Surveillance Systems

The New York State (NYS) Medicaid Program provides healthcare for 34% of the population in New York City (NYC) and 4%-20% in each of the 57 county populations up-state. Prescription data are collected through the sub-mission of claims forms to the Medicaid Program and transmitted daily to the NYS Syndromic Surveillance Program as summary counts by drug category and patient’s ZIP Code, age category, and sex. One of the 18 drug categories is influenza agents, which in-cludes rimantadine, oseltamivir, and zanamivir.

For surveillance of influenza-like illness (ILI) activity, the NYS and NYC Sentinel Physician Influenza Surveillance Program collects from sentinel physicians weekly reports of the total number of patients seen and the number of patients presenting with ILI (defined as temperature > 100 degrees F, presence of cough or sore throat, and absence of other known cause of these symptoms). Not all counties in NYS have sentinel physicians: in the 2003-2004 flu surveillance season (Week 40, in early October, 2003, to Week 20, in late May, 2004), 37 of 57 upstate counties and all 5 counties of NYC had sentinel physicians.

Objective

To evaluate the usefulness of daily counts of prescriptions for influenza agents charged to Medicaid insurance, by county of residence of the recipient, for detection of elevated ILI in NYS, currently monitored through physicians participating in the CDC Influenza Surveillance Program.

A number of syndromic surveillance systems include tools that quickly identify potentially large disease outbreak events. However, the high falsepositive rate continues to be a problem in all of these systems. Our earlier work has showed that multi-source information fusion can improve specificity of the syndromic surveillance systems. However, an anomalous health event that presents as only a few cases may remain undetected because the chief complaint data does not contain enough details. New linked data sources need to be used to enhance detection capabilities. The focus of this project examining the incorporation of laboratory, prescription medications and radiology data linked to the patient encounter within syndromic surveillance systems. These data source linkings may enhance the sensitivity of syndromic surveillance.

Lymphatic filariasis is one of the most prevalent of the tropical diseases, but is also the most neglected.Though significant advances have been made in the understanding both the disease and its control, there is general lack of information about its socioeconomic effects, prevalence and distribution in most endemic societies. Presently, there is global effort towards the elimination of the disease by 2020. The success of this programme depends largely on the use of simple, non-invasive procedures to identify endemic communities. Limb elephantiasis is one of the chronic symptoms of lymphatic filariasis that could be easily diagnosed by persons with minimum training. Therefore, the prevalence of elephantiasis could serve as a useful tool to determine the occurrence and spread of lymphatic filariasis in endemic communities.

Objective

This paper describes how limb elephantiasis was used to determine the occurrence and spread of lymphatic filariasis in Kano state, Nigeria as well as the use of the results for further epidemiological studies.

The first prototype syndromic surveillance in Japan was used during the G8 summit meeting in 2000 with two local prefectures involved. The second trial syndromic surveillance and the first internet-based surveillance used in 2002 for the Japan-Korea 2002 World Cup soccer games. Since 2002, surveillances on over-the-counter medications, ambulance call, and outpatient visits were explored as syndromic approach candidates for early detection. Internet-based events and case reporting frame work has been reviewed for outpatient visits daily reporting concurrently. Limited spread of electrical patient record and vast range of commercialized medical record formats posed obstacles to nationwide syndromic surveillance implementation.

Recent threats from bioterrorism and influenza pandemic empowered Japanese government introducing surveillance of rapid detection mechanism. In line with the revision of the Infection Control Law took place in 2007 April, national syndromic surveillance system was implemented.

Objective

This paper describes recent establishment of national surveillance system for early detection of infectious diseases in Japan. With diagnostic data fed from existed routine surveillance, newly introduced system is expected to provide timely information for control response. We aim to facilitate cross-informative regional surveillance by sharing our experience and system frame work.

This paper describes the early warning that has been activated by the syndromic surveillance system installed within the Armed Forces in French Guiana and the consequences for Public Health decisions.

Objective

To enable the early detection of pandemic influenza, we have designed a system to differentiate between severe and mild influenza outbreaks. Historic information about previous pandemics suggested the evaluation of two specific discriminants: (1) the rapid development of disease to pneumonia within 1-2 days and (2) patient age distribution, as the virus usually targets specific age groups. The system is based on the hypothesis that an increased number of diagnosed pneumonia cases offers an early indication of severe influenza outbreaks. This approach is based on the fact that pneumonia cases will appear promptly in a severe influenza outbreak and can be diagnosed immediately in a physician office visit, while a confirmed influenza diagnosis requires a laboratory test. Furthermore, laboratory tests are unlikely to be ordered outside of the expected influenza season.

Bioterrorism surveillance is an integral component of DCHD’s Comprehensive Emergency Management Plan. This study was a collaborative effort between Duval County Health Department, University of South Florida’s Center for Biological Defense (CBD), and DataSphere, LLC. DCHD’s role in the project was to identify surveillance sites, involve community partners, share data/info with surrounding agencies, counties and the state department of health, and secure funding for the system. CBD’s role in the project was facilitating the operational and technical implementation of the system and serving as a liaison between hospitals, health departments, and DataSphere, LLC. DataSphere, LLC owns and operates BioDefend and was responsible for the technical setup and maintenance of the system. The study addressed the feasibility of automated data collection by healthcare facilities and issues related to implementation of a syndromic surveillance system.

Objective

The purpose of this study was to evaluate the implementation of the BioDefend syndromic surveillance system for its use.

Recent health events in France, such as the dramatic excess of mortality occurred during the 2003 heat wave showed the need for a better provision of information to health authorities. A new syndromic surveillance system based on the recording of general practitioner’s visits by SOS Médecins has been developed by the Aquitaine Regional Epidemiology unit (Cire).

Objective

To describe the surveillance system based on SOS Medecins data, the first GP emergency and healthcare network in France and to show the utility and validity of this data source as a real-time syndromic surveillance system.

An outbreak of dengue fever has occured in French Guiana since the end of November 2005 until July 2006. The dengue serotype circulating was DEN-2, responsible of more than 2 000 confirmed cases and 4 deaths. The previous surveillance system was only based on the laboratories data, and didn’t permit to assess the real situation of dengue infection within the population of French Guiana. Actually, the dengue fever being a viral infection for which no etiological treatments nor immunization were available, a lot of general practioners didn’t send their patients to laboratories but prescribed only a symptomatic treatment. A survey made on the field during February 2006 in a town of 5000 inhabitants in the West of French Guiana showed that the real situation within the population was really more important than the one evaluated by the current surveillance system (135 suspected cases for only 13 confirmed cases reported by the network of laboratories). For that reason, it was decided to put in place a syndromic surveillance system, which can permit to have a better knowledge of the situation for dengue fever. The objectives of this new system were i) to detect earlier the beginning of an outbreak ii) to have a better estimation of the impact of the outbreak within the population and iii) to permit the evaluation of the Public Health strategy set up.

Objective

This paper describes a new syndromic surveillance system installed in French Guiana in April 2006 during an outbreak of dengue fever.

A pandemic caused by influenza A/H5N1 or another novel strain could kill millions of people and devastate economies worldwide. Recent computer simulations suggest that an emerging influenza pandemic might be contained in Southeast Asia through rapid detection, antiviral distribution, and other interventions [1]. To facilitate containment, the World Health Organization (WHO) has established large, global antiviral stockpiles and called on countries to develop rapid pandemic detection and response protocols [2]. However, developing countries in Southeast Asia would face significant challenges in containing an emerging pandemic. Limited surveillance coverage and diagnostic capabilities; poor communication and transportation infrastructure; and lack of resources to investigate outbreaks could cause critical delays in pandemic recognition. Wealthy countries have committed substantial funds to improve pandemic detection and response in developing countries, but tools to guide system planning, evaluation, and enhancement in such places are lacking.

Objective

We propose a framework for evaluating the ability of syndromic, laboratory-based, and other public health surveillance systems to contain an emerging influenza pandemic influenza in developing countries, and apply the framework to systems in Laos.