Schirmer Patricia

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.

The VA has employed ESSENCE for health monitoring since 2006 [1]. Epidemiologists at the Office of Public Health (OPH) monitor the VA population at the national level. The system is also intended for facility-level monitoring to cover 152 medical centers, nearly 800 community-based outpatient clinics (CBOC), and other facilities serving all fifty states, the District of Columbia, and U.S. territories. For the entire set of facilities and current syndrome groupings, investigation of the full set of algorithmic alerts is impractical for the group of monitors using ESSENCE. Signals of interest may be masked by the nationwide alert burden. Customized querying features have been added to ESSENCE, but standardization and IP training are required to assure appropriate use.

Objective

The objective was to adapt and tailor the alerting methodology employed in the Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE) used by Veterans Affairs (VA) for routine, efficient health surveillance by a small, VA headquarter medical epidemiology staff in addition to a nationwide group of infection preventionists (IPs) monitoring single facilities or facility groups.

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.