Hamilton Janet

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.

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.

The Florida Department of Health (DOH) utilizes the Electronic Surveillance System for the Early Notification of Community Based Epidemics (ESSENCE-FL) as its statewide syndromic surveillance system. ESSENCE-FL comprises of chief complaint data from 231 of 240 EDs, representing 96 percent of the total number of EDs in Florida. Historically, syndromic surveillance has categorized patient chief complaint data into syndromes for the purpose of disease surveillance or outbreak detection. Triage notes are much longer freetext, pre-diagnostic data that capture the presenting symptoms and complaints of a patient.

Objective

This study assesses the utilization of triage notes from emergency departments (EDs) and urgent care centers (UCCs) for active case finding in ESSENCE-FL during the Zika response.

In October 2015, the Centers for Disease Control and Prevention (CDC) released health advisory #384 to inform people about increases in fentanyl fatalities. Florida’s statewide syndromic surveillance system, Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL), captures electronic death record data in near real time which allows for the monitoring of mortality trends across the state. One limitation of using death record data for fentanyl surveillance is the lack of a fentanyl-specific overdose ICD-10 code; however, the literal cause of death fields (“literals”) provide a level of detail that is rich enough to capture mentions of fentanyl use. The “literals” are a free text field on the death certificate, recorded by a physician at the time of death and detail the factors that led to the death. ESSENCE-FL has the benefit of not only receiving death record data in near real-time, but also receiving the literal cause of death fields. This work analyzes trends in fentanyl-associated mortality in Florida over time by using the literal cause of death fields within death records data obtained from ESSENCE-FL.

Objective

To characterize fentanyl-associated mortality in Florida using free text queries of the literal causes of death listed on death certificates.

Human MERS-CoV was first reported in September 2012. Globally, all reported cases have been linked through travel to or residence in the Arabian Peninsula with the exception of cases associated with an outbreak involving multiple health care facilities in the Republic of Korea ending in July 2015. While the majority of MERS-CoV cases have been reported in the Arabian Peninsula, several cases have been reported outside of the region. Most cases are believed to have been acquired in the Middle East and then exported elsewhere, with no or rare instances of secondary transmission. Two cases of MERS-CoV were exported to the United States and identified in May 2014. One of these cases traveled from Saudi Arabia to Florida.

DOH conducts regular surveillance for MERS-CoV through the investigation of persons with known risk factors. PUIs have most often been identified by physicians reporting directly to local health departments and by DOH staff regularly querying ED and UCC chief complaint data in ESSENCE-FL. ESSENCE-FL currently captures data from 265 EDs and UCCs statewide and has been useful in identifying cases associated with reportable disease and emerging pathogens. 

Objective

To retrospectively identify initial emergency department (ED) and urgent care center (UCC) visits for Florida’s Middle East respiratory syndrome coronavirus disease (MERS-CoV) patients under investigation (PUIs) in the Florida Department of Health’s (DOH) syndromic surveillance system, the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL), using information gathered from PUI case report forms and corresponding medical records for the purpose of improving syndromic surveillance for MERS-CoV. The results of this study may be further utilized in an effort to evaluate the current MERS-CoV surveillance query.