Deyneka Lana

North Carolina hosted the 2018 FEI WEG in Polk County at the Tryon Equestrian Center in September 2018. Polk County, located in the Mountain region of Western North Carolina, is home to 20,357 people, and the population is widely distributed. Event organizers expected approximately 300,000 to 500,000 people to visit the area, with 800 horses from 71 countries taking part in the games. Providing adequate public health epidemiologic investigations and response for the large scale event in the predominantly rural area presented a challenge. The NC Surveillance & Response Team was created to facilitate enhanced surveillance for significant public health events during the WEG, assist local public health agencies with epidemiologic investigations and response, develop public health risk assessments, and implement control measures. Surveillance data were collected from the North Carolina Electronic Disease Surveillance System (NC EDSS), North Carolina’s and CDC’s National syndromic surveillance systems (NC DETECT and NSSP ESSENCE), Public Health Epidemiologists from Atrium Health and Mission Hospital, and reports from the on-site medical facility (MED-1) at the Tryon Equestrian Center. The data were reviewed and summarized in internal and external situation reports.

Objective: To describe surveillance activities and use of existing state (NC DETECT) and national (NSSP) syndromic surveillance systems during the International Federation for Equestrian Sports (FEI) World Equestrian Games (WEG), in Mill Spring, NC from September 11 to September 23, 2018

Time-of-arrival (TOA) surveillance methodology consists of identifying clusters of patients arriving to a hospital emergency department (ED) with similar complaints within a short temporal interval. TOA monitoring of ED visit data is currently conducted by the Florida Department of Health at the county level for multiple subsyndromes [1]. In 2011, North Carolina's NC DETECT system and CDC's Biosense Program collaborated to enhance and adapt this capability for 10 hospital-based Public Health Epidemiologists (PHEs), an ED-based monitoring group established in 2003, for North Carolina's largest hospital systems. At the present time, PHE hospital systems include coverage for approximately 44% of the statewide general/acute care hospital beds and 32% of all emergency department visits statewide. We present findings from TOA monitoring in one hospital system.

Objective

To describe collaborations between North Carolina Division of Public Health and the Centers for Disease Control and Prevention (CDC) implementing time-of-arrival (TOA) surveillance to monitor for exposure-related visits to emergency departments (ED) in small groups of North Carolina hospitals.

The North Carolina Division of Public Health (NC DPH) has been collecting emergency department data in collaboration with the Carolina Center for Health Informatics in the UNC Department of Emergency Medicine since 1999. As of August 2011, there are 113 of 115 emergency departments sending data electronically at least once daily to NC DETECT. Data elements include disposition, initial vital signs, up to 11 ICD-9-CM final diagnosis codes, up to five external cause of injury codes (E-codes),as well as the arrival date and time, patient sex and age, patient zip and county, and chief complaint. As of January 2008, NC DETECT emergency department data covered 99% of the NC population and captures approximately 4.5 million ED visits each year. As a result, requests for data from researchers continue to increase. Use of the data for public health purposes is covered by the mandate requiring hospitals to submit their emergency department data to NC DPH.

Objective

To describe the process by which researchers request access to data sets of emergency department data from NC DETECT,the history of this process,and the resulting best practices and lessons learned.

NC DETECT provides near-real-time statewide surveillance capacity to local, regional and state level users across NC with twice daily data feeds from 117 (99%) emergency departments (EDs), hourly updates from the statewide poison center, and daily feeds from statewide EMS runs and select urgent care centers. The NC DETECT Web Application provides access to aggregate and line listing analyses customized to users' respective jurisdictions. The most active users are state-level epidemiologists (DPH) and hospital-based public health epidemiologists (PHEs). The use of NC DETECT is included in PHE job descriptions and NC DETECT functionality has been developed specifically to meet the surveillance needs of this group, including data entry of aggregated lab results for flu and respiratory panels. Interviews of local health department (LHD) users completed as part of an evaluation project have suggested that functionality specifically tailored to LHDs may increase their use of the NC DETECT Web application [1]. As of June 2011, there were 139 LHD users with active accounts to use the Web application (out of 384 total users with active accounts).

Objective

To describe the development, implementation and preliminary evaluation of new dashboard interfaces in NC DETECT, designed primarily for infrequent users of NC DETECT at local health departments.

Animal bites may have potentially devastating consequences, including physical and emotional trauma, infection, rabies exposure, hospitalization, and, rarely, death. NC law requires animal bites be reported to local health directors. However, methods for recording and storing bite data vary among municipalities. NC does not have a statewide system for reporting and surveillance of animal bites. Additionally, many animal bites are likely not reported to the appropriate agencies. NC DETECT provides near-real-time statewide surveillance capacity to local, regional, and state level users with twice daily data feeds from NC EDs. Between 2008 and 2010, 110 to 113 EDs were submitting visit data to NC DETECT. Several animal bite-related on-line reports are available and provide aggregate and visit-level analyses customized to users' respective jurisdictions. The NC DETECT ED visit database currently provides the most comprehensive and cost-effective source of animal bite data in NC.

Objective

We describe the use of emergency department (ED) visit data collected through the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) for surveillance of animal bites in North Carolina (NC). Animal bite surveillance using ED visit data provides useful and timely information for public health practitioners involved in bite surveillance and prevention in NC.

NC DETECT is the Web-based early event detection and timely public health surveillance system in the North Carolina Public Health Information Network. The reporting system also provides broader public health surveillance reports for emergency department visits related to hurricanes, injuries, asthma,  vaccine-preventable diseases, environmental health and others. NC DETECT receives data on at least a daily basis from four data sources: emergency departments, the statewide poison center, the statewide EMS data collection system, a regional wildlife center and laboratory data from the NC State College of Veterinary Medicine. Data from select urgent care centers are in pilot testing.

Objective

Managers of the NC DETECT surveillance system wanted to augment standard tabular Web-based access with a Web-based spatial-temporal interface to allow users to see spatial and temporal characteristics of the surveillance data. Users need to see spatial and temporal patterns in the data to help make decisions about events that require further investigation. The innovative solution using Adobe Flash and Web services to integrate the mapping component with the backend database will be described in this paper.

North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) is the Web-based early event detection and timely public health surveillance system in the North Carolina Public Health Information Network. At the present time NC DETECT monitors five data sources: emergency departments, the statewide poison center, the statewide EMS data collection system, a regional wildlife center and laboratories from the NC State College of Veterinary Medicine for suspicious patterns. NC DETECT receives Carolinas Poison Control Center (CPC) data every 24 hours as of August, 2005. CPC provides the poison hotline for the entire state and handles over 105,000 calls a year 24/7/365. Seventy-five percent of calls are from the general public, with the remainder originating from healthcare providers, pharmacists, law enforcement, etc. CPC is staffed by registered nurses and pharmacists specially trained to provide diagnostic and treatment advice for acute and chronic poisonings to the public and healthcare professionals, backed up by board-certified medical toxicologists.

Objective

This paper describes the use of CPC data for early detection of chemical and environmental events and the follow up protocol development process.

The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) provides early event detection and public health situational awareness to hospital-based and public health users statewide. Authorized users are currently able to view data from emergency departments (n=110), the statewide poison control center, the statewide EMS data system, a regional wildlife center and pilot data from a college veterinary laboratory as well as select urgent care centers. While NC DETECT has over 200 registered users, there are public health officials, hospital clinicians and administrators who do not access the system on a regular basis, but still like to be kept abreast of syndromic trends in their jurisdictions. In order to accommodate this interest and reduce redundant data entry among active users, we developed a summary report that can be easily exported and distributed outside of NC DETECT.

Objective

This paper describes a user driven weekly syndromic report designed and developed to improve the efficiency of sharing syndromic information statewide.

While early event detection systems aim to detect disease outbreaks before traditional means, following up on the many alerts generated by these systems can be time-consuming and a drain on limited resources.

Authorized users at local, regional and state levels in North Carolina rely on the North Carolina Disease Event Tracking and Epidemiologic Collection Tool's (NC DETECT) Java-based Web application to monitor and follow-up on signals based on the CDC’s EARS CUSUM algorithms. The application provides users with access to aggregate syndrome-based reports as well as to patient-specific line listing reports for three data sources: emergency departments, ambulance runs and the statewide poison control center. All NC DETECT Web functionality is developed in a user-centered, iterative process with user feedback guiding enhancements and new development. This feedback, along with the need for improved situational awareness and the desire to improve communication among users drove the development of the Annotation Reports and the Custom Event Report.

Objective

We describe the addition of two reports to NC DETECT designed to improve NC public health situational awareness capability.