May — GeoSentinel awarded competitive funding through the Division of Quarantine, National Centers for Infectious Diseases, Centers for Disease Control and Prevention under an initiative to strengthen surveillance and response to emerging pathogens.

GeoSentinel becomes organized as a cooperative effort between ISTM and CDC.

Pilot studies are run and result in a refined surveillance instrument usable by practicing clinicians. International Surveillance Sites begin to join the network.

September — GeoSentinel goes “live” at participating Surveillance Sites using a single-page faxable form that links destination, date of travel, and disease diagnosis in returning travelers. Data from all Sites are centrally aggregated at the Atlanta data center.

Systematic data collection begins.

May — Cooperative agreement between ISTM and CDC that provides core infrastructure support for GeoSentinel extended for 7 years.

June — The GeoSentinel database now contains records on 10,000 ill travelers, migrants, and refugees.

September — In response to an urgent query from London regarding ill returning participants in the Borneo Eco-Challenge 2000 Adventure Race, the GeoSentinel Query-Response mechanism ascertains near simultaneous cases of leptospirosis appearing at multiple global locations. Within 12 hours of the initial query, a wide broadcast alert is disseminated through ProMed-mail, TravelMed, TropMed, and the IDSA EINet to warn race participants still in the incubation period. GeoSentinel Sites interface with public health authorities in USA, Canada, and Australia to provide contact information for all at risk individuals.

March — A public website is inaugurated to highlight current GeoSentinel Alerts and to provide concise summaries of important GeoSentinel findings to all ISTM members as well as to the public.

Select number of sites began beta-testing a web-based data submission system.

May — First generation Internet based data entry begins. By 2005 less than 10% of patient records are being submitted by fax. Sites can enter or update their patient records online, download their own Site-specific data in MS-ACCESS, run canned reports and query their own data in real time.

October — Implementation of a separate password protected website for GeoSentinel Network members to allow direct entry of unusual or alarming cases meeting set criteria. In addition, Network members can use this restricted webspace to submit interesting leads which are then catalogued and built on over time, so that continuity for relatively rare events that may occur spaced over time can be established.

The GeoSentinel Network Member program is inaugurated to complement the more intensive surveillance carried out by existing GeoSentinel Sites. By 2011 over 210 ISTM members in 40 countries with valuable patient populations, who are unable to participate in systematic surveillance but who are willing to more informally provide leads and contacts when they encounter patients having unusual clinical events, have become GeoSentinel Network Members.

April — GeoSentinel trend graph analysis which plots month-by-month trends for 60 key travel-related diagnoses using baselines compiled beginning in 1997 detects out of season dengue in travelers to Thailand.

Rapid queries to GeoSentinel Sites establish travel to Koh Phangan as a possible risk spot and the Thai Ministry of Health begins to respond and intervene.

June — All sites given the option of submitting data using the web-based system.

February — A GeoSentinel analysis of 22,000 patient records appears in the Clinical Infectious Diseases journal.

The analysis indicates that after traveler’s diarrhea, respiratory illness is the most common affliction of travelers and warns that travelers are potentially very efficient vectors for emerging respiratory pathogens.

March — GeoSentinel is among the first to determine that SARS is not just a regional Asian situation when the Toronto Site alerts GeoSentinel and the CDC’s Emergency Operations Center of their situation. GeoSentinel works with the CDC Emergency Operations Center on a daily basis to facilitate bi-directional information sharing with GeoSentinel’s global assets. The first CDC MMWR SARS summary uses GeoSentinel data to quantify baseline levels of respiratory illness in travelers.

In response to threats of respiratory illness originating in Asia, a strategic expansion initiative begins in Asia with Sites at 3 important international gateways (Beijing, Singapore, Yokohama).

By 2009, Asian Sites include Hong Kong, Tokyo, Ho Chi Minh City, and Bangkok.

June — The GeoSentinel database now contains records on 40,000 ill travelers, migrants, and refugees. The data entry system began to allow free-text diagnosis information.

January — GeoSentinel in collaboration with CDC, Health Canada, and TropNet Europ identify falciparum malaria in significant numbers of resort travelers to the Dominican Republic.

Publication of the joint report in the MMWR leads to changes in CDC recommendations for malaria chemoprophylaxis in travelers to this area.

January — Post-tsunami, sentinel travelers with serious wound infections due to multi-resistant acinetobacter, aeromonas, and pseudomonas, as well as other salt-loving bacteria are reported from several individual GeoSentinel locations in developed countries with access to sophisticated diagnostic laboratories. This finding benefits aid workers in affected areas treating seriously injured survivors but who lack diagnostic capabilities.

“Medical tourism” was added as a “Reason for Travel” and “Primary Complaint” was changed to “Main Presenting Symptom.”

August — In response to the pandemic influenza threat, GeoSentinel develops a response plan to allow focused enhanced surveillance for respiratory diagnoses immediately upon indications of the onset of human-to-human transmission. The plan includes daily visual review of the geographic exposures of every suspected respiratory illness submitted to GeoSentinel, and weekly examination of monthly trends in suspected pneumonias, atypical pneumonia, influenza, lower respiratory illness, and presenting respiratory complaints, a strategy that was tested during the SARS outbreak.

January — A comprehensive analysis of 17,353 ill returned travelers from the developing world summarizing the GeoSentinel experience from 1996-2004 is published (N Engl J Med 2006; 254:119-30).

The paper “Spectrum of Disease and Relation to Place of Exposure in Ill Returned Travelers” provides a blueprint for medical providers of what to look for when it comes to diagnosing sick travelers, based on where they have been. Physicians can use the destination-specific differences to guide the diagnosis and treatment of ill travelers.

May — Cooperative agreement between ISTM and CDC that provides core infrastructure support for GeoSentinel extended for 5 years.

Strategic expansion in Europe begins that will by 2009 add Sites in Paris, Madrid, London, Oslo, Hamburg and Amsterdam. GeoSentinel now has 12 European Sites in 8 countries.

May — The second generation GeoSentinel Data Entry and Reporting web application goes live. Patient records entered at any Site worldwide, 24 hours a day, are immediately live in the system. Lists of and links to full patient records selected by diagnosis, syndrome, place of exposure, or country of travel can be generated on-screen in real time by project directors from any internet connection anywhere.

May — Second-generation web-based data entry was introduced. New features added included: data entry process, separate checkboxes for immigrants and expatriates and the online “Help” system.

September — All “Syndromic” diagnoses were characterized as “Confirmed” diagnosis status.

“Etiologic” diagnoses could not be characterized as “etiology unknown.”

Maximum number of possible exposure countries permitted decrease from three to two.

“Immigrant” was defined as a person who has emigrated from country of birth and does not apply to persons who have emigrated within Western Europe, between the United States and Canada, or between Australia and New Zealand.

November — 12 European GeoSentinel Sites form a consortium to launch EuroTravNet, a new ISTM initiative in Europe that is funded for 4 years by the European Centre for Disease Prevention and Control (ECDC) in Stockholm, after a Europe-wide open tender and competition process.

EuroTravNet <www.eurotravnet.eu> is a network of clinical experts in tropical and travel medicine in Europe, to support ECDC in detection, verification, assessment and communication of travel-related diseases. GeoSentinel will provide key infrastructure and IT support as a partner in EuroTravNet.

February — GeoSentinel HealthMap launches. All key diagnoses are automatically geo-located on a worldwide Google map in real time upon entry of the diagnosis into the GeoSentinel database. This is a customized GeoSentinel version of the public HealthMap.

Clicking the event icon opens a balloon with links to relevant web pages in five languages from HealthMap’s proprietary news-crawling software, as well as from ProMED, CDC, WHO, ECDC and other public health sources. This allows for detection of clusters of the same diagnosis and also suspicious syndromes (e.g., unknown fever) that arise in close proximity.

June — GeoSentinel Sites established in Mexico to monitor illness in US visitors and expatriates in response to 2009 pH1N1.

May — Smartphone and e-mail push alerting goes live for individual GeoSentinel users. For select diagnosis codes, daily alerts show diagnosis and map geolocation for all applicable patient records entered since the previous alert.

October — Instantaneous online historical time series and geographical visualizations for each patient event by diagnosis goes live.

February — GeoSentinel Site established in Leogane, Haiti to monitor illness in aid and relief workers post-earthquake.

Completion of strategic expansion to add Sentinel Sites in Africa & Latin America (Lima, Mexico, Capetown) and additional Sites in Europe (Liverpool, Stockholm, Porto, Amsterdam). GeoSentinel now has 16 European Sites in 10 countries encompassing most of the largest international air hubs.

GeoSentinel Global Surveillance System comprised of 54-member travel and tropical medicine in 24 countries on six continents.

April — The GeoSentinel dataset now contains over 143,614 patient records with over 184,208 final diagnoses from our global network of providers at 54 Sites on all continents, with annual growth of 24,000 records per year. These records cover traveler exposures in over 237 countries and territories demonstrating a global reach for surveillance. 516 diagnoses are monitored by region, by precise location, by time of exposure, and by risk group. Ongoing trends are tracked on a month-to-month basis for key diagnoses. The 32 GeoSentinel publications have 709 total citations with 177 in 2010 alone. Network-wide original papers published prior to 2009 were cited an average of 104 times/year from 2006-2010 and the average such GeoSentinel paper has had 44 citations.

May — The following data fields became mandatory for each record: “Travel Related,” “Expatriate,” and “Pretravel Encounter.”

July — CDC published Morbidity and Mortality Weekly Report on Surveillance Related to Travel-Related Disease: GeoSentinel Surveillance System.

October — Added symptoms, diagnostic testing, diagnostic specimen to the core form.

November — Launched first enhanced surveillance form (antimicrobial resistance for enteric pathogens).

Restructured data collection on the core form to have the following tied to each diagnosis and not to the patient – diagnostic test, country/region of exposure, travel reason, travel-related (or not), diagnostic specimen.

GeoSentinel database contains >333,000 records of ill travelers. GeoSentinel has continued to be highly productive with 71 GeoSentinel sites in 30 countries and 221 Affiliate Members with a presence on every continent except Antarctica.

March — GeoSentinel launches Enhanced surveillance Respiratory Tract Infection project (Objective 4 of CITrSS protocol)

April — GeoSentinel launches COVID-19 International Traveler Sentinel Surveillance (CITrSS), Severity Markers for COVID-19 (SMAC) and The Health Care Worker Prophylaxis Trial (HEROs) projects

May — GeoSentinel Annual meeting to be held in Madrid, Spain gets cancelled owing to the COVID-19 pandemic

June — First GeoSentinel webinar takes place