Environmental Health

Understanding how exposure to hazards in our environment (air, water, food and surroundings) affects our health is critical to understanding causes of many chronic and acute diseases and to planning and implementing appropriate response and prevention efforts. Centers of Disease Control and Prevention (CDC) established the congressionally mandated National Environmental Public Health Tracking Program (Tracking Program) to facilitate the analysis and interpretation of both environmental and health outcome data through the building of a national tracking network which integrates data from environmental hazard monitoring, human exposure and health effects surveillance. This network of standardized electronic data provides valid scientific information on environmental exposures and adverse health conditions in a practical format to explore plausible spatial and temporal relations between these factors. The program funds and provides guidance to 24 state and local health departments to develop local tracking networks that feed data into the National Tracking Network, enabling enhanced public health actions.

Objective

The National Environmental Public Health Tracking Program facilitates the linkage of environmental information to health outcomes through development of a national standards-based public health surveillance system that provides useful information to help improve where we live and work. The purpose of this summary is to report how state tracking programs have used their tracking networks to save lives and protect people from health threats.

Air pollution is well documented to cause adverse health effects in the population. Epidemiological/toxicological studies have demonstrated that air pollution is associated with various adverse health outcomes, ranging from mortality to subclinical respiratory symptoms. Classical epidemiological studies of the health effects of air pollution are typically retrospective. In order to assess the effectiveness of any public health messages or interventions in a timely manner there is a need to be able to systematically detect any health effects occurring in real-time. The UK syndromic surveillance systems are coordinated by Public Health England (PHE) and are used to monitor infectious diseases in real-time. This study is the first in the UK to explore whether syndromic surveillance systems can detect public health impacts associated with air pollution events.

Objective: This study examined whether the current UK real-time syndromic surveillance systems can detect public health impacts associated with air pollution events such as fires and ambient air pollution episodes.

The scientific community accepts that global climate change (CC) will affect the dispersion of microbial organisms in the environment. Risks posed by the transport of these organisms to future communities may be very different than those posed today. A shift in health risks may also be linked to climate driven land-use change, which may alter both microbial loadings to receiving waters and human exposure pathways. Uncertainty surrounding microbial fate and transport renders the assessment of CC effects on waterborne pathogens complex and difficult to forecast.

Objective

To use watershed modeling to predict the impacts of future climate change and land management scenarios on microbial water quality.

Comparison of heat-related health effects across regions or among different syndromic surveillance systems is problematic due to the lack of a standardized heat-related syndrome definition. While a national standard for common heat-related syndromes would facilitate data comparisons, local customization of syndromes to adjust for unique public health events or characteristics is often necessary to optimize use of syndromic surveillance data.

Objective

To determine differences in case detection using different syndrome definitions for heat-related health effects.

The United States Environmental Protection Agency (U.S. EPA) has developed a prototype contamination warning system (CWS) for drinking water in response to Homeland Security Presidential Directive 9 (HSPD9). The goal of HSPD9 and the CWS is to expedite contamination containment and emergency response, thereby minimizing public health and economic impacts.

U.S. EPA’s conceptual CWS system, named WaterSentinel, is currently being pilot tested by U.S. EPA and its research partners. WaterSentinel is a multi-faceted approach involving water quality monitoring at optimal locations throughout the drinking water distribution system, enhanced security monitoring at key water utility infrastructure assets, consumer complaint surveillance, and innovative uses of public health surveillance data streams.

Objective

This paper summarizes the use and evaluation of various types of public health surveillance data for the early detection of chemical and biological contamination of drinking water.

Safe drinking water is essential for all communities. Intentional or unintentional contamination of drinking water requires water utilities and local public health to act quickly. The Water Security (WS) initiative of the U.S. Environmental Protection Agency is a multi-faceted approach involving water utilities and local public health officials (LPH) to identify, communicate, contain, and mitigate a drinking water contamination event. Components of WS include: online water quality monitoring, enhanced security monitoring, consumer complaint surveillance, and innovative uses of public health surveillance data streams. LPH already use multiple surveillance data systems to recognize disease events in a timely manner. However, few of these systems can be integrated or specifically designed for detection of drinking water contamination incidents.

Objective

This poster describes the integration of public health surveillance data as a component of an early warning system for detection of a drinking water contamination incident.

On 12/14/06, a windstorm in western Washington caused 4 million residents to lose power; within 24 hours, a surge in patients presented to emergency departments (EDs) with carbon monoxide (CO) poisoning. As previously described, records of all patients presenting to King County EDs with CO poisoning between 12/15/06 to 12/24/06 (n=279) were abstracted, of which 249 met the case definition and eligibility requirements. We attempted to identify each of the 249 confirmed cases of CO poisoning in our syndromic ED data set by comparing the hospital name, date, time, age, sex, zip code, chief complaint, and diagnoses across the two data sets. We designated each record as an exact match, likely match, possible match, or unmatched on the basis of the available fields.

Objective

We evaluated ED and emergency medical services data for describing an outbreak of CO poisoning following a windstorm, and determined whether loss of power was followed by an increase in other health conditions.

Although the majority of work in syndromic surveillance has been its application to bioterrorism and infectious diseases, one of the emerging priorities for its use is for the monitoring of environmental health conditions. Heat-related illness (HRI) is of growing public health importance, especially with global warming concerns and increased frequency of heat waves. Ambient temperatures are responsible for significant morbidity and mortality, as was demonstrated during the 1995 heat wave in Chicago that resulted in over 700 excess deaths and 33,000 emergency room visits due to HRI. A syndromic surveillance system that is able to detect early indications of excess HRI may start the public health response earlier, and thus reduce associated morbidity and mortality. The utility of 911 ambulance dispatch data for the early detection of heat-related illness was explored.

Objective

This paper describes the use of 911 ambulance dispatch data for the early detection of HRI in Toronto, Ontario, Canada.

North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) is the Web-based early event detection and timely public health surveillance system in the North Carolina Public Health Information Network. At the present time NC DETECT monitors five data sources: emergency departments, the statewide poison center, the statewide EMS data collection system, a regional wildlife center and laboratories from the NC State College of Veterinary Medicine for suspicious patterns. NC DETECT receives Carolinas Poison Control Center (CPC) data every 24 hours as of August, 2005. CPC provides the poison hotline for the entire state and handles over 105,000 calls a year 24/7/365. Seventy-five percent of calls are from the general public, with the remainder originating from healthcare providers, pharmacists, law enforcement, etc. CPC is staffed by registered nurses and pharmacists specially trained to provide diagnostic and treatment advice for acute and chronic poisonings to the public and healthcare professionals, backed up by board-certified medical toxicologists.

Objective

This paper describes the use of CPC data for early detection of chemical and environmental events and the follow up protocol development process.

In 2005, three hurricanes made landfall in Florida, with Hurricane Wilma having the most severe impact on Miami-Dade County. Syndromic surveillance is typically used to detect bioterrorism or natural disease outbreaks before specific diagnoses are made. After Wilma, however, the Miami-Dade County Health Department assessed the utility of syndromic data for surveillance of hurricane-related injuries.

Objective

To determine the proportion of injuries in Miami-Dade County that could be related to the impact of Hurricane Wilma, which made landfall in Florida on October 25, 2005.