Johns et al. BMC Public Health 2011, 11(Suppl 2):S3 http://www.biomedcentral.com/1471-2458/11/S2/S3 R E V I E W Open Access A growing global network’s role in outbreak response: AFHSC-GEIS 2008-2009 Matthew C Johns1*, Ronald L Burke1, Kelly G Vest1, Mark Fukuda1, Julie A Pavlin2, Sanjaya K Shrestha3, David C Schnabel4, Steven Tobias5, Jeffrey A Tjaden6, Joel M Montgomery7, Dennis J Faix8, Mark R Duffy9, Michael J Cooper10, Jose L Sanchez1, David L Blazes1, the AFHSC-GEIS Outbreak Response Writing Group2,3,4,5,6,8,9,10 Abstract A cornerstone of effective disease surveillance programs comprises the early identification of infectious threats and the subsequent rapid response to prevent further spread. Effectively identifying, tracking and responding to these threats is often difficult and requires international cooperation due to the rapidity with which diseases cross national borders and spread throughout the global community as a result of travel and migration by humans and animals. From Oct.1, 2008 to Sept. 30, 2009, the United States Department of Defense’s (DoD) Armed Forces Health Surveillance Center Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) identified 76 outbreaks in 53 countries. Emerging infectious disease outbreaks were identified by the global network and included a wide spectrum of support activities in collaboration with host country partners, several of which were in direct support of the World Health Organization’s (WHO) International Health Regulations (IHR) (2005). The network also supported military forces around the world affected by the novel influenza A/H1N1 pandemic of 2009. With IHR (2005) as the guiding framework for action, the AFHSC-GEIS network of international partners and overseas research laboratories continues to develop into a far-reaching system for identifying, analyzing and responding to emerging disease threats. Background A central objective of disease surveillance systems is the early identification of infectious disease outbreaks to facilitate rapid implementation of effective control mea- sures for minimizing disease transmission and morbid- ity. Although outbreak response has come a long way since John Snow’s investigation of cholera and the Broad Street pump in 19th century London [1], effective outbreak response continues to be challenging. Today, a particular challenge is the interconnected nature of our global society. Diseases cross international borders and present themselves in unique ways through a continu- ously changing landscape, making it difficult to rapidly identify, analyze and respond to disease outbreaks. Appropriate and effective monitoring of newly recog- nized disease clusters requires an established, * Correspondence: Matthew.C.Johns@us.army.mil 1Armed Forces Health Surveillance Center, 11800 Tech Rd, Silver Spring, MD 20904, USA Full list of author information is available at the end of the article standardized and well-maintained global surveillance system with a flexible framework for identifying and responding to such events. In 1997, the U.S. Department of Defense (DoD) estab- lished the Global Emerging Infections Surveillance and Response System (GEIS) in response to the Presidential Decision Directive NSTC-7, which identified the need for more robust global disease surveillance [2]. In 2008, GEIS was integrated into the newly formed Armed Forces Health Surveillance Center [3]. As the name implies, the primary mission of AFHSC-GEIS is global disease surveillance and response. A large portion of this mission is accomplished through DoD overseas research laboratories, which were initially established within partner host countries to conduct research on infectious diseases of bilateral concern [4]. This capacity has subsequently been leveraged by AFHSC-GEIS for the purpose of disease surveillance and response. Currently, five DoD overseas research laboratories serve in this capacity: the Armed Forces Research © 2011 Johns et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.