Infectious Disease

Influenza is a significant public health problems in the US leading to over one million hospitalizations in the elderly population (age 65 and over) annually. While influenza preparedness is an important public health issue, previous research has not provided comprehensive analysis of season-by-season timing and geographic shift of influenza in the elderly population. These findings fail to document the intricacies of each unique influenza season, which would benefit influenza preparedness and intervention. The annual harmonic regression model fits each season of disease incidence characterized by its own unique curve. Using this model, characteristics of the seasonal curve for each state and each season can be compared. We hypothesize that travelling waves of influenza in the 48 contiguous states differ dramatically in each influenza season.

Objective

In surveillance it is imperative that we know when and where a disease first begins. The objective of this study was to examine trends in traveling waves of influenza in the US elderly population. Preparedness for influenza is an important yet difficult public health goal due to variability in annual strains, timing, and shift of the influenza virus. In order to better prepare for influenza epidemics, it is important to assess seasonal variation across individual influenza seasons on a state-by-state basis. This approach will lead to effective interventions especially for susceptible populations such as the elderly.

Respiratory viruses cause substantial morbidity and costly resource utilization among young children, especially during the winter months. Accurate estimates of the impact of these viruses are important in guiding prevention efforts and measuring the impact of public health interventions. Previous studies have focused on the rate of hospitalizations resulting from viral infections, particularly those attributable to influenza virus for which a vaccine is available, but have not included healthcare use in the emergency department (ED) nor considered the impact of other viruses such as respiratory syncytial virus (RSV), for which limited preventative methods are available. We used ED surveillance data for acute respiratory infection to measure the population-based impact of specific viruses.

Objective

To use surveillance data to estimate resource utilization and parental lost productivity associated with influenza and RSV infections among young children.

While mass media coverage of bird flu often provides specific information that may prevent or contain the disease, it is often less than ideal; the public may become fearful and panic at the news of a potential outbreak of bird flu which has a high fatality case rate of more than 60% with no available proven vaccine while supplies of antivirals may be in short supply. As reported by Reuters (3/17/2006) using data from the CDC, a correlation was made between the intense media coverage of bird flu outbreaks overseas in the Fall of ‘05, and a ‘spike’ in sales of Tamiflu which was higher than at any other time over the previous 5 years; documented by syndromic surveillance of Medicaid scrips (NYS DOH), and retail pharmacy sales (NYC DOHMH), authorities suspect the drug was stockpiled.

Objective

To ascertain whether mass media reportage of bird flu outbreaks during the moderate US flu season of 2006-7 influenced sales of antivirals in NYC and Upstate NY as monitored by syndromic surveillance, and to compare such data to that generated during the moderate flu season of 2005-06 following a period of intense media coverage in the Fall of 2005.

The former Soviet Union (FSU)—through the Sanitary-Epidemiologic Service (SES)—developed an extensive system of disease surveillance that was effective, yet centrally planned in Moscow. Even after the fall of the FSU in 1991, most newly independent states maintained all or parts of the SES structure. However, even 15 years later, the loss of economic and technical assistance from Moscow has negatively impacted the effectiveness and efficiency of disease surveillance in these republics, including Armenia and Georgia. In 2005, Armenia and Georgia reported tuberculosis (TB) incidences of 71 and 83, respectively, per 100,000.

Objective

To enhance its effectiveness and efficiency, we evaluated TB surveillance in the FSU Republics of Armenia and Georgia.

We have previously shown that timeliness of detection is influenced both by the data source (e.g., ambulatory vs. emergency department) and demographic characteristics of patient populations (e.g., age). Because epidemic waves are thought to move outward from large cities, patient distance from an urban center also may affect disease susceptibility and hence timing of visits. Here, we describe spatial models of local respiratory illness spread across two major metropolitan areas and identify recurring early hotspots of risk. These models are based on methods that explicitly track illness as a traveling wave across local geography.

Objective

To characterize yearly spatial epidemic waves of respiratory illness to identify early hotspots of infection.

Tuberculosis (TB) has reemerged as a global health epidemic in recent years. Although several researchers have examined the use of space-time surveillance to detect TB clusters, they have not used genetic information to verify that detected clusters are due to person-to-person transmission. Using genetic fingerprinting data for TB cases, we sought to determine whether detected clusters were due to recent transmission.

Objective

This paper describes the utility of prospective spacetime surveillance to detect genetic clusters of TB due to person-to-person spread.

The impetus for the development of many first syndromic surveillance systems was the hope of detecting infectious disease outbreaks earlier than with traditional surveillance. Various data sources have been suggested as potential disease indicators. Researchers have analyzed many of these, including those resulting from behaviors that change due to illness, such as purchasing medications, missing school or work, and using health care call centers or the internet to obtain health information. To define the prodromal behavior of patients presenting for care of acute illnesses, we initiated a pilot survey in the emergency room and acute care clinics at Walter Reed Army Medical Center.

Objective

This study describes the results of a survey given to patients to determine if any changes occurred in their behavior secondary to the illness that could potentially be tracked and used to detect a disease outbreak.

Tuberculosis (TB) has reemerged as a global public health epidemic in recent years. TB remains a serious public health problem among certain patient populations, and is prevalent in many urban areas. The World Health Organization estimates that approximately nine million individuals will develop active TB disease and more than two million will die from TB. The global burden of TB remains enormous, and will likely rank high among public health problems in the coming decades. Although evaluating local disease clusters leads to effective prevention and control of TB, there are few, if any, spatiotemporal comparisons for epidemic diseases. In this study, we used the space-time scan statistic to identify where and when the prevalence of TB is high in Fukuoka Prefecture. The ability to detect disease outbreaks is important for local and national health departments to minimize morbidity and mortality through timely implementation of disease prevention and control measures. Because the statistic meets these needs completely, results that are effective and practical for public health officials are expected from this study.

To evaluate the potential of using the sales of Over the Counter (OTC) medicines for early detection of infections of public health concern, retrospective analysis of the sales of OTC common cold medications used for influenza-like illness (ILI) has been carried out in Japan since 2003. This presentation assess correlations and predictability of OTC sales to ILI for 2004-05 influenza season and compares with the results from 2003-04 season to discuss on robustness and versatility of OTC sales surveillance.

One of the most important goals of disease surveillance is to identify the "what" and "when" of an epidemic. Influenza surveillance is made difficult by inconsistent laboratory testing, deficiencies in testing techniques, and coding subjectivity in hospital records. We hypothesized that respiratory diseases other than influenza may serve as a useful proxy for this infection in pediatric populations, due to similarities in the seasonal characteristics of these illnesses.