The following syndrome was developed to explore emergency department visit records involving people experiencing homelessness. Trends over time, patient demographics, geographic distribution, and primary reasons for seeking care were explored. Additionally, we have been using this definition, in combination with other illness/injury specific definitions to assess the trends in among people experiencing homelessness (e.g., cold-related illness among people experiencing homelessness during record low temperatures).
Homeless
Description
Although Electronic Surveillance System for the Early Notification of Community Based Epidemics (ESSENCE) provides tools to detect a significant alert regarding an unusual public health event, combining that information with other surveillance data, such as 911 calls, school absenteeism and poison control records, has proved to be more sensitive in detecting an outbreak. On Monday, June 16, Florida Poison Information Network, which takes after-hours and weekend calls for Miami-Dade County Health Department (MDCHD), contacted the Office of Epidemiology and Disease Control about five homeless persons that visited the same hospital simultaneously with gastrointestinal symptoms on Saturday, June 14. Poison control staff asked MDCHD to investigate further to determine whether it was an outbreak.
Objective
To illustrate how MDCHD utilized ESSENCE in order to track a gastrointestinal outbreak in a homeless shelter.
Referenced File
Description
The City of Atlanta, volunteer organizations, and the faith community operate several homeless shelters throughout the city. Services available at these shelters vary, ranging from day services, such as meals, mail collection, and medical clinics, to overnight shelter accommodations. In addition to the medical clinics available at these facilities, the Atlanta homeless population also utilizes emergency departments in Fulton County for their health care needs.
Objective
This paper describes a cluster of Streptococcus pneumoniae infections identified through emergency department syndromic surveillance.
Referenced File
Description
San Francisco has the highest rate of TB in the US. Although in recent years the incidence of TB has been declining in the San Francisco general population, it has remained relatively constant in the homeless population. Spatial investigations of disease outbreaks seek to identify and determine the significance of spatially localized disease clusters by partitioning the underlying geographic region. The level of such regional partitioning can vary depending on the available geospatial data on cases including towns, counties, zip codes, census tracts, and exact longitude-latitude coordinates. It has been shown for syndromic surveillance data that when exact patients’ geographic coordinates are used, higher detection rates and accuracy are achieved compared to when data are aggregated into administrative regions such as zip codes and census tracts. While the benefits of using a finer spatial resolution, such as patients’ individual addresses, have been examined in the context of spatial epidemiology, the effect of varying spatial resolution on detection timeliness and the amount of historical data needed have not been investigated.
Objective
The objective of this study is to investigate the effect of varying the spatial resolution in a variant of space-time permutation scan statistic applied to the tuberculosis data on the San Francisco homeless population on detection sensitivity, timeliness, and the amount of historical data needed for training the model.
Referenced File
The homelessness syndrome was developed to identify emergency department visits in ESSENCE for patients who are experiencing homelessness or housing insecurity. The syndrome is intended for use with chief complaint, triage notes, and discharge diagnosis codes (ICD-10 CM). The definition heavily relies on diagnosis codes primarily used by non-critical access hospitals and artificial exclusion of critical access facilities should be considered when data are interpreted.
Description
In early 2017, HAV outbreaks were identified in San Diego County (490 cases) and Santa Cruz County (73 cases) in California, affecting primarily the homeless and/or illicit drug users. As of October 10, 2017, LAC had identified 12 outbreak-related HAV cases. Due to LACâs proximity to San Diego County, and its own large homeless population, the syndromic surveillance team of the LAC Department of Public Health created a syndrome category and began querying its ED data to monitor for any increase in HAV-related visits.
Objective:
To create a hepatitis A virus (HAV) syndrome category with which to monitor emergency department (ED) visits for situational awareness during a currently emerging Hepatitis A community outbreak in Los Angeles County (LAC), and to evaluate its usefulness.
Description
On 3/29/2017, the Maricopa County Department of Public Health (MCDPH) received three reports of confirmed HAV infection from an onsite clinic at Campus A that assists individuals experiencing homelessness, a population at risk for HAV transmission. To identify the scope of the problem, the department initiated rapid HAV infection case detection using NSSP ESSENCE.
Objective:
To demonstrate the utility of the National Syndromic Surveillance Programâs (NSSP) version of the Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) for case detection during a 2017 outbreak of hepatitis A virus (HAV) infection among persons experiencing homelessness in Maricopa County, Arizona.