In WA, we've been using a series of increasingly broad queries to monitor measles. The number of visits mentioning measles increases during an outbreak as a result of people seeking care because they were (or think) they were exposed, seeking titers, vaccinations, or having seen reports of measles on the news and concerns than an illness could be measles. As a result, it is important to focus in on visits of highest suspicion as mentions of measles increase. During times of low measles activity, broader definitions may be appropriate for routine surveillance as mentions and diagnoses of measles are relatively rare. The definitions are not mutually exclusive, but could be possibly be modified to be so. An outside application is used to de-duplicate records identified by the various definitions so as to avoid review of the same records
Syndromic surveillance system: ESSENCE (NSSP)
Data sources: All clinical (emergency department, clinic, inpatient)
A variety of fields are used depending on the sensitivity of the query. Procedure combo is currently not queryable systematically, but would also be useful when looking for mentions of measles or rubeola.
Diagnosis. Looks for a diagnosis of measles. Search discharge diagnosis and admit reason code/combo for:
B05[0-9] OR B05.
Narrow. Identifies mentions of or diagnoses of measles excluding visits mentioning titers OR visits for vaccination. Searches chief complaint history, discharge Diagnosis, Triage Notes Orig, Admit Reason Code, Admit Reason Combo, and Clinical Impression for:
B05[0-9] OR B05. OR measle OR m[ea][ae]s[le][el]
AND CC and DD:
ANDNOT (Z23 OR titer)
Medium. Looks for measles terms and synonyms or classic measles symptoms. Searches Chief Complaint History and Discharge Diagnosis for:
rubella OR rubeola OR measle OR m[ea][ae]s[le][el] OR koplik spots OR erythematos rash OR ((fever OR chills OR rigor OR shiver) AND rash) OR B05[0-9] OR B05. OR B06[0-9] OR B06.
AND searches Discharge Diagnosis for:
ANDNOT Z23
Broad. Looks for measles terms/diagnoses symptoms or fever + rash. Searches Chief Complaint History, Discharge Diagnosis, Triage Notes Orig, Clinical Impression, Admit Reason Code, Admit Reason Combo for: (rubella OR rubeola OR measle OR m[ea][ae]s[le][el] OR koplik spots OR erythematos rash OR ((fever OR chills OR rigor OR shiver) AND rash) OR ((B05[0-9] OR B05. OR B06[0-9] OR B06.))) andnot (denies rash OR denies fever OR no fever OR no rash OR [a-z]rash OR rash[a-z] OR reaction OR crash OR arthritis OR no known fever OR no fever)
AND Discharge Diagnosis for:
ANDNOT (B084 OR B01 OR Z23 OR B0682 OR B06.82)