Surveillance Systems

Group A Streptococcal (GAS) pharyngitis, the most common bacterial cause of acute pharyngitis, causes more than half a billion cases annually worldwide. Treatment with antibiotics provides symptomatic benefit and reduces complications, missed work days and transmission. Physical examination alone is an unreliable way to distinguish GAS from other causes of pharyngitis, so the 4-point Centor score, based on history and physical, is used to classify GAS risk. Still, patients with pharyngitis are often misclassified, leading to inappropriate antibiotic treatment of those with viral disease and to under-treatment of those with bone fide GAS. One key problem, even when clinical guidelines are followed, is that diagnostic accuracy for GAS pharyngitis is affected by earlier probability of disease, which in turn is related to exposure. Point-of-care clinicians rarely have access to valuable biosurveillance-derived contextualizing information when making clinical management decisions.

Objective

The objective of this study was to measure the value of integrating real-time contemporaneous local disease incidence (biosurveillance) data with a clinical score, to more accurately identify patients with Group A Streptococcal (GAS) pharyngitis.

The EPA Water Security initiative contamination warning system (CWS) detection strategy involves the use of multiple monitoring and surveillance components for timely detection of drinking water contamination in the distribution system. The public health surveillance (PHS) component of the contamination warning system involves the analysis of health-related data to identify disease events that may stem from drinking water contamination. Public health data include hospital admission reports, infectious disease surveillance, emergency medical service reports, 911 calls and poison control center (PCC) calls. Automated analysis of these data streams results in alerts, which are investigated by health department epidemiologists. A comprehensive operational strategy was developed to describe the processes and procedures involved in the the initial investigation and validation of a PHS alert. The operational strategy established specific roles and responsibilities, and detailed procedural flow descriptions. The procedural flow concluded with the determination of whether or not an alert generated from surveillance of public health data streams is indicative of a possible water contamination incident.

Objective

To develop standard operating procedures (SOPs) to identify or rule out possible water contamination as a cause for a syndromic surveillance alarm.

The Office of the Medical Examiner (OME) is a statewide system for investigation of sudden and unexpected death in Utah. OME, in the Utah Department of Health (UDOH), certified over 2000 of the 13,920 deaths in Utah in 2008. 

Information from OME death investigations is currently stored in three separate UDOH data silos that have limited interoperability. These three electronic data systems include death certificates, medical examiner investigations, and laboratory results. Without interoperability, OME staff is required to enter the same data into multiple systems. In addition, the process of requesting laboratory analysis and receiving results is paper based, significantly slowing final cause of death determination in a majority of cases. 

Epidemiological studies and surveillance activities are hindered by the lack of systems integration in UDOH and often require retrospective data linkage. As an example, in 2005, CDC and the UDOH reported that deaths in Utah caused by drug poisoning from non-illicit drugs had increased fivefold from 1991 to 2003. This significant finding relied on retrospective linkage of death certificates, medical examiner records, and toxicology results to describe the problem.

In 2008, funding from a bioterrorism grant from the US Department of Homeland Security was secured to support development of a unique, integrated system for medical examiner and death certificate data.

Objectives

The objectives of the Utah Medical Examiner Database project are: 

• To provide a single point of entry for medical examiner pathologists and staff to manage investigation information. 
• To develop an operational system that links death certificate, medical examiner, and laboratory data in real time as a resource for epidemiology and public health surveillance.

Previous reports have demonstrated the media’s influence on emergency departments (ED) visits in situations such as dramatized acetaminophen overdose, media report of celebrity suicides, television public announcements for early stroke care and cardiac visits following President Clinton’s heart surgery. No previous study has demonstrated the influence of media-publicized trauma on ED visits. On 16 March 2009, the actress Natasha Richardson suffered a traumatic brain injury leading to her death on 18 March; these events were widely publicized by national news sources. The health departments of New York City, Boston, Duval County and Seattle monitor ED visits daily, and capture 95, 100, 100 and 95% of all ED visits, respectively. The data collected include basic demographic information, chief complaint and in some cases ICD-9 diagnosis codes.

Objective

This study describes an increase in head trauma-related visits to ED in New York City, New York; Boston, Massachusetts; Duval County, Florida; and Seattle, Washington following the widespread media coverage of actress Natasha Richardson’s head injury and subsequent fatal epidural hematoma.

The HL7 messaging standard, version two that was implemented by most vendors and public health agencies did not resolve all systems’ interoperability problems. Design and tool implementation for automated machine-testing messages may resolve many of those problems. This task also has critical importance for rapid deployment of electronic public health systems.

Objective

This document describes the Public Health Information Network efforts on the development of the messaging quality framework, a flexible framework of services and utilities designed to assist public health partners with preparing and communicating quality, standard electronic messages.

 

Group A Streptococcal (GAS) pharyngitis, the most common bacterial cause of acute pharyngitis, causes more than half a billion cases annually worldwide. Treatment with antibiotics provides symptomatic benefit and reduces complications, missed work days and transmission. Physical examination alone is an unreliable way to distinguish GAS from other causes of pharyngitis, so the 4-point Centor score, based on history and physical, is used to classify GAS risk. Still, patients with pharyngitis are often misclassified, leading to inappropriate antibiotic treatment of those with viral disease and to under-treatment of those with bone fide GAS. One key problem, even when clinical guidelines are followed, is that diagnostic accuracy for GAS pharyngitis is affected by earlier probability of disease, which in turn is related to exposure. Point-of-care clinicians rarely have access to valuable biosurveillance-derived contextualizing information when making clinical management decisions.

Objective

The objective of this study was to measure the value of integrating real-time contemporaneous local disease incidence (biosurveillance) data with a clinical score, to more accurately identify patients with GAS pharyngitis.

The EPA Water Security initiative contamination warning system detection strategy involves the use of multiple monitoring and surveillance components for timely detection of drinking water contamination in the distribution system. The public health surveillance (PHS) component of the contamination warning system involves the analysis of health-related data to identify disease events that may stem from drinking water contamination. Public health data include hospital admission reports, infectious disease surveillance, emergency medical service reports, 911 calls and poison control center calls. Automated analysis of these data streams results in alerts, which are investigated by health department epidemiologists. A comprehensive operational strategy was developed to describe the processes and procedures involved in the the initial investigation and validation of a PHS alert. The operational strategy established specific roles and responsibilities, and detailed procedural flow descriptions. The procedural flow concluded with the determination of whether or not an alert generated from surveillance of public health data streams is indicative of a possible water contamination incident.

Objective

To develop standard operating procedures to identify or rule out possible water contamination as a cause for a syndromic surveillance alarm.

The summer of 2010 in Maryland was characterized by unusually high temperatures. This type of increased and prolonged heat can potentially make residents sick, and extreme exposure can even kill people at highest risk. Numerous deaths throughout the state were attributed to this heat wave. The Maryland Department of Health and Mental Hygiene addressed this public health issue by using public messaging and maintaining constant situational awareness through the electronic syndromic surveillance. Thus, the electronic surveillance system for the early notification of community-based epidemics (ESSENCE) was used to monitor heat-related illnesses throughout the state.

Objective

This paper describes the use of ESSENCE, a syndromic surveillance system, to monitor heat-related illnesses throughout the state of Maryland during the summer of 2010.

NC DETECT receives daily data files from emergency departments (ED), the statewide EMS data collection system, the statewide poison center, and veterinary laboratory test results. Included in these data are elements, which may contain Protected Health Information (PHI). It is the responsibility of NC DETECT to ensure that security of these data is managed during their entire life cycle, including receiving, loading, cleaning, storage, managing, reporting, user access, archiving, and destruction. A web interface is provided for users at state, regional and local levels to access syndromic surveillance reports, as well as reports for broader public health surveillance such as injury, occupational health, and disaster management.

Objective

This paper describes how the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) utilizes various methods of encryption and access control to protect sensitive patient data during both integration and reporting.

NPDS is the only source for national surveillance data regarding human exposures to hazardous substances and their health effects. It is a near real-time surveillance system operated by the American Association of Poison Control Centers (AAPCC) in cooperation with CDC’s National Center for Environmental Health. The system receives, analyzes, and displays data from 60 regional Poison Centers (PCs). On 20 April 2010, an explosion occurred on the Deepwater Horizon oil rig, causing oil to be continuously spilled into the Gulf of Mexico. In response, AAPCC created a code that was sent to all 60 PCs, allowing the centers to identify and properly code all calls associated with the oil spill at the local level. This enabled CDC to track all spill-related exposure and information calls.

Objective

The objective of this study was to describe how National Poison Data System (NPDS) was used for surveillance of human health effects associated with crude oil and dispersant exposures during the Deepwater Horizon Oil Spill.