Laboratory Data

Influenza is an important public health problem associated with considerable morbidity and mortality. A disease traditionally monitored via legally mandated reporting, researchers have identified alternative data sources for influenza surveillance. The hospital environment presents a unique opportunity for comparative studies of biosurveillance data with high quality and various level of clinical information ranging from provisional diagnoses to laboratory confirmed cases. This study investigated the alert times achievable from hospital-based sources relative to reporting of influenza cases. The earlier detection of influenza could potentially provide more advanced warning for the medical community and the early implementation of precautionary measures in vulnerable populations.

Objective

To determine the relative alert time of influenza surveillance based on hospital data sources compared to notifiable disease reporting.

The New York State Department of Health (NYSDOH) Syndromic Surveillance System consists of five components: 1. Emergency Department (ED) Phone Call System monitors unusual events or clusters of illnesses in the EDs of participating hospitals; 2. Electronic ED Surveillance System monitors ED chief complaint data; 3. Medicaid data system monitors Medicaid-paid over-the-counter and prescription medica-tions; 4. National Retail Data Monitor/Real-time Outbreak and Disease Surveillance System monitors OTC data; 5. CDC’s BioSense application monitors Department of Defense and Veterans Administration outpatient care clinical data (ICD-9-CM diag-noses and CPT procedure codes), and LabCorp test order data.

Objective

This poster presentation provides an overview of the NYSDOH Syndromic Surveillance System, including data sources, analytic algorithms, and resulting reports that are posted on the NYSDOH Secure Health Commerce System for access by state, regional, county, and hospital users.

Clinician reporting of notifiable diseases has historically been slow, labor intensive, and incomplete. Manual and electronic laboratory reporting (ELR) systems have increased the timeliness, efficiency, and completeness of notifiable disease reporting but cannot provide full demographic information about patients, integrate an array of pertinent lab tests to yield a diagnosis, describe patient signs and symptoms, pregnancy status, treatment rendered, or differentiate a new diagnosis or from follow-up of a known old diagnosis. Electronic medical record (EMR) systems are a promising resource to combine the timeliness and completeness of ELR systems with the clinical perspective of clinician initiated reporting. We describe an operational system that detects and reports patients with notifiable diseases to the state health department using EMR data.

Objective

To leverage EMR systems to improve the timeliness, completeness, and clinical detail of notifiable disease reporting.

We explored the utility of tracking emergency department (ED) visits for febrile illness as a proxy for influenza surveillance, from both a local and a regional perspective.

To evaluate whether a rise or shift in severe morbidity and mortality by influenza can be detected with syndromic surveillance.

The 2003-2004 influenza season was notable for the early, intense and widespread circulation of a Type A drift variant and a resulting rush on vaccine followed by an abrupt decrease in activity by mid-January. By contrast, the 2004-2005 influenza season began with a national vaccine shortage preceding any influenza activity with the resulting need for close monitoring of influenza activity.

The Connecticut Department of Public Health developed its first syndromic surveillance system in September 2001 to monitor for possible bioterrorism events and emerging infections. This system, known as the Hospital Admissions Surveillance System, receives daily reports from all 32 Connecticut acute care hospitals on their total unscheduled admissions in various diagnostic/syndromic categories. Information from one category, pneumonia admissions, has been tracked throughout the last four years as an indicator of influenza activity. The information has been utilized to supplement data from laboratory-confirmed influenza testing. The contrasts between the 2003-04 and 2004-05 influenza seasons provided an opportunity to further examine the specificity of changes in pneumonia admissions as an index of severe influenza activity.

Objective

This paper examines the continued usefulness through the 2004-05 influenza season of a hospital admissions-based syndromic surveillance system as a supplement to laboratory surveillance to monitor severe influenza.

Syndromic surveillance using over the counter (OTC) sales has been shown to provide earlier signals of diarrheal and respiratory disease outbreaks than hospital diagnoses. Under normal circumstances, sales patterns of OTC sales related to gastrointestinal illness (GI) are high in the winter and low in the summer. The Canadian laboratory-based surveillance system that provides weekly counts of reportable bacterial, parasitic and viral isolates by province, has shown that bacterial and parasitic infections tend to be higher in summer and early fall, whereas viral infections (particularly Norovirus and Rotavirus) appear to peak in winter and spring. This suggests that the OTC sales reflect underlying community viral infections rather than bacterial or parasitic infections. If OTC sales are to be considered for use in syndromic surveillance of community GI, the nature of this relationship needs to be clarified. The main objective of this study was to compare temporal distributions of GI-related OTC sales to laboratory-isolate patterns of bacterial, parasitic and viral cases of human GI infections.

Objective

To assess if OTC sales of GI related medications are associated with temporal trends of reportable community viral, bacterial and parasitic infections.

West Nile Virus (WNV) is a mosquito-borne virus that can cause meningitis and encephalitis. Since its discovery in New York City during an encephalitis outbreak in 1999, WNV has become endemic in North America. In the United States, 16,000 human WNV disease cases (including West Nile fever, meningitis, encephalitis, and unspecified clinical illness) and over 600 WNV-related deaths have been reported to the Centers for Disease Control from 46 states. Perennial WNV epidemics occur during summer months, peaking during late August. BioSense Early Event Detection and Situation Awareness System receives daily laboratory test order data feed in HL7 from Laboratory Corporation of America. In this study, test orders were studied for their correlation with WNV activity.

Objective

To determine the feasibility of using BioSense laboratory test order data for West Nile disease surveillance in the United States. 

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.

A Quest Diagnostics Incorporated – CDC collaboration in 2000  pioneered  exploration  of  test  ordering data to enhance infectious diseasessurveillance1. This  year’s  unexpected shortage of vaccine and reports of human illness caused by avian influenza  A  (H5N1)  in  Asia2  heightened concern about  influenza and focused attention on moving toward more complete, real time surveillance. We extended our previous collaboration to explore the use of  the Quest Diagnostics Corporate Informatics Data Warehouse (QIDW) as a tool for surveillance of influenza.

Objective

To explore the potential of a large commercial data warehouse for influenza surveillance.