Surveillance Systems

Our objective was to adapt the city'­s syndromic surveillance system to help guide a violence intervention initiative in response to an upsurge in serious assaults and homicides in Boston.

The interpretation of aberrations detected by syndromic surveillance is critical for success, but poses challenges for local health departments who must conduct appropriate follow-up and confirm outbreaks. This paper describes the response of the Boston Public Health Commission (BPHC) to a cluster of emergency department (ED) visits in children detected by syndromic surveillance.

We explored the utility of tracking emergency department (ED) visits for febrile illness as a proxy for influenza surveillance, from both a local and a regional perspective.

To evaluate whether a rise or shift in severe morbidity and mortality by influenza can be detected with syndromic surveillance.

There are multiple sources of influenza and influenza-like illness (ILI) surveillance data within the state of Georgia. These include laboratory surveillance for influenza viruses, sentinel providers that report ILI, pneumonia and influenza mortality, influenza-associated hospitalizations, and influenza-associated pediatric deaths. The usefulness of emergency department-based (ED) syndromic surveillance (SS) data as an additional source of ILI surveillance data is currently being evaluated at national, state, and local levels.

Objective

To describe Georgia’s experience using ED-based SS as a source of influenza-like illness surveillance data.

Syndromic surveillance using over the counter (OTC) sales has been shown to provide earlier signals of diarrheal and respiratory disease outbreaks than hospital diagnoses. Under normal circumstances, sales patterns of OTC sales related to gastrointestinal illness (GI) are high in the winter and low in the summer. The Canadian laboratory-based surveillance system that provides weekly counts of reportable bacterial, parasitic and viral isolates by province, has shown that bacterial and parasitic infections tend to be higher in summer and early fall, whereas viral infections (particularly Norovirus and Rotavirus) appear to peak in winter and spring. This suggests that the OTC sales reflect underlying community viral infections rather than bacterial or parasitic infections. If OTC sales are to be considered for use in syndromic surveillance of community GI, the nature of this relationship needs to be clarified. The main objective of this study was to compare temporal distributions of GI-related OTC sales to laboratory-isolate patterns of bacterial, parasitic and viral cases of human GI infections.

Objective

To assess if OTC sales of GI related medications are associated with temporal trends of reportable community viral, bacterial and parasitic infections.

Syndromic surveillance is the surveillance of healthrelated data that precedes diagnosis to detect a disease outbreak or other health related event that warrants a public health response. Though syndromic surveillance is typically utilized to detect infectious disease outbreaks, its utility to detect bioterrorism events is increasingly being explored by public health agencies. Many agencies believe that syndromic surveillance holds great promise in enhancing our ability to detect both planned and unplanned outbreaks of disease and have made significant investments to develop syndromic surveillance capabilities.

For instance, the Centers for Disease Control and Prevention has invested in Biosense and the Department of Defense has invested in the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) which it has deployed in partnership with the Department of Veterans Affairs. The Department of Homeland Security has invested heavily in the National Bio-surveillance Integration System which integrates a broad spectrum of bio-surveillance information including data from Biosense and ESSENCE. The University of Pittsburgh has also developed a prominent tool and is considered a thought leader in this space.

Despite the significant investments in the area of syndromic surveillance, the technology is young and the relatively small field remains fragmented. As a result, there is limited public information that addresses the field as a whole.

Objective

The objective of this assessment is to research, develop and maintain a national syndromic surveillance registry that describes each system’s configuration. By collecting current information on the leading systems we will gain a greater understanding of the syndromic surveillance landscape and capabilities.

When a chemical or biological agent with public health implications is detected in the City of Houston, analysis of syndromic surveillance data is an important tool for investigating the authenticity of the alert, as well as providing information regarding the extent of contamination.

Syndromic surveillance data in Houston is currently provided by the Real-Time Outbreak Disease Surveillance, which collects and synthesizes real-time chief complaint data from 34 area hospitals, representing approximately 70% coverage of licensed ER beds in Harris County. Data collected for each complaint includes patient home and work zip codes, allowing for geographic analysis of the data in the case of a localized environmental contamination.

Historically, when alerted to a contaminant in the Houston area, the Houston Department of Health and Human Services (HDHHS) has analyzed health data for each zip code in the geographic area of interest separately, a time-intensive process.

Recognizing the need for a more accurate and timely response to an environmental alert, HDHHS proposes aggregating zip codes into zones, based on coverage of population and areas of high risk. These “Surveillance Zones” will be used to quickly reference syndromic data in the event of a chemical or biological event.

Objective

This paper discusses the development of zones within the City of Houston in order to more quickly and accurately reference surveillance data in the case of chemical or biological events.

Four waves of pandemic influenza from 1918-1920 in New York City caused ~40,000 deaths, primarily of young-adults and children. The explosiveness of the autumn 1918 wave has led many to believe that in the event of a similar pandemic today early detection and intervention strategies may not be effective. Recent historical studies of the 1918 pandemic, however, provide evidence of controllable transmissibility, of a limited early wave4, and of social distancing measures significantly reducing pandemic impact in many US cities. Importantly, mitigation efforts initiated after the beginning of community-wide transmission (even up to the point of 3-6% of a population being infected) significantly reduced the total impact in 1918.

Objective

In response to an Institute of Medicine report recommending community-based pandemic influenza mitigation strategies be informed by surveillance and disease modeling, we aimed to assess the feasibility of using emergency department data to identify model derived threshold triggers for initiating intervention efforts in the event of a 1918-like pandemic.

Heat related illness is the number one cause of human death in relation to extreme weather events in the United States, resulting in an average of 400 deaths per year over the past few decades. It is also expected that both the duration and intensity of these events will increase. The temperature of the surface is measurable from a number of space borne satellites and can be derived using a number of available algorithms. This type of data can be compared to census collected variables to determine the number of persons at risk for heat related morbidity and mortality within urban environments.

Objective

This paper describes a method of determining areas at risk during extreme urban heat events using remote sensing technologies, geographical information systems and artificial neural networks.