Chikungunya

Chikungunya virus disease (CHIK) is a mosquito-borne viral infection currently widespread in the Caribbean with the potential for emergence and endemicity in the U.S. via infected travelers and local mosquito vectors. CHIK disease can be severe and disabling with symptoms similar to dengue. CHIK is not a U.S. nationally notifiable disease and tracking travel-associated and locally acquired cases is currently dependent on voluntary reporting via ArboNET. While ArboNET cases are laboratory confirmed and highly specific, ArboNET is a passive surveillance system where representativeness and timeliness may be lacking. In contrast, submitting an electronic bill following HC services is the most mature and widely used form of eHealth. Providers are highly motivated to submit claims for reimbursement and the eHRC process is ubiquitous in the U.S. HC system. HIPAA-compliant eHRCs from provider offices can be captured in e-commerce and consolidated into electronic data warehouses and used for many purposes including public health surveillance. eHRCs are standardized and each claim contains pertinent person, place, and time information as well as ICD-9 diagnostic codes. IMS Health (IMS) is a global HC information company and maintains one of world’s largest eHealth data warehouses that processes ~1 billion provider office eHRCs annually. IMS consolidates eHRCs from >60% of all U.S. office-based providers from all parts of the U.S. The size and predictability of the eHRC flow into the IMS data warehouse supports projections of national estimates and time trends of conditions of interest.

Objective

This paper describes how high-volume electronic healthcare (HC) reimbursement claims (eHRCs) from providers’ offices can be used to supplement Chikungunya surveillance in the U.S.

In December 2013, an emergence of chikungunya was observed in the French Caribbean region. Starting on the Saint-Martin island, the epidemic of chikungunya spread in Martinique on December 2013. The first cases were then observed in Guadeloupe in December 2013 and in January 2014 in the French Guyana. A specific surveillance system has been implemented based on a sentinel general practitioners’ network enabling the estimation of the number of cases clinically suggestive. Severity of this arbovirus is assessed using the number of hospitalized cases. The syndromic surveillance system SurSaUD, based on the daily collection of two complementary morbidity data sources, is also implemented in these territories and has contributed to the surveillance of this outbreak.

Objective

Description of the temporal pattern of the chikungunya epidemic and the characteristics of patients in the French overseas territories of Americas using the French syndromic surveillance system SurSaUD.

 

CHIKV is transmitted by mosquitoes and often occurs in large outbreaks with high attack rates. Common symptoms (which can be severe and disabling) include fever, joint pain/swelling, headache, muscle pain and rash. In December 2013, the World Health Organization reported local CHIKV transmission in the Caribbean. In July 2014, the first locally-acquired case in the continental U.S. (Florida) and increasing cases in Puerto Rico (PR) were reported. Due to the growing outbreak, VA Office of Public Health began conducting ongoing surveillance.

Objective

We describe challenges and lessons learned conducting surveillance for Chikungunya virus (CHIKV), an emerging infectious disease in the Americas.

The Louisiana Office of Public Health (OPH) Infectious Disease Epidemiology Section conducts emergency department (ED) syndromic surveillance using the Louisiana Early Event Detection System (LEEDS). LEEDS automatically processes electronic chief complaint, admit reason and diagnosis data to identify ED visits indicative of specific syndromes. In response to local transmission of chikungunya virus in the Caribbean and the first travel-associated case in Louisiana in May of 2014, OPH conducted an arboviral syndromic surveillance study to validate arboviral syndromes and evaluate the utility and practicality of detecting and monitoring arboviral disease using ED chief complaint, admit reason and diagnosis text data.

Objective

To validate arboviral syndromes and evaluate the utility and practicality of detecting and monitoring arboviral disease using ED chief complaint, admit reason and diagnosis text data.

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.