Surveillance Systems

Under the Electronic Health Record Incentive Program Rule, hospitals are eligible to receive incentive payments from the Centers of Medicare and Medicaid Services provided they meet certain requirements including Meaningful Use (MU). Demonstrating MU requires meeting a core and menu set of objectives including the capability to submit electronic syndromic surveillance, Electronic Lab Reporting (ELR), and immunization data in accordance with state law and practice. NH is building a NH Heath Information Exchange to serve all NH's MU needs including those of public health. This represents a huge opportunity for public health to collect more data to enhance disease detection and control, improve safety, and reduce health disparities, but also presents an integration challenge.

Objective

To describe steps used to build the required infrastructure to meet Public Health MU reporting requirements for electronic syndromic surveillance, ELR, and immunization data in NH Division of Public Health Services.

Influenza is a serious disease that seasonality causes substantial but varying morbidity and mortality. In Taiwan, estimates of the influenza mortality burden were based on post-hoc analyses of national mortality statistics and not available until at least six months after the corresponding epidemic. Timely monitoring and early detection of influenza-associated excess mortality can guide antiviral or vaccine interventions and help healthcare capacity planning. Beginning April 2009, Taiwan Centers for Disease Control has been collaborating with the Department of Health Office of Statistics to develop an automated system for real-time pneumonia and influenza (P&I) mortality surveillance.

Objective 

To develop and evaluate a nationwide automated system for early detection of aberrations and real-time monitoring of P&I mortality in Taiwan.

Historically, it has been the role of local health departments to administer, monitor, and report flu vaccinations of its residents to the state health department. In 2009, the looming threat of an influenza outbreak (H1N1) led to the extension of the Public Readiness and Emergency Preparedness Act (PREP) (1). On June 15, 2009, Kathleen Sebelius, Secretary of Health and Human Services, assigned all entities, including organizational and individual, tort liability immunity in the distribution and administration of H1N1 vaccines (1). This extension subsequently impaired local health departments ability to capture accurate estimates of flu immunizations being administered to their respective populations. Stark County Health Department, located in Ohio, in collaboration with Kent State University's College of Public Health, designed, developed, and deployed FITS based on the urgent need of accurate population data regarding influenza immunization at the county level.

Objective

To develop and implement a web-based, county-level flu immunization record keeping system that accurately tracks non-identifiable vaccine recipients and seamlessly uploads to the state record keeping system.

Work on vaccination timing and promotion largely precedes the 2009 pandemic. Post-pandemic studies examining the wide range of local vaccination efforts mostly have been limited to surveys assessing the role of administrative strategies, logistical challenges, and perceived deterrents of vaccination [1].

Objective

To assess the effectiveness of a Public Health automated phone campaign to increase vaccination uptake in targeted neighborhoods. To identify alternative predictors of variation in vaccination uptake, specifically to assess the association between vaccination uptake, and weather conditions and day-of-week.

Taiwan had established a nation-wide emergency department (ED)-based syndromic surveillance system since 2004, with a mean detection sensitivity of 0.67 in 2004-06 [1]. However, this system may not represent the true epidemic situation of infectious disease in community, particularly those who don't seek medical care [2]. Moreover, the epidemiological settings, sources of the infection and social network all together may still facilitate the transmissions. These rooted problems cannot be rapidly solved.

Objective

This study has two specific aims:

(1) to establish a web-based, public-access infectious disease reporting system (www.eid.url.tw), using newly designed public syndrome groups and based on computational and participatory epidemiology

(2) to evaluate this system by comparing the epidemiological patterns with national-wide electronic health-database and traditional passive surveillance systems from Taiwan-CDC.

The ability to estimate and characterize the burden of disease on a population is important for all public health events, including extreme heat events. Preparing for such events is critical to minimize the associated morbidity and mortality [1, 2]. Since there are delays in obtaining hospital discharge or death records, monitoring of ED visits is the timeliest and an inexpensive method for surveillance of HRI [1]. Aside from air temperature, other environmental variables are used to issue heat advisories based on the heat index, including humidity and wind [3]. The purpose of this study was to evaluate the relationship between HRI ED visits and weather variables as predictors, in Ohio.

Objective

Correlation and linear regression analyses were completed to evaluate the relationship between a heat-related illness (HRI) classifier using emergency department (ED) chief complaint data and specific weather variables as predictors, in Ohio.

In 2004, the Marion County Public Health Department (MCPHD), which serves a county population over 890,000, began using a real time syndromic surveillance system, ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics) to assist in detecting possible disease outbreaks. Today, about 1600 emergency department visits occur daily in Marion County's 14 emergency departments. Epidemiologists from MCPHD have contributed to the city's Extreme Temperature plans for the last few years. While most of the previous increases in heat related illnesses in Marion County have been attributed to prolonged heat exposure in connection with local auto races, the county had not activated the county wide emergency response plan in several years. From Tuesday, July 19 through Friday, July 22, 2011 the Marion County Extreme Temperature plan was put into action in response to several days of a high heat index.

Objective

To evaluate the usefulness of utilizing real time hospital emergency department chief complaint data to estimate counts of patients presenting at emergency departments with heat related illness during the July 2011 Heat Wave in Indianapolis.

Life science and biotechnology advances have provided transforming capabilities that could be leveraged for integrative global biosurveillance. Global infectious disease surveillance holds great promise as a tool to mitigate the endemic and pandemic infectious disease impacts, and remains an area of broad international interest. All nations have significant needs for addressing infectious diseases that impact human health and agriculture, and concerns for bioenergy research and environmental protection. In January 2011, Los Alamos National Laboratory, Department of State, and the Defense Threat Reduction Agency co-hosted the "Global Biosurveillance Enabling Science and Technology" Conference. Guided by the National Strategy for Countering Biological Threats, and joined by major government stakeholders, the primary objective was to bring together the international technical community to discuss the scientific basis and technical approaches to an effective and sustainable InGBSV system and develop a research agenda enabling a long-term, sustainable capability. The overall objective of the conference was to develop a technology road map for InGBSV, with three underlying components: 1) Identify opportunities for integrating existing biosurveillance systems, the near-term technological advancements that can support such integration, and the priority of future research and development areas; 2) Identify the required technical infrastructure to support InGBSV, such as methodologies and standards for technology evaluation, validation and transition; 3) Identify opportunities, and the challenges that must be overcome, for partnerships and collaborations.

Objective

To review observations and conclusions from a recent Global Biosurveillance conference, provide an assessment of the scientific and technical capabilities and gaps to achieve an effective and sustainable integrative global biosurveillance (InGBSV) system, and recommend research and development priorities enabling InGBSV.

Disease screening facilitates the reduction of disease prevalence in two ways: (1) by preventing transmission and (2) allowing for treatment of infected individuals. Hospitals choosing an optimal screening level must weigh the benefits of decreased prevalence against the costs of screening and subsequent treatment. If screening decisions are made by multiple decision units (DU, e.g., hospital wards), they must consider the disease prevalence among admissions to their unit. Thus, the screening decisions made by one DU directly affect the disease prevalence of the other units when patients are shared. Because of this interdependent relationship, one DU may have an incentive to "free-ride" off the screening decisions of others as the disease prevalence declines. On the other hand, DUs may find it futile to invest in screening if they admit a large number of infected patients from neighbors who fail to screen properly. This problem is important in determining the optimal level of unit autonomy, since increasing a unit's level of autonomy in screening effectively increases the total number of DUs.

Objective

To analyze optimal disease screening in strategic multi-unit settings, and determine how the level of unit autonomy may effect screening decisions.

Argus is an event-based, multi-lingual surveillance system which captures and analyzes information from publicly available Internet media. Argus produces reports that summarize and contextualize indications and warning (I&W) of emerging threats, and makes these reports available to the system's users. The significance of the Escherichia coli (EHEC) outbreak analyzed here lies primarily in the fact that it raised epidemiological questions and public health infrastructure concerns that have yet to be resolved, and required the development of new resources for detecting and responding to newly-emerging epidemics.

Objective

To demonstrate how event-based biosurveillance, using direct and indirect I&W of disease, provides early warning and situational awareness of the emergence of infectious diseases that have the potential to cause social disruption and negatively impact public health infrastructure, trade, and the economy. Specifically, tracking of I&W during the 2011 enterohaemorrhagic EHEC O104:H4 outbreak in Germany and Europe was selected to illustrate this methodology.