Mass Gathering Surveillance

A Quest Diagnostics Incorporated – CDC collaboration in 2000  pioneered  exploration  of  test  ordering data to enhance infectious diseasessurveillance1. This  year’s  unexpected shortage of vaccine and reports of human illness caused by avian influenza  A  (H5N1)  in  Asia2  heightened concern about  influenza and focused attention on moving toward more complete, real time surveillance. We extended our previous collaboration to explore the use of  the Quest Diagnostics Corporate Informatics Data Warehouse (QIDW) as a tool for surveillance of influenza.

Objective

To explore the potential of a large commercial data warehouse for influenza surveillance.

Homeland Security Presidential Directive – 21 (HSPD-21) requires the Department of Health and Human Services to establish a national biosurveillance capability that provides early warning and situation awareness for urgent public health events.  Early concepts of biosurveillance focused primarily on syndromic surveillance methodologies; while recent descriptions call for a more comprehensive and integrated approach to determine a nationwide biosurveillance capability (1, 2).

Objective:

Develop consensus for the definition, scope and assessment of current nationwide capability for biosurveillance based on diverse stakeholder input.

In 2016, the BioSense Platform for national syndromic surveillance made substantial enhancements including data processing changes, a national ESSENCE instance, and management tools to support diverse data sharing needs. On August 21, 2017, a total solar eclipse occurred over much of the United States. The event resulted in large gatherings over multiple days to areas in the Path of Totality (PoT). In the days leading up to the event, public health and emergency preparedness included syndromic surveillance in their monitoring plans. To support this effort, Illinois (IL), Kentucky (KY), and Tennessee (TN) established inter-jurisdictional aggregate data sharing to get a more inclusive view of cause-specific illness or injury in Emergency Department (ED) visits before, during, and after the eclipse.

Objective:

Describe cross-jurisdictional data sharing practices using ESSENCE and facilitated by the BioSense Platform for a national mass gathering event, and the dashboard views created to enhance local data for greater situational awareness.

Oregon’s statewide syndromic surveillance system (Oregon ESSENCE) has been operational since 2012. Non-federal emergency department data (and several of their associated urgent care centers) are the primary source for the system, although other data sources have been added, including de-identified call data from OPC in 2016. OPHD epidemiologists have experience monitoring mass gatherings and have a strong relationship with OPC, collaborating on a regular basis for routine and heightened public health surveillance. Nevertheless, surveillance for the Great American Solar Eclipse (August 2017) presented a challenge due to the 107 reported simultaneous statewide eclipse-watching events planned for the day of the eclipse (some with estimated attendance of greater than 30,000 people and most in rural or frontier regions of the state). Scientific literature is limited on mass gathering surveillance in the developed world, particularly in rural settings, so OPC and OPHD worked together to develop a list of health conditions of interest, including some that would warrant both an ED visit and a call to OPC (e.g., snake bites). Monitoring visits in both data sources in would allow for assessment of total burden on the healthcare system, especially in the case of snake bites where only specific bites require administration of anti-venom.

Objective:

Identify surveillance priorities for emergency department (ED) and Oregon Poison Center (OPC) data ahead of the 2017 Great American Solar Eclipse gatherings in Oregon and create a suite of queries for use in the Health Intelligence Section of the Oregon Public Health Division (OPHD) Incident Management Team (IMT).

The massive flow of people to mass gathering events, such as festivals or sports events like EURO 2016, may increase public health risks. In the particular context of several terrorist attacks that took place in France in 2015, the French national Public Health agency has decided to strengthen the population health surveillance systems using the mandatory notification disease system and the French national syndromic surveillance SurSaUD®. The objectives in terms of health surveillance of mass gathering are: 1/ the timely detection of a health event (infectious cluster, environmental exposure, collective foodborne disease…) 2/ the health impact assessment of an unexpected event such as a terrorist attack. In collaboration with the Regional Emergency Observatory (ORU), a procedure for the labeling of emergencies has been tested to identify the ED records that could be considered as linked to the event.

Objective:

To access the potential health impact on the population during mass gathering over time using labelling procedure in emergency department (ED).

Global Mass gatherings (MGs) such as Olympic Games, FIFA World Cup, and Hajj (Muslim pilgrimage to Makkah), attract millions of people from different countries. The gathering of a large population in a proximity facilitates transmission of infectious diseases. Attendees arrive from different geographical areas with diverse disease history and immune responses. The associated travel patterns with global events can contribute to a further disease spread affecting a large number of people within a short period and lead to a potential pandemic. Global MGs pose serious health threats and challenges to the hosting countries and home countries of the participants. Advanced planning and disease surveillance systems are required to control health risks in these events. The success of computational models in different areas of public health and epidemiology motivates using these models in MGs to study transmission of infectious diseases and assess the risk of epidemics. Computational models enable simulation and analysis of different disease transmission scenarios in global MGs. Epidemic models can be used to evaluate the impact of various measures of prevention and control of infectious diseases.

Objective:

To develop a computational model to assess the risk of epidemics in global mass gatherings and evaluate the impact of various measures of prevention and control of infectious diseases.

The Great American Solar Eclipse of 2017 provided a rare opportunity to view a complete solar eclipse on the American mainland. Much of Oregon was in the path of totality and forecasted to have clear skies. Ahead of the event, OPHD aggregated a list of 107 known gatherings in mostly rural areas across the state, some with estimated attendance of up to 30,000 attendees. Temporary food vendors and a range of sanitation solutions (including open latrines) were planned. International travelers were expected, along with large numbers of visitors traveling by car on the day of the eclipse. The potential for multiple simultaneous mass gatherings across the state prompted OPHD to activate an incident management team (IMT) and to create a Health Intelligence Section to design a mass gathering surveillance strategy. Statewide syndromic surveillance (Oregon ESSENCE) has been used to monitor previous mass gatherings (1) and captures statewide emergency department (ED), urgent care, Oregon Poison Center, and reportable disease data.

Objective:

Develop a public health surveillance plan for the Oregon Public Health Division (OPHD) in anticipation of the expected influx of visitors for the 2017 Great American Solar Eclipse.

The August 21, 2017 total solar eclipse in Idaho was anticipated to lead to a large influx of visitors in many communities, prompting a widespread effort to assure Idaho was prepared. To support these efforts, the Idaho Syndromic Surveillance program (ISSp) developed a plan to enhance situation awareness during the event by conducting syndromic surveillance using emergency department (ED) visit data contributed to the National Syndromic Surveillance Program’s BioSense platform by Idaho hospitals. ISSp sought input on anticipated threats from state and local emergency management and public health partners, and selected 8 syndromes for surveillance. Ideally, the first electronic message containing information on an emergency department visit is sent to ISSp within 24 hours of the visit and includes the chief complaint for the visit. Data on other variables, such as diagnosis codes, are updated by subsequent messages for several days after the visit. Chief complaint (CC) text and discharge diagnosis (DD) codes are the primary variables used for syndrome match; delay in reporting these variables adversely affects timely syndrome match of visits. Because our plan included development of new syndrome definitions and querying data within 24 hours of visits, earlier than ISSp had done previously for trend analysis, we sought to better understand syndrome performance.

Objective:

In August 2017, a large influx of visitors was expected to view the total solar eclipse in Idaho. The Idaho Syndromic Surveillance program planned to enhance situation awareness during the event. In preparation, we sought to examine syndrome performance of several newly developed chief complaint and combination chief complaint and diagnosis code syndrome definitions to aid in interpretation of syndromic surveillance data during the event.

Final Four-associated events culminated in four days of intense activity from 3/31/17-4/3/17, which attracted an estimated 400,000 visitors to Maricopa County (population 4.2 million). Field teams of staff and volunteers were deployed to three days of Music Fest, four days of Fan Fest, and three Final Four games (Games) as part of an enhanced epidemiologic surveillance system.

Objective:

To describe and present results of field-based near-real time syndromic surveillance conducted at first aid stations during the 2017 National Collegiate Athletic Association Division I Men’s College Basketball Championship (Final Four) events, and the use of field team data to improve situational awareness for Mass Gathering events.