Consultancy

In the event of a large-scale public health crisis, successfully detecting and assessing health threats and monitoring population health status over a sustained period of time is likely to require integration of information from multiple sources. In addition, this information must be shared at varying levels of detail both among different agencies or organizations within an affected locality and among response participants at local, state, and federal levels of government. In early 2007, the International Society for Disease Surveillance (ISDS) proposed a project to support member initiated consultations on priority unresolved questions in the field of syndromic surveillance (SS) research, development, or practice. The Duval County Health Department sought and obtained ISDS support to address the use of SS data in combination with other human health and veterinary surveillance data, environmental sampling data, and plume modeling results in the event of an airborne bioterrorist (BT) attack. To date, the development of SS in Florida has mainly focused on systems that monitor information from emergency department (ED) visits. In addition, because SS development was decentralized and managed primarily by county health departments, various systems were used in Florida, including ESSENCE, STARS, EARS and BioDefend.

Objective

The objective of this consultation was to develop expert, consensus-based recommendations for use of SS in combination with other human health, animal health, and environmental data sources to improve situational awareness in the event of a large-scale public health emergency. The consultation, convened by the Duval County, Florida, Health Department, involved other local and state public health offi cials from Florida who addressed this question in the context of a hypothetical BT attack scenario in Duval County. Insights arising from the consultation will be used to strengthen public health surveillance capacities as part of both local and state emergency preparedness efforts in Florida. The approach used by the consultation may be useful to other health departments seeking to enhance their emergency situational awareness capacity.

Public health departments need enhanced surveillance tools for population monitoring, and external researchers have expertise and methods to provide these tools. However, collaboration with potential solution developers and students in academia, industry, and government has not been sufficiently close or well informed for rapid progress. Many peer-reviewed papers on biosurveillance methods have been published by researchers, but few methods have been adopted in systems used by health departments. In a 2013 BioSense User Group survey with responses from users in more than 40 U.S. states, access to improved analytic methods was a top priority. Among the tools most desired by respondents were the ESSENCE biosurveillance system with multiple analytic tools and statistical software packages such as SAS. Multiple obstacles have slowed the progress of practitioners and developers who seek the development and implementation of useful analytic tools. First, the epidemiological challenges and associated operational constraints are not sufficiently understood among academic developers. Many health departments do not have the resources to hire such developers beyond maintenance of information technology, and the health monitors are typically too busy to publish in peer-reviewed journals. Second, data cannot be shared because of privacy and proprietary limitations with varying local rules. Data-sharing has posed difficult administrative problems, both within and external to health departments, in the course of ISDS Technical Conventions committee efforts to promote interactions through use case problems. Third, aspects of situational awareness vary widely among health monitors at different jurisdictional levels, so analytical challenges and constraints vary widely among potential users. Practitioners have pointed out that “surveillance is local”, but local operational and data environments vary widely. A fourth main issue is cross-cultural: Understaffed health departments must respond to successive crises and often lack the time for requirements analysis and technical publication. Such client work situations complicate interaction with academic environments of semester schedules and limited grants and transient student support. This panel brings together academic statisticians who have had successful direct relationships with public health departments to discuss how they have dealt with these challenges.

Objective

The session will explore past collaborations between the scientist panelists and public health departments to highlight approaches that have and have not been effective and to recommend effective, sustainable relationship strategies for the mutual advancement of practical disease surveillance and relevant academic research.