Surveillance

Sequence-informed surveillance is now recognized as an important extension to the monitoring of rapidly evolving pathogens [2]. This includes phylogeography, a field that studies the geographical lineages of species including viruses [3] by using sequence data (and relevant metadata such as sampling location). This work relies on bioinformatics knowledge. For example, the user first needs to find a relevant sequence database, navigate through it, and use proper search parameters to obtain the desired data. They also must ensure that there is sufficient metadata such as collection date and sampling location. They then need to align the sequences and integrate everything into specific software for phylogeography. For example, BEAST [4] is a popular tool for discrete phylogeography. For proper use, the software requires knowledge of phylogenetics and utilization of BEAUti, its XML processing software. The user then needs to use other software, like TreeAnnotator [4], to produce a single (representative) maximum clade credibility (MCC) tree. Even then, the evolutionary spread of the virus can be difficult to interpret via a simple tree viewer. There is software (such as SpreaD3 [5]) for visualizing a tree within a geographic context, yet for novice users, it might not be easy to use. Currently, there are only a few systems designed to automate these types of tasks for virus surveillance and phylogeography.

Objective: We will describe the ZooPhy system for virus phylogeography and public health surveillance [1]. ZooPhy is designed for public health personnel that do not have expertise in bioinformatics or phylogeography. We will show its functionality by performing case studies of different viruses of public health concern including influenza and rabies virus. We will also provide its URL for user feedback by ISDS delegates.

Approximately 100,000 New York City (NYC) residents are currently diagnosed with chronic hepatitis B virus (HBV) infection.1 Routine monitoring and treatment, where indicated, are necessary to reduce HBV disease progression. Using the 2017 European Association for the Study of the Liver (EASL) 2 guidelines on HBV infection management, we developed a surveillance-based definition for treatment eligibility. Validation of this definition will support the creation of a population-level HBV care continuum, which will allow us to monitor gaps from HBV diagnosis to viral suppression and to develop public health interventions to address these gaps.

Objective: To assess the accuracy of a surveillance-based definition for hepatitis B treatment eligibility among New York City residents with chronic hepatitis B infection.

In 2017, FL Department of Health (DOH) became one of thirty-two states plus Washington, D.C funded by the Center for Disease Control and Prevention (CDC) under the ESOOS program. One of the objectives of this funding was to increase the timeliness of reporting on non-fatal opioid overdoses through syndromic surveillance utilizing either the emergency department (ED) or Emergency Medical Services (EMS) data systems. Syndromic case validation is an essential requirement under ESOOS for non-fatal opioid-involved overdose (OIOD). FL's ESOOS program conducted OIOD validation and quality monitoring of EMS case definitions, using data from FL's Emergency Medical Services Tracking and Reporting System (EMSTARS). We examined measurement validity with OIOD cases identified from FL's statewide hospital billing database, FL Agency for Health Care Administration (AHCA).

Objective: Assess the validity of Florida (FL) Enhanced State Opioid Overdose Surveillance (ESOOS) non-fatal syndromic case definitions.

California continues to face a serious public health crisis with the opioid epidemic having substantial health and economic impacts. The epidemic is dynamic and rapidly changing, involving both prescription opioids influenced by prescribing and dispensing patterns as well as illicit opioids influenced by the availability of heroin and recently, the increased availability of fentanyl. The complexity of the issue necessitates data-informed actions through multi-sector, strategic collaboration at both the state and local levels to address the problem comprehensively. With nearly 2,000 opioid overdose deaths per year and wide variation of overdose rates across counties and demographic groups, there is a need for integrated, timely, actionable data for use by state policy makers, local opioid safety coalitions, media, community stakeholders, and the public to monitor and combat this dynamic epidemic at the state and local level. Using fatality data from the California Opioid Overdose Surveillance Dashboard1, the opioid overdose epidemic is described along with the differential geographic and demographic impacts.

Objective: Demonstrate the use of timely, actionable data from a data visualization tool, the California Opioid Overdose Surveillance Dashboard, which integrates statewide, geographic- and demographic-specific data, by describing the changes in opioid overdose deaths in California.

Cyanotoxins are unregulated, emerging contaminants that have been associated with adverse health effects, including gastroenteritis, when consumed at high levels1,2. In May and June of 2018 cyanotoxins were detected in the public drinking water system for Salem, OR at levels above Environmental Protection Agency (EPA) health advisory levels for sensitive groups3. Sensitive groups were defined as children under 6, elderly adults, pregnant women, nursing mothers, people with compromised immune systems, people receiving dialysis, people with pre-existing liver conditions, and pets. Several health advisories were issued, and there was substantial media coverage of the event. The Oregon Health Authority (OHA) organized an Incident Management Team (IMT), which coordinated activities with other state and local agencies. Oregon ESSENCE staff used syndromic surveillance to monitor the population for health effects and healthcare seeking behavior.

Objective: Examine healthcare seeking behavior in a population exposed to low levels of cyanotoxins in the public drinking water supply and quantify how publicity of the event may have affected perceptions of risk in the affected population.

Since 2015, CDC’s Division of Health Informatics and Surveillance staff have conducted evaluations to provide information on the utility, functionality, usability and user satisfaction associated with the National Syndromic Surveillance Program’s BioSense Platform tools. The BioSense Platform tools include: 1) Access and Management Center (AMC), a tool that enables site administrators to manage users and data permissions; 2) Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE), a software application that enables syndromic surveillance related data visualization and analysis; 3) Adminer, a tool that allows users to access site data on the datamart; and 4) Rstudio, an application that can be used for data analysis and visualization. The evaluation findings have informed activities that led to improvements in functionality, development or procurement of platform associated tools, and development of resource materials. In May 2018, NSSP conducted an evaluation with eight jurisdictions that participated in the first user acceptance testing (UAT) evaluations in 2015. The purpose of the evaluation was to assess the present status of utility, functionality, usability and user satisfaction of the tools on the BioSense Platform, and delineate progress since 2015.

Objective: To assess the present status of utility, functionality, usability and user satisfaction of the BioSense Platform.

Social media as Twitter are used today by people to disseminate health information but also to share or exchange on their health. Based on this observation, recent studies showed that Twitter data can be used to monitor trends of infectious diseases such as influenza. These studies were mainly carried out in United States where Twitter is very popular1-4. In our knowledge, no research has been implemented in France to know whether Twitter data can be a complementary data source to monitor seasonal influenza epidemic.

Objective: To investigate whether Twitter data can be used as a proxy for the surveillance of the seasonal influenza epidemic in France and at the regional level.

Recent reporting using data from CDC's National Syndromic Surveillance Program indicates that rates of emergency department (ED) visits involving suspected opioid overdoses increased by 70% in the Midwest from the third quarter (Q3) 2016 (July-September) to the Q3 2017. Large increases in the use and distribution of illicitly-manufactured fentanyl (IMF) and fentanyl analogs, are a key factor driving increased opioid overdose rates in the Midwest and east of the Mississippi River. Fentanyl is a synthetic opioid 50-“100 times more potent than morphine. A better understanding of the distribution of changes in opioid overdose rate from Q3 2016 to Q3 2017 within states needed to inform response and prevention efforts.

Objective: This presentation will provide insight into how the extensive spread of illicitly-manufactured fentanyl impacted opioid overdose rates throughout the Midwest and neighboring states.

In 2002, the United States (US) Centers for Disease Control and Prevention (CDC) launched the National Environmental Public Health Tracking Program (Tracking Program) to address the challenges in environmental health surveillance described by the Pew Environmental Commission (1). The report cited gaps in our understanding of how the environment affects our health and attributed these gaps to a dearth of surveillance data for environmental hazards, human exposures, and health effects. The Tracking Program's mission is to provide information from a nationwide network of integrated health and environmental data that drives actions to improve the health of communities. Accomplishing this mission requires a range of expertise from environmental health scientists to programmers to communicators employing the best practices and latest technical advances of their disciplines. Critical to this mission, the Tracking Program must identify and prioritize what data are needed, address any gaps found, and integrate the data into the network for ongoing surveillance.

Objective: To increase the availability and accessibility of standardized environmental health data for public health surveillance and decision-making.

Globally, road traffic crashes (RTCs) annually kill 1.3 million people and injure 20-50 million others. Nigeria accounts for an estimated 15% of RTC deaths in the WHO African Region.

Objective: This study aimed to describe RTC characteristics and trends in Nigeria and determine progress towards halving RTC-related deaths/injuries by 2020 [i.e., Sustainable Development Goal (SDG) Target 3.6].