Surveillance Systems

Syndromic surveillance data is typically used for the monitoring of symptom combinations in patient chief complaints (i.e. syndromes) or health indicators within a population to inform public health actions. The Tennessee Department of Health collects emergency department (ED) data from more than 80 hospitals across Tennessee to support statewide situational awareness. Most hospitals in Tennessee provide data within 48 hours of the patient being seen in the emergency department. The timeliness of syndromic surveillance data allow for rapid estimates of impact in emergency department populations. Tennessee has successfully used these data to monitor influenza, heat related illnesses, and emergency department impacts from disaster evacuations. In addition to assessing impact and trends, syndromic surveillance can also provide early warnings for conditions of public health concern and increase the lead time public health has to initiate a response. In Tennessee, routine syndromic surveillance for mumps, hepatitis A, and other conditions has been successfully conducted statewide. Three successes from these surveillance efforts include detecting a clinically diagnosed but unreported case of mumps, early identification of hepatitis A cases during Tennessee's ongoing 2018 hepatitis A outbreak, and the detection of an epidemiologically unlikely clinical diagnosis of mumps associated with an exposure at a recreational center.

Objective: To demonstrate the utility of syndromic surveillance data in aiding public health actions and response across multiple investigations in Tennessee.

Mental health is a common and costly concern; it is estimated that nearly 20 percent of adults in the United States live with a mental illness [1] and that more money is spent on mental illness than any other medical condition [2]. One spillover effect of unmet mental health needs may be increasing emergency department utilization. National analysis by Healthcare Cost and Utilization Project (H-CUP) found a 55% increase in emergency department visits for depression, anxiety, and stress reactions between 2006- 2013 [3]. Local public health agencies (LPHAs) can play an important role in reducing costs and burden associated with mental illness. There is opportunity to use emergency department data at a local level to monitor trends and evaluate the effectiveness of local strategies. ESSENCE, available in 31 states, provides near-real time observation-level emergency department data, which can be analyzed and disseminated according to local needs. Using ESSENCE data from 6 local counties in Colorado, we developed methods to estimate the overall burden of mental health and specific mental health disorders seen in the emergency department.

Objective: In order to meet local mental health surveillance needs, we created multiple mental health-related indicators using emergency department data from the Colorado North Central Region (CO-NCR) Early Notification of Community Based Epidemics (ESSENCE), a Syndromic Surveillance (SyS) platform.

Surveillance of severe influenza infections is lacking in the Netherlands. Ambulance dispatch (AD) data may provide information about severity of the influenza epidemic and its burden on emergency services. The current gold standard, primary care-based surveillance of influenza-like-illness (ILI), mainly captures mild to moderate influenza cases, and does not provide adequate information on severe disease. Monitoring the severity of the annual epidemic, particularly among groups most at risk of complications, is of importance for the planning of health services and the public health response.

Objective: We aim to assess whether influenza circulation, as measured through influenza-like-illness (ILI) in primary care, is reflected in ambulance dispatch (AD) calls.

The number of unintentional overdose deaths in New York City (NYC) has increased for seven consecutive years. In 2017, there were 1,487 unintentional drug overdose deaths in NYC. Over 80% of these deaths involved an opioid, including heroin, fentanyl, and prescription pain relievers.1 As part of a comprehensive strategy to reduce overdose mortality in NYC, the NYC Department of Health and Mental Hygiene’s (DOHMH) Overdose Education and Naloxone Distribution (OEND) Program makes naloxone kits available to laypeople free-of-charge through registered Opioid Overdose Prevention Programs (OOPPs). Naloxone kits contain two doses of naloxone and educational materials. The OEND Program distributes kits to registered OOPPs, which then dispense kits to individuals via community-based trainings. In this context, distribution refers to kits shipped to programs, whereas dispensing refers to kits given to individuals. Increased NYC funding has enabled recruitment of more OOPPs including syringe exchange programs, public safety agencies, shelters, drug treatment programs, health care facilities, and other community-based programs and greater dispensing of naloxone kits to laypeople. Naloxone distribution has undergone a dramatic expansion, from 2,500 kits in 2009 to 61,706 kits in 2017.2 In 2018, DOHMH aims to distribute more than 100,000 kits to OOPPs. In order to target naloxone dispensing to neighborhoods in NYC with the highest overdose burden, we developed a tracking system able to capture individual-level geographic data about naloxone kit recipients. Prior to the development of the tracking system, DOHMH collected quarterly, aggregate-level naloxone dispensing data from OOPPs. These data included only the OOPPs™ ZIP Codes but not recipient residence. OOPP ZIP Code was used as a proxy for kits dispensed to individuals. Without individual-level geographic information, however, we could not determine whether naloxone kit dispensing reached people in neighborhoods with high overdose mortality rates. To overcome these barriers, DOHMH developed a comprehensive but flexible individual-level data collection method.

Objective: Describe the development of an individual-level tracking system for community-based naloxone dispensing as part of New York City's (NYC) comprehensive plan to reduce overdose deaths. We present data from the first year of the initiative to illustrate results of the tracking system and describe the potential impact on naloxone dispensing program.

Tanzania adopted IDSR as the platform for all disease surveillance activities. Today, Tanzania's IDSR guidelines include surveillance and response protocols for 34 diseases and conditions of public health importance, outlining in detail necessary recording and reporting procedures and activities to be taken at all levels. A total of 15 disease-specific programs/sections in the Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) are linked to the IDSR, though the extent to which each program uses IDSR data varies. Over the years, IDSR procedures and the structures that support them have received significant government and external resources to maintain and strengthen detection, notification, reporting and analysis of surveillance information. However, with the imminent phasing out of programs (such as the Polio eradication program) that have supported IDSR strengthening and maintenance in the past, resources for surveillance will become more limited and the government will need to identify additional resources to sustain the country's essential surveillance functions. Maternal and Child Survival Program (MCSP), a USAID Funded Program supported MOHCDGEC managing active and passive surveillance systems in improving coordination and strengthen the system taking into consideration declining resources as well as transitioning to polio end game where most of the financial resources were derived from to support vaccine preventable diseases surveillance. The support complements other Global health security agenda (GHSA) on the key thematic areas (Prevent, Detect and Report) support to the MOHCDGEC and working with the newly formed Emergency Operations Center (EOC) to improve response.

Objective: To support streamlining of VPD surveillance into integrated diseases surveillance and response (IDSR) system in Tanzania.

In 2002, the United States (US) Centers for Disease Control and Prevention (CDC) launched the National Environmental Public Health Tracking Program (Tracking Program) to address the challenges and gaps in the nation'™s environmental health surveillance infrastructure. The Tracking Program's mission is to provide information from a nationwide network of integrated health and environmental data that drives actions to improve the health of communities. As a primary objective of the Tracking Program, the Environmental Public Health Tracking Network (Tracking Network) was developed as an online surveillance system with data available for 23 topics and over 450 different health, environmental, and population measures. The integration and display of such disparate data can be challenging. For data consumers without scientific training, or even scientists and public health professionals with limited time, it can be difficult to examine and explore the data in an online surveillance system. Additionally, casual data consumers may not require complex data details; a big picture perspective may be appropriate to their needs. The Tracking Network which applies standardized data, a modern user interface, techniques catering to a variety of data consumers, and best practices in data visualization provides a dynamic data query system that allows users to visualize different types of environmental health data in numerous ways including a variety of charting, mapping, and graphing options. Objective: The presenter will demonstrate complex health and environment surveillance data visualization techniques within the CDC's Environmental Public Health Tracking Network.