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ESSENCE

Description

The National Syndromic Surveillance Program's (NSSP) instance of ESSENCE* in the BioSense Platform generates about 35,000 statistical alerts each week. Local ESSENCE instances can generate as many as 5,000 statistical alerts each week. While some states have well-coordinated processes for delegating data and statistical alerts to local public health jurisdictions for review, many do not have adequate resources. By design, statistical alerts should indicate potential clusters that warrant a syndromic surveillance practitioner's time and focus. However, practitioners frequently ignore statistical alerts altogether because of the overwhelming volume of data and alerts. In 2008, staff in the Virginia Department of Health experimented with rules that could be used to rank the statistical output generated in ESSENCE alert lists. Results were shared with Johns Hopkins University Applied Physics Lab (JHU/APL), the developer of ESSENCE, and were early inputs into what is now known as "myAlerts," an ESSENCE function that syndromic surveillance practitioners can use to customize alerting and sort through statistical noise. NSSP ESSENCE produces a shared alert list by syndrome, county, and age-group strata, which generates an unwieldy but rich data set that can be studied to learn more about the importance of these statistical alerts. Ultimately, guidance can be developed to help syndromic surveillance practitioners set up meaningful ESSENCE myAlerts effective in identifying clusters with public health importance.

Objective: Find practical ways to sort through statistical noise in syndromic data and make use of alerts most likely to have public health importance.

Submitted by elamb on
Description

In March 2018, the Illinois Department of Public Health (IDPH) was informed of a cluster of coagulopathy cases linked to SC use. By June 30, 2018, 172 cases were reported, including five deaths, where 74% were male and the mean age was 35.3 years (range: 18–65 years). All cases presented to an emergency department (ED) at least once for this illness. Ninety-four cases provided clinical specimens and all tested positive for brodifacoum, a long-acting anticoagulant used in rodenticide. Cases were reported to the health department by the Illinois Poison Control Center and direct reporting from hospitals. REDCap was the primary database for tracking cases and collecting demographic information, risk factor data and healthcare facility utilization, including number of ED visits. Syndromic surveillance was utilized to monitor ED visits related to the cluster, assist with case finding and provide situational awareness of the burden on the EDs and geographic spread. In this study, we retrospectively used syndromic surveillance along with the data in REDCap to quantify the number of ED visits per coagulopathy case, understand the reasons for repeat visits, and determine whether visits were captured in syndromic surveillance.

Objective: To determine whether emergency department (ED) visits were captured in syndromic surveillance for coagulopathy cases associated with an outbreak linked to synthetic cannabinoid (SC) use and to quantify the number of ED visits and reasons for repeat visits.

Submitted by elamb on
Description

Hand, foot, and mouth disease is a highly infectious disease common among early childhood populations caused by human enteroviruses (Enterovirus genus).1 The enteroviruses responsible for HFMD generally cause mild illness among children in the United States with symptoms of fever and rash/blisters, but have also been linked to small outbreaks of severe neurological disease such as meningitis, encephalitis, and acute flaccid myelitis.2 Enteroviruses circulate year-round but increase in the summer-fall months across much of the United States.3 The drivers of this seasonality are not fully understood, but research indicates climatic factors, rather than demographic ones, are most likely to drive the amplitude and timing of the seasonal peaks.3 A recent CDC study on nonpolio enteroviruses identified dew point temperature as a strong predictor of local enterovirus seasonality, explaining around 30% of the variation in intensity of transmission across the United States.3

Objective: To assess the relationship between seasonal increases in emergency department (ED) and urgent care center (UCC) visits for hand, foot, and mouth disease (HFMD) among children 0-4 years old and average dew point temperatures in Virginia. To determine if this relationship can be used to develop an early warning tool for high intensity seasons of HFMD, allowing for earlier targeted public health action and communication to the community and local childcare centers during these high intensity seasons.

Submitted by elamb on
Description

The ESSENCE application supports users' interactive analysis of data by clicking through menus in a user interface (UI), and provides multiple types of user defined data visualization options, including various charts and graphs, tables of statistical alerts, table builder functionality, spatial mapping, and report generation. However, no UI supports all potential analysis and visualization requirements. Rapidly accessing data processed through ESSENCE using existing access control mechanisms, but de-coupled from the UI, supports innovative analyses, visualizations and reporting of these data using other tools.

Objective: To describe and provide examples of the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) application programming interface (API) as a part of disease surveillance workflows.

Submitted by elamb on
Description

Although sexual violence is a pressing public health and safety issue, it has historically been challenging to monitor population trends with precision. Approximately 31% of incidents of sexual violence are reported to law enforcement and only 5% lead to an arrest1, making the use of law enforcement data challenging. Syndromic surveillance data from emergency departments provides an opportunity to use care-seeking to more accurately surveil sexual violence without introducing additional burdens on either patients or healthcare providers.

Objective: To describe characteristics of sexual violence emergency department visits in Washington State.

Submitted by elamb on
Description

Timely influenza data can help public health decision-makers identify influenza outbreaks and respond with preventative measures. DoD ESSENCE has the unique advantage of ingesting multiple data sources from the Military Health System (MHS), including outpatient, inpatient, and emergency department (ED) medical encounter diagnosis codes and laboratory-confirmed influenza data, to aid in influenza outbreak monitoring. The Influenza-like Illness (ILI) syndrome definition includes ICD-9 or ICD-10 codes that may increase the number of false positive alerts. Laboratory-confirmed influenza data provides an increased positive predictive value (PPV). The gold standard for influenza testing is molecular assays or viral culture. However, the tests may take 3-10 days to result. Rapid influenza diagnostic tests (RIDTs) have a lower sensitivity, but the timeliness of receiving a result improves to within <15 minutes. We evaluate the utility of RIDTs for routine ILI surveillance.

Objective: To describe influenza laboratory testing and results in the Military Health System and how influenza laboratory results may be used in DoD Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE)

Submitted by elamb on
Description

On August 25, 2017 Hurricane Harvey moved onshore near Port Aransas, Texas, eventually overwhelming areas of Houston with between 41-60 inches of rain (Houston Health Department [HHD], 2017). As a category 4 storm, with wind speeds as high as 130 mph, Harvey broke several rainfall records across the state and ended the prolonged period of twelve years in which no major hurricanes had made landfall in the United States (Mersereau, 2017). Harvey ambled at a leisurely pace through Houston and resulted in devastating flooding that destroyed homes and required the evacuation of approximately 37,000 Houstonians to over 78 shelter facilities across the affected area (HHD, 2017). Through concerted efforts, the American Red Cross and the HHD established the shelter at the George R. Brown Convention Center (GRB) and delivered or coordinated social services, medical and mental health services, disease surveillance and food/sanitary inspection services for the duration of the need for the shelter (HHD, 2017).

Objective: To provide recommendations for future preparedness response efforts based on an assessment of the Post-Hurricane Harvey After-Action Report (AAR).

Submitted by elamb on
Description

Accuracy in identifying drug-related emergency department admissions is critical to understanding local burden of disease and assessing effectiveness of drug abuse prevention and overdose-reduction initiatives. In 2018 the Illinois Department of Public Health (IDPH) began implementation of a mandatory opioid overdose reporting law, applicable to all hospital emergency departments (ED). The mandate requires reporting of patient demographics, causal substance and antagonist ED administration within 48 hours of presentation. This reporting is not name-based. IDPH currently utilizes a near real-time syndromic surveillance (SyS) reporting system for all hospital ED, capturing most of the mandated criteria. Leveraging this existing system facilitates adherence to the mandate while imposing minimal additional burden of reporting on local hospitals. The Division of Patient Safety and Quality at IDPH has thus chosen to evaluate the completeness of overdose reporting and compliance with the opioid overdose mandate that have resulted from use of the current syndromic surveillance system.

Objective: To evaluate capacity of the BioSense ESSENCE platform and pre-defined overdose queries to identify emergency department admissions related to opioid overdose, in compliance with 2018 mandatory overdose reporting laws in Illinois.

Submitted by elamb on
Description

Icy weather events increase the risk for injury from falls on untreated or inadequately treated surfaces. These events often result in ED visits, which represents a significant public health and economic impact1. The goal of this project was to start the process toward an evaluation of the public health impact and the economic impact of falls associated to icy weather in Douglas County, NE for the ultimate purpose of designing and implementing injury prevention related public health protection measures. Additionally, the validated definition will be used by NE DHHS Occupational Health Surveillance Program to identify work related ice-related fall injuries that were covered by workers compensation. To achieve the goal, the first step was to identify a valid and reliable syndromic surveillance. Specifically, this project looked at the applicability of the ESSENCE syndromic surveillance definitions related to injuries associated with falls. Two syndromic surveillance definitions were compared, one that includes triage note and chief complaint search terms, and another that only includes chief complaint. The hypothesis was that the ESSENCE syndromic surveillance definition that includes triage note and chief complaint search terms, rather than the syndromic surveillance definition that only includes chief complaint, would be more effective at identifying ED visits resulting from fall-related injuries.

Objective: This project evaluated and compared two ESSENCE syndromic surveillance definitions for emergency department (ED) visits related to injuries associated with falls in icy weather using 2016-2017 data from two hospitals in Douglas County, Nebraska. The project determined the validity of the syndromic surveillance definition as applied to chief complaint and triage notes and compared the chief complaint data alone to chief complaint plus triage notes definitions to find the most reliable definition for ED visits resulting from fall-related injuries.

Submitted by elamb on
Description

The ESSENCE system is a community-driven disease surveillance system. Installed in over 25 jurisdictions across the US, the system is built on a single codebase that is shared across all instances. While each individual location can customize many of the settings, data sources, and configurations, the underlying code and functionality is shared. This means that when one jurisdiction works with the Johns Hopkins University Applied Physics Laboratory (JHU/APL) to create a new feature, it is available to all sites.

Objective: The objective of this presentation is to discuss the new features that are under development for ESSENCE in 2019. This is a chance to describe the features, the use cases for the features, and open a dialogue with the community on potential new enhancements that are available.

Submitted by elamb on