Public Health

The International Health Regulations (IHR) 2005, provides a framework that supports efforts to improve global health security and requires that, member states develop and strengthen systems and capacity for disease surveillance and detection and response to public health threats. To contribute to this global agenda, an international collaborative comprising of personnel from the Health Protection Agency, West Midlands, United Kingdom (HPA); the Indian Institute of Public Health (IIPH), Hyderabad, Andhra Pradesh (AP) state, India and the Department of Community Medicine, Rajarajeswari Medical College and Hospital (RRMCH), Bangalore, Karnataka state, India was established with funding from the HPA Global Health Fund to deliver the objectives stated above.

Objective:

This project aimed to contribute to ongoing efforts to improve the capability and capacity to undertake disease surveillance and Emergency Preparedness and Response (EPR) activities in India. The main outcome measure was to empower a cadre of trainers through the inter-related streams of training & education to enhance knowledge and skills and the development of collaborative networks in the regions.

Each year Ministry of Health and Social welfare of Tanzania under Epidemiology Section has been reporting many suspected cases of Shigella throughout the country. However only fewer laboratories have been reporting the confirmed cases.

Objective:

To determine whether the IDSR system meets its purpose and objectives, to evaluate the system attributes, and provide recommendations to improve the IDSR system, using the example of bacillary dysentery, a priority disease in Tanzania.

 

In November of 2011 BioSense 2.0 went live to provide tools for public health departments to process, store, and analyze meaningful use syndromic surveillance data. In February of 2012 ESSENCE was adapted to support meaningful use syndromic surveillance data and was installed on the Amazon GovCloud. Tarrant County Public Health Department agreed to pilot the ESSENCE system and evaluate its performance compared to a local version ESSENCE they currently used. The project determined the technical feasibility of utilizing the Internet cloud to perform detailed public health analysis, necessary changes needed to support meaningful use syndromic surveillance data, and any public health benefits that could be gained from the technology or data.

Objective:

This project represents collaboration among CDC’s BioSense Program, Tarrant County Public Health and the ESSENCE Team at the Johns Hopkins University APL. For over six months the Tarrant County Public Health Department has been sending data through the BioSense 2.0 application to a pilot version of ESSENCE on the Amazon GovCloud. This project has demonstrated the ability for local hospitals to send meaningful use syndromic surveillance data to the Internet cloud and provide public health officials tools to analyze the data both using BioSense 2.0 and ESSENCE. The presentation will describe the tools and techniques used to accomplish this, an evaluation of how the system has performed, and lessons learned for future health departments attempting similar projects.

 

The CA/BC border region encompasses a wide range of ecosystems, topography, dense urban areas, and agricultural developments that coexist in a limited geographic area and create numerous humananimal-environmental interfaces. The region is recognized for its high biodiversity, the presence of over 85 endangered plant and animal species, its importance on the Pacific migratory pathway, high levels of population mobility, and hosts the busiest international border in the world. These interfaces pose a significant risk to animal, human, and environmental health, as evidenced by frequent wildlife die offs, antibiotic resistant bacteria in streams, beach closures due to fecal contamination, pesticide toxicities, zoonotic infectious disease outbreaks, and vector borne diseases. In the marked absence of any organization comprehensively addressing the health risks posed by these complex interfaces and recognizing that these issues necessitate a binational, cross-sectoral One Health approach, the Early Warning Infectious Disease Surveillance Program (EWIDS) founded One Border One Health (OBOH) in 2011. OBOH recognizes that early warning systems should systematically monitor animal, human, and environmental health and that early detection is key to control. Hence OBOH’s primary aim is to create and integrate early warning surveillance systems that gather data from disparate sources in order to protect and improve animal, human, and environmental health. This information can be used to inform decision makers about important public health events in the CA/BC border region.

Objective:

To showcase One Border One Health, a binational, multidisciplinary initiative in the California/Baja California (CA/BC) border region whose aim is to reconfigure traditional species-specific approaches to surveillance for emerging and re-emerging pathogens.

 

National efforts to improve quality in public health are closely tied to advancing capabilities in disease surveillance. Measures of public health quality provide data to demonstrate how public health programs, services, policies, and research achieve desired health outcomes and impact population health. They also reveal opportunities for innovations and improvements. Similar quality improvement efforts in the health care system are beginning to bear fruit. There has been a need, however, for a framework for assessing public health quality that provides a standard, yet is flexible and relevant to agencies at all levels.

The U.S. Health and Human Services (HHS) Office of the Assistant Secretary for Health, working with stakeholders, recently developed and released a Consensus Statement on Quality in the Public Health System that introduces a novel evaluation framework. They identified nine aims that are fundamental to public health quality improvement efforts and six cross-cutting priority areas for improvement, including population health metrics and information technology; workforce development; and evidence-based practices.

Applying the HHS framework to surveillance expands measures for surveillance quality beyond typical variables (e.g., data quality and analytic capabilities) to desired characteristics of a quality public health system. The question becomes: How can disease surveillance help public health services to be more population centered, equitable, proactive, health-promoting, risk-reducing, vigilant, transparent, effective, and efficient—the desired features of a quality public health system? Any agency with a public health mission, or even a partial public health mission (e.g., tax-exempt hospitals), can use these measures to develop strategies that improve both the quality of the surveillance enterprise and public health systems, overall. At this time, input from stakeholders is needed to identify valid and feasible ways to measure how surveillance systems and practices advance public health quality. What exists now and where are the gaps?

Objective

To examine disease surveillance in the context of a new national framework for public health quality and to solicit input from practitioners, researchers, and other stakeholders to identify potential metrics, pivotal research questions, and actions for achieving synergy between surveillance practice and public health quality.

The MSSS, described elsewhere (1), has been in use since 2003 and records Emergency Department (ED) chief complaint data along with the patient’s age, gender and zip code in real time. There were 85/139 hospital EDs enrolled in MSSS as of June 2012, capturing 77% of the annual hospital ED visits in Michigan. The MSSS is used routinely during the influenza season for situational awareness and is monitored throughout the year for aberrations that may indicate an outbreak, emerging disease or act of bioterrorism. The system has also been used to identify heat-related illnesses during periods of extreme heat. Very young children, the elderly, and people with mental illness and chronic diseases are at the highest risk of preventable heatrelated illnesses including sunburn, heat exhaustion, heat stroke and/or death (2). During a heat wave in the summer of 2012, data was reviewed on an ad hoc basis to monitor potential increases in heat-related ED visits.

Objective

The purpose of this work was to conduct an enhanced analysis of heat illness during a heat wave using Michigan’s Emergency Department Syndromic Surveillance System (MSSS) that could be provided to Public Health and Preparedness Stakeholders for situational awareness.

 

Twelve years into the 21st century, after publication of hundreds of articles and establishment of numerous biosurveillance systems worldwide, there is no agreement among the disease surveillance community on most effective technical methods for public health data monitoring. Potential utility of such methods includes timely anomaly detection, threat corroboration and characterization, follow-up analysis such as case linkage and contact tracing, and alternative uses such as providing supplementary information to clinicians and policy makers. Several factors have impeded establishment of analytical conventions. As immediate owners of the surveillance problem, public health practitioners are overwhelmed and understaffed. Goals and resources differ widely among monitoring institutions, and they do not speak with a single voice. Limited funding opportunities have not been sufficient for cross-disciplinary collaboration driven by these practitioners. Most academics with the expertise and luxury of method development cannot access surveillance data. Lack of data access is a formidable obstacle to developers and has caused talented statisticians, data miners, and other analysts to abandon the field. The result is that older research is neglected and repeated, literature is flooded with papers of varying utility, and the decision-maker seeking realistic solutions without detailed technical knowledge faces a difficult task. Regarding conventions, the disease surveillance community can learn from older, more established disciplines, but it also poses some unique challenges. The general problem is that disease surveillance lies on the fringe of disparate fields (biostatistics, statistical process control, data mining, and others), and poses problems that do not adequately fit conventional approaches in these disciplines. In its eighth year, the International Society of Disease Surveillance is well positioned to address the standardization problem because its membership represents the involved stakeholders including progressive programs worldwide as well as resource-limited settings, and also because best practices in disease surveillance is fundamental to its mission. The proposed panel is intended to discuss how an effective, sustainable technical conventions group might be maintained and how it could support stakeholder institutions.

Objective

The panel will present the problem of standardizing analytic methods for public health disease surveillance, enumerate goals and constraints of various stakeholders, and present a straw-man framework for a conventions group.