Surveillance Systems

Syndromic surveillance system, which collects non-specific syndromes in the early stages of disease development, has great advantages in promoting early detection of epidemics and reducing the burden of disease confirmation. It is especially effective for surveillance in resource-poor settings, where laboratory confirmation is not possible or practical. Integrating syndromic surveillance with traditional case report system may generate timely, effective and sensitive information for early warning and control of infectious diseases in rural China. A syndromic surveillance system (ISSC) has been implemented in rural Jiangxi Province of China since August 2011.

Objective

To describe the distribution of the infectious related symptoms in an internet-based syndromic surveillance system reported by doctors in village health stations, township and county hospitals in rural Jiangxi Province, China, and to identify the major infectious diseases for syndromic surveillance in different levels of health facility.

Living in a closely connected and highly mobile world presents many new mechanisms for rapid disease spread and in recent years, global disease surveillance has become a high priority. In addition, much like the contribution of non-traditional medicine to curing diseases, non-traditional data streams are being considered of value in disease surveillance. Los Alamos National Laboratory (LANL) has been funded by the Defense Threat Reduction Agency to determine the relevance of data streams for an integrated global biosurveillance system through the use of defined metrics and methodologies. Specifically, this project entails the evaluation of data streams either currently in use in surveillance systems or new data streams having the potential to enable early disease detection. An overview of this project will be presented, together with results of data stream evaluation. This project will help gain an understanding of data streams relevant to early warning/monitoring of disease outbreaks.

Objective:

The overall objective of this project is to provide a robust evaluation of data streams that can be leveraged from existing and developing national and international disease surveillance systems, to create a global disease monitoring system and provide decision makers with timely information to prepare for and mitigate the spread of disease.

The incidence of and hospitalizations for SSTI have steadily increased over the last decade in the United States, primarily due to the emergence and spread of community acquired Methicillin resistant Staphylococcus aureus (CA-MRSA). The ED is a common site for SSTI treatment and serves populations not captured by traditional surveillance, including the homeless and uninsured. The use of near real-time syndromic surveillance within the ED to detect unusual activity for further public health investigation has been used to augment traditional infectious disease surveillance. However, the use of this approach for monitoring local epidemiologic trends in SSTI presentation where laboratory data are not available, has not previously been described.

Objective

We sought to describe the epidemiology of emergency department (ED) visits for skin and soft tissue infections (SSTI) in an urban area with diverse neighborhood populations using syndromic surveillance system data for the time period from 2007-2011. Our aims were threefold: to demonstrate a proof of concept using syndromic surveillance for SSTI surveillance in the absence of laboratory data, to estimate the burden of ED visits associated with SSTI, and to determine potential geographic “hotspots” for these infections.

EEBS’s that use near real-time information from the Internet are an increasingly important source of intelligence for public health organizations. However, there has not been a systematic assessment of EEBS evaluations, which could identify uncertainties about current systems and guide EEBS development to effectively exploit digital information for surveillance.

Objective

To assess evaluations of electronic event-based biosurveillance systems (EEBS’s) and define priorities for EEBS evaluations.

Timely and effective public health decision-making for control and prevention of acute respiratory infectious diseases relies on early disease detection, pathogen properties, and information on contact behavior affecting transmission. However, data on contact behavior are currently limited, and when available are commonly obtained from traditional self-reported contact surveys. Information for contacts among school-aged children is especially limited, even though children frequently have higher attack rates than adults, and school-related transmission is commonly predictive of subsequent community-wide outbreaks, especially for pandemic influenza.

Within this context, high-quality data are needed about social contacts. Precise contact estimates can be used in mathematical models to understand infectious disease transmission and better target surveillance efforts. Here we report preliminary data from an ongoing 2- year study to collect social contact data on school-aged children and examine the transmission dynamics of an influenza pandemic.

Objective

To enhance public health surveillance and response for acute respiratory infectious diseases by understanding social contacts among school-aged children

Public Health departments are increasingly called upon to be innovative in quality service delivery under a dwindling resource climate as highlighted in several publications of the Institute of Medicine. Collaboration with other entities in the delivery of core public health services has emerged as a recurring theme. One model of this collaboration is an academic health department: a formal affiliation between a health professions school and a local health department. Initially targeted at workforce development, this model of collaboration has since yielded dividends in other core public health service areas including community assessment, program evaluation, community-based participatory research and data analysis.

The Duval County Health Department (DCHD), Florida, presents a unique community-centered model of the academic health department. Prominence in local informatics infrastructure capacity building and hosting a CDC-CSTE applied public health informatics fellowship (APHIF) in the Institute for Public Health Informatics and Research (IPHIR) in partnership with the Center for Health Equity Research, University of Florida & Shands medical center are direct dividends of this collaborative model.

Objective

Highlight one academic health department’s unique approach to optimizing collaborative opportunities for capacity development and document the implications for chronic disease surveillance and population health.

Preface

Effective public health surveillance is essential for detecting and responding to emerging public health threats, including terrorism and emerging infectious diseases. New surveillance methods are being developed and tested to improve the timeliness and completeness of detection of disease outbreaks. One promising set of approaches is syndromic surveillance, in which information about health events that precede a firm clinical diagnosis is captured early and rapidly from existing, usually electronic, data sources, and analyzed frequently to detect signals that might indicate an outbreak requiring investigation.

To provide a forum for scientists and practitioners to report on progress in developing and evaluating syndromic surveillance systems, the New York City Department of Health and Mental Hygiene, the New York Academy of Medicine, and CDC convened the second annual National Syndromic Surveillance Conference in New York City during October 23--24, 2003. The conference, supported by the Alfred P. Sloan Foundation, was attended by more than 460 public health practitioners and researchers, who had the opportunity to hear 41 oral presentations and view 50 poster presentations.

The original papers and posters for this conference were chosen by a scientific program committee after a review of submitted abstracts. Senior researchers in the field were also invited to address key concerns in surveillance for early detection of outbreaks. All participants who presented papers or posters at either the conference or at a preconference workshop were invited to submit manuscripts based on their presentations for publication in this Morbidity and Mortality Weekly Report Supplement. Each manuscript was then reviewed by at least two peer reviewers and final publication decisions were made by an editorial committee. Many of the articles are considerably different from the material originally presented at the conference. Certain authors updated their findings, and others were asked to revise their papers into descriptions of syndromic surveillance systems. Other presenters chose to submit only abstracts. Papers are presented here in the following order: system descriptions, research methods, evaluation, and public health practice.

In addition to these reports, other resources on syndromic surveillance are available. The proceedings of the 2002 National Syndromic Surveillance Conference were published in the Journal of Urban Health (accessible at http://jurban.oup journals.org/content/suppl_1/index.shtml). In May 2004, a revisedFramework for Evaluating Public Health Surveillance Systems for Early Detection of Outbreaks was published (MMWR 2004;53[No. RR-5]). An annotated bibliography of published papers and other Internet-accessible materials has been developed and is maintained monthly on a CDC website (http://www.cdc.gov/epo/dphsi/syndromic/index.htm). An Internet-based forum (http://syndromic.forum.cdc.gov) was established for discussion of topics related to syndromic surveillance and was used to distribute answers to audience questions raised at the conference. A related forum (http://surveval.forum.cdc. gov) has been maintained for discussion of topics related to surveillance system evaluation. Finally, the website of the Annual Syndromic Surveillance Conferences (http://www. syndromic.org) includes links to recent news and scientific articles about syndromic surveillance, oral and poster presentations and workshop materials from past conferences, and notices of upcoming conferences. The third National Syndromic Surveillance Conference is planned for November 3--4, 2004, in Boston, Massachusetts.

The editorial committee acknowledges the work of the scientific planning committee: Dennis Cochrane, Christine Hahn, Patrick Kelley, Martin Kulldorff, John Loonsk, David Madigan, Richard Platt, and Don Weiss. The committee is also grateful for the support and efforts of the following staff members in conducting this conference and developing this Supplement: Alan Fleischman, Irv Gertner, and Jessica Hartman, New York Academy of Medicine; Rick Heffernan, New York Department of Health and Mental Hygiene; and Alan Davis, Division of Public Health Surveillance and Informatics, Epidemiology Program Office, CDC; Valerie Kokor, Division of International Health, Epidemiology Program Office; and Stephanie Malloy, Jeffrey Sokolow, and Malbea LaPete, MMWR, Epidemiology Program Office, CDC. Special thanks are given to JoEllen DeThomasis, Division of Applied Public Health Training and Division of Public Health Surveillance and Informatics, Epidemiology Program Office, CDC, who coordinated the preparation of these reports.

--- The Editorial Committee

Patients’ chief complaints (CCs) as a common data source, has been widely used in syndromic surveillance due to its timeliness, accuracy and availability. For automated syndromic surveillance, CCs always classified into predefined syndromic categories to facilitate subsequent data aggregation and analysis. However, in rural China, most outpatient doctors recorded the information of patients (e.g. CCs) into clinic logs manually rather than computers. Thus, more convenient surveillance method is needed in the syndromic surveillance project (ISSC). And the first and important thing is to select the targeted symptoms/syndromes.

Objective

To select the potential targeted symptoms/syndromes as early warning indicators for epidemics or outbreaks detection in rural China

The S&I Framework is an Office of National Coordinator (ONC) initiative designed to support individual working groups who focus on a specific interoperability challenge. One of these working groups within the S&I Framework is the PHRI, which is using the S&I Framework as a platform for a community-led project focused on simplifying public health reporting and ensuring EHR interoperability with public health information systems. PHRI hopes to create a new public health reporting objective for Meaningful Use Stage 3 that is broader than the current program-specific objectives and will lay the ground work for all public health reporting in the future. To date, the initiative received over 30 descriptions of different types of public health reporting that were then grouped into 5 domain categories. Each domain category was decomposed into component elements and commonalities were identified. The PHRI is now working to reconstruct a single model of public health reporting through a consensus process that will soon lead to a pilot demonstration of the most ready reporting types. This panel will outline progress, challenges, and next steps of the initiative as well as describe how the initiative may affect a standard language for biosurveillance reporting.

Objective

The objective of this panel is to inform the ISDS community of the progress made in the Standards & Interoperability (S&I) Framework Public Health Reporting Initiative (PHRI). Also, it will provide some context of how the initiative will likely affect biosurveillance reporting in Meaningful Use Stage 3 and future harmonization of data standards requirements for public health reporting

Since its detection in 1999 in New York, WNV spread westward across the continent, and was first detected in California in 2003 in Imperial County. In California and in many states, birds, especially corvids, are used as sentinel animals to detect WNV activity. Recent seroprevalence studies have shown WNV activity in different wild mammalian species; in the United States, WNV sero-prevalence in some studies in raccoons has ranged from 34–46%. In addition, it has been shown that after experimental infection, raccoons can attain high viral titers and shed WNV in their saliva and feces. Given their peridomestic nature, we investigated the feasibility of their use as sentinels for early warning of WNV and as indicators of WNV activity as a strategy to better localize WNV transmission foci in guiding vector control efforts.

Objective

To investigate the potential of utilizing raccoons as sentinels for West Nile Virus (WNV) in an effort to guide public health surveillance, prevention, and control efforts.