Hamilton Janet

On 12 January 2010 at 1652 hours local time, an earthquake measuring 7.0 on the Richter scale struck near the Haitian capital of Port-au-Prince and created enormous devastation. Florida, as the state closest to Haiti, became an initial focal point for assisting the federal repatriation and humanitarian parolee efforts. Florida supported shipments of personnel and relief supplies into Haiti, and served as the point of entry for repatriated U.S. citizens and those evacuated from Haiti for medical care. As of 9 February 2010, there were 22,500 arrivals in Florida from Haiti related to repatriation and medical humanitarian missions. These patients primarily arrived in Miami, Tampa and Orlando areas. Approximately 650 people arrived in Florida during this period as medical evacuees, and were transported to and often directly admitted to hospitals for treatment of severe or complicated injuries. Some of these patients also generated emergency department (ED) visits on arrival.

Objective

To describe the public health surveillance efforts designed to measure syndromic and disease-specific conditions in patients who were in Haiti during or after the earthquake, and evacuated to Florida.

Federal laws and national directives have focused attention on the development of more robust biosurveillance systems intended to detect events of public health interest in a timelier manner. Presidential Decision Directive 21 calls for integrated biosurveillance data, enhanced clinician awareness, and an epidemiologic surveillance system with sufficient flexibility to tailor analyses to new syndromes and emerging diseases. In 2007, a statewide syndromic surveillance system (ESSENCE) was implemented and hospitals were recruited to participate. Experience with ESSENCE in the context of the ED data analysis, visualization, and reporting prompted the exploration of integrating new data sources into ESSENCE and new analyses specific to these new data. The purpose of the ESSENCE system is now to provide an intuitive environment for state and local epidemiologists to conduct routine descriptive epidemiologic analysis, to monitor morbidity and mortality trends over time and space and across multiple data sources, thereby providing information that can assist with making decisions on how to improve population health.

Objective

Use of the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) in Florida has evolved from early event detection based on emergency department (ED) chief complaints to routine descriptive epidemiologic analysis, data visualization, and reporting across four different data sources, using and building on tools originally developed for syndromic surveillance.

Reportable disease case data are entered into Merlin by all 67 county health departments in Florida and assigned confirmed, probable, or suspect case status. De-identified reportable disease data from Merlin are sent to ESSENCE-FL once an hour for further analysis and visualization using tools in the surveillance system. These data are available for ad hoc queries, allowing users to monitor disease trends, observe unusual changes in disease activity, and to provide timely situational awareness of emerging events. Based on system algorithms, reportable disease case weekly tallies are assigned an awareness status of increasing intensity from normal to an alert category. These statuses are constantly scrutinized by county and state level epidemiologists to guide disease control efforts in a timely manner, but may not signify definitive actionable information.

Objective

In light of recent outbreaks of pertussis, the ability of Florida Department of Health’s (FDOH) Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL) to detect emergent disease outbreaks was examined. Through a partnership with the Johns Hopkins University Applied Physics Laboratory (JHU/APL), FDOH developed a syndromic surveillance system, ESSENCE-FL, with the capacity to monitor reportable disease case data from Merlin, the FDOH Bureau of Epidemiology’s secure webbased reporting and epidemiologic analysis system for reportable diseases. The purpose of this evaluation is to determine the utility and application of ESSENCE-FL system generated disease warnings and alerts originally designed for use with emergency department chief complaint data to reportable disease data to assist in timely detection of outbreaks in promotion of appropriate response and control measures.

Florida has implemented various surveillance methods to augment existing sources of surveillance data and enhance decision making with timely evidence based assessments to guide response efforts post-hurricanes. Historically, data collected from deployed federal assets have been an integral part of this effort. However, a number of factors have made this type of surveillance challenging: logistical is- sues of field work in a post-disaster environment, the resource inten- sive manual data collection process from DMAT sites, and delayed analysis and interpretation of these data to inform decision makers. The ESSENCE-FL system is an automated and secure web-based ap- plication accessed by FDOH epidemiologists and staff at participat- ing hospitals.

Objective

The Florida Department of Health (FDOH), Bureau of Epidemi- ology, partnered with the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) to improve surveillance methods in post dis- aster or response events. A new process was implemented for con- ducting surveillance to monitor injury and illness for those presenting for care to ASPR assets such as Disaster Medical Assistance Team (DMAT) sites when they are operational in the state. The purpose of the current work was to field test and document the operational ex- perience of the newly implemented ASPR data module in ESSENCE- FL (syndromic surveillance system) to receive near real-time automated data feeds when ASPR federal assets were deployed in Florida during the 2012 Republican National Convention (RNC).

ASPR deploys clinical assets, including an EMR system, to the ground per state requests during planned and no-notice events. The analysis of patient data collected by deployed federal personnel is an integral part of ASPR and FDOH’s surveillance efforts. However, this surveillance can be hampered by the logistical issues of field work in a post-disaster environment leading to delayed analysis and interpretation of these data to inform decision makers at the federal, state, and local levels. FDOH operates ESSENCE-FL, a multi-tiered, automated, and secure web-based application for analysis and visualization of clinical data. The system is accessible statewide by FDOH staff as well as by hospitals that participate in the system. To improve surveillance ASPR and FDOH engaged in a pilot project whereby EMR data from ASPR would be sent to FDOH in near realtime during the 2012 hurricane season and the 2012 RNC. This project is in direct support of Healthcare Preparedness Capability 6, Information Sharing, and Public Health Preparedness Capability 13, Public Health Surveillance and Epidemiological Investigation.

Objective:

U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) partnered with the Florida Department of Health (FDOH), Bureau of Epidemiology, to implement a new process for the unidirectional exchange of electronic medical record (EMR) data when ASPR clinical assets are operational in the state following a disaster or other response event. The purpose of the current work was to automate the exchange of data from the ASPR electronic medical record system EMR-S into the FDOH Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL) system during the 2012 Republican National Convention (RNC).

 

A seroprevalence survey carried out in four counties in the Tampa Bay area of Florida (Hillsborough, Pinellas, Manatee and Pasco) provided an estimate of cumulative incidence of infection due to the 2009 influenza A (H1N1) as of the end of that year’s pandemic. During the pandemic, high-level decison-makers wanted timely, credible forecasts as to the likely near-term course of the pandemic. The cumulative percentage of people who will be infected by the end of the epidemic can be estimated from the intrinsic reproductive number of the viral strain, its R0 , which can be measured early in the epidemic. If the current cumulative number of infections can be estimated, then one can determine what fraction of the eventual total number of infected people have already been infected.

Objective

To estimate the number of infections due to the novel 2009 influenza A/H1N1 virus corresponding to each ED visit for ILI in a four-county area of Florida. Knowing such ratios, one could (in future similar situations) estimate the cumulative number of infections due to a novel influenza virus in a population.