Surveillance Systems

Bordetella pertussis infection (whooping cough) has been on the rise and the most cases in the US since 1955 were reported in 2012 (48,277 or 15.4 per 100,000). Pertussis is highly infectious and can cause serious illness in infants and children as well as adults, and in general is preventable by vaccination. Since 2005, it has been recommended that anyone 19-64 years old should have a onetime booster of the pertussis vaccine (Tdap). In 2010, that recommendation was broadened stating people 65 years old and older should also obtain a booster of Tdap. Given the increased number of pertussis cases in the Western US, and that approximately 20% of these cases occurred in patients >20 years of age, we performed pertussis surveillance in Veterans in care at VA medical facilities.

Objective

To perform pertussis surveillance in VA facilities in the Western US.

The MSSS, described elsewhere, has been in use since 2003 and records ED chief complaint data. As of September 2014, there were 88/136 hospital EDs enrolled in MSSS, capturing 83% of the annual hospital ED visits in Michigan.

On April 1, 2014 the Healthy Michigan Plan (HMP) was launched. HMP provides healthcare benefits to low-income adult residents who do not qualify for Medicaid or Medicare. The plan incorporates both federally and state mandated Essential Health Benefits, which includes emergency services.

As insurance coverage expands, more people will have the ability to utilize the services of primary care and other providers. In particular, this will affect previously uninsured, low-income populations who are disproportionately affected by chronic disease.

We question if access to these services will affect the utilization of emergency services as more people will have a medical home to manage and prevent diseases that may otherwise become an emergent issue. Furthermore, this increased access to health care services will expand care options for urgent but not emergent issues beyond EDs. Conversely, as more people acquire health care benefits the demand for primary care services may exceed the level of access to these services which may lead to an increase of ED utilization for primary care.

Objective

The purpose of this work is to use the Michigan Syndromic Surveillance System (MSSS) to assess emergency department (ED) utilization before and after the April 2014 implementation of the Healthy Michigan Plan, an expanded Medicaid program.

The number of US adults who use the internet to access health information has increased from about 95 million in 2005 to 220 million in 2014. The public health impact of this trend is unknown; in theory, patients may be able to better help the doctor arrive at the correct diagnosis, but self-diagnosed patients may also inappropriately self-treat or delay going to the doctor. The current study examines trends in self-diagnoses in NYC EDs, identifies the demographic characteristics of self-diagnosed patients, and compares hospital admission rates of self-diagnosed patients with those who do not self-diagnose.

Objective

To monitor self-reported diagnosis from New York City (NYC) emergency department (ED) chief complaints (CC).

National studies estimate that respiratory syncytial virus (RSV) is responsible for one in 38 emergency department (ED) visits for children < 5 years old. The Council for State and Territorial Epidemiologists position statement (13-ID-07): “RSV-Associated Pediatric Mortality” advocates for improved RSV surveillance including monitoring of RSV-associated pediatric mortality and hospitalizations. The goal of that data collection is to establish prevaccine baselines to evaluate vaccine effectiveness should one become available. As RSV is not reportable in Florida, RSV surveillance relies on a small subset of all Florida hospital laboratories to report data in aggregate and calculation of percent positive of all tests for RSV performed. These data assess virus activity, and do not allow for assessment of morbidity or age-specific analysis. Moreover, this data is not complete or timely, most often becoming available a minimum of a week after the testing was conducted. Florida’s RSV surveillance efforts guide clinical decision making and insurance reimbursements. Florida’s RSV seasonality not only differs from the nation but there is strong variation among five distinct regions, as exemplified by southeast Florida where the RSV season is year round. In Florida, pre-approval of prophylactic treatment by insurance companies is tied to seasonality.

Objective

In Florida, pre-approval of prophylactic treatment by insurance companies is tied to seasonality. Previous analyses determined that Florida’s syndromic surveillance system (Electronic Surveillance System for the Early Notification of Community-based Epidemics [ESSENCE-FL]) was capable of monitoring Florida’s statewide RSV seasonality. This analysis aims to determine if ESSENCE-FL can also be used to describe RSV and RSV-associated hospitalizations in children < 5 years by region and season.

To date, avian influenza virus (AIV) is an unpredictable pathogen affecting both animals, birds and people. The regular emergence of new strains and variants with different properties and pathogenicities requires additional monitoring and careful research of those viruses. It is known that wild birds— especially waterfowl and shorebirds— are the main and primary reservoir of AIV in nature which makes epizootological monitoring of populations of these birds necessary.

Objective

To carry out monitoring studies of circulation of the AIV subtypes H5 and H7 in wild waterfowl and shorebirds around the Azov-Black Sea in Ukraine

Syndromic surveillance can supplement diagnosis-based surveillance in resource-limited settings with limited laboratory infrastructure. Syndromic surveillance allows for early outbreak detection relative to traditional systems and enables community health monitoring during outbreaks. Monitoring and disease diagnosis can be strengthened using pre-diagnostic data and statistical algorithms to detect morbidity trends.

Alerta (2002-11) and Vigila (2011-present) are sequentially implemented electronic disease surveillance systems created by the Peruvian Navy to improve the detection, prevention, and control of disease outbreaks. The phone-, internet-, and radio-based reporting system now covers over 97.5% of the Navy population, encompassing 169 reporting establishments that treat active and retired service members, dependents, and civilian employees. Acute diarrheal disease, respiratory infections, and pneumonias are reported weekly, whereas specific notifiable diseases such as malaria, dengue, and tuberculosis are reported immediately after case detection.

Objective

To use data from the Peruvian Navy’s electronic syndromic surveillance systems to estimate the baseline incidence of acute diarrheal disease (ADD) and detect outbreaks among individuals accessing military medical facilities from 2009-13.

A Neolithic transformation is underway in public health, where the ubiquity of digital healthcare (HC) data is changing public health’s traditional role as data hunter-gatherers to one of data farmers harvesting huge reserves of electronic data. ILINet 1.0 is the current U.S. outpatient ILI surveillance network dependent on ~2000 volunteer sentinel providers recruited by States to report syndromic ILI. ILINet 1.0 began in the 1980s and represents a largely unchanged, ongoing hunter-gatherer approach to ILI outpatient surveillance involving the independent efforts of all state health departments. Many significant changes have occurred in the U.S. healthcare system since ILINet 1.0 was initiated. For example, eCommerce standards emerged in the 1990s creating ubiquitous amounts of easily accessible electronic healthcare administrative data. Since 2001 new public health surveillance approaches and investments have emerged including methods for syndromic surveillance (e.g. BioSense). Most recently healthcare reform efforts hold great promise (as yet largely unrealized) for public health to access electronic information derived from EHRs/HIEs (e.g., Meaningful Use). Could and should the current U.S. gold standard for ILI outpatient surveillance benefit from these new opportunities, and if so, what approach should be used and who should be responsible?

Objective

This paper outlines the current state of ILINet (ILINet 1.0), the accepted national gold standard for outpatient influenza-like illness (ILI) surveillance, and demonstrates how ILINet 2.0 could be more automated, timely, and locally representative if it were to utilize increasingly available electronic healthcare data rather than a specific group of recruited sentinel providers.

On January 2, 2014 the cyclone Bejisa struck Reunion Island. This storm of Category 3 (Saffir–Simpson scale) disturbed electricity supply and drinking water systems. Floods, roof destructions and the threat of landslide led to the evacuation of residents to emergency shleters. In this context, the regional office of French Institute for Public Health Surveillance in Indian Ocean set up an epidemiological surveillance in order to assess the impact in the aftermath of the cyclone.

Objective

To assess the health impact of cyclone Bejisa from data of emergency departments (EDs) and emergency medical service (EMS)

Syndromic surveillance is one of the meaningful use public health menu set objectives for eligible professionals. The value of this data for syndromic surveillance as an adjunct to the more widely adopted emergency department registrations has not been studied extensively. It may be that it would improve the sensitivity or timeliness of detecting certain communicable disease events, or it may just contain signals comparable to what is available via other syndromic surveillance data streams. The value of making the effort to collect this data is considered contingent on the answer to that question.

Public health is concerned with more than just communicable diseases, however. Chronic diseases and their underlying causes are also a significant public health concern. Obesity alone is estimated to be responsible for 2.5% of the global disease burden, and represents a higher fraction in many developed nations. Since chronic diseases are not associated with singular events of brief duration, they are difficult to track with traditional surveillance methods. They are also not typically managed via emergency departments, so syndromic surveillance does not capture them well either.

Chronic diseases are often treated by physicians at ambulatory practices. Thus data from eligible professionals may provide a means for monitoring chronic diseases, or metrics associated with chronic diseases, that would not otherwise be as feasible. As a proof of concept, this study seeks to determine if body mass index (BMI), the standard measure of obesity, can be obtained from ambulatory syndromic surveillance messages.

Objective

To demonstrate the utility of ambulatory syndromic surveillance data to public health domains beyond communicable diseases

In November 2011, Washington State voters passed Initiative 1183 (I-1183) which closed state-owned and contracted liquor stores and opened the market for “hard liquor” sales in the private sector. The change in law was implemented on June 1, 2012. Increases in alcohol-related ED visits were postulated as one potential impact if there was increased alcohol use or excessive consumption associated with the change in law.

Objective

To determine whether there were changes in alcohol-related emergency department (ED) visits in Washington State associated with statewide alcohol system deregulation.