Infectious Disease

The mortality monitoring system (initiated in 2009 during the influenza A(H1N1) pandemic) is a collaboration between the Centre for Infectious Disease Control (CIb) of National Institute for Public Health and the Environment (RIVM) and Statistics Netherlands. The system monitors nation-wide reported number of deaths (population size 2017: 17 million) from all causes, as cause of death information is not available real-time. Data is received from Statistics Netherlands by weekly emails.

Objective:

Weekly numbers of deaths are monitored to increase the capacity to deal with both expected and unusual (disease) events such as pandemic influenza, other infections and non-infectious incidents. The monitoring information can potentially be used to detect, track and estimate the impact of an outbreak or incident on all-cause mortality.

With increasing availability of syndromic meaningful use data, new approaches to disease surveillance utilizing linkages to other data systems are possible. Expanded communicable disease information may be valuable during outbreaks or other public health emergencies. San Diego County is experiencing a significant and protracted hepatitis A outbreak. The disease has been transmitted person-to-person through close contact or through a fecally-contaminated environment, and has been primarily affecting homeless people and injection and non-injection illicit drug users. As of August 31, 2017, there were nearly 400 cases with 15 deaths. Approximately, 70% of the cases were hospitalized. This is one of the nation’s largest hepatitis A outbreaks since the introduction of the hepatitis A vaccine in 1995. Additional cases are expected over the next twelve months. The population affected by this outbreak presents some challenges for outbreak response. It is often a difficult population to reach. In addition, many have multiple comorbidities and often have health care seeking behaviors that differ from the general population. Using the medical record number (MRN) to link hepatitis A disease cases from the communicable disease registry to syndromic HL7 messages for emergency department visits and hospitalizations enabled the identification of additional hospital encounters the cases may have had before, during, or following their hepatitis A disease incident. This allowed an exploration of the ways in which this unique population interacted with the health care system in the context of a communicable disease outbreak. This presentation will highlight the steps to link information across surveillance systems, the results, the challenges, and the benefits of linked information to public health departments.

Objective:

To describe how the County of San Diego linked information from a communicable disease registry and syndromic surveillance system to further describe cases associated with a large hepatitis A outbreak. Specifically, to detail the linkage process which resulted in a longitudinal understanding of individuals’ hospital visits before, during, and after the reported hepatitis A incident.

Influenza is a priority in Armenia. There are two influenza surveillance systems in Armenia: population and sentinel. The medical center (MC) has been included in sentinel surveillance since 2012. In 2015 a study was undertaken to identify gaps in severe acute respiratory infection (SARI) sentinel surveillance system in Surb Astvatsamayr MC.

Objective:

The goal of this study was to identify gaps in the severe acute respiratory infection sentinel surveillance system at Surb Astvatsamayr Medical Center.

The Vietnam National HSS was established in 1994. In the late 1990s and early 2000s, when the epidemic was increasing rapidly, the HSS helped with the intensive close monitoring of the HIV epidemic. In its first 10 years, the HSS was rapidly expanded from 6 to 40 provinces and in some years, it was conducted semi-annually. After two decades, the HIV epidemic situation has changed. In most provinces, HIV prevalence has reported to have declined. Compared to the peak period, the HIV prevalence among key populations (KP) in the past decade decreased from 40-60% to 20% or lower. In many provinces, HIV prevalence was less than 10% among people who inject drugs (PWID) and less than 3% among female sex workers (FSW), and among men who have sex with men (MSM) (Table 1). At the same time, the HIV programme has since been scaled up widely with various interventions and expanded to most of the 63 provinces. In 2014, the government of Vietnam and international stakeholders conducted a joint review of the health sector response to the HIV epidemic and concluded that for better monitoring of the epidemic, a more focused and higher quality surveillance system was needed. In 2015, surveillance stakeholders conducted a detailed review of the HSS to discuss prioritization of the surveillance activities.

Objective:

To describe an exercise to identify priority provinces to be focused in the Vietnam National HIV Sentinel Surveillance (HSS).

The Jermuk region of the Zangezur mezofocus is part of the transcaucasian highland focus of plague. This enzootic area is polyvectorial. The mezofocus has rich fauna with approximately eight species of fleas: Callopsylla caspia, Ctenophthalmus wladimiri, Frontopsylla elata, Amphipsylla rossica, Leptopsylla taschenbergi, Nosopsyllus consimilis, Palaeopsylla vartanovi, and Doratopsylla dampfi. Ct. wladimiri is the most abundant. However, special attention should be paid to C. caspia and N. consimilis as they are the only vectors specific for Yersinia pestis. In these fleas, the bacteria form a plug that blocks digestion and induces starvation. Afflicted fleas bite frenziedly in an effort to feed and the pressure that results releases bacteria from the plug, infecting a new host. Fleas infected with plague during an epizootic are a serious threat to humans, especially when in contact with synanthropic rodents. A survey was conducted to catalog fleas in the foci.

Objective:

The goal was to determine the impact of flea number variation on the epizootic situation in the Jermuk region.

The National Surveillance Team in the Enteric Diseases Epidemiology Branch of the Centers for Disease Control and Prevention (CDC) collects electronic data from all state and regional public health laboratories on human infections caused by Campylobacter, Salmonella, Shiga toxin-producing E. coli, and Shigella in LEDS. These data inform annual estimates of the burden of illness, assessments of patterns in bacterial subtypes, and can be used to describe trends in incidence. Robust digital infrastructure is required to process, validate, and summarize data on approximately 60,000 infections annually while optimizing use of financial and personnel resources.

Objective:

The œledsmanageR, a data management platform built in R, aims to improve the timeliness and accuracy of national foodborne surveillance data submitted to the Laboratory-based Enteric Disease Surveillance (LEDS) system by automating the data processing, validating, and reporting workflow.

Sexually transmitted disease treatment guidelines have incrementally added repeat testing recommendations for Chlamydia trachomatis infections over time, including test-of-cure 3 to 4 weeks following completion of treatment for pregnant women and test-of-reinfection for all patients approximately 3 months after infection. However, few studies have investigated adherence to these recommendations and whether the evolution of guidelines have led to changes in repeat testing patterns over time.

Objective:

To evaluate current rates and temporal trends in adherence with national guidelines recommending chlamydia test-of-cure for pregnant females and test-of-reinfection for all patients.

In May 2015, the MERS-CoV outbreaks in South Korea was sparkled from a hospital of Gyeonggi-do province. In response to this outbreak, the provincial government and infectious disease control center (GIDCC) initiated an emergency department (ED) based Gyeonggi-do provincial acute febrile illness (AFI) surveillance network (GAFINet) to monitor for a subsequent outbreak of emerging or imported infectious diseases since September 2016. Gyeonggi-do province is located in the North-West of South Korea, surrounds the capital city Seoul, and borders North Korea (Figure 1). Considering the geographical coverage, GAFINet Initiative involves ten hospitals, consisted of four university-affiliated hospitals and six provincial medical centers in Gyeonggi-do province. These hospitals participated in this network voluntarily, and most staffs including five infectious diseases specialists had direct or indirect experiences in dealing with MERS-CoV patients.

Objective:

The objectives are to introduce a provincial level surveillance system, which has been initiated in response to the MERS-CoV outbreak of South Korea, and describe findings from systematic investigation of individual admissions attributed to acute febrile illness for the first year.`

The Foot and mouth disease (FMD) virus is a highly contagious and economically devastating trans boundery disease of cloven-hooved domestic and wild animals.

Objective:

To determine the sero-prevalnce of FMD and indicate patterns of animal movement in Borena zone, Ethiopia.

On 3/29/2017, the Maricopa County Department of Public Health (MCDPH) received three reports of confirmed HAV infection from an onsite clinic at Campus A that assists individuals experiencing homelessness, a population at risk for HAV transmission. To identify the scope of the problem, the department initiated rapid HAV infection case detection using NSSP ESSENCE.

Objective:

To demonstrate the utility of the National Syndromic Surveillance Program’s (NSSP) version of the Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) for case detection during a 2017 outbreak of hepatitis A virus (HAV) infection among persons experiencing homelessness in Maricopa County, Arizona.