Public Health Surveillance

Hurricane Harvey made landfall along the Texas coast on August 25th, 2017 as a Category 4 storm. It is estimated that the ensuing rainfall caused record flooding of at least 18 inches in 70% of Harris County. Over 30,000 residents were displaced and 50 deaths occurred due to the devastation. At least 53 temporary refuge shelters opened in various parts of Harris County to accommodate displaced residents. On the evening of August 29th, Harris County and community partners set up a 10,000 bed mega-shelter at NRG Center, in efforts to centralize refuge efforts. Harris County Public Health (HCPH) was responsible for round-the-clock surveillance to monitor resident health status and prevent communicable disease outbreaks within the mega-shelter. This was accomplished through direct and indirect resident health assessments, along with coordinated prevention and disease control efforts. Despite HCPH’s 20-day active response, and identification of two relatively small but potentially worrisome communicable disease outbreaks, no large-scale disease outbreaks occurred within the NRG Center mega-shelter.

Objective:

1) Describe HCPH’s disease surveillance and prevention activities within the NRG Center mega-shelter;

2) Present surveillance findings with an emphasis on sharing tools that were developed and may be utilized for future disaster response efforts;

3) Discuss successes achieved, challenges encountered, and lessons learned from this emergency response.

Because the dynamics and severity of influenza in the US vary each season, yearly estimates of disease burden in the population are essential to evaluate interventions and allocate resources. The CDC uses data from a national health-care based surveillance system and mathematical models to estimate the overall burden of disease in the general population. Over the past decade, crowd-sourced syndromic surveillance systems have emerged as a digital data source that collects health-related information in near real-time. These systems complement traditional surveillance systems by capturing individuals who do not seek medical care and allowing for a longitudinal view of illness burden. However, because not all participants report every week and participants are more likely to report when ill, the number of weekly reports is temporally and spatially inconsistent and the estimates of disease burden and incidence may be biased. In this study, we use data from Flu Near You (FNY), a participatory surveillance system based in the US and Canada1, to estimate and compare Influenza-like Illness (ILI) ARs using different approaches to adjust for reporting biases in participatory surveillance data.

Objective:

To estimate and compare influenza attack rates (AR) in the United States (US) using different approaches to adjust for reporting biases in participatory syndromic surveillance data.

Traditional surveillance methods have a major challenge to estimating the burden of disease due to underreporting. Participatory surveillance techniques can help supplement to monitor and detect foodborne outbreaks while reducing the impact of underreporting. As there is a low participation rate in Singapore, this study aims to better understand the barriers and facilitators to reporting and assesses what improvements can increase participation.

Objective:

To better understand the barriers and facilitators to reporting and assessing what improvements would increase participation.

Final Four-associated events culminated in four days of intense activity from 3/31/17-4/3/17, which attracted an estimated 400,000 visitors to Maricopa County (population 4.2 million). Field teams of staff and volunteers were deployed to three days of Music Fest, four days of Fan Fest, and three Final Four games (Games) as part of an enhanced epidemiologic surveillance system.

Objective:

To describe and present results of field-based near-real time syndromic surveillance conducted at first aid stations during the 2017 National Collegiate Athletic Association Division I Men’s College Basketball Championship (Final Four) events, and the use of field team data to improve situational awareness for Mass Gathering events.

Final Four-associated events culminated in four days of intense activity from March 31st through April 3rd, and added an estimated 400,000 visitors to Maricopa County's 4.2 million residents.

Objective:

To describe and present results for the enhanced epidemiologic surveillance system established during the 2017 National Collegiate Athletic Association Division I Men’s College Basketball Championship (Final Four) events.

Travel and tourism pose global health security risks via the introduction and spread of disease, as demonstrated by the H1N1 pandemic (2009), Chikungunya (2013), and recent Zika virus outbreak. In 2016, nearly 60 million persons visited the Caribbean. Historically no regional surveillance systems for illnesses in visitor populations existed. The Tourism and Health Information System (THiS), designed by the Caribbean Public Health Agency (CARPHA) from 2016-2017, is a new web-based application for syndromic surveillance in Caribbean accommodation settings, with real-time data analytics and aberration detection built in. Once an accommodation registers as part of the surveillance system, guests and staff can report their illness to front desk administration who then complete an online case questionnaire. Alternatively guests and staff from both registered and unregistered accommodations can self-report their illness using the online questionnaire in the THiS web application. Reported symptoms are applied against case definitions in real-time to generate the following syndromes: gastroenteritis, fever & respiratory symptoms, fever & haemorrhagic symptoms, fever & neurologic symptoms, undifferentiated fever, and fever & rash. Reported data is analyzed in real-time and displayed in a data analytic dashboard that is accessible to hotel/guest house management and surveillance officers at the Ministry of Health. Data analytics include syndrome trends over time, gender and age breakdown, and illness attack rates.

Objective:

The new Tourism and Health Information System (THiS) was implemented for syndromic surveillance in visitor accommodations in the Caribbean region. The objective was to monitor for illnesses and potential outbreaks in visitor accommodations (hotels/guest houses) in the Caribbean in real-time using the web-based application.