Acute Hepatitis A Infections among Veterans in Outbreak States, 2016-2018

Although cases of acute HAV have declined in recent years, elevated numbers of HAV infections began to be reported by California and Michigan in the fall of 2016.1,2 Since this time, associated outbreaks have been reported in 9 additional states (Arizona, Utah, Kentucky, Missouri, Tennessee, Indiana, Ohio, Arkansas, and West Virginia).3 No common source of food, beverages or drugs have been identified and transmission appears to be primarily person-to-person with high-risk individuals including people experiencing homelessness, those who use illicit drugs and their close direct contacts.

June 18, 2019

Acute Hepatitis A Infection and Vaccination in the Veterans Health Administration

Since hepatitis A vaccination became widely recommended in the US in the mid-1990's, rates of acute hepatitis A virus (HAV) infection have steadily declined, however, since 2011, incidence of new cases of HAV appears to be increasing1, often linked with foodborne outbreaks and socio-economic trends such as homelessness and substance abuse.2 In 2016, the CDC reported vaccination coverage among adults aged > 19 was 9.5%, 19-49 was 13.4%, and > 50 was 5.4%3.

June 18, 2019

Firearm Injury Encounters in the Veterans Health Administration (VHA), 2010-2015

Firearm violence is an issue of public health concern leading to more than 30,000 deaths and 80,000 nonfatal injuries in the United States annually. To date, firearm-related studies among Veterans have focused primarily on suicide and attempted suicide. Herein, we examine firearm violence among VHA enrollees for all manners/ intents, including assault, unintentional, self-inflicted, undetermined and other firearm-related injury encounters in both the inpatient and outpatient settings. 

June 19, 2017

Carbon Monoxide Poisoning in the Veterans Health Administration, 2010 - 2016

It is estimated that in the United States (US), unintentional non-fire related CO poisoning causes an average of 439 deaths annually, and in 2007 confirmed CO poisoning cases resulted in 21,304 ED visits and 2,302 hospitalizations (71 per million and 8 per million population, respectively)1 . Despite the significant risk of morbidity and mortality associated with CO poisoning, existing surveillance systems in the United States are limited. This study is the first to focus specifically on CO poisoning trends within the VHA population.


August 15, 2017

Dengue, Chikungunya & Zika Virus in VA Caribbean HCS, Nov. 2015-Aug. 2016

DENV, CHIKV and ZIKV are all transmitted by mosquitoes and have occurred in outbreaks in the Caribbean. Common symptoms (which can be severe and disabling) are similar among the 3 viruses and include fever, joint pain/swelling, headache, muscle pain and rash. In December 2015, the first endemic case of ZIKV infection was reported by VACHS. Since that time, an increasing number of ZIKV infections have been reported in Puerto Rico. Due to the growing ZIKV outbreak, we performed ongoing testing and surveillance.


September 07, 2017

Analysis of Alternatives for Combined and/or Collaborative Syndromic Surveillance Within DoD and VA

The Joint Incentive Fund (JIF) Authorization creates innovative DoD/VA sharing initiatives. In 2009, DoD and VA commenced a biosurveillance JIF project whose principle objectives include improved situational awareness of combined VA/ DoD populations 1 and determining the optimal business model allowing both agency biosurveillance programs to operate more efficiently by: 1) consolidating information technology assets; 2) targeting enhanced collaboration for improved public health outcomes; and 3) improving buying power, and return on investment.

August 23, 2017

Enhancing Biosurveillance Specificity Using PraedicoTM, A Next Generation Application

Many methods to detect outbreaks currently exist, although most are ineffective in the face of real data, resulting in high false positivity. More complicated methods have better precision, but can be difficult to interpret and justify. Praedico™ is a next generation biosurveillance application built on top of a Hadoop High Performance Cluster that incorporates multiple syndromic surveillance methods of alerting, and a machine-learning (ML) model using a decision tree classifier  evaluating over 100 different signals simultaneously, within a user friendly interface.

August 29, 2017

Improving the Value Proposition of Surveillance Tools: Innovative Uses for VA ESSENCE

VA began using ESSENCE as a public health surveillance tool in 2005. The system offered alerting capability for pre-defined syndromes and querying capability for outpatient ICD-9 diagnosis codes. Herein, we highlight examples of how we have invested in upgrades to analytic capabilities and expanded data sources available to ESSENCE in order to augment the overall utility of this system within VA.


October 10, 2017

Evaluation of Praedico™, A Next Generation Big Data Biosurveillance Application

The National Strategy for Biosurveillance promotes a national effort to improve early detection and enable ongoing situational awareness of all-hazards threats. Implicit in the Strategy’s implementation plan is the need to upgrade capabilities and integrate multiple disparate data sources, including more complete electronic health record (EHR) data into future biosurveillance capabilities. Thus, new biosurveillance applications are clearly needed.

November 01, 2017

Pertussis Surveillance in Veterans Affairs Medical Centers in Western United States – 2010-2014

Bordetella pertussis infection (whooping cough) has been on the rise and the most cases in the US since 1955 were reported in 2012 (48,277 or 15.4 per 100,000). Pertussis is highly infectious and can cause serious illness in infants and children as well as adults, and in general is preventable by vaccination. Since 2005, it has been recommended that anyone 19-64 years old should have a onetime booster of the pertussis vaccine (Tdap). In 2010, that recommendation was broadened stating people 65 years old and older should also obtain a booster of Tdap.

November 24, 2017


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