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Outbreak Investigation

Description

The use of syndromic surveillance systems to detect illness and outbreaks in the mid 1990s in New York City resulted in recommendations for increased use of these systems for detection of bioterrorist agents, and tracking influenza throughout the region. Discussions on approaches to best respond to surveillance system signals led to initial efforts to organize a coordinating group of various public health agencies throughout the New York City region. These efforts were strengthened after the events of September 11, 2001, and resulted in the development of a regional workgroup consisting of epidemiologists and other staff from all state, county, and municipal health departments who operate, respond to, or oversee public health preparedness surveillance systems throughout the greater New York City metropolitan area.

 

Objective

The rapid and effective coordination of the multi-jurisdictional communications and response to a surveillance system signal are an important goal of public health preparedness planning. This goal is particularly challenging if the signal indicates a possible risk that could adversely affect populations in multiple states and municipalities. This paper examines the value of a regional workgroup in the activation, integration, and coordination of multiple surveillance systems along with efforts to coordinate risk communication messaging. Recommendations for the development of similar groups in other regions are discussed.

Submitted by hparton on
Description

The detailed analysis of the epidemiological literature on the 2003 SARS epidemic published in peer reviewed journals has shown that a majority (78%) of the epidemiological articles were submitted after the epidemic had ended, although the

corresponding studies had relevance to public health authorities during the epidemic. The conclusion was that to minimize the lag between research and the exigency of public health practice in the future, researchers should consider adopting common, predefined protocols and ready-to-use instruments to improve timeliness, and thus, relevance, in addition to standardizing comparability across studies.

 

Objective

This paper describes how the ideas and tools of e-commerce can be translated to the investigation of outbreaks: epidemiologists will ‘shop’ the best available items for their

questionnaire, enhance the chances of producing interoperable questionnaires, and speed up the whole process.

Submitted by hparton on
Description

One of the first county-wide syndromic surveillance systems in the nation, the Syndromic Tracking and Reporting System (STARS) has been in operation since 11/01/2001, and now covers Hillsborough, Pinellas and Collier counties. STARS uses hospital emergency department visit data to detect aberrations of non-specific syndromes and serves as an earlier warning system for public health threats. Patient’s syndrome is collected upon arrival, separately from routine collection of clinical and administrative data; but in some hospitals the process is being streamlined with routine data collection. Aberration detection is done twice daily using the statistical system EARS developed by the CDC. Upon flagging of an aberration, follow-up investigation is conducted to verify cases, and identify source of exposure following a sequence of decision procedure. After several years of operation and some instituted enhancements, a systematic evaluation was called to (1) assess if STARS has met the operation specifications and (2) characterize system efficacy and effectiveness.

 

Objective

To evaluate STARS with respect to quality of syndrome diagnoses, timeliness and completeness of data collection and processing, performance of aberration detection methods, and aberration investigation.

Submitted by elamb on
Description

In February of 2007, the Bureau of Epidemiology (BOE) received a request from Houston Department of Public Works to investigate a possible rise in gastrointestinal (GI) illness associated with complaints about poor water quality in a Northeastern Houston neighborhood. To investigate this complaint, BOE combined case report data with syndromic data from our Real-Time Outbreak Disease Surveillance (RODS). The Houston RODS collects and synthesizes real-time chief complaint data from 34 area hospitals and health facilities, representing approximately 70% coverage of licensed ER beds in Harris County. The system uses a Naïve Bayes Classifier to categorize ER chief complaints into 7 different syndromes, including GI illness.

 

Objective

To investigate public concern over a possible increase in GI illness associated with water quality complaints in Northeast Houston.

Submitted by elamb on
Description

Although Electronic Surveillance System for the Early Notification of Community Based Epidemics (ESSENCE) provides tools to detect a significant alert regarding an unusual public health event, combining that information with other surveillance data, such as 911 calls, school absenteeism and poison control records, has proved to be more sensitive in detecting an outbreak. On Monday, June 16, Florida Poison Information Network, which takes after-hours and weekend calls for Miami-Dade County Health Department (MDCHD), contacted the Office of Epidemiology and Disease Control about five homeless persons that visited the same hospital simultaneously with gastrointestinal symptoms on Saturday, June 14. Poison control staff asked MDCHD to investigate further to determine whether it was an outbreak.

 

Objective

To illustrate how MDCHD utilized ESSENCE in order to track a gastrointestinal outbreak in a homeless shelter.

Submitted by elamb on
Description

On June 22, 2007 increases in over-the-counter (OTC) electrolyte and child anti-fever medication sales were detected through routine OTC surveillance. Increases in emergency department (ED) data for gastrointestinal (GI) illness among <5 year olds were observed on June 23 and 24. Further analyses indicated clustering within one borough of NYC, with three EDs having most of the visits. Because NYC has had limited success in detecting spatial outbreaks using syndromic surveillance in the past, an investigation was not immediately initiated.

DOHMH was notified of a multi-state outbreak of S. wandsworth suspected to be associated with the snack food Veggie Booty® on June 26. Cases were predominantly young children and included 8 confirmed cases among NYC residents with onset dates from March 4 – May 19.

 

Objective

To determine whether increases in GI illness detected through OTC drug sales and ED syndromic surveillance were linked to a multi-state outbreak of S. wandsworth associated with the consumption of Veggie Booty® snack food.

Submitted by elamb on
Description

Syndromic surveillance has traditionally been used by public health in disease epidemiology. Partnerships between hospital-based and public health systems can improve efforts to monitor for disease clusters. Greenville Hospital System operates a syndromic surveillance system, which uses EARS-X to monitor chief complaint, lab, and radiological data for the four emergency departments within the hospital system. Combined, the emergency departments have approximately 145,000 visits per year. During March 2007 an increase in invasive group A Streptococcus (GAS) disease in the community lead to the use of syndromic surveillance to determine if there was a concomitant increase in Scarlet Fever within the community.

Objective

 Demonstrate the utility of collaboration between hospital-based and public health syndromic surveillance systems in disease investigation. Demonstrate the ability of syndromic surveillance in identification and evaluation of process improvements.

Submitted by elamb on
Description

Temporal anomaly detection is a key component of real time surveillance. Today, despite the abundance of temporal information on multiple syndromes, multivariate investigation of temporal anomalies remains under-explored. Traditionally, an outbreak is thought of as disease localization in time. That is, for an event to qualify as an outbreak, a significant deviation from the observed distribution of the disease must occur.  However, the underlying processes that govern the health seeking behavior of a population with respect to one disease can potentially impact multiple syndromes leading to observable correlation patterns in the daily rates of those syndromes. Thus, a deviation from the observed correlation pattern between different syndromes can be an early indicator of potential anomalies when the rise in the daily rates of one or more syndrome is not sufficiently discernable to be identified by standard univariate techniques.

Objective

The objectives of this study are to develop a mathematical multi-syndrome framework for early detection of temporal anomalies, to demonstrate improvement in detection sensitivity and timeliness of the multivariate technique compared with those of standard uni-syndrome analysis, and to put forward a new practical concept for timely outbreak investigation.

Submitted by elamb on
Description

As the summer temperatures soared to their highest ever recorded, Oklahoma experienced its highest disease count ever since the disease had been discovered in New York in 1999. Tulsa County is the second most populous county in Oklahoma and accounted for over one-fourth of the West Nile Cases in Oklahoma. Tulsa City County Health Department is also the only funded mosquito control program in the state that regularly reports to CDC’s AborNet.

 

Objective

Identify, analyze, and summarize WNV in Tulsa County, Oklahoma.

Submitted by hparton on
Description

A large part of the applied research on syndromic surveillance targets seasonal epidemics, e.g. influenza, winter vomiting disease, rotavirus and RSV, in particular when dealing with preclinical indicators, e.g. web traffic. The research on local outbreak surveillance is more limited. Two studies of teletriage data (NHS Direct) have shown positive and negative results respectively. Studies of OTC pharmacy sales have reported similar equivocal performance. As far as we know, no systematic comparison of data sources with respect to multiple point-source outbreaks has so far been published. In the current study, we evaluated the potential of three data sources for syndromic surveillance by analyzing the correspondence between signal properties and point-source outbreak characteristics.

 

Objective

For the purpose of developing a national system of outbreak surveillance, we compared local outbreak signals in three sources of syndromic data – telephone triage of acute gastroenteritis (Swedish Health Care Direct 1177), web queries about symptoms of gastrointestinal illness (Stockholm County’s website for healthcare information), and OTC pharmacy sales of anti-diarrhea medication.

Submitted by teresa.hamby@d… on