Surveillance Systems

The Florida Department of Health in Hillsborough County (FDOH- Hillsborough) conducts enhanced syndromic surveillance on a daily basis. The Electronic Surveillance System for the Early Notification of Community-based Epidemics in Florida (ESSENCE-FL) is the syndromic surveillance system used by epidemiologists within the Florida Department of Health (FDOH). During the time of this study, ESSENCE-FL receives data from 210 of emergency departments (ED) and 33 urgent care centers (UCC) throughout the state of Florida, including 12 EDs and 3 UCCs in Hillsborough County. In 2014, the ESSENCE-FL system added a feature that delivers an automatic daily email to designated primary ESSENCE-FL users in each county containing all visits which have been detected by the state’s visits of interest (VOI) query. The email contains all visits which have been detected by the visits of interest (VOI) query for each ESSENCE-FL users designated county. The VOI query utilizes the combined chief complaint and discharge diagnosis (CCDD) field of a visit for keywords related to reportable diseases and exposures of public health interest. In addition to this VOI email, Hillsborough County analyzes time of arrival alerts, specialized emerging infectious disease queries, poison information center data, and volume levels of syndromes and subsyndromes predetermined by ESSENCE-FL. A daily summary report of the enhanced daily surveillance analysis is then provided to area public health officials within FDOH-Hillsborough and the surrounding counties. This study examines how visits requiring additional investigation are detected and the resources required to complete the investigation.

Objective

Enhanced daily surveillance is used to identify reportable diseases, outbreaks, and clusters and provides situational awareness. This project examines how health care visits requiring additional information are detected using enhanced syndromic surveillance and the resources required from detection through completion.

Zika, chikungunya, and dengue have surged in the Americas over the past several years and pose serious health threats in regions of the U.S. where Ae. aegypti and Ae. albopictus mosquito vectors occur. Ae. aegypti have been detected up to 6 months of the year or longer in parts of Arizona, Florida, and Texas where mosquito surveillance is regularly conducted. However, many areas in the U.S. lack basic data on vector presence or absence. The Zika, dengue, and chikungunya viruses range in pathogenicity, but all include asymptomatic or mild presentations for which individuals may not seek care. Traditional passive surveillance systems rely on confirmatory laboratory testing and may not detect emergent disease until there is high morbidity in a community or severe disease presentation. Participatory surveillance is an approach to disease detection that allows the public to directly report symptoms electronically and provides rapid visualization of aggregated data to the user and public health agencies. Several such systems have been shown to be sensitive, accurate, and timelier than traditional surveillance. We developed Kidenga, a mobile phone app and participatory surveillance system, to address some of the challenges in early detection of day-biting mosquitoes and Aedes-borne arboviruses and to enhance dissemination of information to at-risk communities. 

Objective

(1) Early detection of Aedes-borne arboviral disease;

(2) improved data on Ae. aegypti and Ae. albopictus distribution in the United States (U.S.); and

(3) education of clinicians and the public. 

Syndromic surveillance is an alternative type of public health surveillance which utilizes pre-diagnostic data sources to detect outbreaks earlier than conventional (laboratory) surveillance and monitor the progression of illnesses in populations. These systems are often noted for their ability to detect a wider range of cases in under- reported illnesses, utilize existing data sources, and alert public health authorities of emerging crises. In addition, they are highly versatile and can be applied to a wide range of illnesses (communicable and non-communicable) and environmental conditions. As a result, their implementation in public health practice is expanding rapidly. This scoping review aimed to identify all existing literature detailing the necessary components in the defining, creating, implementing, and evaluating stages of human infectious disease syndromic surveillance systems. 

Public Health England (PHE) uses syndromic surveillance systems to monitor for seasonal increases in respiratory illness. Respiratory illnesses create a considerable burden on health care services and therefore identifying the timing and intensity of peaks of activity is important for public health decision-making. Furthermore, identifying the incidence of specific respiratory pathogens circulating in the community is essential for targeting public health interventions e.g. vaccination. Syndromic surveillance can provide early warning of increases, but cannot explicitly identify the pathogens responsible for such increases.

PHE uses a range of general and specific respiratory syndromic indicators in their syndromic surveillance systems, e.g. “all respiratory disease”, “influenza-like illness”, “bronchitis” and “cough”. Previous research has shown that “influenza-like illness” is associated with influenza circulating in the community1 whilst “cough” and “bronchitis” syndromic indicators in children under 5 are associated with respiratory syncytial virus (RSV)2, 3. However, the relative burden of other pathogens, e.g. rhinovirus and parainfluenza is less well understood. We have sought to further understand the relationship between specific pathogens and syndromic indicators and to improve estimates of disease burden. Therefore, we modelled the association between pathogen incidence, using laboratory reports and health care presentations, using syndromic data. 

Objective

To improve understanding of the relative burden of different causative respiratory pathogens on respiratory syndromic indicators monitored using syndromic surveillance systems in England. 

A variety of government reports have cited challenges in coordinating national biosurveillance efforts at strategic and tactical levels. The General Accountability Office (GAO), an independent nonpartisan agency that investigates how the federal government funding and performs analysis at the request of congressional committees or by public mandate, has published 64 reports on biosurveillance since 2005. The aim of this project is to better characterize these issues by collecting and analyzing a sample of publicly documented biosurveillance systems, and making our data and results available for the public health community to review and evaluate. This study openly publishes the data files of information collected (i.e. CSV, XLS), the Python NLP scripts, and a freely available web-based application developed in R Shiny that filters against the 227 biosurveillance systems and activities to promote a more transparent understanding of how public health practitioners conduct surveillance activities.

Objective

The objective of this project is to advance the science of biosurveillance by providing a user curated cataloging system, to be used across health department and other users, that advances daily surveillance operations by better characterizing three key issues in available surveillance systems: duplication in biosurveillance activities; differing perspectives and analyses of the same data; and inadequate information sharing.

There were several stand-alone vector surveillance applications being used by the New York State Department of Health (NYSDOH) to support the reporting of mosquito, bird, and mammal surveillance and infection information implemented in early 2000s in response to West Nile virus. In subsequent years, the Electronic Clinical Laboratory Reporting System (ECLRS) and the Communicable Disease Electronic Surveillance System (CDESS) were developed and integrated to be used for surveillance and investigations of human infectious diseases and management of outbreaks.

An integrated vector surveillance system project was proposed to address the migration of the stand-alone vector surveillance applications into a streamlined, consolidated solution to support operational, management, and technical needs by using the national standards with the existing resources and technical environment.

Objective

To develop a mosquito surveillance module to collect mosquito information testing for West Nile, East Equine Encephalitis (EEE) and Zika viruses using national standards. To provide a common set of data for local health departments (LHDs) and state users to report and share information. To monitor the type of mosquito species that carry diseases.