ISDS Conference

In the aftermath of September 11th, 2001, the potential for subsequent bioterrorism attacks and more recently, the increased awareness of the threat of Avian flu and other communicable diseases, has compelled the Montana healthcare community to mobilize its diagnostic resources for detecting the presence of toxins or infectious biologic agents at the earliest possible moment. This state-wide, pilot initiative integrates disparate Emergency Room data, making patients’ symptoms and diagnoses available for biosurveillance and achieves interoperability among Montana’s emergency facilities.

Objective

This oral presentation describes a multi-agency and multi-center medical data integration system for syndromic surveillance in the State of Montana. This is a significant public health benefit given the recent threats of bio-terrorism and potential viral epidemics, including Bird-Flu.

Monitoring sales of over-the-counter products is becoming increasingly common for purposes of public health surveillance. Sales data for anti-diarrheal medications have been used to monitor outbreaks of waterborne Cryptosporidium outbreaks. An attractive feature of is its focus upon coupling predictions of sales for a given day (based upon times series methods) with control chart methods from the field of statistical process control.

Objective

This paper suggests and illustrates several approaches to surveillance when data are available for several regions.

Following the heat wave that scorched France in August 2003 a national daily gathering of mortality data was decided in link with the National Institute for Statistics and Economic Studies (Insee). Such gathering is based on Public Records Office equipped with the appropriate software in order to transmit their data to Insee. Then data received daily are transmitted automatically to the National Institut for Health Surveillance. Data are encrypted and transmitted 7 days per week through direct FTP in a pretermined format. For each death certificate, the following information are recorded: zip code, age, sex, date of death.

A pilot test started in June, 2004 with 147 cities for one year. The good evaluation of the system pushed to enlarge it to all eligible cities in France. The enlarged system started on November 1, 2005 and concerned 1,152 Public Records Office which represents around 75% of the daily French mortality.

Reunion Island (population 770,000) is being affected by the most important outbreak of chikungunya disease ever described in the medical literature. Between March 1, 2005 and May 30, 2006, an estimated 255,000 cases have been reported in this French territory located in the Indian Ocean. The vast majority of the cases have been occurring from mid-December, with a peak of 45000 cases week 5, 2006.

The disease is a self-limiting febrile viral disease characterised by arthralgia or arthritis. The symptoms may last for several months but recovery was, until now, considered universal.

Objective

This paper describes the on going surveillance of mortality during the largest outbreak of chikungunya ever known. It is based on a new automatic gathering of mortality data and it is also the first opportunity to test this system in real condition.

Syndromic surveillance systems have long been an important part of the public health arena. The long standing goal of early detection of disease outbreak has gained new urgency and requires a broader spectrum in the era of potential bioterrorism. A number of programs have used syndromic surveillance to broadly monitor community health. Outpatient chief complaints as well as positive laboratory tests have been used to monitor the occurrence of natural diseases. 

Limitations of the systems currently attempted include overbroad syndromic categories, labor intensive syndrome recognition training and time intensive manual data entry. Optimal use of laboratory data has been impeded by some of the same issues as well as a too often narrow focus and significant limitations on real time reporting. Given the likelihood of blunt and/or penetrating trauma being a manifestation of terrorist activity, the continuous inclusion of common traumatic and medical emergency conditions is a valuable tool for surveillance.

Objective

This paper describes the use of a multiple collective community health care database to monitor the occurrence of natural and manmade illness and injuries.

Methicillin resistant staphylococcus aureus (MRSA) is a leading cause of skin and soft tissue infections (SSTI). Until recently, S. aureus pneumonia has been considered primarily a nosocomial infection, and was reported infrequently as a cause of severe community-acquired pneumonia. In recent years, there have been several reports of MRSA community-acquired pneumonia cases associated with influenza among healthy individuals resulting in hospitalization or death. During the 2007-08 influenza season, the WA DOH received reports of necrotizing staphylococcus pneumonia associated with flu-like illness and confirmed flu; these included severe cases of pneumonia caused by MRSA. We examined data from our biosurveillance system to describe trends in staphylococcus infection among ED patients and patients hospitalized with pneumonia or influenza in King County, WA.

Objective

We used our biosurveillance system to describe trends in emergency department visits for SSTI as well as staphylococcus pneumonia hospitalization trends.

Drug-related deaths have increased over the past decade throughout the United States. In New York City (NYC), every year there are approximately 900 psychoactive drug-related fatalities with the majority involving opioids. Unintentional drug overdose is the fourth leading cause of early adult death in NYC, and high rates of drug-related morbidity among drug users are evidenced by over 30,000 drug mentions in NYC emergency departments each year. Moreover, nonfatal overdose may be common among chronic drug users. Despite the relationship between fatal and non-fatal overdose clusters and continued increases in drug-related morbidity and mortality, no regular surveillance system currently exists. The implementation of a drug-related early warning system can inform and target a comprehensive public health response addressing the significant health problem of overdose morbidity and mortality.

Objective

This presentation describes how multiple syndromic data sources from emergency medical services ambulance dispatches and emergency department visits can be combined to routinely monitor citywide spatial patterns of adverse drug events and drug morbidity. This information can be used to target information, treatment and prevention services to drug “hotspots,” to provide early warning for drug-related morbidity, and to detect potential increased risk for overdose death.

Bio-surveillance systems monitor multiple data streams (over-the-counter (OTC) sales, Emergency Department visits, etc.) to detect both natural disease outbreaks (e.g. influenza) and bio-terrorist attacks (e.g. anthrax re-lease). Many detection algorithms show impressive results under simulated environments, but the complex behavior of real-world data and high costs associated with processing false positives make it difficult to develop practical bio-surveillance systems. We believe that using expert knowledge from public health officials will help us to better understand the real-world data, improving our ability to distinguish actual disease outbreaks from non-outbreak patterns.

Objective

This paper describes the evolution of a bio-surveillance system that incorporates user feedback to improve system utility and usability. The system monitors national-level OTC pharmacy sales on a daily basis. We use fast spatio-temporal scan statistics to detect disease outbreaks.

One of the standard approaches to public health surveillance for influenza is to monitor the percent of visits to about 2000 sentinel physicians for influenza-like illness (%ILI; fever plus cough or sore throat). The BioSense System currently receives (among other data) ICD-9 discharge diagnoses from Veteran’s Affairs (VA) and Department of Defense (DOD) outpatient clinics. A literature review found that, in addition to ICD-9 code 487 (the code specific for influenza), 29 other codes have been used previously to monitor influenza. We evaluated the utility of ICD-9 codes reported to BioSense for their utility in monitoring influenza.

Objective

To determine the utility of current CDC BioSense data sources in monitoring influenza activity at the national and state levels.

On August 20th and 21st, 2007, Ohio sustained heavy rains which resulted in severe flooding over a nine-county area in the north-central part of the state. Increased hospital emergency department (ED) visits were expected for gastrointestinal illnesses, but this was not observed. After a media report on September 4, 2007 suggested swarms of mosquitoes were plaguing residents, ED character-specific data were analyzed to see if these data could confirm the report.

Objective

This retrospective analysis of text fragments in emergency department chief complaints illustrates the usefulness of syndromic surveillance in providing timely situational awareness of insect prevalence in post-flood situations.

There exists no standard set of syndromes for syndromic surveillance, and available syndromic case definitions demonstrate substantial heterogeneity of findings constituting the definition. Many syndromic case definitions require the presence of a syndromic finding (e.g., cough or diarrhea) and a fever.

 

Objective

Automated syndromic surveillance systems often use chief complaints as input. Our objective was to determine whether chief complaints accurately represent whether a patient has any of the following febrile syndromes: Febrile respiratory, febrile gastrointestinal, febrile rash, febrile neurological, or febrile hemorrhagic.