Surveillance Systems

Protecting U.S. animal populations requires constant monitoring of disease events and conditions which might lead to disease emergence, both domestically and globally. Since 1999, the Center for Emerging issues (CEI has actively monitored global information sources to provide early detection impact assessments and increased awareness of emerging disease events and conditions. The importance of these activities was reinforced after September 11, 2001, and these processes are now part of the U.S. Department of Agriculture’s response to Homeland Security Presidential Directive 9. Electronic information sources available through the Internet have recently changed the way animal health information is gathered, processed and shared. To respond to these changes, CEI developed a dynamic system containing automated and semiautomated components that process information from various sources to identify, track, and evaluate emerging disease situations.

Objective

This paper describes a system of automatic and semiautomatic processes for data gathering, assessment, and event tracking used by the CEI to enhance monitoring of global animal health events and conditions.

In response to increasing reports of avian influenza being identified throughout the eastern hemisphere, the U.S. Homeland Security Council, the Infectious Disease Society of America, and others have called for expansion of enhanced, real-time electronic syndromic and other advanced surveillance systems to supplement the traditional surveillance systems recommended in U.S. Department of Health & Human Services pandemic influenza preparedness plan guidance. Like many states, the Connecticut Department of Public Health, has updated its own Pandemic Influenza Response Plan to reflect its expanding arsenal of surveillance systems. These systems include a syndromic surveillance system, known as the Hospital Admissions Surveillance System (HASS), developed in September 2001 to monitor for possible bioterrorism events and emerging infections. HASS data has been utilized to supplement information received from laboratoryconfirmed influenza test results, influenza-like-illness reporting, and pneumonia influenza mortality to track seasonal influenza since 2003.

Objective

This paper summarizes the results of a continued review of state pandemic influenza preparedness plans and compares various approaches for routine influenza surveillance during interpandemic periods with approaches for enhanced surveillance during pandemic alerts. The increased reliance of syndromic and other advanced surveillance systems by U.S. states for seasonal influenza tracking and pandemic preparedness planning is documented.

In response to increasing reports of avian influenza being identified throughout the eastern hemisphere, the World Health Organization and the U.S. Department of Health and Human Services have published pandemic influenza preparedness plans. These plans include detailed recommendations for routine influenza surveillance during ongoing interpandemic periods as well as recommendations for enhanced influenza surveillance during episodes of international, national, and local pandemic alerts. Like many states, the Connecticut Department of Public Health (DPH), prepared its own Pandemic Influenza Response Plan. The DPH has also been expanding its arsenal of surveillance systems. These systems include a syndromic surveillance system, known as the Hospital Admissions Surveillance System (HASS), developed in September 2001 to monitor for possible bioterrorism events and emerging infections. HASS data has been utilized to supplement information received from laboratoryconfirmed influenza test, influenza-like-illness reporting, and pneumonia influenza mortality to track seasonal influenza.

Objective

This paper examines the results of a review of state pandemic influenza preparedness plans and compares various approaches for routine influenza surveillance during interpandemic periods with approaches for enhanced surveillance during pandemic alerts. The results of this review are compared with the experience of using a hospital-based syndromic surveillance system as a supplement to laboratory and clinical influenza surveillance systems.

“The ultimate measure of whether a surveillance system has achieved the optimal balance of attributes lies in its usefulness.” No one is better qualified to comment on usefulness than the users. As system developers, we are well advised to consider the opinions of users when building, evaluating, and considering revisions to surveillance systems. 

Health Monitoring Systems, Inc. is a for-profit company that provides biosurveillance capabilities to public health agencies and hospitals using a software-as-a-service model.

Objective

This paper describes results from a survey of public health department users of biosurveillance. The survey solicited input regarding sophistication of analytic methods, perceived value of potential data sources, and utilization resulting in timelier public health interventions.

The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) is the early event detection system that serves public health users across North Carolina. One important data source for this system is North Carolina emergency department visits. ED data from hospitals across the state are downloaded, standardized, aggregated, and updated twice daily.

After hurricane Katrina devastated the Gulf Coast on August 29, 2005, federal officials evacuated two large groups of evacuees into Wake and Mecklenburg counties in North Carolina. In order to identify and monitor the hospital-based public health needs of these and other “unofficial” evacuees, NC state officials used both NC DETECT and hospital-based Public Health Epidemiologist reporting methods, along with other public health surveillance initiatives.

Objective

To compare two different methods of monitoring hurricane Katrina evacuees’ hospital visits in North Carolina.

Shenzhen is a special economic region in southern China, adjacent to Hong Kong, with a population of approximately 14 million. The pioneering efforts of Shenzhen in the development of electronic disease surveillance started as early as in 1995. The setup of syndromic surveillance was started after the SARS outbreak in 2003, including surveillance in Fever Clinics, GI clinics, selected schools, and sentinel surveillance for the workers in selected chicken farms and bird markets. In 2007, a regional plan was developed for systematically integrating the surveillance for environmental health, food safety, lab information systems, infectious disease notification, and outbreak management.

Objective

This paper introduces the challenges and lessons learned from the planning and development of a regional integrated disease surveillance system, presenting a new method to quantitatively measure IT support capabilities in disease surveillance and control, as well as a collaboration model integrating the information from multiple sources.

In 2004, the Indiana State Department of Health (ISDH) partnered with the Regenstrief Institute to begin collecting syndromic data from 14 ED’s to monitor bioterrorism-related events and other public health emergencies. Today, Indiana’s public health emergency surveillance system (PHESS) receives approximately 5,000 daily ED visits as real-time HL7 formatted surveillance data from 55 hospitals. The ISDH analyzes these data using ESSENCE and initiates field investigations when human review deems necessary.1 The Marion County Health Department, located in the state’s capitol and most populous county, is the first local health department in Indiana using ESSENCE.

Objective

This paper describes how local and state stakeholders interact with Indiana’s operational PHESS, including resources allocated to syndromic surveillance activities and methods for managing surveillance data flow. We also describe early successes of the system.

Real-time Outbreak and Disease Surveillance (RODS), a syndromic surveillance system created by the University of Pittsburgh has been used in Ohio by the state and local health departments since late 2003. There are currently 133 health care facilities providing 88% coverage of emergency department visits statewide to the RODS system managed by Health Monitoring Systems Inc. (HMS). The system automatically alerts health department jurisdictions when various syndromic thresholds are exceeded.

As part of response protocols, investigators export a case listing in a comma-separated values file which typically includes thousands of lines with each row containing: date admitted, age, gender, zip code, hospital name, visit number, chief complaint, and syndrome. The HMS-RODS web site provides basic graphs and maps, yet lacks the flexibility afforded by ad hoc queries, cross tabulation, and portability enabling off-line analysis.

Objective

This paper describes the integration of open source applications as portable, customizable tools for epidemiologists to provide rapid analysis, visualization, and reporting during surveillance investigations.

Malaria control programs suffer from weak and fragmented surveillance of the wide range of information required to manage the disease effectively and efficiently. A computational framework to manage, integrate, analyze, and visualize the data resources, a cyberenvironment, can improve the surveillance and the outcomes.

Objective

This paper presents an ontology of a cyberenvironment for malaria surveillance. The ontology encapsulates a comprehensive natural language enumeration of the requirements of the cyberenvironment using a structured terminology. It can be used to systematically analyze and prioritize the functions of the cyberenvironment. It will help the medical, individual, environmental, and strategic management of malaria.

The Ontario Telehealth Telephone Helpline (henceforth referred to as “Telehealth”) was implemented in Ontario in 2001. It is administered by Clinidata, a private contractor hired by the Ontario Ministry of Health and Long-Term Care, 24 hours a day, 7 days a week, including holidays, at no cost to the caller. The calls are answered by registered nurses in both official languages from four calling centres that use identical decision rules (algorithms) and store all call information into one centralized data repository. The calls are usually approximately 10-minutes, patient based, and are directed by a nurse-operated electronic clinical support system.

Objective

Following the lead established by the UK’s NHS Direct Syndromic Surveillance system as well as the SARS Report’s desire to “broaden the information collection capacity of Telehealth as a syndromic surveillance tool,” we are retrospectively evaluating the value of Ontario’s Telehealth’s health helpline as a syndromic surveillance system. To date, there have been no published descriptions of Telehealth. This article endeavours to address this lacuna.