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Law Royal

Description

Introduction: response to this, the Centers for Disease Control and Prevention (CDC), CSTE, and the American Association of Poison Control Centers (AAPCC) members created the Poison Center Public Health Community of Practice (CoP). The CoP acts as a platform, to facilitate sharing experiences, identify best practices, and develop relationships among federal agencies, state and local health departments (HD), and PCs. Since its inception, the CoP garnered over 250 members, hosted more than 25 webinars regarding PC-HD collaborations, and produced five newsletters highlighting subjects pertinent to PC and HD personnel. To date, the CoP's primary focus has been to strengthen PC-HD partnerships; however, recent events highlight opportunities to expand the public health impact of the CoP. In this roundtable, we will discuss how the CoP was leveraged by federal and state health agencies to build new multidisciplinary and inter-agency relationships and how these experiences have led to the proposed guidance.

Objective: - To discuss the development of a set of tools for interagency collaborations on health surveillance - To determine the core contents of the tools based on known gaps in health surveillance - To determine collaborators in development and timelines for completion

Submitted by elamb on
Description

NPDS is a national database of detailed information collected from each call, uploaded in near real-time, from the 57 participating regional poison centers (PCs) located across the US. NPDS is owned and operated by the American Association of Poison Control Centers (AAPCC). Since 2001, scientists from the Centers for Disease Control and Prevention collaborated with AAPCC to use NPDS for surveillance of chemical, poison and radiological exposures. In March of 2011, a 9.0 magnitude earthquake and tsunami damaged the reactors at the Fukushima Daiichi nuclear power plant in Japan, causing a radiological incident classified as a "major accident" according to the International Nuclear Event Scale. The incident resulted in the release of radioactive iodine (I-131) into the global environment, which was detected in precipitation in parts of the United States. While no adverse health effects were expected, concerned citizens contacted public health officials at the local, state and federal levels. Many started to acquire and use potassium iodide (KI) and other iodide-containing products intended for thyroid protection from I-131, even though this was not a public health recommendation by state and federal public health agencies. Shortly after international media coverage began, regional PCs began receiving calls regarding the Japan radiological incident. State and federal health officials were interested in identifying health communication needs and targeting risk communication messages to address radiation concerns and KI usage recommendations as part of the public health response. This was done in part through NPDS-based surveillance.

Objective

To describe how the National Poison Data System (NPDS) was used for surveillance of individuals with potential incident-related exposures in the United States resulting from the Japan earthquake radiological incident of 2011. Our secondary objective is to briefly describe the process used to confirm exposures identified through NPDS-based surveillance.

Submitted by elamb on
Description

For radiological incidents, collecting surveillance data can identify radiation-related public health significant incidents quickly and enable public health officials to describe the characteristics of the affected population and the magnitude of the health impact which in turn can inform public health decision-making. A survey administered by the Council of State and Territorial Epidemiologists (CSTE) to state health departments in 2010 assessed the extent of state-level planning for surveillance of radiation-related exposures and incidents: 70%–84% of states reported minimal or no planning completed. One data source for surveillance of radiological exposures and illnesses is regional poison centers (PCs), who receive information requests and reported exposures from healthcare providers and the public. Since 2010, the Centers for Disease Control and Prevention (CDC) and the American Association of Poison Control Centers (AAPCC) have conducted ongoing surveillance for exposures to radiation and radioactive materials reported from all 57 United States (US) PCs to NPDS, a web-based, national PC reporting database and surveillance system.

 

Objective

To describe radiation-related exposures of potential public health significance reported to the National Poison Data System (NPDS).

Submitted by hparton on
Description

Since 2008, poisoning is the leading cause of injury-related death in the United States; since 1980, the poisoning-related fatality rate in the United States (U.S.) has almost tripled. Many poison-related injuries and deaths are reported to regional PCs which receive about 2.4 million reports of human chemical and poison exposures annually. Federal, state, and local PH agencies often collaborate with PCs and use PC data for PH surveillance to identify poisoning-related health issues. Many state and local PH agencies have partnerships with regional PCs for direct access to local PC data which help them perform this function. At the national level, the National Center for Environmental Health (NCEH) of the Centers for Disease Control and Prevention (CDC) conducts PH surveillance for exposures and illnesses of PH significance using the National Poison Data System (NPDS), the national PC reporting database and real-time surveillance system. Though most PC and PH officials agree that PC data play an important role in PH practice and surveillance, collaboration between PH agencies and PCs can be hindered by numerous challenges. To address these challenges and bolster collaboration, the PC and PH Collaborations Community of Practice (CoP) has collaborated with members to provide educational webinars; newsletters highlighting the intersection of PH and PC work; and in-person meetings at relevant national and international conferences. The CoP includes over 200 members from state and local PH departments, regional PCs, CDC, the American Association of Poison Control Centers (AAPCC), and the U.S. Environmental Protection Agency (EPA).

Objective:

To discuss the use of poison center (PC) data for public health (PH) surveillance at the local, state, and federal levels. To generate meaningful discussion on how to facilitate greater PC and PH collaboration.

Submitted by elamb on
Description

Synthetic cannabinoids include various psychoactive chemicals that are sprayed onto plant material, which is then smoked or ingested to achieve a “high.” These products are sold under a variety of names (e.g., synthetic marijuana, spice, K2, black mamba, and crazy clown) and are sold in retail outlets as herbal products and are often labeled not for human consumption. Law enforcement agencies regulate many of these substances; however, manufacturers may frequently change the formulation and mask their intended purpose to avoid detection and regulation.

On April 6, 2015, automated surveillance algorithms via surveillance through the National Poison Data System (NPDS), a web-based surveillance system of all calls to United States (US) poison centers (PCs), identified an increase in calls to PCs related to synthetic cannabinoid use. To identify risk factors and adverse health effects, CDC analyzed all calls to PCs about synthetic cannabinoid use from January to May, 2015.

Objective

The Centers for Disease Control and Prevention analyzed all calls to poison centers about synthetic cannabinoid use from January to May 2015 to identify risk factors and adverse health effects related to this emerging public health threat.

Submitted by teresa.hamby@d… on
Description

NPDS is a near real-time surveillance system and national database operated by the American Association of Poison Control Centers. NPDS receives records of all calls made to the 55 regional US poison centers (PCs). The Centers for Disease Control and Prevention (CDC) use NPDS to 1) provide public health surveillance for chemical, radiological and biological exposures and illnesses, 2) identify early markers of chemical, radiological, and biological incidents, and 3) find potential cases and enhance situational awareness during a known incident. Anomalies are reviewed daily by a distributed team of PC medical and clinical toxicologists for potential incidents of public health significance (IPHS). Information on anomalies elevated to IPHS is promptly relayed to state epidemiologists or other designated officials for situational awareness and public health response.

Current NPDS surveillance algorithms utilize the Historical Limits Method, which identifies a data anomaly when call volumes exceed a statistical threshold derived from multiple years of historical data. Alternative analysis tools such as those employed by ESSENCE and other computerized data surveillance systems have been sought to enhance NPDS signal analysis capability. Technical improvements have been implemented in 2013 to expand NPDS surveillance capabilities but have not been thoroughly tested. Moreover, other data aberration detection algorithms, such as temporal scan statistics, have not yet been tested on real-time poison center data.

Objective

To compare the effectiveness of current surveillance algorithms used in the National Poison Data System (NPDS) to identify incidents of potential public health significance with 1) new algorithms using expanded NPDS surveillance capabilities and 2) methods beyond the NPDS’ generalized historical limits model.

Submitted by teresa.hamby@d… on
Description

The Centers for Disease Control and Prevention (CDC) uses the National Poison Data System (NPDS) to conduct surveillance of calls to United States PCs. PCs provide triage and treatment advice for hazardous exposures through a free national hotline. Information on demographics, health effects, implicated substance(s), medical outcome of the patient, and other variables are collected.

CDC uses automated algorithms to identify anomalies in both pure call volume and specific clinical effect volume, and to identify calls reporting exposure to high priority agents. Pure and clinical effect volume anomalies are identified when an hourly call count exceeds a threshold based on historical data using HLM.1 Clinical toxicologists and epidemiologists at the American Association of Poison Control Centers and CDC apply standardized criteria to determine if the anomaly identifies a potential incident of public health significance (IPHS) and to notify the respective health departments and local PCs as needed. Discussions with NPDS users and analysis of IPHS showed that alerting based on pure call volume yielded excessive false positives. A study using a 5-year NPDS call dataset assessed the positive predictive value (PPV) of the call volume-based approach. This study showed that less than 4% of anomalies were IPHS.2 A low PPV can cause unnecessary waste of staff time and resources analyzing false positive anomalies.

As an alternative to pure call volume-based detection where all calls to each PC are aggregated for anomaly detection, we considered separating calls by toxicologically-relevant exposure categories for more targeted anomaly detection. We hypothesized that this stratified approach would reduce the number of false positives. 

Objective

Our objective was to compare the effectiveness of applying the historical limits method (HLM) to poison center (PC) call volumes with vs without stratifying by exposure type. 

Submitted by Magou on
Description

The Centers for Disease Control and Prevention (CDC) uses the National Poison Data System (NPDS) to conduct surveillance of calls to United States poison centers (PCs) to identify clusters of reports of hazardous exposures and illnesses. NPDS stores basic information from PC calls including call type (information request only or call reporting a possible chemical exposure), exposure agent, demographics, clinical, and other variables.

CDC looks for anomalies in PC data by using automated algorithms to analyze call and clinical effect volume, and by identifying calls reporting exposures to pre-specified high priority agents. Algorithms analyzing call and clinical effect volume identify anomalies when the number of calls exceeds a threshold using the historical limits method (HLM). Clinical toxicologists and epidemiologists at the American Association of Poison Control Centers and CDC apply standardized criteria to determine if the anomaly is a potential incident of public health significance (IPHS) and then notify the respective health departments and PCs as needed. Discussions with surveillance system users and analysis of past IPHS determined that call volume-based surveillance results in a high proportion of false positive anomalies. A study assessing the positive predictive value (PPV) of this approach determined that fewer than four percent of anomalies over a five-year period were IPHS.1 A low PPV can cause an unnecessary waste of staff time and resources. We hypothesized that first stratifying call volume by exposure category would reduce the number of false positives. With the help of medical toxicologists, we created 20 toxicologically-relevant exposure categories to test this hypothesis. 

Objective

Our objective was to determine if the detection performance of current surveillance algorithms to detect call clusters is improved by stratifying by exposure category. 

Submitted by Magou on