Aberration Detection

Super Bowl XLIX took place on February 1st, 2015 in Glendale, Arizona. In preparation for this large scale public event and related activities, the Maricopa County Department of Public Health (MCDPH) developed methods for enhanced surveillance, situational awareness and early detection of public health emergencies.

Objective

To describe the enhanced epidemiologic surveillance efforts in place during Super Bowl XLIX and related events, review epidemiologic surveillance results, discuss novel approaches for near real-time surveillance for situational awareness and early event detection and examine lessons learned for surveillance strategies during mass gatherings.

The Risk Identification Unit (RIU) of the US Dept. of Agriculture’s Center for Epidemiology and Animal Health (CEAH) conducts weekly surveillance of national livestock health data and routine coordination with agricultural stakeholders. In an initiative to increase the monitored species, health issues, and data sources, CEAH epidemiologists are building a surveillance system based on weekly counts of laboratory test orders along with Colorado State Univ. laboratorians and statistical analysts from the Johns Hopkins Univ. Applied Physics Lab. Initial efforts used 12 years of equine test records from 3 state labs covering most Colorado horse testing. Trial syndrome groups were formed based on RIU experience and published articles. Data analysis, stakeholder input, and discovery of laboratory workflow details were needed to modify these groups and filter test records to eliminate alerting bias. Customized statistical monitoring methods were sought based on specialized lab information characteristics and on likely presentation and health significance of syndrome-associated diseases.

When monitoring public health incidents using syndromic surveillance systems, Public Health England (PHE) uses the age of the presenting patient as a key indicator to further assess the severity, impact of the incident, and to provide intelligence on the likely cause. However the age distribution of cases is usually not considered until after unusual activity has been identified in the allages population data. We assessed whether monitoring specific age groups contemporaneously could improve the timeliness, specificity and sensitivity of public health surveillance.

Objective

To investigate whether aberration detection methods for syndromic surveillance would be more useful if data were stratified by age band.

Global targets for elimination of human rabies mediated by dogs have been set for 2030. In the Americas countries are progressing towards interruption of transmission and declaration of rabies freedom1. Guidance for managing elimination programmes to ensure continued progress during the endgame is critical, yet often limited and lacking in specific recommendations. Characteristic spatiotemporal incidence patterns are indicative of progress, and through their identification, tailored guidance can be provided. 

Objective

To provide surveillance tools to support policymakers and practitioners to identify epidemiological situations and inform the progressive implementation of rabies elimination programmes. 

Patients who suffer from rare diseases can be hard to diagnose for prolonged periods of time. In the process, they are often subjected to tentative treatments for ailments they do not have, risking an escalation of their actual condition and side effects from therapies they do not need. An early and accurate detection of these cases would enable follow-ups for precise diagnoses, mitigating the costs of unnecessary care and improving patients’ outcomes. 

Objective

To identify sufferers of a rare and hard to diagnose diseases by detecting sequential patterns in historical medical claims.