Chronic Disease or Injury

Recent reporting using data from CDC's National Syndromic Surveillance Program indicates that rates of emergency department (ED) visits involving suspected opioid overdoses increased by 70% in the Midwest from the third quarter (Q3) 2016 (July-September) to the Q3 2017. Large increases in the use and distribution of illicitly-manufactured fentanyl (IMF) and fentanyl analogs, are a key factor driving increased opioid overdose rates in the Midwest and east of the Mississippi River. Fentanyl is a synthetic opioid 50-“100 times more potent than morphine. A better understanding of the distribution of changes in opioid overdose rate from Q3 2016 to Q3 2017 within states needed to inform response and prevention efforts.

Objective: This presentation will provide insight into how the extensive spread of illicitly-manufactured fentanyl impacted opioid overdose rates throughout the Midwest and neighboring states.

When the opioid epidemic began in the early 1990s, pills such as oxycodone were the primary means of abuse. Beginning in 2010, injection use of, first, heroin and then synthetic opioids dramatically increased, which led the number of overdose deaths involving opioids to increase fivefold between 1999 and 2016.1 It would be expected that BBP rates would rise with this increase in injection use, and, nationally, there has been a rise in acute hepatitis C (HCV) rates, although the other two main BBPs, acute hepatitis B (HBV) and acute human immunodeficiency virus (HIV) have been flat and declining, respectively.2,3 In this study, we compared New Jersey's reported incidence of these three BBPs (acute HBV, acute HCV, and HIV) over five years (2013-2017) with syndromic surveillance data for opioid use over the same time period in order to test the hypothesis that emergency department (ED) visits for opioid use could be used as a predictor of BBP infection.

Objective: To utilize New Jersey's syndromic surveillance data in the study and comparison of trends in injection opioid use and infection with selected bloodborne pathogens (BBPs) over the years 2013-2017.

Although recent data suggests childhood obesity prevalence has stabilized, an estimated 1 in 3 U.S. children are overweight or obese.1 Further, there is variation by racial and ethnic groups, location, age, and poverty2, resulting in a need for local data to support public health planning and evaluation efforts. Current methods for surveillance of childhood weight status rely on self-report from community-based surveys. However, surveys have long time intervals between data collection periods, are expensive, and are not often able to produce precise small-area estimates. EHRs have been increasingly proposed as an alternative or supplement to community surveys. Childhood weight and height is collected as a part of routine care, and leveraging these data from EHRs may provide rapid and locally precise estimates of childhood weight status. A concern for the use of EHRs is the potential for selection bias. EHRs represent only those seeking healthcare and may not generalize to the population. Additionally, the type of clinical visit (e.g., wellness vs. acute) may affect the prevalence estimates and the likelihood of collecting height and weight data in the EHR. Thus, in addition to EHRs being a convenience sample, there may be additional selection biases based on the type of visit and whether height and weight was measured and recorded. The current work sought to quantify the effect of visit type on childhood overweight and obesity prevalence and generate weights to adjust prevalence for potential EHR-related selection bias.

Objective: To discuss the use of electronic health records (EHRs) for estimation of overweight and obesity prevalence in children aged 2 to 19 years and to compare prevalence between the convenience sample obtained from EHRs to prevalence adjusted for potential selection bias.

Maryland utilizes ESSENCE for identification of emerging public health threats, including non-fatal overdoses. Synthetic cannabinoids are heterogeneous psychoactive compounds identified as substances of abuse [1]. In March 2018, the Illinois Department of Public Health received reports of unexplained bleeding in patients who reported using these products [2]. As a result, CDC initiated coordination of national surveillance activities for possible cases of coagulopathy associated with synthetic cannabinoids use. By May 2018, state health departments reported 202 cases, including five deaths [3]. On April 3, 2018, Maryland reported its index case - a female in her 20'™s who presented to an ED with nausea, blood in her stool, vaginal bleeding, bruising, an elevated internal normalized ratio (> 12.2), and bleeding oral ulcers after quitting use of a synthetic cannabinoid. She was successfully treated with Vitamin K. The first reported mortality in a Maryland resident was a male in his 30'™s who called EMS for fever and blood in his urine but subsequently went into cardiac arrest and was unable to be resuscitated. The patient was known to use synthetic cannabinoids. Brodifacoum exposure was confirmed by laboratory testing. As of September 2018, the Maryland Poison Control Center had received reports of 43 cases, and 3 deaths linked to the outbreak.

Objective: Develop a free text query to track synthetic cannabinoid-related ED visits. Assess trends in synthetic cannabinoid use from 2013-2018 using spatial and time-series analysis.

In Massachusetts, syndromic surveillance (SyS) data have been used to monitor injection drug use and acute opioid overdoses within EDs. Currently, Massachusetts Department of Public Health (MDPH) SyS captures over 90% of ED visits statewide. These real-time data contain rich free-text and coded clinical and demographic information used to categorize visits for population level public health surveillance. Other surveillance data have shown elevated rates of opioid overdose related ED visits, Emergency Medical Service incidents, and fatalities in Massachusetts from 2014-20171,2,3. Injection of illicitly consumed opioids is associated with an increased risk of infectious diseases, including HIV infection. An investigation of an HIV outbreak among persons reporting IDU identified homelessness as a social determinant for increased risk for HIV infection.

Objective: We sought to measure the burden of emergency department (ED) visits associated with injection drug use (IDU), HIV infection, and homelessness; and the intersection of homelessness with IDU and HIV infection in Massachusetts via syndromic surveillance data.

Globally, road traffic crashes (RTCs) annually kill 1.3 million people and injure 20-50 million others. Nigeria accounts for an estimated 15% of RTC deaths in the WHO African Region.

Objective: This study aimed to describe RTC characteristics and trends in Nigeria and determine progress towards halving RTC-related deaths/injuries by 2020 [i.e., Sustainable Development Goal (SDG) Target 3.6].

Cocaine, methamphetamine, and spice are addictive, non-opioid substances that negatively impact a person's health through direct and indirect means. Direct health concerns of non-opioid substance use include anxiety, paranoia, seizure, heart attack, stroke, and potentially death while indirect health concerns include the acquisition of disease and infections, particularly sexually transmitted infections (STIs). Substance users experience an increased risk of acquiring STIs since they may exchange sex for substances, use substances within a social setting that may lead to sexual activity, or engage in risky sexual behavior as a result of impaired judgement associated with substance use. The current study evaluated the use of multiple data sources to monitor changes in the rate of cocaine, methamphetamine, and spice related emergency department visits as well as cocaine- and methamphetamine-related death rates, within Marion County, Indiana between 2013 and 2017.

Objective: To assess the prevalence of non-opioid substance use ”including cocaine, methamphetamine and spice within Marion County, Indiana and propose response recommendations utilizing a current opioid response plan.

On August 15, 2018, the Connecticut Department of Public Health (DPH) became aware of a cluster of suspected overdoses in an urban park related to the synthetic cannabinoid K2. Abuse of K2 has been associated with serious adverse effects and overdose clusters have been reported in multiple states. This investigation aimed to characterize the use of syndromic surveillance data to monitor a cluster of suspected overdoses in real time.

Objective: To describe the use of syndromic surveillance data for real-time situational awareness of emergency department utilization during a localized mass overdose event related to the substance K2.

The mediating pathways in the obesity-asthma link are largely unknown. We aimed to investigate the mediating pathways and to search for the most prominent pathological mechanism between central obesity and childhood asthma.

Objective: To investigate the important mediator linking from obesity to childhood asthma

In 2016, there were approximately 63,000 deaths nationally due to drug overdose. This trend continues to increase with the provisional number of US deaths for 2017 being approximately 72,000 (1). This increase in overdose deaths is fueled largely by the opioid class of drugs. The opioid epidemic began in the 1990s with a steady rise in prescription opioid overdoses. However, after 2010 a rise in heroin overdose deaths also began to occur. In addition to the heroin deaths increasing, there was a sharp rise in overdose deaths due to synthetic opioids including illicitly manufactured fentanyl beginning in 2013 (2). In Missouri, ER visits follow similar trends with heroin overdose visits greatly increasing after 2011. While PDMPs help function as data sources that provide information on the licit drug supply, they cannot give much knowledge on the illicit supply. Because of this, drug seizure data from law enforcement can provide a much-needed tool in understanding the supply of illicit substances and their impact on a county™'s morbidity.

Objective: To evaluate the relationship between heroin and non-heroin opioid seizures reported by law enforcement and the number of ER visits due to heroin and non-heroin opioid poisoning in selected counties in Missouri.