There has been much recent interest in using disease signatures to better recognize disease outbreaks. Conversely, the metrics used to describe these signatures can also be used to better characterize the outbreaks. Recent work at the New York City Department of Health has shown the ability to identify characteristic age-specific patterns during influenza outbreaks. One issue that remains is how to implement a search for such patterns using prospective outbreak detection tools such as SatScan.
A potential approach to this problem arises from another currently active research area: the simultaneous use of multiple datastreams. One form of this is to disaggregate a data stream with respect to a third variable such as age. Two drawbacks to this approach are that the categories used to make the streams have to be defined a priori and that relationships between the streams cannot be exploited. Furthermore, the resulting description is less rich as it describes outbreaks in a few non-overlapping age-specific streams. It would be desirable to look for age specific patterns with the age groupings implicitly defined.
Objective
This paper presents an implementation of a citywide SatScan analysis that uses age as a one-dimensional spatial variable. The resulting clusters identify age-specific clusters of respiratory and fever/flu syndromes in the New York City Emergency Department Data.
In Connecticut (CT), several syndromic surveillance systems have been established by the Department of Public Health (DPH) to detect and monitor potential public health threats. The emergency department syndromic surveillance (EDSS) routinely categorizes chief complaint data into pre-defined syndrome categories, and also has the flexibility to define syndromes in real-time. Thus, DPH can use this system for situational awareness during public health events. Several recent events provided an opportunity to evaluate EDSS for this purpose: 1) two cases of cutaneous anthrax in CT in September 2007; 2) national and local media attention surrounding MRSA infections and published research in October 2007 and 3) the introduction of rotavirus vaccine through the Vaccines for Children Program in July 2006 following its licensing in February 2006.
Objective
To evaluate the performance of the CT EDSS system for situational awareness during specific public health events.
On June 22, 2007 increases in over-the-counter (OTC) electrolyte and child anti-fever medication sales were detected through routine OTC surveillance. Increases in emergency department (ED) data for gastrointestinal (GI) illness among <5 year olds were observed on June 23 and 24. Further analyses indicated clustering within one borough of NYC, with three EDs having most of the visits. Because NYC has had limited success in detecting spatial outbreaks using syndromic surveillance in the past, an investigation was not immediately initiated.
DOHMH was notified of a multi-state outbreak of S. wandsworth suspected to be associated with the snack food Veggie Booty® on June 26. Cases were predominantly young children and included 8 confirmed cases among NYC residents with onset dates from March 4 – May 19.
Objective
To determine whether increases in GI illness detected through OTC drug sales and ED syndromic surveillance were linked to a multi-state outbreak of S. wandsworth associated with the consumption of Veggie Booty® snack food.
On March 7th and 8th of 2007 authorities from federal, state, county, and municipal jurisdictions/agencies having mass migration response responsibilities (as per the Department of Homeland Security Operation Vigilant Sentry, as well as State and Local plans) initiated the last of a series of mass migration exercise events. The mission of the exercise was to “unify” a federal, state, and local response to effectively mitigate a catastrophic mass migration incident, similar to the Mariel Boatlift (125,000+ migrants) in 1980. The exercise included volunteers who visited a few local emergency departments with specific scripts describing an acute medical condition.
Objective
Describe the use of the ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics) system to detect unusual patterns of emergency department use during a full scale mass migration exercise in South Florida.
In 2005, three hurricanes made landfall in Florida, with Hurricane Wilma having the most severe impact on Miami-Dade County. Syndromic surveillance is typically used to detect bioterrorism or natural disease outbreaks before specific diagnoses are made. After Wilma, however, the Miami-Dade County Health Department assessed the utility of syndromic data for surveillance of hurricane-related injuries.
Objective
To determine the proportion of injuries in Miami-Dade County that could be related to the impact of Hurricane Wilma, which made landfall in Florida on October 25, 2005.
Respiratory viruses cause substantial morbidity and costly resource utilization among young children, especially during the winter months. Accurate estimates of the impact of these viruses are important in guiding prevention efforts and measuring the impact of public health interventions. Previous studies have focused on the rate of hospitalizations resulting from viral infections, particularly those attributable to influenza virus for which a vaccine is available, but have not included healthcare use in the emergency department (ED) nor considered the impact of other viruses such as respiratory syncytial virus (RSV), for which limited preventative methods are available. We used ED surveillance data for acute respiratory infection to measure the population-based impact of specific viruses.
Objective
To use surveillance data to estimate resource utilization and parental lost productivity associated with influenza and RSV infections among young children.
Centre for Health Protection (CHP) plans to conduct a pilot project in developing a syndromic surveillance system using data from Emergency Departments (ED) in Hong Kong. This is part of the Communicable Disease Information System initiative, which aims at enhancing the capability of Hong Kong in the control and prevention of communicable diseases.
Objective
This paper describes how the CHP of Hong Kong designed and deployed an online interactive system that uses the data from ED for syndromic surveillance.
The BioSense system receives patient level clinical data from > 370 hospitals and 1100 ambulatory care Departments of Defense and Veterans Affairs medical facilities. Visits are assigned as appropriate to 78 sub-syndromes, including respiratory syncytial virus (RSV). Among infants and children < 1 year of age, RSV is the most common cause of bronchiolitis and pneumonia; 0.5% to 2% require hospitalization. Increasingly, RSV is also recognized as a major cause of pneumonia in elderly adults.
Objective
To analyze final diagnosis data available to BioSense and determine its potential utility for surveillance of RSV illness.
Syndromic surveillance is an investigational approach used to monitor trends of illness in communities. It relies on pre-diagnostic health data rather than laboratory-confirmed clinical diagnoses. Its primary purpose is to detect disease outbreaks, incidents and unusual public health events earlier than possible with traditional public health surveillance methods.
Objective
To describe how epidemiological principles are utilized to distinguish a real alert from statistically significant alerts in order to monitor and create daily reports in the Miami-Dade County Health Department using Electronic Surveillance System for the Early Notification of Community Based Epidemics.
The North Carolina Bioterrorism and Emerging Infection Prevention System (NC BEIPS) receives daily emergency department (ED) data from 33 (29%) of the 114 EDs in North Carolina. These data are available via a Web-based portal and the Early Aberration Reporting System to authorized NC public health users for the purpose of syndromic surveillance (SS). Users currently monitor several syndromes including: gastrointestinal severe, fever/rash illness and influenza-like illness. The syndrome definitions are based on the infection-related syndrome definitions of the CDC and search the chief complaint (CC) and, when available, triage note (TN) and initial temperature fields. Some EDs record a TN, which is a brief text passage that describes the CC in more detail. Most research on the utility of ED data for SS has focused on the use of CC. The goal of this study was to determine the sensitivity, specificity, and both positive and negative predictive value of including TN in the syndrome queries.
Objective
This study evaluates the addition of TN to syndrome queries used in the NC BEIPS.