Poison Center

Regional poison control centers (RPC) receive calls about a variety of poisoning exposures. Callers’ symptoms may not otherwise enter traditional public health (PH) surveillance systems. I report a 16-week pilot study of a new tool to enable the RPC to analyze and integrate call data with the PH, to augment ongoing disease surveillance efforts.

Objective

A new tool allowing analysis of poison control center data and integration of that data into public health surveillance efforts is described.

Poison control centers (PCCs) provide a new source of real-time symptom data that could enhance surveillance systems for foodborne disease outbreaks (FBDOs) through more timely public health department interventions. PCCs provide treatment advice to callers with suspected foodborne illnesses before they seek medical care. The Arizona Poison and Drug and Information Center (APDIC) and the Pima County Health Department (PCHD) are currently evaluating the usefulness of the APDIC’s data collection and triage system to provide early detection of FBDOs in Pima County. Our previous study found that PCC callers with a diarrheal/gastrointestinal syndrome were not duplicative of the cases investigated by PCHD, suggesting that they represent two independent data sets. Evaluating the usefulness of a syndromic surveillance system in terms of its impact on public health is consistent with the CDC’s objectives for improving surveillance. Systems that identify too many cases may overwhelm a health department’s surveillance ability, while too few cases may prevent effective identification of outbreaks.

Objective

This study was designed to test the use of high disease transmission risk criteria in callers to a regional poison control center meeting a predefined case definition for diarrheal/gastrointestinal syndrome as part of an active surveillance program reporting to a county public health department.

Oregon’s statewide syndromic surveillance system (Oregon ESSENCE) has been operational since 2012. Non-federal emergency department data (and several of their associated urgent care centers) are the primary source for the system, although other data sources have been added, including de-identified call data from OPC in 2016. OPHD epidemiologists have experience monitoring mass gatherings and have a strong relationship with OPC, collaborating on a regular basis for routine and heightened public health surveillance. Nevertheless, surveillance for the Great American Solar Eclipse (August 2017) presented a challenge due to the 107 reported simultaneous statewide eclipse-watching events planned for the day of the eclipse (some with estimated attendance of greater than 30,000 people and most in rural or frontier regions of the state). Scientific literature is limited on mass gathering surveillance in the developed world, particularly in rural settings, so OPC and OPHD worked together to develop a list of health conditions of interest, including some that would warrant both an ED visit and a call to OPC (e.g., snake bites). Monitoring visits in both data sources in would allow for assessment of total burden on the healthcare system, especially in the case of snake bites where only specific bites require administration of anti-venom.

Objective:

Identify surveillance priorities for emergency department (ED) and Oregon Poison Center (OPC) data ahead of the 2017 Great American Solar Eclipse gatherings in Oregon and create a suite of queries for use in the Health Intelligence Section of the Oregon Public Health Division (OPHD) Incident Management Team (IMT).

Since 2008, poisoning is the leading cause of injury-related death in the United States; since 1980, the poisoning-related fatality rate in the United States (U.S.) has almost tripled. Many poison-related injuries and deaths are reported to regional PCs which receive about 2.4 million reports of human chemical and poison exposures annually. Federal, state, and local PH agencies often collaborate with PCs and use PC data for PH surveillance to identify poisoning-related health issues. Many state and local PH agencies have partnerships with regional PCs for direct access to local PC data which help them perform this function. At the national level, the National Center for Environmental Health (NCEH) of the Centers for Disease Control and Prevention (CDC) conducts PH surveillance for exposures and illnesses of PH significance using the National Poison Data System (NPDS), the national PC reporting database and real-time surveillance system. Though most PC and PH officials agree that PC data play an important role in PH practice and surveillance, collaboration between PH agencies and PCs can be hindered by numerous challenges. To address these challenges and bolster collaboration, the PC and PH Collaborations Community of Practice (CoP) has collaborated with members to provide educational webinars; newsletters highlighting the intersection of PH and PC work; and in-person meetings at relevant national and international conferences. The CoP includes over 200 members from state and local PH departments, regional PCs, CDC, the American Association of Poison Control Centers (AAPCC), and the U.S. Environmental Protection Agency (EPA).

Objective:

To discuss the use of poison center (PC) data for public health (PH) surveillance at the local, state, and federal levels. To generate meaningful discussion on how to facilitate greater PC and PH collaboration.

Pesticides are used in agriculture and in the home to control pests such as insects, weeds, fungi and rodents. Pesticide poisoning in animals is usually due to misuse or accidental exposure. Information on poisonings in livestock in North America is largely lacking. Examples of hotlines in the U.S. for animal poisoning consultations include the APCC ($65.00 fee) and the Pet Poison Helpline (PPH) ($59.00 fee). The APCC fields calls 24 hours/day, 7 days/week about animal poisonings from the U.S., its territories and Canada. Using data from almost 4 years of APCC calls we describe the occurrence, category and class of pesticides involved, and outcomes of suspected pesticide exposures in livestock. This information is useful to raise awareness, encourage the proper use of pesticides and identify specific pesticides with negative impact on livestock health.

Objective:

This study characterizes the epidemiology of suspected pesticide poisoning in livestock in the United States (U.S.) and Canada using data from calls to the American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Poison Control Center (APCC).

Pesticide-related illness and injury is a reportable condition in Florida. In August and September 2016, aerial spraying for mosquito control was conducted in an effort to reduce the population of Aedes aegypti mosquitoes in Miami-Dade County.1 Two areas Wynwood (in August) and Miami Beach (in September) were sprayed with naled. Naled is an organophosphate insecticide registered with the U.S. Environmental Protection Agency (EPA) which is applied via aerial ultra-low volume (ULV) spraying. In addition to routine surveillance using FPICN and reportable disease surveillance data to identify acute naled-related illness, the Florida Department of Health (DOH) also monitored ED chief complaints data to identify any associated increase in ED visits.

Objective:

To describe the use of Florida Poison Information Center Network (FPICN) and Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL) emergency department (ED) chief complaints data to identify acute naled-related illness following aerial spraying in Miami-Dade county, Florida in response to the Zika outbreak.