Atrubin David

The Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE-FL) receives daily (or bi-hourly) data from 184 emergency departments (ED) from around Florida. Additionally, 30 urgent care centers submit daily data to the system. These 214 facilities are grouped together in an acute care data source category. Five to six days after the start of each school year in Florida, ESSENCE-FL shows increased respiratory illness visits in the school aged population. Previous analyses of these data have shown that this increase is a result of increased transmission of the common cold among school children. In early September 2014, during this sustained yearly increase in respiratory visits, reports of more severe infection caused by Enterovirus D68 (EV-D68) in children in other parts of the country began circulating. Public health officials in Florida, as well as the media, questioned whether children in the state were being infected by this virus capable of causing more severe illness, especially among asthmatics. As is the case with many incipient outbreaks, syndromic surveillance played an integral role in early efforts to detect the presence of this illness. The task of providing situational awareness during this period was complicated by this outbreak coinciding with the start of the school year.

Objective

To provide situational awareness using Florida’s syndromic surveillance system during a 2014 outbreak of EV-D68 in other regions of the country.

National studies estimate that respiratory syncytial virus (RSV) is responsible for one in 38 emergency department (ED) visits for children < 5 years old. The Council for State and Territorial Epidemiologists position statement (13-ID-07): “RSV-Associated Pediatric Mortality” advocates for improved RSV surveillance including monitoring of RSV-associated pediatric mortality and hospitalizations. The goal of that data collection is to establish prevaccine baselines to evaluate vaccine effectiveness should one become available. As RSV is not reportable in Florida, RSV surveillance relies on a small subset of all Florida hospital laboratories to report data in aggregate and calculation of percent positive of all tests for RSV performed. These data assess virus activity, and do not allow for assessment of morbidity or age-specific analysis. Moreover, this data is not complete or timely, most often becoming available a minimum of a week after the testing was conducted. Florida’s RSV surveillance efforts guide clinical decision making and insurance reimbursements. Florida’s RSV seasonality not only differs from the nation but there is strong variation among five distinct regions, as exemplified by southeast Florida where the RSV season is year round. In Florida, pre-approval of prophylactic treatment by insurance companies is tied to seasonality.

Objective

In Florida, pre-approval of prophylactic treatment by insurance companies is tied to seasonality. Previous analyses determined that Florida’s syndromic surveillance system (Electronic Surveillance System for the Early Notification of Community-based Epidemics [ESSENCE-FL]) was capable of monitoring Florida’s statewide RSV seasonality. This analysis aims to determine if ESSENCE-FL can also be used to describe RSV and RSV-associated hospitalizations in children < 5 years by region and season.

Along with commensurate funding, an increased emphasis on syndromic surveillance systems occurred post September 11, 2001 and the subsequent anthrax attacks. Since then, many syndromic surveillance systems have evolved and have ever-increasing functionality and visualization tools. As outbreak detection using these systems has demonstrated an equivocal track record, epidemiologists have sought out other interesting and unique uses for these systems. Over the numerous years of the International Society for Disease Surveillance (ISDS) conference, many of these studies have been presented, however, there has been a dearth of discussion related to how these systems should be used on a routine basis. As the initial goal of these systems was to provide a near real-time disease surveillance tool, the question of how to most effectively conduct this type of routine surveillance is paramount.

Objective

To discuss how various emergency department based syndromic surveillance systems from across the country and world are being used and to develop best practices for moving forward.

 

The Florida Department of Health electronically receives hospital emergency department (ED) data from 180 EDs located in 54 of its 67 counties through its Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL). Florida EDs have begun to offer self-registration options to patients, which include ED self check-in kiosks, and pre-visit registration smartphone applications and websites. ESSENCE-FL receives ED data from multiple hospitals that use these patient self-registration methods. To date, limited investigation has been carried out to determine the impact of these self-registration methods on the data submitted to ESSENCE-FL. This project investigates and describes how SS data are affected by these options and provides possible best practices for identifying and analyzing these data.

Objective

To assess the effect of patient self-registration methods in hospital emergency departments on data in a syndromic surveillance (SS) system and provide suggestions for analysis of these data.

HealthMap collects and aggregates information from online sources to generate outbreak alerts based on disease and geographic location. This project will assess the timeliness and sensitivity of HealthMap based on outbreak posts from EpiCom, the Florida Department of Health’s disease outbreak and health incident alert network.

Objective

To assess the outbreak detection utility of HealthMap, a publically available event-based biosurveillance system utilizing various internet-based media resources to identify outbreaks, at the state and local level. Results may help determine whether HealthMap should be monitored more closely as a supplementary surveillance tool.

Syndromic surveillance has historically been used to track infectious disease, but in recent years, many jurisdictions have utilized the systems to conduct all hazards surveillance and provide situational awareness with respect to previously identified issues. Flakka is a synthetic drug (class: cathinones) that recently has been featured in the media. Flakka is a stimulant that causes delusions, aggression, erratic behavior, a racing heart and sometimes death. Two specific counties (one in Florida and one in Kentucky) have been at the center of this emerging epidemic. In August 2015, Florida Department of Health (FDOH) partner agencies requested flakka-related health data in an effort to better understand the epidemiology and context of this problem. ESSENCE-FL is a large syndromic surveillance system, with four main data sources, that captures 87% of all emergency department (ED) visits statewide.

Objective

To characterize flakka usage in Florida using multiple data sources within the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE-FL)

Near real-time emergency department chief complaint data is accessed through Florida’s syndromic surveillance system: Electronic Surveillance System for the Early Notification of Communitybased Epidemics-Florida (ESSENCE-FL). The Florida Department of Health relies heavily upon these data for timely surveillance of influenza and influenza-like illness (ILI). Hospital discharge data available from the Florida Agency for Health Care Administration (AHCA) captures information about influenza-associated ED visits and is considered complete. The delay in receiving the data (up to a year) hinders timely evidence-based decision making during the influenza season. Previous analyses (comparing the complete AHCA hospital discharge data to the ESSENCE-FL ILI syndrome and Influenza sub-syndrome) have shown ESSENCE-FL is a timely, effective tool to monitor influenza activity in the state and that the Influenza sub-syndrome most closely approximates influenza season activity in Florida. Adults > 65, pregnant women and children < 5 are at increased risk for morbidity and mortality from influenza infection. This investigation aims to determine if syndromic surveillance can be used to characterize in near real-time influenza infection in adults > 65, pregnant women, and children < 5 by comparing ED visits for influenza and ILI in ESSENCE-FL to historical AHCA records of people who incurred ED charges at a Florida hospital with diagnosed influenza.

Objective

To determine if emergency department (ED) based syndromic surveillance can be utilized to characterize in near real-time influenza infection in three high-risk populations: a) adults > 65, b) pregnant women, and c) children < 5.

Syndromic surveillance ED data has historically shown the highest number of visits on Mondays, with decreasing volumes throughout the week. Previous studies have shown that increased negative health outcomes have occurred on Mondays. A study in the European Journal of Epidemiology provided evidence that suggests a higher incidence of cardiovascular events on Mondays compared to other days of the week.

Objective

To investigate the day of week effect on myocardial infarctions (MI) in the age group of 18 – 64 years using ESSENCE-FL emergency department (ED) data.