Evaluation of Syndromic Surveillance

Data quality monitoring is necessary for accurate disease surveillance. However it can be challenging, especially when “real-time” data are required. Data quality has been broadly defined as the degree to which data are suitable for use by data consumers. When compromised at any point in a health information system, data of low quality can impair the detection of data anomalies, delay the response to emerging health threats, and result in inefficient use of staff and financial resources. While the impacts of poor data quality on biosurveillance are largely unknown, and vary depending on field and business processes, the information management literature includes estimates for increased costs amounting to 8-12% of organizational revenue and, in general, poorer decisions that take longer to make.

Objective

To highlight how data quality has been discussed in the biosur- veillance literature in order to identify current gaps in knowledge and areas for future research. 

Michigan has been collecting chief complaint data from emergency departments statewide to support situational awareness activities related to communicable disease since 2004. We validated the syndromic system by comparing the chief complaint data to the electronic medical records of a tertiary hospital in southeast Michigan to better understand the utility of the system for noncommunicable disease situations.

Objective

Validation of the syndromic system by comparing the chief complaint data to the electronic medical records (EMR) of a tertiary hospital.

Each year, influenza affects approximately 5-20% of the United States population causing over 200,000 hospitalizations and 3,000 – 49,000 death. As a key point of entry to the health care system, EDs are responsible for the initial management and treatment of a substantial proportion of these influenza patients, thus directly impacting overall public health. As the front line of influenza diagnosis and treatment, ED providers may benefit from real-time easily shared influenza surveillance information.

Objective

To evaluate the utility and acceptability of a real-time cloud based influenza surveillance tool amongst emergency department (ED) providers.

Social media is of considerable interest as a sensor into the thoughts, interests and health of a population. We consider three types of health events that an analyst may wish to be made aware of:

- Given a known disease, such as MERS, SARS, Measles, etc., an event corresponds to individuals contracting the disease.

- Given a set of symptoms (fever, stomach pain, etc.), an event is an unusual number of individuals1 complaining of the symptoms.

- Most generally: an event is an unusually large group of individuals who can be identified as being effected by some personal illness.

Note that to detect an “unusual number” of something, we need to count the indicators of the event, and we need to compare the current count with past counts. Further, we are generally interested in geographically constrained events, and so for this work we will focus on county-based counts. We will count the number of items (tweets or individuals) expressing the event indicator (a disease name, symptom, or classified as “personal health related” as indicated by our classifier). Our approach to detecting health related events is: filter -> classify -> detect. We first filter out tweets that contain no “health related” terms, then apply a classifier to each tweet. This classifier is designed to flag a tweet as being about “personal health” or not. We then aggregate the positive instances per day at the county level and detect as an event any county/day pair with an unusually high count (as compared to the recent past).

Objective

In this work we investigate the extent to which social media, in particular Twitter, can be used to detect an outbreak of a disease or illness. We term these outbreaks “events”, and we will describe methodologies for detecting events.

The SAGES (Suite for Automated Global Electronic bioSurveillance) team at the John Hopkins University Applied Physics Laboratory was approached by the Public Health Division of the Research, Evidence and Information Programme of the Secretariat of the Pacific Community (SPC) to explore the feasibility of using the SAGES disease surveillance toolkit for two mass gathering events, the 8th Micronesian Games held from 19-31 July in Pohnpei Federated States of Micronesia and the 3rd International Conference on Small Island Developing States (SIDS) held from 1-4 September 2014 in Apia Samoa.

Mass gatherings are congregations of large numbers of people in a specific location(s) for a defined period of time such as major sporting events, concerts and festivals. A downside of these gatherings is the potential for communicable/infectious diseases to spread efficiently and rapidly. Infected individuals may subsequently return home and disseminate these infections in their local populations.

The Pacific syndromic surveillance system commenced in 2010. Enhanced syndromic surveillance is increasingly being used in mass gatherings. This involves inclusion of more syndromes and more regular reporting than routine syndromic surveillance. While enhanced syndromic surveillance is an important mechanism at mass gatherings, also, and somewhat opportunistically, mass gatherings can provide a unique chance to initiate or strengthen existing surveillance systems.

Objective

Present how a surveillance tool such as SAGES was used for disease surveillance for mass gathering activities.

After the major impact of the 2003 heat wave, France needed a reactive, permanent and national surveillance system enabling to detect and to follow-up various public health events all over the territory including overseas. In June 2004, the French syndromic surveillance system based on the emergency department (ED) has been implemented by the national institute for public health surveillance (InVS). Beginning with 23 ED in 2004, the network has progressively included new ED and several steps have contributed to accelerate this permanent increase. A first evaluation of this data source was conducted for the specific surveillance of heat wave.

Objective

Implemented 10 years ago, the French emergency department surveillance system (Oscour Network) has been assessed using four major evaluation criteria in syndromic surveillance: stability, coverage, data quality and utility.

Spurred by recent advances in PH informatics, the implementation of the Medicare and Medicaid Electronic Health Records Incentive Programs (Meaningful Use), and the opportunities provided by the availability of the redesigned BioSense program, SyS has become an increasingly important component of the biosurveillance enterprise. Knowing how and when jurisdictions use SyS, as well as challenges faced, allows ISDS, ASTHO, CDC, and other partners to provide relevant CBA – information transfer, training, and technical assistance – to further biosurveillance practice.

Objective

To present the results of a nationwide survey designed to assess the syndromic surveillance (SyS) practices and capacity-building assistance (CBA) needs of U.S. state public health authorities (PHAs).

A simplified syndromic surveillance system, based on early detection and reporting of four core syndromes and immediate reporting of unusual events, was established across PICTs in 2010. An early evaluation of the system was undertaken to make recommendations on improvements. The evaluation examined whether the system was meeting its objective of serving as an early warning system and its capacity to investigate and respond to outbreaks. Metrics included system acceptability, data quality, timeliness and level of compliance. The evaluation identified a critical need to better equip local public health officials with the knowledge and skills to rapidly and appropriately respond to suspected infectious disease outbreaks across the Pacific.

In response to the evaluation findings, the RAPID (Response and Analysis for Pacific Infectious Diseases) project was implemented to strengthen capacity in surveillance, epidemiology and outbreak response across the PICTs. Principally funded by Australian aid and developed in partnership with the World Health Organization (WHO), the Secretariat of the Pacific Community (SPC) and the Pacific Public Health Surveillance Network (PPHSN), RAPID is an example of a multi-organisational approach to swiftly address identified surveillance issues and strengthen regional surveillance capacity.

Objective

Surveillance evaluations should not only describe surveillance systems but provide evidence to improve public health practice. This presentation documents how knowledge gathered through a syndromic surveillance evaluation in Pacific Island Countries and Territories (PICTs) with local health personnel was translated into action, in collaboration with global health partners.

The occurrence of global polio is at its lowest level, yet the goal of eradication remains elusive with the ongoing circulation in the three remaining endemic countries. Developed countries have a low index of suspicion for polio – relying on astute clinicians to detect imported cases and high immunisation rates to prevent community outbreaks. Australia, like all polio-free countries, remains at risk of a polio importation until polio is eradicated globally. Gaps in routine immunisation coverage coupled with weaknesses in surveillance may put developed countries, such as Australia, at risk of high impact polio outbreaks.

Objective

Few countries have tested the sensitivity of their polio surveillance systems, undertaken a comprehensive risk assessment or questioned whether existing polio surveillance strategies are the optimal surveillance at this stage of the global eradication initiative. To address this issue, a risk assessment and review of Australia’s polio surveillance systems were undertaken to assess the potential risk of polio introduction by an infected person, product or specimen.

Since April 2012, an integrated syndromic surveillance system in rural China (ISSC) has been established in health facilities in two rural counties of Jiangxi Province, China [1]. The objective of ISSC is to integrate syndromic surveillance with conventional case report system for the early detection of infectious disease outbreak in rural China.

Objective

To evaluate the validity of a syndromic surveillance system in health facilities of rural China, signals generated by Shewhart charts from the reported febrile patients in children were compared with that from the common infectious disease patients reported to the conventional case report system (CISDCP, China Information System for Disease Control and Prevention).