Emergency Preparedness

Intense stress can severely degrade one's ability to process and utilize new kinds of information.1 This psychological phenomena may partially explain why epidemiologist are challenged to communicate and establish the value of SyS information with emergency management professionals (EMPs). Despite the timely and useful insights that SyS data and methods can provide, it is very difficult to convey what these data are when EMPs and epidemiologists are working to make intense, highly-scrutinized and high-consequence emergency decisions. If state and local authorities want emergency plans and responses that benefit from the powerful insights that SyS can provide, epidemiologists need to learn how to best report information and establish a strong rapport before emergencies strike. Over the past ten months, ISDS’s NSSP’s Syndromic Surveillance and Public Health Emergency Preparedness, Response and Recovery (SPHERR) Committee has worked to identify gaps, potential best practices, document use cases, and identify tools for integration of SyS data in EM activities. During SPHERR practice exchange meetings, SyS professionals have consistently cited effective communication between SyS staff and emergency preparedness staff as a top priority in integrating SyS more fully into all phases of emergencies.

Objective: Identify and document strategies that enhance the value of syndromic surveillance (SyS) data and information for the response, recovery, mitigation and preparedness needs of local and state emergency management professionals in the U.S.

On September 10, 2017, Irma made landfall in the Florida Keys as a Category 4 hurricane and subsequently tracked up the west side of the state. Due to the size of the storm, it impacted nearly all of Florida. The Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL), the state’s syndromic surveillance system, captures 98% of the emergency department (ED) visits statewide and has historically served a vital function in providing near real-time ED data that are used to track post-disaster morbidity and mortality. After previous hurricanes and tropical storms, increases in carbon monoxide poisonings, animal bites, and injuries have been documented. During post-Irma surveillance, an additional increase in seizure-related ED visits was observed.

Objective: Using Florida's syndromic surveillance data, to describe the increase in seizure activity in the days after Hurricane Irma made landfall in 2017

On August 25, 2017 Hurricane Harvey moved onshore near Port Aransas, Texas, eventually overwhelming areas of Houston with between 41-60 inches of rain (Houston Health Department [HHD], 2017). As a category 4 storm, with wind speeds as high as 130 mph, Harvey broke several rainfall records across the state and ended the prolonged period of twelve years in which no major hurricanes had made landfall in the United States (Mersereau, 2017). Harvey ambled at a leisurely pace through Houston and resulted in devastating flooding that destroyed homes and required the evacuation of approximately 37,000 Houstonians to over 78 shelter facilities across the affected area (HHD, 2017). Through concerted efforts, the American Red Cross and the HHD established the shelter at the George R. Brown Convention Center (GRB) and delivered or coordinated social services, medical and mental health services, disease surveillance and food/sanitary inspection services for the duration of the need for the shelter (HHD, 2017).

Objective: To provide recommendations for future preparedness response efforts based on an assessment of the Post-Hurricane Harvey After-Action Report (AAR).

The Seine River rises at the north-East of France and flows through Paris before emptying into the English Channel. On January 2018 (from 22th January to 11th February, Weeks 4 to 6), major floods occurred in the Basin of Seine River, after an important rainy period. This period was also marked by the occurrence on the same area of a first cold wave on Week 6 (from 5th to 7th February), including heavy snowfall and ice conditions from 9th to 10th February. A second similar cold wave occured from 28th February and 1st March. Floods of all magnitude are known to have potential health impacts on population, both at short, medium and long term both on physical (injuries, diarrhoeal disease, Carbon Monoxyde poisoning, vector-borne disease) and mental health. Extreme cold weather have also the potential to further impact on human health through direct exposure to lower temperatures, and associated adverse conditions, such as snow and ice. Such situations may be particularly associated to direct impact like hypothermia, frostbite and selected bone/joint injuries).

Objective: The presentation describes the results of the daily monitoring of health indicators conducted by the French public health agency during the major floods and the cold wave that occurred in January 2018 in France, in order to early identify potential impact of those climatic events on the population.

Influenza viral infection is contentious, has a short incubation period, yet preventable if multiple barriers are employed. At some extend school holidays and travel restrictions serve as a socially accepted control measure. A study of a spatiotemporal spread of influenza among school-aged children in Belgium illustrated that changes in mixing patterns are responsible for altering disease seasonality3. Stochastic numerical simulations suggested that weekends and holidays can delay disease seasonal peaks, mitigate the spread of infection, and slow down the epidemic by periodically dampening transmission. While Christmas holidays had the largest impact on transmission, other school breaks may also help in reducing an epidemic size. Contrary to events reducing social mixing, sporting events and mass gatherings facilitate the spread of infections. A study on county-level vital statistics of the US from 1974-2009 showed that Super Bowl social mixing affects influenza dissemination by decreasing mortality rates in older adults in Bowl-participating counties. The effect is most pronounced for highly virulent influenza strains and when the Super Bowl occurs closer to the influenza seasonal peak. Simulation studies exploring how social mixing affects influenza spread demonstrated that impact of the public gathering on prevalence of influenza depends on time proximity to epidemic peak. While the effects of holidays and social events on seasonal influenza have been explored in surveillance time series and agent-based modeling studies, the understanding of the differential effects across age groups is incomplete.

Objective: In the presented study, we examined the impact of school holidays (Autumn, Winter, Summer, and Spring Breaks) and social events (Super Bowl, NBA Finals, World Series, and Black Friday) for five age groups (<4, 5-24, 25-44, 45-64, >65 years) on four health outcomes of influenza (total tested, all influenza positives, positives for influenza A, and B) in Milwaukee, WI, in 2004-2009 using routine surveillance.

Syndromic surveillance has become an integral component of public health surveillance efforts within the state of Florida. The near real-time nature of these data are critical during events such as the Zika virus outbreak in Florida in 2016 and in the aftermath of Hurricane Irma in 2017. Additionally, syndromic surveillance data are utilized to support daily reportable disease detection and other surveillance efforts. Although syndromic systems typically utilize emergency department (ED) visit data, ESSENCE-FL also includes data from non-traditional sources: urgent care center visit data, mortality data, reportable disease data, and Florida Poison Information Center Network (FPICN) data. Inclusion of these data sources within the same system enables the broad accessibility of the data to more than 400 users statewide, and allows for rapid visualization of multiple data sources in order to address public health needs. Currently, the ESSENCE-FL team is actively working to incorporate EMS data into ESSENCE-FL to further increase public health surveillance capacity and data visualization.

Objective: To describe the strategy and process used by the Florida Department of Health (FDOH) Bureau of Epidemiology to onboard emergency medical services (EMS) data into FDOH’s syndromic surveillance system, the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL).

Bacillus anthracis, the etiologic agent of anthrax, is a member of a highly diverse group of endospore-forming bacteria. Bacillus anthracis spores are typically found in soil, from which they may spread via contaminated dust, water, and materials of plant and animal origin. Although anthrax is primarily a disease of herbivores, humans may contract anthrax directly or indirectly from animals. Laboratory of the Ministry of Agriculture (LMA) conducts Anthrax diagnostics using Bacteriology and Molecular Biology Methods: Isolated cultures through the classical bacteriology methods are always confirmed by Molecular Biology assay (PCR). In 2014, within Tap7 project ,Identification and Mapping of Anthrax foci in Georgia Anthrax suspected soil samples were tested using two lab diagnostic methods and they were compared to each other.

Objective: Laboratory of the Ministry of Agriculture (LMA) conducts Anthrax diagnostics using Bacteriology and Molecular Biology Methods: Isolated cultures through the classical bacteriology methods are always confirmed by Molecular Biology assay (PCR). In the study the samples were screened for the presence of B. anthracis via two concurrent approaches to compare classical methods and a novel PCR method. Before the TAP-7 project, PCR was only used to confirm the identity of cultures isolated by the Bacteriology. New SOPs and algorythm was created for better laboratory diagnostic.

The Infectious Disease Epidemiology Section (IDEpi) in the Louisiana Office of Public Health (OPH) has several applications for syndromic surveillance including situational awareness during unusual and/or high profile events, such as the uncharacteristic winter weather Louisiana experienced during the 2017-2018 winter season. December 8th, 2017 saw freezing temperatures with some parts of the state experiencing snow, and January 16- 18, 2018 saw record breaking freezing temperatures throughout the state. Both weather events led to many state office, school and business closures. The freezing temperatures from January 16th -18th led to office closures that lasted longer than the freezing temperatures due to the infrastructure damage the freezing temperatures caused. For example, Orleans parish experienced low water pressure throughout its water systems due to broken pipes following the freeze, leading to boil water advisories. Many people throughout Louisiana had broken pipes at their homes, resulting in flooding and further contributing to low water pressure in some areas. IDEpi used syndromic surveillance to monitor the impacts of the severe winter weather and its aftermath on weather related personal injuries throughout the state.

Objective: The Louisiana Early Event Detection System (LEEDS), Louisiana's syndromic surveillance system, was used to monitor uncharacteristically low temperatures during the 2017-2018 winter season and determine the impact of these temperatures on the number of weather related personal injuries in emergency departments throughout Louisiana.

The 2012 National Strategy for Biosurveillance (BSV) recognizes that a well-integrated national BSV enterprise must provide essential information for better decision making at all levels. Submitting an electronic bill following HC services is the most mature and widely used form of eHealth. HIPAA-compliant eHRCs captured in e-commerce can be consolidated into big HC data centers and used for many purposes including BSV. eHRCs are standardized and each claim contains pertinent person, place, and time information that can be leveraged for BSV. IMS Health (IMS) is a global HC information company and maintains one of worldÕs largest eHealth data centers that processed information including eHRCs on >260M unique U.S. patients in 2012.

Objective

This paper describes how high-volume electronic healthcare (HC) reimbursement claims (eHRCs) from providers' offices and retail pharmacies can be used to provide timely and accurate influenza-like illness (ILI) situational awareness at state and CBSA levels

As part of a greater statewide excessive heat response plan, New Hampshire (NH) has been performing HRI surveillance since 2010 to guide response efforts and ultimately reduce HRI morbidity and mortality during situations of excessive heat. Historically, NH hospital Emergency Department Heat illness discharges average around 150 per year, typically in the summer months. NHÕs Excessive Heat Emergency Response Plan documents appropriate state-wide readiness, alerting, emergency, and recovery level of response for heat emergencies with its partners. Together with near real-time surveillance data, flexible query tools, and communication templates, NH is better able to respond to excessive heat emergencies at a moment's notice and take action with its partners to reduce HRI emergencies. Objective: During this presentation NH Division of Public Health Services (NH DPHS) will share how it was able to develop an effective HRI surveillance response through the development of partners, which allowed State of NH decision makers to affect action beyond detection.