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Regional Surveillance

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.

Referenced File
Submitted by hparton on

Hospital discharge data received by public health agencies has a reporting lag time of greater than six months. This data is often used retrospectively to conduct surveillance to assess severity of illness and outcome, and for evaluating performance of public health surveillance systems. 

With the emergence of Health Information Exchanges and Regional Health Information Organizations (RHIOs), inpatient data can be available to public health in near real-time. However, there currently are no established public health practices or information systems for conducting routine surveillance in the inpatient setting. 

Through a contract with the Centers for Disease Control and Prevention, New York State Department of Health

initiated the development of a statewide public–health Health Information Exchanges with New York RHIOs. Daily

minimum biosurveillance data set data-exchange implementation, and evaluation efforts were focused on one RHIO (RHIO A) and one participating hospital system composed of five acute-care facilities.

 

Objective

The objective of this paper is to assess the potential utility of inpatient minimum biosurveillance data set data obtained from RHIOs for pneumonia and influenza surveillance.

Referenced File
Submitted by hparton on

The Distribute project began in 2006 as a distributed, syndromic surveillance demonstration project that networked state and local health departments to share aggregate emergency department-based influenza-like illness (ILI) syndrome data. Preliminary work found that local systems often applied syndrome definitions specific to their regions; these definitions were sometimes trusted and understood better than standardized ones because they allowed for regional variations in idiom and coding and were tailored by departments for their own surveillance needs. Originally, sites were asked to send whatever syndrome definition they had found most useful for monitoring ILI. Places using multiple definitions were asked to send their broader, higher count syndrome. In 2008, sites were asked to send both a broad syndrome, and a narrow syndrome specific to ILI.

 

Objective

To describe the initial phase of the ISDS Distribute project ILI syndrome standardization pilot.

Referenced File
Submitted by hparton on

The first prototype syndromic surveillance in Japan was used during the G8 summit meeting in 2000 with two local prefectures involved. The second trial syndromic surveillance and the first internet-based surveillance used in 2002 for the Japan-Korea 2002 World Cup soccer games. Since 2002, surveillances on over-the-counter medications, ambulance call, and outpatient visits were explored as syndromic approach candidates for early detection. Internet-based events and case reporting frame work has been reviewed for outpatient visits daily reporting concurrently. Limited spread of electrical patient record and vast range of commercialized medical record formats posed obstacles to nationwide syndromic surveillance implementation.

Recent threats from bioterrorism and influenza pandemic empowered Japanese government introducing surveillance of rapid detection mechanism. In line with the revision of the Infection Control Law took place in 2007 April, national syndromic surveillance system was implemented.

 

Objective

This paper describes recent establishment of national surveillance system for early detection of infectious diseases in Japan. With diagnostic data fed from existed routine surveillance, newly introduced system is expected to provide timely information for control response. We aim to facilitate cross-informative regional surveillance by sharing our experience and system frame work.

Referenced File
Submitted by elamb on

Influenza is a significant public health problems in the US leading to over one million hospitalizations in the elderly population (age 65 and over) annually. While influenza preparedness is an important public health issue, previous research has not provided comprehensive analysis of season-by-season timing and geographic shift of influenza in the elderly population. These findings fail to document the intricacies of each unique influenza season, which would benefit influenza preparedness and intervention. The annual harmonic regression model fits each season of disease incidence characterized by its own unique curve. Using this model, characteristics of the seasonal curve for each state and each season can be compared. We hypothesize that travelling waves of influenza in the 48 contiguous states differ dramatically in each influenza season.

 

Objective

In surveillance it is imperative that we know when and where a disease first begins. The objective of this study was to examine trends in traveling waves of influenza in the US elderly population. Preparedness for influenza is an important yet difficult public health goal due to variability in annual strains, timing, and shift of the influenza virus. In order to better prepare for influenza epidemics, it is important to assess seasonal variation across individual influenza seasons on a state-by-state basis. This approach will lead to effective interventions especially for susceptible populations such as the elderly.

Referenced File
Submitted by elamb on

The former Soviet Union (FSU)—through the Sanitary-Epidemiologic Service (SES)—developed an extensive system of disease surveillance that was effective, yet centrally planned in Moscow. Even after the fall of the FSU in 1991, most newly independent states maintained all or parts of the SES structure. However, even 15 years later, the loss of economic and technical assistance from Moscow has negatively impacted the effectiveness and efficiency of disease surveillance in these republics, including Armenia and Georgia. In 2005, Armenia and Georgia reported tuberculosis (TB) incidences of 71 and 83, respectively, per 100,000.

 

Objective

To enhance its effectiveness and efficiency, we evaluated TB surveillance in the FSU Republics of Armenia and Georgia.

Referenced File
Submitted by elamb on

Tuberculosis (TB) has reemerged as a global health epidemic in recent years. Although several researchers have examined the use of space-time surveillance to detect TB clusters, they have not used genetic information to verify that detected clusters are due to person-to-person transmission. Using genetic fingerprinting data for TB cases, we sought to determine whether detected clusters were due to recent transmission.

 

Objective

This paper describes the utility of prospective spacetime surveillance to detect genetic clusters of TB due to person-to-person spread.

Referenced File
Submitted by elamb on

Syndromic surveillance systems use residential zip codes for spatial analysis to identify disease clusters. However, the use of emergency medical services can be influenced by geographic proximity, specialty services, and severity of illness. We evaluated zip codes reported to the Boston Public Health Commission’s syndromic surveillance system from 10 Boston emergency departments (EDs).

 

Objective

To examine the distribution of residential zip codes among patients in Boston EDs over a two month period to better understand how this type of spatial analysis may affect the sensitivity of syndromic surveillance.

Referenced File
Submitted by elamb on

When a chemical or biological agent with public health implications is detected in the City of Houston, analysis of syndromic surveillance data is an important tool for investigating the authenticity of the alert, as well as providing information regarding the extent of contamination.

Syndromic surveillance data in Houston is currently provided by the Real-Time Outbreak Disease Surveillance, which collects and synthesizes real-time chief complaint data from 34 area hospitals, representing approximately 70% coverage of licensed ER beds in Harris County. Data collected for each complaint includes patient home and work zip codes, allowing for geographic analysis of the data in the case of a localized environmental contamination.

Historically, when alerted to a contaminant in the Houston area, the Houston Department of Health and Human Services (HDHHS) has analyzed health data for each zip code in the geographic area of interest separately, a time-intensive process.

Recognizing the need for a more accurate and timely response to an environmental alert, HDHHS proposes aggregating zip codes into zones, based on coverage of population and areas of high risk. These “Surveillance Zones” will be used to quickly reference syndromic data in the event of a chemical or biological event.

 

Objective

This paper discusses the development of zones within the City of Houston in order to more quickly and accurately reference surveillance data in the case of chemical or biological events.

Referenced File
Submitted by elamb on

Shenzhen is a special economic region in southern China, adjacent to Hong Kong, with a population of approximately 14 million. The pioneering efforts of Shenzhen in the development of electronic disease surveillance started as early as in 1995. The setup of syndromic surveillance was started after the SARS outbreak in 2003, including surveillance in Fever Clinics, GI clinics, selected schools, and sentinel surveillance for the workers in selected chicken farms and bird markets. In 2007, a regional plan was developed for systematically integrating the surveillance for environmental health, food safety, lab information systems, infectious disease notification, and outbreak management.

 

Objective

This paper introduces the challenges and lessons learned from the planning and development of a regional integrated disease surveillance system, presenting a new method to quantitatively measure IT support capabilities in disease surveillance and control, as well as a collaboration model integrating the information from multiple sources.

Referenced File
Submitted by elamb on
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