Martin Colleen

During March-May 2013, 14 overdose deaths occurred in RI that were caused by acetyl fentanyl, a novel synthetic opioid about five times more potent than heroin1. Ten of these deaths were clustered in March, causing a significant increase over baseline of monthly illicit drug overdose deaths in RI1. Overdose deaths are well described in RI by forensic toxicology testing results. However, the overall number of ED visits associated with this event was unknown. We used RODS data retrospectively to characterize overdose related ED visits in RI and to analyze trends.

Objective

Determine if the Rhode Island (RI) Real-time Outbreak and Disease Surveillance (RODS) system (a syndromic surveillance system) identified an increase in overdoses during a known cluster of illicit drug overdose deaths in RI and characterize emergency department (ED) overdose visits during the 15 month period prior to and including the known cluster.

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.

The BioSense system receives patient level clinical data from > 370 hospitals and 1100 ambulatory care Departments of Defense and Veterans Affairs medical facilities. Visits are assigned as appropriate to 78 sub-syndromes, including respiratory syncytial virus (RSV). Among infants and children < 1 year of age, RSV is the most common cause of bronchiolitis and pneumonia; 0.5% to 2% require hospitalization. Increasingly, RSV is also recognized as a major cause of pneumonia in elderly adults.

Objective

To analyze final diagnosis data available to BioSense and determine its potential utility for surveillance of RSV illness.

The BioSense system currently receives real-time data from more than 370 hospitals, as well as national daily batched data from over 1100 Department of Defense and Veterans Affairs medical facilities. BioSense maps chief complaint and diagnosis data to 11 syndromes and 78 sub-syndromes (indicators). One of the 11 syndromes is gastrointestinal (GI) illness and 6 of the subsyndromes (abdominal pain; anorexia, diarrhea, food poisoning, intestinal infections, ill-defined; and nausea and vomiting) represent gastrointestinal concepts.

Objective

To describe the potential use of BioSense chief complaint and final diagnosis data for GI illness surveillance.

BioSense is a Centers for Disease Control and Prevention (CDC) national near real-time public health surveillance system. CDC’s BioIntelligence Center (BIC) analysts monitor, analyze, and interpret BioSense data daily and provide support to BioSense users at state and local health departments and facilities sending data. The BioSense Application is continually being enhanced in concordance with public health and clinical partners. Ongoing dialogue between the BIC and these partners is required to gather user feedback, understand what would improve system utility, build collaborative relationships, and develop appropriate jurisdictionspecific communication protocols. In May 2006, BioSense hosted a face-to-face meeting in Atlanta with approximately 50 users to solicit recommendations for the program in general and the application. Also, every 1 to 2 months, a teleconference (“Real Time, Real Talk”) is held for all BioSense users. Because of confidentially issues, jurisdiction-specific data and issues can not be raised during such meetings, thus warranting the need for a forum in which such topics could be addressed.

Objective

To present lessons learned from the BioSense jurisdiction-specific webinars conducted in 2007.

Objective To examine sub-syndrome distributions among BioSense emergency department (ED) chief complaint and final diagnosis based data and to observe patterns by hospital system, age, and gender.

Objective

To describe a standard set of criteria for identifying potentially important anomalies and to compare the criteria with several recent public health events.

The National Poison Data System (NPDS) is maintained and operated by the American Association of Poison Control Centers (AAPCC) for the analysis, visualization, and reporting of call data from all 61 regional poison centers (PCs) in cooperation with CDC's National Center for Environmental Health (NCEH). NCEH collaborates with AAPCC toxicologists using NPDS to facilitate early recognition and monitoring of illness due to intentional or unintentional chemical or toxin exposures. NPDS algorithms identify statistically significant increases in callers' reported signs and symptoms - 131 clinical effects (CEs) such as rash and diarrhea - for detection of national poison exposure anomalies. Each day AAPCC toxicologists make decisions about NPDS anomalies' public health importance. Regional PCs are contacted as required for additional information about potentially important anomalies. NPDS also allows for individual case tracking through user-defined 'case-based definitions.' This additional method is especially useful during an outbreak when the agent and/or symptoms of affected persons are known.

Automated disease surveillance systems that analyze data by syndrome categories have been used to look for outbreaks of disease for about 10 years. Most of these systems notify users of increases in the prevalence of reports in syndrome categories and allow users to view patient level data related to the increase. For most situations this level of investigation is sufficient, but occasionally a more dynamic level of control is required to properly understand an emerging illness in a community. During the SARS outbreak, for example, the respiratory syndrome was defined too broadly to allow users to track SARS. However, some systems, allowed users to build dynamic queries that allowed them to search their data by using the SARS case definition [1]. Users could perform free-text queries that identified records containing specific keywords in the chief complaint or specific combinations of ICD9 codes. This advanced querying capability has proven to be one of the most used features used by monitors of disease surveillance systems. Objective: The objective of this project is to build a new, more flexible query interface that allows users to define and build their query as if they were writing a logical expression for a mathematical computation. The interface is designed so that it can be easily adapted to fit into nearly any syndromic surveillance system.The interface will be evaluated in future versions of the ESSENCE and BioSense Systems.