Emergency Preparedness

The use of syndromic surveillance systems by state and local health departments for the detection of bioterrorist events and emerging infections has greatly increased since 2001. While these systems have proven useful for tracking influenza and identifying large outbreaks, the value of these systems in the early detection of bioterrorism events has been under constant evaluation [3,4].

Objective

The 2001 U.S. anthrax mailings, which followed a week after the tragic events of September 11th, highlighted the nation's vulnerability to bioterrorist attacks. This event, known by its FBI code name "Amerithrax," resulted in 22 known infections and five deaths in various east coast locations, including Connecticut [1]. These cases enforced the need for an effective, federal, state, and locally-integrated biosurveillance system network that can provide early warnings to reduce casualties, as called for in U.S. Homeland Security Presidential Directive-21 (HSPD-21) and emphasized in recent CDC reports [2]. This presentation reviews several post-2001 anthrax cases and the roles played by various biosurveillance systems in their identification. Recommendations for the use of modeling and the development of regional and national coordinated surveillance systems are also discussed.

All WHO member states are signatories of the IHR (1) to improve global health security. Objectives are to improve countries' capacities to detect, notify and respond to PHEICs. Rapid and transparent information sharing are critical for global coordination and rapid response to minimize an eventÍs impact on the public. The IHR require countries to establish a point of contact, or National Focal Point (NFP), responsible for notifying WHO of potential PHEICs and responding to requests of information. Potential PHEICs are assessed by the country and re-assessed by WHO, which posts its assessment together with information on response measures on a secure IHR Event information Site (EIS) accessible by all NFPs.

Objective

We looked at the public health impact in the US of the notification requirement of potential public health emergencies of international concern (PHEIC) under the 2005 International Health Regulations (IHR) to the World Health Organization (WHO).

The Louisiana Office of Public Health (OPH) conducts emergency department (ED) syndromic surveillance using the Louisiana Early Event Detection System (LEEDS). LEEDS automatically processes electronic chief complaint and diagnosis data to identify ED visits indicative of specific syndromes. The Infectious Disease Epidemiology section (IDEpi) of OPH uses LEEDS to monitor infectious disease and injury syndromes during natural or man-made disasters and high profile events. Past events monitored include hurricanes Katrina, Rita and Isaac, the Gulf Coast oil spill, yearly Mardi Gras festivities, marsh fires and chemical leaks. LEEDS has proven to be an invaluable tool in providing all-hazards public health situational awareness during these types of events by enabling near real-time monitoring of infectious disease and injury syndromes.

Objective

To demonstrate the value of syndromic surveillance as a tool to provide situational awareness during high profile events such as the Super Bowl and Mardi Gras in New Orleans, LA.

In emergencies, public health agencies must be able to respond to health threats that can affect entire communities. Agency leaders need to achieve situational awareness through the development of flexible, timely, and accurate electronic biosurveillance systems. Drawing on various sources, the North Carolina Preparedness and Emergency Response Research Center (NCPERRC) and Public Health Informatics Institute (PHII) developed recommendations for state and local public health agencies to build or enhance their biosurveillance capabilities.

Objective

To review and summarize best practices of thought leaders and implementers of biosurveillance systems with an emphasis on event-related situational awareness.

Effective communicable disease control through rapid detection and prompt response to outbreaks is one of the priorities during a humanitarian crisis, as communicable diseases can be a major cause of morbidity and mortality in emergencies, particularly in countries with poor disease surveillance mechanisms. Yemen is among many developing countries being hit by conflicts, displacement of population and disruption of basic services, where among other public health risks and threats the population is exposed to risks of several communicable diseases. Thus, effective preventive and control measures through early detection and rapid identification of infectious diseases and provision of a public health response to communicable disease outbreaks, a crucial priority health intervention, need to be directed towards diseases that are endemic and particularly those which can potentially cause excess numbers of mortality and morbidity within a short span of time.

Objective

The intended objective of the Electronic Disease Early Warning System (eDEWS) is to minimize morbidity and mortality due to communicable diseases through detection of potential outbreaks at their earliest possible stage using a novel modeling approach that mainly facilitates the transformation of data into actionable information.

The October 2010 eruption of Mt Merapi (the most active volcano in the Indonesia that erupts at 5-years intervals) claimed 141 lives, injured 453 people and displaced at least 278,000 people. This geological event became a disaster as national and international agencies had to step in to assist the Yogyakarta Province and Sleman District Administrations in dealing with the devastation caused by the pyroclastic flows. Because of its cyclic nature the task of the local governments is to improve the hazard mitigation system and to increase the resiliency of the population. On 22 July 2013 the Volcano spewed ash clouds and people of two villages of the Cangkringan Sub-District evacuated themselves to the local village halls. The hazards posed by the ash clouds of the volcano, and by the displacement of vulnerable populations, did cause certain physical and emotional sufferings, but could be controlled by the local administration.

Objective

To examine whether the danger zone District Health Office (DHO) and sub-district Health Centers (HCs) were employing an inter-disaster PH S-R System after the October 2010 Mt Merapi eruption and a pre-disaster PH S-R System during the July 2013 Mt Merapi eruption.

The CC text field is a rich source of information, but its current use for syndromic surveillance is limited to a fixed set of syndromes that are routine, suspected, expected, or discovered by chance. In addition to syndromes that are routinely monitored by the NYC Department of Health and Mental Hygiene (e.g., diarrhea, respiratory), additional syndromes are occasionally monitored when requested by outside sources or when expected to increase during emergencies. During Hurricane Sandy, we discovered by manual inspection of data for a few EDs an increase in certain words in the CC field (e.g., 'METHADONE', 'DIALYSIS', and 'OXYGEN') that led to the creation of a 'needs medication' syndrome. Current syndromic surveillance systems cannot detect unanticipated events that are not defined a priori by keywords. We describe a simple data-driven method that routinely scans the CC field for increases in word frequency that might trigger further investigation and/or temporary monitoring.

Objective

To detect sudden increases in word frequency in the Emergency Department (ED) syndromic chief complaint (CC) text field.