Paratyphoid Fever v1

Query purpose: 

Created by the CDC National Syndromic Surveillance Program (NSSP) for use with emergency department data to develop queries for all National Notifiable Diseases defined by the National Notifiable Diseases Surveillance System (NNDSS). Please note that while the disease queries are developed using the NNDSS case definition as the basis for identifying patient visits of interest, the queried patient visits themselves may or may not represent a case patient in NNDSS and further public health investigation will most often be required. This query is intended to be a version 1 and may be further improved upon by the NSSP community of practice in the future. This query is intended to be narrow and capture visits with specific terms to support greater monitoring and actionable public health data. More complex and/or broader queries may exist that more broadly capture symptoms or travel-based terms.

How it was developed: 

1. The CDC team used the NNDSS case definition of paratyphoid fever to identify diagnostic codes (International Classification of Diseases, 9th & 10th Revisions (ICD-9-CM, ICD-10-CM), SNOMED Clinical Terms (CT)) and chief complaint free text for syndrome development.
2. The codes and free text were then categorized as inclusion or exclusion terms. These terms were formatted for querying in ESSENCE.
3. Text analysis was conducted on the initial query to find additional inclusion or exclusion terms.
4. The query was cross-checked internally by NSSP and by CDC subject matter experts as needed.

How it works:

The Chief Complaint Discharge Diagnosis (CCDD) parsed field is used to query both the discharge diagnosis codes and chief complaint free text, and exclusions are incorporated as necessary.

• Inclusion based on paratyphoid fever chief complaint free text terms:
  • The visit is included if it contains:
    1. A chief complaint related to disease name – (“paratyph”) OR
    2. A chief complaint related to alternative name – (“enteric fever”) OR
    3. A chief complaint related to disease agent – (“salmonella” and “paratyphi”) OR
• Inclusion based on ICD-10 discharge diagnosis codes related to paratyphoid fever:
  • The visit is included if it contains:
    1. A discharge diagnosis code for Paratyphoid fever – (A01.1 or A01.2 or A01.3 or A01.4) OR
• Inclusion based on ICD-9 discharge diagnosis codes related to paratyphoid fever:
  • The visit is included if it contains:
    1. A discharge diagnosis code for Paratyphoid fever – (002.1 or 002.2 or 002.3 or 002.9) OR
• Inclusion based on SNOMED discharge diagnosis codes related to paratyphoid fever:
  • The visit is included if it contains:
    1. A discharge diagnosis code for Paratyphoid fever – (76623002 or 71085009 or 51254007 or 85904008) OR
    2. A discharge diagnosis code for Salmonella Paratyphi – (79128009 or 85908006 or 32488009) OR
    3. A discharge diagnosis code for Colitis caused by Salmonella Paratyphi – (1163127003 or 1163128008 or 1163125006) OR
    4. A discharge diagnosis code for Multidrug-resistant Salmonella Paratyphi – (840687007) OR
    5. A discharge diagnosis code for Eruption of skin caused by Salmonella Paratyphi – (1287471003 or 1287511006 or 1287512004 or 1287513009) ANDNOT
• All the above must exclude:
  • An ICD-10 discharge diagnosis code for Adverse reaction of other bacterial vaccines – (T50.A95) OR
  • An ICD-10 discharge diagnosis code for Encounter for immunization – (Z23) OR
  • An ICD-10 discharge diagnosis code for Encounter for other specified prophylactic measures – (Z29.8) OR
  • A SNOMED discharge diagnosis code for Post paratyphoid vaccination encephalitis – (192707002) OR
  • A SNOMED discharge diagnosis code for Adverse reaction to component of paratyphoid vaccine – (219079000)

Plain Language Description:

The definition uses discharge diagnosis codes and free-text chief complaint terms. The definition requires that an emergency department visit contains a reference to the disease by its discharge diagnosis code (in at least one of the following: ICD-9-CM, ICD-10-CM, SNOMED diagnostic codes), or by the disease name listed in the chief complaint text. The paratyphoid fever syndromic surveillance definition includes direct mentions of paratyphoid fever using “paratyph” or “enteric fever” in chief complaint text, and mentions of the pathogen using combined terms for “salmonella” and “paratyphi”. To ensure that only acute paratyphoid fever infections were captured, diagnostic codes were excluded if there were diagnostic codes indicating vaccination.