Laboratory Data

Group A beta-hemolytic Streptococcus (GABHS) has caused outbreaks in recruit training environments, where it leads to significant morbidity and, on occasion, has been linked to deaths. Streptococcal surveillance has long been a part of military recruit public health activities. All Navy and Marine Corps training sites are required to track and record positive throat cultures and rapid tests on weekly basis. The Navy and Marine Corps have used bicillin prophylaxis as an effective control measure against GABHS outbreaks at recruit training sites. Though streptococcal control program policies vary by site, a minimum prophylaxis protocol is required and mass prophylax is indicated when local GABHS rates exceed a specific threshold. Before July 2007, prophylaxis upon initial entry was required between October and March, and when the local rate exceeded 10 cases per 1000 recruits. In July 2007, the Navy instituted a policy of mass prophylaxis upon initial entry throughout the year. Evaluation of GABHS cases before and after implementation of the new policy, including overall rates, identification of outbreaks, and inpatient results will help enhance the Navy’s ability to evaluate threshold levels, provide  systematic/standardized monitoring across the three recruit sites, and inform prophylaxis and monitoring strategies.

Objective

To compare trends of GABHS among recruits before and after changes in prophylaxis implementation using electronic laboratory and medical encounter records.

The Office of the Medical Examiner (OME) is a statewide system for investigation of sudden and unexpected death in Utah. OME, in the Utah Department of Health (UDOH), certified over 2000 of the 13,920 deaths in Utah in 2008. 

Information from OME death investigations is currently stored in three separate UDOH data silos that have limited interoperability. These three electronic data systems include death certificates, medical examiner investigations, and laboratory results. Without interoperability, OME staff is required to enter the same data into multiple systems. In addition, the process of requesting laboratory analysis and receiving results is paper based, significantly slowing final cause of death determination in a majority of cases. 

Epidemiological studies and surveillance activities are hindered by the lack of systems integration in UDOH and often require retrospective data linkage. As an example, in 2005, CDC and the UDOH reported that deaths in Utah caused by drug poisoning from non-illicit drugs had increased fivefold from 1991 to 2003. This significant finding relied on retrospective linkage of death certificates, medical examiner records, and toxicology results to describe the problem.

In 2008, funding from a bioterrorism grant from the US Department of Homeland Security was secured to support development of a unique, integrated system for medical examiner and death certificate data.

Objectives

The objectives of the Utah Medical Examiner Database project are: 

• To provide a single point of entry for medical examiner pathologists and staff to manage investigation information. 
• To develop an operational system that links death certificate, medical examiner, and laboratory data in real time as a resource for epidemiology and public health surveillance.

Current influenza-like illness (ILI) monitoring in Idaho is based on syndromic surveillance using laboratory data, combined with periodic person-to-person reports collected by Idaho state workers. This system relies on voluntary reporting.

Electronic medical records offer a method of obtaining data in an automated fashion. The Computerized Patient Record System (CPRS) captures real-time visit information, vital signs, ICD-9, pharmacy, and lab data. The electronic medical record surveillance has been utilized for syndromic surveillance on a regional level. Funds supporting expansion of electronic medical records offer increased ability for use in biosurveillance. The addition of temporo-spatial modeling may improve identification of clusters of cases. This abstract reviews our efforts to develop a real-time system of identifying ILI in Idaho using Veterans Administration data and temporo-spatial techniques.

Objective

The objective of this study is to describe initial efforts to establish a real-time syndromic surveillance of ILI in Idaho, using data from the Veterans Administration electronic medical record (CPRS).

An essential theme of the US Federal Health Information Technology Strategic Plan is interoperability and the ability to effectively exchange information using specific data and technical standards.1 In 2005, in an effort to accelerate the development of a national laboratory standards-based electronic data-sharing network, APHL and CDC collaborated to launch PHLIP.2 The goals of PHLIP include, but are not limited to, improving the quality of data exchanged, piloting sustainable architecture for laboratory data exchange, sending and receiving HL7 test results from states to CDC programs (v2.3.1), increasing the use of Route-not-Read hubs for regional data exchange, and expanding these efforts beyond National Notifiable Diseases (NNDs). In an effort to achieve these goals, APHL solicited input directly from the PHL community to understand what assistance was necessary to achieve success with ELSM; in this case, Influenza as a prototype. After receiving feedback from PHLs responsible for reporting NNDs, the concept of technical assistance teams was formulated. In early 2010, APHL initiated an effort to send out the PATs to implement the ELSM message for Influenza in as many PHLs as possible by December 2010.

Objective

This paper describes the Public Health Laboratory Interoperability Project (PHLIP) assistance team (PAT) approach and the collaborative efforts between the Association of Public Health Laboratories (APHL) and the Centers for Disease Control and Prevention (CDC) to achieve electronic laboratory surveillance messaging (ELSM) for Influenza. The knowledge transfer and experience gained by state public health laboratories (PHLs) participating in PHLIP could serve as an interoperability model for other data messaging and surveillance initiatives.

Salt Lake Valley Health Department uses syndromic surveillance to monitor influenza-like illness (ILI) activity as part of a comprehensive influenza surveillance program that includes pathogen-specific surveillance, sentinel surveillance, school absenteeism and pneumonia, and influenza mortality. During the 2009 spring and fall waves of novel H1N1 influenza, sentinel surveillance became increasingly burdensome for both community clinics and Salt Lake Valley Health Department, and an accurate, more efficient method for ILI surveillance was needed. One study found that syndromic surveillance performed, as well as a sentinel provider system in detecting an influenza outbreak and syndromic surveillance is currently used to monitor regional ILI in the United States.

Objective

The objective of this study is to compare the performance of syndromic surveillance with the United States Outpatient Influenza-like Illness Surveillance Network (ILINet), for the

detection of ILI during the fall 2009 wave of H1N1 influenza in Salt Lake County.

Accurately assigning causes or contributing causes to deaths remains a universal challenge, especially in the elderly with underlying disease. Cause of death statistics commonly record the underlying cause of death, and influenza deaths in winter are often attributed to underlying circulatory disorders. Estimating the number of deaths attributable to influenza is, therefore, usually performed using statistical models. These regression models (usually linear or poisson regression are applied) are flexible and can be built to incorporate trends in addition to influenza virus activity such as surveillance data on other viruses, bacteria, pure seasonal trends and temperature trends.

Objective

Mortality exhibits clear seasonality mainly caused by an increase in deaths in the elderly in winter. As there may be substantial hidden mortality for a number of common pathogens, we estimated the number of elderly deaths attributable to common seasonal viruses and bacteria for which robust weekly laboratory surveillance data were available.

The New York City (NYC) Department of Health and Mental Hygiene monitors visits daily from 49 of 54 NYC emergency departments (EDs), capturing 95% of all ED visits. ED visits for influenza-like illness (ILI) have reflected influenza activity in NYC, better than the more broadly defined fever/flu and respiratory syndromes, but the correlation with H1N1 is unknown. 

Laboratory-confirmed influenza and respiratory syncytial virus (RSV) were made reportable in NYC in February 2008. DOHMH receives electronic reports of positive tests. 

As part of 2009–10 influenza surveillance, five hospitals were selected for ‘sentinel’ surveillance of hospitalized influenza cases, to test all patients with a respiratory condition for influenza. Sentinel hospitals ensured that patient medical record numbers were in the daily ED syndromic file and in the electronic laboratory reports.

Objective

To determine the correlation of the ILI syndrome with laboratory-confirmed H1N1 and RSV during the October 2009 to March 2010 H1N1 season in NYC.