In 2021, 72,299 Afghan evacuees arrived in the United States as part of “Operation Allies Welcome.” At the time, Afghanistan had low measles immunization coverage and an ongoing outbreak making importation of cases likely.
Few may remember this event, but among more than 72,000 evacuees, 47 measles cases were identified. Historically, attack rates for measles outbreaks in refugee populations living in congregate settings have ranged from 0.9% to 25.5%. In this instance, the attack rate was just 0.065%, and notably, no cases occurred in surrounding communities.
How was measles successfully contained? The answer lies at the heart of successful public health efforts:
- Rapid identification and reporting of cases to local authorities allowed escalation to federal agencies.
- In partnership with state and local health departments, CDC provided technical guidance to enhance surveillance, conduct case investigations and contact tracing, and implement a mass vaccination campaign.
- Information was quickly disseminated back to clinicians providing frontline care. Data on timing and location of initial cases were available early, enabling localized and targeted action.
A Health Alert Network (HAN) notification was issued on Sept. 20, 2021, when 16 cases had been identified. Within two months, vaccination coverage of the evacuee population reached 96%. The full response was described in the Morbidity and Mortality Weekly Report.
While the “boots on the ground” response was essential, equally critical was the bidirectional flow of data — up to centralized public health authorities and back down to clinicians caring for evacuees.
If a similar event occurred in 2026, many question whether an effective and coordinated response would be possible. The ongoing spread of measles suggests not. In the past year, shifts in leadership priorities, staffing, and data-sharing practices have altered critical aspects of a multifaceted monitoring and reporting system. As discussed in the February 2026 Vaccine Update article — “In the Journals: Where Is the Public’s Evidence Base for Health Policy?” — existing, and previously reliable, reporting systems are facing meaningful challenges. These changes have contributed to growing uncertainty about how data are generated, interpreted and communicated. At the same time, clinicians are facing practical challenges, including reporting delays, variability across state systems, and inconsistent access to relevant surveillance data. For example, the most recent measles HAN was issued over a year ago (March 7, 2025), despite ongoing outbreaks across the country, and recently, severe and deadly cases of Haemophilus influenzae type b (Hib) in Florida only came to light during a workshop to discuss removal of vaccine mandates in that state.
Closing the reporting gaps
As scientists, clinicians and public health experts have grappled with the current reality of trying to stem the spread of infectious diseases and care for patients in the absence of reliable surveillance data, new tools have started to emerge. None are as comprehensive or singularly functional as the previous federally based systems, but they each bring important information to the forefront, and together, they can help bridge some of the current gaps.
Epic Cosmos
Epic Cosmos is one of the more powerful emerging tools for near real-time clinical insight, built within the Epic electronic health record.
- Data sources: De-identified electronic health record data across participating Epic health systems.
- Strengths: Scale, as nearly 40% of U.S. inpatient hospitals use Epic, as well as timeliness. Users can assess trends in diagnoses, testing and vaccination patterns with a level of granularity that approximates real-world clinical activity. For vaccine providers, this can serve as an early signal of shifting disease patterns before traditional surveillance systems update.
- Limitations: Not population based; it reflects only participating systems and may overrepresent certain regions or care settings. Access is restricted, and individual institutions may limit how users access the data output. Outputs require careful interpretation due to variability in coding practices and healthcare-seeking behavior.
Can it provide a general sense of trends? Yes. Can it independently track outbreaks? Not yet.
The Pandemic Center at Brown University
The Pandemic Center provides updates through a weekly email, called the “Pandemic Center Tracking Report.” The content focuses on selected domestic and international disease outbreaks, synthesizing data from multiple jurisdictions into clinician-friendly summaries.
- Data sources: Local and state health departments; national and international data reports.
- Strengths: Accessibility as users can quickly visually review trends or rely on concise written summaries that interpret the data. The weekly cadence provides updates during periods of rapid change when official reporting may lag. The delivery of information through the weekly newsletter makes this highly accessible.
- Limitations: Methods can vary by disease, and underlying data sources are often heterogeneous, requiring users to interpret findings with caution.
In contrast to a tool like Cosmos, where clinicians have to interpret the data themselves, this weekly digest offers an efficient, summarized way to stay on top of outbreaks without the need to manipulate datasets.
Find out more or sign up for the report.
Force of Infection and FOI Clinical
Led by epidemiologist Caitlin Rivers at Johns Hopkins, Force of Infection is a newsletter that provides regular updates, analysis and commentary on infectious diseases and public health trends. Newsletter content changes throughout the year. October through April includes a “weather report” summarizing respiratory and gastrointestinal illness activity in the U.S., along with food safety updates. Summer months include broader discussions of epidemiologic and public health topics.
- Data sources: Centers for Disease Control and Prevention; supplementary data from state health department websites.
- Strengths: Summaries can help contextualize broader trends, such as rising RSV activity, and inform anticipatory guidance. The delivery of information through the newsletter makes this highly accessible.
- Limitations: Only select infections are tracked. Summaries are subject to limitations in CDC reporting; however, the authors try to address this with ancillary data from state health department websites.
To address limitations for clinicians in using the Force of Infection reports, FOI Clinical has been developed. The goal of this program is to provide “updates on current outbreaks, with epidemiological context and a takeaway for your practice.” This service is available for a fee based on whether the subscription is individual, group or institutional.
Find out more or sign up for the newsletter.
PopHive
PopHive, developed at the Yale School of Public Health, is an emerging data aggregation platform designed to provide real-time insights into population health trends.
- Data sources: Multiple sources, including CDC systems, Google Trends API, Epic Cosmos, Medicare data, and more.
- Strengths: Integrates multiple data streams, including clinical data, public health reporting, and digital surveillance signals to allow users to detect early signals of disease activity across regions. For clinicians, PopHive has the potential to bridge the gap between traditional surveillance and real-time situational awareness.
- Limitations: The platform is new, and the number of diseases tracked is limited. Likewise, vaccination rates lack granularity.
This is a site to watch as it continues to mature.
BEACON (BU/CEID)
The BEACON (Biothreats Emergence, Analysis and Communications Network) platform, developed through Boston University’s Center on Emerging Infectious Diseases (CEID), focuses on improving outbreak forecasting and situational awareness using advanced analytics and modeling.
- Data sources: Media reports and scientific publications.
- Strengths: The “Disease Events” page provides straightforward information about current cases of disease, such as the recent meningococcal cases in the UK, while also providing citations for more detail. Report maps are being added to allow visual identification of infection locations. It provides forward-looking insights into disease spread rather than simply reporting current conditions, which can be particularly valuable for anticipating surges and informing preparedness efforts.
- Limitations: Forecasting models depend heavily on assumptions and input data quality, so outputs should be interpreted as projections rather than precise predictions.
NYC Health + Hospitals BioPreparedness Map
The NYC Health + Hospitals BioPreparedness Map is a publicly accessible tool that visualizes infectious disease activity and healthcare system readiness across regions with a focus on special pathogens and other biothreats.
- Data sources: International reporting of disease incidence; hospital capacity databases.
- Strengths: This type of outbreak tracking is particularly helpful at a health system or public health level, especially for high consequence pathogens with unique characteristics — such as lack of available vaccines, high likelihood of person-to-person spread, or the need for specialized interventions, like biocontainment units.
- Limitations: Data rely on international case reporting; focus is limited to high consequence pathogens, which may be less meaningful for day-to-day clinical care.
Local public health and health system infection control
While public health departments may not have interactive dashboards or newsletters that are easily accessible on a website, keep in mind that those who work locally are likely in the best position to review and act on local reporting. For example, pediatricians wondering if they should administer RSV monoclonal antibodies past March may not find RSV activity anywhere online, but local hospitals and the health department can often report whether activity is continuing or waning. When guidance is needed, reach out to your local public health officials, as a question from one person likely means others have the same question. These local data points can shape how to counsel patients in the moment, where to focus vaccination efforts, and which additional strategies to deploy in order to decrease or prevent local spread.
Are you aware of other surveillance efforts that we didn’t include here? Please let us know, so we can check it out!
Contributed by: Lori Handy, MD, MSCE , Charlotte A. Moser, MS, Paul A. Offit, MD
In 2021, 72,299 Afghan evacuees arrived in the United States as part of “Operation Allies Welcome.” At the time, Afghanistan had low measles immunization coverage and an ongoing outbreak making importation of cases likely.
Few may remember this event, but among more than 72,000 evacuees, 47 measles cases were identified. Historically, attack rates for measles outbreaks in refugee populations living in congregate settings have ranged from 0.9% to 25.5%. In this instance, the attack rate was just 0.065%, and notably, no cases occurred in surrounding communities.
How was measles successfully contained? The answer lies at the heart of successful public health efforts:
- Rapid identification and reporting of cases to local authorities allowed escalation to federal agencies.
- In partnership with state and local health departments, CDC provided technical guidance to enhance surveillance, conduct case investigations and contact tracing, and implement a mass vaccination campaign.
- Information was quickly disseminated back to clinicians providing frontline care. Data on timing and location of initial cases were available early, enabling localized and targeted action.
A Health Alert Network (HAN) notification was issued on Sept. 20, 2021, when 16 cases had been identified. Within two months, vaccination coverage of the evacuee population reached 96%. The full response was described in the Morbidity and Mortality Weekly Report.
While the “boots on the ground” response was essential, equally critical was the bidirectional flow of data — up to centralized public health authorities and back down to clinicians caring for evacuees.
If a similar event occurred in 2026, many question whether an effective and coordinated response would be possible. The ongoing spread of measles suggests not. In the past year, shifts in leadership priorities, staffing, and data-sharing practices have altered critical aspects of a multifaceted monitoring and reporting system. As discussed in the February 2026 Vaccine Update article — “In the Journals: Where Is the Public’s Evidence Base for Health Policy?” — existing, and previously reliable, reporting systems are facing meaningful challenges. These changes have contributed to growing uncertainty about how data are generated, interpreted and communicated. At the same time, clinicians are facing practical challenges, including reporting delays, variability across state systems, and inconsistent access to relevant surveillance data. For example, the most recent measles HAN was issued over a year ago (March 7, 2025), despite ongoing outbreaks across the country, and recently, severe and deadly cases of Haemophilus influenzae type b (Hib) in Florida only came to light during a workshop to discuss removal of vaccine mandates in that state.
Closing the reporting gaps
As scientists, clinicians and public health experts have grappled with the current reality of trying to stem the spread of infectious diseases and care for patients in the absence of reliable surveillance data, new tools have started to emerge. None are as comprehensive or singularly functional as the previous federally based systems, but they each bring important information to the forefront, and together, they can help bridge some of the current gaps.
Epic Cosmos
Epic Cosmos is one of the more powerful emerging tools for near real-time clinical insight, built within the Epic electronic health record.
- Data sources: De-identified electronic health record data across participating Epic health systems.
- Strengths: Scale, as nearly 40% of U.S. inpatient hospitals use Epic, as well as timeliness. Users can assess trends in diagnoses, testing and vaccination patterns with a level of granularity that approximates real-world clinical activity. For vaccine providers, this can serve as an early signal of shifting disease patterns before traditional surveillance systems update.
- Limitations: Not population based; it reflects only participating systems and may overrepresent certain regions or care settings. Access is restricted, and individual institutions may limit how users access the data output. Outputs require careful interpretation due to variability in coding practices and healthcare-seeking behavior.
Can it provide a general sense of trends? Yes. Can it independently track outbreaks? Not yet.
The Pandemic Center at Brown University
The Pandemic Center provides updates through a weekly email, called the “Pandemic Center Tracking Report.” The content focuses on selected domestic and international disease outbreaks, synthesizing data from multiple jurisdictions into clinician-friendly summaries.
- Data sources: Local and state health departments; national and international data reports.
- Strengths: Accessibility as users can quickly visually review trends or rely on concise written summaries that interpret the data. The weekly cadence provides updates during periods of rapid change when official reporting may lag. The delivery of information through the weekly newsletter makes this highly accessible.
- Limitations: Methods can vary by disease, and underlying data sources are often heterogeneous, requiring users to interpret findings with caution.
In contrast to a tool like Cosmos, where clinicians have to interpret the data themselves, this weekly digest offers an efficient, summarized way to stay on top of outbreaks without the need to manipulate datasets.
Find out more or sign up for the report.
Force of Infection and FOI Clinical
Led by epidemiologist Caitlin Rivers at Johns Hopkins, Force of Infection is a newsletter that provides regular updates, analysis and commentary on infectious diseases and public health trends. Newsletter content changes throughout the year. October through April includes a “weather report” summarizing respiratory and gastrointestinal illness activity in the U.S., along with food safety updates. Summer months include broader discussions of epidemiologic and public health topics.
- Data sources: Centers for Disease Control and Prevention; supplementary data from state health department websites.
- Strengths: Summaries can help contextualize broader trends, such as rising RSV activity, and inform anticipatory guidance. The delivery of information through the newsletter makes this highly accessible.
- Limitations: Only select infections are tracked. Summaries are subject to limitations in CDC reporting; however, the authors try to address this with ancillary data from state health department websites.
To address limitations for clinicians in using the Force of Infection reports, FOI Clinical has been developed. The goal of this program is to provide “updates on current outbreaks, with epidemiological context and a takeaway for your practice.” This service is available for a fee based on whether the subscription is individual, group or institutional.
Find out more or sign up for the newsletter.
PopHive
PopHive, developed at the Yale School of Public Health, is an emerging data aggregation platform designed to provide real-time insights into population health trends.
- Data sources: Multiple sources, including CDC systems, Google Trends API, Epic Cosmos, Medicare data, and more.
- Strengths: Integrates multiple data streams, including clinical data, public health reporting, and digital surveillance signals to allow users to detect early signals of disease activity across regions. For clinicians, PopHive has the potential to bridge the gap between traditional surveillance and real-time situational awareness.
- Limitations: The platform is new, and the number of diseases tracked is limited. Likewise, vaccination rates lack granularity.
This is a site to watch as it continues to mature.
BEACON (BU/CEID)
The BEACON (Biothreats Emergence, Analysis and Communications Network) platform, developed through Boston University’s Center on Emerging Infectious Diseases (CEID), focuses on improving outbreak forecasting and situational awareness using advanced analytics and modeling.
- Data sources: Media reports and scientific publications.
- Strengths: The “Disease Events” page provides straightforward information about current cases of disease, such as the recent meningococcal cases in the UK, while also providing citations for more detail. Report maps are being added to allow visual identification of infection locations. It provides forward-looking insights into disease spread rather than simply reporting current conditions, which can be particularly valuable for anticipating surges and informing preparedness efforts.
- Limitations: Forecasting models depend heavily on assumptions and input data quality, so outputs should be interpreted as projections rather than precise predictions.
NYC Health + Hospitals BioPreparedness Map
The NYC Health + Hospitals BioPreparedness Map is a publicly accessible tool that visualizes infectious disease activity and healthcare system readiness across regions with a focus on special pathogens and other biothreats.
- Data sources: International reporting of disease incidence; hospital capacity databases.
- Strengths: This type of outbreak tracking is particularly helpful at a health system or public health level, especially for high consequence pathogens with unique characteristics — such as lack of available vaccines, high likelihood of person-to-person spread, or the need for specialized interventions, like biocontainment units.
- Limitations: Data rely on international case reporting; focus is limited to high consequence pathogens, which may be less meaningful for day-to-day clinical care.
Local public health and health system infection control
While public health departments may not have interactive dashboards or newsletters that are easily accessible on a website, keep in mind that those who work locally are likely in the best position to review and act on local reporting. For example, pediatricians wondering if they should administer RSV monoclonal antibodies past March may not find RSV activity anywhere online, but local hospitals and the health department can often report whether activity is continuing or waning. When guidance is needed, reach out to your local public health officials, as a question from one person likely means others have the same question. These local data points can shape how to counsel patients in the moment, where to focus vaccination efforts, and which additional strategies to deploy in order to decrease or prevent local spread.
Are you aware of other surveillance efforts that we didn’t include here? Please let us know, so we can check it out!
Contributed by: Lori Handy, MD, MSCE , Charlotte A. Moser, MS, Paul A. Offit, MD