Influenza

Although development of computerized medical record systems in the United States is a high priority, there are relatively few instances of such systems supporting disease surveillance systems. The Indian Health Service (IHS) has had an electronic record database for over 30 years, however, implementation of point of care electronic health records (EHR) and use of these data for public health surveillance has begun only over the past 4 years.

Objective

To develop a robust, sensitive, and specific local, regional, and national public health surveillance system utilizing an electronic clinical information system.

Using an electronic health record (EHR) system, we tracked an outpatient population from a series of primary care providers to identify influenza-like illness (ILI) as part of a multi-state effort directed by the Centers for Disease Control and Prevention. From these patients, we also collected de-identified project-specific information and symptoms using an electronic template to evaluate possible differences among patient groupings as well as longitudinal population patterns.

Objective

Evaluate the use of an EHR network to track ILI incidence in an outpatient population and using laboratory testing, identify influenza cases by subtype as well as other respiratory viruses.

The Washington Comprehensive Hospital Abstract Reporting System (CHARS) has collected discharge data from billing systems for every inpatient admitted to every hospital in the state since 1987 [1]. The purpose of the system is to provide data for making informed decisions on health care. The system collects age, sex, zip code and billed charges of the patient, as well as hospital names and discharge diagnoses and procedure codes. The data have potential value for monitoring the severity of outbreaks such as influenza, but not for prospective surveillance: Reporting to CHARS is manual, not real-time, and there is roughly a 9-month lag in release of information by the state. In 2005, Public Health - Seattle & King County (PHSKC) requested that hospitals report pneumonia and influenza admissions (based on both admission and discharge codes) directly to the PHSKC biosurveillance system; data elements included hospital name, date/time of admission, age, sex, home zip code, chief complaint, disposition, and diagnoses. In 2008, reporting was revised to collect separate admission and discharge diagnoses, whether the patient was intubated or was in the ICU, and a patient/visit key. Hospitals transmit data daily for visits that occurred up to 1 month earlier. Previously, we identified a strong concordance between the volume of influenza diagnoses recorded across the PHSKC and CHARS systems over time [2]. However, discrepancies were observed, particularly when stratified by hospital. We undertook an evaluation to identify the causes of these discrepancies.

Objective

We sought to evaluate the quality of influenza hospitalizations data gathered by our biosurveillance system.

Influenza is a recurrent viral disease with potential to result in pandemics. Therefore it is necessary to have a timely, responsive and accurate detection. The use of Twitter as a source for data mining in biosurveillance has been previously shown useful, and it also has a potential for real-time visualization. However these efforts target messages in English, omitting from surveillance the part of users that speaks other languages, such as Spanish.

Objective

Identify the potential of Twitter as a source for monitoring and visualizing content regarding Influenza-like-Illness in Spanish-speaking populations for biosurveillance purposes.

Influenza is associated with significant morbidity and mortality nationally each year and VA's large elderly population is at particular risk. VA Office of Public Health (OPH) has monitored influenza and influenza-like-illness (ILI) activity using the VA's biosurveillance system since 2009 (1,2). VA influenza surveillance capacity has expanded significantly in recent years to include inpatient influenza data, telephone triage data, laboratory testing data and enhanced geospatial mapping capabilities.

Objective

Herein we summarize our ongoing influenza surveillance activities and describe the 2012-2013 influenza season activity in VA.

Outbreaks of Avian influenza (AI) in poultry were first reported in Nigeria in 2006 (1). The only human case was reported in 2007 (1). The epizootics of AI among poultry and wild birds and subsequent risk to human health highlighted the need to detect influenza viruses with pandemic potential and for establishment of Influenza Sentinel Surveillance (ISS) System. This is to aid the description of the the epidemiology and burden of seasonal human influenza, to provide information for public health decision making, for program planning and preparedness and to serve as an early warning for outbreaks of Avian or pandemic flu. Also, to characterize and monitor trends in illnesses and deaths attributable to SARI (2). Lagos State University Teaching Hospital (LASUTH) is one of the 4 sites for ISS in Nigeria and started functioning in 2009.

Objective

To analyze the Lagos site of the National Influenza Sentinel Surveillance (NISS) system and to determine the viruses responsible for Influenza-like illnesses (ILI) and Severe Acute Respiratory Infection (SARI).

MOH's national sentinel surveillance programme for influenza is part of the WHO international laboratory-based surveillance network to detect the emergence and spread of new antigenic variants of influenza viruses. Virological sample collection is on-going and is carried out during both outbreak and non-outbreak periods.In 2011 and 2012, the sentinel surveillance programme involved a total of 169 sites (18 government primary care clinics and 151 private/general practitioner [GP] clinics).

Objective

 We evaluated the Singapore Ministry of Health's sentinel surveillance system for influenza virus, which included the monitoring of virological samples from patients with influenza-like illness (ILI) seen at government primary care clinics and private general practitioner clinics in 2011-12.

Currently Scotland has a number of influenza surveillance schemes, including âflu-spotter’ practices, and enhanced surveillance general practices that submit clinical samples for virological testing (SERVIS practices). This information feeds annually into the European Influenza Surveillance Scheme1. Information from the systems is seasonal, and limited geographically covering 6% and 3% of the population respectively. The utilisation by Scottish community physicians (general practitioners, GP’s) of the same administration system in over 80% of settings - the General Practice Administration System for Scotland (GPASS) - offers an alternative approach to influenza surveillance with some additional benefits.

Objective

To develop and pilot an enhanced primary care surveillance system of influenza-like illness in Scotland, record influenza vaccine uptake and estimate vaccine effectiveness in season in real time.

Routine primary care data provide the means to systematically monitor a variety of syndromes which could give early warning of health protection issues (microbiological and chemical). It is possible to track milder illnesses which may not present to hospitals (e.g. chicken pox, conjunctivitis) or illnesses for which laboratory specimens are not routinely taken (e.g. influenza). Real-time data are also needed to respond to major health protection incidents.

Objective

To describe the arrangements for Primary Care Surveillance in the UK and provide examples of the benefits of this work for Public Health.