Oda Gina

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. In June 2018, CDC issued a Health Alert Network Advisory providing additional guidance on identification and prevention of HAV and updates on the outbreaks.4 This prompted our office to more closely review our HAV surveillance, to identify Veterans who may be part of these outbreaks, and assess risk factors and outcomes of HAV infection.

Objective: To conduct surveillance for acute Hepatitis A virus (HAV) infections in Veterans from states reporting outbreaks among high-risk individuals beginning in fiscal year (FY) 2017.

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. CDC issued a Health Alert Network Advisory in June 2018 with additional guidance on identification and prevention of HAV and updates on outbreaks in multiple states4 which prompted our program to conduct a more formal review of HAV infections in VHA. Herein we describe recent trends in HAV infection, vaccination and associated risk factors among Veterans.

Objective: To describe the epidemiology of hepatitis A virus (HAV) within the Veterans Health Administration (VHA).

The Veterans Affairs (VA) ESSENCE obtains electronic health record data from 152 medical centers plus clinics in all 50 states, U.S. territories, and the Philippines. ESSENCE analyzes ICD-9 diagnosis codes and demographic data from outpatient and emergency department visits using complex aberrancy-detection algorithms. In 2010, a new instance was stood up (VA Inpatient ESSENCE) which receives weekly feeds of inpatient data from all VA acute care hospitals starting at the beginning of the Fiscal Year (FY10, Oct. 1, 2009). Data include demographics, admission/discharge data (including ICD-9 diagnosis codes), diagnosis related group, bedsection, procedure and surgery data.

Objective

To describe the utility of inpatient data in VA ESSENCE biosurveillance system for healthcare-associated infection and public health surveillance.

There are currently no federal laws mandating the reporting of infectious diseases to public health authorities. Reporting requirements reside at the state level and such laws do not apply to federal agencies including the VA. Heretofore, VA's reporting of infectious diseases to public health authorities has been strictly voluntary, and has been accomplished via traditional methods (phone, mail, and fax) that are highly prone to human error, create a significant administrative burden, and do not adequately safeguard the privacy of Veterans' data. Previously, without a reporting mandate applicable to VA facilities, public health authorities have had an incomplete picture of the VA contribution to the overall infectious disease burden existing in the larger population. Moreover, at a national level, the VA has not had the ability to monitor the prevalence of the various infectious diseases within its own 151 hospitals and 827 community-based outpatient clinics. Nor has the VA been able to meet the spirit of the Health Information Technology for Clinical and Economic Health Act's Meaningful Use requirements, mandating electronic exchange of information.

Objective

In June 2013, in anticipation of the passage of proposed federal legislation (S 875 and HR 1792), the Department of Veterans Affairs (VA) issued a Directive requiring mandatory reporting of infectious diseases to various public health authorities (VHA Directive 2013-008). In terms of implementation strategies, the ideal is to build on an existing technology, optimize the quality and completeness of reporting, and minimize additional work burdens on VA staff.

Influenza is associated with significant morbidity and mortality nationally each year and VA's large elderly population is at particular risk. VA Office of Public Health (OPH) has monitored influenza and influenza-like-illness (ILI) activity using the VA's biosurveillance system since 2009 (1,2). VA influenza surveillance capacity has expanded significantly in recent years to include inpatient influenza data, telephone triage data, laboratory testing data and enhanced geospatial mapping capabilities.

Objective

Herein we summarize our ongoing influenza surveillance activities and describe the 2012-2013 influenza season activity in VA.

The Veterans Health Administration (VHA) operates over 880 outpatient clinics across the nation. The Johns Hopkins Applied Physics Laboratory’s Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) utilizes VHA ICD9 coded outpatient visit data for the detection of abnormal patterns of disease occurrence. The hemorrhagic illness (HI) syndrome category in ESSENCE is comprised of 25 different ICD9 codes, including 12 codes specific for viral hemorrhagic fever (VHF) (e.g., ebola, yellow fever, CrimeanCongo hemorrhagic fever, lassa, etc.) and 13 nonspecific conditions (e.g., purpura not otherwise specified (NOS), thrombocytopathy, and coagulation defect NOS).

Objective

We sought to evaluate the functionality of the diagnosis codes which fall into the syndrome category of hemorrhagic illness.