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Local Public Health Response

Description

Many syndromic surveillance systems have been developed and are operational, yet lack concise guidelines for investigating and conducting followups on daily alarms. Daily emergency department visits from six reporting hospitals in the Duval County area are assessed and classified into a BioDefend (BD) system entry by triage personnel. Alarms are categorized into alerts, 3 SD above a 30 day rolling mean, or warnings, 2-3 SD above the mean. Signals are monitored and in response, public health investigations and recommended interventions are initiated.

 

Objective

To evaluate the protocol that the Duval County Health Department (DCHD) epidemiology staff uses to respond to BD syndromic surveillance system alarms. The response protocol utilizes all signals detected by BD and its secondary resources, within the DCHD jurisdiction.

Submitted by elamb on
Description

On March 7th and 8th of 2007 authorities from federal, state, county, and municipal jurisdictions/agencies having mass migration response responsibilities (as per the Department of Homeland Security Operation Vigilant Sentry, as well as State and Local plans) initiated the last of a series of mass migration exercise events. The mission of the exercise was to “unify” a federal, state, and local response to effectively mitigate a catastrophic mass migration incident, similar to the Mariel Boatlift (125,000+ migrants) in 1980. The exercise included volunteers who visited a few local emergency departments with specific scripts describing an acute medical condition.

 

Objective

Describe the use of the ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics) system to detect unusual patterns of emergency department use during a full scale mass migration exercise in South Florida.

Submitted by elamb on
Description

States and localities are using biosurveillance for a variety purposes including event detection, situational awareness, and response. However, little is known about the impact of biosurveillance on the operational components and functioning of the public health system and the added value of biosurveillance to traditional surveillance methods. A deeper understanding of how state and local public health systems use biosurveillance data and the factors that facilitate and impede its utility are needed to inform efforts to improve public health surveillance.

 

Objectives

A goal of the case studies was to assess the impact of biosurveillance on public health system preparedness, detection and response for a range of public health threats.

Submitted by elamb on
Description

Washoe County District Health Department (WCDHD) is a local health district serving nearly 400,000 residents in Washoe County including cities of Reno and Sparks, the second largest urban area in Nevada. To enhance overall public health surveillance capacities in the agency, WCDHD officially implemented National Retail Data Monitor (NRDM) in September 2004, Real-time Outbreak & Disease Surveillance (RODS) in July 2005, and FirstWatch in August 2005. These three systems monitor over-the-counter sales for medications and healthcare products, chief complaints at emergency room visits, and 911 calls, respectively. Preliminary evaluation of NRDM suggested the usefulness of system. The addition of RODS and FirstWatch also demonstrated the utility in assisting outbreak investigation during the past few months. Unfortunately no written protocols are in place to guide program staff to manage alerts in a standardized fashion and make appropriate responses. Such guidelines from federal or state level are not yet available as we are aware, however, such protocol is highly needed.

 

Objective

The objective of this paper is to describe the standard operation procedures for three existing syndromic surveillance systems in WCDHD, Nevada.

Submitted by elamb on
Description

In October 2006, the Centers for Disease Control and Prevention funded four institutions, including Emory University, to conduct evaluations of the BioSense surveillance system. These evaluations include investigations of situations that represent actual or potential threats to public health in order to describe: 1) the pathways that health departments follow to assess and respond to such threats, 2) the role of various forms of surveillance, including BioSense and other syndromic surveillance systems, in enabling health departments to achieve critical milestones along these pathways, and 3) whether and how surveillance information informs healthcare practice during these events. We anticipate that these case studies will 1) identify approaches to improving BioSense and other syndromic surveillance systems, 2) describe the characteristics of events where syndromic surveillance is most apt to be useful, and 3) provide a baseline for assessing future impacts of advances in the development of BioSense and other forms of public health surveillance. This paper describes preliminary observations from initial case studies conducted by the Emory University team.

 

Objective

This paper describes preliminary observations from case study investigations of the uses of BioSense and other surveillance resources in public health practice.

Submitted by elamb on
Description

The Georgia Power Corporation (GPC) provides power to 155 (97.5%) of the 159 counties in Georgia (GA), and employs 9,600 people throughout the state. GPC is engaged in preparing for pandemic influenza, and committed to protecting the critical infrastructure and ensuring its continuity of operations. The GPC employee “Crisis Absence Reporting Tool” (CART) was designed to provide the Georgia Syndromic

Surveillance (GA SS) Program with employee absentee/ reason to inform Public Health and GPC leadership about health events occurring in their employees statewide.

The GA SS Program has been implemented in 13 (72%) of the 18 Health Districts. In each of these locations, data are transferred from an ED, ambulatory care center, or school district to the Georgia Division of Public Health (GDPH) for analysis and dissemination of results to all stakeholders. GDPH wanted to collaborate with a large corporation with a statewide employee base to conduct absentee and reason for absence SS to provide an additional perspective to the existing data streams used by GA SS.

In GA, the LHD are responsible for organizing pandemic planning committees comprised of community partners to discuss continuity of basic services and maintenance of the critical infrastructure at the local level during an influenza pandemic. Increasing SS capacity is an important component of Local Health District (LHD) pandemic planning strategies in GA.

 

Objective

To create a non-traditional partnership between the GPC and the GDPH to aid in adverse health event detection and response activities during an influenza pandemic or other health emergency. This will include augmenting CART with SS data from the GA SS Program. These data will be analyzed by GA SS and results disseminated to LHDs, who monitor and respond to SS data in their jurisdictions. Analyses will also be provided to GPC to aid in resource allocation to ensure the continuity of services in GA during emergencies.

Submitted by elamb on
Description

Although syndromic surveillance cannot serve its intended purpose without the timely public health response launched after aberration detection, the literature is very limited with respect to response to syndromic surveillance systems alerts and related guidance for public health practitioners. Literature reviews reveal an absence of uniform approaches to developing and evaluating response protocols. The one published study that aimed to inform the development of written protocols was based on experience with a single system, ESSENCE, and concluded that careful development of an evaluation and response framework should be undertaken.

 

Objective

To develop a framework for public health departments to use for developing and enhancing response protocols to syndromic surveillance system alerts.

Submitted by elamb on
Description

Currently, Indiana monitors emergency department patient chief complaint data from 73 geographically dispersed hospitals. These data are analyzed using the Electronic Surveillance System for the Early Notification of Community-based Epidemics application. 

While researchers continue to improve syndromic detection methods, there is significant interest among public health practitioners regarding how to most effectively use the currently available tools. The Public Health Emergency Surveillance System (PHESS) staff have developed and refined a daily syndromic alert analysis and response process based on experiences gained since November 2004.

 

Objective

This paper describes how the Indiana State Department of Health PHESS staff responded to a syndromic surveillance alert related to a bioterrorism preparedness event.

Submitted by elamb on