Infectious Diseases

The Bioterrorism Surveillance Unit of the Los Angeles County (LAC) Department of Public Health, Acute Communicable Disease Control (ACDC) program analyzes Emergency Department (ED) data daily. Currently capturing over 40% of the ED visits in LAC, the system categorizes visits into syndrome groups and analyzes the data for aberrations in count and spatial distribution. Typical usage of the system may be extended for various enhanced surveillance activities by creating additional syndrome categories tailored to specific illnesses or conditions. This report describes how ED data was utilized for enhanced surveillance regarding: (1) a sustained heat wave in California that broke temperature and duration records, (2) a 30,000 gallon raw sewage spill that prompted the closure of two miles of beach, and (3) an alert to ACDC of a high school student who attended school while symptomatic for meningitis.

Objective

To describe enhanced surveillance provided by the LAC Department of Public Health’s syndromic surveillance system for monitoring health events in 2006.

 Syndromic surveillance systems often classify patients into syndromic categories based on emergency department (ED) chief complaints. There exists no standard set of syndromes for syndromic surveillance, and the available syndromic case definitions demonstrate substantial heterogeneity of findings constituting the definition. The use of fever in the definition of syndromic categories is arbitrary and unsystematic. We determined whether chief complaints accurately represent whether a patient has any of five febrile syndromes: febrile respiratory, febrile gastrointestinal, febrile rash, febrile neurological, or febrile hemorrhagic.

In the past, the media has served a source of data for syndromic surveillance of infectious disease, whether it is outbreaks of disease in animals or humans resulting in illness or death.  More often than not, the reverse is true; data based on analyses of   syndromic surveillance often flows from hospital to local health departments and federal governmental agencies such as the CDC to the media which then relays it to the public. In both instances, the media may serve as a purveyor of vital information.  But, sometimes the media reports are less than ideal; the public may become fearful and panic at the news of a potential outbreak of an emerging infectious disease such as bird flu for which there is a high fatality case rate and no proven available vaccine, or curative therapy. Moreover, supplies of vaccine may be limited, and news of a shortage of antiviral medications such as Tamiflu may lead to stockpiling similar to what occurred with Cipro during the anthrax  ‘scare.’  

Objective:

This paper explores how the mass media covered bird flu outbreaks overseas in the Fall of 2005, and the nationís preparations for a possible bird flu pandemic, and how this period of intense media activity affected sales of antivirals in New City and New York State as monitored by syndromic surveillance techniques.

BioSense is a national Centers for Disease Control and Prevention (CDC) initiative to improve the nation's capabilities for early event detection and situational awareness. BioSense data includes Department of Defense and Veterans Affairs ambulatory care diagnoses and procedures, as well as Laboratory Corporation of America lab test orders.  The data are collected, assigned to syndromes based upon definitions developed by a multi-agency working group, analyzed using several detection algorithms, and displayed in various visualizations [2,3].  BioIntelligence Center (BIC) staff at CDC monitors BioSense national data on a daily basis and are available to support state and local public health officials’ monitoring and investigations [3]. As part of its ongoing bioterrorism surveillance, the New Jersey Department of Health and Senior Services (NJDHSS) reviews the BioSense application for syndrome activity and disease alerts of potential public health importance.  In November, 2004, staff noted a Sentinel Infection Alert for Smallpox two days before the Thanksgiving holiday.  The investigation of this Sentinel Alert by NJDHSS was the first Sentinel Alert follow-up investigation by a state health department and helped state and CDC colleagues identify ways to enhance BioSense.

Objective:

This paper describes a situation in November, 2004, regarding a Sentinel Infection Alert for Smallpox that appeared in the BioSense application.

Syndromic surveillance has been used to detect variation in seasonal viral illnesses such as influenza and norovirus infection (1). Limited information is available on the use of a comprehensive bio-surveillance system, including syndromic surveillance, for detection and situational awareness during a sustained outbreak.  

Objective:

To report on surveillance and response activities during the 2006-2007 norovirus season in Boston.

This paper describes a methodology for applying natural language parsing (NLP) technologies, originally developed for analyzing biomedical journal articles, to the monitoring of emergency department patient charts for infectious diseases of interest.

Sickness absence is particularly pronounced within health care organizations where job demands and work environment expose workers to an increased risk of illness and injury, potentially leading to an inability to attend work. Health Care Workers (HCWs), especially nurses who are primarily responsible for front-line patient care, are at high risk of acquiring infections from direct patient contact. In addition, there is greater risk of exposure to contaminated human blood and body fluids.

Objective

1) To identify and describe Occupational Health visits (overall and specific conditions) among full-time Kingston General Hospital employees, according to frequency, duration, workplace variables and seasonality. 2) To consider the association between absenteeism and HCW exposure risk to infectious diseases based on a proxy variable defining level of patient contact. 3) To examine the potential for integration of this occupational health data stream into an existing Emergency Department Syndromic Surveillance system.